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Patterson TJ, Kedzierski A, McKinney D, Ritson J, McLean C, Gu W, Colyer M, McClellan SF, Miller SC, Justin GA, Hoskin AK, Cavuoto K, Leong J, Rousselot Ascarza A, Woreta FA, Miller KE, Caldwell MC, Gensheimer WG, Williamson T, Dhawahir-Scala F, Shah P, Coombes A, Sundar G, Mazzoli RA, Woodcock M, Watson SL, Kuhn F, Halliday S, Gomes RSM, Agrawal R, Blanch RJ. The Risk of Sympathetic Ophthalmia Associated with Open-Globe Injury Management Strategies: A Meta-analysis. Ophthalmology 2024; 131:557-567. [PMID: 38086434 DOI: 10.1016/j.ophtha.2023.12.006] [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: 08/17/2023] [Revised: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 02/12/2024] Open
Abstract
TOPIC Sympathetic ophthalmia (SO) is a sight-threatening granulomatous panuveitis caused by a sensitizing event. Primary enucleation or primary evisceration, versus primary repair, as a risk management strategy after open-globe injury (OGI) remains controversial. CLINICAL RELEVANCE This systematic review was conducted to report the incidence of SO after primary repair compared with that of after primary enucleation or primary evisceration. This enabled the reporting of an estimated number needed to treat. METHODS Five journal databases were searched. This review was registered with International Prospective Register of Systematic Reviews (identifier, CRD42021262616). Searches were carried out on June 29, 2021, and were updated on December 10, 2022. Prospective or retrospective studies that reported outcomes (including SO or lack of SO) in a patient population who underwent either primary repair and primary enucleation or primary evisceration were included. A systematic review and meta-analysis were carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effects modelling was used to estimate pooled SO rates and absolute risk reduction (ARR). RESULTS Eight studies reporting SO as an outcome were included in total. The included studies contained 7500 patients and 7635 OGIs. In total, 7620 OGIs met the criteria for inclusion in this analysis; SO developed in 21 patients with OGI. When all included studies were pooled, the estimated SO rate was 0.12% (95% confidence interval [CI], 0.00%-0.25%) after OGI. Of 779 patients who underwent primary enucleation or primary evisceration, no SO cases were reported, resulting in a pooled SO estimate of 0.05% (95% CI, 0.00%-0.21%). For primary repair, the pooled estimate of SO rate was 0.15% (95% CI, 0.00%-0.33%). The ARR using a random effects model was -0.0010 (in favour of eye removal; 95% CI, -0.0031 [in favor of eye removal] to 0.0011 [in favor of primary repair]). Grading of Recommendations, Assessment, Development, and Evaluations analysis highlighted a low certainty of evidence because the included studies were observational, and a risk of bias resulted from missing data. DISCUSSION Based on the available data, no evidence exists that primary enucleation or primary evisceration reduce the risk of secondary SO. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Tim J Patterson
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beflast, United Kingdom
| | | | - David McKinney
- Northern Ireland Medical and Dental Training Agency (NIMDTA), Beflast, United Kingdom
| | - Jonathan Ritson
- Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom; Royal Centre for Defence Medicine, Birmingham, United Kingdom
| | - Chris McLean
- Epsom and St Helier University Hospitals NHS Trust, Epsom, United Kingdom
| | - Weidong Gu
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Marcus Colyer
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott F McClellan
- Vision Center of Excellence, Research & Development Directorate, J-9, Defence Health Agency, Silver Spring, Maryland
| | - Sarah C Miller
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grant A Justin
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Duke Eye Center, Duke University Hospitals, Durham, North Carolina
| | - Annette K Hoskin
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Lions Eye Institute, University of Western Australia, Perth, Australia
| | - Kara Cavuoto
- Bascom Palmer Eye Institute, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - James Leong
- The University of Sydney, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, Sydney, New South Wales, Australia; Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Andrés Rousselot Ascarza
- Consultorios Oftalmológicos Benisek-Ascarza, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle E Miller
- Uniformed Services University of the Health Sciences, Bethesda, Maryland; Department of Ophthalmology, Navy Medical Center Portsmouth, Portsmouth, Virginia
| | - Matthew C Caldwell
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, Texas
| | - William G Gensheimer
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; White River Junction Veterans Administration Medical Center, White River Junction, Vermont
| | - Tom Williamson
- Department of Ophthalmology, St. Thomas Hospital, London, United Kingdom
| | | | - Peter Shah
- Birmingham Institute for Glaucoma Research, Birmingham, United Kingdom; Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Andrew Coombes
- Department of Ophthalmology, The Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Gangadhara Sundar
- Department of Ophthalmology, National University Hospital, Singapore, Republic of Singapore
| | - Robert A Mazzoli
- Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Malcolm Woodcock
- Worcestershire Acute Hospitals NHS Trust, Worcester, United Kingdom
| | - Stephanie L Watson
- Save Sight Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ferenc Kuhn
- Helen Keller Foundation for Research and Education, Birmingham, Alabama
| | | | - Renata S M Gomes
- Research & Innovation, BRAVO VICTOR, London, United Kingdom; Northern Hub for Veterans and Military Families Research, Northumbria University, Newcastle, United Kingdom
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Republic of Singapore; Singapore Eye Research Institute, Singapore, Republic of Singapore; Lee Kong Chian School of Medicine, Singapore, Republic of Singapore; Duke NUS Medical School, Singapore, Republic of Singapore
| | - Richard J Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Neuroscience & Ophthalmology, Institute of Inflammation & Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, United Kingdom.
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Kaliki S, Vempuluru VS, Mohamed A, Al-Jadiry MF, Bowman R, Chawla B, Hamid SA, Ji X, Kapelushnik N, Kebudi R, Sthapit PR, Rojanaporn D, Sitorus RS, Yousef YA, Fabian ID. Retinoblastoma in Asia: Clinical Presentation and Treatment Outcomes in 2112 Patients from 33 Countries. Ophthalmology 2024; 131:468-477. [PMID: 37839559 DOI: 10.1016/j.ophtha.2023.10.015] [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: 07/31/2023] [Revised: 09/15/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To describe the clinical presentation and treatment outcomes of children who received a diagnosis of retinoblastoma in 2017 throughout Asia. DESIGN Multinational, prospective study including treatment-naïve patients in Asia who received a diagnosis of retinoblastoma in 2017 and were followed up thereafter. PARTICIPANTS A total of 2112 patients (2797 eyes) from 96 retinoblastoma treatment centers in 33 Asian countries. INTERVENTIONS Chemotherapy, radiotherapy, enucleation, and orbital exenteration. MAIN OUTCOME MEASURES Enucleation and death. RESULTS Within the cohort, 1021 patients (48%) were from South Asia (SA), 503 patients (24%) were from East Asia (EA), 310 patients (15%) were from Southeast Asia (SEA), 218 patients (10%) were from West Asia (WA), and 60 patients (3%) were from Central Asia (CA). Mean age at presentation was 27 months (median, 23 months; range, < 1-261 months). The cohort included 1195 male patients (57%) and 917 female patients (43%). The most common presenting symptoms were leukocoria (72%) and strabismus (13%). Using the American Joint Committee on Cancer Staging Manual, Eighth Edition, classification, tumors were staged as cT1 (n = 441 [16%]), cT2 (n = 951 [34%]), cT3 (n = 1136 [41%]), cT4 (n = 267 [10%]), N1 (n = 48 [2%]), and M1 (n = 129 [6%]) at presentation. Retinoblastoma was treated with intravenous chemotherapy in 1450 eyes (52%) and 857 eyes (31%) underwent primary enucleation. Three-year Kaplan-Meier estimates for enucleation and death were 33% and 13% for CA, 18% and 4% for EA, 27% and 15% for SA, 32% and 22% for SEA, and 20% and 11% for WA (P < 0.0001 and P < 0.0001), respectively. CONCLUSIONS At the conclusion of this study, significant heterogeneity was found in treatment outcomes of retinoblastoma among the regions of Asia. East Asia displayed better outcomes with higher rates of globe and life salvage, whereas Southeast Asia showed poorer outcomes compared with the rest of Asia. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India.
| | - Vijitha S Vempuluru
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
| | - Ashik Mohamed
- The Operation Eyesight Universal Institute for Eye Cancer, L.V. Prasad Eye Institute, Hyderabad, India
| | - Mazin Faisal Al-Jadiry
- Pediatric Oncology Unit, Children Welfare Teaching Hospital, Medical City, College of Medicine, University of Baghdad, Bagdad, Iraq
| | - Richard Bowman
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Department of Ophthalmology, Great Ormond Street Children's Hospital, London, United Kingdom
| | - Bhavna Chawla
- Ocular Oncology Service, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Syed Ahmer Hamid
- Department of Ophthalmology, The Indus Hospital, Karachi, Pakistan
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
| | - Rejin Kebudi
- Department of Pediatric Hematology-Oncology, Oncology Institute, Istanbul University, Istanbul, Turkey
| | | | - Duangnate Rojanaporn
- Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Rita S Sitorus
- Department of Ophthalmology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | | | - Ido Didi Fabian
- International Centre for Eye Health, London School of Hygiene & Tropical Medicine, London, United Kingdom; Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Tel-Aviv University, Tel-Aviv, Israel
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Luo Y, Xu M, Yang L, Yao Y, Berry JL, Xu L, Wen X, He X, Han M, Fan X, Fan J, Jia R. Correlating somatic copy number alteration in aqueous humour cfDNA with chemotherapy history, eye salvage and pathological features in retinoblastoma. Br J Ophthalmol 2024; 108:449-456. [PMID: 36931696 PMCID: PMC10505245 DOI: 10.1136/bjo-2022-322866] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
BackgroundThis study determined to probe the potential association between somatic copy number alteration (SCNA) in retinoblastoma (RB) aqueous humour (AH) and pathological high-risk factors, clinical features and previous chemotherapy history. METHODS Single-centre retrospective cohort study from including 58 AH samples collected from 58 patients diagnosed. Among them, 41 samples were collected after enucleation and 17 samples were collected before intravitreal chemotherapy. SCNAs were accessed by conducting shallow whole-genome sequencing in cell-free (cf) DNA of AH. HRs and ORs were applied to measure risk factors. RESULTS Canonical RB SCNAs including 1q gain (87%), 2p gain (50%), 6p gain (76%), 16q loss (69%) were frequently detected. Non-classical RB SCNAs in AH including 17q gain (53%), 19q loss (43%), 7q gain (35%) were also commonly observed. 19q loss was significantly more common in patients with cT3c or worse stage than others (p=0.034). 2p gain(p=0.001) and 7q gain(p=0.001) were both more common in patients with primary enucleation than those with previous chemotherapy. Interestingly, both 2p gain (HR=1.933, p=0.027) and 7q gain (HR=2.394, p=0.005) might predict enucleation. Correlation analysis with pathological features among enucleated eyes showed that 19q loss can predict a higher risk for both massive choroid invasion (OR=4.909, p=0.038) and postlaminar optic nerve invasion (OR=4.250, p=0.043). DISCUSSION Sequencing of AH cfDNA in RB can provide sufficient in vivo information. 19q loss was a potential signature of advanced cases clinically and pathologically.Repeated sampling from eyes receiving sequential chemotherapy should be conducted to evaluate fluctuation of SCNA in future study.
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Affiliation(s)
- Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Mingpeng Xu
- Department of ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ludi Yang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yiran Yao
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jesse L Berry
- USC Roski Eye Institute,Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
- Vision Center at Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Liya Xu
- Vision Center at Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Xuyang Wen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xiaoyu He
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Minglei Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xianqun Fan
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
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4
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Stevens SM, Maeng MM, Markatia ZA, Abou Khzam R, Tang V, Dubovy SR, Johnson TE. Chronic anophthalmic socket pain in the setting of deep orbital pseudocysts. Orbit 2024; 43:131-135. [PMID: 36278956 DOI: 10.1080/01676830.2022.2083186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/23/2022] [Indexed: 06/16/2023]
Abstract
An 89-year-old woman presented with chronic pain and foreign body sensation in a healthy-appearing anophthalmic socket. Computed tomography of the orbits showed hyperdense, cystic lesions superior and posterior to the orbital implant. Orbital exploration was performed; the orbital implant and lesions were removed. Histopathology revealed cystic structures composed of fibrocellular tissue lined with histiocytes and multinucleated giant cells, consistent with pseudocysts. Postoperatively, the patient noted the resolution of her symptoms. While the etiology of the pseudocysts remains unclear, we hypothesize that the answer can be traced back to the original surgery. The cysts may have formed after extravasation of fluid or proteinaceous material from the eye, from glycerin on the donor sclera, or after introduction of foreign material during retrobulbar injection of local anesthesia. This is the first report of pseudocysts occurring in the orbit posterior to an implant.
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Affiliation(s)
- Shanlee M Stevens
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michelle M Maeng
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Zahra A Markatia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rayan Abou Khzam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Thomas E Johnson
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
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Tarar N, Wladis EJ. Outcomes of planned versus emergent enucleation procedures with primary orbital implants. Can J Ophthalmol 2024; 59:e38-e40. [PMID: 36368407 DOI: 10.1016/j.jcjo.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 10/15/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The primary purpose of this study was to explore the outcomes of primary implant placement in patients who have undergone enucleation on either a planned or emergent basis. METHODS A retrospective chart review was performed of 128 enucleations with at least a 1-year postoperative follow-up between November 2008 and May 2019 by a single oculoplastic surgeon at Albany Medical Center. Emergent cases were categorized as those with an active, unclosed globe perforation, secondary to either acute trauma, dehiscence or failed closure of a previously opposed wound, or exposure of a surgical site with dehiscence of the underlying sclera. Patient demographics, clinical features, and postoperative findings were recorded. The incidence of implant exposure was used as an indication of patient outcomes, and the data were subsequently analyzed using t tests. RESULTS Of the 128 enucleations performed, 32 (25%) were carried out on an emergent basis, of which 2 patients (6.25%) developed implant exposure. In contrast, of the 96 enucleations that were carried out in a planned, nonemergent manner, 3 patients (3.1%) developed implant exposure. There was no significant relationship between implant exposure rates in the acute and planned enucleation groups (p = 0.4047). CONCLUSIONS Despite the implications of globe perforation, our analysis suggests no significant correlation of implant exposures in acute versus planned enucleations with primary orbital implants. As such, physicians may confidently place a primary implant at the time of enucleation in both groups, and they may use these data to counsel their patients about the risks of postoperative complications.
