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Arun K, Din N, Stanford M, Cosgrove V, Bizrah M. Fluctuating hypermetropia due to intraocular lens displacement caused by iris pigment epithelial cyst. Am J Ophthalmol Case Rep 2024; 34:102065. [PMID: 38766651 PMCID: PMC11101700 DOI: 10.1016/j.ajoc.2024.102065] [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] [Received: 01/25/2024] [Revised: 04/11/2024] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To report a case of hyperopic shift following lens replacement surgery due to an enlarging iris pigment epithelial (IPE) cyst. Observations A gentleman presented with reduced visual acuity (Snellen unaided 20/25) 12 months followed lens replacement surgery. Examination revealed a retro-pupillary iris lesion that appeared to be displacing the posterior chamber intraocular lens (IOL) and was causing a hyperopic shift (refraction +2.00). Anterior segment optical coherence tomography imaging confirmed this to be an IPE cyst with a posteriorly displaced IOL body. After observation over 30 months, the IPE cyst spontaneously reduced in size and the IOL returned to a more physiological position. Unaided visual acuity improved to Snellen 20/16 and refraction improved to +0.50. Conclusions and Importance To our knowledge, an IPE cyst that shows growth following intraocular surgery has not previously been reported. This growth resulted in a hyperopic shift due to posterior displacement of the IOL. This case demonstrates spontaneous regression of the cyst, and suggests that over time these cysts can change in size.
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Affiliation(s)
- Kirupakaran Arun
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, United Kingdom
| | - Nizar Din
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, United Kingdom
| | - Miles Stanford
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, United Kingdom
| | - Victoria Cosgrove
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, United Kingdom
| | - Mukhtar Bizrah
- Imperial College Healthcare NHS Trust, Western Eye Hospital, 153-173 Marylebone Road, London, NW1 5QH, United Kingdom
- Harley Vision, St John & St Elizabeth Hospital, 60 Grove End Rd, London, United Kingdom
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Zheng Y, Gu X, Yao Y, Pan H, Jia R, Xu X, Zhuang A. Adenomas of the ciliary body epithelium: clinics, histopathology and management. Br J Ophthalmol 2024; 108:826-832. [PMID: 37433648 DOI: 10.1136/bjo-2023-323845] [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: 04/29/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023]
Abstract
AIMS Adenomas of the ciliary body epithelium, including adenoma of the pigmented ciliary body epithelium (APCE) and adenoma of the non-pigmented ciliary body epithelium (ANPCE), are extremely rare, and most knowledge about them comes from sporadic case reports. The purpose of this study was to provide a comprehensive understanding of adenomas of the ciliary body epithelium and to identify the similarities and differences between APCE and ANPCE. METHODS This study was a retrospective case series comprising data from 41 patients obtained from retrieved publications and five cases diagnosed at the Shanghai Ninth People's Hospital. The clinicopathological features, treatment and prognosis of APCE and ANPCE were compared using the non-parametric rank sum test, t-test and the χ2 test. RESULTS The clinical and histopathological features and treatment were analogous between APCE (n=23) and ANPCE (n=23). The overall visual prognosis associated with the two tumours was good, with 63% of the patients having stable or improved vision after treatment. Enucleation was the primary cause of eventual vision loss (three in APCE vs two in ANPCE, p=0.001). Notably, iris invasion was commonly observed in patients with APCE (six in APCE vs zero in ANPCE, p=0.014), and iris invasion was associated with decreased vision eventually (p=0.003). Tumour size was irrelevant to the vision outcome (p=0.65). Metastasis or recurrence did not occur in any of the patients. CONCLUSION In most cases, the clinicopathological features of ANPCE and APCE were similar. Iris invasion was commonly observed in patients with APCE, which was associated with poor visual prognosis.
