Background: The pathogenesis of central serous chorioretinopathy (CSC) remains a subject of intensive research. We aimed to determine correlations between plasma levels of selected angiogenic factors and different forms of CSC. Methods: Eighty patients were enrolled in the study including 30 with a chronic form of CSC, 30 with acute CSC, and 20 controls. Presence of active CSC was determined by fluorescein angiography (FA), indocyanine green angiography (ICGA), and swept-source optical coherence tomography (SS-OCT). Plasma concentrations of angiopoietin-1, endostatin, fibroblast growth factor, placental growth factor (PlGF), platelet-derived growth factor (PDGF-AA), thrombospondin-2, vascular endothelial growth factor (VEGF), VEGF-D, and pigment epithelium–derived factor were measured, and the results were compared between groups. Additionally, mean choroidal thickness (CT) was measured in all patients. Results: Levels of angiopoietin-1 (p = 0.008), PlGF (p = 0.045), and PDGF-AA (p = 0.033) differed significantly between the three groups. Compared with the controls, VEGF (p = 0.024), PlGF (p = 0.013), and PDGF-AA (p = 0.012) were downregulated in the whole CSC group, specifically PDGF-AA (p = 0.002) in acute CSC and angiopoietin-1 (p = 0.007) in chronic CSC. An inverse correlation between mean CT and VEGF levels was noted in CSC patients (rho = −0.27, p = 0.044). Conclusions: Downregulated angiopoietin-1, VEGF, PDGF-AA, and PlGF levels may highlight the previously unknown role of the imbalanced levels of proangiogenic and antiangiogenic factors in the pathogenesis of CSC. Moreover, downregulated VEGF levels may suggest that choroidal neovascularization in CSC is associated with arteriogenesis rather than angiogenesis.

PurposeThe aim of the study was an evaluation of I-125 brachytherapy patients with uveal melanoma with special consideration for the relationship of the treatment results and the irradiation dose applied to the tumor apex.Material and methodsMedical records of 344 adults with uveal melanoma treated with I-125 brachytherapy in the Department of Ophthalmology and Ocular Oncology of the Jagiellonian University, Medical College in Cracow, Poland were retrospectively analyzed. The study was conducted between 2003 and 2012, and the study group was divided into two subgroups depending on the irradiation dose applied to the top of the tumor: 80 Gy to 100 Gy (n = 177) and 100 Gy to 120 Gy (n = 167).ResultsIt was found that the height of the tumor and the largest diameter of the tumor base decreased with every consecutive follow-up measurement and differed significantly in all comparisons (p < 0.0001). No significant correlation between frequency of complications was found between both study groups (χ2 = 0.27; p = 0.6067). The correlation between survival and the irradiation dose as applied to the tumor top was statistically irrelevant (χ2 = 0.44; p = 0.5084). A logistic regression model showed that patient survival depended on the largest diameter of the base and the height of tumor (p = 0.0216), and the risk of death was larger as these dimensions increased (IR, 1.17). An increase of the largest diameter of the base by 1 mm meant a 17% increase in chances of death. In 13.4% of cases, an enucleation was necessary.ConclusionsThe treatment of choroidal melanomas with I-125 iodine isotope brachytherapy is an efficient and recommended method of treatment and in many cases, an alternative to the enucleation of an eyeball.

Background/Aim: This study analysed the prevalence of the characteristics evaluated in dermatoscopy for melanocytic infiltrations of the conjunctiva with various degrees of malignancy. Patients and Methods: A total of 160 conjunctival pigmented lesions were studied. Each lesion was scored using dermatoscopic patterns and the characteristics of malignancy described by Kittler. Also, the Authors' own clues were added to the evaluation. Results: In melanomas, the following characteristics were identified: asymmetry of the pattern and colour, larger average number of colours, the presence of grey colour, structureless area, polymorphic vessels and feeder vessels. A pattern of black dots and a black colour was typical of malignant lesions and pre-cancerous (premalignant) lesions -primary acquired melanosis (PAM) with atypia. Cysts were observed only in the group of naevi. Conclusion: The patterns evaluated with dermatoscopy are present in pigmented lesions of the conjunctiva. There are, however, some characteristics which allow differentiation between melanoma and pigmented naevus and melanosis and also between PAM.There are several lesions that arise from the melanocytes of the conjunctiva. The most common are naevi, primary acquired melanosis (PAM) and malignant melanoma (MM). The predominant conjunctival pigmented tumour is naevus (1, 2). Naevus accounts for 28% of all conjunctival tumours and 52% of melanocytic lesions (3). It is a benign lesion, with a less than 1% (3, 4) tendency to malignant transformation. It is usually a unilateral, slightly elevated, variably pigmented lesion, with clear cysts, and feeder vessels, and is predominantly located in the bulbar conjunctiva (3). All naevi require serial observation using photographic documentation. Any changes in size, shape or colour are suspicious of malignant transformation and should be treated like melanoma. Some patients demand excision for cosmetic reasons (4, 5).PAM accounts for 11% of all conjunctival tumours and 21% of conjunctival pigmented lesions (2, 6, 7). It can be divided into melanosis with atypia and without atypia, depending on the nuclear features and growth pattern of melanocytes in the histopathological examination. The presence of atypia is associated with a very high risk (13-50%) of malignant transformation, while absence of atypia carries no risk for melanoma development (4-6). PAM with atypia is considered to be a form of melanoma in situ, similar to lentigo maligna of the skin (6, 8). PAM occurs as a flat, unilateral, brown, patchy or diffuse lesion usually in middleaged Caucasian individuals (9). It is thought that it is impossible to distinguish clinically PAM without atypia from PAM with atypia (4). PAM must be differentiated from racial melanosis, which is usually bilateral and symmetrical (6). The procedure proposed by Shields and co-workers in patients with PAM involves observation or surgical treatment in combination with cryotherapy and/or topical chemotherapy depending on the size of the lesion. In cases of very large tumours, ...

