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Brown AH, Riemann M, Ramasubramanian A. Microvascular Flow Imaging in Anterior Segment Tumors. Am J Ophthalmol 2024; 261:e1-e2. [PMID: 38431137 DOI: 10.1016/j.ajo.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Alex H Brown
- University of Arizona College of Medicine (A.B.), Phoenix, Arizona, USA
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2
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Munuera I, Sanchez-Monroy J, Puzo M, Mateo A, Mendez-Martinez S. [Primary stromal cyst of the iris: case report]. An Sist Sanit Navar 2024; 47:e1072. [PMID: 38725368 PMCID: PMC11090608 DOI: 10.23938/assn.1072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 05/16/2024]
Abstract
Primary stromal cysts of the iris are rare, often asymptomatic, and incidentally found entities. Treatment is usually indicated in cases of enlargement or complications. However, imaging tests are required to determine their cystic nature and make an accurate differential diagnosis with malignant tumors, as well as for long-term follow-up. Ultrasound biomicroscopy is the technique of choice, although in most centers anterior segment optical coherence tomography is a more accessible and available imaging modality. We present a case of primary stromal cyst of the iris with an atypical presentation to illustrate the diagnosis and initial follow-up using anterior segment optical coherence tomography and photographs, and the management of complications. Anterior segment optical coherence tomography may be useful in the initial study and follow-up of anterior non-pigmented lesions where the cyst can be fully seen.
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Affiliation(s)
- Ines Munuera
- Servicio Aragonés de Salud. Hospital Universitario Miguel Servet. Departamento de Oftalmología. Zaragoza. España. https://ror.org/01r13mt55.
| | - Jorge Sanchez-Monroy
- Servicio Aragonés de Salud. Hospital Universitario Miguel Servet. Departamento de Oftalmología. Zaragoza.España. https://ror.org/01r13mt55.
| | - Martin Puzo
- Servicio Aragonés de Salud. Hospital Universitario Miguel Servet. Departamento de Oftalmología. Zaragoza. España. https://ror.org/01r13mt55.
| | - Antonio Mateo
- Servicio Aragonés de Salud. Hospital Universitario Miguel Servet. Departamento de Oftalmología. Zaragoza. España. https://ror.org/01r13mt55.
| | - Silvia Mendez-Martinez
- Servicio Aragonés de Salud. Hospital San Jorge. Departamento de Oftalmología. Huesca. España. https://ror.org/05e08c338.
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3
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Kim BZ, Lim JZ, McGhee CNJ. Cysts and tumours of the iris: Diagnostic tools and key management considerations-A review. Clin Exp Ophthalmol 2024. [PMID: 38577954 DOI: 10.1111/ceo.14380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 03/24/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
The iris is a unique structure, with exquisite variations in colour and form. Pathological changes, specifically including iris cysts and tumours are relatively uncommon, difficult to diagnose, and yet potentially blinding or life-threatening. Based on a comprehensive literature review, with highly illustrated key case examples, this report aims to guide the clinician in filtering the differential diagnoses of iris cysts and tumours. Evaluation is in the context of key diagnostic clinical tools and management considerations. Diagnostic imaging techniques include serial anterior segment photography, ultrasound, anterior segment optical coherence tomography, and iris fluorescein angiography, however, the roles of computerised topography and magnetic resonance imaging are also considered in this review. Management includes categorisation in terms of solid iris tumours (melanocytic vs. non-melanocytic), or iris cysts (primary vs. secondary) that may be usefully differentiated by clinical assessment, avoiding more invasive interventions. Cystic lesions are generally benign, although implantation cysts in particular cause significant complications and surgical challenges. Most solid tumours are melanocytic and also typically benign. However, in larger lesions, rapid growth, symptoms and complications more likely indicate malignancy, requiring further investigation.
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Affiliation(s)
- Bia Z Kim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Joevy Z Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Eye Clinic, Health New Zealand (Te Whatu Ora) Auckland, Auckland, New Zealand
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4
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Kottaridou E, Hatoum A. Imaging of Anterior Segment Tumours: A Comparison of Ultrasound Biomicroscopy Versus Anterior Segment Optical Coherence Tomography. Cureus 2024; 16:e52578. [PMID: 38249646 PMCID: PMC10798380 DOI: 10.7759/cureus.52578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 01/23/2024] Open
Abstract
Anterior segment tumours of the eye are relatively rare but can pose significant morbidity and mortality. We conducted a literature review to compare the performance of ultrasound biomicroscopy to anterior segment optical coherence tomography in the imaging of these tumours. A total of seven studies were included accounting for a cumulative 1,114 eyes. Ultrasound biomicroscopy has traditionally formed, and remains, the mainstay of tumour imaging due to its ability to penetrate pigmented lesions and delineate the posterior border of tumours, and the current evidence supports this.
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Affiliation(s)
| | - Adam Hatoum
- Accident and Emergency, Barts Health NHS Trust, London, GBR
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5
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Cherkas E, Kalafatis NE, Marous MR, Shields CL. Iris melanoma: Review of clinical features, risks, management, and outcomes. Clin Dermatol 2024; 42:62-70. [PMID: 37865279 DOI: 10.1016/j.clindermatol.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Primary uveal melanoma is rare and affects approximately 8,000 persons per year worldwide. This malignancy can involve the iris, ciliary body, and choroid. Of these three structures, the iris is the least commonly affected site, representing only 4% of all uveal melanomas. Iris melanoma can arise from iris melanocytic nevus, iris melanocytosis, or de novo. In a longitudinal study of 1,611 patients with iris nevus, transformation into melanoma, using Kaplan-Meier estimates, was found in 2.6% by five years and in 4.1% by 10 years. The factors that predicted growth of iris melanocytic nevus into melanoma are denoted by a letter (ABCDEF) guide: A for age ≤40 years old at presentation (hazard ratio [HR] = 3, P = .01), B for blood (hyphema) (HR = 9, P < .0004), C for clock hour of tumor inferiorly (tumor location) (HR = 9, P = .03), D for diffuse flat tumor configuration (HR = 14, P = .02), E for ectropion uveae (HR = 4, P = .002), and F for feathery ill-defined margins (HR = 3, P = .02). At diagnosis, iris melanoma has a mean cross-sectional diameter of 5.5 mm and thickness of 2.1 mm, often with tumor seeding (28%) and secondary glaucoma (35%). We provide a comprehensive review of iris nevus and melanoma to explore relevant demographic and clinical data, risk factors for tumor growth, management, and prognosis, with the hope that clinicians will be more comfortable in understanding this rare malignant condition.
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Affiliation(s)
- Elliot Cherkas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas E Kalafatis
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Molly R Marous
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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6
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Bai H, Bosch JJ, Heindl LM. Current management of uveal melanoma: A review. Clin Exp Ophthalmol 2023. [PMID: 37076276 DOI: 10.1111/ceo.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/12/2023] [Accepted: 02/13/2023] [Indexed: 04/21/2023]
Abstract
Uveal melanoma is the most frequent primary intraocular cancer in adulthood and is mostly localised to the choroid. It can be treated using radiation therapy, laser therapy, local resection and enucleation, with the best results achieved by combining these procedures. However, up to half of patients develop metastatic disease. There are no efficacious treatment methods for patients in advanced stage or with metastasis. In recent years, several novel treatment modalities aimed at improving tumour control and reducing adverse events have emerged. This review summarises current clinical treatment methods and new therapeutic perspectives for uveal melanoma.
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Affiliation(s)
- Haixia Bai
- Eye Center, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jacobus J Bosch
- Centre for Human Drug Research, Leiden, Netherlands
- Leiden University Medical Center, Leiden, Netherlands
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany
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7
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Liu W, Ma W, Guo R, Ji J. Snowflakes in the Eye - An Uncommon Presentation of Iris Metastasis of Esophageal Carcinoma and Review of Literature. Ocul Immunol Inflamm 2022; 30:1568-1571. [PMID: 34003704 DOI: 10.1080/09273948.2021.1906910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To alert clinicians to an uncommon presentation of iris metastasis of esophageal carcinoma. We reported a 67-year-old man complained of blurred vision and ocular pain of his right eye for 1 month. He was diagnosed iridocyclitis of the right eye 2 weeks ago and he had a history of esophageal squamous cell carcinoma for 5 years with no regular treatment. Under slit-lamp microscopy, accumulating snowflakes-like deposits were found in the anterior chamber of the right eye. Ocular metastasis was then confirmed by atypical cells in the aqueous humor and positron emission tomography (PET-CT). METHODS Retrospective review of a case note and review of literature. CONCLUSION We presented a rare case of iris metastasis of esophageal carcinoma and highlighted the importance of maintaining suspicion for metastasis in any elderly patients with uveitis, since the diseases masquerading as uveitis are not only vision threatening but may be potentially fatal.
