Episcleral brachytherapy for uveal melanoma: analysis of 136 cases

PURPOSE: To assess the results of I-125 episcleral brachytherapy (EB) in uveal melanoma: tumour control, visual acuity (VA), eye preservation and survival. PATIENTS: Prospective and consecutive study of patients with a diagnosis of uveal melanoma at the Ocular Oncology Unit in the Valladolid University Teaching Hospital treated with EB between September 1997 and June 2008. Ocular examination and extraocular and systemic extension data were registered in a database at the time of the diagnosis and during the follow-up. RESULTS: Among a total of 310 patients diagnosed between September 1997 and June 2008, 136 were treated with EB (mean age, 58.3). Mean follow-up was 55.3 months. As for tumour type, 66.9% were nodular and 39% mushroom shaped. With respect to size, 80.9% were medium, 7.4% small and 11.8% large. After 4.6 years of follow-up, tumours were controlled in 97.1%, with a 55.1% reduction in mean height; only 2.9% of patients showed recurrence. VA was maintained in 16.2% of patients and 17.6% showed an increase; 33% had retinopathy and 14.6% optic neuropathy. Only 5.1% of patients underwent enucleation due to complications and there has been 1 melanoma-related death to date. CONCLUSIONS: I-125 EB is effective in tumour control, allowing preservation of the eye and useful visual function for the majority of patients (AU)

High-dose iodine-125 episcleral brachytherapy for circumscribed choroidal haemangioma.

AIMS: To evaluate episcleral plaque radiotherapy with high-dose (125)I for the treatment of circumscribed choroidal haemangioma (CCH). METHODS: A retrospective review was performed of patients treated for CCH between 1995 and 2007. Brachytherapy was performed with ROPES plaques loaded with (125)I seeds with a target apex dose of 48 Gy. Main outcome measures were regression of CCH, resolution of retinal detachment, visual acuity changes and frequency of radiation-related complications. RESULTS: Eight patients met the inclusion criteria. Mean tumour base was 11.3 (range 7.8-14.3) mm and mean height was 4.4 (range 2.8-6.5) mm. Six patients had an associated retinal detachment and seven macular exudates or oedema. Mean preoperative visual acuity ranged from no light perception to 0.7. Three patients had received prior argon laser treatment. All patients received one radiation treatment, since no new symptoms due to CCH developed during follow-up (mean 83 (range 23-123) months). Tumour regression was found in all cases. Three patients presented radiation retinopathy and one subretinal fibrosis. Visual acuity remained stable in six patients and decreased two or more lines in two patients. CONCLUSIONS: Episcleral brachytherapy led to tumour regression and resolution of non-rhegmatogenous secondary retinal detachments in this case series that included large CCH. Visual stabilisation was achieved in most cases. Given the acceptable rate of side effects detected, (125)I episcleral brachytherapy should be considered in large tumours, in tumours with a subfoveal location or extensive subretinal fluid, and in tumours that have failed to respond to other treatments.

[Ocular retention in patients with uveal melanoma managed by a multimodality approach]. / Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal.

OBJECTIVE: to analyze ocular survival in eyes with uveal melanoma treated with conservative therapies, in a centre that applies all treatment modalities. METHODS: Patients diagnosed with uveal melanoma and treated between September 1990 and April 2007 were included in an historical cohorts study. RESULTS: 273 patients were included. 193 were treated with conservative treatments (70.69%) and 80 were enucleated as primary treatment. 14 patients were enucleated after conservative treatment (7.2%). Kaplan-Meier survival analysis showed an 88% survival probability of the eye in the first 5 years after conservative treatment and 83% at 10 years. CONCLUSIONS: Conservative treatments for uveal melanoma, especially brachitherapy, are safe and effective in relation to tumor control and rate of secondary effects.

