Faculty Bibliography

PURPOSE/OBJECTIVE:To present our 12-year experience with low energy photon, slotted eye plaque radiation therapy. DESIGN/METHODS:Retrospective interventional case series METHODS: SETTING: The New York Eye Cancer Center. STUDY POPULATION/METHODS:Fifty-two consecutive patients with uveal melanomas near, touching or surrounding the optic disc. INTERVENTION/METHODS:Slotted eye plaque radiation therapy. MAIN OUTCOME MEASURES/METHODS:change in visual acuity, local tumor control, radiation side effects, eye salvage and systemic metastases. RESULTS:Tumors were peripapillary within 1.5-mm of the optic disc (n=8,15%), juxtapapillary touching ≤180 degrees (n=23,44%), or circumpapillary >180 and encircling the disc (n=21,41%). Mean follow-up was 47 months (median 34 months; range 6-146 months). Radiation induced a mean 41.2% reduction in tumor thickness. Life table analysis showed that 69% patients retained their visual acuities ≥20/40 and had a vision loss free survival 84 month after treatment. Also, 90% patients retained their visual acuity between 20/50-20/200 and had a vision loss free survival 36 month after treatment. Slotted plaque brachytherapy was associated with 4% secondary cataract, 11% neovascular glaucoma, no dry eye or eyelash loss. Local tumor control (no recurrence) was achieved in 98.1% patients. Life table analysis showed an overall enucleation-free survival of 93% and metastasis-free survival of 94%. CONCLUSIONS:Slotted plaque radiation therapy provided a normalized plaque-tumor position; such that the entire choroidal melanoma plus a 2-3 mm free margin of normal appearing tissue was included in the targeted zone. At 12-years, slotted plaque radiation therapy resulted in high rates of local tumor control, vision and eye retention.

PURPOSE/OBJECTIVE:The purpose of this study is to report on the efficacy and safety of topical chemotherapy alone for giant ocular surface squamous neoplasia (OSSN). METHODS:In this retrospective, interventional series, 10 eyes with giant OSSN underwent exfoliative biopsy to confirm the diagnosis followed by application of interferon alpha 2b (IFN α2b) and/or 5 fluorouracil, 1% (5FU). Reported outcome measures were tumor response, visual acuity, recurrence, systemic metastasis, and treatment complications. RESULTS:Ten patients (3 female, 7 male) had a mean age of 73 (median, 69; range 40-89) years. Mean tumor diameter was 13.1 (median, 12.3; range 8.2-19.4) mm. Five (50%) eyes were treated with IFN-α2b alone; 1 (10%) with 5-FU alone and 4 (40%) required both IFN-α2b and 5-FU. The mean duration of treatment was 3, 0.5, and 6.4 months for IFN-α2b alone, 5-FU alone, and both IFN-α2b and 5-FU respectively. Complete tumor response was observed in all 10 cases at mean follow-up of 12.8 (median, 11.5; range, 3-25) months. Complications noted were transient irritation and burning (n = 4), dry eyes (n = 2), and transient flu-like symptoms (n = 2). There was no evidence of chemotherapy-related symblepharon, stem cell deficiency, scleral thinning, or corneal opacity. There were no tumor recurrences, and no patient required surgical excision or cryotherapy. CONCLUSION/CONCLUSIONS:Topical chemotherapy was a safe and effective treatment, inducing complete regression in all cases of giant OSSN in this series. There were no sight-limiting complications.

The purpose of this study was to report on a case of Terson's syndrome (TS) using a novel instrument and technique to harvest posterior pole pathology from a postmortem eye. A modified ocular clamp was used to remove the posterior pole from the postmortem enucleated eye. Gross photographs were taken and an ocular sample of the posterior pole was sent to The New York Eye and Ear Pathology Laboratory. TS was identified from gross pathology and histologic examinations. The case history was consistent with that diagnosis. The authors concluded that high-quality gross and histopathologic examination of the posterior pole can be obtained with this novel instrument and technique. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:170-174.].

