Biomedical subjects
Publications and source records attributed to C A Servodidio.
A patient diagnosed with choroidal melanoma presents the ophthalmic nurse with a unique opportunity to practice one of the most challenging aspects of clinical and psychosocial nursing care. Although choroidal melanoma is a treatable cancer, this tumor has the ability to increase in size, to metastasize, and to cause death.
The interpretation of intraocular masses on magnetic resonance imaging (MRI) scan is not always straightforward. A case presentation of a 92 year old woman who was thought to have a neoplasm is presented.
A case presentation of a ten year old girl diagnosed with acute lymphoblastic leukemia is described. Following her combination chemotherapy regimen with steroids and asparaginase, a most interesting development of hyperlipidemia of the blood plasma and lipemia retinalis was noted.
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Anterior ischemic optic neuropathy (AION) occurs when there is compromised blood supply to the optic nerve and can result in visual loss. Ophthalmic nurses are key health professionals to recognize this entity and triage the patient accordingly. A case study of a patient with non-arteritic AION is presented.
A retrospective chart review of 427 eyes diagnosed with unilateral retinoblastoma was performed to determine which eyes, which patients, and when new intraocular tumours would develop after treatment. Mean follow up was 8.16 years. Twenty five (6%) of 427 unilateral retinoblastoma patients developed new intraocular tumours after treatment. Five (1%) unilateral patients who were previously treated with enucleation developed new tumours (in the fellow eye). Fifteen (24%) unilateral patients who were previously treated with external beam radiation developed new tumours (equally in either eye). New tumours did not develop in the macula of either eye. The relative risk of developing new intraocular tumours after treatment was 16% in patients diagnosed before 1 year old and 2.2% for patients diagnosed after 1 year old (p < 0.001). The mean time to onset for the development of new tumours after treatment was 0.74 years; no new tumours appeared after 7.5 years of age. Those patients who are diagnosed with unilateral retinoblastoma in the first 6 months of life and have a family history of the disease are at greatest risk of developing new intraocular tumours.
Retinoblastoma is the most common primary intraocular tumor in children. Retinoblastoma can be hereditary (familial) or nonhereditary (nonfamilial). Nurses who have an understanding of the genetic patterns for retinoblastoma can participate in the counseling of these patients. A chart is provided as a tool for teaching patients about family patterns of retinoblastoma.
Serial ultrasonic measurements performed on 85 melanoma patients who were treated with radioactive plaques and followed for up to 141 months revealed that no 2 patients had identical patterns of change. Eighty-two of the patients were categorized into one of four patterns after treatment: Type D (decrease in height, 57 patients), Type S (same height, 12 patients), Type I (increase in height, 9 patients), and Type RG (tumour regrowth, 4 patients). The calculated mean total change in tumor height for Type D was 1.92 mm at 6 months, 2.58 mm at 12 months, 2.97 mm at 24 months and 3.61 mm at 48 months. For Type I, the mean total change in tumor height was 0.80 mm at 6 months, 0.95 mm at 12 months, 2.28 mm at 24 months, and 3.0 mm at 48 months.
Children diagnosed with retinoblastoma in the first year of life present with differences in laterality, stage, signs, symptoms, and respond differently to treatments when compared to older children. Of those children diagnosed in the first year of life (between 1958 and 1983 inclusive), 280 were bilateral and 121 were unilateral, the most common stage of diagnosis (for unilateral and bilateral) was Group V, and children were affected equally by sex. Children examined in the first three months of life were more often seen because of a positive family history of retinoblastoma, rather than leukocoria. Children who were treated in the first year of life frequently develop second nonocular tumors because they harbor the germinal mutation and receive radiation.
Based on the nursing literature and my own ophthalmic nursing experience, there appears to be some confusion about how the general public, our colleagues, and physicians view the duties and responsibilities of the profession of nursing. We, as nurses, can serve as advocates for our own profession and educate the public about who we are, how we have achieved our current status and goals, and where we expect to be in the future.
Frequently it is the ophthalmic nurse who obtains the patient's pertinent health history and background information. This case study of a patient diagnosed with an orbital carotid fistula shows how the nursing history helped to solve the patient's diagnosis.
Choroidal melanoma is a rare and deadly cancer. Nursing care for these patients involves ophthalmic clinical expertise as well as psychosocial and emotional support. Although past research has been helpful in determining the prognosis of these patients, it is impossible to predict with certainty which patients have tumors or nevi that will grow, will compromise their vision, or will kill them. Providing emotional support, establishing a good rapport with the patients and their support persons, and encouraging patients to schedule and adhere to their mutually agreed on follow-up appointments are nursing interventions that may save or prolong a patient's life.
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Presenting signs and symptoms of 193 patients with choroidal melanomas (followed for up to 152 months) were recorded using retrospective chart review. Eighty patients (41%) had no symptoms (the melanoma was found during routine ophthalmologic examination in 65 patients and during treatment for other eye problem in 15 patients). We found 113 patients (59%) had symptoms (visual acuity or visual field defects, 77 patients; flashes or floaters, 30 patients; pain, 5 patients, and metastatic disease, 1 patient). The tumor size was related to the presence or absence of symptoms (chi-square, 10.6; P = .005). More tumors that presented with symptoms were medium sized (64%) than large (27%). Men had significantly more symptoms (chi-square, 4.1; P = .04). The right eye was more likely to be involved in patients with symptoms (chi-square, 7.3; P = .007). Kaplan-Meier survival analysis for age, sex, presence of tumor or retinal detachment in the macula, tumor location, presence of symptoms, laterality, and tumor size showed that only tumor size was related to a difference in incidence of metastasis (log-rank chi-square, 12.9; P = .002). With increased tumor height, the probability of developing metastasis was greater.
A retrospective analysis of 50 patients with retinoblastoma was undertaken to determine the appearance of intraocular retinoblastoma that had received external beam radiation a minimum of 10 years previously. Of the 91 tumors found in 59 eyes, 76 (84%) continued to be ophthalmoscopically visible after 10 years. The most common ophthalmoscopic appearance was a Type III regression pattern. The type of radiation regression pattern correlated with the pretreatment volume of the tumor. The largest tumors (mean, 10.0 disc diameter [dd]) became Type I regression patterns, whereas the smallest tumors (mean, 1.0 dd) completely disappeared. This represents the first long-term follow-up of the intraocular status of radiated retinoblastoma.
Patients who are diagnosed with choroidal melanoma are frequently devastated and overwhelmed. Simple and creative teaching aids including photographs, visual fields, eye models with clay tumors, actual prostheses, business cards, post-operative teaching sheets, and an example of a support book are discussed as methods to assist in patient teaching.
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