A 21-year-old female presented with a known left orbital mass. The mass was incidentally identified 5 years previously after a motor vehicle accident. After initial discovery, the lesion had been followed with surveillance imaging and remained radiographically stable, during which her only symptom was headache. Recent worsening periorbital pain, headache, and progressive visual decline prompted referral. At presentation, best corrected visual acuity was 20/40 in the left eye with 1+ relative afferent pupillary defect (RAPD). Updated imaging revealed a left intraconal orbital mass compressing the optic nerve. The lesion was approached via lateral orbitotomy with bone flap. The tumor was adherent to the optic nerve, and partial resection was achieved. Histopathology demonstrated a biphasic neoplasm consistent with melanotic neuroectodermal tumor of infancy (MNTI). We report a very rare congenital neoplasm with delayed presentation and slow growth rate.
Purpose:We present an uncommon case of primary intraosseous cavernous hemangioma involving the zygoma which displayed CD31 positivity on pathologic analysis. Observations:Macroscopic examination showed a bulging purple-red mass intrinsic to bone measuring 2.1 × 1.8 × 1.6 cm (Fig 2A). Histopathology demonstrated the lesion was comprised of thin-walled vascular channels lined by a monolayer of endothelial cells interspersed among bony trabeculae (Fig 2B) consistent with intraosseous cavernous hemangioma.7,8 Vascular walls lacked both venous and arterial features. Immunohistostaining demonstrated endothelial cells positive for CD31 (Fig 2C, black arrow), a histologic feature sensitive and specific for vascular endothelial cell differentiation.9 At three months follow up our patient had excellent cosmetic results, normal afferent visual function, and normal ocular motility without recurrence. Conclusions and importance:Primary intraosseous cavernous hemangioma of the zygoma is a rare benign orbital bone tumor that commonly presents as a painless mass causing facial asymmetry. Complete en bloc resection in this case with a modified Medpor implant yielded an excellent postoperative functional and aesthetic outcome. While hemangiomas are the most common orbital soft tissue neoplasm, it should additionally be considered in the differential diagnosis of bony tumors of the zygoma.
BACKGROUND:We tested the ability of a single intravitreal injection of foselutoclax (hereafter UBX1325), a novel senolytic small molecule inhibitor of antiapoptotic protein B-cell lymphoma-extra large, to mitigate the impact of diabetic macular edema. METHODS:Patients with diabetic macular edema with prior suboptimal response to anti-vascular endothelial growth factor treatment were randomly assigned (1:1) to either a single intravitreal injection of 10 μg of UBX1325 or sham and were followed for up to 48 weeks. The primary trial objective was to evaluate the safety and side-effect profile of UBX1325 as assessed by ocular and systemic treatment-emergent adverse events (TEAEs). Our secondary objective was to probe efficacy, defined as mean changes from baseline for UBX1325 versus sham in best corrected visual acuity measured in Early Treatment of Diabetic Retinopathy Study (ETDRS) letters (range, 0-100 letters, higher scores indicate better vision) and retinal structure. RESULTS:Between June 2021 and April 2022, 65 participants (32.3% women) were randomly assigned to either UBX1325 (n=32) or sham (n=33). There were four TEAEs of Grade 3 or greater in the sham group, of which three were considered serious, while there were five in the UBX1325 group of Grade 3 or greater and considered serious. There were no apparent between-group differences with respect to vital signs, electrocardiograms, or routine blood chemistries. For the secondary outcome of efficacy, the difference between UBX1325 and sham in mean change to week 48 in best corrected visual acuity was 5.6 more ETDRS letters (95% confidence interval, -1.5 to 12.7). CONCLUSIONS:In this sham-controlled trial there were no TEAEs that led to discontinuation of treatment with UBX1325 compared with sham. There were trends suggestive of potential efficacy; larger trials are needed to further evaluate these findings. (Funded by UNITY Biotechnology; ClinicalTrials.gov number, NCT04857996.).
Objective: To evaluate the efficacy and safety of remote cochlear implant (CI) programming. The primary efficacy objective was to demonstrate that speech recognition in quiet after remote fitting is no worse than speech recognition in quiet after in-person office fitting. The primary safety endpoint was the absence of unanticipated adverse device effects related to remote programming. Study design and setting: Prospective within-subjects interventional study at 5 US centers. Participants: 17 CI recipients (12 electric-only [EO] hearing; 5 with aidable residual hearing) with a minimum of 6 months of CI experience. Intervention: Programming conducted in person and remotely via a smartphone application. Main outcome measures: Speech recognition, fitting duration, and subjective questionnaires. Results: In the EO cohort, mean AzBio speech recognition for in-person created programs was 89.28% (SE = 3.48), compared with 91.94% (SE = 2.76) for programs created remotely. The combined EO and aidable residual hearing cohort’s mean speech recognition for programs created in person was 89.04% (SE = 2.66) versus 90.99% (SE = 2.09) for remotely created programs. The observed P value for EO and pooled cohorts was <0.001, indicating that speech recognition in quiet after remote fitting is no worse than that after in-person fitting. Absolute differences in fitting durations between programming methods ranged from 3 to 11 minutes. The total time spent for a typical CI office visit ranged from 1 to more than 4 hours for 88.3% of study participants. Conclusions: Remote programming provides noninferior outcomes to in-person programming and represents an important step toward improving the accessibility and affordability of obtaining audiology services by eliminating the need to travel. Participants and audiologists rated remote programming positively.
Purpose:The objective was to report the experience with an alternative to the upper eyelid pentagonal wedge resection technique which results in improved cosmesis due to a greater alignment of incisions with relaxed skin tension lines.Methods:This is a retrospective review of all patients who underwent the T-shaped wedge resection by the authors from 2009 to 2017. A horizontal eyelid crease incision is made across the upper eyelid skin. A rectangular full-thickness excision extending to the eyelid crease anteriorly, with an additional superior triangle of posterior lamellar excision is performed. The anterior lamella above the eyelid crease is left intact and the eyelid crease incision is used to distribute the relative excess anterior lamellar tissue above the eyelid crease to the horizontally shortened tissue below the crease.Results:One hundred and four eyelids of 102 patients were included. The mean patient age was 57 and the procedure was performed on 49 right upper eyelids and 55 left upper eyelids. The indications for eyelid resection were benign lesions (n = 57), basal cell carcinoma (n = 27), trichiasis (n = 15), and squamous cell carcinoma (n = 3). Two patients experienced mild postoperative lagophthalmos, which did not require surgical repair. All patients were satisfied with their postoperative appearance. No patients required reoperation related to their procedure.Conclusion:The T-shaped wedge resection is an alternative to the traditional pentagonal wedge resection of the upper eyelid. This technique uses the natural upper eyelid crease to redistribute the relative excess skin above the defect, rather than extending the excision superior to the eyelid crease which can alter the contour of the crease and potentially create a vertical scar above the crease.
