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1.
World Neurosurg ; 133: e129-e134, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31476453

RESUMO

OBJECTIVE: Choroidal hemangioma (CH) is a benign vascular tumor that induces subretinal fluid collection or exudative retinal detachment and consequent visual symptoms. Current standard treatments for CH include cryotherapy, diathermy, photocoagulation, photodynamic therapy, transpupillary thermotherapy, and radiation therapy. Stereotactic radiosurgery has recently been applied to the treatment of CH because of its characteristic stiff dose-fall-off and accuracy. We have adopted gamma knife radiosurgery (GKRS) to treat CH and have retrospectively assessed tumor volume reductions and improvements to visual acuity achieved thereby. METHODS: Fourteen patients with CHs were treated with GKRS from November 2006 to December 2017. Eight patients had circumscribed CH, and 6 exhibited diffuse CHs and were diagnosed with Sturge-Weber syndrome. The mean age of patients was 27.1 years (range: 8-68 years) and the mean duration of clinical or radiological follow-up was 40.2 months (range: 5-105 months). The mean volume of the tumors at the time of GKRS was 533.5 mm3 (range: 124-1150 mm3), and the mean prescribed marginal dose was 11.6 Gy (range: 10-16 Gy) with 50% isodose lines. RESULTS: The tumor volume decreased by the last follow-up in all patients. The visual acuity improved in 9 patients (64%) and decreased in 1 (7%). Six patients (43%) required trans-pars plana vitrectomy before or after GKRS. There were no symptomatic complications from radiation injury during the follow-up periods. CONCLUSIONS: GKRS could be an acceptable alternative treatment for symptomatic CH when standard therapy is not feasible.


Assuntos
Neoplasias da Coroide/cirurgia , Hemangioma/cirurgia , Radiocirurgia , Adolescente , Adulto , Idoso , Criança , Neoplasias da Coroide/complicações , Neoplasias da Coroide/patologia , Neoplasias da Coroide/terapia , Terapia Combinada , Feminino , Seguimentos , Hemangioma/complicações , Hemangioma/patologia , Hemangioma/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Carga Tumoral , Transtornos da Visão/etiologia , Adulto Jovem
2.
In Vivo ; 34(1): 381-387, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882502

RESUMO

AIM: The aim of this study was to detect clinical factors predictive of loss of visual acuity after treatment in order to develop a predictive model to help identify patients at risk of visual loss. PATIENTS AND METHODS: This was a retrospective review of patients who underwent interventional radiotherapy (brachytherapy) with 106Ru plaque for primary uveal melanoma. A predictive nomogram for visual acuity loss at 3 years from treatment was developed. RESULTS: A total of 152 patients were selected for the study. The actuarial probability of conservation of 20/40 vision or better was 0.74 at 1 year, 0.59 at 3 years, and 0.54 at 5 years after treatment. Factors positively correlated with loss of visual acuity included: age at start of treatment (p=0.004) and longitudinal basal diameter (p=0.057), while distance of the posterior margin of the tumor from the foveola was inversely correlated (p=0.0007). CONCLUSION: We identified risk factors affecting visual function and developed a predictive model and decision support tool (AVATAR nomogram).


Assuntos
Braquiterapia/métodos , Neoplasias da Coroide/radioterapia , Melanoma/radioterapia , Nomogramas , Radioisótopos de Rutênio/uso terapêutico , Neoplasias Uveais/radioterapia , Acuidade Visual/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/patologia , Feminino , Seguimentos , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Neoplasias Uveais/patologia , Acuidade Visual/efeitos da radiação , Adulto Jovem
3.
BMJ Case Rep ; 12(11)2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31753826

RESUMO

We report a rare case of isolated mediastinal and inferior mediastinal lymph node metastases from choroidal melanoma. The patient was treated for primary choroidal melanoma with local tumour resection and radioactive plaque brachytherapy. Eleven years later, he was diagnosed with metastatic disease. Molecular analysis of the metastatic tumour demonstrated a GNAQ Q209P mutation. There was no evidence of malignant blue naevus or primary melanoma of the central nervous system on physical examination or imaging. The rare modality of clinical presentation highlights the unpredictable nature of metastatic uveal melanoma.


