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Velazquez-Martin JP, Fulda E, Domville D, Graue-Wiechers F, Krema H. Presumed idiopathic central serous chorioretinopathy in a 12-year-old girl. Case Rep Ophthalmol 2012; 3:5-10. [PMID: 22615694 PMCID: PMC3357173 DOI: 10.1159/000335894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Idiopathic central serous chorioretinopathy (CSC) typically affects middle-aged males. To date, only one case of idiopathic CSC in a prepubertal subject has been reported. Atypical idiopathic CSC presentation may be challenging to diagnose. Exclusion of secondary causes of serous retinal detachment (SRD) is warranted. We describe the atypical case of a 12-year-old female with a circumscribed SRD that resolved spontaneously and with fluorescein angiography (FA) findings that were compatible with idiopathic CSC. Optical coherence tomography (OCT) and systemic assessment were performed to exclude other etiologies. FA demonstrated multiple focal leaks in early phases, with subretinal leakage and pooling in late phases. OCT showed a localized circumscribed retinal detachment. Complete blood count was within normal limits. Serum cortisol was normal (22.1 μg/dl) and mean arterial blood pressure was 100/60 mm Hg, thereby excluding secondary causes of CSC. This is the second reported case of idiopathic CSC in a prepubertal female and the first one documented by FA and OCT, as well as other studies to exclude secondary causes. Albeit rare, idiopathic CSC should be considered in the differential diagnosis of SRD in this (prepubertal) age group, after excluding secondary ocular or systemic etiologies.
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Krema H, Navajas E, Simpson ER, Payne D. Choroidal metastasis from a mediastinal choriocarcinoma in a male. Can J Ophthalmol 2011; 46:551-2. [PMID: 22153647 DOI: 10.1016/j.jcjo.2011.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Navajas EV, Simpson ER, Krema H, Hammoudi DS, Weisbrod D, Bernardini M, Altomare F. Cancer-associated nummular loss of RPE: expanding the clinical spectrum of bilateral diffuse uveal melanocytic proliferation. Ophthalmic Surg Lasers Imaging Retina 2011; 42:e103-6. [PMID: 22045614 DOI: 10.3928/15428877-20111020-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 09/29/2011] [Indexed: 11/20/2022]
Abstract
This report describes a case of cancer-associated nummular retinal pigment epithelium loss associated with uterine cancer. The patient had progressive visual loss despite treatment with plasmapheresis, intravenous immunoglobulin, and local injection of corticosteroids. Clinical deterioration was corroborated by extension of the areas of retinal pigment epithelium loss, progression of cataracts, and growth of pigmented choroidal and iris lesions. Previously published cases of cancer-associated nummular retinal pigment epithelium loss did not describe the presence of cataracts or uveal melanocytic lesions. This case expands the clinical spectrum of bilateral diffuse uveal melanocytic proliferation.
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Fernandes BF, Weisbrod D, Yücel YH, Follwell M, Krema H, Heydarian M, Xu W, Payne D, McGowan H, Simpson ER, Laperriere N, Sahgal A. Neovascular Glaucoma After Stereotactic Radiotherapy for Juxtapapillary Choroidal Melanoma: Histopathologic and Dosimetric Findings. Int J Radiat Oncol Biol Phys 2011; 80:377-84. [DOI: 10.1016/j.ijrobp.2010.04.073] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 03/18/2010] [Accepted: 04/29/2010] [Indexed: 11/26/2022]
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Krema H, Xu W, Payne D, Vasquez LM, Pavlin CJ, Simpson R. Factors predictive of radiation retinopathy post 125Iodine brachytherapy for uveal melanoma. Can J Ophthalmol 2011; 46:158-63. [DOI: 10.3129/i10-111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Beiki-Ardakani A, Krema H, Sahgal A, Simpson R, Jezioranski J, Heydarian M, Xu W, Weisbrod D, Payne D, Laperriere N. SU-GG-T-86: Retrospective Evaluation of Symmetrically Loaded COMS Plaques for Juxtapapillary Choroidal Melanoma Patients Using Plaque Simulator. Med Phys 2010. [DOI: 10.1118/1.3468474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Krema H, Simpson R, Altomare F, Ebadi M. Paraneoplastic vitelliform retinopathy in metastatic cutaneous melanoma. Retin Cases Brief Rep 2010; 4:246-250. [PMID: 25390667 DOI: 10.1097/icb.0b013e3181ae7155] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
PURPOSE To report the clinical picture and investigative findings of unusual paraneoplastic retinopathy lesions in a patient with metastatic skin melanoma. METHODS A middle-aged man presented with mild blurring of vision in one eye. He had metastatic skin melanoma to the axillary lymph nodes, which was treated by interferon. Fundus photographs showed bilateral unusual multiple vitelliform lesions. Retinal and serologic investigations were performed. RESULTS These vitelliform lesions involved the outer retinal layers and retinal pigment epithelium (RPE) as demonstrated by optical coherence tomography and have completely blocked choroidal fluorescence without late staining in angiography. There was only minimal reduction of Arden ratio in electro-oculography, although electroretinography was essentially normal. Antibipolar cells autoantibodies were not detected in this case. CONCLUSION This melanoma-related paraneoplastic retinopathy may represent a separate entity from the classic findings in melanoma-associated retinopathy (MAR) syndrome. Optical coherence tomography is helpful to differentiate it from simulating lesions. Recognition of this presentation can help to diagnose the presence of an occult metastaticmelanoma in some cases.
