[Transpupillary thermotherapy combined with 106Ru as a method of managing choroidal melanoma]. / Przezzreniczna termoterapia w skojarzeniu z brachyterapia 106Ru jako metoda postepowania w czerniaku naczyniówki.

BACKGROUND: A study was carried out to evaluate the effectiveness of transpupillary thermotherapy (TTT) with diode laser applied as adjuvant treatment to 106Ru brachytherapy in choroidal melanoma. These two methods coined as "sandwich therapy" are complementary and allow to decrease the dose of radiation. MATERIAL AND METHODS: Between November 1996 and December 1997, 45 patients with choroidal melanoma were treated simultaneously with 106Ru and TTT. There were 18 males and 27 females, aged 20 to 78 (mean 57). There were 7 tumors with height of 5 mm or less, 28 ranging 5.43-8.63 mm and 10 with height 9 mm or more. The anterior tumor margin was located in the equator area or posterior to it in 71.1% of cases. The laser treatment was delivered using spots 2-3 mm in size, at a mean power 600 mW, for about 1 minute. The mean radiation dose was 60 Gy to the tumor apex. The follow-up ranged from 12 to 24 months. RESULTS: Reduction in tumor height by at least 30% was exhibited in 35 (77.8%) tumors, in one evaluated as positive result it was 27%. There was no improvement after treatment in 4 cases, 2 eyes were enucleated. A significant relationship was found between tumor thickness and the result of treatment. CONCLUSION: Our preliminary observations suggest that TTT combined 106Ru brachytherapy is an effective method of treatment. A longer follow-up is needed to assess final local results and the impact of treatment on survival.

[Diagnostic problems in intraocular melanoma]. / Problemy diagnostyczne w czerniaku wewnatrzgalkowym.

PURPOSE: To evaluate accuracy of the diagnosis, rate of advancement and therapeutic possibilities of intraocular malignant melanomas, basing on our one-year clinical material. MATERIAL AND METHODS: The total of 288 consecutive patients with suspicion or diagnosis of intraocular malignant melanoma, referred in the year 1997 to the Department of Ophthalmology CM UJ, were analysed. There were 121 males and 167 females, aged 22-76, mean 50. The period of time between the patient's first ocular symptoms and his visit to the ophthalmologist ranged between 7 days and several years. Besides routine ophthalmological examination each patient underwent USG and, if necessary AF, ICG, CT and IMR. RESULTS: Diagnosis of malignant melanoma was confirmed in 141 cases. Among these patients in 69 brachytherapy was applied, in 20 surgical resection of the tumor and in 52 enucleation. In 111 cases other following diseases were diagnosed: iris cysts, deficient iridectomy, iris nevus, choroidal nevus, metastatic tumors, age-related macular degeneration, myelinated nerve fibres, Leber-Coats syndrome, toxoplasmosis and granulomatous uveitis. In 36 cases the diagnosis was not exact and those patients remained under periodic clinical observation. CONCLUSIONS: Our study shows that in many patients intraocular malignant melanoma is diagnosed too late and in these cases enucleation is the only method of treatment. The most diagnostic challenges are connected with differentiation of choroidal melanoma from choroidal nevus and exudative form of age-related macular degeneration.

[The efficacy of "Ticlid" in treatment of diabetic retinopathy]. / Skutecznosc preparatu "Ticlid" w leczeniu retinopatii cukrzycowej.

PURPOSE: The efficacy of "Ticlid" (ticlopidine) with insulin-dependent patients and early forms of diabetic retinopathy was evaluated. MATERIAL AND METHODS: Examinations were carried out with 52 patients (103 eyes), including 31 women and 21 men, average age--39.9. With 33 patients (65 eyes), ticlopidine was applied twice a day in the dose of 250 mg, the rest, i.e. 19 patients (38 eyes), the control group, received a Rutinoscorbine tablet three times a day. Before the beginning of the treatment and then every three months the following parameters were examined: visual acuity for far and near distances, ophthalmoscopy, fluorescein angiography and colour photography of the fundus. With the group of patients who received ticlopidine, fibrinolytic activity of plasma (ECLT), threshold pro-aggregative concentration for ADP in rich platelet plasma and the factor of platelet aggregates (WAP) were determined. The follow-up time of the patients lasted from 16 to 36 months (average 21.5 months). RESULTS: More frequent although nonsignificant improvement and stabilization of far distance visual acuity was ascertained in the patients receiving ticlopidine. The same group manifested a significantly frequent (p < 0.02) improvement and stabilization of the changes in the fundus. A significant shortening of ECLT (p < 0.01), a complete stopping of II phase aggregation, a significant (p < 0.01) increase in WAP could be observed as well. The above results indicate the favourable influence of ticlopidine on retina vessels in patients with the symptoms of diabetic retinopathy.