Dalvin, Lauren A.

Purpose To evaluate the proportion of patients with choroidal nevus in an ocular oncology practice who would be suitable candidates for monitoring via a virtual photoscreening model, wherein imaging is asynchronously reviewed and longitudinally managed by an ocular oncologist. Methods Data were abstracted from the Prospective Ocular Tumor Study Database for all patients diagnosed with choroidal nevus from July 2019-October 2024. A stratification model for identification of virtual pathway candidates was defined and implemented as follows: good virtual pathway candidates included those with posteriorly located lesions for adequate photographic capture and no more than two high-risk features. Risk factors, outlined by the TFSOM-DIM acronym, included thickness >2 mm, presence of subretinal fluid, visual acuity 20/50 or worse, presence of orange pigment, low internal reflectivity, and basal diameter >5 mm. Of posteriorly located lesions, those with 0–2 risk factors were defined as good virtual pathway candidates, 3 risk factors as acceptable in select cases, and 4 or more as poor candidates. Results There were 614 choroidal nevi in 586 patients diagnosed during the study period. Mean patient age at initial visit was 63.5 years old (median 66.1, range 5.8–94.8), with 59.4% female and 98.8% white. Analysis identified 436 (71%) nevi in 408 (69.6%) patients as good virtual pathway candidates, 53 (8.6%) nevi in 53 (9%) patients as potential candidates in select cases, and 125 (20.4%) nevi in 125 (21.3%) patients as poor candidates. Conclusion Nearly 70% of patients with choroidal nevi followed by Mayo Clinic Ocular Oncology were identified as good candidates for follow-up via virtual photoscreening. This highlights the potential for improved clinical efficiency through virtual frameworks in ocular oncology.

Purpose: To describe an exceedingly rare presentation of vitreoretinal involvement of metastatic tonsillar squamous cell carcinoma and illustrate the utility of therapeutic and diagnostic epiretinal membrane biopsy. Methods: Case report. Results: A 57-year-old man presented with new vitreous opacities in the left eye. He had a history of tonsillar squamous cell carcinoma status postsurgical excision and was undergoing chemotherapy and radiation therapy. The patient underwent vitreous biopsy that revealed scant cellularity with concern for squamous neoplasia. Soon after, the patient developed a rapidly progressive epiretinal membrane. Membrane peel surgery with en-bloc removal of the epiretinal membrane was performed. Hematoxylin and eosin stain of the sample revealed multiple squamous eddies and mitotic figures, and cytokeratin AE1/AE3 marker was strongly positive, confirming the diagnosis of metastatic squamous cell carcinoma. Intravitreal melphalan injections were started in the left eye. The patient achieved anatomic and visual improvement. Conclusion: Intraocular squamous cell metastasis is rare, and diagnosis can be challenging. Despite initial inconclusive vitreous biopsy cytology in this case, an epiretinal membrane en-bloc sample was obtained, which confirmed involvement by the squamous cell carcinoma and prompted appropriate treatment.

The National Comprehensive Cancer Network (NCCN) recommended surveillance imaging intervals for uveal melanoma (UM) based on the risk of distant metastasis. The objective of this research is to evaluate if patients, treated at our tertiary cancer center, who had scans consistent with these guidelines, had improved overall survival (OS). This was a single-center, retrospective study of UM patients, who developed metastatic disease. Patients were grouped into risk-of-metastasis cohorts (low, medium, and high-risk) based on the UM NCCN guidelines v1.2023. The frequency of scans was reported within annual intervals for 5 years within the low-risk cohort and for 10 years within the medium-risk cohort, and within 6-month intervals for the first 5 years and then annually in years 6–10 within the high-risk cohort. Conditional landmark analyses were used to evaluate the relationship between OS and consistency with guidelines. Scan frequency was evaluated against socioeconomic status. Of the 740 UM patients identified (1997–2020), 110 experienced metastasis and comprised our analysis population (20 low-risk; 67 medium-risk; and 23 high-risk). The median time to death (95% confidence interval) from diagnosis of metastasis was similar between the low, medium, and high-risk cohorts at 1.2 (1.0, 2.0), 2.0 (1.7, 2.6), and 1.6 (1.3, 2.3) years, respectively. For each cohort, the OS results were similar between those who followed guidelines vs. not at each annual landmark time. Living in disadvantaged areas did not impact imaging frequency (all P > 0.05). Imaging at intervals outlined by the NCCN guidelines v1.2023 did not impact OS for patients who developed metastatic UM.

