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Anguita R, Chou HD, Raval VR, Bajpai V, Ferro Desideri L, Bernardi E, Hussain RN, Kim M, Fung AT, Williams BK, Di Nicola M, Sagoo MS, da Cruz L, Damato B, Kiilgaard JF. Managing vitreoretinal complications in uveal melanoma: Surgical treatment and practical considerations. Semin Ophthalmol 2024:1-10. [PMID: 39194361 DOI: 10.1080/08820538.2024.2381774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/09/2024] [Accepted: 07/15/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND In the past few decades, the primary management for uveal melanoma has evolved from enucleation to eye-preserving treatments. However, despite achieving a high rate of local tumour control, complications following eye-preserving treatments still occur and are partly responsible for functional loss and secondary enucleation. METHODS A literature review by a broad international panel. RESULTS We summarised the current literature on utilizing vitreoretinal (VR) surgery for managing the complications of uveal melanoma. We also provided insights from the authors' personal experience and practical recommendations for clinical care. CONCLUSIONS With the advancement of VR instruments and surgical techniques and the combination of VR and ocular oncology knowledge ("Onco-VR"), it is now possible to manage or even prevent complications such as vitreous haemorrhage, retinal detachment, and toxic tumour syndrome.
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Affiliation(s)
- Rodrigo Anguita
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Hung-Da Chou
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
- Chang Gung Memorial Hospital, Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Vishal R Raval
- Vitreoretina and ocular oncology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Vidhi Bajpai
- Vitreoretina and ocular oncology, Anant Bajaj Retina Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Lorenzo Ferro Desideri
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Enrico Bernardi
- Department of Ophthalmology, Inselspital, University Hospital of Bern, Bern, Switzerland
| | - Rumana N Hussain
- Liverpool Ocular Oncology Service, St Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
| | - Min Kim
- Department of Ophthalmology, Institute of Vision Research, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Adrian T Fung
- Westmead and Central (Save Sight Institute) Clinical Schools, Specialty of Clinical Ophthalmology and Eye Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Basil K Williams
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maura Di Nicola
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mandeep S Sagoo
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Lyndon da Cruz
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Bertil Damato
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, UK
| | - Jens Folke Kiilgaard
- Department of Ophthalmology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Mazzini C, Vicini G, Di Leo L, Massi D, Rizzo S, Giansanti F. Anatomical and Functional Outcomes after Endoresection and Adjuvant Ruthenium Brachytherapy for Uveal Melanoma: A Single-Center Experience. Life (Basel) 2023; 13:902. [PMID: 37109431 PMCID: PMC10146230 DOI: 10.3390/life13040902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/19/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023] Open
Abstract
PURPOSE To evaluate the anatomical and functional outcomes of endoresection and adjuvant ruthenium (Ru)-106 brachytherapy for uveal melanoma (UM). METHODS Retrospective case series of 15 UM patients (15 eyes) treated at our center (Careggi University Hospital, Florence). RESULTS Six patients (40%) were male and nine were female (60%). The mean age of patients at the time of treatment was 61.6 years (±19.41). The mean BCVA at baseline was 20/50. In all cases UM originated from the choroid. The mean tumor thickness at baseline was 7.14 mm (±2.05), and the mean largest basal diameter was 11.2 mm (±1.92). A concurrent retinal detachment was diagnosed in 11 patients (73.3%). Two patients (13.3%) showed vitreous seeding at baseline. Eleven patients (73.3%) were treated with primary endoresection, while four patients (26.7%) were treated with a "salvage endoresection" after primary treatment failure (previous radiation treatment). The mean follow-up time was 28.9 months (±10.6). Thirteen out of fifteen patients were alive and showed no evidence of local recurrence or distance metastasis at the last follow-up visit. The treatment achieved local control of the disease in 14 out of 15 cases (93.3%). In one case, the patient underwent enucleation for disease recurrence. The overall survival rate at the end of the follow-up was 93.3%. The mean BCVA at last follow-up visit was 20/40. Treatment was well tolerated, without significant complications. CONCLUSIONS Endoresection and adjuvant Ru-106 brachytherapy is a valuable conservative option for selected UM patients and can be used both as a primary treatment and as a salvage therapy. It can control melanoma and avoid enucleation, reduce radiation-related complications, and provide tumor tissue for chromosomal analysis and prognostic testing.