Assuntos
Neoplasias da Coroide/patologia , Hemotórax/etiologia , Melanoma/secundário , Adulto , Braquiterapia , Neoplasias da Coroide/terapia , Procedimentos Cirúrgicos de Citorredução , Diagnóstico Diferencial , Humanos , Imunoterapia , Metástase Linfática , Masculino , Melanoma/terapia
4.
BMJ Case Rep ; 12(10)2019 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-31666252

RESUMO

A 1-day-old child was brought to the clinic for evaluation of enlarged right eye (OD). On examination, OD showed buphthalmos with diffuse scleral melanocytosis, fleshy blackish-brown extrascleral mass with corneal extension, and secondary glaucoma. Anterior segment evaluation revealed darkly pigmented iris and fundus evaluation OD revealed a darkly pigmented choroidal lesion. The left eye was within normal limits. A clinical diagnosis of choroidal melanocytoma with ocular melanocytosis was made. Enucleation OD followed by orbital implant was performed. Histopathology showed features of diffuse ocular melanocytosis involving limbus, iris, ciliary body, choroid, sclera, optic nerve head, optic nerve sheath, along with choroidal melanocytoma with extrascleral tumour extension. We presume that choroidal melanocytoma may have arisen from ocular melanocytosis.


Assuntos
Neoplasias da Coroide/congênito , Hidroftalmia/diagnóstico , Melanoma/patologia , Melanose/complicações , Neoplasias da Coroide/diagnóstico por imagem , Neoplasias da Coroide/patologia , Neoplasias da Coroide/cirurgia , Diagnóstico Diferencial , Enucleação Ocular/métodos , Neoplasias Oculares/diagnóstico por imagem , Neoplasias Oculares/patologia , Fundo de Olho , Humanos , Hidroftalmia/etiologia , Lactente , Masculino , Melanose/patologia , Doenças da Esclera/patologia , Resultado do Tratamento
5.
Rom J Morphol Embryol ; 60(2): 673-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31658343

RESUMO

Uveal melanoma is the most common intraocular tumor characterized by increased metastatic potential. The tumor develops from uveal melanocytes that, from an embryological point of view, derive from the cells of the anterior neural crest. The risk factors associated with melanoma development are close related to patient phenotype: light-colored hair and iris, fair skin. Recent studies have shown the link between choroidal melanoma and choroidal pigmentation of white-haired and light-colored eyes individuals. Increased pigmentation of the choroid is associated to marked increase in melanocyte density, which from a histological point of view can be a starting point for choroidal carcinogenesis. This case report is about a 36-year-old patient who presented in an outpatient ophthalmological examination for intermittent vision blurring. The ophthalmological examination revealed a view of 0.8 and nasally from the optic nerve head, a prominent tumor-shaped formation was detected during the fundus examination. The presence of a choroidal melanoma was suspected and eye ultrasound, angio-fluorography, optical coherence tomography (OCT) were performed and confirmed the diagnosis. Due to the small size, a team of three ophthalmologists decided to make brachytherapy. The procedure consisting of brachytherapy was temporarily applied to the scleral wall and was done at Debrecen University Hospital, Hungary, the follow-up monitoring being done at the Clinic in Oradea, Romania. Although the initial prognosis was optimistic, after four years of brachytherapy the tumor recurred, the dimensions found were over 14 mm, which is why enucleation was decided. Prior to enucleation, no computed tomography (CT) metastases were detected. Five months after enucleation, hepatic metastases occurred and after another two months, death occurred.


