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Biomedical subjects

C L Shields

Publications and source records attributed to C L Shields.

430 records · Page 24Linked to original sources
PubMedDate not supplied

Recent developments in the management of retinoblastoma.

The management of retinoblastoma has gradually changed over the past few decades. There is a trend away from enucleation and external beam radiotherapy toward focal conservative treatments. This is primarily because of earlier detection of the disease and more focused treatment modalities. Enucleation is still employed for retinoblastoma that fills most of the eye, especially when there is a concern for tumor invasion into the optic nerve or choroid. After enucleation, an integrated orbital implant, provides improved motility and appearance of the prosthesis. External beam radiotherapy continues to be an important method of treating less advanced retinoblastoma, especially when there is diffuse vitreous or subretinal seeding. Plaque radiotherapy is useful for controlling small- to medium-sized retinoblastomas, even those with focal vitreous seeds. Tumors that recur after failure of other methods are often suitable for plaque treatment. When plaque radiotherapy is employed in a child receiving chemotherapy, eventual radiation retinopathy can occur. Cryotherapy and photocoagulation provide excellent control of selected small tumors. Advanced laser delivery systems, particularly those that have been adapted to the indirect ophthalmoscope, have facilitated the visualization for treatment of tumors. Thermotherapy is the newest focal method for retinoblastoma. When combined with chemotherapy, thermotherapy provides satisfactory tumor control, leaving the child with a reasonably small scar, thus preserving more vision. Chemoreduction, using intravenous or subconjunctival routes, is often employed to reduce initial tumor volume and thus allow for focal treatment to eradicate the residual smaller tumor. Many children with advanced retinoblastoma can be spared external beam radiotherapy and enucleation mostly as a result of chemoreduction and focal methods. Chemoreduction combined with cryotherapy, thermotherapy, and plaque radiotherapy plays an important role in the current management of many children with retinoblastoma.

Antineoplastic Agents↗
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Iris neovascularization in children as a manifestation of underlying medulloepithelioma.

PURPOSE: To report the occurrence of unilateral iris neovascularization in children secondary to medulloepithelioma. METHODS: Presenting features and the clinical course of patients confirmed to have medulloepithelioma were reviewed. RESULTS: Seven patients with medulloepithelioma had iris neovascularization during the clinical course. Associated cataract and lens coloboma occurred in two and three cases, respectively. In six (86%) cases, no apparent cause for iris neovascularization could be detected at presentation. Two cases had tube shunts for management of neovascular glaucoma before medulloepithelioma was recognized. All cases eventually required enucleation. CONCLUSION: Presence of iris neovascularization is an early manifestation of medulloepithelioma. Children with iris neovascularization of unknown cause should be evaluated to exclude underlying medulloepithelioma.

Cataract↗
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Surgical excision of selected amblyogenic periorbital capillary hemangiomas.

To report the successful surgical excision of well-circumscribed capillary hemangiomas of the eyelid and orbit inducing occlusion amblyopia in 2 cases with immediate improvement of the patient's symptoms. A 2-month-old girl was diagnosed with a massive, amblyogenic orbital tumor which was removed intact via an inferior transconjunctival orbitotomy after magnetic resonance imaging (MRI) revealed a well-defined mass filling the entire inferior orbit. Histopathologic examination confirmed the diagnosis of orbital capillary hemangioma. A 1-month-old girl developed occlusion amblyopia due to an enlarging subcutaneous tumor of the left upper eyelid. The discrete mass was excised via an eyelid crease approach and confirmed to be an eyelid capillary hemangioma. There were no short-term or long-term complications in either case. In both cases, immediate resolution of occlusion amblyopia and cosmetic disfiguration was achieved. The final visual acuities were 20/20 at 5 years in the first patient and 20/30 at 4 years follow-up in the second patient. Orbital and eyelid capillary hemangiomas can induce profound permanent amblyopia. If the tumor is well-circumscribed, confirmed with orbital imaging, then surgical excision, with immediate resolution of amblyogenic factors, can be considered as a treatment option.

Amblyopia↗
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Iris melanoma.

Explore the source record for details and available documents.

Adult↗
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Analysis of 100 patients with anterolateral rotatory instability of the knee.

Of 100 consecutive patients with anterolateral rotatory instability analyzed, 84 were males and the average age was 27.4 years. Over 50 per cent were injured while participating in athletics and 40 per cent were injured during daily activities. The group averaged 1.2 operations prior to diagnosis. The most frequently performed procedures were medial meniscectomy, pes anserinus transfer and medial capsular reefings. Eighty-four of 100 patients underwent surgery during the study period. Seventy-one had combined rotatory instability and 13 had anterior lateral rotatory instability alone. Sixty-six patients had articular cartilage damage. Before treating the anterolateral rotatory instability, it is necessary to identify and treat other commonly associated abnormalities.

Adolescent↗
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Fine needle aspiration biopsy in pediatric ophthalmic tumors and pseudotumors.

In an eight-year period (1983-1990) approximately 500 fine needle aspiration biopsies (FNABs) of eye lesions were processed in our laboratory. Eighty-one of the cases, obtained from 77 pediatric patients (ranging from 4 weeks to 16 years of age), were the subject of this study. The specimens included 73 intraocular and 8 orbital aspirates. Forty-four of the specimens were from diagnostic procedures, whereas 37 were obtained from surgical specimens immediately after enucleation. Eight FNABs (four diagnostic and four postenucleation) were deemed inadequate for cytologic diagnosis. Of the remaining 73 cases, 38 were diagnosed as malignant (34 retinoblastomas, 3 medulloepitheliomas, 1 rhabdomyosarcoma), and all were confirmed upon subsequent histologic examination. Four cases were diagnosed as suspicious for malignancy; all of them proved to be malignant (two retinoblastomas, two rhabdomyosarcomas). One orbital aspirate contained cells suggestive of a glial origin and was confirmed histologically as pilocytic astrocytoma. Ten cases were reported as compatible with Coats' disease; all were confirmed to be benign by histologic examination (three cases) or clinical follow-up (seven cases). The remaining 20 benign aspirates (13 with inflammatory cells, 6 with macrophages and 1 with blood) proved to be from benign conditions by histologic examination (4 cases) or clinical follow-up (16 cases). There were no false-positive diagnoses. The overall accuracy of FNAB was 95%, and the accuracy of cytologic interpretation was 100%. We conclude that FNAB is a reliable and accurate diagnostic modality in the assessment of selected pediatric ophthalmic diseases.

Adolescent↗
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Update on the management of posterior uveal melanoma.

The current status of the management of posterior uveal melanoma has been reviewed. Patient age and health status are important factors that affect the therapeutic decision. Plaque radiotherapy, surgical resection, and enucleation are currently the mainstays of management, depending on the indication. However, there has been an increasing trend toward the use of transpupillary thermotherapy alone or in combination with plaque radiotherapy. Photoradiation treatment and gamma-knife surgery are still being evaluated. Based on the current data, conservative or eye-preserving treatment methods and enucleation are comparable in terms of survival. Early diagnosis and treatment is necessary to minimize ocular morbidity and improve patient survival. Poor prognostic factors for posterior uveal melanoma include older age, tumor size, ciliary body involvement, and epithelioid cell type.

Choroid Neoplasms↗
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Choroidal melanoma-associated retinal and retinal pigment epithelial changes.

Many clinical findings associated with choroidal melanoma are the result of secondary changes in the adjacent tissues. There may be alterations in the choriocapillaris, the RPE, the Bruch's membrane, and the sensory retina. Proper identification of these changes is essential for diagnosis and management.

Angiography↗