Prefoveal adherent heavy silicone oil following vitrectomy: Incidence, clinical features and risk factors.

PURPOSE: To study the optical coherence tomography (OCT) and clinical features of all patients presenting with prefoveal 'sticky' heavy silicone oil (HSO) following vitreoretinal surgery and subsequent oil removal. METHODS: A retrospective review of all consecutive patients who underwent vitreoretinal surgery with HSO tamponade over 12 years. All OCT scans were reviewed following HSO removal to determine features consistent with residual prefoveal oil deposits. A detailed analysis was performed to investigate potential clinical features and possible associations.Results: Seven cases of prefoveal HSO (pfHSO) were identified from a total of 51 consecutive cases (13.7%). All cases of pfHSO had a tamponade duration exceeding 3 months. The mean tamponade duration in the pfHSO group was 7.8 (3.5-21) months compared to 4.6 (1-9) months in the unaffected group. The use of mixed HSO compared to HSO increases the risk of pfHSO changes (p = 0.024). CONCLUSION: In summary, 7 novel cases of sticky prefoveal HSO remnants with variable OCT dimensions were identified which could have an impact on the visual prognosis. Removal of pfHSO is extremely challenging and may not always be possible. There were no pfHSO patients identified below 3 months of tamponade duration.

OPTICAL COHERENCE TOMOGRAPHIC PATTERNS OF POSTERIOR SEGMENT STICKY HEAVY SILICONE OIL.

PURPOSE: To describe unique optical coherence tomography observations of adherent preretinal heavy silicone oil after removal. METHODS: Retrospective observational review of files and optical coherence tomography scans of patients who had pars plana vitrectomy with heavy silicone oil. We investigated the possible precipitating preoperative and intraoperative factors and the association with postoperative epiretinal membrane and cystoid macular edema. RESULTS: Forty-one eyes from 39 patients were involved. Two characteristic sticky silicone oil structures were identified in 33 patients (80%): variably reflective macrodroplets (bubbles) and hyperreflective microdroplets (dots). The main contributing variable was the tamponade duration. Other notable associations included postoperative epiretinal membrane and cystoid macular edema formation. Surgical interventions including heavy liquid did not show a strong predilection to their development. We reported two novel findings of sticky prefoveal macrodroplets in five patients and intravitreal macrodroplets and microdroplets casting shadows on the underlying retina in four patients. CONCLUSION: This study confirms previously reported optical coherence tomography observations of sticky emulsified silicone oil remnants after removal. This is the first report of two distinctly different optical coherence tomography appearances after heavy silicone oil removal. The variability in size and reflectivity may be attributed to the amount and nature of the induced inflammatory reaction.

Anterior "beaded" emulsification as a late complication of heavy silicone oil in retina surgery.

We report 2 cases of emulsified silicone oil with a "beaded" appearance adherent to the posterior capsule as a long-term complication of heavy silicone oil tamponade in retina surgery. One case demonstrated mobile beaded opacity that has not been described in the literature previously. This heavy silicone oil complication might cause symptoms similar to posterior capsular opacity. Nd:YAG posterior capsulotomy can be considered as a treatment.

Characteristics, management, and outcome of patients with uveal melanoma treated by Iodine-125 radioactive plaque therapy in a single tertiary cancer center in Jordan.

OBJECTIVE: To evaluate King Hussein Cancer Center experience in using Iodine-125 COMS radioactive plaque for treatment of Uveal Melanoma in Jordan. METHODS: Retrospective case series of eyes with uveal melanoma treated by Iodine-125 COMS radioactive plaque therapy. Data collection required access to medical, radiology, Labs and pathology reports. Main outcomes studied includes: Demographics, tumor features, eye salvage, visual outcome, metastasis, and mortality. RESULTS: Between September 2008 and March 2015, 28 eyes for 28 patients had intraocular uveal melanoma and treated by Iodine-125 radioactive plaque therapy. The mean age at diagnosis was 48 years and 16(57%) were males. The mean tumor thickness was 8 mm (range: 4-13 mm), and 27(96%) patients had medium or large size tumor. The radioactive plaques used had a median size of 16 mm (range: 12-20 mm). The mean apical dose was 83.5 Gy (range 81-87 Gy), and the median radiation rate was 7.25 (range: 4.5-13). At median follow up of 2 years (range 0.5-7 years), eye salvage rate was 93%. Four (15%) patients had distance metastasis, and 3(11%) were dead. Fifty percent of patient had visual acuity better than 20/200 at the last date of follow up. CONCLUSION: Our preliminary results are encouraging and are comparable to another countries worldwide. The use of Iodine-125 COMs plaque therapy at the inspection of implementation of plaque therapy in the developing countries can lead to eye salvage in more than 90% of cases, and reserves functional vision in more than 50% of cases.

Management and Outcome of Uveal Melanoma in a Single Tertiary Cancer Center in Jordan.

OBJECTIVE: The aim of this study was evaluate the features and outcome of management of uveal melanoma in King Hussein Cancer Center as an example of a referral tertiary cancer center in the Middle East. MATERIAL AND METHOD: This was aetrospective, observational case series of 46 eyes of 46 patients with uveal melanoma. Data collection required access to medical records, radiology and pathology reports, and laboratory results. The main outcome measures included age at diagnosis, tumor location and dimensions, TNM stage, treatment modality, visual outcome, metastasis, and mortality. RESULTS: There was slight female preference, and the median age at diagnosis was 45 years. Eighteen (39%) eyes were treated by primary enucleation, and 28 (61%) eyes were treated by I-125 radioactive plaque. The melanoma was in the choroid in 40 (87%) eyes and in the ciliary body in 6 (13%) eyes, with no single tumor in the iris. According to the 7th edition of the American Joint Committee on Cancer staging system (UICC/AJCC); 8 (17%) were T1, 17 (36%) were T2, 16 (35%) were T3, and 5 (11%) were T4. One (2%) patient showed lymph node metastasis (N1), and 6 (13%) patients showed distant metastasis (M1). Pathologically, 2 (10%) of the enucleated eyes were spindle cell type, 4 (20%) were epithelioid cell type, and 14 (70%) were mixed type. Extrascleral extension was seen in three (15%) eyes, and optic nerve invasion in two (10%) eyes. After brachytherapy, 26 (93%) eyes were salvaged, and 2 eyes were consecutively enucleated; one for tumor recurrence, and one for uncontrolled painful neovascular glaucoma. The eye salvage rate post plaque was 93% (26/28), and the visual acuity for the salvaged eyes was equal or better than 0.5 in 11 (42%) eyes, 0.1-0.4 in 5 (19%) eyes, and less than 0.1 in 10 (38%) eyes. CONCLUSION: The incidence of uveal melanomas in our region is low compared to that in the West with a younger age at presentation. Candidate tumors for radioactive plaque therapy were successfully controlled in 93% of cases.