Calcification-like echographic patterns in uveal melanomas treated with brachytherapy.
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Aged↗
Biomedical subjects
N Bornfeld
Publications and source records attributed to N Bornfeld.
Hexadecylphosphocholine may produce reversible functional defects of the retinal pigment epithelium.
Hexadecylphosphocholine is a synthetic phospholipid derivative that has antitumor activity due to its interference with membrane functions. Animal experiments have shown photoreceptor and retinal pigment epithelium (RPE) degeneration after its systemic application. In a phase II trial of hexadecylphosphocholine therapy in 23 patients with advanced metastatic colorectal or lung cancer, visual acuity and color vision testing, slit-lamp examination, tonometry, fundoscopy (including photodocumentation), visual field testing, electrooculography (EOG), and electroretinography (ERG) were performed. A baseline examination was carried out prior to therapy. Patients were reexamined after 2 months and after 5 months. In all, 71% of the patients had a reduced light peak in the EOG during therapy. After the end of therapy the light peak improved again and became normal in most patients. The statistical analysis showed that the light-peak values during therapy were significantly lower than the baseline and posttreatment values. This indicates that hexadecylphosphocholine might be capable of producing a partly reversible functional defect of the RPE. Apart from this finding, no other functional or morphological ocular side effect was detected. The functional changes observed in our patients as well as the morphological changes found in animal experiments are similar to those reported for known diseases of the RPE-photoreceptor complex. Therefore, hexadecylphosphocholine-induced retinopathy might become useful as an animal model for such diseases.
Adenocarcinoma↗
Chromosomal aberrations defining uveal melanoma of poor prognosis.
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Chromosome Aberrations↗
Loss of chromosome 3 alleles and multiplication of chromosome 8 alleles in uveal melanoma.
Uveal melanoma is the most frequent primary intraocular tumor. The etiology is unknown. Using neutral DNA polymorphisms on chromosomes 2, 3, and 8, we have detected loss of chromosome 3 alleles in 8 of 13 tumors and multiplication of chromosome 8 alleles in 6 of 11 tumors. No anomalies at a locus on chromosome 2 were found in 10 of 10 tumors. These results confirm and extend previous cytogenetic findings and suggest that a tumor suppressor gene on chromosome 3 and an oncogene on chromosome 8 may be involved in the formation or progression of this tumor.
Adult↗
Severe visual loss associated with retinal telangiectasis and facioscapulohumeral muscular dystrophy.
Facioscapulohumeral (FSH) muscular dystrophy is known to be associated with retinal telangiectasis. However, there are only few reports of severe visual loss due to exudative complications, so the risk to vision has not been established. Because of the possible therapeutic implications, we have described two cases of young girls who developed FSH muscular dystrophy and exudative retinal detachment due to telangiectasis. In the first patient, the severity of the disease precluded visual recovery despite extensive photo- and cryotherapy. In the other, visual acuity in both affected eyes was retained after treatment. Fundus examinations in young children at risk of having the gene for FSH muscular dystrophy may be justified so that retinal vascular disease can be detected before it becomes untreatable.
Blindness↗
Histopathologic findings in eyes treated with a ruthenium plaque for uveal melanoma.
Fifty-six globes that had to be enucleated following ruthenium plaque therapy were examined histopathologically. These eyes account for 10% of all uveal melanomas treated at the University Eye Clinic Essen up until 1985. All but one revealed at least some supposedly viable tumor cells. The most prominent findings within the tumors were tumor cell necrosis, vacuolization and balloon cell degeneration, vascular obstruction and fibrosis of the tumor stroma with accumulation of pigmented macrophages. Tumor necrosis was complete or nearly complete in five cases. Tumor regression correlated with cell type and pigmentary characteristics of the tumor, with epithelioid and heavily pigmented tumor cells being more radiosensitive. Tumor regression was inhomogeneous, possibly due to polyclonality, with tumor cells of varying radiosensitivity, or due to patchy areas of vascular obliteration. Among other ocular structures, extensive subretinal gliosis, chorioretinal atrophy and scarring of the sclera within the field of radiation were observed. Scleral necrosis was present in only five cases and was limited to areas in which the tumor had infiltrated the deep scleral layers. The findings described were considered to reflect radiation injury rather than spontaneous tumor regression when compared to 70 control eyes that had been enucleated without prior treatment for uveal melanoma.
Aged↗
[Epiretinal membrane formation after pars plana vitrectomy in proliferative diabetic retinopathy].
Recurrent epiretinal membranes are a major contributing factor to functional and visual failures after pars plana vitrectomy for proliferative vitreoretinal disorders. In this study 222 consecutive eyes that have had pars plana vitrectomy for proliferative diabetic retinopathy (operated in 1986 und 1987) were evaluated retrospectively. The study focuses on a subgroup of 108 consecutive eyes all with preoperative tractional retinal detachment and all operated with primary silicone oil injection. A minimum follow up of six months was present in 90% of these cases. Permanent visual success was observed in 40% of the eyes, most of which had dense vitreous hemorrhage preoperatively. Multivariant analysis revealed that among several potential risk factors recurrent epiretinal membranes as well as silicone oil were significantly associated with visual failure. Because of the high incidence of recurrent epiretinal membranes associated with poor functional results silicone oil injection following pars plana vitrectomy should be employed restrictively in patients with proliferative diabetic retinopathy.
