Ultra-wide-field imaging of choroidal melanoma before and after proton beam radiation therapy

Objective: To evaluate the imaging characteristics of choroidal melanoma before and after proton beam radiotherapy via Optos® ultra-wide-field scanning laser ophthalmoscopy. Methods: Retrospective, descriptive study of choroidal melanoma patients treated with proton beam radiotherapy. All patients underwent full clinical evaluation, including best-corrected visual acuity, ultrasound examination and ultra-wide-field scanning laser ophthalmoscopy imaging in the pseudo-colour (red and green channel) as well as auto-fluorescence mode. Tumours were classified and evaluated according to their location, size, presence of subretinal fluid, drusen, orange pigment and reflectance intensity in ultra-wide-field scanning laser ophthalmoscopy. Tumour sonographic (basal diameter, height) and ultra-wide-field scanning laser ophthalmoscopy imaging dimensions (maximal diameter) were documented. Results: A total of 39 eyes (38 patients) were followed for 24 months (range 6–48 months). Mean best-corrected visual acuity dropped from 20/40 to 20/63 after proton beam radiotherapy. There was no change in the imaging tumour characteristics during follow-up. Subretinal fluid changes were better detected in the autofluorescence compared to pseudo-colour mode. Mean tumour diameter did not significantly change in the ultra-wide-field scanning laser ophthalmoscopy although it did so in the ultrasound. No patient showed local tumour recurrence. Conclusion: The ultra-wide-field scanning laser ophthalmoscopy imaging characteristics of choroidal melanoma in the Optos® system do not significantly change after proton beam radiotherapy after a mean follow-up of 2 years.

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Isolated juxtapapillary retinal capillary haemangioblastoma and exudative maculopathy in an elderly patient without von Hippel-Lindau syndrome: combined proton beam radiotherapy and intravitreal anti-VEGF

BMJ Case Reports ◽

10.1136/bcr-2021-244077 ◽

2021 ◽

Vol 14 (8) ◽

pp. e244077

Author(s):

Ahmed Adan ◽

Luke Carine ◽

Heinrich Heimann ◽

Marta Ugarte

Keyword(s):

Proton Beam ◽

Combined Therapy ◽

Tumour Size ◽

Subretinal Fluid ◽

Proton Beam Radiotherapy ◽

Von Hippel Lindau ◽

Anti Vegf ◽

Retinal Capillary ◽

Endothelial Growth Factor ◽

Von Hippel Lindau Syndrome

A 71-year-old Caucasian man presented with an isolated juxtapapillary retinal capillary haemangioblastoma on the superior and temporal left optic disc with active exudation resulting in macular intraretinal and subretinal fluid, reduced vision, scotoma and distortion with progression over 6 weeks. He did not have von Hippel-Lindau syndrome. After proton beam radiotherapy (PBR), the tumour size remained unchanged, but did not stop the exudation. Three anti-vascular endothelial growth factor (VEGF) (ie, bevacizumab) injections at monthly intervals resulted in reduced macular oedema. Combined therapy with PBR and anti-VEGF injections sustained our patient’s vision at 12 months follow-up.

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Scanning Laser Ophthalmoscopy and Angiography With a Wide-Field Contact Lens System

Archives of Ophthalmology ◽

10.1001/archopht.123.2.244 ◽

2005 ◽

Vol 123 (2) ◽

pp. 244 ◽

Cited By ~ 64

Author(s):

Giovanni Staurenghi

Keyword(s):

Contact Lens ◽

Scanning Laser ◽

Wide Field ◽

Scanning Laser Ophthalmoscopy ◽

Lens System

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Ultra-wide-field scanning laser ophthalmoscopy and optical coherence tomography in FEVR: findings and its diagnostic ability

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316226 ◽

2020 ◽

pp. bjophthalmol-2020-316226

Author(s):

