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The paper presents clinical and morphological case analysis of primary intraocular malignant medulloepitelioma (medulloblastoma) of rare localization (central part of the retina with optic nerve involvement) that simulated retinoblastoma in a 2-year-old child. Histological features of the tumor are given in details (tubular and mesh structures of the tumor, rosettes, ribbons, cells with hyperchromic nuclei, and cellular polymorphism). An experience of creating a primary intraocular malignant medulloepitelioma cell culture, as yet exclusive in the Russian Federation, is described. Culture sensitivity for particular drugs (oxaliplatin, irinotecan, ifosfamide, and ascorbic acid at different concentrations) was evaluated by MTT-assay. Of the four products, IC50 (3.3 mg/ml) was obtained only for ascorbic acid. Despite the relative rarity of primary intraocular malignant medulloepitelioma, its differential diagnosis should be carried out, with retinoblastoma in mind in the first place. The obtained data on the effectiveness of ascorbic acid against intraocular malignant medulloepitelioma cells can be used to supplement the existing chemotherapeutic protocols in pediatric ocular and neuro-oncology.

Aim: To determine the effectiveness of plaque radiation therapy for anterior uveal melanomas and to evaluate the risk and frequency of complications at different time intervals after the treatment., Material and Methods: During 2010-2013 a total of 30 patients (10 male, 20 female) aged 11-73 (50 years on the average) with iris or iridociliary melanomas were treated with Ru-106 and Sr-90 ophthalmic plaques. In 8 patients the brachytherapy was preceded by local tumor excision. Morphological diagnosis was verified in 10 patients (8 iridectomies, 2 enucleations), of them 8 cases turned out to be spindle cell melanomas and the other 2--mixed cell melanomas. Follow-up period ranged from 1 to 54 months with the median of 13,5 months., Results: Tumor regression was achieved in all cases. Enucleation had to be performed in 2 patients due to cornea and sclera necrosis. In the early post-brachytherapy period (up to 1 month) the most frequent radiation-related complications were keratopathy and uveitis (8 and 6 patients correspondingly). In patients observed for up to 3 months (28 patients) these were keratopathy and cataract (8 and 5 patients correspondingly). In the long-term (over 6 months) cataract predominated (17 patients). At the end of the study all patients were alive. Metastatic disease was diagnosed in one patient 30 months after the treatment., Conclusions: The results of the present clinical study confirm the effectiveness of brachytherapy for iris and iridociliary melanomas, which implies that tumor is well locally controlled and radiation-related complications are moderate and curable. This method of local tumor destruction can be another alternative to enucleation in cases when local tumor excision cannot be performed.

Unlabelled: Choosing the treatment method for patients with large choroidal melanomas remains a subject of debate. No literature data can be found on survival of such patients after either eye-preserving surgery or enucleation that takes into account the initial tumor size. The purpose of the study was to analyze the five-year survival rates for large choroidal melanomas (by J.A. Shields) in respect of the provided treatment., Material and Methods: Medical records of 103 patients who had undergone treatment for choroidal melanoma (initial prominence 5.0-10.2 mm, initial diameter 7.3-20 mm) were studied. Eye-preserving surgery was performed on 60 patients, of whom 46 patients received brachytherapy (single session in 37 cases) and the other 14 patients--brachytherapy in combination with transpupillary thermotherapy (with subsequent endoresection of the tumor in one case). A total of 16 patients from this group required secondary enucleation. Primary enucleation was performed on 63 patients. Histopathological results confirming choroidal melanoma were analyzed in all 79 cases., Results and Discussion: The 5-year melanoma-specific cumulative survival rate in the group of eye-preserving surgery was 0.8146, while in the group of primary enucleation it reached 0.8951. The 8-year rate was 0.6921 and 0.7558 correspondingly. However, according to Gehan-Wilcoxon test, the differences were statistically insignificant (p = 0.11). The five-year survival of large choroidal melanoma patients who underwent eye-preserving surgery and no enucleation was 0.7708, 9-year - 0.6175., Conclusion: Since the five-year melanoma-specific survival rate after primary enucleation is higher than that after eye-preserving surgery and secondary enucleation (though the difference is statistically insignificant), treatment options for large choroidal melanomas have to be chosen individually, taking into account the age and attitude of the patient as well as the size of the tumor.

Results of complex ultrasonic examination in different time after socket reconstruction using biomaterial "Alloplant" are presented. Modified technique of primary socket reconstruction showed good cosmetic result.

The question of necessity and time of silicon oil (SO) removal after tamponade for traumatic retinal detachment (TRD) is still controversial. So the study of changes in the eye filled with SO for a long time is of great interest. Histopathologic analysis of 9 enucleated eyes filled with SO for TRD during long-time period (from 6 months till 30 years) was performed. The characteristic change was inflammatory reaction with fibrin membranes surrounding silicon drops and development of proliferative vitreoretinopathy and tractional retinal detachment in the following. In 2 cases the inflammatory process around SO was associated with bone formation. The most severe complication was the imbibition of retina with SO in a vacuole-like manner associated with total atrophy of neural structures. Obtained data show that time for SO removal should be less than 6 months after surgery.

