1,721,043 research outputs found
Author response: Choroidal abnormalities detected by near-infrared imaging (NIR) in pediatric patients with neurofibromatosis type 1 (NF1)
No full textCytogenetic analysis of uveal melanomas: a long-term experience
Full text linkBackground/aim: Cytogenetic profile of posterior uveal melanoma (mainly monosomy 3) is actually considered the most specific prognostic factor for uveal melanoma patients. Nevertheless, there is still no consensus on which cytogenetic analysis should be used, and there is still no long-term data about the safety of sampling procedure. The aims of this study were to evaluate (i) long-term safety and efficacy of in-vivo 25-gauge transcleral Fine Needle Aspiration Biopsy (FNAB) and (ii) predictive value of Fluorescent In-situ Hybridization (FISH) vs Multiplex Ligation-dependent Probe Amplification (MLPA) analysis for cytogenetic testing of posterior uveal melanoma.
Methods: One hundred thirty-nine consecutive patients affected by posterior uveal melanoma with tumour thickness > 3mm underwent in-vivo 25-G transcleral FNAB (through the tumor base) just before applying the I-125 active plaque. A double pass sampling was performed. Sampled material underwent both FISH (chromosome 3 and 6) and MLPA analysis using standard procedures. Follow-up examination, including A/B-Scan eye and orbit ultrasonography, was performed after 1 month and every 6 months thereafter. Follow-up was longer than 24 months.
Result: Follow-up was 54±16 months (range, 24-84 months). FNAB yielded sufficient material for FISH analysis in 117 cases (84.2%). Fifty-six cases had monosomy 3 (47.9%). No clinically relevant monosomy 3 heterogeneity was detected (double pass sampling). Chromosome 6 co-detection using FISH was performed in forty-four patients. Monosomy 3 and +6p resulted mutually exclusive in 40 cases (90.9%). Univariate Cox analysis showed metastatic disease to be strongly associated with monosomy 3 (p=0.005). No misclassification occurred in
low risk patients having both disomy 3 and +6p. MLPA was performed in twenty- four patients revealing monosomy 3 in thirteen cases (54%) (vs twelve cases classified by FISH) and a 3p14-q29 deletion in one case (4%) (classified as monosomy 3 by FISH). Considering this sub-group of twenty-four patients having both FISH and MLPA, nine patients (41%) developed metastatic disease during follow-up, including the case showing monosomy 3 only by MLPA. Patient with partial chromosome 3 deletion by MLPA is still alive without metastases. Due to FNAB procedure, tree patients developed transient, localized and self-limited subretinal haemorrhages after FNAB. Neither other short- and long-term complications nor extrascleral extensions were documented during follow up.
Conclusion: The use of 25-G transcleral FNAB appears a long-term safe and effective procedure for in-vivo cytogenetic testing of posterior uveal melanoma. Combined analysis of both arms of uveal melanoma bifurcated pathway (-3 and +6p) increase predictive value of FISH technique. MLPA allows obtaining more information than standard FISH in uveal melanoma prognostication. The biological and prognostic value of partial chromosome 3 deletion, as well as others subtle chromosomes alterations or complex MLPA results, remains unclear
Antiangiogenesis in ocular oncology: More than meets the eye: These agents have multiple applications in the management of chorioretinal vasculature conditions
No full textUltrasound biomicroscopy examination of anterior uveal tumors: information on location and size only?
No full textThe aim of the study was to assess whether ultrasound biomicroscopy (UBM) examination of anterior uveal tumors could help in tissue differentiation. Five anterior uveal tumors in five patients underwent UBM (Paradigm P45, 50 MHz) examination prior to fine needle aspiration (FNA) of the lesion; two melanomas, one nevus, one metastatic carcinoma, and one bilateral iris lymphoma were cytologically diagnosed. Only UBM information was obtained from four small non-growing lesions consistent with iris nevi. Four ciliary body pigmented tumors elevated by 4 to 6 mm were examined both with UBM and immersion standardized echography (Cinescan S, Quantel Medical). UBM showed high reflective iris subsurface in all iris nevi. Of the FNA verified iridociliary pigmented tumors, the iris pigment epithelium was found to be indistinct in iridociliary melanoma only. Iridociliary melanoma, nevus and metastatic carcinoma showed angle invasion and similar acoustic pattern and reflectivity on UBM examination. Multiple iris masses were imaged in lymphoma and metastatic carcinoma. Two ciliary body low to medium reflective and two ciliary body high reflective tumors on standardized echography, consistent with ciliary body melanoma and melanocytoma, were plagued or observed for four and thirteen years; UBM was informative for superficial margins and angle invasion only. In conclusion, UBM was very useful for location and size of small anterior uveal tumors, but could not help in tissue differentiation of iridociliary tumors. Multiple iris lesions were found in iridociliary lymphoma or metastatic carcinoma only. Standardized echography allowed for tissue differentiation in at least 4-mm thick ciliary body pigmented tumors
Pharmacotherapy and immunotherapy of conjunctival tumors
No full textConjunctiva and cornea tumors represent a large spectrum of conditions ranging from benign lesions to aggressive and life-threatening malignancies. Topical pharmacotherapies and immunotherapies have recently acquired a relevant role in the management of conjunctival tumors and, in the past 2 decades, there has been a shift from surgery alone toward the use of these agents, both as a sole therapy or as adjunct to surgery (before or after surgery). The 3 main agents that have been used for topical medical treatment of conjunctival tumors are mitomycin-C, 5-fluorouracil, and interferon-α2b. Advantages of topical pharmacotherapies and immunotherapies include the ability to treat the entire ocular surface and prevention of surgical side effects and complications. The aim of this review is to summarize the current use of topical pharmacotherapy and immunotherapy in the management of conjunctival tumors
Biopsies in uveal melanoma
No full textThe ability to obtain the proper clinical diagnosis in cases of suspected intraocular tumors has greatly advanced during the past 50 years. The clinical characteristics of most intraocular tumors (size, shape, color, and texture) are detectable by skilled ophthalmoscopic examination and, with the use of adjunctive techniques (mainly ultrasonography), the proper diagnosis can be reached without invasive procedures. Notwithstanding, some intraocular tumors need to be biopsied to obtain a reliable diagnosis. In the cytogenetic era, intraocular tumor management is changing, and tumor-sampling procedures are becoming the main prognostic (and theoretically also diagnostic) tools for uveal melanoma. In spite of the widespread use of biopsies in general surgical practice, in ophthalmic oncology, indications and contraindications for biopsy continue to be under debate. The purpose of this paper is to critically evaluate the role of uveal melanoma biopsy in current clinical practice
Standard versus bolus photodynamic therapy in circumscribed choroidal hemangioma: functional outcomes
No full textPURPOSE. To compare standard versus bolus photodynamic therapy (PDT) in the treatment of symptomatic circumscribed choroidal hemangioma (CCH).
