[Transpupillary thermotherapy in exudative age-related macular degeneration]. / Przezzrenicza termoterapia w leczeniu wysiekowej postaci zwyrodnienia plamki zwiazanego z wiekiem.

PURPOSE: Assessment of TTT results in patients with exudative age-related macular degeneration. MATERIAL AND METHODS: The study comprised of 65 patients (73 eyes), in age 50-84 years (average age-75 yrs). The diagnosis of exudative AMD was established on the basis of fundus examination and fluorescein angiography (FA) and in some cases on indocyanine green angiography. The baseline visual acuity (VA) ranged from counting fingers at 50 cm to 0.8. In 31 (42.5%) eyes occult CNV, in 11 (15%) minimally classic CNV and in 31 (42.5%) eyes predominantly classic CNV were observed. Subfoveal CNV was present in 70 (95.9%) eyes and perifoveal in 3 (4.1%). TTT was delivered using a diode laser at 810 nm wavelength, a spot size of 1.2 to 4.5 mm and a duration of 60 seconds for each spot with power settings between 320-800 mW. Follow-up examinations were carried out every 10-12 weeks. In cases with persistent leakage from CNV in late frames of FA a retreatment was performed. The follow-up period ranged from 6 to 28 months (average - 9.8 months). RESULTS: Visual acuity improved in 22 (30.1%) eyes, stabilized in 34 (46.6%) and deteriorated in 17 (23.3%). Fluorescein angiography showed no CNV leakage in 58 (79.5%) eyes. In 56 (71.8%) with regression of leakage in fluorescein angiography improvement or stabilization of visual acuity was detected. Subretinal haemorrhages after TTT were observed in 4 eyes (5.5%). At the end of the follow-up period fibrosis of CNV was detected in 12 eyes (16.4%). CONCLUSIONS: TTT is effective and safe method of treatment of occult and classic CNV in a course of wet AMD. In a majority of cases TTT results in total or partial regression of CNV and stabilization of visual acuity.

[The analysis of I125 brachytherapy complications in cases of uveal melanoma]. / Analiza powiklan brachyterapii 125I w czerniakach naczyniówki.

PURPOSE: Analysis of type and frequency of complications after brachytherapy 1125 between 1-12 months after treatment and during the following controls. MATERIALS AND METHODS: 147 persons (76 men and 71 women) aged 23-86 years (mean 57 years), were treated in our clinic in 1998-2001. In 43% of the cases the thickness of the tumor was more than 8 mm and in 94% the maximum diameter was bigger than 8.1 mm. The irradiation dose was 80-120 Gy, mean 100 Gy. RESULTS: Regression and stabilization of the tumor was achieved in 84.3% of all cases. Complications of different type and intensity associated with brachytherapy I125 were observed in majority of the cases. The complications observed were: radiation retinopathy (52%), radiation maculopathy (33.6%), radiation optic neuropathy (25.3%), vitreous hemorrhage (8.8%), glaucoma (20.5%) and cataract (18.5%). CONCLUSIONS: 125I brachytherapy yields good results in cases of uveal melanoma, however it's associated with post radiation complications.

[Epidemiology of choroidal melanoma in the material of the Department of Ophthalmology CM UJ in Cracow]. / Epidemiologia czerniaka naczyniówki w materiale Kliniki Okulistyki CM UJ w Krakowie.

PURPOSE: Epidemiological analysis of the choroidal melanoma cases-sent from all over the Poland and treated in our clinic between January 1998 and December 2002. MATERIAL AND METHODS: The study included 687 patients with choroidal melanoma 348 women and 339 men. RESULTS: The age of patients was 14-97 years (mean 56 years). The most numerous group consisted of patients between 60-70 years of age (22.7%). Most of the cases came from the regions of Malopolska, Silesia, Lower-Silesia and Mazovia. The time between first symptoms and the first visit in our clinic was between 1 week to 2 years. According to the COMS classification we found small melanoma in 13% of cases, medium in 51% and large in 36% of cases. We found the presence of other malignancies besides the choroidal melanoma in 4.3% patients. We analyzed the demography and positive family history of ocular and general malignancies in the patients.

