Retinoblastoma is the most common primary malignant intraocular tumor in children. Seeding, specifically the dispersion of the tumor into the adjacent compartments, represents a major parameter determining the degree of retinoblastoma according to the International Classification of Retinoblastoma. In this article we focused on vitreous seeding, one of the main limiting factors in the successful "eye preservation treatment" of retinoblastoma. This article presents an overview of the history of vitreous seeding of retinoblastoma, established treatment procedures and new-research modalities. The introduction of systemic chemotherapy in the treatment of retinoblastoma at the end of the 1990s represented a significant breakthrough, which enabled the progressive abandonment of radiotherapy with its attendant side effects. However, the attained concentrations of chemotherapeutics in the vitreous space during systemic chemotherapy are not sufficient for the treatment of vitreous seeding, and the toxic effects of systemic chemotherapy are not negligible. A significant change came with the advent of chemotherapy in situ, with the targeted administration of chemotherapeutic drugs, namely intra-arterial and intravitreal injections, contributing to the definitive eradication of external radiotherapy and a reduction of systemic chemotherapy. Although vitreous seeding remains the most common reason for the failure of intra-arterial chemotherapy, this technique has significantly influenced the original treatment regimen of children with retinoblastoma. However, intravitreal chemotherapy has made the greatest contribution to increasing the probability of preservation of the eyeball and visual functions in patients with advanced findings. Novel local drug delivery modalities, gene therapy, oncolytic viruses and immunotherapy from several ongoing preclinical and clinical trials may represent promising approaches in the treatment of vitreous retinoblastoma seeding, though no clinical trials have yet been completed for routine use.
Retinal Neoplasms , Retinoblastoma , Child , Humans , Retinoblastoma/chemically induced , Retinoblastoma/drug therapy , Retinal Neoplasms/chemically induced , Retinal Neoplasms/drug therapy , Melphalan/adverse effects , Antineoplastic Agents, Alkylating/pharmacology , Antineoplastic Agents, Alkylating/therapeutic use , Vitreous Body/pathology , Intravitreal Injections , Retrospective Studies
Retinoblastoma is the most common primary malignant intraocular tumor in children. Seeding, specifically the dispersion of the tumor into the adjacent compartments, represents a major parameter determining the degree of retinoblastoma according to the International Classification of Retinoblastoma. In this article we focused on vitreous seeding, one of the main limiting factors in the successful "eye preservation treatment" of retinoblastoma. This article presents an overview of the history of vitreous seeding of retinoblastoma, established treatment procedures and new-research modalities. The introduction of systemic chemotherapy in the treatment of retinoblastoma at the end of the 1990s represented a significant breakthrough, which enabled the progressive abandonment of radiotherapy with its attendant side effects. However, the attained concentrations of chemotherapeutics in the vitreous space during systemic chemotherapy are not sufficient for the treatment of vitreous seeding, and the toxic effects of systemic chemotherapy are not negligible. A significant change came with the advent of chemotherapy in situ, with the targeted administration of chemotherapeutic drugs, namely intra-arterial and intravitreal injections, contributing to the definitive eradication of external radiotherapy and a reduction of systemic chemotherapy. Although vitreous seeding remains the most common reason for the failure of intra-arterial chemotherapy, this technique has significantly influenced the original treatment regimen of children with retinoblastoma. However, intravitreal chemotherapy has made the greatest contribution to increasing the probability of preservation of the eyeball and visual functions in patients with advanced findings. Novel local drug delivery modalities, gene therapy, oncolytic viruses and immunotherapy from several ongoing preclinical and clinical trials may represent promising approaches in the treatment of vitreous retinoblastoma seeding, though no clinical trials have yet been completed for routine use.
