Search

To delineate and discuss a not yet described possible ocular complication of selective intra-arterial chemotherapy (SIAC) for treatment of retinoblastoma.A 23-month-old girl with a large unilateral retinoblastoma was treated with repeated SIAC using 5 mg melphalan between July 2010 and January 2012. Clinical course of tumor and further ocular changes after therapy and histopathologic findings are described.In total, 5 SIAC were performed over a time period of 18 months. After the last SIAC, diffuse dense cataract prevented further funduscopy. In addition, anterior chamber seeding was obvious, leading to the decision to enucleate the eye. Histopathologically, nearly complete regression of the main tumor mass with prominent calcifications, but vital tumor seeding in the vitreous, on the lens surface, on the ciliary body, and in the anterior chamber, was observed. Peculiar vacuolation of the lens epithelial cells, liquefaction of the subepithelial lens fibers, and diffuse small vacuoles within the lens were striking.Repeated SIAC with melphalan may induce cataract formation, possibly as a toxic effect of the chemotherapeutic to the lens, maybe combined with radiation exposure during fluoroscopy. This ocular complication should be taken into consideration as a limitation of the number of feasible repeated treatments.

To measure the value of augmented reality technology usage to teach the medical students performing binocular indirect ophthalmoscopy.Thirty-seven medical students were randomly assigned to the training of binocular indirect ophthalmoscopy either in the conventional way or with augmented reality ophthalmoscopy (ARO). For testing student's skills, they had to examine a real person using a conventional ophthalmoscopy system and draw the optic disk. They also had to fill out a questionnaire. Subjective and objective evaluations were performed.Thirty-seven students were randomly assigned to two groups. Eighteen students were trained with conventional ophthalmoscopy and 19 students with ARO. The questionnaires showed no differences. Performing an objective analysis, the median ophthalmoscopy training score for the conventional ophthalmoscopy group was 1.2 (range, 0.67-2) and showed a significant difference (P0.0033) to the ARO group (median 2; range, 0.67-2).The study provides evidence that a single ARO training is efficient to improve ophthalmoscopy skills. As the objective analysis showed, the ARO group had a significantly superior performance. Our study also indicates that subjective evaluation of the fundus drawings without systematic analysis is prone to errors.

To present a modified surgical technique in the treatment of retinal detachment secondary to advanced Coats’ disease in children, and report on long-term anatomical and functional outcome. We analysed an interventional case series of 13 patients (13 eyes) with advanced Coats’ disease characterised by retinal detachment in addition to massive subretinal exudates and vascular malformation. The presented patients underwent pars plana vitrectomy (PPV), including a modified technique of exocryotherapy applied after fluid–air exchange in order to achieve complete treatment of the vascular changes, to reduce associated side-effects, and to avoid retinectomy and silicone oil tamponade. Within a median follow-up period of 37 months (range: 18–66 months), no enucleation was necessary. Four eyes (31 %) did not need any further therapy, and in nine eyes (69 %) additional treatments were performed. Six patients (46 %) required revisional surgery with silicone oil tamponade. In ten eyes (77 %), the pathologic vessels and exudates finally regressed and the retina reattached. Visual acuity (VA) could be stabilized in the majority of patients: in three eyes (27 %) VA improved, in four eyes (36 %) VA remained stable, in four eyes (36 %) visual acuity (VA) deteriorated, and in two eyes VA could not be evaluated. The presented modified technique allows for sufficient cryotherapy of vascular malformations, even in the presence of massive exudation, in a subset of patients with advanced Coats’ disease, and thus may reduce surgery-related complications and improve the rehabilitation process of these young patients.

About 50% of patients with uveal melanoma (UM) develop metastases during the course of their disease. We analyzed serum levels of Growth Differentiation Factor-15 (GDF-15), with the aim of identifying patients with early metastases. GDF-15 concentration was measured using an enzyme-linked immunosorbent assay (ELISA) in serum samples from 188 UM patients (170 patients without metastases; 18 patients with clinically detectable metastases) and 18 healthy control individuals. Data were analyzed with respect to differences between patients with and without clinically detectable UM metastases. GDF-15 serum levels were further analyzed with regard to significant patient and tumor characteristics as revealed by histology and multiplex ligation-dependent probe amplification (MLPA) to determine chromosome 3 copy number. GDF-15 expression in UM was investigated by immunohistochemistry. Patients with clinically detectable metastases had significantly higher GDF-15 serum levels compared to those without clinically detectable metastases as well as to healthy individuals (ANOVA; p

