scholarly journals Palladium-103 plaque therapy for multifocal iris melanoma: Radiation of the entire anterior segment of the eye

2020 ◽  
pp. 112067212091423
Author(s):  
Paul T Finger ◽  
Ankit Singh Tomar ◽  
Kimberly J Chin
Keyword(s):  
Visual Acuity ◽  
Local Control ◽  
Anterior Segment ◽  
Case Series ◽  
Corneal Opacity ◽  
Iris Melanoma ◽  
Good Visual Acuity ◽  
Eye Plaque ◽  
Plaque Brachytherapy

Purpose: To investigate the safety and tolerability of total anterior segment palladium-103 (103Pd) eye plaque brachytherapy for multifocal iris melanoma. Methods: Interventional case series of 11 patients with multifocal iris melanomas. Anterior segment ultrasound revealed tumor size, location, and intraocular margins. Epicorneal amniotic membrane grafts protected the cornea and decreased pain during total anterior segment 103-Pd ophthalmic plaque brachytherapy. Results: Eleven diffuse iris melanomas were American Joint Committee on Cancer 8th edition–classified as T1 (n = 5, 45.5%) and T2 (n = 6, 54.5%). Plaque radiation was completed to a minimum mean tumor dose of 85 Gy (mean dose rate, 58.1 cGy/h). Ultrasonographic tumor thickness regression was 41% (follow up mean 58.7, median 50, range: 8–139 months). Despite 100% local control and 100% eye retention, one patient (9.1%) developed metastatic disease. Four eyes required cataract surgery. There was no corneal stem-cell deficiency, corneal opacity, radiation maculopathy, or optic neuropathy. While visual acuity prior to treatment was 20/40 or better in 10 (91%), 9 were 20/40 or better (81.9%) at last follow-up. Four (36%) had glaucoma prior to treatment and three eyes developed glaucoma after treatment for a total of 63%. Conclusion: Total anterior segment (103Pd) plaque brachytherapy resulted in local control, good visual acuity, eye and life preservation in the treatment of multifocal iris melanoma.

scholarly journals Effect of monocular surgery for large-angle horizontal deviation in adults

1970 ◽  
Vol 3 (1) ◽  
pp. 27-30 ◽  
Author(s):  
S Ganguly ◽  
R Pradhan
Keyword(s):  
Visual Acuity ◽  
Large Angle ◽  
Anterior Segment ◽  
Case Series ◽  
Strabismus Surgery ◽  
Slit Lamp ◽  
Surgical Success ◽  
Squint Surgery ◽  
Indirect Ophthalmoscope

Background: Surgical success rate of strabismus is variable. Objective: To evaluate the outcome of monocular strabismus surgery for adults with largeangle deviation. Subjects and methods: This study was that of a retrospective interventional case series. A total of 48 consecutive adult patients with large-angle socially-noticeable strabismus underwent clinical evaluation for squint surgery. They were divided into 2 groups of which 28 had exotropia while 20 had esotropia with deviation ranging from 40 to 80 prism diopters (PD). Visual acuity measurement (V/A), cycloplegic refraction and orthoptic evaluation were done in all cases along with detailed anterior segment evaluation. Fundus examination was carried out with indirect ophthalmoscope and slit-lamp bio-microscopy with + 90 D lens. For each case, a repeat evaluation was done after a six-week interval. The surgical procedure was monocular recession and resection carried out under peri-bulbar anesthesia by the same surgeon. Post-operative visual acuity, fusion, stereopsis and ocular alignment were noted in all cases during follow up visits. Results: Successful ocular alignment (< 10 PD) was achieved in 40 patients while binocularity was noted in 3. Forty patients were happy with the cosmetic outcome and psychosocial rehabilitation. No statistically significant improvement was noted in visual acuity and binocular function. Successful alignment was related to pre-operative deviation of less than 30 degrees. Conclusion: Monocular surgery under peri-bulbar anesthesia is a useful procedure for large-angle horizontal strabismus. Key words: strabismus; exotropia; esotropia; fusion; binocularity DOI: 10.3126/nepjoph.v3i1.4275Nepal J Ophthalmol 2011;3(5):27-30

scholarly journals Clinical Application of Foldable Capsular Vitreous Bodies in the Treatment of Severe Ocular Trauma and Silicone Oil Dependent Eyes