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Affiliation(s)
- Wei Liu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Wenjiang Ma
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruru Guo
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Jian Ji
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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8
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Farhat W, Yeung V, Ross A, Kahale F, Boychev N, Kuang L, Chen L, Ciolino JB. Advances in biomaterials for the treatment of retinoblastoma. Biomater Sci 2022; 10:5391-5429. [PMID: 35959730 DOI: 10.1039/d2bm01005d] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Retinoblastoma is the most common primary intraocular malignancy in children. Although traditional chemotherapy has shown some success in retinoblastoma management, there are several shortcomings to this approach, including inadequate pharmacokinetic parameters, multidrug resistance, low therapeutic efficiency, nonspecific targeting, and the need for adjuvant therapy, among others. The revolutionary developments in biomaterials for drug delivery have enabled breakthroughs in cancer management. Today, biomaterials are playing a crucial role in developing more efficacious retinoblastoma treatments. The key goal in the evolution of drug delivery biomaterials for retinoblastoma therapy is to resolve delivery-associated obstacles and lower nonlocal exposure while ameliorating certain adverse effects. In this review, we will first delve into the historical perspective of retinoblastoma with a focus on the classical treatments currently used in clinics to enhance patients' quality of life and survival rate. As we move along, we will discuss biomaterials for drug delivery applications. Various aspects of biomaterials for drug delivery will be dissected, including their features and recent advances. In accordance with the current advances in biomaterials, we will deliver a synopsis on the novel chemotherapeutic drug delivery strategies and evaluate these approaches to gain new insights into retinoblastoma treatment.
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Affiliation(s)
- Wissam Farhat
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Vincent Yeung
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Amy Ross
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Francesca Kahale
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Nikolay Boychev
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Liangju Kuang
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
| | - Lin Chen
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA. .,Department of Ophthalmology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.,Department of Optometry and Visual Science, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Joseph B Ciolino
- Department of Ophthalmology, Schepens Eye Research Institute of Mass Eye and Ear, Harvard Medical School, Boston, MA 02114, USA.
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9
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Montesel A, Eandi CM, Zografos L. Focal choroidal excavation associated with nonmelanocytic iris tumor. Eur J Ophthalmol 2022; 33:NP84-NP87. [PMID: 35001692 DOI: 10.1177/11206721211073210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To describe a unique unilateral association between an iris stromal tumor and a macular focal choroidal excavation. CASE DESCRIPTION A 40-year old patient presented with a small iris tumor associated with a unilateral macular lesion disclosed during a routine ophthalmologic examination. The patient was asymptomatic and visual function was not affected. After clinical and instrumental evaluation, a diagnosis of nonmelanocytic undefined stromal tumor of the iris associated with macular focal choroidal excavation was made. The size and shape of the two lesions remained stable during a 7-year follow-up and the patient did not develop other signs. CONCLUSION The concurrent presence of a stromal iris tumor associated with focal choroidal excavation has never been reported. Further reports of this association are required in order to understand its exact pathogenesis.
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Affiliation(s)
- Andrea Montesel
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland
| | - Chiara M Eandi
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland.,Department of Surgical Science, University of Torino, Torino, Italy
| | - Leonidas Zografos
- Department of Ophthalmology, University of Lausanne, 60542Fondation Asile des Aveugles, 60541Jules Gonin Eye Hospital, Lausanne, Switzerland
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10
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Krohn J, Sundal KV, Frøystein T. Topography and clinical features of iris melanoma. BMC Ophthalmol 2022; 22:6. [PMID: 34980044 PMCID: PMC8725464 DOI: 10.1186/s12886-021-02236-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
Background To characterise the topographical and clinical features of primary iris melanoma and to visualise the patterns of tumour extent in the iris. Methods Clinical characteristics of iris melanomas were analysed, and data on their size, shape, and location were converted into a database of two-dimensional iris charts by means of computer-drawing software. The geometric centre of each tumour was entered into corresponding sectors of the chart. The extent of the melanomas was computationally visualised by merging the iris drawings and displaying the number of overlapping tumours on colour-coded iris maps. Results Twenty-nine patients (18 females and 11 males) with a mean age of 52 years met the inclusion criteria. The mean largest tumour diameter was 6.1 mm (range, 1.8–11.0 mm). Five tumours (17%) involved the pupillary margin, 10 (34%) involved the iris root, and 10 (34%) involved both sites. The hemispheric location of the tumour centroid was superior in 3 eyes (11%) and inferior in 25 (89%) (p < 0.0001), and the distribution between the temporal and nasal hemispheres was 17 (61%) and 11 (39%), respectively (p = 0.26). In females, the iris melanomas were located more temporally (p = 0.02) and had more often originated from a pre-existing naevus (p = 0.03), than in males. There was also shift towards more temporally located melanomas in younger patients. Conclusions The lower temporal iris quadrant is the preferential area of melanoma occurrence and growth. Iris melanoma tends to be more temporally located in females, who compared with males also have a higher proportion of melanomas arising from a pre-existing naevus.
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Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway. .,Department of Ophthalmology, Haukeland University Hospital, N-5021, Bergen, Norway.
| | - Kristoffer Våge Sundal
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen, Bergen, Norway
| | - Torbjørn Frøystein
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
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11
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Tigari B, Saini M, Manchanda S, Vankdoth S. Large ciliary body melanoma. BMJ Case Rep 2021; 14:e246386. [PMID: 34764100 PMCID: PMC8587378 DOI: 10.1136/bcr-2021-246386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/03/2022] Open
Affiliation(s)
- Basavaraj Tigari
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manu Saini
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shubham Manchanda
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santhosh Vankdoth
- Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Abstract
Peripheral iris pigment epithelial cysts are benign lesions of the anterior segment. They are located at the iridociliary junction and can produce a localised distortion and/or displacement of the iris. Patients who have these lesions are usually asymptomatic and in the absence of a careful slitlamp examination will often remain undetected. The aetiology of these cysts is unknown and they tend to be unilateral and solitary in nature. The cyst walls are composed of iris pigment epithelium and the lumen contains clear fluid. Women are three times more likely to develop these cysts, which must be differentiated from malignancies of the iris or ciliary body. We report a case involving a peripheral pigmentary iris cyst and discuss methods of differentiating this benign lesion from serious ocular tumours.
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Affiliation(s)
- Angela Z Minavi
- University Eye Institute, College of Optometry, University of Houston, Houston, Texas 77204-2020, USA.
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13
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Kuzmanović Elabjer B, Bušić M, Pleše A, Bjeloš M, Miletić D, Vukojević N. Ultrasound Biomicroscopy Documented Anterior Uveal Melanoma Regression after Ruthenium-106 Plaque Therapy. Ocul Oncol Pathol 2021; 7:224-232. [PMID: 34307336 DOI: 10.1159/000512030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/03/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Ultrasound biomicroscopy (UBM) is the only widely used method for the evaluation of anterior uveal melanoma (AUM). Objective Documentation of regression of AUM treated with ruthenium-106 (Ru-106) plaque types CCB and CCC using UBM. Methods This single institution-based retrospective case series involved 10 Caucasian patients with AUM followed after brachytherapy with UBM from January 2014 until February 2019. The largest prominence of the tumor perpendicular to the sclera or the cornea (including scleral/corneal thickness) (D) and the largest basal dimension (B) were measured in millimeters with UBM for all patients prior to the brachytherapy and at 4-month interval follow-up. Tumor regression was calculated as a percentage of decrease in the initial D and B values. Results The study involved 10 patients with a mean age of 64.4 years (yr) (range 46-80 yr). D ranged from 1.82 to 5.5 mm (median 2.99 mm) and B from 2.32 to 12.38 mm (median 4.18 mm). The apical radiation dose in all patients was 100 Gy. The median follow-up was 42.02 months. Regression for D was 21.11 ± 13.66%, 31.09 ± 14.66%, and 34.92 ± 19.86% at 1st, 2nd, and 3rd year of the follow-up, respectively, while for B it was 21.58 ± 16.05%, 28.98 ± 17.71%, and 32.06 ± 18.96%, respectively. Tumor recurrence was documented in 2/10 patients. Conclusion The major regression of AUM, treated with Ru-106 plaque types CCB and CCC, was documented in the first 2 years after brachytherapy in our study group. In the following years, only minimal regression was documented that warns of the need for close monitoring and active search for local recurrences.
