Andrew Rong, MD

All Publications

• Efficacy of Topical Chemotherapy in Ocular Adnexal Sebaceous Carcinoma. Ophthalmic plastic and reconstructive surgery Rong, A. J., Camacho, M., Dubovy, S. R., Gallo, R. A., Karp, C. L., Blessing, N. W. 2025; 42 (4): e122-e126

  Abstract

  This study aimed to report clinical outcomes of topical chemotherapy for ocular adnexal sebaceous carcinoma (OaSC) with intraepithelial spread. A retrospective chart review of patients with OaSC treated at the Bascom Palmer Eye Institute between 2000 and 2023 was conducted. Patient inclusion criteria included: (1) biopsy-proven diagnosis of OaSC, (2) intraepithelial pagetoid involvement confirmed by conjunctival map biopsy, (3) implementation of topical chemotherapy for tumor control, and (4) repeat conjunctival map biopsy following cessation of topical chemotherapy. We reviewed 120 patients with OaSC and 10 patients met the inclusion criteria (n = 10). Topical chemotherapy agents were utilized via monotherapy or in combination and included mitomycin C (MMC) 0.02% or 0.04% (8 cases), 5-fluorouracil 1% (3 cases), and interferon alpha-2a 1 million units/ml (2 cases). Inadequate control of intraepithelial disease was observed in 8 (8/10, 80%) of cases. Resolution of pagetoid disease was achieved in 2 patients (2/10, 20%) with MMC monotherapy. Seven patients (7/10, 70%) experienced adverse effects from topical chemotherapy, with MMC accounting for 6 cases and 5-fluorouracil accounting for 1 case. Topical chemotherapy was ineffective in controlling the majority of OaSC patients with pagetoid involvement. Both patients who achieved local conjunctival tumor control were treated with MMC for at least 3 total weeks of therapy, although residual disease within the eyelid was still identifiable on pathology following surgical resection. Topical MMC may be used in the neoadjuvant setting for OaSC with pagetoid spread; however, additional studies are needed to determine the optimal dosing and treatment duration to minimize adverse effects and reduce ocular surface comorbidity.

  View details for DOI 10.1097/IOP.0000000000003053

  View details for PubMedID 40925608

• Monopolar Electrosurgery-Induced Axillary Burns From Aluminum-Containing Antiperspirant Deodorant Use During Blepharoplasty. Ophthalmic plastic and reconstructive surgery McLaughlin, S. A., Gallo, R. A., Rong, A. J. 2025; 42 (4): e128-e130

  Abstract

  Electrosurgery is a widely utilized and generally safe surgical technique; however, rare cases of iatrogenic skin burns can occur. Here, the authors present a 60-year-old woman with bilateral vision-impairing dermatochalasis and xanthelasma who sustained bilateral axillary burns following monopolar electrosurgery during a blepharoplasty. The burns fully healed after 3 months with no medical intervention. No intraoperative or external risk factors for electrosurgery burns were identified other than the patient's preoperative application of an aluminum-containing antiperspirant deodorant. This case highlights an underrecognized risk of aluminum-containing antiperspirant deodorants as an unintended intraoperative current grounding and underscores the importance of preoperative patient counseling to mitigate such iatrogenic complications in oculoplastic surgery.

  View details for DOI 10.1097/IOP.0000000000003056

  View details for PubMedID 40892394

• Pediatric Orbital Myxoma With Ethmoid and Orbital Involvement. The Journal of craniofacial surgery Stauber, Z. M., Mirsky, N. A., Younis, R., Thaller, S. R., Rong, A. 2025

  Abstract

  Myxomas are benign, connective tissue tumors of mesenchymal origin, often observed in cardiac tissue, but occasionally arising in the head and neck region. Orbital involvement is exceedingly uncommon, particularly in pediatric patients. This case report presents a 5-year-old male with a progressive decline in ophthalmic function, found to have a periorbital myxoma occupying the right posterior ethmoid cavity and extending into the right orbit. Imaging revealed a nonenhancing expansile lesion with bony remodeling and displacement of extraocular muscles. Complete resection was completed through a combined open orbital and endoscopic ethmoid approach. Final pathology confirmed sinonasal myxoma. Postoperative recovery was uneventful, with imaging at 3 months showing no recurrence. The patient will continue to be followed closely in the future.

  View details for DOI 10.1097/SCS.0000000000011691

  View details for PubMedID 40749133

• Single-Cell RNA Profiling of Ocular Adnexal Sebaceous Carcinoma Reveals a Complex Tumor Microenvironment and Identifies New Biomarkers. American journal of ophthalmology Zhang, M. G., Gallo, R. A., Tan, C. H., Camacho, M., Fasih-Ahmad, S., Moeyersoms, A. H., Sayegh, Y., Dubovy, S. R., Pelaez, D., Rong, A. J. 2025; 270: 8-18

  Abstract

  Ocular adnexal sebaceous carcinoma (OaSC) is an aggressive malignancy that often necessitates orbital exenteration. Its tumor composition and transcriptional profile remain largely unknown, which poses a significant barrier to medical advances. Here, we report the first in-depth transcriptomic analysis of OaSC at the single-cell resolution and discern mechanisms underlying cancer progression for the discovery of potential globe-sparing immunotherapies, targeted therapies, and biomarkers to guide clinical management.Laboratory investigation with a retrospective observational case series.Single-cell RNA sequencing was performed on six patient specimens: three primary tumors, two tumors with pagetoid spread, and a normal tarsus sample. Cellular components were identified via gene signatures. Molecular pathways underlying tumorigenesis and pagetoid spread were discerned via gene ontology analysis of the differentially expressed genes between specimens. CALML5 immunohistochemistry was performed on an archival cohort of OaSC, squamous cell carcinoma, ocular surface squamous neoplasia (OSSN), and basal cell carcinoma cases.Analysis of 29,219 cells from OaSC specimens revealed tumor, immune, and stromal cells. Tumor-infiltrating immune cells include a diversity of cell types, including exhausted T-cell populations. In primary OaSC tumors, mitotic nuclear division and oxidative phosphorylation pathways are upregulated, while lipid biosynthesis and metabolism pathways are downregulated. Epithelial tissue migration pathways are upregulated in tumor cells undergoing pagetoid spread. Single-cell RNA sequencing analyses also revealed that CALML5 is upregulated in OaSC tumor cells. Diffuse nuclear and cytoplasmic CALML5 staining was present in 28 of 28 (100%) OaSC cases. Diffuse nuclear and membranous CALML5 staining was present in 5 of 25 (20%) squamous cell carcinoma and OSSN cases, while diffuse nuclear staining was present in 1 of 12 (8%) basal cell carcinoma cases.This study reveals a complex OaSC tumor microenvironment and confirms that the CALML5 immunohistochemical stain is a sensitive diagnostic marker.

