1
|
Mazzeo TJMM, Cristina Mendonça Freire R, Guimarães Machado C, Gomes AMV, Curi ALL. Vitreoretinal Surgery in Uveitis: From Old to New Concepts - A Review. Ocul Immunol Inflamm 2024; 32:740-753. [PMID: 37093650 DOI: 10.1080/09273948.2023.2193842] [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: 11/28/2022] [Accepted: 03/16/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this article is to do a comprehensive literature review about the current role of pars plana vitrectomy in uveitis and in its different structural complications such as cystoid macular edema, epiretinal membrane, macular hole, and retinal detachment. METHODS This comprehensive literature review was performed based on a search on PubMed, BioMed Central, Science Open, and CORE databases, of relevant articles abording pars plana vitrectomy in uveitis. DISCUSSION Uveitis is a complex disease with multiple etiologies and pathogenic mechanisms. Therapeutic pars plana vitrectomy (PPV) may aid in uveitic structural complications such as cystoid macular edema, epiretinal membranes, macular hole, and retinal detachments even though some cases may present unpredictable visual outcomes. Diagnostic PPV with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients. CONCLUSION Over the years, pars plana vitrectomy has undergone significant transformations since its invention nearly 5 decades ago, however, the quality of evidence in the literature regarding its use for uveitis has not improved in the same way. Even though some structural uveitis complications (as previously mentioned) may respond well to surgery, there is still a certain unpredictability regarding its visual outcomes. On the other hand, diagnostic vitrectomy with appropriate ancillary testing is also a valuable tool for the assessment and diagnosis of uveitis in a large proportion of patients.
Collapse
Affiliation(s)
| | | | - Cleide Guimarães Machado
- Retina and Vitreous Department, Suel Abujamra Institute, São Paulo, Brazil
- Retina and Vitreous Department, University of São Paulo (USP), São Paulo, Brazil
| | | | - André Luiz Land Curi
- Clinical Research Laboratory of Infectious Diseases in Ophthalmology, National Institute of Infectious Diseases (INI - Fiocruz), Rio de Janeiro, Brazil
| |
Collapse
|
2
|
Hussain RN, Damato B, Heimann H. Choroidal biopsies; a review and optimised approach. Eye (Lond) 2023; 37:900-906. [PMID: 35941182 PMCID: PMC10050311 DOI: 10.1038/s41433-022-02194-0] [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: 03/25/2022] [Revised: 07/11/2022] [Accepted: 07/18/2022] [Indexed: 11/09/2022] Open
Abstract
The majority of choroidal tumours are diagnosed accurately with clinical examination and the additional data obtained from non-invasive imaging techniques. Choroidal biopsies may be undertaken for diagnostic clarity in cases such as small melanocytic or indeterminate lesions, identifying the primary tumour in the case of choroidal metastases or the subclassification of rarer conditions such as uveal lymphoma. There is however an increasing use of biopsy techniques for prognostication in uveal melanoma. This review explores the main indications and surgical techniques for tumour acquisition, and the optimised approach utilised by the current authors to improve successful yield for histological and genetic analysis.
Collapse
Affiliation(s)
- R N Hussain
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK.