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Affiliation(s)
- Biljana Kuzmanović Elabjer
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Mladen Bušić
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Andrej Pleše
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Mirjana Bjeloš
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Daliborka Miletić
- Faculty of Dental Medicine and Health Care Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,Faculty of Medicine Osijek, University Josip Juraj Strossmayer in Osijek, Osijek, Croatia.,University Eye Clinic - WHO Collaborating Center, University Hospital "Sveti Duh", Zagreb, Croatia
| | - Nenad Vukojević
- University Eye Clinic, University Hospital Centre Zagreb, Zagreb, Croatia
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14
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Abstract
Iris melanomas represent 2–5% of uveal melanomas. Iris melanomas vary in their size, shape, degree of pigmentation and clinical behavior. The main local clinical complications of iris melanomas are tumor vascularization, ectropion uvea, pupillary distortion, pigment dispersion, sector cataract, chronic uveitis, hyphema and glaucoma with irreversible optic nerve damage. The most effective treatment for iris nevus and melanoma remains debatable; treatment modalities have been proposed depending on the local status as well as the age and general condition of the patient. A melanocytic iris nevus is usually observed until documented progression is identified. In this case, radiotherapy or surgical resection is generally performed. Cataract, glaucoma and limbal stem cell deficiency are usually secondary to radiotherapy, while incomplete tumor excisions, which could lead to recurrence, hemorrhage, vitreous loss, dislocated lens, iridocyclitis, macular edema, retinal detachment, glaucoma and cataract, are related to surgical resection. In some cases, a combination of radiotherapy and surgery is used. Conservative treatment is an efficient alternative to enucleation and allows good local tumor control.
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15
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Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L. UVEAL MELANOMA BIOPSY A REVIEW. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 76:247-252. [PMID: 33086848 DOI: 10.31348/2020/9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In intraocular tumors, diagnosis is usually based on clinical examination and imaging without the need for invasive surgery or tissue sampling. The diagnosis can be confirmed by biopsy, however, in the case of intraocular malignancy, the biopsy is considered controversial. Due to the development of uveal melanoma cytogenetic prognostics and the progression in generalised uveal melanoma treatment, intraocular melanoma biopsy is becoming increasingly important. Diagnostic biopsy of intraocular tumors is indicated in cases of diagnostic uncertainty for findings with conflicting non-invasive test results and for small melanocyte lesions. Tumor prognostic biopsy is performed to obtain a tissue sample for tumor cytogenetic testing, which can help to determine the prognosis and specific metastatic risk of the patient. For anterior segment tumors, anterior chamber fluid sampling, thin-needle iris biopsy, punch biopsy, surgical biopsy or biopsy using vitrectomy may be used. For posterior segment tumors, procedures include transscleral or transretinal thin-needle biopsy, vitrectomy-assisted biopsy, punch biopsy, endoresection or transscleral exoresection. Complications of intraocular melanoma biopsy include too small or non-valuable sample collection, intra-tumoral heterogeneity, intra-ocular trauma and induction of intraocular or extraocular tumor dissemination.
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16
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Rusňák Š, Hecová L, Kasl Z, Sobotová M, Hauer L. Therapy of uveal melanoma A Review. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2020; 77:1-13. [PMID: 33086849 DOI: 10.31348/2020/10] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of intraocular melanoma therapy is to achieve local tumor control, reduce the risk of metastasis development, preserve the eyeball and possibly the visual function of the eye. The choice of therapeutic approach requires a comprehensive view and individual approach to each patient with uveal melanoma. Factors considered include local finding (location, tumor size and shape, tumor activity, central visual acuity, intraocular complications), age and the patients overall physical and psychological condition, as well as the patients wishes. The most widely used method of uveal melanoma treatment is radiotherapy. The effect of radiation is caused by the absorption of ionizing radiation energy, the effect of radiation on the cell is manifested by cell death (depletion), or by a cytogenetic information change (mutation). Brachytherapy uses scleral applicators with radionuclide - ruthenium (Ru-106) applicators dominate in Europe and iodine (I-125) applicators in the USA. In external radiotherapy, the source of ionizing radiation is outside the patients body. Both stereotactic radiosurgery and fractionated stereotactic radiotherapy are used. In the Czech Republic, treatment is carried out using Leksell gamma knife or CyberKnife, while proton therapy dominates in the world. The development of serious radiation complications (radiation retinopathy, neuropathy, neovascular glaucoma, toxic tumor syndrome, etc.) should be considered. Surgical therapy involves a variety of invasive procedures. Iridectomy is performed for iris melanoma. Anteriorly located choroidal melanomas and / or ciliary body melanomas can be resolved by transscleral resection (exoresection). For posterior choroidal melanomas, a combination of external tumor irradiation with pars plana vitrectomy is used. Enucleation is a method of choice in advanced tumors that cannot be effectively irradiated. Orbital exenteration is indicated in advanced tumors with extrabulbar spread or in relapsed tumor after previous enucleation.
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Micro-incision, trans-iridal aspiration cutter biopsy for ciliary body tumours. Can J Ophthalmol 2020; 56:124-129. [PMID: 32919996 DOI: 10.1016/j.jcjo.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/25/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To perform micro-incision, trans-iridal, aspiration-cutter-assisted biopsy for ciliary body tumours. DESIGN Retrospective, nonrandomized, observational, interventional case series. METHODS Five consecutive patients undergoing ciliary body tumour biopsy were clinically diagnosed using slit-lamp photography, gonioscopy, high-frequency ultrasound imaging, and systemic radiographic staging. A 1-2 mm clear cornea incision was placed opposite to the central clock hour of the ciliary body tumour. Viscoelastic was infused into the anterior chamber for stabilization and endothelial protection. Then, a 27-gauge aspiration cutter was used to make an iridotomy at the iris root and then extend through the iris into the tumour. Biopsy was performed using mechanical cutting starting at 300 cuts per minute and aspiration at 600 mm Hg. After withdrawal of the cutter from the eye, the effluent tube was flushed into a 3 cc syringe, inspected for specimen under the operating microscope and sent for pathology. Multiple biopsies were performed on each patient. Viscoelastic was removed and Seidel examination of the corneal wound performed. RESULTS Five eyes were biopsied. A mean 3.6 passes were used to obtain tumour tissue. Tumour cells and tissue were obtained in all cases. Cytologic, histopathologic, and immuno-histochemical analysis were performed (100%, n = 5/5). Diagnoses included melanoma (60%, n = 3/5), melanocytoma (20%, n = 1/5), and leiomyoma (20%, n = 1/5). Transient postoperative hyphemas cleared within 1 week (80%, n = 4/5). No secondary glaucoma, infection, or cataracts were noted. CONCLUSION Aspiration-cutter biopsy through the iris root provided a minimally invasive, safe method for obtaining ciliary body tissue for cytology, histopathology, and immunohistochemical analysis.
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Mahesh M, Sudharshan S, Khetan V, Janani MK, Krishnakumar S. Polymerase chain reaction-proven tuberculous anterior segment mass mimicking juvenile xanthogranuloma in a child. Indian J Ophthalmol 2020; 68:2033-2035. [PMID: 32823470 PMCID: PMC7690467 DOI: 10.4103/ijo.ijo_852_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mass lesions arising from the anterior segment in children involving the iris and ciliary body can be of myogenic, neurogenic, or hematogenic/vascular origin. These include nevi, melanomas, adenoma, adenocarcinoma, cysts, metastatic tumours among others. Multiple iris mass lesions due to tuberculosis in children are rare. We present an uncommon atypical presentation of multiple anterior segment mass lesions referred to us as neoplasia. Although excision biopsy can be diagnostic, it was deferred and anterior chamber tap was done. Aqueous cytology was suspicious of juvenile xanthogranuloma (JXG) but polymerase chain reaction (PCR) confirmed tuberculous etiology. Treatment with antituberculous therapy (ATT) and steroids lead to complete resolution of the lesions.
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Affiliation(s)
- Meenakshi Mahesh
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - S Sudharshan
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - M K Janani
- Sankara Nethralaya Referral Laboratory, Chennai, Tamil Nadu, India
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The Effectiveness of Ultrasound Biomicroscopic and Anterior Segment Optical Coherence Tomography in the Assessment of Anterior Segment Tumors: Long-Term Follow-Up. J Ophthalmol 2020; 2020:9053737. [PMID: 32655943 PMCID: PMC7317619 DOI: 10.1155/2020/9053737] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023] Open
Abstract
Background Differential diagnosis and follow-up of small anterior segment tumors constitute a particular challenge because they determine further treatment procedures. The aim of this study was to evaluate the efficacy of the UBM (ultrasound biomicroscopy) and AS-OCT (anterior segment optical coherent tomography) in distinguishing different types of anterior segment lesions. Methods It was a retrospective, noncomparative study of case series of 89 patients with the suspicion of anterior segment tumor referred to the Ophthalmology Clinic, Medical University of Białystok, Poland, between 2016 and 2020. UBM was used to assess tumor morphology including height, location, and internal and external features. In cases in which UBM did not provide enough data, the AS-OCT images were analyzed. The data on demographics, best corrected visual acuity (BCVA), intraocular pressure (IOP), and rate of complications were also collected. Patients were followed up from 1 to 48 months. Results The mean observation period was 26.61 ± 16.13 months. Among the patients, there were 62 women and 27 men at a mean age of 55.59 ± 19.48 (range: from 20 to 89 years.) The types of tumors were cysts (41%), solid iris tumors (37.1%), ciliary body tumors (7.9%), peripheral anterior synechiae (PAS 3.4%), corneal tumors (4.5%), and others (5.6%). Patients with cysts were younger than patients with solid iris tumor (p=0.002). Women had a cyst as well as solid iris tumor more frequently than men, but less often a ciliary body tumor (p < 0.05). The horizontal size of tumor was positively correlated with patients' age (rs = 0.38 and p=0.003) and negatively correlated with visual acuity (rs = −0.42 and p=0.014). During the 4 years of diagnosis, only 2.2% of lesions exhibited growth (growth rate of 0.02 mm per year). Among 15 cases in which visualization with UBM was not satisfactory (mostly iris nevi), AS-OCT was helpful in diagnosis of 13 patients. Conclusions Both UBM and AS-OCT are effective methods in detection and diagnosis of tumors of the anterior eye segment, but in some cases, AS-OCT adds additional value to the diagnosis. Many lesions can be managed conservatively because they did not demonstrate growth during 4 years of the follow-up period.
