PurposeSilicone oil a burgeoning adjuvant in the treatment of uveal melanoma where it is used for tissue protection during I-125 brachytherapy. While risk factors in the development of radiation retinopathy (RR) have been identified, treatment modulation for high-risk patients has largely been overlooked. We seek to expand the literature on this subject by reporting outcomes of I-125 brachytherapy with silicone oil in a high-risk population in the community setting.MethodsFive patients with uveal melanoma and at least one risk factor for RR development underwent iodine-125 (I-125) plaque brachytherapy with concurrent pars plana vitrectomy (PPV), silicone oil administration, and fine needle aspiration biopsy (FNAB). Plaque and silicone oil removal were performed after seven days. Minimum follow-up was 12 months.ResultsFollow-up ranged from 12 to 56 months. Macular radiation doses ranged from 12.55 to 141.5 Gy; the two eyes with the largest doses developed RR at 34 and 15 months as well as neovascular glaucoma (NVG). Surgical complications included one rhegmatogenous retinal detachment (RD) and an intra-operative vitreous hemorrhage with post-operative hyphema requiring additional intervention.ConclusionRR may be attenuated by silicone oil administration in patients with some risk factors. In tumors farther from the macula, this benefit is more readily apparent. Tumors located more posteriorly may not benefit from silicone oil administration considering postoperative complications and operating time. Patient demographics, tumor characteristics, and anticipated macular radiation dosage may help determine which patients can benefit from silicone oil and identify patient risks for adverse outcomes.
A 56-year-old man who had twice previously undergone orthotopic heart
transplantation was admitted with dyspnea and heart failure symptoms. A biopsy
excluded rejection. Left heart catheterization revealed a coronary cameral
fistula. After the patient was given mild diuretics, his condition improved. No
significant fistula flow was detected, and he was discharged. Several months
later, the patient was readmitted with worsening chest pain and dyspnea. Left
ventricular end-diastolic pressure and flow through the fistula were increased.
To correct the coronary cameral fistula, we performed a coil embolization
without complications. Several months later at follow-up, the patient’s symptoms
had resolved, and his left ventricular end-diastolic pressure had normalized. We
conclude that coronary fistulas may be caused by trauma to the heart during the
de-airing process, which may be prevented in the future with the development of
safer and more effective de-airing techniques.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.