role of periocular carboplatin in treatment of advanced intraocular retinoblastoma

To evaluate the results of combined chemotherapy and periocular carboplatin injection to control advanced intraocular retinoblastoma [Rb]. In this prospective interventional case-series, we included 8 eyes of 8 patients with advanced intraocular Rb [group C or D in International Intraocular Retinoblastoma Classification, IIRC]. In these patients, periocular carboplatin was injected as a primary adjuvant therapy combined with chemotherapy [VEC regimen] or as a secondary treatment in patients who had recurrent disease or did not respond to primary chemotherapy and local modalities. All patients were examined under anesthesia [EUA] and fundus photography was done by Ret-cam before treatment. Fifteen miligrams of carboplatin was injected into subconjunctival or subtenon space in 3-4 weeks interval. Eight eyes of eight patients were enrolled. Five patients were male and three patients were female. Mean age of patients at the time of treatment was 34 months and the mean duration between initial presentation of Rb and beginning of treatment was 7.5 months. Mean injection of periocular carboplatin in each eye was 3.1 times. Past medical history in our patients before starting of this treatment included: External Beam Radiotherapy [EBRT] in 3 eyes, cryotherapy in 4 eyes, transpupillary thermotherapy [TTT] in 4 eyes and brachytherapy in 2 eyes. Four eyes were in group C and four eyes were in group D. In 3 patients carboplatin was injected as primary treatment and in five patients it was injected for tumor recurrence following initial treatment failure or relapse. Three patients had vitreous, one had sub-retinal and remaining four had both vitreous and sub-retinal seeding. The degree of seeding was low in two patients, moderate in two patients and severe in four patients. At the end of study, tumor was regressed in six eyes [75%], relapsed in one [12.5%] and recurred in another [12.5%]. In both eyes with relapsed and recurrent tumors, enucleation was done. Combined chemotherapy and periocular carboplatin injection as well as focal treatment may be an effective method to control advanced intraocular Rb

Plaque radiotherapy in recurrent or incomplete-excised conjunctival squamous cell carcinoma and melanoma

To assess the results of brachytherapy in patients with recurrent or incomplete excised conjunctival squamous cell carcinoma [SCC] and malignant melanoma. Three patients underwent brachytherapy of one eye and one patient underwent brachytherapy of both eyes with ruthenium-106 [RU-106] plaques, all of them had a history of incomplete resection or recurrence of the tumor after surgery. All patients were male with an average age at diagnosis of 54 years [range, 34-76 years].The shape and the size of plaques were determined based on location and size of the suspected area. The plaque was inserted to deliver a target dose of 80-100 Gy in the region of conjunctival malignancy. The diagnosis was squamous cell carcinoma in three eyes and conjunctival melanoma in two eyes. All patients had surgical history of one to three previous excisions with or without cryotherapy before brachytherapy. There were microscopic residual tumors after excision in 2 eyes and recurrent lesion was evident in 3 other eyes. A mean dose of 95 Gy was delivered to the tumor bed. Complete tumor regression without any evidence of recurrent lesion was obtained in all five eyes. The patients were followed for 32 months on average [range, 18-42 months]. No radiation related complication was detected, with an exception of a dry eye in the last follow up. Brachytherapy with RU-106 plaque is an alternative method for treatment of selected patients with recurrent or residual conjunctival SCC and melanoma

Investigation of intraocular pressure changes due to different serum level heights by using tonopen in acquired globes from the Iran Eye Bank

To investigate intraocular pressure [IOP] changes due to different serum level heights by using Tonopen in acquired globes from the Iran Eye Bank [IEB]. In this interventional prospective case series, serum were infused into 18 normal globes acquired from IEB by using 21G needle inserted in vitreal space through optic nerve head to change the IOP by different fluid level heights from the globe surface. IOP of globes were measured and recorded by Tonopen over the sclera and over the cornea at different serum level heights. Twelve globes were acquired from male donors and 6 globes were from female donors. Mean age of donors were 57 year old. Mean measured pressures by Tonopen of the 18 globes at the serum level heights of 13.6, 27.2, 40.8, 54.4 and 68 cm from the globe surface were 14, 23.6, 34.8, 44 and 52.8 mmHg over the sclera and 13.1, 22.8, 34.8, 44.1 and 52.8 mmHg over the cornea respectively. Using a Tonopen is a proper method to measure the acquired globes IOP, except in serum level height of 13.6 cm [10 mmHg] from the globe surface. In addition, if tonometry over the cornea is not available, it can be done by using Tonopen over the sclera