Assuntos
Neoplasias da Coroide/diagnóstico , Melanoma/diagnóstico , Adulto , Neoplasias da Coroide/patologia , Humanos , Masculino , Melanoma/patologia , Prognóstico
6.
Turk J Ophthalmol ; 49(5): 305-309, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31650817

RESUMO

A 78-year-old Caucasian woman presented with pain in her right and only eye that was worse on abduction. Her history was significant for a choroidal melanoma affecting her left eye for which she underwent an orbital exenteration 12 years previously. Computed tomography and magnetic resonance imaging of the right orbit identified a mass lesion affecting the medial rectus, suspicious for metastatic melanoma. A histopathological diagnosis of metastatic melanoma was subsequently made following biopsy of the right medial rectus.


Assuntos
Neoplasias da Coroide/patologia , Melanoma/secundário , Músculos Oculomotores/diagnóstico por imagem , Exenteração Orbitária/efeitos adversos , Órbita/diagnóstico por imagem , Neoplasias Orbitárias/secundário , Idoso , Biópsia , Feminino , Humanos , Imagem por Ressonância Magnética , Melanoma/diagnóstico , Neoplasias Orbitárias/diagnóstico , Tomografia Computadorizada por Raios X
7.
Int J Mol Sci ; 20(18)2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31509978

RESUMO

Tumorous metastasis is a difficult challenge to resolve for researchers and for clinicians. Targeted delivery of antitumor drugs towards tumor cells' nuclei can be a practical approach to resolving this issue. This work describes an efficient nuclear-targeting delivery system prepared from trans-activating transcriptional activator (TAT) peptide-functionalized graphene nanocarriers. The TAT peptide, originally observed in a human immunodeficiency virus 1 (HIV-1), was incorporated with graphene via an edge-functionalized ball-milling method developed by the author's research group. High tumor-targeting capability of the resulting nanocarrier was realized by the strong affinity between TAT and the nuclei of cancer cells, along with the enhanced permeability and retention (EPR) effect of two-dimensional graphene nanosheets. Subsequently, a common antitumor drug, mitomycin C (MMC), was covalently linked to the TAT-functionalized graphene (TG) to form a nuclear-targeted nanodrug MMC-TG. The presence of nanomaterials inside the nuclei of ocular choroidal melanoma (OCM-1) cells was shown using transmission electron microscopy (TEM) and confocal laser scanning microscopy. In vitro results from a Transwell co-culture system showed that most of the MMC-TG nanodrugs were delivered in a targeted manner to the tumorous OCM-1 cells, while a very small amount of MMC-TG was delivered in a non-targeted manner to normal human retinal pigment epithelial (ARPE-19) cells. TEM results further confirmed that apoptosis of OCM-1 cells was started from the lysis of nuclear substances, followed by the disappearance of nuclear membrane and cytoplasm. This suggests that the as-synthesized MMC-TG is a promising nuclear-target nanodrugfor resolution of tumorous metastasis issues at the headstream.


Assuntos
Neoplasias da Coroide/tratamento farmacológico , Sistemas de Liberação de Medicamentos/métodos , Grafite/química , Melanoma/tratamento farmacológico , Mitomicina/administração & dosagem , Peptídeos/química , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/química , Linhagem Celular , Linhagem Celular Tumoral , Núcleo Celular/efeitos dos fármacos , Núcleo Celular/metabolismo , Núcleo Celular/ultraestrutura , Neoplasias da Coroide/metabolismo , Neoplasias da Coroide/patologia , Portadores de Fármacos/química , Humanos , Melanoma/metabolismo , Melanoma/patologia , Microscopia Eletrônica de Transmissão , Mitomicina/química , Nanoestruturas/administração & dosagem , Nanoestruturas/química , Nanoestruturas/ultraestrutura , Produtos do Gene tat do Vírus da Imunodeficiência Humana/química
8.
J Med Case Rep ; 13(1): 238, 2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31370890

