scholarly journals Multifocal Intraretinal Tumour Deposits following Treatment of an Ipsilateral Choroidal Melanoma

2020 ◽  
Vol 6 (6) ◽  
pp. 410-415
Author(s):  
Aaron Jamison ◽  
Julie Connolly ◽  
Paul Cauchi ◽  
Chee Thum ◽  
Vikas Chadha
Keyword(s):  
Visual Acuity ◽  
Malignant Melanoma ◽  
Uveal Melanoma ◽  
Choroidal Melanoma ◽  
Black Spot ◽  
Retrospective Case ◽  
Snellen Visual Acuity ◽  
Choroidal Malignant Melanoma ◽  
A Site ◽  
Plaque Brachytherapy

<b><i>Background/Aims:</i></b> The aim of this study was to report a patient who, following plaque brachytherapy for a choroidal melanoma, developed two separate retinal foci of malignant melanoma in the same eye, and suggest possible mechanisms that might explain such an occurrence. <b><i>Methods:</i></b> We conducted a retrospective case report. <b><i>Results:</i></b> A 79-year-old Caucasian male developed a left inferotemporal choroidal melanoma in 2016 and subsequently underwent ruthenium-106 plaque brachytherapy under the care of the Scottish Ocular Oncology Service. Serial B-scan ultrasonography demonstrated a post-treatment reduction in tumour height to &#x3c;2 mm. In 2018, 27 months after the treatment, the patient complained of a “black spot” in the centre of his left eye vision. His visual acuity had reduced to counting fingers from 6/24 (corrected Snellen visual acuity). Several new areas of pigmentation and elevation were observed, and uveal melanoma recurrence was initially suspected. Given the multifocal nature of the presentation, the multi-disciplinary team recommended enucleation. Histological examination of the enucleated eye revealed three discrete foci of malignant melanoma – the previously treated choroidal malignant melanoma, and two solitary deposits of malignant melanoma within the retina. <b><i>Conclusion:</i></b> Retinoinvasive melanoma is a rare subtype of uveal melanoma, characterised by transvitreal melanoma invasion of the retina at a site non-contiguous with the uveal tumour, which may explain the clinical and pathological findings of the reported case.

Approach to the patient in the diagnosis of Choroidal Malignant Melanoma. Question and Answer

2019 ◽  
pp. 317-320
Keyword(s):  
Risk Factor ◽  
Malignant Melanoma ◽  
Diagnostic Method ◽  
Choroidal Melanoma ◽  
Intraocular Tumors ◽  
Indirect Ophthalmoscopy ◽  
Choroidal Malignant Melanoma ◽  
Choroidal Melanomas ◽  
Venous Phase ◽  
Treatment Changes

The most valuable diagnostic method in intraocular tumors is indirect ophthalmoscopy. USG is very important in determining the thickness of the lesion and documenting post-treatment changes. However, in today's conditions, we have important auxiliary examination opportunities. OCT is especially important in detecting macular edema and fluid. In choroidal melanomas, thickening and edema of the macula may be observed before treatment due to increased VEGF levels in the eye. OCT is important in detecting such changes. Since FAF shows the amount of lipofuscin in the lesion, it reveals the activity of the lesion. Hyperotofluorescence of> 50% of the lesion surface, in other words, the diffuse pattern is a risk factor for growth and metastasis. On fluorescein angiography, choroidal melanoma shows focal hyperfluorescence starting from the late venous phase and gradually increasing.

OCT changes in peri-tumour normal retina following ruthenium-106 and proton beam radiotherapy for uveal melanoma

2020 ◽  
pp. bjophthalmol-2019-314802
Author(s):  
Rumana Hussain ◽  
Florian Moritz Heussen ◽  
Heinrich Heimann
Keyword(s):  
Proton Beam ◽  
Uveal Melanoma ◽  
Choroidal Melanoma ◽  
Retinal Layer ◽  
Proton Beam Radiotherapy ◽  
Retinal Layers ◽  
Spectral Domain Oct ◽  
Ruthenium 106 Brachytherapy ◽  
Safety Margins ◽  
Plaque Brachytherapy

