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"Yousef, Yacoub"
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Declining incidence and improving survival of ocular and orbital lymphomas in the US between 1995 and 2018
This epidemiological study examined ocular and orbital lymphomas in the United States from 1995 to 2018, using data from the North American Association of Central Cancer Registries database of 87,543 patients with ocular and adnexal malignancies. We identified 17,878 patients (20.4%) with ocular and orbital lymphomas, with an age-standardized incidence rate (ASIR) of 2.6 persons per million (ppm). The incidence was the highest in the orbit (ASIR = 1.24), followed by the conjunctiva (ASIR = 0.57). Non-Hodgkin B-cell lymphoma was the most prevalent subtype (85.4%), particularly marginal-zone lymphoma (45.7%). Racial disparities were noted, with Asia–Pacific Islanders showing the highest incidence (orbit, 1.3 ppm). The incidence increased significantly from 1995 to 2003 (Average Percent Change, APC = 2.1%) but declined thereafter until 2018 (APC = − 0.7%). 5-year relative survival (RS) rates varied, with the highest rate for conjunctival lymphoma (100%) and the lowest for intraocular lymphoma (70.6%). Survival rates have generally improved, with an annual increase in the 5-year RS of 0.45%. This study highlights the changing epidemiological landscape, pointing to initial increases and subsequent decreases in incidence until 2003, with survival improvements likely due to advancements in treatment. These findings underscore the need for further research to investigate the root causes of these shifts and the declining incidence of ocular lymphoma.
Journal Article
Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study
BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.
Journal Article
Imaging of Uveal Melanoma—Current Standard and Methods in Development
Uveal melanoma is the most common primary intraocular malignancy in adults, characterized by an insidious onset and poor prognosis strongly associated with tumor size and the presence of distant metastases, most commonly in the liver. Contrary to most tumor identification, a biopsy followed by a pathological exam is used only in certain cases. Therefore, an early and noninvasive diagnosis is essential to enhance patients’ chances for early treatment. We reviewed imaging modalities currently used in the diagnostics of uveal melanoma, including fundus imaging, ultrasonography (US), optical coherence tomography (OCT), single-photon emission computed tomography (SPECT), fundus fluorescein angiography (FFA), indocyanine green angiography (ICGA), fundus autofluorescence (FAF), as well as positron emission tomography/computed tomography (PET/CT) or magnetic resonance imaging (MRI). The principle of imaging techniques is briefly explained, along with their role in the diagnostic process and a summary of their advantages and limitations. Further, the experimental data and the advancements in imaging modalities are explained. We describe UM imaging innovations, show their current usage and development, and explain the possibilities of utilizing such modalities to diagnose uveal melanoma in the future.
Journal Article
Deep Learning Applications for Dental-Disease Classification Using Intraoral Photographic Images: Current Status and Future Perspectives
Dental conditions, including caries, periodontal disease, plaque accumulation, malocclusion, and oral mucosal abnormalities, remain highly prevalent worldwide. Early detection is crucial for preventing disease progression, simplifying treatment, and improving patient outcomes. Conventional diagnostic methods rely on subjective visual and tactile examinations, which are often inconsistent. Recent advances in deep learning (DL), particularly convolutional neural networks and vision transformers, enable automated, accurate detection of dental diseases from intraoral images captured via smartphones or dedicated imaging devices. DL-driven systems facilitate cost-effective virtual consultations, community screenings, and remote oral health monitoring. This narrative review was conducted following a structured search of PubMed, Scopus, Web of Science, Embase, and Google Scholar (October 2020–October 2025), which identified 74 eligible studies on intraoral photographic imaging-based DL systems, encompassing caries, gingival inflammation, plaque, malocclusion, and soft-tissue lesions. Most studies focused on caries, plaque, and periodontal disease using CNN and U-Net-based models, often reporting accuracies above 85% but with substantial performance drops in external validation. Despite promising results, clinical integration remains limited by challenges such as class imbalance, limited external validation, heterogeneous imaging protocols, and insufficient model interpretability. Emerging approaches, including self-supervised and federated learning, explainable artificial intelligence, multimodal data fusion, and smartphone-based diagnostics, offer potential solutions. Standardized imaging workflows, high-quality annotations, and robust clinical trials are essential to translate DL-based dental diagnostic systems into real-world practice. This narrative review aims to guide the development of reliable, equitable, and clinically deployable DL solutions for oral health assessment.
