Surgical outcomes of unwrapped acrylic orbital implants: A review of 192 patients.

PURPOSE: The purpose of this study is to report the results in a series of acrylic orbital implant placements without the use of wrapping material. METHODS: We retrospectively reviewed the records of the patients who underwent enucleation with acrylic orbital implant insertion without scleral wrapping at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 2013 and 2020. RESULTS: There were 192 patients: 102 women and 90 men, mean age: 60 years (range: 13-90 years). In the majority of cases, the reason for enucleation was uveal melanoma (148 patients-77.1%), followed by secondary glaucoma in 22 patients (11.5%) and painful, phthisical eye in 16 (8.3%). The median follow-up was 23 months (range: 1-96 months). The stability of the implants was satisfactory in the majority of cases, and there were no cases of implant migration identified during the study period. We noted a total of 4 (2%) implant exposures. Other postoperative complaints included eyelid malposition-21 patients (11%), Tenon's capsule thinning (15 patients-7.8%) and post-enucleation eye socket syndrome (PEES)-7 patients (3.6%). The rate of postoperative complications was associated only with a history of previous ocular surgery (P=0.006). CONCLUSIONS: The stability and functional outcomes of unwrapped acrylic orbital implants in this group of patients were satisfactory during the follow-up period.

Clinical evaluation of a paper chart for predicting ruthenium plaque placement in relation to choroidal melanoma.

PurposeTo determine the accuracy of estimated tumour location and required plaque position using fundus diagrams, and to evaluate their applicability in daily clinical practice.Patients and methodsBetween September 2013 and March 2016, all patients treated with ruthenium plaque brachytherapy for choroidal melanoma at the Department of Ophthalmology in Poznan underwent pretreatment planning with the use of printed or electronic fundus diagrams www.oculonco.comThe estimated distances were then verified intraoperatively.ResultsThere were 40 eyes of 40 patients: 15 men, 25 women, with a median age of 61 years (range: 21-88). The median longitudinal basal diameter (LBD) of the treated melanomas was 10.4 mm (range: 6.5-14.9) and the median thickness was 4.1 mm (range: 1.9-6). The final postition of the anterior tumour margin was within 1 mm of the estimated location in 39 cases (97 %), and within 2 mm in 1 case (3 %). Median follow-up was 15 months (range: 3-36). By the close of the study, there was one local tumour recurrence (3%) and one patient died of unrelated cause 1 year after treatment. No patient developed metastases by study close.ConclusionsThe plaque planning system using the paper fundus diagrams proved to be accurate, easily applicable and should aid plaque placement where computer modelling is not possible.

The surgical approach to the management of anterior uveal melanomas.

PURPOSE: Surgical excision of peripheral iris or ciliary body melanomas can be performed antero-posteriorly (irido-cyclectomy) with mydriasis or postero-anteriorly (cyclo-iridectomy) with miosis. The aim of this study was to evaluate the results of both surgical techniques. METHODS: Patients were enrolled in the study if they underwent irido-cyclectomy or cyclo-iridectomy for iris and/or ciliary body melanoma at the Liverpool Ocular Oncology Centre between 1993 and 2012. RESULTS: The 24 patients (8 male, 16 female) had a median age of 57 years. The largest median basal tumour diameter and the median tumour thickness were 4.8 and 2.2 mm, respectively. The resection was performed antero-posteriorly in 9 (37%) patients and postero-anteriorly or circumferentially in 15 (63%). Nine tumours contained epithelioid cells. Genetic studies were performed in 10 patients, showing chromosome 3 loss in two. Postoperative complications included hypotony in 9 (37%) patients, cataract in 8 (33%), hyphaema in 8 (33%), cyclodialysis in 1 (4%), wound dehiscence in 1 (4%) and bullous keratopathy in 1 patient (4%). The median follow-up time was 2.4 years. The last known visual acuity was 6/6-6/12 in 20 (91%) patients and 6/18-6/60 in 2 (9%), with 2 (8%) requiring secondary enucleation. Local tumour recurrence developed in 1 patient (4%). Two (8%) patients died of metastatic disease. CONCLUSIONS: Surgical resection of peripheral iris melanomas achieves high rates of visual conservation and local tumour control and may be the preferred option when tissue is required for laboratory studies.