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Krema H, Pavlin C, Simpson R, Fernandes B. Uveal effusion simulating uveal ring melanoma. Can J Ophthalmol 2009; 44:604-5. [PMID: 19789602 DOI: 10.3129/i09-066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Sahgal A, Somani S, Xu W, Krema H, Heydarian M, Michaels H, McGowan H, Payne D, Simpson R, Laperriere N. 21 SIGNIFICANT LATE TOXICITIES ASSOCIATED WITH STEREOTACTIC RADIOTHERAPY FOR JUXTAPAPILLARY CHOROIDAL MELANOMA. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72408-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Heydarian M, van-Prooijen M, Beiki-Ardakani A, Ruschin M, Sahgal A, Krema H, Payne D, Laperriere N. Sci-Fri AM(2): Brachy-08: Dosimetric Comparison of Different Radiation Techniques in the Treatment of Juxtapapillary Choroidal Melanoma. Med Phys 2009. [DOI: 10.1118/1.3244200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Krema H, Simpson ER, Pavlin CJ, Payne D, Vasquez LM, McGowan H. Management of ciliary body melanoma with iodine-125 plaque brachytherapy. Can J Ophthalmol 2009; 44:395-400. [DOI: 10.3129/i09-097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Krema H, Somani S, Sahgal A, Xu W, Heydarian M, Payne D, McGowan H, Michaels H, Simpson ER, Laperriere N. Stereotactic radiotherapy for treatment of juxtapapillary choroidal melanoma: 3-year follow-up. Br J Ophthalmol 2009; 93:1172-6. [DOI: 10.1136/bjo.2008.153429] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Somani S, Sahgal A, Krema H, Heydarian M, McGowan H, Payne D, Xu W, Michaels H, Laperriere N, Simpson ER. Stereotactic radiotherapy in the treatment of juxtapapillary choroidal melanoma: 2-year follow-up. Can J Ophthalmol 2009; 44:61-5. [DOI: 10.3129/i08-177] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Shields CL, Cater J, Shields JA, Chao A, Krema H, Materin M, Brady LW. Combined plaque radiotherapy and transpupillary thermotherapy for choroidal melanoma: tumor control and treatment complications in 270 consecutive patients. ARCHIVES OF OPHTHALMOLOGY (CHICAGO, ILL. : 1960) 2002; 120:933-40. [PMID: 12096964 DOI: 10.1001/archopht.120.7.933] [Citation(s) in RCA: 107] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate tumor control and treatment complications following plaque radiotherapy combined with transpupillary thermotherapy for choroidal melanoma. DESIGN Prospective noncomparative interventional case series. INTERVENTION All patients received treatment for choroidal melanoma using plaque radiotherapy followed by 3 sessions of transpupillary thermotherapy provided at plaque removal and at 4-month intervals. PARTICIPANTS Two hundred seventy patients with newly diagnosed choroidal melanoma. MAIN OUTCOME MEASURES The 2 main outcome measures included local tumor recurrence and treatment-related complications. The clinical data regarding patient features, tumor features, radiotherapy and thermotherapy parameters were analyzed for their effect on the 2 main outcomes using Cox proportional hazards regression models. RESULTS Prior to treatment, the median base of the tumor was 11 mm (range, 4-21 mm) and the median thickness was 4 mm (range, 2-9 mm). Most tumors were located in the posterior pole with a median proximity of 2 mm to the foveola and 2 mm to the optic disc. The median radiotherapy dose to the tumor apex was 9000 rad. Transpupillary thermotherapy was applied in 3 sessions at 4-month intervals for a median of 700 mW. The tumor decreased in thickness to a median of 2.3 mm by 1 year and 2.1 mm by 2 years' follow-up with stable findings thereafter. Using Kaplan-Meier estimates, tumor recurrence was 2% at 2 years and 3% at 5 years. Risk factors for tumor recurrence included macular location of the tumor epicenter (P =.03), diffuse tumor configuration (P =.005), and tumor margin extending underneath the foveola (P =.001). Using Kaplan-Meier estimates, treatment-related complications at 5 years included maculopathy in 18% of the participants, papillopathy in 38%, macular retinal vascular obstruction in 18%, vitreous hemorrhage in 18%, rhegmatogenous retinal detachment in 2%, cataract in 6%, and neovascular glaucoma in 7%. Enucleation for radiation complications was necessary in 3 cases (1%). CONCLUSION Plaque radiotherapy combined with transpupillary thermotherapy provides excellent local tumor control with only 3% recurrence at 5 years' follow-up.
