Publications by authors named "Irina Belinsky"

30 Publications

  • Page 1 of 1

Partial Vision Loss After Orbital Decompression in a Patient With Thyroid Eye Disease, Chorioretinal Folds, and Disc Edema.

J Neuroophthalmol 2021 Feb 19. Epub 2021 Feb 19.

Department of Ophthalmology (LD, AQT, AT, IB), New York University, New York, New York; Department of Ophthalmology (AQT, AT), Manhattan Eye, Ear, and Throat Hospital, Northwell Health, New York, New York; and Department of Ophthalmology (VIE), New York Eye and Ear Infirmary of Mount Sinai, New York, New York.

Abstract: Concomitant chorioretinal folds with disc edema can be seen in cases of thyroid eye disease presenting with compressive optic neuropathy and may portend optic nerve ischemia. We describe an unusual case of a 64-year-old man who developed partial vision loss after orbital decompression.
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http://dx.doi.org/10.1097/WNO.0000000000001174DOI Listing
February 2021

An In Utero Presentation of Trilateral Retinoblastoma.

Ophthalmol Retina 2020 Dec 26. Epub 2020 Dec 26.

Ophthalmic Oncology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Ophthalmology, Weill Cornell Medical Center, New York, New York.

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http://dx.doi.org/10.1016/j.oret.2020.12.017DOI Listing
December 2020

Multicameral Steatocystoma Simplex of the Caruncle.

Ophthalmic Plast Reconstr Surg 2020 Nov 5. Epub 2020 Nov 5.

Department of Ophthalmology, New York University Langone Medical Center, New York, New York.

A yellow cyst of the caruncle in a 68-year-old man displayed the characteristic sebaceous glands and sebocytes of steatocystoma within the cyst wall, with a unique configuration of multiple branching compartments. The cyst lining was of trichilemmal character, lacking a keratohyalin granular layer, and replicated the immunohistochemical characteristics of a previously reported caruncular steatocystoma with the exception of a positive trichilemmal marker, calretinin, in the present case. Four previous cases of caruncular steatocystoma have been described, only one of which incorporated immunohistochemical analysis. Steatocystoma develops from a sebaceous gland duct, which displayed in this case multiple chambers subdividing what is usually a single round lumen.
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http://dx.doi.org/10.1097/IOP.0000000000001861DOI Listing
November 2020

Pseudopemphigoid: Sarcoidosis presenting as cicatricial conjunctivitis with symblepharon.

Eur J Ophthalmol 2020 Nov 2:1120672120969046. Epub 2020 Nov 2.

Department of Ophthalmology, New York University Langone Medical Center, New York, NY, USA.

Conjunctival involvement in sarcoidosis is commonly characterized by epibulbar nodules or follicular conjunctivitis. The authors describe an apparently healthy woman who developed extensive monocular cicatricial conjunctivitis with symblepharon. The array of conditions presenting with cicatricial conjunctivitis was considered, with mucous membrane pemphigoid leading the diagnostic possibilities. Conjunctival biopsy disclosed the non-infectious, non-caseating granulomas of sarcoidosis and a systemic evaluation disclosed pulmonary nodules and hilar lymphadenopathy. As the patient had no respiratory symptoms and an old history of hepatic steatosis, oral hydroxychloroquine and topical cyclosporin were chosen for therapy rather than systemic corticosteroids.
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http://dx.doi.org/10.1177/1120672120969046DOI Listing
November 2020

Orbital Rosai-Dorfman disease initially diagnosed as IgG4-related disease: a case report.

Acta Neuropathol Commun 2020 07 18;8(1):113. Epub 2020 Jul 18.

Department of Pathology, NYU Grossman School of Medicine, NYU Langone Health, 550 First Ave, MSB 5th Floor, New York, NY, 10016, USA.

