Additional cell damage after transpupillary thermotherapy in choroidal malignant melanoma

The aim of this study was to evaluate the effectiveness of transpupillary thermotherapy (TTT) in generating tumour necrosis by light and electron microscopy, as well as to evaluate additional cell damage in the area directly adherent to the necrotic zone. Four eyes of four patients diagnosed with intraocular malignant melanoma of the uvea were treated experimentally with diode laser TTT. In all cases a standard technique was used. All eyes were enucleated: one eye the day after TTT, two eyes 2 days after TTT, and one eye 6 weeks after TTT. Immediately after enucleation the eyes were immersed in standard Karnovsky's fixative with cocodylate buffer and prepared for light and electron microscopy. In the treated area of all four melanomas we found a dense band of necrotic tissue (zone A) consisting of an amorphous mass of dead cells sharply demarcated from the rest of the neoplastic tissue. Next to this zone was a more eosinophilic and also sharply demarcated band (zone B) that consisted of similar but less intensive changes. In the next band (zone C), marked injury to the cellular membrane and subcellular structures were seen on electron microscopy. The next band (zone D) consisted of changes mainly observed only within the cytoplasm of neoplastic cells and significantly less intensive than those in zone C. Outside zone D tumour cells that were normal in appearance were seen. No scleral alterations induced by heat were found. We concluded that after TTT the cytotoxic effect gradually decreases in proportion to the distance from the central point of the diode laser spot, with additional cell damage in the area adjacent to the necrotic zone. The interval between TTT and enucleation had no influence on the histological results.

[Trans-scleral resection of choroidal malignant melanoma]

PURPOSE OF THE STUDY

Case presentation of local transscleral resection of choroidal malignant melanoma.

MATERIAL AND METHODS

A 45-year-old woman with enormous choroidal tumor not suitable for treatment with ruthenium plaque. Methods--microsurgical, local transscleral tumor resection with subsequent ruthenium plaque application performed in general hypotension.

RESULTS

Non complicated tumor resection proved the possibility of eye preservation with final distant vision 0.5 and close vision 1.0/30.

[Analysis of the local synthesis of Toxoplasma gondii-specific immunoglobulins in the anterior eye chamber fluid. Report of two cases]

We reported two cases strongly suspected of ocular toxoplasmosis, in which a puncture of anterior eye chamber was performed for a final verification of clinical diagnosis. In both patients, fresh focal lesions of retinochoroiditis associated with old pigmented retinal scars were diagnosed. The 62-year-old women had a serological evidence of recently acquired T. gondii infection with an increasing IgG titre of a low avidity and a presence of specific IgM and IgA antibodies. In the 13-year-old girl, an immunological profile of the chronic infection was shown, confirmed by a high IgG avidity value. In the patient with a clinical picture of recurrent congenital toxoplasmosis, intraocular production of T. gondii-specific IgG was found in anterior eye chamber. The analysis of the specific antibodies synthesis in ocular fluid by the Western blot seems to be a valuable immunodiagnostic method for a final diagnosis of ocular toxoplasmosis.

[Cataract extraction and lens implantation in glaucomatous eyes after trabeculectomy]

PURPOSE

Presentation of problems connected with an implantation of eye lens after trabeculectomy with changed anatomic conditions.

PATIENTS AND METHODS

In 51 cases of patients with cataract and glaucoma, following a trabeculectomy operation, ECCE was made by corneal incision and lens implantation into posterior chamber. In the analysis, the following were taken into consideration: state of the eye before cataract operation, intrasurgical difficulties with necessary application of additional surgical actions, evaluation of postoperative course.

RESULTS

In 41.1% of patients, surgical operations followed a non-typical way and the below procedures were necessary: loosening of adhesions, mechanical pupillary dilation, tearing off fibrous or stained membrane, iridorrhaphy and pupil reconstruction. Posterior chamber lens was implanted in 96% of patients and the following acuity was achieved: 0.5-1.0 in 25 eyes, 0.3-0.4 in 13 eyes, 0.02-0.2 in 10 eyes. There was no acuity improvement in 3 eyes only.

CONCLUSIONS

Operation posterior chamber lens implantation after trabeculectomy can proceed in a non-typical way because of changed anatomic conditions. Postoperative functional results depend on the degree of nerve lesion (injury), but they are often better than preoperative prognoses indicate.

[Use of diode laser in the treatment of intraocular tumors: preliminary report]

PURPOSE OF THE STUDY

The purpose of the study was to evaluate the effectiveness of diode laser transpupillary thermotherapy and to determine in what extent it may act as the only method of therapy of choroidal tumors, and when it should be used in combination with other methods. The study has preliminary character.

PATIENTS

15 eyes of 14 patients aged 38 to 82 years (mean--57 years) were treated because of intraocular tumor with the use of diode laser transpupillar thermotherapy in 13 patients primary intraocular tumor was diagnosed, and in 1 patient there was metastasis; in 13 cases tumors were localized unilaterally, whereas in 1 case they appeared in both eyes. The follow-up period (from the start of the treatment) ranged from 1 to 3 months.

