Historical Perspective on Iridocyclectomy: Contributions of Professor Leonid F. Linnik

Background: Optical coherence tomography angiography (OCTA) is a valuable imaging tool for the diagnosis of several retinal and choroidal diseases. Its role in ocular oncology is clinically promising but still controversial. In this review, we report the main applications and limits of the use of OCTA for the study of intraocular tumors. Summary: OCTA allows a rapid, safe, low-cost, and high-resolution visualization of the retinal and choroidal vasculature. Attempts have been made to use this technology in ocular oncology to differentiate benign and malignant lesions and to assist physicians in the evaluation and monitoring of post-treatment complications. Main limitations include failure in correct segmentation due to the tumor inner profile or thickness, poor penetration of the laser into the lesion, masking effect from overlying fluid, media opacities and poor fixation. Key Messages: The main applications of OCTA in ocular oncology consist of the documentation of tumor-associated choroidal neovascularizations and the study of vascular changes following tumor treatments. In particular, the diffusion of wide-field protocols makes OCTA suitable for the diagnosis and follow-up of radiation chorio-retinopathy, allowing a detailed visualization of both macular and peripheral ischemic changes. Optimistically, future innovations in OCTA technology may offer new perspectives in the diagnosis and follow-up of intraocular tumors.

Dear Friends, Forty years is a long time. Approximately, 40 years ago, Paul McCartney announced the dissolution of the Beatles, Pele retired from soccer, and President Nixon resigned amid the Watergate scandal. So much has happened worldwide since these events. In the ophthalmology world, 40 years ago, cataract spectacles were routinely prescribed for visual rehabilitation, but more and more patients benefited from intraocular implantation of a fairly new device, the intraocular lens. Laser treatment for diabetic retinopathy was considered, but not yet rationalized. Some patients were entered into the original Diabetic Retinopathy Study in the early 1970s. Otherwise, diabetic patients were destined to blindness. Forty years ago, we were establishing our practice in ocular oncology. Ocular tumors were dismissed as rare, often requiring the enucleation. There was little clinical interest in intraocular tumors. The subspecialty of ocular oncology did not exist. Globe-saving methods for intraocular tumors using plaque radiotherapy were a developing technique for melanoma and external beam radiotherapy for some cases of retinoblastoma. At that time, diagnostic challenges were steep, especially in the clinical recognition of various intraocular tumors as many clinicians were not familiar with wide-angle viewing with the indirect ophthalmoscope and fundus photography was in its infancy. Fluorescein angiography and ocular ultrasonography were thoughts in the process of development. Now let's morph and “dissolve into” today's world. Ocular oncology has emerged as a vitally important subspecialty, bursting with innovative treatments and remarkable success. More than saving vision, we have achieved ultimate goals of saving life and the eye. Organized local and national societies for ocular oncology educate physicians and patients, including the International Society of Ocular Oncology for global communication. Daily electronic communication and online publication allow rapid spread of information to remote regions of the world, at a button's click. The playing field for ocular cancer worldwide is slowly equalizing. In this special issue of the Indian Journal of Ophthalmology, authors from India and beyond publish their observations, achievements, and failures in ocular oncology. Regarding retinoblastoma, new methods of intravenous, intra-arterial, and even intravitreal chemotherapy have led to high rates of the globe salvage with patient safety and preservation of visual acuity. Remarkably, some children are cured with 1 or 2 doses of single-agent chemotherapy delivered into the ophthalmic artery. Vitreous retinoblastoma seeds, a previously-doomed finding, are now reversed with chemotherapy lavage of the vitreous cavity. Impressive. Regarding uveal metastasis, the introduction of fine needle aspiration biopsy, directly into the tumor, has allowed rapid and precise analysis of tumor for origin and cell type, leading to earlier detection of the primary cancer site. Treatment of metastasis with standard radiotherapy or plaque radiotherapy as well as photodynamic therapy or intravitreal injections has led to minimally-invasive tumor control, often with the return of visual acuity. Regarding uveal melanoma, tumor size and genomic status allow a better estimation of ultimate metastatic risk. A thin needle is slipped into the tumor to aspirate only 10 or 20 cells for DNA or RNA analysis, leading to a genetic profile of the tumor, predicting risk for metastasis or lack thereof. Furthermore, uveal melanomas can now be detected at an incredibly small size, under 2 millimeters in thickness, using optical coherence tomography (OCT) as well as documented risk factors. Melanomas that previously disguised as an innocent nevus can be unmasked by autofluorescence for early detection. And the nonmalignant choroidal hemangioma and retinal hemangioblastoma with their hidden threat for vision loss can be more clearly identified on indocyanine green or fluorescein angiography and OCT, with eradication using with photodynamic therapy, photocoagulation, or localized radiotherapy. Looking back, we are proud of the enormous advancement in the field of ocular oncology over the past 4 decades and most exceptionally in the past 5 years. A baby that would have otherwise been left without an eye in the 1970s, will now likely have the globe retained and with navigational vision or reading visual potential. The father that might have lost his eye to a large melanoma in the past will now likely have detection of the tumor at a 2.0 mm stage for early treatment and favorable prognosis. This progress has endured excitement and disappointment, competition and worry, darkness and sunshine. Through carefully designed protocols, diligent patient monitoring, tediously calculation of outcomes, and contemplation of results, we have succeeded. Like John Lennon of the Beatles sang, “It's been a hard day's night” but the effort is certainly worthwhile, to make our patients “feel alright”.

