Orbital Tumors Research Articles

Diffuse iris melanoma leading to secondary glaucoma in a lion (Panthera leo)-A case report.

To describe the case of a 12-year-old male African lion (Panthera leo) presented with ocular discharge, corneal edema, and buphthalmos of the right eye. Ocular ultrasonography showed an intraocular mass involving the iris and ciliary body. Enucleation was performed. Subsequent histopathological analysis revealed a pleomorphic pigmented neoplastic cell population infiltrating, expanding and effacing the iris and ciliary body and occupying the ciliary cleft. The histopathological and immunohistochemical features were consistent with a diffuse iris melanoma (DIM). DIM is the most common primary intraocular neoplasm of domestic cats, but rarely reported in large felids. The prognosis in large felids is unknown and warrants identifying additional cases and careful monitoring of affected individuals.

Injectable nanocomposite hydrogel with cascade drug release for treatment of uveal melanoma

Uveal melanoma (UM) is the most common malignant intraocular tumor with the trait of distant metastases. Currently, the standard clinical therapy results in suboptimal outcomes due to ineffective inhibition of tumor metastasis. Thus, developing novel therapeutic modalities for UM remains a critical priority. Herein, we have developed an injectable nanocomposite hydrogel (HA-DOX/LAP gel) through integrating hyaluronic acid-based drug-loaded nanoparticles into an alginate-dopamine gel, delivering the chemotherapeutic drugs, lapatinib and doxorubicin for combinational treatment of UM. HA-DOX/LAP gel is fabricated in situ by a simple injection of the mixed precursor solution into tumor sites and maintains in vivo for more than 21 days. The entrapped drug-loaded nanoparticles can gradually release from HA-DOX/LAP gel, enhancing tumor targeting and penetration, and synchronously releasing lapatinib and doxorubicin into the acidic intracellular environment to synergistically destroy UM cells. In vivo anti-tumor studies conducted in MuM-2B tumor models demonstrated that HA-DOX/LAP gel significantly impedes tumor growth, diminishes postoperative recurrence, and prolongs overall survivals of UM tumor-bearing mice through only single injection. Remarkably, the escaped drug-loaded nanoparticles effectively reduce the risk of tumor metastases. Our findings provide new insights for the development of multifunctional nanocomposite-incorporating combination therapy against UM by targeting tumor recurrence and metastases.

Tissue Glue-Assisted Plaque Radiotherapy for Choroidal Tumors with Scleral Thinning.

To evaluate tissue glue-assisted plaque placement regarding accuracy, stability, and longer-term outcomes for choroidal tumors with scleral thinning. All patients with tissue glue-assisted plaque radiotherapy at a single ocular oncology center were evaluated for patient demographics, tumor features, surgical details, tumor response, and glue-related complications. There were 13 patients (mean age 72 years) treated with tissue glue-assisted plaque radiotherapy for choroidal melanoma (n=12) or choroidal metastasis (n=1). At presentation, the tumor was mean 4.3 mm to the optic disc and 2.0 mm to the foveola with mean basal diameter of 9.5 mm and thickness of 4.2 mm. In all cases, the tissue glue-assistance was employed due to extreme scleral thinning in the bed of proposed radiation. The plaque size was 15 mm (n=5), 18 mm (n=7), or 20 mm (n=1). At application, there was no immediate glue hypersensitivity, ultrasonography confirmed accuracy of placement, and the glue remained adherent for the entire treatment duration (mean 113 hours) with stable plaque location at removal. At removal, the plaque-glue composite was peeled off the globe without need for glue dissolvent and without scleral disruption. At 12 months mean melanoma thickness (2.7 mm, regression 36%). There were no conjunctival, corneal, or scleral complications. Tissue glue-assisted plaque radiotherapy is safe and effective for treatment of choroidal tumors with thin sclera.