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Affiliation(s)
- Nazish Tarar
- Department of Ophthalmology, Albany Medical College, Albany, NY.
| | - Edward J Wladis
- Department of Ophthalmology, Albany Medical College, Albany, NY
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Eiger-Moscovich M, Ruben M, Dockery PW, Yaghy A, Shields CL. Familial retinoblastoma: variations in clinical presentation and management based on paternal versus maternal inheritance. J AAPOS 2024; 28:103804. [PMID: 38218546 DOI: 10.1016/j.jaapos.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/19/2023] [Accepted: 11/07/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Several studies have demonstrated the effect of parent-of-origin on retinoblastoma penetrance. The purpose of the current study was to assess differences in clinical presentation of paternally versus maternally inherited retinoblastoma. METHODS The clinical records of all children with familial retinoblastoma treated on a tertiary Ocular Oncology Service between December 1975 and May 2020 were reviewed retrospectively. RESULTS A total of 179 patients with familial retinoblastoma were included. Paternal inheritance (PI) was identified in 109 (61%) patients and maternal inheritance (MI) in 70 patients (39%). A comparison (PI vs MI) revealed PI patients were older at presentation (57.2 vs 24.4 months [P = 0.002]) with no difference in patient sex (53% females vs 57% males [P = 0.606]) or number of family members affected (3.2 vs 3.0 family members [P = 0.255]). PI patients had more advanced classification according to the International Classification of Retinoblastoma (ICRB) (group E: 31% vs 8% [P = 0.012)] and greater largest tumor in basal diameter (9.0 vs 6.2 mm [P = 0.040]) and thickness (5.6 vs 4.0 mm [P = 0.038]); they were also less likely to be located in the macula (40% vs 60% [P = 0.004]). There was no difference in tumor laterality (69% vs 64% bilaterality [P = 0.530]). PI patients required enucleation more frequently (34% vs 14% [P = 0.007]). There was no difference in need for plaque radiotherapy (P = 0.86) or chemotherapy (P = 0.85). One PI patient developed metastatic retinoblastoma, and there were no retinoblastoma-related deaths. CONCLUSIONS Patients with paternally inherited retinoblastoma presented at an older age, with larger, more peripheral tumors and more advanced ICRB group, and were more likely to require enucleation compared to those with maternally inherited retinoblastoma.
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Affiliation(s)
- Maya Eiger-Moscovich
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Ophthalmology, Hadassah Medical Center, Kalman Ya'akov Man St, Jerusalem, Israel
| | - Megan Ruben
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Philip W Dockery
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Antonio Yaghy
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Quigley C, Elshelmani H, Fajin G, Byrne AM, McCloskey C, O'Neill V, Horgan N. Socket outcomes following enucleation for uveal melanoma: post enucleation socket syndrome can be challenging. Eye (Lond) 2024; 38:192-197. [PMID: 37407695 PMCID: PMC10764347 DOI: 10.1038/s41433-023-02657-y] [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: 03/13/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE To evaluate socket outcomes of enucleation for uveal melanoma. METHODS This study was a retrospective chart review conducted in December 2022 of all patients who underwent enucleation surgery for uveal melanoma between 2010 and 2015 in the Royal Victoria Eye and Ear Hospital, to evaluate socket outcomes including completion of revision surgery, type of surgery, and completion of multiple revision surgeries, and potential associations. RESULTS Between June 2010 and December 2015, 72 patients underwent enucleation for uveal melanoma in the ocular oncology service, including 25 females and 47 males, mean age 65, range 11-91 years old. There were 68 primary enucleations and 4 secondary enucleations. Complete follow-up data was available for mean 4 years, range 1-11 years. Fourteen patients underwent further surgery, including one exenteration for local recurrence. Oculoplastic surgery (n = 6, 8%), implant exposure repair (n = 3, 6%), and orbit volume expanding surgery (n = 4, 6%) were also performed. Eight patients (11%) underwent one further surgery and five patients (7%) underwent a series of procedures. There was a significant association with younger age at enucleation (age <65) with undergoing further surgery (p = 0.03, Fisher's Exact Test (FET)), and also an association of younger age with undergoing multiple further surgeries (p = 0.02, FET). There was no association found with other predictor variables, including primary versus secondary enucleation status. Most patients (75%) with PESS underwent more than one surgery. CONCLUSION Post enucleation surgery 82% of patients did not undergo further surgery, but younger patients were more likely to undergo anophthalmic socket revision or oculoplastic surgery. Management of post enucleation socket syndrome was challenging and usually involved a series of procedures.
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Affiliation(s)
- Clare Quigley
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland.
| | - Hanan Elshelmani
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
| | - Gabrijela Fajin
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
| | - Aisling McGlacken- Byrne
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
| | - Clare McCloskey
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
| | - Valerie O'Neill
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
| | - Noel Horgan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2, D02 XK51, Ireland
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El Mehdi T, Siham C, Imane K, Noufissa B, Amal B. Pigmented medulloepithelioma of the optic nerve: A challenging diagnostic entity. INDIAN J PATHOL MICR 2024; 67:207-210. [PMID: 38358224 DOI: 10.4103/ijpm.ijpm_116_22] [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] [Indexed: 02/26/2023] Open
Abstract
Because of its rarity, the diagnosis of optic nerve medulloepithelioma poses a real diagnostic challenge. Medulloepithelioma is a congenital tumor that derives from the primitive medullary epithelium present in the neural tube and the optic vesicle. Its classical location is the ciliary body. Cases of retinal or optic nerve locations have been rarely reported in the literature. Only 11 cases have been published in the English literature. Herein, we report the case of a 2-year-old boy who underwent enucleation of the right eye for a presumed diagnosis of right-eye retinoblastoma, based on the presence of leukocoria on ophthalmological examination. Pathological examination showed an optic nerve medulloepithelioma. A review of the literature is also discussed in our work.
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Affiliation(s)
- Tiabi El Mehdi
- Department of Pathology, Mohammed VI University Hospital, Oujda; Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Chariba Siham
- Department of Ophtalmology, Mohammed VI University Hospital, Oujda; Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Kamaoui Imane
- Department of Radiology, Mohammed VI University Hospital, Oujda; Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Benajiba Noufissa
- Department of Pediatrics, Mohammed VI University Hospital, Oujda; Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
| | - Bennani Amal
- Department of Pathology, Mohammed VI University Hospital, Oujda; Faculty of Medicine and Pharmacy of Oujda, Mohammed First University of Oujda, Morocco
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Nkanga ED, Nlemadim AC, Arazi M, Nkanga DG, Duke RE, Fabian ID, Nkanga ED, Odey FA, Meremikwu MM. PATIENT-RELATED FACTORS AND CLINICAL MANAGEMENT OUTCOMES OF RETINOBLASTOMA IN CALABAR, NIGERIA. West Afr J Med 2023; 40:S36-S37. [PMID: 38070170] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Background Retinoblastoma is curable in industrialized countries. However, it is associated with mortality in resource-poor nations due to disparities and poor access to eye care. Aim was to determine the relationships between patient-related factors and clinical outcomes of Retinoblastoma management in a tertiary hospital in Nigeria. Materials and methods This was a retrospective study of all children who were diagnosed and treated for Retinoblastoma from January 2017 through December 2022. Information obtained from their records included biosocioeconomic data, symptoms, lag time from initial symptoms, staging, treatment and outcome (dead or alive). Results Fifty-three patients, aged 6 to 88 months on first hospital presentation were recruited. There were 29(54.7%) females and 20(37.7%) patients died. Parental low socioeconomic class, rural residence and poor nutrition occurred more in those that survived, though not significantly (p>0.05). Median(interquartile) age at diagnosis [24(18-36) months, p=0.005] and lag time [13(6-20) months, p=0.274] were low in the survived group. Bilateral Retinoblastoma (20.8%,p=0.002), brain metastasis (22.6%,p<0.001), IRSS IV (18.9%,p=0.01) and relapse (34%,p<0.001) occurred more among the patients that died. The overall survival (OS) was 22(11.77-32.23) months with 1-year OS of 63%. Treatment with only chemotherapy [HR 4.76(95%CI:1.726-13.128)], incomplete chemotherapy [HR 5.61(95%CI:1.271-24.741)], relapse [HR 5.98(95%CI:1.376-25.983)] and eye surgery after 3 chemotherapy cycles [HR 8.22(95%CI:1.087-62.239)] were predictors of mortality. Conclusion Early presentation of retinoblastoma especially of advanced and bilateral disease may lead to improved survival if chemotherapy and eye surgery are appropriately performed. Routine screening and immediate referral of retinoblastoma particularly in rural areas are recommended.
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Affiliation(s)
- Elizabeth D Nkanga
- Department of Ophthalmology, University of Calabar, PMB 1115, Calabar, Cross River State, Nigeria.
- Calabar Children's Eye Centre, Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Anthony C Nlemadim
- Paediatric Oncology Unit, Department of Paediatrics, University of Calabar Teaching Hospital Calabar, Cross River State, Nigeria
| | - Mattan Arazi
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel
| | - Dennis G Nkanga
- Department of Ophthalmology, University of Calabar, PMB 1115, Calabar, Cross River State, Nigeria.
- Calabar Children's Eye Centre, Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
- Medical Retina Unit, Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roseline E Duke
- Department of Ophthalmology, University of Calabar, PMB 1115, Calabar, Cross River State, Nigeria.
- Calabar Children's Eye Centre, Department of Ophthalmology, University of Calabar, Calabar, Cross River State, Nigeria
| | - Ido D Fabian
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Essemfon D Nkanga
- All Saints University School of Medicine, Hillsborough Street, Roseau, Dominica, West Indies
| | - Friday A Odey
- Paediatric Oncology Unit, Department of Paediatrics, University of Calabar Teaching Hospital Calabar, Cross River State, Nigeria
| | - Martin M Meremikwu
- Paediatric Oncology Unit, Department of Paediatrics, University of Calabar Teaching Hospital Calabar, Cross River State, Nigeria
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Mc Glacken-Byrne A, Murtagh P, O'Neill V, Horgan N. Ocular oncology service during the COVID-19 outbreak: uveal melanoma characteristics presenting in 2019 compared to 2020. Ir J Med Sci 2023; 192:2607-2611. [PMID: 36805408 PMCID: PMC9938682 DOI: 10.1007/s11845-023-03310-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/08/2023] [Indexed: 02/21/2023]
Abstract
AIM We aim to evaluate the impact of the COVID-19 pandemic on ocular oncology in Ireland, comparing uveal melanoma trends in 2019 to 2020. METHODS Patients included for analysis were those that presented to the ocular oncology service from January 2019 to December 2020 in the Royal Victoria Eye and Ear Hospital in Dublin, who underwent primary treatment for uveal melanoma-proton beam therapy, brachytherapy or enucleation. RESULTS Ninety-seven patients presented in 2019 (n = 46) and 2020 (n = 51) who underwent primary treatment for uveal melanoma. Presentation via the eye casualty department was more common in 2020. Dimensions of choroidal melanomas were increased both in basal diameter and thickness compared to those in 2019. More patients had enucleations in 2020 than in 2019 (21.6% vs 9.3%, respectively) and less had proton beam therapy (6.2% vs 12.4%). More patients had evidence of extra-scleral extension at the time of surgery in 2020 compared to 2019 (4.1%, n = 4 versus 0%, respectively). The mean duration of brachytherapy therapy was longer in 2020 (5.3 days ± 35.8) compared to 2019 (4.6 days ± 38.7). Mean time between presentation and primary treatment was 35.6 ± 28.8 days in 2019 and 24.1 ± 20.4 days in 2020. CONCLUSIONS More advanced disease is suggested by the increased mean basal diameter and tumour thickness, extra-scleral extension and longer duration of brachytherapy. Time from diagnosis to treatment was not delayed in 2020.
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Affiliation(s)
- Aisling Mc Glacken-Byrne
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland.
| | - Patrick Murtagh
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland
| | - Valerie O'Neill
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland
| | - Noel Horgan
- Department of Ophthalmology, Royal Victoria Eye and Ear Hospital, Adelaide Rd, Dublin 2, D02 XK51, Ireland
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11
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Herranz Cabarcos A, Herranz Cabarcos S. Orbital administration of fillers for optimization of symmetry in patients with microphthalmos or acquired anophthalmic sockets: A review. Arch Soc Esp Oftalmol (Engl Ed) 2023; 98:703-712. [PMID: 37863426 DOI: 10.1016/j.oftale.2023.10.005] [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] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
The treatment of facial asymmetry in patients with microphthalmos or acquired anophthalmic sockets usually requires aggressive reconstructive surgeries. In recent years, studies have been published on the use of fillers to optimize orbital tissue symmetry, as minimally invasive techniques. For this reason, we performed a systematic review of the literature published to date on the use of fillers for the treatment of volume loss in acquired anophthalmic or microphthalmic cavities. Fourteen articles were reviewed in which the material used, the injection technique, the anatomical study of the patients before the procedure and the presence of associated complications were analyzed. Various materials have been used as fillers, including autologous fat, calcium hydroxyapatite, collagen, hyaluronic acid, or polyacrylamide gel. Standard peribulbar and retrobulbar injection techniques were applied, with few associated complications, the most serious being the development of vasovagal symptoms. Patient follow-up is usually limited in most studies to 12 months. In Conclusion, the use of fillers seems to be a safe practice, with good results and few complications, although studies with longer follow-up times than those published to date would be required.
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Affiliation(s)
- A Herranz Cabarcos
- Servicio de Oftalmología, Consorci Sanitari Moisès Broogi, Sant Joan Despí, Barcelona, Spain.
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12
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Ullrich K, Patel BCK, Malhotra R. Material risk: vitreoretinal surgery, evisceration, enucleation and sympathetic ophthalmia-where are we currently? Eye (Lond) 2023; 37:3542-3550. [PMID: 37198435 PMCID: PMC10686393 DOI: 10.1038/s41433-023-02562-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 04/04/2023] [Accepted: 04/24/2023] [Indexed: 05/19/2023] Open
Abstract
Sympathetic ophthalmia (SO) is known to occur after severe penetrating eye injury, evisceration and even enucleation surgery. Recent evidence suggests that a greater risk lies after multiple vitreoretinal procedures. The risk of SO following evisceration is only minimally greater than that following enucleation surgery. This review evaluates literature on SO to date and provides figures for the risk of developing SO for the purposes of the consent process. The issue of SO and Material Risk following vitreoretinal surgery is reviewed and figures for the purposes of consent are outlined. This is of particular relevance for patients in whom the contralateral eye is and will likely remain the better seeing eye. Sympathetic ophthalmitis is known to occur after severe penetrating eye injury, after evisceration and enucleation. More recently, sympathetic ophthalmitis has been recognised to occur after vitreoretinal surgery. This article reviews the evidence on material risk when consenting patients for elective and emergency eye procedures after ocular trauma or surgery. When a globe needs to be removed because of irreparable ocular injury, previous publications dictated the procedure to be an enucleation because of the fear of an increased risk of SO after an evisceration. Perhaps the issue of material risk of sympathetic ophthalmia (SO) remains over-emphasised by ophthalmic plastic surgeons and under-recognised by vitreoretinal surgeons during the consent process for evisceration, enucleation and vitreoretinal surgery. Antecedent trauma and number of previous surgeries may actually be a more significant risk factor than the type of eye removal. Recent medicolegal cases also help us understand the importance of the discussion of this risk. We present our current understanding of the risk of SO after different procedures and suggest how this information may be included in a patient consent.
