25 Gauge Endoresection for Moderate to Large Choroidal Melanoma

Venkatesh, Pradeep; Gogia, Varun; Gupta, Shikha; Shah, Bhavin M.

doi:10.1007/s13193-015-0459-z

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…Can opportunities be advanced for blind children to thrive and contribute fully to society, everywhere? JUNYANG ZHAO, MD 1 QIYAN LI, MD 2 SONGYI WU, MD 3 LIWEN JIN, MD 3 XIAOLIN MA, MD 4 MEI JIN, MD 3 YIZHUO WANG, MD 5 BRENDA GALLIE, MD 6,7…”

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confidence: 99%

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Zhao

et al. 2018

Ophthalmology

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was hypotensive anesthesia used? We have noted that, during endoresection of choroidal melanoma, intraocular hemorrhage may be very severe and may not be controlled with hypotensive anesthesia and raised infusion pressure alone. Perfluorocarbon liquids may be needed as a temporary tamponade which is replaced with silicone oil on around day 10. 4 It would be interesting to know specific difficulties, if any, the authors faced during endoresection of retinoblastoma, considering that calcifications within the mass may be difficult to cut/remove with the cutter. In how many cases did the authors remove silicone oil and what was the usual time interval between the primary vitrectomy and the silicone oil removal?

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Section: Replymentioning

confidence: 99%

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Zhao

et al. 2018

Ophthalmology

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“…To our knowledge, there are a few publications concerning the endoresection as a prevention of TTS following the choroidal melanoma irradiation [8,9]. Most reports present the results of endoresection in eyes with established TTS or analyse the results of endoresection as a primary method of treatment with or without adjuvant brachytherapy [5,9,[12][13][14][15][16][17][18][19][20].…”

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confidence: 99%

Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

Kubicka‐Trząska¹,

Morawski²,

Markiewicz³

et al. 2020

Arch Med Sci Civil Dis

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The aim of this study was to evaluate the efficacy and safety of endoresection for choroidal melanoma to prevent and treat the toxic tumour syndrome (TTS). Material and methods: Thirteen patients who underwent primary proton beam therapy (PBRT) for choroidal melanoma followed by endoresection were evaluated. Main outcome measures were functional and anatomical results, surgical complications, rate of local recurrence, presence or absence of metastatic spread. Results: The median time of the follow-up period was 61.6 months. Six patients with clinical signs of TTS and seven with large tumours to prevent TTS underwent endoresection. Tumour thickness was 5.8 to 9.3 mm (mean: 7.6), the basal diameters were 10.6 to 15.0 mm (mean: 13.4). Preoperative best corrected visual acuity (BCVA) was 6/7.5 to counting fingers and the final BCVA was 6/15 to no light perception, and was better in those treated to prevent TTS (p = 0.01). The most universal early postoperative complication was bleeding from the scleral bed. The most common late postoperative complications were epiretinal membrane formation (30.8%), cystoid macular oedema (23.1%) and silicone oil-induced glaucoma (15.4%). Two (15.4%) patients developed phthisis bulbi, neither developed local recurrence. One patient developed liver metastases. Conclusions: Endoresection for choroidal melanoma is a safe and effective procedure with a high rate of local tumour control. The procedure appears to be useful in the prophylaxis and treatment of TTS after PBRT of choroidal melanoma.

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Re: Zhao et al.: Pars plana vitrectomy and endoresection of refractory intraocular retinoblastoma ( Ophthalmology . 2018;125:320-322)

Tripathy

2018

Ophthalmology

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questions, which we decided to perform morphologic immunocytochemical studies, marking each cell and cellular contents of the outer retinal layers with specific antibodies. CRALBP (cellular retinaldehyde-binding protein) stains the whole retinal pigment epithelium (RPE) cell body and processes, allowing clear visualization of the apical processes and interdigitations ensheathing the cone outer segments. In our preparations, we do not see any structure similar to the contact cylinder described by Spaide and Curcio. 3 We center our study on the fovea, where interdigitations of the RPE extend the entire length of cones outer segments and reach the cone ellipsoid level (Fig 4A, C, D, and Fig 5 in the original article). The electron microscopy study to which Curcio et al refer in their letter shows structures in the perifoveal areas, where cones outer segments are shorter and their tips do not reach the RPE. Also, as they state, manipulation and the integrity of cones and RPE processes during the preparation of transmission electron microscopy samples could create certain artifacts difficult to interpret.So, if interdigitations in the fovea extend and reach the ellipsoids, which are thought to be the second band, the third band cannot be the interdigitation zone because there would be no anatomic structure in between that could explain the hyporeflectivity. Then, we discard the interdigitation zone as responsible for band 3. Instead, we propose that phagosomes can explain the third band hyperreflectivity. As seen in Fig 6D-F in the original article, they are located in the RPE apical zone, within the cell bodies (Fig 6E, F). The possibility that phagosomes are what produce the band 3 hyperreflectance has not been described to date and could explain some changes of this band that were difficult to explain with previous interpretations. 5 In our model, band 4 hyperreflectivity is explained by the basal RPE, where the mitochondria accumulate, together with the Bruch's membrane. We believe the space between phagosomes (apical RPE, band 3) and mitochondria (basal RPE, band 4) correspond with the hyporeflective band. In this space, we find (apart from melanosomes, lipofuscin, and melanolipofuscin) the nucleus, cytoplasm, and other RPE cell organelles. In fact, all the inner retinal hyporeflective OCT bands correspond with nuclear layers, the same as we are proposing here for the melanosome zone, where we include the RPE nucleus.Of course, we agree with Curcio et al that more experimental data must be obtained to verify our proposal, but we believe we cannot close the discussion yet. We should consider this as an open field for new interpretations, taking into account that the interpretation that Curcio et al propose has still some unclear aspects that should be clarified. We are sure that next technologies including adaptive optics OCT would help to clarify the interpretation.

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25 Gauge Endoresection for Moderate to Large Choroidal Melanoma

Cited by 4 publications

References 6 publications

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Prevention and treatment of the toxic tumour syndrome following primary proton beam therapy of choroidal melanomas

Re: Zhao et al.: Pars plana vitrectomy and endoresection of refractory intraocular retinoblastoma ( Ophthalmology . 2018;125:320-322)

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