A modified TAE regimen of IAI for neovascular AMD produced good functional outcomes over 12 months with the small number of injections.
We report a case of choroidal melanoma with massive extraocular extensions through the sclera. A 64-year-old woman reported blurred vision in her right eye. At the first visit, visual acuity was 10/20 OD. An ophthalmological examination revealed a raised choroidal mass and exudative retinal detachment in the lower retina. A diagnosis of peripheral choroidal melanoma was confirmed by additional test results. Because the tumor size was large and no systemic metastasis was found, we recommended enucleation. However, the patient refused and requested only to be followed without treatment. Seven months later, the tumor showed extraocular extensions through the sclera into subconjunctival space and she finally agreed to undergo enucleation. Histopathologic findings showed that the tumor was a mixed cell malignant melanoma of the choroid. The eye was filled with tumor cells, and the tumor had massive extraocular extensions into the orbit through the sclera and scleral emissarium vessels. The intraocular tumor was markedly necrotic, which indicated rapid growth. Choroidal melanomas can increase quickly in size resulting in extraocular extensions through the sclera.
Purpose To report a case of choroidal melanoma with massive extraocular extension through the sclera. Methods A 64‐year‐old woman presented visual impairment in the right eye with a few months duration. On her first visit, her corrected visual acuity was 10/20 OD. Ocular examination revealed a raised choroidal mass behind the lens and serous retinal detachment in the lower retina. The choridal mass showed a mushroom shaped solid lesion on ultrasonography. The diagnosis of peripheral choroidal melanoma was confirmed by further examinations with the computed tomography, magnetic resonance imaging, and brain perfusion scintigraphy. Results Because no systemic metastasis was found, we proposed her enucleation. However, she refused the enucleation and wished to be followed without any treatment. Seven months later, the tumor showed extraocular extension, and invasion of the subconjunctiva through the sclera. Finally, her right eyeball was enucleated. Histopathologically, the tumor was determined as mixed cell malignant melanoma of the choroid. The eyeball was congested with tumor cells and the tumor showed massive extraocular extension through the sclera to the orbit. The intraocular tumor presented marked necrotic lesions that indicate rapid growth of the tumor. Conclusion Choroidal melanoma extends rapidly, and resulted in extraocular extension through the sclera.
Purpose To report three cases of reverse pupillary block after suture of intraocular lens(IOL) to the ciliary sulcus in avitreous eyes. Methods Visual impairment occurred in three eyes of three patients with past surgical history of vitrectomy and suture of IOL to the ciliary sulcus. Their findings of anterior segment showed deep anterior chamber (6000μm~4330μm) with concavity of the intermediate and peripheral iris, compression bonding of the pupil and IOL, and pigmentation of the trabecular meshwork. The diagnosis of a reverse pupillary block was made by opthalmological examinations and additional tests, e.g., ultrasonography and Pentacam®. In all eyes, laser iridotomy(LI) was performed in the superior peripheral iris to eliminate reverse pupillary block. Results As a result, reverse pupillary block was eliminated and the depth of anterior chamber returned to normal (4018μm~3700μm), furthermore, concavity of the iris and compression bonding of the pupil and IOL were disappeared in all eyes. Conclusion In the eyes with past surgical history of vitrectomy and suture of IOL to the ciliary sulcus, reverse pupillary block might occur and LI can be effective.
Purpose: Intravitreal anti-vascular endothelial growth factor (VEGF) is a mainstream treatment for reducing ME secondary to BRVO (BVO-ME). Regrettably, most reports of intravitreal anti-VEGF for BVO-ME have disclosed only short-term outcomes. Here, we characterized long-term indicators for the visual prognosis of patients with BVO-ME, including the correlation between retinal structure by OCT and visual acuity. Methods: Patients with BVO-ME were retrospectively recruited based on clinical records in Kansai Medical University Hospital from June 2012 to March 2022. Patients were divided into two groups according to BCVA at the final visit: Group A (≥0.7) and Group B (≤0.6). Results: 47 eyes from 45 patients were assessed. The mean follow-up period from initial to final visit was 64.38 ± 15.07 (range, 38-100) months. BCVA in Group A (n = 32) was significantly greater than in Group B (n = 15) at all timepoints. The ratio that the number of eyes which the EZ band and the foveal bulge were intact in Group A was higher than in Group B (p = 0.0004 and p = 0.0002, respectively). The ratio that the number of eyes which recurrence SRD was observed by the final visit in Group A was lower than in Group B (p = 0.0485). Conclusion: The integrity of the EZ band and an intact foveal bulge were significant predictors for visual acuity. In contrast, recurrent SRD led to poor visual acuity in the long term, even if BCVA was good in the short term.
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