Purpose/ObjectivesTo determine the outcome of 125I plaque brachytherapy for primary ocular melanoma tumors at the Yale Cancer Center. To compare the outcomes for medium vs. large tumor size and the impact of transpupillary thermotherapy (TTT), as an adjunct, on outcome, and toxicity.Materials/MethodsWe retrospectively reviewed the characteristics and outcomes of 38 patients who received primary 125I plaque brachytherapy for ocular melanoma at the Yale Cancer Center (YCC) between February 1993 and June 2005; follow-up data were available for 27 patients who are included in this analysis. Patients were divided into two categories, those with medium (M) tumors measuring 2.5-10 mm in apical height or a median basal tumor diameter (MBTD) ≤16mm and those with large tumors (L) measuring >10 mm in height or an MBTD >16. Patient charts were reviewed for pre- and post-procedure visual acuity, local recurrence, subsequent enucleation, toxicity, and survival. Survival data was obtained from patient charts as well as the Social Security Death Index Database.ResultsMedian age at treatment was 54 years (range, 30-89). Median follow-up time for the cohort was 3.7 years. 63% had ≥2-year follow-up and 33% had ≥5-year follow-up. The median tumor dimensions were 17 x 13 x 7.5 mm. Eleven (40.7%) medium-sized tumors and 16 (59.3%) large tumors were implanted. Patients were treated with a median dose of 97 Gy to the tumor apex at a median dose rate of 82.8 cGy/hour. A TTT was performed in 8 patients, 2 in the M cohort and 6 in the L cohort. Enucleation was performed in 5 patients, all in patients with large tumors. Four of 5 (80%) were successfully salvaged and alive at time of analysis. Five-year survival rates were 80% for the 20 patients treated ≥5-years-ago. Median survival was 6 years, 9.8 years in the M group, 3.5 years for L group. There were 3 local recurrences, all which occurred in the L cohort. Two were successfully salvaged (1 with TTT, the other with enucleation and TTT) and were alive at the time of analysis. Median visual acuity was 20/50 pre-treatment and median visual acuity post-implant was 20/400. The most common side effects for all patients were cataract formation (9/27), vitreous hemorrhage (5/27), and retinopathy (7/27). Four patients underwent elective enucleation without evidence of local recurrence.Conclusions125I plaque brachytherapy for ocular melanoma at the YCC showed results comparable to previously published data in terms of visual acuity, local control, survival, and toxicity. Results for patients with medium-sized uveal melanomas were particularly excellent. While plaque brachytherapy for large-sized uveal melanoma is associated with greater local recurrence, it is a feasible alternative to enucleation. Purpose/ObjectivesTo determine the outcome of 125I plaque brachytherapy for primary ocular melanoma tumors at the Yale Cancer Center. To compare the outcomes for medium vs. large tumor size and the impact of transpupillary thermotherapy (TTT), as an adjunct, on outcome, and toxicity. To determine the outcome of 125I plaque brachytherapy for primary ocular melanoma tumors at the Yale Cancer Center. To compare the outcomes for medium vs. large tumor size and the impact of transpupillary thermotherapy (TTT), as an adjunct, on outcome, and toxicity. Materials/MethodsWe retrospectively reviewed the characteristics and outcomes of 38 patients who received primary 125I plaque brachytherapy for ocular melanoma at the Yale Cancer Center (YCC) between February 1993 and June 2005; follow-up data were available for 27 patients who are included in this analysis. Patients were divided into two categories, those with medium (M) tumors measuring 2.5-10 mm in apical height or a median basal tumor diameter (MBTD) ≤16mm and those with large tumors (L) measuring >10 mm in height or an MBTD >16. Patient charts were reviewed for pre- and post-procedure visual acuity, local recurrence, subsequent enucleation, toxicity, and survival. Survival data was obtained from patient charts as well as the Social Security Death Index Database. We retrospectively reviewed