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Affiliation(s)
- Yue Zheng
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiang Gu
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yiran Yao
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Hui Pan
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiaofang Xu
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Ai Zhuang
- Department of Ophthalmology, Shanghai Jiao Tong University School of Medicine Affiliated Ninth People's Hospital, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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Mirzayev I, Gündüz AK, Gündüz ÖÖ, Özalp Ateş FS, Okcu Heper A. Anterior segment swept-source optical coherence tomography and ultrasound biomicroscopy in iris and ciliary body lesions. Expert Rev Med Devices 2024; 21:439-446. [PMID: 38803101 DOI: 10.1080/17434440.2024.2344668] [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: 12/14/2023] [Accepted: 02/06/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Differentiation of iris and ciliary body lesions as benign or malignant and cystic or solid is important. The aim of this study was to compare anterior segment swept-source optical coherence tomography (AS SS-OCT) and ultrasound biomicroscopy (UBM) findings in iris and ciliary body tumors. RESEARCH DESIGN AND METHODS Forty-two eyes of 38 cases with iris and ciliary body tumors imaged with UBM and AS SS-OCT between September 2018 and September 2023 were evaluated retrospectively. RESULTS Of 42 eyes, 14 had melanoma, 14 iris pigment epithelial (IPE) cysts, 7 nevi, 3 Lisch nodules, 2 iris stromal cysts, 1 pars plana cysts, and 1 iris mammillations. An equivalent (100%) visualization of the anterior tumor margin was obtained with both techniques. Compared to AS SS-OCT, UBM was superior for posterior margin visualization in melanocytic tumors and IPE cysts. Bland-Altman plots demonstrated good agreement between UBM and AS SS-OCT for melanocytic tumors < 2.5 mm in base diameter and < 2 mm in thickness. CONCLUSIONS Although, UBM is the gold standard for ciliary body and iridociliary tumors. AS SS-OCT should be considered as an excellent alternative to UBM, especially in minimally elevated iris lesions.
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Affiliation(s)
- Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Halil Şıvgın Çubuk State Hospital, Ophthalmology Clinic, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Private Eye Clinic, Ankara, Turkey
| | - Ömür Özlenen Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Funda Seher Özalp Ateş
- Department of Biostatistics and Medical Informatics, Manisa Celal Bayar University Faculty of Medicine, Manisa, Turkey
| | - Aylin Okcu Heper
- Department of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
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4
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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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Weis E, Surgeoner B, Salopek TG, Cheng T, Hyrcza M, Kostaras X, Larocque M, McKinnon G, McWhae J, Menon G, Monzon J, Murtha AD, Walker J, Temple-Oberle C. Management of Uveal Melanoma: Updated Cancer Care Alberta Clinical Practice Guideline. Curr Oncol 2023; 31:24-41. [PMID: 38275828 PMCID: PMC10814960 DOI: 10.3390/curroncol31010002] [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: 09/25/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
OBJECTIVE The purpose of this guideline update is to reassess and update recommendations in the prior guideline from 2016 on the appropriate management of patients with uveal melanoma. METHODS In 2021, a multidisciplinary working group from the Provincial Cutaneous Tumour Team, Cancer Care Alberta, Alberta Health Services was convened to update the guideline. A comprehensive review of new research evidence in PubMed as well as new clinical practice guidelines from prominent oncology groups informed the update. An enhancement in methodology included adding levels of evidence and strength of recommendations. The updated guideline was circulated to all members of the Provincial Cutaneous Tumour Team for review and endorsement. RESULTS New and modified recommendations address provider training requirements, diagnostic imaging for the detection of metastases, neo-adjuvant pre-enucleation radiotherapy, intravitreal anti-vascular endothelial growth factor agents for radiation retinopathy, genetic prognostic testing, surveillance following definitive local therapy, and systemic therapy for patients with metastatic uveal melanoma. DISCUSSION The recommendations represent evidence-based standards of care agreed to by a large multidisciplinary group of healthcare professionals.
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Affiliation(s)
- Ezekiel Weis
- Department of Ophthalmology, University of Alberta, Edmonton, AB T6G 2E1, Canada
- Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Brae Surgeoner
- Cancer Care Alberta, Calgary, AB T2S 3C3, Canada; (B.S.); (X.K.)
| | - Thomas G. Salopek
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada;
| | - Tina Cheng
- Tom Baker Cancer Center, Division of Medical Oncology, Department of Oncology, Calgary, AB T2N 4N2, Canada; (T.C.); (J.M.)
| | - Martin Hyrcza
- Laboratory Medicine, Department of Pathology, Arnie Charbonneau Cancer Institute, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | | | - Matthew Larocque
- Division of Medical Physics, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (M.L.); (G.M.)
| | - Greg McKinnon
- Division of Surgical Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (G.M.); (C.T.-O.)