Inflammatory orbital lesions include a broad list of diagnoses, many of them with overlapping clinical and radiographic features. They often present a diagnostic conundrum, even to the most experienced orbital specialist, thus placing considerable weight on surgical biopsy and histopathological analysis. However, histopathological diagnosis is also inherently challenging due to the rarity of these lesions and the overlaps in histologic appearance among distinct disease entities. We herein present the case of an adolescent male with a subacutely progressive orbital mass that generated a significant diagnostic dilemma. Early orbital biopsy was consistent with a benign fibro-inflammatory lesion, but corticosteroid therapy was ineffective in halting disease progression. After an initial substantial surgical debulking, histopathological analysis revealed several key features consistent with IgG4-related disease (IgG4-RD), a systemic fibro-inflammatory process typically accompanied by multifocal tumor-like lesions. Surprisingly, within months, there was clear evidence of clinical and radiographic disease progression despite second-line rituximab treatment, prompting a second surgical debulking. This final specimen displayed distinctive features of Rosai-Dorfman disease (RDD), a systemic inflammatory disease characterized by uncontrolled histiocytic proliferation. Interestingly, certain features of this re-excision specimen were still reminiscent of IgG4-RD, which not only reflects the difficulty in differentiating RDD from IgG4-RD in select cases, but also illustrates that these diagnoses may exist along a spectrum that likely reflects a common underlying pathogenetic mechanism. This case emphasizes the importance of surgical biopsy or resection and histopathological analysis in diagnosing-and, ultimately, treating-rare, systemic inflammatory diseases involving the orbit, and, furthermore, highlights the shared histopathological features between RDD and IgG4-RD.
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http://dx.doi.org/10.1186/s40478-020-00995-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368749PMC
July 2020

Orbital and Eyelid Inflammation With "Muciphages" and Extravasated Mucin From an Ethmoido-orbital Mucocele.

Ophthalmic Plast Reconstr Surg 2021 Jan-Feb 01;37(1):e1-e3

Department of Ophthalmology.

A 22-year-old woman presented with an acute compressive optic neuropathy due to a ruptured ethmoido-orbital mucocele. She underwent urgent orbital decompression and drainage of the mucocele via an endoscopic approach. Postoperatively, her course was complicated by an orbital compartment syndrome supervened, exhibiting severe eyelid edema caused by infiltration with mucin and mucin-containing macrophages ("muciphages"). Biopsy of the eyelid showed infiltration with "muciphages," macrophages laden with extravasated mucinous material. This is the first report that documents the clinical and histopathologic course of orbital inflammation following mucocele extravasation into the orbit and eyelids.
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http://dx.doi.org/10.1097/IOP.0000000000001685DOI Listing
April 2020

Keratinous Cyst of the Caruncle Developing From a Sebaceous Gland Duct: Case Report With Immunohistochemical Analysis.

Ophthalmic Plast Reconstr Surg 2020 Nov/Dec;36(6):e139-e140

Department of Ophthalmology, New York University Langone Medical Center, New York, New York.

An enlarging white caruncular cyst in a 24-year-old woman proved to be a keratinous cyst lined by keratinizing squamous epithelium that lacked a keratohyalin granular layer (trichilemmal keratinization). The cyst most likely originated from a sebaceous gland duct. A panel of immunohistochemical stains was employed that compared and contrasted the cyst lining with the overlying caruncular conjunctival epithelium and further eliminated the likelihood of a conjunctival cyst. The most useful confirmatory stains were the positive trichilemmal marker calretinin, the positive sebaceous ductal marker cytokeratin 17 (suprabasal epithelium), and the negative conjunctival markers cytokeratins 7 and 19. Only one previous report of a very rare similar caruncular cyst is recorded in the literature without an extensive immunohistochemical analysis.
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http://dx.doi.org/10.1097/IOP.0000000000001656DOI Listing
April 2020

Fibrous Dysplasia-like Lacrimal Sac Tumor Associated With Dacryocystitis.

Ophthalmic Plast Reconstr Surg 2020 Jan/Feb;36(1):e23-e24

From the Departments of Ophthalmology.

A 72-year-old woman who presented with right-sided epiphora and conjunctivitis underwent a probing and irrigation procedure with normal results. She improved with antibiotic-steroid drops. A swelling in the medial canthal region completely resolved. One year later, she returned with symptoms of dacryocystitis. An external dacryocystorhinostomy was performed. Characteristic dacryoliths were removed from the sac lumen, and biopsy of the sac wall showed spicules of lamellar bone within a fibrous stroma. Diagnosed as fibrous dysplasia of the lacrimal sac, this rare entity represents the second such case in the literature.The histopathology of an ossified lacrimal sac resembled fibrous dysplasia of bone and exemplifies the second case of this rare entity in the literature.
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http://dx.doi.org/10.1097/IOP.0000000000001526DOI Listing
January 2020

Idiopathic Conjunctival Calcinosis Associated With an Intradermal and Subepithelial Nevus of the Eyelid Margin.

