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van Poppelen NM, Cassoux N, Turunen JA, Naus NC, Verdijk RM, Vaarwater J, Cohen V, Papastefanou VP, Kiratli H, Saakyan SV, Tsygankov AY, Rospond-Kubiak I, Mudhar HS, Salvi SM, Kiilgaard JF, Heegaard S, Moulin AP, Saornil MA, Garciá-Alvarez C, Fili M, Eide NA, Meyer P, Kivelä TT, de Klein A, Kilic E, Al-Jamal RT. The Pediatric and Young Adult Choroidal and Ciliary Body Melanoma Genetic Study, A Survey by the European Ophthalmic Oncology Group. Invest Ophthalmol Vis Sci 2024; 65:12. [PMID: 38573618 PMCID: PMC10996971 DOI: 10.1167/iovs.65.4.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/28/2023] [Indexed: 04/05/2024] Open
Abstract
Purpose To explore the genetic background of choroidal and ciliary body melanoma among children and young adults, with special focus on BAP1 germline variants in this age group. Methods Patients under the age of 25 and with confirmed choroidal or ciliary body melanoma were included in this retrospective, multicenter observational study. Nuclear BAP1 immunopositivity was used to evaluate the presence of functional BAP1 in the tumor. Next-generation sequencing using Ion Torrent platform was used to determine pathogenic variants of BAP1, EIF1AX, SF3B1, GNAQ and GNA11 and chromosome 3 status in the tumor or in DNA extracted from blood or saliva. Survival was analyzed using Kaplan-Meier estimates. Results The mean age at diagnosis was 17 years (range 5.0-24.8). A germline BAP1 pathogenic variant was identified in an 18-year-old patient, and a somatic variant, based mainly on immunohistochemistry, in 13 (42%) of 31 available specimens. One tumor had a somatic SF3B1 pathogenic variant. Disomy 3 and the absence of a BAP1 pathogenic variant in the tumor predicted the longest metastasis-free survival. Males showed longer metastasis-free survival than females (P = 0.018). Conclusions We did not find a stronger-than-average BAP1 germline predisposition for choroidal and ciliary body melanoma among children and young adults compared to adults. Males had a more favorable survival and disomy 3, and the absence of a BAP1 mutation in the tumor tissue predicted the most favorable metastasis-free survival. A BAP1 germline pathogenic variant was identified in one patient (1%), and a somatic variant based mainly on immunohistochemistry in 13 (42%).
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Affiliation(s)
- Natasha M. van Poppelen
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nathalie Cassoux
- Department of Ophthalmology, Curie Institute, Université Paris Cité UFR Médecine, Paris, France
| | - Joni A. Turunen
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Eye Genetics Group, Folkhälsan Research Center, Helsinki, Finland
| | - Nicole C. Naus
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert M. Verdijk
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pathology, Leiden Universital Medical Center, Leiden, The Netherlands
| | - Jolanda Vaarwater
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Victoria Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
| | | | - Hayyam Kiratli
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Svetlana V. Saakyan
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Alexander Y. Tsygankov
- Department of Ophthalmology, Moscow Helmholtz Research Institute of Eye Diseases, Moscow, Russia
| | - Iwona Rospond-Kubiak
- Department of Ophthalmology, Poznan University of Medical Sciences, Poznán, Poland
| | - Hardeep S. Mudhar
- National Specialist Ophthalmic Pathology Service (NSOPS), Department of Histopathology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Sachin M. Salvi
- Sheffield Ocular Oncology Service, Department of Ophthalmology, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Jens F. Kiilgaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, University of Copenhagen, Copenhagen, Denmark
- Department of Pathology, University of Copenhagen, Copenhagen, Denmark
| | - Alexandre P. Moulin
- Department of Ophthalmology, Jules-Gonin Eye Hospital, Lausanne University, Lausanne, Switzerland
| | - Maria A. Saornil
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Ciro Garciá-Alvarez
- Department of Ophthalmology, Hospital Clinico Universitario de Valladolid, Valladolid, Spain
| | - Maria Fili
- Department of Ophthalmology, St. Erik Eye Hospital, Stockholm, Sweden
| | - Nils A. Eide
- Department of Ophthalmology, Oslo University Hospital, Oslo, Norway
| | - Peter Meyer
- Department of Ophthalmology, Basel University Hospital, Basel, Switzerland