Trainee experience in virtual reality simulation in orbital surgery

ABSTRACT Purpose To demonstrate the role of Virtual Reality (VR) in orbital surgery as an educational tool for surgical trainees. Methods A single-center prospective study was conducted from February 2021 to April 2023. Pre-operative magnetic resonance imaging and computed tomography scans were used to create patient-specific VR models of the orbit using ImmersiveTouch Software. Accuracy of the models was qualitatively assessed by an attending oculofacial surgeon. Surveys regarding understanding of the surgical plan were distributed to trainees before the VR simulation, after its use, and following surgery. Results VR models were made for 28 cases, and 52 surveys were completed by residents in ophthalmology, otolaryngology, plastic surgery, and by oculofacial fellows. The VR models for 93% of the cases were rated as accurate by the attending physician. Assigned trainee tasks included measurement of an orbital fracture (n = 1, 1.9%), measurement of orbital tumors (n = 12, 23.1%), and drilling of the orbital bone to simulate an orbital decompression (n = 10, 19.2%). The tumor measurements made by trainees using the VR system were not significantly different than those recorded by the radiologists (p > 0.05). Early trainees (i.e. residents and the first year oculofacial fellow) noted significant improvement in their understanding of the pathology relative to important anatomical landmarks within the orbit after utilizing the VR models prior to surgery (p < 0.001). Conclusions Patient-specific VR models accurately simulate orbital pathology and may improve trainees’ understanding of orbital anatomy early in their careers.

Case Report: Periocular Steroid Injection Combined Vemurafenib Therapy in the Long-term Management of Orbital Involvement of Erdheim-Chester Disease.

Abstract Purpose: To report a rare case of vision loss from Erdheim-Chester Disease (ECD) and long term, follow up, management and results. Case Report: A 62-year-old woman presented with bilateral exophthalmos and deterioration in visual acuity of both eyes. Magnetic resonance imaging studies revealed bilateral intraconal orbital tumors. She was diagnosed optic neuropathy in both eyes. The patient was treated with pegylated interferon and systemic pulse steroid. However, recurrences were common. Subsequently, the patient underwent regular corticosteroid injection directly into the retro-orbital region of both eyes monthly, which led to intermittent improvement of vision. At the 8th month of visual impairment, Vemurafenib was initiated. Results: The visual acuity and visual field scores were stable for 6 years during the follow-up. No major complication was observed. Conclusion: Combined vemurafenib and perioculer steroid injection is a well tolerated therapy with less systemic adverse effects which may benefit patients with orbital involvement of ECD. Key words: Erdheim–Chester disease; compressive optic neuropathy; vemurafenib; Optical coherence tomography; Optical coherence tomography angiography.

POSSIBLE ERRORS IN THE DIAGNOSIS OF INTRAOCULAR TUMORS

Rationale: The article discusses difficulties in the differential diagnosis of intraocular tumors (IOT), particularly in cases of small choroidal melanoma. Despite a substantial number of publications dedicated to the diagnosis of intraocular tumors, difficulties in interpreting imaging methods, such as optical coherence tomography (OCT), persist.Objective: to analyze the OCT patterns that have led to diagnostic errors.Methods: We analyzed the OCT results of 15 patients whose diagnosis of «choroidal hemangioma» was revised to «choroidal melanoma» in 11 cases or «progressive nevus» in 4 cases. The mean age at the time of IOT detection was 50.20±13.08 years (range: 35–79 years); the average tumor prominence was 2.22±0.82 mm (range: 1-3.6 mm), and the average diameter was 8.01±2.72 mm (range: 3.11–11.5 mm). A detailed analysis of the specific OCT patterns that led to diagnostic errors was conducted.Results and discussion: The characteristics of the identified OCT patterns that frequently caused diagnostic difficulties were thoroughly examined, such as cystic changes and the «subretinal cleft» phenomenon. Cases in which complex OCT patterns overlapped with both melanoma and hemangioma were also analyzed, reinforcing the need for a multimodal approach to the interpretation of imaging data. Conclusion: for accurate diagnosis and to avoid erroneous planning of treatment strategies, OCT should be evaluated within the context of the clinical picture and patient history.

