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Materin, Miguel Angel

Overview:

Ocular oncologist Miguel Materin, MD joined Duke Eye Center as Professor of Ophthalmology and Director of Ophthalmic Oncology in September 2016. He joins Duke from Yale University School of Medicine where he was an Associate Professor of Ophthalmology & Visual Science. Prior to his appointment at Yale, he was at Wills Eye Hospital at Thomas Jefferson University in Philadelphia, where he served as Director of Diagnostic Studies for the Ocular Oncology Service.

Dr. Materin’s clinical practice involves diagnosis and treatment of patients with ocular tumors, including benign and malignant tumors of the eye. He has special interests in ocular melanoma, retinoblastoma, choroidal hemangiomas, retinal hemangioblastomas, metastases, astrocytic tumors and tumors related to other conditions or syndromes, like von Hippel Lindau disease, Tuberous Sclerosis among others. 

He is an internationally recognized ocular oncologist, who has served as a member of the International Advisory Board (Ocular Oncology) for the Canadian Journal of Ophthalmology. Dr. Materin has published extensively in the peer-reviewed literature, including journals and book chapters. He has been invited as visiting professor in US, Canada, Israel, Spain, Brazil, Puerto Rico, Argentina, and gave lectures worldwide.

Dr. Materin has received the Achievement Award from the American Academy of Ophthalmology and he is a Member of Merit of Clinica Barraquer (Barcelona, Spain). He has served as Director of Diagnostic Studies at the Ocular Oncology Service at Wills Eye Hospital for 7 years. He is an active member of the International Society of Ocular Oncology, American Academy of Ophthalmology, Pan American Association of Ophthalmology and Argentine Society of Ophthalmology.


Dr. Materin serves on the education committee of the American Association of Ocular Oncology and Pathology and is the President Elect for the Pan American Society of Ocular Oncology.

Positions:

Professor of Ophthalmology

Ophthalmology, Vitreoretinal Diseases & Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1986

M.D. — University of Buenos Aires (Argentina)

Publications:

BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT.

To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP) in the setting of metastatic ovarian cancer.In this observational case report, a 59-year-old woman presented with bilateral worsening vision and photophobia. She had been diagnosed with metastatic ovarian cancer 5 years prior for which she received Tamoxifen. Ophthalmic examination was completed followed by fluorescein angiography and optical coherence tomography (Spectralis OCT; Heidelberg Engineering).The visual acuity was 20/150 in both eyes. Exam demonstrated an iris pigmented lesion in the right eye, bilateral nuclear sclerotic cataracts, multiple orange lesions in the fundus, elevated pigmented uveal melanocytic tumors with diffuse choroidal thickening and multifocal early hyperfluorescence of these lesions (giraffe-like pattern) on fluorescein angiography, and exudative retinal detachment on OCT. The patient was diagnosed with BDUMP in the setting of metastatic ovarian carcinoma. Further metastatic workup demonstrated enlarged lymphadenopathy in the right axilla and inguinal regions. The patient declined chemotherapy and was initiated on plasmapheresis.BDUMP is a peculiar paraneoplastic syndrome in the setting of metastatic ovarian cancer, where antigens from the retinal pigment epithelium, iris and choroidal melanocytes cross-react with ovarian tumor cell antibodies that are circulating in the serum. Plasmapheresis can decrease the concentrations of the antibodies, maintain reasonable functional vision and improve the quality of life.

Authors
Alasil, T; Coady, PA; Koudsi, S; Mathur, M; Materin, MA
MLA Citation
Alasil, T, Coady, PA, Koudsi, S, Mathur, M, and Materin, MA. "BILATERAL DIFFUSE UVEAL MELANOCYTIC PROLIFERATION: A CASE REPORT. (Accepted)" Retinal cases & brief reports 11.1 (December 2017): 71-74.
PMID
27046327
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
11
Issue
1
Publish Date
2017
Start Page
71
End Page
74
DOI
10.1097/icb.0000000000000292

Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma.

Gene expression profile (GEP) testing segregates uveal melanoma (UM) into 2 main prognostic classes. It is unknown if a greater tumor regression response after iodine 125 (I125) brachytherapy correlates with class 2 GEP status. The purpose of this study was to determine whether there is a significant relationship between the rate of UM height regression and GEP classification testing after I125 plaque brachytherapy.Multicenter, retrospective cohort study.Adult UM patients treated with I125 plaque brachytherapy who had concurrent tumor biopsy at the time of surgery with a GEP test result from January 1, 2010 through June 30, 2014.Baseline clinical data and GEP class assignments were obtained. The ultrasonographic tumor height was recorded at baseline and at 3, 6, 9, and 12 months and at the most recent final follow-up visits. Subanalysis of paired cases based on pretreatment ultrasound height was performed. Statistical analysis was performed using Wilcoxon rank-sum tests, the Fisher exact test, and Kaplan-Meier analysis.Percentage change in tumor height from baseline.A total of 353 patients were included in the study. Median follow-up was 2.1 years (range, 0.5-5.3 years). Gene expression profile status was class 1 in 247 tumors (70%) and class 2 in 106 tumors (30%). Increased patient age, larger tumor dimensions, and greater tumor thickness were associated with class 2 GEP status (P = 0.006, P < 0.001, and P < 0.001, respectively). The percentage reduction in tumor height from baseline was significantly greater in class 1 than class 2 tumors at 3 months (17.5% vs. 11.8%; P = 0.007) and 6 months (26.8% vs. 17.1%; P = 0.007), respectively, but there was no significant difference in reduction between class 1 and 2 tumors at 9 months (P = 0.26) and 12 months (P = 0.57) after treatment. Class 1A and 1B tumors showed similar reduction compared with class 2 tumors (P < 0.05).Class 1 UM tumors tend to regress more rapidly than class 2 tumors in the first 6 months after plaque radiotherapy. Class 1A and 1B tumors regress at similar rates after plaque radiotherapy.

Authors
Mruthyunjaya, P; Seider, MI; Stinnett, S; Schefler, A; Ocular Oncology Study Consortium,
MLA Citation
Mruthyunjaya, P, Seider, MI, Stinnett, S, Schefler, A, and Ocular Oncology Study Consortium, . "Association between Tumor Regression Rate and Gene Expression Profile after Iodine 125 Plaque Radiotherapy for Uveal Melanoma." Ophthalmology 124.10 (October 2017): 1532-1539.
PMID
28549517
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
124
Issue
10
Publish Date
2017
Start Page
1532
End Page
1539
DOI
10.1016/j.ophtha.2017.04.013

Venous Loop Reveals an Occult Retinoblastoma Tumor.

A 14-day-old girl presented with bilateral hereditary retinoblastoma. At 3 months, a slight bend in the superotemporal arcade was observed to have developed into a venous loop. With concern for an occult lesion along the arcade, handheld optical coherence tomography (hhOCT) confirmed a small tumor and helped to guide prompt laser treatment while sparing the venous arcade. A venous loop is a previously unrecognized clinical finding that preceded the clinical detection and hhOCT confirmation of the tumor. The authors hypothesize that the venous loop was induced by pro-angiogenic factors secreted by the tumor. Portable hhOCT is a valuable adjunct imaging modality in the diagnosis and management of small retinoblastoma tumors. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:768-770.].

Authors
Liu, KC; Walter, SD; Finn, AP; Materin, MA
MLA Citation
Liu, KC, Walter, SD, Finn, AP, and Materin, MA. "Venous Loop Reveals an Occult Retinoblastoma Tumor." Ophthalmic surgery, lasers & imaging retina 48.9 (September 2017): 768-770.
PMID
28902340
Source
epmc
Published In
OSLIRetina
Volume
48
Issue
9
Publish Date
2017
Start Page
768
End Page
770
DOI
10.3928/23258160-20170829-14

Topical Imiquimod in the Treatment of Conjunctival Actinic Keratosis.

Conjunctival actinic keratosis is rare and difficult to treat, as recurrences are common. Imiquimod, an immune response modulator, is currently Food and Drug Administration-approved for cutaneous actinic keratosis and superficial basal cell carcinomas. Emerging reports have shown it to be effective in treating some periocular and conjunctival lesions. The authors present a case of a 68-year-old white man with recurrent actinic keratosis involving the pretarsal conjunctiva, which was successfully treated with 5% topical imiquimod following previous failure with cryotherapy and interferon α-2b. The patient had ocular irritation that resolved on cessation of treatment. To the authors' knowledge, this is the first report of conjunctival actinic keratosis being treated with and successfully eradicated by topical imiquimod.

Authors
Rowlands, MA; Giacometti, JN; Servat, J; Materin, MA; Levin, F
MLA Citation
Rowlands, MA, Giacometti, JN, Servat, J, Materin, MA, and Levin, F. "Topical Imiquimod in the Treatment of Conjunctival Actinic Keratosis." Ophthalmic plastic and reconstructive surgery 33.1 (January 2017): e21-e23.
PMID
25853505
Source
epmc
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
33
Issue
1
Publish Date
2017
Start Page
e21
End Page
e23
DOI
10.1097/iop.0000000000000432

An international survey of classification and treatment choices for group D retinoblastoma.

