Proton Beam Therapy for Iris Melanomas in 107 Patients.

PURPOSE: To report on the clinical characteristics and outcomes for patients with iris melanoma using proton therapy. DESIGN: Retrospective study. PARTICIPANTS: One hundred seven patients with iris melanoma from 3 regional ophthalmologic centers. METHODS: A retrospective study was conducted for iris melanoma patients from 3 regional ophthalmologic centers referred to and treated at a single proton therapy facility between 1996 and 2015. MAIN OUTCOME MEASURES: At each follow-up visit, examinations included measurement of best-corrected VA, slit-lamp, examination, indirect ophthalmoscopy, and ultrasound biomicroscopy. RESULTS: With a median follow-up of 49.5 months, 5 of 107 patients experienced a local relapse within a median of 36.3 months. The cumulative incidence of relapse was 7.5% at 5 years. All 5 patients showed involvement of the iridocorneal angle (P = 0.056). Diffuse iris melanoma showed a higher risk of relapse (P = 0.044). Four patients showed out-of-field relapse and 1 showed angular relapse. Three patients were retreated with proton therapy, whereas 2 other patients, one with T1b disease and another with diffuse T3 disease, underwent secondary enucleation. None of the patients experienced metastases nor died of iris melanoma. Vision improved in 59.4% of patients (n = 60/101). However, cataracts occurred in 57.4% of the 54 patients (n = 31) without cataract or implant at diagnosis. Secondary glaucoma was reported in 7.6% of the patients (n = 8), uveitis in 4.7% (n = 5), and hyphema in 3.7% (n = 4). All but 5 cases of complications were mild, transient, and not sight limiting after treatment. Five cases of glaucoma, including 1 with uveitis, were severe and associated with visual deterioration. CONCLUSIONS: Proton therapy showed efficacy and limited morbidity in iris melanomas.

Proton beam therapy for presumed and confirmed iris melanomas: a review of 36 cases.

BACKGROUND: To report the clinical features and outcomes of iris melanomas treated by proton beam therapy. MATERIALS AND METHODS: A retrospective study was conducted at the Croix-Rousse University Hospital of Lyon, Department of Ophthalmology, in 36 patients treated by proton beam therapy for presumed (n = 29) and confirmed (n = 7) iris melanomas between July 1997 and October 2010. Ciliary body melanomas with iris involvement were excluded. The patients' mean age was 54.4 years (range, 22-82 years). The average tumor diameter was 3.8 mm (range, 2.5-8.0). The iridocorneal angle was invaded by the tumor in 47% of cases (n = 17), the ciliary body in 17% of cases (n = 6), and the sclera in 3% (n = 1). Raised intraocular pressure was present before treatment in 11.1 % of cases (n = 4). Tumor biopsy was performed in 19% of cases (n = 7). Four patients had undergone an initial incomplete surgical excision of tumor before radiotherapy. Surgical preparation of the eye with tantalum ring positioning had been performed in all cases 3-4 weeks before irradiation. The prescribed dose was 60 Cobalt Gray Equivalent (CGE) of proton beam radiotherapy delivered in four fractions on four consecutive days. RESULTS: The median follow-up was 50 months (mean 60.5, range 15-136). One patient (2.7%) was lost to follow-up. None of the patients showed tumor progression, local recurrence, or metastasis. None of the patients required secondary enucleation. Cataract was developed in 62% of patients, glaucoma in two cases (6%) after irradiation, and hyphema with the aggravation of pre-existing glaucoma in one patient. No patients developed neovascular glaucoma. CONCLUSIONS: Proton beam therapy appears to be the treatment of choice for the conservative treatment of iris melanomas with excellent tumor control and an acceptable rate of complications. Longer follow-up studies on a larger series is necessary to consolidate these results.

Three hundred and sixty degree retinotomy for retinal detachments with severe proliferative vitreoretinopathy.

AIMS: To assess the anatomic and functional results of 360° retinotomy for rhegmatogenous retinal detachment (RD) with severe proliferative vitreoretinopathy (PVR). MATERIALS AND METHODS: Retrospective, non-comparative, interventional, case study of 20 consecutive patients. All surgical operations are as follows: vitrectomy, membrane peeling, PFCL, circumferential 360° retinotomy with anterior retinectomy, and silicone oil tamponade. The decision to pursue retinotomy was made during surgery after exploring all conventional techniques and after maximum membrane removal. RESULTS: The mean number of previous interventions was 1.7 (median 2; range: 0-4). All retinas were reattached at the end of surgery. After 38 months of mean follow-up (range: 18-53 months) the complete retinal reattachment rate was 70 % (14/20). At the end of follow-up, four eyes (20 %) were enucleated and two patients are deceased. Silicone oil was removed in five eyes (25 %). Five eyes (25 %) developed corneal degeneration, four (20 %) rubeosis and one eye (5 %) presented an optic nerve atrophy. Final post-operative visual acuity in eyes with reattached retinas (n = 14) was better or equal to 20/200 in two cases, counting fingers in six cases , hand movements in five cases and light perception in one case. CONCLUSIONS: Only two of 20 operated eyes (10 %) had visual acuity better or equal to 20/200, but only four eyes (20 %) were enucleated. The aim of 360° retinotomy is to avoid further surgery on already fragile and multi-operated eyes.

Intraocular sarcoidosis: association of clinical characteristics of uveitis with findings from 18F-labelled fluorodeoxyglucose positron emission tomography.

AIMS: To assess specific clinical criteria in patients with uveitis that are related to signs of sarcoidosis on (18)F-labelled fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET). METHODS: Retrospective study of 54 consecutive patients with chronic uveitis for whom a PET scan was done because of suspected sarcoidosis, between July 2004 and December 2009. All the patients underwent a clinical examination, biological tests and a high-resolution CT of the chest. RESULTS: 17 of the 54 patients (31.5%) presented hypermetabolic foci on (18)F-FDG-PET scan consistent with sarcoidosis. Among them eight patients (14.8%) underwent biopsy showing non-caseating granuloma. At the end of the study, 10 patients (18.5%) were considered as having a presumed sarcoidosis and seven patients (12.9%) as having indeterminate sarcoidosis. The increasing age at the diagnosis of uveitis (p=0.01), the presence of posterior synechiae (p=0.01) and a positive high-resolution CT of the chest (p=0.01) were significantly related to an abnormal PET scan. CONCLUSIONS: Increasing age at the diagnosis of uveitis, the presence of posterior synechiae and the positivity of high-resolution chest CT are associated with (18)F-FDG PET scan signs consistent with sarcoidosis.