Orbital and eyelid inflammatory myofibroblastic tumors: a clinicopathological analysis of 13 cases

Objective: To investigate the clinicopathological features of orbital and eyelid inflammatory myofibroblastic tumors (IMTs). Methods: A retrospective analysis was conducted among 13 patients with IMTs treated at Tianjin Eye Hospital between January 2000 and October 2023. The clinicopathological data, immunohistochemical staining characteristics, molecular phenotypes, and follow-up outcomes were collected and analyzed. Results: The study cohort comprised 7 males and 6 females. The median age was 44 (22, 68) years. The tumor was observed in the left eye in 6 cases and the right eye in 7 cases. The age at onset ranged from 5 to 76 years, with a disease course of 1 month to 2 years before tumor excision. The tumor was located within the orbit in 10 cases (including one case of a systemic multifocal lesion) and in the eyelid in 3 cases. Pathological characteristics of the tumors were mainly proliferation of spindle or ovoid fibroblasts and myofibroblasts, with varying degrees of mucoid degeneration or collagenization of the mesenchyme, and varying amounts of lymphocytes and plasma cells infiltrated in the background. Immunohistochemical analysis revealed that Vimentin and α-SMA were positive in all cases (13/13, 13/13), ALK1 was positive in 5 cases (5/11), CK was positive in 1 case (1/1), and Desmin was positive in 1 case (1/6). ALK fluorescence in situ hybridization was positive in 2 out of 3 cases, and EBER in situ hybridization was negative in 6 cases. Nine patients were available for the follow-up of 7 to 139 months. Seven patients remained tumor-free, 2 experienced relapses, and no deaths or metastases were reported. Conclusions: Orbital and eyelid IMTs predominantly occurred in adults, with localized lesions in most cases and favorable prognoses. The disease was histopathologically characterized by proliferation of fibroblasts and myofibroblasts. The accurate diagnosis depended on a comprehensive assessment of the morphological features of the tumor histopathology as well as immunohistochemical markers such as ALK and α-SMA, and molecular detection.

EXTH-07. UNRAVELING THE ROLE OF SHH SIGNALING PATHWAY IN RETINOBLASTOMA

Abstract Retinoblastoma (RB) is a pediatric cancer affecting the retina, often requiring surgical removal of one or both eyes due to the limited effectiveness of current treatments. There is an urgent need for advanced therapeutic strategies capable of effectively eliminating tumors, thereby obviating the need for surgical removal of eyes in affected children. Achieving this goal requires a deeper understanding of the cellular and molecular mechanisms governing RB initiation and progression. Using a transgenic mouse model, we identified the crucial role of the Shh signaling pathway in Rb1 mutation-induced tumorigenesis, highlighting its potential as a novel therapeutic target for RB treatment. We have observed frequent overexpression of Shh signaling proteins (SHH, GLI1, and GLI2) in human RB, correlating with aggressive clinicopathological features. GLI2 overexpression is necessary for Rb1 deletion-induced RB tumor initiation in mouse retinal progenitor cells (RPCs). These mouse intraocular tumors accurately replicate human RB at both cellular and molecular levels. Additionally, Shh pathway activation extends to normal retinal cells adjacent to human RB tumors, suggesting the involvement of Shh signaling in RB-microenvironment interactions. Importantly, our studies have identified a novel small molecular inhibitor targeting the Shh pathway, effectively inhibiting RB growth in vitro and in vivo by targeting both tumor cells and the tumor microenvironment (TME). The proposed research aims to provide unprecedented insights into the role of SHH signaling pathway in RB initiation and progression and the supporting communication network between RB tumors and TME. These outcomes have the potential to treat RB effectively while improving the well-being of young individuals with RB and those at risk of RB.