Ophthalmic Plast Reconstr Surg 2019 Sep/Oct;35(5):e110-e111

Pathology, New York University Langone Medical Center, New York, New York, U.S.A.

A 37-year-old woman underwent excision of a congenital melanocytic nevus of the right lower eyelid margin for cosmetic reasons. She suffered from a severe dry eye syndrome which was partially alleviated with various topical eye drops. Histopathology of the excised tissue displayed flecks of calcium that were present within the immediate subepithelial conjunctival fibrous tissue but not the nevocytes or the cutaneous surface. Unlike calcinosis cutis, wherein calcium is deposited within the cutaneous dermis, calcification of the conjunctival substantia propria is rare and may be related to the dry eye state.
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http://dx.doi.org/10.1097/IOP.0000000000001434DOI Listing
January 2020

Cystoid corneoscleral squamous cell carcinoma.

Can J Ophthalmol 2019 08 2;54(4):e166-e168. Epub 2019 May 2.

Department of Ophthalmology, New York University Langone Medical Center, New York, NY.

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http://dx.doi.org/10.1016/j.jcjo.2019.01.002DOI Listing
August 2019

Angiofibroma of the Eyelid: A Rare Clinical and Histologic Variant.

Ophthalmic Plast Reconstr Surg 2019 Jul/Aug;35(4):e199-e102

Departments of Ophthalmology.

A flesh-colored, supraciliary lesion of the left upper eyelid in a 47-year-old man was excised for cosmetic reasons. Histopathology and immunohistochemistry demonstrated CD34-positive benign spindle cells, factor XIIIa-positive dendritic cells, and CD163-positive histiocytes, all dispersed within a diffuse collagenous background. Prominent loose perivascular cuffs of fibroblastic cells and collagen surrounded small blood vessels. Interpreted as an angiofibroma, the histopathology bore resemblance to that of a single previously-reported forearm lesion termed a "dermal fibroma with a distinctive perivascular cell arrangement." The lesion represents the first eyelid example of an unusual variant of angiofibroma.
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http://dx.doi.org/10.1097/IOP.0000000000001423DOI Listing
December 2019

Steatocystoma Simplex of the Caruncle: Case Report and Immunohistologic Study.

Ophthalmic Plast Reconstr Surg 2019 Mar/Apr;35(2):e45-e47

Department of Ophthalmology.

A yellow cystic lesion of the caruncle in a 23-year-old woman proved to be a solitary steatocystoma, a rare occurrence in that location. While the histopathologic diagnosis was evident from clusters of sebaceous cells within the cyst wall, a panel of immunohistochemical stains further distinguished the lesion from a keratinous cyst. The most useful stains for differentiating the two conditions were carcinoembryonic antigen, epithelial membrane antigen, cytokeratins 17 and 19, and calretinin. Only three previous cases of caruncular steatocystoma simplex have been reported, none of which included immunohistochemical studies. The current findings support the origin of the cyst from the small duct that connects the unilobular sebaceous gland associated with vellus hairs to the follicular canal.
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http://dx.doi.org/10.1097/IOP.0000000000001321DOI Listing
December 2019

Esophageal Squamous Cell Carcinoma Metastatic to the Orbit.

Ophthalmic Plast Reconstr Surg 2018 Jul/Aug;34(4):e127-e128

Department of Ophthalmology, New York University Langone Medical Center.

A 74-year-old man presenting with proptosis and orbital inflammation was found on magnetic resonance imaging to have a unilateral intraconal mass. Biopsy revealed a high-grade malignant tumor that was interpreted as squamous cell carcinoma. Positron emission tomography-computed tomography imaging subsequently identified a primary lesion in the esophagus. Esophageal squamous cell carcinoma is a rare cause of orbital metastasis, with only 4 previously reported cases. The authors discuss an approach to orbital malignancies of obscure origin.
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http://dx.doi.org/10.1097/IOP.0000000000001141DOI Listing
August 2018

Bilateral Limbal Keratin-Associated Amyloidosis.

Ophthalmic Plast Reconstr Surg 2018 May/Jun;34(3):e92-e93

Department of Ophthalmology.

