Primary Intrabulbar Neurofibroma

PURPOSE

Eye globe enucleation due to other than a malignant tumor is very rare today. Solitary intraocular neurofibroma without other signs of neurofibromatosis is a rare benign tumor and few cases have been reported to date.

MATERIAL AND METHODS

In 10 year interval from Jan 1 2007 to Dec 31 2016 we analyzed non-malignant eye globe enucleations.

RESULTS

Of the 49 enucleated blind eyes, each patient had visual acuity with no light perception, 34 (69.4%) were indicated for enucleation due to complications following previous postoperative surgery after trauma, 14 patients (28.6%) were due to secondary glaucoma and other complications following previous intraocular surgery, and in one patient (2%) the primary isolated intraocular neurofibroma was verified after enucleation.

CASE REPORT

A patient with isolated intrabulbar neurofibroma has been monitored since childhood for intraocular lesion and histologically verified at adult age. At the time of enucleation, he was 25 years old, squint since childhood and was observed for hamartoma in his right eye since he was 13 years old. Due to the progression of intrabulbar lesion, loss of visual acuity (functional state - no light perception) and secondary glaucoma, the right eye globe was enucleated at adult age and histopathological examination confirmed intraocular neurofibroma in the absence of neurofibromatosis.

CONCLUSION

Every enucleated eye globe should be subjected to a thorough histopathological examination. Isolated intraocular neurofibromas can occur as isolated orbital or intrabulbar masses without systemic features.

Multicentric recurrent uveal melanoma

Uveal melanoma is a rare malignancy originating from melanocytes within the uveal tract of the eye. True multifocal uveal melanomas (>2melanomas in 1 eye) occurring in the same eye are very rare. We report a clinically and histologically well-documented case of a patient who presented with 3 uveal melanoma lesions in the same eye over a span of 2.5 years. The eye had to be enucleated finally and diagnosis confirmed histologically. This case report highlights the need for a close follow-up, even after successful treatment of the presenting lesion in uveal melanomas.

Clinical spectrum and treatment outcome of retinoblastoma with Group D and E diseases: A single institution retrospective review

The purpose of our study was to evaluate the ocular survival and event-free survival after multimodal therapy for group D and E of retinoblastoma (RB). Enucleation of group D and E is controversial as the risks of chemotherapy must be weighed against the potential for vision.A 10-year retrospective study from one center of 86 patients with advanced intraocular disease defined as International Classification Retinoblastoma (ICRB) group "D" or "E." Cases with visible extraocular extension at diagnosis were excluded. Ocular survival and patient survival were assessed. Indirect ophthalmoscopy at examination under anesthesia to visualize the tumor was used to evaluate clinical response.The median onset age in 86 patients with group D or E eye was 16 months (1-167 months). There were 29 (34%) bilateral cases. Leukocoria was the most common presentation sign (61%). Chemoreduction was primarily used in the treatment of intraocular RB. Selective ophthalmic arterial injection (SOAI) was applied as a component of multimodal therapy in 34 of the 86 cases. The globe preservation rate in patients with group D or E eyes was 19%. Using chemoreduction for advanced eyes, more eyes are being preserved which enables 70% 5-year ocular survival in patients with group D eyes.In triaging appropriate patients, multidisciplinary strategy can reduce tumor size with chemoreduction and consolidate the regressed tumor with local ophthalmic therapy to ensure globe salvage.

Chromosome 6p Amplification in Aqueous Humor Cell-Free DNA Is a Prognostic Biomarker for Retinoblastoma Ocular Survival