Cataract↗
[Diagnosis and therapy of malignant melanoma of the uvea (choroid and ciliary body)].
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Choroid↗
[Retinal lesions after transvitreal use of ultrasound].
Removal of a dislocated natural lens into the vitreous cavity is now performed using vitreous surgery techniques combined with intravitreal phacoemulsification via the pars plana. In contrast to the earlier external surgical approach to luxated lenses, postoperative complications, particularly retinal detachment, are rare. However, retinal damage may occur when ultrasound is used at therapeutic intensities. We therefore examined ultrasound-induced retinal lesions produced in rabbit eyes by treating the retina directly with ultrasound using the type of tip conventionally used for pars plana lensectomy (Fragmatom). Histological evaluation showed that acoustic energy at low intensities led primarily to damage of photoreceptor cell outer and inner segments, which correlated with a discrete pigment reaction visible on ophthalmoscopy. More severe lesions were seen in destruction of the inner retina and resulted in retinal blanching or caused a small retinal break. High energy led to a full-thickness retinal defect with rupture of choroidal vessels and heavy bleeding into the vitreous cavity. Within these lesions the retinal pigment epithelium and Bruch's membrane were also disturbed. Our ophthalmoscopical and histological findings indicate that the mechanism of ultrasound-induced chorio-retinal lesions is not exclusively thermal in nature and differs from other coagulation modalities.
Animals↗
[Capillary hemangioma of the retina. Laser scanning tomography follow-up after radiotherapy].
We present a patient with isolated angiomatosis retinae, in whom ruthenium irradiation was administered for treatment of a secondary serous retinal detachment. Prior to therapy, we measured an increased vessel diameter. Following treatment, decreasing venous vessel diameter was documented three-dimensionally utilizing laser scanning tomography. The changes in vessel height (87%) exceeded the changes in width (49%). This is most probably because the vessels are embedded in the nerve fiber layer, stabilized by the surrounding tissues more in a horizontal than in a vertical direction. In addition, spontaneous venous pulsation located in the optic disc and in the retina was documented.
Adult↗
Nonrandom chromosomal abnormalities in primary uveal melanoma.
We report on 14 cases of clonal chromosomal anomalies in patients with primary uveal melanoma. An increased dosage of chromosome 8 or of parts of the long arm of chromosome 8 (8q) were detected in eight patients (57%). The smallest multiplied area of 8q appeared to be the region 8q2.1----qter. Monosomy of chromosome 3 was seen in six patients (43%), five of which were associated with anomalies of chromosome 8. Increased dosage of parts of chromosome 8q and loss of heterozygosity of chromosome 3, or the combination of both, seemed to be nonrandom for uveal melanoma and may distinguish it genetically from cutaneous malignant melanoma. Anomalies of chromosome 6, mostly resulting in additional material of 6p or a deletion of 6q, were found in six patients (43%). These anomalies, which seem to be common features of cutaneous malignant melanoma, were considered secondary rather than primary changes in uveal melanoma, since they were present only in subclones in most cases. Loss of the Y chromosome, restricted to tumor cells, was detected in four male patients, and loss of one X chromosome was detected in a female patient.
Adult↗
New and recurrent tumor foci following local treatment as well as external beam radiation in eyes of patients with hereditary retinoblastoma.
The study is based on a retrospective analysis of data from 200 patients with hereditary retinoblastoma. Apart from four unilateral cases with a positive family history all patients had bilateral disease; 229 appeared suitable for conservative treatment while 167 eyes had to be enucleated. Primary local treatment was performed in 102 eyes, while 127 eyes received primary external beam radiation using a linear accelerator. Follow-up was adjusted by life tables, with 75% of the patients being observed longer than 2 years. Using life-table statistics new and recurrent tumors were found in 41% of all patients and in 95% of these cases they were noted within 26 months after initiation of therapy. Among eyes treated with primary external beam radiation new and recurrent tumors were observed significantly less frequently when 50 Gy (22% compared with 49% after 40 Gy) and a highly accurate beam alignment technique (22% compared with 48% after alignment to the outer bony canthus) were applied. The incidence of recurrent tumors following primary local treatment did not differ significantly with regard to the application of either photo- or cryocoagulation (28% vs 33%), while no recurrence was observed among tumors that were suitable for primary treatment using ruthenium or cobalt plaques.
Brachytherapy↗
[Cytostatic and immunosuppressive treatment of ocular Behçet syndrome].
