Akella, Madhuri; Singh, Simar R; Dogra, Mohit
A 33-year-old male, on treatment for metastatic renal cell carcinoma, presented with redness, heaviness and dull pain in his right eye over the past 10 days. He had undergone a left nephrectomy and received multiple cycles of cisplatin-based chemotherapy one year ago for clear-cell type renal cell carcinoma. He was currently in remission and was being maintained on fortnightly intravenous nivolumab injections since the past 6 months. Best-corrected visual acuity was 20/50 and 20/20 in the right and left eye respectively and the right eye had a relative afferent pupillary defect and defective color vision (on Ishihara chart). Anterior segment evaluation of the right eye showed conjunctival congestion while the fundus revealed an elevated optic disc with blurred margins. Extraocular movements and intraocular pressures were within normal limits. Left eye examination was unremarkable. Magnetic resonance imaging of the orbit showed hyperintensity and increased thickness of the preseptal orbital tissue [Fig. 1, red arrow] and thickening of the optic nerve (blue arrow) in the right eye.
Hitoshi Imamura, Hitoshi Tabuchi, Daisuke Nagasato, Hiroki Masumoto, Hiroaki Baba, Hiroki Furukawa & Sachiko Maruoka
We assessed the ability of deep learning (DL) models to distinguish between tear meniscus of lacrimal duct obstruction (LDO) patients and normal subjects using anterior segment optical coherence tomography (ASOCT) images.
The study included 117 ASOCT images (19 men and 98 women; mean age, 66.6 ± 13.6 years) from 101 LDO patients and 113 ASOCT images (29 men and 84 women; mean age, 38.3 ± 19.9 years) from 71 normal subjects. We trained to construct 9 single and 502 ensemble DL models with 9 different network structures, and calculated the area under the curve (AUC), sensitivity, and specificity to compare the distinguishing abilities of these single and ensemble DL models.
For the highest single DL model (DenseNet169), the AUC, sensitivity, and specificity for distinguishing LDO were 0.778, 64.6%, and 72.1%, respectively. For the highest ensemble DL model (VGG16, ResNet50, DenseNet121, DenseNet169, InceptionResNetV2, InceptionV3, and Xception), the AUC, sensitivity, and specificity for distinguishing LDO were 0.824, 84.8%, and 58.8%, respectively. The heat maps indicated that these DL models placed their focus on the tear meniscus region of the ASOCT images.
The combination of DL and ASOCT images could distinguish between tear meniscus of LDO patients and normal subjects with a high level of accuracy. These results suggest that DL might be useful for automatic screening of patients for LDO.
Victoria Leung, Rafic Antonios, Evan Kalin-Hajdu
Patrick Daigle, Ming-Han Lee, Mariana Flores, Paolo Campisi, Dan DeAngelis
Orbital cellulitis is an infection of the soft tissues lying behind the orbital septum. The etiologic agents differ across age group, but gram-positive cocci colonizing the skin and the nasopharynx, such as Staphylococcus and Streptococcus species, are most commonly identified in children. Haemophilus influenzae, a gram-negative facultative anaerobe, was frequently identified before the introduction of the Haemophilus vaccine in 1985. We report the case of a 15-year-old man who presented with a severe orbital cellulitis complicated by a subperiosteal abscess (SPA) secondary to Capnocytophaga sputigena.
Aaron R. Kaufman, Daniel J. Oh, Ariel Gliksberg, Mary Lou Schmidt, Mehmet C. Mocan
The presence of petechiae of the face and conjunctiva is a well-described finding seen in strangulation injuries. These petechiae are commonly seen post-mortem in deaths by asphyxia and are consequently used in forensic analysis. Conjunctival and facial petechiae have also been noted to occur in nonfatal asphyxia, and their presence may be a sign that a severe strangulation injury has occurred. The mechanism for facial and conjunctival petechial hemorrhages in asphyxia is thought to be rupture of capillaries with little connective tissue support secondary to local pressure elevation from continued arterial flow while venous output is obstructed. We herein report an unusual case of a pediatric patient in which this clinical presentation signaled underlying recreational self-inflicted strangulation. This case report is adherent to the principles of the Declaration of Helsinki and is compliant with Health Insurance Portability and Accountability Act guidelines.
