Publications by authors named "Codrin E Iacob"

27 Publications

  • Page 1 of 1

First report of human infection caused by occurring in a post-corneal transplant patient with endophthalmitis.

Med Mycol Case Rep 2021 Jun 21;32:73-76. Epub 2021 Apr 21.

Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, NY, USA.

Keratomycosis or mycotic keratitis is recognized as one of the major causes of ophthalmic morbidity worldwide. The most common organisms linked to keratomycosis include spp., spp., and spp. However, varieties of saprobic fungi have been reported as causative agents of keratomycosis. Amongst these are members of the genus Herein we present the first reported case of infection in a post-corneal transplant patient, suggesting an increasing role for species as emerging human pathogens, particularly in the transplant population.
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http://dx.doi.org/10.1016/j.mmcr.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102205PMC
June 2021

Cultured Human Uveal Melanocytes Express/secrete CXCL1 and CXCL2 Constitutively and Increased by Lipopolysaccharide via Activation of Toll-like Receptor 4.

Curr Eye Res 2021 May 26:1-14. Epub 2021 May 26.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

: Lipopolysaccharide (LPS) can activate Toll-like receptor 4 (TLR4) and increase the expression of CXCL1 and CXCL2, the potent neutrophils chemoattractants, in various cell types. These effects have not been previously reported in the uveal melanocytes. This study was designed to investigate the effects of LPS on the activation of TLR4 and expression of CXCL1/CXCL2 in cultured human uveal melanocytes and the relevant signal pathways.: Effects of LPS on the expression of TLR4 were tested using real-time PCR, flow cytometry and fluorescence immunostaining. Effects of LPS-induced expression/secretion of CXCL1/CXCL2 were studied using real-time PCR in cell lysates and ELISA in conditioned media of cultured uveal melanocytes. Activated NF-κB and phosphorylated MAPK signals were tested in cells with and without LPS treatment using flow cytometry. Effects of various signal inhibitors on p38, ERK1/2, JNK1/2 and NF-κB on the secretion of CXCL1/CXCL2 were tested by ELISA. The effects of neutralized antibodies of CXCL1/CXCL2 on the severity of LPS-induced uveitis were tested in a mouse model.: LPS stimulation increased the expression of TLR4 mRNA and protein in culture uveal melanocytes. Constitutive secretion of CXCL1/CXCL2 was detected in uveal melanocytes and was significantly increased dose- and time-dependently by LPS stimulation. LPS mainly increased the activated NF-κB and phosphorylated JNK1/2. LPS-induced expression of CXCL1/CXCL2 was blocked by NF-κB and JNK1/2 inhibitors. The severity of LPS-induced uveitis was significantly inhibited by neutralizing antibody to CXCL1/CXCL2: This is the first report on the LPS-induced expression of CXCL1 and CXCL2 by uveal melanocytes via the activation of TLR4. These results suggest that uveal melanocytes may play a role in the immune reaction that eliminates the invading pathogens. Conversely, an excessive LPS-induced inflammatory reaction may also lead to the development of inflammatory ocular disorders, such as non-infectious uveitis.
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http://dx.doi.org/10.1080/02713683.2021.1929326DOI Listing
May 2021

Doppelgänger dilemma: Leiomyoma versus uveal melanoma.

Am J Ophthalmol Case Rep 2021 Jun 6;22:101040. Epub 2021 Mar 6.

The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.

Background: Ciliary body tumors can remain undetected and achieve large dimensions. Pigmented ciliary body tumors include: melanoma, leiomyoma and melanocytoma, however correct diagnosis may require tissue diagnosis with immunohistochemical stains.

Case Presentation: Two men presented with identical ciliochoroidal tumors. Both had darkly pigmented dome-shaped anterior uveal masses, exudative retinal detachments and transillumination shadowing. Ocular PET-CT imaging revealed that both were metabolically active consistent with a diagnosis of cancer. However, immunohistochemical examination revealed one a leiomyoma and the other melanoma.

Conclusion: Uveal leiomyoma can be an indistinguishable doppelgänger to ciliochoroidal melanoma, where the diagnosis can only be established by immunohistopathology.
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http://dx.doi.org/10.1016/j.ajoc.2021.101040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7973119PMC
June 2021

Cost-effective treatment of ocular surface squamous neoplasia for an undocumented and uninsured New York City patient: a case report.

J Med Case Rep 2020 Oct 2;14(1):174. Epub 2020 Oct 2.

Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, NY, USA.

Background: New York City has a heterogeneous population with many undocumented and uninsured immigrants from equatorial areas who have a higher incidence of ocular surface squamous neoplasia. To the best of our knowledge, this is the first documented selection of this cost-effective treatment of ocular surface squamous neoplasia (the use of absolute ethanol along the corneal margin, primary excision, double freeze-thaw cryopexy, and primary conjunctival closure) for an undocumented and uninsured New York City patient.