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Affiliation(s)
- K Ullrich
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, UK.
- Department of Ophthalmology, Queen Elizabeth Hospital, 28 Woodville Road, Woodville, SA, Australia.
| | - B C K Patel
- Department of Ophthalmology, Division of Ophthalmic Plastic and Reconstructive Surgery, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - R Malhotra
- Corneoplastic Unit, Queen Victoria Hospital NHS Trust, East Grinstead, West Sussex, RH19 3DZ, UK
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13
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Atima MO, Idakwo U, Komolafe O, Eisuke S, Shintaro N, Balogun EO, Dingwoke EJ, Orugun AJ, Ukumobe KO, Pam JD, Aladiuba A. Presentation pattern and survival rate of retinoblastoma following chemotherapy: a prospective study. BMC Pediatr 2023; 23:538. [PMID: 37891551 PMCID: PMC10612210 DOI: 10.1186/s12887-023-04347-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND This study presents the clinical pattern of presentation and survival rate of retinoblastoma, which is the most prevalent form of pediatric intraocular cancer. The aim of this study is to provide baseline information about the clinical presentation and management of retinoblastoma at ECWA Eye Hospital. Additionally, the study identifies priority areas for enhancing medical care for children diagnosed with this cancer. ECWA Eye Hospital, situated in Kano State, Nigeria, is a specialized eye center located in the North-Western region of the country. METHODS A prospective study spanning five years was conducted at ECWA Eye Hospital to investigate clinically diagnosed cases of retinoblastoma. The study took place from January 2018 to December 2022. The patients received standardized pre-medication and chemotherapy protocols for retinoblastoma. Subsequently, a five-year follow-up was conducted to monitor the patients' progress. The collected data was analyzed, descriptive statistics were generated, and the survival rate was calculated. RESULTS During the five-year study period, a total of 35 cases of retinoblastoma were diagnosed. The patients had an average age of 3.21 ± 1.32 years. The most common presentation patterns observed were fungating ocular mass and proptosis. Among the cases, there were 10 instances of bilateral proptosis and 25 instances of unilateral proptosis. While no patients exhibited bilateral leukocoria, eight cases of unilateral leukocoria with anterior segment seedlings were identified. The additional patterns of presentation are proptosis, leukocoria, fungating orbital mass, redness and loss of vision. The mortality rate was 80% (28 cases), while the survival rate was 20% (7 cases). Notably, all the survivors had unilateral retinoblastoma. CONCLUSION The majority of cases observed at ECWA Eye Hospital involve advanced retinoblastoma. In low-resource settings where alternative treatment options are limited, chemotherapy is considered a viable treatment option. Early presentation of retinoblastoma in patients may lead to a higher survival rate when chemotherapy is administered.
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Affiliation(s)
| | | | | | - Shimizu Eisuke
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Nakayama Shintaro
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Emmanuel Oluwadare Balogun
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
| | - Emeka John Dingwoke
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Kaduna State, Nigeria
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Lim JZ, Crawford AZ, McGhee CNJ. Tumor Profiles of Late Presentation Uveal Ring Melanoma With Novel Characteristics - A Case Series. Invest Ophthalmol Vis Sci 2023; 64:44. [PMID: 37889509 PMCID: PMC10617633 DOI: 10.1167/iovs.64.13.44] [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: 07/01/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose The purpose of this study was to investigate the clinical features, tumor characteristics, including histopathology and cytogenetic analysis, and management of patients with uveal ring melanoma in New Zealand. Methods A retrospective review was conducted on all uveal melanoma cases treated in a single national oncology center in New Zealand. The study period was from January 1, 2013 to December 31, 2022 (10 years). Written consent was obtained from all patients included in this case series. Results Uveal ring melanoma of ciliary body origin (n = 4) comprised 0.7% of all uveal melanomas (n = 571). Ethnicity distribution was three patients of New Zealand European ancestry and one patient of Chinese/Pasifika ancestry. Three patients (75%) were symptomatic at presentation (spontaneous hyphema, glaucoma, and cataract), whereas one was asymptomatic but subsequently developed painful refractory glaucoma. All eyes underwent enucleation. Three eyes had primary iris biopsies with subsequent enucleation for refractory glaucoma and pain and one eye underwent primary enucleation. All cases demonstrated malignant tumor characteristics including diffuse 270 to 360-degree ciliary body ring growth pattern, epithelioid-cell type and presence of either BAP-1 expression loss or gain of MYC gene. Two cases (50%) developed distant organ metastasis - liver, parotid gland, and breast. Of those, one patient was deceased at the time of follow-up whereas one had completed treatment for metastases. Conclusions Uveal ring melanoma is a rare tumor that is highly invasive and malignant. When detected, prompt definitive treatment should be advocated, and patient counselling should be given regarding the high risk of developing a painful, blind eye with increased risk of metastasis in the absence of treatment.
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Affiliation(s)
- Joevy Z. Lim
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Department of Ophthalmology, Te Whatu Ora – Health New Zealand Auckland, New Zealand
| | - Alexandra Z. Crawford
- Department of Ophthalmology, Te Whatu Ora – Health New Zealand Auckland, New Zealand
| | - Charles N. J. McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
- Department of Ophthalmology, Te Whatu Ora – Health New Zealand Auckland, New Zealand
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15
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Rokohl AC, Trester M, Pine KR, Heindl LM. How to diagnose dry anophthalmic socket syndrome (DASS) in the clinical routine. Graefes Arch Clin Exp Ophthalmol 2023; 261:2713-2715. [PMID: 37103625 PMCID: PMC10432313 DOI: 10.1007/s00417-023-06074-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Affiliation(s)
- Alexander C Rokohl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany.
| | - Marc Trester
- Trester-Institute for Ocular Prosthetics and Artificial Eyes, Cologne, Germany
| | - Keith R Pine
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | - Ludwig M Heindl
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Center for Integrated Oncology (CIO) Aachen-Bonn-Cologne-Düsseldorf, Cologne, Germany
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Nalcı Baytaroğlu H, Gündüz AK, Mirzayev I, Özalp Ateş FS. Factors affecting eye conservation and metastasis in posterior uveal melanomas. Eur J Ophthalmol 2023; 33:2024-2033. [PMID: 36762394 DOI: 10.1177/11206721231155054] [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] [Indexed: 02/11/2023]
Abstract
PURPOSE To determine the effect of patient and tumor features and different treatments on eye removal (enucleation or exenteration) and metastasis in posterior uveal melanoma (PUM). METHODS Retrospective analysis. Patient age (≤60 vs >60 years), sex (female vs male), visual acuity (VA, ≤20/40 vs >20/40), largest tumor basal diameter (LTBD), tumor thickness, tumor stage according to American Joint Committee on Cancer (AJCC) 8th edition, ciliary body involvement, distance to optic disc (OD)/fovea (≤3 mm vs >3 mm), OD involvement, and histopathology were evaluated. Primary treatment options were transpupillary thermotherapy, plaque radiotherapy, Cyberknife radiosurgery, exoresection, and eye removal. Risk factors for primary eye removal were determined using logistic regression test and those for secondary eye removal and metastasis with Cox regression analysis. RESULTS Of 387 cases, 153 (39.5%) underwent primary eye removal. Multivariable risk factors for primary eye removal included AJCC tumor stage (p = 0.001, OR:4.586; p < 0.001, OR:34.545; p < 0.001, OR:103.468 for stages T2, T3, and T4 vs stage T1, respectively), and VA≤20/40 (p = 0.014, OR:2.597). Multivariable risk factors for secondary eye removal were VA≤20/40 (p = 0.019, RR:2.817) and AJCC stage T3 vs T1 (p = 0.021, RR:2.666). Eye preservation rates in patients undergoing eye-conserving treatments were 80.3%, 69.6%, and 51.5% at 5, 10, and 15 years, respectively. Metastasis-free survival rates were 81.0%, 73.0%, and 56.7% at 5, 10, and 15 years, respectively. Multivariable risk factors for metastasis included eye removal as primary treatment (p = 0.005, RR:2.828) and mixed type histopathology (p < 0.001, RR:4.804). DISCUSSION Early diagnosis is crucial for both eye preservation and survival in PUM. Increasing AJCC tumor stage and lower VA were risk factors for eye removal in this study. Mixed type histopathology and primary eye removal were risk factors for metastasis.
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Affiliation(s)
- Hilal Nalcı Baytaroğlu
- Ulucanlar Eye Education and Research Hospital, Ankara, Turkey
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Private Eye Clinic, Ankara, Turkey
| | - Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Çubuk State Hospital, Ankara, Turkey
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Landau Prat D, Zvi D, Zloto O, Hartstein M, Vardizer Y, Ben Simon GJ. Acquired Anophthalmic Socket: Clinical Course and Treatment Options. Int Ophthalmol Clin 2023; 63:163-185. [PMID: 37439616 DOI: 10.1097/iio.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
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Sarode D, McClay T, Roberts F, Connolly J, Cauchi P, Chadha V. Post-enucleation outcomes of patients with uveal melanoma in Scotland. Eye (Lond) 2023; 37:988-994. [PMID: 36266538 PMCID: PMC10050000 DOI: 10.1038/s41433-022-02280-3] [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: 03/01/2022] [Revised: 09/24/2022] [Accepted: 10/04/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate post-enucleation outcomes and assess the effect of extrascleral extension (ESE) on these outcomes for patients with uveal melanoma (UM) managed at a tertiary referral centre in Scotland. SUBJECTS/METHODS Retrospective review of all cases of UM managed by the Scottish Ocular Oncology Service for which enucleation was undertaken between 13/03/2008 and 31/12/2020. Primary outcomes were length of survival, time-to-metastasis (TTM) and local recurrence rate. Secondary outcomes were the effects of the presence of ESE, ESE size, and the use of adjuvant external beam radiotherapy (EBRT) on the primary outcomes. RESULTS Of 172 enucleated UMs, 32 (18.6%) had ESE. Over a median follow-up period of 33.7 months (range = 1.1-163.7 months), 91 (52.9%) patients died. The median length of all-cause survival of 54.1 months (range = 1.1-163.7 months). One-year, 5-year, and 10-year survival rates were 84.8%, 49.1%, and 30.9%, respectively. Eighty-four (49.7%) patients had metastatic disease. The median TTM of 42.2 months (range = 0.4-106.8 months). Proportions of patients who developed metastases within 1-year, 5-years and 10-years post-enucleation were 22.7%, 52.8%, and 71.8%, respectively. There was one instance of local orbital recurrence. ESE was associated with a significantly shorter length of survival (p = 0.03). There was a trend towards a shorter length of survival and TTM with ESE > 5 mm and those who received adjuvant EBRT. CONCLUSIONS ESE was present in one-sixth of our cohort and was associated with a significantly shorter length of survival, particularly in the presence of ESE > 5 mm or high-risk characteristics warranting adjuvant EBRT. This data will aid prognostication of the patients in our service.
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Affiliation(s)
- Deep Sarode
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK.
| | - Tara McClay
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Fiona Roberts
- Department of Pathology, Queen Elizabeth University Hospital, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Julie Connolly
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Paul Cauchi
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - Vikas Chadha
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
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Chadha V, Cauchi P, Kincaid W, Waterston A, Schipani S, Salvi S, Cram O, Ritchie D. Consensus statement for metastatic surveillance of uveal melanoma in Scotland. Eye (Lond) 2023; 37:894-899. [PMID: 35945341 PMCID: PMC10050391 DOI: 10.1038/s41433-022-02198-w] [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: 02/27/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 11/09/2022] Open
Abstract
Ophthalmic treatments are successful in managing uveal melanomas achieving good local control. However, a large number still metastasise, primarily to the liver, resulting in mortality. There is no consensus across the world on the mode, frequency, duration or utility of regular liver surveillance for metastasis and there are no published protocols. The Scottish Ocular Oncology Service (SOOS) constituted a Scottish Consensus Statement Group (SCSG) which included ocular oncologists, medical oncologists, radiologists and a uveal melanoma patient as a lay member. This group carried out an extensive review of literature followed by discussions to arrive at a consensus regarding surveillance planning for posterior uveal melanoma patients in Scotland. The Consensus Statement would provide a framework to guide each patient's surveillance plan and provide all patients with clarity and transparency on the issue. The SCSG was unable to find adequate evidence on which to base the strategy. The consensus statement recommends a risk-stratified approach to surveillance for these patients dividing them into low to medium-risk and high-risk groups defining the mode and duration of surveillance for each. It supplements the UK-wide Uveal Melanoma National Guidelines and allows a more uniform consensus-based approach to surveillance in Scotland. It has been adopted nationally by all health care providers in Scotland as a guideline and is available to patients on a publicly accessible website.
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Affiliation(s)
- Vikas Chadha
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
| | - Paul Cauchi
- Scottish Ocular Oncology Service, Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - Wilma Kincaid
- Department of Radiology, Gartnavel General Hospital, Glasgow, UK
| | | | | | - Sachin Salvi
- Sheffield Ocular Oncology Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Oliver Cram
- Department of Radiology, Gartnavel General Hospital, Glasgow, UK
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Krakauer M, Jennings E, Gupta L, Si Z, Yu D, Lu X, Prendes MA, Shah H. A comparison of primary and secondary eye removal after open globe injury: A multi-centre study. Eye (Lond) 2023; 37:1249-1253. [PMID: 35606549 PMCID: PMC10101944 DOI: 10.1038/s41433-022-02098-z] [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: 12/02/2021] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND/OBJECTIVES Our goal was to compare the characteristics and surgical outcomes of patients who underwent primary eye removal surgery after open globe injury with those who underwent secondary eye removal surgery after open globe repair. SUBJECTS/METHODS This was a retrospective review of subjects who underwent evisceration or enucleation within 3 months of an open globe injury, at three Level I trauma centres in three U.S. cities between July 2014 and July 2020. RESULTS 19 patients underwent primary eye removal and 20 underwent secondary eye removal. The most common mechanism of trauma in patients who underwent primary eye removal was gunshot. Compared to the secondary eye removal group, patients who underwent primary eye removal were significantly more likely to be male; have longer hospital stays; be discharged to another care facility rather than home; have facial fractures; suffer intracranial injury; and be unable to consent themselves for surgery. Both groups had a low surgical complication rate with one case of socket contracture in each group. CONCLUSIONS The standard of care for an open globe injury is prompt repair, but there are occasions when the globe is so damaged that it is deemed unrepairable. We found that globes that required primary eye removal were more often due to gunshot wounds, and that there was greater morbidity associated with these injuries. The authors' preferred surgical approach was evisceration with placement of a silicone sphere; patient outcomes demonstrate that this method was found to be safe, with a low complication and infection rate.