Aqueous humor contains tumor-derived cell-free DNA (cfDNA) and can serve as a liquid biopsy for retinoblastoma. We previously associated somatic copy-number alteration (SCNA) 6p gain with a 10-fold increased risk of enucleation. Here we provide a 2-year update to further explore 6p gain as a prognostic biomarker for ocular survival. Patients diagnosed with retinoblastoma from December 2014 to July 2019 from whom aqueous humor was sampled were included. cfDNA was extracted and shallow whole-genome sequencing performed to identify highly recurrent retinoblastoma SCNAs (gain of 1q, 2p, 6p, loss of 13q, 16q). 116 aqueous humor samples from 50 eyes of 46 patients were included: 27 eyes were salvaged, 23 were enucleated. Highly recurrent retinoblastoma SCNAs were found in 66% eyes. 6p gain was the most prevalent SCNA (50% eyes). It was particularly more prevalent in enucleated eyes (73.9%) than in salvaged eyes (29.6%; P = 0.004). 6p gain in aqueous humor cfDNA portended nearly 10-fold increased odds of enucleation (OR = 9.87; 95% confidence interval = 1.75-55.65; P = 0.009). In the enucleated eyes, 6p gain was associated with aggressive histopathologic features, including necrosis, higher degrees of anaplasia, and focal invasion of ocular structures. With extended follow-up and nearly double the aqueous humor samples, we continue to demonstrate 6p gain as a potential prognostic biomarker for retinoblastoma. IMPLICATIONS: Aqueous humor is a high-yield source of tumor-derived DNA in retinoblastoma eyes. Detection of 6p gain in the aqueous humor allows for targeted, patient-centered therapies based on this molecular prognostic marker. Prospective, multicenter studies with aqueous humor sampled from all eyes at diagnosis are warranted to validate these findings.

Intraocular Dissemination of Uveal Melanoma Cells Following Radiotherapy: Evolving Management Over the Past Decade

BACKGROUND AND OBJECTIVE

To describe the presentation and the authors' evolving management strategy for intraocular dissemination of uveal melanoma cells following radiotherapy during the past decade.

PATIENTS AND METHODS

Patients with uveal melanoma who developed intraocular dissemination of pigmented cells following radiotherapy. Histopathology was available in two cases.

RESULTS

Four patients underwent treatment for progressive intraocular dissemination of uveal melanoma cells at 9 to 41 months following I-125 plaque radiotherapy (three patients) or proton beam radiotherapy (one patient). Treatments included primary enucleation (one patient), vitrectomy followed later by enucleation (one patient), and vitrectomy followed by intravitreal chemotherapy (two patients). Enucleated eyes demonstrated diffuse invasion of intraocular tissues by viable melanoma cells. No patient has developed systemic metastasis to date.

CONCLUSIONS

Intraocular dissemination of pigmented cells following radiotherapy for uveal melanoma should raise suspicion for viable invasive melanoma cells. Prompt vitrectomy with intravitreal chemotherapy can be effective in avoiding enucleation in selected cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:573-579.].

Nuclear expression of BAP-1 in transvitreal incisional biopsies and subsequent enucleation of eyes with posterior choroidal melanoma

BACKGROUND

As a majority of patients with choroidal melanoma do not undergo enucleation, tumour tissue for prognostic testing has to be obtained with alternate methods. Transvitreal incisional biopsies enable histological examination as well as immunohistochemical staining of BRCA1-associated protein-1 (BAP-1).

METHODS

Fifty-nine patients diagnosed with choroidal melanoma in transvitreal biopsies between years 2003 and 2019 were included. Twenty-one of these patients subsequently underwent enucleation. The level of nuclear expression of BAP-1 in transvitreal biopsies and enucleations was evaluated and the concordance calculated. Metastasis-free survival and HR for metastasis were analysed.

RESULTS

The mean tumour thickness and diameter at biopsy was 3.8 mm (SD 2.1) and 9.3 mm (SD 4.8), respectively. For biopsies, 37 of 59 tumours (63%) were classified as having high nuclear BAP-1 expression, and 22 (37%) as low. For enucleations, 13 of 21 tumours (62%) were classified as having high nuclear BAP-1 expression, and 8 (38%) as low. Eighty-six per cent of biopsies had an identical BAP-1 classification as the subsequent enucleation, yielding a Cohen's kappa coefficient of 0.70. Patients with low nuclear BAP-1 expression in transvitreal biopsies had a significantly shorter metastasis-free survival (p=0.001), with a size-adjusted Cox regression HR for metastasis of 13.0 (95% CI 3.1 to 54.4, p=0.0004).

