Plaque brachytherapy for choroidal melanoma with vitreous haemorrhage: a therapeutic challenge.

A 47-year-old man presented with profound loss of vision in right eye and relative afferent pupillary defect. On fundus examination, posterior pole details were obscured due to dense vitreous haemorrhage. B-scan ultrasonography was performed that revealed a mushroom-shaped hyperechoic lesion with medium internal reflectivity on A-scan ultrasonography. After performing contrast-enhanced MRI of the orbit, a diagnosis of choroidal melanoma was established. Patient was managed using plaque brachytherapy based on multiplanar MRI. This was followed 10 months later by pars plana vitrectomy and cataract extraction. Vision postoperatively improved to 20/60. A systematic clinical assessment along with supportive ancillary investigations augments diagnostic accuracy and reduces delay in definitive management.

Gamma Knife Radiosurgery for Choroidal Hemangioma: A Single-Institute Series.

OBJECTIVE: Choroidal hemangioma (CH) is a benign vascular tumor that induces subretinal fluid collection or exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, photodynamic therapy, transpupillary thermotherapy, and radiation therapy. Stereotactic radiosurgery has recently been applied to the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. We have adopted gamma knife radiosurgery (GKRS) to treat CH and have retrospectively assessed tumor volume reductions and improvements to visual acuity achieved thereby. METHODS: Fourteen patients with CHs were treated with GKRS from November 2006 to December 2017. Eight patients had circumscribed CH, and 6 exhibited diffuse CHs and were diagnosed with Sturge-Weber syndrome. The mean age of patients was 27.1 years (range: 8-68 years) and the mean duration of clinical or radiological follow-up was 40.2 months (range: 5-105 months). The mean volume of the tumors at the time of GKRS was 533.5 mm3 (range: 124-1150 mm3), and the mean prescribed marginal dose was 11.6 Gy (range: 10-16 Gy) with 50% isodose lines. RESULTS: The tumor volume decreased by the last follow-up in all patients. The visual acuity improved in 9 patients (64%) and decreased in 1 (7%). Six patients (43%) required trans-pars plana vitrectomy before or after GKRS. There were no symptomatic complications from radiation injury during the follow-up periods. CONCLUSIONS: GKRS could be an acceptable alternative treatment for symptomatic CH when standard therapy is not feasible.

Changes in fundus autofluorescence of choroidal melanomas following treatment.

PURPOSE: We have previously shown that fundus autofluorescence (FAF) associated with pigmented choroidal lesions can be attributed to mainly lipofuscin (orange pigment) but also to hyperpigmentation, drusen, or fibrous metaplasia. The purpose of this study is to describe the effects of treatment on FAF in choroidal melanomas after plaque radiotherapy alone or in combination with transpupillary thermotherapy (TTT). METHODS: Retrospective chart review of eight consecutive patients with choroidal melanoma treated with plaque radiotherapy alone or in combination with TTT who underwent FAF photography before and after treatment. The correlation between FAF patterns and foci of orange pigment, hyperpigmentation, drusen, or fibrous metaplasia was evaluated. RESULTS: The median follow-up time was 4 (range 2-9) months. Foci of orange pigment and hyperpigmentation became larger and more numerous after treatment. Fibrous metaplasia was also increased. A complete correlation between increased FAF and orange pigment was found in all eight tumours (100%) before and after treatment. No correlation between hyperpigmentation and increased FAF was found before treatment but a partial correlation was found in all eyes after treatment. Before treatment, correlation between fibrous metaplasia was present in three eyes and increased FAF was partial in two eyes with no correlation in one case. After treatment, this correlation was partial in all presenting eyes (7). CONCLUSIONS: Following treatment, choroidal melanomas may show increased FAF, mainly due to an increase in the amount of lipofuscin (orange pigment) and hyperpigmentation.

Vitrectomy for circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy.

We report successful surgical management of a circumscribed choroidal hemangioma with exudative retinal detachment refractory to transpupillary thermotherapy (TTT). A 33-year-old man with symptomatic serous macular detachment in the left eye (Snellen acuity: 20/200) secondary to a paramacular choroidal hemangioma was treated with TTT. The nonresponsive detachment was subsequently managed by vitrectomy, endophotocoagulation and silicon-oil tamponade. It resulted in complete resolution of the tumor and the detachment. Silicon oil was removed at four months. Visual acuity improved to 20/80 by the last follow-up visit at 10 months without any recurrence.