| | - John McWhae
- Departments of Surgery and Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada;
| | - Geetha Menon
- Division of Medical Physics, Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1Z2, Canada; (M.L.); (G.M.)
| | - Jose Monzon
- Tom Baker Cancer Center, Division of Medical Oncology, Department of Oncology, Calgary, AB T2N 4N2, Canada; (T.C.); (J.M.)
| | - Albert D. Murtha
- Division of Radiation Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada
| | - John Walker
- Division of Medical Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB T6G 1Z2, Canada;
| | - Claire Temple-Oberle
- Division of Surgical Oncology, University of Calgary, Calgary, AB T2N 1N4, Canada; (G.M.); (C.T.-O.)
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Abstract
Objectives: To report the clinical and demographic characteristics, imaging findings, treatment results, and follow-up data of patients with iris cysts. Materials and Methods: The medical records of 37 patients with iris cysts were retrospectively analyzed. Ultrasound biomicroscopy (UBM), swept-source optical coherence tomography (SS-OCT), and SS-OCT angiography (SS-OCTA) were performed to examine the iris cysts. Results: The mean age of the patients was 34.4 years, ranging from 5 to 85 years. Twenty-four patients (65%) were female and 13 (35%) were male. Mean follow-up period was 21.3 months, ranging from 4 months to 8 years. Thirty-five (94.5%) of the cysts were classified as primary and 2 (4.5%) were classified as secondary. Thirty-one (83.7%) of the primary cysts were pigment epithelial and 4 were stromal. Primary iris pigment epithelial cysts were classified as peripheral in 26 patients (72.2%), midzonal in 4 (11.1%), and dislodged in 1 (2.7%). Stromal cysts were classified as acquired in 3 patients (8.1%) and congenital in 1 patient (2.7%). Secondary iris cysts were caused by perforating eye injury. UBM could visualize both the anterior and posterior surfaces of the cysts (26 patients). Anterior segment SSOCT could visualize the anterior but not the posterior surface of the cysts (4 patients). Iris cysts did not display intrinsic vascularity on SS-OCTA (4 patients). All pigment epithelial cysts were managed by observation. Of the 4 primary stromal cysts, 3 were managed by surgical excision and 1 by observation. Two secondary cysts required surgical removal. Conclusion: Pigment epithelial cysts generally remain stable without need for treatment. However, iris stromal cysts frequently require surgical intervention. UBM and SS-OCT were valuable in the diagnosis of iris cysts. On UBM, iris cysts appear with a thin, hyperechoic wall with hypoechoic internal content. Iris cysts did not have intrinsic vascularity on anterior segment SS-OCTA.
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Affiliation(s)
- Helin Ceren Köse
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Kaan Gündüz
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - Melek Banu Hoşal
- Ankara University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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Abstract
PURPOSE OF REVIEW This review will discuss the utility of high-resolution anterior segment optical coherence tomography (HR-OCT), in-vivo confocal microscopy (IVCM) and ultrasound biomicroscopy (UBM) in characterizing and diagnosing various ocular surface tumors, namely ocular surface squamous neoplasia (OSSN), conjunctival lymphoma and conjunctival melanoma. The strengths and limitations of each imaging modality will be discussed along with the characteristics findings of each lesion on each imaging platform. RECENT FINDINGS HR-OCT can consistently be utilized in the clinic setting to distinguish between epithelial ocular surface tumors such as OSSN as compared with subepithelial tumors such as conjunctival lymphoma and conjunctival melanoma given their distinctive findings. IVCM can be used as an adjunct to HR-OCT to obtain cellular and surface characteristics, whereas UBM can be used to assess tumor depth and thickness for larger and highly pigmented lesions as well as to detect intraocular invasion. SUMMARY HR-OCT, IVCM and UBM are all helpful imaging modalities to diagnose and characterize various ocular surface tumors and can serve as valuable adjuncts to monitor treatment response and assess for recurrence ocular surface tumors.
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Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Wathanee Sripawadkul
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology University of Miami, Miami, FL, USA
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Konopińska J, Lisowski Ł, Mariak Z, Obuchowska I. Clinical Features of Iris Cysts in Long-Term Follow-Up. J Clin Med 2021; 10:jcm10020189. [PMID: 33430337 PMCID: PMC7825794 DOI: 10.3390/jcm10020189] [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] [Received: 12/03/2020] [Revised: 12/29/2020] [Accepted: 01/04/2021] [Indexed: 11/23/2022] Open
Abstract
This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.
