Preliminary results on phosphorus-31 nuclear magnetic resonance evaluation of human uveal melanoma in enucleated eyes.

Clinical evaluation of uveal melanomas by nuclear magnetic resonance (NMR) techniques depends on ascertaining how these tumors characteristically appear in NMR images and spectra. The authors have determined NMR characteristics of suspected uveal melanomas by phosphorus-31 (31P) NMR spectroscopy of freshly enucleated human eyes. Nuclear magnetic resonance examination was performed at 8.

Drusen characteristics in patients with exudative versus non-exudative age-related macular degeneration.

The drusen characteristics of 38 eyes from 38 patients with bilateral drusen associated with age-related macular degeneration (AMD) were compared in a masked fashion to 89 fellow eyes from 89 patients with unilateral exudative AMD (disciform scarring or choroidal neovascularization). The average age of the drusen group (67.4 years) was significantly less (P = 0.

Interobserver and intraobserver reliability in the clinical classification of drusen.

The interobserver and intraobserver reliability in determining clinical characteristics of drusen were measured in 161 eyes with age-related macular degeneration (AMD). The percent agreement was 76% for the number of drusen; 89% for the presence or absence of soft drusen; 79% for the presence or absence of confluence drusen; 84% for the presence or absence of focal hyperpigmentation; and, 91% for the presence or absence of geographic (areolar) atrophy. Kappa for each of these characteristics ranged from 0.

Epidemiologic aspects of uveal melanoma.

Although the underlying cause or causes of uveal melanoma have yet to be elucidated, important insights may be gained by examining the epidemiologic features of the disease. Uveal melanoma is an uncommon cancer with an incidence of only six cases per million population per year. It is most often diagnosed in the sixth decade and is somewhat more common in males.

Proton and sodium 23 magnetic resonance imaging of human ocular tissues. A model study.

Clinical evaluation of uveal melanomas by magnetic resonance imaging (MRI) techniques depends on developing an understanding of the appearance of these tumors in magnetic resonance (MR) images. We have determined MR characteristics of uveal melanomas by proton (1H) and sodium 23 MRI of freshly enucleated human eyes at 1.5 tesla.

Death from uveal melanoma. Number of epithelioid cells and inverse SD of nucleolar area as prognostic factors.

Criteria for the Callender classification of uveal melanoma are subjective and lead to variations among observers of the same tumor. Two other measures for cell type-the number of epithelioid cells per high-power field (Epi/HPF) and the inverse SD of nucleolar area (ISDNA)-were evaluated as prognostic factors for survival following enucleation for uveal melanoma in 232 patients. Variables significantly related to the number of Epi/HPF were related to ISDNA.

Uveal melanomas near the optic disc or fovea. Visual results after proton beam irradiation.

Proximity to the disc and fovea is a risk factor for visual loss after proton beam irradiation of uveal melanomas. Of 562 eyes treated over a 10-year period with pretreatment visual acuity of 20/200 or better, 363 (64.6%) contained tumors within 2 disc diameters (DD) of the disc or fovea.

Long-term results of proton beam irradiated uveal melanomas.

The first 128 consecutive patients with uveal melanomas treated with proton beam irradiation were studied in order to evaluate survival and visual acuity status of patients with relatively long-term follow-up. The median follow-up was 5.4 years, and no patient was lost to follow-up.

Clinical characteristics of choroidal neovascular membranes.

Eighty-three choroidal neovascular membranes (CNVMs) associated with pathologic entities other than age-related macular degeneration (study group) were compared with 64 CNVMs associated with macular degeneration (comparison group). Nine CNVMs (11%) in the study group, compared with 28 CNVMs (44%) in the comparison group, were occult membranes. Of the remaining well-defined CNVMs, 16 (22%) in the study group, compared with 21 (58%) in the comparison group, were subfoveal.

Limited choroidal hemorrhage mistaken for a choroidal melanoma.

Considerable progress has been made during the last few years in evaluating patients with suspected choroidal melanomas but difficulties continue to persist. In this report, the authors describe three cases with an unusual localized posterior choroidal hemorrhage, which were thought to be choroidal melanomas and referred for proton beam irradiation. These limited hemorrhagic choroidal detachments presented as a dark brown mass of considerable elevation, but were discrete, well localized, and located posterior to the equator.

Bilateral melanocytic uveal tumors associated with systemic non-ocular malignancy. Malignant melanomas or benign paraneoplastic syndrome?

A 90-year-old woman developed bilateral diffuse melanocytic tumors of the uveal tract nearly 1 year before she died from an occult ovarian carcinoma. Although the syndrome of bilateral diffuse melanocytic tumors of the uvea and systemic carcinoma has been described, the uveal tumors in this patient were different in that they were indistinguishable histologically from mixed cell-type malignant melanoma. Although the relationship between the systemic malignancy and the uveal tumors is unclear, the cytologic features of the uveal tumors in this syndrome are probably more variable than originally thought.

Prognostic factors for metastasis following proton beam irradiation of uveal melanomas.

Prognostic indicators for the development of metastasis following proton beam irradiation of uveal melanomas were evaluated for 510 patients treated from 1975 to 1984. Thirty-three patients developed metastasis (6.5%) from 3 to 51 months following treatment.

Visual outcome after proton beam irradiation of uveal melanoma.

Prognostic factors for visual loss following proton irradiation of uveal melanoma were evaluated for 440 eyes treated from 1975 to 1984, with visual acuity 20/200 or better before treatment. Analysis involved Kaplan-Meier survival curves and Cox proportional hazards analysis with visual outcome defined as worse than 20/200. Prognostic factors were tumor height: rate ratio (ratio of rate of visual loss for one category of the variable relative to the rate of visual loss for a reference category of that variable) of 5.

Retinal vasculitis in polyarteritis nodosa.

Although uncommon, a wide variety of ocular manifestations can be seen in polyarteritis nodosa. These occur as a result of the arteritis or secondary to the associated renal induced hypertension. A case of biopsy documented polyarteritis nodosa is reported in which the patient presented with bilateral iritis, vitritis, and a retinal vasculitis involving both the retinal arteries and veins, a feature not described previously.

Proton therapy at Harvard.

Fractionated precision high-dose proton radiotherapy has been carried out at the Harvard Cyclotron Laboratory (HCL) since 1973, in a collaborative effort with the Radiation Medicine Department of Massachusetts General Hospital (MGH) and the Retina Service of the Massachusetts Eye and Ear Infirmary (MEEI). This paper will discuss proton treatment in general, treatment planning procedures, and results to date in major patient categories. 846 patients have been treated with fractionated proton therapy at the Harvard Cyclotron, with normal tissue and tumor responses consistent with an RBE of 1.

Proton beam irradiation and hyperthermia. Effects on experimental choroidal melanoma.

Ultrasonically induced hyperthermia (4.75 MHz) and proton irradiation (160 meV) were evaluated alone and combined to treat experimental choroidal melanoma in 58 rabbit eyes. Threshold tumoricidal doses were established for each modality.

Pathologic examination of ciliary body melanoma treated with proton beam irradiation.

Proton beam irradiation is one of the radiotherapeutic techniques currently used to manage uveal melanomas. Although this therapeutic modality has been in use for a decade and although nearly 500 patients have been so treated, there are only two published reports of the pathologic examination of these eyes. Key features found on pathologic examination of our patient's enucleated eye included vascular alterations in the tumor's blood supply, lymphocytic infiltrates, and lipoidal degeneration of tumor cells.