Prognostic assessment of choroidal melanoma based on interphase cytogenetics and pathological features

It is now well recognised that in uveal melanoma and specifically choroidal melanoma, monosomy 3 has a stronger association with death caused by metastases than clinical and histological parameters. However, the identification of the presence or absence of monosomy 3 and its correlation with morphological heterogeneity within tissue sections has not been assessed. Furthermore, the role of monosomy 3 in predicting time to death is not fully understood. All these aspects have been investigated in more detail in this thesis. In the introduction to this thesis previously published work concerning new and well- established prognostic factors in choroidal melanoma is reviewed. Diagnostic modalities including cytogenetic studies and treatment of this malignant neoplasm and its metastatic disease are also discussed. In the first study of this thesis the technique of chromosome in situ hybridisation (CISH) was adapted to allow its application to archival choroidal melanoma, which was both formalin and gluteraldehyde fixed. The advantage of this technique compared with other techniques available is that it is applicable to archival material allowing the direct correlation of chromosomal changes with histology. CISH was shown to be an effective method for assessing monosomy 3 in these archival paraffin embedded tissue sections. The efficiency of the CISH technique was compared with fluorescence in situ hybridisation (FISH). The main additional advantage of FISH is that it is possible to assess the copy number of several chromosomes at one time. However, a consistent signal could not be obtained with FISH in archival tissue thus the CISH technique was adopted for further study of archival choroidal melanoma. The CISH technique was then used to assess the presence or absence of monosomy 3 in an archival series of melanoma examining tumours from individuals that had died from metastatic melanoma and comparing them with individuals that had survived. The results confirmed the work of previous studies that monosomy 3 is an important predictor of death in choroidal melanoma. However, this study also showed that disomy 3 does not guarantee survival since a small group of tumours displaying disomy 3 resulted in metastatic death. The reasons for this may be related to the inclusion criteria used in this investigation since this was a retrospective study. Furthermore, with the CISH technique used in this study the probes were centromere specific and regional losses of chromosome 3 might not have been detected. However, regional losses seem to occur only in a minority of cases. Finally, and probably more likely, there are additional alterations that allow invasion and metastases in choroidal melanoma. This study also showed that monosomy 3, in some cases, could also be predicted from histology, particularly by the presence of epithelioid cells and vascular loops. One advantage of this archival series was the long follow up available such that late deaths from metastatic melanoma were represented (the longest time to death for metastatic melanoma was 14 years) as well as those that succumbed to metastases at around 3 years. Additional this study showed that monosomy 3 does not influence time until death as there was no significant difference in this interval between metastatic melanomas, with and without monosomy 3. Another advantage of CISH is that it is possible to assess chromosome copy number in conjunction with cell morphology. This aspect of the technique was assessed in the final study of this thesis. A group of choroidal melanomas with well-defined populations of epithelioid and spindle cells were identified from the original study group. Counting was undertaken within these defined morphological populations and monosomy 3 was heterogeneous in a subpopulation of these choroidal melanomas occurring in epithelioid but not spindle shaped cells. This has implications for cytogenetic screening for monosomy 3 since the genetic information obtained from small samples may not be representative. Therefore, a sample composed purely of spindle cells might carry less prognostic significance than one containing both spindle and epithelioid cells. In conclusion, CISH has proven a valuable additional technique allowing retrospective studies of monosomy 3 in choroidal melanoma therefore including larger numbers than most prospective studies and a longer follow-up. Utilising CISH has provided important additional information concerning the significance of monosomy 3 in choroidal melanoma

Bilateral Birdshot Retinochoroiditis and Retinal Astrocytoma

Background. This case highlights the importance of recognising multiple pathologies within the eye which may not necessarily be linked. Both birdshot retinochoroiditis and astrocytoma are rare conditions. The case underlines the need for early identification and treatment of birdshot retinochoroiditis with steroids and disease modifying drugs. Astrocytoma in the absence of tuberous sclerosis is also uncommon. Case Presentation. A 36-year-old male presented with 3-month history of bilateral progressive flashing lights and floaters. He was systemically well with no significant past medical history. Fundal examination revealed retinal vasculitis and active creamy lesions in the choroid radiating from the optic nerve. In the supranasal periphery of the right eye there was a raised white, jagged lesion protruding into the vitreous. Fluorescein angiogram and indocyanine green showed marked venous vasculitis, hypofluorescence, and disc leakage in keeping with birdshot retinochoroiditis. The supranasal lesion features were in keeping with astrocytoma and this was thought to be a coincidental finding. Conclusions. Retinal astrocytoma may be present as an isolated ocular finding; however, patients must still be investigated for tuberous sclerosis which is the most common association. Birdshot retinochoroiditis typically responds well to steroid therapy, and disease modifying drugs should be considered as soon as possible

Revisiting transconjunctival sutureless 25-gauge vitrectomy: still worthwhile?

To present the outcomes of various retinal conditions treated with the sutureless 25-gauge (25G) vitrectomy technique. Retrospective case review of 232 eyes of 228 patients who underwent 25G vitrectomy from January 2003 to August 2006. Follow-up was a minimum of 3 months. Indications for surgery included idiopathic macular hole, rhegmatogenous retinal detachment, epiretinal membrane and proliferative diabetic retinopathy. Main outcome measures included final visual acuity, re-operation rate and surgical complications such as endophthalmitis, hypotony and retinal (re)detachment. For all cases, the mean overall visual acuity (logMAR) improved from 0.9 preoperatively to 0.5 (P < 0.0001). The improvement in acuity was highest in the rhegmatogenous detachment and diabetic groups. Transient postoperative hypotony was observed in 15 cases (9.2%) on day 1 after surgery but all these cases resolved. In 7.3% of the cases (17 out of 232) additional surgery was performed due to retina (re)detachment but final anatomic success was achieved in all cases; the detachments occurred within the first 3 months. One patients developed endophthalmitis (0.4%) which coincided with subconjunctival antibiotics being discontinued in favour of topical treatment. The 25G system remains a safe and effective technique for a variety of retinal conditions; significant fast visual rehabilitation is an advantage

