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Micro-incision, trans-iridal aspiration cutter biopsy for ciliary body tumours

Finger, Paul T; Chua, Michael R; Iacob, Codrin E
OBJECTIVE:To perform micro-incision, trans-iridal, aspiration-cutter-assisted biopsy for ciliary body tumours. DESIGN/METHODS:Retrospective, nonrandomized, observational, interventional case series. METHODS:Five consecutive patients undergoing ciliary body tumour biopsy were clinically diagnosed using slit-lamp photography, gonioscopy, high-frequency ultrasound imaging, and systemic radiographic staging. A 1-2 mm clear cornea incision was placed opposite to the central clock hour of the ciliary body tumour. Viscoelastic was infused into the anterior chamber for stabilization and endothelial protection. Then, a 27-gauge aspiration cutter was used to make an iridotomy at the iris root and then extend through the iris into the tumour. Biopsy was performed using mechanical cutting starting at 300 cuts per minute and aspiration at 600 mm Hg. After withdrawal of the cutter from the eye, the effluent tube was flushed into a 3 cc syringe, inspected for specimen under the operating microscope and sent for pathology. Multiple biopsies were performed on each patient. Viscoelastic was removed and Seidel examination of the corneal wound performed. RESULTS:Five eyes were biopsied. A mean 3.6 passes were used to obtain tumour tissue. Tumour cells and tissue were obtained in all cases. Cytologic, histopathologic, and immuno-histochemical analysis were performed (100%, n = 5/5). Diagnoses included melanoma (60%, n = 3/5), melanocytoma (20%, n = 1/5), and leiomyoma (20%, n = 1/5). Transient postoperative hyphemas cleared within 1 week (80%, n = 4/5). No secondary glaucoma, infection, or cataracts were noted. CONCLUSION/CONCLUSIONS:Aspiration-cutter biopsy through the iris root provided a minimally invasive, safe method for obtaining ciliary body tissue for cytology, histopathology, and immunohistochemical analysis.
PMID: 32919996
ISSN: 1715-3360
CID: 4592322

Doctor reported outcomes: Real-world data from a tertiary eye cancer center

Maheshwari, Abhilasha; Finger, Paul T; Malpani, Abhishek; Jain, Puneet; Tomar, Ankit Singh; Garg, Gaurav
Purpose/UNASSIGNED:To provide real-world data on the world-wide-web for patient and doctor awareness. Methods/UNASSIGNED:From December 2017 to January 2020, consecutive patients with choroidal melanoma (CM), iris ciliary body melanoma (ICM), and ocular surface squamous carcinoma (OSSC) had specific outcomes recorded at each return visit. Each result was anonymized, entered in an online portal, and sent to a unique software program where it was used to create real-world data of number of patients, mean vision, local tumor control, eye salvage, systemic metastases, and length of follow-up for our eye cancer center. Results/UNASSIGNED:A HIPAA compliant, internet-based software program was developed and linked to public access web page to collect and analyze near-real-time data pertaining to the treatment, vision, life, and follow-up time of patients. During this period, CM radiation plaque tumor control was 99.7%, median vision 20/25 (mean 20/50) and eye salvage 95.8%. ICM tumor control was 99.1% and the median vision 20/20 (mean 20/20). OSSC tumor control was 100% and the most common vision was 20/20 (mean 20/25). Rates of primary enucleation as treatment were 4.2% for CM, 2.8% for ICM, and 0% for OSSC. All patient results were updated by the ophthalmic oncology fellow at each patient visit as to reflect near-real-time outcomes at our center. Conclusion/UNASSIGNED:Prospective data collection of returning patients was found to be a simple method to reflect patient care outcomes. This method of reporting doctor outcomes offers a measure of transparency for patients and an opportunity to compare results with other clinical practices.
PMID: 33323598
ISSN: 1998-3689
CID: 4717822

A Multicenter, International Collaborative Study for AJCC-Staging of Retinoblastoma: Metastasis-Associated Mortality