Revealing the structural microenvironment of high metastatic risk uveal melanomas following decellularisation

Uveal melanoma (UM) is a rare aggressive intraocular tumour that spreads most commonly to the liver in tumours with loss of one copy of chromosome 3 (HR-M3); current treatments for metastatic disease remain largely ineffective. Pre-clinical research is increasingly using three-dimensional models that better recapitulate the tumour microenvironment (TME). One aspect of the TME is the acellular extracellular matrix (ECM) that influences cell proliferation, migration and response to therapy. Although commercial matrices are used in culture, the composition and biochemical properties may not be representative of the tumour ECM in vivo. This study identifies UM metastatic risk specific ECM proteins by developing methodology for decellularisation of low- and high- metastatic risk tissue samples (LR-D3 vs. HR-M3). Proteomic analysis revealed a matrisome signature of 34 core ECM and ECM-associated proteins upregulated in HR-M3 UM. Combining additional UM secretome and whole cell iTRAQ proteomic datasets revealed enriched GO and KEGG pathways including ‘regulating ECM binding’ and ‘PI3K/Akt signalling’. Structural analyses of decellularised matrices revealed microarchitecture of differing fibre density and expression differences in collagen 4, collagen 6A1 and nidogen 1, between metastatic risk groups. This approach is a powerful tool for the generation of ECM matrices relevant to high metastatic risk UM.

Ultrasound-guided core-needle biopsy for extra-ocular orbital soft tissue tumours: a minimally invasive alternative to surgical biopsy

PurposeTo assess the feasibility, accuracy, and safety of ultrasound (US)-guided coaxial core-needle biopsy (CNB) for histomolecular diagnosis of extra-ocular orbital soft tissue tumours as a minimally invasive alternative to surgical biopsy. MethodsThis retrospective study was conducted at a single Comprehensive Cancer Center and included all consecutive patients referred to our center between 2015 and 2023 for the diagnosis and treatment of orbital soft tissue tumours. All patients underwent US-guided transconjunctival coaxial CNB using a semiautomatic 18-gauge biopsy gun. Pathological analysis included morphological analysis, immunostainings, and molecular biology techniques when required. ResultsA total of 26 patients were included consisting of 21 adults (median age: 64 years, range: 24-93 years), 1 adolescent (17 years), and 4 children (aged 4 weeks, 5 weeks, 26 months, and 6 years). Tumour largest diameters ranged from 11 to 57 mm (median 23 mm). The overall feasibility of CNB was 88% (23/26), and it was 100% (5/5) in children. The histological accuracy was 91% (21/23), and its safety was 96% (25/26). Molecular biology analyses were requested in 9 out of 23 cases and were successful in all instances. The final diagnoses included hematological malignancies (n = 8), carcinomas (n = 5), metastases (n = 4), sarcomas (n = 4), and benign mesenchymal tumours (n = 5). ConclusionsThis study supports the use of US-guided coaxial CNB for the pathological and molecular diagnosis of orbital soft tissue tumours in both children and adults. This technique shows promise as a minimally invasive alternative to open surgical biopsy.

Double Vision as the Presenting Symptom of Metastatic Breast Cancer in an 83-Year-Old Lady

Breast cancer is the most common type of malignant tumor that occurs in women. Despite this, physicians report that they screen elderly patients for breast cancer less than young patients, regardless of cancer history. This case report describes an elderly patient who presented with diplopia, eyelid swelling, and restricted eye movement, leading to the discovery of a diffuse orbital tumor and Stage IV left breast carcinoma with metastases to bone, liver, and peritoneum. The patient had been told to stop mammograms years prior to her diagnosis despite her past history of uterine cancer. The case underscores the possibility of orbital metastasis from breast cancer and highlights the necessity of diligent cancer screening in elderly women.