Estudio de la conservación del globo ocular con un abordaje multiterapéutico en el melanoma uveal / Ocular retention in patients with uveal melanoma managed by a multimodality approach

Objetivo: Analizar la supervivencia de los globosoculares afectados de melanoma uveal sometidos atratamiento conservador, en un centro que aplicatodas las modalidades de tratamiento.Métodos: Se han incluido en el estudio los pacientesdiagnosticados de melanoma de úvea tratadosentre septiembre de 1990 y abril de 2007 en la unidadde Oncología Ocular del Hospital Clínico Universitariode Valladolid realizándose un estudio decohortes histórico.Resultados: De los 273 pacientes incluidos en elestudio, se trataron 193 pacientes con terapias conservadoras(70,69%), mientras que se enuclearon deforma primaria 80 (29,30%). Se enuclearon de formasecundaria 14 de los sometidos a tratamientoconservador (7,2%) El análisis de supervivencia deKaplan-Meier reveló que tras la aplicación de untratamiento conservador, la probabilidad de conservacióndel globo ocular a los 5 años es del 88% y alos 10 años es del 83%.Conclusiones: El presente estudio pone de manifiestola seguridad de los tratamientos conservadores en el melanoma uveal, especialmente de la braquiterapiaepiescleral, en cuanto a control local dela enfermedad y a tasa de efectos secundarios(AU)

Objective: to analyze ocular survival in eyes withuveal melanoma treated with conservative therapies,in a centre that applies all treatment modalities.Methods: Patients diagnosed with uveal melanomaand treated between September 1990 and April2007 were included in an historical cohorts study.Results: 273 patients were included. 193 were treatedwith conservative treatments (70.69%) and 80were enucleated as primary treatment. 14 patientswere enucleated after conservative treatment(7.2%). Kaplan-Meier survival analysis showed an88% survival probability of the eye in the first 5years after conservative treatment and 83% at 10years.Conclusions: Conservative treatments for uvealmelanoma, especially brachitherapy, are safe andeffective in relation to tumor control and rate ofsecondary effects(AU)

[Surgical treatment of acquired myogenic eyelid ptosis]. / Tratamiento quirúrgico de ptosis palpebral miogénica adquirida.

OBJECTIVE: To report the surgical outcome of aponeurosis surgery in patients with acquired myogenic eyelid ptosis and describe surgical guidelines for their correction. METHODS: The clinical records of two patients with acquired myogenic eyelid ptosis after surgical correction were reviewed. RESULTS: In two patients with acquired myogenic eyelid ptosis and barely good levator function, levator resection surgery was performed. Corneal complications appeared in both cases. CONCLUSION: Patients with acquired myogenic eyelid ptosis are at risk of post-operative surgical complications from corneal exposure. Surgical correction should be conservative and performed only when the visual axis is compromised.

Tratamiento quirúrgico de ptosis palpebral miogénica adquirida / Surgical treatment of acquired myogenic eyelid ptosis

Objetivo: Reportar el resultado de la cirugía de la aponeurosis del elevador en dos pacientes con ptosis palpebral miogénica adquirida y describir pautas quirúrgicas para su corrección.Métodos: Se revisaron las historias clínicas de dos pacientes con ptosis palpebral miogénica posterior a la corrección quirúrgica.Resultados: En dos pacientes con ptosis palpebral miogénica adquirida con escasa función del elevador se realizó cirugía de resección del elevador. Aparecieron complicaciones corneales en ambos casos.Conclusión: Los pacientes con ptosis palpebral miogénica tienen riesgo de complicaciones post-quirúrgicas por exposición corneal. La corrección quirúrgica debe ser conservadora y realizarse solamente cuando el eje visual está comprometido

Objective: To report the surgical outcome of aponeurosis surgery in patients with acquired myogenic eyelid ptosis and describe surgical guidelines for their correction. Methods: The clinical records of two patients with acquired myogenic eyelid ptosis after surgical correction were reviewed. Results: In two patients with acquired myogenic eyelid ptosis and barely good levator function, levator resection surgery was performed. Corneal complications appeared in both cases. Conclusion: Patients with acquired myogenic eyelid ptosis are at risk of post-operative surgical complications from corneal exposure. Surgical correction should be conservative and performed only when the visual axis is compromised

[Ocular hypertension as the principal indicator of onset of uveal melanoma]. / Hipertensión ocular como principal forma de presentación del melanoma uveal.