Proximate causes of intraocular pressure (IOP) decompensation accompanied with persistent pain syndrome were determined based on results of morphological examination of 59 eyes enucleated due to terminal previously operated glaucoma and medical history analysis. Excessive scarring, formation of solid hyalinized membrane in the site of filter pad, closure of anterior chamber angle with synechia as an outcome of chronic iridocyclitis and inappropriate surgical approach lead to increase in the resistance of the aqueous humor outflow and result in glaucoma decompensation causing complications that necessitate enucleation. The most common complications are the following: bacterial corneal ulcer with potential perforation and endophthalmitis, hemorrhagic choroidal detachment, vitreous hemorrhage, persistent pain syndrome and phthisis bulbi.

The efficacy of hemostasis achievement during conduction of a retrobulbar vascular-nervous bunch ligation (RVNBL), using titanic clips while evisceroenucleation performance, was studied up. A comparative analysis of clinical and functional results of surgical treatment of 36 patients, suffering terminal dolorous glaucoma and disaster of a sympathetic ophthalmia complication after an eye penetrating wounding occurrence. In 16 patients (the first group) a standard method of a hemostasis achievement was used while doing evisceroenucleation - a deep orbital tamponade for 5 minutes. In 20 patients (the second group) a procedure of RVNBL was conducted, using titanic clips before the bunch transsection doing. There was established, that while doing a RVNPL using titanic clips, a hemorrhage never occurs, a retrobulbar hematoma do not formated, the soft tissues reaction in the early postoperative period is less pronounced, and the patients postoperative rehabilitation period shortens.

Results of retrospective analysis of medical charts of 328 patients after enucleation due to uveal melanoma (UM) are represented. Our study showed that recurrent tumor occurs in 2.44% cases. The main reasons of recurrence are scleral invasion or tumor damage during surgery. After enucleation due to juxtapapillary UM recurrence is rare and occurs after long-term follow-up. Thus after enucleation due to UM implant insertion is possible in case of scleral integrity and absence of macroscopically apparent tumor extension beyond sclera.

The aim of the study was to compare survival rates of patients with stage T2 choroidal melanoma (CM) with prominence more than 6.0 mm after eye-preserving treatment using Ru-106 brachytherapy (BT) combined with transpupillary thermotherapy (TTT) and after primary enucleation. The main group included patients treated with BT alone or combined with simultaneous TTT. Patients with CM after primary enucleation served as control. The groups were standardized in terms of age (p = 0.063), mean prominence (p > 0.149), mean maximal base diameter (p > 0.85), number of unfavorable localized tumors (juxtapapillary and ciliochoroidal) (p = 0.246), follow-up duration (p > 0.23). Kaplan-Meier analysis showed 5 year level of metastasing after eye-preserving treatment as high as 16%, after enucleation--13% (p > 0.96). Eye-preserving treatment using BT combined with TTT in patients with CM with prominence less than 10.0 mm (T2N0M0) allows to preserve eye as an organ and to save some degree of useful visual acuity. This treatment strategy can be considered an appropriate option.

This paper analyzes the data available in the literature on the incidence of uveal melanomas. It historically describes enucleation and the specific features of its performance in patients with and without uveal melanoma. The specific features of enucleation in patients with uveal melanoma, indications for locomotor stump formation, and procedures for calculating the parameters of an implant are considered. Analysis of the data available in the literature shows that there is presently no unambiguous opinion as to the most rational enucleation modes and as to the capacities and types of used implants as a whole. This primarily applies to enucleation used in patients with intraocular neoplasms.

The capacities of current ultrasound technologies in determining the extent of intraocular tumors were clinically studied. The proposed algorithm of ultrasound study of intraocular tumors allows for not only making the exact measurements of a neoplasm, but also for determining the three-dimensional configuration of an object within the eye.

Carbonic composite materials, syntactical carbonic foam, and carbonic felt (carbotextim), were used to form a solid mobile locomotor stump after experimental and clinical enucleation and during delayed stump plasty. Experiments with 96 rabbits demonstrated good results of using carbonic composites for lamellar ophthalmic surgery. Clinical follow-up of 86 patients demonstrated the advantages of carbonic implants vs. the traditional ones. Carbonic implants meet all the requirements to materials used in plastic ophthalmo-surgery: they are porous, easily intergrown with adjacent tissues, do not migrate, retain their shape and volume, are not denuded or rejected, easily sterilized. These properties recommend carbonic implants in intricate cases with marked inflammations of the adjacent tissues and in combination with transplantation of free mucosal grafts. The material structure permits modelling individual transplants during surgery.

The shape of the eye prostheses depends on the plastic surgery type. Standard prostheses with thin but not sharp edges are used to recreate the conjunctival cavity, prostheses with a deep retraction or flat ones are employed for a delayed introduction into the stump, prostheses with a 'swelling' at the upper edge are of use in surgery to correct the upper eyelid falling in, prostheses with a flattened lower edge and a 'shelf' at the upper edge are used to fortify the lower eyelid. Individual prostheses are recommended after plastic surgery. The prostheses should not prevent free closing and blinking of the eyelids, retaining the identical opening of the eyes. An inadequately chosen prosthesis brings to nothing the tremendous work made by the surgeon. Ocular prosthetics may be regarded as the final stage stabilizing the results of plastic surgery.

A new method is proposed for evisceroenucleation with formation of a locomotive stump permitting to remove complications connected with anophthalmos. In experiment, morphologic investigation of changes in the implant (allocartilage) in dynamics from 20 days to 1 year have shown that the implant preserves its form and initial fixation for the whole period of observation. This provides good prosthetic conditions. Ultrasonic scanning is recommended as an effective method to control the implant adaptation and locomotive stump formation.