Tomar, Ankit Singh; Finger, Paul T; Gallie, Brenda; Mallipatna, Ashwin; Kivelä, Tero T; Zhang, Chengyue; Zhao, Junyang; Wilson, Matthew W; Kim, Jonathan; Khetan, Vikas; Ganesan, Suganeswari; Yarovoy, Andrey; Yarovaya, Vera; Kotova, Elena; Yousef, Yacoub A; Nummi, Kalle; Ushakova, Tatiana L; Yugay, Olga V; Polyakov, Vladimir G; Ramirez-Ortiz, Marco A; Esparza-Aguiar, Elizabeth; Chantada, Guillermo; Schaiquevich, Paula; Fandino, Adriana; Yam, Jason C; Lau, Winnie W; Lam, Carol P; Sharwood, Phillipa; Moorthy, Sonia; Long, Quah Boon; Essuman, Vera Adobea; Renner, Lorna A; Català, Jaume; Correa-Llano, Genoveva
PURPOSE/OBJECTIVE:edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual to estimate metastatic and mortality rates for children with retinoblastoma(RB). DESIGN/METHODS:International, multicenter, registry-based retrospective case series PARTICIPANTS: 2190 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents. METHODS:Patient-specific data fields for RB were designed by participating eye cancer specialists. All RB patients with adequate records to allow tumor staging by the AJCC criteria and follow-up for metastatic disease were studied. MAIN OUTCOME MEASURES/METHODS:Metastasis-related 5- and 10-year survival data after initial tumor staging were estimated with the Kaplan-Meier method depending on AJCC clinical (cTNM) and pathological (pTNM) tumor, node, metastasis category and age, tumor laterality, and presence of heritable trait. RESULTS:Of the 2190 patients, the records of 2085 patients(95.2%) with 2905 eyes were complete. The median age at diagnosis was 17.0 months. 1260 (65.4%) had unilateral RB. Amongst the 2085 patients, tumor categories were cT1a in 55 (2.6%), cT1b 168 (8.1%), cT2a 197 (9.4%), cT2b 812 (38.9%), cT3 835 (40.0%) and cT4 in 18 (0.9%) patients. Of these, 1397 eyes in 1353 patients(48.1%) were treated with enucleation. One hundred and nine patients (5.2%) developed metastases and died. The median time(n=92) from diagnosis to metastasis was 9.50 months. The 5- year Kaplan-Meier cumulative survival estimates by clinical tumor categories were 100% for category cT1a, 98% (95% confidence interval[CI], 97-99) for cT1b and cT2a, 96% (95% CI, 95-97) for cT2b, 89%(95% CI, 88-90) for cT3 tumors, and 45%(95% CI, 31-59) for cT4 tumors, respectively. Risk of metastasis increased with increasing cT (and pT) category(p < .001). Cox proportional hazards regression analysis confirmed a higher risk of metastasis in category cT3 (hazard rate [HR], 8.09; 95% CI, 2.55-25.70; p<0.001) and cT4 (HR, 48.55; 95% CI, 12.86-183.27; p< 0.001) compared to category cT1. Age, tumor laterality and presence of heritable trait did not influence the incidence of metastatic disease. CONCLUSION/CONCLUSIONS:edition AJCC RB Staging System for metastasis-related mortality and offered a proof of concept yielding quantitative, predictive estimates per category in a large, real life, heterogenous RB patient population.
PMID: 32512116
ISSN: 1549-4713
CID: 4566032

A Multicenter, International Collaborative Study for American Joint Committee on Cancer Staging of Retinoblastoma: Part II: Treatment Success and Globe Salvage