METHODS

All patients were treated with transpupillary thermotherapy (TTT) with the use of diode laser OcuLight SLx, IRIS Medical instruments, Inc. The power and size of the laser spots depended on the tumor size and pigmentation. Mean power used for the treatment was 600 mW, while mean exposure time was 1 minute.

RESULTS

Altogether, within 15 treated eyes in 8 cases regression, in 6--stabilization and in 1--progression was stated. As to complications and side effects, visual field scotomas in the treated area as well as deterioration of visual acuity were found during the treatment. In 2 cases a slight improvement of visual acuity was found.

CONCLUSIONS

In selected cases transpupillary thermotherapy (TTT) can be effective especially in regard to small tumors (height up to 4.5 mm). Probably in the future it will be the only method of treatment. Treatment of larger tumors (height more than 4.5 mm) should be connected with the use of ruthenium plaque (106Ru). All complications and side effects found in the course of treatment were not dangerous to the eye (small hemorrhage) and were relatively easily tolerated by the patients. With longer follow-up of greater group of patients probably it will be possible to establish optimal parameters, advantages and possible other complications of such therapy.

[Professor Witold J. Orłowski. Obituary for 10th anniversary of his death]

The article presents an outline of Prof. W.J. Orłowski's (1918-1988) biography. He studied at Warsaw University (1936-1939) and Lódź University (1945-1947). He became interested in ophthalmology as early as before completing his studies. He graduated in medicine in 1950, few years later obtained doctor's degree and in 1961 received the thid degree (habilitation) and lectureship. From 1st June 1965 till 30th June 1988 he was Head of Ophthalmologic Clinic at Poznań Medical Academy. He wrote a considerable number of ophthalmologic textbooks, 208 research papers, and was an editor of textbooks and periodicals. Prof. W.J. Orłowski's scientific interest focused on retina diseases which resulted in founding Retinological Section in 1970, and thus starting to develop Polish retinology. As a humanist he rendered services to journalism where, as early as his high school time, he used to publish board bulletins, and edited periodicals including "Glass Houses", "The Forge at the Young", "Life of Youth". During his university studies he worked as journalist in "The Republic" and in "Lódź Daily". After graduating from university he continued his medical and journalist passions as author and editor for "Medical News", "Let's Live Longer", "The Eye Clinic". He was an outstanding expert in the history of ophthalmology. Prof. W.J. Orłowski was a man of a wide range of interests. His hobbies included stamps collecting and numismatics. He received wide recognition among both Polish and foreign ophthalmologists as well earned deep respect from his colleagues and students.

[The role of complex diagnostic examination in von Hippel-Lindau disease]

Von Hippel-Lindau disease belongs to phakomatosis. It is a dominantly autosomally inherited disease. The aim of the study was to present and evaluate different methods of diagnostic examinations (computer tomography, magnetic resonance imaging and ultrasonography) in 14 patients with the disease. The results of investigations showed a wide variety of visceral manifestations. All the patients are carefully followed up. Control examinations every six months allow to check for and treat any new pathological changes in the retina.

[Marshall syndrome--case report]

A girl, 15, with Marshall syndrome, was hospitalized for retinal tear and detachment of the left eye. The results of ophthalmological examination and applied eye surgery have been described. The authors confirm the essential phenotypical overlap of Marshall and Stickler syndromes. This suggest that they are caused by variable expression of a differently mutated gene, probably the type II procollagen gene (COL2A1), known to play a part in the etiology of Stickler syndrome. This justifies the usage, by some authors, of the common name of Marshall-Stickler syndrome.

[Genetic heterogeneity of retinitis pigmentosa]

The authors present a classification of retinitis pigmentosa (rp) based on the modes of inheritance. Known genetic conditions of autosomal recessive, X-linked recessive and autosomal dominant forms of rp are shown, presenting molecular principles of the illness. They also describe clinical subtypes of rp with suggested genotype-phenotype correlations and principles of modern genetic diagnostics and genetic counselling.

[Genetically determined retinoblastoma]

The modern view for the mechanisms of retinoblastoma origination, based on the tumor suppressor genes theory, has been described in this work. The structure and function of the retinoblastoma gene and its protein product, with reference to the cell cycle, has been presented. On the ground of this data, possibilities of genetic molecular diagnostics and principles of competent genetic counselling have been described.

[Retinal detachment in pseudophakia]

In the years 1987-1991, a total of 851 cataract extraction with artificial lens implantation were performed in the Ophthalmological Clinic of the Medical Academy in Poznań. There were 244 anterior and 607 posterior chamber IOLs. Retinal detachment was observed in this clinical material in 6 eyes (0.7%), only in the group of anterior chamber IOLs. The methods of applied retinal detachment surgery, its results and the status of the fellow eye are presented.