| | - B Damato
- Ocular Oncology Service, Moorfields Eye Hospital, London, EC1V 2PD, UK
- NIHR Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
| | - H Heimann
- Liverpool Ocular Oncology Centre, Royal Liverpool Hospital, Liverpool, L7 8XP, UK
| |
Collapse
|
3
|
Gündüz AK, Mirzayev I. Surgical Approach in Intraocular Tumors. Turk J Ophthalmol 2022; 52:125-138. [PMID: 35481734 PMCID: PMC9069084 DOI: 10.4274/tjo.galenos.2021.24376] [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: 12/01/2022] Open
Abstract
Surgery in intraocular tumors is done for excision/biopsy and the management of complications secondary to the treatment of these tumors. Excision/biopsy of intraocular tumors can be done via fine-needle aspiration biopsy (FNAB), transretinal biopsy (TRB), partial lamellar sclerouvectomy (PLSU), and endoresection. FNAB, TRB, and PLSU can be used in tumors that cannot be diagnosed by clinical examination and other ancillary testing methods. PLSU is employed in tumors involving the iridociliary region and choroid anterior to the equator. Excisional PLSU is performed for iridociliary and ciliary body tumors with less than 3 clock hours of iris and ciliary body involvement and choroidal tumors with a base diameter less than 15 mm. However, for biopsy, PLSU can be employed with any size tumor. Endoresection is a procedure whereby the intraocular tumor is excised using vitrectomy techniques. The rationale for performing endoresection is based on the fact that irradiated uveal melanomas may cause complications such as exudation, neovascular glaucoma, and intraocular pigment and tumor dissemination (toxic tumor syndrome), and removing the dead tumor tissue may contribute to better visual outcome. Endoresection is recommended 1-2 weeks after external radiotherapy. Pars plana vitrectomy is also used in the management of complications including vitreous hemorrhage, retinal detachment, and epiretinal membrane that can occur after treatment of posterior segment tumors using radiotherapy and transpupillary thermotherapy. It is important to make sure the intraocular tumor has been eradicated before embarking on such treatment.
Collapse
Affiliation(s)
- Ahmet Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Ibadulla Mirzayev
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| |
Collapse
|
4
|
Gündüz AK, Mirzayev I, Ceyhan K, Özalp Ateş FS. Transretinal biopsy via 23-gauge pars plana vitrectomy for retinal and choroidal tumors: cytopathological results, surgical complications, and patient outcomes. Jpn J Ophthalmol 2021; 65:250-260. [PMID: 33420856 DOI: 10.1007/s10384-020-00795-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 10/09/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the cytopathological results, surgical complications, and patient outcomes after transretinal biopsy (TRB) for diagnosis of retinal/choroidal tumors METHODS: Records of 40 cases who underwent TRB via 23-gauge (23 G) pars plana vitrectomy between March 2011 and March 2020 were reviewed. STUDY DESIGN Retrospective. RESULTS Twenty-six (65.0%) cases were women and 14 (35.0%) were men. The mean age at diagnosis was 57.2 (range: 18-83) years. The mean tumor base diameter was 12.0×9.8 mm and the mean tumor thickness was 4.9 mm. According to cytopathological examination, 29 (72.5%) cases had choroidal melanoma, 2 (5.0%) had non-small cell lung cancer metastasis, 1 (2.5%) had adenoma of retinal pigment epithelium, 1 (2.5%) had small cell lung cancer metastasis, 1 (2.5%) had invasive breast cancer metastasis, 1 (2.5%) had retinal astrocytic hamartoma, and 1 (2.5%) had pseudoneoplastic gliosis. Cytopathological examination of 4 (10.0%) cases revealed findings consistent with macular and extramacular degeneration. Postoperative complications were mild vitreous hemorrhage in 16 (40.0%) cases, gradually worsening cataract in 4 (11.8%), retinal detachment in 1 (2.5%), hyphema in 1 (2.5%), glaucoma in 1 (2.5%), and macular hole in 1 (2.5%). During the mean 11.1 (range: 1-55) months follow-up, 1 (3.4%) patient with choroidal melanoma developed liver metastasis. All patients were alive at the end of follow-up. CONCLUSIONS TRB using 23 G pars plana vitrectomy can be used to make the cytopathologic diagnosis of retinal/choroidal tumors whenever the clinical diagnosis is not certain or in cases with known diagnosis to obtain information on cell type/cytogenetics. In our series, the most common diagnosis after cytopathologic examination was choroidal melanoma.
Collapse
Affiliation(s)
- Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey. .,Private Office, Farilya Business Center, 8/38, Ufuk Universitesi Cad, Çukurambar, 06510, Ankara, Turkey.
