Ophthalmology clinics of North America最新文献

Melanomas of the ocular and adnexal structures comprise approximately 5% of all melanomas. The majority (85%) of ocular melanomas are uveal in origin; primary conjunctival and orbital melanomas are rare. The diagnosis of uveal melanoma is made by clinical examination including indirect ophthalmoscopy and by ancillary studies such as fluorescein angiography and ultrasonography. Metastases to the liver develop within 15 years after the initial diagnosis and treatment in approximately 50% of patients with posterior uveal melanoma; however, clinically evident metastatic disease at the time of initial presentation is uncommon, indicating that there is early subclinical metastasis in most cases.

A broad spectrum of lymphomas can affect the eye and orbital tissues. This article discusses those that affect the orbit, lids, lacrimal gland, and conjunctiva.

This article describes surgical methods for resecting uveal melanoma, emphasizing techniques for preventing complications. Outcomes of surgery and the indications, contraindications, and controversies of resecting uveal melanoma are discussed.

Choroidal hemangioma is an uncommon benign vascular tumor of the choroid that can be circumscribed or diffuse. Circumscribed choroidal hemangiomas are usually diagnosed between the second to fourth decade of life when they cause visual disturbances owing to the development of an exudative retinal detachment. Circumscribed tumors occur sporadically, without any associated local or systemic anomalies. Diffuse choroidal hemangiomas are usually evident at birth and generally occur as a part of neuro-oculo-cutaneous hemangiomatosis (Sturge-Weber syndrome).

This article discusses the indications for intraocular tumor biopsy, the techniques used for obtaining material, and the approaches for analysis of these specimens.

Over the past two decades, radiotherapy has replaced enucleation as the standard treatment for uveal melanoma. Although this method does not alter survival, preservation of the globe and, in some instances, visual function, is achieved. This article presents the authors' and other investigators' experience with proton therapy.

This article discusses ocular surface squamous neoplasia, a spectrum of malignancy that includes intraepithelial dysplasia, carcinoma in situ of the conjunctiva and cornea, and invasive squamous cell carcinoma.

Retinoblastoma is the most common eye cancer in children. Pilot studies of chemotherapy for intraocular retinoblastoma have been reported by several groups, using different combinations, dosages, schedules, and durations of carboplatin, etoposide, or teniposide, with or without vincristine, and with or without cyclosporine to counteract multidrug resistance. All studies of chemotherapy for intraocular retinoblastoma have included consolidation by focal therapy, with or without radiation. Chemotherapy alone reduces tumor size but does not cure retinoblastoma. Focal therapy, consisting of photocoagulation, thermotherapy, cryotherapy, or brachytherapy, is necessary to consolidate chemotherapy response.

Familial adenomatous polyposis (FAP) is a colon cancer predisposition syndrome in which hundreds to thousands of precancerous colonic polyp become evident at a mean age of 16 years (range, 7-36 years). By age 35 years, 95% of patients have polyps. Gardner syndrome is the eponym given to a subgroup of FAP with extracolonic manifestations, such as pigmented ocular fundus lesions that resemble congenital hypertrophy of the retinal pigment epithelium, among others.

This article discusses primary lymphoma of the central nervous system, which is a variant of extranodal non-Hodgkin's lymphoma that arises from specific sites such as the brain, spinal cord, meninges, or eyes.