CONCLUSION

Loss of nuclear BAP-1 expression occurred in a large proportion of the small tumours included in this study. BAP-1 immunoreactivity in transvitreal incisional biopsies of choroidal melanoma is substantially concordant with immunoreactivity in enucleated specimens and identifies patients with poor metastasis-free survival.

Lessons Learned from Somatic Cell Nuclear Transfer

Somatic cell nuclear transfer (SCNT) has been an area of interest in the field of stem cell research and regenerative medicine for the past 20 years. The main biological goal of SCNT is to reverse the differentiated state of a somatic cell, for the purpose of creating blastocysts from which embryonic stem cells (ESCs) can be derived for therapeutic cloning, or for the purpose of reproductive cloning. However, the consensus is that the low efficiency in creating normal viable offspring in animals by SCNT (1–5%) and the high number of abnormalities seen in these cloned animals is due to epigenetic reprogramming failure. In this review we provide an overview of the current literature on SCNT, focusing on protocol development, which includes early SCNT protocol deficiencies and optimizations along with donor cell type and cell cycle synchrony; epigenetic reprogramming in SCNT; current protocol optimizations such as nuclear reprogramming strategies that can be applied to improve epigenetic reprogramming by SCNT; applications of SCNT; the ethical and legal implications of SCNT in humans; and specific lessons learned for establishing an optimized SCNT protocol using a mouse model.

Infective Endocarditis with No Underlying Disease for Which Bacterial Endophthalmitis Have Been the First Symptom

Bacterial endophthalmitis is a rare complication of infective endocarditis (IE). We herein report a case of IE with no underlying disease for which endophthalmitis could have been the first symptom. A 58-year-old man was admitted to our hospital with a fever, vision disturbances, and pain in the left hand joint. His left eye was removed because fusion on the cornea progressed. Streptococcus agalactiae was detected in blood cultures, fluid cultures from his left hand joint, and the removed eye. Bacterial endophthalmitis may present as the first symptom of IE and develop without underlying disease due to S. agalactiae infection.

Bilateral enucleation due to multi-bacterial fulminant endogenous panophthalmitis

The case is presented of a 62 year-old woman with a rapid, progressive bilateral decrease in visual acuity and panuveitis with orbital cellulitis. She was also in poor general condition, with emesis and fever. Septicaemia due to Klebsiella pneumoniae and bilateral endogenous panophthalmitis were diagnosed. The ocular infection quickly progressed to sclerokeratitis and bilateral perforation despite broad spectrum systemic antibiotic management, and eventually the patient required bilateral enucleation. Microbiological cultures of the surgical pieces identified Klebsiella pneumoniae and Candida magnoliae. To our knowledge, this is the third published case that required bilateral enucleation or evisceration due to endogenous panophthalmitis, and the first case of endogenous ocular infection caused by Candida magnoliae.

Density of PAS positive patterns in uveal melanoma: Correlation with vasculogenic mimicry, gene expression class, BAP-1 expression, macrophage infiltration, and risk for metastasis

Purpose

Periodic acid-Schiff (PAS) positive patterns of vasculogenic mimicry (VM) have been associated with poor prognosis in uveal melanoma (UM). We examined these patterns with digital image analysis and transmission electron microscopy, and correlated them with BAP-1 expression, gene expression class, macrophage infiltration, and metastatic disease in full tumor cross-sections and intratumor regions.

Methods

Thirty-two enucleated eyes with UM were stained immunohistochemically (BAP-1, laminin, CD31, and CD68) and with PAS without hematoxylin counterstain. Retrospective data on gene expression class and patient survival were retrieved. Tumor sections were digitally scanned and analyzed with the QuPath Bioimage analysis software, and imaged with transmission electron microscopy.