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Venkateswaran N, Mercado C, Wall SC, Galor A, Wang J, Karp CL. High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 16:81-95. [DOI: 10.1080/17469899.2021.1851598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Mercado
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Grupo de Investigacion Escuela Barraquer, Escuela Superior de Oftalmologia del Instituto Barraquer de America, Bogota, Colombia
| | - Sarah C. Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
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Méndez-Martínez S, Santiago Varela M, Blanco-Teijeiro MJ, Piñeiro-Ces A. Diagnosis and long-term monitoring of adenomas of the ciliary body epithelium by ultrasound biomicroscopy. Eur J Ophthalmol 2020; 31:2032-2041. [PMID: 32830591 DOI: 10.1177/1120672120952645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The natural course of adenomas of the ciliary-body epithelium (ACE) is uncertain, due to their low incidence and their frequent initial surgical management.Their differential diagnosis with amelanotic melanoma or metastasis is challenging and diagnostic biopsies require sufficient tissue and highly specialized pathologists. Ultrasound biomicroscopy offers high resolution images and clear sonographic signs suggestive of ACE allowing a more precise differential diagnosis and therefore, a more conservative initial attitude. METHODS Descriptive, retrospective, non-comparative study of consecutive cases of ACE observed between October 2003 and December 2019 in a reference unit in ocular oncology of a tertiary hospital. Patients were studied on a quarterly basis the first year and, subsequently, every 6 months with a complete ophthalmological exam and ultrasound biomicroscopy with the platform Aviso linear scanning 50 MHz probe (Quantel Medical, Clermont-Ferrand, France). RESULTS Three ACE were analysed for a median of 3 years (interquartile range: 2.5-5.5 years). Clinical features include a whitish-to-brown spherical mass, with engorged superficial vessels. Ultrasound biomicroscopy shows an oval-spherical shape, medium-to-high echogenicity, low acoustic attenuation, regular internal structure, and respect for the neighboring structures. By their clinical-ultrasonographic characteristics, one was considered an adenoma of the pigmented ciliary-body epithelium (browner and hyperechogenic) and two were classified as adenomas of the non-pigmented ciliary epithelium (whitish appearance and medium-echogenicity). CONCLUSION Ultrasound biomicroscopy allows a reasonable clinicalsonographic suspicion of ACE. An initial conservative management is proposed as a safer option for stable, mildly symptomatic patients, avoiding aggressive sight threatening treatments.
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Affiliation(s)
| | - María Santiago Varela
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain
| | - María José Blanco-Teijeiro
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain.,Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Área de Oftalmología, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Piñeiro-Ces
- Unidad de Retina Quirúrgica y Tumores Intraoculares del Adulto, Servicio de Oftalmología, Complejo Hospitalario Universitario de Santiago, Área Sanitaria de Santiago de Compostela y Barbanza, SERGAS, Santiago de Compostela, Spain.,Laboratorio de Investigación en Tumores Intraoculares del Adulto, IDIS, Consellería de Sanidade, Xunta de Galicia, Santiago de Compostela, Spain.,Departamento de Cirugía y Especialidades Médico-Quirúrgicas, Área de Oftalmología, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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11
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Kosmala J, Grabska-Liberek I, Stanislovas Ašoklis R. Recommendations for ultrasound examination in ophthalmology. Part I: Ultrabiomicroscopic examination. J Ultrason 2019; 18:344-348. [PMID: 30763020 PMCID: PMC6444308 DOI: 10.15557/jou.2018.0050] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2018] [Indexed: 12/29/2022] Open
Abstract
Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging - an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball - an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method. Range of ultrasounds used in medical imaging is between 2 and 80 MHz. The highest frequencies are applied in medical imaging of an anterior segment of an eyeball. This paper covers the newest method of ultrasound imaging – an ultrabiomicroscopic examination. Its name reflects resolution which has so far been unavailable, and which allows for imaging a structure of the examined tissues. The article includes basic information about the structure and principles of operation of ultrabiomicroscopic examination tools. Moreover, its position among other methods for echographic examination of an eyeball was determined. Examination techniques and the role of standards of conduct at each stage of a diagnostic procedure were discussed. A role of insufficient cooperation between constructors of new ultrasonographic diagnostic tools and software IT specialist with the users of these tools, which results in the lack of consistency between the components of these sets was emphasized. Based on long term experience in ultrabiomicroscopic examinations, the authors shared observations on practical aspects of this method. Finally, indications and contraindications for ultrabiomicroscopic diagnostics were listed. Introduction of an ultrahigh frequency ultrasound probe allowed for the visualization of an post-iridial area of an anterior segment of an eyeball – an area whose diagnosis is impossible with other diagnostic methods. A wide spectrum of diagnostic indications, which covers both diseases and development anomalies of an anterior segment of an eyeball, confirms a special meaning of this method.
