MR Imaging–Pathologic Correlation of Uveal Melanomas Undergoing Secondary Enucleation after Proton Beam Radiotherapy

Background: Currently, radiotherapy represents the most widely employed therapeutic option in patients with uveal melanoma. Although the effects of proton beam radiotherapy on uveal melanoma end ocular tissues have been histologically documented, their appearance at MR imaging is still poorly understood. The purpose of our study was to elucidate the magnetic resonance (MR) semiotics of radiotherapy-induced changes to neoplastic tissues and ocular structures in patients with uveal melanoma undergoing secondary enucleation after proton beam radiotherapy. Methods: Nine patients with uveal melanoma who had undergone proton beam radiotherapy, MR imaging, and subsequent secondary enucleation were retrospectively selected. The histopathologic findings evaluated for irradiated tumors were necrosis, fibrosis, and viable tumor, while the histopathologic findings evaluated for extratumoral ocular/periocular tissues were radiation-related intraocular inflammation, vitreous hemorrhage, optic nerve degeneration, iris neovascularization, and periocular fibrotic adhesions. On MR images, the appearance of the abovementioned histologic features was assessed on conventional and diffusion-weighted sequences. Results: T2-weighted sequences performed better in detecting radiation-induced necrosis, fibrosis, optic nerve degeneration, and periocular fibrotic adhesions. T1-weighted sequences were preferable for identifying cataracts, vitreous hemorrhage, and inflammatory complications. Contrast-enhanced T1-weighted sequences were irreplaceable in assessing iris neovascularization, and in confirming inflammatory complications. Conclusions: In the light of their increasing role in the multidisciplinary management of patients with uveal melanoma, radiologists should be aware of the MR appearance of the effects of radiotherapy on neoplastic and ocular tissue, in order to improve the accuracy of follow-up MR examinations.

Gaining insight on mitigation of rubeosis iridis by UPARANT in a mouse model associated with proliferative retinopathy

Proliferative retinopathies (PR) lead to an increase in neovascularization and inflammation factors, at times culminating in pathologic rubeosis iridis (RI). In mice, uveal puncture combined with injection of hypoxia-conditioned media mimics RI associated with proliferative retinopathies. Here, we investigated the effects of the urokinase plasminogen activator receptor (uPAR) antagonist—UPARANT—on the angiogenic and inflammatory processes that are dysregulated in this model. In addition, the effects of UPARANT were compared with those of anti-vascular endothelial growth factor (VEGF) therapies. Administration of UPARANT promptly decreased iris vasculature, while anti-VEGF effects were slower and less pronounced. Immunoblot and qPCR analysis suggested that UPARANT acts predominantly by reducing the upregulated inflammatory and extracellular matrix degradation responses. UPARANT appears to be more effective in comparison to anti-VEGF in the treatment of RI associated with PR in the murine model, by modulating multiple uPAR-associated signaling pathways. Furthermore, UPARANT effectiveness was maintained when systemically administered, which could open to novel improved therapies for proliferative ocular diseases, particularly those associated with PR. Key messages • Further evidence of UPARANT effectiveness in normalizing pathological iris neovascularization. • Both systemic and local administration of UPARANT reduce iris neovascularization in a model associated with proliferative retinopathies. • In the mouse models of rubeosis iridis associated with proliferative retinopathy, UPARANT displays stronger effects when compared with anti-vascular endothelial growth factor regimen.

Spontaneous Hyphema from Iris Microhemangiomatosis in an Elderly Patient with Hypertensive Crisis

Background: Iris microhemangiomatosis is a rare vascular iris tumor, with potential severe complications such as increased intraocular pressure (IOP). We aim to describe a case report of a patient presenting with hyphema secondary to iris microhemangiomatosis triggered by excessive high blood pressure. Case Presentation: A 74-year-old woman was treated for hypertensive crisis. After her high blood pressure had been controlled and stabilized, she was discharged home. However, the same day, she complained about an acute decrease in vision in her left eye. Best corrected visual acuity was 20/20 on the right eye and 20/200 on the left eye. On biomicroscopy, a hyphema was seen. Iris neovascularization was absent, IOP and fundus examination were normal. After spontaneous resolution of the hyphema, a fluorescein angiography of the anterior segment was performed, which revealed bilateral subtle early hyperfluorescence with late staining scattered at the pupillary margin. The patient was diagnosed with iris microhemangiomatosis. During the follow-up of 24 months, the blood pressure was stable and well controlled. The patient did not experience any recurrent hemorrhage. Discussion and Conclusion: Spontaneous hyphema is the most common complication of iris vascular tumors. We report the occurrence of a spontaneous hyphema triggered by uncontrolled blood pressure in a patient with a very rare condition, i.e., iris microhemangiomatosis. In order to avoid complications of microhemangiomatosis such as uncontrolled glaucoma or recurrent bleeding requiring surgery, blood pressure should be monitored closely and controlled.