| | - Tero T. Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Annelies de Klein
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emine Kilic
- Department of Ophthalmology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rana'a T. Al-Jamal
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Ocular Oncology Service, Moorfields Eye Hospital, London, United Kingdom
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Papamlichael E, Logeswaran A, Papastefanou VP, Watson M, Coombes A. Evaluation and management of a spontaneous corneal rupture secondary to pellucid marginal degeneration, using swept-source anterior segment optical coherence tomography. Oxf Med Case Reports 2021; 2021:omab003. [PMID: 33732482 PMCID: PMC7947267 DOI: 10.1093/omcr/omab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 12/29/2020] [Accepted: 01/01/2021] [Indexed: 12/03/2022] Open
Abstract
We describe a case of bilateral spontaneous corneal perforation secondary to pellucid marginal degeneration and present the associated swept-source anterior segment optical coherence tomography (SS-ASOCT) findings and management principles used. A 47-year-old woman presented with ocular pain, redness, foreign body sensation and clear discharge in the right eye in 2017 and with very similar symptoms in 2019 in the left eye. Clinically she had a corneal perforation at the inferior cornea with associated loss of anterior chamber volume. Corneal topography demonstrated peripheral thinning and steepening in the contralateral eye. ASOCT images revealed full-thickness perforation, iridocorneal touch and iris stranding. The patient was managed with a combination of contact bandaging and corneal gluing. SS-ASOCT is a useful adjunctive tool in the clinical assessment and evaluation of spontaneous corneal perforation. Alongside the clinical evaluation, it can be used to monitor the clinical response.
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Affiliation(s)
- Esther Papamlichael
- Department of Ophthalmology, Bart’s Health NHS Trusts, Royal London Hospital, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
- Correspondence address. Moorfields Eye Hospital NHS Foundation Trust, 162 City Road, London EC1V 2PD, UK. E-mail:
| | - Abison Logeswaran
- Department of Ophthalmology, Bart’s Health NHS Trusts, Royal London Hospital, London, UK
| | | | - Martin Watson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - Andrew Coombes
- Department of Ophthalmology, Bart’s Health NHS Trusts, Royal London Hospital, London, UK
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3
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Affiliation(s)
- Vasilios P Papastefanou
- Ocular Oncology Service, Moorfields Eye Hospital, London, England.,NIHR Biomedical Research Centre for Ophthalmology, UCL Institute of Ophthalmology, Moorfields Hospital, London, England
| | - Mandeep S Sagoo
- Ocular Oncology Service, Moorfields Eye Hospital, London, England
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Papastefanou VP, Kang S, Simkiss P, Zambarakji H. Eye clinic liaison officers service in the United Kingdom. Int J Health Plann Manage 2019; 35:506-519. [PMID: 31729071 DOI: 10.1002/hpm.2938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To investigate the role of eye clinic liaison officers (ECLOs) in the United Kingdom and analyse patients' demographics and services provided. METHODS This is a retrospective observational study. Data were collected from the Royal National Institute of Blind People for ECLOs in Wales, Scotland, Northern Ireland and England for the first quarter of 2015. Statistical analysis was performed using chi-square and t test as appropriate. RESULTS Trusts with ECLOs support vary greatly in the UK regions. Only one-third of NHS trusts in England have an ECLO service. Over 4000 patients were assessed. The majority of patients were of White ethnic background (94%), lived alone (37%), had no carers (58%) and were in their 80s (29.5%). The principal ocular conditions causing sight loss and certification were age-related macular degeneration (41.6%) and glaucoma (18.1%). Approximately 70% of patients are first seen at 13 to 18 months from diagnosis. CONCLUSIONS ECLO services vary in the UK regions. England has the lowest ECLO availability per trust and the majority of those assessed were of White British origin with AMD. There are significant delays from diagnosis to the first visit indicating the need for improved services. Further studies are necessary to develop the evidence base for the expansion and funding of ECLO services.