IntroductionUveal melanoma is most commonly treated with radiotherapy, destroying the tumour cells with adequate safety margins and limiting collateral damage to surrounding structures to preserve maximal vision. We used optical coherence tomography (OCT) to study the effects of radiotherapy on the retina.MethodsPatients with posteriorly located choroidal melanoma treated with proton beam radiotherapy (PBR) and ruthenium-106 brachytherapy between January 2010 and June 2014 underwent spectral domain OCT.ResultsImages of 32 patients following ruthenium-106 brachytherapy and 44 patients following proton beam teletherapy were analysed. Following plaque brachytherapy, an early marked disruption of the outer retinal layers could be observed in 30 cases (94%) with retinal atrophy evident in 26 cases (81%). In contrast, the images from patients who underwent PBR showed subtle outer retinal layer change with 16 cases (36%) showing some inner-outer segment junction disruption by 6 months and 63%  by 24 months with minimal atrophy. In cases with tumours <2 mm from the fovea, the visual loss was significantly less at 6 and 12 months in the proton beam group.ConclusionIn comparison to ruthenium-106 plaque brachytherapy, PBR leads to more subtle and slower changes in the outer retinal layers enabling retention of visual function for longer. The difference in dosing regime and dose distribution across the tumour is likely to be causative for this structural differential.

scholarly journals Self-retained cryopreserved amniotic membrane for treating severe corneal ulcers: a comparative, retrospective control study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Han Y. Yin ◽  
Anny M. S. Cheng ◽  
Sean Tighe ◽  
Philip Kurochkin ◽  
Jamie Nord ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Adjuvant Therapy ◽  
Corneal Ulcer ◽  
Control Group ◽  
Retrospective Case ◽  
Corneal Ulcers ◽  
Initial Visual Acuity ◽  
Snellen Visual Acuity ◽  
Clinically Significant ◽  
Control Study

Abstract To compare the effectiveness of self- retained cryopreserved AM as an adjuvant therapy for infectious corneal ulcers. Retrospective, case–control study of 24 eyes of 24 consecutive patients with central and paracentral corneal infectious ulcers and initial visual acuity worse than 20/200. Among them, 11 eyes of 11 patients received additional placement of self-retained cryopreserved AM. Epithelialization and Best Corrected Snellen Visual Acuity (BCSVA) were compared between the two groups. At baseline, both groups had comparable age, gender, visual acuity (VA), size and location of corneal ulcer. Patients receiving additional placement of cryopreserved AM had significantly faster epithelialization within 3.56 ± 1.78 weeks vs 5.87 ± 2.20 weeks (p = 0.01) and achieved complete epithelialization in significantly more patients (72.7% vs 23.1% p = 0.04) despite overall larger baseline defect size (32.7 ± 19.5 mm2 vs 21.5 ± 10.7 mm2, p = 0.11). Consequently, the AM group had clinically significant BCSVA (> 3 lines) (81.8% vs 38.4%, p = 0.047) and total VA improvement (log MAR 0.7 ± 0.6 vs 1.6 ± 0.9, p = 0.016) compared to the control group at the time of complete epithelialization. In-office sutureless AM may be an effective adjuvant therapy in treating sight-threatening infectious corneal ulcers by promoting faster corneal epithelialization and overall better recovery of the VA.

OCT-A evaluation of radiation vasculopathy following slotted plaque brachytherapy

2021 ◽  
pp. 112067212110443
Author(s):  
Anthony Fam ◽  
Ankit S Tomar ◽  
Paul T Finger
Keyword(s):  
Visual Acuity ◽  
Radiation Dose ◽  
Choroidal Melanoma ◽  
Vessel Density ◽  
Imaging Data ◽  
Fiber Layer ◽  
Cross Sectional ◽  
Capillary Vessel ◽  
Plaque Brachytherapy ◽  
Radial Peripapillary Capillary

Purpose: To determine a reliable diagnostic method to reveal and monitor subclinical progression of neural and perineural radiation vasculopathy. Methods: A retrospective cross-sectional study, where optical coherence tomography angiography (OCT-A) imaging data was collected and analyzed from 22 consecutive patients that had been treated with circumneural slotted plaque brachytherapy for peripapillary, juxtapapillary, or circumpapillary choroidal melanomas. Pre-operative dosimetry of palladium-103 radiation dose to the optic nerve and fovea were collected. Quantified differences in OCT-A-measured vessel density and length in treated verses untreated contralateral control eyes were collected. Vessel density and length were correlated to radiation dose, plaque slot depth, visual acuity outcomes, and circumpapillary retinal nerve fiber layer thickness. Results: Patients had post-irradiation follow-up of median 39 months, interquartile range 62 months). The mean optic disc radiation dose was 89.9 Gy ± 39.2 (86.5, 30.8–189.0). In comparison to controls, OCT-A imaging revealed significant differences in radial peripapillary capillary vessel density (18 μm2 in case eyes, 34 μm2 in control eyes; p < 0.001) and length (10 μm in case eyes, 14 μm in control eyes; p < 0.001). Change in vessel density did not show a significant correlation to radiation dose, slot depth, or visual acuity. However, change in vessel length was significantly correlated to radiation dose ( p = 0.049) and change in visual acuity ( p < 0.001). Conclusions: OCT-A imaging revealed that radial peripapillary capillary vessel density and length were significantly reduced after circumneural irradiation for choroidal melanoma. Therefore, OCT-A imaging can be used to monitor progression of papillary vasculopathy associated with radiation optic neuropathy.