2021 ◽  
Author(s):  
Hao Jiang ◽  
Chao Xue ◽  
Yanlin Gao ◽  
Ying Chen ◽  
Yan Wang
Keyword(s):  
Visual Acuity ◽  
Clinical Application ◽  
Ocular Trauma ◽  
Silicone Oil ◽  
Anterior Segment ◽  
Vitreous Body ◽  
Corneal Opacity ◽  
Ultrasound Biomicroscopy ◽  
Significant Difference

Abstract Background: Recently, a new type of foldable capsular vitreous body (FCVB) has been developed for clinical application to fill the vitreous cavity with vitreous substitutes. It may be an ideal substitute for the vitreous body in eyes with severe retinal detachment. The aim of this study was to assess the application of a foldable capsular vitreous body (FCVB) in the treatment of severe ocular trauma and silicone oil (SO) dependent eyes.Methods: A retrospective analysis was performed on the clinical application of FCVB in the treatment of severe ocular trauma and SO dependent eyes. The results of best-corrected visual acuity and intraocular pressure (IOP) evaluation, B-scan ultrasonography or color Doppler ultrasonography, ultrasound biomicroscopy, and anterior segment photography were recorded during follow-up. A paired t-test was used to compare the difference in IOP before and after FCVB implantation. Results: Seven eyes of seven patients were included in the 6 months follow-up. In all cases, B-scan ultrasonography and ultrasound biomicroscopy showed that FCVB adapted closely to the globe wall and ciliary body, thus supporting the retina. Visual acuity did not improve, except in one case from LP to HM. The mean±SD IOP was 9.29±1.60mmHg prior to FCVB implantation and 10.43±0.98mmHg after implantation, with no significant difference between these measurements (P=0.066). Five of the seven patients developed differing degrees of corneal opacity and keratopathy. Conclusions: FCVB implantation may be a safe and effective method for the treatment of severe ocular trauma and SO dependent eyes. However, corneal opacity and keratopathy are potential serious complications after surgery. Appropriate case selection and proper surgical time require further investigation.

Intracameral r-tPA for the management of severe fibrinous reactions in TASS after cataract surgery

2021 ◽  
pp. 112067212110020
Author(s):  
Perach Osaadon ◽  
Nadav Belfair ◽  
Itay Lavy ◽  
Eyal Walter ◽  
Jaime Levy ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Anterior Segment ◽  
Case Series ◽  
Corneal Edema ◽  
Recombinant Tissue Plasminogen Activator ◽  
Maximal Effect ◽  
Corrected Visual Acuity ◽  
Tissue Plasminogen

Background: To describe the use of intracameral recombinant tissue plasminogen activator (r-tPA) in the treatment of severe fibrinous reactions in toxic anterior segment syndrome (TASS) after cataract surgery. Methods: A case series of 59 eyes of 59 patients with severe fibrinous anterior chamber reaction following cataract surgery who received intracameral r-tPA (25 µg/0.1 ml). The main outcome measures after intracameral r-tPA were the incidence of complete fibrinolysis, time of maximal effect, visual acuity, and complications. Results: Severe fibrinous reactions appeared 11.5 ± 5.3 days after cataract surgery. Fibrinolysis was observed 2.33 ± 2.70 days after rtPA use and 36 eyes (61%) exhibited resolution of the fibrin by the end of the first day following injection ( p < 0.001). Transient corneal edema observed at 1-day after injection was the only complication reported during the injection of r-tPA or at follow-up. Eight eyes (13.6%) required a second r-tPA injection. Best-corrected visual acuity improved from 0.88 ± 0.67 logMAR units before rtPA injection to 0.48 ± 0.49 logMAR units at 1-month ( p < 0.001). Conclusions: The application of r-tPA was a quick and efficacious therapeutic approach for the management of severe fibrinous reactions in TASS after cataract surgery. In a clinical setting, intracameral r-tPA may be useful when rapid visual recovery is needed.