Acta Ophthalmol. 2011: 89: 17–24 Abstract. Purpose: To evaluate whether tumour therapy for malignant uveal melanoma leads to a shedding of melanoma cells into the systemic circulation. Methods: Ninety-four peripheral blood samples from 81 patients with malignant uveal melanoma were collected before and after different tumour therapies and the number of circulating melanoma cells (CMCs) was investigated (seven patients with enucleation, 49 patients with stereotactic radiotherapy, 19 patients with endoresection of the tumour, 15 patients with ruthenium-brachytherapy and four patients with transpupillary thermotherapy). A cellular approach was used to detect CMCs through an immunocytological assay with tumour cell enrichment by immunomagnetic cell sorting. The number of CMCs was analysed further according to specific patient characteristics, tumour parameters and the development of metastasis. Results: There was no significant difference between the number of CMCs before and after the different therapies (p = 0.78). There was also no significant association between established prognostic parameters of primary uveal melanoma and the detection of CMCs (all p >0.05). The number of CMCs was not related to the development of metastasis in a short median follow-up time of 16 months (p > 0.05). Conclusion: No changes in CMC values were observed before and after different tumour therapies. In the majority of cases therapy does not lead to a shedding of detectable melanoma cells into the systemic circulation.

Purpose: To determine and compare cyclo-oxygenase-2 (COX-2) expression in photon-radiated and non-radiated malignant uveal melanomas and to analyse the correlation between COX-2 expression and prognosis. Methods: Immunohistochemical staining for COX-2 was performed on 21 uveal melanomas that were endoresected after prior stereotactic radiotherapy with photons and on 22 tumours that were treated by endoresection without prior radiotherapy. COX-2 staining was further analysed in respect to cell type, maximal prominence, time interval between radiotherapy and surgery, apoptotic index (AI), proliferative index (PI) and the development of metastatic disease. Results: There was no difference in COX-2 expression between radiated and non-radiated melanomas (P > 0.15). COX-2 staining correlated with neither the tumour prominence (P > 0.40) nor the AI or the PI (both P > 0.35). Tumours with high COX-2 expression were significantly more likely to develop metastasis (P = 0.022). Conclusion: Radiotherapy with photons does not induce COX-2 expression in malignant melanomas of the uvea. But high COX-2 expression may be a marker for poor prognosis.

PURPOSE The purpose of this study was to report two cases with choroidal melanoma who underwent endoresection and developed choroidal neovascular membrane (CNVM) during follow-up. METHODS An interventional case series. RESULTS A 62-year-old man with choroidal melanoma in his left eye was treated with endoresection with pars plana vitrectomy followed by radioactive ruthenium plaque radiotherapy. Thirteen months after the surgery, the patient developed a CNVM at the superior edge of the surgical excision site and was treated with argon laser photocoagulation. Twenty-eight months after laser photocoagulation, the patient was alive with no sign of CNVM recurrence. A 59-year-old man with choroidal melanoma in his left eye underwent endoresection with pars plana vitrectomy followed by radioactive ruthenium plaque radiotherapy. Twenty-one months later, he developed a CNVM, which was treated by photodynamic therapy. After 45 months of follow-up after photodynamic therapy, the patient had no sign of recurrent CNVM. CONCLUSION Choroidal neovascular membrane is a rare complication after endoresection of choroidal melanoma. Being aware of this risk leads to early diagnosis and prompt treatment that can prevent deterioration of vision.

Conjunctival amyloidosis is a rare disorder. It is often clinically not suspected or diagnosed. This study intended to demonstrate the clinical and histopathologic features of this infrequent disease, including an immunohistochemical search for amyloidotic proteins.Retrospective case series of the clinical and histopathologic characteristics of six patients with conjunctival amyloidosis. Immunohistochemical analysis with respect to possible amyloidotic components of the conjunctival deposits was performed.The diagnosis of amyloidosis was not suspected in all six cases presenting with an amelanotic conjunctival lesion. In three patients a conjunctival tumor of unknown origin, in one case each a papillomatous alteration of the conjunctiva, a conjunctival granulomatous inflammation, and a lymphoma were assumed respectively. The diagnosis of amyloidosis was made by histopathology. Immunohistochemical examination found lambda and kappa light chains as well as prealbumin within the amyloid deposits in one of the six specimens.The diagnosis of amyloidosis has to be kept in mind in cases with an unclear conjunctival mass or inflammatory process. Only a tissue biopsy is able to prove the diagnosis. A possible underlying systemic disease has to be ruled out.