RESUMO

BACKGROUND: Choroidal osteoma is rare clinical entity of unknown etiology, characterized by formation of mature cancellous bone within the choroid. It typically affects young females, with no racial predilection. Vision loss occurs mainly due to photoreceptor degeneration secondary to decalcification and/or development of choroidal neovascularization especially if located at the subfoveal area. CASE PRESENTATION: Our case is 9-year-old Indian (Indo-Aryan) boy identified incidentally with clinical features suggestive of choroidal osteoma with marked diminution of vision. Spectral domain optical coherence tomography demonstrated high reflectivity from the choroid and atrophy of the overlying retinal layers and B-scan ultrasound demonstrated multiple highly reflective calcified lesions within the choroid. CONCLUSION: Although available literature shows that the occurrence of this rare clinical entity is more commonly seen in young females, our case report has shown that it may be seen at a very early age. The treatment options are still not available if significant atrophy of retinal pigment epithelium has already occurred; however, vision loss due to associated choroidal neovascularization may be treated with currently available treatment options. In our case, the vision loss was due to the significant atrophy of the retinal layers. Choroidal neovascularization was not seen and our patient was advised to attend follow-up regularly.


Assuntos
Neoplasias da Coroide/patologia , Osteoma/patologia , Criança , Neoplasias da Coroide/diagnóstico por imagem , Feminino , Angiofluoresceinografia , Humanos , Masculino , Osteoma/diagnóstico por imagem , Tomografia de Coerência Óptica , Transtornos da Visão/diagnóstico , Transtornos da Visão/etiologia
9.
BMC Ophthalmol ; 19(1): 193, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455325

RESUMO

BACKGROUND: In the recently published article entitled "Ocular ultrasound versus MRI in the detection of extrascleral extension in a patient with choroidal melanoma" Jacobsen et al. describe a case in which a hyper-intense extra-ocular lesion on MRI was erroneously diagnosed as an extrascleral extension of the tumor. Based upon this the authors conclude "the superiority of ocular ultrasound in the diagnostic management of extra scleral extension in choroidal melanoma". In our view, there are numerous flaws in the investigation that cast doubt on this message. MAIN: First of all, this is quite a bold statement when only one patient has been evaluated. Secondly, the manuscript only presents a post-contrast T1-weighted image, whereas multiple MRI-sequences need to be included to determine if a hyperintense region is an extrascleral invasion. Moreover, no modern MRI-techniques such Dynamic Contrast Enhanced (DCE) or Diffusion Weighted Imaging (DWI) have been included in the evaluation of this patient, making it hard to use this single case to compare the efficacy of MRI and Ultrasound. The presented data do, however, give clear clues that the hyperintense lesion is likely to be inflammatory. CONCLUSION: Although the study falls short in providing a comprehensive comparison between current MRI techniques and ultrasound, it does show that the evaluation of ocular MR-images should be made in a multi-disciplinary setting involving both ophthalmologist and radiologists, since the field of ocular MRI is continuously progressing.


Assuntos
Neoplasias da Coroide/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Melanoma/diagnóstico por imagem , Doenças da Esclera/diagnóstico por imagem , Neoplasias da Coroide/patologia , Humanos , Melanoma/patologia , Invasividade Neoplásica , Doenças da Esclera/patologia , Ultrassonografia/métodos
11.
Biomed Res Int ; 2019: 3909102, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380420