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Affiliation(s)
- Jacek Kosmala
- Department of Ophthalmology, Medical Centre of Postgraduate Education, Professor Witold Orlowski Independent Public Clinical Hospital , Warsaw , Poland
| | - Iwona Grabska-Liberek
- Department of Ophthalmology, Medical Centre of Postgraduate Education, Professor Witold Orlowski Independent Public Clinical Hospital , Warsaw , Poland
| | - Rimvydas Stanislovas Ašoklis
- Vilnius University, Faculty of Medicine , Vilnius , Lithuania ; Center of Eye Diseases in Vilnius University Hospital Santaros Klinikos , Vilnius , Lithuania
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Sinha R, Chaniyara MH, Urkude J, Pujari A. Surgical removal of a giant iris stromal cyst: an intraoperative optical coherence tomography-guided approach. BMJ Case Rep 2017; 2017:bcr-2017-220972. [PMID: 29282204 DOI: 10.1136/bcr-2017-220972] [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: 11/03/2022] Open
Abstract
An 11-year-old girl was brought with the chief complaint of progressive diminution of vision in her right eye for the past 3 months. There was no history of ocular trauma or any ocular surgery. Systemic and family history was insignificant. Visual acuity was 20/20 in her left eye and counting finger close to face with projection of rays being accurate in her right eye. Slit lamp examination of her right eye showed large cystic lesion filling almost entire anterior chamber. With the help of various imaging modalities like anterior segment optical coherence tomography (OCT) and ultrasound biomicroscopy diagnosis of iris stromal cyst was confirmed. Right eye surgical removal of the iris stromal cyst was done under real-time imaging of intraoperative OCT (iOCT). Best-corrected visual acuity at 6 months follow-up was 20/20 without any recurrence. iOCT-guided approach for complete removal of the iris cyst seems more promising.
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Affiliation(s)
- Rajesh Sinha
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Manthan Hasmukhbhai Chaniyara
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanand Urkude
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Amar Pujari
- Department of Ophthalmology, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Vora GK, Demirci H, Marr B, Mruthyunjaya P. Advances in the management of conjunctival melanoma. Surv Ophthalmol 2016; 62:26-42. [PMID: 27321895 DOI: 10.1016/j.survophthal.2016.06.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 06/07/2016] [Indexed: 12/28/2022]
Abstract
Malignant melanoma of the conjunctiva is a rare but serious condition. Over the last several years, there have been important advances in the classification, diagnosis, and treatment of this condition. Recent cytogenetic and immunohistochemical studies are increasing understanding of its tumorigenesis. Diagnosis, although still made via histopathology, has been aided with imaging techniques such as ultrasound biomicroscopy and anterior segment optical coherence tomography. Primary treatment consists of surgical excision. But adjuvant treatments with cryotherapy, topical chemotherapy, and radiation therapy have shown increased success. Sentinel lymph node biopsy has shown early promise of detecting micro-metastasis. Long term follow-up of patients with conjunctival melanoma with systemic surveillance is necessary to detect recurrences and metastases.
