Transpupillary Thermotherapy Research Articles

Estimating Hazard Function and Survival Analysis of Tuberculosis Patients in Erbil city

The study aimed to estimate the effects of prognostic factors on tuberculosis (TB) survival. Two models have been studied (Logistic model and Cox regression models) in survival analysis.
 Kaplan Meier has been applied to estimate the hazard function. The Kaplan Meier curve has been used to show the risks of dyeing of the factors in this study of tuberculosis data set. The data was obtained from Kurdistan Regional Government, Iraq /Ministry of health/General Directorate of Health, Hawler/Chest and Respiratory disease Center, in period 11th January 2015 through 23th November 2019 of all tuberculosis patients followed up by the hospital until 14th April 2020. Kaplan Meier estimator results indicates that in the factor X-ray result TB has the highest value of estimated mean time until death, the Kaplan Meier curves are clearly indicated that the risk of dying increased with the time especially after 15 months. The logistic regression model identifies that (Gender, Chest symptoms, Type of patient, Site of TB, Transpupillary thermotherapy (TTT-outcome)) are the prognostic factors that influence in tuberculosis survival. Moreover, the Cox regression model identifies that (Age group, Gender, Site of TB, TTT-outcome) are the most common factors that have an impact on tuberculosis.
 Logistic regression model was selected to be the best model for our study data of tuberculosis by using the criterions; Akaike Information Criterion (AIC) and Bayesian information criterion (BIC) to comparing two models. It's worth mentioning; the results obtained by utilizing the statistical packages in Mat-lab and SPSS V.25, which was used to analyze our study data.

Optical Coherence Tomography Angiography Microvascular Variations in Pre- and Posttreatment of Retinoblastoma Tumors

Introduction: The purpose of this study is to describe variations in microvasculature before and after treatment of treatment-naive lesions and during consolidation therapy of retinoblastoma lesions using an investigational portable optical coherence tomography angiography (OCTA) system. Methods: This study is a single-center, prospective, observational case series. Recruited subjects were either undergoing surveillance for retinoblastoma or had newly detected retinoblastoma. Nine tumors from 7 eyes in 6 patients were included. During exams under anesthesia, the tumors were imaged with an investigational portable OCTA system. OCTA images were analyzed to assess vascular changes before and after treatment. Results: In all 6 presented cases, OCTA imaging revealed distinctive vascular patterns, such as dilated feeder arteries and draining veins, disorganized and complex branching patterns, irregular vessel calibers, and dilation and tortuosity of vessels. After treatment, OCTA imaging revealed decreased intrinsic tumor vascularity and reduced dilation of draining and feeder vessels. Tumor relapse demonstrated prominent vascularity (n = 1) that resolved on repeat OCTA after transpupillary thermotherapy treatment. Type 2 (n = 1), 3 (n = 6), and 4 (n = 1) tumor regression patterns were seen in our patients after treatment, and OCTA findings were consistent with a previously published report. Interestingly, in one of the presented cases, OCTA demonstrated clear feeder, draining, and intrinsic tumor vessels that were not as evident on fluorescein angiography. Conclusions: OCTA may offer a noninvasive and sensitive technique to evaluate the vasculature of both the tumor and the surrounding retina in retinoblastoma. With additional research and development into its use in patients with retinoblastoma, OCTA may one day be useful in assessing treatment response and residual tumor activity.

Globe salvaging conservative management of Retinoblastoma

Purpose: Retinoblastoma is the most common intraocular tumor of children. Globe salvaging conservative management is gaining popularity with advances in early diagnosis and advent of focal and systemic therapies. Materials and Methods: This study is retrospective noncomparative interventional study at oculoplasty and ocular oncology department of Tilganga Institute of ophthalmology, Nepal in 2017-18. Results: Thirty-five retinoblastoma patients with forty-five affected eyes were treated during the study period. Twelve eyes were salvaged and twenty-six lives were saved though more than sixty five percent of eyes were in group D or E. We could avoid exenteration and minimize enucleation in the study. Conclusion: Globe salvaging management is possible with early diagnosis and multimodal management. Keywords: Eye Neoplasms, Pediatric Cancer, Periocular Chemotherapy, Retinoblastoma, Transpupillary Thermotherapy.