Retinal Neoplasms , Retinoblastoma , Child , Humans , Antineoplastic Agents, Alkylating/therapeutic use , Intravitreal Injections , Melphalan , Retinal Neoplasms/chemically induced , Retinal Neoplasms/drug therapy , Retinoblastoma/chemically induced , Retinoblastoma/drug therapy , Retrospective Studies , Vitreous Body/pathology
PURPOSE: 1. To highlight a less-known clinical entity neuroretinitis and the need for differentiation of this entity from the other retinal disease that can mimic. 2. To be familiar with ocular finding in Cat scratch disease. CASE REPORT: Authors describe a clinical course of bilateral neuroretinitis in a 9-year-old boy who was referred to our clinic with painless decreased corrected visual aquity in the right eye (6/18) and in the left eye (6/9). Fundus examination disclosed bilateral stellate maculopathy. Patient had a history of close contact with a cat. Serologic tests for infective disease confirmed the presence of IgG antibody against Bartonella henselae (1:64). Specific antibiotic treatment with bacteriostatical activity against Bartonella henselae restored functional and anatomical changes in both of eyes within two month. RESULTS: Noninfective etiology of bilateral neuroretinitis was essential to exclude in differential diagnosis. Diagnosis of Cat scratch disease was based on positive epidemiological diagnosis, bilateral manifestation of neuroretinitis, high IgG antibody titre against Bartonella henselae and successful treatment of this disease after specific antibiotic therapy. CONCLUSION: Neuroretinitis is the most common ocular manifestation of cat scratch disease. Familiarity with differential diagnosis of neuroretinitis is essential for prompt causal treatment initialisation.
Bartonella Infections/complications , Bartonella henselae , Retinitis/microbiology , Bartonella Infections/diagnosis , Child , Humans , Male , Retinitis/diagnosis
OBJECTIVE: The aim of this study is to evaluate outcomes of hematological examinations in patients under 60 years of age affected by central (CRVO) or branch (BRVO) retinal vein occlusion. Furthermore, it also proves possible existence of risk factors resulting in early atherosclerosis and hematological disease. PATIENTS AND METHODS: Eleven patients (5 women and 6 men) of 38 years of age in average (15-56 years) were examined. Eight patients suffered from CRVO, 3 patients from BRVO. All patients were tested for hematological diseases. We focused on the following hematological parameters: presence of paraprotein, homocysteine blood level, lipoprotein A, presence of antiphospholipid antibody, level of activated protein C resistance, protein S, protein C, antithrombin III. The average follow up period was 19 months. RESULTS: hematological screening was positive in 5 patients, 4 patients out of them suffered from CRVO. High homocysteine blood level was detected in 2 patients and more over, an increased level of antiphospholipid antibodies was diagnosed in 1 patient. An increased level of lipoprotein A was determined in 2 remaining patients. BRVO was diagnosed in one case. Outcome of the hematological examination proved the pathological level of activated protein C resistance and lower level of protein S. CONCLUSION: according to these results we assume, the co-existence of more risk factors for hematological disease increase the probability of CRVO.
Retinal Vein Occlusion/complications , Activated Protein C Resistance/complications , Adolescent , Adult , Antibodies, Antiphospholipid/blood , Antithrombin III/analysis , Blood Coagulation Disorders/complications , Female , Humans , Hyperhomocysteinemia/complications , Lipoprotein(a)/blood , Male , Middle Aged , Protein S/analysis
The Charles University Teaching Hospital in Prague - Motol started to treat patients with retinoblastoma by means of brachytherapy after obtaining the permission to use closed source of ionizing radiation in the beginning of the year 2003. The applicator containing ruthenium (106Ru) emitting mostly the beta radiation was chosen. Half-life is 369 days and the nominal activity of the source is 21.1 MBq. The applicator is placed in place for one to several days according to the prominence of the tumor and actual activity of the source. Duration of the application is calculated with a special program. In the year 2003, three patients with retinoblastoma were treated. In one case bilateral involvement was determined, and the brachytherapy was used for treatment of both eyes. The next patient was treated twice; one treatment followed the other with different localization of the applicator because of too large basis of the tumor. In 2003, altogether the brachytherapy was used for treatment of retinoblastoma five times. In all cases, the combined treatment (chemoreduction, teletherapy, transpupillary thermotherapy, or cryotherapy) was performed. One eyeball was enucleated because of severe post-radiation retinopathy, the second one for persisting tractional retinal detachment. In remaining cases no serious complications or progression of the malignancy were observed.