Results

The mean area proportion covered by CD31, laminin, and PAS positive patterns in tumor cross-sections was 0.9% (SD 0.6), 3.0% (SD 1.9), and 8.4% (SD 5.9), respectively. PAS density was statistically significantly greater in tumors with gene expression class 2 (p=0.02). The cumulative 5-year metastasis-free survival decreased for each quartile of increased PAS density (1.0, 0.75, 0.40, and 0.17, p=0.004). Forty percent of the tumors had heterogeneous BAP-1 expression. Intratumor regions with low BAP-1 expression were more likely to harbor VM (p<0.0001), and had statistically significantly greater PAS density (p<0.0001) and number of CD68 positive cells (p=0.01).

Conclusions

PAS positive patterns in UM are composed of a mixture of blood vessels and extracellular matrix (ECM), including VM. Increased density of PAS positive patterns correlated with gene expression class and metastasis, and colocated to tumor regions with macrophage infiltration and low BAP-1 expression.

[Transition in the treatment viewpoint and method for injured eyes with no light perception]

Exploratory pars plana vitrectomy (EPPV) made one quarter of injured eyes with no light perception (NLP) rescued. Previously, the clinical routine in making a decision of enucleation for injured eyes with NLP was based on preoperative evaluation. Such ideas, however, have altered with development of EPPV. Some extraordinary lesions can be explored in those moribund eyes during EPPV and dealt with newly developed techniques. This article reveals the pathological basis of traumatized NLP eyes and the advantages and effects of EPPV, and puts forward the concept that decision making of enucleation should be based on findings obtained during EPPV. (Chin J Ophthalmol, 2019, 55: 645-646).

[Advanced periocular basal cell carcinoma-a therapeutic challenge]

BACKGROUND

Basal cell carcinomas are the most common periocular malignant tumor. In advanced periocular basal cell carcinoma, vismodegib is a new treatment option which might potentially avoid surgical eye removal.

CASE REPORT

We treated a 76-year-old patient unwilling to consent to surgery with vismodegib for advanced periocular basal cell carcinoma on the left forehead that had already undergone several previous treatments. After initial partial remission, the tumor regrew under ongoing therapy, so that radical surgical excision including orbital exenteration was performed. Unfortunately, the patient died thereafter due to septic multi-organ failure.

CONCLUSION

Basal cell carcinoma and its new treatment options are gaining importance for ophthalmology due to rising incidence and prevalence rates. Vismodegib is a new encouraging option. However, for advanced tumors, it must be resolved whether complete histological remission may be achieved to avoid surgical intervention, or whether the area of resection can be significantly reduced. Current multicenter studies investigate these aspects further (ClinicalTrails.gov identifier: NCT03035188).

A case report of infectious scleritis with corneal ulcer caused by Scedosporium aurantiacum

RATIONALE

Scedosporium species is rare pathogen of ocular infection. The accurate diagnosis is delaying in many cases and the clinical prognosis is poor due to its resistance to antifungal agents. This report describes a patient with infectious scleritis and corneal ulcer caused by Scedosporium auranticum infection who required enucleation to control the infection.

PATIENT CONCERNS

A 70-year-old woman visited our clinic after experiencing ocular discomfort in her right eye for 4 days after minor ocular trauma, with soil exposure.

DIAGNOSES

Scedosporium species was isolated from a culture of corneal tissue, Scedosporium aurantiacum was identified in a culture of necrotic tissue.

INTERVENTIONS

She was started on treatment with antifungal agents, including topical amphotericin B and systemic fluconazole, but her ocular condition did not improve. Although the lesion showed temporary improvement, ocular pain and corneal ulcer recurred 3 months later. Evisceration was performed due to corneal perforation, and enucleation was also performed for dehiscence of the conjunctiva and scleral necrosis.

OUTCOMES

After enucleation, postoperative systemic voriconazole treatment controlled the infection without recurrence.

