European Journal of Cancer Part B Oral Oncology

Introduction: To describe the distinctive optical coherence tomography (OCT) characteristics and the underlying mechanisms leading to the uncommon occurrence of macular hole (MH) development in ocular toxoplasmosis. Case Presentation: A 13-year-old girl with a history of bilateral ocular toxoplasmosis presented with newly onset floaters and a progressive loss of vision in her right eye. Examination revealed macular chorioretinal scars in both eyes. Foveal area in the right eye also revealed some barely distinct creamy white lesions which were visible in OCT as punctate inner and outer retinitis with some full thickness lesions, indicating active disease in the right eye. Treatment with oral co-trimoxazole and prednisolone was initiated. At two-weeks follow-up, there was complete necrosis of fovea leading to formation of MH with an overhanging membrane. Rapid evolution continued with signs of progressive closure of the hole starting within a week of MH formation. At four months, the foveal contour had restored with some evidence of regeneration of external limiting membrane. However, a small outer layer defect persisted and visual acuity remained at 3/60, with only a minimal subjective improvement in visual function. Conclusion: Liquefactive necrosis of retina can lead to a rapid course of MH formation without the presence of visibly florid retinal lesions and vitritis in toxoplasmosis. Spontaneous closure of the MH is possible with medical treatment, but the visual prognosis remains uncertain, as the MH is mostly closed with disorganized retinal tissue. OCT is crucial for diagnosis and monitoring, underscoring the importance of immediate attention to new symptoms.

Introduction: Vitreous, retinal and suprochoroidal hemorrhages might develop secondary to trauma, retinal tear or detachment, neovascularization due to ischemic retina. If the clearance of retinal and vitreous hemorrhages can be accelerated, more effective treatments can be planned for the underlying pathology. Case Presentations: We present 6 different cases with dense vitreous, preretinal, and subretinal hemorrhages due to Valsalva retinopathy, polypoid choroidal vasculopathy (PCV), diabetic retinopathy (DR), neovascular age-related macular degeneration (nAMD), retinitis pigmentosa with vasculitis, and myopic choroidal neovascularization. To accelerate the clearance of these dense intraocular hemorrhages, a novel nonsurgical method of electromagnetic iontophoresis (MagnoVisionTM) was used together with some appropriate medications in an outpatient setting without any complications or side effects. In all cases, liquefaction of the intraocular hemorrhage began by 5 days and mostly resolved by 10 days. This nonsurgical rapid clearance allowed us to diagnose and evaluate the underlying retinal and choroidal pathologies earlier and to treat them appropriately as early as possible. Conclusion: Combined use of electromagnetic iontophoresis, subtenon platelet rich plasma (PRP) and bevacizumab injection, and oral bromelain can be considered as an effective and safe new treatment method for vitreous and retinal hemorrhages without any need for surgical intervention.

Introduction: To report the cases of six patients with the coexistence of Polypoidal Choroidal Vasculopathy (PCV) and choroidal nevi. Cases presentation: Six patients with the coexistence of PCV and choroidal nevi were thoroughly evaluated by slit-lamp biomicroscopy examination, color fundus photography, optical coherence tomography (OCT), OCT angiography (OCT-A) fluorescein angiography (FA), indocyanine green angiography (ICG-A), fundus blue autofluorescence (BAF), and ocular ultrasound (OU). The typical features of PCV and nevi were present in all patients, three of whom were treated with intravitreal anti-angiogenic agents. In each clinical case, the choroidal Haller's vessels adjacent to the nevus were visibly more dilated compared to normal. Color fundus photography, OCT, OCT-A, FA, ICG-A, BAF, and OU revealed similar findings across all cases. Observations revealed that choroidal nevi could instigate modifications in the outer retina, resulting in persistent alterations capable of triggering the formation of neovascularization. Conclusion: The occurrence of a PCV alongside nevus is an uncommon complication. We present the largest monocentric cohort of eyes with PCV associated with choroidal nevi. Findings from all exams performed were consistent across all cases, highlighting the potential link between PCV and nevi.