  View details for DOI 10.1016/j.ajo.2024.10.001

  View details for PubMedID 39393421

  View details for PubMedCentralID PMC11735305

• Circulating Adenoid Cystic Carcinoma associated MYB transcripts enable rapid and sensitive detection of metastatic disease in blood liquid biopsies. The journal of liquid biopsy Moeyersoms, A. H., Knechtel, K. W., Rong, A. J., Gallo, R. A., Zhang, M., Marsh, H. M., Sargi, Z. B., Leibowitz, J. M., Civantos, F. J., Weed, D. T., Dubovy, S. R., Tse, D. T., Pelaez, D. 2024; 6

  Abstract

  Adenoid cystic carcinoma (ACC) is a rare and lethal malignancy that originates in secretory glands of the head and neck. A prominent molecular feature of ACC is the overexpression of the proto-oncogene MYB. ACC has a poor long-term survival due to its high propensity for recurrence and protracted metastasis. Currently, clinical technologies lack the efficiency to distinguish patient prognosis prior to its redevelopment. We hypothesize that metastatic ACC can be detected by monitoring tumor-specific MYB expression in patients' blood. We developed a quantitative polymerase chain reaction (qPCR) assay for MYB transcripts and screened blood samples from four patient cohorts: no history or evidence of ACC (n=23), past history of ACC and no evidence of disease (NED) for greater than three years (n=15), local ACC (n=6), and metastatic ACC (n=5). Our assay detected significantly elevated levels of MYB transcripts in the metastatic ACC cohort (p < 0.01). Receiver operating characteristic (ROC) curves comparing metastatic to NED and metastatic to local disease were significant, with p values < 0.0001 and 0.0008, respectively. Single-cell RNA sequencing (scRNA-seq) of blood from metastatic ACC identified a cluster of circulating tumor cells (CTCs) expressing MYB. Here, we report a sensitive, cost-effective, and minimally invasive diagnostic test that leverages tumor-specific signatures to screen for metastatic ACC disease, potentially enhancing detection earlier than the current clinical standard.

  View details for DOI 10.1016/j.jlb.2024.100276

  View details for PubMedID 39801676

  View details for PubMedCentralID PMC11725320

• Atypical Periocular Lesions: Muir-Torre Syndrome. Ophthalmic plastic and reconstructive surgery Chau, V., DeLuca, N., Tan, C., Fasih-Ahmad, S., Dubovy, S. R., Rong, A. J. 2024; 40 (5): e194

  View details for DOI 10.1097/IOP.0000000000002660

  View details for PubMedID 38687295

• Bilateral Thermal Keratopathy Due to Plasma Skin Regeneration. Ophthalmic plastic and reconstructive surgery Meyer, B. I., Gutkind, N. E., Shoji, M. K., Rong, A. J. 2024; 40 (3): e89-e91

  Abstract

  A 40-year-old woman underwent periocular plasma skin regeneration, a cosmetic treatment for periorbital rejuvenation. She subsequently developed bilateral thermal keratitis, manifesting as blurred vision, irritation, and redness, with a vision decrease to 20/60 and 20/50 in her OD and OS, respectively. Examination demonstrated bilateral large, irregular corneal epithelial defects and edema, necessitating treatment with amniotic membrane grafts, bandage contact lenses, and hypertonic saline. One year posttreatment, her visual acuity improved to 20/20 and 20/25, albeit with ongoing symptomatic dryness and bilateral anterior stromal haze. This case, as only the second reported instance of ocular damage from periocular plasma skin regeneration, underscores the need for heightened awareness of potential ocular complications following plasma skin regeneration and reinforces the importance of protective measures during periocular procedures.

  View details for DOI 10.1097/IOP.0000000000002618

  View details for PubMedID 38738721

• Difficulties of nasocutaneous fistula repair, following lacrimal outflow system malignancy resection. Orbit (Amsterdam, Netherlands) Gutkind, N. E., Pirakitikulr, N., Alabiad, C., Tse, D. T., Rong, A. 2024; 43 (1): 90-94

  Abstract

  To evaluate the incidence of nasocutaneous fistula (NCF) development, following en bloc resection of lacrimal outflow system malignancies (LOSM), and describe the methods of surgical repair.Retrospective review of all patients who underwent resection of LOSM with reconstruction and post-treatment protocol at the University of Miami between 1997 and 2021.Of the 23 included patients, 10 (43%) developed postoperative NCF. All NCFs developed within one year of surgical resection or completion of radiation therapy. NCF was seen more frequently in patients who underwent adjuvant radiation therapy and those who had reconstruction of the orbital wall with titanium implants. All patients underwent at least one revisional surgery to close the NCF, including local flap transposition (9/10), paramedian forehead flap (5/10), pericranial flap (1/10), nasoseptal flap (2/10), and microvascular free flap (1/10). Local tissue transfer, pericranial, paramedian, and nasoseptal forehead flaps failed in most cases. Two patients had long-term closure; one patient who underwent a paramedian flap and a second who underwent a radial forearm free flap, suggesting that well-vascularized flaps may be the most viable option for repair.NCF is a known complication, following en bloc resection of lacrimal outflow system malignancies. Risk factors for formation may include adjuvant radiation therapy and use of titanium implants for reconstruction. Surgeons should consider utilizing robust vascular-pedicled flaps or microvascular free flaps for repair of NCF in this clinical scenario.