Case Presentation: A 35-year-old man from Ecuador presented to a New York City emergency department due to worsening discomfort of a long-standing left eye pterygium. A slit-lamp examination of the left eye demonstrated a nasally located conjunctival mass measuring 6 × 8 mm extending onto the cornea (3 mm superiorly and 6 mm inferiorly on the cornea). Histological diagnosis confirmed squamous cell carcinoma in situ arising from the pterygium. Surgical excision with adjunctive absolute alcohol with additive double freeze-thaw cryopexy was performed. Our patient has remained free of tumor recurrence at year 2 postoperative visit.

Conclusions: Our case highlights the need to choose a cost-effective treatment for ocular surface squamous neoplasia in an at-risk population among undocumented and uninsured patients. Areas in the world with similar types of populations or treatment challenges may need to consider this approach as a primary treatment option.
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http://dx.doi.org/10.1186/s13256-020-02510-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529473PMC
October 2020

Micro-incision, trans-iridal aspiration cutter biopsy for ciliary body tumours.

Can J Ophthalmol 2021 Apr 10;56(2):124-129. Epub 2020 Sep 10.

New York Eye and Ear Infirmary of Mount Sinai, New York City, NY.

Objective: To perform micro-incision, trans-iridal, aspiration-cutter-assisted biopsy for ciliary body tumours.

Design: Retrospective, nonrandomized, observational, interventional case series.

Methods: Five consecutive patients undergoing ciliary body tumour biopsy were clinically diagnosed using slit-lamp photography, gonioscopy, high-frequency ultrasound imaging, and systemic radiographic staging. A 1-2 mm clear cornea incision was placed opposite to the central clock hour of the ciliary body tumour. Viscoelastic was infused into the anterior chamber for stabilization and endothelial protection. Then, a 27-gauge aspiration cutter was used to make an iridotomy at the iris root and then extend through the iris into the tumour. Biopsy was performed using mechanical cutting starting at 300 cuts per minute and aspiration at 600 mm Hg. After withdrawal of the cutter from the eye, the effluent tube was flushed into a 3 cc syringe, inspected for specimen under the operating microscope and sent for pathology. Multiple biopsies were performed on each patient. Viscoelastic was removed and Seidel examination of the corneal wound performed.

Results: Five eyes were biopsied. A mean 3.6 passes were used to obtain tumour tissue. Tumour cells and tissue were obtained in all cases. Cytologic, histopathologic, and immuno-histochemical analysis were performed (100%, n = 5/5). Diagnoses included melanoma (60%, n = 3/5), melanocytoma (20%, n = 1/5), and leiomyoma (20%, n = 1/5). Transient postoperative hyphemas cleared within 1 week (80%, n = 4/5). No secondary glaucoma, infection, or cataracts were noted.

Conclusion: Aspiration-cutter biopsy through the iris root provided a minimally invasive, safe method for obtaining ciliary body tissue for cytology, histopathology, and immunohistochemical analysis.
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http://dx.doi.org/10.1016/j.jcjo.2020.08.002DOI Listing
April 2021

and endogenous panophthalmitis: clinical and histopathological features.

Am J Ophthalmol Case Rep 2020 Sep 11;19:100738. Epub 2020 May 11.

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, USA.

Purpose: To report an unusual case of endogenous panophthalmitis involving and describe its clinical and histopathological features.

Findings: A 30 year-old man with history of human immunodeficiency virus, polysubstance abuse, syphilis, and recently treated pneumonia presented with polymicrobial endogenous panophthalmitis. Two separate ocular specimens confirmed simultaneous and involvement. Histopathological analysis demonstrated fulminant polymorphonuclear infiltration of all ocular tissue layers. Despite aggressive management including two intravitreal injections and enucleation, the patient died, ultimately after receiving care at four neighboring urban medical centers.

Conclusions And Importance: has been a recently and increasingly described pathogen leading to mortality in metropolitan hospitals worldwide. To the authors' knowledge, has not previously been reported with endophthalmitis or panophthalmitis. Future cases may be expected with the reported rise in . A high suspicion of its contribution to panophthalmitis could be warranted early in the evaluation and management of profoundly immunocompromised patients, particularly those who have had sequential care at multiple neighboring metropolitan hospitals.
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http://dx.doi.org/10.1016/j.ajoc.2020.100738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240712PMC
September 2020

Quantitative Study of Human Scleral Melanocytes and Their Topographical Distribution.

Curr Eye Res 2020 12 25;45(12):1563-1571. Epub 2020 May 25.

Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai , New York, NY, USA.

Purpose: While fibroblasts constitute the main cell component of the sclera, the purpose of the present study was to investigate the cell densities of melanocytes at different regions of the sclera, and to compare them with associated scleral fibroblast densities in human donor eye sections.

Methods: . Paraffin-embedded sections of sclera from 21 human eyes were stained with hematoxylin-eosin (H&E) and immunohistochemical staining (S-100/AEC). Scleral melanocyte and fibroblast numbers were counted in different regions of the sclera. The relationship between the melanocyte density and iris pigmentation was also analyzed.