Introduction Metastatic iris tumors from lung cancer are uncommon and challenging to diagnose. As lung cancer treatments improve, life expectancy increases, potentially leading to more cases of metastasis. These tumors often cause neovascular glaucoma, making intraocular pressure (IOP) management crucial, especially in terminal-stage patients. Case Presentation A 65-year-old man with small cell lung carcinoma (SCLC) presented with right ocular pain and blurred vision. His right IOP was 55 mmHg, and examination revealed anterior chamber cells, multiple greyish-white iris masses, and right iris neovascularization. Anterior chamber fluid cytology confirmed the diagnosis of metastatic iris tumors from SCLC. Despite treatment with topical eye drops, oral acetazolamide, and intravenous hypertonic mannitol, the IOP remained poorly controlled. Intravitreal aflibercept was subsequently administered into his right eye for neovascular glaucoma. Neovascular glaucoma disappeared rapidly, but IOP did not improve. However, intravenous infusion of hypertonic mannitol was no longer required, and the complaints of nausea associated with intraocular pressure decreased. Although this patient died four months after the initial visit due to multiple metastases of SCLC, the intravitreal aflibercept was effective in shrinking the iris tumor size and lowering intraocular pressure in the terminal phase of the disease. Conclusion This is the first reported use of intravitreal aflibercept for SCLC metastases to the iris. While the prognosis of patients with metastatic iris tumors remains poor, intravitreal aflibercept injections show potential in reducing iris tumor size and lowering IOP. Although not curative, this therapeutic approach may play a significant role in the symptom management of these patients.

Purpose: The purpose of this study was to report a case of retinal alterations due to proven Vitamin A deficiency. Methods: We report a case of a 39-year-old woman who presented with progressing nyctalopia and mildly reduced visual acuity over a period of 1-2 years, despite being on oral Vitamin A supplementation, following a history of gastric bypass and biliopancreatic diversion surgeries many years ago. Results: Vitamin A levels were severely reduced (<0.1 µmol/L, reference range: 1.05–2.08 µmol/L). The outer retinal layers exhibited structural alterations and a reduction in thickness, while choroidal thickness was increased. The electroretinogram showed complete depletion of scotopic responses and a mild reduction in photopic responses. After intravenous Vitamin A supplementation, complete resolution of both functional and structural changes was achieved. Conclusion: This case highlights the importance of considering Vitamin A deficiency even in patients receiving ongoing oral Vitamin A supplementation, particularly if symptoms and clinical findings suggest its presence. Choroidal thickening and outer retinal thinning may provide further insights into the pathophysiology of this condition in future analyses.

Introduction: Iatrogenic Cushing Syndrome (ICS) can be caused by synthetic glucocorticoids administered through various routes. ICS caused by corticosteroid eye drops is an exceptional event, being more frequent in pediatric age. Herein, we describe a case of iatrogenic Cushing syndrome (ICS) associated with secondary adrenal insufficiency (SAI) caused by ocular topical corticosteroid treatment. Case presentation: An 11-year-old girl was referred to our ocular inflammation department due to idiopathic, chronic, non-hypertensive, non-granulomatous bilateral anterior uveitis, treated with topical dexamethasone (eye drops, 1mg/ml) for one year. During the past year, the child and her mother observed a gradual change in her physical appearance, particularly noting the development of a cushingoid facial appearance. Laboratory data revealed morning serum adrenocorticotropic hormone (ACTH) of 3.6 ng/L [7.2-63.3] and morning serum cortisol of 0.20 μg/dL [6.2-19.4]. She was treated with methotrexate (15 mg/week, orally), and the topical corticosteroid regimen was progressively tapered and discontinued after three months. Nine months after the patient discontinued corticosteroid eyedrops, her cushingoid face disappeared, and her laboratory data improved. Regarding the ophthalmological examination, the uveitis remained in remission with methotrexate, with no new episodes of intraocular inflammation. Conclusion: Although rare, ophthalmologists must be aware of ICS and SAI and prioritize using the least potent corticosteroid for the shortest duration necessary. Additionally, clinicians should avoid abrupt cessation of long-term corticosteroid therapy, as this can precipitate an adrenal crisis in the presence of adrenal insufficiency.

Introduction: Pneumo-orbit and periorbital subcutaneous emphysema secondary to defects in the sinus wall have been well described in the context of traumatic or surgical sequelae. However, these rarely occur atraumatically in the setting of an idiopathic or congenital sinus wall dehiscence, with a risk for orbital compartment syndrome and irreversible vision loss. We describe a case of idiopathic lamina papyracea dehiscence with resultant pneumo-orbit and elevated intraocular pressure. Case Presentation: A 28-year-old man experienced a sudden onset of unilateral orbital and subcutaneous periorbital emphysema following Valsalva maneuver. He had unilateral subcutaneous emphysema, crepitus, violaceous discolouration of the lids, and chemosis of the palpebral conjunctiva. Visual acuity was intact and intraocular pressure was mildly elevated. Imaging showed an idiopathic lamina papyracea dehiscence. The patient was advised of sinus precautions with uneventful spontaneous resolution and no visual sequelae. Conclusion: Lamina papyracea dehiscence predisposes to spontaneous Valsalva-induced orbital or periorbital emphysema with a risk of elevated intraocular pressure, optic neuropathy, and vision loss; prompt recognition and early management can prevent vision-threatening sequelae.