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Affiliation(s)
- Mark Krakauer
- Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
| | - Erin Jennings
- Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Lalita Gupta
- Department of Ophthalmology and Visual Sciences, Case Western Reserve/University Hospitals Eye Institute, Cleveland, OH, USA
| | - Zhuangjun Si
- Department of Ophthalmology and Visual Sciences, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Daohai Yu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Xiaoning Lu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Mark A Prendes
- Department of Ophthalmology and Visual Sciences, Case Western Reserve/University Hospitals Eye Institute, Cleveland, OH, USA
| | - Hassan Shah
- Department of Ophthalmology and Visual Sciences, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
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21
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Mouriaux F. How to analyze conjunctival inflammation in dry anophthalmic socket syndrome (DASS)? Graefes Arch Clin Exp Ophthalmol 2023; 261:629-630. [PMID: 36355084 DOI: 10.1007/s00417-022-05899-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 10/20/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Frederic Mouriaux
- Ophthalmology Dept, CHU Rennes, Université Rennes 1, Rennes, France.
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22
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Abramson DH, Mandelker DL, Brannon AR, Dunkel IJ, Benayed R, Berger MF, Arcila ME, Ladanyi M, Friedman DN, Jayakumaran G, Diosdado MS, Robbins MA, Haggag-Lindgren D, Shukla N, Walsh MF, Kothari P, Tsui DWY, Francis JH. Mutant-RB1 circulating tumor DNA in the blood of unilateral retinoblastoma patients: What happens during enucleation surgery: A pilot study. PLoS One 2023; 18:e0271505. [PMID: 36735656 PMCID: PMC9897525 DOI: 10.1371/journal.pone.0271505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/04/2022] [Indexed: 02/04/2023] Open
Abstract
Cell free DNA (cfDNA) and circulating tumor cell free DNA (ctDNA) from blood (plasma) are increasingly being used in oncology for diagnosis, monitoring response, identifying cancer causing mutations and detecting recurrences. Circulating tumor RB1 DNA (ctDNA) is found in the blood (plasma) of retinoblastoma patients at diagnosis before instituting treatment (naïve). We investigated ctDNA in naïve unilateral patients before enucleation and during enucleation (6 patients/ 8 mutations with specimens collected 5-40 minutes from severing the optic nerve) In our cohort, following transection the optic nerve, ctDNA RB1 VAF was measurably lower than pre-enucleation levels within five minutes, 50% less within 15 minutes and 90% less by 40 minutes.
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Affiliation(s)
- David H. Abramson
- Department of Surgery, Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Ophthalmology, Weill Cornell Medical Center, New York, New York, United States of America
- * E-mail:
| | - Diana L. Mandelker
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - A. Rose Brannon
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Ira J. Dunkel
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Pediatrics, Weill Cornell Medical Center, New York, New York, United States of America
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Michael F. Berger
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Maria E. Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Danielle Novetsky Friedman
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Gowtham Jayakumaran
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Monica S. Diosdado
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Melissa A. Robbins
- Department of Surgery, Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Dianna Haggag-Lindgren
- Department of Surgery, Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Neerav Shukla
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Michael F. Walsh
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Prachi Kothari
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
| | - Dana W. Y. Tsui
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Jasmine H. Francis
- Department of Surgery, Ophthalmic Oncology Service, Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Department of Ophthalmology, Weill Cornell Medical Center, New York, New York, United States of America
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23
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Naseripour M, Sedaghat A, Mirshahi R, Abdolalizadeh P, Koushki A, Faranoush M, Ghorbani M, Kashkouli MB, Sadeghipour A, Chaibakhsh S, Mehrvar A. Targeted chemotherapy in retinoblastoma: A step forward from patient survival to globe survival. Eur J Ophthalmol 2023; 33:574-586. [PMID: 35414292 DOI: 10.1177/11206721221093018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND/ OBJECTIVES Despite being the most common intraocular malignancy in childhood, there is a substantial disparity between developing and developed countries in terms of patient and globe survival in retinoblastoma (Rb). The current study intends to determine patient and globe survival before and after the introduction of the new targeted treatment modalities in a developing country. METHODS Medical records of 350 patients (516 eyes) with retinoblastoma referred to a tertiary referral center for Rb in Tehran, Iran, were reviewed. In order to compare patient and globe survival before and after the availability of the new treatment modalities, including intra-arterial and intravitreal chemotherapy, the patients were divided into group 1 (2001-2007) and group 2 (2008-2018) based on the calendar period of diagnosis. RESULTS Two-hundred-twenty-three eyes of 149 patients and 293 eyes of 201 patients were categorized into groups 1 and 2, respectively. The 5-year patient survival was 97% across the current survey, and the overall survival rate was 96% in group 1 and 99% in group 2 (P = 0.08). Overall, 50% of eyes with retinoblastoma underwent enucleation, which was the primary in 63% (116/184) of the unilateral and 30% (99/322) of the bilateral cases. Primary enucleation was significantly lower in group 2 (35%) in contrast to group 1 (50%) (P < 0.001). In addition, globe survival improved significantly in the International Classification of Retinoblastoma Groups D (17% in group 1 vs. 66% in group 2, P < 0.001) and E (1% in group 1 vs. 23% in group 2 P < 0.001) during the two timelines. In enucleated eyes, despite the increased rate of prelaminar involvement in group 2 (13% vs. 2% in group 1, P = 0.003), the rate of high-risk histopathologic findings was similar between the two groups. CONCLUSION Similar to developed countries, the application of new targeted treatment modalities, including intra-arterial and intravitreal chemotherapy, has been associated with significantly improved globe survival in Rb patients. However, it should be noted that even with the availability of these novel treatment options, the decision for on-time enucleation should not be deferred.
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Affiliation(s)
- Masood Naseripour
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Ahad Sedaghat
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Reza Mirshahi
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Parya Abdolalizadeh
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Amin Koushki
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Mohammad Faranoush
- Pediatric growth and development research center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Division of vascular and endovascular neurosurgery, Firoozgar Hospital, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahmani Kashkouli
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Alireza Sadeghipour
- Department of Pathology, Oncopathology Research Center, 440827Iran University of Medical Sciences, Tehran, Iran
| | - Samira Chaibakhsh
- Eye Research Center, The Five Senses Health Institute, 48492Rassoul Akram Hospital, Iran University, of Medical Sciences, Tehran, Iran
| | - Azim Mehrvar
- MAHAK Hematology Oncology Research Center (MAHAK-HORC), MAHAK Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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24
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Bussières L, Gobert D, Black DO, Vaillancourt L. Metastatic pulmonary adenocarcinoma to an anophthalmic socket. Canadian Journal of Ophthalmology 2022; 58:e134-e136. [PMID: 36435208 DOI: 10.1016/j.jcjo.2022.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 09/21/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
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25
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Dong LK, Park JK, Gulati R, Campbell B, Lee HBH. Silicone Sphere Implant Extrusion From Orbital Granulomatosis With Polyangiitis: A Rare Complication in the Anophthalmic Socket. Ophthalmic Plast Reconstr Surg 2022; 38:e170-e173. [PMID: 35699211 DOI: 10.1097/iop.0000000000002224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Orbital implant extrusion is a known complication following evisceration and enucleation. In this case report, we present a 45-year-old woman who presented with a left silicone implant exposure and infection 2 years following evisceration with saddle nose on examination. CT of the maxillofacial bones without contrast showed bilateral soft tissue infiltration around the superior recti muscles, as well as a nasal septum perforation from extensive sinus disease. Left orbitotomy revealed a small fibrotic mass near the orbital roof. Biopsy and serology results were consistent with granulomatosis with polyangiitis.
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Affiliation(s)
- Libing Kathy Dong
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, U.S.A
| | - Ji Kwan Park
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, U.S.A
- Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, IN, U.S.A
| | - Rohit Gulati
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, U.S.A
| | - Benjamin Campbell
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, U.S.A
- Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, IN, U.S.A
| | - Hui Bae Harold Lee
- Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, U.S.A
- Oculofacial Plastic and Orbital Surgery, Indianapolis, IN, U.S.A
- Ascension St. Vincent Hospital, Indianapolis, IN, U.S.A
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26
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Adewara BA, Badmus SA, Adegbehingbe BO, Awe OO, Onakpoya OH, Adeoye AO. Trends in Eye Removal Surgeries at a Tertiary Care Hospital Over Three Decades. West Afr J Med 2022; 39:1068-1074. [PMID: 36260833] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To determine the trends in eye removal surgeries at a tertiary hospital in Nigeria over 26 years. METHODS A retrospective comparative review of clinical records of all patients who had eye removal surgery at a tertiary hospital in Ile-Ife, Nigeria, between 2014 and 2019 was done. Patients' demographic and clinical data, including indication for eye removal and type of surgery were analysed and compared with two earlier studies at the same hospital between 1994 and 2013. RESULTS There was an average of 14.3 surgeries per year between 2014 and 2019. Patients' ages ranged from 2 to 102 years, M:F was 1.5:1, the commonest indication for eye removal was infection (n=30, 34.9%), and the most common surgery was evisceration (n=70, 81.4%). Studies from 1994 to 2003 and 2005 to 2013, reported an average of 9.2 and 10 surgeries per year; ages ranging from 4 days to 88 years and 3 months to 88 years; with a M:F of 2.1:1 and 3.4:1 respectively. In both studies, the commonest indication for eye removal was trauma (43.4% and 43.8% respectively) and the most common surgery was enucleation (57.6% and 55% respectively). Trend data showed a progressive increase in eye infections (12% vs 15% vs 34.9%) and eviscerations (19.6% vs 31.2% vs 81.4%) over time. CONCLUSION There was a change in trend towards an increase in eviscerations and infective indications for eye removal at the hospital over three decades. Prompt and optimal treatment of orbito-ocular infections is recommended to reduce the incidence of eye removal surgeries.
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Affiliation(s)
- B A Adewara
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - S A Badmus
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - B O Adegbehingbe
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - O O Awe
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - O H Onakpoya
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - A O Adeoye
- Department of Ophthalmology, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
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27
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Tomar AS, Finger PT, Gallie B, Kivelä TT, Mallipatna A, Zhang C, Zhao J, Wilson MW, Brennan RC, Burges M, Kim J, Berry JL, Jubran R, Khetan V, Ganesan S, Yarovoy A, Yarovaya V, Kotova E, Volodin D, Yousef YA, Nummi K, Ushakova TL, Yugay OV, Polyakov VG, Ramirez-Ortiz MA, Esparza-Aguiar E, Chantada G, Schaiquevich P, Fandino A, Yam JC, Lau WW, Lam CP, Sharwood P, Moorthy S, Long QB, Essuman VA, Renner LA, Semenova E, Català-Mora J, Correa-Llano G, Carreras E. Metastatic Death Based on Presenting Features and Treatment for Advanced Intraocular Retinoblastoma: A Multicenter Registry-Based Study. Ophthalmology 2022; 129:933-945. [PMID: 35500608 PMCID: PMC9329221 DOI: 10.1016/j.ophtha.2022.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 04/12/2022] [Accepted: 04/25/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate presenting features, tumor size, and treatment methods for risk of metastatic death due to advanced intraocular retinoblastoma (RB). DESIGN International, multicenter, registry-based retrospective case series. PARTICIPANTS A total of 1841 patients with advanced RB. METHODS Advanced RB was defined by 8th edition American Joint Committee on Cancer (AJCC) categories cT2 and cT3 and new AJCC-Ophthalmic Oncology Task Force (OOTF) Size Groups (1: < 50% of globe volume, 2: > 50% but < 2/3, 3: > 2/3, and 4: diffuse infiltrating RB). Treatments were primary enucleation, systemic chemotherapy with secondary enucleation, and systemic chemotherapy with eye salvage. MAIN OUTCOME MEASURES Metastatic death. RESULTS The 5-year Kaplan-Meier cumulative survival estimates by patient-level AJCC clinical subcategories were 98% for cT2a, 96% for cT2b, 88% for cT3a, 95% for cT3b, 92% for cT3c, 84% for cT3d, and 75% for cT3e RB. Survival estimates by treatment modality were 96% for primary enucleation, 89% for systemic chemotherapy and secondary enucleation, and 90% for systemic chemotherapy with eye salvage. Risk of metastatic mortality increased with increasing cT subcategory (P < 0.001). Cox proportional hazards regression analysis confirmed a higher risk of metastatic mortality in categories cT3c (glaucoma, hazard ratio [HR], 4.9; P = 0.011), cT3d (intraocular hemorrhage, HR, 14.0; P < 0.001), and cT3e (orbital cellulitis, HR, 19.6; P < 0.001) than in category cT2a and with systemic chemotherapy with secondary enucleation (HR, 3.3; P < 0.001) and eye salvage (HR, 4.9; P < 0.001) than with primary enucleation. The 5-year Kaplan-Meier cumulative survival estimates by AJCC-OOTF Size Groups 1 to 4 were 99%, 96%, 94%, and 83%, respectively. Mortality from metastatic RB increased with increasing Size Group (P < 0.001). Cox proportional hazards regression analysis revealed that patients with Size Group 3 (HR, 10.0; P = 0.002) and 4 (HR, 41.1; P < 0.001) had a greater risk of metastatic mortality than Size Group 1. CONCLUSIONS The AJCC-RB cT2 and cT3 subcategories and size-based AJCC-OOTF Groups 3 (> 2/3 globe volume) and 4 (diffuse infiltrating RB) provided a robust stratification of clinical risk for metastatic death in advanced intraocular RB. Primary enucleation offered the highest survival rates for patients with advanced intraocular RB.
