scholarly journals Immunotherapy-Resistant Vitreoretinal Metastatic Melanoma

2020 ◽  
pp. 1-4
Author(s):  
Arthi Venkat ◽  
Elaine M. Binkley ◽  
Sunil Srivastava ◽  
Naveen Karthik ◽  
Arun D. Singh
Keyword(s):  
Metastatic Melanoma ◽  
Cutaneous Melanoma ◽  
Pars Plana Vitrectomy ◽  
Systemic Disease ◽  
Case Series ◽  
Subsequent Development ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Pars Plana ◽  
Vitreous Biopsy

<b><i>Purpose:</i></b> To describe 2 cases of vitreoretinal metastases in patients treated with immunotherapy for metastatic melanoma. <b><i>Methods:</i></b> Retrospective case series. <b><i>Results:</i></b> We pre­sent 2 patients with metastatic melanoma treated with systemic immunotherapy with subsequent development of ocular vitreoretinal metastasis. The first patient was a male with metastatic melanoma from a site of unknown origin that was in complete remission following a course of ipilimumab and nivolumab therapy. He presented to an outside provider for evaluation of vitritis and a pigmented lesion in the right eye that was presumed secondary to toxoplasmosis. After failing initial management with oral antibiotics, he underwent diagnostic pars plana vitrectomy, and vitreous biopsy was consistent with metastatic melanoma to the vitreous. He was additionally found to have an elevated pigmented retinal mass consistent with a retinal metastasis from melanoma that initially failed treatment with plaque brachytherapy and ultimately required enucleation. The second case was a monocular male with metastatic melanoma from cutaneous melanoma with decreased vision 3 months after the initiation of nivolumab therapy. He presented with dense vitreous debris in his seeing eye and was thought to have nivolumab-associated inflammation. He was initially treated with difluprednate with improved vision and decrease in vitreous debris, but developed dense pigment deposition in the affected eye later in the treatment course. Diagnostic pars plana vitrectomy was performed, and vitreous biopsy was positive for malignant melanoma cells. His systemic disease was in remission at the time of diagnosis of ocular metastasis. External beam radiation was recommended given his monocular status. <b><i>Conclusion:</i></b> Vitreoretinal metastasis can develop despite favorable systemic response to immunotherapy in patients with metastatic cutaneous melanoma. Lack of ocular penetration and extension of life span with immunotherapeutic agents may be the underlying mechanism for vitreoretinal metastasis.

scholarly journals Combined pars plana glaucoma drainage device placement and vitrectomy using a vitrectomy sclerotomy site for tube placement: a case series

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Enchi Kristina Chang ◽  
Sanchay Gupta ◽  
Marika Chachanidze ◽  
John B. Miller ◽  
Ta Chen Chang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Glaucoma Drainage Devices ◽  
Pars Plana ◽  
Sclerotomy Site

Abstract Purpose The purpose of this study is to report the safety and efficacy of pars plana glaucoma drainage devices with pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement in patients with refractory glaucoma. Methods Retrospective case series of 28 eyes of 28 patients who underwent combined pars plana glaucoma drainage device and pars plana vitrectomy between November 2016 and September 2019 at Massachusetts Eye and Ear. Main outcome measures were intraocular pressure (IOP), glaucoma medication burden, best corrected visual acuity, and complications. Statistical tests were performed with R and included Kaplan-Meier analyses, Wilcoxon paired signed-rank tests, and Fisher tests. Results Mean IOP decreased from 22.8 mmHg to 11.8 mmHg at 1.5 years (p = 0.002), and mean medication burden decreased from 4.3 to 2.1 at 1.5 years (p = 0.004). Both IOP and medication burden were significantly lower at all follow-up time points. The probability of achieving 5 < IOP ≤ 18 mmHg with at least 20% IOP reduction from preoperative levels was 86.4% at 1 year and 59.8% at 1.5 years. At their last visit, three eyes (10.7%) achieved complete success with IOP reduction as above without medications, and 14 eyes (50.0%) achieved qualified success with medications. Hypotony was observed in 1 eye (3.6%) prior to 3 months postoperatively and 0 eyes after 3 months. Visual acuity was unchanged or improved in 23 eyes (82.1%) at their last follow-up. Two patients had a visual acuity decrease of > 2 lines. Two eyes required subsequent pars plana vitrectomies for tube obstruction, and one eye had transient hypotony. Conclusions The results of pars plana glaucoma drainage device and pars plana vitrectomy using one of the vitrectomy sclerotomy sites for tube placement are promising, resulting in significant IOP and medication-burden reductions through postoperative year 1.5 without additional risk of postoperative complications. Inserting glaucoma drainage devices into an existing vitrectomy sclerotomy site may potentially save surgical time by obviating the need to create another sclerotomy for tube placement and suture one of the vitrectomy ports.