[Use of indocyanine green for photodynamic therapy of choroidal melanoma--preliminary report]. / Zastosowanie zieleni indocyjaninowej w leczeniu fotodynamicznym czerniaka naczyniówki--doniesienie wstepne.

PURPOSE: To evaluate the usefulness of indocyanine green (ICG) in the photodynamic therapy (iPDT) of choroidal melanoma. MATERIAL AND METHODS: Thirty eight patients with choroidal melanoma were treated with iPDT. Tumor thickness ranged from 2.6 to 4.1 mm in ultrasonography. Before iPDT Ruthenium-106 plaques were used in 18 cases, in 6 cases with additional transpupillary thermotherapy ("sandwich method"), and Iodine-125 plaques in 3 cases. In 11 eyes the iPDT was the only performed treatment. Therapy was performed with 810 nm diode laser after intravenous injection of 25 mg solution of indocyanine green. Six months after iPDT ophthalmological examination was performed with ultrasonography and ICGA images evaluation. RESULTS: The baseline ICG study showed pathological intrinsic vasculature in all examined cases. Six months after iPDT changes in microcirculation, as well as significant decrease of tumors thickness in ultrasonography (mean 38%), were detected in all cases. Complete regression of intrinsic vessels was demonstrated by ICGA in 26 cases, and partial regression of pathological vascularization was found in 12 patients. CONCLUSIONS: Our preliminary study suggests, that ICG mediated iPDT can be a new and promising way, to treat choroidal melanoma.

[Photodynamic therapy with indocyanine green for choroidal neovascularization caused by age-related macular degeneration--a preliminary record]. / Zastosowanie zieleni indocyjaninowej w leczeniu fotodynamicznym neowaskularyzacji podsiatkówkowej w przebiegu zwyrodnienia plamki zwiazanego z wiekiem--doniesienie wstepne.

PURPOSE: To evaluate the usefulness of indocyanine green in the photodynamic therapy (iPDT) of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). MATERIAL AND METHODS: Twelve patients with choroidal neovascularization secondary to AMD were treated with iPDT. Therapy was performed with 810 nm diode laser after intravenous injection of 25 mg solution of indocyanine green. Within 3 months follow-up two visits were performed with ICGA images evaluation, at each control. RESULTS: After therapy complete regression of the CNV was demonstrated by ICGA in 3 cases, partial regression was found in 5 patients, 3 revealed no changes and in one case the progression of the CNV was noted in spite of the treatment. Six patients presented increase in visual acuity, in 5 no changes were observed, and in one case a 2-line decrease in VA was detected by 3 months of follow-up. CONCLUSIONS: Our preliminary study suggests that ICG mediated PDT can be a new and promising way, to treat neovascular AMD.

Indocyanine green angiography in the diagnosis of small choroidal tumours.

OBJECTIVE: To evaluate indocyanine green (ICG) angiography in the diagnosis of small choroidal tumours. METHODS: We studied 40 patients with small choroidal tumours, 22 males and 18 females. The tumour thickness on ultrasonography ranged from 2.2 to 4.3 mm. RESULTS: Nineteen pigmented tumours showed early and late diffuse hypofluorescence, consistent with naevi. Eight non-pigmented tumours showed normal choroidal vessels in calibre, configuration, and branching, typical of non-pigmented naevi. The early frame of ICG angiography showed in 13 cases pathological, intrinsic vascularization, suggestive of melanomas. CONCLUSION: This preliminary study suggests that ICG angiography may be helpful in differentiating choroidal naevi from small melanomas.

Expression of p16 in sporadic primary uveal melanoma.