scholarly journals In vivo Confocal Microscopy in Differentiating Ipilimumab-Induced Anterior Uveitis from Metastatic Uveal Melanoma

2016 ◽  
Vol 7 (3) ◽  
pp. 404-409 ◽  
Author(s):  
Hayyam Kiratli ◽  
Mehmet C. Mocan ◽  
Murat İrkeç
Keyword(s):  
Visual Acuity ◽  
Confocal Microscopy ◽  
Uveal Melanoma ◽  
Anterior Uveitis ◽  
Choroidal Melanoma ◽  
Inflammatory Cells ◽  
In Vivo Confocal Microscopy ◽  
Keratic Precipitates ◽  
Metastatic Process

This report aims to describe the facilitating role of in vivo confocal microscopy in differentiating inflammatory cells from a metastatic process in a patient with uveal melanoma and multiple systemic metastases who developed anterior uveitis while under ipilimumab treatment. A 43-year-old woman developed systemic metastases 11 months after treatment of amelanotic choroidal melanoma in her right eye with 30 Gy fractionated stereotactic radiotherapy. She first received temozolomide and then 4 cycles of ipilimumab 3 mg/kg/day. After the third cycle, severe anterior uveitis with coarse pigment clumps on the lens was seen in the left eye. Her left visual acuity declined from 20/20 to 20/80. Confocal microscopy revealed globular keratic precipitates with hyperreflective inclusions and endothelial blebs all suggestive of granulomatous uveitis. The uveitic reaction subsided after a 3-week course of topical corticosteroids, and her visual acuity was 20/20 again. Although uveal melanoma metastatic to the intraocular structures of the fellow eye is exceedingly rare and metastasis masquerading uveitis without any identifiable uveal lesion is even more unusual, it was still mandatory to rule out this distant possibility in our particular patient who already had widespread systemic metastases. Confocal microscopy was a useful complementary tool by identifying the inflammatory features of the keratic precipitates.

scholarly journals BAP1 Germline Mutation Associated with Bilateral Primary Uveal Melanoma

2019 ◽  
Vol 6 (1) ◽  
pp. 10-14 ◽  
Author(s):  
Michael D. Yu ◽  
Babak Masoomian ◽  
Jerry A. Shields ◽  
Carol L. Shields
Keyword(s):  
Visual Acuity ◽  
Uveal Melanoma ◽  
Choroidal Melanoma ◽  
Pathogenic Mutation ◽  
Clinical Testing ◽  
Plaque Radiotherapy ◽  
Systemic Metastasis ◽  
History Of ◽  
History Of Cancer

Purpose: To describe the occurrence of bilateral primary uveal melanoma in 2 patients with mutation on the gene encoding BRCA1-associated protein 1 (BAP1). Methods: Retrospective chart review of patients with bilateral primary uveal melanoma and subsequent positive germline BAP1 mutation. Results: There were 2 patients with bilateral uveal melanoma and BAP1 germline positivity. Neither patient demonstrated oculodermal melanocytosis. Patient 1 underwent enucleation of his right eye (OD) at the age of 44 years for a 9.6-mm-thick choroidal melanoma. He returned 4 years later with a 10.0-mm-thick choroidal melanoma in his left eye (OS) and was treated with plaque radiotherapy. He had a strong family history of cancer, and clinical testing for germline BAP1 mutation identified a pathogenic mutation in BAP1. At the 18-month follow-up, visual acuity was 20/200 OS without evidence of systemic metastasis. Patient 2 initially presented at age 54 years with extensive, diffuse iris melanoma OD, initially treated with plaque radiotherapy, but local recurrence after 3 years necessitated enucleation. Four years later, a 6.0-mm-thick ciliary body melanoma OS was found and successfully treated with plaque radiotherapy. Clinical testing for germline BAP1 mutation identified a pathogenic mutation in BAP1. At the 8-year follow-up, visual acuity was 20/40 OS without evidence of local recurrence or systemic metastasis. The patient expired secondary to an unrelated brain infarction. Conclusion: Bilateral uveal melanoma is exceedingly rare. Patients with bilateral uveal melanoma, especially when coincident with remote systemic cancers or a family history of cancer, should be evaluated for germline BAP1 mutation. Lifelong monitoring for related systemic malignancies is advised.