To determine which IIRC scheme was used by retinoblastoma centers worldwide and the percentage of D eyes treated primarily with enucleation versus globe salvaging therapies as well as to correlate trends in treatment choice to IIRC version used and geographic region.An anonymized electronic survey was offered to 115 physicians at 39 retinoblastoma centers worldwide asking about IIRC classification schemes and treatment patterns used between 2008 and 2012. Participants were asked to record which version of the IIRC was used for classification, how many group D eyes were diagnosed, and how many eyes were treated with enucleation versus globe salvaging therapies. Averages of eyes per treatment modality were calculated and stratified by both IIRC version and geographic region. Statistical significance was determined by Chi-square, ANOVA and Kruskal-Wallis tests using Prism.The survey was completed by 29% of physicians invited to participate. Totally 1807 D eyes were diagnosed. Regarding IIRC system, 27% of centers used the Children's Hospital of Los Angeles (CHLA) version, 33% used the Children's Oncology Group (COG) version, 23% used the Philadelphia version, and 17% were unsure. The rate for primary enucleation varied between 0 and 100% and the mean was 29%. By IIRC version, primary enucleation rates were: Philadelphia, 8%; COG, 34%; and CHLA, 37%. By geographic region, primary enucleation rates were: Latin America, 57%; Asia, 40%; Europe, 36%; Africa, 10%, US, 8%; and Middle East, 8%. However, systemic chemoreduction was used more often than enucleation in all regions except Latin America with a mean of 57% per center (P<0.0001).Worldwide there is no consensus on which IIRC version is used, systemic chemoreduction was the most frequently used initial treatment during the study period followed by enucleation and primary treatment modality, especially enucleation, varied greatly with regards to IIRC version used and geographic region.

Authors
Scelfo, C; Francis, JH; Khetan, V; Jenkins, T; Marr, B; Abramson, DH; Shields, CL; Pe'er, J; Munier, F; Berry, J; Harbour, JW; Yarovoy, A; Lucena, E; Murray, TG; Bhagia, P; Paysse, E; Tuncer, S; Chantada, GL; Moll, AC; Ushakova, T; Plager, DA; Ziyovuddin, I; Leal, CA; Materin, MA; Ji, X-D; Cursino, JW; Polania, R; Kiratli, H; All-Ericsson, C; Kebudi, R; Honavar, SG; Vishnevskia-Dai, V; Epelman, S; Daniels, AB; Ling, JD; Traore, F; Ramirez-Ortiz, MA
MLA Citation
Scelfo, C, Francis, JH, Khetan, V, Jenkins, T, Marr, B, Abramson, DH, Shields, CL, Pe'er, J, Munier, F, Berry, J, Harbour, JW, Yarovoy, A, Lucena, E, Murray, TG, Bhagia, P, Paysse, E, Tuncer, S, Chantada, GL, Moll, AC, Ushakova, T, Plager, DA, Ziyovuddin, I, Leal, CA, Materin, MA, Ji, X-D, Cursino, JW, Polania, R, Kiratli, H, All-Ericsson, C, Kebudi, R, Honavar, SG, Vishnevskia-Dai, V, Epelman, S, Daniels, AB, Ling, JD, Traore, F, and Ramirez-Ortiz, MA. "An international survey of classification and treatment choices for group D retinoblastoma." International journal of ophthalmology 10.6 (January 2017): 961-967.
PMID
28730089
Source
epmc
Published In
International Journal of Ophthalmology
Volume
10
Issue
6
Publish Date
2017
Start Page
961
End Page
967
DOI
10.18240/ijo.2017.06.20

Anterior Chamber Non-Hodgkin Lymphoma of the Iris Masquerading as Uveitis-Glaucoma-Hyphema Syndrome.

To report a case of iris non-Hodgkin lymphoma initially thought to be uveitis-glaucoma-hyphema (UGH) syndrome.We reviewed the clinical, radiographic, and histopathologic findings in a patient with recurrent hyphemas and increased ocular pressure who eventually was found to have a rapidly growing iris mass.An 89-year-old man with a history of cataract extraction and mantle cell lymphoma developed recurrent hyphema, which was subsequently revealed to be due to an iris mass. A biopsy revealed non-Hodgkin lymphoma that could not be formally subclassified but was suspicious for mantle cell lymphoma. The tumor showed a partial response to ibrutinib.Iris lymphoma can masquerade as a cause of recurrent hyphema after cataract extraction. Ophthalmologists should be aware of this presentation, especially in patients with a history of lymphoma.

Authors
Gauthier, AC; Nguyen, A; Munday, WR; Xu, ML; Materin, MA
MLA Citation
Gauthier, AC, Nguyen, A, Munday, WR, Xu, ML, and Materin, MA. "Anterior Chamber Non-Hodgkin Lymphoma of the Iris Masquerading as Uveitis-Glaucoma-Hyphema Syndrome." Ocular oncology and pathology 2.4 (October 2016): 230-233.
PMID
27843901
Source
epmc
Published In
Ocular Oncology and Pathology
Volume
2
Issue
4
Publish Date
2016
Start Page
230
End Page
233

NCCN Guidelines Insights: Melanoma, Version 3.2016.

The NCCN Guidelines for Melanoma have been significantly revised over the past few years in response to emerging data on a number of novel agents and treatment regimens. These NCCN Guidelines Insights summarize the data and rationale supporting extensive changes to the recommendations for systemic therapy in patients with metastatic or unresectable melanoma.

Authors
Coit, DG; Thompson, JA; Algazi, A; Andtbacka, R; Bichakjian, CK; Carson, WE; Daniels, GA; DiMaio, D; Fields, RC; Fleming, MD; Gastman, B; Gonzalez, R; Guild, V; Johnson, D; Joseph, RW; Lange, JR; Martini, MC; Materin, MA; Olszanski, AJ; Ott, P; Gupta, AP; Ross, MI; Salama, AK; Skitzki, J; Swetter, SM; Tanabe, KK; Torres-Roca, JF; Trisal, V; Urist, MM; McMillian, N; Engh, A
MLA Citation
Coit, DG, Thompson, JA, Algazi, A, Andtbacka, R, Bichakjian, CK, Carson, WE, Daniels, GA, DiMaio, D, Fields, RC, Fleming, MD, Gastman, B, Gonzalez, R, Guild, V, Johnson, D, Joseph, RW, Lange, JR, Martini, MC, Materin, MA, Olszanski, AJ, Ott, P, Gupta, AP, Ross, MI, Salama, AK, Skitzki, J, Swetter, SM, Tanabe, KK, Torres-Roca, JF, Trisal, V, Urist, MM, McMillian, N, and Engh, A. "NCCN Guidelines Insights: Melanoma, Version 3.2016." Journal of the National Comprehensive Cancer Network : JNCCN 14.8 (August 2016): 945-958.
PMID
27496110
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
8
Publish Date
2016
Start Page
945
End Page
958
DOI
10.6004/jnccn.2016.0101

Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology.

This selection from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Melanoma focuses on adjuvant therapy and treatment of in-transit disease, because substantial changes were made to the recommendations for the 2016 update. Depending on the stage of the disease, options for adjuvant therapy now include biochemotherapy and high-dose ipilimumab. Treatment options for in-transit disease now include intralesional injection with talimogene laherparepvec (T-VEC), a new immunotherapy. These additions prompted re-assessment of the data supporting older recommended treatment options for adjuvant therapy and in-transit disease, resulting in extensive revisions to the supporting discussion sections.

Authors
Coit, DG; Thompson, JA; Algazi, A; Andtbacka, R; Bichakjian, CK; Carson, WE; Daniels, GA; DiMaio, D; Ernstoff, M; Fields, RC; Fleming, MD; Gonzalez, R; Guild, V; Halpern, AC; Hodi, FS; Joseph, RW; Lange, JR; Martini, MC; Materin, MA; Olszanski, AJ; Ross, MI; Salama, AK; Skitzki, J; Sosman, J; Swetter, SM; Tanabe, KK; Torres-Roca, JF; Trisal, V; Urist, MM; McMillian, N; Engh, A
MLA Citation
Coit, DG, Thompson, JA, Algazi, A, Andtbacka, R, Bichakjian, CK, Carson, WE, Daniels, GA, DiMaio, D, Ernstoff, M, Fields, RC, Fleming, MD, Gonzalez, R, Guild, V, Halpern, AC, Hodi, FS, Joseph, RW, Lange, JR, Martini, MC, Materin, MA, Olszanski, AJ, Ross, MI, Salama, AK, Skitzki, J, Sosman, J, Swetter, SM, Tanabe, KK, Torres-Roca, JF, Trisal, V, Urist, MM, McMillian, N, and Engh, A. "Melanoma, Version 2.2016, NCCN Clinical Practice Guidelines in Oncology." Journal of the National Comprehensive Cancer Network : JNCCN 14.4 (April 2016): 450-473.
PMID
27059193
Source
epmc
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
4
Publish Date
2016
Start Page
450
End Page
473
DOI
10.6004/jnccn.2016.0051

Melanoma, Version 2.2016

Authors
Coit, DG; Thompson, JA; Algazi, A; Andtbacka, R; Bichakjian, CK; III, CWE; Daniels, GA; DiMaio, D; Ernstoff, M; Fields, RC; Fleming, MD; Gonzalez, R; Guild, V; Halpern, AC; Jr, HFS; Joseph, RW; Lange, JR; Martini, MC; Materin, MA; Olszanski, AJ; Ross, MI; Salama, AK; Skitzki, J; Sosman, J; Swetter, SM; Tanabe, KK; Torres-Roca, JF; Trisal, V; Urist, MM; McMillian, N; Engh, A
MLA Citation
Coit, DG, Thompson, JA, Algazi, A, Andtbacka, R, Bichakjian, CK, III, CWE, Daniels, GA, DiMaio, D, Ernstoff, M, Fields, RC, Fleming, MD, Gonzalez, R, Guild, V, Halpern, AC, Jr, HFS, Joseph, RW, Lange, JR, Martini, MC, Materin, MA, Olszanski, AJ, Ross, MI, Salama, AK, Skitzki, J, Sosman, J, Swetter, SM, Tanabe, KK, Torres-Roca, JF, Trisal, V, Urist, MM, McMillian, N, and Engh, A. "Melanoma, Version 2.2016." JOURNAL OF THE NATIONAL COMPREHENSIVE CANCER NETWORK 14.4 (April 2016): 450-+.
Source
wos-lite
Published In
Journal of the National Comprehensive Cancer Network : JNCCN
Volume
14
Issue
4
Publish Date
2016
Start Page
450
End Page
+

Cyclosporine for Dry Eye Associated With Nivolumab: A Case Progressing to Corneal Perforation.

