[Survival rates for large choroidal melanomas].

UNLABELLED: Choosing the treatment method for patients with large choroidal melanomas remains a subject of debate. No literature data can be found on survival of such patients after either eye-preserving surgery or enucleation that takes into account the initial tumor size. The purpose of the study was to analyze the five-year survival rates for large choroidal melanomas (by J.A. Shields) in respect of the provided treatment. MATERIAL AND METHODS: Medical records of 103 patients who had undergone treatment for choroidal melanoma (initial prominence 5.0-10.2 mm, initial diameter 7.3-20 mm) were studied. Eye-preserving surgery was performed on 60 patients, of whom 46 patients received brachytherapy (single session in 37 cases) and the other 14 patients--brachytherapy in combination with transpupillary thermotherapy (with subsequent endoresection of the tumor in one case). A total of 16 patients from this group required secondary enucleation. Primary enucleation was performed on 63 patients. Histopathological results confirming choroidal melanoma were analyzed in all 79 cases. RESULTS AND DISCUSSION: The 5-year melanoma-specific cumulative survival rate in the group of eye-preserving surgery was 0.8146, while in the group of primary enucleation it reached 0.8951. The 8-year rate was 0.6921 and 0.7558 correspondingly. However, according to Gehan-Wilcoxon test, the differences were statistically insignificant (p = 0.11). The five-year survival of large choroidal melanoma patients who underwent eye-preserving surgery and no enucleation was 0.7708, 9-year - 0.6175. CONCLUSION: Since the five-year melanoma-specific survival rate after primary enucleation is higher than that after eye-preserving surgery and secondary enucleation (though the difference is statistically insignificant), treatment options for large choroidal melanomas have to be chosen individually, taking into account the age and attitude of the patient as well as the size of the tumor.

[Silent sinus syndrome (clinical case). New potential for enophthalmos correction].

Silent sinus syndrome (SSS) is a rare condition presenting with spontaneous enophthalmos and hypoglobus caused by volume reduction of maxillary sinus due to centripetal collapse of its walls. A case of SSS manifested during pregnancy in 43 years old patient is presented. In 16 months after manifestation of symptoms endoscopic sinus surgery was performed with no postoperative improvement of ocular symptoms. Intraorbital injection of stabilized hyaluronic acid gel was performed for correction of globe position. In control ultrasound examination color Doppler mapping revealed improvement of regional blood flow on the side of injection.

[Implants in ophthalmology and potential of visual control].

Results of complex ultrasonic examination in different time after socket reconstruction using biomaterial "Alloplant" are presented. Modified technique of primary socket reconstruction showed good cosmetic result.

[Rationale for implant insertion after enucleation of eyes with uveal melanoma].

Results of retrospective analysis of medical charts of 328 patients after enucleation due to uveal melanoma (UM) are represented. Our study showed that recurrent tumor occurs in 2.44% cases. The main reasons of recurrence are scleral invasion or tumor damage during surgery. After enucleation due to juxtapapillary UM recurrence is rare and occurs after long-term follow-up. Thus after enucleation due to UM implant insertion is possible in case of scleral integrity and absence of macroscopically apparent tumor extension beyond sclera.

[Method of implant insertion in anophthalmic socket].

The method of extraocular muscles fixation is presented, it consist in direct fixation to alloplant according to their physiological attachment to ensure stump movement after enucleation. A total of 54 patients aged 26-82 years were treated. Primary enucleation was performed in 46 patients and 8 patients were previously treated with brachytherapy. Surgery was performed under general anesthesia using microsurgical technique. After alloplant was fixed to the anterior surface of tenon's capsule a running suture was put horizontally and conjunctival suture had vertical orientation. A pressure dressing was applied for 2-3 days. Generally there were no technical difficulties, but in patients after brachytherapy separation of muscles and tenon's capsule was complicated because of scarring in the site of previous radiation.

[Enucleations in uveal melanoma (analysis of archival records)].

The paper analyzes outpatient cards of 415 patients who underwent enucleation for uveal melanoma (UM) in 1962-2008 and who have been registered in the Moscow City Ophthalmology Center since 1990. The patients' mean age was 58.94 +/-1.29 years. During the follow-up, 56 patients died 5.24 +/- 1.84 years postoperatively. The distribution of UM by the histological types was as follows: spindle cell (n = 275; 66.27%); mixed cell (n = 100; 24.09%), and epithelioid cell (n = 26; 6.27%) UM. Eleven (2.65%) patients were diagnosed as having necrotic melanoma. Poor (preequatorial and juxtapapillary) position was observed in 35.4% of the patients. Mortality in patients with UM after enucleation was 14.44% with a life expectancy of 5.24 +/- 1.84 years. The findings make it possible to recommend that an enucleation procedure should be developed, by concurrently forming a locomotor stump, which promotes the improvement of the results of individual cosmetic prosthetics in patients with UM that is not to undergo organ-saving treatment.

[Enucleation in patients with intraocular melanomas].

This paper analyzes the data available in the literature on the incidence of uveal melanomas. It historically describes enucleation and the specific features of its performance in patients with and without uveal melanoma. The specific features of enucleation in patients with uveal melanoma, indications for locomotor stump formation, and procedures for calculating the parameters of an implant are considered. Analysis of the data available in the literature shows that there is presently no unambiguous opinion as to the most rational enucleation modes and as to the capacities and types of used implants as a whole. This primarily applies to enucleation used in patients with intraocular neoplasms.

[Complex treatment for decompensated edematous exophthalmos].

In endocrine ophthalmolopathy, there may be persistent dysfunction of the organ of vision due to corneal lesion or optical neuropathy. As an illustration of severe corneal lesion in edematous exophthalmos decompensation, the authors give their own observation that shows it necessary to use in such cases complex treatment comprising pulse therapy with glucocorticoids, followed by a long-term dosage reduction and switching over to its oral administration, as well radiotherapy and surgery.