  View details for DOI 10.1080/01676830.2023.2211682

  View details for PubMedID 37199572

  View details for PubMedCentralID PMC10656355

• Lymphoepithelioma-like carcinoma of the eyelid and ocular adnexa. Orbit (Amsterdam, Netherlands) Shoji, M. K., Sengillo, J. D., Abou Khzam, R., Dubovy, S. R., Rong, A. J. 2024; 43 (1): 140-146

  Abstract

  A 93-year-old Caucasian woman presented to clinic for evaluation of a progressively enlarging left eyelid mass. Exam revealed a large, indurated, poorly mobile mass involving the left upper eyelid. Imaging demonstrated a crescentic enhancing soft-tissue mass in the left upper eyelid without evidence of deeper orbital involvement. Biopsy demonstrated tumor nests positive for cytokeratin AE1/AE3, P63, and P40 consistent with a diagnosis of eyelid lymphoepithelioma-like carcinoma (LELC). The patient underwent surgical resection with subsequent left upper eyelid reconstruction and adjuvant radiation. She had no clinical evidence of disease recurrence at follow-up. LELC is an uncommon tumor that rarely involves the eyelid and ocular adnexa. Early identification is important due to its malignant potential, as the majority of previously reported cases demonstrated local or distant metastatic spread. Future studies are needed to determine the optimum treatment regimen for this rare periorbital neoplasm.

  View details for DOI 10.1080/01676830.2022.2085305

  View details for PubMedID 35733412

• Osteolytic sarcoidosis of the orbit without pulmonary involvement. Orbit (Amsterdam, Netherlands) Gallo, R. A., Zhang, M. G., Abou Khzam, R., Tang, V. D., Dubovy, S. R., Rong, A. J. 2023; 42 (5): 548-552

  Abstract

  A 69-year-old woman with a history of a left orbital mass presented to the emergency room with progressive breakthrough pain in her left orbit despite medical therapy. On examination, there was extraocular motility restriction with diplopia upon left supraduction. Computed tomography (CT) scan of the orbits revealed soft tissue thickening of the left medial and superior periorbita and left lacrimal fossa; bony erosion of the left frontal bone, left orbital roof, and left lamina papyracea; and bilateral mass-like enlargement of the extraocular muscles. An orbitotomy with incisional biopsy was performed, and histopathological examination revealed non-caseating granulomatous inflammation consistent with sarcoidosis. Chest imaging demonstrated no sequela of pulmonary sarcoidosis, and her serum angiotensin converting enzyme (ACE) level was within normal range. She was treated with high-dose oral steroids with resolution of her symptoms. Her pain returned at the conclusion of the steroid taper, and it was controlled with chronic subcutaneous methotrexate and adalimumab injections.

  View details for DOI 10.1080/01676830.2022.2042826

  View details for PubMedID 35312414

• Orbital Gas after 25-Gauge Pars Plana Vitrectomy with Incorrect Gas Mixture. Case reports in ophthalmology Ashkenazy, N., Danzig, C. J., Rong, A. J., Read, S. P., Maeng, M. M., Flynn, H. W., Albini, T. A. 2023; 14 (1): 301-306

  Abstract

  We present 2 cases of sutureless 25-gauge pars plana vitrectomy and fluid-gas exchange, in which incorrect gas concentrations likely led to elevated intraocular pressures and retrobulbar gas. Combined removal of orbital gas with anterior orbitotomy and pars plana vitrectomy was performed in the first case to address expanding intraocular and retrobulbar gas resulting from a suspected error in gas dilution. Vitreous and orbital gas removal by needling was effective in the second case. In patients with elevated intraocular pressure and orbital gas accumulation after vitrectomy, combined intraocular and orbital decompressions were effective in optimizing clinical outcomes. There is no consensus regarding the best management of orbital gas after vitrectomy. We propose that a multidisciplinary technique should be considered, when available.

  View details for DOI 10.1159/000530401

  View details for PubMedID 37485242

  View details for PubMedCentralID PMC10359692

• Ipilimumab and Nivolumab for Treatment of Eyelid Spindle Cell Melanoma. American journal of ophthalmology Shoji, M. K., Rong, A. J. 2023; 250: e1-e2

  View details for DOI 10.1016/j.ajo.2023.02.010

  View details for PubMedID 36801380

• Effects of Mitomycin-C and 5-Fluorouracil on Ocular Adnexal Sebaceous Carcinoma Cells. American journal of ophthalmology Gallo, R. A., Lang, S. H., Gomez, A., Sabater, A. L., Tse, D. T., Pelaez, D., Rong, A. J. 2022; 240: 14-22

  Abstract

  To investigate the effects of mitomycin-C (MMC) and 5-fluorouracil (5-FU) on the viability, proliferation, and migratory capacity of cultured ocular adnexal sebaceous carcinoma (SC) cells.Laboratory investigation.Human SC cell lines (Bascom Palmer 50 and 52 [BP50 and BP52]) and human limbal stem cells (LSCs) were treated with various concentrations of MMC and 5-FU. Cytotoxicity was assessed with the tetrazolium MTT colorimetric viability assay on normal corneal vs tumor cells. Growth curves and scratch assays were performed to characterize the effects of these chemotherapeutic agents on SC proliferation and migration, respectively.MMC decreased BP52 cell viability in a dose-dependent manner with a half-maximal effective dose (EC50) of 11.8 μM after 72 hours. SC viability decreased >50% at 80 mM 5-FU after 72 hours. MMC reduced LSC viability in a dose-dependent manner with an EC50 value of 3.24 μM, and 5-FU decreased LSC viability >50% at 160 μM. MMC decreased SC cell proliferation and migration in a dose-dependent manner. 5-FU displayed antiproliferative effects but did not affect cell migration at concentrations below 1000 μM.Our in vitro data corroborate clinical observations that MMC is efficacious for treating ocular adnexal SC, albeit at the expense of LSC viability. Our findings also demonstrate that topical 5-FU exhibits antiproliferative effects that supersede its cancer-killing and antimigratory effects on cultured SC cells.

