Management Of Intraocular Tumors Research Articles

Glaucoma secondary to intraocular tumors: mechanisms and management.

Glaucoma secondary to intraocular tumors is important to consider in eyes with a known tumor and those with unilateral or refractory glaucoma. The purpose of this review is to discuss the mechanisms and management of intraocular tumors with related secondary glaucoma. Several intraocular tumors can lead to glaucoma, including iris melanoma, iris metastasis, iris lymphoma, trabecular meshwork melanoma, choroidal melanoma, choroidal metastasis, retinoblastoma, and medulloepithelioma. The mechanisms for glaucoma include solid tumor invasion into the angle, tumor seeding into the angle, angle closure, and iris neovascularization. Management of the tumor can lead to resolution of glaucoma. Management of the secondary glaucoma may involve medical therapy, transscleral cyclophotocoagulation, laser trabeculoplasty, and potentially antivascular endothelial growth factor therapy. Minimally invasive glaucoma surgery (MIGS) can be considered for eyes with treated, regressed posterior segment malignancies if there is no iris or ciliary body involvement. Importantly, avoidance of MIGS, filtering, or shunting surgery in eyes with active malignancies is emphasized. Intraocular tumors can produce secondary glaucoma. Treatment of the primary tumor can sometimes resolve the glaucoma. Topical, oral, or laser therapies can be considered. Avoidance of MIGS, filtering, or shunting surgery is advised until the malignancy is completely regressed.

Curie experience with transvitreal and transcleral FNAB

AbstractFine needle aspiration biopsies (FNAB) with different techniques have been recently developed during the management of intraocular tumors especially uveal melanoma. The need of a biopsy to diagnosed intraocular tumors remains rare. However in some difficult cases of achromic tumors FNAB can be helpful to distinguished achromic melanoma, metastasis, or choroidal malt lymphoma. FNAB is mainly used for choroidal melanoma prognostication. It has been shown that choroidal melanoma prognosis depends on well‐known clinical factor but also genetic factors within the tumor (monosomy 3 and 8q addition or GEP class II). Determination of patient prognosis by FNAB open the way to adjuvant chemotherapy for high risk patients. Different techniques can be used to obtain sufficient tumor samples and these different techniques will be exposed during this symposium. Curie experience using transcleral or transvitreal FNAB will be described.

Indigenous 125I Brachytherapy Source for the Management of Intraocular Melanomas in India

Episcleral plaque brachytherapy using (125)I seed is a viable option for the management of intraocular cancer with minimal invasiveness and surgical complications. This article describes the fabrication of (125)I seeds and initial experience on their use for the management of intraocular choroidal melanomas. The process of (125)I seed fabrication includes immobilization of (125)I into palladium-coated silver wires, its encapsulation in titanium capsules using Nd: YAG laser and quality control to assure safety. Plaque preparation consists of the assignment of seeds to slots on the plaque to achieve a desired dose rate distribution. The clinical study reported here includes the retrospective review of 9 eyes of 9 patients who underwent ophthalmic brachytherapy between May 2008 and June 2011. The average apical diameter before brachytherapy was 7.6 mm and the average largest basal diameter was 12.1 mm, which reduced to 3.3 and 7.2 mm, respectively, after the procedure at an average follow-up of 24 months. Patients in our studies experienced good local tumor control. The results of this study represent a significant step forward in the management of intraocular tumors in India.

Intraocular tumors the value of spectral and color Doppler sonography

We evaluated the efficacy of spectral and color Doppler sonography as a screening procedure for intraocular tumors. Thirty patients who had intraocular tumors were included in the study. Abnormal Doppler shifts were demonstrated 19 of 20 patients with choroidal malignant melanomas, especially at the base of the tumors. The average maximum systolic blood flow velocity in the vessels of these tumors was 17 ± 6.8 cm/sec (14 to 28 cm/sec). In one of the choroidal metastasis, blood vessels were seen around the lesion with a 14-cm/sec maximum peak systolic velocity. Intratumoral vascularity could not be demonstrated in the other tumors. Spectral and color Doppler imaging is a relatively new and promising modality in the management of intraocular tumors and may help to provide a more precise preoperative histological diagnosis noninvasively; however, long-term follow-up is needed.

Melanocytomas of the optic nerve and uvea.