Efficacy and safety of current treatment options for peripheral retinal haemangioblastomas: a systematic review.

Approximately twenty per cent of Von Hippel-Lindau patients with retinal haemangioblastomas (RH) suffer from visual impairment. Various treatment options are available for peripheral RH. However, management of peripheral RH is complex due to multifocality and bilaterality. To summarize published evidence on efficacy and safety of different interventions for peripheral RH and to provide treatment recommendations for specialists. Comprehensive searches were performed using Medline, Embase, Web of Science and Google Scholar database on 4 March 2020. English publications that described outcomes related to efficacy or complications in at least two patients with peripheral RH were included. Efficacy and safety were estimated by complete tumour eradication rate, pretherapeutic and treatment-related complication rate. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to calculate the risk estimate of complications between treatment options. Twenty-seven articles were included in this review describing nine different treatment options for peripheral RH: laser photocoagulation (n = 230), cryotherapy (n = 50), plaque radiotherapy (n = 27), vitreoretinal surgery (n = 88), photodynamic therapy (PDT; n = 14), transpupillary thermotherapy (TTT; n = 10), external beam radiotherapy (n = 3), systemic treatment (n = 7) and intravitreal anti-VEGF (n = 2). Complete tumour eradication was achieved in 86.7% (95% CI: 83.5-89.9%) of all eyes. For the different treatments, this was after laser photocoagulation 89.9% (86.1-93.7%), cryotherapy 70.2% (57.0-83.4%), plaque radiotherapy 96.3% (89.1-100.0%), vitreoretinal surgery (100.0%), PDT 64.3% (38.3-90.3%) and TTT 80.0% (53.8-100.0%). No complete tumour eradication was achieved after systemic therapy, external beam radiotherapy or intravitreal anti-VEGF. Photodynamic therapy and vitreoretinal surgery showed the highest complication rate after treatment compared to the other treatments (OR 10.5 [95% CI: 2.9-38.4]) and (OR 5.9 [95% CI: 3.4-9.9]), respectively. Cases that had pretherapeutic complications showed a higher treatment-related complication rate (OR 14.8 [95% CI: 7.3-30.0]) than cases without complications before treatment. These findings suggest that laser photocoagulation is the safest and most effective treatment method for peripheral RH up to 1.5 mm in diameter. Vitreoretinal surgery has the highest success rate for complete tumour eradication and may be the most suitable treatment option in the presence of pretherapeutic complications and for larger tumours.

Optical Coherence Tomography — Angiography in Revealing Predictors of Small Choroidal Melanoma Transpupillary Thermotherapy Efficiency

Purpose. To reveal predictors of small choroidal melanoma transpupillary thermotherapy efficiency using optical coherence tomography-angiography.Patients and methods. 34 patients with small choroidal melanoma at an average age of 55.0 ± 2.9 years were examined. Optical coherence tomography-angiography was performed on an OCT-Angiography Software for RS-3000 Advance Optical Coherent Tomograph, Nidek, Japan, before and 4 months after 1 session of transpupillary thermotherapy. Transpupillary thermotherapy (TTT) was performed with a Nidec DC 3300 diode laser.Results. Prior to TTT — a loop-shaped, cranked-convoluted with an uneven lumen heterogeneous nature of the vasculature of the tumor with numerous bends and interlacing, located under the vessels of the retina in the central zone; the area of neovascular vasculature is 32.82 mm2, the density is 12.42 %. The limiting avascular zone is on the periphery. Around melanoma is a homogeneous hyperreflective rim of dilated choriocapillaries. 4 months after 1 session of TTT in 24 (70.6 %) of 34 cases — occlusion of the choriocapillaries in the central and peripheral zone of the tumor (avascular regions), expansion of the large and medium vessels of the choroid around the focus — predictors of complete tumor devitalization (chorioretinal scar). In 6 (17.6 %) of 34 patients, occlusion of the choriocapillaries in the central zone, expansion of large and medium vessels of the choroid around the tumor, along its periphery and in the paracentral region, retinochoroidal anastamoses along the periphery and in the paracentral zone, heterogeneous neovascularization of the choriocapillaries around; decrease in the area of vasculature — 12.44 mm2, density — 6.15 %, (p < 0.05) — predictors of partial devitalization of small choroidal melanoma (residual tumor). In 4 (11.8 %) of 34 cases, tumor vessels in the tumor area, large and medium vessels of the choroid around, along its periphery and in the central zone, occlusion of the choriocapillaries in the central zone, retinochoroidal anastamoses in the periphery and in the central zone, heterogeneous neovascularization choriocapillaries around; vascular network area — 29.13 mm2, density — 10.17 %, (p > 0.05), lack of devitalization (continued growth).Conclusion. The introduction of optical coherence tomography-angiography revealed the predictors of the effectiveness of transpupillary thermotherapy of the initial melanoma of the choroid, which are various types of tumor vascularization, indicating its about complete, partial or absence devitalization after treatment.

