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INTRODUCTION@#We aimed to describe the clinical characteristics, diagnostic challenges, treatment patterns and outcomes of uveal melanoma (UM) in a tertiary care centre.@*METHODS@#This is a retrospective case series of 11 consecutive patients with UM who were managed in a tertiary referral centre between 2002 and 2017. Epidemiological, clinical, pathological and radiological characteristics were reviewed. Classification of choroidal melanoma as small, medium or large was based on the criteria established by the Collaborative Ocular Melanoma Study.@*RESULTS@#Mean age at presentation was 42.9 (range 27‒67) years. In 7 (64%) patients, a definitive diagnosis of UM was made after a mean follow-up period of 6.4 (range 1‒17) months. There were one, six and four patients with small-, medium- and large-sized choroidal melanomas, respectively. Treatment was enucleation in 5 (45.5%) patients, plaque brachytherapy in 4 (36.4%) patients, transpupillary thermotherapy in 1 (9.1%) patient, and observation in 1 (9.1%) patient. Median follow-up was 29 months. Metastatic disease developed in 5 (45.5%) patients at the mean age of 46.6 (range 38‒56) years, with median overall survival of 20 months. Genetic mutations in three patients were monosomy 3 (n = 2), and gain of 3q and 8q (n = 1).@*CONCLUSION@#Our study supports the finding that UM in Chinese and Asian Indian patients presents at a younger age than in Caucasians. Although it is rare, ophthalmologists should remain mindful of this life-threatening disease. We propose establishing a national and regional registry for ocular tumours with genetic information to characterise the disease spectrum in Southeast Asia.
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The management of intra ocular tumors has undergone a sea change from the era of enucleation or external beam radiation. With the advent of new chemotherapy protocols, globe and vision salvage have become possible in a majority of cases of retinoblastoma. This article is an overview of the various modalities available for the management of intra ocular tumors and their indications. Chemotherapy has been covered elsewhere in this series of articles on ocular oncology. Photocoagulation and cryopexy are easily administered modalities of treatment for small tumors and totally within the ophthalmologist’s domain. Slightly larger tumors are treatable with brachytherapy. The susceptibility of the tumors to chemotherapy and radiation decide the choice of treatment and the dosage. Management of intra ocular tumors very often needs a multidisciplinary approach including ophthalmologist, oncologist, radiation physicist, and radiotherapist.
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Background: Choroidal coloboma, especially with optic disc involvement affects the blood vessel (BV) pattern in the fundus. Aim: The aim of this study was to report the observations on the pattern of retinal BVs in eyes with fundus coloboma. Design: Retrospective observational study. Materials and Methods: Twenty four eyes of 19 patients with fundus coloboma and the disc involvement in the coloboma was classified according to a previous publication. Results: Four varieties of BVs were identified in the area of coloboma – BVs that were continuous with those arising from the optic disc; vessels emanating from the floor of coloboma whose continuity with central retinal artery or its branches could be indirectly established; and those emanating from the floor of coloboma whose continuity with central retinal artery could not be established. In addition, extraocular BVs were visible through the thinned sclera. The retinal BVs often traversed the coloboma to reach the normal retina. The disc itself was found to be small and had no physiological cup (if not colobomatous). Conclusions: One should be aware of the major BVs transgressing the coloboma while performing relaxing cuts in the intercalary membrane, during the surgery for retinal detachments in eyes with coloboma. Physiological cup is usually absent (when the disc is not colobomatous). Hence, any cupping in such eyes should be viewed with suspicion.
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To correlate the clinical presentation, tumor characteristics, and histopathological findings of choroidal melanoma in the Indian population A retrospective analysis of 113 patients of choroidal melanoma over a period of 10 years was done. Patient demography, clinical presentation, tumor characteristics, and histopathological findings were correlated. Among 113 patients histopathologically diagnosed with choroidal melanoma over 10 years, most were males. The mean age was 45.9 +/- 14.84 years among which 6 [5.3%] patients were less than 20 years. Thirty-six [31.8%] patients were misdiagnosed. The mean basal diameter was 12.41 +/- 1.4 mm. Mixed cell type was seen in 71 [63%] patients, while 28 [25%] patients had spindle cell type. Epithelioid cell type was present in 11 [10%] patients and necrotic cell type was seen in 3 [2%] patients. Enucleation was the primary treatment modality in 107 [94.6%] patients, while exenteration was done in 6 [5.3%] patients. Three patients with epithelioid cell type with orbital extension underwent exenteration. The mean follow-up period was 14 months. No mortality was reported at the end of 5 years in patients with longer follow-up. Malignant melanoma of the choroid is a rare occurrence. They can occur in younger age group and can be misdiagnosed. Mixed cell type is commonest. Diffuse tumors with epithelioid cell type are likely to have orbital extension
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Choroidal neovascularization (CNV) is a rare complication associated with coloboma of the choroid. We describe three cases of coloboma choroid where there was loss of vision due to CNV development at the edge of the coloboma. One was managed by photodynamic therapy alone and two were managed by a combination of reduced fluence PDT and intravitreal bevacizumab. Significantly we noted that one treatment session was sufficient to achieve regression of the CNV and improvement in visual acuity.
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Retinoblastoma [RB] is the most common intraocular malignancy in children. Recently, there have been significant advances made in the molecular pathology and the management of the disease. Last decade has witnessed better understanding of the genetics of RB, the discovery of new tumor markers expressed by the RB tumors, the identification of high-risk histopathological factors following enucleation, and newer methods of treatment including periocular chemotherapy and superselective intraarterial chemotherapy. All these advances have translated in improved survival rates for the affected children, improved rates of eye salvage, and improved visual outcomes. This article briefly reviews these advances. Method of Literature Search: Literature on the Medline database was searched using the PubMed interface. The search strategy included MeSH and natural language terms using the keywords mentioned. Reference lists in retrieved articles and textbooks were also searched for relevant references