Results: . Melanocytes were found in the posterior region of the sclera, especially around the vessels and nerves in emmissarial canals, whereas no or rare melanocytes were found in equatorial and anterior regions. In H&E sections, melanocyte densities in eyes with light-colored irides were significantly less than in eyes with medium or dark-colored irides ( < .05). In S-100-stained sections, more melanocytes could be detected than those in the H&E sections in light-colored eyes ( < .05), but not in medium or dark-colored eyes ( > .05). The numbers of scleral fibroblasts were relatively stable in different regions. In the posterior scleral region, the numbers of fibroblasts were slightly higher than the number of melanocytes, however, this differences were not statistically significant ( > .05).

Conclusion: . Notable numbers of melanocytes were present in the posterior sclera suggesting that these cells may play a role in ocular physiology and in the pathogenesis of various disorders of the sclera.
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http://dx.doi.org/10.1080/02713683.2020.1767789DOI Listing
December 2020

Genomic profiling proves metastasis of cutaneous melanoma to vitreal fluid.

Melanoma Res 2020 12;30(6):590-593

Hematology Oncology.

Cutaneous melanoma metastases can contribute to visual disturbances through a variety of factors, including metastasis to the vitreal fluid. The optimum management of metastatic cutaneous melanoma to the vitreal fluid is unknown, but can include radiation therapy or systemic therapy including immunotherapy. A high degree of suspicion is necessary to consider this complication while working with patients with cutaneous melanoma.
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http://dx.doi.org/10.1097/CMR.0000000000000655DOI Listing
December 2020

Intraocular leiomyoma: Current concepts.

Surv Ophthalmol 2020 Jul - Aug;65(4):421-437. Epub 2020 Jan 7.

The New York Eye and Ear Infirmary, Mount Sinai Hospital, New York, NY, USA.

Intraocular leiomyoma is a benign smooth muscle tumor. First recognized before the era of immunohistochemistry, uveal leiomyomas have been described in case reports and small case series. We add 3 new cases, for a total of 80. Of these, there were 29 men and 51 women. The mean and median ages were 35.8 and 30.5 years respectively, with a range of 8 to 80 years. Curiously, ciliary body tumors were more common in females, whereas iris and posterior choroidal leiomyomas were more prevalent in males. Infrequently associated with systemic fibroids, nuclear expression of sex steroid receptors was inconsistent. Iris and posterior choroidal leiomyoma were predominantly amelanotic, while 40% of ciliary body leiomyomas were brown. Two-thirds of the leiomyomas blocked transillumination partially or completely, a feature shared by uveal melanoma. In general, low-frequency ultrasound imaging reveals low to moderate internal reflectivity; however, high-frequency anterior uveal ultrasound was used to localize a leiomyoma as resident in the suprachoroidal space with an overlying layer of intact choroid. In the few cases examined by physiologic imaging, increased metabolic activity (typically associated with malignancy and inflammation) has been noted. We found that pigmented uveal leiomyomas can be clinically identical to melanoma. Therefore, histopathology with immunohistochemical staining for smooth muscle actin was the most reliable diagnostic method to differentiate pigmented uveal leiomyoma from melanoma. Treatment is governed by the clinical diagnosis, tumor size and location, as well as prognosis for vision and globe preservation.
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http://dx.doi.org/10.1016/j.survophthal.2019.12.008DOI Listing
January 2020

Intravitreous Cutaneous Metastatic Melanoma in the Era of Checkpoint Inhibition: Unmasking and Masquerading.

Ophthalmology 2020 02 24;127(2):240-248. Epub 2019 Sep 24.

Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia.

Purpose: Cutaneous melanoma metastatic to the vitreous is very rare. This study investigated the clinical findings, treatment, and outcome of patients with metastatic cutaneous melanoma to the vitreous. Most patients received checkpoint inhibition for the treatment of systemic disease, and the significance of this was explored.

Design: Multicenter, retrospective cohort study.

Participants: Fourteen eyes of 11 patients with metastatic cutaneous melanoma to the vitreous.

Methods: Clinical records, including fundus photography and ultrasound results, were reviewed retrospectively, and relevant data were recorded for each patient eye.

Main Outcome Measures: Clinical features at presentation, ophthalmic and systemic treatments, and outcomes.

Results: The median age at presentation of ophthalmic disease was 66 years (range, 23-88 years), and the median follow-up from diagnosis of ophthalmic disease was 23 months. Ten of 11 patients were treated with immune checkpoint inhibition at some point in the treatment course. The median time from starting immunotherapy to ocular symptoms was 17 months (range, 4.5-38 months). Half of eyes demonstrated amelanotic vitreous debris. Five eyes demonstrated elevated intraocular pressure, and 4 eyes demonstrated a retinal detachment. Six patients showed metastatic disease in the central nervous system. Ophthalmic treatment included external beam radiation (30-40 Gy) in 6 eyes, intravitreous melphalan (10-20 μg) in 4 eyes, enucleation of 1 eye, and local observation while receiving systemic treatment in 2 eyes. Three eyes received intravitreous bevacizumab for neovascularization. The final Snellen visual acuity ranged from 20/20 to no light perception.

