Uveal Melanoma Biopsy: A Review

Intraocular tumor diagnosis is based on clinical findings supported by additional imaging tools, such as ultrasound, optical coherence tomography and angiographic techniques, usually without the need for invasive procedures or tissue sampling. Despite improvements in the local treatment of uveal melanoma (UM), the prevention and treatment of the metastatic disease remain unsolved, and nearly 50% of patients develop liver metastasis. The current model suggests that tumor cells have already spread by the time of diagnosis, remaining dormant until there are favorable conditions. Tumor sampling procedures at the time of primary tumor diagnosis/treatment are therefore now commonly performed, usually not to confirm the diagnosis of UM, but to obtain a tissue sample for prognostication, to assess patient's specific metastatic risk. Moreover, several studies are ongoing to identify genes specific to UM tumorigenesis, leading to several potential targeted therapeutic strategies. Genetic information can also influence the surveillance timing and metastatic screening type of patients affected by UM. In spite of the widespread use of biopsies in general surgical practice, in ophthalmic oncology the indications and contraindications for tumor biopsy continue to be under debate. The purpose of this review paper is to critically evaluate the role of uveal melanoma biopsy in ophthalmic oncology

Intravitreal dexamethasone implant in radiation-induced macular oedema

To evaluate the efficacy and duration of activity of a single intravitreal dexamethasone implant in patients affected by radiation maculopathy.METHODS: Thirteen consecutive eyes of 13 patients affected by radiation maculopathy secondary to eye irradiation for a primary uveal melanoma (Iodine-125 brachytherapy) and treated with a single intravitreal 0.7\u2009mg dexamethasone implant were retrospectively evaluated. Each patient underwent full ophthalmological examination, including fluorescein angiography and spectral domain optical coherence tomography (SD-OCT), even in en-face modality. Follow-up was performed monthly over a 6-month period. RESULTS: At preinjection visit, the median central subfield thickness (CST) by SD-OCT was 407\u2009\ub5m (IQR, 357-524\u2009\ub5m) and the median best-corrected visual acuity (BCVA) was 61 ETDRS score (IQR, 54-67). The median gain of ETDRS letter at 1 month was 6.5 (IQR, 4-15) (p<0.01). The median CST showed a reduction of 120\u2009\ub5m (IQR, 62-134) (p<0.01). Further CST reduction was reported at 2 months' follow-up, with CST stabilisation at 3 months and maintenance of BCVA. At 4, 5 and 6 months' follow-up, all patients presented progressive retinal thickening (p<0.01) and BCVA reduction (p<0.01). No side effects were documented. CONCLUSION: Intravitreal dexamethasone implant reduces macular oedema secondary to radiation maculopathy and also improved visual acuity in a consistent proportion of patients. Signs of macular oedema recurrence may be detected at a median of 4 months after injection

Retinal Vascular Abnormalities related to Neurofibromatosis Type 1: Natural History and Classification by OCT Angiography in 473 Patients

PURPOSE: To analyze and classify neurofibromatosis type 1 (NF1) related retinal vascular abnormalities (RVAs), their natural history and correlation with disease severity, in a large cohort of patients.METHODS: This was an observational longitudinal study with prospective enrollment. Four hundred and seventy-three patients affected by NF1 and 150 age-matched healthy subjects were consecutively enrolled. RVAs were detected by means of near-infrared reflectance and studied by optical coherence tomography angiography (OCTA). The superficial vascular plexus (SVP) and the deep vascular complex (DVC) were quantitatively and qualitatively analyzed.RESULTS: We identified RVAs in 82 of 473 (17%) NF1 patients, but in none of the 150 healthy subjects. A comparison revealed that NF1 patients with RVAs showed a higher number of NF1 diagnostic criteria (4.3 \ub1 1.5 versus 3.9 \ub11.5, respectively; p=0.02) than patients without RVAs. Three different RVA types were identified on OCTA: macrovascular angiomatosis of the sole SVP; macrovascular angiomatosis of the SVP combined with microvascular angiomatosis of the DVC; and combined macrovascular angiomatosis of both SVP and DVC. The prospective analysis of OCTA images showed no significant longitudinal evolution of RVAs (mean follow-up: 3.7 \ub1 2.8 years). A single patient developed de novo a single RVA, and two RVAs showed detectable changes during follow-up.CONCLUSION: In NF1 patients RVAs are a characteristic sign that correlates with a more severe systemic disease expression, usually remaining stable during time. OCTA allows for the identification of different RVAs subtypes

IDENTIFICATION AND CLASSIFICATION OF MACULAR MORPHOLOGIC BIOMARKERS RELATED TO VISUAL ACUITY IN RADIATION MACULOPATHY: A Multimodal Imaging Study

To identify and classify, by a multimodal imaging approach, the most relevant macular morphologic biomarkers related to visual acuity in patients affected by radiation maculopathy secondary to brachytherapy

Peripapillary vascular changes in radiation optic neuropathy: an optical coherence tomography angiography grading

To investigate peripapillary vascular changes secondary to radiation optic neuropathy (RON) using optical coherence tomography angiography (OCT-A) and to propose a clinical grading of RON based on OCT-A findings