The establishment of long-term uveal melanoma (UM) cell lines is difficult. However, studying living cells and their behaviour in the presence of other cells and the extracellular matrix is important in terms of understanding tumour biology and malignant behaviour. We have established three UM cell lines and report a first characterisation of these cell lines. Three established UM cell lines (UMT2, UMT26 and UMT33) were analysed according to their morphologic characteristics, melanocytic differentiation, adhesion on different extracellular matrices and proliferative activity. Copy number changes of chromosomes 1, 3, 6 and 8 were studied by multiplex ligation-dependent probe amplification (MLPA). Oncogenic mutations in UM involving exons 4 and 5 of GNAQ and GNA11, respectively, were analysed by sequencing. All cell lines grew in suspension. UMT2 cells were homogeneous, UMT26 and UMT33 cells heterogeneous with regard to cell size and pigmentation. All UM cell lines revealed a melanocytic differentiation. UMT2 and 33 adhered on various extracellular matrices, while UMT26 only adhered to basal membrane extract (BME). This difference corresponded to the different expression of various integrins. Ki67 was expressed by 89 % of UMT2 and 95 % of UMT33 cells, which thus were in a proliferative stage, while only 2 % of UMT26 cells revealed immunostaining for this proliferation marker. The doubling time of UMT2 was 3 days, 12 days for UMT33, and circa 3–4 months for UMT26. MLPA revealed disomy 3 in UMT2 and monosomy 3 in UMT33. The same point mutation was found in UMT2, 26 and 33, in exon 5 of GNA11 at codon 209 (p.Q209L). The establishment of UM cell lines under serum-free conditions is possible. Characterisation of UMT2, 26, and 33 revealed obvious differences in cytomorphology, melanocytic differentiation, adhesion on extracellular matrices, and proliferative activity. UMT2, 26 and 33 showed the same oncogenic mutation in exon 5 of GNA11.

Purpose To evaluate the sulcus anatomy and possible correlations between sulcus diameter and white-to-white (WTW) diameter in pseudophakic eyes, data that may be important in the stability of add-on intraocular lenses (IOLs). Setting University Eye Hospital, Tuebingen, Germany. Design Case series. Methods In pseudophakic eyes, the axial length (AL) and horizontal WTW were measured by the IOLMaster device. Cross-sectional images were obtained with a 50 MHz ultrasound biomicroscope on the 4 meridians: vertical, horizontal (180 degrees), temporal oblique, and nasal oblique. Sulcus-to-sulcus (STS), angle-to-angle (ATA), and sclera-to-sclera (ScTSc) diameters were measured. The IOL optic diameter (6.0 mm) served as a control. To test reliability, optic measurements were repeated 5 times in a subset of eyes. Results The vertical ATA and STS diameters were statistically significantly larger than the horizontal diameter ( P =.0328 and P =.0216, respectively). There was no statistically significant difference in ScTSc diameters. A weak correlation was found between WTW and horizontal ATA ( r = 0.5766, P r = 0.5040, P =.0002). No correlation was found between WTW and horizontal ScTSc ( r = 0.2217, P =.1217). Conclusions The sulcus anatomy had a vertical oval shape with the vertical meridian being the largest, but it also had variation in the direction of the largest meridian. The WTW measurements showed a weak correlation with STS. In pseudophakic eyes, Soemmerring ring or a bulky haptic may affect the ciliary sulcus anatomy. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To report the long-term functional and anatomical outcome of full macular translocation (FMT) in eyes with neovascular age-related macular degeneration (AMD) following photodynamic therapy (PDT).Twelve eyes of 12 consecutive patients with neovascular AMD who were PDT-nonresponders and underwent FMT were analysed. Best-corrected visual acuity (BCVA) measurement, fundus photography, and fluorescein angiography at baseline and at follow-up examinations in 3 months intervals were performed. Primary end point was change of BCVA from baseline to last visit.Totally 12 eyes of 12 patients were analysed. Mean time interval between the last PDT and FMT was 3.7 months (range 1-10 months). Mean follow-up after FMT was 25.6 months. BCVA ranged at baseline from 20/1000 to 20/80 (mean 20/230). At the last visit, mean BCVA was by 20/185. BCVA improved in 50% (6/12) of eyes by more than 1 line. Twenty five per cent (3/12) of eyes had final BCVA within +/-1 line from baseline. In 25% (3/12) of eyes the BCVA decreased by more than 1 line. One eye had recurrent CNV. In four eyes a cystoid macular oedema developed. No retinal detachment or disturbing diplopia was noted.In the present study, FMT in PDT-nonresponders stabilised or improved visual acuity in the majority of the eyes in a mean follow-up period of nearly 2 years. FMT can be considered as a therapeutical option in eyes who are nonresponders to the PDT in neovascular AMD.

