Carmela Grazia Caputo

BRACHYTHERAPY ALONE or with NEOADJUVANT PHOTODYNAMIC THERAPY for AMELANOTIC CHOROIDAL MELANOMA: Functional Outcomes and Local Tumor Control

Purpose: To compare visual outcomes and local tumor control between two groups of patients with amelanotic choroidal melanoma treated with brachytherapy alone, or neoadjuvant photodynamic therapy before brachytherapy. Methods: Patients diagnosed with amelanotic choroidal melanoma were recruited for the study and divided into two groups: brachytherapy alone (Group A) and photodynamic therapy preceding brachytherapy (Group B). Patients of both groups were selected to be comparable. Results: Twenty-six patients with amelanotic choroidal melanoma were enrolled in the study. Within Group B, 1 month after photodynamic therapy, ultrasonography showed reduction of tumor height in 11 patients (73.4%). The mean doses of irradiation to macula and optic nerve, at baseline were 74.37 and 52.07 Gy, whereas after photodynamic therapy there was a decrease of 17.26% (P = 0.008) and 21.22% (P = 0.025), respectively. In terms of visual acuity, a mean decrease of 14 ETDRS letters and 5 ETDRS letters was observed at 24 months follow-up, in Groups A and B, respectively (P = 0.001). Conclusion: Photodynamic therapy as neoadjuvant therapy before brachytherapy reduces tumor thickness in 73.4% of cases. As a result, a decrease of radiation toxic effects on visual function could be obtained, without compromising disease control.

Bovine pericardium for scleral closure in transscleral local resection of choroidal melanoma

Bovine Pericardium for Scleral Closure in Transscleral Local Resection of Choroidal Melanoma The current treatment of uveal melanoma aims to conserve the eye as well as useful vision. Conservative therapy includes brachytherapy, charged particle teletherapy, stereotactic radiotherapy, transpupillary thermotherapy, and transscleral local resection. Despite technical advances, local resection of posterior uveal melanoma (choroidectomy and cyclochoroidectomy) remains a challenging procedure, and therefore, it is indicated only in selected cases. Transscleral local resection should be performed for tumors whose larger basal diameter is less than 16 mm and whose thickness exceeds 8 to 9 mm; because in these cases, the incidence of complications related to radiotherapy increases and consequently the chances of conserving vision are reduced.1 Local resection, if performed in selected cases and by an experienced team, has been shown to obtain excellent results in terms of local tumor control and in preserving a good visual function.2,3 Retinal detachment is one of the main complications of this surgical procedure. Its main cause are retinal tears, which are most likely to occur if the tumor is adherent to the retina.4 When a retinal tear occurs, immediate vitreoretinal surgery, performed soon after the removal of the tumor, usually prevents postoperative retinal detachment.4 In addition, the ripping of the scleral flap constitutes a further complication of transscleral local resection. It mainly occurs when the site of a rectus muscle insertion is involved in the dissection because of thinner scleral tissue. In this study, we present our experience of using bovine pericardium patches allografts to strengthen globe stability, repairing possible iatrogenic defects in the scleral flap, and to assist immediate vitrectomy, thus avoiding fluid leakage at the margins of the sutured scleral flap.

INTERACTS (INTErventional Radiotherapy ACtive Teaching School) guidelines for quality assurance in choroidal melanoma interventional radiotherapy (brachytherapy) procedures

Eye plaque brachytherapy represents a safe and effective therapeutic approach for choroidal melanoma, combining clinical outcomes with an eye and visual preservation. As it represents a complex procedure, a specific quality assurance program is strongly suggested to improve patients and operators safety, and to reduce possible complications linked to surgical procedure and radiation exposure. The aim of this paper is to describe the INTERACTS (Interventional Radiotherapy Active Teaching School) guidelines for quality assurance in choroidal melanoma interventional radiotherapy (brachytherapy) used in our institution.

Secondary Orbital and Intraocular Lymphoma Treated With Immunochemotherapy

PURPOSE To assess ocular and orbital structure by ocular echography and magnetic resonance imaging, fluoroangiography, indocyanine green angiography, and optical coherence tomography before and after therapy with rituximab (Mabthera) and chlorambucil in a patient with concurrent intraorbital and intraocular lymphoma and diplopia. METHODS A 69-year-old man referred blurred vision and proptosis in his left eye associated with diplopia. Best-corrected visual acuity was 0.3 logarithm of the minimum angle of resolution in the left eye and 0.02 logarithm of the minimum angle of resolution in the right eye. Ocular echography and magnetic resonance imaging revealed the presence of concurrent orbital and intraocular tumor, and a B-cell lymphocytic lymphoma was diagnosed by incisional biopsy. The patient was treated with the oral alkylating agent chlorambucil and with intravenous infusions of the monoclonal anti-CD20 antibody rituximab (Mabthera) and evaluated with visual acuity, echography, fluoroangiography, indocyanine green angiography, and magnetic resonance imaging. RESULTS After combined immunochemotherapy with rituximab/chlorambucil, the patient showed in the left eye a significant improvement of visual acuity (0.1 logarithm of the minimum angle of resolution) and a disappearance of diplopia at the end of follow-up. CONCLUSION In this case report, combined systemic therapy with chlorambucil and rituximab was effective to reduce and control orbital and intraocular lymphoma.

Photodynamic Therapy in Ocular Oncology

Although introduced for the treatment of maculopathies, photodynamic therapy (PDT) is now largely used in some eye cancers treatment. The selective tissue damage with PDT is achieved by sequestration of the photosensitizer in the target tissue and focal activation of the photosensitizer by low energy directed light. In this way, it is possible to achieve the destruction of the tumor tissue by safeguarding the surrounding healthy structures. Our study describes the clinical uses and efficacy of photodynamic therapy in ocular oncology.