  View details for DOI 10.1016/j.ajo.2021.12.016

  View details for PubMedID 34995523

  View details for PubMedCentralID PMC9250945

• Levator Palpebrae Superioris With Inferior Oblique Muscle Flaps for Total Ocular Surface Reconstruction. Ophthalmic plastic and reconstructive surgery Maeng, M. M., Casella, A., Shoji, M. K., Amescua, G., Rong, A. J. 2022; 38 (6): e176-e180

  Abstract

  A healthy middle-aged man sustained extensive burns after a motor vehicle accident, including fourth-degree burns to the ocular adnexa. He had bilateral eyelid necrosis with complete tissue loss to the orbital rim. Progressive corneal thinning occurred bilaterally despite frequent lubrication, weekly amniotic membrane placement, and a Gunderson flap, ultimately requiring evisceration of his OS. In accordance with family wishes to perform all interventions for the OD, he underwent ocular surface reconstruction with levator palpebrae superioris (LPS) and inferior oblique (IO) muscle flaps, supplemented with an orbital fat transfer and bucket-handle muscle flap. These flaps were covered with porcine urinary bladder matrix and remained viable with complete globe coverage postoperatively. Although local eyelid flaps traditionally involve tissue supplied by branches of the external carotid artery, this case suggests that orbital-internal carotid artery based flaps utilizing the LPS and IO muscles may achieve ocular surface coverage after complete periocular and facial soft tissue loss.

  View details for DOI 10.1097/IOP.0000000000002233

  View details for PubMedID 35793646

• Fedratinib-induced orbital inflammation. Orbit (Amsterdam, Netherlands) Lee, J. Y., Gallo, R. A., Vu, D. M., Anagnostopoulos, A. G., Rong, A. J. 2022; 41 (3): 346-349

  Abstract

  A 69-year-old man with myelofibrosis presented with a two-day history of left periorbital swelling, blurred vision, and non-radiating dull orbital pain. On examination, there was restricted left-sided extraocular motility with conjunctival injection, chemosis, and periorbital edema. Magnetic resonance imaging demonstrated left-sided pre- and post-septal fat stranding concerning for orbital cellulitis. Two weeks before symptom onset, the patient began fedratinib therapy for myelofibrosis but discontinued this medication upon hospital admission. After restarting fedratinib, he presented with similar right-sided ophthalmic signs. A review of his medication history revealed a temporal relationship between symptom onset and fedratinib use. After medication discontinuation, his symptoms improved rapidly.

  View details for DOI 10.1080/01676830.2020.1852263

  View details for PubMedID 33243070

• Establishment and Characterization of a Novel Human Ocular Adnexal Sebaceous Carcinoma Cell Line. Translational vision science & technology Rong, A. J., Gallo, R. A., Zhang, M. G., Doddapaneni, R., Griswold, A. J., Lee, J. Y., Kurtenbach, S., Dubovy, S. R., Tse, D. T., Pelaez, D. 2021; 10 (6): 34

  Abstract

  Sebaceous carcinoma (SC) is a malignant eyelid tumor of the ocular adnexa that is primarily treated via surgical excision. Few therapies exist in advanced cases, and medical therapy is limited because of our incomplete understanding of SC biology. Herein, we describe a technique to culture human ocular adnexal SC for use as an in vitro model.Human ocular adnexal SC tumor cells were isolated from a patient undergoing orbital exenteration surgery and named Bascom Palmer 50 (BP50). They were cultured in Dulbecco's modified Eagle medium/nutrient mixture F-12 supplemented with 10% fetal bovine serum and antibiotics and were maintained at 37°C in humidified 5% CO2. The cells were characterized by immunohistochemistry, exome sequencing, and short tandem repeats analysis. In vitro drug screening against mitomycin-C (MMC) was performed using a cell viability assay.BP50 grew past 40 passages with a doubling time of 52.3 hours. Immunocytochemical staining revealed expression of SC-associated markers adipophilin, epithelial membrane antigen, p53, and androgen receptor. Whole exome sequencing showed a significant carryover in somatic mutations between the tumor tissue and corresponding cell line, revealing genetic markers consistent with SC. MMC affected cell viability in a dose-dependent manner.BP50 displays characteristics of ocular adnexal SC and therefore may facilitate improved understanding of SC biology and the high throughput assessment of novel therapeutic compounds and new drug combinatorial approaches targeted for this disease.Drug screening with MMC against these cells shows in vitro evidence to support its continued clinical use in SC.

  View details for DOI 10.1167/tvst.10.6.34

  View details for PubMedID 34043754

  View details for PubMedCentralID PMC8161695

• Orbito-scleral-sinus invasion of basal cell carcinoma in an immunocompromised patient on vismodegib. Orbit (Amsterdam, Netherlands) Tran, A. Q., Patete, C. L., Blessing, N. W., Rong, A. J., Garcia, A. L., Dubovy, S., Tse, D. T. 2021; 40 (2): 155-158

  Abstract

  A 45-year-old man presented with a progressively enlarging left lower lateral eyelid lesion. The initial biopsy was inconclusive; however, a repeat biopsy 5 years later revealed infiltrative morpheaform basal cell carcinoma with sclerosis. Two years later, the patient presented with ophthalmoplegia of the left eye. Computed tomography illustrated a heterogeneous enhancing soft tissue mass in the inferolateral orbit with erosion into the globe. Despite treatment with vismodegib for 1 year, the lesion progressed to involve the entire left lower eyelid and corneal-scleral junction with adjacent maxillary sinus invasion. The patient tested positive for human immunodeficiency virus and underwent a left orbital exenteration followed by adjuvant radiotherapy. The patient remained stable with no evidence of recurrent disease or distant metastasis 2 years after exenteration. This rare case highlights a neglected basal cell carcinoma in those immunocompromised with histopathological correlation of the aggressive disease on to the globe.

  View details for DOI 10.1080/01676830.2020.1753783

  View details for PubMedID 32283962

• Scleral Erosion Secondary to MIRAgel Scleral Buckle. Ophthalmic plastic and reconstructive surgery Clauss, K. D., Patel, N., Dubovy, S. R., Rong, A. J. 2020; 37 (4): e152

  View details for DOI 10.1097/IOP.0000000000001875

  View details for PubMedID 33079760

• Ocular Perfusion Following Orbital Apex Exenteration. Ophthalmic plastic and reconstructive surgery Gallo, R. A., Pirakitikulr, N., Tse, D. T., Rong, A. J. 2020; 37 (3): e85-e88

  Abstract

  A 68-year-old man with a history of type 2 diabetes mellitus and kidney transplantation on chronic immunosuppression presented with right-sided proptosis and vision loss. He was hospitalized 4 months prior for invasive sinus aspergillosis. MRI revealed abnormal enhancement in the right orbital apex, inferior medial right orbit, anterior cranial fossa floor, and anterior aspect of the falx cerebri. The patient was successfully managed with extensive sinus surgery, bifrontal craniotomy with resection of dura, cribriform plate resection, and a right orbital apex exenteration. The globe and anterior orbital structures were preserved to cover the large surgical sinodural-orbital defect and avoid complex reconstructive surgery. Orbital perfusion was maintained by exploiting the robust anastomoses between branches of external carotid and ophthalmic artery.