Conclusions: The differential diagnosis of vitreous debris in the context of metastatic cutaneous melanoma includes intravitreal metastasis, and this seems to be particularly apparent during this era of treatment with checkpoint inhibition. External beam radiation, intravitreous melphalan, and systemic checkpoint inhibition can be used in the treatment of ophthalmic disease. Neovascular glaucoma and retinal detachments may occur, and most eyes show poor visual potential. Approximately one quarter of patients demonstrated ocular disease that preceded central nervous system metastasis. Patients with visual symptoms or vitreous debris in the context of metastatic cutaneous melanoma would benefit from evaluation by an ophthalmic oncologist.
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http://dx.doi.org/10.1016/j.ophtha.2019.09.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003537PMC
February 2020

Amyloidosis Presenting as a Mass Abutting the Tympanic Membrane.

Ear Nose Throat J 2019 Sep 30:145561319868453. Epub 2019 Sep 30.

Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

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http://dx.doi.org/10.1177/0145561319868453DOI Listing
September 2019

Histopathological Study on the Proposed Pathogenesis of Intratarsal Keratinous Cysts.

Ophthalmic Plast Reconstr Surg 2019 Jul/Aug;35(4):365-368

Pathology, University of Ottawa, The Ottawa Hospital, Ottawa, Ontario, Canada.

Purpose: Intratarsal keratinous cysts (IKCs) are a recently described entity that is frequently misdiagnosed clinically as chalazia and mislabeled in the literature as "intratarsal epidermal inclusion cysts" or "epidermoid cysts." It is important to accurately diagnose IKCs and distinguish them from chalazia because IKCs require a complete surgical excision and can exhibit multiple recurrences following curettage. The authors performed a retrospective case series to further elucidate the pathogenesis of IKCs and to determine the diagnostically optimal panel of stains for diagnosis.

Methods: A study group of 8 specimens of IKCs and control specimens of epidermal inclusion cysts were obtained from their pathology laboratories. The authors compared the histological and immunohistochemical profile of IKCs and epidermal inclusion cysts by staining sections from each specimen with hematoxylin and eosin, periodic acid-Schiff, Masson trichrome, cytokeratin 5, cytokeratin 17, carcinoembryonic antigen, and epithelial membrane antigen. The immunoreactivity data were then analyzed using a 2-tailed Mann-Whitney test, assuming a nonparametric population (p < 0.05 is significant).

Results: Histopathologically, IKCs are embedded in the tarsus lined by stratified squamous epithelium with an inner undulating cuticle filled with a compact keratinous-appearing material. The authors demonstrate that IKCs develop progressively from dilated meibomian ducts to the formation of complete cysts with their markers. The most valuable immunochemical stains to diagnose IKC were cytokeratin 17, carcinoembryonic antigen, and epithelial membrane antigen (p < 0.05 with each).

Conclusions: These findings provide a better understanding of the pathogenesis and the immunohistochemical findings of this relatively new entity allowing for more appropriate diagnosis of IKCs aiming to reduce future complications from their management.
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http://dx.doi.org/10.1097/IOP.0000000000001271DOI Listing
December 2019

Conjunctival myxoma: A case report with unique high frequency ultrasound (UBM) findings.

Indian J Ophthalmol 2018 Nov;66(11):1629-1631

Department of Pathology, The New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.

A 39-year-old female presented with a painless yellow-pink tumor on her right eye. High-frequency ultrasound imaging revealed an epibulbar lesion with homogenous low internal reflectivity and no evidence of intraocular invasion. The patient underwent excisional biopsy leading to a pathology diagnosis of myxoma. Additional surgical margins as well as adjuvant cryotherapy margins were followed by extensive conjunctival repair. Herein, we report on a conjunctival myxoma with unique ultrasonographic findings.
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http://dx.doi.org/10.4103/ijo.IJO_518_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213696PMC
November 2018

p16 Expression Is Not a Surrogate Marker for High-Risk Human Papillomavirus Infection in Periocular Sebaceous Carcinoma.

Am J Ophthalmol 2016 Oct 25;170:168-175. Epub 2016 Jul 25.

Department of Pathology, Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts.

Purpose: To evaluate the role of high-risk human papillomavirus (HR-HPV) infection in periocular sebaceous carcinoma (SC) using multiple methods of detection, and to determine whether p16 overexpression is present and can be used as a surrogate marker for HR-HPV.

Design: Retrospective observational case series with laboratory investigations.

Methods: Unstained paraffin sections of 35 cases of periocular SC were analyzed with immunohistochemistry for p16 and subjected to polymerase chain reaction (PCR) for HR-HPV. A subset of 18 lesions that were p16-positive was further studied with a novel method of mRNA in situ hybridization (ISH) for the detection of transcriptionally active HR-HPV, an advanced technique with an enhanced sensitivity and specificity.