scholarly journals One Year Outcomes and Stability of a Novel Scleral Anchored Intraocular Lens

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Edoardo Abed ◽  
Matteo Forlini ◽  
Edlira Bendo ◽  
Aurelio Imburgia ◽  
Alessandro Mularoni ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Intraocular Lens ◽  
Anterior Segment ◽  
Case Series ◽  
Specular Microscopy ◽  
Iop Measurement ◽  
Prospective Case Series ◽  
One Year

Purpose. To assess one year results and stability of the implantation of a scleral anchored intraocular lens (IOL). Design. Interventional prospective case series. Methods. Sixty eyes of 60 patients affected by either aphakia or IOL dislocation were included in this study. Patients underwent vitrectomy, scleral fixation of the IOL, and, if present, dislocated IOL removal. Patients were evaluated preoperatively and at 1, 3, 6, and 12 months after surgery by best-corrected distance visual acuity (BCVA) assessment, intraocular pressure (IOP) measurement, corneal specular microscopy, and optical coherence tomography (OCT) of both the macula and anterior segment. Results. At twelve months, mean BCVA significantly improved ( p < 0.0001 ), and none of the patients experienced a decrease of visual acuity. A 10% decrease of endothelial cell count occurred after surgery. Cystoid macular edema occurred in three patients (5%). A transient increase of intraocular pressure was noted in 7 cases (12%). At one month, horizontal and vertical IOL tilt was 1.04 ± 0.87 and 0.74 ± 0.71 degrees, respectively, and did not significantly change in the follow-up ( p > 0.05 ). None of the patients had decentration or dislocation of scleral-fixated IOL during the follow-up. Conclusion. Implantations of scleral plug fixated IOL provide good visual results, low complication rate, and excellent stability of the lens until one-year follow-up.

scholarly journals Impact of DMEK on visual quality in patients with Fuchs’ endothelial dystrophy

2021 ◽  
Author(s):  
Vanessa Ademmer ◽  
Bishr Agha ◽  
Mehdi Shajari ◽  
Thomas Kohnen ◽  
Ingo Schmack
Keyword(s):  
Visual Acuity ◽  
Corneal Thickness ◽  
Anterior Segment ◽  
Case Series ◽  
Visual Quality ◽  
Secondary Outcome ◽  
Patient Reported ◽  
Fuchs Endothelial Dystrophy ◽  
The Impact

Abstract Purpose To investigate short-term (3 months follow-up) changes in visual quality following Descemet membrane endothelial keratoplasty (DMEK) for Fuchs endothelial dystrophy (FED). Methods In this prospective institutional case series, 51 patients that underwent DMEK for FED were included. Assessment included the Quality of Vision (QoV) questionnaire preoperatively, at 1 month, and 3 months after surgery. Secondary outcome measures were anterior segment parameters acquired by Scheimpflug imaging, corrected distance visual acuity (CDVA), and endothelial cell density (ECD). Results Glare, hazy vision, blurred vision, and daily fluctuation in vision were the symptoms mostly reported preoperatively. All symptoms demonstrated a significant reduction of item scores for severity, frequency, and bothersome in the course after DMEK (P < 0.01). Glare and fluctuation in vision remained to some extent during the follow-up period (median score = 1). Preoperatively, corneal densitometry correlated moderately to weakly with severity of hazy vision (rs = 0.39; P = 0.03) and frequency (rs = 0.26; P = 0.02) as well as severity (rs = 0.27; P = 0.03) of blurry vision. CDVA and central corneal thickness (CCT) did not correlate with visual complains. Conclusions Following DMEK for FED, patient-reported visual symptoms assessed by the QoV questionnaire represent a useful tool providing valuable information on the impact of DMEK on visual quality that cannot be directly estimated by morphological parameters and visual acuity only.