RESUMO

Purpose: To explore the effect of VEGF (vascular endothelial growth factor) on the vasculogenic mimicry (VM) formation of Choroidal Melanoma (CM) through PI3k signal pathway, to find novel targets for CM therapy. Methods: This research investigated the molecular mechanism of VEGF promoting VM formation of CM. First, we evaluated the expressions of VEGF in 20 CM specimens by immunohistochemical determination. Then we detected expressions of VEGF, AKT, MT1-MMP, MMP2, and MMP9 of OCM-1 in hypoxia. siRNA was used to inhibit the expression of VEGF, to realize the control of the VM formation. The VM formation was evaluated through wound healing assay, transwell assay, and apoptosis. And then we testify the correlation of the VM and the factors in protein and mRNA level preliminarily. Results: VEGF protein was expressed in CM in all 20 cases of CM, especially along the VM. In hypoxia, the expression of VEGF in OCM-1 increased significantly. VEGF gene deletion reduced the proliferation, migration, and invasion of OCM-1. VEGF gene deletion impaired the expression of invasive associated genes like VEGF, p-AKT, AKT, MT1-MMP, MMP2, and MMP9. These results indicate that VEGF induce VM formation in CM by activating PI3K/AKT signaling pathway. Conclusions: VEGF promoted VM formation by the PI3K signal transduction pathway, indicating a molecular mechanism which may be used to develop new therapeutic targets for the clinical treatment of CM.


Assuntos
Neoplasias da Coroide/genética , Melanoma/genética , Neovascularização Patológica/genética , Fator A de Crescimento do Endotélio Vascular/genética , Linhagem Celular Tumoral , Proliferação de Células/genética , Neoplasias da Coroide/patologia , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Masculino , Melanoma/patologia , Proteínas de Neoplasias/genética , Neovascularização Patológica/patologia , Fosfatidilinositol 3-Quinases/genética , Transdução de Sinais/genética
12.
Ophthalmic Genet ; 40(4): 338-341, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31407624

RESUMO

Purpose: The aim of the present study is to report the clinical and genetic characteristics of nevus of Ota with choroidal melanoma in Chinese patients. Patients and Methods: Patients with nevus of Ota with choroidal melanoma were identified by searching the computerized database and patient medical records of Beijing Shijitan Hospital and Shaanxi Yulin Tradition Chinese Medicine Hospital. The patients (2 men and 1 woman; mean age, 52 years; age range, 52­57 years) were all treated by enucleation or local endoresection, and choroidal melanoma was confirmed by pathologic examination. Results: The patients (2 men and 1 woman; mean age, 52 years; age range, 52­57 years) were all treated by enucleation or local endoresection, and choroidal melanoma was confirmed by pathologic examination. The study found that patients with nevus of Ota had higher risk for malignant melanoma. Furthermore, we found two suspicious gene mutations involving FAM111B and DSC2, that might contribute to the etiology of the disease. Conclusions: The results indicate that patients with nevus of Ota should undergo regular ophthalmological observation and be aware of the potential for malignancy.


Assuntos
Proteínas de Ciclo Celular/genética , Neoplasias da Coroide/patologia , Desmocolinas/genética , Melanoma/patologia , Mutação , Nevo de Ota/patologia , Neoplasias da Coroide/complicações , Neoplasias da Coroide/genética , Neoplasias da Coroide/cirurgia , Feminino , Humanos , Masculino , Melanoma/complicações , Melanoma/genética , Melanoma/cirurgia , Pessoa de Meia-Idade , Nevo de Ota/etiologia , Nevo de Ota/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Prognóstico
13.
J Cancer Res Ther ; 15(3): 504-511, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31169211

RESUMO

Aims and Objectives: Brachytherapy using removable ophthalmic plaques loaded with suitable small sealed radioactive seeds adjacent to the ocular's tumor has been widely used as an effective treatment. The aim of this study was to investigate the dose distribution in a modeled eyeball followed to loading of an ocular melanoma tumor with different concentrations of gold nanoparticles (GNPs) as dose enhancement agent by Monte Carlo (MC) calculations. Materials and Methods: The MC code of MCNPX 2.6.0 was used to modeling of COMS standard eye plaque loaded with 24 125I sources (6711 model) located on the sclera of modeled eyeball with detailed structures and materials. A choroidal melanoma tumor was simulated and loaded with different concentrations of spherical gold GNPs (50 nm in diameter). Dose enhancement factors (DEFs) of ocular components were calculated. Results: The dosimetric properties of 125I source (6711 model) and dose distribution of COMS standard eye plaque were calculated successfully as recommended by TG-43U1; AAPM. Loading of tumor with GNPs increased dose to the tumor and decreased dose to the normal tissues; the DEF was increased up to 2.280 and 2.030 for tumor apex, while it was decreased to 0.760 and 0.892 for macula and for gold-tumor mixture and nanolattice distributions, respectively. Conclusion: Loading the choroidal tumor volume with GNPs improves the dose distribution by increasing dose to the tumor and decreasing dose to the health components in ocular brachytherapy with 125I seeds 20-mm COMS plaque.