The role of three-component selective intra-arterial chemotherapy in the failure of standard organ-preserving treatment in children with intraocular retinoblastoma

Introduction. Retinoblastoma (RB) is a malignant tumor of the retina, the survival rate for the intraocular form reaches 99 %. According to the researchers, the risk factors for the occurrence of refractory or recurrent forms of RB are the size of the tumor at primary diagnosis (more than 15 mm), the child's age at the onset of the disease (up to one year), bilateral RB, and the presence of subretinal and vitreal screenings. If methods of local destruction of the tumor are not applicable for the successful treatment of intraocular refractory or recurrent RB, then they resort to the second line of polychemotherapy as an alternative to enucleation. New versions of local chemotherapy and radiation therapy (gamma knife) are being developed and applied. Nowadays, researchers have a negative attitude towards traditional radiation therapy (EBRT) as a method of organ-preserving treatment due to serious consequences (asymmetry of the facial skeleton and second radio-induced tumors).Aim of the study — to increase the effectiveness of organ-preserving treatment in patients with refractory or recurrent intraocular RB.Materials and methods. In the period from 10.2018 to 12.2019 at the N.N. Blokhin National Medical Research Centre of Oncology it was received three-component selective intra-arterial chemotherapy (SIAC) in 15 patients (15 eyes) aged 11 to 52 months. Eyes initially affected by RB (n = 15), according to the IIRC (Murphree) classification, had the following groups: group B in 1 case, group C in 3, group D in 7, and group E in 4 eyes. It should be noted that all patients initially received intensive combined conservative therapy: in 11 (73 %) of 15 cases — systemic chemotherapy VEC; in 13 (86 %) of 15 — SIAC with melphalan, in all cases, additionally, two-component SIAC was used in combination with melphalan with topotecan. In some cases, local therapy in the form of intravitreal chemotherapy (IVIC) was added to the treatment of 6 (40 %) of 15 patients in the form of melphalan monotherapy and in one case (6 %) a doublet was used in combination with melphalan and topotecan. Also, in some patients, additional local ophthalmic therapy was used: transpupillary thermotherapy (TTT) in 6 out of 15 patients, including in combination with cryotherapy (CT) in 1 patient and in combination with brachytherapy (BT) in one case. At the same time, incomplete tumor regression (refractory form of the disease) was noted in 7 out of 15, and a recurrent course of the disease — in 8 out of 15 patients. Incomplete tumor regression and recurrent RB were the reasons for the appointment of a three-component SIAC using carboplatin, melphalan and topotecan, in combination with IVIC with pronounced endophytic growth of RB, as an alternative to irradiation and enucleation of the eye.Results. The average number of three-component SIAC courses was 1.46 ± 0.63 (rang 1—3). The combination of SIAHT with IVHT was performed in 3 out of 15 patients. All children (n = 15) are alive with a median period of follow-up of23.92 ± 15.68 (10—64) months. One in 15 patients was lost from observation due to their parents’ desire to be treated abroad. It is known that the child is alive, but there is no data on the condition of his eyes. 9 out of 14 patients needed additional treatment after SIAC intensification. To consolidate the resulting effect as a full regression in 2 cases, the final IVIC courses were conducted (n = 2). In connection with the presence of residual tumor and/or intraocular progression and/or appearance of new lesions in 1 of 9 patients were IVIC and TTT, 2 of 9 — IVIC, SIAC, CT, TTT. In 4 out of 9 cases, enucleation was performed, and in 2 out of 4 — the operation was performed after continuing the attempt of organ-preserving treatment: after CT and TTT (n = 1) and IVIC, CT, TTT and BT (n = 1). No child was given ERBT. There were no cases of stroke after SIAC. We managed to save 10 (71.4 %) of 14 eyes with visual acuity: object vision in 4 (40 %) out of 10, eye fixation in 3 (30 %) out of 10, and light perception in 3 (30 %) out of 10 cases. The average follow-up period from the end of three-component SIAC in 14 patients was 13.57 ± 5.27 (6—22) months.Conclusion. Thus, the three-component SIAC is effective and safe for patients with refractory and recurrent retinoblastoma, as evidenced by a high percentage of retained eyes and the presence of visual functions from light perception to object vision.