Cassie A. Cameron, Valerie Juniat, Marcus Pyragius, Dinesh Selva
Necrotizing fasciitis (NF) of the periorbital region is a rare occurrence, though has been shown to cause severe facial disfigurement, blindness, and death.
We report a case of community-acquired methicillin-resistant Staphylococcus aureus (MRSA)–associated periorbital NF in a 25-year-old woman, who presented with left eye and nostril redness and swelling after picking a pimple on her nose a few days prior. She had no significant medical history and was not diabetic. She was initially diagnosed with facial cellulitis and commenced on antibiotics, but returned 2 days later with worsening cellulitis, bilateral leg pain and redness, and shortness of breath. Within a day, she developed pneumonia and sepsis, and she was intubated and transferred to our unit. She was found to have MRSA on blood culture, and she was commenced on meropenem, vancomycin, and clindamycin. Ophthalmic examination while intubated showed left nose, cheek, and upper and lower eyelid redness and swelling. The swelling felt indurated without any evidence of crepitus or frank necrosis. She also had evidence of bilateral thigh cellulitis and was taken to theatre for urgent surgical exploration and debridement of the face and thighs….. FULL TEXT
Alexander Grosinger, James A. Garrity, Diva R. Salomão
Hibba Quhill, Daniel Gosling, Katharine Sears, Paul Rundle
Aims To investigate the success and recurrence rates and visual outcomes in a large case series of amelanotic posterior choroidal melanomas treated by means of primary photodynamic therapy (PDT) with verteporfin.
Methods Retrospective case series from a single specialist ocular oncology centre. All patients had a clinical diagnosis of choroidal melanoma and were selected for PDT based on tumour characteristics. Included patients had at least 24 months of follow-up from initiation of treatment and all but one had not received treatment prior to PDT.
Results 69 patients were included. Mean tumour thickness was 1.9 mm (range 0.5–4.4), while the mean basal diameter was 6.9 mm (range 2.4–11.0). Included lesions were stage cT1a (n=66) or cT2a (n=3). The mean duration of follow-up from treatment initiation was 57 months (range 24–116 months). Seven lesions (10%) failed to respond to PDT. 10 patients (16%) experienced recurrence during follow-up. Overall success rate in this series was 75% (n=52). 83% of successfully treated patients (n=43) maintained or gained vision by final follow-up. Visual outcomes were significantly better in those patients who received PDT therapy alone in comparison to those who needed other treatments for their melanoma (Fisher’s exact test, p=0.004). Unfortunately, one patient (1.4%) in the series developed systemic metastases and died.
Conclusion Selected amelanotic posterior uveal melanomas may be successfully treated with PDT with retention of good vision in the majority of cases, maintained with a mean of 57 months (minimum of 24 months) of follow-up.
Ingvild Ramberg, Peter Bjerre Toft, Jeanette Bæhr Georgsen, Volkert Dirk Siersma, Mikkel Funding, David Hebbelstrup Jensen, Christian von Buchwald, Steffen Heegaard
Aims Human papillomavirus (HPV) is considered a causative agent for the development of a broad range of human carcinomas. The role of HPV in the development of conjunctival intraepithelial neoplasia (CIN) and carcinoma (cSCC) remains unclear. The purpose of the present study was to investigate the HPV prevalence in a nationwide cohort and to describe clinical and histopathological features in relation to HPV status.
Methods All cases of CIN and cSCC in Denmark from 1980 to 2016 were included. We combined p16 immunohistochemistry (IHC), RNA in situ hybridisation (RNA ISH) and HPV DNA PCR to detect HPV. The results were correlated to clinical and histopathological parameters.
Results One hundred twelve primary tumours and 33 recurrent tumours were included for HPV analysis. Twenty-four (21%) of the primary tumours were HPV positive by PCR. Eighteen of out 19 HPV-positive tumours were positive by RNA ISH. HPV16 was the most prevalent genotype (n=18, 75%). The patients with HPV-positive tumours were significantly younger (mean difference 11.5 years, 95% CI 5.2 to 17.9, p=0.0005) and had a higher recurrence compared with patients with HPV-negative tumours (HR 2.30, 95% CI 1.02 to 5.21, p=0.046). The HPV-positive tumours were associated with a positive p16 IHC and a non-keratinising morphology.
Conclusion We describe distinct clinical and histopathological features associated with HPV status in cSCC. The finding of transcriptionally active HPV in this material lends support to a causal role of HPV in a subset of cSCC.