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Affiliation(s)
- Cinzia Mazzini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
| | - Giulio Vicini
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Laura Di Leo
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Daniela Massi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Section of Pathological Anatomy, Department of Health Sciences, University of Florence, 50139 Florence, Italy
| | - Stanislao Rizzo
- Ophthalmology Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy
- Consiglio Nazionale delle Ricerche (CNR), 56124 Pisa, Italy
| | - Fabrizio Giansanti
- Unit of Ocular Oncology, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
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Fionda B, Pagliara MM, Chyrek AJ, Guix B, O'Day RFJ, Fog LS, Martínez-Monge R, Tagliaferri L. Ocular Brachytherapy (Interventional Radiotherapy): Preserving the Vision. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00043-2. [PMID: 36792447 DOI: 10.1016/j.clon.2023.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/16/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Abstract
Uveal melanoma represents the most common intraocular neoplasia among adults. Brachytherapy (interventional radiotherapy; IRT) has a great advantage, when compared with enucleation, both in terms of organ and function sparing. The Collaborative Ocular Melanoma Study introduced into clinical practice a standardised procedure that allowed the equivalence of IRT with enucleation in terms of overall survival to be demonstrated. IRT is carried out by placing a plaque in direct contact with the sclera under the uveal melanoma. Several radioactive sources may be used, including 106-ruthenium, 125-iodine, 103-palladium and 90-strontium. It is a multidisciplinary procedure requiring the collaboration of interventional radiation oncologists and ophthalmologists in the operating theatre and medical physicists for an accurate treatment time calculation. It also relies on ultrasound imaging to identify the lesion and verifiy the correct plaque placement. An emerging tool of paramount importance could be the use of artificial intelligence and predictive models to identify those patients at higher risk of developing late side-effects and therefore who may deserve preventive and supportive therapies.
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Affiliation(s)
- B Fionda
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - M M Pagliara
- U.O.C. Oncologia Oculare, Dipartimento di Scienze dell'Invecchiamento, Neurologiche Ortopediche e Della Testa Collo, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A J Chyrek
- Brachytherapy Department, Greater Poland Cancer Centre, Poznań, Poland
| | - B Guix
- Department of Radiation Oncology, Foundation IMOR, Barcelona, Spain
| | - R F J O'Day
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia
| | - L S Fog
- The Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R Martínez-Monge
- Department of Oncology, Clínica Universitaria de Navarra, CCUN, Pamplona, Spain
| | - L Tagliaferri
- U.O.C. Radioterapia Oncologica, Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica Ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Ruschen H, Romano MR, Ferrara M, Loh GK, Wickham L, Damato BE, da Cruz L. Perfluorocarbon syndrome-a possible, overlooked source of fatal gas embolism following uveal-melanoma endoresection. Eye (Lond) 2022; 36:2348-2349. [PMID: 35352011 PMCID: PMC9674629 DOI: 10.1038/s41433-022-02021-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 01/29/2022] [Accepted: 03/10/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Heinrich Ruschen
- Department of Anaesthesia, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Mario R Romano
- Department of Biomedical Science, Humanitas University, Via Montalcini 4, Pieve Emanuele, 20090, Milan, Italy
| | - Mariantonia Ferrara
- Department of Ophthalmology, Humanitas Gavazzeni-Castelli, Via Mazzini11, 24128, Bergamo, Italy
| | - Graeme K Loh
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK.
| | - Louisa Wickham
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
| | - Bertil E Damato
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Lyndon da Cruz
- Department of Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London, EC1V 2PD, UK
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Framme C, Sachs HG, Wachtlin J, Bechrakis NE, Hoerauf H, Gabel VP. Main Principles of Vitrectomy Using Intraocular Tamponades - A Basic Course in Surgery. Klin Monbl Augenheilkd 2022; 239:1337-1353. [PMID: 36410334 PMCID: PMC9678440 DOI: 10.1055/a-1929-9413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/30/2022] [Indexed: 11/23/2022]
Abstract
This article is intended to clearly present the basic principles for the use of intraocular tamponades in vitreous/retinal surgery in the event of retinal detachment and other pathologies using additional video footage. It examines the various gases, silicone oils and perfluorocarbon liquids with their indications, administration and in particular intraoperative handling including pitfalls and complications. Characteristic animations show the principles of use in surgery in a comprehensible way. The two lead authors dedicate this article to their teacher Prof. Dr. V.-P. Gabel, who in the early 1990s successfully established the first vitrectomy courses for ophthalmologists at Regensburg University Eye Clinic each year. Many colleagues who still work in retinal surgery today first started learning about this segment on these courses. The other coauthors participated under his supervision in annual vitrectomy wet labs run by the German Academy of Ophthalmology.
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Affiliation(s)
- Carsten Framme
- Augenklinik, Medizinische Hochschule Hannover, Deutschland
| | | | - Joachim Wachtlin
- Augenheilkunde, Sankt Gertrauden-Krankenhaus, Berlin, Deutschland
| | | | - Hans Hoerauf
- Augenheilkunde, Universitätsmedizin Göttingen, Deutschland
| | - Veit-Peter Gabel
- Augenheilkunde, Universität Regensburg, Emeritus, München, Deutschland
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Ebert JJ, Di Nicola M, Williams BK. Operative Complications of Posterior Uveal Melanoma Surgery. Int Ophthalmol Clin 2022; 62:15-33. [PMID: 35752883 DOI: 10.1097/iio.0000000000000428] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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