We report a case of choroidal neovascularisation (CNV) that developed after surgical removal of submacular lipid plaques secondary to diabetic maculopathy.A 73-year-old man with diabetic maculopathy underwent standard pars plana vitrectomy and surgical removal of the submacular lipid plaques.Preoperative visual acuity was 20/200. Funduscopy revealed a macular oedema and subretinal lipid plaques at the macula. Nine months after surgery visual acuity had dropped to 20/320 and subfoveal CNV was diagnosed by fluorescein angiography. Observational management was chosen. At the last examination, 27 months after surgery, visual acuity had worsened to 20/500 and a CNV scar was seen at the macula.CNV development should be kept in mind as a possible complication of surgical removal of submacular lipid plaques in patients with diabetic retinopathy.

Amyloid is found in several corneal dystrophies, including distinct lattice corneal dystrophies (LCD) and Avellino corneal dystrophy. Recently, point mutations in the transforming growth factor-beta-induced gene (TGFBI) encoding for keratoepithelin (KE) have been demonstrated in these corneal disease entities. We intended to investigate if KE was also a component of the rarely seen secondary corneal amyloid deposits.Immunohistochemical staining with a polyclonal antibody against KE was performed on formalin-fixed paraffin-embedded tissue of five corneal buttons with secondary amyloid obtained after keratoplasty. Secondary amyloidosis was due to Fuchs endothelial dystrophy (FED) with bullous keratopathy and/or recurrent erosions in all cases. The diagnosis had been established by light microscopy using Congo red staining. Two cases of LCD type I served as positive controls and three corneas with FED and one with keratoconus without amyloid served as negative controls.All corneas with secondary amyloidosis as well as LCD type I revealed positive staining in the respective amyloid deposits. KE was localized in the subepithelial pannus and in the anterior stroma in the corneas with secondary amyloidosis. In the specimens with LCD type I it was distributed in the amyloid deposits located in the anterior and mid-stroma. Staining for KE showed a granular appearance in all cases. The intensity of staining was variable among the specimens.KE is found not only in primary amyloid deposits of hereditary corneal dystrophies, but also in secondary amyloidosis of the cornea of diverse ethiologies.

Importance The present study intended to analyze the suitability of single-dose stereotactic radiotherapy in the treatment of uveal melanoma that cannot be handled with ruthenium-brachytherapy and therefore is a challenge for ophthalmologists concerning local tumor control, as well as preservation of the eye and visual function. Objectives To evaluate local tumor control, eye preservation, visual course, radiation complications, metastases, and death after single-dose stereotactic radiotherapy (SDRT) applied exclusively or combined with tumor resection in uveal melanomas that are neither suitable nor favorably located for ruthenium brachytherapy. Design Retrospective, observational case series. Setting Primary care center. Participants Seventy-eight patients with uveal melanoma were treated. Intervention Between June 3, 2003, and March 18, 2008, patients with uveal melanoma received SDRT monotherapy (group 1, 60 patients) or SDRT combined with tumor resection (group 2, 18 patients). Radiotherapy was performed with a tumor-surrounding dose of 25 Gy on a linear accelerator. Main Outcome Measures Local tumor control, eye preservation, visual results, and radiation complications. Results Within a median follow-up of 33.7 months (range, 0.13-81.13 months), 6 recurrences occurred in group 1; none recurred in group 2. The Kaplan-Meier estimate for local control was 85% at 3 years in group 1 and 100% in group 2 (P = .22). Eye preservation rate was 77% vs 87% at 3 years (groups 1 and 2, respectively) (P = .82). Visual acuity decreased with a median loss of −18 Snellen lines (group 1) and −22 Snellen lines (group 2). More retinopathies (P = .07), opticopathies (P = .27), and rubeotic glaucomas (P = .10) occurred in group 1. No significant difference was observed in the development of metastases (P = .33). The groups differed in overall survival because of 2 deaths occurring shortly after surgery in group 2 for unexplained reasons (P = .06). Conclusions and Relevance Survival analysis suggested that SDRT with combined tumor resection might be associated with increased tumor control and fewer radiation complications than SDRT as monotherapy. Both groups had similar eye retention rates and were comparable concerning the decrease in visual function in most eyes. However, the protocol was stopped after 3 unexplainable deaths after surgery.