Value of the strain ratio in the differential diagnosis of intraocular tumors by elastosonography: A retrospective case-control study

Purpose: To examine the role of the strain ratio in elastosonography for the differential diagnosis of common intraocular tumors such as choroidal melanoma, choroidal hemangioma, choroidal metastatic carcinoma, and retinoblastoma. Methods: This study included patients suffering from intraocular space?occupying lesions and who visited Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from June 2016 to March 2020. All patients underwent a physical examination, fundus examination with mydriasis, color Doppler ultrasonography, elastosonography, magnetic resonance imaging (MRI), and fundus angiography within 1 week. All patients were grouped as choroidal melanoma, choroidal metastatic carcinoma, retinoblastoma, choroidal hemangioma, and optic disk melanocytoma. A receiver operating characteristic (ROC) curve analysis was performed to assess the strain ratio for diagnosing malignant intraocular tumors. Results: A total of 155 patients (161 eyes) were recruited. The strain ratios measured were 39.59 ± 15.92 for choroidal melanoma, 36.85 ± 13.64 for choroidal metastatic carcinoma, 38.93 ± 17.27 for retinoblastoma, 13.42 ± 10.93 for choroidal hemangioma, and 3.84 ± 1.32 for optic disk melanocytoma. The strain ratios of the three malignant lesions were significantly higher than those of the two benign lesions (all P < 0.001). The area under the ROC curve was 0.95 ± 0.028. The optimal cutoff point was 22.67, with 85.7% sensitivity and 96.4% specificity. Conclusion: There were significant differences in elasticity between the malignant and benign intraocular tumors. The strain ratio using elastosonography could serve as an important auxiliary examination to distinguish between benign and malignant intraocular tumors

Effects on Periocular Tissues after Proton Beam Radiation Therapy for Intraocular Tumors

BACKGROUND: To present our experience on orbital and periorbital tissue changes after proton beam radiation therapy (PBRT) in patients with intraocular tumors, apart from treatment outcomes and disease control. METHODS: Medical records of 6 patients with intraocular tumors who had been treated with PBRT and referred to oculoplasty clinics of two medical centers (Seoul National University Hospital and Seoul Metropolitan Government-Seoul National University Boramae Medical Center) from October 2007 to September 2014 were retrospectively reviewed. The types of adverse effects associated with PBRT, their management, and progression were analyzed. In anophthalmic patients who eventually underwent enucleation after PBRT due to disease progression, orbital volume (OV) was assessed from magnetic resonance (MR) images using the Pinnacle3 program. RESULTS: Among the six patients with PBRT history, three had uveal melanoma, and three children had retinoblastoma. Two eyes were treated with PBRT only, while the other four eyes ultimately underwent enucleation. Two eyes with PBRT only suffered from radiation dermatitis and intractable epiphora due to canaliculitis or punctal obstruction. All four anophthalmic patients showed severe enophthalmic features with periorbital hollowness. OV analysis showed that the difference between both orbits was less than 0.1 cm before enucleation, but increased to more than 2 cm3 after enucleation. CONCLUSION: PBRT for intraocular tumors can induce various orbital and periorbital tissue changes. More specifically, when enucleation is performed after PBRT due to disease progression, significant enophthalmos and OV decrease can develop and can cause poor facial cosmesis as treatment sequelae.

Clinical effectiveness and safety of domestic 125I plaque irradiation for experimental choroidal melanoma / 中华实验眼科杂志

Background Choroidal melanoma (CM)is the most common primary intraocular tumor,and brachytherapy is one of the most common therapeutic modality in the treatment of the tumor.However,this irradiation approach has not been evaluated in China. Objective The present study was to analyze the effectiveness and safety of domestic 125I plaque irradiation in the treatment of CM. Methods Forty New Zealand albino rabbits were randomized into 5 groups with 8 rabbits 8 eyes (right eyes) in each group.CM models were established in 16 of 40 New Zealand albino rabbits by implanting the rat B16F10 melanoma cell fragments into the suprachoroidal space of right eyes.After 3 weeks,domestic 125I plaque was fixed at the location of CM in the irradiation group 1,and 8 rabbits with CM served as model control group.The clinical effectiveness of 125I plaque for CM was evaluated based on the fundus examination with indirect ophthalmoscopy,B scan ultrasonography,fundus photographs and color Dopplerimaging.Regarding the safety study,domestic 125I plaque was fixed on the normal right cycs of normal rabbits,while the plaques without 125I seeds were used as the sham group.No intervene was performed in the rabbits of blank group.The number of CD4+,CD8+ T cells in peripheral blood was detected by flow cytometry before plaques implanted and on 3,7,15 and 30 days after the plaque was removed.The animals were sacrificed and the eyes were obtained for histology examination.The use of the experimental animals complied with Statement of ARVO. Results After implantation of B16F10 melanoma cell fragments,CM grew steadily and rapidly with the similar size between irradiation group 1 and model control group ( P =0.550).One week after administration of the treatment,tumor size was(0.31±0.07 )cm in irradiation group 1 and (0.85±0.18 )em in the model control group,with the significant difference between them( P=0.001 ).Two week after application of 125I plaque,the size of tumor was smaller than that before irradiation (P=0.007 ).Histologically,the tumors were mostly limited beneath the pigment epithelial layer with less neovascularization,fibrosis in the tumor was found in some area in the irradiation group when compared with model control group.No significant differences were found in the proportions of CD4+,CD8+ T cells and CD4+/CD8+ at different time points in the irradiation groups of normal eyes and sham group (Fgroup =0.770,8.110,2.230; P=0.380,0.060,0.140; Ftime =0.770,3.220,4.230; P =0.550,0.170,0.004 ).Chronic inflammatory cells infiltration cornea,subconjunctival epithelial and selera surface,but sclera had no necrosis and organization.Conclusions These results suggest that domestic 125I plaque irradiation is effective for the treatment of CM,and has limited side effects on normal rabbits.