scholarly journals The Effectiveness of Ultrasound Biomicroscopic and Anterior Segment Optical Coherence Tomography in the Assessment of Anterior Segment Tumors: Long-Term Follow-Up

2020 ◽  
Vol 2020 ◽  
pp. 1-8 ◽  
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Ewa Wasiluk ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ciliary Body ◽  
Anterior Segment ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Iris Tumor ◽  
Long Term Follow Up ◽  
Additional Value ◽  
Clinic Medical

Background. Differential diagnosis and follow-up of small anterior segment tumors constitute a particular challenge because they determine further treatment procedures. The aim of this study was to evaluate the efficacy of the UBM (ultrasound biomicroscopy) and AS-OCT (anterior segment optical coherent tomography) in distinguishing different types of anterior segment lesions. Methods. It was a retrospective, noncomparative study of case series of 89 patients with the suspicion of anterior segment tumor referred to the Ophthalmology Clinic, Medical University of Białystok, Poland, between 2016 and 2020. UBM was used to assess tumor morphology including height, location, and internal and external features. In cases in which UBM did not provide enough data, the AS-OCT images were analyzed. The data on demographics, best corrected visual acuity (BCVA), intraocular pressure (IOP), and rate of complications were also collected. Patients were followed up from 1 to 48 months. Results. The mean observation period was 26.61 ± 16.13 months. Among the patients, there were 62 women and 27 men at a mean age of 55.59 ± 19.48 (range: from 20 to 89 years.) The types of tumors were cysts (41%), solid iris tumors (37.1%), ciliary body tumors (7.9%), peripheral anterior synechiae (PAS 3.4%), corneal tumors (4.5%), and others (5.6%). Patients with cysts were younger than patients with solid iris tumor (p=0.002). Women had a cyst as well as solid iris tumor more frequently than men, but less often a ciliary body tumor (p<0.05). The horizontal size of tumor was positively correlated with patients’ age (rs = 0.38 and p=0.003) and negatively correlated with visual acuity (rs = −0.42 and p=0.014). During the 4 years of diagnosis, only 2.2% of lesions exhibited growth (growth rate of 0.02 mm per year). Among 15 cases in which visualization with UBM was not satisfactory (mostly iris nevi), AS-OCT was helpful in diagnosis of 13 patients. Conclusions. Both UBM and AS-OCT are effective methods in detection and diagnosis of tumors of the anterior eye segment, but in some cases, AS-OCT adds additional value to the diagnosis. Many lesions can be managed conservatively because they did not demonstrate growth during 4 years of the follow-up period.

Bilateral simultaneous primary choroidal melanomas: Treated with palladium-103 plaque radiation

2018 ◽  
Vol 28 (5) ◽  
pp. NP1-NP5
Author(s):  
Abhilasha Maheshwari ◽  
Paul T Finger
Keyword(s):  
Visual Acuity ◽  
Local Control ◽  
Tumor Regression ◽  
Choroidal Melanoma ◽  
Subretinal Fluid ◽  
Choroidal Melanomas ◽  
Clinical Description ◽  
The Right ◽  
Plaque Brachytherapy

Purpose: To provide a clinical description of a case of bilateral choroidal melanoma in a patient treated with palladium-103 (103Pd) plaque brachytherapy. Methods: An 81-year-old man presented with choroidal melanoma in both eyes. In consideration of tumor sizes and locations, treatment involved insertion of 103Pd radioactive plaque in the right eye followed by the left at an interval of 2 months. Results: At 1-year follow-up, bilateral local control has been associated with apical tumor height regression, and visual acuity has been preserved (20/20 in the right eye and 20/25 in the left). Exudative subretinal fluid has resolved. There has been no metastasis. Conclusion: Bilateral choroidal melanomas are rare, reported to be either simultaneous or sequential as well as treatable. In this case, we were able to achieve tumor regression and preserve visual acuity in both eyes after plaque brachytherapy.

scholarly journals 106Ruthenium eye plaque brachytherapy in the management of medium sized uveal melanoma