Expression of p16 protein, intragenic mutations of CDKN2A and hypermethylation of CDKN2A promoter region in 41 sporadic primary uveal melanomas were studied. There were 2 cases of spindle cell B histological type, 11 of A + B and 28 of mixed type. All melanomas infiltrated sclera but in 28 cases infiltration was superficial while in 13 profound. In 7 cases the tumor infiltrated the optic nerve. Expression of p16 was studied by immunohistochemistry and recorded by assessment of the proportion of positive tumor cells and staining intensity. Results were expressed as staining index (IRS). Intragenic mutations were studied by PCR-SSCP followed by sequencing, while hypermethylation of the promoter region by CpG methylation assay. In 15% of cases less than 10% of melanoma cells were p16 positive, in 70% of cases less than 50% of cells, while in 7% more than 80% of cells stained for p16 (mean IRS for all cases was 4.87 +/- 2.43). In B type the IRS was 8.5 +/- 0.7, in A + B type 6.0 +/- 2.1 and in the mixed type 4.17 +/- 2.43 (differences statistically significant). In melanomas profoundly infiltrating sclera mean IRS was 4.16, while in those infiltrating optic nerve 3.71 (statistically not significant). Analysis of the intragenic mutations revealed in two patients a GAC/GAT substitution in codon 84--a silent mutation. No hypermethylation of the CpG island of the p16 promoter region was found. In conclusion, we found that the degree of p16 expression is related to the histological type of tumor but not to the histological indicators of tumor invasiveness and that intragenic mutations and promoter hypermethylation are not major mechanisms of p16 inactivation in sporadic uveal melanoma.

[Retinopathy of prematurity: risk factors analysis]. / Analiza czynników ryzyka wystepowania retinopatii wczesniaków.

PURPOSE: The study aimed at evaluating potential risk factors of retinopathy of prematurity (ROP). MATERIAL AND METHODS: Two-hundred and thirty-one premature infants were divided into 3 groups, according to the stage of ROP: group A consisted of 68 infants who underwent cryotherapy for severe ROP, group B of 45 with ROP regressed spontaneously, and group C of 118 premature infants without ROP. Risk factors were identified based on the medical records of the infants and interview with mothers. Data were subjected to statistical analyses using logistic regression model. RESULTS: The analysis identified four main risk factors of ROP: birth weight, gestational age, Apgar score at one minute, and time of oxygen exposure. The probability of qualifying an infant to group A is the highest for those with gestational age less than 28 weeks, birth weights below 1000 g, and Apgar score up to 3 points. The infants with gestational age over 31 weeks, birth weight over 1500 g, and Apgar score higher than 6 points were included in group C. In case of oxygen therapy over 25 days, the infants are highly probable to be included into group A. However, in case of the oxygen therapy les than 5 days, infants can be assigned to group C. CONCLUSIONS: The evaluation of the role of the individual risk factors can be helpful in identifying neonates at high risk of ROP, and including them in the early and systematic ophthalmological care.

The level of total sialic acid, alfa-antitrypsin, ceruloplasmin in the serum of patients with choroidal melanoma.

Melanoma of the choroid is a fatal disease because of its metastases. The quest is ongoing for more reliable serum markers for detecting and staging ocular melanoma. Total serum sialic acid and acute phase proteins are valuable adjuncts in the management of malignancies, including melanoma. The aim of the paper was to asses the level of total sialic acid (TSA), total sialic acid to total protein (TP) ratio (TSA/TP) and the level of alfa-antitrypsin (AAT) and ceruloplasmin (CER) in patients with choroidal melanoma. The concentrations of TSA, TP, AAT and CER were evaluated in 61 patients with choroidal melanoma and 84 healthy controls. 36 patients had larger tumors and 25 patients had smaller melanomas. 36 patients were treated with brachytherapy. The mean concentration of TSA in all intraocular melanoma patients was 84.86 +/- 19.37 mg/dl and was significantly higher than in control group 53.63 +/- 8.47 mg/dl (p < 0.001). TSA level was significantly higher in patients with large tumors than in those with smaller choroidal melanomas. There were not differences between groups of patients treated with brachy-therapy and those not treated. TSA/TP in melanoma patients was 11.88 +/- 2.97 and it was higher than in control group 7.32 +/- 1.21 (p < 0.001). AAT level was 236.56 +/- 141.53 mg/dl in the group of melanoma patients and in the control group was 226.42 +/- 46.74 mg/dl but the differences were not statistically significant. The concentration of CER in the study group was 28.25 +/- 11.01 mg/dl and in the control group it was 29.56 + 6.33 mg/dl but the differences were not statistically significant. The assessment of TSA in blood serum may be useful in evaluation of patients with choroidal melanoma.