Uveal Melanoma Metastasis to the Contralateral Eye Structures: A Retrospective Comparative Analysis of 13 Consecutive Patients

To report uveal melanoma (UM) metastasis to the contralateral ocular and periocular structures. Retrospective study. Thirteen patients with UM metastasis to the contralateral ocular and periocular structures were included. Clinical records were reviewed retrospectively. The development and time to onset of contralateral ocular and periocular metastasis, systemic metastasis, and death. Of the 13 000 treated UM patients, 13 patients were diagnosed with UM metastasis to the contralateral ocular and periocular structures. Mean patient age at primary UM diagnosis was 60 years (median, 60 years; range, 37-87 years). The primary uveal melanoma was in the choroid (n= 11) or ciliary body (n= 2) and was treated with brachytherapy (n= 11), proton beam radiotherapy (n= 1), or enucleation (n= 1). Systemic metastasis developed in 11 patients (85%) at a mean of 66 months (median, 34 months; range, 12-216 months) after diagnosis of the primary UM. All 11 patients (100%) showed liver metastasis and 8 patients (62%) also showed extrahepatic metastasis. The sites of metastasis to the contralateral ocular or periocular structures included the choroid in 4 patients (31%), the orbit in 7 patients (54%), and the eyelid in 2 patients (15%). One patient with eyelid metastasis demonstrated concurrent conjunctival nodule. Mean time to diagnosis of contralateral ocular or periocular metastasis was 94 months (median, 48 months; range, 9-375 months). Contralateral choroidal metastasis was multifocal in 3 of 4 patients (75%). Of 7 patients with orbital metastasis, 5 showed extraocular muscle involvement with restricted ocular motility. Treatment for contralateral choroidal metastasis included brachytherapy (n= 2), transpupillary thermotherapy (n= 1), and observation (n= 1). Treatment for contralateral periocular (orbit or eyelid) metastasis was excision (n= 5), external beam radiotherapy (n= 2), and observation (n= 2). Of 13 patients, death was documented in 11 patients at a mean of 17 months (median, 9 months; range, 3-54 months) as a result of systemic UM metastasis (n= 10) or unrelated cause (n= 1). Metastasis resulting from UM to the contralateral ocular and periocular structures is rare and generally occurs in patients with disseminated metastasis. Orbital tissue is the most common site of involvement, and these patients have short life expectancy.

Evaluation of the effectiveness of organ preservation treatment of choroidal melanomas by optical coherence tomography findings

To analyze OCT findings in terms of the condition of eye fundus tissues in various outcomes of organ preservation treatment of CM. The study included 20 patients (20 eyes) who underwent the following organ preservation therapy 1 to 374 months prior to enrollment: transpupillary thermotherapy (TTT) - 8 eyes, brachytherapy (BT) - 8 eyes, BT with subsequent TTT - 4 eyes. Mean age of patients at the time of therapy start was 59.25±10.86 (33-81) years. In multi-step therapy (12 eyes), the mean interval between the stages was 28.08±20.39 months. According to echobiometry findings, tumor prominence at the time of therapy start was 3.35±2.08 (1-7.37) mm. At the time of post-treatment OCT scan, there was no prominence in 5 eyes, in other eyes it was 1.26±1.24 (0.4-5.7) mm. Comparison of ophthalmoscopy picture with OCT findings allowed identification of the following changes: a scar and hyperplasia of pigment epithelium in the scar, a scar with reactive pigment hyperplasia at the level of RPE and choroid, radioreaction, growth area from under and inside the scar, incomplete local control, absence of local control. The author's own expertise in evaluating the effectiveness of local choroidal melanoma therapy suggests that optical coherence tomography should be used to monitor all patients being followed up after organ preservation treatment of choroidal melanoma: after transpupillary thermotherapy - for 3 months, after brachytherapy - during first 24 months, and in case of doubts for longer.