Melanoma epitelioide de coroide / Choroidal epithelioid melanoma

Descrevemos um caso de melanoma de coroide em um paciente do sexo masculino e 56 anos de idade. A angiografia revelou tumor exofítico de 6 diâmetros de disco em olho esquerdo com vascularização própria, sugerindo melanoma de coroide que foi confirmado com ecografia e tomografia ocular, determinando a enucleação do olho afetado.

We describe a case of choroidal melanoma in a 56-year-old male patient. Angiography revealed an exophytic tumor of 6 disc diameters in the left eye with its own vascularization, suggesting choroidal melanoma, which was confirmed by ultrasonography and eye CT, determining the enucleation of the affected eye.

Clinical epidemiology of retinoblastoma at the Philippine General Hospital:1998-2008

Objective@#This study determined the clinical characteristics of retinoblastoma (RB) from 1998 to 2008 and compared the epidemiological and clinical patterns with those of the period from 1967 to 2001.@*Methods@#We reviewed the clinical records of 152 patients with RB from 1998 to 2008 in terms of demographic and ophthalmological data and clinical staging or classification.@*Results@#Sixty-three percent of cases were unilateral and 37% were bilateral. Three (3%) of 95 unilateral cases and 7 (12%) of 57 bilateral cases had family history of RB (p = 0.038). The mean age at onset was 17.8 months for unilateral and 7.4 months for bilateral cases, while the mean age at diagnosis was 26.4 months and 13.7 months respectively. The delay from onset to diagnosis was 69% in unilateral and 56% in bilateral RB groups. Financial cost (71.4%) was the leading reason for delay, followed by misdiagnosis (24.5%), and inaccessibility of medical facility (2.0%). The most common manifestations were leukocoria (77%), extraocular findings of orbital mass (9%), and proptosis (6%). Advanced intraocular stage was seen in 63 – 71.6% among those with unilateral and 56 – 60% in those with bilateral tumor.@*Conclusion@#The onset of disease had not changed over the years, but patients in general were brought earlier for consultation. Most cases presented in the advanced stage. Decreasing the occurrence of extraocular RB through early consultation and treatment can improve patient survival.

Fine-Needle Aspiration Biopsy of Intraocular Tumors

PURPOSE: To evaluate the efficacy and safety of fine-needle aspiration biopsy in the diagnosis of suspected intraocular malignancy and simulating conditions. METHODS: We performed a retrospective study of the medical records of patients who underwent diagnostic pars plana transvitreal biopsy. RESULTS: A total of 12 biopsies were performed in 11 eyes of 11 patients with intraocular tumor and the final diagnosis was confirmed by cytologic examination in 10 eyes. There was insufficient amount of material for cytologic examination in one case. In another case, biopsy was repeated to obtain the final result due to false negative result of the first biopsy. Localized intraocular hemorrhage was found to be the most common complication, but resolved spontaneously in most cases. Retinal detachment and tumor recurrence were not observed. CONCLUSIONS: Transvitreal fine-needle aspiration biopsy is an accurate diagnostic procedure in the evaluation of intraocular tumors difficult to diagnose with other non-invasive diagnostic technique and it can be performed safely with minimal complication.

Five Cases of Transpupillary Thermotherapy for Intraocular Tumors

PURPOSE: To evaluate the effects of transpupillary thermotherapy(TTT) for several intraocular tumor. METHODS: The 5 intraocular tumors (2 capillary hemangioma, 1 metastatic tumor, 1 retinal angioma, 1 melanocytoma) were treated with transpupillary thermotherapy. We compared preoperative visual acuity, size, fundus finding, ultrasonogram to postoperative data. RESULTS: The one capillary hemangioma and metastatic tumor were improved in fundus finding. The other tumors were not improved. The visual acuity of patient with metastatic tumor was improved from F.C/30cm to 0.15. CONCLUSIONS: Transpupillary thermotherapy was effective tool for intraocular tumors. We may need the guideline for treatment of intraocular tumor by using transpupillary thermotherapy.

Treatment and Prognosis of Retinoblastoma: Clinicopathologic Analysis of 101 Cases

The clinicopathologic characteristics, treatments and prognosis of retinoblastoma, the most common intraocular tumor in children, were studied retrospectively in 101 cases(128eyes) who visited our clinic from 1987 to 1996. All patients were followed for 2 years or longer. Twenty seven cases were bilateral and seventy four cases were unilateral,. Eihgty four eyes were enucleated. Twenty one eyes were successfully treated by conservative modality. The rest refused any type of treatment. Orbital recurrence or distant metastasis were observed in 5 cases after enucleation without systemic treatment, and one died in spite of irradiation and aggressive chemotherapy. It is widely recognized that the prognosis for survival of retinoblastoma patients, especially unilateral, is excellent, however the authors emphasize the importance of careful postoperative histopathologic review and long term periodic follow-up to improve long-term prognosis.