Systemic melanoma metastatic to the retina and vitreous.

Purpose: Report of a case of retinal and vitreous metastases of a systemic melanoma, possibly arising in the lung, that responded favourably to radiotherapy.

Case Report: Retinal and vitreous metastases were demonstrated in a 57-year-old woman during routine follow-up after surgical resection of a melanoma presumed to be a primary pulmonary melanoma. After a 7-week observation period, which confirmed the progressive nature of the intra-ocular lesions, the patient was treated by external beam radiotherapy at a dose of 35 Gy delivered in 14 fractions of 2.

[Medullo-epithelioma: presentation of 3 cases].

Three cases of medullo-epithelioma are reported from a study of almost 350 cases of retinoblastomas or pseudo-retinoblastomas. The cases concern one female and two male children of 1,5, 2,5 and 6 years of age respectively at the time of diagnosis. Suspected of carrying retinoblastoma, two of the children were enucleated.

[New retinal tumors in hereditary retinoblastoma].

364 eyes from 230 patients with retinoblastoma diagnosed and treated at the Lausanne University Eye Clinic from 1964 to June 1994 were retrospectively analyzed with respect to the risk of developing new tumour foci following initial therapy. Among them, 119 eyes from 90 hereditary affected patients were included, consisting of 86 bilateral cases and 4 unilateral cases. The mean follow-up was 65.

[Unusual presentation of retinoblastoma].

Among the 185 retinoblastoma patients seen at the Lausanne Retinoblastoma Clinic from 1963-1993, 24 (14%) first presented with another sign than classical leukocoria (60.5%) or strabismus (21.5%).

[Lyme disease in Switzerland: ocular involvement].

Lyme disease is a multisystem disorder caused by the spirochete Borrelia burgdorferi, which is transmitted by a tick (Ixodes Ricinus). Lyme disease is divided into three stages (infection, dissemination and immunological reactions). Ocular manifestations are rare except for conjunctivitis and facial nerve palsy.

[Short and long-term advantages and disadvantages of prolene monofilament sutures in penetrating keratoplasty].

The authors have studied the short and long-term advantages and inconveniences of Prolene monofilament sutures employed in perforating keratoplastic surgery. Contrary to Nylon, Prolene has the advantage of no structural or tensional modifications, postoperative measurements of corneal astigmatism thus remaining more stable with the time. Accordingly, where very little or no astigmatism is noted, the slight or no change in corneal refraction with time is an obvious advantage ot the patient.

[Differential treatment of postoperative and uveitis-induced inflammatory cystoid macular edema].

Twenty-five eyes (23 patients) with inflammatory cystoid macular edema (CME) (11 after cataract surgery and 14 eyes (12 patients) with uveitis) were followed in a prospective open study. The aim was to determine the efficiency of a combined treatment of Diamox (acetazolamide), Voltaren Ophtha (diclofenac, a NSAID) and Ultracortenol (prednisolone acetate) and in the case of treatment failure, the usefulness of posterior subtenon's injections of corticosteroids (Kenacort 40 mg (triamcinolone)). Seven eyes (all pseudophakic CMEs) responded successfully to the initial therapy.

[Treatment of exterior extension of choroid melanomas by accelerated proton beams].

Among the 934 patients with a choroidal melanoma treated in first intention with an accelerated proton beam since 1984, 41 (4.4%) presented an extrascleral extension, of which 11 were located anteriorly and 30 posteriorly. For these 30 cases, the diagnosis was made by B ultrasonography only when the volume of the extension was important, between 20 and 2280 mm3.

[Uveal melanomas and vitreous hemorrhage. Diagnosis and treatment].

In choroidal melanoma vitreous hemorrhage can occur as initial event or as complication of conservative therapy. To understand better these relations, four groups of cases were examined: 1.) 126 choroidal melanomas which were treated conservatively with Cobalt 60 applicator from 1969 till 1984.

[Treatment of retinoblastoma and results. Lausanne 1963-1989].