BackgroundWide-field imaging plays an increasingly important role in ocular oncology clinics. The purpose of this review is to describe the commonly used wide-field imaging devices and review conditions seen in ocular oncology clinic that underwent wide-field imaging as part of the multimodal evaluation.Summary of reviewWide-field or wide-angle imaging is defined as greater than 50° field of view. Modern devices can reach far beyond this reporting fields of view up to 267°, when utilizing montage features, with increasingly impressive resolution. Wide-field imaging modalities include fundus photography, fluorescein angiography (FA), fundus autofluorescence (FAF), indocyanine angiography (ICG), spectral domain optical coherence tomography (SD-OCT), and recently wide-field OCT Angiography (OCTA). These imaging modalities are increasingly prevalent in practice. The wide-field systems include laser, optical, and lens based systems that are contact or non-contact lens systems each with its own benefits and drawbacks. The purpose of this review is to discuss commonly used wide-field imaging modalities for retinal and choroidal tumors and demonstrate the use of various widefield imaging modalities in select ocular oncology cases.ConclusionsClinical examination remains the gold standard for the evaluation of choroidal and retinal tumors. Wide-field imaging plays an important role in ocular oncology for initial documentation, surgical planning, determining the relationship of the tumor to adjacent ocular structures, following tumor size after treatment, and monitoring for recurrence.

Background: Early and accurate diagnosis of choroidal tumors including benign nevi, melanomas, and vascular lesions is essential for effective clinical management. Conventional imaging techniques such as fundus photography, optical coherence tomography, fundus autofluorescence, and ultrasonography have greatly advanced the accuracy of choroidal tumor assessment but do have limitations. Hyperspectral imaging (HSI) is a noninvasive modality capturing high-resolution spectral data across multiple wavelengths and has shown promise in various medical fields. Its emerging use in ophthalmology may offer novel insights, although clinical evidence remains preliminary. Summary: This review explores the principles of HSI and its early investigational role in ocular oncology. Although clinical evidence remains limited, HSI may help improve lesion differentiation, tumor margin delineation and potentially provide indirect biochemical insights. When combined with existing imaging techniques, HSI could support a more comprehensive and individualized diagnostic approach. Key challenges and future directions are discussed. Key Messages: HSI is a promising, noninvasive imaging innovation with potential to enhance choroidal tumor characterization. While still primarily investigational, further clinical validation is essential to determine its role in ophthalmic practice.

Evaluating the Rare and Predicting the Worst: Lessons for Thyroid Nodules

Orbital tumor removal remains one of the most challenging aspects of ophthalmic plastic and reconstructive surgery. Kronlein, 19 in 1888, described the removal of the lateral orbital wall, allowing access for the removal of posterior orbital tumors for the first time. Refinement of orbital surgery has continued over the past century with improvement in imaging for localization of tumors and instrumentation for improved surgical extirpation. Recent advancements in orbital tumor sugery include the use of smaller or hidden incisions, the more widespread application of the CO 2 laser as a dissection instrument, intraoperative computerized tumor location mapping devices, and continued multidisciplinary efforts in obtaining access to tumors. The location of the orbital tumor remains the primary factor in the determination of the surgical approach for tumor excision. Other criteria include the size of the tumor, probable histopathology, signs of vision impairment, tumor invasion of surrounding tissues, and involvement of structures contiguous to the orbit. Radiographic imaging is, therefore, an essential component of the preoperative work-up. A comprehensive approach to the surgical removal of orbital tumors is discussed, with an emphasis on newly described techniques.