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Krema H, Shields CL, Shields JA, Singh A. Bilateral multiple orbital Lymphangiomas in a patient with systemic lymphangiomatosis. J Pediatr Ophthalmol Strabismus 2002; 39:118-20. [PMID: 11911542 DOI: 10.3928/0191-3913-20020301-14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Chao AN, Shields CL, Shields JA, Krema H. Plaque radiotherapy for choroidal hemangioma with total retinal detachment and iris neovascularization. Retina 2002; 21:682-4. [PMID: 11756902 DOI: 10.1097/00006982-200112000-00026] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chao AN, Shields CL, Krema H, Shields JA. Outcome of patients with periocular sebaceous gland carcinoma with and without conjunctival intraepithelial invasion. Ophthalmology 2001; 108:1877-83. [PMID: 11581065 DOI: 10.1016/s0161-6420(01)00719-9] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the clinical findings, histopathologic features, methods of management, and outcomes in 25 patients with eyelid sebaceous gland carcinoma with and without conjunctival intraepithelial (pagetoid) invasion. PARTICIPANTS Twenty-five patients with sebaceous gland carcinoma of the periocular region. DESIGN Retrospective, observational case series. METHODS The patients were divided into two groups: group A included those with sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion, and group B included those with sebaceous gland carcinoma without conjunctival intraepithelial invasion. The demographic, clinical, and histopathologic features of sebaceous gland carcinoma were reviewed separately for each group. Ocular management results and systemic prognosis were reviewed. RESULTS Of the 25 patients, 18 (72%) were females and 7 (28%) were males. The mean age at diagnosis was 65 years (range, 17-90 years). There were 11 patients (44%) in group A, and 14 (56%) in group B. The most common symptom in group A was ocular irritation (45%), and in group B the most common symptom was eyelid lump (86%). The most common sign in group A was diffuse eyelid thickening (72%), and in group B the most common sign was a distinct eyelid mass (43%). Six patients (55%) in group A, compared with one patient (7%) in group B, had both upper and lower eyelid involvement. The most frequent location of tumor epicenter was the outer third of the eyelid in both groups: 37% in group A and 57% in group B. Histopathologic origin of tumor was multicentric in four patients (36%) of group A and six patients (50%) of group B. Before referral, local recurrence had been found in 4 of 12 patients (33%) who underwent surgical treatment elsewhere. After referral, local recurrence was detected in 1 patient (9%) in group A and in 2 patients (14%) in group B. Orbital exenteration was necessary in 4 patients (36%) in group A and in one patient (7%) in group B. Tumor-related metastases occurred in two patients (18%) in group A and in two patients (14%) in group B. CONCLUSIONS Sebaceous gland carcinoma with conjunctival intraepithelial (pagetoid) invasion has different clinical features compared with that without pagetoid invasion. Conjunctival intraepithelial (pagetoid) invasion carries a higher risk for orbital exenteration, but the risk of tumor-related metastases is similar in both groups.
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Singh A, Krema H, Singh AD. Looking through a cataract. J Cataract Refract Surg 2001; 27:12. [PMID: 11256358 DOI: 10.1016/s0886-3350(00)00853-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Shields JA, Husson M, Shields CL, Krema H, Eagle RC, Singh AD. Orbital malignant fibrous histiocytoma following irradiation for retinoblastoma. Ophthalmic Plast Reconstr Surg 2001; 17:58-61. [PMID: 11206748 DOI: 10.1097/00002341-200101000-00011] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE An unusual case is reported of orbital malignant fibrous histiocytoma that developed after irradiation for retinoblastoma. METHODS Case report. RESULTS A 5-month-old girl underwent enucleation of the left eye, external beam irradiation of the right eye, and systemic chemotherapy for bilateral sporadic retinoblastoma. At age 17 years, a malignant fibrous histiocytoma developed in the medial aspect of the orbit and nasal cavity. After attempted excisional biopsy, she underwent craniofacial resection, orbital exenteration, maxillectomy, and tracheostomy. The patient was alive 12 months postoperatively without local or metastatic disease. CONCLUSIONS Although orbital fibrous histiocytoma occurs usually as a primary tumor of adulthood, it can also develop as a secondary tumor after irradiation for retinoblastoma.
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