Globe-salvaging treatment of amelanotic uveal melanoma with posterior extraocular extension

Introduction: Extraocular extension (EOE) of uveal melanoma is rare and generally associated with poor systemic prognosis. Case Report: We report a patient with amelanotic uveal melanoma with an extraocular extension managed with combination of surgical resection of the posterior extraocular extension along with transpupillary thermotherapy (TTT) to the choroidal lesion, thereby salvaging the globe. To the best of our knowledge, we are the first case to report such combination treatment for amelanotic uveal melanoma with posterior extension without evidence of orbital recurrence or systemic metastasis over a follow-up period of thirteen years. Conclusion: Careful resection of the extraocular tumor component along with aggressive treatment of the primary intraocular tumor may achieve globe salvage in carefully selected cases.

Regression of posterior uveal melanoma following iodine-125 plaque radiotherapy based on pre-treatment tumor apical height.

PurposeThe aim of this study was to analyze regression rates and local control of uveal melanoma patients treated with iodine-125 (125I) brachytherapy based on initial tumor apical height.Material and methodsPatients treated in a single institution from January 1st, 1996 to 2019 with 125I plaques (ROPES and COMS) for uveal melanoma were included in this study. Patients treated with brachytherapy for iris and those treated with transpupillary thermotherapy prior to brachytherapy were excluded. The sample was classified into 4 categories depending on initial apical tumor height (h0), i.e., h0 ≤ 2.5 (small), 2.5 < h0 ≤ 6.25 (small-medium), 6.25 < h0 ≤ 10 (medium-large), and h0 > 10 mm (large). Percentage of original tumor apical height (Δh) was collected during follow-ups. Patterns of regression were evaluated using linear least squares adjustments. Multivariable Cox regression were performed.ResultsIn total, 305 patients met the inclusion criteria, and 27, 166, 100, and 13 were considered for small, small-medium, medium-large, and large categories, respectively. Median follow-up was 82.4, 56.8, 76.1, 89.1, and 100.1 months for the entire cohort and each sub-group, respectively. Pattern of decrease when h0 ≤ 2.5 mm was not detectable. For the rest sub-groups, changes in height could be fitted using functional form: Δh (T) = ae–bT + c, R2 ≥ 0.97. Multivariate Cox analysis factors predictive of local control failure revealed a hazard ratio (HR) of 6.1 (95% CI: 0.7-58.2%, p = 0.05) for patients who remained similar sized after treatment for small-medium tumors. For the rest sub-groups, Cox analysis did not indicate statistical significance in any single variable.ConclusionsHeight changes can be modeled by a negative exponential function for the first 7 years after treatment depending on the initial height, except for those less than 2.5 mm. Non-responding small-medium tumors multiply by 6 the probability of failure in local control.

Evaluation of efficacy of indocyanine green enhanced transpupillary thermotherapy as a single treatment for recurrence of intraocular retinoblastoma

Evaluation of efficacy of indocyanine green enhanced transpupillary thermotherapy as a single treatment for recurrence of intraocular retinoblastoma

Лазерная транспупиллярная термотерапия ограниченных гемангиом хориоидеи

Лазерная транспупиллярная термотерапия ограниченных гемангиом хориоидеи

Identification of the main factors in the 3-D simulation of laser-induced thermal damage in choroidal melanomas