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Davis RL, Reilly CM, Moore PA. Surgical excision of iridociliary tumors using a postero-anterior cyclo-iridectomy and thermocautery in two dogs. Vet Ophthalmol 2020; 23:579-587. [PMID: 32237209 DOI: 10.1111/vop.12755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To report the surgical excision of an iridociliary adenoma and iridal melanocytoma using a postero-anterior cyclo-iridectomy in two dogs. PROCEDURE A 7 year old neutered male English springer spaniel (case 1) and a 7 year old neutered male Labrador mix (case 2) were presented for evaluation of an intrairidal mass OS. RESULTS Complete ophthalmic examination revealed a large, dorsonasal, well-demarcated, intrairidal mass OS. A tan to pink intrairidal mass extending into the iridocorneal angle (case 1) and a pigmented intrairidal mass (case 2) were present. B-mode ultrasonography showed a focal, soft tissue, homogenous mass within the uvea adjacent to and contacting the lens. Neither pars plana involvement nor vitreal extension was present. A postero-anterior cyclo-iridectomy was performed through a polyhedral scleral flap. Thermocautery was used to complete the cyclo-iridectomy (case 1) and partial iridectomy (case 2) to excise the mass en bloc. Histopathology revealed a completely excised iridociliary adenoma (case 1) and iris melanocytoma (case 2). The surgery sites healed without complication. Mild uveitis (cases 1 and 2), scant vitreal hemorrhage (case 1), and mild hyphema (case 2) were present three days postoperatively but had resolved ten days postoperatively. The patients remain visual twenty-two months (case 1) and seven months (case 2) postoperatively with a normal intraocular examination other than an iridal defect and mild dorsonasal lens capsular opacities. CONCLUSIONS The surgical approach described in these cases is utilized in physician-based medicine. This approach and the use of thermocautery provide a viable surgical option for excision of large iridociliary tumors in dogs.
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Affiliation(s)
| | | | - Phillip A Moore
- Department of Clinical Science, Auburn University, Auburn, Alabama
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21
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Liu W, Kim JM, Young BK, Nath R, Chen Z, Decker RH, Astrahan MA, Pointdujour-Lim R. Novel Eye Plaque Designs for Brachytherapy of Iris and Ciliary Body Melanoma and the First Clinical Application. Ocul Oncol Pathol 2018; 5:220-227. [PMID: 31049331 DOI: 10.1159/000493269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/17/2018] [Indexed: 12/20/2022] Open
Abstract
Background While traditional eye plaque brachytherapy can be used for the treatment of iris melanoma, it faces challenges of poor patient tolerability due to cornea-plaque touch caused by radius of curvature mismatch and potential dosimetric inaccuracy from incomplete coverage. We present novel plaque designs and the first clinical application of the plaques for iris melanoma. Methods Two dome-shaped plaques (EP2132 and EP1930) were designed to vault above the cornea to treat tumors of the iris and ciliary body. Image-based treatment planning of the first 2 clinical cases using the EP2132 plaque covered the tumor base plus a 2 mm margin and the involved ciliary body with at least 75 Gy to the tumor apex. Results The tumors decreased in size following treatment. The patients tolerated the treatment well. There was no adverse event associated with the traditional iris plaques, such as decreased vision, pain, corneal edema, glaucoma, or cataract. Conclusion The novel dome-shaped plaques for the treatment of iris melanoma provide effective dose distribution, improved surgical maneuverability, and increased tolerability for the patient. This plaque model can be used to treat iris melanoma of various sizes, configurations, and locations, including the ciliary body. The need for a customized plaque platform for each patient is minimized.
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Affiliation(s)
- Wu Liu
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jenna May Kim
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin K Young
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Ravinder Nath
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zhe Chen
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Roy H Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Renelle Pointdujour-Lim
- Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, USA.,Yale Smilow Cancer Center, Yale University School of Medicine, New Haven, Connecticut, USA
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Possible role of standardized echography complementing ultrasound biomicroscopy in tumors of the anterior eye segment: a study in a series of 13 patients. J Ultrasound 2018; 21:209-215. [PMID: 29774459 DOI: 10.1007/s40477-018-0301-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 01/14/2018] [Indexed: 10/16/2022] Open
Abstract
PURPOSE To evaluate the efficacy of standardized A-scan echography (ASE) complementing ultrasound biomicroscopy (UBM) to propose the most efficient method as grounds for the diagnosis, treatment, and follow-up of anterior eye-segment tumors. METHODS The inclusion criteria were tumors of the ciliary body and peripheral choroidal tumors, whose anterior border could not be visualized with a 10 MHz ultrasound probe. The largest basal dimension and the highest prominence of the tumor were measured with a UBM Lin 50 probe. A standardized A-scan examination determined the tumor's thickness and internal reflectivity. Thus, tissue differentiation led to a standardized echography-based diagnosis (SED). RESULTS The study included 13 patients. SED was achieved in all examined tumors. The smallest thickness of the tumor of the ciliary body enabling SED was only 1.78 mm. The highest prominence of the tumor (3.66 ± 1.39 mm) was generally larger than its thickness (3.30 ± 1.71 mm). CONCLUSION When approaching ciliary body tumors, both ASE and UBM should be performed, the former to accurately differentiate the tumor and measure its height, and the latter to delineate anterior tumor margins and iris involvement. Standardized echography-based diagnosis was grounds for further evaluation and/or treatment in this case series. The highest prominence of the ciliary body tumor perpendicular to the sclera as evidenced by UBM was generally higher than the thickness obtained with standardized echography. Hence, we propose ASE thickness to be the grounds for staging the severity of ciliary body tumors in the algorithm for their management.
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Swisher SD, Klein H, Lennox AM, Reavill DR, Teixeira LBC, Shaw GC. Four cases of iridociliary tumors in domestic rabbits (Oryctolagus Cuniculus
). Vet Ophthalmol 2018; 21:646-651. [DOI: 10.1111/vop.12550] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Heidi Klein
- IndyVet Emergency and Specialty Hospital; Indianapolis IN USA
| | - Angela M. Lennox
- Avian and Exotic Animal Clinic of Indianapolis; Indianapolis IN USA
| | | | | | - Gillian C. Shaw
- Comparative Ocular Pathology Laboratory of Wisconsin; Madison WI USA
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Georgalas I, Petrou P, Papaconstantinou D, Brouzas D, Koutsandrea C, Kanakis M. Iris cysts: A comprehensive review on diagnosis and treatment. Surv Ophthalmol 2017; 63:347-364. [PMID: 28882598 DOI: 10.1016/j.survophthal.2017.08.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
Iris cysts, both primary and secondary, are a diagnostic and treatment challenge. Primary cysts arise either from the iris pigment epithelium or the iris stroma. Posterior pigment epithelial cysts are subdivided according to their location as central, midzonal, and peripheral. Iris stromal cysts are classified either as congenital or acquired. Free-floating cysts are usually dislodged pigment epithelial cysts. Secondary cysts are classified according to the underlying cause as implantation cysts, drug-induced, uveitic, tumor-induced, parasitic, or as cysts associated with systemic disorders. Differential diagnosis is based on the clinical presentation and imaging. Ultrasound biomicroscopy is the gold standard for the imaging of iris cysts, combining excellent resolution with sufficient tissue penetration. Treatment of iris cysts depends largely on whether they become symptomatic or not. Symptoms include obstruction of the visual axis, corneal decompensation, secondary uveitis, and secondary glaucoma. Treatment options cover a range from simple observation to fine-needle aspiration (with or without intracystic injection of absolute alcohol or antimitotic agents), laser (argon, Nd:YAG), or surgical excision. In the past, the prevailing notion was that of a radical surgical intervention in the form of iridectomy or iridocyclectomy. Given the high rate of recurrence, a stepwise conservative approach is currently favored by most clinicians.