Melanocytomas are an example of changing attitudes toward clinical management of intraocular tumors. They also might exemplify the power of pathological examination and follow-up in patient care and treatment. Prior to the observations of Zimmerman [10], most patients with melanocytomas underwent enucleation. Today, these patients are followed up conservatively and continue to enjoy vision. Melanocytomas are fairly uncommon tumors found more often in blacks and hyperpigmented individuals than in whites. Women are slightly more likely to have this tumor than are men. Melanocytomas are uniformly densely hyperpigmented lesions found on the optic nerve, choroid, ciliary body, and iris and are benign, stationary tumors that seldom cause symptoms or secondary complications. In patients with papillary melanocytomas, the most common visual disturbance is enlargement of the blind spot. With larger tumors, an afferent pupillary defect may be noted. Ciliary body and iris tumors may cause secondary anterior segment complications such as glaucoma, hyphema, or ectopia. Dispersion of pigment by melanocytomas is common and should not necessarily be interpreted as a sign of malignant transformation. Ancillary tests such as fluorescein angiography, ICG angiography, ultrasonography, CT, MRI, and the 32P test are of little clinical benefit in differentiating between melanocytomas and malignant melanomas and may lead to erroneous conclusions. Treatment for melanocytomas is conservative, its mainstay being serial clinical examinations, fundus photography, and visual field examinations to record tumor size and document growth. Lesions that grow rapidly may have transformed to a malignant melanoma and should be treated accordingly.

Intraocular Tumors: A Text and Atlas

Jerry Shields, MD, and Carol Shields, MD, have put together an exhaustive and probably the most comprehensive review of intraocular tumors. It contains considerably more up-to-date material than the previous book, Diagnosis and Management of Intraocular Tumors , written by Jerry Shields alone. The newer book includes over two decades of the experience of Jerry and Carol Shields and the collective thoughts of world experts on the subject. The book reviews all intraocular tumors arising from the uveal tract, the sensory retina, and the pigment epithelium, including miscellaneous and metastatic tumors, and covers clinical and pathologic features as well as current approaches to diagnosis and management. The initial three chapters cover important anatomic considerations and provide an overview of diagnostic and management approaches for ocular tumors in general. Chapter 2 covers in relevant detail modern diagnostic methods such as magnetic resonance imaging, computed tomography, ultrasonography, and fine-needle biopsy. Chapter 3 includes

THE EXPANDING ROLE OF LASER PHOTOCOAGULATION FOR INTRAOCULAR TUMORS

Methods of management for intraocular tumors include observation, radiotherapy, surgery, and laser therapy. Indications for and techniques of laser photocoagulation in the management of intraocular tumors have never been clearly defined in one report, however. A review of selected cases of choroidal and retinal tumors treated with laser therapy between 1974 and 1993 was conducted, as was the literature on laser treatment of intraocular tumors. Based on these observations, indications for, techniques of, and results of laser treatment of selected intraocular tumors are discussed. The results suggest that the preferred technique of laser treatment varies with the type of tumor. Small melanomas are treated by two or three sessions of laser around the tumor and subsequent heavy treatment directly to the tumor. Choroidal nevus with serous detachment of the fovea is treated by either delimiting laser or direct treatment of focal leaks, depending on the distance of the lesion from the foveola. Choroidal hemangiomas are treated by light to medium photocoagulation over the tumor surface to create chorioretinal adhesion and reattachment of the retina. A small retinoblastoma is best treated by surrounding the tumor with heavy laser to destroy its blood supply without treating the lesion directly. Retinal capillary hemangioma can be treated by heavy direct laser application to the tumor, or by obliterating first the feeding artery and later the draining vein. Laser photocoagulation is an acceptable therapeutic option for selected benign and malignant intraocular tumors, and its role in the overall management of patients with intraocular tumors is expanding.