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Affiliation(s)
- Gargi K Vora
- Department of Ophthalmology, Duke University, Durham, North Carolina, USA
| | - Hakan Demirci
- Department of Ophthalmology and Visual Sciences, W.K. Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian Marr
- Department of Surgery, Memorial Sloan Kettering Cancer Center, Ophthalmic Oncology Service Weill-Cornell Medical School, New York, New York, USA
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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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15
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[Fine-needle aspiration in an extremely late post-traumatic iris cyst]. ACTA ACUST UNITED AC 2015; 90:324-6. [PMID: 25851404 DOI: 10.1016/j.oftal.2015.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 02/09/2015] [Accepted: 02/25/2015] [Indexed: 11/22/2022]
Abstract
CLINICAL CASE A 45 year-old woman with unknown ophthalmology history complained of pain, redness and visual acuity (VA) loss in her left eye for the last three weeks. A serous iris cyst with an overlying peripheral corneal leukoma was located in the iris stroma using ultrasonic biomicroscopy. It was assumed that it was secondary to a penetrating trauma from her childhood. The cyst healed and VA improved after fine-needle aspiration and partial posterior synechiolysis. DISCUSSION Iris inclusion cysts may appear many years after penetrating trauma or surgery. Fine-needle aspiration is a good choice for its diagnosis and treatment.
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Falke K, Krüger P, Hosten N, Zimpfer A, Guthoff R, Langner S, Stachs O. Experimental differentiation of intraocular masses using ultrahigh-field magnetic resonance imaging--a case series. PLoS One 2013; 8:e81284. [PMID: 24349051 PMCID: PMC3857191 DOI: 10.1371/journal.pone.0081284] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/20/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The case reports presented here were compiled to demonstrate the potential for improved diagnosis and monitoring of disease progress of intraocular lesions using ultrahigh-field magnetic resonance microscopy (MRM) at 7.1 Tesla. METHODS High-resolution ex vivo ocular magnetic resonance (MR) images were acquired on an ultrahigh-field MR system (7.1 Tesla, ClinScan, Bruker BioScan, Germany) using a 2-channel coil with 4 coil elements and T2-weighted turbo spin echo (TSE) sequences of human eyes enucleated because of different intraocular lesions. Imaging parameters were: 40×40 mm field of view, 512×512 matrix, and 700 µm slice thickness. The results were correlated with in vivo ultrasound and histology of the enucleated eyes. RESULTS Imaging was performed in enucleated eyes with choroidal melanoma, malignant melanoma of iris and ciliary body with scleral perforation, ciliary body melanoma, intraocular metastasis of esophageal cancer, subretinal bleeding in the presence of perforated corneal ulcer, hemorrhagic choroidal detachment, and premature retinopathy with phthisis and ossification of bulbar structures. MR imaging allowed differentiation between solid and cystic tumor components. In case of hemorrhage, fluid-fluid levels were identified. Melanin and calcifications caused significant hypointensity. Microstructural features of eye lesions identified by MRM were confirmed by histology. CONCLUSION This study demonstrates the potential of MRM for the visualization and differential diagnosis of intraocular lesions. At present, the narrow bore of the magnet still limits the use of this technology in humans in vivo. Further advances in ultrahigh-field MR imaging will permit visualization of tumor extent and evaluation of nonclassified intraocular structures in the near future.
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Affiliation(s)
- Karen Falke
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Paul Krüger
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Norbert Hosten
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Annette Zimpfer
- Institute of Pathology, University of Rostock, Rostock, Germany
| | - Rudolf Guthoff
- Department of Ophthalmology, University of Rostock, Rostock, Germany
| | - Sönke Langner
- Institute of Diagnostic Radiology and Neuroradiology, Greifswald University Hospital, Greifswald, Germany
| | - Oliver Stachs
- Department of Ophthalmology, University of Rostock, Rostock, Germany
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Kaliki S, Shields CL, Eagle RC, Vemuganti GK, Almeida A, Manjandavida FP, Mulay K, Honavar SG, Shields JA. Ciliary Body Medulloepithelioma. Ophthalmology 2013; 120:2552-2559. [DOI: 10.1016/j.ophtha.2013.05.015] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 11/26/2022] Open
