RESUMO
Uveal melanoma (UM) is uncommon in African Americans. Owing to its rarity, UM may not be suspected in African Americans leading to delayed diagnosis. In addition, socioeconomic factors may also play a role in delayed diagnosis. Clinical and ultrasonographic features may be atypical due to racial pigmentation, necessitating diagnostic fine needle aspiration biopsy. Herein, we report an illustrative case series of 12 African Americans with UM highlighting clinical features and diagnostic challenges.
Assuntos
Melanoma , Neoplasias Uveais , Humanos , Negro ou Afro-Americano , Neoplasias Uveais/diagnóstico , Melanoma/diagnóstico , Melanoma/patologia , Biópsia por Agulha FinaAssuntos
Biometria , Corpo Ciliar/diagnóstico por imagem , Cistos/diagnóstico por imagem , Erros de Diagnóstico , Implante de Lente Intraocular , Doenças da Úvea/diagnóstico por imagem , Adulto , Câmara Anterior/patologia , Corpo Ciliar/patologia , Paquimetria Corneana , Remoção de Dispositivo , Feminino , Humanos , Microscopia AcústicaRESUMO
AIM: To compare quantified ultrasonographic A-scan parameters of common choroidal tumors. METHODS: Consecutive patients with a clinical diagnosis of choroidal melanoma (n = 100), choroidal nevus (n = 30), choroidal metastasis (n = 10), and circumscribed choroidal hemangioma (n = 10) were included in this study. Ultrasonographic A-scans (8 MHz, 1,550 m/s, tissue sensitivity = 67 dB) were performed by standard techniques. Using a custom made MATLAB® script, four quantifiable A-scan parameters: tumor height (mm), number of internal reflectivity peaks (numerical value), median internal reflectivity (%), and angle κ (°) were obtained for all (n = 150) tumors. RESULTS: The mean number of internal reflectivity peaks for choroidal nevus, choroidal metastasis, and circumscribed choroidal hemangioma was 3.1, 5.1, and 4.0, respectively. The median internal reflectivity for choroidal melanoma varied from 21.5 to 99.5% (mean = 76.4%). The median internal reflectivity was ≥65% in all choroidal nevus (100%), choroidal metastasis (100%), and circumscribed choroidal hemangioma (100%), and majority of the choroidal melanoma (78%). CONCLUSIONS: The quantified A-scan patterns of common choroidal tumors were significantly influenced by the tumor height. Other than median internal reflectivity of < 65%, which seems to distinguish choroidal melanoma from other tumors (choroidal nevus, choroidal metastasis, and circumscribed choroidal hemangioma), there were no specific diagnostic patterns.
RESUMO
The MIRAgel implantation was popularized in the 1980s as an alternative to silicone for scleral buckle retinal detachment repair. However, long-term follow-up has revealed that the implants can expand, creating globe compression and potentially visually devastating intraocular invasion. The authors document a 33-year-old monocular male patient presenting 20 years after MIRAgel implantation with extensive expansion, posterior migration, globe compression, and possible optic nerve compression. Debulking of the MIRAgel stabilized the vision and restored affected extraocular movements. The authors highlight that posterior MIRAgel migration can cause optic nerve compression, and implant debulking may require a multi-disciplinary approach. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:815-818.].
Assuntos
Migração de Corpo Estranho/diagnóstico , Doenças do Nervo Óptico/diagnóstico , Nervo Óptico/diagnóstico por imagem , Poli-Hidroxietil Metacrilato/análogos & derivados , Complicações Pós-Operatórias , Próteses e Implantes/efeitos adversos , Visão Monocular , Adulto , Constrição Patológica , Migração de Corpo Estranho/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Doenças do Nervo Óptico/etiologia , Poli-Hidroxietil Metacrilato/efeitos adversosRESUMO
PURPOSE: To compare the rates of tumour recurrence following episcleral brachytherapy for uveal melanoma before and after implementation of intraoperative echographic confirmation of plaque placement. MATERIALS AND METHODS: All patients with primary single ciliary body or choroidal melanoma treated with iodine-125 or ruthenium-106 plaque brachytherapy between 1 January 2004 and 30 December 2013 were included. Exclusion criteria were patients with previous radiation treatment and patients who received adjuvant transpupillary thermotherapy. Since February 2007, intraoperative echographic confirmation was initiated to ensure that the plaque was centred on the tumour base and/or all tumour margins were covered by the plaque. RESULTS: 252 patients were included in the study. Local tumour control after primary brachytherapy was achieved in 242/252 (96.0%). Of the 10 patients with treatment failure, 8 patients had local recurrence and 2 patients had failure to response. With the incorporation of the intraoperative echographic confirmation for plaque positioning the treatment failure rate decreased from 9.3% (5/54 patients) to 1.5% (3/198 patients). Continuous and categorical univariable predictors of recurrence were analysed for statistical significance. The only statistically significant variable was the intraoperative echographic confirmation (HR: 0.16; p=0.032) for recurrence within the first 24â months. CONCLUSIONS: Intraoperative echographic confirmation of plaque placement during episcleral brachytherapy for choroidal melanoma reduces the risk of early local recurrence.