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Affiliation(s)
- Ilias Georgalas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece.
| | - Petros Petrou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Dimitrios Papaconstantinou
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Dimitrios Brouzas
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Chrysanthi Koutsandrea
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
| | - Menelaos Kanakis
- Department of Ophthalmology, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital, Athens, Greece
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Arslantürk Eren M, Gündüz AK, Gündüz ÖÖ. Evaluation of Iris Melanoma with Anterior Segment Optical Coherence Tomography. Turk J Ophthalmol 2017; 47:231-234. [PMID: 28845329 PMCID: PMC5563553 DOI: 10.4274/tjo.66742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 06/24/2016] [Indexed: 12/01/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) is a relatively new imaging modality that allows assessment of anterior segment structures. AS-OCT enables the differentiation of benign and malignant tumors through the evaluation of lesion size, internal structure, degree of vascularity, and anterior and posterior surfaces. Herein, we discuss the AS-OCT findings of a patient with spindle type iridociliary melanoma diagnosed in pathologic examination.
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Affiliation(s)
| | - Ahmet Kaan Gündüz
- Ankara Üniversitesi Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Özlenen Ömür Gündüz
- Ankara Üniversitesi Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Abstract
Biopsy involves the surgical removal of a tissue specimen for histopathologic evaluation. Most intraocular tumors are reliably diagnosed based on the clinical evaluation or with noninvasive diagnostic techniques. However, accurately diagnosing a small percentage of tumors can be challenging. A tissue biopsy is thus needed to establish a definitive diagnosis and plan the requisite treatment. From fine-needle aspiration biopsy (FNAB) to surgical excision, all tissue collection techniques have been studied in the literature. Each technique has its indications and limitations. FNAB has been reported to provide for 88–95% reliable and safe ophthalmic tumor diagnosis and has gained popularity for prognostic purposes and providing eye conserving treatment surgeries. The technique and instrumentation for biopsy vary depending upon the tissue involved (retina, choroid, subretinal space, vitreous, and aqueous), suspected diagnosis, size, location, associated retinal detachment, and clarity of the media. The cytopathologist confers a very important role in diagnosis and their assistance plays a key role in managing and planning the treatment for malignancies.
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Affiliation(s)
- Pukhraj Rishi
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Abhinav Dhami
- Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Jyotirmay Biswas
- Department of Larsen and Toubro Ocular Pathology, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Liu SL, Nie YH, He T, Yan XX, Xing YQ. Iris metastasis as the first sign of small cell lung cancer: A case report. Oncol Lett 2017; 13:1547-1552. [PMID: 28454289 PMCID: PMC5403398 DOI: 10.3892/ol.2017.5648] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/16/2016] [Indexed: 11/24/2022] Open
Abstract
The current study documents an unusual case of iris metastasis as the first sign of small cell lung cancer (SCLC) and reviews the relevant literature to increase understanding and awareness of this rare condition. A 59-year-old male chronic smoker presented with a painful and red right eye without any disturbance of vision. The patient also complained of associated chronic cough and anorexia. Upon examination, an exfoliative, pinkish-white lesion of the right iris was observed. A systemic work-up was performed, which incidentally detected metastatic SCLC in the lower lobe of the right lung and was confirmed by histopathological examination. A thorough evaluation demonstrated no organ metastases, except in the iris. Following the failure of conservative approaches, the eye had to be enucleated. The clinical features, treatment and prognosis of this condition are briefly reviewed and the results of contrast-enhanced ultrasound (CEUS) examination observed in this case are presented. Despite their rarity, iris lesions should be considered as possible manifestations of underlying malignancies. Imaging techniques, particularly CEUS, may aid the detection, diagnosis and monitoring of such lesions.
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Affiliation(s)
- Shi-Liang Liu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yu-Hong Nie
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Tao He
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xi-Xi Yan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Yi-Qiao Xing
- Eye Center, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
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Fea AM, Briamonte C, Aragno V, Grignolo FM. Vascularized solid iris lesion in a 3 year old child: 5 years of follow up. BMC Ophthalmol 2016; 16:89. [PMID: 27306385 PMCID: PMC4908797 DOI: 10.1186/s12886-016-0267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2015] [Accepted: 06/02/2016] [Indexed: 11/25/2022] Open
Abstract
Background Iris tumors are rare in young patients. When an iris lesion occurs in a pediatric patient, it can be difficult to classify because of the wide spectrum of iris proliferations. Case presentation We report on an unusual case of a vascularized iris lesion in a three year old Caucasian patient, with no symptoms and no visual impairment. We evaluated in a 50-month follow up with non-invasive diagnostic tools in order to avoid eye biopsy. Conclusion We focused attention on the differential diagnoses and underlined the role of non-invasive diagnostic tools in a child to avoid or postpone the eye biopsy. We performed a review of the literature to identify the best medical practice in pediatric iris lesions with atypical characteristics.
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Microincision, Aspiration Cutter-Assisted Multifocal Iris Biopsy for Melanoma. Eur J Ophthalmol 2016; 27:62-66. [DOI: 10.5301/ejo.5000809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/20/2022]
Abstract
Purpose To describe a minimally invasive method to create multifocal full-thickness surgical iridectomy biopsies. Methods Seven patients suspected to have diffuse iris melanoma underwent multifocal surgical iridectomy biopsy through a single 1.0-mm clear corneal incision. A 25-G inked trocar was used to create one visible corneal portal, through which the anterior chamber was filled with sodium hyaluronate 1%. Then, a 25-G aspiration cutter probe was introduced through the corneal incision such that the aspiration portal was occluded by the iris biopsy sites. Then aspiration (600 mm Hg) cutting (300 cuts per minute) was used to create full- and partial-thickness surgical iridectomy biopsies at multiple locations. After each biopsy the probe was removed, and its contents aspirated into a separate 3-mL syringe (marked by clock hour location). The sodium hyaluronate 1% was removed and wound checked for leakage. Results Diagnostic specimens were obtained in all cases. Five were found to be diffuse iris melanomas and 2 were indeterminate iris melanocytic proliferations. No patients developed a secondary increase in intraocular pressure, hyphema, infection, cataract, or vision loss. No cases of intraocular tumor dissemination were observed. No patient complained of glare or monocular diplopia. Three of 7 corneal wounds were self-sealing. Conclusions Multifocal surgical iridectomy biopsy can be minimally invasive and effective allowing for partial- and full-thickness iris biopsy. Use of a 25-G aspiration cutting probe allowed for small incision surgery, rapid rehabilitation, and no significant complications.
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Zargar S, Prendiville KJ, Martinez E. Iris pigment epithelial cysts in a newborn. GMS OPHTHALMOLOGY CASES 2016; 6:Doc07. [PMID: 27625966 PMCID: PMC5015791 DOI: 10.3205/oc000044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE We report a case of iris pigment epithelial cysts in a newborn and discuss the importance of an accurate diagnosis for prevention of amblyopia. METHODS We describe a case of an abnormal red reflex seen on a newborn exam. RESULTS A full-term female born via normal spontaneous vaginal delivery without any complications was seen in the newborn nursery. She was noted to have an abnormal eye exam. Pupils were large with circular dark excrescences of the iris pigment epithelium. She was referred to a pediatric ophthalmologist where she was noted to fixate and follow faces. No afferent pupillary defect was seen. OD red reflex was normal whereas OS red reflex was blocked mostly by dark excrescences. A 2-3 mm dark brown lesion was seen in the OD iris and a 3-5 mm dark brown lesion was seen in the OS iris, consistent with a pupillary iris pigment epithelial cyst. Central visual axis was clear OU. Glaucoma was not present and patching was not performed. Observations and clinical photographs were recommended with follow-up in three months. CONCLUSION Iris pigment epithelial cysts are uncommonly seen in children. The primary care provider first seeing a newborn must be aware of lesions obscuring a red reflex with appropriate follow-up. Follow-up in three months with IOP measurements is recommended. Iris pigment epithelial cysts in children may be a cause of amblyopia, thus prompt evaluation is important for prognostic purposes and the prevention of amblyopia.
