Choroidal haemangioma and photodynamic therapy. Anatomical and functional response of patients with choroidal hemangioma treated with photodynamic therapy. / Hemangioma coroideo y terapia fotodinámica. Respuesta anatómica y funcional de los pacientes con hemangioma coroideo tratados con terapia fotodinámica.

OBJECTIVE: To study the effectiveness and limitations of photodynamic therapy (PDT) as treatment of choice in patients with symptomatic circumscribed choroidal haemangioma. METHODS: A retrospective study was conducted on 16 patients (13 men and 3 women, with mean age of 54.88 years) with circumscribed choroidal haemangioma, who attended our centre and were treated with PDT in the last 7 years. RESULTS: All patients had circumscribed choroidal haemangioma, which caused a decrease in visual acuity (VA) secondary to the presence of intraretinal microcystic oedema or neurosensory detachment. The mean initial VA was 0.23, and the final mean VA after performing PDT was 0.38 (all the VA were measured in decimal scale). It should be noted that patients needed a mean of 1.69 PDT sessions. Three of the patients needed rescue treatment with trans-pupillary thermotherapy, intravitreal injection of anti-vascular endothelial growth factor (ranibizumab, aflibercept) or a dexamethasone intravitreal implant (Ozurdex®). The indication for a change of treatment was the persistence of intraretinal microcystic oedema and/or neurosensory detachment (or incomplete resolution) after 3 PDT sessions. As overall results, 62.5% of patients evolved into anatomical and functional (increase in AV or stability) resolution. CONCLUSIONS: PDT is a straight forward and fast procedure, with a good anatomical and functional response, causing minimal damage to adjacent vessels.

[Results of Iodine-125 radiotherapy in the treatment of uveal melanoma]. / Resultados de la radioterapia con placas de Iodo-125 en el tratamiento del melanoma de úvea.

PURPOSE: To evaluate our experience in the treatment of uveal melanoma by means of Iodine-125 brachytherapy. A reprospective case series study. MATERIAL AND METHOD: Patients diagnosed of uveal melanoma and treated with Iodine-125 brachytherapy in the Ciudad Sanitaria y Universitaria de Bellvitge (CDUV), from September 1996 to December 2000 and follow up of more than one year. RESULTS: During the period of study, 145 patients were diagnosed of uveal melanoma, of which, 77 were treated with Iodine-125 COMS type plaques; among these, 58 were elegible for this study. After a mean of 2.4 year follow up period (878 days) a mean reduction in height of 53.84% and a mean reduction in volume of 75.88% was observed. As for visual acuity, 32.7% of patients presented a vision of 0.1 or better in last follow up check; 13.5% presented low vision at the moment of diagnosis and continued the same up to last follow up check. The rest of patients experienced loss which conditioned vision to less than 0.1. As for complications, we have observed transient diplopia (8.6%), cataract (3.4%), vitreous bleeding (10.3%), neovascular glaucoma (6.8%), radiation retinopathy (17.24%), radiation neuropathy (6.8%), posterior scleritis (2%), pigmental scattering (2%), tumor progression (2%), endophtalmitis (2). Secondary enucleations were carried out in 6.8% of patients. Metastatic disease was observed in 15.5% of the patients. CONCLUSIONS: Brachytherapy with Iodine-125 may induce significant regression in most of patients affected of uveal melanoma, with good preservation of visual acuity and a low rate of complications.

Resultados de la radioterapia con placas de iodo-125 en el tratamiento del melanoma de úvea / Results of iodine-125 radiotherapy in the treatment of uveal melanoma

Objetivo: Evaluar nuestra experiencia en el tratamiento del melanoma maligno de úvea mediante braquiterapia con Iodo-125.Diseño: Estudio retrospectivo de una serie de casos. Material y métodos: Pacientes diagnosticados de melanoma de úvea y tratados mediante braquiterapia con Iodo-125 en la Ciudad Sanitaria y Universitaria de Bellvitge (CSUB), desde septiembre del 1996 hasta diciembre del 2000, y con un seguimiento superior a un año. Resultados: Durante el período de estudio hemos diagnosticado 145 pacientes de melanoma de úvea, de los cuales 77 fueron tratados mediante placas radioactivas tipo COMS cargadas con Iodo-125, de los cuales 58 eran elegibles para el estudio. Con un seguimiento medio de 2,4 años (878 días), se ha constatado una reducción media del grosor tumoral inicial de un 53,84 por ciento y una reducción media del volumen tumoral de un 75,88 por ciento. n cuanto a la agudeza visual, el 32,7 por ciento de los pacientes presentaban una visión en su último seguimiento igual o mejor a 0,1; el 13,5 por ciento presentaban una baja visión en el momento del diagnóstico y continuaban con ella en el último seguimiento; y el resto de los pacientes habían experimentado una pérdida que les condicionaba una visión inferior a 0,1.En cuanto a las complicaciones hemos observado, diplopía transitoria (8,6 por ciento), cataratas (3,4 por ciento), hemovítreo (10,3 por ciento), glaucoma neovascular (6,8 por ciento), retinopatía por radiación (17,24 por ciento), neuropatía por radiación (6,8 por ciento), escleritis posterior (2 por ciento), dispersión pigmentaria (2 por ciento), progresión tumoral (3,4 por ciento), endoftalmitis (2 por ciento).Se ha realizado enucleación secundaria en el 6,8 por ciento. Hemos observado la aparición de metástasis en el 15,5 por ciento de pacientes. Conclusiones: La braquiterapia con Iodo-125, es capaz de inducir una regresión significativa en la mayoría de pacientes portadores de un melanoma maligno de úvea, con buena preservación de su agudeza visual, y con índices de morbilidad bajos (AU)

[Intraocular manifestations of systemic cancer]. / Manifestaciones intraoculares del cáncer sistémico.

Systemic cancer may present intraocular features in three forms: as a sign of the presence of lymphoreticular tumors, of solid tumors or as a paraneoplastic syndrome.