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Koray Ceyhan
- Departmant of Cytology, Ankara University Faculty of Medicine, Ankara, Turkey
| | | |
Collapse
|
5
|
Klofas LK, Bogan CM, Coogan AC, Schultenover SJ, Weiss VL, Daniels AB. Instrument Gauge and Type in Uveal Melanoma Fine Needle Biopsy: Implications for Diagnostic Yield and Molecular Prognostication. Am J Ophthalmol 2021; 221:83-90. [PMID: 32818452 PMCID: PMC8117558 DOI: 10.1016/j.ajo.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To systematically evaluate and compare the effects of using small-gauge needles and vitrectors on the ability to obtain adequate diagnostic and prognostic uveal melanoma biopsy specimens. DESIGN Comparative evaluation of biopsy instruments. METHODS Survival of uveal melanoma cells was evaluated in vitro following needle aspiration. Five therapeutically enucleated eyes were sampled in triplicate for ex vivo diagnostic biopsy experiments with 25 gauge (25 G) needle, 27 gauge (27 G) needle, and 27 G vitrector. During surgery in 8 patients, paired diagnostic transscleral fine needle aspiration biopsies were performed using both 25 G and 27 G needles. A review of cytologic specimens was performed by a panel of 3 expert cytopathologists. A retrospective chart review was performed to evaluate 100 consecutive tumors undergoing prognostic biopsy for gene expression profiling to assess the relationship between needle gauge and prognostic adequacy. RESULTS No significant cell shearing of uveal melanoma cells occurred in vitro with 25 G, 27 G, or 30 G needles. For ex vivo biopsy samples, diagnostic yield was 100% using 25 G needle (5/5) or 27 G vitrector (5/5) but 60% using a 27 G needle (3/5). For in vivo samples, no difference in diagnostic yield was found between 25 G (75%, 6/8) or 27 G (75%, 6/8) needle sizes. Of 100 molecular prognostic biopsy samples evaluated, 65 were obtained using 27 G needles; for these biopsies, the prognostic yield was 65/65 (100%). CONCLUSIONS For diagnostic biopsy of uveal melanoma, a larger-gauge needle or a 27 G vitrector may have better overall cellularity and diagnostic yield when compared to a 27 G needle. However, for much more common molecular prognostic testing, a 27 G needle provided adequate sample in 100% (65/65) of cases, and a larger needle provided no additional benefit.
Collapse
Affiliation(s)
- Lindsay K Klofas
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Carley M Bogan
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alice C Coogan
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Schultenover
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vivian L Weiss
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.
| |
Collapse
|
6
|
Large Choroidal Melanocytoma Simulating Choroidal Melanoma: A Difficult Differential Diagnosis and an Inevitable Enucleation. Case Rep Ophthalmol Med 2020; 2020:8890857. [PMID: 33294243 PMCID: PMC7700045 DOI: 10.1155/2020/8890857] [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: 07/24/2020] [Revised: 11/08/2020] [Accepted: 11/15/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe a case of choroidal melanocytoma mimicking a melanoma. Methods Retrospective case report. Patient. A 48-year-old Moroccan woman presented with progressive, painless decreased vision in her left eye for 2 months. Results Her visual acuity was light perception in the left eye and 20/20 in the right one. Fundus examination and fluorescein angiography of the left eye showed a total retinal detachment with a large superior brownish mass. The clinical examination, B-scan ultrasonography, and magnetic resonance imaging all suggested a malignant melanoma. Consequently, the eye was enucleated. The histopathology later revealed a benign melanocytoma of the choroid. Discussion. Melanocytoma is a rare benign pigmented tumor. It is classically described as a tumor of the optic nerve head, but there are some exceptional case reports of uveal tract locations (iris, ciliary body, and choroid). In such cases, it can be difficult to clinically differentiate a melanocytoma from a malignant melanoma.