Primary hyperparathyroidism (PHPT) usually presents with symptoms of hypercalcemia which is due to excessive secretion of parathyroid hormone (PTH). Surgical removal of the secreting tumor either adenoma or hyperplasia remains the mainstay of treatment. Around 2% to 25% of the lesions are located in the mediastinum. We reviewed our institution's surgical treatment and approach to mediastinal parathyroid adenoma (MPA). We retrospectively reviewed the demography, comorbidities, clinical presentation, surgical approach, and outcome for patients in our institution who underwent surgery for MPA from September 2019 until August 2023.All patients with MPA who underwent surgery were included in the review. The surgical approaches used were both video-assisted thoracoscopic surgery (VATS) and median sternotomy. There were three patients with PHPT due to MPA who underwent surgery. Out of the three patients, two were female. The mean age was 48.6 years old, ranging from 16 to 66 years old. All of them presented with PHPT with a raised mean serum calcium level of 3.52 mmol/L (range: 2.84-4.38 mmol/L) and a mean PTH or intact PTH (iPTH) level of 274.6 pmol/L (range: 8.87-695 pmol/L). Ultrasound of the neck was performed for all the patients before further investigations were done to look for the ectopic parathyroid gland. Computed tomography (CT) of the thorax showed mediastinal parathyroid mass in all the patients with an average size of 2.4 x 2.1 x 2.3cm (range: 1.3-3.8cm), which showed uptake in 99mTc-hexakis-2-methoxyisobuthylisonitrile (Tc99m-MIBI) scintigraphy. VATSwas performed for two cases and an upper partial sternotomy was performed for one patient. Postoperatively, iPTH and serum calcium levels were reduced significantly for all patients. There were no post-operative complications in our study. Comprehensive diagnostic imaging and surgical planning are important for the localization of MPA. In our review, all cases were promptly diagnosed and underwent surgery without complication.

Objective: To provide a comprehensive literature review of original work on artificial intelligence in ocular oncology. Methods: Scoping review of PubMed-indexed original articles (n = 94) on the use of artificial intelligence in ocular oncology, retrieved during the month of February 2026 and independently screened by two ocular oncologists. Results: Most of the literature on artificial intelligence (AI) in ocular oncology focuses on uveal melanoma and its differentials (n = 39, 41%), followed by retinoblastoma (n = 14, 15%) and orbital tumors (n = 12, 13%). The purpose of using the AI models was to screen, diagnose, and classify the disease (n = 59, 62%) and to treat, predict outcomes, and monitor the disease (n = 35, 37%). Most literature (n = 32, 34%) on AI in ocular oncology originates from China. Datasets comprised images in 78% (n = 73) of the studies, clinical parameters in 14% (n = 13), and omics data in 12% (n = 11). Most studies worked on developing AI models (n = 83, 88%), of which two reached a deployment stage. Few studies evaluated or incorporated pre-existing models (n = 11, 12%). Supervised learning strategy was most commonly employed (n = 75, 80%). Among studies that developed AI models, traditional machine learning architectures were used in 36, deep learning in 39, and a combination in 8. Most studies (n = 59, 63%) were at a Clinical AI Readiness Evaluator Technology Readiness Level 4, i.e., at the prototype development stage. Conclusions: Despite the limitation of a single database search, a surge in AI applications in ocular oncology after 2020 is evident. Most studies are in the model development stage, and few have been deployed in the real world for clinical implementation. Very few models have proven effective in real-world clinics and the community, holding promise for the future.

To identify factors influencing psychosocial adjustment in patients with surgical removal of benign breast tumor. With a survey design, data were collected using the Psychosocial Adjustment to Illness Scale-Self Report (PAIS-SR), Body Image Scale, Physical Discomfort Scale, and Family Support Scale with patients who had had surgical removal of a benign breast tumor from September to November 2017. Data were analysed with descriptive statistics, t-test, ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. The mean scores for physical discomfort, body image, family support, and psychosocial adjustment were 1.57±0.51, 0.37±0.64, 3.62±0.67, and 4.00±0.45, respectively. Family support, body image, physical discomfort, number of surgical removal of benign breast tumor (twice), and cancer insurance status (yes) were verified as factors influencing psychosocial adjustment. These factors accounted for 57.4% of psychosocial adjustment. In this study, family support, body image, and physical discomfort were identified as significant predictors of psychosocial adjustment. Therefore, this study can be used as fundamental data to develop nursing intervention strategies in order to increase psychosocial adjustment in patients with surgical removal of a benign breast tumor.