To present the clinical outcome of 2 cases of severe dry eye associated with Nivolumab, with 1 case progressing to corneal perforation.Case report.: A 58-year-old man with metastatic melanoma was referred for the management of severe bilateral dry eyes after undergoing his sixth cycle of Nivolumab. The right eye progressed to corneal perforation 4 weeks after referral, after which Nivolumab was discontinued. When metastatic disease recurred, Nivolumab was continued with an ocular surface stabilized with an intensive regimen that included topical cyclosporine.: A 46-year-old woman with metastatic melanoma was referred for severe dry eye symptoms around the timing of her third cycle of Nivolumab. Improvement of symptoms and surface staining was achieved with a regimen that included aggressive lubrication and topical cyclosporine. On follow-up after completing Nivolumab therapy, metastatic melanoma has remained regressed.Nivolumab can cause or worsen dry eye disease to the point of corneal perforation. Given that its antitumor effect is immune-mediated, therapies targeting ocular surface inflammation can be effective for stabilizing dry eye disease in patients who continue treatment with Nivolumab.

Authors
Nguyen, AT; Elia, M; Materin, MA; Sznol, M; Chow, J
MLA Citation
Nguyen, AT, Elia, M, Materin, MA, Sznol, M, and Chow, J. "Cyclosporine for Dry Eye Associated With Nivolumab: A Case Progressing to Corneal Perforation." Cornea 35.3 (March 2016): 399-401.
PMID
26771550
Source
epmc
Published In
Cornea
Volume
35
Issue
3
Publish Date
2016
Start Page
399
End Page
401
DOI
10.1097/ico.0000000000000724

A 71-year-old woman with decreased vision, nyctalopia, and peripheral vision loss.

Authors
Parikh, R; Materin, MA; Lesser, R; Baehring, J; Sznol, M; Galvin, JA
MLA Citation
Parikh, R, Materin, MA, Lesser, R, Baehring, J, Sznol, M, and Galvin, JA. "A 71-year-old woman with decreased vision, nyctalopia, and peripheral vision loss." Digital journal of ophthalmology : DJO 22.4 (January 2016): 85-90.
PMID
28924411
Source
epmc
Published In
Digital journal of ophthalmology : DJO / sponsored by Massachusetts Eye and Ear Infirmary
Volume
22
Issue
4
Publish Date
2016
Start Page
85
End Page
90
DOI
10.5693/djo.02.2016.06.001

Clinical and histologic findings in patients with uveal melanomas after taking tumor necrosis factor-α inhibitors.

OBJECTIVE: To describe the progression of uveal melanocytic lesions to melanomas after initiation of tumor necrosis factor-α (TNF-α) inhibitors. PATIENTS AND METHODS: We report 3 cases of uveal melanoma occurring after treatment with TNF-α inhibitors, 2 from Mayo Clinic and 1 from Yale University. The study took place from February 27, 2009, through July 15, 2013. RESULTS: Two women and one man with inflammatory disease who received TNF-α inhibitors had subsequent development of uveal melanomas. The 2 women had inflammatory bowel disease and had been followed up for melanocytic tumors that grew markedly within 1 year after beginning treatment with TNF-α inhibitors to the point of requiring treatment. One had histologic confirmation of the melanoma. The male patient had rheumatoid arthritis that was being treated with TNF-α inhibitors. Serial ultrasonography was performed to monitor bilateral diffuse scleritis, and within 16 months of initiation of TNF-α inhibitor therapy, a choroidal mass was detected that continued to grow over the next 3 months. The patient elected to have enucleation, which revealed uveal melanoma and thinning of the sclera from the previous scleritis. CONCLUSION: Our 3 cases of uveal melanocytic tumors occurring after the use of TNF-α inhibitors add to the growing literature suggesting a correlation between TNF-α inhibitors and the development of malignant neoplasms. Considering the association between cutaneous melanoma and TNF-α inhibitors, we recommend that patients have an eye examination before initiation of TNF-α inhibitors, and those with preexisting nevi should be followed up at regular intervals.

Authors
Damento, G; Kavoussi, SC; Materin, MA; Salomão, DR; Quiram, PA; Balasubramaniam, S; Pulido, JS
MLA Citation
Damento, G, Kavoussi, SC, Materin, MA, Salomão, DR, Quiram, PA, Balasubramaniam, S, and Pulido, JS. "Clinical and histologic findings in patients with uveal melanomas after taking tumor necrosis factor-α inhibitors." Mayo Clinic proceedings 89.11 (November 3, 2014): 1481-1486.
PMID
25444484
Source
epmc
Published In
Mayo Clinic Proceedings
Volume
89
Issue
11
Publish Date
2014
Start Page
1481
End Page
1486
DOI
10.1016/j.mayocp.2014.08.012

Benign melanocytic tumors of the uvea

© Springer-Verlag Berlin Heidelberg 2014. Benign melanocytic uveal tumors are generally known as nevi (also spelled as “naevi”). Nevus is a Latin word meaning birthmark or mole and is a general term for a congenital mark on the skin. In ophthalmology, the term nevus refers to an abnormal, hamartomatous cluster of melanocytes. Uveal melanocytes are derived from neural crest and share this embryologic origin with cutaneous melanocytes.

Authors
Materin, MA; Singh, AD
MLA Citation
Materin, MA, and Singh, AD. "Benign melanocytic tumors of the uvea." Clinical Ophthalmic Oncology: Uveal Tumors. January 1, 2014. 41-74.
Source
scopus
Publish Date
2014
Start Page
41
End Page
74
DOI
10.1007/978-3-642-54255-8_5

Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium.

We present a description of retinoblastoma treated with supraselective intra-arterial chemotherapy, demonstrating selective delivery of the infused chemotherapeutic agent into the tumor bed by MRI. A 7-month-old presented with group E (international classification) unilateral retinoblastoma. We treated the patient with several rounds of intra-ophthalmic artery melphalan. Gadolinium was infused along with melphalan to visualize the distribution of this chemotherapeutic drug. Intraoperative MRI was obtained within 15 min after treatment and showed increased enhancement of the tumor and subretinal space. We demonstrate here that supraselective administration of chemotherapy into the ophthalmic artery appears to result in drug delivery to the tumor and subretinal space.

Authors
Materin, MA; Kuzmik, GA; Jubinsky, PT; Minja, FJ; Asnes, JD; Bulsara, KR
MLA Citation
Materin, MA, Kuzmik, GA, Jubinsky, PT, Minja, FJ, Asnes, JD, and Bulsara, KR. "Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium." Journal of neurointerventional surgery 5.6 (November 2013): e42-.
PMID
23188789
Source
epmc
Published In
Journal of NeuroInterventional Surgery
Volume
5
Issue
6
Publish Date
2013
Start Page
e42
DOI
10.1136/neurintsurg-2012-010508.rep

Sector laser photocoagulation for the prevention of macular edema after plaque radiotherapy for uveal melanoma: a pilot study.

OBJECTIVE: To investigate the role of sector laser photocoagulation for prevention of macular edema after plaque radiotherapy for uveal melanoma. METHODS: Noncomparative, pilot interventional case series. The main outcome measure was optical coherence tomography-evident macular edema. RESULTS: A total of 29 patients had sector laser photocoagulation (sector panretinal photocoagulation) and sub-Tenon triamcinolone injection. The median tumor thickness and base was 3.3 mm and 10.0 mm. The median radiation dose and rate to the macula was 2,944 cGy and 31.0 cGy/hour. At the 12-month and 24-months follow-up, cystoid macular edema was found in 17% and 24% of the sector panretinal photocoagulation group. There were no major side effects registered. CONCLUSION: Sector panretinal photocoagulation in combination with sub-Tenon triamcinolone appears to show potential as a safe and beneficial intervention for the prevention of macular edema after plaque radiotherapy for uveal melanoma in this series.

Authors
Materin, MA; Bianciotto, CG; Wu, C; Shields, CL
MLA Citation
Materin, MA, Bianciotto, CG, Wu, C, and Shields, CL. "Sector laser photocoagulation for the prevention of macular edema after plaque radiotherapy for uveal melanoma: a pilot study." Retina (Philadelphia, Pa.) 32.8 (September 2012): 1601-1607.
PMID
22466484
Source
epmc
Published In
Retina
Volume
32
Issue
8
Publish Date
2012
Start Page
1601
End Page
1607
DOI
10.1097/iae.0b013e3182437e70

Exome sequencing identifies recurrent somatic RAC1 mutations in melanoma.

We characterized the mutational landscape of melanoma, the form of skin cancer with the highest mortality rate, by sequencing the exomes of 147 melanomas. Sun-exposed melanomas had markedly more ultraviolet (UV)-like C>T somatic mutations compared to sun-shielded acral, mucosal and uveal melanomas. Among the newly identified cancer genes was PPP6C, encoding a serine/threonine phosphatase, which harbored mutations that clustered in the active site in 12% of sun-exposed melanomas, exclusively in tumors with mutations in BRAF or NRAS. Notably, we identified a recurrent UV-signature, an activating mutation in RAC1 in 9.2% of sun-exposed melanomas. This activating mutation, the third most frequent in our cohort of sun-exposed melanoma after those of BRAF and NRAS, changes Pro29 to serine (RAC1(P29S)) in the highly conserved switch I domain. Crystal structures, and biochemical and functional studies of RAC1(P29S) showed that the alteration releases the conformational restraint conferred by the conserved proline, causes an increased binding of the protein to downstream effectors, and promotes melanocyte proliferation and migration. These findings raise the possibility that pharmacological inhibition of downstream effectors of RAC1 signaling could be of therapeutic benefit.