Transpupillary thermotherapy in the treatment of circumscribed choroidal hemangiomas.

PURPOSE: To evaluate the efficacy of transpupillary thermotherapy (TTT) for the treatment of serous retinal detachment secondary to circumscribed choroidal hemangiomas (CCH). MATERIAL AND METHODS: Four eyes of four consecutive patients who presented decreased vision due to serous macular detachment secondary to CCH were enrolled in this study. After informed consent was obtained, the four eyes were treated with TTT. All the patients underwent pretreatment ocular examination, which included fluorescein angiography and ultrasonography. TTT was applied using a diode laser at 810 nm with a spot size of 4.3 mm. The diode laser was transmitted through a contact lens. The end-point of the treatment was a detectable light-gray appearance of the entire lesion. The patients were re-examined monthly during the first 6 months, and regularly thereafter. RESULTS: Within 3 months of treatment all eyes had already demonstrated decreased exudation on clinical examination and on fluorescein angiography. Reduction in tumor prominence was observed in all eyes by A-B ultrasonography. Three patients showed an improvement in visual acuity (VA) over a period of 6 months. Case 2 from 20/60 to 20/25; case 3 from 20/400 to 20/50 and case 4 from 20/80 to 20/20. The VA in case 1 remained unchanged (counting fingers). No recurrences were observed within a mean follow-up of 14.5 months. CONCLUSIONS: TTT showed no deleterious side effects in treating serous macular detachment secondary to CCH, and must be regarded as a therapeutic alternative to manage selected cases.

[Secondary retinal detachment accompanying intraocular tumors]. / Wtórne odwarstwienie siatkówki towarzyszace wewnatrzgalkowym guzom zlosliwym.

PURPOSE: Aim of the study--the attempt to answer, what is the present incidence mechanism of arising, and what parameters can influence the development of secondary retinal detachment (s. r. d.) caused by intraocular choroidal tumor. MATERIAL AND METHOD: 107 eyes of 105 consecutive patients aged 21 to 82 years (mean 62 years), diagnosed clinically as having choroidal malignant tumor, were evaluated. All patients were examined clinically including examination of anterior segment and fundus, ultrasonography and fluorescein angiography of the eye. Eyes qualified for enucleation were also examined histopathologically. RESULTS: Out of all evaluated eyes s. r. d. was observed in 27 eyes (26 cases--25%). Exclusively in this group it occurred in 16 women (62%) and 10 men (38%). Right eye was involved in 10 cases, left eye in 15 and in 1 case both eyes were involved. The cause of s. r. d. was primary malignant choroidal tumor and in 3 cases--metastatic tumor. The therapy included brachytherapy, diode laser transpupillary thermotherapy (TTT), chemotherapy, local tumor excision and combined treatment. The s. r. d. was observed in cases of small tumors (2.77 mm) as well as very large ones (up to 11.56 mm). After therapy the detachment conceded in 10 eyes (37%). Analysis of clinical images, fluorescein angiograms and histopathological evaluation enabled better understanding of mechanisms leading to s. r. d. CONCLUSIONS: 1. In evaluated group the s. r. d. occurred more often in women (62%) than in men (38%). 2. Like intraocular tumors--it was seen more often in the left eye (59%) than in right one (41%). 3. The s. r. d. may occur in large tumors (over 6 mm) as well as in small ones (3 mm). 4. In case of large tumors the detachment has mainly "mechanical" character, however it may be also influenced by increased permeability of tumor vessels and impaired function of retinal pigment epithelium; the latter mechanism seems to play the main role in case of small tumors; in both cases the external retinal layer is damaged. 5. The most common cause of s. r. d. are tumors located in posterior pole (45%) and least frequently in upper-temporal quadrant (7%). 6. After brachytherapy, TTT or local tumor excision in selected cases s. r. d. may totally regress.

Transpupillary thermotherapy for subfoveal choroidal neovascularization associated with choroidal nevus.