Journal Article
Beyond the 5-Year Window: Late-Onset Ocular Morbidity and a Proposed 10-Year Functional Survivorship Protocol for Pediatric Orbital Rhabdomyosarcoma
Background: Orbital rhabdomyosarcoma (RMS) is the most common primary pediatric malignant orbital tumor, typically curable with chemotherapy and radiation. Data regarding MRI chemotherapy response and long-term ophthalmologic outcomes remain limited in non-cooperative-group settings. Methods: We retrospectively reviewed children with primary orbital RMS treated at King Hussein Cancer Center (2002–2025) with vincristine, actinomycin-D, and cyclophosphamide (VAC). Pre-local-control MRI responses were classified as complete (CR), partial (PR), stable/minor (SD/MR), or progressive disease (PD). Survival and ophthalmologic outcomes were analyzed. Results: Twenty-two patients (median age 5.6 years) were included. All had localized disease (77% low-risk). All received VAC; 20 (91%) received radiotherapy (median 45 Gy). Pre-radiotherapy MRI showed 8 (36%) CR and 11 (50%) PR. Four patients (18%) died. Five-year event-free survival (EFS) and overall survival (OS) were 73% and 84%, respectively. Cataracts developed in 45% of the cohort (50% of irradiated patients) at a median of 39.1 months (range 9.4–95.1). At last assessment, visual acuity was good in 60%, moderate in 25%, and severely impaired in 15%. Conclusions: Excellent survival in orbital RMS is achievable in resource-stratified settings. Induction MRI progressive disease (PD) was associated with poor outcomes in this cohort and may represent an early prognostic signal warranting further validation in larger studies. Furthermore, the documented maximum cataract latency of 95 months suggests that the standard 5-year surveillance window is insufficient. These findings support extending ophthalmologic surveillance beyond the standard 5-year window. We propose, based on our retrospective institutional data, a 10-year functional survivorship framework.
Journal Article
The Impact of Edition Differences in the International Retinoblastoma Classification (IIRC vs. ICRB) on Staging and Globe Salvage Prognosis: Analysis of 642 Eyes
Purpose: The objectives of this study were to compare the prognostic performance, staging concordance, and eye salvage prediction of the International Intraocular Retinoblastoma Classification (IIRC) and the International Classification of Retinoblastoma (ICRB), and to assess the clinical impact of definitional discrepancies between the two systems. Design: This study used retrospective, observational case series. Participants: A total of 642 eyes with intraocular retinoblastoma (Rb) that received conservative management with intent for globe salvage (2003–2024) were assessed. Methods: Clinical records and imaging were reviewed for tumor characteristics. Each eye was staged according to both IIRC and ICRB criteria. Prognostic performance for eye salvage was analyzed using odds ratios (OR), the concordance index (C-index), and likelihood ratio χ2 tests. Main Outcome Measures: The eye salvage rate and concordance between IIRC and ICRB staging were assessed. Results: The overall eye salvage rate was 73% (471/642), decreasing significantly with larger tumor size, subretinal fluid (SRF) extent, and more seeding (p < 0.0001). The globe salvage was 24% for tumors occupying >50% of the globe compared to 77% for smaller tumors, and 47% for tumors with SRF > 1 quadrant compared to 62% for tumors with SRF ≤ 1 quadrant. Under the IIRC, the salvage rates by group were 98%, 94%, 92%, 51%, and 14% (A–E); under the ICRB, 98%, 94%, 94%, 60%, and 24%. Failure odds (ORs) increased across stages from 2.8 in Group B to 276 in Group E (IIRC) and 145.2 (ICRB). Eighty-seven (14%) eyes were upstaged under the ICRB. Of these, 72 (11%) with tumors > 50% of globe volume shifted from IIRC Group D to ICRB Group E (25% salvage), and 15 (2.3%) with SRF > 3 mm shifted from IIRC Groups B/C to ICRB Group D. The ICRB showed superior discrimination (C-index = 0.824; 95% CI, 0.80250–0.84937) compared with IIRC (C-index = 0.790; 95% CI, 0.768–0.814). Conclusions: Both systems accurately predict eye salvage, but definitional variations significantly affect staging and outcome interpretation. The ICRB improves discrimination for advanced tumors by including large tumors in Group E, while the IIRC provides finer stratification in intermediate disease through SRF extent. Integrating these criteria could yield a unified, more prognostically precise classification for Rb.