Authors
Krauthammer, M; Kong, Y; Ha, BH; Evans, P; Bacchiocchi, A; McCusker, JP; Cheng, E; Davis, MJ; Goh, G; Choi, M; Ariyan, S; Narayan, D; Dutton-Regester, K; Capatana, A; Holman, EC; Bosenberg, M; Sznol, M; Kluger, HM; Brash, DE; Stern, DF; Materin, MA; Lo, RS; Mane, S; Ma, S; Kidd, KK; Hayward, NK; Lifton, RP; Schlessinger, J; Boggon, TJ; Halaban, R
MLA Citation
Krauthammer, M, Kong, Y, Ha, BH, Evans, P, Bacchiocchi, A, McCusker, JP, Cheng, E, Davis, MJ, Goh, G, Choi, M, Ariyan, S, Narayan, D, Dutton-Regester, K, Capatana, A, Holman, EC, Bosenberg, M, Sznol, M, Kluger, HM, Brash, DE, Stern, DF, Materin, MA, Lo, RS, Mane, S, Ma, S, Kidd, KK, Hayward, NK, Lifton, RP, Schlessinger, J, Boggon, TJ, and Halaban, R. "Exome sequencing identifies recurrent somatic RAC1 mutations in melanoma." Nature genetics 44.9 (September 2012): 1006-1014.
PMID
22842228
Source
epmc
Published In
Nature Genetics
Volume
44
Issue
9
Publish Date
2012
Start Page
1006
End Page
1014
DOI
10.1038/ng.2359

Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium.

We present a description of retinoblastoma treated with supraselective intra-arterial chemotherapy, demonstrating selective delivery of the infused chemotherapeutic agent into the tumor bed by MRI. A 7-month-old presented with group E (international classification) unilateral retinoblastoma. We treated the patient with several rounds of intra-ophthalmic artery melphalan. Gadolinium was infused along with melphalan to visualize the distribution of this chemotherapeutic drug. Intraoperative MRI was obtained within 15 min after treatment and showed increased enhancement of the tumor and subretinal space. We demonstrate here that supraselective administration of chemotherapy into the ophthalmic artery appears to result in drug delivery to the tumor and subretinal space.

Authors
Materin, MA; Kuzmik, GA; Jubinsky, PT; Minja, FJ; Asnes, JD; Bulsara, KR
MLA Citation
Materin, MA, Kuzmik, GA, Jubinsky, PT, Minja, FJ, Asnes, JD, and Bulsara, KR. "Verification of supraselective drug delivery for retinoblastoma using intra-arterial gadolinium." BMJ case reports 2012 (January 2012).
PMID
23162039
Source
epmc
Published In
BMJ Case Reports
Volume
2012
Publish Date
2012
DOI
10.1136/bcr-2012-010508

The relationship between cutaneous and uveal melanoma: These different entities share some similarities

Authors
Materin, MA
MLA Citation
Materin, MA. "The relationship between cutaneous and uveal melanoma: These different entities share some similarities." Retina Today NOVEMBER-DECEMBER (November 1, 2011).
Source
scopus
Published In
Retina Today
Issue
NOVEMBER-DECEMBER
Publish Date
2011

Molecular alternations in uveal melanoma.

Authors
Materin, MA; Faries, M; Kluger, HM
MLA Citation
Materin, MA, Faries, M, and Kluger, HM. "Molecular alternations in uveal melanoma." Current problems in cancer 35.4 (July 2011): 211-224.
PMID
21911184
Source
epmc
Published In
Current Problems in Cancer
Volume
35
Issue
4
Publish Date
2011
Start Page
211
End Page
224
DOI
10.1016/j.currproblcancer.2011.07.004

Ocular neoplastic disease.

Ocular neoplasms, both primary and metastatic, may present with visual disturbance or vision loss and often are asymptomatic. Clinical ophthalmologic examination may demonstrate leukocoria, abnormal pupillary light reflex, or a mass lesion with or without retinal detachment or hemorrhage. Retinoblastoma in children and uveal melanoma and ocular metastases in adults are the most important ocular malignant neoplasms referred for imaging to aid with diagnosis and staging. Familiarity with their common imaging appearances, the common patterns of spread, and the diagnostic findings of greatest concern to the ocular oncologist will enhance accuracy of imaging interpretation. Clinical ophthalmologic examination and imaging using B-scan ultrasound, A-scan ultrasound, fluorescein angiography, computed tomography and magnetic resonance imaging have complementary roles in ocular tumor staging and treatment assessment.

Authors
Mahajan, A; Crum, A; Johnson, MH; Materin, MA
MLA Citation
Mahajan, A, Crum, A, Johnson, MH, and Materin, MA. "Ocular neoplastic disease." Seminars in ultrasound, CT, and MR 32.1 (February 2011): 28-37. (Review)
PMID
21277489
Source
epmc
Published In
Seminars in Ultrasound, CT and MRI
Volume
32
Issue
1
Publish Date
2011
Start Page
28
End Page
37
DOI
10.1053/j.sult.2010.12.001

Paraneoplastic retinopathy with multiple detachments of the neurosensory retina and autoantibodies against interphotoreceptor retinoid binding protein (IRBP) in cutaneous melanoma.

Authors
Bianciotto, C; Shields, CL; Thirkill, CE; Materin, MA; Shields, JA
MLA Citation
Bianciotto, C, Shields, CL, Thirkill, CE, Materin, MA, and Shields, JA. "Paraneoplastic retinopathy with multiple detachments of the neurosensory retina and autoantibodies against interphotoreceptor retinoid binding protein (IRBP) in cutaneous melanoma." The British journal of ophthalmology 94.12 (December 2010): 1684-1696.
PMID
19286685
Source
epmc
Published In
British Journal of Ophthalmology
Volume
94
Issue
12
Publish Date
2010
Start Page
1684
End Page
1696
DOI
10.1136/bjo.2008.151480

Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions.

PURPOSE: To establish the characteristics of secondary retinal and retinal pigment epithelial (RPE) changes associated with the presence of choroidal melanoma and choroidal nevus as documented by optical coherence tomography (OCT) and fundus autofluorescence (FAF). MATERIALS AND METHODS: PubMed review of major English publications examining the correlation between clinical characteristics of choroidal melanoma and nevus with OCT and FAF findings. RESULTS: The intrinsic properties of choroidal melanoma, as well as overlying RPE changes, drusen, and lipofuscin are best characterized by FAF, while OCT is more sensitive for the identification of subretinal and intraretinal fluid as well as atrophy, degeneration, and photoreceptor loss in the neurosensory retina. CONCLUSIONS: Secondary retinal changes associated with choroidal melanocytic lesions can be documented by OCT and FAF. OCT-evident changes are observed more often with choroidal melanoma than choroidal nevus. OCT is better suited to identify the overlying retinal detachment and edema, even before these findings are clinically apparent. FAF is most useful in documenting the presence of lipofuscin, a finding that represents one of the important criteria in differentiating small choroidal melanoma from benign choroidal nevus.

Authors
Materin, MA; Raducu, R; Bianciotto, C; Shields, CL
MLA Citation
Materin, MA, Raducu, R, Bianciotto, C, and Shields, CL. "Fundus autofluorescence and optical coherence tomography findings in choroidal melanocytic lesions." Middle East African journal of ophthalmology 17.3 (July 2010): 201-206.
PMID
20844674
Source
epmc
Published In
Middle East African Journal of Ophthalmology
Volume
17
Issue
3
Publish Date
2010
Start Page
201
End Page
206
DOI
10.4103/0974-9233.65489

Small choroidal melanoma with monosomy 3.

PURPOSE: To report a patient with small juxtapapillary choroidal melanoma with chromosome 3 monosomy treated with I(125) plaque and transpupillary thermotherapy (TTT). A 64-year-old Caucasian male presented with painless blurred vision of the left eye. Ocular examination disclosed a small juxtapapillary choroidal melanocytic tumor with overlying subretinal fluid and orange pigment. Ultrasound showed an elevated choroidal mass of 2 mm thickness with low reflectivity on A-scan and hollowness on B scan, consistent with a small choroidal melanoma. The patient was treated with plaque I(125) radiotherapy combined with one session of TTT. Genetic testing of the tumor cells obtained by fine needle aspiration biopsy showed chromosome 3 monosomy. At 1 year after treatment, the tumor was regressed with resolution of subretinal fluid and 20/40 visual acuity. A small choroidal melanoma can manifest monosomy of chromosome 3, a known predictive factor for the development of systemic metastasis.

Authors
Ghassemi, F; Shields, CL; Materin, MA; Shields, JA
MLA Citation
Ghassemi, F, Shields, CL, Materin, MA, and Shields, JA. "Small choroidal melanoma with monosomy 3." Middle East African journal of ophthalmology 17.3 (July 2010): 268-269.
PMID
20844685
Source
epmc
Published In
Middle East African Journal of Ophthalmology
Volume
17
Issue
3
Publish Date
2010
Start Page
268
End Page
269
DOI
10.4103/0974-9233.65487

Angiography of retinal and choroidal tumors

The evaluation of intraocular tumors differs from almost all other oncologic evaluations because there is little reliance on tissue diagnosis. Definitive therapies such as enucleation and radiation are usually based on the results of ophthalmoscopy, and a limited number of ancillary studies without the aid of biopsy. Although biopsies can be performed on most intraocular tumors, the ocular morbidity associated with these procedures is usually not worth the added benefit of a tissue diagnosis. © 2009 Springer New York.