Computational numerical simulation is a valuable tool for studying processes that involve living tissues, since it is not invasive, safer, and cheaper than in vivo experiments. The study of heat transfer within human eyes raises special interest given the numerous existing treatments that involve exposing the eye to external heat sources. Furthermore, there is not much blood flow in most tissues of the eye, which means there is a limited cooling effect and a higher chance of severe thermal damage. Choroidal melanomas are malignant ocular tumors that arise in the choroid, that can be treated by a variety of thermal procedures, among other techniques. Transpupillary thermotherapy (TTT) is one of these treatments, which consists of irradiating the tumor with diode laser, thus heating the tumor within a specific temperature range. In our previous studies, the influence of some parameters on the temperature and thermal damage within the human eye following TTT treatment was studied– the parameters were Vitreous Humor (VH) viscosity, laser output power, and the size of the tumor. Since the data available that are needed for mathematical modeling are scarce and uncertain, the quality of the results was also uncertain. In this study, the main goal was to perform sensitivity analyses to identify which thermal-physical properties significantly influence the results of simulations. A 3-D model of the human eye with a small choroidal melanoma was used. The Navier-Stokes equations were included to consider natural convection inside the VH. A numerical strategy was used to represent tumor shrinkage due to thermal damage. A fractional factorial design of experiments was adopted, and the results were analyzed by building ANOVA (analysis of variance) tables for each case. Our results indicate that the radiation absorption coefficient for the tumor and for the choroid are the only parameters that significantly influence the results among those analyzed ones. This suggests that the uncertainties of most thermophysical properties do not substantially harm the predictions of the simulations. Also, this reinforces that the level of melanin on the tumor should be carefully assessed in order to decide the treatment protocol, since this level is directly related to the absorption coefficient.

Low Dose 125I Brachytherapy And Transpupillary Thermal Therapy (TTT) For Small To Medium Size Choroidal Melanoma

To evaluate our institutional outcomes after treatment of small to medium size choroidal melanoma with low dose COMS brachytherapy. Single center, retrospective review of small to medium size choroidal melanoma < 5 mm in apical height managed from 2005-2019 with 125I brachytherapy at prescribed dose < 80 Gy, using a homogeneous dose calculation methodology. Ocular outcomes included visual acuity, presence of ocular radiation side effects, and local tumor recurrence. The Kaplan-Meier method was used to estimate overall survival, and metastasis rates were reported using cumulative incidence with death as a competing risk. Univariable associations were analyzed using Cox proportional hazards regression. Radiation statistics were calculated using Monte Carlo dosimetry. There were 146 patients included. Patient demographics and presenting tumor features are described in Table 1. Patients were treated with 125I plaque radiotherapy at median dose 65 Gy (IQR: 65-65 Gy) to depth of 5 mm, with additional transpupillary thermotherapy (TTT) at the time of plaque removal in 140 (95.9%) cases. Median follow-up was 6.7 years (IQR: 2.7-9.3 years). At final follow-up, median logMAR visual acuity was 1.1 (IQR: 0.4-2.0) with Snellen acuity 20/15-20/40 (20%), 20/50-20/160 (26%), and 20/200 or worse (54%). Radiation complications were as follows: cystoid macular edema in 54 (38%), radiation maculopathy in 71 (50%), non-proliferative radiation retinopathy in 53 (38%), proliferative radiation retinopathy in 20 (14%), and radiation papillopathy in 53 (38%). There were 11 patients who required subsequent pan-retinal laser photocoagulation (8%). Radiation dose did not appear to impact radiation maculopathy or retinopathy, but radiation papillopathy was significantly associated with point dose, maximum dose, and mean dose to the optic disc (p < 0.05). Local tumor control was achieved in 145 (99.3%) patients with recurrence in 1 (0.7%) patient 6.5 years after plaque. The 5-year cumulative incidence of distant metastasis was 7.2% with 5-year overall survival of 96.2%. Low dose 125I plaque radiotherapy with TTT provided high rates of local tumor control. Radiation maculopathy, retinopathy, and papillopathy were still observed even with reduced radiation apex dose. Future studies are warranted to determine rates of tumor control and ocular toxicity in low dose brachytherapy without TTT.Abstract 3687; TablePatient CharacteristicsMedian age61 years (IQR: 51-68 years)SexFemale 58%ComorbiditiesAtherosclerotic disease 44%Diabetes 18%Hyperlipidemia 45%Hypertension 49%Tumor CharacteristicsMedian logMAR visual acuity0.18 (IQR: 0.0-0.4)Snellen acuity20/15-20/40 68%20/50-20/160 29%20/200 or worse 3%Tumor dimensionsLargest basal diameter (IQR) 8.0 mm (IQR: 6.7-10.0 mm)Thickness (IQR) 2.0 mm (IQR: 2.0-2.0 mm)Secondary retinal detachment18%Subfoveal/subretinal fluid88% Open table in a new tab

Трансформирующий фактор роста TGF-β при различном клиническом течении начальной меланомы хориоидеи до и после органосохранного лечения

«Российская офтальмология онлайн» - электронное информационное издание, создается с 1 марта 2010 года под эгидой Российского общества офтальмологов. Основная задача проекта - научно-информационная поддержка специалистов в области офтальмологии.

