Line Chamot

Cobalt-60 Treatment of Choroidal Hemangiomas

PURPOSE We investigated the therapeutic possibilities of gamma brachytherapy to improve the final functional results of eyes with choroidal hemangiomas, which are benign vascular tumors that can induce progressive impairment of visual acuity. METHODS We treated 41 patients with choroidal hemangioma with cobalt-60 applicators. The lesions consisted of 39 circumscribed hemangiomas and two diffuse hemangiomas in patients with Sturge-Weber syndrome. Before treatment, visual acuity in the affected eye was 20/200 in ten patients, 20/200 to 20/50 in 17 patients, 20/40 to 20/25 in 11 patients, and 20/20 in three patients. All patients were symptomatic. The macula was infiltrated by the tumor in 12 eyes (29.3%). There was retinal detachment in 40 eyes (97.6%), cystoid edema in ten eyes (24.4%), subretinal fibrosis in eight eyes (19.5%), and areolar atrophy in two eyes (4.9%). RESULTS After treatment, the retina was reattached in all eyes, and the tumor progressively transformed into a flat scar. The postirradiation macular lesions that we identified were pigment migrations in the macular region, subretinal fibrosis, and an areolar atrophic scar. We correlated the functional results at two, five, and ten years after treatment with the initial visual acuity, and with pre-existing and posttreatment macular lesions. CONCLUSIONS Our results suggest that radiotherapy is a valuable therapeutic modality for choroidal hemangiomas, particularly in hemangiomas that involve the macula, and for tumors associated with bullous retinal detachment.

Proton beam irradiation of choroidal hemangiomas

PURPOSE To present a large series of choroidal hemangiomas treated with proton beam irradiation and to describe the treatment outcomes. METHODS We treated 54 eyes of 53 patients with choroidal hemangioma. The lesions consisted of 48 circumscribed hemangiomas and six diffuse hemangiomas in patients with Sturge-Weber syndrome. The total applied dose was 27.3 Gy in four eyes, 22.7 Gy in three eyes, and 16.4 Gy to 18.2 Gy in 47 eyes. RESULTS The retina reattached within six months after treatment in all 54 eyes and no recurrence of the secondary retinal detachment occurred within the follow-up period of 6 months to 9 years. Tumors treated with the higher doses regressed faster than tumors treated with the lower doses, but radiation-induced complications of the optic nerve appeared in all four eyes treated with a total dose of 27.3 Gy. Of 31 eyes treated with 16.4 to 18.2 Gy and followed for more than 1 year, 22 had an improvement in their visual acuity, and nine retained the same visual acuity. At the last follow-up examination, the best-corrected visual acuity was 20/20 or better in nine eyes, 20/40 to 20/25 in 13 eyes, 20/100 to 20/50 in six eyes, and 20/200 or less in three eyes. CONCLUSIONS Proton beam irradiation of choroidal hemangiomas appears to be a valid therapeutic alternative. A total proton dose ranging from 16.4 to 18.2 Gy applied in four daily fractions seems adequate to ensure local control of both tumor and secondary retinal detachment.

Fundus Changes Associated With Congenital Hypertrophy of the Retinal Pigment Epithelium

The clinical characteristics and follow-up changes of 64 patients with solitary congenital hypertrophy of the retinal pigment epithelium were studied. Thirty-five of the patients were followed up for one to 14 years with serial fundus photography. Progressive increase of the hypopigmented part of the lesion was observed in 29 of the 35 patients who were followed up (82.8%). An enlargement of the lesion was seen in 26 of the 35 patients (74.3%). Two additional changes, that is, pigmented areas adjacent to congenital hypertrophy of the retinal pigment epithelium and linear streaks of the pigment epithelium, were documented. Pathogenetic mechanisms for the development of these changes remain unknown.