Results: The clinical findings were in keeping with those of comparable earlier studies. Strong immunohistochemical p16 positivity (meeting the criterion of >70% nuclear and cytoplasmic staining) was present in 29 of 35 cases of periocular SC (82.9%). The selected 18 p16-positive cases tested were negative for HR-HPV using mRNA ISH. PCR yielded unequivocal results with adequate DNA isolated in 24 cases, 23 of which were negative for HR-HPV. One case was positive for HPV type 16, which was found to be a false positive as collaterally determined by mRNA ISH negativity.

Conclusion: No evidence was found for HR-HPV as an etiologic agent in the development of periocular SC using multiple modalities to maximize sensitivity and specificity and reduce the limitations of any single test. p16 overexpression is common in periocular SC but unrelated to HR-HPV status. Although p16 may be used as a surrogate marker for HR-HPV status in other tissue sites, this interpretation of p16 positivity is not applicable to periocular SC.
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http://dx.doi.org/10.1016/j.ajo.2016.07.012DOI Listing
October 2016

Rapidly growing iris melanocytoma with secondary glaucoma in a 6-year-old child.

Eur J Ophthalmol 2016 Jun 10;26(4):e71-3. Epub 2016 Jun 10.

New York Eye and Ear Infirmary of Mt. Sinai, New York, NY - USA.

Purpose: To describe an unusual case of pediatric iris melanocytoma with pigment dispersion glaucoma that resolved after resection of the primary tumor.

Methods: Retrospective case review of the clinical record, ultrasonographic images, and histopathology.

Results: A 6-year-old Asian girl, with a dark iris tumor, pigment dispersion, and secondary glaucoma, was initially treated with topical antiglaucoma medication and observation. Rapid growth prompted biopsy, revealing melanocytoma. As the tumor continued to grow, excision of the primary tumor was performed. Surgery proved curative in that the pigment dispersion slowly reabsorbed and her glaucoma resolved.

Conclusions: In this case, rapid growth did not indicate malignant transformation. Initial observation for growth and judiciously timed surgical intervention prevented progression, loss of vision, and potentially the loss of the eye.
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http://dx.doi.org/10.5301/ejo.5000726DOI Listing
June 2016

Small Intestinal Submucosa Implantation for the Possible Treatment of Vocal Fold Scar, Sulcus, and Superficial Lamina Propria Atrophy.

Ann Otol Rhinol Laryngol 2016 Feb 13;125(2):137-44. Epub 2015 Sep 13.

Department of Pathology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York, USA.

Objectives: Evaluate the histologic effects of grafting porcine-derived small intestinal submucosa (SIS) into the vocal fold superficial lamina propria (SLP) layer for the potential treatment of vocal fold scar, sulcus and superficial lamina propria atrophy.

Methods: Small intestinal submucosa was implanted into the right vocal fold SLP of 6 mongrel dogs. The left vocal fold served as a sham surgical control. At 2, 4, and 6 weeks postoperative, bilateral vocal fold specimens were evaluated histologically.

Results: At 2 and 4 weeks, respectively, SIS-implanted vocal folds demonstrated moderate and mild inflammation and acute and chronic inflammation. At 6 weeks, inflammation was minimal and chronic. The 6-week specimens showed copious amounts of newly generated hyaluronic acid (HA) within the graft. There was no reactive fibrosis at 6 weeks.

Conclusions: In the canine model, SIS appears safe for SLP grafting. Inflammation is similar to that of sham surgery. Small intestinal submucosa results in newly generated HA without concomitant fibrosis. Small intestinal submucosa has potential to be used in treatment of disorders with SLP, including vocal fold scar, sulcus, and atrophy. Studies evaluating the effect of SIS implantation on vocal fold function, as well as the ultimate fate of the graft, are required.
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http://dx.doi.org/10.1177/0003489415601685DOI Listing
February 2016

Palladium-103 eye plaque brachytherapy for primary adenocarcinoma of the ciliary body epithelium.

Brachytherapy 2011 Nov-Dec;10(6):503-7. Epub 2011 Mar 9.

The New York Eye Cancer Center, New York City, NY 10065, USA.

Purpose: To present an interventional case report on the use of plaque brachytherapy for adenocarcinoma of the nonpigmented ciliary epithelium.

Methods And Materials: A 36-year-old woman with unilateral right eye pain and finger counting vision was noted to have an anterior segment intraocular mass. It extended between the iris and lens and into the pupillary aperture. High-frequency ultrasound imaging revealed a ciliary body origin. A minimally invasive biopsy technique allowed for a cytology and histopathology diagnosis of primary adenocarcinoma of the ciliary epithelium. Treatment was performed with palladium-103 ophthalmic plaque brachytherapy (80-Gy apex). Main outcome measures include visual acuity, local control, radiation complications, and metastatic disease.