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Affiliation(s)
- Shabnam Zargar
- University of California, Riverside School of Medicine, UCR Health Family Medicine Center, Palm Springs, USA,*To whom correspondence should be addressed: Shabnam Zargar, University of California, Riverside School of Medicine, UCR Health Family Medicine Center, 555 E. Tachevah Dr., 2E-204, Palm Springs, CA 92262, USA, Phone: +1 760-561-7346, Fax: +1 760-257-5553, E-mail:
| | | | - Eladio Martinez
- Instituto Mexicano del Seguro Social, Hospital General Regional no. 1, IMSS Hospital General De Zona N0 6 Tecate, Tecate, Mexico
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Pedro-Aguilar L, Fuentes-Cataño C, Pedroza-Seres M. Ultrasound biomicroscopic analysis of iris cysts. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2016; 91:81-85. [PMID: 26692126 DOI: 10.1016/j.oftal.2015.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 10/13/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To describe the ultrasound biomicroscopic (UBM) features and complications associated with iris cysts. DESIGN A retrospective case series. METHODS Thirteen patients with iris cysts were identified in a 10 year period study at a ophthalmologic reference Center in Mexico City. The variables included demographic data, ocular and medical history, clinical course, and complications. All patients were examined by UBM, and type, number, location, and acoustic characteristics of cysts were evaluated. Descriptive statistics were performed. RESULTS Thirteen patients were included (8 men and 5 women). The mean age was 44.5 ± 15.5 years (range 6-70 years). The origin most prevalent was neuroepithelial (92.3%), and 7.7% had stromal cysts. Regarding to location 76.9% were found in the periphery, and 69.2% between meridians II and VI. All cysts showed a moderate to high reflectivity in the wall. Complications were present in 38.5% of cases (15.4% partial angle closure, 15.4% secondary angle closure glaucoma and 7.7% dyscoria). CONCLUSIONS Most cysts are derived from iris pigmented epithelium, with a benign course and a minor rate of complications. The UBM is an indispensable tool that allows us to plan more specific and conservative treatments, with less damage to ocular structures and, therefore, better visual prognosis.
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Affiliation(s)
- L Pedro-Aguilar
- Departamento de Córnea y Cirugía Refractiva, Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - C Fuentes-Cataño
- Departamento de Inflamación Ocular y Uveítis, Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México
| | - M Pedroza-Seres
- Departamento de Uveítis, Instituto de Oftalmología Fundación Conde de Valenciana, Ciudad de México, México.
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Rivero V, Aparicio MJ, Suárez-Leoz M, Fernández A. Hemovítreo secundario a quiste iridociliar. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2015; 90:600-3. [PMID: 26050937 DOI: 10.1016/j.oftal.2014.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 07/29/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022]
Affiliation(s)
- V Rivero
- Clínica Oftalmológica Suárez-Leoz, Madrid, España.
| | - M J Aparicio
- Clínica Oftalmológica Suárez-Leoz, Madrid, España
| | | | - A Fernández
- Clínica Oftalmológica Suárez-Leoz, Madrid, España
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The Diagnostic and Therapeutic Challenges of Posttraumatic Iris Implantation Cysts: Illustrative Case Presentations and a Review of the Literature. Case Rep Ophthalmol Med 2015; 2015:375947. [PMID: 26347837 PMCID: PMC4549539 DOI: 10.1155/2015/375947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/22/2015] [Accepted: 07/05/2015] [Indexed: 11/17/2022] Open
Abstract
Posttraumatic iris implantation cysts are rare ocular findings that are often associated with poor visual outcomes. Iris implantation cysts can present clinicians with diagnostic and therapeutic challenges given their variable presentations and frequently destructive nature. In this paper, we provide descriptions of two unusual cases of posttraumatic iris implantation cysts. The first case is of a recurrent keratin-filled iris implantation cyst that developed after open globe injury and intraocular implantation of cilia and was treated with cyst debulking procedures, injections of 5-Fluorouracil, and iridocyclectomy. The second case is of recurrent posttraumatic serous iris implantation cysts that were treated with laser, cyst aspiration, and injections of 5-Fluorouracil. We use these cases as a platform to discuss the different manifestations of implantation cysts, the roles of anterior segment optical coherence tomography, ultrasound biomicroscopy, and histopathology in facilitating timely and accurate diagnosis and review the range of available therapeutic modalities. We discuss conservative treatment approaches, including the novel use of 5-Fluorouracil therapy as an adjunct therapy, as well as more aggressive surgical excision requiring ocular reconstruction. Through a discussion of these cases and review of the literature, we provide recommendations to assist clinicians in managing this uncommon but vision-threatening condition and minimizing complications.
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Saakyan SV, Amiryan AG, Valskiy VV, Mironova IS. [Plaque radiotherapy for anterior uveal melanomas]. Vestn Oftalmol 2015; 131:5-12. [PMID: 26080576 DOI: 10.17116/oftalma201513125-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the effectiveness of plaque radiation therapy for anterior uveal melanomas and to evaluate the risk and frequency of complications at different time intervals after the treatment. MATERIAL AND METHODS During 2010-2013 a total of 30 patients (10 male, 20 female) aged 11-73 (50 years on the average) with iris or iridociliary melanomas were treated with Ru-106 and Sr-90 ophthalmic plaques. In 8 patients the brachytherapy was preceded by local tumor excision. Morphological diagnosis was verified in 10 patients (8 iridectomies, 2 enucleations), of them 8 cases turned out to be spindle cell melanomas and the other 2--mixed cell melanomas. Follow-up period ranged from 1 to 54 months with the median of 13,5 months. RESULTS Tumor regression was achieved in all cases. Enucleation had to be performed in 2 patients due to cornea and sclera necrosis. In the early post-brachytherapy period (up to 1 month) the most frequent radiation-related complications were keratopathy and uveitis (8 and 6 patients correspondingly). In patients observed for up to 3 months (28 patients) these were keratopathy and cataract (8 and 5 patients correspondingly). In the long-term (over 6 months) cataract predominated (17 patients). At the end of the study all patients were alive. Metastatic disease was diagnosed in one patient 30 months after the treatment. CONCLUSIONS The results of the present clinical study confirm the effectiveness of brachytherapy for iris and iridociliary melanomas, which implies that tumor is well locally controlled and radiation-related complications are moderate and curable. This method of local tumor destruction can be another alternative to enucleation in cases when local tumor excision cannot be performed.
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Affiliation(s)
- S V Saakyan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - A G Amiryan
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - V V Valskiy
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - I S Mironova
- Moscow Helmholtz Research Institute of Eye Diseases, Ministry of Health of the Russian Federation, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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Alario AF, Pirie CG. Fluorescein gonioangiography of the normal canine eye using a dSLR camera adaptor. Res Vet Sci 2015; 100:277-82. [PMID: 25823859 DOI: 10.1016/j.rvsc.2015.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 03/14/2015] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to describe fluorescein gonioangiography (FGA) of the normal canine eye using a digital single lens reflex (dSLR) camera adaptor. Dogs were anesthetized using intravenous propofol. Imaging was performed using a Lovac Barkan goniolens, dSLR camera, dSLR camera adaptor, camera lens, and accessory flash. Twelve dogs with a mean age of 2.0 +/- 0.8 years were imaged. No characteristic angiographic phases were observed. Leakage from the peri-limbal capillary network was a common finding and occurred 7.7 +/- 2.2 s post injection in 9 (75%) dogs. In 3 (25%) dogs, filling of the circumferential ciliary artery was observed 10.3 +/- 2.8 s post injection. Dye leakage within the iris base and into the aqueous humor was demonstrated in 4 (33%) and 6 dogs (50%) respectively. No adverse events were noted. This study demonstrates FGA findings in normal canine eyes using a cost effective dSLR camera adaptor.
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Affiliation(s)
- Anthony F Alario
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA
| | - Christopher G Pirie
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA, USA.
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Beckwith-Cohen B, Bentley E, Dubielzig RR. Outcome of iridociliary epithelial tumour biopsies in dogs: a retrospective study. Vet Rec 2015; 176:147. [DOI: 10.1136/vr.102638] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Billie Beckwith-Cohen
- The Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), School of Veterinary Medicine, the University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
| | - Ellison Bentley
- Department of Surgical Sciences; School of Veterinary Medicine, The University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
| | - Richard R. Dubielzig
- The Comparative Ocular Pathology Laboratory of Wisconsin (COPLOW), School of Veterinary Medicine, the University of Wisconsin-Madison; 2015 Linden Drive Madison Wisconsin 53706 USA
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López-Arroquia TE, Avendaño-Cantos EM, Mesa-Varona D, Gálvez-Martínez J, López-Romero S, Nuñez-Plascencia R, González del Valle F. Amblyopia secondary to iris cyst. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2014; 89:495-499. [PMID: 24365400 DOI: 10.1016/j.oftal.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 10/30/2013] [Accepted: 11/10/2013] [Indexed: 06/03/2023]
Abstract
CLINICAL CASE A 5 year-old child diagnosed with moderate anisometropic amblyopia secondary to primary cyst of iris pigment epithelium. He was evaluated with ultrasound biomicroscopy (BMU) and optical coherence tomography (OCT) of anterior segment. DISCUSSION The OCT, although with some limitations, is a useful tool to study the anterior segment. It is probably more recommendable than BMU in the childhood.