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Wang BH, Yao YF. Effect of primary iris and ciliary body cyst on anterior chamber angle in patients with shallow anterior chamber. J Zhejiang Univ Sci B 2013; 13:723-30. [PMID: 22949363 DOI: 10.1631/jzus.b1200124] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the prevalence of primary iris and/or ciliary body cysts in eyes with shallow anterior chamber and their effect on the narrowing of the anterior chamber angle. METHODS Among the general physical check-up population, subjects with shallow anterior chambers, as judged by van Herick technique, were recruited for further investigation. Ultrasound biomicroscope (UBM) was used to detect and measure the cysts located in the iris and/or ciliary body, the anterior chamber depth (ACD), the angle opening distance at 500 µm (AOD500), and the trabecular-iris angle (TIA). A-scan ultrasonography was used to measure the ocular biometry, including lens thickness, axial length, lens/axial length factor (LAF), and relative lens position (RLP). The effect of the cyst on narrowing the corresponding anterior chamber angle and the entire angle was evaluated by the UBM images, ocular biometry, and gonioscopic grading. The eye with unilateral cyst was compared with the eye without the cyst for further analysis. RESULTS Among the 727 subjects with shallow anterior chamber, primary iris and ciliary body cysts were detected in 250 (34.4%) patients; among them 96 (38.4%) patients showed unilateral single cyst, 21 (8.4%) patients had unilateral double cysts, and 42 (16.8%) patients manifested unilateral multiple and multi-quadrants cysts. Plateau iris configuration was found in 140 of 361 (38.8%) eyes with cysts. The mean size of total cysts was (0.6547 ± 0.2319) mm. In evaluation of the effect of the cyst size and location on narrowing the corresponding angle to their position, the proportion of the cysts causing corresponding angle narrowing or closure among the cysts larger than 0.8 mm (113/121, 93.4%) was found to be significantly higher than that of the cysts smaller than 0.8 mm (373/801, 46.6%), and a significant higher proportion was also found in the cysts located at iridociliary sulcus (354/437, 81.0%) than in that at the pars plicata (131/484, 27.1%). In evaluating the effect of the cyst on the entire anterior chamber angle, the eyes with multiple and multi-quadrants cysts manifested significant narrowing of the entire anterior chamber angle as compared with the eyes without cysts, based on the data analysis in comparison of TIA, AOD500, and gonioscopic grading evaluation. The unilateral single or double cysts in the eyes had no significant effect on narrowing of anterior chamber angle as compared with eyes without cysts. The iris and/or ciliary body cysts did not seem to affect the axial length, ACD, lens thickness, RLP, LAF. CONCLUSIONS The prevalence of primary iris and ciliary body cyst was 34.4% in the subjects with shallow anterior chamber. The cysts larger than 0.8 mm, locating at iridociliary sulcus, or multiple and extensive cysts were inclined to cause the angle narrowing or closure.
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Affiliation(s)
- Bing-hong Wang
- Department of Ophthalmology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
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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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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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Giuliari GP, McGowan HD, Pavlin CJ, Heathcote JG, Simpson ER. Ultrasound biomicroscopic imaging of iris melanoma: a clinicopathologic study. Am J Ophthalmol 2011; 151:579-585.e1. [PMID: 21238949 DOI: 10.1016/j.ajo.2010.09.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 09/19/2010] [Accepted: 09/21/2010] [Indexed: 11/17/2022]
Abstract
PURPOSE To demonstrate the correlation of ultrasound biomicroscopy (UBM) features of iris melanoma with histopathology. DESIGN Retrospective analysis of medical records. METHODS The medical records of patients that underwent surgery for iris melanoma at the Princess Margaret Hospital, University of Toronto, from June 1990 to October 1998 were reviewed. The clinical features, as well as the UBM findings prior to surgical intervention, were evaluated. The anatomic features noted on UBM were correlated with histopathologic features seen in the surgical specimens. RESULTS Fourteen cases met the inclusion criteria and were included in the final analysis. The ultrasound acoustic characteristics showed a broad spectrum of findings among iris melanomas. Tumor acoustic parameters correlated well with histologic features, including tumor vascularity, surface plaque, extrascleral extension, ciliary body involvement, and integrity of iris pigment epithelium. CONCLUSIONS UBM is a useful imaging technique for the in vivo assessment of primary iris melanoma and can provide detailed imaging of the tumor's interface with the angle structures. The preoperative assessment of these tumors by UBM may aid the surgeon in choosing the most appropriate technique to ensure total removal.