Results: The patient presented with counting fingers vision, focal angle closure, cataract, and a 5.5-mm thick ciliary body malignancy. At 3 years after radiation therapy and 2.5 years after cataract extraction, her visual acuity was improved to 20/30 and the tumor residua stabilized at 60% of its initial thickness. There has been neither radiation-related keratopathy, retinopathy, optic neuropathy nor metastatic disease.

Conclusions: Plaque brachytherapy was used to treat primary adenocarcinoma of the ciliary epithelium. With 3-year followup, there has been excellent local control, preservation of the eye, and recovery of vision.
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http://dx.doi.org/10.1016/j.brachy.2011.01.013DOI Listing
February 2012

The diagnostic value of exfoliative cytology vs histopathology for ocular surface squamous neoplasia.

Am J Ophthalmol 2009 Nov 5;148(5):772-778.e1. Epub 2009 Aug 5.

The New York Eye Cancer Center, New York, NY 10065, USA.

Purpose: To determine the reliability and role of conjunctival exfoliative cytologic and histopathologic diagnosis of biopsied tissue in ocular surface squamous neoplasia.

Design: Retrospective review of an interventional case series of patients biopsied and treated for squamous conjunctival and corneal neoplasia.

Methods: Forty-nine patients who underwent conjunctival cytologic analysis (n = 36), conjunctival biopsy (n = 35), or both were evaluated. For the purposes of this study, three ocular pathologists reviewed the results of cytologic and biopsied tissue in a masked fashion.

Results: Evaluation of cytologic smears revealed a 91% concordance in interpretation of conjunctival cytologic material as no dysplasia vs dysplasia. The concordance dropped to 59% in grading the degree of dysplasia. The cytologic material was found to be inadequate for interpretation in 1 case. Evaluation of subsequent biopsy revealed a 98% concordance between the pathologists in interpretation of biopsied tissue as no dysplasia vs any degree of dysplasia. The concordance decreased to 83% in grading the degree of dysplasia. Cytologic evaluation was capable of distinguishing a neoplastic from nonneoplastic process before tissue biopsy in 80% of cases.

Conclusions: Ocular surface cytologic analysis is a simple, safe, and relatively noninvasive diagnostic tool. It was found helpful in detecting dysplasia before surgical resection. It was used in the settings of recurrent tumor and for follow-up care of patients treated with topical chemotherapy. Although cytologic smears cannot replace incisional or excisional biopsy for definitive diagnosis, exfoliative cytologic analysis can play an important role in the diagnosis and management of patients with ocular surface squamous neoplasia.
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http://dx.doi.org/10.1016/j.ajo.2009.06.015DOI Listing
November 2009

Reactive keratoma of the central corneal epithelium.

Eur J Ophthalmol 2009 May-Jun;19(3):484-6

New York University School of Medicine, New York, NY, USA.

Purpose: The authors present a unique corneal tumor.

Methods: A 75-year-old gardener presented with a 1-year history of a slowly growing central corneal lesion with progressive visual loss. We performed an ophthalmic examination, slit lamp photography, high-frequency ultrasonography, and culture with sensitivity (followed by therapeutic scrape biopsy).

Results: Clinical examination revealed a gray-white central corneal tumor without extension to the limbus. No significant tumor neovascularization or intraocular inflammation was noted. High frequency ultrasound revealed no penetration of the corneal stroma. The tumor was removed with a platinum spatula. Histopathology revealed simple hyperkeratosis characterized by stratified hyperkeratotic corneal epithelium with metaplastic granular layer characteristic of epidermis. Few and focal clusters of passenger bacteria were found (as seen in cutaneous leukoplakia). Cultures revealed a few Gram-positive cocci and no fungus. A human papilloma virus wide-screen spectrum assay (in situ hybridization) was negative.

Conclusions: The authors present a benign keratoma of the central corneal epithelium. High frequency ultrasound and scrape biopsy histopathologic techniques were used to diagnose and treat this keratoleukoma caused by a reactive keratoma as well as improve his vision.
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http://dx.doi.org/10.1177/112067210901900328DOI Listing
June 2009

High-frequency ultrasound of extranodal limbal Rosai-Dorfman disease: affecting the conjunctiva, sclera, and cornea.

Cornea 2007 Aug;26(7):888-90

New York Eye Cancer Center, New York, NY 10021, USA.

Purpose: To correlate the clinical, high-frequency ultrasound, and pathology characteristics of an epibulbar Rosai-Dorfman tumor.

Methods: We report a case of a steroid-resistant yellow perilimbal epibulbar tumor referred for ophthalmic oncology evaluation. It was documented by slit-lamp photography and evaluated by high-frequency ultrasound. A hematology-oncology evaluation and excisional biopsy were performed.