Wide-field angiography in retinal vein occlusions

Background Retinal vein occlusion (RVO) is the second most common retinal vascular disease after diabetic retinopathy. It can result in significant visual loss from complications like macula edema, retinal and iris neovascularization, and vitreous hemorrhage. Recently, ultra-widefield imaging (UWF) has been developed for posterior pole visualization and has shown to be useful in the evaluation and treatment of RVO. Main text Ultra-widefield imaging (UWF) imaging allows for visualization of the retina up to an angle of 200°. This is especially important in detecting peripheral retinal pathologies, especially in retinal conditions such as RVO, where the disease process affects the peripheral as well as central retina. In particular, retinal non-perfusion in RVO is a risk factor for neovascularization. Various techniques, such as ischemic index and stereographic projection, have been described to assess areas of ischemia on UWF images. Retinal non-perfusion has an impact on disease complications, such as macular edema, and retinal and iris neovascularization. Retinal non-perfusion also has implications on disease response, including visual acuity, reduction in retinal edema and treatment burden. Conclusion Ultra-widefield imaging (UWF) imaging plays an important role in the assessment and management of RVO, especially in measuring retinal non-perfusion in the peripheries.

Diabetes and Phacoemulsification Cataract Surgery: Difficulties, Risks and Potential Complications

Diabetes mellitus is one of the most prevalent chronic diseases worldwide. Diabetic patients are at risk of developing cataract and present for surgery at an earlier age than non-diabetics. The aim of this study was to review the problems associated with cataract surgery in a diabetic patient. Corneal complications in diabetic patients include delayed wound healing, risk of developing epithelial defects or recurrent erosions due to the impairment of epithelial basement membranes and epithelial–stromal interactions. Diabetic patients present lower endothelial cell density and their endothelium is more susceptible to trauma associated with cataract surgery. A small pupil is common in diabetic patients making cataract surgery technically challenging. Finally diabetic patients have an increased risk for developing postoperative pseudophakic cystoid macular edema, posterior capsule opacification or endophthalmitis. In patients with pre-proliferative or proliferative diabetic retinopathy, diabetic macular edema or iris neovascularization adjunctive therapy such as an intravitreal anti-vascular endothelial growth factor injection, can inhibit exacerbation related to cataract surgery.

Expression of platelet-derived growth factor-C in aqueous humor of patients with neovascular glaucoma and its correlation with vascular endothelial growth factor

Aim: The aim of this study was to investigate the expression of platelet-derived growth factor-C in aqueous humor of patients with neovascular glaucoma and its correlation with vascular endothelial growth factor. Methods: This study involved 62 eyes of 62 patients with advanced neovascular glaucoma requiring transscleral cyclophotocoagulation. Aqueous humor was collected through paracentesis. Samples from 11 eyes of 11 patients with age-related cataract were collected as control. Concentrations of platelet-derived growth factor-C and vascular endothelial growth factor in aqueous humor were quantified by enzyme-linked immunosorbent assay. Meanwhile, the correlations between the concentrations of platelet-derived growth factor-C and vascular endothelial growth factor were analyzed. The elements including retinal photocoagulation treatment, iris neovascularization grade, and primary fundus disease were also studied to find out their roles in the concentrations of the two factors. Results: The vascular endothelial growth factor and platelet-derived growth factor-C concentrations in aqueous humor from controls were (679.54 ± 49.81) pg/mL and (18.60 ± 1.85) pg/mL, respectively. Both of them were significantly lower than neovascular glaucoma patients ( p < 0.001). The vascular endothelial growth factor and platelet-derived growth factor-C concentrations of neovascular glaucoma patients treated with retinal photocoagulation were (1095.99 ± 52.71) pg/mL and (28.55 ± 0.94) pg/mL, respectively, which were both significantly lower than those of untreated neovascular glaucoma patients, (1146.28 ± 69.57) pg/mL and (30.04 ± 1.64) pg/mL ( p = 0.008, p = 0.034). There was a weak correlation between the expression level of vascular endothelial growth factor and platelet-derived growth factor-C in aqueous humor with neovascular glaucoma ( r = 0.346, p = 0.006). However, iris neovascularization grade and primary fundus disease were not significant elements in the expression level of vascular endothelial growth factor and platelet-derived growth factor-C. Conclusion: Higher concentrations of vascular endothelial growth factor and platelet-derived growth factor-C were found in aqueous humor of patients with neovascular glaucoma compared with control, which could be lowered by retinal photocoagulation to some extent. Platelet-derived growth factor-C inhibitors may be another potential target for ocular neovascular diseases.