A new device for ocular globe enucleation.

It is important to perfect the enucleation technique, especially in cases of intraocular malignancy, to obtain an adequate amount of tissue for histologic analysis and to cause a minimum amount of trauma to the remaining orbital structures. This study describes the use of a new device for ocular globe enucleation. The new instrument has been employed in 16 consecutive enucleation procedures with no complications. The new device has promoted good division of the optic nerve and allowed severing of the optic nerve stump at a length of more than 10 mm.

Ultrasound biomicroscopy features of iris and ciliary body melanomas before and after brachytherapy.

BACKGROUND AND OBJECTIVE: To determine ultrasound biomicroscopy (UBM) features of iris and ciliary body melanomas before and after brachytherapy. PATIENTS AND METHODS: Four uveal anterior melanoma cases undergoing brachytherapy were retrospectively studied. All cases were examined by UBM prior to treatment and repeatedly after treatment. RESULTS: Before brachytherapy, UBM examination showed a solid mass in the iris, ciliary body, or both in all four cases and allowed its characterization, sizing, and positioning. Two cases had a pigmented scleral lesion corresponding to the tumor location, but UBM did not detect any scleral infiltration at those sites. After brachytherapy, all lesions showed progressive decrease in size and progressive attenuation of their limits. Internal reflectivity was variable. Complications related to brachytherapy were demonstrated, including cataract, peripheral anterior synechiae at tumor location, and secondary scleral thinning. CONCLUSION: UBM played an important role as a complementary diagnostic method for anterior uveal melanomas, particularly ciliary body melanomas, but also allowed therapeutic planning (brachytherapy or surgery) and follow-up after treatment.

Optical coherence tomography enhanced depth imaging of choroidal tumors.

PURPOSE: To describe the spectral-domain optical coherence tomography (SD-OCT) features of choroidal tumors imaged using enhanced depth imaging (EDI) technique. DESIGN: Prospective observational case series. METHODS: One tumor each from 23 eyes of 23 patients was included. All the patients underwent clinical fundus photography, ultrasonography, and EDI SD-OCT. Qualitative characteristics (tumor outline, reflectivity and/or shadowing of choroidal layers, and detection of inner sclera) and quantitative characteristics (measurement of maximum tumor thickness and the largest tumor diameter) were assessed. RESULTS: Patients (male=12) were categorized as: amelanotic choroidal nevus (4), melanotic choroidal nevus (9), choroidal melanoma (3), circumscribed choroidal hemangioma (3), and choroidal metastasis (4). In all cases, EDI SD-OCT was able to identify the tumor distinctly from the surrounding normal choroid. Qualitative analysis revealed: amelanotic nevi, homogenous and medium reflective band with visible choroidal vessels; melanotic nevi and choroidal melanomas, high reflective band in the anterior choroid with shadowing, and nonvisualization of choroidal vessels and inner sclera; choroidal hemangiomas, medium/low reflective band without shadowing; and choroidal metastasis, low reflective band in the deep choroid with enlargement of the suprachoroidal space. Maximum tumor diameter and thickness was measurable by EDI SD-OCT only in 10 cases that were <9.0 mm in diameter and <1.0 mm in thickness (undetectable by ultrasonography). CONCLUSIONS: It is possible to obtain cross-sectional views of a variety of choroidal tumors using EDI SD-OCT. Small choroidal tumors nondetectable by ultrasonography can be objectively measured by this technique.

Relationship between histopathological features of chemotherapy treated retinoblastoma and P-glycoprotein expression.

BACKGROUND: P-glycoprotein (P-gp) has been identified as a possible mediator of chemoresistance in retinoblastoma. The aim of this study was to determine the expression of P-gp in retinoblastoma treated with chemotherapy prior to enucleation. METHODS: Seventeen enucleated specimens of retinoblastoma from 16 patients were studied. Nine had been treated with chemotherapy alone, and eight had been treated with chemotherapy and other forms of local treatment. Tumour differentiation as well as choroidal and optic nerve invasion were assessed. P-gp immunohistochemical staining was performed and evaluated as negative, low or high. RESULTS: Histopathological assessment of the cases showed that 14 of 17 eyes (82.3%) had viable retinoblastoma cells. Nine retinoblastomas were considered regressed with a well-differentiated component, five regressed retinoblastomas had viable cells with poor differentiation and three retinoblastomas had regressed leaving no viable cells. Sixteen of 17 retinoblastomas were P-gp positive. In the one case with optic nerve invasion and the three cases with massive choroidal invasion, P-gp expression was found in invading retinoblastoma cells. CONCLUSION: Almost all retinoblastomas expressed P-gp. High levels of P-gp expression might play a role in chemotherapy resistance of retinoblastoma or, conversely, chemotherapy might induce P-gp expression. These results might have an impact on management of bilateral retinoblastoma.

Neuropatia óptica isquêmica anterior bilateral com oclusão das artérias cilioretinianas secundária a linfoma sistêmico / Anterior bilateral ischemic optic neurophaty with occlusion of ciliorentinal artery secundary to lymphoma

Neuropatia óptica isquêmica anterior (NOIA) com oclusão de artérias cilioretinianas secundária a linfoma é uma condição rara caracterizada por perda abrupta da visão, edema pálido da papila óptica e da retina na região papilomacular. Sua fiopatologia está associada principalmente a redução do fluxo sanguineo nas artérias ciliares posteriores curtas que irrigam a porção anterior do nervo óptico. O diagnóstico diferencial deve ser feito com infiltração linfomatosa do nervo óptico, bem como neuropatias tóxicas medicamentosas. Um caso de um portador de linfoma sistêmico há 2 anos com perda recente, súbita e total da visão de ambos os olhos é relatado, e ressaltado que a NOIA deve ser lembrada pelos clínicos diante de pacientes portadores de linfoma sistêmico. Oclusão bilateral da arteria cilioretiniana deve lembrar doença sistemica grave