LESSONS

S aurantiacum keratitis is difficult to eradicate, even with several months of treatment with systemic and topical antifungal agents, and tends to progress to scleritis. The infection can be terminated by the orbital enucleation. Infection with this rare organism should be included in the differential diagnosis of patients with severe infectious keratitis.

Orbital Teratoma: A rare congenital tumour

BACKGROUND

Orbital teratomas are congenital, unilateral germ cell tumors, which are present at birth with moderate to massive proptosis. The rare tumour has to be managed individually and is at times difficult.

CASE

A female child in her 2nd day of life was brought to our department with complains of forward bulging of the left eye which was noticed since the time of her birth.

OBSERVATION

Examination and investigations revealed a mass with scattered foci of calcification. The mass was causing expansion of left orbit with thinning and scalloping of bony boundaries of left orbit with no intracranial component. The scan suggests the diagnosis of orbital teratoma which was further confirmed by histopathological examination.

CONCLUSION

The rare tumour presents a challenge in management. The aim of management depends upon the extent of tumour, preservation of vision whenever possible, promotion of normal orbital growth and cosmesis.

Posterior auricular muscle patch graft for exposed orbital implant

The purpose of this article is to describe a surgical technique to repair an exposed orbital implant by posterior auricular muscle autograft. A retrospective review was conducted of four patients with an exposed orbital implant that were treated with a posterior auricular muscle graft. Four patients received posterior auricular muscle patch graft to the exposed orbital implant. The donor site healed with minimal scarring and remained well hidden. The graft incorporated fully into surrounding orbital tissue with no recurrent exposure at average of 13 month follow-up. The posterior auricular muscle autograft is a viable technique for repairing an exposed orbital implant.

Spontaneous Regression of Florid Retinal Neovascularization Following Resolution of Traction Retinal Detachment in an Eye With Treated Retinoblastoma

A 19-month-old boy with unilateral retinoblastoma with iris and retinal neovascularization at initial presentation displayed traction retinal detachment, retinal non-perfusion, and persistent retinal neovascularization after completion of intra-arterial chemotherapy. Two months following resolution of traction retinal detachment, restoration of retinal perfusion and regression of neovascularization occurred without additional intervention. Spontaneous regression of retinal neovascularization is possible following resolution of traction retinal detachment. [J Pediatr Ophthalmol Strabismus. 2019;56:e24-e27.].

Pattern of ocular injuries in Bangladesh and its surgical management at hospital setting: A retrospective study

OBJECTIVE

To determine the pattern of ocular injuries and their surgical management..

Methods

The retrospective study was conducted at the Chittagong Eye Infirmary and Training Complex, Chittagong, Bangladesh, and comprised hospital data of patients with ocular injuries from October 1, 2016, to December 31, 2017. Information gathered related to type and cause of injuries, visual acuity, postoperative complications, follow-up visits, and outcome. SPSS version 22 was used for data analysis.

Results

Of the total injuries, 370 (91%) were classified open globe and 36 (9%) as close globe. In terms of type of injury, 330 (81.4%) were penetrating, 30 (7.3%) ruptured globe, 29 (7.1%) lime burn and 17 (4.2%) injuries were traumatic hyphaema and chemical in nature. Open globe injuries were mostly found in subjects aged 18 years or below. Surgery was the main mode of management in 388 (95.5%) patients.

Conclusion

Preventive measures along with high-quality management should receive priority for reducing monocular blindness.

[Change of priorities when selecting the method of eye removal: enucleation versus evisceration]

The development and evolution of conservative and surgical methods of treating patients with various ocular pathologies influence the priorities when selecting the method of eye removal.

PURPOSE

To perform comparative analysis of eye removal methods based on the results of own studies over a long period.

MATERIAL AND METHODS

The study analyses eye removal surgeries performed in Helmholtz Moscow Research Institute of Eye Diseases over the period of 1991 to 2016 and investigates the reasons of selecting enucleation and evisceration methods.