Systemic Melanoma Metastatic to the Retina and Vitreous

Purpose: Report of a case of retinal and vitreous metastases of a systemic melanoma, possibly arising in the lung, that responded favourably to radiotherapy. Case Report: Retinal and vitreous metastases were demonstrated in a 57-year-old woman during routine follow-up after surgical resection of a melanoma presumed to be a primary pulmonary melanoma. After a 7-week observation period, which confirmed the progressive nature of the intra-ocular lesions, the patient was treated by external beam radiotherapy at a dose of 35 Gy delivered in 14 fractions of 2.5 Gy. Complete disappearance of the vitreous invasion and progressive elimination of the retinal invasion were observed over a period of 9 months. Final visual function was 20/25. Review of Published Cases: A review of the literature identified 28 cases of melanoma with metastases to the retina and vitreous. In almost all of these cases, the primary tumour was a cutaneous melanoma and the mean patient survival following the diagnosis of intra-ocular metastases was 22 months. Retinal metastases, as in the case reported here, present a vascular tropism and tend to develop around veins. These metastases are generally unilateral and may be either solitary or multiple. Tumour invasion of the vitreous occurred by means of isolated cells forming a suspension of aggregates or spherules. Vitreous haemorrhage and irreducible neovascular glaucoma leading to functional impairment, which requires enucleation, were both the most frequent and the most serious complications of these metastases. Treatment is always palliative and is effective in cases with limited retinal and vitreous invasion, as in the case reported here. Conclusions: Metastatic melanoma in the retina and vitreous is a rare entity and can lead to functional impairment and enucleation because of neovascular glaucoma. As treatment is only effective in cases with limited invasion, systematic screening is recommended in all patients with a metastatic cutaneous melanoma presenting with suggestive ocular symptoms.

Spontaneous regression of an isolated retinal astrocytic hamartoma.

An 11-year-old girl was referred to our department in January 1994 with mild metamorphopsia of the left eye. Visual acuity measured with a standard Snellen chart was 20/20 in each eye. The right eye appeared normal, while examination of the left eye revealed a normal anterior segment and a solitary yellowish-white, moderately elevated intraretinal lesion in the papillomacular area. The mass obscured the underlying retinal details. Hard exudates and subretinal fluid were noted along the margins of the lesion. Radial chorioretinal folds due to the subretinal fluid accumulation were also present (Figure 1). Fluorescein angiography revealed a multitude of tortuous and telangiectatic tumor vessels with rapid filling in the early phase and hyperfluorescence in the late phase (Figure 1). On B-scan ultrasonography, the mass measured 0.9 mm in thickness and was acoustically solid with no distinct foci of calcification. Neurologic examination and skull and chest computed tomographic scans were normal. No intracranial or cutaneous lesions were observed. Periodic observation without treatment was decided upon. Nine months later, partial regression in size of the retinal mass, leaving a slightly depigmented area of retinal pigment epithelium, was observed (Figure 2). Fluorescein angiography demonstrated decreased vascularization of the lesion and less intense staining (Figure 2). On B-scan ultrasonography, the thickness of the mass was unchanged (0.9 mm). Fundus examination and fluorescein angiography performed on the most recent examination, in January 2003, revealed discrete atrophy of the lesion, which now showed less distinct margins (Figure 3). Visual acuity remained stable (20/20) in both eyes. No defect in the visual field was observed and the metamorphopsia had disappeared. On B-scan ultrasonography, the mass had decreased to 0.6 mm in thickness. Discussion

Conjunctival intraepithelial neoplasia in a patient treated with tacrolimus after liver transplantation.

Purpose: To report a case of conjunctival intraepithelial neoplasia in a patient treated with tacrolimus after liver transplantation for hepatic carcinoma. Methods: Description of the initial clinical presentation of a patient, tumor management, and 15-month follow-up. Results: A 70-year-old man presented with a conjunctival intraepithelial neoplasia that developed on the site of a preexisting pterygium. After total surgical removal and additional application of mitomycin, local tumor control was achieved. Conclusions: We describe a case of intraepithelial conjunctival neoplasia in a patient treated with systemic tacrolimus. Local tumor control was achieved at 15 months after appropriate surgical management.

Collective of patients with conjunctival melanoma treated at the Jules Gonin Eye Hospital (Lausanne)

Purpose Since 1985, a new therapeutic strategy for the conservative treatment of conjunctival melanoma has been developed at the Jules Gonin Eye Hospital (Lausanne). In order to evaluate its long-term results, we had to identify and classify our patients. Methods We looked retrospectively in our clinical and histopathological databases for all cases of conjunctival melanoma treated in Lausanne since 1985. Results 189 patients were identified. We studied patients’ parameters, clinical presentation and histopathological characteristics of all consecutive conjunctival melanoma cases. Conclusion A database of 189 conjunctival melanoma patients treated with the same therapeutic strategy since 1985 was established. This collective will allow for further studies with regard to the long-term results of the Lausanne conservative therapeutic strategy of this rare ocular tumour.