Collapse
|
7
|
Frizziero L, Midena E, Trainiti S, Londei D, Bonaldi L, Bini S, Parrozzani R. Uveal Melanoma Biopsy: A Review. Cancers (Basel) 2019; 11:cancers11081075. [PMID: 31366043 PMCID: PMC6721328 DOI: 10.3390/cancers11081075] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/18/2019] [Accepted: 07/25/2019] [Indexed: 12/11/2022] Open
Abstract
Intraocular tumor diagnosis is based on clinical findings supported by additional imaging tools, such as ultrasound, optical coherence tomography and angiographic techniques, usually without the need for invasive procedures or tissue sampling. Despite improvements in the local treatment of uveal melanoma (UM), the prevention and treatment of the metastatic disease remain unsolved, and nearly 50% of patients develop liver metastasis. The current model suggests that tumor cells have already spread by the time of diagnosis, remaining dormant until there are favorable conditions. Tumor sampling procedures at the time of primary tumor diagnosis/treatment are therefore now commonly performed, usually not to confirm the diagnosis of UM, but to obtain a tissue sample for prognostication, to assess patient's specific metastatic risk. Moreover, several studies are ongoing to identify genes specific to UM tumorigenesis, leading to several potential targeted therapeutic strategies. Genetic information can also influence the surveillance timing and metastatic screening type of patients affected by UM. In spite of the widespread use of biopsies in general surgical practice, in ophthalmic oncology the indications and contraindications for tumor biopsy continue to be under debate. The purpose of this review paper is to critically evaluate the role of uveal melanoma biopsy in ophthalmic oncology.
Collapse
Affiliation(s)
- Luisa Frizziero
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy
| | - Edoardo Midena
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy.
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy.
| | - Sara Trainiti
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | - Davide Londei
- Department of Ophthalmology, University of Padova, 35128 Padova, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico, 35128 Padova, Italy
| | - Silvia Bini
- IRCCS-Istituto di Ricovero e Cura a Carattere Scientifico-Fondazione Bietti, 00198 Rome, Italy
| | | |
Collapse
|
8
|
|
9
|
Bagger MM. Intraocular biopsy of uveal melanoma Risk assessment and identification of genetic prognostic markers. Acta Ophthalmol 2018; 96 Suppl A112:1-28. [PMID: 30133961 DOI: 10.1111/aos.13858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Mette Marie Bagger
- Departments of Clinical Genetics and Ophthalmology; Rigshospitalet Blegdamsvej; Copenhagen University Hospital; Copenhagen Denmark
| |
Collapse
|
10
|
A CASE OF RETINAL METASTASIS OF LARYNGEAL SQUAMOUS CELL CARCINOMA WITH HISTOPATHOLOGIC CONFIRMATION BY VITRECTOMY-ASSISTED EN BLOCK EXTRACTION. Retin Cases Brief Rep 2017; 14:127-130. [PMID: 29210965 DOI: 10.1097/icb.0000000000000666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE To present a case report of retinal metastasis of laryngeal squamous cell carcinoma that was diagnosed by a histopathologic finding from the surgically extracted tumor tissue. METHODS A 66-year-old man, who was suffered from the treatment-resistant laryngeal carcinoma, was referred to our department because of visual field defect in his right eye. A fundus examination revealed a parafoveal white retinal lesion, which rapidly expanded to the central fovea and decreased the visual acuity. A tissue extraction by 27G pars plana vitrectomy was performed to confirm the diagnosis. RESULTS The abnormal retinal tissue was extracted en block through 10-mm sclerocorneal tunnel during pars plana vitrectomy. The histopathologic findings revealed that the retinal lesion was retinal metastasis of laryngeal carcinoma. CONCLUSION We must keep in mind that retinal metastasis can be one of the differential diagnoses for white retinal lesions of unknown cause.
Collapse
|
11
|
Koch KR, Hishmi AM, Ortmann M, Heindl LM. Uveal Melanoma Cell Seeding after Transretinal Tumor Biopsy? Ocul Oncol Pathol 2017; 3:164-167. [PMID: 29071267 DOI: 10.1159/000453360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/10/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To report a case and the histopathology of uveal melanoma cell seeding following transretinal tumor biopsy for a suspected uveal lesion. METHODS Interventional case report. RESULTS A 66-year-old male presented with a pigmented perilimbal episcleral lesion overlying an intraocular mass at the pars plana, 3.5 years after transretinal biopsy and ruthenium plaque brachytherapy for a choroidal melanoma at the posterior pole. The patient underwent enucleation of the eye. Histopathology confirmed a recurrence of uveal melanoma with intra- and extrascleral tumor portions. Serial sections revealed the posterior border of this newfound pars plana melanoma separated from the radiation scar by a viable and tumor-free choroidal area, thus failing to establish a continuity between secondary and primary tumor. CONCLUSION Transretinal tumor biopsy is of high diagnostic and prognostic value in the management of uveal lesions, but also bears the potential risk for tumor cell seeding.
