External beam radiation for localized periocular amyloidosis: a case series.

Purpose: To evaluate the effectiveness of low dose external beam radiation therapy to halt progression of localized periocular light chain (AL) amyloidosis, a clonal plasma cell disorder. Methods: This is a retrospective review of patients referred to a tertiary care center for external beam radiation treatment of biopsy proven localized periocular light chain amyloidosis. The primary outcome measure was clinical disease stability at one year following radiation therapy as evidenced by slit lamp exam and external photography. Pre and post radiation MRI imaging of the affected area were also used as a means to monitor disease progression. Results: Four symptomatic patients with localized periocular AL amyloidosis received external beam radiation therapy ranging from 20-30 Gy fractioned over 10-20 fractions. Three of the four patients had prior surgical debulking with or without ptosis repair. Amyloid deposition did not progress in any patient at one year. Further follow-up of two patients revealed amyloid progression at two years post radiation. Conclusions: External beam radiation therapy for localized periocular AL amyloidosis demonstrated efficacy at halting disease progression at one year; however, the long-term efficacy is unknown. Monitoring of periocular amyloid is best achieved with slit lamp exam and external photography as opposed to MRI.

[Radiowave surgery for epibulbar tumor and nontumor masses].

The paper analyzes the results of removal of epibulbar tumor and nontumor masses, by using the radiowave surgical technique. The authors used two basic modes: fulguration and completely rectified and/ or completely filtered wave. Postoperative healing was aseptic and areactive. The duration of reparation depended on the working conditions, the volume of excised tissues, and the individual pattern of reparative processes. No intraoperative and postoperative complications were found. There were no cases of relapses and on-going growth during 9-12-month follow-ups. The authors have concluded that a radiowave knife may be used in surgery for epibulbar tumor and nontumor masses.

[Recurrent pterygium over 15 years: epibulbar cartilaginous findings]. / Rezidivierendes "Pterygium" über 15 Jahre: epibulbärer knorpelhaltiger Befund.

BACKGROUND: Epibulbar and extraocular cartilage bearing tumors in adults are extremely rare. PATIENT: A nasally located pterygium in a 24-year-old patient was excised and recurred over the ensuing 15 years six times requiring local excisions, and each time a histological diagnosis of pterygium was made. Only a curative excision including a biopsy of the insertion of the m. rectus medialis and a sclerokeratoplasty revealed the tumor to bear cartilage histologically in an unusual place. A Ruthenium-106 brachytherapy was followed by a triple procedure for visual rehabilitation, and no further recurrences were observed. CONCLUSION: The differential diagnosis of a cartilaginous tumor most likely a choristoma growing in an unusual localisation should be considered in adults suffering from recurrent pterygia without known physical risk factors, and a curative excision be performed. Further treatment options depend on the appearance of the tumor.

Acute lymphoblastic leukemia manifesting in an adult as a conjunctival mass.

PURPOSE: To describe the clinical manifestation and course of disseminated acute lymphoblastic leukemia in an adult. METHODS: Case report. Recurrence of disseminated disease was heralded by "salmon patch" involvement of the conjunctiva. The ocular tumor was treated successfully with external beam radiotherapy. RESULTS: The patient, who had a history of T-cell acute lymphoblastic leukemia, had recurrent disease involving the left eye conjunctiva. The diagnosis was confirmed by histopathologic analysis. CONCLUSIONS: Although acute lymphoblastic leukemia typically occurs in children, the tumor can masquerade as a conjunctival lymphoma in adults.

Graves ophthalmopathy: MR evaluation of 10-Gy versus 24-Gy irradiation combined with systemic corticosteroids.

PURPOSE: To establish the most effective radiation dose for treatment of Graves ophthalmopathy (GO). MATERIALS AND METHODS: A combination of 10 Gy (n = 15) or 24 Gy (n = 16) of radiation and corticosteroids was used to treat 31 patients with GO. Magnetic resonance (MR) images obtained before treatment showed swollen extraocular muscles with prolonged T2 relaxation times in all patients. RESULTS: Before therapy, T2 relaxation time of extraocular muscle was 79.6 msec (95% confidence interval, 76.3, 82.9) in the 24-Gy group and 77.4 msec (95% confidence interval, 74.6, 80.1) in the 10-Gy group (P = .32). After therapy, T2 relaxation time was 62.8 msec (95% confidence interval, 61.2, 64.4) in the 24-Gy group and 68.9 msec (95% confidence interval, 66.8, 71.1) in the 10-Gy group. In the 24-Gy group, there was a significant decrease in T2 relaxation times (P = .001) and clinical response to initial treatment was better. At 1- and 3-month follow-up, the resistance rate was lower in the 24-Gy group. CONCLUSION: In treatment of GO, 24 Gy of radiation is a more effective dose than 10 Gy when combined with systemic corticosteroids.

Radiation therapy in amyloidosis of the eyelid and conjunctiva: a case report.

Many questions about amyloidosis are still unanswered. Etiology and pathogenesis remain unclear. Diagnosis is difficult to prove without a biopsy. Several approaches have been tried, but no effective cure has been documented. Russian authors report the use of cobalt therapy for a patient with local laryngeal amyloidosis. This paper presents a case report of a patient with local amyloidosis of the conjunctiva. Superficial radiation therapy was used, and resulted in some shrinkage of the lesions. Surgical excision was later utilized to remove the remaining amyloid deposits.