  View details for DOI 10.1097/IOP.0000000000001838

  View details for PubMedID 32890118

• Periorbital botulinum toxin A improves photophobia and sensations of dryness in patients without migraine: Case series of four patients. American journal of ophthalmology case reports Venkateswaran, N., Hwang, J., Rong, A. J., Levitt, A. E., Diel, R. J., Levitt, R. C., Sarantopoulos, K. D., Lee, W. W., Galor, A. 2020; 19: 100809

  Abstract

  Individuals receiving botulinum toxin A (BoNT-A) injections in the head and neck for migraine treatment have reported decreases in photophobia and sensations of dryness, independent of ocular surface parameters. We hypothesized that patients without migraine but with similar ocular neuropathic-like symptoms would also experience symptomatic improvement with periocular BoNT-A injections, independent of ocular surface changes.We identified four individuals without a history of migraine but with neuropathic ocular pain (symptoms of dryness, burning, and photophobia that were out of proportion to ocular surface findings and unresponsive to ongoing dry eye (DE) therapies). Individuals underwent 1 session of periocular BoNT-A injections. Validated questionnaires (Visual Light Sensitivity Questionnaire-8, Dry Eye Questionnaire-5) assessed photophobia and DE symptoms pre- and 1-month post-injections. All four reported improvements in frequency and severity of photophobia and eye discomfort following BoNT-A injections. Tear film parameters (phenol red thread test, tear break-up time, corneal staining, and Schirmer test) and eyelid (palpebral fissure height and levator palpebrae superioris function) and eyebrow (position) anatomy were also evaluated before and after injections. Despite a unanimous improvement in symptoms, there were no consistent changes in ocular surface parameters with BoNT-A injections across individuals.Periocular BoNT-A shows promise in reducing photophobia and sensations of dryness in individuals with neuropathic-like DE symptoms without a history of migraine, independent of tear film, eyelid, or eyebrow parameters.

  View details for DOI 10.1016/j.ajoc.2020.100809

  View details for PubMedID 32671286

  View details for PubMedCentralID PMC7350146

• Acute Ptosis in a Middle-aged Man With Hypertension. JAMA ophthalmology Al-Khersan, H., Rong, A. J. 2020; 138 (9): 996-997

  View details for DOI 10.1001/jamaophthalmol.2020.1320

  View details for PubMedID 32672796

• Persistent Basal Cell Carcinoma Following Self-Treatment With a "Natural Cure," Sanguinaria canadensis. Ophthalmic plastic and reconstructive surgery Bozung, A. K., Ko, A. C., Gallo, R. A., Rong, A. J. 2020; 37 (2): e71-e73

  Abstract

  A 65-year-old woman presented with a 6-week history of redness, eyelid swelling, and discharge in the right eye. Slit lamp examination revealed right medial canthal erythema with cicatricial lower lid ectropion, retraction, and inferior punctal obliteration. The patient was previously diagnosed with a medial canthal basal cell carcinoma 1.5 years ago, but opted for self-treatment with black salve, a commonly used naturopathic "cure" for skin cancer. Each application resulted in increasingly severe periorbital inflammation with eventual eschar formation. Over time, this led to cicatricial band formation over the medial canthus. After biopsy confirmation of residual basal cell carcinoma within the cicatricial tissues, the patient underwent Mohs surgery followed by multistaged reconstruction. Herein, we report a case of patient whose use of an unproven naturopathic "cure" led to persistent periorbital inflammation, persistence of malignancy, and significant tissue destruction.

  View details for DOI 10.1097/IOP.0000000000001784

  View details for PubMedID 32732547

• Eye-sparing Treatment of Localized Orbital Medulloepithelioma With Neoadjuvant Chemoradiation. Ophthalmic plastic and reconstructive surgery Gallo, R. A., Shoag, J., Johnson, T. E., Solomon, D. A., Perry, A., Podda, A., Lee, J. Y., Rong, A. J. 2020; 37 (1): e13-e16

  Abstract

  A 9-year-old girl presented with a 3-day history of progressive proptosis accompanied by transient discomfort and blurry vision in the OD. MRI revealed a heterogeneously enhancing intraconal lesion that partially encased and displaced the optic nerve. There was no intraocular or intracranial involvement, nor were there signs of distant metastasis. Histopathologic evaluation and immunohistochemistry were consistent with orbital medulloepithelioma. The patient received 4 cycles of chemoradiation per a retinoblastoma protocol. Repeat MRI scans showed significant tumor regression, and further surgical debulking was performed. There has been no evidence of recurrence for over 14 months. Herein, the authors describe an eye-sparing, multimodal treatment of a rare case of localized orbital medulloepithelioma.