Assuntos
Braquiterapia , Ouro , Radioisótopos do Iodo , Nanopartículas Metálicas , Dosagem Radioterapêutica , Braquiterapia/métodos , Neoplasias da Coroide/patologia , Neoplasias da Coroide/radioterapia , Fracionamento da Dose de Radiação , Ouro/química , Humanos , Nanopartículas Metálicas/química , Radiometria
14.
J Fr Ophtalmol ; 42(8): 834-838, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31196663

RESUMO

PURPOSE: To describe didactically the local, regional and systemic spread of choroidal melanoma. PATIENTS AND METHODS: Two patients who had undergone primary enucleation for the management of choroidal melanoma in 2018 at the University Hospital of Nice were included. Extrascleral extension and invasion of the vortex veins were evaluated, as well as synchronous and metachronous metastases, based on our database. RESULTS: Patient 1 was diagnosed with large choroidal melanoma with partial scleral invasion and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3, and a gain of chromosome 8q. Systemic work-up was unremarkable. Patient 2 was diagnosed with a large choroidal melanoma with extrascleral extension and vortex vein involvement. Cytogenetic analysis demonstrated a loss of chromosome 3 and a gain of chromosome 8q. Systemic work-up revealed several liver metastases. A total of 1762 patients were included in our database. Eighty-five patients (4.8 %) and 46 patients (2.6 %) experienced vortex vein invasion and extrascleral extension respectively. Patients with vortex vein invasion were diagnosed with synchronous and metachronous liver metastases in 1.2 % and 18.8 % respectively. Patients with extrascleral extension had synchronous and metachronous liver metastases in 6.5 % and 30.4 % respectively. The mean follow-up was 49.4 months (1-180). CONCLUSION: Extrascleral extension and vortex vein invasion illustrate the local, regional and systemic spread of choroidal melanoma. The latter are often associated with genetically aggressive tumours associated with high metastatic risk.


Assuntos
Neoplasias da Coroide/patologia , Melanoma/patologia , Idoso , Neoplasias da Coroide/genética , Neoplasias da Coroide/cirurgia , Enucleação Ocular , França , Humanos , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Masculino , Melanoma/genética , Melanoma/secundário , Melanoma/cirurgia , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica , Estudos Retrospectivos , Esclera/patologia , Esclera/cirurgia , Doenças da Esclera/patologia , Doenças da Esclera/cirurgia , Neoplasias Uveais/genética , Neoplasias Uveais/patologia , Neoplasias Uveais/secundário , Neoplasias Uveais/cirurgia , Neoplasias Vasculares/genética , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia
16.
Ophthalmol Retina ; 3(5): 429-435, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31044735