PURPOSE/OBJECTIVE:Pd) plaque brachytherapy. DESIGN/METHODS:Retrospective, nonrandomized, interventional case series. PARTICIPANTS/METHODS:Fifty patients with primary malignant melanoma of the iris. METHODS:Palladium-103 plaque brachytherapy. MAIN OUTCOME MEASURES/METHODS:Changes in tumor size, pigmentation, and vascularity; incidence of iris neovascularization; and radiation-related complications. RESULTS:The mean age in the case series was 61.2±14.9 years. The mean tumor thickness was 1.4±0.6 mm. According to the American Joint Committee on Cancer, eighth edition, staging criteria for iris melanoma, 21 tumors (42%) were T1a, 5 tumors (10%) were T1b, and 24 tumors (48%) were T2a. The tumor was melanotic in 37 cases (74%) and amelanotic in 13 cases (26%); of these, 13 tumors (26%) showed variable pigmentation. After brachytherapy, mean tumor thickness decreased to 0.9±0.2 mm. Pigmentation increased in 32 tumors (64%), decreased in 11 tumors (22%), and was unchanged in 6 tumors (12%). For intrinsic vascularity (n = 19), 12 tumors (63%) showed decrease and 7 tumors (37%) showed complete resolution. Appearance of ectropion uveae showed diminution in 15 tumors (43%); newly present corectopia was observed in 6 patients (12%). On high-frequency ultrasound imaging, of the 42 tumors (84%) with low to moderate internal reflectivity, 30 tumors (60%) showed an increase in internal reflectivity on regression. Iris stromal atrophy was noted in 26 patients (52%), progression or new-onset cataract was noted in 22 patients (44%), neovascular glaucoma was noted in 1 patient (2%), and there were no cases of corneal opacity. There was no clinical evidence (0%) of radiation-induced retinopathy, maculopathy, or optic neuropathy. Mean follow-up in this series was 5.2 years (range, 0.5-17 years). CONCLUSIONS:Pd plaque brachytherapy included decreased intrinsic tumor vascularity, increased tumor pigmentation, and decreased tumor thickness with synchronous increase in internal ultrasonographic reflectivity. No irreversible sight-limiting complications were noted.

PURPOSE/OBJECTIVE:To document subtype-specific clinical features of lymphoma of the eyelid, and their effect on patient outcome. DESIGN/METHODS:Retrospective observational case series. METHODS:Patient data were collected from 7 international eye cancer centers from January 1, 1980 through December 31, 2015. The cases included primary and secondary lymphomas affecting the eyelid. Overall survival, disease-specific survival (DSS), and progression-free survival were the primary endpoints. RESULTS:Eighty-six patients were included. Mean age was 63 years and 47 (55%) were male. Non-Hodgkin B-cell lymphomas constituted 83% (n = 71) and T-cell lymphomas constituted 17% (n = 15). The most common subtypes were extranodal marginal-zone lymphoma (EMZL) (37% [n = 32]), follicular lymphoma (FL) (23% [n = 20]), diffuse large B-cell lymphoma (DLBCL) (10% [n = 9]), mantle cell lymphoma (MCL) (8% [n = 7]), and mycosis fungoides (MF) (9% [n = 8]). EMZL had a female predilection (69% [22 of 32]), whereas MCL (71% [5 of 7]) and MF (88% [7 of 8]) had a male predominance. MCL (57% [4 of 7]), DLBCL (56% [5 of 9]), and MF (88% [7 of 8]) were frequently secondary lymphomas. Localized EMZL and FL were mostly treated with external beam radiation therapy, whereas DLBCL, MCL, and high Ann Arbor stage EMZL and FL were frequently treated with chemotherapy. DLBCL and MCL had a poor prognosis (5-year DSS, 21% and 50%, respectively), whereas EMZL, FL, and MF had a good prognosis (5-year DSS, 88%, 88% and 86%, respectively). CONCLUSIONS:Lymphoma of the eyelid consists mainly of the lymphoma subtypes EMZL, FL, DLBCL, MCL, and MF. High-grade DLBCL and MCL, as well as MF, are frequently secondary eyelid lymphomas. The main predictor of outcome was the histologic subtype: EMZL, FL, and MF had a significantly better prognosis than MCL and DLBCL.

BACKGROUND/AIMS:To evaluate the effect of adjuvant intravitreal triamcinolone acetonide (ITA) for radiation maculopathy (RM) recalcitrant to high-dose bevacizumab in patients with choroidal melanoma after plaque radiotherapy. METHODS:Eight eyes of eight patients with RM secondary to plaque radiotherapy for choroidal melanoma, recalcitrant to high-dose bevacizumab (3.0 mg) were retrospectively evaluated. Intravitreal injections of ITA (4 mg/0.1 mL) were performed at 4-week to 16-week intervals as an adjunct to continued bevacizumab therapy. Change in central foveal thickness (CFT) as measured by optical coherence tomography and change in visual acuity (VA) were the main outcome measures. RESULTS:At the time of diagnosis of choroidal melanoma, VA was 20/20 to 20/50 in 88% (n=7) and 20/60 to 20/200 in 12% (n=1). The mean radiation dose to the fovea was 81 Gy (median 75.2 Gy; range: 22.72-132.8 Gy). The mean onset to RM was 25 months after plaque therapy (median 25 months; range 12-44 months). At the time of initiation of ITA, VA was 20/20 to 20/50 in 38% (3/8), and 20/60 to 20/200 in 62% (5/8). After initiation of ITA, VA was stable or improved in 100% of patients (n=8) at 3 months, 88% at 6 months, 88% at 9 months and 75% at 12 months. Mean CFT was 417 µm at ITA initiation, 339 µm at 1 month, 355 µm at 6 months, 339 µm at 9 months and 359 µm at 1 year. CONCLUSION:Intravitreal triamcinolone can be added to preserve vision and decrease macular oedema in patients with RM recalcitrant to high-dose anti-vascular endothelial growth factor agents.