Search

Introduction: Proton beam therapy has been utilised for the treatment of uveal melanoma in the UK for over 30 years, undertaken under a single centre. In the UK, all ocular tumours are treated at one of four centres. We aimed to understand the variation in referral patterns to the UK proton service, capturing all uveal melanoma patients treated with this modality. Methods: Retrospective analysis of data regarding all patients treated at the Clatterbridge Proton service between January 2004 and December 2014. Results: A total of 1084 patients with uveal melanoma were treated. The mean age was 57 years (range 9–90 years), basal diameter of 11.5 mm (range 2.0–23.4 mm) and tumour thickness of 3.9 mm (range 0.1–15.4 mm). The majority were TNM stage I (39%) or II (36%). The distance to the optic nerve varied from 0 to 24.5 mm with 148 (14%) of patients having ciliary body involvement. There were variations in the phenotypic characteristic of the tumours treated with protons from different centres, with London referring predominantly small tumours at the posterior pole, Glasgow referring large tumours often at the ciliary body and Liverpool sending a mix of these groups. Discussion: In the UK, common indications for the use of proton treatment in uveal melanoma include small tumours in the posterior pole poorly accessible for plaque treatment (adjacent to the disc), tumours at the posterior pole affecting the fovea and large anterior tumours traditionally too large for brachytherapy. This is the first UK-wide audit enabling the capture of all patients treated at the single proton centre.

Background/aims: Optic nerve sheath fenestration (ONSF) is a surgical intervention in the management of idiopathic intracranial hypertension (IIH) infrequently performed in the United Kingdom. Numerous surgical approaches have been described, including medial transconjunctival, lateral and endoscopic. We describe our outcomes and complications from ONSF via a supero-medial eyelid skin crease incision in patients with IIH. Methods: We performed a retrospective review of consecutive patients undergoing ONSF for IIH between January 2011 and December 2017 by a single surgeon. Results: Thirty patients were included in the analysis with a median follow-up of 14.5 months. Bilateral ONSFs were undertaken in 27 (90%). The data from one eye per patient were analysed. The mean kinetic perimetry score in mean radial degrees of the I4e isopter improved from 27.3° to 35.7°, p= 0.04. After removing cases with optic atrophy, the median modified Frisén grade of papilloedema improved from 2.5 to 1.0, p= 0.007. A total of 5/30 (17%) patients had complications: two (7%) had recurrence/late failure (one managed medically and one with cerebrospinal fluid [CSF] diversion surgery), one had transient cotton wool spots post-operatively, one had transient retinal haemorrhages and one patient had a transiently oval pupil. No patients had repeat ONSF, but CSF diversion surgery was subsequently carried out in 4/30 (13%) patients. Conclusions: ONSF via a supero-medial eyelid skin crease approach is effective at improving visual function in patients with IIH. The complication rates are low when compared with CSF diversion surgery and other surgical approaches for ONSF.

Purpose: To determine the safety and effectiveness of orbital decompression for thyroid eye disease (TED) in our unit. To put this in the context of previously published literature. Patients and methods: A retrospective case review of all patients undergoing orbital decompression for TED under the care of one orbital surgeon (SMS) between January 2009 and December 2015. A systematic literature review of orbital decompression for TED. Results: Within the reviewed period, 93 orbits of 55 patients underwent decompression surgery for TED. There were 61 lateral (single) wall decompressions, 17 medial one-and-a-half wall, 11 two-and-a-half wall, 2 balanced two wall, and 2 orbital fat only decompressions. For the lateral (single) wall decompressions, mean reduction in exophthalmometry (95% confidence interval (CI) was 4.2 mm (3.7–4.8), for the medial one-and-a-half walls it was 2.9 mm (2.1–3.7), and for the two-and-a-half walls it was 7.6 mm (5.8–9.4). The most common complications were temporary postoperative numbness (29% of lateral decompressions, 17% of other bony decompressions, OR 0.50, 95% CI 0.12–2.11) and new postoperative diplopia (9% of lateral decompressions, 39% of other bony decompressions, OR 6.8, 95% CI 1. 5–30.9). Systematic literature searching showed reduction in exophthalmometry for lateral wall surgery of 3.6–4.8 mm, with new diplopia 0–38% and postoperative numbness 12–50%. For other bony decompressions, reduction in exophthalmometry was 2.5–8.0 mm with new diplopia 0–45% and postoperative numbness up to 52%. Conclusion: Differing approaches to orbital decompression exist. If the correct type of surgery is chosen, then safe, adequate surgical outcomes can be achieved.

PurposeTo share our initial experience in the use of intralesional interferon alpha-2a at primary presentation in ocular surface tumours as a method of immunoreduction prior to definitive surgical management.MethodsCase series of patients referred to Sheffield Ocular Oncology Service with rapidly growing ocular surface tumours, treated with intralesional interferon alpha-2a at first presentation prior to definitive surgical management.ResultsAll three patients, two with conjunctival melanoma and one with ocular surface squamous neoplasia (OSSN) demonstrated immunoreduction of tumour without any adverse side effects.ConclusionsInterferon alpha-2a is effective in conjunctival melanoma and OSSN. Intralesional interferon at first presentation may be used for immunoreduction prior to definitive surgical management. This may improve surgical and long-term outcomes, improve patient experience, and help meet cancer treatment targets.