Cobalt-60 treatment of choroidal hemangiomas.

PURPOSE: We investigated the therapeutic possibilities of gamma brachytherapy to improve the final functional results of eyes with choroidal hemangiomas, which are benign vascular tumors that can induce progressive impairment of visual acuity. METHODS: We treated 41 patients with choroidal hemangioma with cobalt-60 applicators. The lesions consisted of 39 circumscribed hemangiomas and two diffuse hemangiomas in patients with Sturge-Weber syndrome. Before treatment, visual acuity in the affected eye was 20/200 in ten patients, 20/200 to 20/50 in 17 patients, 20/40 to 20/25 in 11 patients, and 20/20 in three patients. All patients were symptomatic. The macula was infiltrated by the tumor in 12 eyes (29.3%). There was retinal detachment in 40 eyes (97.6%), cystoid edema in ten eyes (24.4%), subretinal fibrosis in eight eyes (19.5%), and areolar atrophy in two eyes (4.9%). RESULTS: After treatment, the retina was reattached in all eyes, and the tumor progressively transformed into a flat scar. The postirradiation macular lesions that we identified were pigment migrations in the macular region, subretinal fibrosis, and an areolar atrophic scar. We correlated the functional results at two, five, and ten years after treatment with the initial visual acuity, and with pre-existing and posttreatment macular lesions. CONCLUSIONS: Our results suggest that radiotherapy is a valuable therapeutic modality for choroidal hemangiomas, particularly in hemangiomas that involve the macula, and for tumors associated with bullous retinal detachment.

Radial asymmetry in the topography of retinoblastoma. Clues to the cell of origin.

Retinoblastoma is a malignancy of the human developing retina. In situ as well as in vitro studies have attributed tumoral histogenesis either to a primitive retinoblast with neuronal and glial differentiation potentials, or to a photosensory progenitor cell. Here it is shown in vivo that the retinal topography of 457 retinoblastoma and retinoma foci is radially asymmetrical. Tumor density appears to mimic the horizontal visual streak characteristic of red/green cone cell distribution. Such a non-random distribution seems to invalidate the hypothesis of a primitive multipotential neuroblast as the unique source of retinoblastoma and may support the view that retinoblastoma evolves along the cone cell lineage.

Ophthalmia nodosa and the oculoglandular syndrome of Parinaud.

We present a case of ophthalmia nodosa and Parinaud's oculoglandular syndrome in a patient scratched by a cat six and a half months previously and who gave a positive result to an antigen test for cat scratch disease. In conjunctival swabs were also found urticarial hairs, tracheal fragments, processionary caterpillar oenocytes, and a grain of pollen. The pathogenic part played by each of these foreign bodies is discussed, as well as the possibility of the oculoglandular syndrome being due to the reactivation of a latent virus, the organism of cat scratch disease. So far as we know, this work provides the first description of the association of ophthalmia nodosa with the oculoglandular syndrome of Parinaud.

[Irradiation treatment of choroidal hemangiomas]. / Le traitement des hémangiomes de la choroïde par radiothérapie.

Therapeutic results obtained following the treatment of 24 cases of choroidal hemangiomas (21 solitary and 3 in a Sturge-Weber syndrome) treated with 60Co applicators or an accelerated proton beam were analyzed. The observation period was less than 2 years for 4 cases, 2 to 5 years for 10 cases, 5 to 10 years for 7 cases and more than 10 years for 3 cases. Reabsorption of retinal detachment without any recurrency was obtained for all the cases. The V.A. was increased in 16 cases, did not change in 4 cases and decreased in 4 other cases. Final V.A. was 6/7.5 or more in 9 cases (37.5%), 6/60 à 6/7.5 in 6 cases (25%), and 6/60 or less in 9 cases (37.5%). None of the cases we treated presented complications induced by radiotherapy (actinic papillitis, circulatory disturbances in the macular area, or neovascular glaucoma). The comparison of the results we obtained with cases treated by photocoagulation or external radiotherapy demonstrated a slight advantage in favour of the focalized radiotherapy, which is not statistically significant because of the small number of cases included in the studies. Meanwhile, contact radiotherapy and irradiation with an accelerated proton beam seems to be a substantial alternative for the treatment of large hemangiomas and tumors invading the macula.

