Medical first for SA after cancer treatment used to help save baby AJ’s sight

A HIGHLY specialised procedure ,which required a particular team of medical experts in another province, was used to help save the sight of nine-month-old Anthony Croxford, who suffered from a rare condition.

Hearing that your baby boy needs to undergo sight-saving surgery at the age of just nine months is difficult news for any parent to receive.

However, this was the experience of Erica Croxford, whose son Anthony – known as AJ to his family – was diagnosed with a rare skin condition, juvenile xanthogranuloma, which resulted in a growth inside his left eye.

According to Dr Hamzah Mustak, an ocular oncology and oculoplastics specialist practising at UCT Private Academic Hospital, the condition most often presents as a benign lump or bump on the skin and is not usually cause for concern.

However, more than one lesion on the skin can also be accompanied by a lesion in the eye, which can be serious.

In AJ’s case, it had resulted in a growth causing glaucoma, or severe pressure in the eye, that could lead to loss of sight or even loss of 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.

“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,” explains Dr Mustak.

While Dr Mustak does use brachytherapy as a form of treatment on tumours in the eye, this is the first time it has been used in South Africa as a treatment for a patient with this particular condition.

The unique collaboration between UCT Private Academic Hospital and Groote Schuur Hospital afforded the opportunity for this highly specialised care to be available at the facility.

Erica said that she felt a strong mother’s instinct about a small mark she noticed shortly after the birth of her son.

“From the time AJ was just two days old I was aware of this mark on his cheek and 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,” she said.

“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,” Erica said.

The weeks and months that followed would prove to be some of the most difficult that AJ and his family would have to endure.

During this time AJ was referred to an ophthalmologist who, after taking a biopsy of the mark under AJ’s arm, was able to diagnose his condition.

By this stage the pressure in AJ’s eye had increased dramatically and he had to undergo several treatments as well as four operations to try and treat the glaucoma and the tumour in his eye.

Despite all these efforts the membrane of AJ’s eye had grown out of control, and he was referred to Dr Mustak.

“After an initial appointment with AJ in early June, it was clear we needed to try brachytherapy, which reduces the chances of unaffected tissues getting some radiation, as is the case with external beam radiation,” said Dr Mustak.

“We are the only unit in South Africa 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.

Just over three weeks have passed since AJ’s brachytherapy and, having taken him for two pressure check-ups back home in KwaZulu-Natal, his mom is happy to report that his eye pressure has now stabilised at a healthy level.

Read more about the procedure here.