97 cases of retinoblastoma were studied with particular attention to methods of treatment and results. The series includes 41 unilateral cases (42%) and 56 bilateral cases (58%), giving a total of 153 eyes. Of these, 19 (20%) were familial cases.

[Subretinal neovascularization: evolution of cicatrix of photocoagulation in the absence of recurrence].

Eleven patients successfully treated with the argon or krypton laser for macular subretinal neovascularization were followed up in order to determine the extent of long-term enlargement of the chorioretinal scars. The mean follow-up time was 51.5 months and the mean increase in choroidal scar size 46.

[Retinal artery occlusion: etiology and risk factors apropos of 151 cases].

A retrospective study covering 151 patients was conducted in order to determine the incidence of risk factors (arterial hypertension, diabetes mellitus, smoking, hyperlipidemia, and cardiovascular disorders) in cases of retinal artery occlusion. Occlusion of the central artery was found in 43% of the patients, occlusion of one or several branch arteries in 53%, and cilioretinal artery occlusion in 4%. A monofactorial study of risk factors produced a statistically significant value only for arterial hypertension (P = 0.

[Malignant melanoma of the conjunctiva: histopathologic study].

The pathological features of 17 malignant melanomas of the conjunctiva, treated by local excision at the Clinique universitaire de Lausanne, were studied, and the most frequent difficulties encountered by the pathologist are presented. Cox's proportional hazards model confirmed that tumor thickness had a prognostic significance and showed that cell type was significant too.

[Long-term course of indirect traumatic ruptures of the choroid].

During the last 10 years, 46 cases of indirect choroidal tears were observed with repeated photographies and fluorescein angiographies. Patients were essentially young men with a mean age of 21.7 years.

Occurrence of uveal melanoma in contact with a chorioretinal cryocoagulation scar.

A case of a uveal melanoma arising in an eye previously treated with cryocoagulation for a horseshoe retinal tear is described. In the anterior border of the tumor, a notch, clearly fitting the curve of the chorioretinal scar was observed. Possible mechanisms which may be responsible for the local arrest of the tumor extension are discussed.

[Importance of ocular biopsies in the etiologic diagnosis of uveitis].

In many uveitis cases a biopsy of ocular tissues can enable an exact diagnosis to be established, unnecessary additional examinations to be avoided, and an appropriate therapeutic regimen to be selected. In general, follicle biopsy is performed where sarcoidosis is suspected, keratocentesis in viral uveitis and toxoplasmosis, and vitreous biopsy in tentatively diagnosed primary intraocular lymphoma (reticulosarcoma) and bacterial or mycotic endophthalmitis.

[Irradiation treatment of choroidal hemangiomas].

Therapeutic results obtained following the treatment of 24 cases of choroidal hemangiomas (21 solitary and 3 in a Sturge-Weber syndrome) treated with 60Co applicators or an accelerated proton beam were analyzed. The observation period was less than 2 years for 4 cases, 2 to 5 years for 10 cases, 5 to 10 years for 7 cases and more than 10 years for 3 cases. Reabsorption of retinal detachment without any recurrency was obtained for all the cases.

[Report on the conservative treatment of melanoma of the uvea at the Lausanne University Ophthalmologic Clinic].

A great number of techniques are currently available for the conservative treatment of uveal melanomas: ocular applicators emitting gamma rays 60Co, 125I) or high-energy beta rays (106Ru/106Rh), light photocoagulation, surgical excision, and accelerated proton beam irradiation. Life expectancy following conservative treatment is equal to or better than that following enucleation. This is demonstrated by nonrandomized comparative studies, and by the authors' own long-term results following the conservative treatment of melanomas by 60Co applicators: mortality due to metastases of small melanomas was 3% (V = smaller than 10 x 10 x 3 mm), with medium-size melanomas it was 12% (V = 10 x 10 x 3-15 x 15 x 5 mm), and with large melanomas 21% (V = larger than 15 x 15 x 5 mm).