Zasadniczy podział nowotworów spojówki ze względu na pochodzenie wyróżnia guzy melanocytarne i amelanocytarne-pierwsze z nich to rozrosty melanocytów, drugie zaś stanowią głównie rozplem komórek nabłonka lub limfocytów (1). W tej grupie mogą powstawać guzy nowotworowe, zarówno łagodne, jak i złośliwe (1-3). Nowotwory złośliwe spojówki są

Purpose: To perform a retrospective analysis of factors which might affect the occurrence of a relapse of uveal melanoma after 125 I brachytherapy. Material and methods: The analysis concerned 343 patients treated in the years 2001-2012. The effect on local recurrence of such factors as patient's sex, age, tumour size, shape, pigmentation, location, presence of orange pigment or petechiae on tumour surface, retinal detachment, and blood or dispersed pigment in vitreous body were studied. Additional analysis concerned physical properties of brachytherapy (total dose, irradiation dose applied to tumour apex and base and irradiation time). Two groups of patients were distinguished: with and without a relapse. The diagnostic criterion for the relapse was growth of the tumour base or height by 0.5 mm. Results: Local recurrence of the uveal melanoma was observed in 29 patients (8.5%). Recurrences occurred with significantly higher frequency (p < 0.001), when the anterior tumour edge involved the ciliary body. Patients' survival in relation to the moment the occurrence of the relapse was statistically significant for application time (p = 0.004) and tumour pigmentation (p = 0.010). The deaths of patients with a local relapse were most rare when brachytherapy lasted from 72 to 95.9 hours and most frequent in cases of brownish tumour pigmentation. Patient sex, tumour shape and size, presence of orange pigment, retinal detachment, petechiae and bleeding to vitreous body as well as the dose of irradiation to tumour top and base did not have any significant effect on relapse occurrence. Conclusions: Treatment of uveal melanomas with 125 I applicators allows for a high rate of positive local results. Nonetheless, the recurrence probability always exists. The involvement of the ciliary body could influence this. The survival depending on the time of relapse could be statistically significant for application time and dark-brown tumour pigmentation.

Purpose Analysis of all cases choroidal melanoma treated with proton beam radiotherapy (PBRT) in 2011‐2013 in Krakow. Methods The retrospective analysis of 39 patients with choroidal melanoma treated with proton beam in Krakow in 2011‐2013 was performed. There were 20 (51%) women and 19 (49%) men in mean 53,7 years (24 ‐ 74). . The largest tumor diameter ranged from 4,6 mm to 16.2 mm, and tumor thickness from 1.4 mm to 10.3 mm. Treatment was delivered in 4 fractions on 4 consecutive days. All patients received the dose of 60 CGE (Cobalt Grey Equivalent) given to PTV (planning target volume). Results The tumour had regressed in 20 patients (51 %) and remained stable in 19 patients (49 %). The large tumours in 4 cases were removed during vitrectomy (endoresection). One tumor was excised with exoresection. In the case of 1 patient, despite intraocular tumour regression occurring the choroidal melanoma had spread multifocally into the orbit, which necessitated orbit exenteration. In this case tumor cells in scleral vessels were detected in histopathologycal examination. The results ensured that the eyeballs of 38 patients (99%) could be saved. Visual acuity improved in 5 cases, was stable in 21 and decreased in 14 patients The follow‐up period Conclusion Proton beam radiotherapy is an effective method for treating patients with choroidal melanoma. This method ensures an eyeball preservation rate of 99%, with the vision function of 67% patients being saved. Decreasing visual function was caused by choroidal melanomas location close to macula and/or optic nerve disc in our group it were in 19 (49%) cases.

Background/Aim: This study aimed to develop an algorithm allowing the differentiation between conjunctival melanoma and other melanocytic infiltrations of the conjunctiva, on the basis of a dermatoscopic examination. Patients and Methods: A total of 160 conjunctival pigmented lesions were studied (40 melanomas and 120 non-melanoma conjunctival infiltrations). The clinical characteristics of the tumours were assessed with the use of dermatoscopic characteristics as described by Kittler, and with taking into consideration the typical characteristics of conjunctival lesions. Results: On the basis of modified dermatoscopic criteria, an algorithm was generated consisting of an assessment of the presence of 9 suspicious characteristics, e.g. more than two colours, colour asymmetry, pattern asymmetry, vascular polymorphism, presence of short vessels, linear vascular pattern, the presence of a peripheral structureless area, the presence of a grey structureless area and black dots in any part of the lesion. The presence of any of these characteristics scores 1 point. If a melanocytic lesion scores ≥3 points, the probability of diagnosing melanoma is on the level of p>0.001. Conclusion: The use of the proposed algorithm, based on modified dermatoscopic characteristics, may be a valuable tool for the diagnosis of conjunctival melanoma.Conjunctival melanoma (CMM) is a rare tumour: it is approximately 500 times less frequent than skin melanoma (1). It constitutes 1.6% of all non-cutaneous melanomas and 1-5% 3161 This article is freely accessible online.

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