Visual improvement in amblyopic eye following treatment-induced vision loss in dominant eye with uveal melanoma

2019 ◽  
Vol 104 (2) ◽  
pp. 202-207
Author(s):  
Aldo Vagge ◽  
Carol L Shields ◽  
Jerry A Shields ◽  
Renelle Pointdujour-Lim ◽  
Bruce Schnall
Keyword(s):  
Visual Acuity ◽  
Uveal Melanoma ◽  
Visual Loss ◽  
Vision Loss ◽  
Case Series ◽  
Retrospective Case ◽  
Corrected Visual Acuity ◽  
Visual Improvement ◽  
Dominant Eye ◽  
The Mean

ObjectiveTo determine the frequency and amount of visual improvement in amblyopic eyes of adults following visual loss in the dominant eye resulting from treatment of uveal melanoma.Methods and analysisRetrospective case series of adult patients with amblyopia and dominant eye visual loss resulting from treatment of uveal melanoma. Review of best-corrected visual acuity (BCVA) in each eye (amblyopia eye vs melanoma eye) at date first seen and over time following treatment of uveal melanoma. BCVA in each eye was graded as improved (>2 logarithm of minimal angle of resolution (logMAR) lines) or unimproved (<2 logMAR lines).ResultsTwenty-one patients that met the inclusion criteria. Mean age at presentation was 56 years (range 39–73 years). Following treatment of the uveal melanoma and decline of BCVA in the dominant, the BCVA in the amblyopic eye improved in 11/21 (52%; 95% CI 30% to 74 %) patients. The degree of visual loss in the melanoma eye was to the level of the amblyopic eye or worse in 14 patients. In this group, BCVA improved in the amblyopic eye in 9/14 (64%; 95% CI 35% to 87 %) patients. Of these nine with improved eyes, the mean starting visual acuity was logMAR 0.6 (20/80) with mean improvement of logMAR 0.4 (4 lines±0.13 (range 0.2–0.6). Eight of nine eyes achieved a BCVA of 20/25 (n=3) or 20/20 (n=5).ConclusionVisual acuity in the amblyopic eye of adults can improve following visual loss in the contralateral dominant eye associated with treatment for uveal melanoma.

scholarly journals Iodine-125 Episcleral Plaque Brachytherapy for AJCC T4 Posterior Uveal Melanoma: Clinical Outcomes in 158 Patients

2019 ◽  
Vol 5 (5) ◽  
pp. 340-349
Author(s):  
Benjamin A. King ◽  
Caroline Awh ◽  
Brad T. Gao ◽  
Jiajing Wang ◽  
Mehmet Kocak ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Treatment Failure ◽  
Uveal Melanoma ◽  
Cumulative Incidence ◽  
Vitreous Hemorrhage ◽  
Patient Age ◽  
Ocular Morbidity ◽  
Iodine 125 ◽  
Baseline Visual Acuity ◽  
Plaque Brachytherapy

Background/Aims: The aim of this study is to report the burden of ocular morbidity following iodine-125 episcleral plaque brachytherapy (EPBT) in the treatment of American Joint Committee on Cancer (AJCC) T4-staged posterior uveal melanoma (PUM). Methods: Clinical records of patients with T4-staged PUM treated with 125I EPBT were analyzed for incidence of treatment failure and radiation-induced complications. Results: Cumulative incidence of local treatment failure was 9% (95% CI 5–15%) at 5 years and was associated with decreased tumor height (HR = 0.78; p = 0.01). Cumulative incidence of enucleation at 5 years was 21% and was correlated with worsening baseline visual acuity (HR = 1.42; p = 0.05). Increasing patient age was associated with higher rates of vitreous hemorrhage (HR = 1.03; p = 0.02) and cataract surgery (HR = 1.05; p < 0.001). Increased tumor height was associated with higher rates of neovascular glaucoma (HR = 1.16; p = 0.03) and vitreous hemorrhage (HR = 1.23; p < 0.001). Conclusion: 125I EPBT is an effective treatment for T4-staged PUM and achieves high rates of local control. Treatment failure appears to be more common among minimally elevated tumors. Other causes of ocular morbidity were associated with increasing tumor height, patient age, and baseline visual acuity.

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