Ocular symptoms of Behçet's syndrome in 16 patients and the results of cytostatic and immunosuppressive therapy with cyclosporin A (6 patients), chlorambucil (6 patients), and a combination of cyclophosphamide and procarbacin (4 patients) are described. The clinical course and therapeutic outcome were compared to the patients' visual acuity and the duration of the disease prior to institution of cytostatic therapy. Average follow-up was 4.6 years, maximum 9 years. The principal ocular symptom in all patients was hemorrhagic, occlusive periphlebitis. Other symptoms, in descending order of frequency, were chorioretinitis, iridocyclitis, complicated cataract, secondary glaucoma and exudative retinal detachment. The patients in whom cytostatic therapy was instituted no later than 6 months after onset of the disease showed an improvement in or stabilization of visual acuity, as well as a clear reduction in signs of intraocular inflammation and frequency of recurrence. No improvement in visual acuity or ocular symptoms was achieved in cases where the disease was very advanced, despite cytostatic-immunosuppressive therapy. The results support early institution of immunosuppressive therapy in cases with Behçet's syndrome where severe, irreversible damage has not yet occurred and in which vision is threatened in both eyes. However, due consideration must be given to the potential risks of immunosuppressive therapy, in particular the risk of a malignant tumor.
Acyclovir↗
[Metastases of malignant extra-ocular tumors to the choroid. Diagnosis and fractionated radiotherapy].
A total of 161 cases of choroidal metastases are reviewed. Breast or bronchial carcinomas are the most frequent primary tumors. One-third of the patients develop bilateral choroidal metastases. In 67% of all cases metastatic choroidal lesions were found in the posterior pole. Eighty-nine percent of all patients had a history of malignant tumor, in 11% of all patients choroidal metastasis was the first sign of a primary carcinoma elsewhere in the body. Sixty percent of all patients with choroidal metastases had additional other distant metastases at the time of diagnosis of choroidal involvement. The survival rate is poor: 50% of all patients with choroidal metastasis had died 1 year later. In 35% of all patients, choroidal metastases occurred despite prior systemic therapy with cytotoxic drugs or hormone therapy. In many cases the spontaneously course leads to irreversible loss of central visual acuity due to tumor growth, tumor necrosis or the complications of an exudative retinal detachment. Early fractionated external beam in radiation may prevent this outcome. The clinical course in 71 eyes following irradiation is reported. In 80% radiation therapy led to regression or eradication of the tumor, and a vision of at least 0.4 was maintained in 61% of the treated eyes.
Breast Neoplasms↗
[Development and dosimetry of a 125 iodine applicator for brachytherapy of intraocular tumors].
Due to the low gamma energy (27-35 ke V), iodine 125 is especially suitable for brachytherapy of intraocular tumors. 125I is available as encapsulated seeds. Applicators can be individually loaded with these seeds to accommodate the shape of the tumor as much as possible. To measure the depth-dose distribution LiF thermoluminence detectors (TLDs, 1 mm3) are embedded in an RW-1 eye phantom at various distances and directions from the high active plaque positioned at the top of the phantom. To obtain the three-dimensional dose distribution, the TLDs are read after exposure for the appropriate time period. Based on experimental measurements of the 125I plaque, a computer program is developed to calculate the dose distribution within the eye and the radiation time for intraocular tumors. These results are very similar to those obtained when using mathematical equations published in the literature. In summary, three-dimensional dose distribution at various distances from an 125I eye plaque has been experimentally determined using a new method. This is an important prerequisite for introducing 125I plaques into the treatment of intraocular tumors.
Brachytherapy↗
Enucleation combined with orbital implants for malignant melanoma of the uvea.
Advanced malignant melanomas of the uvea unsuited for an eye salvaging approach require enucleation of the tumor containing eye. A series of 68 patients is reported who underwent enucleation combined with insertion of a spherical dura-encased implant after 30 Gray pre-irradiation therapy of the orbit. Postoperative results with special attention to cosmetic outcome and motility of the prosthesis suggest that the insertion of an orbital implant should be preferred to the enucleation with no implant.
Esthetics↗
[Preoperative irradiation before enucleation in malignant melanoma of the uvea. Review of the literature and initial personal experiences].
The results of animal experiments and clinical studies concerning preoperative radiation of malignant extraocular tumors suggest that pre-enucleation radiation may be helpful in reducing the incidence of tumor-related death after enucleation of an eye containing a melanoma. Based on a retrospective study of 80 patients with malignant melanomas of the choroid or ciliary body, in which pre-enucleation irradiation with 8.5 Gray or 20 Gray was performed, no beneficial effect could be found in terms of better survival. The need for a prospective, randomized and possibly multicentered study is emphasized.
Adolescent↗
[Dosimetry of ruthenium applicators with an eye phantom and small volume thermoluminescence detectors].
Even though 106Ru/106Rh applicators have been in clinical use over more than two decades for the radiotherapy of malignant uveal melanomas, the dosimetry of emitted beta radiation is still a physical problem. The dose rate at the applicator surface and the depth dose in tissue equivalent material can be determined only within +/- 30% error. Using new cubic-shaped thermoluminescence detectors (TLD) with small volume the dose distribution is examined in water equivalent material (RW-1). The spatial resolution is 14 times better compared to the previous technique. From dose measurements in an eye phantom the homogeneity of nuclide deposition and the depth dose distribution of a 106Ru/106Rh applicator are determined.
Brachytherapy↗