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Affiliation(s)
| | - Swan Kang
- Eye Treatment Centre, Barts Health, Whipps Cross University Hospital, London, UK
| | | | - Hadi Zambarakji
- Eye Treatment Centre, Barts Health, Whipps Cross University Hospital, London, UK
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5
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Boudry C, Alvarez-Muñoz P, Arencibia-Jorge R, Ayena D, Brouwer NJ, Chaudhuri Z, Chawner B, Epee E, Erraïs K, Fotouhi A, Gharaibeh AM, Hassanein DH, Herwig-Carl MC, Howard K, Kaimbo Wa Kaimbo D, Laughrea PA, Lopez FA, Machin-Mastromatteo JD, Malerbi FK, Ndiaye PA, Noor NA, Pacheco-Mendoza J, Papastefanou VP, Shah M, Shields CL, Wang YX, Yartsev V, Mouriaux F. Worldwide inequality in access to full text scientific articles: the example of ophthalmology. PeerJ 2019; 7:e7850. [PMID: 31687270 PMCID: PMC6825414 DOI: 10.7717/peerj.7850] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/08/2019] [Indexed: 11/20/2022] Open
Abstract
Background The problem of access to medical information, particularly in low-income countries, has been under discussion for many years. Although a number of developments have occurred in the last decade (e.g., the open access (OA) movement and the website Sci-Hub), everyone agrees that these difficulties still persist very widely, mainly due to the fact that paywalls still limit access to approximately 75% of scholarly documents. In this study, we compare the accessibility of recent full text articles in the field of ophthalmology in 27 established institutions located worldwide. Methods A total of 200 references from articles were retrieved using the PubMed database. Each article was individually checked for OA. Full texts of non-OA (i.e., “paywalled articles”) were examined to determine whether they were available using institutional and Hinari access in each institution studied, using “alternative ways” (i.e., PubMed Central, ResearchGate, Google Scholar, and Online Reprint Request), and using the website Sci-Hub. Results The number of full texts of “paywalled articles” available using institutional and Hinari access showed strong heterogeneity, scattered between 0% full texts to 94.8% (mean = 46.8%; SD = 31.5; median = 51.3%). We found that complementary use of “alternative ways” and Sci-Hub leads to 95.5% of full text “paywalled articles,” and also divides by 14 the average extra costs needed to obtain all full texts on publishers’ websites using pay-per-view. Conclusions The scant number of available full text “paywalled articles” in most institutions studied encourages researchers in the field of ophthalmology to use Sci-Hub to search for scientific information. The scientific community and decision-makers must unite and strengthen their efforts to find solutions to improve access to scientific literature worldwide and avoid an implosion of the scientific publishing model. This study is not an endorsement for using Sci-Hub. The authors, their institutions, and publishers accept no responsibility on behalf of readers.
