ABSTRACT
A 45-year-old female with history of contact lens wear presented with a persistent corneal ulcer that was unresponsive to topical moxifloxacin. The patient's exam was concerning for fungal keratitis. Cultures were obtained, and the patient was started on fortified amphotericin B drops and oral voriconazole. The cultures identified Candida dubliniensis as the causative organism. The patient's exam worsened despite treatment, and the decision was made for surgery. At the time of surgery, her cornea was found to have unexpectedly perforated. She underwent cryotherapy; tectonic penetrating keratoplasty; anterior chamber tap; intracameral voriconazole, amphotericin B, and cefuroxime; and a partial conjunctival flap. Pathology from the cornea showed GMS and PAS stains positive for fungal forms. C. dubliniensis is a yeast closely related to Candida albicans that was first described in 1995 as a cause of oral candidiasis in patients with AIDS. There are a few published cases of endophthalmitis due to C. dubliniensis in the ophthalmology literature, but to our knowledge, no cases of fungal keratitis due to this organism have been reported. C. dubliniensis is a novel cause of fungal keratitis that can be difficult to identify and treat but is felt to be less virulent than C. albicans and generally susceptible to available anti-fungal therapies.
Subject(s)
Allergens/adverse effects , Betaine/analogs & derivatives , Blepharitis/chemically induced , Dermatitis, Allergic Contact/etiology , Detergents/adverse effects , Hair Preparations/adverse effects , Surface-Active Agents/adverse effects , Betaine/adverse effects , Blepharitis/diagnosis , Chronic Disease , Conjunctivitis, Allergic/chemically induced , Conjunctivitis, Allergic/diagnosis , Dermatitis, Allergic Contact/diagnosis , Female , Humans , Middle AgedABSTRACT
PURPOSE: To compare fluorescence in situ hybridization (FISH) using a centromeric probe for chromosome 3 (CEP3) and 3p26 locus-specific probe with single-nucleotide polymorphism array (SNP-A) analysis in the detection of high-risk uveal melanoma. METHODS: Fifty cases of uveal melanoma (28 males, 22 females) treated by enucleation between 2004 and 2010 were analyzed. Fresh tissue was used for FISH and SNP-A analysis. FISH was performed using a CEP3 and a 3p26 locus-specific probe. Tumor size, location, and clinical outcome were recorded during the 7-year study period (median follow-up: 35.5 months; mean: 38.5 months). The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS: Monosomy 3 was detected by FISH-CEP3 in 27 tumors (54%), FISH-3p26 deletion was found in 30 (60%), and SNP-A analysis identified 31 (62%) of the tumors with monosomy 3. Due to technical failures, FISH and SNP-A were noninterpretable in one case (2%) and two cases (4%), respectively. In both cases of SNP-A failure, tumors were positive for FISH 3p26 deletion and in a single case of FISH failure, monosomy 3 was found using SNP-A. No statistically significant differences were observed in any of the sensitivity or specificity measures. CONCLUSIONS: For prediction of survival at 36 months, FISH CEP3, FISH 3p26, and SNP-A were comparable. A combination of prognostication techniques should be used in an unlikely event of technical failure (2%-4%).
Subject(s)
Chromosomes, Human, Pair 3/genetics , In Situ Hybridization, Fluorescence/methods , Melanoma/diagnosis , Polymorphism, Single Nucleotide , Uveal Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Chromosome Deletion , Female , Follow-Up Studies , Humans , Male , Melanoma/genetics , Melanoma/metabolism , Middle Aged , Predictive Value of Tests , Retrospective Studies , Risk Factors , Time Factors , Uveal Neoplasms/genetics , Uveal Neoplasms/metabolism , Young AdultABSTRACT
Conjunctival melanocytic tumors represent a spectrum of pigmented tumors that include benign, premalignant and malignant tumors. Conjunctival nevi are the most common pigmented tumors and are typically found in the interpalpebral bulbar conjunctiva. These lesions usually contain fine clear cysts on slit lamp biomicroscopy. Primary acquired melanosis includes lesions from increased melanin pigmentation without proliferation of melanocytes to melanoma in situ. In the new classification system, the idea is to use the term 'primary acquired melanosis' only as a clinical description, highlighting the fact that the biologic behavior of acquired melanotic lesions cannot be predicted solely based upon clinical grounds without histopathologic examination. Conjunctival melanoma represents only 5% of all melanomas arising in the ocular region and is associated with a high mortality rate. The management of primary acquired melanosis, nevi and conjunctival melanomas involves various modalities used either alone or concomitantly depending on the size and extent of the lesion.
Subject(s)
Conjunctival Neoplasms/classification , Conjunctival Neoplasms/therapy , Antineoplastic Agents/therapeutic use , Conjunctival Neoplasms/pathology , Humans , Melanoma/diagnosis , Melanoma/drug therapy , Melanoma/pathology , Melanoma/radiotherapy , Melanosis/drug therapy , Melanosis/pathology , Nevus, Pigmented/pathology , PrognosisABSTRACT
PURPOSE: To describe the clinical course and ancillary findings of 3 patients with choroidal melanoma who inadvertently received multiple intravitreal injections of bevacizumab for a presumed diagnosis of choroidal neovascular membrane. DESIGN: Observational case series. METHODS: Three patients with choroidal melanomas who received a series of monthly intravitreal injections of bevacizumab for presumed choroidal neovascularization were evaluated. Clinical, ultrasonographic, and angiographic findings are presented. Histopathologic features are correlated with clinical features in 2 patients who underwent enucleation. RESULTS: Lack of benefit in halting tumor progression was observed in all 3 cases. In 2 cases treated with enucleation, there was evidence of bevacizumab-induced gliotic/fibrotic retinal changes. CONCLUSIONS: We present 3 cases of choroidal melanomas that showed progression while patients received multiple intravitreal injections of bevacizumab. The use of the drug led to the formation of a gliotic/fibrotic membrane that resulted in masking of the underlying tumor and consequently delayed the correct diagnosis.
Subject(s)
Angiogenesis Inhibitors/administration & dosage , Antibodies, Monoclonal/administration & dosage , Choroid Neoplasms/drug therapy , Melanoma/drug therapy , Aged, 80 and over , Antibodies, Monoclonal, Humanized , Bevacizumab , Choroid Neoplasms/diagnostic imaging , Choroid Neoplasms/pathology , Choroidal Neovascularization/diagnosis , Choroidal Neovascularization/drug therapy , Diagnostic Errors , Eye Enucleation , Female , Fibrosis/pathology , Fluorescein Angiography , Gliosis/pathology , Humans , Intravitreal Injections , Melanoma/diagnostic imaging , Melanoma/pathology , Middle Aged , Retina/pathology , Retreatment , Ultrasonography , Vascular Endothelial Growth Factor A/antagonists & inhibitorsABSTRACT
The authors report the successful use of Descemet's stripping automated endothelial keratoplasty (DSAEK) to treat a 45-year-old woman with amantadine-associated corneal edema. Discontinuation of the medication and treatment with corticosteroids did not result in resolution of the edema. The patient underwent sequential phakic DSAEK in both eyes with significant anatomic, visual, and functional improvement. Histopathologic analysis of Descemet's membrane by light microscopy revealed a paucity of endothelial cells. This case highlights the importance of considering amantadine toxicity in the differential diagnosis of corneal edema without an identifiable ocular cause and suggests the utility of DSAEK in the treatment of this rare condition.
