Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial.

OBJECTIVE: To determine the efficacy and safety of periocular triamcinolone acetonide (40 mg) for the prevention of macular edema in patients undergoing plaque radiotherapy for uveal melanoma. DESIGN: Prospective, randomized, controlled clinical trial. PARTICIPANTS AND CONTROLS: One-hundred sixty-three patients with newly diagnosed uveal melanoma undergoing iodine 125 plaque radiotherapy were entered into the study. Fifty-five patients were randomized to the control group and 108 to the triamcinolone group. Eighteen-month data were available for 143 (88%) of the 163 patients. INTERVENTION: Periocular injection of triamcinolone acetonide (40 mg in 1 ml) at the time of plaque radiotherapy and 4 months and 8 months later. Optical coherence tomography was performed at each patient evaluation. MAIN OUTCOME MEASURES: Optical coherence tomography-evident macular edema, moderate vision loss, and poor final visual acuity. RESULTS: Optical coherence tomography-evident macular edema occurred significantly less often in the triamcinolone group compared with the control group up to 18 months after plaque radiotherapy (hazard estimate, 0.45; 95% confidence interval, 0.19-0.70; P = 0.001). At the 18-month follow-up, moderate vision loss (loss of 3 lines or more of best-corrected visual acuity [BCVA]) and severe vision loss (BCVA <5/200 Snellen) occurred significantly less frequently in the triamcinolone group than in the control group (31% vs. 48% [P = 0.039] and 5% vs. 15% [P = 0.048], respectively). Rates of elevated intraocular pressure and cataract progression were similar in both groups. CONCLUSIONS: Periocular triamcinolone is beneficial in reducing the risk of macular edema up to 18 months after plaque radiotherapy for uveal melanoma and significantly reduces the risk of moderate vision loss and poor visual acuity in these patients.

Peripheral exudative hemorrhagic chorioretinopathy simulating choroidal melanoma in 173 eyes.

PURPOSE: To evaluate the clinical features and outcomes of eyes with peripheral exudative hemorrhagic chorioretinopathy (PEHCR) simulating choroidal melanoma. DESIGN: Noncomparative case series. PARTICIPANTS: A total of 173 eyes in 146 patients. METHODS: Retrospective chart review. MAIN OUTCOME MEASURES: Clinical features and outcome. RESULTS: All cases were referred for possible choroidal melanoma. The mean patient age was 80 years, 145 (99%) were Caucasian, and 98 (67%) were female. The main lesion had a mean diameter of 10 mm and mean thickness of 3 mm. The lesion was located temporally in 103 eyes (77%), involved 1 or 2 quadrants in 123 eyes (92%), and was located between the equator and the ora serrata in 119 eyes (89%). Features included subretinal hemorrhage in 134 eyes (78%), retinal exudation in 37 eyes (21%), retinal pigment epithelial (RPE) detachment in 48 eyes (28%), and sub-RPE hemorrhage in 45 eyes (26%). Peripheral RPE alterations or drusen were found in 120 ipsilateral eyes (69%) and 73 contralateral eyes (42%). Macular RPE alterations, drusen, or choroidal neovascularization was found in 83 ipsilateral eyes (48%) and 97 contralateral eyes (56%). After observation (mean 15 months), lesion regression or stability was found in 80 eyes (89%) and progression was found in 10 eyes (11%). CONCLUSIONS: PEHCR is a hemorrhagic retinal degenerative process that simulates choroidal melanoma.

Globe salvage using chemoreduction for advanced retinoblastoma in a glaucomatous eye with buphthalmos.

PURPOSE: To report globe salvage using chemoreduction (CRD) for advanced retinoblastoma in a glaucomatous eye with buphthalmos. METHODS: Case report. RESULTS: A 7-month-old girl presented with epiphora and buphthalmos in the right eye. She was found to have bilateral retinoblastoma. Classified as group E, the right eye exhibited a total retinal detachment and buphthalmos from secondary glaucoma. The left eye was classified as group B. Systemic workup revealed no metastatic disease. CRD was employed with future planned enucleation of the right eye. After six cycles of CRD and focal consolidating treatments, complete regression of retinoblastoma in both eyes was achieved. The right eye showed complete resolution of the retinal detachment and no active tumor or seeds at 18 months follow-up, allowing for salvage of the eye. CONCLUSION: In this child with secondary glaucoma and buphthalmos from retinoblastoma, CRD provided complete tumor control and globe salvage.

Intravitreal bevacizumab (avastin) and ranibizumab (lucentis) for choroidal neovascularization overlying choroidal osteoma.

PURPOSE: To report the effect of anti-vascular endothelial growth factor (VEGF) therapy for choroidal neovascularization overlying choroidal osteoma. METHOD: In an interventional case report, intravitreal anti-VEGF therapy was used for tumor-related choroidal neovascularization. RESULTS: A 34-year-old woman with bilateral choroidal osteoma had a decrease in visual acuity in the right eye from 20/30 to 20/100. Ophthalmoscopy revealed partially decalcified circumpapillary, macular choroidal osteoma with overlying subretinal hemorrhage and choroidal neovascular membrane. Intravitreal bevacizumab (Avastin; Genentech, Inc., South San Francisco, CA) resulted in membrane regression and visual acuity improvement to 20/50 at 6 weeks. Further therapy with intravitreal ranibizumab (Lucentis; Genentech, Inc.) resolved persistent subretinal fluid, and visual acuity improved to 20/30 at the 6-month follow-up. CONCLUSIONS: Therapy with intravitreal anti-VEGF medications might be an alternative for patients with choroidal neovascularization overlying choroidal osteoma.

Endolymphatic sac tumor as initial manifestation of von hippel-lindau syndrome.

PURPOSE: To report endolymphatic sac tumor (ELST) as the initial finding in von Hippel-Lindau (VHL) syndrome. METHODS: Case report. RESULTS: A 4-year-old boy presented in February 2001 with right hearing loss and seventh nerve palsy from ELST. Genetic analysis showed a VHL mutation (gene 3p25-26). Systemic and ocular examination for VHL syndrome-related tumors was unrevealing. Four years later, multiple retinal hemangioblastoma (retinal capillary hemangioma) were detected in both eyes and successfully treated with argon laser photocoagulation. CONCLUSION: ELSTs can be the initial manifestation of VHL syndrome. Lifelong screening for related tumors, particularly retinal hemangioblastoma, is advised.