Interleukin 2 (IL-2) therapy: potential advantages of locoregional versus systemic administration

PurposeMalignant neoplasms arising in the brain and central nervous system have a poor prognosis and present with symptoms such as headache, epileptic seizures, and paralysis of the arms and legs. Treatment of glioma, the most frequent primary brain tumor, is based on surgical removal of the tumor, radiation therapy, and chemotherapy. However, since gliomas grow invasively, surgical removal of the entire tumor is considered difficult. In addition, the standard treatment, temozolomide, possesses the problem of resistance. Therefore, the risk of recurrence is high, and the development of noble therapeutic agents for Glioma is required. We have screened for compounds with anti-tumor activity against Glioma from our natural compound library and focused on ginger extract, Compound A. In this study, we investigated the effect of Compound A on Glioma cell lines.Methods and ResultsTo evaluate the antitumor activity of Compound A on Glioma in vitro , MTT assay was performed. Human glioma cell lines U87-MG and U251 cells were treated with Compound A. After 96 hours, cell viability was evaluated using CCK-8. The IC50 value of Compound A in U87-MG cells was calculated to be 16.3 μM. The IC50 of Compound A in U251 cells was 10.8 μM. Next, to examine the effect of Compound A on normal cells, we performed the same MTT assay using primary cultured rat astrocytes. The MTT assay showed no decrease in cell viability in primary cultured rat astrocytes at 15 μM, whereas an antitumor effect was observed in a human glioma cell line.DiscussionIn this study, Compound A showed antitumor activity against Glioma without affecting normal cells. In the future, we will examine the effects of Compound A in an immunocompromised mouse brain in which U87-MG-RFP cells are implanted, which may lead to the development of therapeutic agents against Glioma.

Relevance. The treatment of soft tissue sarcomas, a rare and diverse type of cancer, requires an integrated approach that involves a multidisciplinary team of specialists. Surgical removal of the primary tumor is recommended in specialized centers after a thorough diagnosis and development of an individualized treatment plan. It is crucial to assess the risk of local recurrence even before surgery and to ensure continuity of care for patients who undergo non-curative operations. Radio- and chemoresistance in sarcomas limits the effectiveness of radiation therapy and chemotherapy, and delays in initiating treatment can worsen the prognosis. However, modern radiotherapy equipment and techniques for reducing radiation doses allow us to overcome resistance in malignant cells and reduce tumor size. Description of the clinical case. A patient with a suspected malignant neoplasm of the right parotid salivary gland underwent surgery, according to the results of the histological examination, and a carcinosarcoma of the salivary gland G3 (pT2N0M0) was confirmed. However, the edge of the resection was not indicated. One month after the surgical removal of the tumor, the patient experienced a local recurrence of the disease. However, they did not receive any further antitumor treatment at that time. Only one year later, they were admitted to an oncological clinic, where they received palliative radiation therapy after verification of the local relapse and consultation with the federal center. The irradiation was carried out in two stages: multifractionated hypofractional irradiation in a single dose of 3.7 Gy twice a day for a total dose of 19 isoGy, followed by a 3-week break and daily hypofractionated irradiation in a single dose of 3 Gy for a total of 61 Gy. Against the background of treatment, we were able to achieve a reduction in tumor mass by 85% compared to the initial size. We also saw a reduction in pain and an improvement in the general somatic status and quality of life of the patient. Unfortunately, this positive response was short-lived due to the aggressiveness of the histological form of the disease. In this clinical case, surgery to remove the residual tumor was not performed. Conclusion. Hypofractionated radiation therapy is an effective treatment option for recurrent rhabdomyosarcoma in the parotid salivary gland, as it allows for a significant reduction in tumor formation. However, due to its biological characteristics and aggressive nature, it requires continuous and urgent comprehensive treatment.