[Genetic basis of Leber's hereditary optic neuroretinopathy]

Basic information about mitochondrial inheritance have been presented. The nature of inheritance of Leber's hereditary optic neuroretinopathy (LHON) has been described. The recent reports about heterogeneity of mutations, heteroplasm and nucleo-mitochondrial interaction have been taken into consideration. Principles of modern genetic diagnostics and counselling of LHON have been described.

[Etiopathogenesis and treatment of glaucoma in Sturge-Weber syndrome]

The theories that attempt to explain etiopathogenesis of glaucoma in Sturge-Weber syndrome are presented. The assumptions for treatment of this kind of glaucoma have been explained on the grounds of literature and 2 observed cases (one with bilateral location). The best results are obtained with pharmacological treatment. Surgical procedures may result in many intraoperative and postoperative complications.

[Intraocular lens implantation in the glaucomatous eye]

Cataract extraction with intraocular lens implantation was performed in 32 eyes of 32 patients in the years 1990-1992. Surgery was performed in 10 eyes with well-controlled intraocular pressure without any antiglaucomatous operation, in 10 because of inadequate control with simultaneous trabeculectomy, in 7 after earlier filtering procedures and in 5 with secondary glaucoma. Surgical technics, intra- and postoperative complications and the results are discussed. Visual acuity in 18 eyes was 0.5-1.0, in 10 eyes 0.1-0.4 and in 2 it was 0.05. The follow-up for all the eyes yielded normal intraocular pressure, in most cases without additional pharmacological treatment.

[Serous macular detachment caused by congenital optic pit]

The observations concerning the treatment of 5 patients suffering from the serous macular detachment caused by the optic pit are presented. In all 5 cases, the laser photocoagulation along the temporal margin of disc was applied. The retinal attachment was obtained in 2 eyes.

[Retinoschisis vs. retinal detachment--diagnosis and treatment]

In the years 1985-1990, 987 patients with retinal detachment were treated in the Ophthalmological Clinic of Medical Academy in Poznań. In 25 patients, from the above group, the coexistence of retinoschisis was observed. The clinical picture of retinal detachment and retinoschisis was the basis for explaining the pathogenesis of two different phenomena: "retinoschisis versus retinal detachment" and "retinal detachment versus retinoschisis". The surgical treatment applied to 25 eyes resulted in 88% retinal attachment.

[Retinal detachment in the eyes with retinopathy of prematurity]

In the period of 1983-1988 among 57 retinal detachments in children and youth in 8 cases (10 eyes) the authors found the retinopathy of prematurity as a cause of retinal detachment. The characteristic picture of changes in these eyes was discussed. Combined surgical procedures were performed in 7 cases achieving a cure in 6. Emphasized was the significance of periodical examinations of these eyes with the aim of eventual prophylaxis of retinal detachment and of therapy of amblyopia.

[Proliferative vitreoretinopathy as a cause of early recurrence of retinal detachment]

Analysed were the results of surgical treatment, causes of the failure and early recurrence in 108 patients with retinal detachment in whom was performed an indentation of the sclera by means of a balloon (1st group--50) or by an episcleral implant (2d group--58). In the first group the apposition was achieved in 92 p.c., in the 2d group in 90 p.c. An early recurrence (2 weeks to 2 months) was observed in 9 eyes which were operated again achieving an apposition of the retina in 6 eyes. There were following causes of the failure: the existence of a second hole, rupture of the balloon, PVR before surgery and traction of the retina in the region of the hole. An early recurrence occurred in the consequence of intensification of the PVR together with inaccurate localization of the implant, existence of the PVR before the operation and traction of the retina in the vicinity of the hole, formation of a new hole.

[Vitreo-retinal biomicroscopy using bilaterally aspherical Volk lenses (+78 D, +90 D)]

Aspherical+ Volk lenses allow a full realization of El Bayadi conception of use of a great power a positive lens for the indirect ophthalmoscopy by means of a biomicroscope. The authors compared the techniques of ophthalmoscopy with utilization of a biomicroscope pointing to following advantages of the Volk lens: the lack of contact with the patient's eye (avoidance of eventual transmission of infection), possibility of examination of the entire area of the fundus, a detailed evaluation of the vitreous, possibility of examination even by narrow pupil, a high comfort of examination for the patient. These advantages were confirmed during the examination of 51 eyes with retinal detachment, pathological changes of the macula and the optic disc and with intraocular tumors.

[Principles of qualifying retinal detachment for pneumoretinopexy]

The gases SF6 and C2F6 were used in 88 patients (88 eyes) with retinal detachment as endotamponade. Eighty eight patients constituted 3 groups in which the gas was used on the basis of following indications: 1) the eyes with retinal detachment from above and with holes between 9-12-3 or with a macular hole; 2) eyes with retinal detachment "without hole" or with a hole for evaluation for its size and localization, as an intervention preceding an extrascleral invagination; 3) eyes with retinal detachment from above in which after extrascleral indentation in spite of a good localization the retina did not reappose. On the basis of the presented material the authors emphasize the values of the pneumoretinopexy as a solitary procedure, a diagnostic procedure or completing an extrascleral indentation. The perils of this method are presented and the causes of failures discussed.