Machine learning and single-cell RNA sequencing reveal relationship between intratumor CD8+ T cells and uveal melanoma metastasis

PurposeUveal melanoma (UM) is adults’ most common primary intraocular malignant tumor. It has been observed that 40% of patients experience distant metastasis during subsequent treatment. While there exist multigene models developed using machine learning methods to assess metastasis and prognosis, the immune microenvironment’s specific mechanisms influencing the tumor microenvironment have not been clarified. Single-cell transcriptome sequencing can accurately identify different types of cells in a tissue for precise analysis. This study aims to develop a model with fewer genes to evaluate metastasis risk in UM patients and provide a theoretical basis for UM immunotherapy.MethodsRNA-seq data and clinical information from 79 μm patients from TCGA were used to construct prognostic models. Mechanisms were probed using two single-cell datasets derived from the GEO database. After screening for metastasis-related genes, enrichment analysis was performed using GO and KEGG. Prognostic genes were screened using log-rank test and one-way Cox regression, and prognostic models were established using LASSO regression analysis and multifactor Cox regression analysis. The TCGA-UVM dataset was used as internal validation and dataset GSE22138 as external validation data. A time-dependent subject work characteristic curve (time-ROC) was established to assess the predictive ability of the model. Subsequently, dimensionality reduction, clustering, pseudo-temporal analysis and cellular communication analysis were performed on GSE138665 and GSE139829 to explore the underlying mechanisms involved. Cellular experiments were also used to validate the relevant findings.ResultsBased on clinical characteristics and RNA-seq transcriptomic data from 79 samples in the TCGA-UVM cohort, 247 metastasis-related genes were identified. Survival models for three genes (SLC25A38, EDNRB, and LURAP1) were then constructed using lasso regression and multifactorial cox regression. Kaplan-Meier survival analysis showed that the high-risk group was associated with poorer overall survival (OS) and metastasis-free survival (MFS) in UM patients. Time-dependent ROC curves demonstrated high predictive performance in 6 m, 18 m, and 30 m prognostic models. Cell scratch assay showed that the 24 h and 48 h migration rates of cells with reduced expression of the three genes were significantly higher than those of the si-NC group. CD8 + T cells may play an important role in tumour metastasis as revealed by immune infiltration analysis. An increase in the percentage of cytotoxic CD8 + T cells in the metastatic high-risk group was found in the exploration of single-cell transcriptome data. The communication intensity of cytotoxic CD8 was significantly enhanced. It was also found that the CD8 + T cells in the two groups were in different states, although the number of CD8 + T cells in the high-risk group increased, they were mostly in the exhausted and undifferentiated state, while in the low-risk group, the CD8 + T cells were mostly in the functional state.ConclusionsWe developed a precise and stable 3-gene model to predict the metastatic risk and prognosis of patients. CD8 + T cells exhaustion in the tumor microenvironment play a crucial role in UM metastasis.

First‐in‐human orbital tumor surgery guided by near‐infrared II window fluorescence imaging: A feasibility study

AbstractPrecise resection of orbital tumors is a critically important but elusive issue. Fluorescence imaging in the near‐infrared II window (NIR‐II) holds the potential to provide the surgeons with real‐time identification for orbital tumors. Here, for the first time, we evaluated the feasibility and clinical value of NIR‐II fluorescence imaging in orbital tumor surgery. To establish the method of NIR‐II fluorescence imaging for orbital tumors, we developed a NIR‐II fluorescence imaging system and indocyanine green (ICG) served as the fluorescent contrast agent. Twenty‐two patients diagnosed with orbital tumors and scheduled for standard‐of‐care surgery were enrolled in this study. Time‐course NIR‐II fluorescence imaging of two patients with superficial orbital tumors showed the optimum imaging time was 2 h post injection of ICG. Fifteen patients were allocated for diagnostic test, which showed that both the in situ and ex vivo NIR‐II fluorescence imaging showed better sensitivity and specificity than the surgeon judgment. In the feasibility trial of the remaining five patients, the surgeon encountered 34 suspicious regions and surgical decisions were changed nine times due to NIR‐II fluorescence imaging. The resultant seven additional resections were justified by histopathology and the two conservative treatments did not result in recurrence. Based on these findings, we suggested that ICG‐based NIR‐II fluorescence imaging was feasible to guide precise resection of orbital tumors. A future randomized controlled trial with a larger cohort is encouraged to further verify the clinical value.