Introduction: This case report describes a finding of dramatic improvement in drusen volume and visual acuity in a 73-year-old patient diagnosed with dry age-related macular degeneration (AMD) undergoing daily home photobiomodulation alongside AREDS-2 supplements. Case Presentation: This is a retrospective review of a case presentation from 2023 to 2024. After 8 months of continuous home photobiomodulation, the patient’s visual acuity improved from 20/30 to 20/20 in the left eye while the right eye stabilized at 20/25. The outer retina was preserved without signs of geographic atrophy, with a robust reduction in the total number and volume of drusen in both eyes, left greater than right, as shown with optical coherence tomography macular cross-sectional scans. Conclusions: These findings support that photobiomodulation has the potential to improve the management of dry AMD and the overall quality of life, consistent with phase III clinical trials. Future studies are warranted to further establish optimized protocols for broader clinical implementation.

Introduction: Inherited retinal diseases (IRDs), particularly ciliopathies, often lead to irreversible blindness and are frequently accompanied by systemic manifestations such as nephronophthisis. Current treatment options are limited, necessitating the exploration of supplementary strategies to slow disease progression. Methods: We present a rare case from a retinal surgery clinic involving a 30-year-old male with autosomal recessive retinitis pigmentosa (ARRP) and juvenile nephronophthisis. Comprehensive ocular and genetic evaluations were conducted, followed by the implementation of nutritional interventions aimed at mitigating multi-systemic effects. Results: Genetic testing revealed pathogenic variants in CEP83, PCARE, and VPS13B genes, confirming the diagnosis of ARRP. Nutritional strategies, including omega-3 fatty acids, antioxidants, and tailored dietary modifications for renal health, were integrated alongside standard medical care. These interventions contributed to the stabilization of retinal degeneration and improved management of end-stage renal disease (ESRD). Conclusions: Integrating personalized nutritional strategies into the management of ciliopathies can enhance patient out-comes by addressing both ocular and systemic manifestations. These findings underscore the need for policy development around nutritional education and support for patients with inherited ciliopathies

Introduction: Herein, we report on the option and clinical advantage of the Preserflo MicroShunt insertion into the posterior chamber ciliary sulcus in a patient with advanced pseudoexfoliation glaucoma at a high risk of corneal decompensation. Case Presentation: We describe a 64-year-old advanced pseudoexfoliation glaucoma patient who despite maximal tolerated medical therapy and two failed glaucoma surgeries, still suffered from uncontrolled intraocular pressure (IOP) of 36 mm Hg in his left eye. The patient underwent the implantation of the Preserflo MicroShunt. The shunt was placed nasally into an area of unscarred conjunctiva, with the anterior part of the shunt inserted into the ciliary sulcus. Postoperatively, the patient’s IOP dropped to 6 mm Hg on the first day and stabilized at 11 mm Hg at the 6-month mark. An elevated, posteriorly located bleb was observed, and the patient no longer required additional topical medications. Endothelial cell (EC) count remained stable with no signs of corneal edema. The patient did not experience any serious postoperative complications. Conclusion: Implantation of the Preserflo MicroShunt into the ciliary sulcus appears to be a viable option for patients at high risk of corneal decompensation, hence, offering effective IOP control while minimizing EC loss. Further studies with larger patient groups are warranted to better evaluate the safety and efficacy of this technique.

Background: Cefuroxime-induced toxic maculopathy can occur when an incorrect or correct dilution is injected intracamerally during cataract surgery. Case Report: An 83-year-old male developed toxic maculopathy on the first postoperative day after uneventful cataract surgery. An investigation of the case confirmed that the patient developed sporadic toxic maculopathy after a standard intracameral cefuroxime dose. The patient showed complete recovery of vision during the first postoperative week. Conclusion: Cefuroxime-induced toxic maculopathy may occur sporadically and have a good visual outcome. It may be distinguished from toxic maculopathy induced by incorrect dilution based on its different clinical appearance and, in some cases, the guarded outcome. Correct dilution of cefuroxime is of utmost importance.

