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Schittkowski MP, Weiss N. [Ocular prosthetics in children-Possibilities and challenges]. DIE OPHTHALMOLOGIE 2023; 120:139-149. [PMID: 36662298 DOI: 10.1007/s00347-022-01794-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/13/2022] [Indexed: 01/21/2023]
Abstract
One of the greatest challenges for ocularists is prosthetic fitting in children, especially in children with congenital anomalies such as clinical anophthalmia or functionless (blind) microphthalmia. The most frequent reason for prosthetic fitting in children is a condition following enucleation for retinoblastoma, followed by trauma and congenital pathologies. The standard treatment after enucleation or evisceration begins intraoperatively with the selection of an suitable implant and the use of a conformer at the end of the operation to shape the prosthetic cavity. An initial prosthesis can be fitted 4 weeks postoperatively, with a final fitting taking place 3 months later. If iatrogenic scarring or scarring due to an infection of the prosthetic cavity occurs, the approach of the ocularist must be appropriately adapted with the use of modified prosthesis shapes and shorter treatment intervals. Surgical options include scar excision and oral mucosa or amniotic membrane transplantation. Congenital anomalies require the shortest treatment intervals and even more so for anophthalmia than for microphthalmia. The strategy is characterized by simultaneous stimulation of the soft tissue of the ocular adnexa as well as the bony orbit. As self-inflating hydrogel expanders are no longer available, conservative prosthetic treatment is the only option. Close cooperation between child/parent, ocularist and ophthalmic plastic surgeon is the best prerequisite for a good long-term treatment outcome.
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Affiliation(s)
- Michael P Schittkowski
- Abteilung Augenheilkunde, Bereich Strabologie, Neuroophthalmologie und okuloplastische Chirurgie, Universitätsmedizin Göttingen, R.-Koch-Str. 40, 37085, Göttingen, Deutschland.
| | - Nikolai Weiss
- Institut für künstliche Augen, Friedrich-Ebert-Str. 116, 34119, Kassel, Deutschland
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Kopsidas K, Mudhar H, Sisley K, Hammond DW, Worthington L, Suvarna K, Foran B, Salvi S. Aggressive Ciliary Body Adenocarcinoma with Bilateral Lung Metastases: Histological, Molecular, Genetic and Clinical Aspects. Ocul Oncol Pathol 2018; 5:79-84. [PMID: 30976584 DOI: 10.1159/000487805] [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: 12/06/2017] [Revised: 02/13/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose of the Study To describe the clinical and histopathological features of an aggressive ciliary body adenocarcinoma with pulmonary metastases and skull base spread. Procedures and Results A 45-year-old female patient presented with a post-traumatic phthisical eye that was eviscerated. This showed an unexpected carcinoma (positive for cytokeratins and melanocytic markers), the histological differential diagnosis for which included a primary ciliary body adenocarcinoma or a metastasis. The patient developed rapid post-surgical localized recurrence that required an orbital exenteration. This showed identical tumour to the evisceration specimen, with vascular invasion in orbital blood vessels and a contaminated orbital soft tissue margin. Staging imaging revealed multiple lung metastases, which were biopsied and shown to be a disseminated ciliary body adenocarcinoma rather than a disseminated primary lung carcinoma. The tumour spread locally to the skull base for which radiotherapy was given. Unfortunately, the patient passed away a few weeks later. Conclusions To our knowledge, this is the first case of ciliary body adenocarcinoma with bilateral lung metastases. The malignant potential of these tumours should be considered as a possibility, and appropriate screening and staging tests should therefore be considered to guide appropriate management.
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Affiliation(s)
- Konstantinos Kopsidas
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Hardeep Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Karen Sisley
- Academic Unit of Ophthalmology and Orthoptics, Department of Oncology and Metabolism, University of Sheffield, the Medical School Sheffield, Sheffield, United Kingdom
| | - David W Hammond
- Academic Unit of Ophthalmology and Orthoptics, Department of Oncology and Metabolism, University of Sheffield, the Medical School Sheffield, Sheffield, United Kingdom
| | - L Worthington
- Academic Unit of Ophthalmology and Orthoptics, Department of Oncology and Metabolism, University of Sheffield, the Medical School Sheffield, Sheffield, United Kingdom.,Sheffield Hallam University, Sheffield, United Kingdom
| | - Kim Suvarna
- Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Bernadette Foran
- Department of Clinical Oncology, Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Sachin Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Brownstein S, Jastrzebski A, Saleh S, Jordan DR, Gilberg SM, Leonard BC, Hurley BR. Unsuspected and misdiagnosed posterior uveal melanoma following enucleation and evisceration in Ottawa-Gatineau. Can J Ophthalmol 2018; 53:155-161. [PMID: 29631828 DOI: 10.1016/j.jcjo.2017.07.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 05/03/2017] [Accepted: 07/21/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVE There is a gap in the recent literature on the topic of clinically misdiagnosed and unsuspected posterior uveal melanomas (PUM) with a calculation of the frequency of these events for a specific geographical area. As the only ophthalmic pathology laboratory in our region, we determined the rate of these outcomes over a 16-year period. METHODS We retrospectively reviewed 2558 consecutive ophthalmic pathologic specimens in the Ottawa-Gatineau region, of which 334 were eviscerations and 227 were enucleations. We calculated the frequency of clinically misdiagnosed PUM and of clinically unsuspected PUM. We also determined the rate of uveal melanoma undergoing enucleation. RESULTS From 100 diagnoses of PUM, 2 (2.0%) cases were clinically unsuspected and 2 (2.0%) cases were clinically misdiagnosed. The rate of uveal melanoma undergoing enucleation was 5.6 cases per 1 000 000 of population per annum. From 2009 to 2012, the incidence of this event was 3.8 cases per 1 000 000 per annum, which was lower than the previous three 4-year increments. CONCLUSIONS We present the first and only single-centred, population-based data on the rates of unsuspected PUM and of clinical misdiagnosis of PUM in the era of modern diagnostic imaging. Our rate of clinical misdiagnosis is within the range of recent reports of this event. Unsuspected PUM occurred at a rate substantially lower than previously published. The incidence of uveal melanoma undergoing enucleation has decreased despite an increase in population, which reflects a shift in management from enucleation to radiation therapy.
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Affiliation(s)
- Seymour Brownstein
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont..
| | - André Jastrzebski
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Solin Saleh
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont; Department of Pathology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - David R Jordan
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Steven M Gilberg
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Brian C Leonard
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
| | - Bernard R Hurley
- Department of Ophthalmology, University of Ottawa, The Ottawa Hospital, the Ottawa Hospital Research Institute, Ottawa, Ont
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Abstract
This article explores the range of tumor specimens that may be submitted to ophthalmic pathology. The handling of complex enucleation and exenteration is described along with smaller eyelid, conjunctival and corneal specimens. The importance of a good understanding of the unique anatomy of the ocular region and detailed clinical information is emphasized as this results in the taking of appropriate blocks for histology and consequently clinically helpful reports. Recommendations for handling specimens where further tissue is required for molecular studies is discussed.
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Affiliation(s)
- Fiona Roberts
- Department of Pathology, Queen Elizabeth University Hospital, Govan Rd, Glasgow G51 4 TF, United Kingdom.
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