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Affiliation(s)
- Ankit Singh Tomar
- Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York
| | - Paul T Finger
- Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York.
| | - Brenda Gallie
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada
| | - Tero T Kivelä
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashwin Mallipatna
- The Eye Cancer Clinic, Princess Margaret Cancer Centre, and Department of Ophthalmology and Vision Sciences, Hospital for Sick Children, Toronto, Canada; Department of Ocular Oncology, Narayana Nethralaya Eye Hospital, Bangalore, India
| | - Chengyue Zhang
- Pediatric Oncology Center, Beijing Children's Hospital, Beijing, China
| | - Junyang Zhao
- Pediatric Oncology Center, Beijing Children's Hospital, Beijing, China
| | - Matthew W Wilson
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Rachel C Brennan
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Michala Burges
- Department of Ophthalmology, Hamilton Eye Institute, University of Tennessee Health Science Center, College of Medicine, and Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jonathan Kim
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California; The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Jesse L Berry
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California; The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Rima Jubran
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California; The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Vikas Khetan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Suganeswari Ganesan
- Department of Vitreoretina Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Andrey Yarovoy
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Vera Yarovaya
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Elena Kotova
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Denis Volodin
- Ocular Oncology Department, The S.N. Fyodorov Eye Microsurgery Federal State Institution, Moscow, Russian Federation
| | - Yacoub A Yousef
- Department of Surgery (Ophthalmology), King Hussein Cancer Center, Amman, Jordan
| | - Kalle Nummi
- Ocular Oncology Service, Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatiana L Ushakova
- SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation; Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Olga V Yugay
- SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation
| | - Vladimir G Polyakov
- SRI of Pediatric Oncology and Hematology of N.N. Blokhin National Medical Research Center Oncology of Russian Federation, Moscow, Russian Federation; Medical Academy of Postgraduate Education, Moscow, Russian Federation
| | - Marco A Ramirez-Ortiz
- Department of Ophthalmology, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | - Paula Schaiquevich
- Precision Medicine Coordination Hospital JP Garrahan and CONICET, National Scientific and Technical Research Council, Buenos Aires, Argentina
| | - Adriana Fandino
- Ophthalmology Service Hospital JP Garrahan, Buenos Aires, Argentina
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Winnie W Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Carol P Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Kowloon, Hong Kong
| | - Phillipa Sharwood
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | - Vera Adobea Essuman
- Ophthalmology Unit, Department of Surgery, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lorna A Renner
- Department of Child Health, University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ekaterina Semenova
- Department of Ocular Tumor, Orbital Disease, and Ophthalmic Radiation Therapy, The New York Eye Cancer Center, New York, New York
| | - Jaume Català-Mora
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu. Esplugues de Llobregat, Barcelona, Spain
| | - Genoveva Correa-Llano
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu. Esplugues de Llobregat, Barcelona, Spain
| | - Elisa Carreras
- Retinoblastoma Unit, Department of Ophthalmology, Hospital Sant Joan de Déu. Esplugues de Llobregat, Barcelona, Spain
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Surukrattanaskul S, Keyurapan B, Wangtiraumnuay N. Correlation between clinical presentations, radiological findings and high risk histopathological features of primary enucleated eyes with advanced retinoblastoma at Queen Sirikit National Institute of Child Health: 5 years result. PLoS One 2022; 17:e0270362. [PMID: 35857757 PMCID: PMC9299328 DOI: 10.1371/journal.pone.0270362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/08/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose To evaluate the correlation between clinical presentations, radiological findings and high risk histopathological features of primary enucleated eyes in patients with advanced retinoblastoma at a tertiary child hospital in Thailand. Materials and methods We retrospectively reviewed the medical records of patients who were treated with primary enucleation of tumor eyes between 2015–2020. Demographic data, radiological assessment, and histopathological findings were collected. The association between clinical presentations and high-risk histopathological features in the primary enucleated eyes were evaluated. The radiological findings, which showed characteristic of high risk features, were compared with the histopathological findings. Results Thirty-three enucleated eyes were enrolled in this study. The mean age at diagnosis was 23.12 months. Most patients had unilateral group E retinoblastoma, with no difference in sex and laterality of the eye. Leukocoria was the most common presentation, followed by proptosis and uveitis. Older age at presentation were statistically associated with post laminar cribrosa optic nerve invasion (P-value 0.0027) and high-risk histopathological features in enucleated eyes (P-value 0.0032). Clinical presentations with proptosis were statistically associated with post laminar cribrosa optic nerve invasion, while leukocoria and uveitis were statistically associated with anterior segment invasion. Unifocal intraocular mass with necrosis was the most common histopathological finding. High-risk features were found in 45% of primary enucleated eye. The sensitivity and specificity of magnetic resonance imaging (MRI) for detected optic nerve invasion in retinoblastoma patients were 75% and 54%, respectively. Conclusion Patients with unilateral retinoblastoma who presented with older age related to high-risk features after enucleation. Ophthalmic examination with slitlamp is the best way for detection of anterior segment invasion. Choroidal invasion was unable to predict with clinical presentation. MRI was the better imaging for detection of post laminar cribrosa optic nerve invasion.
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Affiliation(s)
- Supawan Surukrattanaskul
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Bungornrat Keyurapan
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Nutsuchar Wangtiraumnuay
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
- * E-mail:
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Mirzayev I, Gündüz AK, Okçu Heper A. Partial lamellar sclerouvectomy surgery for anteriorly located uveal tumour resection: a 20-year experience. Eye (Lond) 2022; 36:969-977. [PMID: 33941875 PMCID: PMC9046411 DOI: 10.1038/s41433-021-01545-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/21/2020] [Revised: 03/02/2021] [Accepted: 04/07/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the results of partial lamellar sclerouvectomy (PLSU) for anteriorly located uveal tumours. METHODS We reviewed the tumour features, histopathologic findings, complications, visual acuity outcomes, eye preservation, metastasis, and mortality data of 56 cases with uveal tumours who underwent PLSU between February 1999 and February 2019. RESULTS The mean largest tumour base diameters were 5.8 × 3.4 mm and the mean tumour thickness was 3.3 mm. Histopathologically, 30 (53.6%) eyes had malignant melanoma, 13 (23.2%) had nevus, 5 (8.9%) had iris stromal cyst, 4 (7.1%) had melanocytoma, 2 (3.6%) had Fuchs' adenoma, 1 (1.8%) had iris pigment epithelial cyst, and 1 (1.8%) had invasive breast cancer metastasis. The most common postoperative complications included cataract in 21 (37.5%) eyes, vitreous haemorrhage in 15 (26.8%), scleral thinning in 10 (17.9%), and hyphema in 6 (10.7%). At a mean follow-up of 40.4 (range: 10-201) months, tumour recurrence was observed in 2/30 (6.7%) eyes with melanoma and 1/5 (20.0%) eye with iris stromal cyst. Eyes with recurrent melanoma were treated with enucleation. Liver metastasis developed in only 1 (3.3%) melanoma case. All patients were alive at the end of follow-up. CONCLUSIONS PLSU is a successful treatment method for many anteriorly located uveal tumours. In our series, the overall tumour recurrence and globe salvage rates were 5.4% and 96.4% respectively. Among melanoma cases, the metastasis rate was 3.3% and survival rate was 100%.
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Affiliation(s)
- Ibadulla Mirzayev
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey
- Department of Ophthalmology, Dünya Göz Hospital, Ankara, Turkey
| | - Ahmet Kaan Gündüz
- Department of Ophthalmology, Ankara University Faculty of Medicine, Ankara, Turkey.
- Private Office, Farilya Business Center 8/38, Çukurambar, Ankara, Turkey.
| | - Aylin Okçu Heper
- Departmant of Pathology, Ankara University Faculty of Medicine, Ankara, Turkey
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Steckler AM, Francis JH, Shoushtari AN, Abramson DH, Barker CA. Uveal melanoma metastatic at initial diagnosis: a case series. Melanoma Res 2022; 32:120-123. [PMID: 35152255 PMCID: PMC8901542 DOI: 10.1097/cmr.0000000000000807] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Detectable metastasis at the time of initial diagnosis of uveal melanoma (UM) is rare. The purpose of this investigation was to evaluate the characteristics and outcomes in patients with metastatic UM (MUM) at initial diagnosis. An institutional review board-approved retrospective case series analysis was performed in 21 patients that presented for management of MUM at initial diagnosis. Patient, tumor and treatment parameters were recorded, and ophthalmic symptoms, metastasis response and overall survival were assessed. Among 21 patients, median tumor diameter was 18 mm (range, 9.1-35 mm), with 76% classified as a Collaborative Ocular Melanoma Study (COMS) large size. Sites of metastasis included liver (95%), bone (29%) and lung (29%), among others, and were confirmed by biopsy in 95% of patients studied. Symptomatic primary tumors were present in 81%, causing pain (24%) or vision loss (57%). Primary tumor therapy (PTT) was provided upfront for 52% of patients with enucleation (24%) and brachytherapy (29%). Eye pain developed 3-6 months after diagnosis in four of 10 patients who did not receive upfront PTT, whereas it did not occur in any of the 11 patients who received upfront PTT (P = 0.04). PTT palliated pain in all cases. The median overall survival was 11.9 months (range, 2.5-21.1 months). Patients presenting with MUM at initial diagnosis have high-risk tumors and experience survival like patients who develop metastases metachronously. PTT is not associated with survival but may mitigate ophthalmic symptoms, especially in patients with large tumors at risk for causing symptoms.
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Affiliation(s)
- Alexa M. Steckler
- Department of Radiation Oncology (Brachytherapy Service), Memorial Sloan Kettering Cancer Center
| | - Jasmine H. Francis
- Department of Surgery (Ophthalmic Oncology Service), Memorial Sloan Kettering Cancer Center
| | | | - David H. Abramson
- Department of Surgery (Ophthalmic Oncology Service), Memorial Sloan Kettering Cancer Center
| | - Christopher A. Barker
- Department of Radiation Oncology (Brachytherapy Service), Memorial Sloan Kettering Cancer Center
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31
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Luo Y, Zhou C, He F, Fan J, Wen X, Ding Y, Han Y, Ding J, Jin M, Liu Z, Wang S, Han M, Yuan H, Sun H, Xiao Y, Wu L, Wang J, Li Y, Yang H, Yu J, Gong J, Xu Y, Wen Y, Gao Z, Mei L, Ye J, Liu H, Chen Z, Xue S, Liu R, Chen H, Lu W, Liao H, Guo Q, Cui J, Zhu D, Lu F, Tang S, Wu Y, Yangkyi T, Guanghong Z, Wubuli M, Huiyu G, Wang X, He Y, Sheng X, Wang Q, Tan J, Liang J, Sun X, Zhang J, Ji X, Jin L, Zhao J, Yang X, Jia R, Fan X. Contemporary Update of Retinoblastoma in China: Three-Decade Changes in Epidemiology, Clinical Features, Treatments, and Outcomes. Am J Ophthalmol 2022; 236:193-203. [PMID: 34626572 DOI: 10.1016/j.ajo.2021.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [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: 03/19/2021] [Revised: 05/30/2021] [Accepted: 09/22/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE To report three-decade changes of clinical characteristics, progress of treatments, and risk factors associated with mortality and enucleation in patients with retinoblastoma in China. DESIGN Retrospective cohort study. METHODS This multicenter study included 2552 patients diagnosed with retinoblastoma in 38 medical centers in 31 provinces in China from 1989 to 2017, with follow-up data. Kendall's tau-b value was used to describe correlation coefficients between the three eras (between 1989 and 2008, between 2009 and 2013, and between 2014 and 2017) and clinical or demographic features. Hazard ratios and odds ratios were applied to measure risk factors. RESULTS A total of 324 (13%) patients died and 1414 (42%) eyes were removed. The 1-year, 3-year, and 5-year overall survival rates were 95%, 86%, and 83%, respectively. Patients were diagnosed at a better stage by International Classification for Retinoblastoma over time (Kendall's tau-b value = -0.084, P < .001). Pathological risk factors were also observed less in recent eras. New conservative therapies were adopted and used in more patients. The eye removal rate gradually decreased (Kendall's tau-b value = -0.167, P < .001). The overall survival rates were 81%, 83%, and 91% in the three eras. By multivariate Cox regression, bilateral tumors and extraocular extension were identified as risk factors for death. Among intraocular disease, Group E indicated higher risk of mortality. By multivariate logistics regression, unilateral tumors, earlier era of diagnosis, and extraocular extension were risk factors for eye salvage failure. Among intraocular retinoblastoma, Groups D and E had higher risk of eye salvage failure. CONCLUSIONS Patients were diagnosed at an earlier stage in recent eras. Conservative therapies, including intra-arterial chemotherapy, were increasingly being used. The above changes may contribute to the decreasing enucleation rate. Although no significant impact was identified on the mortality by the three eras, a decreasing trend was shown.
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Affiliation(s)
- Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Fanglin He
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Xuyang Wen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Yanping Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Jingwen Ding
- Department of Ophthalmology, Beijing Tongren Hospital (J.D)
| | - Mei Jin
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University (M.J, J.Z)
| | - Zhenyin Liu
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center (Z.L, J.Z)
| | - Sha Wang
- Department of Ophthalmology, Central South University Xiangya School of Medicine (S.W, J.T)
| | - Minglei Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Department of Ophthalmology, Qilu Children's Hospital of Shandong University (M.H)
| | - Hongfeng Yuan
- Department of Ophthalmology, the First hospital Affiliated with AMU (H.Y)
| | - Hong Sun
- Department of Ophthalmology, Shandong Provincial Hospital (H.S)
| | - Yishuang Xiao
- Department of Ophthalmology, Kunming Children's Hospital (Y.X)
| | - Li Wu
- Department of Ophthalmology, Wuhan University Renmin Hospital (L.W)
| | - Jiancang Wang
- Department of Ophthalmology, Hebei Children's Hospital (J.W)
| | - Yangjun Li
- Department of Ophthalmology, Xi'an Tangdu Hospital of No.4 Military Medical University (Y.L)
| | - Huasheng Yang
- Zhongshan Ophthalmic Center, Sun Yat-sen University (H.Y)
| | - Jiawei Yu
- Department of Ophthalmology, Harbin Children's Hospital (J.Y)
| | - Jianyang Gong
- Ophthalmology of the First Affiliated Hospital Anhui Medical University (J.G)
| | - Yuxin Xu
- Department of Ophthalmology, the Second affiliated Hospital of Anhui Medical University (Y.X)
| | - Yuechun Wen
- Department of Ophthalmology, the Provincial Hospital Affiliated to Anhui Medical University (Y.W)
| | - Ziqing Gao
- Department of Ophthalmology, the First Affiliated Hospital of Bengbu Medical College (Z.G)
| | - Lixin Mei
- Department of Ophthalmogy, Yijishan Hospital, Wannan Medical College (L.M)
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital Zhejiang University School of Medicine (J.Y)
| | - Hu Liu
- Jiangsu Province Hospital (H.L)
| | - Zhijun Chen
- Children's Hospital of Nanjing Medical University (Z.C)
| | - Shangcai Xue
- Second Provincial People's Hospital of Gansu (S.X)
| | - Rong Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology (R.L)
| | - Hong Chen
- Department of Ophthalmology, Union Hospital Affiliated with Tongji Medical College, Huazhong University of Science and Technology, Wuhan (H.C)
| | - Wei Lu
- Department of Ophthalmology, the Second Hospital of Dalian Medical University (W.L)
| | - Hongfei Liao
- Department of Ocular Trauma and Orbital Diseases, Affiliated Eye Hospital of Nanchang University (H.L)
| | - Qing Guo
- The First Affiliated Hospital of Harbin Medical University, Harbin 150001, Heilongjiang Province, China (Q.G)
| | - Jizhe Cui
- The Second Hospital of Jilin University (J.C)
| | - Dan Zhu
- The Affiliated Hospital of Inner Mongolia Medical University (D.Z)
| | - Fang Lu
- West China Hospital, Sichuan University (F.L)
| | | | - Yu Wu
- People's Hospital of Guangxi Zhuang Autonomous Region (Y.W)
| | | | - Zhang Guanghong
- Beijing Road Clinical Department of Xinjiang Military Command General Hospital Urumqi (Z.G)
| | | | - Guo Huiyu
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University (G.H)
| | - Xian Wang
- The Affiliated Hospital of Guizhou Medical University (X.W)
| | - Yanjin He
- Tianjin medical university eye hospital (Y.H)
| | - Xunlun Sheng
- Ning Xia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region (X.S)
| | - Qing Wang
- Qinghai University Affiliated Hospital (Q.W)
| | - Jia Tan
- Department of Ophthalmology, Central South University Xiangya School of Medicine (S.W, J.T)
| | - Jianhong Liang
- Department of Ophthalmology, Peking University People's Hospital (J.L)
| | - Xiantao Sun
- Department of Ophthalmology, Henan Children's Hospital (X.S)
| | - Jing Zhang
- Department of Ophthalmology, Guangzhou Women and Children's Medical Center (Z.L, J.Z)
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital affiliated with Shanghai Jiaotong University School of Medicine (L.J)
| | - Liwen Jin
- Department of Ophthalmology, Quanzhou Women's and Children's Hospital (L.J)
| | - Junyang Zhao
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University (M.J, J.Z)
| | - Xinji Yang
- Department of Ophthalmology, The General Hospital of Chinese People's Armed Police Forces (X.Y)
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F)
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, M.H, R.J, X.F); Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China (Y.L, C.Z, F.H, J.F, X.W, Y.D, Y.H, R.J, X.F).