Clinical Presentations and Outcomes of Retinoblastoma Patients in relation to the Advent of New Multimodal Treatments: A 12-Year Report from Single Tertiary Referral Institute in Thailand.

Purpose To investigate the clinical presentations and outcomes of retinoblastoma in relation to the advent of new multimodal treatments in Thailand. Patients and Methods. Retrospective case series. We evaluated the clinical presentation, staging, details of treatment, and treatment outcomes of retinoblastoma patients who were treated at Ramathibodi Hospital, Bangkok, Thailand, between January 1, 2007, and December 31, 2018. The log-rank test was used to explore clinical characteristics and treatment modalities that affected globe salvage and survival curves. Results This study included 124 eyes of 81 patients with retinoblastoma. Forty-three patients (53.1%) had bilateral retinoblastoma. The median age at diagnosis was 8 months (range, 1–48 months). Of 124 eyes, 9 eyes (7.3%) had extraocular retinoblastoma and 115 eyes (92.7%) had intraocular retinoblastoma, which were classified by the International Classification of Retinoblastoma (ICRB) as group A, 4 eyes (3.5%); group B, 19 eyes (16.5%); group C, 6 eyes (5.2%); group D, 31 eyes (27%); and group E, 56 eyes (47.8%). Treatment included systemic chemotherapy, intra-arterial chemotherapy, ruthenium-106 plaque brachytherapy, external beam radiation therapy, cryotherapy, transpupillary thermotherapy, subtenon chemotherapy, and intravitreal chemotherapy. At the median follow-up period of 38.4 months (range, 0.2–148.2 months), the overall globe salvage rate of intraocular retinoblastoma was 51.7%. For unilateral retinoblastoma, globe salvage rate was 37.5% (group B, 100%; group C, 100%; group D, 50%; and group E, 18.8%). For bilateral intraocular retinoblastoma, the globe salvage rate was 57.8% (group A, 100 %; group B, 94.4%; group C, 100%; group D, 64.7%; and group E, 28.2%). The overall survival rate was 93.8%. Conclusions Recent advanced treatment modalities have improved the probability of globe salvage. However, enucleation remains an important life-saving intervention in many advanced cases.

Small choroidal melanoma: outcomes following apical height dose brachytherapy

AimTo assess the outcomes of small choroidal melanoma following iodine-125 episcleral brachytherapy (apical height dose of 85 Gy).MethodsPatients with small choroidal melanoma that underwent iodine-125 episcleral brachytherapy between January 2004...

Transpupillary thermotherapy of choroidal melanoma

A retrospective analysis of the immediate and long-term effectiveness of the treatment of the choroidal melanoma using transpupillary thermotherapy (TTT) was carried out. The study included 84 patients with choroidal melanoma (C69.3) who received treatment between 2007 and 2018. Patients were sampled from the Belarusian Cancer Register. The average values of the thickness of the tumor were 2.6±1.3 mm, the diameter of the base - 7.2±3.3 mm. TTT was carried out using a diode laser with a wavelength of 860 nm and radiation power of 200 - 800 mW, the exposure time was 60 s, and the diameter of the laser spot was varied between 1 and 3 mm. The entire surface of the tumor was thermally treated with overlapping fields from the periphery to the top. 75 patients underwent a single session of TTT, while 9 - two sessions with an interval of 3–4 weeks. As a result of the treatment, 51 (60.7%) patients showed complete tumor resorption, 28 (33.3%) patients had stabilization of the tumor process, and 5 (6.0%) patients had no effect. In the group of patients with stabilization of the tumor process, continued growth was recorded in 16 (19.1%) patients with follow-up periods of 3 months to 4 years. In 19 (37.3%) patients from the group with complete tumor regression, relapse was observed 1 to 8 years after TTT. Metastatic disease (disease progression) developed in 5 (5.9%) patients, of which in 1 patient during the first 12 months, in 1 patient - after 4 years, and in 3 patients more than after 5 years of the follow-up observation. Analysis of the effectiveness of TTT of choroidal melanoma showed that an increase in the thickness and diameter of the base of the tumor focus results in the decrease of immediate effectiveness, and the rise of the likelihood of continued tumor growth.