Epidemiological profile and clinical characteristics of ocular and periocular tumors in North and Central India.

To describe the epidemiological profile and clinical characteristics of ocular and periocular tumors in patients presenting to three tertiary care referral centers in North and Central India. Hospital-based consortium study. Retrospective, descriptive, observational study. A total of 3184 patients were diagnosed with 3557 ocular and periocular tumors over 11 years from 2010 to 2021. Of these, 2395 (67.33%) were benign, 84 (2.36%) were premalignant, and 1078 (30.30%) were malignant. The most common location was the ocular surface (n = 1294, 37.09%), followed by the eyelid (n = 1185, 33.97%), intraocular (n = 624, 17.88%), and orbit (n = 454, 13.01%). The most common tumors were retinoblastoma (n = 483, 13.57%), ocular surface squamous neoplasia (OSSN) (n = 301, 8.46%), and dermoid cyst (n = 167, 4.69%). In the pediatric age group, retinoblastoma was the most common tumor (n = 483, 13.57%), while in adults, it was OSSN (n = 301, 8.46%). The stage at presentation for malignant tumors was divided into in-situ (57.14%), local spread (8.16%), and metastasis (32.83%). For specific tumor locations, the stages were 78.83%, 17.51%, and 2.18%, respectively, for eyelid tumors; 51.76%, 27.05%, and 17.64%, respectively, for orbital tumors; 88.37%, 5.81%, and 5.19%, respectively for ocular surface tumors; and 35.71%, 14.15%, and 50.28%, respectively, for intraocular tumors. Identifying the epidemiological characteristics of ocular and periocular tumors will aid in early diagnosis and timely intervention. Intraocular tumors showed delayed diagnosis, advanced stages at presentation, and required patients to travel longer distances for treatment, indicating the need for strengthened diagnostic and treatment facilities to improve access to care.

Primary primitive neuroectodermal tumour in the orbit of a domestic shorthair cat (Felis catus)

AbstractA 13‐year‐old, domestic shorthair cat presented for evaluation of left‐sided exophthalmos, epiphora and third eyelid elevation of approximately 4‐month duration. Based on ophthalmic exam findings, a retrobulbar mass was suspected. Computed tomography of the head revealed a fluid to soft‐tissue, non‐contrast‐enhancing mass caudoventral to the left globe. Based on these findings, a retrobulbar abscess was considered the most likely differential, while a neoplastic mass could not be completely excluded. The mass and left globe were surgically excised via a modified lateral orbitotomy and exenteration. Histopathology and special staining of the mass was consistent with an orbital primitive neuroectodermal tumour, while the globe was unremarkable.

Acute spontaneous vortex vein occlusion: clinical features, multimodal imaging and natural course

AimsTo describe the clinical features, multimodal imaging, treatments and natural course of acute spontaneous vortex vein occlusion.MethodsClinical data were collected on nine patients with acute vortex vein occlusion. The symptoms...

Clinical and Genetic characteristics of patients with Peripheral Retinal Fleck in Koreans.

To describe the clinical and genetic features of Korean patients with peripheral retinal flecks unrelated to aging. A retrospective analysis was conducted on the clinical characteristics of patients with symmetric peripheral retinal flecks. Age-related deposits such as reticular pseudodrusen were excluded, as well as secondary deposits related to intraocular inflammation, tumor, and drug toxicity. Multimodal imaging, electrophysiological examinations, and genetic testing were analyzed. A total of 10 patients (2 males and 8 females) with bilateral peripheral flecks were enrolled in this study. A mean age at diagnosis was 30.5±19.6 years (4-59 years). Within the 10 patients, 6 were genetically confirmed with monogenic retinal disorders. Biallelic pathogenic variants in RDH5 were found in 5 patients, and 1 patient was diagnosed with retinopathy related to Alport syndrome due to a pathogenic variant in COL4A5. Although not genetically confirmed, one case associated with nanophthalmos and another case showing chorioretinal mottling in a carrier of ocular albinism have been identified. In one patient, genetic testing also revealed unknown causes. The mean logMAR initial visual acuity was 0.12±0.18 and 0.07±0.18 in right and left eyes, respectively. Night blindness was reported by 4 patients (40%), with 3 showing decreased or delayed rod response in electroretinogram, particularly those with RDH5 mutations. Differences in the deposit layers and the patterns of flecks were observed on multimodal imaging. In the study population, we observed various causes and clinical differences in the retinal fleck patterns among Koreans, including RDH5-related fundus albipunctatus and Alport syndrome. Despite reports of night blindness symptoms in some cases, all patients demonstrated satisfactory corrected visual acuity.