METHODS. Twenty consecutive cases of CCH were included in this prospective randomized study. Each patient was randomly assigned to receive either standard PDT (10-minute 6 mg/mq(2) verteporfin infusion; treatment at 15 min; 50 J/cm(2); 83 s) or bolus PDT (6 mg/mq(2) verteporfin infusion bolus in 1 min; treatment at 5 min; 100 J/cm(2); 166 s). Best-corrected visual acuity (BCVA), fundus photography, optical coherence tomography, fluorescein, and indocyanine green angiography were performed at baseline and during follow-up. Retinal sensitivity was tested with microperimetry before and after treatment. Follow-up was longer than 32 months.
RESULTS. Mean follow-up was 58 11 months. All cases (100%) showed clinical regression of the treated lesion. Neuroretinal and retinal pigment epithelium (RPE) changes were found in 9(90%) bolus PDT over treated area. No similar RPE changes were found in patients treated with standard PDT There was a no statistically significant difference in BCVA outcome between the 2 groups (p=0.078). Microperimetry revealed reduced sensitivity over the treated area in 7 bolus PDT vs 1 in standard treated eyes (p=0.008).
CONCLUSIONS. Both standard and bolus PDT induce regression of symptomatic CCH. Bolus PDT may cause RPE and retinal changes associated with reduced retinal sensitivity
Clinical Ophthalmic Oncology
No full textWritten by internationally renowned experts, Clinical Ophthalmic Oncology provides practical guidance and advice on the diagnosis and management of the complete range of ocular cancers. The book supplies all of the state-of-the-art knowledge required in order to identify these cancers early and to treat them as effectively as possible. Using the information provided, readers will be able to:
· Provide effective patient care using the latest knowledge on all aspects of ophthalmic oncology.
· Verify diagnostic conclusions based on comparison with numerous full-color clinical photographs from the authors' private collections, histopathologic microphotographs, imaging studies, and crisp illustrations
· Locate required information quickly owing to the clinically focused and user-friendly format.
In this volume guidance is provided on diagnosis and therapy for retinal tumors including vitreoretinal lymphoma and paraneoplastic disorders
Quantification of vascular and neuronal changes in the peripapillary retinal area secondary to diabetic retinopathy
No full textPURPOSE: To investigate and quantify peripapillary vascular and neuronal changes secondary to diabetic retinopathy, using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA).DESIGN: This was a cross-sectional study.METHODS: 51 eyes of 51 patients affected by non-proliferative diabetic retinopathy (NPDR) and 19 age-matched healthy control eyes underwent full ophthalmic examination, including OCT and OCTA in the peripapillary area. Vessel area density (VAD), vessel length fraction (VLF) and vessel diameter index (VDI) were quantified in a ring-shaped region of interest of each OCTA image. Capillaries and larger vessels were separately analysed. The thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell complex (GCC) was also analysed.RESULTS: VAD and VLF of peripapillary capillaries were significantly reduced in NPDR eyes, along with the progression of NPDR (p<0.05). VDI was significantly reduced in mild (p=0.0093) and moderate (p=0.0190) NPDR eyes, but not in severe NPDR (p=0.0841). Larger peripapillary vessels showed a significant increase of both VAD and VDI in NPDR eyes. pRNFL and GCC thickness decreased in NPDR eyes, reaching statistical significance only for GCC. No statistically significant correlation was found between perfusion parameters and pRNFL and GCC thickness.CONCLUSIONS: Retinal capillary remodelling in NPDR involves the peripapillary vascularisation too, as confirmed by OCTA quantitative parameters. The peripapillary macrovasculature and microvasculature need to be separately evaluated. The lack of direct correlation between peripapillary capillaries changes and the loss of retinal nerve fibres suggests that neuronal damage cannot be simply considered secondary to the microvascular one
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