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Affiliation(s)
- T E López-Arroquia
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España.
| | - E M Avendaño-Cantos
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
| | - D Mesa-Varona
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
| | - J Gálvez-Martínez
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
| | - S López-Romero
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
| | - R Nuñez-Plascencia
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
| | - F González del Valle
- Servicio de Oftalmología, Complejo Hospitalario La Mancha-Centro, Ciudad Real, España
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Hau SC, Papastefanou V, Shah S, Sagoo MS, Restori M, Cohen V. Evaluation of iris and iridociliary body lesions with anterior segment optical coherence tomography versus ultrasound B-scan. Br J Ophthalmol 2014; 99:81-6. [PMID: 25091953 PMCID: PMC4283679 DOI: 10.1136/bjophthalmol-2014-305218] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Aims To compare anterior segment optical coherence tomography (AS-OCT) with ultrasound B-scan (USB) in evaluating iris and iridociliary body lesions. Methods Image features and resolution comparison between AS-OCT and USB in 126 patients (126 eyes) presenting with iris or iridociliary body lesion. Bland–Altman plots were generated to assess the level of agreement between the two techniques. Results The three most common diagnoses were iris naevi (62 (49.2%)), iris pigment epithelial cysts (23 (18.3%)) and iris melanoma (11 (8.7%)). Image feature comparison for USB was better than AS-OCT in visualising all tumour margins (81 (64.3%) vs 59 (46.8%)), posterior tumour margin (54 (42.9%) vs 16 (12.7%)) and producing less posterior shadowing (121 (96%) vs 43 (34.1%)). Image resolution comparison revealed USB to be slightly better for resolving the overall tumour (45 (35.7%) vs 43 (34.1%)) and posterior tumour surface (70 (55.6%) vs 32 (25.4%)) but AS-OCT was better for resolving the anterior (62 (49.2%) vs 4 (3.2%)) and lateral tumour surface (62 (49.2%) vs 31 (24.6%)). Comparing the three most common diagnoses, USB was better for visualising iris pigment epithelial cysts (12 (52.2%) vs 2 (8.7%)) and iris melanoma (7 (63.6%) vs 1 (9.1%)) but AS-OCT was better (28 (45.2%) vs 15 (24.2%)) for visualising iris naevi. Bland–Altman plots showed good agreement between the two techniques for lesions smaller than 3 mm in base and 2 mm in elevation. Conclusions AS-OCT is superior to USB for imaging small lesions pertaining to the anterior iris but USB is better for imaging larger iris lesions with posterior or ciliary body extension.
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Affiliation(s)
- Scott C Hau
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Vasilios Papastefanou
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK Ocular Oncology Service, St. Bartholomew's Hospital, London, UK
| | - Shima Shah
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Mandeep S Sagoo
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK Ocular Oncology Service, St. Bartholomew's Hospital, London, UK UCL Institute of Ophthalmology, London, UK
| | - Marie Restori
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Victoria Cohen
- NIHR Biomedical Research Centre in Ophthalmology Moorfields Eye Hospital NHS Foundation Trust, London, UK Ocular Oncology Service, St. Bartholomew's Hospital, London, UK
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Abstract
A 70-year-old woman presented to the Eye Casualty department with a 10-day history of worsening pain and redness in her right eye, associated with progressively reduced vision. History revealed that the patient had recently completed a course of chemotherapy for metastatic breast cancer. Anterior examination of the right eye revealed a vascularised iris mass causing pupillary distortion, intraocular inflammation and raised intraocular pressure. She was diagnosed with a right iris metastasis secondary to breast cancer. Ocular management consisted of topical steroids and intraocular pressure-lowering agents, which improved her ocular symptoms. She subsequently received primary radiotherapy, which has successfully reduced the size of the tumour.
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Affiliation(s)
- Valerie Juniat
- Ophthalmology Department, Kent & Canterbury Hospital, Canterbury, UK
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Coleman DJ, Silverman RH, Rondeau MJ, Lloyd HO, Daly S. Explaining The Current Role Of High Frequency Ultrasound In Ophthalmic Diagnosis (Ophthalmic Ultrasound). EXPERT REVIEW OF OPHTHALMOLOGY 2014; 1:63-76. [PMID: 20037660 DOI: 10.1586/17469899.1.1.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Ultrasound has become as indispensable as indirect ophthalmoscopy or slit lamp in evaluation of the eye. It is an important adjuvant for the clinical assessment of a variety of ocular and orbital diseases. Advances in instrumentation, higher frequencies and more sensitivity and resolution have resulted in continuous improvement in image quality.Very high frequency ultrasound uses frequencies in the range of 35 to 100 MHz to show greater detail of the anterior segment. Penetration is limited for these higher frequencies to only a few millimeters and thus only the anterior vitreous behind the ciliary body and lens can be imaged. High frequency ultrasound in the range of 20 to 30 MHz has a penetration of about 10 mm and can be used for posterior pole evaluation of the retina and choroid.
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Affiliation(s)
- D Jackson Coleman
- Margaret M. Dyson Vision Research Institute, Department of Ophthalmology, Weill Medical College of Cornell University, New York, NY
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Chiu-Tsao ST, Astrahan MA, Finger PT, Followill DS, Meigooni AS, Melhus CS, Mourtada F, Napolitano ME, Nath R, Rivard MJ, Rogers DWO, Thomson RM. Dosimetry of (125)I and (103)Pd COMS eye plaques for intraocular tumors: report of Task Group 129 by the AAPM and ABS. Med Phys 2012; 39:6161-84. [PMID: 23039655 DOI: 10.1118/1.4749933] [Citation(s) in RCA: 146] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Dosimetry of eye plaques for ocular tumors presents unique challenges in brachytherapy. The challenges in accurate dosimetry are in part related to the steep dose gradient in the tumor and critical structures that are within millimeters of radioactive sources. In most clinical applications, calculations of dose distributions around eye plaques assume a homogenous water medium and full scatter conditions. Recent Monte Carlo (MC)-based eye-plaque dosimetry simulations have demonstrated that the perturbation effects of heterogeneous materials in eye plaques, including the gold-alloy backing and Silastic insert, can be calculated with reasonable accuracy. Even additional levels of complexity introduced through the use of gold foil "seed-guides" and custom-designed plaques can be calculated accurately using modern MC techniques. Simulations accounting for the aforementioned complexities indicate dose discrepancies exceeding a factor of ten to selected critical structures compared to conventional dose calculations. Task Group 129 was formed to review the literature; re-examine the current dosimetry calculation formalism; and make recommendations for eye-plaque dosimetry, including evaluation of brachytherapy source dosimetry parameters and heterogeneity correction factors. A literature review identified modern assessments of dose calculations for Collaborative Ocular Melanoma Study (COMS) design plaques, including MC analyses and an intercomparison of treatment planning systems (TPS) detailing differences between homogeneous and heterogeneous plaque calculations using the American Association of Physicists in Medicine (AAPM) TG-43U1 brachytherapy dosimetry formalism and MC techniques. This review identified that a commonly used prescription dose of 85 Gy at 5 mm depth in homogeneous medium delivers about 75 Gy and 69 Gy at the same 5 mm depth for specific (125)I and (103)Pd sources, respectively, when accounting for COMS plaque heterogeneities. Thus, the adoption of heterogeneous dose calculation methods in clinical practice would result in dose differences >10% and warrant a careful evaluation of the corresponding changes in prescription doses. Doses to normal ocular structures vary with choice of radionuclide, plaque location, and prescription depth, such that further dosimetric evaluations of the adoption of MC-based dosimetry methods are needed. The AAPM and American Brachytherapy Society (ABS) recommend that clinical medical physicists should make concurrent estimates of heterogeneity-corrected delivered dose using the information in this report's tables to prepare for brachytherapy TPS that can account for material heterogeneities and for a transition to heterogeneity-corrected prescriptive goals. It is recommended that brachytherapy TPS vendors include material heterogeneity corrections in their systems and take steps to integrate planned plaque localization and image guidance. In the interim, before the availability of commercial MC-based brachytherapy TPS, it is recommended that clinical medical physicists use the line-source approximation in homogeneous water medium and the 2D AAPM TG-43U1 dosimetry formalism and brachytherapy source dosimetry parameter datasets for treatment planning calculations. Furthermore, this report includes quality management program recommendations for eye-plaque brachytherapy.
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Alario AF, Pirie CG, Pizzirani S. Anterior segment fluorescein angiography of the normal feline eye using a dSLR camera adaptor. Vet Ophthalmol 2012; 16:204-13. [PMID: 22857390 DOI: 10.1111/j.1463-5224.2012.01058.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe anterior segment fluorescein angiography (ASFA) of the normal feline eye using a digital single-lens reflex (dSLR) camera adaptor. ANIMALS Ten cats free of ocular and systemic disease were evaluated. METHODS All cats received maropitant citrate (1.0 mg/kg SQ) and diphenhydramine (2.0 mg/kg SQ) 20 min prior to anesthesia using propofol (4 mg/kg IV bolus, 0.2 mg/kg/min CRI). Standard color and red-free images were obtained prior to the administration of 10% sodium fluorescein (20 mg/kg IV). Imaging was performed using a dSLR camera (Canon 7D), dSLR camera adaptor, camera lens (Canon EF-S 60 mm f/2.8 macro), and an accessory flash (Canon 580EXII). Imaging occurred at a rate of 1/second immediately following IV bolus of sodium fluorescein for a total of 30 s, then at 1, 2, 3, 4, 5, and 10 min. RESULTS Ten cats with an average age of 3.7 ± 0.9 years and various iris colors were imaged. Arterial, capillary, and venous phases occurred 4.6, 7.8, and 8.9 s postinjection, respectively. Visibility of the vasculature was not impaired by the degree of iris pigmentation. Patency of a persistent pupillary membrane was noted in one cat. Vessel leakage was common, as well as, leakage into the aqueous humor. Proper patient positioning and restricted ocular movements were critical. No adverse events were noted. CONCLUSIONS This study demonstrates ASFA findings in normal feline eyes using a cost-effective dSLR camera adaptor. Fluorescein leakage from vessels and into the aqueous humor was a common finding. Visibility of iris vasculature was not impaired by the degree of iris pigmentation.