Azacytidine treatment affects the methylation pattern of genomic and cell-free DNA in uveal melanoma cell lines

BackgroundUveal melanoma (UM) is the most common primary intraocular tumour in adults, and approximately 50% of patients will develop metastasis. Epigenetic changes are a major factor in cancer progression. We aimed to determine whether methylation profiles could be altered using a DNA methyltransferase (DNMT) inhibitor in UM cell lines.MethodsFour primary and metastatic UM cell lines were treated with azacytidine and analysed for cell proliferation, colony formation, and BAP1 protein expression. Genomic and cell-free (cf)DNA methylation were compared.ResultsIn all cell lines, azacytidine treatment resulted in dose-dependent effects on proliferation, colony formation, and radiosensitivity. Methylation profiling revealed differences in methylation between cell lines according to BAP1 expression. Matched primary and metastatic cell lines showed very similar patterns. Alterations were seen in pathways known to be important in UM progression, such as PI3K/Akt and MAPK signaling, and in pathways involved in cancer progression, such as regulation of stemlike potential, cell motility, and invasion. These changes were maintained in genomic and cell-free DNA.ConclusionsThis data suggests that DNMT inhibitors cause changes in UM cells that are maintained in cfDNA. The results suggest that targeting methylation in UM treatment and monitoring response to treatment using cfDNA methylation could be a valuable tool.

Clinical Characteristics of Choroidal Metastases

The most common intraocular tumors in adults are metastases from primary tumors: breast cancer, lung cancer, and other organ neoplasms. They are most typically located in the choroid, in the posterior pole of the eye. This article outlines the characteristic clinical features along with ultrasound and optical coherence tomography findings that aid in differential diagnosis. It also illustrates the growth pattern of metastatic nodules from their formation to their eventual fusion into a diffuse tumor conglomerate with an irregularly shaped surface and internal structure

Postoperative Outcomes of Enucleation without Closure of the Conjunctiva

Purpose: To evaluate the long-term outcomes of enucleation without conjunctival closure in a large patient cohort. Methods: A retrospective chart review was conducted from January 2011 to January 2024, examining 144 eyes of 143 patients who underwent enucleation without conjunctival closure by a single oculoplastic surgeon. Data collected included patient demographics, indications for surgery, implant types, and complications. Results: This study included 144 eyes from 143 patients undergoing enucleation without conjunctival closure. Patients had a mean age of 46.47 years (SD: 19.76; range: 4–92 years), with a mean follow-up of 14.66 months (range: 2–142 months). Indications for enucleation included blind painful eyes for a variety of reasons (e.g., endophthalmitis, end-stage glaucoma, irreparable corneal graft failure, irreparable corneal melt, and intraocular tumors, etc.) which was the most common reason in our practice (72.92%). Porous polyethylene spheres (86.11%) and polymethyl methacrylate spheres (13.89%) were the primary implants used, with no observed implant complications. Three cases (2.08%) developed conjunctival cysts post-trauma. Conclusions: Enucleation without conjunctival closure in an otherwise normal eye with no evidence of severe conjunctival shrinkage appears to be a safe and effective procedure with a low complication rate comparable to traditional techniques involving suture-based conjunctival approximation. Meticulous closure of Tenon’s capsule may be sufficient to prevent implant-related complications. This approach could potentially reduce surgical time and simplify the enucleation procedure without compromising patient outcomes.