[Argon laser photocoagulation of circumscribed choroidal hemangiomas]. / Hémangiomes choroïdiens circonscrits traités par photocoagulation au laser Argon.

PURPOSE: Therapeutic retrospective results obtained after Argon laser photocoagulation of 17 circumscribed choroidal hemangiomas were analyzed. MATERIAL AND METHODS: Seventeen circumscribed choroidal hemangiomas associated with serous retinal detachment were analyzed. All patients were symptomatic but one. Duration of visual symptoms varied from 2 weeks to 3 years. Mean tumor thickness was 3,3mm (1 to 6,5mm). Mean tumor diameter was 6,5mm (2.5 to 15mm). Tumors were juxtapapillary in 9 cases (57%). The mean distance from the fovea was 1,5mm (0 to 3mm), and the fovea was pathological in all cases but two. The tumoral surface was covered by Argon laser spots with the central avascular area spared in the case of subfoveal hemangioma. In the case of subretinal fluid persistence 3 months later, 1 or more photocoagulation sessions were carried out. Follow-up was 27 months (6 to 156 months). RESULTS: Success (complete subretinal fluid resolution) was obtained in 82.4% with 1 or 2 laser photocoagulation sessions. Recurrence was observed in 4 cases (23.5%) but treated with success. Final visual acuity, related to the initial foveal condition, was >=0.5 in 23.5% of cases, and >=0.1 in 70.6% of cases. DISCUSSION: Anatomical and functional results were satisfactory considering initial foveal conditions. Irradiation (external beam irradiation, proton beam therapy, brachytherapy) has been used with success for several years. However, radiation-induced damage was described in addition to a few practical disadvantages. CONCLUSION: Argon laser photocoagulation was an effective noninvasive therapy for circumscribed choroidal hemangioma. It remains for us the reference method for treating this tumor.

[Double irradiation for macroscopic radioresistance or recurrence of melanomas of the posterior uvea: clinical, ballistic, therapeutic and prognostic aspects. Series of 19 cases among 462 patients]. / Double irradiation pour radiorésistance macroscopique ou récidive dans les mélanomes de l'uvée postérieure: aspects cliniques, ballistiques, thérapeutiques et pronostiques: A propos de 19 cas sur 462 patients.

We describe two comparative series of patients treated with double-dose betaraysbrachytherapy (106 Ruthenium) between 1983 and 1994, and double-dose proton beam therapy between 1991 and 1996. The indications for double-dose irradiation with the same radio-element corresponded to "macroscopically abnormal" situations: immediate and prolonged radioresistance, recurrence or secondary radioresistance. Thirteen cases are called series 1 (Ruthenium) and 6 cases are called series 2 (protons). The series 1 allows a more reliable study as far as follow-up is higher (5.8 to 7.5 years) than in series 2 where the follow-up is shorter (13.6 to 29 months). Although double-dose irradiation was macroscopically efficient in 11 out of 13 cases in series 1, and in 3 out of 6 cases in series 2 (stabilization or decrease of tumour height measured before the second therapeutic session), 2 patients are deceased and 1 has a metastatic disease in the group "recurrence" of Ruthenium serie. Another one has also a metastatic disease in the group "recurrence" of protons series. Nevertheless double-dose radiotherapy allows a complementary decrease or stabilization of tumour height after a first session. It also decreases the indications for enucleation if there is no severe anatomic complications, when a tumour does not regress or recurs after a first session of radiations.

[Comparative study of the tumor regression rate of 127 uveal melanomas irradiated with 106 Ru/106 Rh. Attempted analysis of the correlations between per-operative cytology and histopathology of the enucleated eye and the tumoral regression on the one hand, and general prognosis on the other hand]. / Etude comparative de la vitesse de régression tumorale de 127 mélanomes uvéaux irradiés par 106 RU/106 RH. Essai d'analyse des corrélations entre la cytologie per-opératoire, l'histophathologie des globes énucléés et la régression tumorale d'une part, le pronostic général d'autre part.

A study of the speed of tumor regression in 127 uveal melanomas treated with beta-rays brachyterapy, since June 1983, allows a division into 2 groups: radiosensitive forms with a volume less than 50% in the following year, and radioresistant forms. Correlation between radio sensitivity and tumor cell type were obtained with intraoperative cytopunction, and showed the prevalence of epithelioid type. The results of enucleation indicate the prevalence of fusiform type inside the radioresistant tumor group. No precise correlation could be brought between death and the previous data, the most important negative criteria being the level of initial tumor height equal or superior to 7 mm.