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Affiliation(s)
- Christophe Boudry
- Normandie Univ, UNICAEN, Média Normandie, Caen, France.,URFIST, Ecole Nationale des Chartes, PSL Research University, Paris, France
| | | | - Ricardo Arencibia-Jorge
- Empresa de Tecnologías de la Información (ETI), Grupo de las Industrias Biotecnológica y Farmacéutica (BioCubaFarma), Havana, Cuba
| | - Didier Ayena
- Université de Lomé, Faculté des Sciences de la santé, Hôpital de Bè, Lomé, Togo
| | - Niels J Brouwer
- Leiden University Medical Center, Department of Ophthalmology, Leiden, The Netherlands
| | - Zia Chaudhuri
- University of Delhi, Lady Hardinge Medical College, PGIMER, Dr RML Hospital, New Delhi, India
| | - Brenda Chawner
- Victoria University of Wellington, School of Information Management, Wellington, New Zealand
| | - Emilienne Epee
- Université de Yaoundé, Faculté de Médecine et des Sciences Biomédicales, Yaoundé, Cameroon
| | - Khalil Erraïs
- Université de Tunis El-Manar, Faculté de Médecine de Tunis, Tunis, Tunisia
| | - Akbar Fotouhi
- Tehran University of Medical Sciences, School of Public Health, Department of Epidemiology and Biostatistics, Tehran, Iran
| | | | | | | | | | | | - Patricia-Ann Laughrea
- Laval University, Department of Ophthalmology and Head and Neck Surgery, Quebec, Canada
| | - Fernando A Lopez
- Universidad Metropolitana para la Educación y el Trabajo, Centro de Innovación de los Trabajadores, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | | | | | | | - Nina A Noor
- JEC Eye Hospitals and Clinics, Jakarta, Indonesia
| | | | | | - Mufarriq Shah
- Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Department of Optometry, Peshawar, Pakistan
| | - Carol L Shields
- Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Vasily Yartsev
- Scientific Research Institute of Eye Diseases, Moscow, Russia
| | - Frederic Mouriaux
- Univ Rennes, INSERM, INRA, CHU de Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France.,Service d'ophtalmologie, CHU de Rennes, Rennes, France
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Affiliation(s)
- Vasilios P. Papastefanou
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
| | - Ian Dooley
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
| | - Hadi Zambarakji
- Ophthalmology Service, Whipps Cross University Hospital, Barts Health NHS Trust, E1 1NR, London, UK
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Papastefanou VP, Plowman PN, Reich E, Pavlidou E, Restori M, Hungerford JL, Arora AK, Cohen VML, Sagoo MS. Analysis of Long-term Outcomes of Radiotherapy and Verteporfin Photodynamic Therapy for Circumscribed Choroidal Hemangioma. Ophthalmol Retina 2018; 2:842-857. [PMID: 31047538 DOI: 10.1016/j.oret.2017.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/24/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the long-term therapeutic outcome for different treatments of circumscribed choroidal hemangioma (CCH). DESIGN Retrospective observational study. SUBJECTS Patients with newly diagnosed CCH. METHODS Observation, verteporfin (Visudyne) photodynamic therapy (PDT), lens-sparing external beam radiotherapy (LS-EBRT), or plaque brachytherapy. MAIN OUTCOME MEASURES Best-corrected visual acuity (BCVA) at baseline and throughout follow-up, tumor dimensions, and OCT central thickness (where available) at baseline and throughout follow-up were recorded. RESULTS There were 60 treatment-naïve consecutive cases with CCH between January 2000 and June 2014; 42 (70%) received treatment. These were LS-EBRT (23/60 [38%]; mean follow-up, 45.5 months), PDT (16/60 [27%]; mean follow-up, 38 months), and plaque radiotherapy (3/60 [5%]; mean follow-up, 92 months). Macular location, mottled or orange pigment, and absence of drusen were significantly more frequent in the treatment group. In the LS-EBRT group, median thickness reduction on ultrasound B scan was 1.6 mm (mean ± standard deviation, 1.65±1.6; range, -6.5 to +0.7). The mean ± standard deviation BCVA gain was 0.22±0.34, with >3 Snellen lines in 48% of cases. Kaplan-Meier estimates were 80% for any gain and 40% for >3 Snellen lines gain at 5 years. In the PDT group, the median decrease in thickness was 0.95 mm (mean ± standard deviation, 1.0±0.8; range, -2.5 to +0.2). The mean ± standard deviation BCVA gain was at 0.3±0.51, with >3 Snellen lines in 30% of cases. Kaplan-Meier estimates were 93% for any gain and 68% for >3 Snellen lines at 5 years. Double versus single duration PDT had more favorable outcomes with a greater reduction in tumor thickness (P = 0.04), central retinal thickness (P = 0.02), and improvement in visual acuity (median, 0.33 vs -0.05). There was no difference in decrease in tumor thickness or BCVA gain between the LS-EBRT and PDT groups. With plaque brachytherapy, the mean decrease in thickness was 2.5 mm, but BCVA loss of >2 Snellen lines was noted in all 3 cases at the end of follow-up. Radiation complications developed in 10 of 23 cases (43.5%) from the LS-EBRT group and 2 of 3 cases (67%) from the plaque brachytherapy group. CONCLUSIONS LS-EBRT is equivalent to PDT in CCH management for post-treatment BCVA and tumor thickness reduction. The risk of LS-EBRT and plaque brachytherapy was late radiation-related complications. Double duration PDT was more favorable than single duration.