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Affiliation(s)
- G Paolo Giuliari
- Princess Margaret Hospital, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
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Long-term follow-up of 42 patients with small ciliary body tumors with ultrasound biomicroscopy. Am J Ophthalmol 2010; 149:616-22. [PMID: 20346778 DOI: 10.1016/j.ajo.2009.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 11/13/2009] [Accepted: 11/17/2009] [Indexed: 11/22/2022]
Abstract
PURPOSE To establish the growth behavior of small ciliary body tumors in a relatively large cohort of patients over an extended period. DESIGN Retrospective, noncomparative case series. METHODS Ciliary body tumors less than 4 mm in size within the penetration power of ultrasound biomicroscopy (UBM) were included. Tumor height was assessed by ultrasound biomicroscopy. Tumor growth was defined as an increase in height of at least 20% from baseline, as measured on 2 consecutive UBM readings. The data were collected longitudinally, and a statistical analysis was performed. RESULTS Forty-two patients were included in the study with a median follow-up of 9.0 years (range, 1.0 to 17.2 years). The median age was 59 years (range, 17 to 82 years). Median initial tumor height was 2.05 mm (range, 1.11 to 3.80 mm). The overall average rate of growth was 0.0014 mm per year (P = .68). The 5- and 10-year accumulative tumor growth rates were 12% and 29%, respectively. In the first 3 years after diagnosis, the growth rate of ciliary body lesions with an initial tumor thickness less than or equal to 2 mm was 0.054 mm per year (P = 0.0001); thereafter, tumor size appeared to stabilize. Tumors with an initial thickness greater than 2 mm showed a small but significant rate of regression of 0.0125 mm per year (P = 0.04). CONCLUSIONS Most small tumors of the ciliary body show little growth over an extended period and can be managed conservatively without invasive diagnostic interventions. However, long-term follow-up is required. Indications for treatment include growth in height or lateral extension, extrascleral extension or the need for cataract surgery.
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Wilczynski M, Bartela J, Synder A, Omulecki W. Comparison of internal anterior chamber diameter measured with ultrabiomicroscopy with white-to-white distance measured using digital photography in aphakic eyes. Eur J Ophthalmol 2009; 20:76-82. [PMID: 19882535 DOI: 10.1177/112067211002000110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Measuring the anterior chamber diameter (AC) is important both for diagnostics and before ocular surgery. In clinical practice, horizontal AC diameter is usually estimated on the basis of measurements of corneal diameter (so-called white-to-white [WTW] distance). The usual method for selecting an appropriate size for an AC lens is to add 1 mm to WTW measurement. The purpose of this study was to compare AC diameter measured using ultrasound biomicroscopy (UBM) with WTW distance measured using digital photography in aphakic eyes. METHODS The data were gathered prospectively from a nonrandomized consecutive series of aphakic patients. The examined group consisted of 23 eyes of 23 adult patients, mean age 71.17 years. WTW diameter was measured in the 3 o'clock and 9 o'clock meridian on a digital photograph. Internal horizontal AC diameter measurements were performed in the 3 o'clock and 9 o'clock meridian with the Sonomed Ultrabiomicroscopy device with a 50-MHz probe. RESULTS Mean horizontal WTW diameter measured using digital photographs was 11.65+/-0.38 mm and mean horizontal internal AC diameter measured using UBM was 13.53+/-0.83 mm. A significant difference in mean WTW diameter measured using digital photography and UBM was found (Mann-Whitney U test, p<0.05). There was a significant correlation between these values (Spearman=0.70, p<0.001). CONCLUSIONS In order to obtain good and precise measurements of internal AC diameter, a method of direct visualization of the intraocular structures should be used. Despite the limits of a small case series, our results support the use of UBM technique for preoperative evaluation of the internal AC diameter and AC intraocular lens sizing in aphakic eyes.
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Affiliation(s)
- Michal Wilczynski
- Department of Ophthalmology, Medical University of Lodz, University Barlicki Hospital, Lodz, Poland.
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Krema H, Simpson ER, Pavlin CJ, Payne D, Vasquez LM, McGowan H. Management of ciliary body melanoma with iodine-125 plaque brachytherapy. Can J Ophthalmol 2009; 44:395-400. [DOI: 10.3129/i09-097] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Anterior segment imaging: ultrasound biomicroscopy and anterior segment optical coherence tomography. Curr Opin Ophthalmol 2008; 19:115-21. [DOI: 10.1097/icu.0b013e3282f40bba] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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