  View details for DOI 10.1097/IOP.0000000000001703

  View details for PubMedID 32427730

• Teprotumumab for the Treatment of Active Thyroid Eye Disease. The New England journal of medicine Douglas, R. S., Kahaly, G. J., Patel, A., Sile, S., Thompson, E. H., Perdok, R., Fleming, J. C., Fowler, B. T., Marcocci, C., Marinò, M., Antonelli, A., Dailey, R., Harris, G. J., Eckstein, A., Schiffman, J., Tang, R., Nelson, C., Salvi, M., Wester, S., Sherman, J. W., Vescio, T., Holt, R. J., Smith, T. J. 2020; 382 (4): 341-352

  Abstract

  Thyroid eye disease is a debilitating, disfiguring, and potentially blinding periocular condition for which no Food and Drug Administration-approved medical therapy is available. Strong evidence has implicated the insulin-like growth factor I receptor (IGF-IR) in the pathogenesis of this disease.In a randomized, double-masked, placebo-controlled, phase 3 multicenter trial, we assigned patients with active thyroid eye disease in a 1:1 ratio to receive intravenous infusions of the IGF-IR inhibitor teprotumumab (10 mg per kilogram of body weight for the first infusion and 20 mg per kilogram for subsequent infusions) or placebo once every 3 weeks for 21 weeks; the last trial visit for this analysis was at week 24. The primary outcome was a proptosis response (a reduction in proptosis of ≥2 mm) at week 24. Prespecified secondary outcomes at week 24 were an overall response (a reduction of ≥2 points in the Clinical Activity Score plus a reduction in proptosis of ≥2 mm), a Clinical Activity Score of 0 or 1 (indicating no or minimal inflammation), the mean change in proptosis across trial visits (from baseline through week 24), a diplopia response (a reduction in diplopia of ≥1 grade), and the mean change in overall score on the Graves' ophthalmopathy-specific quality-of-life (GO-QOL) questionnaire across trial visits (from baseline through week 24; a mean change of ≥6 points is considered clinically meaningful).A total of 41 patients were assigned to the teprotumumab group and 42 to the placebo group. At week 24, the percentage of patients with a proptosis response was higher with teprotumumab than with placebo (83% [34 patients] vs. 10% [4 patients], P<0.001), with a number needed to treat of 1.36. All secondary outcomes were significantly better with teprotumumab than with placebo, including overall response (78% of patients [32] vs. 7% [3]), Clinical Activity Score of 0 or 1 (59% [24] vs. 21% [9]), the mean change in proptosis (-2.82 mm vs. -0.54 mm), diplopia response (68% [19 of 28] vs. 29% [8 of 28]), and the mean change in GO-QOL overall score (13.79 points vs. 4.43 points) (P≤0.001 for all). Reductions in extraocular muscle, orbital fat volume, or both were observed in 6 patients in the teprotumumab group who underwent orbital imaging. Most adverse events were mild or moderate in severity; two serious events occurred in the teprotumumab group, of which one (an infusion reaction) led to treatment discontinuation.Among patients with active thyroid eye disease, teprotumumab resulted in better outcomes with respect to proptosis, Clinical Activity Score, diplopia, and quality of life than placebo; serious adverse events were uncommon. (Funded by Horizon Therapeutics; OPTIC ClinicalTrials.gov number, NCT03298867, and EudraCT number, 2017-002763-18.).

  View details for DOI 10.1056/NEJMoa1910434

  View details for PubMedID 31971679

• Orbital Bony Reconstruction With Presized and Precontoured Porous Polyethylene-Titanium Implants. Ophthalmic plastic and reconstructive surgery Blessing, N. W., Rong, A. J., Tse, B. C., Erickson, B. P., Lee, B. W., Johnson, T. E. 2020

  Abstract

  Complex bony orbital defects are reconstructively challenging due to loss of intraoperative anatomical landmarks and adjacent support. Presized and precontoured porous polyethylene-titanium implants (Medpor Titan 3D Orbital Floor Implant) are designed to reestablish normal orbital floor and medial wall anatomy and are modeled after anatomically averaged orbits. This is the first study to report clinical outcomes with this implant.This retrospective case series reviewed clinical data and outcomes for patients undergoing orbital reconstruction with a presized and precontoured porous polyethylene-titanium orbital implant from January 2016 to June 2018.A total of 34 orbits of 33 patients were identified (mean age: 43 ± 16 years, 70% men). Most bony defects were a result of trauma and included large orbital floor deformities (100%), medial wall defects (74%), disrupted inferomedial struts (68%), and broken posterior ledges (82%). Symptomatic diplopia (73%) and enophthalmos (89%, mean: 3.7 ± 2.1 mm) were common preoperatively. Many cases were revisions (44%). Mean follow up was 7.8 ± 6.7 months. All patients had improved globe positioning, enophthalmos, and hypoglobus. Seven patients had persistent postoperative diplopia: 6 responded to prism therapy and 1 required strabismus surgery. One patient required retrobulbar hematoma drainage and 1 patient required implant explantation due to chronic infection.Commercially available presized and precon-toured porous polyethylene-titanium implants are useful for complex orbital bony defects and can achieve functional improvements in diplopia, enophthalmos, and extraocular motility with a low incidence of postoperative complications or revisional surgery.

  View details for DOI 10.1097/IOP.0000000000001829

  View details for PubMedID 32976336

• Filler-Associated Vision Loss. Facial plastic surgery clinics of North America Tran, A. Q., Staropoli, P., Rong, A. J., Lee, W. W. 2019; 27 (4): 557-564

  Abstract

  Soft tissue fillers continue to gain popularity in addressing volume loss and changes associated with facial aging. The rare but devastating complication from iatrogenic vascular occlusion can result in irreversible vision loss. This article discusses the complications of vision loss associated with fillers and reviews applicable treatment techniques and prevention methods.

  View details for DOI 10.1016/j.fsc.2019.07.010

  View details for PubMedID 31587773

• Multimodal imaging features of intraocular foreign bodies. Seminars in ophthalmology Rong, A. J., Fan, K. C., Golshani, B., Bobinski, M., McGahan, J. P., Eliott, D., Morse, L. S., Modjtahedi, B. S. 2019; 34 (7-8): 518-532

  Abstract

  Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

  View details for DOI 10.1080/08820538.2019.1674894

  View details for PubMedID 31609153

• Orbital cholesterol granuloma: A report and discussion of orbital findings. American journal of ophthalmology case reports Rong, A. J., Erickson, B. P., Blessing, N. W., Dubovy, S. R., Lee, B. W. 2019; 15: 100468

  Abstract

  To report a case of orbital cholesterol granuloma and discuss the orbital findings seen in this entity.A 38-year-old male presented with an 8-month history of progressive left upper lid ptosis and hypoglobus. Clinical examination was significant for 3 mm of hypoglobus and restricted supraduction in the left eye. Contrasted computed tomography imaging revealed a well-circumscribed lesion in the superotemporal orbit causing extensive bone erosion that appeared to arise from the lacrimal gland. An incisional biopsy was performed, and histopathological evaluation demonstrated fibrovascular tissue surrounding a mixture of histiocytes and cholesterol clefts, consistent with a cholesterol granuloma.Orbital cholesterol granulomas are rare lesions that are predominantly found in the superotemporal orbit. These lesions can be associated with marked bony changes in the superotemporal fossa that can be mistaken for a lacrimal gland neoplasm; however, bony erosion is a hallmark of this lesion and should be considered on the differential diagnosis of any lacrimal gland mass with extensive bony erosion.

