Faculty Bibliography

PURPOSE: To present a case series of peripheral pigmented placoid corneal endotheliopathy (PPPCE). METHODS: A retrospective chart review of patient demographics, medical histories, and clinical characteristics was performed. Examinations included the following specialized imaging modalities: slit-lamp photography, gonioscopy, high-frequency ultrasound biomicroscopy, and anterior segment ocular coherence tomography. A PubMed and multiple corneal textbook literature search using the key words cornea, pigment, plaque, and endothelium revealed that no similar cases were reported. RESULTS: Five eyes in 4 asymptomatic female patients were affected. Their mean age was 53 years (range, 43-61 years), and 3 were of African American descent and 1 was of Hispanic descent. The PPPCE lesions had a vertical dimension of 0.2 to 1.7 mm and a horizontal dimension of 0.5 to 6.1 mm. All the PPPCE lesions were well demarcated, brown, and peripherally located on the inferior corneal endothelium. Clock-hour meridians extended from 4 to 7 o'clock, with the largest PPPCE lesion spanning 4.3 clock hours. Gonioscopy revealed distinct well-circumscribed brown-pigmented plaques adherent to the corneal endothelium with no extension beyond the trabecular meshwork. Ultrasound biomicroscopy and anterior segment ocular coherence tomography revealed the presence of hyperreflective lesions with no corneal stromal invasion, edema, or epitheliopathy. There were no synchronous anterior or posterior segment abnormalities. The PPPCE lesions have remained unchanged for a mean of 17 months (range, 8-34). CONCLUSIONS: Four healthy patients were noted to have PPPCE lesions. Although their etiology remains unknown, PPPCE behavior, morphology, and inferior corneal location suggest an origin from iris stromal melanocytes or iris pigment epithelium.

There are several pigmented nonneoplastic lesions that can clinically simulate melanocytic tumors. The authors report an unusual conjunctival epithelial inclusion cyst that contained luminal bacterial colonies, hemorrhage, and epithelial debris. Clinical appearance convincingly simulated a melanoma. The clinical and histopathologic features of this lesion are discussed.

BACKGROUND AND OBJECTIVE: To report results after amniotic membrane-protected epicorneal plaque brachytherapy for anterior uveal melanoma. PATIENTS AND METHODS: Sixty-three patients were treated with epicorneal radioactive plaques for 5 to 7 days. To prevent corneal damage, eye irritation, and reduce pain, 0.1-mm-thick fresh-frozen amniotic membrane grafts were interposed between the plaque and the cornea during brachytherapy. All amniotic membranes were removed at the end of brachytherapy. Patients were questioned about subjective comfort during treatment and observed for clinical outcomes. RESULTS: Only 4.8% of patients reported pain during brachytherapy. Short-term brachytherapy-related corneal complications including mild keratopathy, corneal epithelial defect, and edema were noted in 41.3% of patients. All corneal complications resolved within 2 weeks. No patients developed corneal melting or opacity during a mean follow-up of 28 months. Local tumor control was achieved in 95.2%. CONCLUSION: Amniotic membrane-buffered epicorneal plaque therapy provided comfort and excellent local tumor control. [Ophthalmic Surg Lasers Imaging Retina. 2013;44:477-482.].

PURPOSE: To evaluate the prognostic utility of the American Joint Committee on Cancer (AJCC) staging system for ocular adnexal lymphoma (OAL). METHODS: A multicenter, consecutive case series of patients with biopsy-proven conjunctival, orbit, eyelid, or lacrimal gland/sac lymphoma was performed. The electronic pathology and clinical records were reviewed for new or recurrent cases of ocular adnexal lymphoma. The main outcome measures included pathology and clinical staging (AJCC and Ann Arbor systems), treatment, and recurrence (local and systemic). Statistical analysis included demographic evaluations and the Kaplan-Meier survival probability method. RESULTS: Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue were the most common (n=60/83, 72%). The most common Ann Arbor clinical stages were IE (76%) followed by IIE (17%) and IIIE (7%). Pathology identified 13 cases (15%) that were upstaged to group IV (p=0.017). Similarly, AJCC clinical stages were cT1NOMO (21.7%), cT2NOMO (44.6%), cT3N0M0 (5%), and cT4NOMO (2.4%). Local control was achieved in 75% of treated patients. There were 19 local recurrences from which 14 (74%) belonged to the non-radiation treatment groups. Lower-risk groups (T1 and T2 without lymph node involvement or metastatic disease of AJCC and IE of Ann Arbor) had longer disease-free survival than the higher-risk groups (AJCC T1, T2 with nodal involvement or metastatic disease, T3, and T4 as well as Ann Arbor II, III, and IV). The overall mean follow-up was 43.3 months (range 6-274). CONCLUSIONS: Regardless of stage, recurrence and disease-free survival were more closely related to treatment and histopathology rather than tumor size or site-specific location.