Introduction: Thermal injuries associated with cosmetic eyelid surgery can significantly impair corneal integrity, potentially leading to vision loss. Conventional management, including bandage contact lens use, topical steroids, lubrication, autologous serum tears, and vitamin C, plays a crucial role in preventing long-term complications. This case report explores the potential benefits of multilayer amniotic membrane transplantation (AMT) as an adjunct to standard therapy for treating diathermy-associated corneal burns. Review of the literature advocates the beneficial effects of supplementary AMT in managing thermal corneal trauma. Case description: A 75-year-old man presented with unilateral diathermy-associated corneal laceration superior to the visual axis following cosmetic blepharoplasty. Vision had deteriorated from his baseline 20/30 to 20/125 postoperatively. Intervention involved multilayer AMT alongside standard care, including topical steroids and antibiotics, oral doxycycline, and vitamin C. Postoperative course was monitored with anterior segment optical coherence tomography (AS-OCT) imaging. By three months, complete corneal healing and restoration of baseline visual acuity were achieved. Conclusion: This is the first documented case of multilayer AMT as an effective supplement to conventional management of diathermy-associated corneal injury. While AMT’s unique properties likely contributed to corneal healing and visual recovery, the results should be interpreted in the context of a multimodal therapeutic approach.

Introduction Paraneoplastic optic neuropathy (PON) is a rare immune-mediated optic neuropathy, secondary to an underlying malignancy. This report describes a rare case of bilateral PON as the initial manifestation in a 77-year-old male, leading to the early detection and treatment of pre-clinical small cell lung cancer (SCLC). Case Presentation The patient initially presented with incidental bilateral disc swelling but was asymptomatic, with preserved visual function. Initial investigations, including orbito-cranial imaging, lumbar puncture, temporal artery ultrasound, and serological testing, were inconclusive. Six weeks later, the patient had persistent disc swelling with compromised bilateral visual function and was commenced on oral steroids. Further diagnostic workup identified paraneoplastic antibodies (anti-CV2/CRMP-5 and anti-Hu) and PET scan findings consistent with a nodular SCLC. Following biopsy confirmation, the patient received carboplatin and etoposide chemotherapy, followed by radiotherapy. Initial oral steroids, prior to cancer treatment, resulted in resolution of optic disc swelling and stabilization of visual function. Conclusion This case underscores the importance of a systematic approach to optic neuropathies where an initial diagnosis is not found, revisiting diagnostic pathways when initial findings remain ambiguous, and consideration of PON as a differential – even in the absence of known malignancy or typical cancer symptoms. Timely recognition allows for early intervention, improving patient outcomes. This report contributes to the limited literature on PON and highlights the role of multidisciplinary care in managing complex cases involving paraneoplastic syndromes.

Introduction: Demarcation laser photocoagulation (DLP) is an infrequently utilized modality for limited retinal detachments. The current study, a retrospective consecutive case series, reviewed anatomic and visual outcomes in these patients at a single academic center. Case presentations: A search of the electronic medical record identified ten eyes of ten patients. Five of the ten patients were asymptomatic at the time of initial treatment. Five patients had symptoms corresponding to retinal detachment. The asymptomatic patients remained stable without progression at last follow-up (range 1 to 8 years). In two of five symptomatic patients, the retinal detachment progressed through the laser demarcation and subsequently underwent vitreoretinal surgery. At the last follow up, the retina was attached in all five symptomatic patients. Conclusion: In this small series of patients undergoing DLP, the retina remained stable in asymptomatic patients but the retinal detachment progressed through the laser demarcation in the majority of symptomatic patients.

Introduction: This is an observational case report to detail a challenging case of nodular posterior scleritis (NPS) in a leukemic patient following chemotherapy and allograft. Case Presentation: A 69-year-old leukemic patient presented with unilateral vision loss and pain following febrile neutropenia caused by bacteremia and infectious pneumopathy. Ocular B-mode ultrasound and cerebral magnetic resonance imaging revealed posterior scleritis with a scleral nodule, exudative retinal detachment (ERD), and choroiditis with serous choroidal detachment (SCD). The anterior chamber tap and systemic investigations were normal. Vitrectomy with vitreous biopsy did not provide additional information. A diagnosis of idiopathic nodular posterior scleritis was made. Topical corticosteroids, intravitreal injections of vancomycin and ceftazidime, oral trimethoprim-sulfamethoxazole, and intravenous tazocillin were administered. Over the following weeks, the SCD completely regressed, while the nodule and the ERD partially regressed. Conclusion: NPS is a rare pathology, most commonly idiopathic. A systemic check-up and vitrectomy with sub-retinal biopsy should be considered in immunosuppressed leukemic patients when the etiology of the nodule remains