Ting Zhang ◽

Zhirong Wang ◽

Limei Sun ◽

Songshan Li ◽

Li Huang ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Diagnostic Test ◽

Clinical Significance ◽

Screening Strategy ◽

Scanning Laser ◽

Youden Index ◽

Wide Field ◽

Scanning Laser Ophthalmoscopy ◽

Healthy Controls ◽

Optical Coherence

Background/Aims To describe some novel vitreoretinal microstructural findings in patients with mild familial exudative vitreoretinopathy (FEVR) on ultra-wide-field scanning laser ophthalmoscopy (UWF-SLO) and UWF optical coherence tomography (UWF-OCT) and to evaluate their clinical significance.MethodsA total of 32 patients and 32 healthy controls were studied. An additional independent 40 FEVR patients, 44 patients with non-FEVR retinopathies and 40 healthy controls participated in a diagnostic test to validate the abilities of novel findings in FEVR screening.ResultsA novel anatomic change, named Temporal Mid-Peripheral Vitreoretinal Interface Abnormality (TEMPVIA), was found on UWF-SLO in 88.3% of FEVR patients and in none of the healthy controls. The clinical significance of TEMPVIA was further validated by a diagnostic test in new independent cases, with satisfying sensitivity (91.5%) and specificity (98.8%) and Youden Index 0.90. In addition to foveal hypoplasia, some previously unrecognised, novel clinical changes in FEVR, for instance, retinoschisis, focal retinal thickening, sudden thinning of the retina and retinal ridge, were identified using UWF-OCT.ConclusionThe results of this study have led to an update of the clinical spectrum of FEVR and have improved our understanding of its pathogenesis. TEMPVIA is therefore suggested to be a useful biomarker in the screening strategy for mild FEVR.

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OCT changes in peri-tumour normal retina following ruthenium-106 and proton beam radiotherapy for uveal melanoma

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2019-314802 ◽

2020 ◽

pp. bjophthalmol-2019-314802

Author(s):

Rumana Hussain ◽

Florian Moritz Heussen ◽

Heinrich Heimann

Keyword(s):

Proton Beam ◽

Uveal Melanoma ◽

Choroidal Melanoma ◽

Retinal Layer ◽

Proton Beam Radiotherapy ◽

Retinal Layers ◽

Spectral Domain Oct ◽

Ruthenium 106 Brachytherapy ◽

Safety Margins ◽

Plaque Brachytherapy

IntroductionUveal melanoma is most commonly treated with radiotherapy, destroying the tumour cells with adequate safety margins and limiting collateral damage to surrounding structures to preserve maximal vision. We used optical coherence tomography (OCT) to study the effects of radiotherapy on the retina.MethodsPatients with posteriorly located choroidal melanoma treated with proton beam radiotherapy (PBR) and ruthenium-106 brachytherapy between January 2010 and June 2014 underwent spectral domain OCT.ResultsImages of 32 patients following ruthenium-106 brachytherapy and 44 patients following proton beam teletherapy were analysed. Following plaque brachytherapy, an early marked disruption of the outer retinal layers could be observed in 30 cases (94%) with retinal atrophy evident in 26 cases (81%). In contrast, the images from patients who underwent PBR showed subtle outer retinal layer change with 16 cases (36%) showing some inner-outer segment junction disruption by 6 months and 63% by 24 months with minimal atrophy. In cases with tumours <2 mm from the fovea, the visual loss was significantly less at 6 and 12 months in the proton beam group.ConclusionIn comparison to ruthenium-106 plaque brachytherapy, PBR leads to more subtle and slower changes in the outer retinal layers enabling retention of visual function for longer. The difference in dosing regime and dose distribution across the tumour is likely to be causative for this structural differential.

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Long-Term Visual Outcomes for Small Uveal Melanoma Staged T1 Treated by Proton Beam Radiotherapy

Cancers ◽

10.3390/cancers11081047 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1047 ◽

Cited By ~ 2

Author(s):

Adélaïde Toutée ◽

Martina Angi ◽

Sylvain Dureau ◽

Christine Lévy-Gabriel ◽

Livia Lumbroso-Le Rouic ◽

...

Keyword(s):

Proton Beam ◽

Optic Disc ◽

Uveal Melanoma ◽

Early Stage ◽

Tumor Control ◽

Proton Beam Radiotherapy ◽

Visual Outcomes ◽

The Mean

There is increasing evidence of the survival benefit of treating uveal melanoma in an early stage, however it is important to discuss with the patient the associated risk of visual loss. We investigated visual outcomes for uveal melanomas staged T1 (T1UM) treated by proton beam radiotherapy (PBR) as a function of their distance to fovea-optic disc. This retrospective study included a cohort of 424 patients with T1UM treated with PBR between 1991 and 2010 with at least a 5-year follow-up. Visual acuity (VA) was analyzed for patients with posterior edge of tumor located at ≥3 mm (GSup3) or <3 mm (GInf3) from fovea-optic disc. The mean follow-up duration was 122 months, no tumor recurrence was observed. The mean baseline and final VA were 20/25 and 20/32 for GSup3 (n = 75), and 20/40 and 20/80 for GInf3 (n = 317) respectively. The frequency of a 20/200 or greater visual conservation was 93.2%(CI95%:87.7–99.1) and 60.1%(CI95%:54.9–65.9) for GSup3 and GInf3 respectively. This difference between groups was statistically significant (p < 0.001). The risk factors for significant VA loss (less than 20/200) were GInf3 location (p < 0.001), tumor touching optic disc (p = 0.04), initial VA inferior to 20/40 (p < 0.001), documented growth (p = 0.002), and age greater than 60 years (p < 0.001). In summary, PBR for T1UM yields excellent tumor control and good long-term visual outcomes for tumors located ≥3 mm from fovea-optic disc.