Journal Article
Delayed Intravitreal Anti-VEGF Therapy for Patients During the COVID-19 Lockdown: An Ethical Endeavor
To assess the impact of Jordanian's Corona Virus Disease (COVID-19) lockdown on visual acuity and macular thickness in patients with macular edema receiving intravitreal injections, and to assess the ethical endeavor of lockdown among serious sight threatening conditions.
This retrospective observational study included patients planned for intravitreal injections who did not complete the planned course before the lockdown (ie, before 20th of March 2020). Data included demographics, indication for the intravitreal injection, corrected distance visual acuity (CDVA), and central macular thickness on Optical Coherence Tomography (OCT) before and after the lockdown.
One-hundred and sixty-six eyes of 125 patients were studied, 68 (54.4%) patients were males, and the mean (± standard deviation, SD) age was 64.79 (±9.41) years. Mean (±SD) duration of delay in the planned injection was 60.97 (±24.35) days. The change in visual acuity was statistically significant for patients with diabetic macular edema (p= 0.045 improvement), patients with central retinal vein thrombosis (CRVO) (p= 0.05 deterioration), and patients with age-related macular degeneration (AMD) (p= 0.005 deterioration). Of interest, delay of more than 2 months and the previous need for 3 or more injections were significant poor prognostic factors for visual outcome for patients with diabetic macular edema (p=0.027 and 0.045).
The impact of delay in the scheduled intravitreal injections resulted in variable outcomes depending on the indication. Triaging the urgency of patients should be based on the indication to support the equity principle of bioethics, where those in need are prioritized against others, depending on potential adverse outcome.
Journal Article
Prognostic factors for eye globe salvage by external beam radiation therapy for resistant intraocular retinoblastoma
PURPOSE: To analyse the prognostic factors for eye salvage for eyes with intra-ocular retinoblastoma (RB) that is resistant to systemic chemotherapy and focal therapy by external beam radiation therapy (EBRT).
METHODS: A retrospective analysis of 28 eyes with intra-ocular RB that was resistant for systemic chemotherapy and focal consolidation therapy and received EBRT. Outcome measures included tumor stage at diagnosis, stage migration, type of tumor seeds, treatment modalities, eye globe salvage, metastasis, and survival.
RESULTS: Most of the patients (83%) had bilateral RB, and 42% were females. All eyes were treated initially by combination of systemic chemotherapy and focal consolidation therapy. The dose of EBRT was 45 Gy. The mean follow-up was 6.5 years, and the overall eye globe salvage rate post EBRT was 46%: 67% (2/3) for group B, 71% (5/7) for group C, and 33% (6/18) for group D. Patient's gender, tumor site, laterality, and tumor stage at diagnosis were not significant prognostic factors (p> 0.05) for final outcome. The significant poor prognostic factors were tumor stage migration during systemic chemotherapy (p= 0.03) and presence of vitreous seeds at time of EBRT (p=0.001). Post EBRT complication rate was 68% (19/28) including; retinal detachment (3), vitreous hemorrhage (4), neovascular glaucoma (1), cataract (16), radiation retinopathy (2), and second malignancy (2).
CONCLUSION: EBRT is an alternative for enucleation when RB is resistant to combined chemoreduction/focal consolidation therapy in absence in vitreous seeds. The known risks for EBRT are not justified for patients with unilateral RB and for those who have functional vision in the other eye.
Journal Article