Vitreoretinal Surgical Approaches in Intraocular Tumors

Although primary vitreoretinal techniques are rarely used in the primary treatment of intraocular tumors, they are mostly used for differential diagnosis and as an adjuvant treatment for the actual radiotherapy of these tumors. Especially biopsies are taken for masquerading syndromes, biopsies for prognostic evaluation and alternative/adjuvant treatment methods of intraocular tumors have been emphasized in this paper. The principles of vitreoretinal approaches in these cases are evaluated in light of our clinical experience and current literature data.

Azzopardi Phenomenon in a Non-neoplastic Phthisical Eye: A Case Report

Objective: The Azzopardi phenomenon, known as the deoxyribonucleic acid deposition on various structures due to cellular necrosis, has never been reported in non-neoplastic eyes. Methods: We report a case of a 48-year-old man who had congenital nystagmus with poor vision in both eyes, presented with decreased vision and photophobia in his left eye. An exudative retinal detachment was found, which did not respond to systemic steroid treatment. Glaucoma due to occlusio pupillae was later developed. Laser iridotomy and anti-glaucoma medications decreased intraocular pressure to an acceptable level. Vision in the left eye gradually deteriorated during the 10-year clinical course. Evisceration was finally performed due to persistent dull aching ocular pain along with signs of ocular hypotony Results: Histopathological examination showed phthisis bulbi and focal nodular retinal gliosis. The Azzopardi phenomenon was found at the retinal vessel walls, within the retinal layers and along the internal limiting membrane. There was neither evidence of intraocular tumors nor foreign bodies. Conclusion: This case demonstrated that the Azzopardi phenomenon could be present in a non-neoplastic eye with a longstanding disease that proceeds to phthisis bulbi.

Range of Clinical Neuro-Ophthalmopathology: more than Tumors

The importance of close co-operation of ophthalmologists, neurologists, neurosurgeons and neuro-ophthalmopathologists as well in clinical as in scientific settings is underlined. Typical neuro-ophthalmopathological examples of frequent and rare cases from pathology of the eyelid, the cornea, intraocular tumors, ocular trauma and tumors of the orbit are presented as well as systemic pathologies such as inflammatory diseases of the eye, phakomatoses, malformations and mitochondrial disorders in which the histopathological investigation by neuro-ophthalmopathologists may contribute to diagnosis and therapeutic decision-making. The chosen examples should provide a narrow focus on some clinical queries answered by neuro-ophthalmopathology and exemplify methodological options, but – in the given frame – cannot represent the full range of eye pathology. Relevant literature is included for further reading. Ophthalmologists, neurologists and neurosurgeons should be aware from the additional value of a concise neuro-ophthalmopathological diagnosis for the optimal treatment of eye diseases and should insist in a professional neuro-ophthalmopathological investigation whenever and wherever possible.

Clinical applications of OCTA in ocular oncology: pearls and pitfalls

Background: Optical Coherence Tomography Angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review we report the main applications and limits of the use of OCTA for the study of intraocular tumors. Summary: OCTA allows a rapid, safe, low-cost and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to tumor inner profile or thickness, poor penetration of laser into the lesion, masking effect from overlying fluid and media opacities and poor fixation. Key messages: The main applications of OCTA in ocular oncology consist in the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy allowing a detailed visualoization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.

Transpupillary laser thermotherapy for retinoblastoma

The review article presents the literature data concerning the history of the use of thermotherapy in the treatment of intraocular tumors, in particular, retinoblastoma (Rb). The article describes the historical aspects of the use of transpupillary thermotherapy (TTT) and the possibility of using this method in the treatment of RB nowadays. The analysis of Russian and foreign publications on the main parameters of laser radiation and the multiplicity of TTT was carried out. The efficacy of TTT as an independent method of Rb treatment has been demonstrated. The frequency of the main complications of TTT in Rb is presented. Key words: ophthalmology, retinoblastoma, transpupillary thermotherapy, laser treatment, pediatric oncology.

Diagnostic retinal biopsy in the management of secondary non-CNS vitreoretinal lymphoma masquerading as viral retinitis: a case report

Background Intraocular lymphoma accounts for fewer than 1% of intraocular tumors. When the posterior segment is involved, it can be further classified as vitreoretinal or choroidal lymphoma. Vitreoretinal lymphoma (VRL) can rarely masquerade as an infectious retinitis making diagnosis and management challenging. Results A 73-year-old woman with a history of non-central nervous system (CNS) involving diffuse large B-cell lymphoma (DLBCL) was referred for worsening blurry vision—visual acuity of count figures at 2 ft—in her right eye for 8 months. Dilated fundus examination of the right eye was significant for retinal whitening and dot-blot hemorrhages, which was concerning for a viral retinitis and guided initial management. Secondary intraocular lymphoma was also considered. The retinal disease continued to progress despite intravitreal and systemic antiviral therapy, and a diagnostic vitrectomy was inconclusive. A retinal biopsy was then performed, which showed DLBCL, confirming a diagnosis of secondary VRL. Three subsequent treatments with intravitreal methotrexate led to regression of the VRL. Conclusions Our case highlights the utility of a retinal biopsy after an inconclusive diagnostic vitrectomy in a challenging scenario of VRL to establish a diagnosis and initiate successful treatment. A multidisciplinary team of providers was essential for diagnosis, comprehensive workup, medical and surgical management of the patient.