The authors determined whether untreated breast cancer patients have elevated plasma levels of transforming growth factor-beta 1 (TGF-beta 1). Increased plasma TGF-beta 1 levels recently were found after chemotherapy in patients with advanced breast cancer. However, it currently is unknown whether this elevation in plasma TGF-beta 1 is caused by chemotherapy-induced normal tissue damage or whether it results from the presence of the tumor. An enzyme-linked immunosorbent assay was used to measure plasma TGF-beta 1 levels in 26 newly diagnosed breast cancer patients before and after definitive surgery. Patients were grouped by postoperative tumor status: 1) negative lymph nodes (group 1); 2) positive lymph nodes (group 2); and 3) overt residual disease (group 3). The site of TGF-beta 1 production in the tumors was localized by immunohistochemistry and in situ hybridization. Plasma TGF-beta 1 levels were elevated preoperatively in 81% of the patients; TGF-beta 2 and TGF-beta 3 were undetectable. The preoperative TGF-beta 1 levels in the three patient groups were similar; however, the postoperative plasma TGF-beta 1 levels differed by disease status. The mean plasma TGF-beta 1 level in group 1 (n = 12) normalized after surgery (19.3 +/- 3.2 vs. 5.5 +/- 1.0 ng/mL, p < 0.001). In contrast, the mean plasma TGF-beta 1 levels remained above normal in both group 2 (n = 9) and group 3 (n = 5) after surgery. Transforming growth factor-beta 1 expression was found to be preferentially increased in the tumor stroma. Breast tumors result in increased plasma TGF-beta 1 levels in 81% of patients. After surgical removal of the primary tumor, the plasma TGF-beta 1 level normalizes in the majority of patients; persistently elevated levels correlate with the presence of lymph node metastases or overt residual tumor. These findings suggest that the usefulness of TGF-beta 1 as a potential plasma marker for breast tumors deserves further study.

Inhibins and activins are growth factors belonging to the transforming growth factor-beta) family and are known to influence cell proliferation and differentiation. Because transforming growth factor-beta is involved in physiological and tumoral changes of uterine tissues, the present study aimed to evaluate whether human normal and neoplastic endometrial and cervical epithelial cells express and secrete inhibin A, inhibin B, and activin A. To test this hypothesis, different approaches were used. By RT-PCR, the expression of specific messenger RNAs (mRNAs) for the inhibin alpha, activin betaA and betaB subunits, and activin receptor type II and type IIB was investigated: 1) in primary cultures of endometrial (stroma and epithelium) or cervical (epithelium) cells from healthy women; and 2) in specimens of endometrial or cervical carcinoma. To demonstrate a possible secretion of the proteins, dimeric inhibin A, inhibin B, and activin A were measured in culture medium of normal epithelial or stromal endometrial cells and in uterine washing fluid of healthy women or patients with endometrial adenocarcinoma. Levels of the proteins were also measured in serum of women with endometrial or cervical carcinoma. Cultured endometrial stromal or epithelial cells and epithelial cervical cells expressed inhibin alpha, activin betaA and betaB, and activin receptor type II and type IIB mRNAs. The same finding was obtained in specimens of endometrial or cervical carcinomas. Dimeric inhibin A, inhibin B, and activin A were measured in culture medium of both endometrial and cervical cells. In particular, resulting activin A levels were significantly higher in epithelial than in stromal cultured endometrial cells (P < 0.01). Dimeric proteins were also detected in the washing fluid of the uterine cavities of healthy women (controls) and with endometrial adenocarcinoma, in which higher activin A levels were found (P < 0.01 vs. controls). Women with endometrial carcinoma showed serum activin A levels significantly higher than healthy controls (P < 0.01), which significantly decreased after surgical removal of endometrial or cervical tumors (P < 0.01). The present study, for the first time, showed that inhibin A, inhibin B, and activin A, as well as activin receptors, are expressed in normal and neoplastic human uterine tissues. A secretion of activin A from tumoral cells into systemic circulation is suggested by the observation that the high levels in serum of patients with endometrial or cervical carcinoma decreased after the surgical removal of the tumor.

Breast cancer is the most commonly diagnosed cancer among women worldwide. Surgical removal of tumors is often necessary and many patients suffer complications due to subsequent breast reconstruction. A safe and effective breast reconstructive material is needed for patients recovering from surgical removal of small breast cancer tumors. Our lab has developed injectable collagen/tannic acid beads seeded with patient-derived preadipocytes for regeneration of healthy breast tissue in patients post-lumpectomy. Previous research indicates that the inclusion of tannic acid in the matrix imparts an anticancer property. This research seeks to determine the variables needed to control collagen/tannic acid bead diameter and seeded cell attachment, which are essential to proper bead implantation and function. We found that as tannic acid concentration increases within the beads, cell attachment decreases. Bead diameter is controlled by bead generator voltage, solution osmolality, the degree of cell attachment, and tannic acid concentrations. Higher voltages resulted in significant decrease in bead diameter. Collagen/tannic acid beads decreased in diameter when placed in solutions of increasing osmolality. Higher degrees of cell attachment across the surface of the beads were associated with a significant decrease in diameter. In beads made with high concentrations of tannic acid, bead diameter was found to decrease. Collagen/TA beads are a promising subdermal tissue regenerative matrix with anticancer activity as an alternative to simple lipofilling in breast reconstructive procedures. This study was conducted to better understand the properties of collagen/TA beads in order to improve injection efficacy and tissue regenerative activity.