Authors
Arevalo, JF; Shields, CL; Shields, JA; Materin, MA; Mendoza, AJ
MLA Citation
Arevalo, JF, Shields, CL, Shields, JA, Materin, MA, and Mendoza, AJ. "Angiography of retinal and choroidal tumors." Retinal Angiography and Optical Coherence Tomography. December 1, 2009. 179-198.
Source
scopus
Publish Date
2009
Start Page
179
End Page
198
DOI
10.1007/978-0-387-68987-6_8

Clinical applications of optical coherence tomography in intraocular tumors

There are several tumors that can occur in the posterior segment of the eye. 1,2 They are generally classified based on the main tissue involved such as the choroid, retinal pigment epithelium (RPE), or retina. The spectrum of tumors in each tissue varies. For example, tumors in the choroid include the melanocytic nevus, melanoma, metastasis, cavernous hemangioma, and other less common tumors such as lymphoma, neurilemoma, leiomyoma, and osteoma. 1,2 Lesions of the RPE include congenital hypertrophy, congenital simple hamartoma, combined hamartoma, reactive hyperplasia, adenoma, and adenocarcinoma. Those affecting the retina include capillary hemangioma, cavernous hemangioma, racemose hemangioma, vasoproliferative tumor, astrocytic hamartoma, and retinoblastoma. The differentiation of these tumors by experienced clinicians is made primarily by indirect ophthalmoscopy. Ancillary testing with intravenous fluorescein angiography, indocyanine green angiography, ultrasonography, optical coherence tomography (OCT), color Doppler testing, magnetic resonance imaging, computed tomography, and fine-needle aspiration biopsy can assist in confirming the diagnosis. 1,2 This chapter presents the OCT findings of selected intraocular tumors. © 2009 Springer New York.

Authors
Shields, CL; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Materin, MA, and Shields, JA. "Clinical applications of optical coherence tomography in intraocular tumors." Retinal Angiography and Optical Coherence Tomography. December 1, 2009. 359-373.
Source
scopus
Publish Date
2009
Start Page
359
End Page
373
DOI
10.1007/978-0-387-68987-6_20

Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial.

OBJECTIVE: To determine the efficacy and safety of periocular triamcinolone acetonide (40 mg) for the prevention of macular edema in patients undergoing plaque radiotherapy for uveal melanoma. DESIGN: Prospective, randomized, controlled clinical trial. PARTICIPANTS AND CONTROLS: One-hundred sixty-three patients with newly diagnosed uveal melanoma undergoing iodine 125 plaque radiotherapy were entered into the study. Fifty-five patients were randomized to the control group and 108 to the triamcinolone group. Eighteen-month data were available for 143 (88%) of the 163 patients. INTERVENTION: Periocular injection of triamcinolone acetonide (40 mg in 1 ml) at the time of plaque radiotherapy and 4 months and 8 months later. Optical coherence tomography was performed at each patient evaluation. MAIN OUTCOME MEASURES: Optical coherence tomography-evident macular edema, moderate vision loss, and poor final visual acuity. RESULTS: Optical coherence tomography-evident macular edema occurred significantly less often in the triamcinolone group compared with the control group up to 18 months after plaque radiotherapy (hazard estimate, 0.45; 95% confidence interval, 0.19-0.70; P = 0.001). At the 18-month follow-up, moderate vision loss (loss of 3 lines or more of best-corrected visual acuity [BCVA]) and severe vision loss (BCVA <5/200 Snellen) occurred significantly less frequently in the triamcinolone group than in the control group (31% vs. 48% [P = 0.039] and 5% vs. 15% [P = 0.048], respectively). Rates of elevated intraocular pressure and cataract progression were similar in both groups. CONCLUSIONS: Periocular triamcinolone is beneficial in reducing the risk of macular edema up to 18 months after plaque radiotherapy for uveal melanoma and significantly reduces the risk of moderate vision loss and poor visual acuity in these patients.

Authors
Horgan, N; Shields, CL; Mashayekhi, A; Salazar, PF; Materin, MA; O'Regan, M; Shields, JA
MLA Citation
Horgan, N, Shields, CL, Mashayekhi, A, Salazar, PF, Materin, MA, O'Regan, M, and Shields, JA. "Periocular triamcinolone for prevention of macular edema after plaque radiotherapy of uveal melanoma: a randomized controlled trial." Ophthalmology 116.7 (July 2009): 1383-1390.
PMID
19481812
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
116
Issue
7
Publish Date
2009
Start Page
1383
End Page
1390
DOI
10.1016/j.ophtha.2009.01.051

Regression of uveal melanoma after plaque radiotherapy and thermotherapy based on chromosome 3 status.

PURPOSE: To evaluate regression rates after plaque radiotherapy and thermotherapy of uveal melanoma with chromosome 3 monosomy versus disomy. DESIGN: Noncomparative case series. PARTICIPANTS: Two hundred and seventy patients with uveal melanoma. METHODS: Fine needle aspiration biopsy was used at the time of plaque radiotherapy to sample tumor cells for genetic testing. MAIN OUTCOME MEASURES: Tumor thickness regression based on chromosome 3 status. RESULTS: At the time of plaque radiotherapy, the median tumor thickness was 4.0 mm for melanomas with chromosome 3 monosomy and 3.5 mm for those with disomy 3. The median tumor thickness (% original thickness) at 4, 8, 12, 15, and 18 months after radiotherapy for melanoma with monosomy 3 was 77%, 67%, 58%, 55%, and 50% and for those with disomy 3 was 82%, 70%, 69%, 67%, and 61%. The median monthly regression rate was 3.1% for tumors with monosomy 3 and 2.7% for those with disomy 3. The overall regression and monthly rate of regression was statistically greater at 12 months (P < 0.001) and 15 months (P = 0.003) for melanomas with monosomy 3 compared with disomy 3. CONCLUSIONS: Uveal melanomas with chromosome 3 monosomy showed faster and greater tumor thickness regression at 12 and 15 months after plaque radiotherapy and thermotherapy than melanomas with disomy 3.

Authors
Shields, CL; Bianciotto, C; Rudich, D; Materin, MA; Ganguly, A; Shields, JA
MLA Citation
Shields, CL, Bianciotto, C, Rudich, D, Materin, MA, Ganguly, A, and Shields, JA. "Regression of uveal melanoma after plaque radiotherapy and thermotherapy based on chromosome 3 status." Retina (Philadelphia, Pa.) 28.9 (October 2008): 1289-1295.
PMID
18628721
Source
epmc
Published In
Retina
Volume
28
Issue
9
Publish Date
2008
Start Page
1289
End Page
1295
DOI
10.1097/iae.0b013e31817f7b3e

Autofluorescence of choroidal nevus in 64 cases.

PURPOSE: To describe the autofluorescence features of choroidal nevi. DESIGN: Noncomparative case series. PARTICIPANTS: Sixty-four consecutive patients. METHODS: Correlation of fundus photography with autofluorescence photography. MAIN OUTCOME MEASURE: Autofluorescence features of choroidal nevus and overlying retinal pigment epithelium (RPE). RESULTS: The mean patient age was 62 years. The choroidal nevus was a mean of 5 mm from the optic disk and foveola. The mean tumor basal dimension was 5.0 mm and mean tumor thickness was 1.0 mm. The choroidal nevus showed hypoautofluorescence in 56%, isoautofluorescence in 19%, and hyperautofluorescence in 25%. The autofluorescence features appeared unaffected by tumor thickness, but increasing tumor base and disrupted overlying RPE appeared to produce slightly brighter autofluorescence. Nevi located in the macular region showed darker hypoautofluorescence than those outside the macular region. Overlying RPE hyperplasia, atrophy, and fibrous metaplasia were generally hypoautofluorescent. Drusen, subretinal fluid, and orange pigment were generally hyperautofluorescent. The brightest hyperautofluorescence was found with orange pigment. CONCLUSIONS: Choroidal nevus shows little intrinsic autofluorescence. Overlying RPE alterations show dramatic autofluorescence ranging from dark hypoautofluorescence of RPE atrophy to bright hyperautofluorescence of orange pigment.

Authors
Shields, CL; Pirondini, C; Bianciotto, C; Materin, MA; Harmon, SA; Shields, JA
MLA Citation
Shields, CL, Pirondini, C, Bianciotto, C, Materin, MA, Harmon, SA, and Shields, JA. "Autofluorescence of choroidal nevus in 64 cases." Retina (Philadelphia, Pa.) 28.8 (October 2008): 1035-1043.
PMID
18779708
Source
epmc
Published In
Retina
Volume
28
Issue
8
Publish Date
2008
Start Page
1035
End Page
1043
DOI
10.1097/iae.0b013e318181b94b

Periocular triamcinolone for prevention of macular edema after iodine 125 plaque radiotherapy of uveal melanoma.

OBJECTIVE: To investigate the potential benefit of periocular depot triamcinolone in the prevention of macular edema after iodine 125 plaque radiotherapy for uveal melanoma. METHODS: This comparative, nonrandomized, interventional study included 87 patients with uveal melanoma who underwent plaque radiotherapy. The triamcinolone group included 55 consecutive patients who were treated with 40 mg of periocular triamcinolone at the time of plaque application and 4 months and 8 months later. The comparison group comprised 32 consecutive patients treated with plaque radiotherapy without triamcinolone. Patients were evaluated at 4 months, 8 months, 12 months, 18 months, and 24 months after plaque application with clinical examination, fundus photography, and optical coherence tomography (OCT). The associations of clinical variables with the development of OCT-evident macular edema (the main outcome measure) were investigated using Cox proportional hazards analysis. RESULTS: By multivariate analysis, eyes treated with periocular triamcinolone had a significant reduction in the risk of radiation-induced macular edema (P = 0.002; hazard estimate = 0.49; 95% confidence interval, 0.17- 0.80). Adverse effects associated with periocular triamcinolone treatment included elevation of intraocular pressure (7% of cases) and blepharoptosis (5% of cases). CONCLUSIONS: Periocular triamcinolone treatment significantly lowered the risk of macular edema after plaque radiotherapy for uveal melanoma in this series but did not significantly alter the rate of vision loss at 24 months of follow-up.

Authors
Horgan, N; Shields, CL; Mashayekhi, A; Teixeira, LF; Materin, MA; O'Regan, M; Shields, JA
MLA Citation
Horgan, N, Shields, CL, Mashayekhi, A, Teixeira, LF, Materin, MA, O'Regan, M, and Shields, JA. "Periocular triamcinolone for prevention of macular edema after iodine 125 plaque radiotherapy of uveal melanoma." Retina (Philadelphia, Pa.) 28.7 (July 2008): 987-995.
PMID
18698302
Source
epmc
Published In
Retina
Volume
28
Issue
7
Publish Date
2008
Start Page
987
End Page
995
DOI
10.1097/iae.0b013e31816b3192

Autofluorescence of choroidal melanoma in 51 cases.