2020 ◽  
Author(s):  
Ping Jiang ◽  
Konstantine Purtskhvanidze ◽  
Gerit Kandzia ◽  
Dirk Neumann ◽  
Ulf Luetzen ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Uveal Melanoma ◽  
Tumor Control ◽  
Significant Difference ◽  
Median Period ◽  
Cataract Development ◽  
Eye Plaque ◽  
Better Than ◽  
Plaque Brachytherapy

Abstract Background: To evaluate 106Ruthenium Brachytherapy in management of medium sized uveal melanoma, with emphasis on 5-year outcome and toxicity.Methods: From 2007 to 2015, 39 patients were treated with 106 Ru eye plaques brachytherapy. At the time of diagnosis, the median tumor depth was 3.0 mm (CI: 1.6-8.9 mm). Median dose at the apex of the tumor was 145 Gy (± SD: 12.1Gy). The median sclera dose was 444.0Gy (±SD: 257.3 Gy). Results: Median follow-up was 61.5 months (CI: 8.1-138 mon.). 34 patients (87.1%) remained free of recurrence. In 26 (66.7%) patients a total regression was achieved after a median period of 12 months (CI: 3-60 mon.). By the final examination, the visual acuity of 26 (66.7%) patients was better than 20/200. 12 (30.7%) patients had a visual acuity better than 20/40.Retinopathy was detected in 11 (28.2%) patients. After treatments only 1 (5.1%) patients had active vascular changes by the last examination. Moderate optic neuropathy was observed in 4 (10.3%) patients. Cataract development was diagnosed in 21 (53.8%) patients, although 16 (41%) of them had bilateral cataract development.Special emphasis was made on patients with larger tumors. Twelve out of the 39 patients had a tumor with a depth of 5mm or more. There was no significant difference neither in local control (75 % in tumors ≥5mm versus 92.6 % in tumors <5mm) nor in side effects between both groups. Conclusions: Our study proved 106 Ru -brachytherapy to be an excellent treatment option with regard to tumor control and preservation of the visual acuity in well-selected patients. The data suggest that this treatment is also suitable for tumors with a depth of more than 5mm.

scholarly journals Proton beam radiation for iris melanoma: case series and review of literature

2021 ◽  
Vol 6 (1) ◽  
pp. e000683
Author(s):  
Jasmine Alexandra Hauzinger ◽  
Georgios Blatsios ◽  
Gertrud Haas ◽  
Claus Zehetner ◽  
Luisa Velez-Escola ◽  
...  
Keyword(s):  
Proton Beam ◽  
Anterior Segment ◽  
Case Series ◽  
Complication Rates ◽  
Beam Radiation ◽  
Tumour Control ◽  
Iris Melanoma ◽  
Significant Difference ◽  
Proton Beam Radiation

ObjectivePurpose of this study is to analyse the visual outcomes, the complication and eye retention rate as well as tumour control data of patients treated with proton beam radiation therapy (PBRT) for iris melanoma.MethodsRetrospective case series and review based on patients’ records. All tumours were categorised according to the American Joint Committee of Cancer staging criteria for primary iris melanoma und underwent either sectorial or whole anterior segment PBRT.ResultsThirteen cases were identified of which five received PBRT of the whole anterior segment and eight received sectorial PBRT. Local tumour control after a mean follow-up of 25 months was 92%. Complications after PBRT included cataract (46%), secondary glaucoma (31%), superficial keratitis (15%) and madarosis (8%). Complications were more common in patients necessitating irradiation of the entire anterior segment than in patients which received sectorial irradiation. Eye retention was achieved in all cases. No statistically significant difference in the mean best corrected visual acuity (BCVA) and intraocular pressure (IOP) was found before and after treatment. Comparison of mean BCVA and IOP between different treatment groups (complete anterior segment vs sectorial irradiation) at the last follow-up visit were also not significantly different. No patient developed metastatic disease during follow-up.ConclusionPBRT is a safe and vision preserving therapeutic modality for iris melanoma. Complete irradiation of the anterior segment is associated with higher complication rates.

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.

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