Purpose To describe the clinical characteristics, histopathologic subtype distribution, treatment, and outcomes of patients with primary orbital lymphoma. Major Findings There were 126 biopsy-confirmed cases of primary orbital lymphoma, with 81 (64.3%) female and 110 (87.3%) white. The average age at diagnosis was 62.7 ± 13.9 years. There were 26 (20.6%) cases with bilateral involvement. The most frequent lymphoma subtype was MALT lymphoma (N = 76, 60.3%), followed by diffuse large B-cell lymphoma (N = 18, 14.3%) and follicular lymphoma (N = 12, 9.5%). Prognosis was generally favorable, as local recurrence occurred in only 14 (11.1%) patients and final best corrected visual acuity (BCVA) loss of >1 line was seen in 30 (28.0%) patients. Bilateral lymphoma and advanced stage (Ann Arbor Stage III or IV) at presentation were associated with increased risk of local recurrence ( p = 0.0025, p = 0.049). Improved disease-specific survival was associated with diagnosis at Stage I or II ( p = 0.013), MALT subtype ( p = 0.034), or lack of chemotherapy requirement as primary treatment ( p = 0.0073). Conclusions In this single center academic cohort, MALT lymphoma subtype was most common. Overall orbital recurrence frequency was low, and bilateral lymphoma and advanced stage were associated with increased risk of local recurrence. MALT lymphoma subtype was associated with improved disease-specific survival. Long-term follow-up showed that most patients retained good visual acuity in the affected eye(s).

Ophthalmic immune-related adverse events (Eye-irAEs) from immune checkpoint inhibitors can cause visual morbidity. The absence of standardized definitions for Eye-irAEs not only impedes the development of evidence-based treatments but also progress in translational research. The objective of this study was to develop consensus guidance for an approach to Eye-irAEs. Four ophthalmic physicians (uveitis specialists and neuro-ophthalmologists) drafted Eye-irAE consensus guidance and definitions, which were reviewed by the multidisciplinary Eye-irAE definition panel. The panel was divided into Group A (Neuro-ophthalmology/Orbital Disease) and Group B (Uveitis/Ocular Surface Disease). A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. For each disorder, five diagnostic components were evaluated: symptoms, examination findings, laboratory studies/imaging findings, diagnostic criteria, and treatment. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free-text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND Corporation/ University of California Los Angeles Health Services Utilization Study (RAND/UCLA) Appropriateness Method with prespecified definitions. 29 panelists from 25 academic medical centers voted on 114 rating scales (66 neuro-ophthalmic/orbital disease components, 48 uveitis/ocular surface disease components); of these, 86.3% (57/66) in Group A and 89.6% (43/48) in Group B reached first-round consensus. After revisions, all items except 6.1% (4/66) in Group A and 1.6% (1/60) in Group B received second-round consensus. Consensus definitions were achieved for 10/11 neuro-ophthalmic/orbital disorders: optic neuritis, inflammatory optic disc edema, arteritic ischemic optic neuropathy, optic perineuritis, orbital inflammation, thyroid eye disease-like orbital inflammation, cavernous sinus syndrome, oculomotor mononeuritis, trochlear mononeuritis, and abducens mononeuritis. Consensus definitions were achieved for 9/10 uveitis/ocular surface disorders: anterior uveitis, intermediate uveitis, posterior uveitis, panuveitis, Vogt-Koyanagi-Harada-like syndrome, sarcoidosis-like syndrome, acute macular neuroretinopathy, dry eye disease, and scleritis. These disease definitions establish a standardized classification for Eye-irAE, highlighting differences between irAEs and other inflammatory disorders. Importantly, diagnostic certainty does not always align directly with the need to treat as an Eye-irAE. Given the consensus from this representative panel group, it is anticipated the definitions will be used broadly across clinical and research settings.

This case report describes invasion of a laser-assisted in situ keratomileusis (LASIK) flap interface by conjunctival malignant melanoma in a male patient aged 71 years.