RESUMO

PURPOSE: To describe the 3 distinct patterns of choroidal nevi in swept-source (SS) OCT and apply that classification to a cohort of consecutive choroidal nevi. Also, we aim to describe the findings of these lesions in near-infrared reflectance (NIR) at different wavelengths (820 and 1050 nm). DESIGN: Single-center, retrospective, observational study. PARTICIPANTS: One hundred four consecutive patients with choroidal nevi. METHODS: Retrospective analysis of choroidal nevi imaged with SS OCT and NIR. MAIN OUTCOME MEASURES: Lesions were classified according to OCT patterns as type A (high reflectivity with optical shadowing), type B (medium reflectivity with partial visualization of the scleral boundary), and type C (hyporeflective with complete visualization of the scleral boundary). RESULTS: Of 104 choroidal nevi, 97 lesions (93.3%) could be classified into 1 of the SS OCT patterns. Forty-nine percent corresponded to type A, 26% corresponded to type C, and 18.3% corresponded to type B. In NIR (n = 820), 76% of lesions were hyperreflective, whereas in NIR (n = 1050), most of the lesions were hyporeflective (59.6%; inverse reflectance). CONCLUSIONS: Choroidal nevi present distinct patterns according to SS OCT features. Clinical implications are yet to be determined. In NIR, inverse reflectance may be a consequence of the confocality of the device, rather than a property of the lesions.


Assuntos
Neoplasias da Coroide/patologia , Nevo Pigmentado/patologia , Oftalmoscopia/métodos , Tomografia de Coerência Óptica/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/diagnóstico por imagem , Feminino , Angiofluoresceinografia , Humanos , Masculino , Pessoa de Meia-Idade , Nevo Pigmentado/diagnóstico por imagem , Estudos Retrospectivos , Espectrofotometria Infravermelho , Adulto Jovem
17.
Ophthalmol Retina ; 3(3): 270-277, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31014705

RESUMO

PURPOSE: To characterize the enhanced depth imaging (EDI) OCT features of ultrasonographically flat choroidal nevi. DESIGN: Retrospective observational study. PARTICIPANTS: Patients with ultrasonographically flat choroidal nevi identified over a 3-year period. METHODS: Comprehensive eye examinations and multimodal imaging were performed every 6 to 12 months. MAIN OUTCOME MEASURES: Lesion thickness and features, EDI-OCT findings. RESULTS: A total of 102 nevi (98 patients) were included. Median follow-up was 9 months (range 0-144 months) and 1 to 8 (mean 2.1) OCTs were performed. On OCT, nevi were classified into 5 subtypes: 3.2% were "not visible," 37.2% had "hyperreflectivity confined within normal choroidal thickness," 16.0% had characteristic anteriorly bowed hyperreflectivity with "discrete" borders and cascading edges, 14.9% were "flat with posterior bowing," and 28.7% were "elevated." One nevus of the "elevated" type demonstrated clinically insignificant growth (<10% in thickness) after 22 months of follow-up. CONCLUSIONS: Five distinct EDI-OCT patterns of choroidal nevi seemed flat on ultrasonography, and many demonstrated thickness and elevation not measurable on B-scan ultrasonography. Lesion thickness can be measured using EDI-OCT.


Assuntos
Neoplasias da Coroide/patologia , Nevo Pigmentado/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia de Coerência Óptica/métodos , Adulto Jovem
18.
Ophthalmic Surg Lasers Imaging Retina ; 50(3): e74-e76, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30893460

RESUMO

The authors present a unique case of bilateral isolated choroidal melanocytosis in an annular pattern that, to our knowledge, has not previously been described. A 44-year-old asymptomatic American Indian woman presented with bilateral choroidal hyperpigmentation in an annular pattern for 12 clock hours around the peripheral retina. No other uveal, scleral, or cutaneous hyperpigmentation was observed. Optical coherence tomography did not demonstrate choroidal thickening or subretinal fluid. The diagnosis of bilateral isolated choroidal melanocytosis was made. Long-term follow-up of this patient and other cases described in the literature is necessary to determine the malignant potential of these lesions. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:e74-e76.].