RESULTS

Over the period of 1991 to 2001, there were 968 eye removal surgeries performed in the department of traumatology, with reasons listed as trauma aftermath - 884 (91.3%) cases, outcomes of various diseases - 85 (8.7%) cases. From 2002 to 2016, a total of 2529 eye removal surgeries have been performed due to non-oncological reasons, of which 1337 (52.9%) were enucleation surgeries and 1190 (47.1%) - evisceration surgeries. However, over the last 15 years, there has been a clear tendency for changing priorities when selecting the method of eye removal: from 2002 to 2016, the number of eviscerations has increased by 4.2 times (from 16 to 66.6%), while the percentage of enucleations has decreased from 84 to 33.4%. The rise in frequency of eviscerations was noted in post-traumatic pathologies, including post-traumatic uveitis and preatrophy, and buphthalmos.

CONCLUSION

Analysis of clinical and statistical data accumulated over more than 10 years showed positive dynamics in the decrease of eye removal cases and changes in priority when selecting the method towards evisceration, which causes fewer complications, has better functional and esthetic results - especially considering the ongoing development of new evisceration techniques.

Rhegmatogenous retinal detachment in a patient with choroidal melanoma simulating choroidal detachment: a case report

BACKGROUND

Ophthalmologists and retina specialists may consider choroidal detachment if patients with rhegmatogenous retinal detachment present with choroidal elevation. That misdiagnosis may lead to inappropriate treatments, development of tumor cell dissemination, and eventual promotion of patient death. We report a case of a patient with rhegmatogenous retinal detachment associated with choroidal melanoma simulating choroidal detachment according to fundus findings.

CASE PRESENTATION

A 78-year-old Japanese woman with blurred vision in her right eye was referred to our hospital because of rhegmatogenous retinal detachment with complicated atypical choroidal detachment. Her intraocular pressure was normal with clear anterior chamber. Retinal detachment involving the inferior and nasal retina was observed, and a retinal hole was noted in the same quadrant. A small yellowish choroidal elevation was located in the inferonasal site. Gadolinium-enhanced magnetic resonance imaging revealed enhancement corresponding to the elevation, leading to the identification of a choroidal tumor. Enucleation of the patient's right eye was eventually performed. The enucleated eye histologically demonstrated malignant melanoma.

CONCLUSIONS

If hypotony or an inflammatory sign is absent, ophthalmologists should pay attention to the differential diagnosis of choroidal elevations observed in such patients.

Retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl

To report a case of retinoblastoma presenting as haemorrhagic choroidal detachment in a 10-year-old girl. The patient, apparently well, presented with sudden blurring of vision in the setting of blunt trauma. On examination and ocular ultrasound, haemorrhagic choroidal detachment was suspected. She underwent external drainage via sclerostomies. The haemorrhage resolved ultrasonographically, but the vision did not improve. Five months postoperatively, she presented with sudden eye pain, lid swelling and proptosis. The ancillary workups were consistent with panophthalmitis and was treated as such. Six months postoperatively, the pain and lid swelling persisted; hence, the painful near absolute eye was enucleated. The histopathology revealed small round blue cells with necrosis consistent with retinoblastoma. Immunohistochemistry was positive for synaptophysin and negative for S100 confirming retinoblastoma. Retinoblastoma is the most common intraocular malignancy in children. The importance of increased awareness of its various presentations is of utmost importance to prevent life-threatening and vision-impairing complications.