Conjunctival amyloid is usually of the immunoglobulin light chain (AL) variety. The authors report an exceptional case of bilateral limbal amyloid deposits that were identified by mass spectrometry as keratin-related specifically regarding to basal keratinocyte keratins 5 and 14. Cytokeratin-related amyloid has been described by immunohistochemical analysis of formalin-fixed cutaneous and mucous membrane lesions but not ocular tissues. The conjunctival lesion in the right eye contained intraepithelial dyskeratotic cells that extended to the surface, causing a lacy leukoplakia on clinical examination. The authors excluded the diagnosis of hereditary benign intraepithelial dyskeratosis in this patient. Collection of patient data and all protected patient health information was compliant with the Health Insurance Portability and Accountability Act.
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http://dx.doi.org/10.1097/IOP.0000000000001091DOI Listing
July 2018

Apocrine Cystadenoma of the Eyelid: A Rare Palpebral Neoplasm. Report of 2 Cases.

Ophthalmic Plast Reconstr Surg 2018 Mar/Apr;34(2):e67-e69

Department of Ophthalmology, New York University Langone Medical Center, New York City, New York.

The authors report 2 cases of apocrine cystadenoma of the eyelid, 1 of which was studied with immunohistochemical and other special stains. While a previous report describes the tumor in a palpebro-orbital location, no other detailed descriptions of a purely eyelid location are present in the literature. Apocrine cystadenoma occupies an unusual portion of the spectrum of Moll gland tumors of the eyelid. It has no definitive clinical characteristics and may be diagnosed pathologically by hematoxylin-eosin-stained sections.
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http://dx.doi.org/10.1097/IOP.0000000000001044DOI Listing
July 2018

Lacrimal Apparatus Defect Repair: Use of the Monocanalicular Silicone Stent.

Dermatol Surg 2017 10;43(10):1296-1298

Department of Ophthalmology, NYU Langone Medical Center, New York, New York Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York Ophthalmic Oncology Service, New York-Presbyterian Hospital, Columbia University Medical Center, New York, New York.

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http://dx.doi.org/10.1097/DSS.0000000000001212DOI Listing
October 2017

Spheno-Orbital Meningiomas: An Analysis Based on World Health Organization Classification and Ki-67 Proliferative Index.

Ophthalmic Plast Reconstr Surg 2018 Mar/Apr;34(2):143-150

Skull Base Division, Neuro-Ophthalmology Service, Wills Eye Hospital, Philadelphia, Pennsylvania, Department of Ophthalmology, New York University Langone Medical Center, New York, New York, and Department of Neurological Surgery, Department of Pathology, and Department of Radiation Oncology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.

Purpose: To evaluate the clinical behavior of spheno-orbital meningiomas with regard to World Health Organization (WHO) tumor grade and Ki-67, a cellular marker of proliferation.

Methods: A retrospective review over a 16-year period of the demographic, clinical, radiographic, and surgical data of all patients with spheno-orbital meningioma who underwent surgical resection. Tumor specimens were examined histologically using the current WHO 2016 classification and immunohistochemically using Ki-67/MIB-1 monoclonal antibody.

Results: Thirty-eight patients met all inclusion criteria: 78.9% of tumors were WHO grade I with a mean Ki-67 of 3.76, and 93% of patients were clinically stable at last follow up; 10.5% of lesions were WHO grade II (atypical) with a mean Ki-67 of 14.93, and 10.5% of lesions were WHO grade III (anaplastic) with a mean Ki-67 of 58.3. All grade II and III meningiomas exhibited an aggressive clinical course. There were statistically significant correlations between disease clinical progression and WHO tumor grade (p < 0.001), between disease clinical progression and Ki-67 (p < 0.001), and between increasing Ki-67 index and higher WHO grade (p < 0.001). For WHO grade I lesions, a Ki-67 of ≥3.3 correlated with recurrence (p = 0.0256). Overall, disease-specific mortality occurred in 5 (13%) patients.

Conclusions: Ki-67 index is a valuable marker to use in conjunction with WHO grade to predict meningioma behavior, particularly in histologically borderline lesions, and possibly to identify a subset of WHO grade I tumors at risk of recurrence. This combination of methods can aid in tailoring treatment and surveillance strategies.
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http://dx.doi.org/10.1097/IOP.0000000000000904DOI Listing
July 2018

Extent of Resection, Visual, and Endocrinologic Outcomes for Endoscopic Endonasal Surgery for Recurrent Pituitary Adenomas.