[Prevention of retinal detachment]. / Prophylaxie du décollement rétinien.

The decision to prophylactically treat retinal lesions which could eventually lead to retinal detachment is often a delicate one. The author attempts to outline the principles of an attitude as reasonable as possible to limit the risks inherent in such a prophylactic treatment and to avoid its excessive use.

[Conservative treatment of malignant intra-ocular tumours seen in Lausanne. First report (author's transl)]. / Traitement conservateur des tumeurs intra-oculaires à Lausanne. Premier bilan.

Conservative treatment of malignant tumours situated within the eye, was begun in Lausanne eight years ago. Although the period of observation has been short and the number of patients limited, we can already note the first results, insisting particularly on the dangers and difficulties encountered during this plan of treatment.

[Retinal detachment]. / Le décollement de la rétine.

Over the last few years there has been a further increase in the surgical treatment of the retinal detachment. Reapplication of the retina is now very often achieved immediately. Repeated intervention has become less common and operative methods less aggressive. This communication aims to give an idea of present concepts in the treatment of retinal detachment and to explain some surgical attitudes. It also recalls the importance of early diagnosis, as well as the examination methods and the prophylactic measures generally used. Some new ideas on the etiology of retinal detachment are also discussed.

[Retinoblastoma, a curable tumor (author's transl)]. / Le rétinoblastome, une tumeur curable.

The retinoblastoma is one of the rare curable malignant tumors. Its diagnosis is usually simple, but the first signs are late in appearing and not always recognized. The reasons for delay in diagnosis are examined, and the clinical picture and treatment discussed.

[Pars plana vitrectomy in diabetic retinopathy (author's transl)]. / Vitretomie par la pars plana et rétinopathie diabétique.

The authors illustrate by means of a film the surgical difficulties and dangers involved in a vitrectomy procedure completed by a peeling of preretinal membranes. Taking a case of proliferative diabetic retinopathy, they demonstrate and justify their surgical indications for vitrectomy in diabetics.

[Treatment of retinal detachment by episcleral compression with drainage (author's transl)]. / Traitement du décollement de rétine per plombage circulaire avec drainage.

This paper describes situations in which a circular or semicircular episcleral compression using a silicon sponge, with evacuation of the subretinal fluid, is preferable to a silastic cerclage without drainage. Results obtained in 46 cases are presented. This is the second part of a report presented at the French Society of Ophthalmology in May 1979, devoted to results obtained with the technique of silastic cerclage without drainage.

[Diagnosis of intraocular tumors: phosphorus 32 test]. / Diagnostic des tumeurs intraoculaires: test au phosphore-32.

The 32P test occupies an interesting place among the methods used in the diagnosis of intraocular tumours. It must, however, be reserved for certain situations only, and carried out under clearly defined conditions. The authors outline the indications and modalities of this test, and report the results obtained at the clinic of ophthalmology of Lausanne where it has been in use over the last 10 years.

[Treatment of retinoblastomas, Clinique de Lausanne, 1944--1978]. / Traitement des rétinoblastomes, Clinique de Lausanne, 1944--1978.

Retinoblastoma remains a rare disease, but still one which has an uncertain life and functional prognosis. The diagnosis is often made late because the principal signs such as leukokoria and strabismus have not been recognized, thus a conservative treatment is no longer possible. However, when treated at an early stage, a child suffering from retinoblastoma has every chance of a complete cure and even normal vision may be preserved. Irradiation therapy plays an essential role, using local radiation by radioactive applicators or by external Betatron electron beams. Based on 52 cases, the methods of treatment and the results obtained at the Ophthalmology Department of Lausanne are reported, including one case of spontaneous cure of a bilateral retinoblastoma.