Autologous fat graft in irradiated orbit postenucleation for retinoblastoma

Autologous fat grafting has been extensively and successfully adopted in a number of pathologic conditions in regenerative surgery especially on irradiated fields in order to improve pain symptoms and tissue trophism promoting scar release. In the present study, we report our experience with autologous fat grafting for the treatment of postirradiation fibrosis and pain on three consecutive patients undergoing orbital enucleation for locally advanced retinoblastoma (RB) and subsequent radiotherapy. We selected three consecutive patients who underwent orbital enucleation for locally advanced RB and subsequent local radiotherapy showing severe reduction in orbital volume and eyelid length and retraction due to fibrosis, spontaneous local pain exacerbated after digital pressure with no possibility to place an ocular implant. They underwent autologous fat grafting in the orbital cavity and results were evaluated by clinical examination at 5 and 14 days, and 1, 3, 6 months, and 1 year after surgery. A significant release of scar retraction, reduction of fibrosis and orbital rim contraction together with an important improvement of pain symptoms was observed in all patients. The local changes observed enabled an ease placement of an ocular prosthetic implant (implant). No local or systemic complication occurred. Fat grafting is a promising treatment for patients showing radiotherapy related complication in the orbital area and it should be adopted by all oculoplastic surgeon in order to improve pain syndrome creating the ideal local conditions for the placement of an ocular prosthetic implant.

Targeting the Platelet-Derived Growth Factor-beta Stimulatory Circuitry to Control Retinoblastoma Seeds

Purpose

Vitreous seeding remains the primary reason for treatment failure in eyes with retinoblastoma (Rb). Systemic and intra-arterial chemotherapy, each with its own inherent set of complications, have improved salvage rates for eyes with advanced disease, but the location and biology of vitreous seeds present a fundamental challenge in developing treatments with minimal toxicity and risk. The aim of this study was to target the platelet-derived growth factor (PDGF)- PDGF-receptor β (PDGFRβ) signaling pathway and investigate its role in the growth of Rb seeds, apoptotic activity, and invasive potential.

Methods

We performed ex vivo analyses on vitreous samples from Rb patients that underwent enucleation and from patient-derived xenografts. These samples were evaluated by quantitative PCR, immunohistochemistry, and ELISA. The effects of disruption of the PDGF-PDGFRβ signaling pathway, both by pharmacologic and genomic knockdown approaches, were evaluated in vitro by cell proliferation and apoptotic assays, quantitative PCR analyses, Western blotting, flow cytometry, and imaging flow cytometry. A three-dimensional cell culture system was generated for in-depth study of Rb seeds.

Results

Our results demonstrated that PDGFRβ signaling is active in the vitreous of Rb patients and patient-derived xenografts, sustaining growth and survival in an AKT-, MDM2-, and NF-κB-dependent manner. The novel three-dimensional cell culture system mimics Rb seeds, as the in vitro generated spheroids have similar morphologic features to Rb seeds and mimicked their natural physiology.

Conclusions

Targeting the PDGFRβ pathway in vitro reduces Rb cell growth, survival, and invasiveness and could augment current therapies. This represents a novel signaling pathway for potential targeted therapy to further improve ocular survival in advanced Rb.

Retinoblastoma: The importance of early diagnosis

INTRODUCTION

Retinoblastoma is the most frequent malignant intraocular tumour in childhood, and both its cure and the sequelae arising from it, mainly depend on an early diagnosis. There is currently no consensus on its diagnostic and therapeutic management.

PATIENTS AND METHODS

A descriptive, retrospective, and non-randomised study was conducted on a series of cases (39 patients -58 eyes), treated during the period 2006-2013, in the Regional Reference Centre for Tumours of the National Health Service Quality Agency.

RESULTS

The most frequent presentation sign is leukocoria (71.8%), followed by strabismus (17.9%). All cases of bilateral tumour had a germline mutation of the RB1 gene, and 20% had a family history. Stage E was observed in 55% of the patients, and 90% required chemotherapy treatment. The eye was maintained in 57% of those who had mild stages, compared to 43% who maintained it in advanced stages.

CONCLUSIONS

This analysis included 58 eyes. There are no previous studies in our community and there are few series so numerous throughout the country. Based on non-standardised treatment, the most appropriate is chosen according to the characteristics of the tumour. The multidisciplinary management, formed by ophthalmology, paediatric oncology, radiotherapy, and radiophysical oncology, is fundamental for the selection of the most appropriate treatment. Chemo-reduction, along with consolidation treatments, offers encouraging results in the control of these tumours, especially in those of less severity. Enucleation continues to be the method of choice in the most advanced staging with vitreous involvement, with the importance of early diagnosis being highlighted.