Endocrine ophthalmopathy (EOP) is a multidisciplinary problem at the intersection of endocrinology and ophthalmology. The patients presenting with this condition experience deficit of adequate medical aid due to the poor cooperation between ophthalmologists and endocrinologists. There are practically no specialized centres in this country where the patients with EOP could receive the combined treatment of this pathology including the surgical intervention. Taken together, late diagnostics and delayed seeking the efficacious medical assistance, the absence of stable compensation of the functional disorders of the thyroid gland, erroneous identification of the phase of the disease, and incorrect choice of the methods for its treatment, the lack of coordination and consistency in the actions of ophthalmologists and endocrinologists are responsible for the low effectiveness of EOP treatment. On the other hand, the absence of the unified approach to diagnostics and treatment of endocrine ophthalmopathy, the necessity of introducing the international experience gained in this field into the routine clinical practice and pooling efforts of representatives of different medical disciplines (endocrinologists, ophthalmologists, radiologists, endocrine surgeons, and neurosurgeons) created the prerequisites for the solution of the EOP problems and gave impetus to the development of the recommendations being proposed.
At present local excision of tumours of the iris and ciliary body is commonly undertaken, but it is often difficult to be sure of the exact nature and extent of the neoplasm. The importance of fluorescein angiography in the diagnosis of choroidal tumours is well known (Sollom, 1968;Brovkina and Zinchenko, 1977), but this technique is rarely used in the diagnosis of tumours of the iris and the ciliary body. The literature on this subject is based on the examination of small groups of patients (Craandijk and Kerk, 1970;Sevel and Tobias, 1972;Wilensky and Holland, 1974;Freeman and Friedman, 1975;.The results of fluorescein angiography obtained in 55 patients with tumours of the iris and iridociliary region is the subject of the present paper.
Patients and methodsFifty-five patients (22 males and 33 females) were examined. The age of the patients ranged from 16 to 62 (mean 45 9 years). In 38 patients (69%) the tumour was situated both in the ciliary body and in the iris, in 15 (27%) in the peripheral part of the iris only, and in 2 the pupillary portion of the iris was the site of the growth.All the patients were treated surgically. In 52 cases local excision was performed, and 3 eyes were enucleated.Benign tumours were found in 33 cases, 30 of which were leiomyomas, 2 were naevi, and I was a haemangioma. Twenty-two malignant tumours were
Local treatment of choroidal melanoma (CM) attracts the attention of many ophthalmology specialists, especially in recent years as the capabilities to target irradiation at small objects and possibilities of surgical interventions on the eyeball have expanded. The article discusses the medical indications for local treatment of CM. Review of literature of the last 16 years and author's own observations on CM patients who underwent almost all kinds of conventional methods of local treatment allowed thorough analysis of indications and counter-indications for their usage. Among the authors who favor local destruction and removal of large CM, the main indication is the possibility to preserve vision and anatomical structures of the eye. This led to unreasonably wide spread of local destruction (removal) of large CM, primarily the endovitreal resection method. However, such metastasis risk factors as CM size and its localization are being overlooked. Literature analysis and author's own observations helped validate the unsafety of the local treatment of large CM. The article features long-term results of contact and distant radiation therapy, and presents CM metrics for best therapeutic effect.
The article is concentrated on the mechanism of the development of optic neuropathy in patients with edematous proptosis one of the clinical forms of endocrine ophthalmopathy. All probable options for the pathogenesis of optic neuropathy are reviewed in detail: increased intraorbital pressure, compression of the optic nerve by enlarged extraocular muscles, the formation of the apical syndrome with compression of the optic nerve in the zone of the Zinns ring, an increase in the volume of orbital fat, tension of the optic nerve by an anteriorly shifted eye (exophthalmos), and arterial blood flow impairment in the ophthalmic artery, impaired venous blood flow in the orbit. Based on 103 follow-ups of patients with edematous proptosis and optic neuropathy (68 of them had initial optical neuropathy), the author offers her concept of the pathogenesis of optic neuropathy in patients with sub- and decompensated edematous proptosis, considering optic neuropathy as a complication of endocrine ophthalmopathy. The signs of optical neuropathy in the initial stage of its development are conceived.
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