World Neurosurg 2017 Jun 9;102:35-41. Epub 2017 Mar 9.

Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA; Department of Otolaryngology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA. Electronic address:

Objective: To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas.

Methods: We retrospectively analyzed 61 patients from 2009 to 2016 who underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after previous microscopic or endoscopic transsphenoidal operation.

Results: The previous surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2% of patients. The mean preoperative maximal tumor diameter was 2.3 cm. Tumor commonly invaded the suprasellar cistern (63.9%). Gross total resection (GTR) was achieved in 31 patients (51.7%). GTR rate was 68.4% and 21.7% for Knosp grade 0-2 and grade 3-4 tumors, respectively (P < 0.001). GTR was 73.1% and 35.3% for patients with previous microscopic and endoscopic transsphenoidal surgery, respectively (P = 0.002). On multivariate analysis, smaller tumor size (odds ratio [OR], 1.1 per cm; P = 0.007), Knosp grade 0-2 (OR, 9.7; P = 0.002), and previous microscopic approach (OR, 12.7; P = 0.007) were independent predictors of GTR. Preoperative visual deficit outcome was improved in 32.5%, unchanged in 62.5%, and worse in 5.0%. New postoperative endocrinopathies included adrenal insufficiency (6.5%), hypothyroidism (8.1%), hypogonadism (6.5%), and diabetes insipidus (4.9%). Complications included postoperative cerebrospinal fluid leak (4.9%), meningitis (1.6%), medical complications (4.9%), and postoperative hematoma requiring re-exploration (3.2%).

Conclusions: The endoscopic endonasal approach provides a safe and effective option for recurrent pituitary adenomas. Smaller tumor size, absence of cavernous sinus invasion, and previous microscopic approach were independent predictors of GTR. This finding might suggest that inadequate exposure or limited viewing angle may adversely affect extent of resection in primary microscopic surgeries.
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http://dx.doi.org/10.1016/j.wneu.2017.02.131DOI Listing
June 2017

Primary Extradural Ectopic Orbital Meningioma.

Ophthalmic Plast Reconstr Surg 2017 May/Jun;33(3S Suppl 1):S99-S101

*Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York New York; and †Department of Ophthalmology, Weill Cornell Medical College, New York, New York, U.S.A.

The authors describe a rare case of a primary extradural ectopic meningioma occurring in a 9-year-old female. A review of the literature with respect to clinical presentation, radiographic findings, management, and outcome among similar cases is discussed. Common features that may assist with diagnosing this unusual tumor include absence of bone or optic nerve sheath involvement, presentation at a young age, occurrence in the medial orbit, and sinus asymmetry on radiographic imaging. Preferred method of treatment is complete surgical excision.
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http://dx.doi.org/10.1097/IOP.0000000000000578DOI Listing
September 2017

PSEUDO UVEAL MELANOMA CAUSED BY OPTIC DISK DRUSEN WITH JUXTAPAPILLARY CHOROIDAL NEOVASCULAR MEMBRANE.

Retin Cases Brief Rep 2016 ;10(2):168-70

*Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York; †Department of Ophthalmology, St. John's Episcopal Hospital, Far Rockaway, New York; and ‡Department of Ophthalmology, Maimonides Medical Center, Brooklyn, New York.

Purpose: To describe two cases of choroidal hemorrhage caused by optic disk drusen-induced choroidal neovascularization simulating uveal melanoma.

Methods: Observational case reports of two patients and brief review of the literature.

Results: Two patients were referred with pigmented juxtapapillary lesions concerning for choroidal melanoma. Multimodal imaging revealed the presence of optic disk drusen with overlying choroidal neovascular membranes and peripapillary choroidal hemorrhage. Both patients were treated with antivascular endothelial growth factor and the lesions resolved.

Conclusion: In the setting of diagnostic uncertainty, careful multimodal imaging can assist in distinguishing between malignant choroidal melanoma and a benign simulating lesion. Optic disk drusen with associated neovascularization and hemorrhage should be included in the list of pseudomelanomas.
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http://dx.doi.org/10.1097/ICB.0000000000000218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5317008PMC
January 2017

ISCHEMIC RETINOPATHY IN NEUROFIBROMATOSIS TYPE 1.

