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In patients with thyroid-associated ophthalmopathy, responses to treatment are rare and usually minor. Teprotumumab, an antibody to the insulin-like growth factor I receptor, led to significant responses in 69% of patients and to decreased proptosis. Medical therapies for moderate-to-severe thyroid-associated ophthalmopathy (Graves’ orbitopathy) that have proved to be effective and safe in adequately powered, prospective, placebo-controlled trials are lacking. This unmet need is due to the incompletely understood pathogenesis of the disease. 1 Current treatments are inconsistently beneficial and often associated with side effects, and their modification of the ultimate disease outcome is uncertain. 1 – 3 Previous clinical trials, which were rarely placebo-controlled, suggest that high-dose glucocorticoids, alone 3 – 5 or with radiotherapy, 6 , 7 can reduce inflammation-related signs and symptoms in patients with active ophthalmopathy. However, glucocorticoids and orbital radiotherapy minimally affect proptosis and can cause dose-limiting adverse . . .

The authors describe a case of myeloid sarcoma of the orbit in a pediatric patient. An 8-month-old male infant presented to the ophthalmology clinic with a left orbital mass, which had been increasing in size over the previous 2 months. The mass was initially diagnosed at another clinic as an infantile hemangioma, and had been treated with a topical formulation of timolol. In the ophthalmology clinic, orbital magnetic resonance imaging showed a solid enhancing mass. A biopsy was performed, and histopathology revealed myeloid sarcoma. The disease responded well to a standard chemotherapy regimen. Myeloid sarcoma is a rare, extra-medullary presentation that can occur as an isolated tumor, concurrently with or at relapse of acute myeloid leukemia. Because few cases of myeloid sarcoma in the orbit have been reported, this case report aids in the management of myeloid sarcoma in pediatric patients. The report describes an 8-month-old male infant, the youngest patient to develop myeloid sarcoma without preexisting acute myeloid leukemia. [J Pediatr Ophthalmol Strabismus. 2016;53:e64-e68.].

The article reports on a study to evaluate the safety and efficacy of teprotunumab as a form of treatment for patients with thyroid-associated ophthalmopathy. The results indicate that among these patients teprotunumab was found to be quite effective.

We describe the case of a 37-year-old woman who experienced a painful thrombosis of an orbital venous malformation. We successfully treated her with surgical decompression via a computer-assisted, endoscopic transethmoidal orbitotomy. Removal of the lamina papyracea and evacuation of the thrombus provided immediate symptomatic relief. Decompression via an endoscopic transethmoidal route provides a more direct and less invasive approach than other techniques.

Retinal vascular abnormalities are associated with choroidal melanoma. Although tumor ischemia, resulting in soluble angiogenic factor production, is a proposed etiology of these abnormalities, other sources of ischemia may also contribute. Mushroom-shaped choroidal melanomas have increased loss of the overlying choriocapillaris and increased subretinal fluid when compared to dome-shaped tumors; factors that may result in outer retinal ischemia, angiogenic factor production and resultant retinal vascular abnormalities. The differing amounts of retinal vascular abnormalities overlying dome-shaped compared to mushroom-shaped melanomas were determined to evaluate this hypothesis. Retinal vascular abnormalities observed on fluorescein angiograms of eyes with choroidal melanoma were compared to the tumor configuration and presence of subretinal fluid. 23 eyes of 22 patients were included in the study. Retinal vascular abnormalities observed included dilated capillaries, telangiectatic capillaries, capillary nonperfusion, microaneurysms, neovascularization, lipid exudation and late staining of dye within the retina. Retinal vascular abnormalities were present in 4 of 14 eyes with dome-shaped tumors (29%) and in 8 of 9 eyes with mushroom-shaped tumors (89%). (Fisher's Exact Test, p = 0.009). Retinal vascular abnormalities were present in 2 of 10 eyes without subretinal fluid (20%) and in 10 of 13 eyes with subretinal fluid (77%). (Fisher's Exact Test, p = 0.012). Retinal vascular abnormalities are associated with mushroom-shaped choroidal melanomas more commonly than dome-shaped tumors. Outer retinal ischemia may result from choriocapillaris loss or the presence of subretinal fluid, contributing to soluble angiogenic factor production and resultant retinal vascular abnormalities in these eyes. Retinal vascular abnormalities are associated with mushroom-shaped choroidal melanomas more commonly than dome-shaped tumors. These retinal vascular abnormalities may be related to an increase in outer retinal ischemia associated with mushroom-shaped tumors.