PURPOSE: To present a series of patients with uveal melanoma masquerading as ocular hypertension. METHODS: Patients diagnosed with uveal melanoma were reviewed, selecting those cases with initial presentation as secondary unilateral glaucoma. Clinical and histopathological information useful for prognosis was examined, such as anterior border localization, size and shape of the tumor, associated ocular pathology, cell type and degree of extraocular extension. RESULTS: Seven patients out of a total of 160 diagnosed with melanoma presented with ocular hypertension (4.3% of the total). Six tumors were large, with only one of them being middle-size. All cases had an associated asymmetric cataract on the affected side. Four cases had neovascular glaucoma, two pseudo-phacolytic glaucoma and the remaining case had invasion of the anterior chamber angle. All cases were unresponsive to medical treatment for glaucoma, due to the unsuspected tumor they harbored. Visual acuity was lower than 0.1 in the affected eye in all patients. Only one case had extraocular extension. A histopathologic examination performed in six cases showed that 3 tumors had epithelioid cellularity and also 3 had varying degrees of extrascleral extension. CONCLUSIONS: In patients presenting with the association of unilateral glaucoma and asymmetric cataract, it is crucial to perform imaging studies, such as ultrasound, in order to rule out the presence of an intraocular tumor, and to achieve an early diagnosis, improving the patient's prognosis and the morbidity of treatments.

Hipertensión ocular como principal forma de presentación del melanoma uveal / Ocular hypertension as the principal indicator of onset of uveal melanoma

Objetivo: Presentar una serie de casos de pacientes con melanoma uveal cuya forma de presentación fue la hipertensión ocular (HTO).Métodos: Se revisaron los pacientes con diagnóstico de melanoma uveal seleccionando los casos cuya forma inicial de presentación del tumor fuera un glaucoma unilateral secundario. Se examinaron los datos clínicos e histopatológicos de valor pronóstico como localización del borde anterior, tamaño y forma del tumor, patología ocular acompañante, tipo celular, y grado de extensión extraocular.Resultados: Siete pacientes de un total de 160 diagnosticados de melanoma se presentaron con hipertensión ocular (4,3% del total). Seis fueron melanomas uveales grandes y el restante de tamaño mediano. Todos mostraron una catarata asimétrica en el lado afecto. Cuatro se presentaron con glaucoma neovascular, dos como pseudoglaucoma facolítico y uno con invasión del ángulo de cámara anterior. Todos se encontraban bajo tratamiento médico de glaucoma sin buena respuesta, por no sospecharse hasta ese momento el tumor intraocular. La mejor AV corregida en el ojo afecto fue menor de 0,1 en todos los pacientes. Sólo uno de los casos presentaba extensión extraocular. La histopatología efectuada en seis de los casos mostró 3 tumores de celularidad epitelioide y también 3 con diferentes grados extensión extraescleral.Conclusión: En los pacientes que presenten el cuadro de glaucoma unilateral y catarata asimétrica, es fundamental la realización de técnicas de imagen, como la ecografía, que permitan descartar la presencia de un tumor intraocular, y para realizar el diagnóstico en estadios precoces, mejorando el pronóstico del paciente y la morbilidad de los tratamientos

Purpose: To present a series of patients with uveal melanoma masquerading as ocular hypertension.Methods: Patients diagnosed with uveal melanoma were reviewed, selecting those cases with initial presentation as secondary unilateral glaucoma. Clinical and hystopathological information useful for prognosis was examined, such as anterior border localization, size and shape of the tumor, associated ocular pathology, cell type and degree of extraocular extension.Results: Seven patients out of a total of 160 diagnosed with melanoma presented with ocular hypertension (4.3% of the total). Six tumors were large, with only one of them being middle-size. All cases had an associated asymmetric cataract on the affected side. Four cases had neovascular glaucoma, two pseudo-phacolytic glaucoma and the remaining case had invasion of the anterior chamber angle. All cases were unresponsive to medical treatment for glaucoma, due to the unsuspected tumor they harbored. Visual acuity was lower than 0.1 in the affected eye in all patients. Only one case had extraocular extension. A hystopathologic examination performed in six cases showed that 3 tumors had epithelioid cellularity and also 3 had varying degrees of extrascleral extension.Conclusions: In patients presenting with the association of unilateral glaucoma and asymmetric cataract, it is crucial to perform imaging studies, such as ultrasound, in order to rule out the presence of an intraocular tumor, and to achieve an early diagnosis, improving the patient’s prognosis and the morbidity of treatments