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He B, Tanya SM, Wang C, Kezouh A, Torun N, Ing E. The Incidence of Sympathetic Ophthalmia After Trauma: A Meta-analysis. Am J Ophthalmol 2022; 234:117-125. [PMID: 34283983 DOI: 10.1016/j.ajo.2021.06.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/03/2021] [Revised: 06/10/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Sympathetic ophthalmia (SO) is a rare, bilateral panuveitis that occurs following open globe injury (OGI), with a variable incidence reported in the literature. Our objective was to determine the incidence proportion and incidence rate of SO following OGI to help guide shared physician-patient decision making. DESIGN Systematic review and meta-analysis. METHODS A systematic literature search was performed using the MEDLINE, EMBASE, and Cochrane databases from inception to November 2020 for population-based studies on OGI and SO in adults and children. Two reviewers independently screened search results. Random-effects meta-analyses were performed to calculate the incidence proportion and incidence rate. The Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tool was used to assess the risk of bias. The study was registered on PROSPERO CRD42020198920. RESULTS A total of 24 studies were utilized in the meta-analyses. After OGI, the estimated overall incidence proportion of SO was 0.19% (95% CI 0.14%-0.24%) and the incidence rate of SO was 33 per 100,000 person-years, (95% CI 19.61-56.64) with I2 of 13% and 72%, respectively. CONCLUSIONS SO after OGI is rare. The estimated incidence proportion and incidence rate are useful when counselling patients regarding management options after OGI. Further studies are needed to examine the influence of age, the extent and location of trauma, timing of repair, and prophylactic eye removal on the incidence of SO.
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Affiliation(s)
- Bonnie He
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada (B.H.)
| | - Stuti M Tanya
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada (S.M.T.)
| | - Chao Wang
- Faculty of Health, Social Care and Education, Kingston University London, London, England (C.W.)
| | - Abbas Kezouh
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, Québec, Canada (A.K.)
| | - Nurhan Torun
- Department of Ophthalmology, Harvard University, Cambridge, Massachusetts, United States of America (N.T.)
| | - Edsel Ing
- Department of Ophthalmology and Visual Sciences, University of Toronto, Toronto, Ontario, Canada (E.I.).
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Rehman O, Narang S, Nayyar S, Aggarwal P. Unusual case of intraocular medulloepithelioma in an adult male. Rom J Ophthalmol 2021; 65:296-299. [PMID: 35036657 PMCID: PMC8697787 DOI: 10.22336/rjo.2021.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2021] [Indexed: 11/18/2022] Open
Abstract
Medulloepithelioma is a rare tumor of the eye, arising from the posterior segment. This embryonic tumor is mostly seen in children and is very rare in adult population. This case report presents the case of a 39-year-old Indian male, who had gradual vision loss over 4 years in his left eye with new onset of pain. He was referred to our center in view of secondary cataract and intraocular mass. Vision in right eye was 20/ 20 while left eye had no light perception at presentation. Ocular examination of the left eye revealed shallow anterior chamber, florid iris neovascularization, raised intraocular pressure and cataractous lens. B-scan ultrasonography showed a heterogenous mass filling the entire globe. MRI scan confirmed the finding, showing a mass hyper-intense to vitreous. No invasion of optic nerve or sclera was observed. Left eye enucleation with PMMA implant placement was performed and histopathology confirmed the diagnosis of benign teratoid medulloepithelioma. At the time of submission of this report, the patient was still under follow-up and had no detectable metastases at 15 months follow-up. This report highlights a very rare case of embryonic tumor in adult male, which could be managed successfully with a high index of suspicion and timely intervention.
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Affiliation(s)
- Obaidur Rehman
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Subina Narang
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Shifali Nayyar
- Department of Ophthalmology, Government Medical College and Hospital, Chandigarh, India
| | - Phiza Aggarwal
- Department of Pathology, Government Medical College and Hospital, Chandigarh, India
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Zhou C, Wen X, Ding Y, Ding J, Jin M, Liu Z, Wang S, Han M, Yuan H, Xiao Y, Wu L, Wang J, Li Y, Yu J, Wen Y, Ye J, Liu R, Chen Z, Xue S, Lu W, Liao H, Cui J, Zhu D, Lu F, Tang S, Wu Y, Yangkyi T, Zhang G, Wubuli M, Guo H, Wang X, He Y, Sheng X, Wang Q, Luo Y, Fan J, Qi J, Yu Z, Tan J, Liang J, Sun X, Jin L, Yang X, Zhang J, Ji X, Zhao J, Jia R, Fan X. Eye-Preserving Therapies for Advanced Retinoblastoma: A Multicenter Cohort of 1678 Patients in China. Ophthalmology 2021; 129:209-219. [PMID: 34536465 DOI: 10.1016/j.ophtha.2021.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/28/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 02/05/2023] Open
Abstract
PURPOSE This study attempted to estimate the impact of eye-preserving therapies for the long-term prognosis of patients with advanced retinoblastoma with regard to overall survival and ocular salvage. DESIGN Retrospective cohort study covering all 31 provinces (38 retinoblastoma treating centers) of mainland China. PARTICIPANTS One thousand six hundred seventy-eight patients diagnosed with group D or E retinoblastoma from January 2006 through May 2016. METHODS Chart review was performed. The patients were divided into primary enucleation and eye-preserving groups, and they were followed up for survival status. The impact of initial treatment on survival was evaluated by Cox analyses. MAIN OUTCOME MEASURES Overall survival and final eye preservation. RESULTS After a median follow-up of 43.9 months, 196 patients (12%) died, and the 5-year overall survival was 86%. In total, the eyeball preservation rate was 48%. In this cohort, 1172 patients (70%) had unilateral retinoblastoma, whereas 506 patients (30%) had bilateral disease. For patients with unilateral disease, 570 eyes (49%) underwent primary enucleation, and 602 patients (51%) received eye-preserving therapies initially. During the follow-up (median, 45.6 months), 59 patients (10%) from the primary enucleation group and 56 patients (9.3%) from the eye-preserving group died. Multivariate Cox analyses indicated no significant difference in overall survival between the 2 groups (hazard ratio [HR], 1.25; 95% confidence interval [CI], 0.85-1.84; P = 0.250). For patients with bilateral disease, 95 eyes (19%) underwent primary enucleation, and 411 patients (81%) received eye-preserving therapies initially. During the follow-up (median, 40.1 months), 12 patients (13%) from the primary enucleation group and 69 patients (17%) from the eye-preserving group died. For bilateral retinoblastoma with the worse eye classified as group E, patients undergoing primary enucleation exhibited better overall survival (HR, 2.35; 95% CI, 1.10-5.01; P = 0.027); however, this survival advantage was not evident until passing 22.6 months after initial diagnosis. CONCLUSIONS Eye-preserving therapies have been used widely for advanced retinoblastoma in China. Patients with bilateral disease whose worse eye was classified as group E and who initially underwent eye-preserving therapies exhibited a worse overall survival. The choice of primary treatment for advanced retinoblastoma should be weighed carefully.
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Affiliation(s)
- Chuandi Zhou
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China; Chuandi Zhou's current affiliation is Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xuyang Wen
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yi Ding
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jingwen Ding
- Department of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Mei Jin
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Zhenyin Liu
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Sha Wang
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
| | - Minglei Han
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Ophthalmology, Qilu Children's Hospital of Shandong University, Jinan, China
| | - Hongfeng Yuan
- Department of Ophthalmology, Army Medical Center of PLA, Chongqing, China
| | - Yishuang Xiao
- Department of Ophthalmology, Kunming Children's Hospital, Kunming, China
| | - Li Wu
- Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiancang Wang
- Department of Ophthalmology, Hebei Children's Hospital, Shijiazhuang, China
| | - Yangjun Li
- Department of Ophthalmology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jiawei Yu
- Department of Ophthalmology, Harbin Children's Hospital, Harbin, China
| | - Yuechun Wen
- Department of Ophthalmology, The First Affiliated Hospital of USTC (Anhui Provincial Hospital), University of Science and Technology of China, Hefei, China
| | - Juan Ye
- Department of Ophthalmology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rong Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhijun Chen
- Department of Ophthalmology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shangcai Xue
- Department of Ophthalmology, Second Provincial People's Hospital of Gansu, Lanzhou, China
| | - Wei Lu
- Department of Ophthalmology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Hongfei Liao
- Department of Ocular Trauma and Orbital Diseases, Affiliated Eye Hospital of Nanchang University, Nanchang, China
| | - Jizhe Cui
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Dan Zhu
- Department of Ophthalmology, The Affiliated Hospital of Inner Mongolia Medical University, Huhhot, China
| | - Fang Lu
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
| | - Song Tang
- Department of Ophthalmology, Affiliated Shenzhen Eye Hospital of Ji-nan University, Shenzhen, China
| | - Yu Wu
- Department of Ophthalmology, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Tseden Yangkyi
- Department of Ophthalmology, Tibet Autonomous Region Eye Center, Tibetan Medicine Hospital, Lhasa, China
| | - Guanghong Zhang
- Department of Ophthalmology, The General Hospital of Xinjiang Military Command of PLA, Urumchi, China
| | - Miershalijiang Wubuli
- Department of Ophthalmology, Kashgar Prefecture Second People's Hospital, Kashgar, China
| | - Huiyu Guo
- Department of Ophthalmology, Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou, China
| | - Xian Wang
- Department of Ophthalmology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Yanjin He
- Department of Ophthalmology, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Xunlun Sheng
- Department of Ophthalmology, NingXia Eye Hospital, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Qing Wang
- Department of Ophthalmology, Qinghai University Affiliated Hospital, Xining, China
| | - Yingxiu Luo
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jiayan Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhangsheng Yu
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Department of Bioinformatics and Biostatistics, Shanghai Jiao Tong University, Shanghai, China
| | - Jia Tan
- Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
| | - Jianhong Liang
- Department of Ophthalmology, Peking University People's Hospital, Beijing, China
| | - Xiantao Sun
- Department of Ophthalmology, Henan Children's Hospital, Zhengzhou, China
| | - Liwen Jin
- Department of Ophthalmology, Quanzhou Women's and Children's Hospital, Quanzhou, China
| | - Xinji Yang
- Department of Ophthalmology, The General Hospital of Chinese People's Armed Police Forces, Beijing, China
| | - Jing Zhang
- Department of Interventional Radiology and Vascular Anomalies, Guangzhou Women and Children's Medical Center, Guangzhou, China.
| | - Xunda Ji
- Department of Ophthalmology, Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Junyang Zhao
- Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| | - Xianqun Fan
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
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El Zomor H, Nour R, Saad A, Taha H, Shelil AE, Aleieldin A, Saad Zaghloul M, Alfaar AS. Unilateral retinoblastoma; natural history and an age-based protocol in 248 patients. Eye (Lond) 2021; 35:2564-2572. [PMID: 33188294 PMCID: PMC8377076 DOI: 10.1038/s41433-020-01275-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/24/2020] [Accepted: 10/29/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES We aimed to study the clinical state and prognosis of patients with unilateral retinoblastoma who were being treated at a paediatric comprehensive cancer centre in a limited-resource country, to assess the different phases of treatment and the success of different, more complex real-life models. SUBJECTS In this retrospective study, we created a snapshot of our retinoblastoma database for the period between 2007 and 2015. Patients whose data were included in the study were followed up until 2016. Out of a total of 744 screened patients, we included data of 248 patients who had been diagnosed with unilateral retinoblastoma. RESULTS As classified as per the International Retinoblastoma Classification, 1 patient presented with group A, 21 with group B, 39 with group C, 104 with group D and 83 with group E retinoblastoma. Chemotherapy was the initial line of treatment in 115 patients and enucleation in 133 others. Later, 141 patients (56.9%) required further management. Patients had a mean ocular survival time of 20.8 months. Nine patients developed extraocular disease at a later stage of management: five after upfront enucleation and four after neoadjuvant chemotherapy. Mean overall survival time stood at 90.2 months. Four and three deaths were recorded in groups D and E, respectively. A single patient died in the initial chemotherapy arm, while six passed away in the initial enucleation arm. CONCLUSION Our study highlights the importance of initial chemotherapy and close follow-up after enucleation of classes D and E affected eyes even in absence of germline mutations.
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Affiliation(s)
- Hossam El Zomor
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | - Radwa Nour
- London School of Hygiene and Tropical Medicine, London, UK
| | - Anas Saad
- Cleveland Clinic Foundation, Cleveland, OH, USA
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hala Taha
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | | | | | - M Saad Zaghloul
- Egyptian National Cancer Institute, Cairo, Egypt
- Children's Cancer Hospital Egypt, Cairo, 57357, Egypt
| | - Ahmad S Alfaar
- Experimental Ophthalmology, Department of Ophthalmology, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany.
- Ophthalmology Department, Faculty of Medicine, Leipzig University, Leipzig, Germany.
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Kaliki S, Jakati S, Vempuluru VS, Mallu A, Mishra DK. Retinoblastoma associated with orbital pseudocellulitis and high-risk retinoblastoma: a study of 32 eyes. Int Ophthalmol 2021; 42:19-26. [PMID: 34363179 DOI: 10.1007/s10792-021-01993-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/11/2021] [Accepted: 07/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the correlation between retinoblastoma (RB) associated with orbital pseudocellulitis and high-risk histopathology features. METHODS Retrospective study of 32 patients who underwent primary enucleation for RB presenting with orbital pseudocellulitis. RESULTS All RB patients presented with orbital pseudocellulitis. The mean age at presentation of RB was 30 months (median, 24 months; range, 3-70 months). There were 14 (44%) males and 18 (56%) females. All patients were referred with a diagnosis of RB with orbital pseudocellulitis. Tumor was bilateral in 12 (38%) patients but orbital pseudocellulitis was unilateral in all cases. The pseudocellulitis features included proptosis (n = 9; 28%), eyelid edema (n = 22; 69%), conjunctival congestion (n = 23; 72%), and conjunctival chemosis (n = 15; 47%). Based on clinical features and orbital imaging, all patients were diagnosed to have group E intraocular RB. All patients received intravenous steroids prior to enucleation. On histopathology, tumor necrosis was present in all cases with a mean % necrosis of 60% (median, 60%; range, 10% to 90%). Most tumors (72%) were poorly differentiated. High-risk histopathology features were noted in 23 (72%) cases and adjuvant chemotherapy was advised for all these patients. The most common high-risk histopathology features included post-laminar optic nerve infiltration (34%) and scleral infiltration (22%). Over a mean follow-up period of 34 months (median, 9 months; range, < 1-188 months), there was no event of metastasis or death in any patient. CONCLUSION RB presenting with orbital pseudocellulitis is associated with high incidence of high-risk histopathology features.