[The role of beta-ray therapy in the treatment of choroidal and ciliary body melanomas]. / Place de la bêtacuriethérapie de contact dans le traitement des mélanomes de la choroïde et du corps ciliaire.

100 cases of uveal melanomas, were treated with 106RU 106RH beta-brachytherapy, between June 1983 and September 1987. 82 eyes having a follow-up superior or equal to 12 months, were analysed. 13 of these 82 eyes have been enucleated. 4 patients have died. 3 have at this time, hepatic dissemination. The first 43 patients were analysed at the 18th month after irradiation. The majority of tumors with initial thickness inferior to 5 mm had a regression superior to 50%, at the 18th month. The majority of tumors with initial thickness superior to 5 mm, had a regression inferior to 50%, at the same time. Functional results have also been noticed in this series of 43 eyes, and were satisfactory.

[Evaluation of 100 melanomas of the choroid and ciliary body treated by application of ruthenium (RU 106 Rh 106)]. / Bilan de 100 mélanomes de la choroïde et du corps ciliaire traités par applicateur de ruthénium (RU 106 Rh 106).

100 cases of uveal melanomas, were treated with 106 RU 106 RH beta-brachytherapy, between June 1983 and September 1987. 82 eyes having a follow-up superior or equal to 6 months, were analysed. 13 of these 82 eyes have been enucleated. 2 patients, have died, 2 have at this time, hepatic dissemination. The first 43 patients were analysed at the 18th month after irradiation. The majority of tumors with initial thickness inferior to 5 mm had a regression superior to 50%, at the 18th month. The majority of tumors with initial thickness superior to 5 mm, had a regression inferior to 50%, at the same time. Functional results have also been noticed in this series of 43 eyes, and were satisfactory.

An ultrasonographic study of choroidal indentation height after scleral buckling with lyophylized human tissues.

The height of the choroidal indentation produced by 26 lamellar scleral pockets filled with lyophylized human fascia lata and by 9 exoplants made up of lyophylized human dura mater was measured with A-scan and B-scan ultrasonography. The mean height of the choroidal indentation produced by lamellar scleral pockets was 4.3 mm 5-20 days postoperatively, 3.2 mm 3 months postoperatively, and 2.5 mm 6-9 months postoperatively. The mean height of the choroidal indentation produced by exoplants made up of dura mater was 4.6 mm 5-20 days postoperatively, 3.5 mm 3 months postoperatively, and 2.9 mm 6 months postoperatively.

Fluorescein angiography after retinal detachment microsurgery.

The eyes of 78 patients who underwent retinal detachment microsurgery (82 eyes) were prospectively evaluated postoperatively with fluorescein angiography. Of these 14.6% showed angiographic evidence of cystoid macular oedema (CMO.). A significantly greater risk of developing cmo was discovered in aphakic eyes (30% CMO.) as compared to phakic eyes (7% CMO.) and in eyes where the maculae were detached pre-operatively (23% CMO.), as compared to eyes where the maculae were attached pre-operatively (5% CMO.). Eyes which had undergone several surgical procedures for retinal reattachment (38% CMO.) were compared to eyes which had undergone only one surgical procedure (6.5% CMO.). It was found that 4.9% of the 82 eyes showed cellophane premacular membrane without dye leakage. A further 6% of the eyes showed premacular membranes associated with dye leakage. No statistically significant risk factor associated with the development of macular pucker was disclosed in this series.

Iris fluorescein angiography and Irvine Gass' syndrome.

Iris fluorescein angiography and fundus fluorescein angiography were performed three months to three years after cataract extraction in two series of aphakic eyes--32 eyes with vitreous adherence to the wound, and 32 with no vitreous adherence to the wound. In these series there is a significant correlation between dye leakage on iris fluorescein angiography and vitreous adherence to the corneal wound since dye leakage was observed in 40.6% of eyes with vitreous adherence to the wound and only 3.1% of eyes with no vitreous adherence to the corneal wound. On the other hand cystoïd macular edema was observed in 100% of eyes with vitreous adherence to the wound associated with dye leakage on iris fluorescein angiography and in only 10% of eyes with vitreous adherence to the wound but no dye leakage on iris fluorescein angiography.