AIM: To describe the autofluorescence features of choroidal melanoma. DESIGN: Non-comparative case series. PARTICIPANTS: 51 consecutive patients. METHODS: Standard fundus photography and autofluorescence photography (580 nm excitation, 695 nm barrier filter) were performed on all patients. Clinical features were correlated with autofluorescence features. MAIN OUTCOME MEASURE: Autofluorescence features of choroidal melanoma and overlying retinal pigment epithelium (RPE). RESULTS: The mean patient age was 59 years. The choroidal melanoma was a mean of 3.6 mm from the optic disc and 2.6 mm from the foveola. The mean tumour basal dimension was 11 mm and the mean tumour thickness was 4 mm. The choroidal melanoma showed intrinsic hypoautofluorescence (39%), isoautofluorescence (6%) and hyperautofluorescence (55%). Slightly increased hyperautofluorescence of the melanoma was found in pigmented tumours (versus non-pigmented), those with greater thickness and basal dimensions, and those with overlying disrupted RPE. Related RPE hyperplasia and atrophy showed hypoautofluorescence, drusen, RPE detachment and subretinal fluid showed slight hyperautofluorescence, and orange pigment displayed the brightest hyperautofluorescence. CONCLUSIONS: Choroidal melanoma generally shows slight intrinsic hyperautofluorescence and the brightness increases with pigmented tumours, larger tumours, and those associated with disrupted RPE. Overlying orange pigment shows remarkably bright hyperautofluorescence.

Authors
Shields, CL; Bianciotto, C; Pirondini, C; Materin, MA; Harmon, SA; Shields, JA
MLA Citation
Shields, CL, Bianciotto, C, Pirondini, C, Materin, MA, Harmon, SA, and Shields, JA. "Autofluorescence of choroidal melanoma in 51 cases." The British journal of ophthalmology 92.5 (May 2008): 617-622.
PMID
18441171
Source
epmc
Published In
British Journal of Ophthalmology
Volume
92
Issue
5
Publish Date
2008
Start Page
617
End Page
622
DOI
10.1136/bjo.2007.130286

Uveal prolapse following cataract extraction simulating melanoma.

Prolapsed uveal tissue through a cataract incision can simulate any pigmented epibulbar mass, including conjunctival melanoma, extraocular extension ofa ciliary body or choroidal melanoma, and pigmented squamous cell carcinoma of the conjunctiva. The authors describe an 88-year-old woman who presented with an enlarging pigmented epibulbar mass on the left eye. Although the lesion closely simulated a conjunctival melanoma or extraocular extension of a uveal melanoma, closer evaluation revealed thin uveal tissue extending through partial wound dehiscence from cataract surgery that was performed 3 years earlier. The lesion was consistent with prolapsed uveal tissue through a cataract wound masquerading as a melanoma. Therefore, uveal prolapse should be considered in the differential diagnosis of conjunctival melanoma or extraocular extension of uveal melanoma.

Authors
Marr, BP; Shields, JA; Shields, CL; Materin, MA; Tuncer, S
MLA Citation
Marr, BP, Shields, JA, Shields, CL, Materin, MA, and Tuncer, S. "Uveal prolapse following cataract extraction simulating melanoma." Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye 39.3 (May 2008): 250-251.
PMID
18556954
Source
epmc
Published In
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Volume
39
Issue
3
Publish Date
2008
Start Page
250
End Page
251
DOI
10.3928/15428877-20080501-10

Optical coherence tomography of optic disk melanocytoma in 15 cases.

OBJECTIVE: To describe the optical coherence tomography (OCT) features of optic disk melanocytoma. DESIGN AND PARTICIPANTS: Case series including 15 patients. MAIN OUTCOME MEASURES: OCT characteristics of the tumor. RESULTS: The mean age of the patients was 42 years. By ophthalmoscopy, the mean basal diameter of the tumor was 2.7 mm, and by ultrasonography, the mean thickness was 1.8 mm. By OCT, the tumor showed a nodular appearance in 14 cases (93%). The tumor displayed a gradual sloping transition from normal retina into the mass, hyperreflectivity at its anterior tumor surface, and dense posterior shadowing with an optically empty appearance in all 15 cases (100%). Thicker tumors displayed thinner anterior hyperreflective borders and denser shadowing. There were no internal qualities of the tumor or disk visible by OCT due to dense shadowing. Other findings of OCT included vitreous seeds in 2 cases (13%) and adjacent retinal edema in 1 case (7%). There were no cases of retinal traction, subretinal fluid, macular edema, or epiretinal membrane in the macula. CONCLUSIONS: Optic disk melanocytoma shows characteristic features by OCT including a gradual transition from normal retina into nodular tumor, and the mass displays a bright anterior border layer with optically empty internal details.

Authors
Shields, CL; Perez, B; Benavides, R; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Perez, B, Benavides, R, Materin, MA, and Shields, JA. "Optical coherence tomography of optic disk melanocytoma in 15 cases." Retina (Philadelphia, Pa.) 28.3 (March 2008): 441-446.
PMID
18327136
Source
epmc
Published In
Retina
Volume
28
Issue
3
Publish Date
2008
Start Page
441
End Page
446
DOI
10.1097/iae.0b013e31815e9853

Early macular morphological changes following plaque radiotherapy for uveal melanoma.

PURPOSE: To evaluate the time of onset and risk factors for the development of macular edema following plaque radiotherapy for uveal melanoma, using optical coherence tomography (OCT). METHODS: This observational case series included 135 consecutive patients with uveal melanoma treated with Iodine(125) plaque radiotherapy and adjunctive transpupillary thermotherapy (TTT) laser. Patients were evaluated at baseline and 6-month intervals following treatment using ophthalmoscopy, B-scan ultrasonography, fundus photography, and OCT. RESULTS: Median follow-up was 24 months. The mean time to onset of macular edema by OCT was 12 months. Median best-corrected logMAR visual acuity at the time of onset of OCT-evident macular edema was 0.3 (equivalent to 20/40 Snellen). The development of OCT-evident macular edema was significantly associated with maximum tumor thickness (P = 0.0016), largest tumor base (P < 0.0001), radiation dose, and dose-rate to the tumor base (P = 0.0315 and P = 0.0204, respectively). Neither radiation dose to the foveola nor treatment with adjunctive TTT laser was significantly associated with the development of macular edema. CONCLUSIONS: OCT is useful in the early detection of radiation-induced macular edema, before clinical signs of radiation maculopathy develop and before substantial visual loss occurs. The development of macular edema is significantly associated with larger initial tumor size.

Authors
Horgan, N; Shields, CL; Mashayekhi, A; Teixeira, LF; Materin, MA; Shields, JA
MLA Citation
Horgan, N, Shields, CL, Mashayekhi, A, Teixeira, LF, Materin, MA, and Shields, JA. "Early macular morphological changes following plaque radiotherapy for uveal melanoma." Retina (Philadelphia, Pa.) 28.2 (February 2008): 263-273.
PMID
18301032
Source
epmc
Published In
Retina
Volume
28
Issue
2
Publish Date
2008
Start Page
263
End Page
273
DOI
10.1097/iae.0b013e31814b1b75

Resolution of exudative retinal detachment from retinal astrocytoma following photodynamic therapy.

Authors
Shields, CL; Materin, MA; Marr, BP; Krepostman, J; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Marr, BP, Krepostman, J, and Shields, JA. "Resolution of exudative retinal detachment from retinal astrocytoma following photodynamic therapy." Archives of ophthalmology (Chicago, Ill. : 1960) 126.2 (February 2008): 273-274.
PMID
18268226
Source
epmc
Published In
Archives of Ophthalmology
Volume
126
Issue
2
Publish Date
2008
Start Page
273
End Page
274
DOI
10.1001/archophthalmol.2007.54

Regression of extrafoveal choroidal osteoma following photodynamic therapy.

Authors
Shields, CL; Materin, MA; Mehta, S; Foxman, BT; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Mehta, S, Foxman, BT, and Shields, JA. "Regression of extrafoveal choroidal osteoma following photodynamic therapy." Archives of ophthalmology (Chicago, Ill. : 1960) 126.1 (January 2008): 135-137.
PMID
18195235
Source
epmc
Published In
Archives of Ophthalmology
Volume
126
Issue
1
Publish Date
2008
Start Page
135
End Page
137
DOI
10.1001/archopht.126.1.135

Endolymphatic sac tumor as initial manifestation of von hippel-lindau syndrome.

PURPOSE: To report endolymphatic sac tumor (ELST) as the initial finding in von Hippel-Lindau (VHL) syndrome. METHODS: Case report. RESULTS: A 4-year-old boy presented in February 2001 with right hearing loss and seventh nerve palsy from ELST. Genetic analysis showed a VHL mutation (gene 3p25-26). Systemic and ocular examination for VHL syndrome-related tumors was unrevealing. Four years later, multiple retinal hemangioblastoma (retinal capillary hemangioma) were detected in both eyes and successfully treated with argon laser photocoagulation. CONCLUSION: ELSTs can be the initial manifestation of VHL syndrome. Lifelong screening for related tumors, particularly retinal hemangioblastoma, is advised.

Authors
Salazar, PF; Shields, CL; Materin, MA; Shields, JA
MLA Citation
Salazar, PF, Shields, CL, Materin, MA, and Shields, JA. "Endolymphatic sac tumor as initial manifestation of von hippel-lindau syndrome." Retinal cases & brief reports 2.4 (January 2008): 332-334.
PMID
25390606
Source
epmc
Published In
Retinal Cases and Brief Reports
Volume
2
Issue
4
Publish Date
2008
Start Page
332
End Page
334
DOI
10.1097/icb.0b013e318124a4c8

Optical coherence tomography of choroidal osteoma in 22 cases: evidence for photoreceptor atrophy over the decalcified portion of the tumor.