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Affiliation(s)
- Swathi Kaliki
- The Operation Eyesight Universal Institute for Eye Cancer (SK, VSV, AM), L V Prasad Eye Institute, Hyderabad, 500034, India.
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory (SJ, DKM), L V Prasad Eye Institute, Hyderabad, India
| | - Vijitha S Vempuluru
- The Operation Eyesight Universal Institute for Eye Cancer (SK, VSV, AM), L V Prasad Eye Institute, Hyderabad, 500034, India
| | - Akhila Mallu
- The Operation Eyesight Universal Institute for Eye Cancer (SK, VSV, AM), L V Prasad Eye Institute, Hyderabad, 500034, India
| | - Dilip K Mishra
- Ophthalmic Pathology Laboratory (SJ, DKM), L V Prasad Eye Institute, Hyderabad, India
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Abstract
PURPOSE To report a case of vitreous seeding in a medium-sized choroidal melanoma and review the literature. METHODS Observational case report and review of literature for pathogenesis, role of vitreous biopsy, and treatment outcomes. RESULTS A case of 57-year-old man diagnosed with vitreous seeding in the left eye 1 year after episcleral brachytherapy for medium-sized choroidal melanoma. The patient was initially diagnosed to have subretinal and vitreous hemorrhage due to rupture of a retinal artery macroaneurysm for which focal laser and intravitreal antivascular endothelial growth factor injections were administered. Over the next 9 months, the vitreous hemorrhage cleared and choroidal melanoma with retinal invasion became evident. One year after brachytherapy, the primary tumor regressed with resolution of surrounding subretinal fluid and hemorrhage. However, gradual decline in the visual acuity from 20/50 to 20/500 with increase of pigmented debris over the retinal surface and in the vitreous cavity was noted. A vitreous biopsy confirmed the presence of viable melanoma cells (epithelioid type), and the eye was enucleated. Histopathology showed microscopic persistence of primary tumor with diffuse vitreous seeding. CONCLUSION Vitreous seeding of choroidal melanoma poses a diagnostic and management challenge.
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Affiliation(s)
- Vishal Raval
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Randy C Bowen
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Hansell Soto
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
| | - Charles Biscotti
- Department of Anatomic Pathology, R. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Gabrielle Yeaney
- Department of Anatomic Pathology, R. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio; and
| | - Jonathan Sears
- Retina department, Cole Eye Institute, Cleveland Clinic, Cleveland
| | - Arun Singh
- Department of Ocular Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Fazio MA, Gardiner SK, Bruno L, Hubbard M, Bianco G, Karuppanan U, Kim J, El Hamdaoui M, Grytz R, Downs JC, Girkin CA. Histologic validation of optical coherence tomography-based three-dimensional morphometric measurements of the human optic nerve head: Methodology and preliminary results. Exp Eye Res 2021; 205:108475. [PMID: 33516762 PMCID: PMC8044038 DOI: 10.1016/j.exer.2021.108475] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 01/12/2021] [Accepted: 01/22/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the three-dimensional (3D) morphology of the deep load-bearing structures of the human optic nerve head (ONH) as revealed in vivo by spectral domain optical coherence tomography (SDOCT) with ex vivo quantitative 3D histology. METHODS SDOCT imaging of the ONH was performed in six eyes from three brain-dead organ donors on life-support equipment awaiting organ procurement (in vivo conditions). Following organ procurement (ex vivo conditions), the eyes were enucleated and underwent a pars plana vitrectomy followed by pressurization to physiologic IOP and immersion fixation. Ex vivo ONH morphology was obtained from high-fidelity episcopic fluorescent 3D reconstruction. Morphologic parameters of the observed ONH canal geometry and peripapillary choroid, as well as the shape, visibility and depth of the lamina cribrosa were compared between ex vivo and in vivo measurements using custom software to align, scale, and manually delineate the different regions of the ONH. RESULTS There was significant correspondence between in vivo and ex vivo measurements of the depth and shape of the lamina cribrosa, along with the size and shape of Bruch's membrane opening (BMO) and anterior scleral canal opening (ASCO). Weaker correspondence was observed for choroidal thickness; as expected, a thinner choroid was seen ex vivo due to loss of blood volume upon enucleation (-79.9%, p < 0.001). In addition, the lamina was shallower (-32.3%, p = 0.0019) and BMO was smaller ex vivo (-3.38%, p = 0.026), suggesting post mortem shrinkage of the fixed tissue. On average, while highly variable, only 31% of the anterior laminar surface was visible in vivo with SDOCT (p < 0.001). CONCLUSIONS Morphologic parameters by SDOCT imaging of the deep ONH showed promising correspondence to histology metrics. Small but significant shrinkage artifact, along with large effects of exsanguination of the choroid, was seen in the ex vivo reconstructions of fixed tissues that may impact the quantification of ex vivo histoarchitecture, and this should be considered when developing models and biomarkers based on ex vivo imaging of fixed tissue. Lack of visibly of most of the lamina surface in SDOCT images is an important limitation to metrics and biomarkers based on in vivo images of the ONH deep tissues.
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Affiliation(s)
- Massimo A Fazio
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States; Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States; The Viterbi Family Department of Ophthalmology, University of California, San Diego, San Diego, CA, United States.
| | - Stuart K Gardiner
- Devers Eye Institute, Discoveries in Sight, Legacy Health, Portland, OR, United States
| | - Luigi Bruno
- Department of Mechanical, Energy and Management Engineering, University of Calabria, Rende, CS, Italy
| | - Meredith Hubbard
- Department of Neurobiology, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Gianfranco Bianco
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Udayakumar Karuppanan
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jihee Kim
- Department of Biomedical Engineering, The University of Alabama at Birmingham, Birmingham, AL, United States
| | - Mustapha El Hamdaoui
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Rafael Grytz
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - J Crawford Downs
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Christopher A Girkin
- Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, AL, United States
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Bas Z, Dalvin LA, Tadepalli S, Rao R, Shah A, Leahey AM, Shields CL. Outcomes of Intravenous Chemotherapy (Chemoreduction) for Retinoblastoma Based on Patient Age in 964 Eyes of 554 Patients. Asia Pac J Ophthalmol (Phila) 2021; 10:373-380. [PMID: 33481399 DOI: 10.1097/apo.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To evaluate retinoblastoma control after intravenous chemotherapy (chemoreduction) by patient age at presentation. DESIGN Retrospective case series. METHODS This study included 964 eyes of 554 patients treated with chemoreduction at Ocular Oncology Service at Wills Eye Hospital. Patients received 6 monthly cycles of standard chemoreduction. Additional therapies for tumor control were performed as needed. RESULTS Of 964 eyes, a comparison by age group (<6 months vs. 6-12 months vs. 13-24 months vs. >24 months) revealed more advanced age group with higher frequency of group E tumor (15% vs. 25% vs. 32% vs. 39%, P < 0.001). By treatment outcomes, complete tumor control was achieved with chemoreduction alone more often in less advanced age group (46% vs. 30% vs. 17% vs. 8%, P < 0.001). Additional treatment after chemoreduction was needed more often in more advanced age group with external beam radiotherapy (EBRT; 9% vs. 16% vs. 20% vs. 15%, P = 0.006) or enucleation (12% vs. 18% vs. 26% vs. 37%, P < 0.001). Over time (1994-1998 vs. 1999-2003 vs. 2004-2008 vs. 2009-2013 vs. 2014-2019), the paradigm for additional required treatment after chemoreduction shifted toward less EBRT (27% vs. 24% vs. 14% vs. 7% vs. 2%, P < 0.001) and more intra-arterial (0% vs. 0% vs. 1% vs. 25% vs. 48%, P < 0.001) and intravitreal (0% vs. 0% vs. 3% vs. 10% vs. 20%, P < 0.001) chemotherapy. CONCLUSIONS Chemoreduction is a safe and effective treatment method for patients with retinoblastoma, demonstrating the best tumor control in the younger age groups.
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Affiliation(s)
- Zeynep Bas
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Lauren A Dalvin
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN
| | - Sameeksha Tadepalli
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Raksha Rao
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
| | - Amish Shah
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Ann M Leahey
- Department of Pediatric Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Carol L Shields
- Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA
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Klofas LK, Bogan CM, Coogan AC, Schultenover SJ, Weiss VL, Daniels AB. Instrument Gauge and Type in Uveal Melanoma Fine Needle Biopsy: Implications for Diagnostic Yield and Molecular Prognostication. Am J Ophthalmol 2021; 221:83-90. [PMID: 32818452 PMCID: PMC8117558 DOI: 10.1016/j.ajo.2020.08.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To systematically evaluate and compare the effects of using small-gauge needles and vitrectors on the ability to obtain adequate diagnostic and prognostic uveal melanoma biopsy specimens. DESIGN Comparative evaluation of biopsy instruments. METHODS Survival of uveal melanoma cells was evaluated in vitro following needle aspiration. Five therapeutically enucleated eyes were sampled in triplicate for ex vivo diagnostic biopsy experiments with 25 gauge (25 G) needle, 27 gauge (27 G) needle, and 27 G vitrector. During surgery in 8 patients, paired diagnostic transscleral fine needle aspiration biopsies were performed using both 25 G and 27 G needles. A review of cytologic specimens was performed by a panel of 3 expert cytopathologists. A retrospective chart review was performed to evaluate 100 consecutive tumors undergoing prognostic biopsy for gene expression profiling to assess the relationship between needle gauge and prognostic adequacy. RESULTS No significant cell shearing of uveal melanoma cells occurred in vitro with 25 G, 27 G, or 30 G needles. For ex vivo biopsy samples, diagnostic yield was 100% using 25 G needle (5/5) or 27 G vitrector (5/5) but 60% using a 27 G needle (3/5). For in vivo samples, no difference in diagnostic yield was found between 25 G (75%, 6/8) or 27 G (75%, 6/8) needle sizes. Of 100 molecular prognostic biopsy samples evaluated, 65 were obtained using 27 G needles; for these biopsies, the prognostic yield was 65/65 (100%). CONCLUSIONS For diagnostic biopsy of uveal melanoma, a larger-gauge needle or a 27 G vitrector may have better overall cellularity and diagnostic yield when compared to a 27 G needle. However, for much more common molecular prognostic testing, a 27 G needle provided adequate sample in 100% (65/65) of cases, and a larger needle provided no additional benefit.
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Affiliation(s)
- Lindsay K Klofas
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA
| | - Carley M Bogan
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Alice C Coogan
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen J Schultenover
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vivian L Weiss
- School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anthony B Daniels
- Division of Ocular Oncology and Pathology, Department of Ophthalmology and Visual Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA; School of Medicine, Vanderbilt University, Nashville, Tennessee, USA; Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Program in Cancer Biology, Vanderbilt University, Nashville, Tennessee, USA.
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Martel A, Nahon-Estève S, Baillif S, Février E, Alketbi M. Versatility of the epidermis, dermis fat graft for reconstructing complex orbital gunshot traumas. J Fr Ophtalmol 2020; 44:e69-e71. [PMID: 33288304 DOI: 10.1016/j.jfo.2020.05.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/26/2020] [Indexed: 11/18/2022]
Affiliation(s)
- A Martel
- Service d'ophtalmologie, centre hospitalier universitaire Pasteur, 30, voie Romaine, 06000 Nice, France; Université Côte d'Azur, Nice, France.
| | - S Nahon-Estève
- Service d'ophtalmologie, centre hospitalier universitaire Pasteur, 30, voie Romaine, 06000 Nice, France
| | - S Baillif
- Service d'ophtalmologie, centre hospitalier universitaire Pasteur, 30, voie Romaine, 06000 Nice, France; Université Côte d'Azur, Nice, France
| | - E Février
- Service d'ophtalmologie, centre hospitalier universitaire Pasteur, 30, voie Romaine, 06000 Nice, France
| | - M Alketbi
- Service d'ophtalmologie, centre hospitalier universitaire Pasteur, 30, voie Romaine, 06000 Nice, France
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Ancona-Lezama D, Dalvin LA, Shields CL. Modern treatment of retinoblastoma: A 2020 review. Indian J Ophthalmol 2020; 68:2356-2365. [PMID: 33120616 PMCID: PMC7774148 DOI: 10.4103/ijo.ijo_721_20] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 05/23/2020] [Accepted: 07/07/2020] [Indexed: 12/23/2022] Open
Abstract
Retinoblastoma management remains complex, requiring individualized treatment based on International Classification of Retinoblastoma (ICRB) staging, germline mutation status, family psychosocial factors and cultural beliefs, and available institutional resources. For this 2020 retinoblastoma review, PubMed was searched for articles dated as early as 1931, with an emphasis on articles from 1990 to the present day, using keywords of retinoblastoma, chemotherapy, intravenous chemotherapy, chemoreduction, intra-arterial chemotherapy, ophthalmic artery chemosurgery, intravitreal chemotherapy, intracameral chemotherapy, cryotherapy, transpupillary thermotherapy, laser, radiation, external beam radiotherapy, plaque radiotherapy, brachytherapy, and enucleation. We discuss current treatment modalities as used in the year 2020, including intravenous chemotherapy (IVC), intra-arterial chemotherapy (IAC), intravitreal chemotherapy (IvitC), intracameral chemotherapy (IcamC), consolidation therapies (cryotherapy and transpupillary thermotherapy [TTT]), radiation-based therapies (external beam radiotherapy [EBRT] and plaque radiotherapy), and enucleation. Additionally, we present a consensus treatment algorithm based on the agreement of three North American retinoblastoma treatment centers, and encourage further collaboration amongst the world's most expert retinoblastoma treatment centers in order to develop consensus management plans and continue advancement in the identification and treatment of this childhood cancer.