PURPOSE: To describe a patient with classic subfoveal choroidal neovascularization (CNV) associated with choroidal nevus, which was successfully treated using transpupillary thermotherapy. DESIGN: Interventional case report. METHODS: A 53-year-old woman underwent ophthalmologic evaluation, including fluorescein and indocyanine green angiography. Clinical and angiographic data were prospectively analyzed to evaluate visual acuity changes and angiographic evolution. RESULTS: Three months after transpupillary thermotherapy, visual acuity had improved from 20/100 to 20/40. Fluorescein and indocyanine green angiograms showed absence of leakage from CNV. Final visual acuity was 20/32 after a 15-month follow-up. CONCLUSIONS: Transpupillary thermotherapy may be a viable option for subfoveal CNV associated with CN, although further studies are needed to establish the correct setting.

Choroidal neovascular membrane associated with choroidal osteoma (CO) treated with trans-pupillary thermo therapy.

Choroidal neovascular membrane, a known complication of choroidal osteoma causing visual loss when located subfoveally, can be successfully treated with transpupillary thermo therapy.

Laser and proton radiation to reduce uveal melanoma-associated exudative retinal detachments.

PURPOSE: To assess whether laser-induced hyperthermia with proton irradiation of choroidal melanoma may decrease exudative retinal detachments more rapidly. DESIGN: Case control study. METHODS: Patients treated with laser-induced hyperthermia and proton radiation; results were compared with similar patients treated with only protons. RESULTS: All 11 patients treated with combined laser and proton therapy had resorption of subretinal fluid with a mean duration of retinal detachment of 193 days compared with 263 days in the group treated with only proton therapy (P <.04). At 1 year, visual acuity was similar. CONCLUSIONS: Combined laser radiation more rapidly dissipates exudative detachments than radiation alone.

[Choroidal nevi associated with serous macular detachment]. / Décompensation exsudative anatomique et fonctionnelle de 12 naevi choroïdiens.

PURPOSE: To describe the aspect and progression of choroidal nevi associated with macular serous detachment and to analyze different treatments. MATERIAL: and methods: Twelve posterior choroidal nevi were associated with subretinal fluid. The fovea was detached in 11 cases. Tumor thickness was 2 mm or less. RESULTS: No treatment was given in 6 cases and spontaneous subretinal fluid regression was observed in 3 of these 6 cases. Success was also observed in 2 of 3 cases treated with corticotherapy, but subretinal fluid recurred. Gas injection was performed in 1 case and transpupillary thermotherapy in 2 others, all 3 with successful definitive drying of the nevus. Visual acuity decreased in 6 cases (in 3 untreated cases and in 3 cases treated with corticotherapy), remained stable in 3 cases, and increased in 3 cases (in 1 untreated case, in 1 gas injection case, and in 1 case after thermotherapy). Tumor growth was observed in 3 cases, on the average 2 years after diagnosis (25%). CONCLUSION: Subretinal fluid is rarely observed with choroidal nevi and its progression is variable. Various treatments in addition to observation such as corticotherapy, gas injection, transpupillary thermotherapy seem effective in stabilizing or improving visual function. Supervision is nevertheless needed to detect tumor growth that can be frequent in these nevi associated with subretinal fluid.

Preretinal neovascularisation associated with choroidal melanoma.

BACKGROUND: The rare occurrence of iris neovascularisation and choroidal (subretinal) neovascularisation in patients with choroidal melanoma has been reported. However, the occurrence of preretinal neovascularisation (NVE) fed from the retinal circulation in eyes with choroidal melanoma is far less frequently reported. METHODS: Three case reports of choroidal melanoma with the very rare finding of overlying NVE. RESULTS: The three patients had choroidal melanomas, localised serous retinal detachment, and NVE. Two cases showed definite retinal capillary non-perfusion, and one of these two cases demonstrated retinal telangiectasis. One patient's melanoma responded quickly to iodine-125 plaque radiotherapy; however, the retinal neovascularisation persisted and caused vitreous haemorrhage. Localised scatter photocoagulation was successful in causing the complete regression of the neovascularisation. The other two patients had their eyes enucleated (one with planned pre-enucleation external beam radiotherapy). Demonstration of preretinal vessels in one of the cases was possible in histological sections. CONCLUSION: Preretinal neovascularisation may occur as a complication of choroidal melanoma. Possible aetiologies include the release of tumour angiogenic factors, inflammation, chronic retinal detachment with secondary retinal ischaemia, retinal vascular occlusion secondary to retinal vessel invasion by the tumour, or following radiation therapy. Optimal management of the neovascularisation is not known at this time. Supplemental localised scatter photocoagulation may be of benefit in some cases.