Retin Cases Brief Rep 2015 ;9(4):290-4

*Vitreous Retina Macula Consultants of New York, New York, New York; †LuEsther T. Mertz Retinal Research Center, Manhattan Eye Ear and Throat Hospital, New York, New York; ‡Moorfields Eye Hospital, London, United Kingdom; §Department of Ophthalmology, New York University School of Medicine, New York, New York; ¶Edward S. Harkness Eye Institute, Columbia University College of Physicians and Surgeons, New York, New York; and **Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York.

Purpose: To describe a patient with severe ischemic retinopathy and maculopathy in the context of neurofibromatosis Type 1.

Methods: Case report illustrated with multimodal clinical imaging. A 16-year-old female with neurofibromatosis Type 1 presented with visual deterioration over several weeks. Her right eye was amblyopic because of an optic nerve glioma treated in childhood with chemotherapy.

Results: Corrected visual acuities were counting fingers in the right eye and 20/150 in the left eye. Examination revealed bilateral optic disk pallor. In the left eye, severe and extensive ischemic retinopathy and maculopathy were noted with collateral formation and neovascularization. Proximal arterial occlusion at the level of the internal carotid and ophthalmic arteries was excluded on neuroimaging, including computed tomography angiography.

Conclusion: Neurofibromatosis Type 1 may present in the ocular fundus with a variety of lesion types, including vasoproliferative tumors, hamartoma, uveal melanoma, and hemangioma. Vascular occlusions are relatively uncommon. Ocular ischemic syndrome secondary to moyamoya syndrome is well described in neurofibromatosis Type 1 but was excluded in our patient. A spectrum of retinal microvascular abnormalities has also been described, but disease-specific evidence to guide treatment is lacking.
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http://dx.doi.org/10.1097/ICB.0000000000000193DOI Listing
July 2016

Enucleation vs Ophthalmic Artery Chemosurgery for Advanced Intraocular Retinoblastoma: A Retrospective Analysis.

JAMA Ophthalmol 2015 Sep;133(9):1062-6

Ophthalmic Oncology Service, Memorial Sloan-Kettering Cancer Center, New York, New York2Department of Ophthalmology, Weill Cornell Medical College, New York, New York.

Importance: Ophthalmic artery chemosurgery (OAC) has emerged as a primary treatment for advanced-stage retinoblastoma. To our knowledge, the incidence of orbital recurrence in eyes treated with OAC has not been described.

Objective: To determine the incidence of orbital recurrence following enucleation or OAC as primary treatments for advanced-stage retinoblastoma.

Design, Setting, And Participants: Single-institution cohort study with retrospective record review at an academic ophthalmic oncology practice. A total of 140 eyes in 135 patients who presented between February 14, 2006, and March 4, 2014, and were classified as having Reese-Ellsworth group 5 or International Classification of Retinoblastoma (Children's Oncology Group) group D or E retinoblastoma were included; 63 patients (63 eyes) were primarily treated with enucleation and 72 patients (77 eyes) were primarily treated with OAC. This analysis was conducted between August 1, 2014, and March 1, 2015.

Main Outcomes And Measures: Incidence of and time to orbital recurrence, metastasis, and death.

Results: There were 5 orbital recurrences (incidence, 7.9%) in the primary enucleation group and 1 orbital recurrence (incidence, 1.3%) in the primary OAC group during median follow-up times of 42.6 months (range, 6.2-97.1 months) and 38.7 months (range, 9.0-104.3 months), respectively. The 24-month Kaplan-Meier estimate for orbital recurrence-free survival was worse for the enucleation group (92.1%; 95% CI, 82.0-96.7) than for the OAC group (100%) (log-rank test, P = .049). The enucleation group had 5 cases of metastatic disease (7.9%) and 2 deaths (3.2%). In the OAC group, there were 3 cases of metastatic disease (4.2%) and no deaths. Kaplan-Meier analysis of metastasis-free survival and overall survival yielded no differences between the 2 treatment groups. Analysis of a number of features of the 2 groups revealed more eyes with iris neovascularization in the enucleation group (25.4%) than in the OAC group (5.2%) and more eyes with group E retinoblastoma in the enucleation group (87.3%) than in the OAC group (29.9%), although neither of these factors was an independent predictor of orbital relapse in a Cox proportional hazards model.

