Radiotherapy for nasolacrimal tract epithelial cancer.

PURPOSE: Tumors of the lacrimal sac are rare and have traditionally been treated surgically. We investigated the use of irradiation for treatment. METHODS AND MATERIALS: Three consecutive patients with primary epithelial cancer of the nasolacrimal apparatus were treated with irradiation. A tumor dose of 52-66 Gy was delivered with conventional fractionation to fields limited to the primary site and immediately surrounding tissues. RESULTS: Local tumor control was achieved in all three patients. Two patients subsequently developed metastatic cervical adenopathy; both were controlled with irradiation to the neck. One of these two died of distant metastases. Two patients are alive and well at 13 years and at 26 months. CONCLUSION: We conclude that epithelial lacrimal sac tumors are controllable by radiation therapy and with a good cosmetic result. Poorly differentiated lesions require elective cervical nodal irradiation.

Microwave hyperthermia for choroidal melanoma in rabbits.

Radiation has provided excellent local control rates in choroidal melanoma, but significant impairment in visual acuity has occurred in 30-60% of patients due in part to the development of radiation vasculopathy in the fovea and optic disc. Hyperthermia has been shown to have a synergistic effect when added to radiation therapy in human malignancies. The use of hyperthermia in ocular melanoma may allow a reduction in the total radiation dose necessary to achieve local control. A 2450-MHz microwave plaque applicator with integral surface cooling was used to deliver hyperthermia treatments to rabbit eyes containing choroidal melanomas. Extensive thermal mapping was done in acute eyes. In 18 survival animals, a single 23-G needle thermocouple probe with three sensors was inserted into the tumor. Target temperatures of 41.0-46.0 degrees C were maintained for 1 hour. All tumor-bearing eyes were followed for 1 month after treatment, or until tumor growth was noted, with serial ultrasound measurements and visual examinations. A 92% response rate was obtained in tumors treated at temperatures greater than 43.0 degrees C for 1 hour with no significant toxicity. Heat alone has significant tumoricidal properties in this animal model.

Sympathetic ophthalmia complicating helium ion irradiation of a choroidal melanoma.

Sympathetic ophthalmia was diagnosed 49 months after helium ion irradiation of a left choroidal melanoma. The patient maintained good vision until 18 months after therapy, when she developed neovascular glaucoma. This complication required multiple therapeutic procedures, including topical anti-inflammatory and antiglaucomatous drops, 360 degrees peripheral panretinal cryoblation, and a single 180 degrees application of inferior cyclocryotherapy over a 2 1/2-year period. Four weeks after the cyclocryotherapy, inflammation was noted in both eyes, and, one month later, enucleation of the left sympathogenic eye was performed. Serial histopathologic sections showed a full-thickness, fibrovascular, scleral scar and tantalum marker ring suture without uveal incarceration. Penetrating surgical trauma, a uveal melanoma, and multiple nonpenetrating treatments resulted in the development of sympathetic ophthalmia.

Phorbol ester-induced orbital myositis.

A single injection of TPA (12-0-tetradecanoyl-phorbol-13-acetate) into the superior rectus muscle of New Zealand white rabbits produced inflammation and edema, followed by fibrosis and muscle restriction. Strain gauge measurements showed a 60% increase in muscle restriction at 24 hours and an increase greater than 400% at 12 weeks. Clinical and histologic characteristics paralleled those of human idiopathic orbital myositis and thyroid orbital myopathy. The combination of initial muscular inflammation and enlargement, subsequent fibrosis and restricted extraocular motility, and histologic evidence of these changes creates a useful model of orbital myositis.

Congenital craniofacial anomalies of ophthalmic importance.

Congenital craniofacial abnormalities frequently require ophthalmic evaluation and surgical management. Called upon to perform as part of the craniofacial team managing the often severely deformed craniofacial patient, the ophthalmologist must bring a basic knowledge of craniofacial syndromes and developmental anatomy, as well as clinical acumen to help preserve or improve ocular and adnexal function. As an introduction to this area of ophthalmology, the clinical features, classification, appropriate facial embryology, assessment and surgical considerations of the various congenital craniofacial abnormalities are reviewed. The expanding availability of craniofacial surgeons and surgical teams along with improved surgical results will ultimately require an increasing involvement by many more ophthalmologists in the evaluation and management of these congenital abnormalities.

Bilateral orbital cavernous haemangiomas.

Simultaneous bilateral orbital lesions are rare. The differential diagnosis includes orbital pseudotumour, metastasis, leukaemia, lymphoma, Wegener's granulomatosis, and neurofibromatosis. We report what we believe to be the first case of bilateral orbital cavernous haemangiomas.

Thyroid dysfunction: managing the ocular complications of Graves' disease.

The pathophysiology of Graves' orbitopathy has yet to be illucidated, but much can be done to reverse the potentially blinding effects of this debilitating ocular disease. Although only 5 to 10% of patients suffer severe ocular complications, many have significant signs and symptoms requiring ophthalmic medical and surgical intervention. Numerous systemic and topical therapies exist for all aspects of the ocular effects of hyperthyroidism, but clear clinical indications or advantages are lacking. Surgical therapies for residual abnormalities have solidified under recent clinical guidelines.

Bilateral ciliary body melanomas.

We describe a 78-year-old woman with bilateral primary ciliary body melanomas. The tumours presented 6 months apart and were treated with iridocyclectomy. Histopathological examination revealed type B spindle cell melanomas. To our knowledge this is the first reported case of bilateral ciliary body melanomas.

Uveal melanoma with opaque media: absence of definitive diagnosis before enucleation.

It is often difficult to make a correct diagnosis of a uveal melanoma in an eye with opaque media. A patient with a blind, painful eye and opaque media was evaluated clinically and with computed axial tomography and ultrasonography. We were unable to establish the definitive diagnosis of a uveal melanoma until the eye was examined histologically. Necrotic melanomas usually present with inflammatory signs, may produce opaque media and can be difficult to diagnose with clinical and imaging studies.

Fluorescein angiography in ciliary body melanomas.

We retrospectively studied the value of iris fluorescein angiography in predicitng benignity or malignancy in 10 cases of ciliary body melanoma with iris extension. No correlation between fluorescein-angiographic appearance and histopathologic features was observed. Fluorescein angiography adds little to the management of ciliary body melanomas with iris extension.

MR imaging of orbital cavernous hemangioma.

Four cases of biopsy proven orbital cavernous hemangioma were studied with magnetic resonance imaging. The hemangiomas were isointense with brain on T1-weighted spin echo (SE) images and well differentiated from adjacent structures due to intense signal from surrounding fat. The T2-weighted SE images of the hemangioma were of high signal intensity in comparison to the orbital fat. The use of surface receiving coils produced striking detail of all soft tissue structures especially on T1-weighted images.