Erik Kock

Conjunctival malignant melanoma in Sweden 1969-91.

Abstract. Clinical information, follow‐up and histopathological parameters of the primary lesions were assessed for all (45) individuals with conjunctival malignant melanomas in Sweden presenting during a 22.5 year period (1969 to mid 1991). The annual incidence of conjunctival malignant melanoma in Sweden was 0.0240 per 100 000. On average, two new cases were diagnosed each year (population 8.6 million in 1991). Sixty‐two per cent of the lesions recurred, but re‐growth in itself was not correlated to reduced survival. The actuarial 10‐year survival proportion using life‐table analysis was 70%. A significantly reduced survival due to tumour‐related death was noted in patients with tumours with high mitotic indices, many epitheloid cells and in lesions exceeding 10 mm in diameter. Other factors that may influence survival are presented in the context of previous reports. The present policy in Sweden for treating patients with malignant melanoma of the conjunctiva is outlined and discussed.

Psychological reactions and quality of life in patients with posterior uveal melanoma treated with ruthenium plaque therapy or enucleation: a one year follow-up study.

Purpose To investigate psychological reactions and quality of life among patients with posterior uveal melanoma.Methods Consecutive patients with uveal malignant melanoma (99/106), referred to st Eriks Eye Hospital 1995–1996, treated with rutheniuim plaque radiotherapy (n = 50) or enucleation (n = 49), were included in this non-randomised prospective comparative study. Questionnaires were completed before treatment (Hospital Anxiety and Depression Scale, HAD scale) and 2 and 12 months after diagnosis including the HAD scale, the Impact of Event Scale and the EORTC QLQ-C30. A disease-specific questionnaire was included 12 months after diagnosis. Between-group differences were analysed by chi-square, Students t-test and ANOVA.Results A majority of the patients reported reduced ‘Quality of Life’ (72–85%), ‘Emotional functioning’ (60–74%) and ‘Cognitive functioning’ (51–61%). ‘Fatigue’ was the most frequently reported symptom (61–72%) followed by ‘Insomnia’ (43–58%). Anxiety and depressive symptoms were relatively frequent up to 1 year after treatment, but the levels of anxiety decreased during the first year after treatment. Disease and treatment-related problems were reported in both treatment groups 1 year after diagnosis. Enucleated patients had more problems with appearance and judging distances, whereas those treated with radiotherapy reported vision impairment to a higher extent.Conclusion Enucleated patients reported high levels of emotional distress, problems with appearance and judging distances during the first year after treatment. Patients treated with radiotherapy reported similar levels of quality of life and emotional problems, but more problems with visual impairment. These differences in impact on disease-related functioning should be taken into account when treatment options are discussed.

Experimental fibroplasia in the rabbit vitreous

Fibroblasts were cultured from autologous dermal connective tissue of albino rabbits and implanted (1×106–3×106 cells) into the vitreous space of 18 rabbit eyes under sterile surgical conditions. In 13 eyes a distinct growth of the cells occurred, and vitreous strands were formed. In 9 eyes a retinal detachment followed, and in some it was associated with traction of optic nerve tissue into the vitreous. The proliferating fibroblasts produced collagen fibrils showing a band period of 45–55 nm. Intravitreal collagen formation is considered to be a pathologic phenomenon capable of inducing the development of vitreous retraction and retinal detachment. Züchtung von Fibroblasten aus dem Bindegewebe der Kaninchenhaut in Zellkulturen. Autologe Fibroblasten (1×106–3×106 Zellen) wurden unter sterilen Bedingungen in den Glaskörperraum der 18 Kaninchenaugen eingespritzt. In 13 Augen konnte eine deutliche Proliferation der Fibroblasten beobachtet werden, nach deren Entwicklung sich feinfädige Glaskörperverdichtungen bildeten. Eine Netzhautablösung folgte in 9 Augen, bisweilen durch eine Traktion des Nervus opticus in den Glaskörperraum kompliziert. Die proliferierenden Fibroblasten produzierten kollagene Fibrillen mit periodischen Querstreifen von 45–55 nm. Die Bildung von Kollagen im Glaskörper ist ein pathologisches Phänomen, das zur Entwicklung einer Glaskörperschrumpfung und Netzhautablösung führen kann.

Experimental Epiretinal Membranes Induced by Intravitreal Carbon Particles

We injected 20-nm carbon particles into the vitreous of 14 young rabbits that were killed eight to ten weeks later. Histologic examination showed partial posterior vitreous detachments, epiretinal cellular proliferation, and membranes in all eyes and retinal detachments in five eyes. Electron microscopy disclosed that the epiretinal membranes were formed mainly by Müller cell expansions, astrocytes, and macrophages. Müller cells penetrated the internal limiting membrane and removed carbon particles from the vitreous by endocytosis. The experiments indicated that gaps are produced in the internal limiting membrane by glial cells and macrophages that invade the vitreous in an attempt to remove foreign material. The experimental epiretinal membranes resembled idiopathic preretinal gliosis or macular pucker.

Prevalence of primary acquired melanosis and nevi of the conjunctiva and uvea in the dysplastic nevus syndrome. A case-control study.