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Comparative Cytogenetic Abnormalities in Paired Choroidal Melanoma Samples Obtained Before and After Proton Beam Irradiation by Transscleral Fine-Needle Aspiration Biopsy and Endoresection

Cancers ◽

10.3390/cancers11081173 ◽

2019 ◽

Vol 11 (8) ◽

pp. 1173 ◽

Cited By ~ 4

Author(s):

Alexandre Matet ◽

Khadija Aït Raïs ◽

Denis Malaise ◽

Martina Angi ◽

Rémi Dendale ◽

...

Keyword(s):

Proton Beam ◽

Fine Needle Aspiration ◽

Fine Needle Aspiration Biopsy ◽

Choroidal Melanoma ◽

Needle Aspiration ◽

Aspiration Biopsy ◽

Beam Irradiation ◽

Proton Beam Irradiation ◽

Fine Needle ◽

Before And After

This study compared the cytogenetic profiles of choroidal melanoma samples retrieved before and after proton beam irradiation. Twenty-four consecutive patients who underwent both fine-needle aspiration biopsy (FNAB) during tantalum clip positioning, and endoresection within three months of irradiation, were retrospectively included. Chromosome alterations were explored by array comparative genomic hybridization. Age at diagnosis was 50 ± 14 years, tumor thickness was 8.6 ± 1.7 mm and tumor diameter was 12.4 ± 2.3 mm. Six FNAB samples were non-contributive (25%), versus one endoresection sample (4%) (p = 0.049). Among 17 cases with paired contributive samples, the profiles of chromosomes 3 and 8 were identical in all cases, except one with partial chromosome 3 loss on the FNAB sample only. Three cases presented additional discordant aberrations on chromosomes other than 3 or 8q. Overall, we identified monosomy 3 in two cases, 8q gain in six cases, and both alterations in three cases. All cases presented GNAQ or GNA11 mutations assessed by a custom next-generation sequencing panel. Among the six cases with non-contributive initial FNAB, three cases presented abnormal 3 or 8q chromosomes detected on the endoresection material. These results demonstrate the higher rentability of endoresection material for cytogenetic analysis compared to FNAB, and provide clinical evidence of tumor heterogeneity in choroidal melanoma.

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Intravitreal Dexamethasone Implant (Ozurdex®) for Exudative Retinal Detachment after Proton Beam Therapy for Choroidal Melanoma

European Journal of Ophthalmology ◽

10.5301/ejo.5000940 ◽

2017 ◽

Vol 27 (5) ◽

pp. 596-600 ◽

Cited By ~ 1

Author(s):

Ariane Malclès ◽

Anh-Minh Nguyen ◽

Thibaud Mathis ◽

Jean-Daniel Grange ◽

Laurent Kodjikian

Keyword(s):

Visual Acuity ◽

Retinal Detachment ◽

Proton Beam ◽

Safety Profile ◽

Choroidal Melanoma ◽

Case Series ◽

Proton Beam Therapy ◽

Exudative Retinal Detachment ◽

Dexamethasone Implant

Purpose To evaluate the efficacy and safety of intravitreal 0.7-mg dexamethasone implant (DEX-I) (Ozurdex®) in the treatment of extensive exudative retinal detachment (RD) associated with uveal melanoma treated using proton beam therapy (PBT). Methods Data from 10 patients with exudative RD after PBT treated with intravitreal injection of 0.7-mg DEX-I were reviewed retrospectively. The main outcome measures were resolution of exudative RD, visual acuity, and safety profile. Results Mean age was 55.6 years (range 34-85). Mean time between PBT and DEX-I was 12.4 months (range 3-25). Mean follow-up was 9.9 months (range 4-15). Intravitreal Ozurdex® reduced exudative RD in 7 cases (70%) on average 3.1 months after injection with complete resolution of RD in 6 of these (60%). For half of the patients, their level of vision remained stable; the other half experienced a deterioration in visual acuity at the end of follow-up. No adverse effects were observed. Conclusions In this small case series, treatment with intravitreal DEX-I reduced exudative RD in the majority of cases and had an acceptable safety profile.

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