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Affiliation(s)
| | - P Nicholas Plowman
- Department of Radiation Oncology, St. Bartholomew's Hospital, London, UK
| | | | | | - Marie Restori
- Ultrasound Department, Moorfields Eye Hospital, London, UK
| | | | | | | | - Mandeep S Sagoo
- Ocular Oncology Service, London, UK; UCL Institute of Ophthalmology, London, UK
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8
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Burris CKH, Papastefanou VP, Thaung C, Restori M, Arora AK, Sagoo MS, Cohen VML. Detection of extrascleral extension in uveal melanoma with histopathological correlation. Orbit 2018; 37:287-292. [PMID: 29313397 DOI: 10.1080/01676830.2017.1423083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Uveal melanoma is the most common primary intraocular malignancy. Extrascleral extension (ESE) is rare, but associated with an increased rate of orbital recurrence and an overall poor prognosis. Clinical studies show low rates when compared with histological studies. Due to the prognostic importance of ESE, we sought to compare our clinical, intraoperative, and histological detection rates. DESIGN A retrospective cross-sectional case series. METHODS A list of eyes enucleated for uveal melanoma was compiled from the admissions records of the London Ocular Oncology Service during the 28-month period, i.e. January 2010-April 2012. The surgical and clinical notes of patients with histopathology proven ESE were reviewed to determine when it was first diagnosed or suspected. The subsequent management of these cases is discussed. RESULTS A total of 16 out of 174 (9%) eyes had histologically proven ESE. Eight of 16 cases were detected preoperatively at clinical examination, including the use of ocular ultrasound, 3 of 16 were discovered intra-operatively, and 5 of 16 deemed microscopic ESE, were first detected on histological examination. Seven of 7 (100%) of cases with anterior ESE were detected clinically by slit lamp biomicroscopy, while only 1 out of 9 (11%) of cases with posterior ESE was detected preoperatively with ultrasound. CONCLUSIONS Slit lamp biomicroscopy is sensitive for detecting anterior ESE. Most posterior ESE is microscopic, but macroscopic posterior ESE may also be missed by B-scan ocular ultrasound. Orbital surgeons should be suspicious of clinically undetected posterior ESE, and consider adjuvant orbital radiotherapy in cases with macroscopic ESE.
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Affiliation(s)
| | - Vasilios P Papastefanou
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Caroline Thaung
- d Eye Pathology , UCL Institute of Ophthalmology , London , UK
| | - Marie Restori
- c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Amit K Arora
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
| | - Mandeep S Sagoo
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK.,e National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust , London , UK
| | - Victoria M L Cohen
- b Ocular Oncology , St. Bartholomew's Hospital , London , UK.,c Ocular Oncology , Moorfields Eye Hospital , London , UK
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10
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Burris CKH, Papastefanou VP, Thaung C, Hay G, Grantham M, Cohen VML. Nonteratoid Medulloepithelioma Presenting in a 78-Year-Old Male. Ocul Oncol Pathol 2016; 2:218-221. [PMID: 27843898 DOI: 10.1159/000445209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/01/2016] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Medulloepithelioma is a rare congenital neoplasm derived from precursors of the nonpigmented ciliary epithelium of the ciliary body. The average patient age at clinical presentation is 3.8 years. CASE PRESENTATION We present the case of a 78-year-old male with progressive lens subluxation and ocular hypertension who was found to have a ciliary body mass. After enucleation for presumed ciliary body melanoma, histopathology showed a nonteratoid medulloepithelioma. Cytogenetic analysis revealed abnormalities in chromosomes 3 and 8. CONCLUSION Medulloepithelioma is often initially misdiagnosed. Though congenital in nature, it can exhibit rapid growth, have chromosomal abnormalities, and must be considered in all age groups.
