Intraoperative sonographically assisted radioactive iodine 125 plaque brachytherapy for choroidal melanoma: visual acuity outcome.

OBJECTIVES: The purpose of this study was to present a retrospective series of cases from a single Canadian academic center assessing visual acuity outcomes after intraoperative sonographically assisted iodine 125 ((125)I) plaque brachytherapy treatment. METHODS: The cases of 28 patients (16 male and 12 female; mean age ± SD diagnosis, 62.3 ± 15 years) with choroidal melanoma treated with (125)I plaque brachytherapy using intraoperative sonography between 1997 and 2002 were reviewed. RESULTS: The mean longitudinal, transverse, and depth dimensions were 11.4, 10.6, and 4.7, respectively. The median follow-up was 48 months (range, 3-102 months) for our cohort of patients. The prescribed dose was 85 Gy to a height of 5 mm (for an apex height ≤5 mm) or to the tumor apex (for an apex height >5 mm). Five years after (125)I plaque brachytherapy, all tumors had regressed in their longitudinal, transverse, and depth dimensions. The prebrachytherapy tumor depth (P = .023) and sclera dose (P = .036) were found to significantly affect visual acuity after plaque brachytherapy at 24 months. One recurrence was recorded 6 years after plaque brachytherapy. CONCLUSIONS: This study supports (125)I plaque brachytherapy as an efficacious treatment for patients with choroidal melanoma, and intraoperative sonography may help with optimizing tumor control. In addition, to our knowledge, this study is the first to report the sclera dose as a significant predictor of visual acuity.

Intra-operative echographic localization for radioactive ophthalmic plaques in choroidal melanoma.

The objectives were to evaluate the beneficial effect of intra-operative echographic plaque site localization and to assess the rate of complications of postplaque insertion. This paper is a descriptive study of 48 patients with choroidal melanoma who underwent iodine-125 (I(125)) or ruthenium-106 (Ru(106)) plaque radiotherapy with intra-operative echographic confirmation of plaque placement with the aid of a nonradioactive plaque (dummy) at McGill University Health Centre from 1997 to 2003. Patients' mean age was 63.7 years; 52% (25/48) male, 48% (23/48) female. Twenty-seven percent (13/48) of the tumors were confined to the right eye and 73% (35/48) to the left eye. Forty-eight percent (23/48) of the tumors were located posterior to the equator, 14.6% (7/48) were anterior to the equator, 18.7% (9/48) in posterior pole, and 18.7% (9/48) at equator. Sixty-nine percent (33/48) received I(125) and 31% (15/48) had Ru(106) treatment. Ninety percent of the dummy plaques were initially positioned suboptimally and required repositioning under echographic guidance. At mean follow-up of 18.8 months, there was no tumor-related death or metastasis, but one patient required enucleation. The dummy plaque technique under echographic visualization resulted in reduction of radioactive exposure time during surgery of up to 50%. Intra-operative echographic utilization has the ability to localize precisely the tumor-plaque relationship, thereby optimizing the radiation delivered to the choroidal melanoma, while minimizing the surgeon's exposure time.

Iodine-125 radiotherapy for choroidal melanoma.

The objective was to evaluate the effect of the gender, size, and tumor location at the time of the diagnosis on the regression response of choroidal melanoma following plaque radiotherapy treatment. The paper is a longitudinal prospective study of 28 patients diagnosed with choroidal melanoma at McGill University Health Centre from 1997 to 2002. All patients were treated with episcleral iodine-125 (I(125)) plaque radiotherapy. Plaques were inserted at the tumor site under echographic visualization. All patients had medium-size tumors, except for three. Patients had periodic ophthalmic evaluation at 3 and 6 months post radiation treatment, followed by 6-month intervals thereafter. Patients' mean age was 62 +/- 15 years, 16 males and 12 females. Fifty percent of the tumors were located posterior to the equator with significant reduction in size at 12 months post plaque radiotherapy treatment. Significant regression was observed in all the tumor diameters at 5 years post treatment follow-up. Reduction in the depth diameter was significant (P < 0.01) in both male and female groups post treatment. There was a 25% (P < 0.001) reduction in the medium size of tumors at 5-year follow-up. Tumors located posterior to the equator responded best to I(125) plaque radiotherapy. Male patients responded better than females to treatment. Medium-size melanoma responded well to plaque radiotherapy.

