A D Singh

Efficacy of photodynamic therapy in circumscribed choroidal haemangioma

AbstractPurpose To report efficacy of photodynamic therapy (PDT) in the treatment of three cases of juxtafoveal circumscribed choroidal haemangioma.Methods Data on three patients (two primary, and one failed TTT) treated with verteporfin, 6 mg/m2 given as i.v. infusion over 10 min. Diode laser (690 nm) with an intensity of 600 mW/cm2 for 83 s (50 mJ/cm2) was applied 5 min after completion of infusion. Overlapping multiple spots (2500 μm) were applied to cover the entire surface of the tumour. The mean pretreatment tumour size was 7 mm (base) × 2.2 (thickness) mm. Periodic follow-up with ophthalmoscopy, ultrasonography, and angiographic studies was performed.Results All three cases showed complete regression of the tumour with resolution of subretinal fluid, flattening of tumour, and absence of choroidal vasculature on ICG. The visual acuity either improved or remained stable in all three cases. The overlying retinal vessels remained unaffected. There were no ocular or systemic complications.Conclusions PDT is an effective treatment for management of juxtafoveal circumscribed choroidal haemangioma.

Proton beam therapy for iris melanoma: a review of 15 cases

AimTo report results of proton beam therapy for iris melanoma.MethodsA retrospective case series of 15 patients with nonresectable iris melanomas treated with proton beam therapy between August 1998 and August 2004. The main outcome measures were (1) local tumour control, (2) complications, and (3) eye retention.ResultsOf the 15 cases, 11 patients showed documented growth (including two cases of local recurrence following iridocyclectomy) while a further three cases were biopsy-proven melanoma. One patient presented with a newly acquired vascular nodule of the iris associated with angle seeding and glaucoma. Tumour control at mean follow-up of 34 months was 93% (14 of 15 eyes). Common complications included glaucoma in 53% (five patients had glaucoma prior to irradiation), dry eye (27%) and cataract in three patients (20%). Eye retention was possible in 80% (12 cases).ConclusionProton beam therapy is an effective treatment for cases of nonresectable iris melanoma. The major complications are cataract and glaucoma.

Photodynamic therapy of choroidal haemangioma associated with Sturge-Weber syndrome.

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Choroidal neovascularization secondary to choroidal osteoma: successful treatment with photodynamic therapy

Choroidal neovascularization secondary to choroidal osteoma: successful treatment with photodynamic therapy

Extrascleral extension of choroidal malignant melanoma following transpupillary thermotherapy

retinal detachment of both eyes is a rare finding. An annual incidence of 0.35 patients with bilateral simultaneous retinal detachment per 100 000 populations was estimated recently in Norway. These patients were significantly younger. They are usually myopic with multiple round retinal holes. Unilateral and bilateral retinal or vitreous haemorrhages are common features secondary to subarachnoid haemorrhage. They occur in 3–5% of cases of subarachnoid haemorrhages and usually come to the attention of an ophthalmologist during recovery after the patient regains consciousness. Any patient presenting with retinal or vitreous haemorrhages associated with neurological symptoms such as headache, nausea, or altered consciousness should be investigated to exclude intracranial haemorrhages; however, bilateral vitreous haemorrhages and headache are not pathognomonic of Terson’s syndrome. A non-diabetic vitreous haemorrhage most frequently arises as a result of vitreous separation. Our case demonstrates the importance of careful inspection as vitreous haemorrhage clears together with ultrasound B-scan to exclude rhegmatogenous retinal detachment even when the cause of vitreous haemorrhage is not considered to be related to vitreous separation.

Iris neovascularization in children as a manifestation of underlying medulloepithelioma.

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

Bovine pericardium (Tutopatch) wrap for hydroxyapatite implants

PurposeTo evaluate bovine pericardium (Tutopatch®) as a wrapping material for hydroxyapatite implants in patients undergoing enucleation for uveal melanoma.MethodProspective cohort study of patients who had enucleation for uveal melanoma between January 2003 and August 2003 were included in the study. Any patient with less than 3 months follow-up was excluded. Enucleation was performed under general anaesthesia followed by insertion of hydroxyapatite implants wrapped in bovine pericardium (Tutopatch). The recti muscles were sutured directly to the wrap. The tenons capsule and conjunctiva were closed in two layers. A conformer was inserted at 1 week and artificial eye at 2–3 months. The patients were followed up regularly and were assessed for cosmetic result, exposure of implant, and the need for any further surgical procedures.ResultsA total of 19 patients (seven male and 12 female) were included in the study. Median age at diagnosis was 63 years (range 38–80 years). Median follow-up was 26 months (range 22–30 months). No patient developed postoperative complications of wound dehiscence. The overall cosmetic result was excellent in all the patients. The rate of postoperative complications compared favourably with published data using other wrapping materials/implants.ConclusionTutopatch® is a safe wrapping material for hydroxyapatite orbital implants in patients undergoing enucleation for uveal melanoma.

Ciliary body naevus.

Purpose To describe clinical, ultrasound biomicroscopy (UBM), and histopathologic characteristics of benign melanocytic tumors of the ciliary body.DesignConsecutive case series.MethodsSix patients with a pigmented ciliary body tumour underwent complete ophthalmic examination and UBM, with histopathologic examination carried out on three cases.ResultsSix patients presented with a pigmented iridociliary mass, with central displacement of iris root. UBM revealed a stromal mass arising in pars plicata and/or pars plana in all six with a cyst in three cases (intrinsic=1 and extrinsic=2). Iridocyclectomy was performed because of documented growth in three cases, and all three cases proved to be ciliary body spindle-cell naevus. The other three patients have remained stable.ConclusionsOn clinical basis and with available ancillary studies, ciliary body naevi cannot be reliably differentiated from ciliary body melanocytoma and ciliary body melanoma. Even with clinically documented growth, the lesions may prove to be ciliary body naevi.

Neoadjuvant topical mitomycin C chemotherapy for conjunctival and corneal intraepithelial neoplasia

Neoadjuvant topical mitomycin C chemotherapy for conjunctival and corneal intraepithelial neoplasia

Combined enucleation and orbitotomy for choroidal melanoma with orbital extension

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