Conclusions And Relevance: In this single-institution retrospective study of advanced intraocular retinoblastoma, there were more orbital recurrences in the group primarily treated with enucleation. Ophthalmic artery chemosurgery for advanced intraocular retinoblastoma was not found to increase the chance of orbital recurrence, metastatic disease, or death compared with primary enucleation.
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http://dx.doi.org/10.1001/jamaophthalmol.2015.2243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851832PMC
September 2015

"Low Fat" Spindle Cell Lipoma of the Eyelid: A Diagnostic Challenge.

Ophthalmic Plast Reconstr Surg 2017 May/Jun;33(3S Suppl 1):S49-S51

Departments of Ophthalmology and Pathology, New York University Langone Medical Center, New York, New York, U.S.A.

The authors describe a spindle cell lipoma that occurred in the anterior lamellae of the eyelid in a 47-year-old man. This benign tumor was reported previously only once within that location and poses histologic challenges when a "low fat" or "fat free" variant is present.
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http://dx.doi.org/10.1097/IOP.0000000000000492DOI Listing
June 2017

Ointment Granulomas Following Sutureless Transconjunctival Blepharoplasty: Diagnosis and Management.

Ophthalmic Plast Reconstr Surg 2015 Jul-Aug;31(4):282-6

*Department of Ophthalmology, †Institute of Reconstructive Plastic Surgery, and ‡Department of Pathology, New York University Langone Medical Center, New York, New York, U.S.A.

Purpose: To describe a case series of ointment granuloma as a complication of sutureless transconjunctival blepharoplasty.

Methods: A retrospective review of the medical records of 8 patients with this complication was conducted, including the histopathology of excised tissues. Institutional review board oversight was waived as this was not an institutional study but a Health Insurance Portability and Accountability Act-compliant retrospective chart review from the private medical practice of one of authors' coauthors. It adhered to the principles set forth in the Declaration of Helsinki.

Results: Eight patients developed painless lower eyelid and anterior orbital masses following presumed successful blepharoplasty. Each had received intra- or immediate postoperative lubricating ointment. The mean time from surgery to appearance of the lesions was 50 days (range: 9 days-10 months). Three patients responded to intralesional injection of steroid with complete resolution. Five patients required surgical excision of the lesions without recurrence to date. Histopathological examination of the excised tissues revealed large, pleomorphic lipid-dropout pools bordered by attenuated histiocytes and giant cells.

Conclusions: The appearance of eyelid lumps or fullness in the early and mid-postoperative recovery should suggest ointment granuloma. If recognized early, management should commence with intralesional injection of steroids, although the definitive treatment is surgical excision. The authors recommend minimizing the access of topical ointments to the open inferior fornix, placing the medication sparingly onto the cornea at the close of surgery and instructing patients in avoiding overuse.
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http://dx.doi.org/10.1097/IOP.0000000000000296DOI Listing
February 2016

Extranodal natural killer/T-cell lymphoma masquerading as conjunctivitis.

Can J Ophthalmol 2014 Aug 17;49(4):e87-90. Epub 2014 Jul 17.

New York University Langone Medical Center, New York, N.Y.

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http://dx.doi.org/10.1016/j.jcjo.2014.04.008DOI Listing
August 2014

Location of the zygomatico-orbital foramen on the inferolateral orbital wall: clinical implications.

Orbit 2013 Oct 22;32(5):275-7. Epub 2013 Jul 22.

Department of Ophthalmology, NYU Langone Medical Center , New York , USA and.

Purpose: To describe the location of the zygomatico-orbital foramen on the inferolateral orbital wall.

Methods: This anatomic study examined 28 orbits of 14 dry human adult skulls. The zygomatico-orbital foramen was identified by passing a thin wire from the zygomatico-facial foramen to its orbital aspect and a thin flexible ruler was used to measure 1) the distance perpendicular to the closest point on the inferior orbital rim, 2) the distance from the inferior orbital fissure, and 3) the distance from the area used for retrobulbar injections.

Results: The mean distance from the zygomatico-orbital foramen to the closest point on the inferior orbital rim was 4.7 mm (range from 1 to 7 mm). The mean distance from the inferior orbital fissure was 14.9 mm (range from 10 to 18 mm). The mean distance from the area of retrobulbar injection was 6.0 mm (range from 3 to 10 mm).

