Purpose: To report clinical features, pathology characteristics, and treatment outcomes of five patients with Rosai-Dorfman disease (RDD). Methods: A retrospective case series of patients with RDD from the Ocular Oncology Service of Wills Eye Hospital between 1974 and 2018. Results: There were six eyes of five patients (3 males, 2 females) with ophthalmic manifestations of RDD. The mean age at the initial presentation was 33 years (median 35, range 10–52 years). Before referral, the tumor was initially suspected to be lymphoma (n = 3), idiopathic orbital inflammation (n = 2), or pterygium (n = 1). The disease was unilateral (n = 4) or bilateral (n = 1). The mean duration of symptoms was 9 months (median 8, range 5–24 months). The disease produced nodules in the conjunctiva (n = 4) or orbit (n = 2). Two patients with conjunctival involvement had corneal involvement. One patient with bilateral conjunctiva lesions demonstrated bilateral orbital involvement and bilateral anterior uveitis. The mean tumor basal dimension was 13 mm (median 9, range 6–27 mm) for conjunctiva lesions and 37 mm (median 37, range 34–40 mm) for orbital lesions. The main symptom (per patient) included proptosis (n = 2), palpable mass (n = 1), and foreign body sensation (n = 2). No patient experienced pain or tenderness. Palpable, nontender lymphadenopathy was detectable in two patients in the cervical and inguinal lymph nodes. Systemic involvement with paranasal sinusitis and mediastinal/pulmonary lymphadenopathy occurred in two patients, both with orbital involvement. Surgical resection was performed for all patients. At a mean follow-up of 31 months (median 12, range, 10–76 months) after the surgery, tumor control was achieved in all six eyes without local recurrence. Conclusion: In this series of six eyes with RDD, patients with orbital and/or intraocular disease were more likely to demonstrate lymphadenopathy and systemic involvement, while those with unilateral perilimbal conjunctival tumors remained localized.

Background: To assess the impact of brachytherapy on macular microvasculature utilizing optical coherence tomography angiography (OCTA) in treated choroidal melanoma. Methods: In this retrospective observational case series, we reviewed the recorded data of the patients with unilateral extramacular choroidal melanoma treated with ruthenium − 106 (¹⁰⁶Ru) plaque radiotherapy with a follow-up period of more than 6 months. Automatically measured OCTA retinal parameters were analysed after image processing. Results: Thirty-one eyes of 31 patients with the mean age of 51.1 years were recruited. Six eyes had no radiation maculopathy (RM). From 25 eyes with RM, nine eyes (36%) revealed a burnout macular microvasculature with imperceptible vascular details. Twenty-one non-irradiated fellow eyes from the enrolled patients were considered as the control group. Foveal and optic disc radiation dose had the highest value to predict the burnout pattern (ROC, AUC: 0.763, 0.727). Superficial and deep foveal avascular zone (FAZ) were larger in irradiated eyes in comparison to non-irradiated fellow eyes (1629 μm² vs. 428 μm², P = 0.005; 1837 μm² vs 268 μm², P = 0.021; respectively). Foveal and parafoveal vascular area density (VAD) and vascular skeleton density (VSD) in both superficial and deep capillary plexus (SCP and DCP) were decreased in all irradiated eyes in comparison with non-irradiated fellow eyes (P < 0.001). Compared with non-irradiated fellow eyes, irradiated eyes without RM had significantly lower VAD and VSD at foveal and parafoveal DCP (all P < 0.02). However, these differences at SCP were not statistically significant. Conclusion: The OCTA is a valuable tool for evaluating RM. Initial subclinical microvascular insult after ¹⁰⁶Ru brachytherapy is more likely to occur in DCP. The deep FAZ area was identified as a more critical biomarker of BCVA than superficial FAZ in these patients.

Purpose: To report a case of a grown Soemmering ring that manifested as an iris tumour 24 years after cataract surgery. Methods: A case report. Results: A 27-year-old white man was presented with a suspected iris tumour in his left eye. He had undergone lensectomy in both eyes without intraocular lens implantation 24 years ago. Last year, he was treated by topical anti-glaucoma medication for left eye intraocular pressure (IOP) rising. Six months later, his ophthalmologist found two separate iris bumps. The patient was referred to an ocular oncologist and was to be treated with plaque brachytherapy as iris melanoma, but he denied. Ultrasound biomicroscopy (UBM) of the left eye showed significant angle narrowing due to separate ovoid hyper echoic masses behind the iris, which was clearly separated from the ciliary body. Retained and growth lens material caused a Soemmering ring to enlarge, which was the reason for glaucoma and iris bumping. The patient has been followed for more than one year without any changes being observed. Conclusion: An enlarged and grown Soemmering ring should be considered in the differential diagnosis of any iris and ciliary body tumour, especially in patients who have had cataract surgery.

This study investigates the feasibility of using tear sample analysis, based on protein corona formation on gold nanoparticles combined with electrospray ionization mass spectrometry (ESI-MS) and machine learning techniques, as a non-invasive approach for the detection of choroidal melanoma. The aim is to assess whether protein-nanoparticle interactions can support early and reliable identification of this ocular condition. Tear samples were collected using Schirmer strips from six healthy individuals and six patients diagnosed with choroidal melanoma, with subsequent augmentation to 18 samples per group. Gold nanoparticles (AuNPs, ~ 20 nm) were synthesized via citrate reduction and incubated with tear samples to form protein coronas, which were analyzed using ESI-MS. Eight statistical and entropy-based features (mean, variance, skewness, kurtosis, Shannon entropy, approximate entropy, sample entropy, and permutation entropy) were extracted from spectral data. Additionally, Continuous Wavelet Transform (CWT) with Mexican hat wavelet was applied to convert mass spectrometry data into 128 × 128 RGB images for deep learning analysis. Classification was performed using traditional machine learning models (Random Forest, Support Vector Machine, Decision Tree, Deep Neural Network) and transfer learning with pre-trained CNNs (VGG16, ResNet50, Xception), evaluated through 5-fold cross-validation. Significant differences in spectral intensity parameters were observed between healthy individuals and choroidal melanoma patients (p < 0.001), with notably lower Mean_Intensity values in cancer patients (56.41 ± 46.06 vs. 111.02 ± 10.01, Cohen’s d = 1.64). While m/z parameters showed moderate differences that didn’t reach statistical significance (p = 0.082), entropy-based features demonstrated strong discriminative power. Among traditional machine learning models, Random Forest achieved the highest accuracy (0.959 ± 0.003) and ROC AUC (0.993 ± 0.000) with remarkable computational efficiency (3.90 s per fold). For deep learning approaches using CWT-generated images, VGG16 demonstrated superior performance (Accuracy: 0.976 ± 0.008, ROC AUC: 0.997 ± 0.002) despite requiring significantly higher computational resources (1349.52 s per fold). This study demonstrates that tear sample analysis using protein corona formation on gold nanoparticles with ESI-MS and advanced machine learning techniques offers a promising non-invasive approach for choroidal melanoma detection with performance metrics that compare favorably to existing methods. The significant differences in spectral intensity parameters between groups suggest distinctive proteomic signatures that can be leveraged for diagnostic purposes. While both traditional machine learning and deep learning approaches achieved exceptional performance, each offers distinct advantages in terms of computational efficiency and feature extraction capabilities.