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Affiliation(s)
- Anthony F Alario
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, MA 01536, USA
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Giuliari GP, Krema H, McGowan HD, Pavlin CJ, Simpson ER. Clinical and ultrasound biomicroscopy features associated with growth in iris melanocytic lesions. Am J Ophthalmol 2012; 153:1043-9. [PMID: 22321804 DOI: 10.1016/j.ajo.2011.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 11/07/2011] [Accepted: 11/08/2011] [Indexed: 10/14/2022]
Abstract
PURPOSE To determine the clinical and ultrasound biomicroscopy (UBM) features associated with growth in iris melanocytic lesions. STUDY DESIGN Retrospective case series analysis. METHODS We included all iris melanocytic lesions that were monitored between January 2005 and November 2009. At the end of the analysis, 44 eyes of 44 patients were included in the final analysis. The clinical features analyzed were: iris color, largest base diameter, radial location of the lesion epicenter, circumferential location of the lesion epicenter, lesion configuration, lesion pigmentation, intrinsic vascularity within the lesion, presence of associated pigmentation, the impact on the pupil, presence of iris atrophy, and lesion-induced localized cataracts. The UBM features included lesion thickness, presence of corneal touch, presence of surface plaque, internal structure, and internal reflectivity. Regression analysis was performed to define the features associated with growth. RESULTS Twenty-three percent of the lesions showed documented growth. Mean follow-up was 21.4 months (range: 10-48). Clinical features associated with growth were a large basal diameter at baseline (P = .004) and inferior location (P = .004). UBM features associated with growth were: a greater baseline thickness (P = .01), presence of corneal touch (P = .007), an irregular internal structure (P = .0001), and the presence of dots and linear streaks (P < .0001). Clinical features that were not associated with growth were the radial location of the lesion in the iris (P > .999), lesion configuration (P > .999), lesion pigmentation (P > .999), the presence of pigment dispersion (P = .70), iris freckles (P = .15), corectopia (P > .999), ectropion (P > .999), and intrinsic vascularity (P = .70). UBM features not associated with growth were the presence of a surface plaque (P = .07) and the internal reflectivity (P = .77). CONCLUSION Substantial growth in iris melanocytic lesions is associated with original larger basal diameter and inferior lesion location. On UBM growth is associated with greater original thickness, presence of corneal touch, and an irregular internal structure. Presence of these features could modify the frequency of observation of those lesions.
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Alario AF, Pirie CG, Pizzirani S. Anterior segment fluorescein angiography of the normal canine eye using a dSLR camera adaptor. Vet Ophthalmol 2012; 16:10-9. [DOI: 10.1111/j.1463-5224.2012.01007.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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A modified COMS plaque for iris melanoma. J Contemp Brachytherapy 2011; 3:131-3. [PMID: 23346122 PMCID: PMC3551354 DOI: 10.5114/jcb.2011.24819] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 07/15/2011] [Accepted: 07/22/2011] [Indexed: 11/17/2022] Open
Abstract
Melanoma of the iris is a rare condition compared to posterior ocular tumors and in this case report we present a 51-year-old female patient with diffuse iris melanoma. Traditional COMS (Collaborative Ocular Melanoma Study) plaques are used at our institution for radiation therapy, so a novel modification of the traditional plaque was required to allow better conformance with placement on the cornea. The usual silastic insert was machined to dimensions in compliance with the cornea, placed without incident, and treatment delivered with excellent patient tolerance of the modified plaque.
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Abstract
PURPOSE To describe the authors' technique and preliminary results using electron beam radiation as rescue therapy for recalcitrant squamous cell carcinoma of the conjunctiva and cornea. METHODS A retrospective review comprised of an interventional case series of patients with pathologically confirmed diagnosis of squamous cell carcinoma of the conjunctiva and cornea, who had failed multiple standard treatments and underwent electron beam radiation therapy. Outcomes, radiation-related complications, and adverse effects were documented. Mortality and local control rates were calculated by the Kaplan-Meier survival probability method. RESULTS Eight patients met the inclusion criteria; of these, 6 (75%) were men and 2 (25%) were women, with ages ranging from 38 to 65 years (mean 50 years). One tumor (12.5%) was classified as T2N0M0, 6 (75%) were classified as T3N0M0, and one (12.5%) was classified as T4N0M0. Follow up from electron beam radiation therapy ranged from 3 to 72 months (mean 30.25 months). The most common side effect was erythema and edema of the eyelids with diffuse transient eyelash loss, seen in all patients. Tumor local control and regression after electron beam radiation therapy were noted in 6 patients (75%); recurrence was noted in 2. There was neither metastatic spread nor tumor-related deaths. CONCLUSIONS The authors report a small case series where local tumor control was achieved with electron beam radiation therapy for recalcitrant squamous cell carcinoma of the conjunctiva and cornea. This approach may be considered for patients who fail conventional therapy.
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Kathil P, Milman T, Finger PT. Characteristics of Anterior Uveal Melanocytomas in 17 Cases. Ophthalmology 2011; 118:1874-80. [DOI: 10.1016/j.ophtha.2011.01.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Revised: 01/25/2011] [Accepted: 01/25/2011] [Indexed: 10/18/2022] Open
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Dorecka M, Miniewicz-Kurkowska J, Michalska-Małecka K, Świątek B, Romaniuk W. Needle aspiration with surgical excision of an epithelial posttraumatic iris cyst--a case report. Med Sci Monit 2011; 17:CS60-2. [PMID: 21525817 PMCID: PMC3539601 DOI: 10.12659/msm.881754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to report on epithelial posttraumatic iris cyst that was successfully treated with needle aspiration and surgical excision with surrounding iris tissue. Case Report A 30-year-old women was treated for a large fluid-filled cyst in the anterior chamber of the left eye; 25 years before, she had an open globe injury. She observed deterioration of her visual acuity 1 year before her visit to our clinic. During ophthalmological examination, an iris cyst was diagnosed. As a result, she had Nd: YAG laser puncture of the cyst in the left eye, performed 5 months before she came to our clinic. After a short time of decompression, the cyst rapidly grew in size (2/3 of the anterior chamber), and her visual acuity was getting worse due to an aggressive growth of the iris cyst. Visual acuity was 0.06. Needle aspiration with surgical excision of the cyst with surrounding iris tissue was performed. Histopathologic examination confirmed an epithelial cyst. At the 1-year follow-up, there was no evidence of recurrence of the iris cyst, and BCVA was 0.2. Conclusions This case report provides evidence that needle aspiration with surgical excision of iris cyst seems to be an effective treatment method of this complication.
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Affiliation(s)
- Mariola Dorecka
- Department of Ophthalmology, University Hospital No5, Medical University of Silesia, Katowice, Poland.
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Abstract
Surgical resection of uveal melanomas is an alternative eye-salvaging approach to the more commonly used irradiation techniques. There are two surgical resection techniques: Transscleral resection or “Exoresection” via a partial lamellar sclerouvectomy and “Endoresection” via a pars plana vitrectomy. While exoresection is more applicable to anteriorly located tumors with ciliary body and/or iris involvement, endoresection is more suitable for posteriorly located tumor without ciliary body involvement. Both approaches are suitable for large tumors with >8 mm in thickness. In general, eyes containing these large tumors have a very dismal prognosis regarding long-term visual function, eye retention, and irradiation-induced side effects. By removing the tumor burden from the eye, histopathologic and cytogenetic information of the tumor is available and complications associated with the so-called toxic tumor syndrome are avoided. However, both types of surgical resection are challenging surgical procedures, bearing the risk of early and late postoperative complications.
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Affiliation(s)
- Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
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Abstract
Iris cysts though uncommon, present diagnostic and therapeutic challenges. With the advent of better investigational modalities it is not so difficult to characterize iris cysts and differentiate them from uveal tumors. Management strategies however, are still not clearly defined and long term course especially of inclusion cysts of the iris remains dismal. In this review we present the classification, pathogenesis, differential diagnosis and management options along with long term clinical course of eyes with iris cysts.
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Affiliation(s)
- Aparna Rao
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
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