Brachytherapy , Retinal Neoplasms/radiotherapy , Retinoblastoma/radiotherapy , Ruthenium Radioisotopes/therapeutic use , Child, Preschool , Combined Modality Therapy , Female , Humans , Infant , Male
Eighteen patients suffering of retinoblastoma during three years period (1999-2001) were treated in two departments of ophthalmology in the Czech Republic. In four cases, the involvement was bilateral. In six eyes, because of very late stage of the disease at the time of diagnosis, the initial treatment was the enucleation. The rest, (sixteen eyes) was treated by chemoreduction (chemotherapy) and different combinations of local therapeutic methods according to their respective findings. Nine eyes from this cohort were enucleated in different period of time after the beginning of the treatment because of the relapse of the disease, its continuing or complications of the treatment. In the remaining seven eyes there are no sings of tumor activity. The fractioned radiotherapy was used in the treatment in one eye only and this eye was enucleated subsequently. So the maintaining therapy was successful in seven eyes of sixteen involved, or in 43.75% of cases.
Retinal Neoplasms/therapy , Retinoblastoma/therapy , Child, Preschool , Combined Modality Therapy , Female , Humans , Infant , Male
The objective of the work was to compare the effectiveness of transscleral laser photocoagulation and cryocoagulation of the retina in the treatment of retinopathy of premature infants (ROP). During the period from March 1999 to April 2001 at the Ophthalmological Clinic for children and adults in the Motol Faculty Hospital 80 eyes of 40 children with the borderline stage of ROP were treated. In 40 eyes cryocoagulation was performed, in 40 transcleral photocoagulation of the retina. The mean gestation age of the infants on delivery was 28.7 weeks, the postconception age at the time of operation 36.7 weeks. The follow up period varied from 1 to 24 months. All therapeutic provisions were made with premedication and under local anaesthesia. For a stabilized finding without progression we took an adherent retina without subsequent traction changes. Cryocoagulation was successful in 87.5%, laser photocoagulation in 85%. Both methods proved equally effective. In photocoagulation the authors recorded a lower incidence of local complications. General undesirable effects were not recorded in any of the treated children. Transscleral photocoagulation extends contemporary therapeutic possibilities in patients with ROP.
Cryosurgery , Laser Coagulation , Retina/surgery , Retinopathy of Prematurity/surgery , Humans , Infant , Infant, Newborn
Complications after surgical oncological treatment and irradiation such as impaired growth of the facial skeleton, orbitoethmoid fistulae and others are an important problem for the patient's further fate. For their elimination collaboration of the ophthalmologist and maxillofacial or plastic surgeon is essential as various reconstruction procedures must be used some of which are mentioned in the paper. Some procedures are demonstrated on three patients where osteotomies of the orbit and implantations of bone grafts were performed as well as transplantation of vascularized tissues and skin flaps. In all mentioned patients marked improvement was recorded.
Eye Neoplasms/surgery , Orbital Neoplasms/surgery , Plastic Surgery Procedures/methods , Rhabdomyosarcoma/surgery , Adolescent , Child , Child, Preschool , Female , Humans , Male
The authors wish to demonstrate on the case of a 52-year-old female patient who suffered from non-specific symptoms and impaired visual functions, typical changes on the fundus which may be due to some serious haematological diseases. In the case of the mentioned patient the haematological disease (Waldenström's disease) was manifested by hyperviscous and anaemic syndrome. The ophthalmological finding in the general picture was not dominant but on the whole typical and contributed to a more rapid diagnosis of the fundamental disease. Changes on the fundus by which the hyperviscous syndrome is manifested must be known and in the differential diagnosis the possibility of haematological disease should be taken into account as in the majority patients are involved who are at risk of sudden loss of eyesight and sudden death.