Conclusions: The location of the zygomatico-orbital foramen within the inferolateral orbit is quite variable. This is the first study to attempt to quantify its proximity to the site of retrobulbar injection. We conclude that it is an important anatomical structure to consider when giving retrobulbar anesthesia, especially given the variability in technique among ophthalmologists.
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http://dx.doi.org/10.3109/01676830.2013.799703DOI Listing
October 2013

Anterior segment optical coherence tomography of conjunctival nevus.

Ophthalmology 2011 May 13;118(5):915-9. Epub 2010 Dec 13.

Ocular Oncology Service, Suite 1440, Wills Eye Institute, 840 Walnut Street, Philadelphia, PA 19107, USA.

Purpose: To evaluate conjunctival nevi using anterior segment optical coherence tomography (AS-OCT).

Design: Retrospective interventional case series.

Participants: There were 22 eyes of 21 patients with conjunctival nevus imaged with AS-OCT for evaluation and detection of cysts within conjunctival nevi.

Intervention: Anterior segment OCT.

Main Outcome Measures: Evaluation and detection of intralesional cysts.

Results: All margins of the nevus, including the deep margin, could be visualized on AS-OCT with high resolution of the anterior margin in 100% of cases, posterior margin in 82% of cases, and lateral margin in 86% of cases. The nevus was optically dense with homogeneous pattern in all cases. Some degree of deep optical shadowing, mostly from pigmented nevi, was noted in 86%. Intrinsic cysts within the nevus were detected by slit-lamp biomicroscopy in 18 cases (82%) and by AS-OCT in 17 cases (77%). In comparison with histopathologic findings, AS-OCT detected intrinsic cysts with a sensitivity of 80%, specificity of 100%, positive predictive value (PPV) of 100%, and negative predictive value (NPV) of 60%. Slit-lamp biomicroscopy (by experienced observers) compared with histopathology revealed detection of cysts with a sensitivity of 100%, a specificity of 100%, a PPV of 100%, and an NPV of 100%.

Conclusions: Anterior segment OCT provides high-resolution imaging of conjunctival nevi with the ability to demonstrate all margins and to provide information on the presence of intralesional cysts, which are important in the diagnosis. The main drawback is optical shadowing of deeper structures from pigment within nevi.
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http://dx.doi.org/10.1016/j.ophtha.2010.09.016DOI Listing
May 2011

Conjunctival melanoma: outcomes based on tumor origin in 382 consecutive cases.

Ophthalmology 2011 Feb 17;118(2):389-95.e1-2. Epub 2010 Aug 17.

Ocular Oncology Service, Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.

Purpose: To evaluate prognostic factors based on origin of conjunctival melanoma.

Design: Interventional case series.

Participants: Three hundred eighty-two consecutive patients.

Methods: Retrospective chart review.

Main Outcome Measures: Melanoma-related metastasis and death.

Results: The melanoma arose from primary acquired melanosis (PAM; n = 284; 74%), from pre-existing nevus (n = 26; 7%), and de novo (n = 72; 19%). The mean tumor base was 11 mm for melanoma arising from PAM, 6 mm for melanoma arising from nevus, and 10 mm for those arising de novo. At 5 years (10 years), melanoma metastasis occurred in 19% (25%) in melanoma arising from PAM (P = 0.003), 10% (26%) in melanoma from nevus (P = 0.193), and 35% (49%) in those de novo. Factors predictive of metastasis by multivariable analysis included tumor origin de novo (P = 0.001), palpebral location (P<0.001), nodular tumor (P = 0.005), and orbital invasion (P = 0.022). At 5 years (10 years), melanoma-related death occurred in 5% (9%) in melanoma arising from PAM (P<0.001), 0% (9%) in melanoma arising from nevus (P<0.057), and 17% (35%) in those arising de novo. Factors predictive of death by multivariable analysis included tumor origin de novo (P<0.001), fornix location (P = 0.04), and nodular tumor (P = 0.001).

Conclusions: Melanoma arising de novo carries a higher risk of melanoma-related metastasis and death compared with those cases arising from PAM or nevus.
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http://dx.doi.org/10.1016/j.ophtha.2010.06.021DOI Listing
February 2011