Combination of multimodal imaging features predictive of choroidal nevus transformation into melanoma

2018 ◽  
Vol 103 (10) ◽  
pp. 1441-1447 ◽  
Author(s):  
Lauren A Dalvin ◽  
Carol L Shields ◽  
David Arturo Ancona-Lezama ◽  
Michael D Yu ◽  
Maura Di Nicola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Multimodal Imaging ◽  
Imaging Features ◽  
Orange Pigment ◽  
Kaplan Meier ◽  
Five Factors ◽  
Two Factors ◽  
Choroidal Nevus ◽  
Visual Acuity Loss

AimTo characterise combinations of multimodal imaging risk factors and predictive value for choroidal nevus transformation into melanoma.MethodsThis is a retrospective review of multimodal imaging features for 3806 choroidal nevi from 1 January 2007 through 1 January 2017. Kaplan-Meier estimates and Cox regression analyses were used to calculate 5-year percentages of growth to melanoma and HR.ResultsUsing multimodal imaging, six risk factors predictive of choroidal nevus transformation into melanoma were identified, namely tumour thickness >2 mm, subretinal fluid, symptoms of visual acuity loss to 20/50 or worse, orange pigment, hollow acoustic density and tumour largest basal diameter >5 mm. Kaplan-Meier 5-year estimated tumour growth was found in 1% of nevi with no risk factors, 11% (range 9%–37%) with one factor, 22% (12%–68%) with two factors, 34% (21%–100%) with three factors, 51% (0%–100%) with four factors and 55% (0%–100%) with five factors. HR for growth was 0.1 with no factor, 2.1–7.8 with one factor, 1.8–12.1 with two factors, 4.0–24.4 with three factors, 4.6–170.0 with four factors and 12.0–595.0 with five factors. The highest HR with each combination of two, three, four or five risk factors always included symptoms of visual acuity loss and orange pigment.ConclusionSix risk factors for choroidal nevus transformation into melanoma by multimodal imaging have been identified. Risk for transformation into melanoma is 1% when no factors are present, and approaches 100% with specific combinations of three or more risk factors. Understanding how combinations of factors influence risk of transformation into melanoma can guide counselling and treatment decisions.

scholarly journals Multimodal imaging of Hurler syndrome-related keratopathy treated with deep anterior lamellar keratoplasty

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Elodie Da Cunha ◽  
Cristina Georgeon ◽  
Nacim Bouheraoua ◽  
Marc Putterman ◽  
Françoise Brignole-Baudouin ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Multimodal Imaging ◽  
Lamellar Keratoplasty ◽  
Deep Anterior Lamellar Keratoplasty ◽  
Imaging Features ◽  
Hurler Syndrome ◽  
Hematopoietic Stem ◽  
First Choice ◽  
Anterior Lamellar Keratoplasty ◽  
Sd Oct

Abstract Background Hurler syndrome-associated keratopathy is an exceedingly rare corneal disorder that requires corneal transplantation in advanced stages. Precise assessment of the corneal condition is necessary for deciding which type of keratoplasty (i.e., deep anterior lamellar or penetrating) should be proposed. We aimed to confront the results of multimodal imaging with those of histology in a case of Hurler syndrome-associated keratopathy. Case presentation A 16-year-old patient with Hurler’s syndrome treated with hematopoietic stem cell transplantation was referred for decreased vision related to advanced keratopathy. The patient was treated with deep anterior lamellar keratoplasty (DALK) in both eyes with uncomplicated outcome. Visual acuity improved from 0.1 (20/200) preoperatively to 0.32 (20/63) and 0.63 (20/32) after transplantation. The corneal endothelial cell density was 2400 cells/mm2 in both eyes 3 years after transplantation. In vivo confocal microscopy (IVCM) and spectral domain optical coherence tomography (SD-OCT) were performed preoperatively. The corneal buttons retrieved during keratoplasty were processed for histology. In SD-OCT scans, corneal opacities appeared as diffuse stromal hyperreflectivity associated with increased corneal thickness. IVCM showed diffuse cytoplasmic granular hyperreflectivity and rounded/ellipsoid aspects of keratocytes, presence of small intracellular vacuoles, and hyperreflective epithelial intercellular spaces. Bowman’s layer was thin and irregular. The corneal endothelium was poorly visualized but no endothelial damage was observed. Histology showed irregular orientation and organization of stromal lamellae, with the presence of macrophages whose cytoplasm appeared clear and granular. A perinuclear clear halo was visible within the epithelial basal cells. Bowman’s layer featured breaks and irregularities. Conclusions The observed corneal multimodal imaging features in mucopolysaccharidosis-related keratopathy were concordant with histology. Compared with standard histology, multimodal imaging allowed additional keratocyte features to be observed. It revealed both morphological and structural changes of all corneal layers but the endothelium. This information is essential for therapeutic management which should include DALK as the first-choice treatment in case of impaired visual acuity.

