Introduction: Historically, approximately 30–32% of uveal melanoma patients develop metastases and die within 5 years. Larger tumor dimensions and monosomy 3 and/or Class 2 gene expression profile of the tumor are associated with an increased risk of metastasis. We evaluated the performance of these prognostic markers in patients undergoing surveillance in a community medical oncology practice. Methods: Uveal melanoma patients treated by a single vitreoretinal surgical oncologist and monitored by a single medical oncologist were identified via a clinical database search for analysis. Specified prognostic markers were evaluated for sensitivity, specificity, positive and negative predictive value, as well as prognostic accuracy. Results: We identified 37 uveal melanoma patients, followed for a median of 4.0 ± 3.7 years. Twenty-seven (73%) patients underwent plaque brachytherapy with vitrectomy and silicone oil for radiation attenuation; seven (19%) patients underwent brachytherapy alone; three (8%) had enucleation. There were no intraocular treatment failures. Six (16.2%) patients developed metastasis, and only one patient died of metastatic disease. Disomy 3 and Class 1 accurately predicted a low risk for metastasis (>90% negative predictive value). However, monosomy 3 and Class 2 had a low positive predictive value and prognostic accuracy in “high-risk” patients. Conclusions: In this single-center cohort, we observed an unexpectedly low rate of 5-year metastasis. AJCC stage correlated poorly with metastasis or survival. Molecular prognostic results of Disomy 3 and Class 1 gene expression profile accurately predicted a “low” risk for metastasis (>90% negative predictive value). Further evaluation of these unique surgical techniques needs to be carried out.

Purpose: Charles Bonnet Syndrome (CBS) is an underdiagnosed condition affecting patients with significant vision loss who experience complex visual hallucinations while maintaining cognitive insight. This scoping review aims to synthesize existing literature on CBS prevalence, risk factors, and screening practices, and to propose a standardized, clinically implementable screening workflow for ophthalmologists. Patients and Methods: We conducted a structured literature search across four databases (PubMed, Embase, Web of Science, Scopus) using keywords related to CBS, visual impairment, screening, and diagnosis. Inclusion criteria encompassed peer-reviewed studies involving patients with vision loss that reported the use of screening tools, diagnostic criteria, or clinical assessments of CBS. Excluded were case reports with fewer than five patients, articles lacking full text or peer review, and those focused primarily on psychiatric or neurologic hallucinations. We identified 1,582 articles, with 89 studies meeting the final inclusion criteria. Results: CBS prevalence ranged from 2% to 30%, depending on the underlying ocular condition and screening method used. Age-related macular degeneration showed the highest association. Few studies utilized validated screening tools though the QR-SCB and NEVHI instruments demonstrated clinical utility. Barriers to diagnosis included patient reluctance to report symptoms and clinician unfamiliarity. We developed a pragmatic clinical model incorporating risk stratification, direct questioning, validated tools, and functional assessment to improve detection in ophthalmology clinics. Conclusion: CBS remains underdiagnosed despite its significant psychosocial burden. A structured screening approach may increase diagnostic accuracy and support timely intervention. The proposed model offers ophthalmologists a practical pathway to integrate CBS assessment into routine care.

Medical schools are increasingly reducing required contact hours and incorporating self-directed learning strategies, yet the impact of these curricular changes on academic performance remains uncertain. This retrospective cohort study compared performance on NBME-based organ system examinations across three consecutive pre-clerkship cohorts at a U.S. allopathic medical school that experienced different levels of required instructional time. Cohorts included 178 students and differed in total required contact hours from 306 to 412 h. Mean MCAT scores did not differ significantly among cohorts (510.4 ± 5.4, 509.6 ± 6.3, and 510.0 ± 4.9; p = 0.74). Significant differences in the proportion of students scoring above the national reference value were observed in the Pulmonology (p = 0.003), Gastroenterology (p = 0.020), and Endocrinology (p = 0.003) blocks; however, these differences did not demonstrate a consistent relationship with contact hour totals. Across cohorts experiencing different contact-hour requirements and concurrent curricular changes, examination performance did not demonstrate a consistent pattern corresponding to the amount of required instructional time. These findings demonstrate that lower contact-hour requirements were not accompanied by consistently poorer short-term standardized outcomes in these cohorts; however, the independent contribution of contact hours cannot be separated from concurrent curricular changes.

Background: Behavioral psychiatric symptoms can be the only warning signs of more serious conditions such as paraneoplastic limbic encephalitis. Differentiating between primary psychiatric disorders and paraneoplastic neurological syndromes is crucial as they require distinct treatment approaches. In this case report, we provide an overview of paraneoplastic encephalitis and introduce a unique case that showcases a misdiagnosis of psychogenic non-epileptic seizures (PNES) in a male as the primary symptom of paraneoplastic encephalitis due to pure seminoma. This case highlights the underlying pathophysiology of antibody-mediated paraneoplastic encephalitis and its significance. Case presentation: A 31-year-old male with no known past medical history presented due to recurrent seizures. There was no prior history of epilepsy or exposure to seizure-triggering agents. Imaging and electroencephalogram findings during his initial hospitalizations pointed to a potential diagnosis of PNES. The patient continued to experience seizures following discharge, leading to repeat hospitalizations. During the fourth hospitalization, the patient received mood-stabilizing anti-seizure medications and benzodiazepines, but he deteriorated and required intubation. It was during this time that the patient was transferred to our facility. Magnetic resonance imaging of the brain revealed multifocal areas of hyperintensity and restricted diffusion with avid enhancement. Immunotherapy was initiated with improvement of non-epileptic spells and encephalopathy. Outpatient workup uncovered malignant pure seminoma with metastases to the retroperitoneum. The authors theorize that paraneoplastic neurological disorders stemming from testicular cancer led to the neurological symptoms seen in this case. Conclusion: This report highlights a rare occurrence of paraneoplastic limbic encephalitis associated with pure testicular seminoma, clinically manifested as PNES. The diagnostic challenge posed by variability of presenting symptoms in paraneoplastic encephalitis emphasizes the importance of accurate differentiation from conditions such as autoimmune encephalitis. Current diagnostic approaches for paraneoplastic and autoimmune etiologies involve detection of known antibodies, as well as brain imaging. Notable antibodies associated with psychogenic non-epileptic seizures symptoms include anti-GAD-65, anti-Ma2, KLH11-antibodies, anti-Hu, and NMDA receptor antibodies. Recognizing paraneoplastic limbic encephalitis symptoms is challenging and often leads to misdiagnosis or overlooking of malignancies highlighting the need for awareness, comprehensive evaluation and timely treatment. Through this comprehensive case analysis, we enhance the understanding of underlying mechanisms, associated symptoms, and treatment options.

We thank the leadership of the Collaborative Ocular Oncology Group (COOG) for their thoughtful comments