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Affiliation(s)
- David Ancona-Lezama
- Ocular Oncology Service, Institute of Ophthalmology and Visual Sciences, Tecnologico de Monterrey, Mexico
| | - Lauren A Dalvin
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Carol L Shields
- Ocular Oncology Service Wills Eye Hospital, Philadelphia, PA, USA
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Furdová A, Babál P. Primary Intrabulbar Neurofibroma. Cesk Slov Oftalmol 2020; 76:62-67. [PMID: 33126800 DOI: 10.31348/2020/13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Eye globe enucleation due to other than a malignant tumor is very rare today. Solitary intraocular neurofibroma without other signs of neurofibromatosis is a rare benign tumor and few cases have been reported to date. MATERIAL AND METHODS In 10 year interval from Jan 1 2007 to Dec 31 2016 we analyzed non-malignant eye globe enucleations. RESULTS Of the 49 enucleated blind eyes, each patient had visual acuity with no light perception, 34 (69.4%) were indicated for enucleation due to complications following previous postoperative surgery after trauma, 14 patients (28.6%) were due to secondary glaucoma and other complications following previous intraocular surgery, and in one patient (2%) the primary isolated intraocular neurofibroma was verified after enucleation. CASE REPORT A patient with isolated intrabulbar neurofibroma has been monitored since childhood for intraocular lesion and histologically verified at adult age. At the time of enucleation, he was 25 years old, squint since childhood and was observed for hamartoma in his right eye since he was 13 years old. Due to the progression of intrabulbar lesion, loss of visual acuity (functional state - no light perception) and secondary glaucoma, the right eye globe was enucleated at adult age and histopathological examination confirmed intraocular neurofibroma in the absence of neurofibromatosis. CONCLUSION Every enucleated eye globe should be subjected to a thorough histopathological examination. Isolated intraocular neurofibromas can occur as isolated orbital or intrabulbar masses without systemic features.
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Menon V, Thulasidas M, Narula R, Mulay K, Honavar SG. Multicentric recurrent uveal melanoma. Indian J Ophthalmol 2020; 68:2305-2307. [PMID: 32971703 PMCID: PMC7727941 DOI: 10.4103/ijo.ijo_511_20] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/04/2020] [Accepted: 05/06/2020] [Indexed: 11/30/2022] Open
Abstract
Uveal melanoma is a rare malignancy originating from melanocytes within the uveal tract of the eye. True multifocal uveal melanomas (>2melanomas in 1 eye) occurring in the same eye are very rare. We report a clinically and histologically well-documented case of a patient who presented with 3 uveal melanoma lesions in the same eye over a span of 2.5 years. The eye had to be enucleated finally and diagnosis confirmed histologically. This case report highlights the need for a close follow-up, even after successful treatment of the presenting lesion in uveal melanomas.
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Affiliation(s)
- Vikas Menon
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Centre for Sight, New Delhi, India
| | - Mithun Thulasidas
- Ophthalmic Plastic Surgery and Ocular Oncology Services, Centre for Sight, New Delhi, India
| | - Ritesh Narula
- Vitreo-Retina Services, Centre for Sight, New Delhi, India
| | - Kautubh Mulay
- Ophthalmic Plastic Surgery, Ocular Oncology and Ocular Pathology Services, Centre for Sight, Hyderabad, Telangana, India
| | - Santosh G Honavar
- Ophthalmic Plastic Surgery, Ocular Oncology and Ocular Pathology Services, Centre for Sight, Hyderabad, Telangana, India
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Weng PY, Chen SH, Kao LY, Tsai YJ, Yang SH, Tseng CK, Tsay PK, Jaing TH. Clinical spectrum and treatment outcome of retinoblastoma with Group D and E diseases: A single institution retrospective review. Medicine (Baltimore) 2020; 99:e22201. [PMID: 32957352 PMCID: PMC7505397 DOI: 10.1097/md.0000000000022201] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The purpose of our study was to evaluate the ocular survival and event-free survival after multimodal therapy for group D and E of retinoblastoma (RB). Enucleation of group D and E is controversial as the risks of chemotherapy must be weighed against the potential for vision.A 10-year retrospective study from one center of 86 patients with advanced intraocular disease defined as International Classification Retinoblastoma (ICRB) group "D" or "E." Cases with visible extraocular extension at diagnosis were excluded. Ocular survival and patient survival were assessed. Indirect ophthalmoscopy at examination under anesthesia to visualize the tumor was used to evaluate clinical response.The median onset age in 86 patients with group D or E eye was 16 months (1-167 months). There were 29 (34%) bilateral cases. Leukocoria was the most common presentation sign (61%). Chemoreduction was primarily used in the treatment of intraocular RB. Selective ophthalmic arterial injection (SOAI) was applied as a component of multimodal therapy in 34 of the 86 cases. The globe preservation rate in patients with group D or E eyes was 19%. Using chemoreduction for advanced eyes, more eyes are being preserved which enables 70% 5-year ocular survival in patients with group D eyes.In triaging appropriate patients, multidisciplinary strategy can reduce tumor size with chemoreduction and consolidate the regressed tumor with local ophthalmic therapy to ensure globe salvage.
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Affiliation(s)
- Pei-Yin Weng
- Department of Nursing, Chang Gung Memorial Hospital
| | - Shih-Hsiang Chen
- Divisions of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University
| | | | | | - Shu-Ho Yang
- Department of Nursing, Chang Gung Memorial Hospital
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Memorial Hospital
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Tang-Her Jaing
- Divisions of Hematology/Oncology, Chang Gung Children's Hospital, Chang Gung University
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Xu L, Polski A, Prabakar RK, Reid MW, Chevez-Barrios P, Jubran R, Kim JW, Kuhn P, Cobrinik D, Hicks J, Berry JL. Chromosome 6p Amplification in Aqueous Humor Cell-Free DNA Is a Prognostic Biomarker for Retinoblastoma Ocular Survival. Mol Cancer Res 2020; 18:1166-1175. [PMID: 32434859 PMCID: PMC7415535 DOI: 10.1158/1541-7786.mcr-19-1262] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 04/10/2020] [Accepted: 05/18/2020] [Indexed: 11/16/2022]
Abstract
Aqueous humor contains tumor-derived cell-free DNA (cfDNA) and can serve as a liquid biopsy for retinoblastoma. We previously associated somatic copy-number alteration (SCNA) 6p gain with a 10-fold increased risk of enucleation. Here we provide a 2-year update to further explore 6p gain as a prognostic biomarker for ocular survival. Patients diagnosed with retinoblastoma from December 2014 to July 2019 from whom aqueous humor was sampled were included. cfDNA was extracted and shallow whole-genome sequencing performed to identify highly recurrent retinoblastoma SCNAs (gain of 1q, 2p, 6p, loss of 13q, 16q). 116 aqueous humor samples from 50 eyes of 46 patients were included: 27 eyes were salvaged, 23 were enucleated. Highly recurrent retinoblastoma SCNAs were found in 66% eyes. 6p gain was the most prevalent SCNA (50% eyes). It was particularly more prevalent in enucleated eyes (73.9%) than in salvaged eyes (29.6%; P = 0.004). 6p gain in aqueous humor cfDNA portended nearly 10-fold increased odds of enucleation (OR = 9.87; 95% confidence interval = 1.75-55.65; P = 0.009). In the enucleated eyes, 6p gain was associated with aggressive histopathologic features, including necrosis, higher degrees of anaplasia, and focal invasion of ocular structures. With extended follow-up and nearly double the aqueous humor samples, we continue to demonstrate 6p gain as a potential prognostic biomarker for retinoblastoma. IMPLICATIONS: Aqueous humor is a high-yield source of tumor-derived DNA in retinoblastoma eyes. Detection of 6p gain in the aqueous humor allows for targeted, patient-centered therapies based on this molecular prognostic marker. Prospective, multicenter studies with aqueous humor sampled from all eyes at diagnosis are warranted to validate these findings.
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Affiliation(s)
- Liya Xu
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Ashley Polski
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Rishvanth K Prabakar
- Department of Molecular and Computational Biology, University of Southern California, Los Angeles, California
| | - Mark W Reid
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
| | - Patricia Chevez-Barrios
- Departments of Pathology and Genomic Medicine and Ophthalmology, Houston Methodist, Weill Cornell Medical College, Houston, Texas
| | - Rima Jubran
- Department of Hematology-Oncology, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan W Kim
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
| | - Peter Kuhn
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Aerospace and Mechanical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
- Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, California
| | - David Cobrinik
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
- Department of Biochemistry and Molecular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - James Hicks
- Department of Biological Sciences, Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jesse L Berry
- The Vision Center at Children's Hospital Los Angeles, Los Angeles, California.
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, California
- USC Roski Eye Institute, Keck Medical School of the University of Southern California, Los Angeles, California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California, Los Angeles, California
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Paez-Escamilla M, Walter SD, Mohsenin A, Decatur CL, Harocopos GJ, Dubovy S, Harbour JW. Intraocular Dissemination of Uveal Melanoma Cells Following Radiotherapy: Evolving Management Over the Past Decade. Ophthalmic Surg Lasers Imaging Retina 2020; 50:573-579. [PMID: 31589755 DOI: 10.3928/23258160-20190905-06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 03/11/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To describe the presentation and the authors' evolving management strategy for intraocular dissemination of uveal melanoma cells following radiotherapy during the past decade. PATIENTS AND METHODS Patients with uveal melanoma who developed intraocular dissemination of pigmented cells following radiotherapy. Histopathology was available in two cases. RESULTS Four patients underwent treatment for progressive intraocular dissemination of uveal melanoma cells at 9 to 41 months following I-125 plaque radiotherapy (three patients) or proton beam radiotherapy (one patient). Treatments included primary enucleation (one patient), vitrectomy followed later by enucleation (one patient), and vitrectomy followed by intravitreal chemotherapy (two patients). Enucleated eyes demonstrated diffuse invasion of intraocular tissues by viable melanoma cells. No patient has developed systemic metastasis to date. CONCLUSIONS Intraocular dissemination of pigmented cells following radiotherapy for uveal melanoma should raise suspicion for viable invasive melanoma cells. Prompt vitrectomy with intravitreal chemotherapy can be effective in avoiding enucleation in selected cases. [Ophthalmic Surg Lasers Imaging Retina. 2019;50:573-579.].
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Herrspiegel C, Kvanta A, Lardner E, Ramsköld Cabaca L, Wells J, Bartuma K, Seregard S, Stålhammar G. Nuclear expression of BAP-1 in transvitreal incisional biopsies and subsequent enucleation of eyes with posterior choroidal melanoma. Br J Ophthalmol 2020; 105:582-586. [PMID: 32522791 PMCID: PMC8005798 DOI: 10.1136/bjophthalmol-2020-316498] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND As a majority of patients with choroidal melanoma do not undergo enucleation, tumour tissue for prognostic testing has to be obtained with alternate methods. Transvitreal incisional biopsies enable histological examination as well as immunohistochemical staining of BRCA1-associated protein-1 (BAP-1). METHODS Fifty-nine patients diagnosed with choroidal melanoma in transvitreal biopsies between years 2003 and 2019 were included. Twenty-one of these patients subsequently underwent enucleation. The level of nuclear expression of BAP-1 in transvitreal biopsies and enucleations was evaluated and the concordance calculated. Metastasis-free survival and HR for metastasis were analysed. RESULTS The mean tumour thickness and diameter at biopsy was 3.8 mm (SD 2.1) and 9.3 mm (SD 4.8), respectively. For biopsies, 37 of 59 tumours (63%) were classified as having high nuclear BAP-1 expression, and 22 (37%) as low. For enucleations, 13 of 21 tumours (62%) were classified as having high nuclear BAP-1 expression, and 8 (38%) as low. Eighty-six per cent of biopsies had an identical BAP-1 classification as the subsequent enucleation, yielding a Cohen's kappa coefficient of 0.70. Patients with low nuclear BAP-1 expression in transvitreal biopsies had a significantly shorter metastasis-free survival (p=0.001), with a size-adjusted Cox regression HR for metastasis of 13.0 (95% CI 3.1 to 54.4, p=0.0004). CONCLUSION Loss of nuclear BAP-1 expression occurred in a large proportion of the small tumours included in this study. BAP-1 immunoreactivity in transvitreal incisional biopsies of choroidal melanoma is substantially concordant with immunoreactivity in enucleated specimens and identifies patients with poor metastasis-free survival.
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Affiliation(s)
- Christina Herrspiegel
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kvanta
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | - Louise Ramsköld Cabaca
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jill Wells
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Katarina Bartuma
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Seregard
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gustav Stålhammar
- St. Erik Eye Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Gouveia C, Huyser C, Egli D, Pepper MS. Lessons Learned from Somatic Cell Nuclear Transfer. Int J Mol Sci 2020; 21:ijms21072314. [PMID: 32230814 PMCID: PMC7177533 DOI: 10.3390/ijms21072314] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 02/06/2023] Open
Abstract
Somatic cell nuclear transfer (SCNT) has been an area of interest in the field of stem cell research and regenerative medicine for the past 20 years. The main biological goal of SCNT is to reverse the differentiated state of a somatic cell, for the purpose of creating blastocysts from which embryonic stem cells (ESCs) can be derived for therapeutic cloning, or for the purpose of reproductive cloning. However, the consensus is that the low efficiency in creating normal viable offspring in animals by SCNT (1–5%) and the high number of abnormalities seen in these cloned animals is due to epigenetic reprogramming failure. In this review we provide an overview of the current literature on SCNT, focusing on protocol development, which includes early SCNT protocol deficiencies and optimizations along with donor cell type and cell cycle synchrony; epigenetic reprogramming in SCNT; current protocol optimizations such as nuclear reprogramming strategies that can be applied to improve epigenetic reprogramming by SCNT; applications of SCNT; the ethical and legal implications of SCNT in humans; and specific lessons learned for establishing an optimized SCNT protocol using a mouse model.
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Affiliation(s)
- Chantel Gouveia
- Institute for Cellular and Molecular Medicine, Department of Immunology and South African Medical Research Council (SAMRC) Extramural Unit for Stem Cell Research and Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa;
- Department of Obstetrics and Gynaecology, Reproductive Biology Laboratory, University of Pretoria, Steve Biko Academic Hospital, Pretoria 0002, South Africa;
- Correspondence: ; Tel.: +27-(0)76-546-5119
| | - Carin Huyser
- Department of Obstetrics and Gynaecology, Reproductive Biology Laboratory, University of Pretoria, Steve Biko Academic Hospital, Pretoria 0002, South Africa;
| | - Dieter Egli
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10027, USA;
| | - Michael S. Pepper
- Institute for Cellular and Molecular Medicine, Department of Immunology and South African Medical Research Council (SAMRC) Extramural Unit for Stem Cell Research and Therapy, Faculty of Health Sciences, University of Pretoria, Pretoria 0002, South Africa;
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Indini A, Sessa M, Merelli B, Foresti C, Mandalà M. A case of severe pharyngeal-cervical-brachial syndrome induced by nivolumab and responding to infliximab therapy. Eur J Cancer 2020; 129:1-3. [PMID: 32092585 DOI: 10.1016/j.ejca.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/20/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Alice Indini
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Maria Sessa
- Unit of Neurology, Department of Neuroscience, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Merelli
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Camillo Foresti
- Unit of Neurology, Department of Neuroscience, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Mario Mandalà
- Unit of Medical Oncology, Department of Oncology and Hematology, Papa Giovanni XXIII Hospital, Bergamo, Italy.
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