Intraocular Tumors: A Text and Atlas

This text is an updated version of Dr Jerry Shields'<i>Diagnosis and Management of Intraocular Tumors</i>, published by CV Mosby in 1983. The organization is similar to the original but with much needed revisions in clinical diagnosis, management, and prognosis. In addition, where necessary, emphasis on more modern diagnostic procedures, such as magnetic resonance imaging and high-resolution computed tomographic scanning, has been added to the discussion and photographs. The revised text significantly differs from the old in its expanded coverage of retinoblastomas and melanocytic tumors, intraocular malignancies very familiar to the authors in their oncology practice at the Wills Eye Hospital. A chapter on current understanding of the genetics of retinoblastoma is concise and well written and is a much-needed contribution on the disease and its prognosis for patients and families. The chapters are well organized. Each begins with a detailed table of contents and ends with a concise summary

Color Doppler Imaging in the Management of Intraocular Tumors

Forty-four intraocular mass lesions were studied using a new, noninvasive ultrasound technique known as color Doppler imaging (CDI). This technique displays color-encoded Doppler flow information throughout a two-dimensional gray scale image thus providing selective analysis of Doppler spectra in small vessels using pulsed Doppler. Abnormal Doppler shifts were demonstrated within 39 neoplastic lesions studied, but Doppler shifts could not be detected in three tumor-simulating lesions. In a group of 12 choroidal melanomas studied after radiation therapy, lower Doppler shifts were seen compared with a group of 28 tumors before therapy. This change in Doppler shift may reflect the decreased vascular supply of the tumor. Color Doppler imaging may be of value as an additional useful tool in the diagnosis and management of intraocular tumors.

Diagnosis and Management of Intraocular Tumors

Diagnosis and Management of Intraocular Tumors

Diagnosis and Management of Intraocular Tumors

The previous "bible" on this subject was<i>Tumors of the Eye</i>by Algernon B. Reese, in 1976, which included intraocular tumors and those of the conjunctivae, lids, lacrimal apparatus, and orbit. Jones and Jakobiec, in 1979, edited contributions on<i>Diseases of the Orbit</i>. The present volume by Shields brings us up-to-date information on intraocular tumors. The author had a background in ocular pathology with Richard Green at the Wilmer Institute and Lorenz Zimmerman at the Armed Forces Institute of Pathology, and since 1978 has been in charge of an independent oncology unit at the Wills Eye Hospital, Philadelphia, where thousands of patients with intraocular tumors have been seen and treated. A short chapter is devoted to diagnostic methods, including the three-mirror contact lens, indirect ophthalmoscopy, wide angle fundus photography, fluorescein angiography, A- and B-scan ultrasonography, the 32P uptake test, computed tomography scanning, and intraocular biopsy. These tests are profusely illustrated

Diagnosis and Management of Intraocular Tumors

Diagnosis and Management of Intraocular Tumors

Bibliotheca Ophthalmologica No. 75, Modern Problems of Ophthalmology, vol 7, Treatment of Intraocular Tumors and Progress in Chorioretinal Surgery.

At the fifth meeting of the Jules Gonin Club held in Munich in August 1966, consideration was given to the twin topics of current techniques in the management of intraocular tumors and methods to avoid excessive surgery in the repair of retinal detachment. This volume contains in succinct form the various papers delivered at that meeting in English, German, or French, with brief resumes in English following each paper. In the first portion of the book, interest in current methods of treatment of malignant tumors of the posterior segment is stimulated by enthusiastic reports regarding therapy with light coagulation or radioactive discs. Francois reported that 26 patients with choroidal melanomas in the early stages were cured of the tumor by light coagulation, while Stallard stated that 83 of 107 patients showed postirradiation recession of the tumor following application of a radioactive cobalt disc. The success rate, as one would expect,

Experimental Evaluation of Hematoporphyrin in the Detection and Management of Intraocular Tumors

Experimental Evaluation of Hematoporphyrin in the Detection and Management of Intraocular Tumors

Intraocular Growths in Children

Three cases here reported illustrate the difficulty and importance of the diagnosis and management of intraocular tumors in children. In one a retinoblastoma (socalled glioma) was excised and the child remained alive and well two and one-half years later. In the second case a malignant growth was simulated by an anomalous condition, probably benign. In the third the sequels of an attack of probable meningitis were encountered. Read before the Pacific Coast Oto-Ophthalmological Society, April, 1926. Three cases here reported illustrate the difficulty and importance of the diagnosis and management of intraocular tumors in children. In one a retinoblastoma (socalled glioma) was excised and the child remained alive and well two and one-half years later. In the second case a malignant growth was simulated by an anomalous condition, probably benign. In the third the sequels of an attack of probable meningitis were encountered. Read before the Pacific Coast Oto-Ophthalmological Society, April, 1926.