PURPOSE To investigate whether conjunctival and uveal nevi and primary acquired melanosis are more common in individuals with the dysplastic nevus syndrome than in control subjects derived from the general population. METHODS Power calculations were used to determine the sample size. After invitation, 162 individuals with the dysplastic nevus syndrome and 119 control subjects, matched for sex and age but otherwise randomized from the Stockholm county census file, were entered into the study. All individuals were examined in a masked fashion by the same ophthalmologist, and the presence of conjunctival and uveal melanocytic lesions and the iris color, skin type, and hair color of each individual were recorded. Contingency tables and odds ratios were used for statistical evaluation. RESULTS The proportions of individuals with the dysplastic nevus syndrome featuring primary acquired melanosis of the conjunctiva, or nevi of the iris and choroid were not significantly different from those of control subjects. However, individuals with the dysplastic nevus syndrome appeared to have a more sun-sensitive skin type and a reddish or blond hair color more often than control subjects. CONCLUSION In contrast to previous reports, this study suggests that ocular melanocytic lesions are no more common in individuals with the dysplastic nevus syndrome than in the general population. Therefore, this work does not provide support that periodic ophthalmic surveillance of individuals with the dysplastic nevus syndrome for the purpose of detecting conjunctival or uveal melanomas, or their precursors, is meaningful.

Retinoblastoma in Sweden 1958--1971. A clinical and histopathological study.

This study includes all cases of retinoblastoma reported in Sweden between 1958 and 1971. The incidence of the disease was 1 per 18 000 live births. Only in six cases was there a familial history and five of these cases were bilateral. The tumour was bilateral in 37.5 % of all cases. All cases with unilateral tumour had been treated with enucleation. In the bilateral cases one eye had also been enucleated and the other eye treated by local irradiation therapy. Tumour invasion into choroid was found in 29% and into the optic nerve in 11% of the cases. The mortality was only 4.5%.

The EORTC ophthalmic oncology quality of life questionnaire module (EORTC QLQ-OPT30). Development and pre-testing (Phase I-III).

AbstractAims The research objective was to develop a questionnaire module to be used, in addition to the European Organisation into Research and Treatment of Cancer (EORTC) QLQ-C30, for measurement of quality of life (QL) among patients with uveal melanoma treated with methods such as transpupillary thermotherapy, plaque radiotherapy, proton beam radiotherapy, local resection, and enucleation. The present paper describes the development through Phases I–III.Methods Relevant QL issues were generated from literature search and from interviews with ophthalmologists, nurses, and patients with uveal melanoma representing three major treatment options: enucleation, plaque brachytherapy, and proton beam therapy.Results The provisional module was pretested in 61 patients from Finland, Sweden, and UK. The EORTC QLQ-OPT30 module consists of 26 items for all patients, and four additional items for patients receiving treatments other than enucleation. It measures ocular irritation, vision impairment, headache, worry about recurrent disease, problems with driving, problems with appearance functional problems due to vision impairment, and problems reading.Conclusions Several treatment modalities are available for uveal melanoma. There is limited knowledge of the impact of these treatments on QL in the long and short term. We hope that the OPT30 module together with the EORTC QLQ-C30 core questionnaire can be a useful tool in research.

Intraocular levels of cefuroxime in uninflamed rabbit eyes

Abstract. Intraocular levels of cefuroxime following subconjunctival, intravitreal and combined intravitreal and intravenous administration were determined in uninflamed rabbit eyes. Intraocular levels of the antibiotic were assayed by a biological method. Penetration of cefuroxime into the vitreous following subconjunctival administration was poor. Subconjunctival administration produced higher levels of cefuroxime in the aqueous when compared to parenteral administration alone. Higher levels of cefuroxime were achieved both in the aqueous and in the vitreous after an intravitreal injection. Intravitreal injection of 100 and 1000 μg cefuroxime produced intravitreal levels close to the minimum inhibitory concentration (MIC) for most ocular pathogens up to 24 h after drug administration. Intravenous supplementation did neither enhance the intraocular levels nor did it delay the clearance of the intravitreally injected antibiotic. Mild histopathological changes were seen with equal frequency both in the control and the test eyes and are attributed to the sampling techniques. Electroretinography (ERG) showed no definite changes suggestive of retinal toxicity up to 55 days after intravitreal administration.

Standardized Precision Radiotherapy in Choroidal Metastases

Metastases in the choroid of the eye are frequent in patients with disseminated malignancy. We here report the results using the precision radiotherapy technique described by Schipper et al. to treat 14 of 17 consecutive patients (21 eyes) with symptoms from such metastases. A beam defining collimator was used and a lateral field was given with the treated eye individually fixed. Varying fractionations and doses were used. The biologically effective dose for early effects (BED3) was 47 to 90 Gy and for late effects (BED10) 28 to 59 Gy. In 14 eyes (82%) the metastases regressed completely. The visual acuity was stabilized or improved in all patients and none needed local surgery. Three patients developed signs of radiation retinopathy, but only in one case the visual function was compromised. With this standardized technique no individualized dose planning was needed, the risk of radiation cataract was minimized and a dry eye avoided.

Multiple melanocytic tumours in a case of ocular melanocytosis.

Abstract. A case of ocular melanocytosis with the simultaneous occurrence of a choroidal malignant melanoma, a ciliary body melanocytoma and a surface plaque iris naevus in an 80‐year‐old male Caucasian is reported. Patients with ocular or oculodermal melanocytosis are considered to be at risk for tumour formation and malignant transformation; the multiple melanocytic tumours of the present case support this hypothesis.—