Tomar, Ankit Singh; Finger, Paul T; Gallie, Brenda; Mallipatna, Ashwin; Kivelä, Tero T; Zhang, Chengyue; Zhao, Junyang; Wilson, Matthew W; Brenna, Rachel C; Burges, Michala; Kim, Jonathan; Khetan, Vikas; Ganesan, Suganeswari; Yarovoy, Andrey; Yarovaya, Vera; Kotova, Elena; Yousef, Yacoub A; Nummi, Kalle; Ushakova, Tatiana L; Yugay, Olga V; Polyakov, Vladimir G; Ramirez-Ortiz, Marco A; Esparza-Aguiar, Elizabeth; Chantada, Guillermo; Schaiquevich, Paula; Fandino, Adriana; Yam, Jason C; Lau, Winnie W; Lam, Carol P; Sharwood, Phillipa; Moorthy, Sonia; Long, Quah Boon; Essuman, Vera Adobea; Renner, Lorna A; Semenova, Ekaterina; Català, Jaume; Correa-Llano, Genoveva; Carreras, Elisa
PURPOSE/OBJECTIVE:To evaluate the ability of the American Joint Committee on Cancer (AJCC) 8th edition to predict local tumor control and globe salvage for children with retinoblastoma (RB). DESIGN/METHODS:International, multicenter, registry-based retrospective case series. PARTICIPANTS/METHODS:A total of 2854 eyes of 2097 patients from 18 ophthalmic oncology centers from 13 countries over 6 continents. METHODS:International, multicenter, registry-based data were pooled from patients enrolled between January 2001 and December 2013. All RB eyes with adequate records to allow tumor staging by the AJCC 8th edition criteria and follow-up to ascertain treatment outcomes were included. MAIN OUTCOME MEASURES/METHODS:Globe-salvage rates were estimated by AJCC clinical (cTNMH) categories and tumor laterality. Local treatment failure was defined as use of enucleation or external beam radiation therapy (EBRT), with or without plaque brachytherapy or intra-arterial chemotherapy (IAC). RESULTS:Unilateral RB occurred in 1340 eyes (47%). Among the 2854 eyes, tumor categories were cT1 to cT4 in 696 eyes (24%), 1334 eyes (47%), 802 eyes (28%), and 22 eyes (1%), respectively. Of these, 1275 eyes (45%) were salvaged, and 1179 eyes (41%) and 400 eyes (14%) underwent primary and secondary enucleation, respectively. The 2- and 5-year Kaplan-Meier cumulative globe-salvage rates without the use of EBRT by cTNMH categories were 97% and 96% for category cT1a tumors, 94% and 88% for cT1b tumors, 68% and 60% for cT2a tumors, 66% and 57% for cT2b tumors, and 32% and 25% for cT3 tumors, respectively. Risk of local treatment failure increased with increasing cT category (P < 0.001). Cox proportional hazards regression analysis confirmed a higher risk of local treatment failure in categories cT1b (hazard ratio [HR], 3.5; P = 0.004), cT2a (HR, 15.1; P < 0.001), cT2b (HR, 16.4; P < 0.001), and cT3 (HR, 45.0; P < 0.001) compared with category cT1a. Use of plaque brachytherapy and IAC improved local tumor control in categories cT1a (P = 0.031) and cT1b (P < 0.001). CONCLUSIONS:Multicenter, international, internet-based data sharing validated the 8th edition AJCC RB staging to predict globe-salvage in a large, heterogeneous, real-world patient population with RB.
PMID: 32526306
ISSN: 1549-4713
CID: 4574722

Hypochlorous acid antiseptic washout improves patient comfort after intravitreal injection: A patient reported outcomes study

Fam, Anthony; Finger, Paul T; Tomar, Ankit S; Garg, Gaurav; Chin, Kimberly J
Purpose/UNASSIGNED:) drops which frequently cause ocular discomfort and prolonged irritation. In an effort to improve comfort while maintaining efficacy, we studied a hypochlorous acid (HOCL 0.01%) spray washout prior to injection. Methods/UNASSIGNED:followed by HOCL 0.01% washout. Facets of comfort were measured by a Likert-scaled questionnaire to compare their experiences after IVI. Results/UNASSIGNED:reduced the duration of discomfort (P = 0.001) and need for artificial tears postinjection (P = 0.003). It improved their reported quality of life (P = 0.04) and sleep (P = 0.01). There were neither HOCL-related side effects nor endophthalmitis during this study. Conclusion/UNASSIGNED:antisepsis significantly improved patient comfort following IVIs.
PMID: 33120635
ISSN: 1998-3689
CID: 4646802

COVID-19 prophylaxis in ophthalmology [Editorial]

Finger, Paul T; Fam, Anthony; Tomar, Ankit S; Garg, Gaurav; Chin, Kimberly J
PMID: 32971608
ISSN: 1998-3689
CID: 4605932

Lymphoma of the lacrimal gland - An International Multicenter Retrospective Study