  View details for DOI 10.1016/j.ajoc.2019.100468

  View details for PubMedID 31198882

  View details for PubMedCentralID PMC6556881

• Predictors of Neovascular Glaucoma in Central Retinal Vein Occlusion. American journal of ophthalmology Rong, A. J., Swaminathan, S. S., Vanner, E. A., Parrish, R. K. 2019; 204: 62-69

  Abstract

  To determine the risk factors for development of neovascular glaucoma (NVG) in patients after an acute central retinal vein occlusion (CRVO).Retrospective cohort study.Review of medical records of 646 patients with a diagnosis of CRVO between 2013 and 2017 at the Bascom Palmer Eye Institute.(1) CRVO onset to presentation <90 days; (2) absence of anterior segment neovascularization on presentation; (3) no intravitreal anti-vascular endothelial growth factor (anti-VEGF) injection before presentation. Patients meeting inclusion criteria were screened for potential risk factors for development of NVG. Risk of developing NVG was assessed with Kaplan-Meier survival analysis and Cox proportional hazards models.Thirteen of 98 patients (13%) who met inclusion criteria developed NVG. The mean adjusted time to NVG diagnosis from onset of CRVO-related symptoms was 212 days. Patients presenting with a worse initial visual acuity (P = .034), a relative afferent pupillary defect (RAPD) (P = .002), or a history of systemic hypertension (P = .026) had an increased risk of NVG compared to those who did not. Age, body mass index, history of glaucoma, history of diabetes, and central retinal thickness were not significantly associated with development of NVG.Risk factors for NVG development included history of systemic hypertension, worse visual acuity on presentation, and RAPD on presentation. Patients presenting with these findings should be followed at closer intervals and informed of the greater risk for neovascularization. Intravitreal anti-VEGF therapy delayed but did not prevent NVG.

  View details for DOI 10.1016/j.ajo.2019.02.038

  View details for PubMedID 30862502

  View details for PubMedCentralID PMC6642681

• Ocular and cerebral infarction from periocular filler injection. Orbit (Amsterdam, Netherlands) Ansari, Z. A., Choi, C. J., Rong, A. J., Erickson, B. P., Tse, D. T. 2019; 38 (4): 322-324

  Abstract

  A 20-year-old woman presented with loss of vision in her right eye and a "black nose" after receiving hyaluronic acid filler injections in her right glabella 1 month prior. Her vision was no light perception, and external examination revealed resolving skin necrosis at the nasal tip. A dilated fundus exam showed a fibrotic membrane emanating from a pale optic nerve and a diffusely atrophic retina with sclerotic vessels. An MRI demonstrated scattered right-sided parietal lobe infarcts. These findings were consistent with inadvertent cannulation of the supraorbital artery, followed by injection of filler into the internal carotid circulation. The product traveled in a retrograde fashion, occluding the right ophthalmic artery, right dorsal nasal artery, and arterial segments to the Circle of Willis. This case highlights the importance of understanding the complex vascular architecture of the periorbita and the mechanism by which such occlusions occur.

  View details for DOI 10.1080/01676830.2018.1537287

  View details for PubMedID 30376386

• Concurrent acute retinal necrosis and orbital inflammation: Report of 2 cases. American journal of ophthalmology case reports Swaminathan, S. S., Yannuzzi, N. A., Rong, A. J., Crane, A. M., Albini, T. A. 2019; 14: 47-50

  Abstract

  To describe the rare entity of concurrent herpetic acute retinal necrosis (ARN) and orbital inflammation.Two cases of ARN with simultaneous orbital inflammation are described. A 40-year old male presented with a painful left eye and hand motion visual acuity (VA). Both panuveitis and orbital inflammation with involvement of the sclera and optic nerve were observed. He was initially treated with oral steroid therapy, after which the orbital inflammation improved but the panuveitis remained. A diagnostic anterior chamber paracentesis was positive for HSV-2 by PCR. He was started on systemic antivirals, but ultimately developed a retinal detachment. The second patient was an 18-year old female with hand motion VA in the left eye. Panuveitis and severe conjunctival chemosis were observed. MRI demonstrated dacryoadenitis with preseptal inflammation. The patient was initially started on oral steroid therapy, which alleviated the orbital inflammation but not the intraocular inflammation. An anterior chamber diagnostic paracentesis was positive for HSV-1, after which the patient underwent vitrectomy for a retinal detachment. The patient was started on systemic antiviral therapy.Herpetic disease should remain on the differential for cases of concurrent intraocular and orbital inflammation. Early recognition of this process may help prevent severe vision loss. It is important to recognize that orbital inflammation secondary to herpetic disease may be diverse in its presentation.

  View details for DOI 10.1016/j.ajoc.2019.01.012

  View details for PubMedID 30854495

  View details for PubMedCentralID PMC6393694

• 0.01% Hypochlorous Acid as an Alternative Skin Antiseptic: An In Vitro Comparison. Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] Anagnostopoulos, A. G., Rong, A., Miller, D., Tran, A. Q., Head, T., Lee, M. C., Lee, W. W. 2018; 44 (12): 1489-1493