Assuntos
Neoplasias da Coroide/diagnóstico , Neoplasias da Coroide/patologia , Melanoma/patologia , Adulto , Feminino , Humanos
19.
Br J Ophthalmol ; 103(10): 1448-1452, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30602446

RESUMO

AIMS: To characterise the clinical and topographical features of circumscribed choroidal haemangioma (CCH) and to visualise the patterns of tumour extent in the ocular fundus. METHODS: Data on the size, shape and location of 113 CCH were converted into a database of two-dimensional retinal charts by means of computer drawing software. The extent of the tumours was visualised by merging the charts and displaying the number of overlapping tumours on colour-coded maps. RESULTS: The mean largest tumour diameter was 7.2 mm (range, 2.5-11.0 mm), mean tumour height was 2.4 mm (range, 0.7-4.6 mm) and mean diameter/height ratio was 3.2 (range, 2.1-6.0). The mean distance from the posterior tumour margin to the foveola and optic disc margin was 1.7 mm (range, 0-15 mm) and 2.4 mm (range, 0-11 mm), respectively. The hemispheric location of the tumour centroid was temporal in 75 eyes (66%) and nasal in 38 (34%) (p=0.0005) and the distribution between the superior and inferior hemispheres was 68 (60%) and 45 (40%), respectively (p=0.03). The presence of subretinal fluid (SRF) was significantly associated with young age at diagnosis (p=0.0002), low tumour diameter/height ratio (p=0.0004), nasal hemisphere location (p=0.006) and close proximity to the optic disc (p=0.004). CONCLUSIONS: The superotemporal quadrant close to the macula is the most frequent location of CCH. The tumours are generally characterised by a diameter/height ratio of >2. Tumours in young patients, with marked elevation, in nasal hemisphere and in proximity to the optic disc are associated with SRF exudation.


Assuntos
Neoplasias da Coroide/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Neoplasias da Coroide/patologia , Corantes/administração & dosagem , Feminino , Angiofluoresceinografia , Hemangioma/patologia , Humanos , Verde de Indocianina/administração & dosagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ultrassonografia
20.
Am J Ophthalmol ; 197: 168-179, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30195895

RESUMO

PURPOSE: To test the hypothesis that widely used clinical risk factors for growth of choroidal nevi are associated with malignant transformation. METHODS: Fine needle biopsy for assignment of gene expression profile (class 1 or class 2) was performed in 207 choroidal melanocytic tumors < 3.5 mm in thickness. The class 2 profile was employed as a validated biomarker for malignant transformation. The following data were collected: patient age and sex, tumor diameter and thickness, distance of posterior tumor margin from the optic disc, and the presence or absence of serous retinal detachment, orange lipofuscin pigment, drusen, retinal pigment epithelial fibrosis, retinal pigment epithelial atrophy, visual symptoms, and documented tumor growth. RESULTS: Clinical features associated with the class 2 profile included patient age > 60 years and tumor thickness > 2.25 mm (Fisher exact test, P = .002 for both). Documented growth was not associated with the class 2 profile (P = .5). The odds ratio of a tumor having the class 2 profile was 2.8 (95% confidence interval 1.3-5.9) for patient age > 60 years and 3.5 (95% confidence interval 1.4-8.8) for tumor thickness > 2.25 mm. For patients with both risk factors, the "number needed to treat" to identify 1 patient with a class 2 tumor was 4.3 (P = .0002). No other clinical feature or combination of features was associated with the class 2 profile. CONCLUSIONS: None of the widely used choroidal nevus risk factors for tumor growth, nor documented growth itself, is pathognomonic of malignant transformation as defined by class 2 gene expression profile. Patient age and tumor thickness may be helpful for identifying small choroidal melanocytic tumors that are more likely to have the class 2 profile. Observation for growth prior to treatment continues to be reasonable for most patients with suspicious choroidal nevi. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias da Coroide/diagnóstico , Nevo Pigmentado/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Coroide/genética , Neoplasias da Coroide/patologia , Feminino , Marcadores Genéticos , Humanos , Masculino , Pessoa de Meia-Idade , Nevo Pigmentado/genética , Nevo Pigmentado/patologia , Fatores de Risco , Adulto Jovem
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