Vest, Stine Dahl; Mikkelsen, Lauge Hjorth; Holm, Frederik; Rasmussen, Peter Kristian; Hindso, Tine Gadegaard; Knudsen, Marina K H; Coupland, Sarah E; Esmaeli, Bita; Finger, Paul T; Graue, Gerardo F; Grossniklaus, Hans E; Honavar, Santosh G; Mulay, Kaustubh; Sjö, Lene D; Sniegowski, Matthew E; Vemuganti, Geeta K; Thuro, Bradley A; Heegaard, Steffen
PURPOSE/OBJECTIVE:To characterize the clinical features of subtype-specific lacrimal gland lymphoma and their effect on patient survival. DESIGN/METHODS:Multi-center retrospective interventional case series. METHODS:Patient data were collected from 6 international eye cancer centers from January 1, 1980 through December 31, 2017. All patients with histologically verified primary or secondary lymphoma of the lacrimal gland were included. Primary endpoints were overall survival (OS) and disease-specific survival (DSS). RESULTS:260 patients with lacrimal gland lymphoma were identified. The median age was 58 years and 52% of patients were men. Non-Hodgkin B-cell lymphomas constituted 99% (n=258) and T-cell lymphomas constituted 1% (n=2). The most frequent lymphoma subtypes were extranodal marginal zone B-cell lymphoma (EMZL) (n=177, 68%), follicular lymphoma (FL) (n=26, 10%), diffuse large B-cell lymphoma (DLBCL) (n=25, 10%), and mantle cell lymphoma (MCL) (n=17, 7%). Low-grade lymphomas (EMZL and FL) were most commonly treated with external beam radiotherapy (EBRT), whereas high-grade lymphomas (DLBCL and MCL) were treated with chemotherapy in combination with Rituximab and/or EBRT. The prognosis was relatively good with a 5-year OS and DSS of 73.8% and 87.5%, respectively. Lymphoma subtype was a statistically significant predictor for DSS with EMZL (5-year DSS: 93.4%) having the best prognosis, and DLBCL (5-year DSS: 52.6%) having the poorest. CONCLUSIONS:This is the largest reported collection of data of subtype-specific lacrimal gland lymphoma. The subtype distribution of lacrimal gland lymphoma resembles that of the ocular adnexa. Prognosis is good and the histologic subtype is a significant predictor for disease-specific survival.
PMID: 32574779
ISSN: 1879-1891
CID: 4493072

Tuneable algorithms for tracking activity images in dynamic speckle applications

Buffarini, L.; Rabal, H.; Cap, N.; Grumel, E.; Trivi, M.; Finger, P.
Herein we present a generalized algorithm for processing activity images. Existing algorithms are applicable only to particular cases, and a new, broader approach is therefore proposed here that is based on a set of tuneable filters for images, using an extension of the addition and subtraction operations. The choice of tuning parameter is determined based on the desired result in each experimental case. We include several objective criteria to guide the choice of the most suitable value for the parameter. The use of our approach is exemplified with typical images with dynamic speckle, such as reading under paper, corn seeds and ultrasound images. These examples are also potentials applications in engineering environments.
SCOPUS:85081009629
ISSN: 0143-8166
CID: 4393382

Cutaneous Cell-Mediated Delayed Hypersensitivity to Intravitreal Bevacizumab [Case Report]

Fam, Anthony; Finger, Paul T
The literature contains few reports describing autoimmune reactions to intravitreal bevacizumab and no Type-IV delayed hypersensitivity reactions. This was unexpected, as administration of intravenous bevacizumab has frequently caused dermatologic side-effects. This difference was likely attributable in part to the minimum 300-times difference between intravitreal versus intravenous dosing. Here, we present a case of a 52-year-old male who was treated with plaque brachytherapy for a subfoveal choroidal melanoma. The patient was treated with intravitreal bevacizumab for macular edema, retinal detachment and to delay radiation retinopathy. Following his eighth injection, the patient experienced pruritus, rashes, and progressive exacerbations associated with subsequent injections. Cessation of bevacizumab with or without medication (e.g., oral steroid, antihistamine) resulted in complete remission. Switching to periodic intravitreal aflibercept resulted in no additional cutaneous reactions. Physicians administering intravitreal bevacizumab should be aware of this potential systemic side-effect. Its delayed time course facilitates identification and, thus, treatment to resolution.
PMCID:7813138
PMID: 33488016
ISSN: 0975-1599
CID: 4766782

Anti-Vascular Endothelial Growth Factor Therapy Immediately after Plaque Radiation Therapy Prevents or Delays Radiation Maculopathy

Powell, Brittany E; Finger, Paul T
PMID: 32192938
ISSN: 2468-7219
CID: 4352992