ObjectiveTo observe the effectiveness of radiotherapy for refractory choroidal hemangioma. MethodsEight patients (8 eyes) with choroidal hemangioma were enrolled in this retrospective study. All the patients had received laser or photodynamic therapy before without effectiveness. The patients included 7 males and 1 females. The age was ranged from 11 to 54 years old, with an average of (27.50±15.18) years. All the patients were affected unilaterally, including 3 right eyes and 5 left eyes. There were 5 eyes with circumscribed choroidal hemangioma, 3 eyes with diffused choroidal hemangioma. All eyes had extensively exudative retinal detachment. The vision was from light sensation to 0.01. The volume of the tumors was ranged from 1.96 to 5.35 cm3, with a mean of (3.37±1.06) cm3. All the patients were treated with X rays by conventional fractional radiotherapy. Four of 8 patients were applied 24Gy totally in 8 fractions, while the other 4 patients were applied 46Gy in 23 fractions. Follow-up period ranged from 7 to 95 months, with medium of 42 months. ResultsRetinas reattached in all the eyes while exudation being absorbed. No retinal detachment happened again. To the last follow-up, the vision was from light sensation to 0.6. Visual activity improved in 6 eyes while 2 eyes improved obviously. Visual acuity was stable in remaining 2 eyes. The volume of the tumors decreased to 1.24-2.16 cm3, with a mean of (1.68±0.30) cm3. The percentage of the tumor decreased by 14.6-72.7, with an average of (44.89±21.30)%. No radiotherapy-associated complication occurred. ConclusionRadiotherapy is an efficient and safe treatment for refractory choroidal hemangioma.
Objective:To observe the therapeutic effi cacy of chemotherapy combin ed with ophthalmic therapy on retinoblastoma (RB). Methods:The survival rate, eye ball remaining rate, and the control of the disease condition of 37 patients (56 eyes) with RB were retrospectively analyzed. The standard of the well contr ol of the disease included: (1) the ocular tumor shrank or even disappeared, and the tumor had creamlike changes or calcification and cicatrisation; (2) no oc u lar tumor recurrence in patients who had undergone enucleation; (3) no metastasi s found in the followup period. All of the patients had at least one eye with RB (ge;Ⅲb stage) underwent c hemotherapy. According to the response of the tumor to the chemotherapy, the pat ients generally underwent 6 times of systemic chemotherapy at regular intervals of 3-4 weeks. The medicines for chemotherapy included vincristine, cyclohosphamide , etoposide phosphate, and carboplatin. According to the self condition, the pati ents underwent chemotherapy combined with several ophthalmic therapies like phot ocoagulation, cryotherapy, transpupillary thermotherapy, 106Ru brachytherapy, en ucleation, etc. The observation duration lasted 2-59 months, with the average o f 35 months. Results:Thirty patients (83.3%) survived and were followed up, and 6 died (16.6%). One patient with bilateral tumor couldn't be followed up afte renucleation of both eyes. Among these 30 patients (45 eyes), eye ball remainin g rate at stage I-Ⅱ, Ⅲ-Ⅳ, and Ⅴ was 100% (10 eyes), 70% (10 eyes), and 14 .3% (21 eyes), respectively. In the followup duration, the disease in all of the 3 0 patients was controlled well. Conclusions:Chemotherapy combi ned with ophthalmic therapy is effective on RB.
Radiotherapy is the prior treatment for uveal melanoma, but a major problem confronted most of the patients is radiation retinopathy, which accompanied with severe visual loss and secondary enucleation potential. There is no optium choice and normative strategy so far, the intraocular melanoma society has focused on application of anti-vascular endothelial growth factor drugs injection and glucocorticoids. This article reviews a series of potential managements for radiation retinopathy and its further stage .
Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT. The visual acuity ranged from 0.1 to 0.8 with an average of 0.3plusmn;0.2. The largest base diameter of tumor ranged from 6.8 mm to 17.9 mm with an average of (11.3plusmn;2.8) mm；The tumor height ranged from 3.9 mm to 10.6 mm with an average of (7.2plusmn;2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as ldquo;growingrdquo; if tumor height increased 2 mm or tumor largest base diameter increased 250 mu;m, otherwise the tumor was considered ldquo;controlledrdquo;. The followup ranged from 15 to 57 months with an average (33.01plusmn;9.81) months. The local tumor control rate, enucleation rate and visual acuity, complications after treatment were observed.Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79plusmn;3.35) mm, which had statistically significant difference（t=2.195，F=0.49；P=0.032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19plusmn;2.57) mm, which had statistically significant difference（t=2.069，F=0.018；P=0.0435) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7%. Three eyeballs were enucleated after treatment，the enucleation rate was 10.0%. The visual acuity remained unchanged in 12 eyes，improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%), secondary retinal detachment in three eyes (10.0%), secondary glaucoma in one eye (3.3%), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.
Objective To observe the macular morphological changes of choroidal melanoma with coherence tomography (OCT) after plaque radiotherapy (PRT). Methods A total of 48 patients (48 eyes) with choroidal melanoma who underwent125I PRT were enrolled in this study. All the patients were examined documenting OCT to get the image of macula. The macula of all the patients was not involved. The median visual acuity was 0.4plusmn;0.2, which ranged from 0.02 to 1.0. There were 18 eyes (37.5%) with retinal detachment, 12 eyes (25.0%) with retinal pigment epithelium (RPE) changes, seven eyes (14.6%) with macular edema, epimacular membrane, detachment combined with edema, exudation and RPE changes, 11 eyes (22.9%) with normal macular structure. The median follow-up time was (10.4plusmn;5.9) months, which ranged from one to 24 months. The tumor control situation and visual acuity were observed in follow-up period. The same equipment and methods of OCT were used to return visit in follow-up period. The macular morphological changes at the final visit and its relationship with PRT and visual acuity were contrastively analyzed. Results All the patients had good control of tumor. The vision acuity improved in two eyes (4.2%), unchanged in 10 eyes (20.8%), and decreased in 36 eyes (75.0%). The differences of the visual acuity was statistically significant between before and after treatment (Z=-3.778,P＜0.05). There were 13 eyes (27.1%) with retinal detachment; nine eyes (18.8%) with RPE changes; 17 eyes (35.4%) with macular edema, detachment combined with edema, exudation and RPE changes; six eyes (12.5%) with proliferation, atrophy, detachment combined with edema, exudation and epimacular membrane;three eyes (6.3%) with normal macular structure. There were 15 patients (31.3%) with two or more abnormal macular morphology after PRT. Conclusions Retinal detachment, RPE changes, macular edema and exudation are common abnormal macular morphology after PRT. The incidence rate of abnormal macular morphology is increased. There are 31.3% patients with two or more abnormal macular morphology.