Tumour-busting implant inserted in baby's eye to save his sight

Anthony Croxford in the arms of mother Erica after surgery for juvenile xanthogranuloma.
Anthony Croxford in the arms of mother Erica after surgery for juvenile xanthogranuloma.
Image: UCT Private Academic Hospital

Nine months ago a KwaZulu-Natal family could not have imagined that the bumps on their newborn's skin would lead to difficult sight-saving surgery for a rare condition. 

Anthony Croxford — known as AJ — was born with juvenile xanthogranuloma, a rare condition in which benign tumours grow beneath the skin. In his case, the growth of the tumour in his left eye threatened his eyesight. 

Mother Erica said she noticed a small mark on her son's cheek two days after his birth. “I had a feeling there was something not quite right about it. The doctors I spoke to couldn’t tell me what it was but did not seem too concerned, so I tried to put it out of my mind.

“Then in December 2020 I noticed another mark on AJ’s armpit but little did we know that this was juvenile xanthogranuloma and that more than one skin lesion could indicate another in his eye.

“Shortly after that, around new year, he woke up one morning with a terribly swollen, milky eye and no movement in the pupil. I rushed him to the doctor and that is when the journey really began. At the time he was just four months old.”

AJ was referred to an ophthalmologist who diagnosed his condition. After several procedures and four operations, the baby was referred to Dr Hamzah Mustak, an ocular oncology and oculoplastics specialist at the University of Cape Town Private Academic Hospital.

Mustak said the growth in AJ's eye had caused glaucoma, or severe pressure in the eye, that could have led to loss of sight and the eye itself.

“When AJ came to us in June this year, we immediately began to prepare for a highly specialised procedure using brachytherapy, most often used to treat certain types of cancer,” he said.

“This is a form of internal radiation therapy, whereby the radiation is temporarily implanted or placed at the affected area. While the growth in AJ’s eye was not cancerous, it needed to be eradicated to prevent the eventual loss of his eye.

“We are the only unit in SA that offers customised brachytherapy for the eyes and it was necessary for us to custom-design the radiation implant for AJ, which was done in consultation with my colleague at the hospital, radiation oncologist Dr Julie Wetter.

“The process begins with examining the eye, taking measurements and then designing a template. A dosage is then calculated for the delivery of focused radiation to the tumour.

“From there the template and dosage calculations are provided to physics experts who, using complex mathematics, calculate and create the plans for the production of the implant, which in this case was made of stainless steel, with the precise radiation dosage embedded within.

“When it comes to brachytherapy in the eye, there is an additional layer of complexity to the process, as this is an organ that moves a lot. We therefore needed to use a particular design, like a big ring, to secure the implant so that when there is movement the implant remains anchored to the eye muscles.”

Mustak said the operation took around 40 minutes, after which the implant stayed in AJ's eye socket for 17 hours to allow the radiation to be delivered to the tumour.

Hospital manager Lizl Rodrigues said staff were honoured to have played a role. “We are so privileged that this highly specialised form of treatment could be provided here at our hospital and we are glad that we could help to make it more accessible for this little patient and his family. We wish AJ all the best on his road to recovery.”

It's been four weeks since the procedure and Erica said the pressure in AJ's eye has stabilised.

“It’s not yet the end of the road, as AJ will be scheduled for cataract surgery at some point in the near future.

“Only after that will we really know what his vision is going to be like in that little eye. However, the outlook is for now very positive.”

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