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Affiliation(s)
| | - Vasilios P Papastefanou
- Department of Ocular Oncology, St. Bartholomew's Hospital, London, UK; Department of Ocular Oncology, Moorfields Eye Hospital, London, UK
| | - Caroline Thaung
- Department of Eye Pathology, UCL Institute of Ophthalmology, London, UK
| | - Gordon Hay
- Department of Ocular Oncology, St. Bartholomew's Hospital, London, UK
| | | | - Victoria M L Cohen
- Department of Ocular Oncology, St. Bartholomew's Hospital, London, UK; Department of Ocular Oncology, Moorfields Eye Hospital, London, UK
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11
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Papastefanou VP, Islam S, Szyszko T, Grantham M, Sagoo MS, Cohen VML. Metabolic activity of primary uveal melanoma on PET/CT scan and its relationship with monosomy 3 and other prognostic factors. Br J Ophthalmol 2014; 98:1659-65. [PMID: 25084771 PMCID: PMC4251304 DOI: 10.1136/bjophthalmol-2014-305304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To correlate the metabolic activity of primary uveal melanoma on positron emission tomography (PET)/CT scan with known clinical and pathological prognostic factors. Methods A retrospective cohort analysis of eyes enucleated for uveal melanoma that underwent preoperative imaging with a PET/CT scan was performed. Tumour dimensions were recorded and classified using Collaborative Ocular Melanoma Study (COMS) and American Joint Committee on Cancer (AJCC) Tumour - Nodes - Metastases (TNM) criteria. Metabolic activity was determined by measurement of the maximal standardised uptake value (SUVmax) on PET/CT scans. SUVmax of >2.5 and >4 was also used as cut-off value for metabolic positivity. Chromosome 3 and 8 status was determined using fluorescence in situ hybridisation analysis. Pearson correlation, χ2 test and non-parametric tests were used. p<0.05 was considered statistically significant. Results Seventy-six uveal melanomas were imaged preoperatively with a PET/CT scan. Overall 92% of tumours had a SUVmax >2.5 and 67% had a SUVmax >4. Monosomy 3 was found in 35 melanomas, of which 94% had an SUVmax >2.5 and 80% had an SUVmax >4. Only 57% of disomy 3 melanomas had an SUVmax >4. SUVmax was significantly increased in tumours with monosomy 3 (p=0.043) but not in tumours with chromosome 8 gain (p=0.49). SUVmax and increasing tumour size were positively correlated (p<0.05). Using the AJCC criteria, there was a significant difference in SUVmax among prognostic groups (p=0.024). There was no correlation with histopathological cell type (p=0.923). Conclusions Metabolic activity of uveal melanoma on PET/CT scan is positively correlated with monosomy 3, increasing tumour size and TNM prognostic groups. No association with chromosome 8 gain or histopathology cell type was noted. SUVmax >4 is a relative but not an absolute indicator of monosomy 3 status.