scholarly journals CHOROIDAL NEVUS IMAGING FEATURES IN 3,806 CASES AND RISK FACTORS FOR TRANSFORMATION INTO MELANOMA IN 2,355 CASES

Retina ◽  
2019 ◽  
Vol 39 (10) ◽  
pp. 1840-1851 ◽  
Author(s):  
Carol L. Shields ◽  
Lauren A. Dalvin ◽  
David Ancona-Lezama ◽  
Michael D. Yu ◽  
Maura Di Nicola ◽  
...  
Keyword(s):  
Risk Factors ◽  
Imaging Features ◽  
Choroidal Nevus

scholarly journals Retinal Detachment After Cataract Surgery and Posterior Laser Capsulotomy in a Young Healthy Male Patient: Case Report

2020 ◽  
pp. 1-3
Author(s):  
Marco Zeppieri ◽  
Marco Zeppieri
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Retinal Detachment ◽  
Cataract Surgery ◽  
Intraocular Lens ◽  
Vision Loss ◽  
Nuclear Cataract ◽  
Cataract Formation ◽  
Laser Treatments ◽  
Visual Acuity Loss

Background: The onset of cataract formation is normally experienced in senile age. The process of lens opacification can also be influenced by other factors, including systemic diseases, infection, trauma, medication, ultraviolet light exposure, genetic predisposition and environmental sources. Gradual vision loss accompanied by a myopic refractive shift can be caused by nuclear cataract formation, even in young patients. Phacoemulsification cataract removal and intraocular lens insertion surgery is indicated when visual acuity loss and/or myopic anisometropia becomes a problem. Surgical and laser treatments are risk factors in developing retinal detachment, especially in myopic patients. Case Presentation: This is a case of an early onset nuclear cataract in a young male. A 44-year-old man visited the hospital complaining of gradual vision loss in his right eye. History study revealed no systemic or ophthalmic diseases or trauma. The patient underwent phacoemulsification nuclear cataract removal and intraocular lens insertion surgery in his right eye, followed by Nd:YAG laser posterior capsulotomy 3 years later. He underwent phacoemulsification nuclear cataract surgery in his left eye at the age of 48 years, followed by laser capsulotomy treatment 2 years later. At the age 50, a routine eye examination revealed retinal detachment in his right eye. He underwent vitrectomy surgery twice. Conclusion: Nuclear lens opacification is seldom of clinical importance in young healthy adult patients; however, it can be the cause of progressive visual acuity loss, especially in the presence of a myopic refractive shift. Surgery, laser treatment and myopia are all risk factors in retinal detachment. This case shows that thorough and periodic routine eye examinations are a must when dealing with patients with unexpected and atypical signs and symptoms, especially having underwent surgery and laser treatments.

scholarly journals Bilateral Diffuse Uveal Melanocytic Proliferation Presenting as Small Choroidal Melanoma

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
J. N. Ulrich ◽  
S. Garg ◽  
G. K. Escaravage ◽  
T. M. Meredith
Keyword(s):  
Visual Acuity ◽  
Clinical Picture ◽  
Clinical Case ◽  
Radioactive Iodine ◽  
Palliative Chemotherapy ◽  
Choroidal Melanoma ◽  
Orange Pigment ◽  
History Of ◽  
Choroidal Nevus ◽  
The Right

Purpose. To describe a patient with Bilateral Diffuse Uveal Proliferation who presented initially with a clinical picture consistent with choroidal melanoma.Methods. Presentation of a clinical case with fundus photos, fluorescein angiography, and optical coherence tomography.Results. A 70-year-old Caucasian male with history of esophageal cancer presented with an asymptomatic pigmented choroidal lesion in his left eye initially diagnosed as choroidal nevus. This lesion enlarged over the course of a year and developed orange pigment and increased thickness. A metastatic workup was negative, and a radioactive iodine plaque was placed on the left eye. Over the next six months, the visual acuity in his left eye decreased. His clinical picture was consistent with unilateral Diffuse Uveal Proliferation. A recurrence of his esophageal carcinoma with metastasis was discovered and palliative chemotherapy was initiated. Although his visual acuity improved in the left eye, similar pigmentary changes developed in the right fundus. His visual acuity in both eyes gradually decreased to 20/200 until his death a year later.Conclusion. BDUMP should always be considered in the differential diagnosis of patients with pigmented fundus lesions and a history of nonocular tumors.

Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017

2020 ◽  
pp. bjophthalmol-2020-317303
Author(s):  
Hsun-I Chiu ◽  
Huan-I Su ◽  
Yu-Chieh Ko ◽  
Catherine Jui-Ling Liu
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Medical Records ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Kaplan Meier ◽  
Chinese Ethnicity ◽  
Preoperative Visual Acuity

AimsTo determine long-term outcomes and risk factors for failure after mitomycin C (MMC)-augmented initial trabeculectomy (IT) in Taiwanese patients.MethodsWe reviewed medical records of patients with glaucoma undergoing IT during December 2006–December 2016. We defined complete success as an intraocular pressure (IOP) of >5 or ≤21 mm Hg or IOP reduction of ≥20% from baseline without supplemental medications and qualified success as the aforementioned IOP levels with or without supplemental medications. Kaplan-Meier survival and Cox proportional analyses evaluated success rates and risk factors for failure, respectively.ResultsWe enrolled 190 patients (237 eyes; mean age: 54.0±15.3 years; mean postoperative follow-up period: 68.4±35.1 months). Mean IOP and glaucoma medications decreased from 22.2±10.8 to 14.4±5.2 mm Hg (p<0.001) and 3.0±0.7 to 1.8±1.2 (p=0.015), respectively, at the last visit. Cumulative qualified success rates were 93.9%, 93.0%, 86.5% and 67.1% at the 1, 2, 5 and 10 years follow-up, respectively; however, only 7.7% of the eyes reached complete success at the last visit. Eyes with poor preoperative visual acuity were associated with low qualified success rates (HR=1.689, p=0.027); patients aged >70 years had higher complete success rates than did those aged ≤70 years. Five cases (2.11%) exhibited bleb-associated complications.ConclusionDespite satisfactory long-term success rates, most eyes needed medication for IOP control, supporting the notion of predisposed scarring vitality in patients of Chinese ethnicity following MMC-augmented trabeculectomy.

scholarly journals Visual Acuity Loss and Associated Risk Factors in the Retrospective Progression of Stargardt Disease Study (ProgStar Report No. 2)

Ophthalmology ◽  
2016 ◽  
Vol 123 (9) ◽  
pp. 1887-1897 ◽  
Author(s):  
Xiangrong Kong ◽  
Rupert W. Strauss ◽  
Michel Michaelides ◽  
Artur V. Cideciyan ◽  
José-Alain Sahel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Stargardt Disease ◽  
Visual Acuity Loss ◽  
Associated Risk Factors ◽  
Disease Study

An Analysis of Dental Implants Survival and Success

2018 ◽  
Vol 69 (9) ◽  
pp. 2465-2466
Author(s):  
Iustin Olariu ◽  
Roxana Radu ◽  
Teodora Olariu ◽  
Andrada Christine Serafim ◽  
Ramona Amina Popovici ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Medical History ◽  
Retrospective Cohort Study ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Demographic Data ◽  
Kaplan Meier ◽  
Number Of Patients ◽  
Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

scholarly journals Multimodal Imaging Findings and Treatment with Dexamethasone Implant in Three Cases of Idiopathic Macular Telangiectasia Type 1

2021 ◽  
pp. 92-97
Author(s):  
Paola Cirafici ◽  
Maria Musolino ◽  
Michela Saccheggiani ◽  
Carlo Enrico Traverso ◽  
Massimo Nicolò
Keyword(s):  
Visual Acuity ◽  
Macular Edema ◽  
Multimodal Imaging ◽  
Diagnostic Errors ◽  
Wide Field ◽  
Vascular Changes ◽  
Macular Telangiectasia ◽  
First Choice ◽  
Idiopathic Macular Telangiectasia

This is a report of 3 patients diagnosed with idiopathic macular telangiectasia type 1 (MacTel 1) at Medical Retina Center of the University of Eye Clinic of Genova and then prospectically followed for a mean time of 26 months between 2016 and 2019. It is the first report of patients affected by MacTel 1 treated with dexamethasone (DEX) implant as a first choice of treatment. Aim of our study is to better characterize the disease using a multimodal wide-field imaging and to determine efficacy of DEX implant on MacTel 1 in terms of central macular thickness (CMT) and best-corrected visual acuity (BCVA). MacTel 1 is a rare unilateral disease, characterized by telangiectatic retinal capillaries, cystoid macular edema, and lipid deposition occurring temporal to the fovea. Patients underwent a comprehensive ophthalmic examination, BCVA, swept-source optical coherence tomography (SS-OCT), SS-OCT angiography (SS-OCTA), ultra-widefield (UWF) color, and fluorescein angiography (FA) fundus photograph. All the patients presented monolateral reduced BCVA and macular edema with increased CMT evaluated by SS-OCT. With SS-OCTA, we showed that the telangiectasia-associated vascular changes originate in the deep retinal vascular plexus and as a consequence macular edema and exudation develop causing vision loss. Furthermore, UWF imaging helped us to highlight vascular changes typical of Coats Disease at the far retinal periphery. All the patients were treated with DEX intravitreal implant, showing a decrease in CMT and a stabilization of visual acuity. Due to the recurrent nature of macular edema, patients underwent a mean of 4 DEX implants during the follow-up period. In order to address the clinical features of this uncommon disease avoiding diagnostic errors, it might be important to use a multimodal imaging approach. The anatomical and functional beneficial effects of DEX implant were well evident although transient.

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