Аngiogenesis in Uveal Melanoma

Uveal melanoma (UM) is less than 0.5 % in the spectrum of human tumors, and less than 5 % among all types of melanoma, therefore, it is considered to be rare. At the same time, UM is recognized as the most common intraocular malignant neoplasm. Its share among all intraocular tumors is 60 %. Radical local treatments are considered effective, but the frequency of distant metastases is unacceptably high, and the life expectancy of patients with metastatic stage of the disease is short and on average is 4–5 months. Survival rates have remained stable for the past 40 years, reflecting the lack of current effective system strategies. The tumor metastasizes in a haematogenic way, so it is not surprising that angiogenesis is constantly in the focus of scientific developments. The importance of studying angiogenesis in UM is due to the ability to predict based on the quantitative indicators of vessels inside the tumor and to search for potential targets of antiangiogenic therapy in the future. The authors used two methods of studying angiogenesis in UM: morphological with quantitative vascular counting and immunohystochemical method (IHC) with markers of endothelial cells CD34 and CD31, VIII factor, VEGF molecules, bFGF, thrombospondin and others. IHC-staining of vessels in UM allowed to visualize vessels that were not visible due to intense pigmentation of tumors or compression of vessels by tumor cells. Comparison of data obtained by the two methods demonstrated the advantages of IHS analysis over classical morphological methods. It was found that UM, as a malignant solid tumor, differs high averages of vessels per unit area. The highest rates are recorded in epitheloid melanoma, which is associated with a higher rate of growth, and more frequent metastasis, compared to similar rates in revere cell melanoma. The number of vessels per unit area in the viewing area in UM decreases with age, which explained the development of metastases in more distant after enucleation time in elderly patients. Differences in vascular density in tumors of different localization were revealed and described: they were the maximum in pre-equatorial tumors, and minimal — in iris tumors.

Modern possibilities of optical reconstructive surgery in patients after removal of tumor of iridociliary zone

Choroid tumors constitute 2/3 of all intraocular tumors, out of which 23% are tumors of the iris and the ciliary body, and the rest are tumors of the choroid. After removing the tumor of the iridociliary zone (ICZ) it is necessary to perform optical reconstructive surgery to reduce light aberrations and increase visual functions. Purpose. To identify key features of the complex rehabilitation of patients after removal of the ICZ tumor. Material and methods. The clinical and functional results of the complex rehabilitation of 12 patients (12 eyes) aged from 35 to 84 years (average 66 years) were studied at least 1 year after removal of the ICZ tumor. The area of the iris defect before the reconstructive surgery ranged from 15% to 55%. Preoperative uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) were 0.26 ± 0.19 (from 0.01 to 0.6) and 0.46 ± 0.22 (from 0.1 to 0.8) respectively. All patients were underwent phacoemulsification of cataract and implantation of the iris-lens diaphragm. Results. After the reconstructive surgery, UCVA and BCVA increased:0.5 ± 0.17 (from 0.2 to 0.7) and 0.61 ± 0.27 (from 0.3 to 0.9) respectively. Undesirable optical effects were decreased, and patients were satisfied with the cosmetic result. Conclusion. The presented algorithm of optical reconstructive surgery after removal of the ICZ tumor creates necessary conditions for increasing postoperative functional results and improving the quality of life of these patients. Key words: tumor of the iridociliary zone, iris-lens diaphragm, optical reconstructive surgery, phacoemulsification of cataract.

Vitrectomy-Assisted Biopsy: An in vitro Study on the Impact of Cut Rate and Probe Size

<b><i>Purpose:</i></b> The aim of this study was to optimize the technique of performing vitrectomy-assisted biopsy of intraocular tumors by comparing the cytohistological findings in specimens obtained with different vitrectomy probes and cut rates. <b><i>Methods:</i></b> Vitrectomy-assisted biopsies were taken from a fresh porcine liver. For each sampling, the vacuum level was 300 mm Hg. The following parameters were compared; cut rate (60, 600 and 6,000 cuts per minute [cpm]), probe type (standard and two-dimensional cutting [TDC]), and probe diameter (23-gauge and 25-gauge). The specimens were assessed by automated whole-slide imaging analysis and conventional light microscopy. <b><i>Results:</i></b> Seventy-two biopsies were analyzed for the number of hepatocytes, total area of tissue fragments, and total stained area of each microscope slide. For all probe types, these parameters were significantly and positively correlated with the cut rate. TDC probes led to significantly higher scores than those of standard probes, independent of the cut rate. There were no significant differences in results when using 23-gauge or 25-gauge standard probes. Light microscopic examination demonstrated well-preserved cells sufficient for cytohistological analyses in all investigated cases. <b><i>Conclusions:</i></b> The higher the cut rate, the larger is the amount of aspirated cellular material. There were no significant differences between 23-gauge and 25-gauge biopsies. Cut rates up to 6,000 cpm did not adversely affect the cytohistological features of the samples.