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Affiliation(s)
| | - Shahriar Islam
- Department of Nuclear Medicine, St Bartholomew`s Hospital, London, UK
| | - Teresa Szyszko
- Department of Nuclear Medicine, St Bartholomew`s Hospital, London, UK
| | | | - Mandeep S Sagoo
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK UCL Institute of Ophthalmology, London, UK
| | - Victoria M L Cohen
- Ocular Oncology Service, St Bartholomew's and Moorfields Eye Hospital, London, UK
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Karampelas M, Sim DA, Keane PA, Papastefanou VP, Sadda SR, Tufail A, Dowler J. Evaluation of retinal pigment epithelium–Bruch's membrane complex thickness in dry age-related macular degeneration using optical coherence tomography. Br J Ophthalmol 2013; 97:1256-61. [DOI: 10.1136/bjophthalmol-2013-303219] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Papastefanou VP, Nogueira V, Hay G, Andrews RM, Harris M, Cohen VML, Sagoo MS. Choroidal naevi complicated by choroidal neovascular membrane and outer retinal tubulation. Br J Ophthalmol 2013; 97:1014-9. [PMID: 23686326 DOI: 10.1136/bjophthalmol-2013-303234] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To present the outcomes of a series of patients with choroidal neovascular membrane (CNV) secondary to a choroidal naevus and report the presence of outer retinal tubulation. METHODS In this retrospective series, patients underwent a complete clinical and imaging assessment (fundus photo, fluorescein angiography and optical coherence tomography) and were observed or managed with intravitreal anti-VEGF injections dependent on whether visual acuity was affected. RESULTS Seventeen patients were included in this study. Of this, 46% (8/17) had classic or predominantly classic CNV and 53% (9/17) had occult or minimally classic CNV. Active treatment with intravitreal anti-VEGF injections was required in 35% (6/17). Visual acuity improved in three eyes by 2-4 Snellen lines, remained stable in one eye and worsened in two eyes by 2 Snellen lines. CNV partially regressed in five cases. In the observation group (65%, 11/17), visual acuity did not change during follow-up period. Outer retinal tubulation was found in 18% (3/17). CONCLUSIONS Anti-VEGF treatment is effective in the management of vision threatening CNV secondary to a choroidal naevus. Functional or anatomical improvement was obtained in 66% of treated eyes. Outer retinal tubulation, noted in 18%, showed the clinical importance of this sign in determining continuation of anti-VEGF treatment.
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Abstract
PURPOSE To describe the results of photodynamic therapy (PDT) for juxtapapillary and peripheral retinal capillary hemangioma (RCH). PATIENTS AND METHODS Interventional case series of four eyes (four patients) with juxtapapillary RCH and one eye (one patient) with peripheral RCH. Two eyes with juxtapapillary RCH had received two sessions of full-fluence, double-duration PDT; whereas other two eyes had received single session of half-fluence, single-duration PDT. The peripheral RCH was treated with a single session of full-fluence, single-duration PDT. RESULTS Two patients had von Hippel-Lindau disease. Follow-up duration ranged from 4 months to 1 year. Pre-PDT visual acuity (VA) ranged from 20/200 to HM (juxtapapillary RCH) and 20/100 (peripheral RCH). Among the eyes with juxtapapillary RCH, tumor regression with partial resolution of macular edema was noted in two eyes (one eye each with half-fluence and full-fluence PDT), whereas two eyes had no change in tumor size with persistent macular edema. VA remained stable in three eyes and declined in one eye. In an eye with peripheral RCH, regression of tumor and macular edema with VA improvement was noted. Post-PDT complications included epiretinal membrane (one eye) and transient exudative retinal detachment (one eye). CONCLUSION PDT can be effective in reducing macular edema associated with RCH but this does not always correspond with an improvement in VA especially for juxtapapillary tumors.
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Papastefanou VP, Cohen VML. Ciliary-body adenoma of the non-pigmented epithelium with rubeosis iridis treated with plaque brachytherapy and bevacizumab. Eye (Lond) 2012; 26:1388-90. [PMID: 22814808 DOI: 10.1038/eye.2012.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
Uveal melanoma is the most common primary intraocular malignancy and the leading primary intraocular disease which can be fatal in adults. In this paper epidemiologic, pathogenetic, and clinical aspects of uveal melanoma are discussed. Despite the advance in local ocular treatments, there has been no change in patient survival for three decades. Development of metastases affects prognosis significantly. Current survival rates, factors predictive of metastatic potential and metastatic screening algorithms are discussed. Proposed and emerging treatments for uveal melanoma metastases are also overviewed. Current advances in genetics and cytogenetics have provided a significant insight in tumours with high metastatic potential and the molecular mechanisms that underlie their development. Biopsy of those lesions may prove to be important for prognostication and to allow further research into genetic mutations and potential new therapeutic targets in the future.