Retrospective comparison between growth and retinopathy of prematurity model versus WINROP model

© Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.Objective: To compare the weight and insulin-like growth factor-1 in neonatal retinopathy (WINROP) to the growth and retinopathy of prematurity (G-ROP) model in a Portuguese cohort. Design: Retrospective case series. Methods: Clinical records of consecutive infants who underwent retinopathy of prematurity (ROP) screening from April 2012 to May 2019 were retrospectively reviewed. Both WINROP and G-ROP models were accessed for sensitivity and specificity for type 1 ROP. A separate analysis of both algorithms was performed in infants with gestational age (GA) <30 weeks. Results: Of the 375 infants included in the study, 313 were eligible for G-ROP analysis and 311 for WINROP. In the G-ROP group, 22 infants developed type 1 ROP (sensitivity 90.91%, 95% confidence interval [CI] 70.84%-98.98%). In the WINROP group, 23 infants needed treatment (sensitivity of 86.96%, 95% CI 66.41%-97.22%). Both models reached 100% sensitivity for type 1 ROP if restricted to GA <30 weeks. Conclusions: Both models were easy to use and had similar sensitivities. If restricted to GA <30 weeks, both models detected all type 1 ROP.info:eu-repo/semantics/publishedVersio

Assessing Patients with Asymptomatic Retinal Emboli Detected at Retinal Screening

<p><b>Article full text</b></p> <p><br></p> <p>The full text of this article can be found here<b>.</b> <a href="https://link.springer.com/article/10.1007/s40123-016-0055-5">https://link.springer.com/article/10.1007/s40123-016-0055-5</a></p><p></p> <p><br></p> <p><b>Provide enhanced content for this article</b></p> <p><br></p> <p>If you are an author of this publication and would like to provide additional enhanced content for your article then please contact <a href="http://www.medengine.com/Redeem/”mailto:[email protected]”"><b>[email protected]</b></a>.</p> <p><br></p> <p>The journal offers a range of additional features designed to increase visibility and readership. All features will be thoroughly peer reviewed to ensure the content is of the highest scientific standard and all features are marked as ‘peer reviewed’ to ensure readers are aware that the content has been reviewed to the same level as the articles they are being presented alongside. Moreover, all sponsorship and disclosure information is included to provide complete transparency and adherence to good publication practices. This ensures that however the content is reached the reader has a full understanding of its origin. No fees are charged for hosting additional open access content.</p> <p><br></p> <p>Other enhanced features include, but are not limited to:</p> <p><br></p> <p>• Slide decks</p> <p>• Videos and animations</p> <p>• Audio abstracts</p> <p>• Audio slides</p

INFLAMMATORY BOWEL DISEASE: OUTPATIENT TREATMENT PROFILE

ABSTRACT BACKGROUND Crohn&#8217;s disease and ulcerative colitis are the two major forms of inflammatory bowel disease. The incidence and prevalence of both conditions have increased and are progressively increasing. These diseases are frequently recurrent and clinically highly severe. In Brazil, the lack of epidemiological data related to such diseases has left these patients in a vulnerable state and contributed to increased morbidity. OBJECTIVE To describe the profiles of patients with inflammatory bowel disease treated in an outpatient service in Brazil. METHODS This descriptive, exploratory, and retrospective documentary study with a quantitative approach was performed in an outpatient treatment service for inflammatory bowel disease, at a university polyclinic located in Rio de Janeiro, Brazil, from May to July 2016. The study included 556 patients and was approved by the research ethics committee of the institution (CAAE no. 55179316.6.0000.5259/2016). RESULTS The data showed a high prevalence of inflammatory bowel disease in white female patients. Crohn&#8217;s disease was diagnosed in more patients than was ulcerative colitis; the ileocolon was the most commonly affected location in patients with Crohn&#8217;s disease. The stenotic phenotype was prevalent in patients with Crohn&#8217;s disease. CONCLUSION The prevalence of the stenotic phenotype in Crohn&#8217;s disease in relation to others demonstrates the need for further investigations in this field of study in Brazil. In conclusion, the data showed that the epidemiologic profile of the study population is similar to that published in the national and international literature

Heavy silicone oil tamponade - a multicentre experience

OBJECTIVE: To report multicentred use of the heavy silicone oil Densiron 68 for anatomical reattachment following rhegmatogenous retinal detachment (RRD) repair and its associated complications. METHODS AND ANALYSIS: Patients from seven vitreoretinal units within the UK that underwent RRD repair with Densiron 68 between January 2015 and December 2019 were identified. Primary outcome measures were primary and final reattachment rate, retained Densiron and failure rate. Secondary outcome measures were duration of tamponade, final visual acuity (VA) and complications of heavy silicone oil. RESULTS: 134 eyes of 134 patients were involved in the study. Primary surgical success was achieved in 48.5%, while a final reattachment rate of 73.4% was observed. The mean duration of Densiron 68 tamponade was 139.5 days. Mean final VA was 1.01 (range 0–2.9). 8 eyes (6.0%) required long-term topical steroids for anterior uveitis, whereas none of the eyes required long-term pressure-lowering treatment. Emulsification rate was 10.7% (6 eyes). CONCLUSION: This is the largest real-world study on Densiron 68 in the UK. Densiron 68 facilitates tamponade of inferior retinal pathology and may be considered as an option for tamponade of inferior retinal pathologies