PURPOSE: To evaluate the retinal status overlying choroidal osteoma using optical coherence tomography (OCT). DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Twenty-two eyes with choroidal osteoma. METHODS: Choroidal osteoma was studied with fundus photography, ultrasonography, and OCT. MAIN OUTCOME MEASURE: Retinal status over the calcified and decalcified portions of choroidal osteoma. RESULTS: There were 8 completely calcified and 14 partially decalcified choroidal osteomas. Optical coherence tomography was performed over the calcified portion in 21 eyes and over the decalcified portion in 10 eyes. The calcified portion displayed an overlying intact inner retina (n = 21 [100%]), intact outer retina (n = 20 [95%]), and intact photoreceptor layer (n = 21 [100%]). In contrast, the decalcified portion showed an intact inner retina (n = 9 [90%]) and markedly thinned to absent outer retina and photoreceptor layers (n = 10 [100%]). Of the 18 eyes with subfoveolar choroidal osteoma, visual acuity (VA) was 20/20 to 20/50 in all 11 eyes with calcified tumor, and OCT confirmed preservation of retinal architecture. In contrast, VA was 20/200 or worse in all 7 eyes with subfoveolar decalcified tumor, correlating with OCT findings of outer retinal thinning and photoreceptor loss. CONCLUSIONS: The retina shows profound outer layer thinning and photoreceptor loss over decalcified choroidal osteoma. These findings correlate with poor VA over decalcified subfoveolar choroidal osteoma compared with good VA over calcified subfoveolar tumor.

Authors
Shields, CL; Perez, B; Materin, MA; Mehta, S; Shields, JA
MLA Citation
Shields, CL, Perez, B, Materin, MA, Mehta, S, and Shields, JA. "Optical coherence tomography of choroidal osteoma in 22 cases: evidence for photoreceptor atrophy over the decalcified portion of the tumor." Ophthalmology 114.12 (December 2007): e53-e58.
PMID
17884171
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
114
Issue
12
Publish Date
2007
Start Page
e53
End Page
e58
DOI
10.1016/j.ophtha.2007.07.037

Small choroidal melanoma with chromosome 3 monosomy on fine-needle aspiration biopsy.

PURPOSE: To evaluate the presence of chromosome 3 monosomy in small choroidal melanoma using fine-needle aspiration biopsy (FNAB). DESIGN: Noncomparative case series. PARTICIPANTS: Fifty-six patients with small choroidal melanoma measuring 3 mm or less in thickness who were undergoing plaque radiotherapy. METHODS: Fine-needle aspiration biopsy was used at the time of plaque radiotherapy to sample tumor cells using a 27-gauge long needle via an indirect transvitreal approach into the tumor apex for postequatorial tumors or a 30-gauge short needle via a direct transscleral approach into the tumor base for preequatorial tumors. MAIN OUTCOME MEASURES: Chromosome 3 monosomy in small choroidal melanoma. RESULTS: The median tumor thickness was 2.6 mm. Monosomy 3 was found in 15 (27%) cases and disomy 3 was found in 32 (57%) cases. In 9 (16%) cases, genomic DNA yield was insufficient for genetic analysis. Fine-needle aspiration biopsy with a 27-gauge needle transvitreal approach provided quantity sufficient for genetic testing in 31 (97%) of 32 cases versus 16 (67%) of 24 cases sampled with a 30-gauge transscleral technique. Compared with disomy 3 tumors, monosomy 3 tumors were statistically more likely to occur in older patients (P = 0.040). Monosomy 3 (versus disomy 3) tumors showed thickness of more than 2 mm in 100% (vs. 84%), subretinal fluid in 87% (vs. 94%), symptoms in 40% (vs. 56%), orange pigment in 93% (vs. 81%), and margin of 3 mm or less to the optic disc in 20% (vs. 50%). There was no statistical difference between monosomy 3 and disomy 3 tumors in the presence or number of these clinical factors. However, small choroidal melanomas with monosomy 3 mutation were more likely to have had documented growth (63%) compared with those with disomy 3 (25%; P = 0.025; odds ratio, 5.00). CONCLUSIONS: Using FNAB at the time of plaque radiotherapy, monosomy 3 was found in approximately 27% of small choroidal melanomas, more often in older patients and tumors with documented growth. Transvitreal biopsy into the tumor apex provided better yield compared with transscleral biopsy into the tumor base.

Authors
Shields, CL; Materin, MA; Teixeira, L; Mashayekhi, A; Ganguly, A; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Teixeira, L, Mashayekhi, A, Ganguly, A, and Shields, JA. "Small choroidal melanoma with chromosome 3 monosomy on fine-needle aspiration biopsy." Ophthalmology 114.10 (October 2007): 1919-1924.
PMID
17698199
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
114
Issue
10
Publish Date
2007
Start Page
1919
End Page
1924
DOI
10.1016/j.ophtha.2007.04.054

Autofluorescence of orange pigment overlying small choroidal melanoma.

PURPOSE: To describe the autofluorescence features of orange pigment (intracellular lipofuscin) overlying small presumed choroidal melanomas. METHODS: The diagnostic testing results (fluorescein angiography, optical coherence tomography, and fundus autofluorescence imaging) for two patients with pigmented choroidal melanoma and two patients with nonpigmented choroidal melanoma were reviewed. RESULTS: Clinically, the intracellular lipofuscin pigment appeared brown overlying the nonpigmented melanoma (two cases) and orange overlying the pigmented melanoma (two cases). Fluorescein angiography demonstrated that the lipofuscin pigment displayed fluorescein blockage in all four cases. Optical coherence tomography revealed serous retinal detachment in all four cases. Fundus autofluorescence imaging showed discrete, bright hyperautofluorescence of the orange pigment separated by hypoautofluorescent voids. The melanoma was isoautofluorescent. CONCLUSIONS: Intracellular lipofuscin overlying small choroidal melanomas shows discrete and bright hyperautofluorescence. The brightness correlates directly with the clinically visible orange pigment.

Authors
Shields, CL; Bianciotto, C; Pirondini, C; Materin, MA; Harmon, SA; Shields, JA
MLA Citation
Shields, CL, Bianciotto, C, Pirondini, C, Materin, MA, Harmon, SA, and Shields, JA. "Autofluorescence of orange pigment overlying small choroidal melanoma." Retina (Philadelphia, Pa.) 27.8 (October 2007): 1107-1111.
PMID
18040254
Source
epmc
Published In
Retina
Volume
27
Issue
8
Publish Date
2007
Start Page
1107
End Page
1111
DOI
10.1097/iae.0b013e31814934ef

Brown trabeculectomy bleb from necrotic iris melanocytoma.

Authors
Sagoo, MS; Shields, CL; Eagle, RC; Materin, MA; Ehya, H; McQueen, B; Shields, JA
MLA Citation
Sagoo, MS, Shields, CL, Eagle, RC, Materin, MA, Ehya, H, McQueen, B, and Shields, JA. "Brown trabeculectomy bleb from necrotic iris melanocytoma." Acta ophthalmologica Scandinavica 85.5 (August 2007): 571-572.
PMID
17655614
Source
epmc
Published In
Acta ophthalmologica Scandinavica
Volume
85
Issue
5
Publish Date
2007
Start Page
571
End Page
572
DOI
10.1111/j.1600-0420.2006.00833.x

Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases: the Deborah Iverson, MD, Lectureship.

OBJECTIVE: To evaluate the feasibility of genetic testing of uveal melanoma using fine-needle aspiration biopsy (FNAB). METHODS: We reviewed the clinical records of all patients of the Ocular Oncology Service at Wills Eye Hospital with the diagnosis of uveal melanoma who underwent FNAB for genetic testing for chromosome 3 status between November 1, 2005, and March 1, 2006. The FNAB was performed immediately before plaque radiotherapy. The specimens underwent genetic analysis using DNA amplification and microsatellite assay to determine the presence of monosomy 3. RESULTS: A total of 140 eyes of 140 patients with uveal melanoma were sampled for chromosome 3 abnormalities using FNAB. Monosomy 3 was found in 44 cases (31%), disomy 3 was found in 76 cases (54%), and the genomic DNA yield was insufficient for genetic analysis in 20 cases (14%). Monosomy 3 was found in 16 of 61 small melanomas (26%), 24 of 67 medium melanomas (36%), and 4 of 12 large melanomas (33%). Adequate DNA was achieved in 97% of cases using a 27-gauge needle via the transvitreal tumor apex approach and in 75% of cases using a 30-gauge needle via the transscleral tumor base approach. Factors predictive of monosomy 3 included greater tumor basal dimension (P=.02) and greater distance from the optic disc (P=.02). Transient localized vitreous hemorrhage was found in 46% of eyes. No cases of diffuse vitreous hemorrhage, retinal detachment, or tumor recurrence along the biopsy tract were found. CONCLUSION: We found that in most cases, FNAB provides adequate DNA for genetic analysis of uveal melanoma using microsatellite assay.

Authors
Shields, CL; Ganguly, A; Materin, MA; Teixeira, L; Mashayekhi, A; Swanson, LA; Marr, BP; Shields, JA
MLA Citation
Shields, CL, Ganguly, A, Materin, MA, Teixeira, L, Mashayekhi, A, Swanson, LA, Marr, BP, and Shields, JA. "Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases: the Deborah Iverson, MD, Lectureship." Archives of ophthalmology (Chicago, Ill. : 1960) 125.8 (August 2007): 1017-1024.
PMID
17698747
Source
epmc
Published In
Archives of Ophthalmology
Volume
125
Issue
8
Publish Date
2007
Start Page
1017
End Page
1024
DOI
10.1001/archopht.125.8.1017

Brown trabeculectomy bleb from necrotic iris melanocytoma

Authors
Sagoo, MS; Shields, CL; Jr, ERC; Materin, MA; Ehya, H; McQueen, B; Shields, JA
MLA Citation
Sagoo, MS, Shields, CL, Jr, ERC, Materin, MA, Ehya, H, McQueen, B, and Shields, JA. "Brown trabeculectomy bleb from necrotic iris melanocytoma." ACTA OPHTHALMOLOGICA SCANDINAVICA 85.5 (August 2007): 571-572.
Source
wos-lite
Published In
Acta ophthalmologica Scandinavica
Volume
85
Issue
5
Publish Date
2007
Start Page
571
End Page
572
DOI
10.1111/j.1600-0420.2007.00833.x

Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases.