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Affiliation(s)
- Vasilios P. Papastefanou
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK
- Ocular Oncology Service, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Victoria M. L. Cohen
- Ocular Oncology Service, Moorfields Eye Hospital, London EC1V 2PD, UK
- Ocular Oncology Service, St Bartholomew's Hospital, London EC1A 7BE, UK
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Petrou CP, Papastefanou VP, Panani E, Karkanis G, Petrou P, Koukoulomatis P. Anesthesia for phacotrabeculectomy. Ophthalmology 2008; 115:752-752.e3. [PMID: 18387411 DOI: 10.1016/j.ophtha.2007.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 10/16/2007] [Indexed: 11/24/2022] Open
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Papastefanou VP, Bozas E, Mykoniatis MG, Grypioti A, Garyfallidis S, Bartsocas CS, Nicolopoulou-Stamati P. VEGF isoforms and receptors expression throughout acute acetaminophen-induced liver injury and regeneration. Arch Toxicol 2007; 81:729-41. [PMID: 17431590 DOI: 10.1007/s00204-007-0201-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Accepted: 02/28/2007] [Indexed: 12/14/2022]
Abstract
Acetaminophen (APAP) is a widely-used analgesic and a known hepatotoxic agent. Vascular endothelial growth factor (VEGF) is a growth factor with multiple functional roles. VEGF plays an important role in angiogenesis and hepatic regeneration. The aim of this study was to determine the expression of VEGF isoforms and its receptors throughout liver regeneration after the administration of a toxic dose of APAP in rats. Ten groups of adult male rats received a dose of 3.5 g/kg b.w. of APAP per os. The rats were killed post administration at 0-288 h. Blood and liver tissue were extracted. Determination of serum transaminases and alkaline phosphatase activities was performed. Liver injury and regeneration were assessed with hematoxylin-eosin specimens, morphometric analysis, hepatic thymidine kinase assay and Ki-67 expression. Reverse transcription-polymerase chain reaction and immunohistochemical methods were used for assessment of VEGF isoforms and receptors differential expression. High activities of aspartate aminotransferase were observed at 24 and 36 h with another peak of activity at 192 h post administration. Alanine aminotransferase was highest at 36 h. Alkaline phosphatase was increased post 24 h being higher at 72,192 and 240 h. Centrilobular necrosis was observed at 48-72 h and thorough restoration of the liver microarchitecture was observed at 288 h. Liver regeneration lasted from 24-192 h according to the results from thymidine kinase activity and Ki-67 expression. VEGF and VEGF receptor-2 m-RNA levels presented with a three-peak pattern of expression at 12-24, 72-96 and 192-240 h post administration. Significant difference was noted between periportal and centrilobular immunohistochemical expression. VEGF proves to play a critical role during APAP-induced liver regeneration as it presents with three points of higher expression. The first two time points are associated with the initial inflammatory reaction to the noxious stimulus and the hepatocyte regenerative process where as the third one is indicative of the potential involvement of VEGF in processes of remodeling.
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Affiliation(s)
- Vasilios P Papastefanou
- Department of Experimental Pharmacology, Medical School, University of Athens, Mikras Asias 75, Goudi, 115 27 Athens, Greece.
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Papastefanou VP, Bozas E, Papoutsi Z, Grypioti A, Garyfallidis S, Nikolopoulou-Stamati P, Mykoniatis MG. Expression of vascular endothelial growth factor isoforms and receptors throughout acetaminophen-induced liver toxicity and regeneration. Toxicol Lett 2006. [DOI: 10.1016/j.toxlet.2006.06.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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