scholarly journals Sutureless 25-Gauge Pars Plana Vitrectomy Combined with Retropupillary Fixation of an Iris-Claw Intraocular Lens

2016 ◽  
Vol 7 (3) ◽  
pp. 433-439
Author(s):  
Spyridon E. Chalkiadakis ◽  
Efstratios A. Parikakis ◽  
Simon R.J. Taylor
Keyword(s):  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Case Series ◽  
Visual Rehabilitation ◽  
Aesthetic Result ◽  
Viable Solution ◽  
Pars Plana ◽  
Real Challenge ◽  
Operating Surgeon ◽  
Iris Claw

Background: The surgical case of a dropped intraocular lens inside the vitreous cavity constitutes a real challenge for the operating surgeon. Herein, we describe a case series where an alternative optical rehabilitation technique for late intraocular lens-bag complex dislocation has been used. Methods: A modern vitrectomy device was used to remove the capsule with the dropped intraocular lens using sutureless 25-gauge pars plana vitrectomy. To ensure a better aesthetic result, with faster patient recovery and a reduced number of operations, the whole procedure was performed during the same operating session; an iris-claw intraocular lens for aphakia was selected for implantation. The implant was passed behind the constricted iris with the concave surface facing it. The lens was grasped with the manufacturer’s holding forceps and fixed onto the posterior surface of the iris using the special enclavation needles. Results: We have operated 12 eyes in two different clinical centres successfully, with minimal intra- and/or postoperative complications. Conclusion: We believe that this is a viable solution for the visual rehabilitation of patients, who would otherwise need more than one operation for a lens exchange.

scholarly journals The serious eye inflammation of post intraocular Avastin injection

2020 ◽  
Vol 3 (2) ◽  
pp. 01-06
Author(s):  
Fathy Abdolmejed ◽  
Khalid Almajri ◽  
Ghamela Ali
Keyword(s):  
Pars Plana Vitrectomy ◽  
Statistical Study ◽  
Medical Center ◽  
Systemic Disease ◽  
Management Strategies ◽  
Causative Organism ◽  
P Value ◽  
Coagulase Negative Staphylococci ◽  
Treatment Protocols ◽  
Pars Plana

Retrospective statistical study a collection of all patients with post intra vitreal injection (IVI) endophthalmitis in last 10 year period between 2010–2019 in eye department of Tobruk medical center -Tobruk and eye department of Alwahda hospital - Derna. We aim in this study to review the microbiology, clinical characteristics, diagnosis, and management strategies of post-intra vitreal injection endophthalmitis, by comparing our results with the different studies designs and treatment protocols. There were 9 patients of the after intra vitreal injections endophthalmitis cases. The age average is 70 years, 6 cases are females and 3 casees are male, all of them were practice post intravitreal Avastin injection endophthalmitis. There were 8 patients had Diabetes mellitus (DM), 2 patients had cardiovascular disease and 1 patient had hepatitis C as a systemic disease. The most common causative organism after intra vitreous injection endophthalmitis is Coagulase-negative staphylococci (CNS) 100% from the 56% positive causative organisms and 44% are no detected microorganisms, the outcome of cases which managed with pars-plana-vitrectomy (PPV) improved significantly about 60 Letters (> 3 Lines) and cases managed without PPV > 15 Letters (> 3 Lines). The cases of post intraocular endophthalmitis which diagnosed and treated early with PPV give a good result and can save the vision. The cases of acute POE in the first 3 day had significant better function (P value = 0.02).

scholarly journals An update in the management of spinal metastases

2015 ◽  
Vol 73 (9) ◽  
pp. 795-802 ◽  
Author(s):  
Andrei F. Joaquim ◽  
Ann Powers ◽  
Ilya Laufer ◽  
Mark H. Bilsky
Keyword(s):  
New Technologies ◽  
Systemic Disease ◽  
Spinal Metastases ◽  
Integrated Approach ◽  
External Beam Radiation ◽  
Tumor Control ◽  
Mechanical Instability ◽  
Beam Radiation ◽  
Definitive Therapy ◽  
Neurologic Function