Collapse
Affiliation(s)
- Konrad R Koch
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Ahmed M Hishmi
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Monika Ortmann
- Department of Pathology, University of Cologne, Cologne, Germany
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| |
Collapse
|
12
|
Grewal DS, Cummings TJ, Mruthyunjaya P. Outcomes of 27-Gauge Vitrectomy-Assisted Choroidal and Subretinal Biopsy. Ophthalmic Surg Lasers Imaging Retina 2017; 48:406-415. [PMID: 28499052 DOI: 10.3928/23258160-20170428-07] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 02/22/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the initial experience of 27-gauge vitrectomy-assisted choroidal and subretinal biopsy PATIENTS AND METHODS: Retrospective, interventional case series. Eighteen eyes of 18 patients undergoing 27-gauge vitrectomy-assisted choroidal (n = 16) or subretinal biopsy (n = 2). Clinical and lesion characteristics, cytopathology, histology, gene expression profiling (GEP), visual acuity (VA), complications including vitreous hemorrhage (VH), development of rhegmatogenous retinal detachment (RD), and need for additional surgeries were analyzed. RESULTS Indications were choroidal melanoma (n = 10), indeterminate choroidal (n = 5), and subretinal lesions (n = 3). Mean lesion height was 3.33 mm ± 1.55 mm (range: 0.80 mm to 6.75 mm) and largest diameter was 8.63 mm ± 4.14 mm (range: 3 mm to 15.5 mm). Mean number of intralesional biopsy passes required was 1.76 ± 0.83 (range: one to four). During a mean follow-up of 7.4 months ± 2.7 months (range: 4 months to 14 months), VA was unchanged (0.5 logMAR ± 0.6 logMAR vs. 0.7 logMAR ± 0.84 logMAR; P = .07). Pathologic diagnosis was obtained in 16 of 18 eyes (88.9%), and GEP data were collected for all 11 choroidal melanomas. Post-biopsy VH occurred in 13 of 18 eyes (72.2%) and was severe enough to require a concurrent limited vitrectomy in six eyes (33.3%). These eyes had a greater lesion height compared to eyes not requiring a vitrectomy (4.08 mm ± 1.68 mm vs. 2.76 mm ± 1.43 mm; P = .04). A rhegmatogenous RD requiring repeat surgery developed in two of 18 eyes (11.1%). CONCLUSION The authors concluded that 27-gauge vitrectomy-assisted choroidal and subretinal biopsy established a diagnosis in 88.9% of eyes in lesions 0.8 mm or larger. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:406-415.].
Collapse
|
13
|
VITRECTOMY-ASSISTED BIOPSY FOR MOLECULAR PROGNOSTICATION OF CHOROIDAL MELANOMA 2 MM OR LESS IN THICKNESS WITH A 27-GAUGE CUTTER. Retina 2017; 37:1377-1382. [DOI: 10.1097/iae.0000000000001362] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
14
|
The Histopathological Finding of the Surgically Extracted Atypical Dome-Shaped Choroidal Osteoma. Case Rep Ophthalmol Med 2017; 2017:2874823. [PMID: 28396814 PMCID: PMC5370480 DOI: 10.1155/2017/2874823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/08/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose. To report a case of atypical dome-shaped choroidal osteoma, which was diagnosed by histopathological finding of surgically extracted tumor. Case Report. A 35-year-old woman presented with visual field abnormality in the left eye (OS). Her best-corrected visual acuity with Landolt ring chart was 1.0 OS. The funduscopic examination revealed a yellowish dome-shaped choroidal tumor located in the temporal side of the macula with exudative retinal detachment. 25-gauge pars plana vitrectomy and the extraction of the tumor were performed for the definitive diagnosis. Results. As a result of histopathological finding from the extracted tumor, she was diagnosed with choroidal osteoma. 10 months after the last surgery, the BCVA is 0.7 OS. The tumor is not relapsed. Conclusions. We must keep in mind that choroidal osteoma can be one of the differential diagnoses for the dome-shaped choroidal tumor.