the characteristics and outcomes of 38 patients who received primary 125I plaque brachytherapy for ocular melanoma at the Yale Cancer Center (YCC) between February 1993 and June 2005; follow-up data were available for 27 patients who are included in this analysis. Patients were divided into two categories, those with medium (M) tumors measuring 2.5-10 mm in apical height or a median basal tumor diameter (MBTD) ≤16mm and those with large tumors (L) measuring >10 mm in height or an MBTD >16. Patient charts were reviewed for pre- and post-procedure visual acuity, local recurrence, subsequent enucleation, toxicity, and survival. Survival data was obtained from patient charts as well as the Social Security Death Index Database. ResultsMedian age at treatment was 54 years (range, 30-89). Median follow-up time for the cohort was 3.7 years. 63% had ≥2-year follow-up and 33% had ≥5-year follow-up. The median tumor dimensions were 17 x 13 x 7.5 mm. Eleven (40.7%) medium-sized tumors and 16 (59.3%) large tumors were implanted. Patients were treated with a median dose of 97 Gy to the tumor apex at a median dose rate of 82.8 cGy/hour. A TTT was performed in 8 patients, 2 in the M cohort and 6 in the L cohort. Enucleation was performed in 5 patients, all in patients with large tumors. Four of 5 (80%) were successfully salvaged and alive at time of analysis. Five-year survival rates were 80% for the 20 patients treated ≥5-years-ago. Median survival was 6 years, 9.8 years in the M group, 3.5 years for L group. There were 3 local recurrences, all which occurred in the L cohort. Two were successfully salvaged (1 with TTT, the other with enucleation and TTT) and were alive at the time of analysis. Median visual acuity was 20/50 pre-treatment and median visual acuity post-implant was 20/400. The most common side effects for all patients were cataract formation (9/27), vitreous hemorrhage (5/27), and retinopathy (7/27). Four patients underwent elective enucleation without evidence of local recurrence. Median age at treatment was 54 years (range, 30-89). Median follow-up time for the cohort was 3.7 years. 63% had ≥2-year follow-up and 33% had ≥5-year follow-up. The median tumor dimensions were 17 x 13 x 7.5 mm. Eleven (40.7%) medium-sized tumors and 16 (59.3%) large tumors were implanted. Patients were treated with a median dose of 97 Gy to the tumor apex at a median dose rate of 82.8 cGy/hour. A TTT was performed in 8 patients, 2 in the M cohort and 6 in the L cohort. Enucleation was performed in 5 patients, all in patients with large tumors. Four of 5 (80%) were successfully salvaged and alive at time of analysis. Five-year survival rates were 80% for the 20 patients treated ≥5-years-ago. Median survival was 6 years, 9.8 years in the M group, 3.5 years for L group. There were 3 local recurrences, all which occurred in the L cohort. Two were successfully salvaged (1 with TTT, the other with enucleation and TTT) and were alive at the time of analysis. Median visual acuity was 20/50 pre-treatment and median visual acuity post-implant was 20/400. The most common side effects for all patients were cataract formation (9/27), vitreous hemorrhage (5/27), and retinopathy (7/27). Four patients underwent elective enucleation without evidence of local recurrence. Conclusions125I plaque brachytherapy for ocular melanoma at the YCC showed results comparable to previously published data in terms of visual acuity, local control, survival, and toxicity. Results for patients with medium-sized uveal melanomas were particularly excellent. While plaque brachytherapy for large-sized uveal melanoma is associated with greater local recurrence, it is a feasible alternative to enucleation. 125I plaque brachytherapy for ocular melanoma at the YCC showed results comparable to previously published data in terms of visual acuity, local control, survival, and toxicity. Results for patients with medium-sized uveal melanomas were particularly excellent. While plaque brachytherapy for large-sized uveal melanoma is associated with greater local recurrence, it is a feasible alternative to enucleation.