The best clinical treatment for spinal metastases requires an integrated approach with input from an interdisciplinary cancer team. The principle goals of treatment are maintenance or improvement in neurologic function and ambulation, spinal stability, durable tumor control, and pain relief. The past decade has witnessed an explosion of new technologies that have impacted our ability to reach these goals, such as separation surgery and minimally invasive spinal procedures. The biggest advance, however, has been the evolution of stereotactic radiosurgery that has demonstrated durable tumor control both when delivered as definitive therapy and as a postoperative adjuvant even for tumors considered markedly resistant to conventional external beam radiation. In this paper, we perform an update on the management of spinal metastases demonstrating the integration of these new technologies into a decision framework NOMS that assesses four basic aspects of a patient’s spine disease: Neurologic, Oncologic, Mechanical Instability and Systemic disease.

The role of radiosurgery in the management of WHO Grade II and III intracranial meningiomas

2013 ◽  
Vol 35 (6) ◽  
pp. E16 ◽  
Author(s):  
Dale Ding ◽  
Robert M. Starke ◽  
John Hantzmon ◽  
Chun-Po Yen ◽  
Brian J. Williams ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Radiosurgery ◽  
Case Reports ◽  
Case Series ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Who Grade ◽  
Intracranial Meningiomas ◽  
Grade Ii ◽  
Grade Iii

Object WHO Grade II and III intracranial meningiomas are uncommon, but they portend a significantly worse prognosis than their benign Grade I counterparts. The mainstay of current management is resection to obtain cytoreduction and histological tissue diagnosis. The timing and benefit of postoperative fractionated external beam radiation therapy and stereotactic radiosurgery remain controversial. The authors review the stereotactic radiosurgery outcomes for Grade II and III meningiomas. Methods A comprehensive literature search was performed using PubMed to identify all radiosurgery series reporting the treatment outcomes for Grade II and III meningiomas. Case reports and case series involving fewer than 10 patients were excluded. Results From 1998 to 2013, 19 radiosurgery series were published in which 647 Grade II and III meningiomas were treated. Median tumor volumes were 2.2–14.6 cm3. The median margin doses were 14–21 Gy, although generally the margin doses for Grade II meningiomas were 16–20 Gy and the margin doses for Grade III meningiomas were 18–22 Gy. The median 5-year PFS was 59% for Grade II tumors and 13% for Grade III tumors, which may have been affected by patient age, prior radiation therapy, tumor volume, and radiosurgical dose and timing. The median complication rate following radiosurgery was 8%. Conclusions The current data for radiosurgery suggest that it has a role in the management of residual or recurrent Grade II and III meningiomas. However, better studies are needed to fully define this role. Due to the relatively low prevalence of these tumors, it is unlikely that prospective studies will be feasible. As such, well-designed retrospective analyses may improve our understanding of the effect of radiosurgery on tumor recurrence and patient survival and the incidence and impact of treatment-induced complications.

External beam radiation for localized periocular amyloidosis: a case series

Orbit ◽  
2018 ◽  
Vol 38 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Thomas S. Copperman ◽  
Minh Tam Truong ◽  
John L. Berk ◽  
Rachel K. Sobel
Keyword(s):  
Case Series ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation

scholarly journals Selective Laser Trabeculoplasty for Glaucoma Secondary to Emulsified Silicone Oil after Pars Plana Vitrectomy: A Pilot Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Zeynep Alkin ◽  
Banu Satana ◽  
Abdullah Ozkaya ◽  
Berna Basarir ◽  
Cigdem Altan ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Consecutive Case ◽  
Laser Trabeculoplasty ◽  
Pars Plana ◽  
The Mean

Background. To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO).Methodology/Principal Findings. Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1(P=0.01), 17.9 ± 3.1 mmHg at month 1(P=0.008), 15.8 ± 3.9 mmHg at month 3(P=0.003), and 16.2 ± 4.7 mmHg at month 6(P=0.004). IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6.Conclusion/Significance. SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

BILATERAL METASTATIC CUTANEOUS MELANOMA TO RETINA AND VITREOUS AFTER IPILIMUMAB TREATED WITH PARS PLANA VITRECTOMY AND RADIOTHERAPY

2018 ◽  
Vol 12 (3) ◽  
pp. 184-187 ◽  
Author(s):  
Sam Kanavati ◽  
Christian Ottensmeier ◽  
Vipul Foria ◽  
Radhika Krishnan
Keyword(s):  
Cutaneous Melanoma ◽  
Pars Plana Vitrectomy ◽  
Pars Plana
Sign in / Sign up

Export Citation Format

Share Document