Risk Factors for Tumor Recurrence Following Primary Intravenous Chemotherapy (Chemoreduction) for Retinoblastoma in 869 Eyes of 551 Patients.

To identify risk factors for retinoblastoma recurrence following chemoreduction. This was a retrospective review of patients with retinoblastoma treated from 1994 to 2019 using chemoreduction with analysis for recurrence using Kaplan-Meier, Cox regression, and logistic regression. There were 869 eyes of 551 patients with retinoblastoma treated with chemoreduction. Follow-up in 556 eyes revealed main solid tumor recurrence (n = 355, 64%), subretinal seed recurrence (n = 244, 44%), vitreous seed recurrence (n = 162, 29%), and/or new tumor (n = 118, 21%) requiring management with focal therapy (transpupillary thermotherapy, cryotherapy) (n = 294, 53%), intra-arterial chemotherapy (n = 125, 22%), intravitreal chemotherapy (n = 36, 6%), plaque radiotherapy (n = 120, 22%), external beam radiotherapy (n = 57, 10%), and/or enucleation (n = 49, 9%). Of all recurrences, 62% were detected by 1 year, 86% by 2 years, 94% by 3 years, 98% by 5 years, 99% by 10 years, and 100% by 15 years. Risk factors for recurrence on multivariate analysis included younger patient age at presentation (odds ratio [OR] = 1.02 [1.00 to 1.04] per 1 month decrease, P = .02), greater International Classification of Retinoblastoma group (OR = 1.24 [1.05 to 1.47] per 1 more advanced group, P = .01), shorter tumor distance to optic disc (OR = 1.11 [1.01 to 1.21] per 1 mm decrease, P = .03), and presence of subretinal seeds (OR = 1.66 [1.09 to 2.53], P = .02). Retinoblastoma recurrence after chemoreduction is usually detected within the first 3 years following treatment. Younger patients with more advanced, posteriorly located tumors and subretinal seeds at presentation are at increased risk, but recurrence can often be managed with globe-sparing therapy. [J Pediatr Ophthalmol Strabismus. 2020;57(4):224-234.].

A 20-year audit of retinoblastoma treatment outcomes.

ObjectivesTo evaluate the long-term treatment outcomes in intraocular retinoblastoma (RB) including the associated factors for eventual treatment with external beam radiotherapy (EBRT) and enucleation as well as to analyse the risk factors for metastasis and death in extraocular RB.MethodsRetrospective analysis of 390 eyes from 256 (89.8%) intraocular RB and 29 (10.2%) extraocular RB cases diagnosed and treated between October 1998 and May 2018 at one of the largest tertiary care centers in Turkey.ResultsOf 351 intraocular RB eyes, 53.3% had group D/E disease at presentation. 75 (21.4%) of 351 eyes underwent primary enucleation. Of the remaining 276 eyes undergoing eye-conserving treatments, 201 (72.8%) were salvaged. Most of these eyes were treated using intravenous chemotherapy and/or focal treatments [transpupillary thermotherapy (TTT) and cryotherapy] initially. EBRT was eventually required in 48 (17.4%) eyes and secondary enucleation in 75 (27.2%) eyes. At mean follow-ups of 76.7 and 39.7 months for intraocular and extraocular RB cohorts, respectively, 180 (46.2%) eyes underwent primary/secondary enucleation and exenteration. Overall, 13 cases developed metastasis and 9 died. Two patients with trilateral RB also expired. Multivariable risk factors for enucleation were the presence of vitreous seeds (p < 0.001), absence of EBRT administration (p = 0.033), 5–9 TTT applications compared with no TTT (p = 0.031), and each 1 mm increase in tumour base diameter (p < 0.001). Univariate factors predictive of metastasis were the presence of extraocular RB detected by imaging methods (p < 0.001) and extrascleral/optic nerve cut end involvement at histopathological examination (p < 0.001).ConclusionsIn our series, 72.8% of the intraocular RB eyes undergoing eye-conserving treatments were saved. The globe salvage rate for all intraocular and extraocular RB eyes was 53.8% and the overall survival rate was 96.1%.