Results: Ophthalmic examination revealed a solitary yellow perilimbal epibulbar tumor. High-frequency ultrasound imaging revealed low internal reflectivity and partial-thickness scleral and corneal invasion with no extension into the anterior segment. Primary excision was performed. Although histopathology revealed large atypical histiocytes, immunochemistry found them to be both S-100 positive and CD1a negative (diagnostic of Rosai-Dorfman disease). Hematology-oncology evaluation revealed no systemic disease or links to human herpesvirus. Local control required cryotherapy and sub-Tenon steroid injection.

Conclusions: Epibulbar Rosai-Dorfman tumors can invade the sclera and are often treated by surgical excision. High-frequency ultrasound imaging should be used to determine the presence or extent of invasion before surgery.
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http://dx.doi.org/10.1097/ICO.0b013e318074e439DOI Listing
August 2007

Giant sarcoid tumor of the iris and ciliary body.

Ocul Immunol Inflamm 2007 Mar-Apr;15(2):121-5

The New York Eye Cancer Center and the Ocular Tumor and Uveitis Services, The New York Eye and Ear Infirmary, New York City, NY 10065, USA.

Purpose: To report the occurrence of a giant iridociliary sarcoid tumor.

Methods: The patient was evaluated by medical history, ophthalmoscopic examination (including photography and ultrasonography) as well as systemic, hematologic, and radiographic examinations. Tumor biopsies allowed for cytopathologic, histopathologic, and immunohistochemical analysis.

Results: The 39-year-old black male was found to have a right iris and ciliary body tumor. Ultrasonography revealed a 10 x 12-mm base, 5.6-mm height, low internal reflectivity, and vitreous debris. Radiographic imaging revealed mediastinal and bilateral hilar lymphadenopathy. A purified protein derivative (PPD) and a hematologic survey were negative. Pathology evaluations of the surgical specimens revealed features of non-caseating granulomata consistent with sarcoidosis. A combination of topical and systemic steroid therapy was locally curative.

Conclusions: We describe a giant iridociliary sarcoid tumor in a patient with no lacrimal gland enlargement, conjunctival nodules, or skin lesions. A biopsy was required to establish the diagnosis.
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http://dx.doi.org/10.1080/09273940601174053DOI Listing
August 2007

Conjunctival malignant melanoma-associated pseudomelanoma of the apposing tarsal conjunctiva.

Cornea 2006 Oct;25(9):1121-3

New York Eye Cancer Center, New York, NY 10021, USA.

Purpose: To describe a case of conjunctival malignant melanoma associated with pseudomelanomatous alteration of the apposing tarsal conjunctiva.

Methods: A 93-year-old woman presented with an elevated, pigmented mass on her superior bulbar conjunctiva. The tumor was associated with increased pigmentation of the apposing superior tarsal conjunctiva. An excisional biopsy of the epibulbar melanoma and pigmented tarsal conjunctiva was performed.

Results: Histopathologic evaluation of the epibulbar tumor revealed epithelioid melanocytes diagnostic of malignant melanoma. Histopathologic evaluation of the pigmented tarsal lesion showed large areas of ulceration and foci of granulation tissue composed of neovascular sprouts arising in the background of a loose connective tissue, with a moderate chronic inflammatory infiltrate. The infiltrate was composed of mature lymphocytes, plasma cells, and scattered histiocytes. Densely packed intracytoplasmic, brown pigment granules that stained positive with HMB 45 were found, attesting to adjacent melanocytes' releasing melanin-laden granules. There was no evidence of malignancy in the pigmented tarsal specimen.

Conclusion: Noncontiguous pigmented conjunctival tumor can be found in apposition to an epibulbar melanoma. Although a limited biopsy could be considered, only a complete resection and histopathologic evaluation can determine whether the entire lesion is free of malignant melanoma.
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http://dx.doi.org/10.1097/01.ico.0000226358.26678.98DOI Listing
October 2006

Whole-body positron emission tomography/computed tomography imaging and staging of orbital lymphoma.

Ophthalmology 2006 Oct 24;113(10):1854-8. Epub 2006 Jul 24.

New York Eye Cancer Center, New York, New York 10021, USA.

Objectives: To report the use of whole-body positron emission tomography fused with computed tomography (PET/CT) for the diagnosis and staging of orbital lymphoma.

Design: Retrospective observational case series.

Participants: Four patients with biopsy-proven orbital lymphoma were evaluated by 18-fluoro-2-deoxyglucose whole-body PET/CT imaging.

Methods: Positron emission tomography/CT images were studied for the presence of glucose uptake. Foci were considered suspicious based on their standardized uptake values (SUVs). Physiologic images (PET) and their anatomic counterparts (CT) were fused to allow form and function to be evaluated on the same diagnostic page.

Main Outcome Measures: Positron emission tomography/CT images were assessed for foci with abnormally high SUVs that correlated with biopsy-proven lymphoma.

Results: Positron emission tomography/CT detected orbital lymphoma in 3 patients (75%). It also revealed systemic lymphoma in 2 of the 4 patients. The 2 patients found to have systemic lymphoma were diagnosed to have extranodal marginal zone B-cell orbital lymphoma of the mucosa-associated lymphoid tissue (MALT) type. Similarly, the 2 with negative PET/CT results also had orbital MALT-type lymphoma. We found that PET/CT imaging helped guide further management in all 4 patients.