Retinal Diseases/complications , Waldenstrom Macroglobulinemia/complications , Diagnosis, Differential , Female , Humans , Middle Aged , Retinal Diseases/diagnosis , Waldenstrom Macroglobulinemia/diagnosis
In four patients with orbital expansion the authors used computed tomography (CT) to locate the bioptic needle inserted into the orbit. In all these instances it proved possible to collect a sufficient amount of pathological tissue to assess the diagnosis. Serious side-effects were observed only in one case, where the patient developed after insertion of the needle transient bradycardia. CT was also used to locate the needle for exhausting of blood from a lymphangioma of the orbit.
Biopsy, Needle/methods , Orbit/pathology , Radiography, Interventional , Tomography, X-Ray Computed , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Orbit/diagnostic imaging
The application of radiosurgical treatment in ophthalmology is a new and not quite common procedure. The existence of 80 departments in the world with more than 15,000 treated patients suggests however that the therapeutic method is being extended and that its application in ophthalmology will be more extensive in future. The most numerous indication groups for treatment with a Leksell gamma-knife(LGK) worldwide are vascular malformations (44%), benign tumours (33%) and malignant tumours (22%). Other groups include among others functional disorders and metastatic processes (15).
Eye Neoplasms/surgery , Hemangioma/surgery , Radiosurgery , Adolescent , Adult , Female , Humans , Male , Radiosurgery/instrumentation , Sturge-Weber Syndrome/surgery , von Hippel-Lindau Disease/surgery
In the last years, the therapy of ocular melanoma with Leksell's gamma-knife was indicated at several clinics in Prague. It referred to bulky tumors and to unfavourably localized tumors so that only enucleation of the eyeball was the only alternative in our conditions. The results of the treatment of 11 patients have been evaluated in this article. Some other patients treated with this method have not been included in this sample for various reasons (short-term follow-up, combination of radiotherapy with gamma-knife with other therapeutic modality etc.) Gradual decrease in tumor size developed in 10 patients during follow-up. The decrease in tumor size has been observed on repeated ultrasound examinations and magnetic resonance imaging. The growth of tumor was reappeared in one patient, which led to the necessity of enucleation of the eyeball. The complications in other patients were numerous but not serious to such extent that would lead to enucleation. Marked deterioration in visual acuity connected with the treatment occurred in 6 patients. The results achieved by this method are comparable with those achieved by other therapeutic modalities and with the results from other clinics employing gamma-knife for the treatment of uveal melanoma. The results lead to the conclusion that this is an effective method of treatment of uveal melanoma and that this method is able to go through further development, especially in combination with other therapeutic modalities.
Melanoma/surgery , Radiosurgery/instrumentation , Uveal Neoplasms/surgery , Adult , Aged , Humans , Melanoma/pathology , Middle Aged , Uveal Neoplasms/pathology
Masquerade syndromes comprise a number of diseases imitating as to their clinical picture inflammation of the eye. These diseases comprise also malignant tumours. The authors present three patients where intraocular tumours (lymphoma, leukaemia, melanoma of the choroid) reminded of chronic uveitis.
Eye Neoplasms/diagnosis , Uveitis/diagnosis , Aged , Chronic Disease , Diagnosis, Differential , Eye/pathology , Female , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/pathology , Leukemic Infiltration , Lymphoma, Non-Hodgkin/diagnosis , Male , Melanoma/diagnosis , Middle Aged
The authors summarize the knowledge of diagnostics of giant cell arteritis and attempt to determine the criteria for indication of temporal artery biopsy. The difficulties of diagnostics are documented by case-report of 75-year-old patient in whom considerably varied complex of symptoms of temporal arteritis combined with development of polymyalgia rheumatica has developed.
Biopsy , Giant Cell Arteritis/diagnosis , Temporal Arteries/pathology , Aged , Female , Giant Cell Arteritis/pathology , Humans