Visualization of posterior lens capsule integrity by 20-MHz ultrasound probe in ocular trauma.

PURPOSE: To evaluate the use of the 20-MHz ultrasound probe in facilitating visualization of the posterior lens capsule in ocular trauma. DESIGN: Interventional case report. METHODS: Serial examinations using 10-MHz, 20-MHz, and 50-MHz ultrasound technologies were performed on the anterior segment of the right eye of an 18-year-old man referred with a diagnosis of globe penetration and secondary traumatic cataract. RESULTS: Cross-sectional echograms of the anterior segment using the 20-MHz ultrasound showed posterior lens capsule integrity. CONCLUSION: When verifying the status of the posterior lens capsule in cases of ocular trauma, the 20-MHz ultrasound probe is a useful and novel approach.

Ultrasound biomicroscopy of pseudophakic eyes with chronic postoperative inflammation.

PURPOSE: To evaluate the ultrasound biomicroscopy (UBM) findings in pseudophakic eyes with chronic noninfectious postoperative inflammation and discuss the use of the technique in these cases. SETTING: Uveitis Service, Department of Ophthalmology, McGill University, Montréal, Québec, Canada. METHODS: Fifty-four eyes of 51 patients with chronic noninfectious postoperative inflammation were prospectively evaluated between January 1998 and September 2001. Patients with aphakia, a dislocated intraocular lens (IOL) in the posterior segment, and endophthalmitis were excluded. All patients had a UBM examination that comprised locating the IOL position, investigating the presence of lens remnants, and evaluating the anterior segment of the eye. RESULTS: Ultrasound biomicroscopic examination revealed IOL misplacement in 37 eyes (68.5%). Of these, 23 (62.2%) had a sulcus-implanted posterior chamber IOL (PC IOL), 9 (24.3%) an in-the-bag PC IOL, and 5 (13.5%) an anterior chamber IOL. Haptic misplacement was significantly higher with sulcus-implanted PC IOLs than with in-the-bag PC IOLs (P<.01). Other UBM findings included edematous ciliary body processes and hypoechogenic and/or thickened ciliary bodies in 11 eyes (20.4%), peripheral anterior synechias in 8 eyes (14.8%), a significant number of lens remnants (graded as severe) in 6 eyes (11.1%), a thick cyclitic membrane in 3 eyes (5.6%), and an early cyclitic membrane in 2 eyes (3.7%). CONCLUSIONS: Irritation of ocular tissues by an IOL was the main cause of chronic postoperative noninfectious inflammation in pseudophakic eyes. Therefore, detecting the IOL position and its relationships to ocular tissues is very important in planning the treatment. Ultrasound biomicroscopy is a practical method that accurately provides this information.

Ultrasound biomicroscopy of the Artisan phakic intraocular lens in hyperopic eyes.

PURPOSE: To study in situ the intraocular position of the Artisan iris-claw intraocular lens (IOL) (model 203) (Ophtec) in phakic hyperopic eyes using ultrasound biomicroscopy (UBM). METHODS: Echograms of the anterior chamber were taken preoperatively and 24 to 317 days postoperatively in 4 eyes implanted with the Artisan IOL (power +4.0 to +6.0 diopters). The preoperative anterior chamber depth (ACD) and the postoperative distance between the IOL and the corneal endothelium (endothelium-optic distance) and between the IOL and the lens were measured. The echograms were assessed for the effect of the IOL on iris tissue. RESULTS: The preoperative ACD ranged from 3.10 to 3.56 mm and the postoperative endothelium-optic distance, from 2.03 to 2.54 mm. The distance between the lens and the posterior surface of the IOL ranged from 0.35 to 0.79 mm. Several UBM echograms showed indentation of iris tissue by the IOL haptics and optic edge, although no pigmentary dispersion was noted. CONCLUSIONS: Adequate space was maintained between the Artisan hyperopic IOL and the corneal endothelium, angle, and crystalline lens. Haptic indentation of the iris, which could lead to pigment erosion, was observed. Preoperative gonioscopy and maintenance of normal intraocular pressure postoperatively suggest the indentation was secondary to inadequate lens vaulting relative to the high natural arch of the iris in hyperopic eyes. Shortening the haptics or increasing the lens vault might resolve this problem.