Clinical evaluation of a paper chart for predicting ruthenium plaque placement in relation to choroidal melanoma.

PurposeTo determine the accuracy of estimated tumour location and required plaque position using fundus diagrams, and to evaluate their applicability in daily clinical practice.Patients and methodsBetween September 2013 and March 2016, all patients treated with ruthenium plaque brachytherapy for choroidal melanoma at the Department of Ophthalmology in Poznan underwent pretreatment planning with the use of printed or electronic fundus diagrams www.oculonco.comThe estimated distances were then verified intraoperatively.ResultsThere were 40 eyes of 40 patients: 15 men, 25 women, with a median age of 61 years (range: 21-88). The median longitudinal basal diameter (LBD) of the treated melanomas was 10.4 mm (range: 6.5-14.9) and the median thickness was 4.1 mm (range: 1.9-6). The final postition of the anterior tumour margin was within 1 mm of the estimated location in 39 cases (97 %), and within 2 mm in 1 case (3 %). Median follow-up was 15 months (range: 3-36). By the close of the study, there was one local tumour recurrence (3%) and one patient died of unrelated cause 1 year after treatment. No patient developed metastases by study close.ConclusionsThe plaque planning system using the paper fundus diagrams proved to be accurate, easily applicable and should aid plaque placement where computer modelling is not possible.

Additional cell damage after transpupillary thermotherapy in choroidal malignant melanoma.

The aim of this study was to evaluate the effectiveness of transpupillary thermotherapy (TTT) in generating tumour necrosis by light and electron microscopy, as well as to evaluate additional cell damage in the area directly adherent to the necrotic zone. Four eyes of four patients diagnosed with intraocular malignant melanoma of the uvea were treated experimentally with diode laser TTT. In all cases a standard technique was used. All eyes were enucleated: one eye the day after TTT, two eyes 2 days after TTT, and one eye 6 weeks after TTT. Immediately after enucleation the eyes were immersed in standard Karnovsky's fixative with cocodylate buffer and prepared for light and electron microscopy. In the treated area of all four melanomas we found a dense band of necrotic tissue (zone A) consisting of an amorphous mass of dead cells sharply demarcated from the rest of the neoplastic tissue. Next to this zone was a more eosinophilic and also sharply demarcated band (zone B) that consisted of similar but less intensive changes. In the next band (zone C), marked injury to the cellular membrane and subcellular structures were seen on electron microscopy. The next band (zone D) consisted of changes mainly observed only within the cytoplasm of neoplastic cells and significantly less intensive than those in zone C. Outside zone D tumour cells that were normal in appearance were seen. No scleral alterations induced by heat were found. We concluded that after TTT the cytotoxic effect gradually decreases in proportion to the distance from the central point of the diode laser spot, with additional cell damage in the area adjacent to the necrotic zone. The interval between TTT and enucleation had no influence on the histological results.

[Trans-scleral resection of choroidal malignant melanoma]. / Przeztwardówkowe wyciecie zlosliwego czerniaka naczyniówki.

PURPOSE OF THE STUDY: Case presentation of local transscleral resection of choroidal malignant melanoma. MATERIAL AND METHODS: A 45-year-old woman with enormous choroidal tumor not suitable for treatment with ruthenium plaque. Methods--microsurgical, local transscleral tumor resection with subsequent ruthenium plaque application performed in general hypotension. RESULTS: Non complicated tumor resection proved the possibility of eye preservation with final distant vision 0.5 and close vision 1.0/30.

[Use of diode laser in the treatment of intraocular tumors: preliminary report]. / Wykorzystanie lasera diodowego w leczeniu guzów wewnatrzgalkowych--doniesienie wstepne.