Conclusions: Positron emission tomography/CT should be considered as a new method of diagnosing, staging, and restaging patients with orbital lymphomas.
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http://dx.doi.org/10.1016/j.ophtha.2006.04.029DOI Listing
October 2006

Bilateral epibulbar granulocytic sarcomas: a case of an 8-year-old girl with acute myeloid leukaemia.

Graefes Arch Clin Exp Ophthalmol 2007 Jan 27;245(1):170-2. Epub 2006 Apr 27.

The New York Eye Cancer Center, 115 East 61st Street, New York, NY 10021, USA.

Purpose: An 8-year-old girl with a history of acute myeloid leukaemia (AML) presented with bilateral ocular discomfort, conjunctival injection, photophobia, and epiphora.

Methods: Clinical examination and high-frequency ultrasound showed bilateral epibulbar tumours.

Results: Granulocytic sarcomas were suspected and leukaemic infiltration was confirmed by fine-needle aspiration biopsy based cytopathologic examination.

Conclusions: Epibulbar granulocytic sarcoma in AML is rare (particularly in a child). We describe the first high-frequency ultrasound images and illustrate the use of a minimally invasive fine-needle aspiration biopsy technique to confirm our diagnosis.
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http://dx.doi.org/10.1007/s00417-006-0341-3DOI Listing
January 2007

Giant secondary conjunctival inclusion cysts: a late complication of strabismus surgery.

Ophthalmology 2006 Jun 2;113(6):1049.e1-2. Epub 2006 May 2.

New York Eye Cancer Center, New York, New York 10021, USA.

Purpose: To present giant conjunctival inclusion cysts as a late complication of strabismus surgery.

Design: Retrospective case series of selected patients.

Participants: Four patients with a history of strabismus surgery who had developed giant conjunctival inclusion cysts.

Methods: A chart review was performed. The patient's ocular history, ophthalmic examinations, and imaging (ultrasound/ultrasound biomicroscopy and/or computed tomography) were recorded. Surgical excision with subsequent histopathologic correlation was obtained in 3 cases.

Main Outcome Measures: Clinical and imaging characteristics with histopathologic correlation.

Results: Four patients with giant conjunctival inclusion cysts had a history of strabismus surgery. Ultrasound biomicroscopy was performed in 3 cases and revealed large, cystic, well-circumscribed tumors with low internal reflectivity and hyperechoic components. Computed tomography of the orbits was used to evaluate posterior extension. Their size induced limitation in motility, strabismus, and problems related to chronic exposure. Histopathologic evaluations were consistent with benign inclusion cysts of the conjunctiva.

Conclusions: Giant conjunctival inclusion cysts may appear decades after strabismus surgery. Tumor size, cystic nature, and involvement of underlying structures can be determined by ultrasonography and radiographic imaging. Complete surgical removal can be curative.
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http://dx.doi.org/10.1016/j.ophtha.2006.02.031DOI Listing
June 2006

Reactive lymphoid hyperplasia one month after LASIK surgery.

Graefes Arch Clin Exp Ophthalmol 2006 Apr 12;244(4):529-31. Epub 2005 Oct 12.

The New York Eye Cancer Center, New York, NY 10021, USA.

Background: To describe a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK).

Methods: This observational case report describes a 31-year-old man who underwent LASIK and presented 1 month later with a fleshy, conjunctival (plical) tumour in the left eye. An excisional biopsy of the tumour was performed.

Results: Histopathology of the excised tumour revealed reactive lymphoid hyperplasia involving the left conjunctiva.

Discussion: Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumours. This report describes the unusual occurrence of a lymphoid conjunctival tumour after LASIK eye surgery.
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http://dx.doi.org/10.1007/s00417-005-0132-2DOI Listing
April 2006

Reactive lymphoid hyperplasia 1 month after LASIK surgery.

Graefes Arch Clin Exp Ophthalmol 2006 Feb 21;244(2):262-4. Epub 2005 Jul 21.

The New York Eye Cancer Center, 115 East 61st Street, New York City, NY 10021, USA.

Purpose: This study was conducted to investigate a case of reactive lymphoid hyperplasia following laser assisted in situ keratomileusis (LASIK).

Methods: A 31-year-old man who underwent LASIK presented 1 month later with a fleshy conjunctival (plical) tumor in the left eye. An excision biopsy of the tumor was performed.

Results: Histopathology of the excised tumor revealed reactive lymphoid hyperplasia.

Discussion: Conjunctival lymphomas can masquerade as chronic conjunctivitis and can be preceded by reactive lymphoid hyperplasia. It is important to identify and differentiate these tumors. This report describes the unusual occurrence of a lymphoid conjunctival tumor after LASIK eye surgery.
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http://dx.doi.org/10.1007/s00417-005-0007-6DOI Listing
February 2006