Collapse
|
15
|
van den Bosch T, Vaarwater J, Verdijk R, Muller K, Kiliç E, Paridaens D, de Klein A, Naus N. Risk factors associated with secondary enucleation after fractionated stereotactic radiotherapy in uveal melanoma. Acta Ophthalmol 2015; 93:555-60. [PMID: 25879399 DOI: 10.1111/aos.12731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 03/01/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To evaluate risk factors for secondary enucleation after fractionated stereotactic radiotherapy (fSRT) in uveal melanoma. METHODS In this retrospective study, clinical data of 118 consecutive patients who had initially been treated with fSRT between 1999 and 2009 were collected and analysed. The patients who had undergone secondary enucleation were identified and examined for clinical, histopathological and cytogenetical (fluorescence in situ hybridization determined) data. Also, the reasons for secondary enucleation, such as treatment failure (progressive tumour growth or tumour recurrence) or complications following fSRT (painful blind eye), were recorded and examined. RESULTS The secondary enucleation rate was 16% after a median follow-up of 4.7 years, with 5% due to treatment failure and 11% due to complications. In the univariate analysis, large tumour diameter (p = 0.019) and large tumour height (p = 0.001) were associated with secondary enucleation, tumour involvement of the optic disc showed borderline significance (p = 0.068). Cox regression multivariate analysis displayed large tumour height as independent prognostic factor (HR 1.42, 95% CI 1.12-1.81, p = 0.004). Following secondary enucleation, mitotic figures were present in five of 18 tumours, and gain of chromosome 8q was also present in five tumours. Within the subgroup of patients who required secondary enucleation due to failed tumour control by fSRT (N = 6), mitotic figures were present in four of six tumours while gain of 8q was present in three of six tumours. CONCLUSION Secondary enucleation after previous fSRT was associated with large tumour height. High mitotic counts and gain of chromosome 8q were frequently found in secondary enucleations and possibly indicate a more aggressive or radiation-resistant tumour.
Collapse
Affiliation(s)
| | - Jolanda Vaarwater
- Department of Clinical Genetics, Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Rob Verdijk
- Department of Pathology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Karin Muller
- Department of Radiotherapy; Deventer Hospital; Deventer The Netherlands
| | - Emine Kiliç
- Department of Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Dion Paridaens
- Ocular Oncology; Rotterdam Eye Hospital; Rotterdam The Netherlands
- Department of Ophthalmology; Geneva University Hospitals; Geneva Switzerland
| | - Annelies de Klein
- Department of Clinical Genetics; Erasmus University Medical Center; Rotterdam The Netherlands
| | - Nicole Naus
- Department of Ophthalmology; Erasmus University Medical Center; Rotterdam The Netherlands
| |
Collapse
|
16
|
Vitreoretinal Surgery for Complications of Choroidal Tumor Biopsy. Ophthalmology 2014; 121:2482-8. [DOI: 10.1016/j.ophtha.2014.06.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 05/19/2014] [Accepted: 06/18/2014] [Indexed: 11/18/2022] Open
|
17
|
Bagger M, Tebering JF, Kiilgaard JF. The Ocular Consequences and Applicability of Minimally Invasive 25-Gauge Transvitreal Retinochoroidal Biopsy. Ophthalmology 2013; 120:2565-2572. [DOI: 10.1016/j.ophtha.2013.07.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/22/2013] [Accepted: 07/26/2013] [Indexed: 02/01/2023] Open
|