PURPOSE OF THE STUDY: The purpose of the study was to evaluate the effectiveness of diode laser transpupillary thermotherapy and to determine in what extent it may act as the only method of therapy of choroidal tumors, and when it should be used in combination with other methods. The study has preliminary character. PATIENTS: 15 eyes of 14 patients aged 38 to 82 years (mean--57 years) were treated because of intraocular tumor with the use of diode laser transpupillar thermotherapy in 13 patients primary intraocular tumor was diagnosed, and in 1 patient there was metastasis; in 13 cases tumors were localized unilaterally, whereas in 1 case they appeared in both eyes. The follow-up period (from the start of the treatment) ranged from 1 to 3 months. METHODS: All patients were treated with transpupillary thermotherapy (TTT) with the use of diode laser OcuLight SLx, IRIS Medical instruments, Inc. The power and size of the laser spots depended on the tumor size and pigmentation. Mean power used for the treatment was 600 mW, while mean exposure time was 1 minute. RESULTS: Altogether, within 15 treated eyes in 8 cases regression, in 6--stabilization and in 1--progression was stated. As to complications and side effects, visual field scotomas in the treated area as well as deterioration of visual acuity were found during the treatment. In 2 cases a slight improvement of visual acuity was found. CONCLUSIONS: In selected cases transpupillary thermotherapy (TTT) can be effective especially in regard to small tumors (height up to 4.5 mm). Probably in the future it will be the only method of treatment. Treatment of larger tumors (height more than 4.5 mm) should be connected with the use of ruthenium plaque (106Ru). All complications and side effects found in the course of treatment were not dangerous to the eye (small hemorrhage) and were relatively easily tolerated by the patients. With longer follow-up of greater group of patients probably it will be possible to establish optimal parameters, advantages and possible other complications of such therapy.

[Advantages and disadvantages of periocular analgesia]. / Zalety i wady znieczulenia okologalkowego.

PURPOSE: To evaluate the advantages of local analgesia in the form of posterior periocular blockade in comparison with retrobulbar blockade, used till now. METHODS: During last 5 months 277 operations were performed in local analgesia, including 225 periocular and 52 retrobulbar. RESULTS: Periocular analgesia is sufficient in cataract and antiglaucomatous surgery. The following complications were observed: palpebral haematoma, subconjunctival infiltration and transient visual loss. CONCLUSION: In comparison with retrobulbar periocular technique of analgesia is less painful, easier to perform and safer in terms of perforation of the eyeball. Yet its inconvenience is that it must be done about 20 minutes before the surgery, connected with the delay effect of Bupivacaine.

[Optic disc drusen--clinical picture and diagnostic problems]. / Druzy tarczy nerwu wzrokowego--obraz kliniczny i trudnosci diagnostyczne.

The aim of the paper was to establish the methods which allow to diagnose optic disc drusen and to differentiate them from other diseases with similar clinical picture. 10 patients with diagnosis or suspicion of optic disc drusen were examined. The results suggest that usefulness of ultrasonography, fluorescein angiography and static perimetry.

[Ultrasonographic image of retinal detachment with proliferative changes (PVR) in B scan]. / Obraz ultrasonograficzny odwarstwienia siatkówki ze zmianami proliferacyjnymi (PVR) w projekcji B.

In 1992, 20 eyes with retinal detachment and PVR D1-D3 were treated. In 18 of them ultrasonography was performed mainly in the eyes with opaque media. Based on selected examples, the authors indicate the usefulness of B-scan ultrasonography in diagnosis of advanced stages of PVR.

[Selected cases of metastatic tumors to the visual system]. / Wybrane przypadki przerzutów nowotworowych do narzadu wzroku.

Metastases are always bad prognostic symptoms. They occur rather rarely, but may involve each element of visual system uni- or bilaterally. Usually we found these metastatic tumors in patients with earlier diagnosed neoplastic disease, in various tissues and organs. Therefore, in majority of cases treatment is only palliative, especially in those with the only eye or when the process is bilateral.

[Results of prevention of retinal detachment by using photocoagulation]. / Wyniki profilaktyki odwarstwienia siatkówki przy pomocy fotokoagulacji.

Prophylactic retinal photocoagulation (in order to prevent the retinal detachment) was performed in the Ophthalmological Department of Medical School in Poznan in the period 1980-1984 and 1987-1988 in 114 eyes, in the Ophthalmological Department in Halle in the period 1982-1983 in 160 eyes. Qualified for coagulation were following changes: holes in the upper quadrants, tears, lattice-like degeneration and vitreoretinal adhesions in the fellow-eye, in high myopia, in aphakia, in cases with subjective symptoms (flashes) or in cases with suspected family history (familial incidence of retinal detachment). In our material the percentage of retinal detachment in the fellow-eye amounted 3.5 p.c. In the Poznan Department in spite of performed prophylactic intervention retinal detachment occurred in 3 eyes, in Halle in 7.

[Bilateral cysts of the vitreous body]. / Obustronna torbiel w ciele szklistym.

A bilateral cyst of the vitreous was diagnosed in a woman-patient, aged 61 with high myopia. The cyst was probably of degenerative etiology. Because of a very rare incidence of vitreous cysts which is connected with diagnostic difficulties the authors present this case in detail.