  Abstract

  Compare the in vitro efficacy of hypochlorous acid 0.01% (HA), povidone iodine 5% (PI), chlorhexidine gluconate 4% (CHG), and isopropyl alcohol 70% (IPA) against common skin microorganisms.Time-kill studies were conducted against methicillin-susceptible Staphylococcus aureus (MSSA) and Staphylococcus epidermidis (MSSE), methicillin-resistant S. aureus (MRSA) and S. epidermidis (MRSE), Candida albicans, Corynebacterium species (striatum and amycolatum), Propionibacterium acnes, Pseudomonas aeruginosa, Streptococcus pyogenes, Staphylococcus capitis, and Staphylococcus xylosus.Methicillin-resistant S. aureus: Bactericidal effect was immediate for HA and IPA. For PI and CHG, the effect occurred at 1 and 10 minutes, respectively. Methicillin-resistant S. epidermidis: Hypochlorous acid, IPA, and PI had immediate bactericidal effects, whereas CHG required 1 minute. Methicillin-susceptible Staphylococcus aureus: All agents had bactericidal effects at 1 minute. C. species, S. pyogenes, P. aeruginosa, and P. acnes: All antiseptics demonstrated immediate bactericidal effects. Methicillin-susceptible Staphylococcus epidermidis and S. capitis: Hypochlorous acid and IPA had immediate effect, whereas PI and CHG required 1 minute. C. albicans: Hypochlorous acid, IPA, and PI were immediately bactericidal, whereas CHG required 1 minute. S. xylosus: Hypochlorous acid and CHG were immediately bactericidal, whereas IPA and PI required 1 and 2 minutes, respectively.In vitro studies of HA 0.01% were observed to have equal or more efficacious antiseptic properties compared with IPA, CHG, and PI. Future studies will be needed to investigate its role in periocular use.

  View details for DOI 10.1097/DSS.0000000000001594

  View details for PubMedID 29985866

• Subperiosteal fibroma of the orbit. Orbit (Amsterdam, Netherlands) Rong, A. J., Ulloa-Padilla, J. P., Blessing, N. W., Tse, D. T., Dubovy, S. R., Choi, C. J. 2018; 37 (5): 378-380

  Abstract

  Fibromas are benign, well-circumscribed tumors that are characterized as spindle-cell lesions with interlacing fibrous stroma. Here, we describe the clinical presentation, management, and outcome of a patient with an orbital fibroma. To our knowledge, this is the second case report of a biopsy-proven subperiosteal orbital fibroma to date.

  View details for DOI 10.1080/01676830.2017.1423348

  View details for PubMedID 29303383

• Orbital metastatic small cell carcinoma of the pancreas with optic nerve compression. Canadian journal of ophthalmology. Journal canadien d'ophtalmologie Rong, A. J., Choi, C. J., Ghassibi, M. P., Dubovy, S. R., Johnson, T. E. 2018; 53 (1): e22-e24

  View details for DOI 10.1016/j.jcjo.2017.06.017

  View details for PubMedID 29426454

• Vision Loss Secondary to Autologous Adipose Stem Cell Injections: A Rising Problem. JAMA ophthalmology Rong, A. J., Lam, B. L., Ansari, Z. A., Albini, T. A. 2018; 136 (1): 97-99

  View details for DOI 10.1001/jamaophthalmol.2017.5453

  View details for PubMedID 29192301

• Imaging characteristics of intraocular foreign bodies: a comparative study of plain film X-ray, computed tomography, ultrasound, and magnetic resonance imaging. Retina (Philadelphia, Pa.) Modjtahedi, B. S., Rong, A., Bobinski, M., McGahan, J., Morse, L. S. 2015; 35 (1): 95-104

  Abstract

  To determine the imaging features of common intraocular foreign bodies (IOFBs) and the ability to differentiate types of IOFBs.Four-mm IOFBs were inserted via through pars plana approach into cadaveric lamb eyes. Six metallic (aluminum, brass, copper, silver, steel, and lead) and seven nonmetallic (plastic [CF6 spectacle plastic and polyvinyl chloride pipe], glass [bottle glass and windshield glass], wood [dry and wet poplar], and stone [slate]) IOFBs were imaged using plain film x-ray, computed tomography scan, ultrasound, and magnetic resonance imaging (T1, T2, and gradient echo sequences).Plain film x-ray had limited ability to differentiate most IOFBs. Computed tomography findings can be divided into low attenuation objects (wood), moderate attenuation (CF6 spectacle plastic), high attenuation without surrounding artifact (polyvinyl chloride, slate, bottle glass, windshield glass, and aluminum), high attenuation with shadow artifact and minimal edge streak artifact (steel, brass, copper), and high attenuation with significant shadow artifact and prominent streak artifact (silver and lead). Density (in Hounsfield units) aided in differentiating the types of IOFBs. Gradient echo sequences on magnetic resonance imaging also held utility. Ultrasound images had considerable overlap in appearances.Imaging techniques can significantly aid in determining the IOFBs type, with computed tomography serving as the best initial modality. X-ray holds limited utility while ultrasound and magnetic resonance imaging are best reserved as adjunctive tests.

  View details for DOI 10.1097/IAE.0000000000000271

  View details for PubMedID 25090044

• Solitary plexiform neurofibroma of the forehead: A rare and unusual presentation INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY EXTRA Rong, A. J., Ledgerwood, L. G., Jin, L., Tollefson, T. T. 2014; 9 (1): 15-17

  View details for DOI 10.1016/j.pedex.2013.11.002

  View details for Web of Science ID 000435161100005

• Structure of the essential diversity-generating retroelement protein bAvd and its functionally important interaction with reverse transcriptase. Structure (London, England : 1993) Alayyoubi, M., Guo, H., Dey, S., Golnazarian, T., Brooks, G. A., Rong, A., Miller, J. F., Ghosh, P. 2013; 21 (2): 266-76

  Abstract

  Diversity-generating retroelements (DGRs) are the only known source of massive protein sequence variation in prokaryotes. These elements transfer coding information from a template region (TR) through an RNA intermediate to a protein-encoding variable region. This retrohoming process is accompanied by unique adenine-specific mutagenesis and, in the prototypical BPP-1 DGR, requires a reverse transcriptase (bRT) and an accessory variability determinant (bAvd) protein. To understand the role of bAvd, we determined its 2.69 Å resolution structure, which revealed a highly positively charged pentameric barrel. In accordance with its charge, bAvd bound both DNA and RNA, albeit without a discernable sequence preference. We found that the coding sequence of bAvd functioned as part of TR but identified means to mutate bAvd without affecting TR. This mutational analysis revealed a strict correspondence between retrohoming and interaction of bAvd with bRT, suggesting that the bRT-bAvd complex is important for DGR retrohoming.

  View details for DOI 10.1016/j.str.2012.11.016

  View details for PubMedID 23273427

  View details for PubMedCentralID PMC3570691