* BACKGROUND AND OBJECTIVE: To evaluate whether the combination of simultaneous hyperthermia by transpupillary thermotherapy and indocyanine green-based photodynamic therapy is an effective treatment for small and medium choroidal melanomas. * PATIENTS AND METHODS: Twenty-five patients with small and medium choroidal melanomas were treated with combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy. * RESULTS : The median age of the 25 patients was 64 years (range, 35 to 88 years). The pretreatment volume of the tumors ranged from 1 5.9 to 653.5 mm3 (mean, 1 1 8.7 ± 146.6 mm3). After a mean of 2.4 treatments (range, 1 to 5 treatments), all of the tumors but one showed a significant volume reduction without clinical evidence of recurrences. The follow-up ranged from 6 to 59 months (mean, 12 ± 14 months). Complications included retinal vascular occlusions, edema and superficial scarring of the macula, and rhegmatogenous retinal detachment. * CONCLUSIONS: The effects of combined simultaneous transpupillary thermotherapy and indocyanine green-based photodynamic therapy appears to be effective in achieving local tumor control in selected small and medium choroidal melanomas. [Ophthalmic Surg Lasers Imaging 2005;36:463-470.]

The authors describe the use of photodynamic therapy with verteporfin for subfoveal choroidal neovascular membrane secondary to optic nerve drusen. A 28-year-old woman had a peripapillary choroidal neovascular membrane secondary to optic nerve drusen with significant metamorphopsia. Photodynamic therapy using verteporfin was performed. Visual acuity improved to 20/20 with resolution of metamorphopsia and absence of leakage on fluorescein angiography a few weeks after verteporfin therapy. The patient's condition remained stable for 16 months with 20/20 vision. Photodynamic therapy with verteporfin may be a useful treatment option in patients with choroidal neovascular membranes secondary to optic nerve drusen.

BACKGROUND AND OBJECTIVE:To describe a cluster of patients who had acute-onset endophthalmitis following cataract surgery.PATIENTS AND METHODS:Ten patients with endophthalmitis following cataract surgery who were referred from three different anterior segment surgeons were evaluated.RESULTS:Presenting visual acuities ranged from 20/30 to light perception (median, 20/80). All 10 eyes demonstrated vitritis, 8 of 10 eyes had hypopyon, and the remaining 2 eyes had significant anterior segment fibrin. All patients were treated with intravitreal injections of vancomycin and ceftazidime, as well as subconjunctival steroids. Vitreous cultures were positive in 2 of 10 eyes, and both grew Staphylococcus epidermidis, aqueous cultures were negative in 8 of 8 eyes (not performed in 2 patients). Follow-up ranged from 13 to 85 days (median, 37 days). All eyes showed complete resolution of inflammation and visual acuity improved to 20/40 or better in 9 eyes (90%).CONCLUSIONS:Acute-onset endophthalmitis may occur in a cluster of patients within a short time frame. Early diagnosis and treatment may result in favorable visual outcomes.

BACKGROUND AND OBJECTIVE:Tissue Plasminogen Activator (TPA) has been used as an adjunct in the surgical removal of submacular hemorrhage. It is usually used intraoperatively, but may not provide enough time for effective fibrinolysis, especially for a large hemorrhage. The present study was conducted to evaluate the efficiency and safety of preoperative use of TPA for large submacular hemorrhages.METHODS:Five eyes with large submacular hemorrhage secondary to age-related macular degeneration underwent subretinal injection of TPA in the office 24 hours before surgery. All hemorrhages were less than seven days old and at least 3 mm thick.RESULTS:Preoperative visual acuity ranged from counting fingers to hand motion (HM). Patient follow-up ranged from 3 months to 24 months (mean, 11 months). Final visual acuity ranged from 20/30 to HM. Four of the five eyes (80%) showed improved visual acuity after surgery and 3/5 (60%) attained visual acuity of 20/200 or better.CONCLUSION:Preoperative use of TPA for drainage of large submacular hemorrhage appears to be safe and may result in efficient clot removal. The true efficacy of TPA in the treatment of submacular hemorrhage can only be proven by a prospective randomized trial.

ALEXANDRAKIS, GEORGE MD; CHAUDHRY, NAUMAN A MD; LIGGETT, PETER E MD; WEITZMAN, MARC MD Author Information