PURPOSE: To evaluate the feasibility of genetic testing of uveal melanoma using fine-needle aspiration biopsy (FNAB). METHODS: Noncomparative case series of 140 patients in which FNAB was performed immediately prior to plaque radiotherapy. The specimen was sent for genetic analysis using DNA amplification and microsatellite assay for evaluation for monosomy 3. RESULTS: Monosomy 3 was found in 44 cases (32%) and disomy 3 in 76 cases (54%); genomic DNA yield was insufficient for genetic analysis in 20 cases (14%). Monosomy 3 was found in 26% of small melanomas (16/61), 36% of medium melanomas (24/67), and 33% of large melanomas (4/12). Adequate DNA was achieved in 97% of cases using a 27-gauge needle via transvitreal tumor apex approach and in 75% of cases using a 30-gauge needle via transscleral tumor base approach. Factors predictive of monosomy 3 included greater tumor basal dimension (P = .016) and greater distance from the optic disc (P = .019). Transient localized vitreous hemorrhage was found in 46% of eyes. There was no case of diffuse vitreous hemorrhage, retinal detachment, or tumor recurrence along the biopsy tract. CONCLUSIONS: FNAB provides adequate DNA in most cases for genetic analysis of uveal melanoma using microsatellite assay.

Authors
Shields, CL; Ganguly, A; Materin, MA; Teixeira, L; Mashayekhi, A; Swanson, LA; Marr, BP; Shields, JA
MLA Citation
Shields, CL, Ganguly, A, Materin, MA, Teixeira, L, Mashayekhi, A, Swanson, LA, Marr, BP, and Shields, JA. "Chromosome 3 analysis of uveal melanoma using fine-needle aspiration biopsy at the time of plaque radiotherapy in 140 consecutive cases." Transactions of the American Ophthalmological Society 105 (January 2007): 43-52.
PMID
18427593
Source
epmc
Published In
Transactions of the American Ophthalmological Society
Volume
105
Publish Date
2007
Start Page
43
End Page
52

Optical coherence tomography of retinal astrocytic hamartoma in 15 cases.

OBJECTIVE: To describe the features of retinal astrocytic hamartoma using optical coherence tomography (OCT). DESIGN: Retrospective, observational, noncomparative case series. PARTICIPANTS: Fifteen consecutive eyes from 14 patients with retinal astrocytic hamartoma. MAIN OUTCOME MEASURES: Optical coherence tomography characteristics of the tumor. RESULTS: The mean patient age at OCT was 33 years, and tuberous sclerosis was present in 3 patients (21%). By ophthalmoscopy, the mean basal diameter of the tumor was 3.6 mm. By OCT, the tumor showed hyperreflectivity at its surface, internal retinal disorganization, and a gradual gently sloping transition from a normal retina into a tumorous retina in all 15 cases (100%). By OCT, the retinal disorganization was limited to the inner retina in 3 (20%), outer retina in 0 (0%), full retina in 5 (33%), and inner retina with no view of deeper layers due to shadowing in 7 (47%). On OCT, there was mild retinal traction on the surface of the tumor in 4 (27%), discrete internal moth-eaten optically empty spaces representing intralesional calcification or intratumoral cavities in 10 (67%), and optical shadowing posterior to the tumor in 14 (93%). Other retinal findings on OCT included shallow elevation of the adjacent retina in 2 (13%), adjacent retinal edema in 4 (27%), and macular edema in 3 (20%). CONCLUSIONS: Retinal astrocytic hamartoma shows characteristic features on OCT, including a gradual transition from a normal retina into an optically hyperreflective mass with retinal disorganization, characteristic moth-eaten spaces, and posterior shadowing.

Authors
Shields, CL; Benevides, R; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Benevides, R, Materin, MA, and Shields, JA. "Optical coherence tomography of retinal astrocytic hamartoma in 15 cases." Ophthalmology 113.9 (September 2006): 1553-1557.
PMID
16949441
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
113
Issue
9
Publish Date
2006
Start Page
1553
End Page
1557
DOI
10.1016/j.ophtha.2006.03.032

Progressive enlargement of cavity within melanoma masquerading as iris cyst.

PURPOSE: To describe progressive enlargement of intralesional cavities within a mass that masqueraded clinically as an iris pigment epithelial cyst for 2 years but later proved to be a melanoma. METHODS: An 81-year-old woman developed asymptomatic focal elevation of the iris, and ultrasound biomicroscopy showed a fluid-filled mass that was interpreted as an iris pigment epithelial cyst. Over a 2-year period of observation, the cavity enlarged from 0.7 to 10 mm, and the solid component enlarged from approximately 6 to 16 mm basal dimension. RESULTS: On referral, visual acuity was 20/400 in the right eye and 20/25 in the left eye. The affected right eye displayed a pigmented mushroom-shaped ciliary body mass with anterior chamber invasion, distorting the pupil and occupying 40% of the anterior chamber. Ultrasound biomicroscopy and B-scan ultrasonography revealed many cavities within the 14-mm-thick mass, suggestive of ciliary body melanoma. After enucleation, histopathology disclosed multiple cavities, some with granular eosinophilic material, within a mushroom-shaped mixed-cell melanoma. CONCLUSION: Cavitation can occur in ciliary body melanoma and can lead to misinterpretation as a cyst. Cavitary melanoma should be considered in the differential diagnosis of cystic lesions of the anterior segment.

Authors
Criss, JS; Shields, CL; Materin, MA; Reichel, E; Eagle, RC; Shields, JA
MLA Citation
Criss, JS, Shields, CL, Materin, MA, Reichel, E, Eagle, RC, and Shields, JA. "Progressive enlargement of cavity within melanoma masquerading as iris cyst." Cornea 25.7 (August 2006): 863-865.
PMID
17068469
Source
epmc
Published In
Cornea
Volume
25
Issue
7
Publish Date
2006
Start Page
863
End Page
865
DOI
10.1097/01.ico.0000220771.96530.2e

Intravitreal triamcinolone acetonide for acute radiation papillopathy.

OBJECTIVE: To evaluate intravitreal triamcinolone acetonide for patients with visually symptomatic acute radiation-induced papillopathy. METHODS: In a prospective, nonrandomized, single-center case series, intravitreal triamcinolone acetonide (4 mg/0.1 mL) was injected through the pars plana using sterile technique in 9 patients with radiation papillopathy after plaque radiotherapy for choroidal melanoma. Status of radiation papillopathy and final visual acuity were the main outcome measures. RESULTS: At the time of diagnosis of the choroidal melanoma, visual acuity was 20/20 to 20/40 (n = 6), 20/60 (n = 2), and 20/100 (n = 1). The mean radiation dose to the optic disk was 6,175 cGy (median, 5,994 cGy; range, 3,571-12,760 cGy). Radiation papillopathy developed a mean of 18 months (median, 17 months; range, 6-33 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. Concomitant radiation maculopathy was found in 8 eyes manifesting as macular edema (n = 8), intraretinal dot hemorrhages (n = 6), intraretinal exudation (n = 6), or nerve fiber layer infarction (n = 3). The radiation papillopathy findings included optic disk hyperemia (n = 9), edema (n = 9), and circumpapillary hemorrhage (n = 8). At the time of diagnosis of radiation papillopathy, visual acuity was 20/70 (n = 1), 20/100 (n = 4), 20/200 (n = 1), and counting fingers (n = 3). At 1 week after injection of triamcinolone acetonide, visual acuity improvement was found in seven patients, and resolution of optic disk hyperemia and edema was noted for four and three patients, respectively. At a mean follow-up of 11 months (median, 9 months; range, 6-19 months), visual acuity was stable or improved in 7 patients, and resolution of optic disk hyperemia and edema was found in all 9 patients. The mean time to improvement in visual acuity by > or =2 lines was 3 weeks (median, 1 week; range, 1-12 weeks). The mean time to complete resolution of radiation papillopathy was 4 months. The two patients with worse final visual acuity also had macular hole and central retinal vein obstruction. The only complication of this therapy was possibly related cataract in three patients. CONCLUSION: During short-term follow-up, acute radiation-induced papillopathy appears to respond rapidly to intravitreal triamcinolone acetonide injection with resolution of optic disk hyperemia and edema and modest return of visual acuity. The long-term effects remain unknown.

Authors
Shields, CL; Demirci, H; Marr, BP; Mashayekhi, A; Dai, VV; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Demirci, H, Marr, BP, Mashayekhi, A, Dai, VV, Materin, MA, and Shields, JA. "Intravitreal triamcinolone acetonide for acute radiation papillopathy." Retina (Philadelphia, Pa.) 26.5 (May 2006): 537-544.
PMID
16770260
Source
epmc
Published In
Retina
Volume
26
Issue
5
Publish Date
2006
Start Page
537
End Page
544
DOI
10.1097/00006982-200605000-00007

Photoreceptor loss overlying congenital hypertrophy of the retinal pigment epithelium by optical coherence tomography.

OBJECTIVE: To describe the cross-sectional retinal anatomy overlying congenital hypertrophy of the retinal pigment epithelium (CHRPE) using optical coherence tomography (OCT). DESIGN: Retrospective, observational, noncomparative case series. PARTICIPANTS: Ten consecutive patients with CHRPE. MAIN OUTCOME MEASURES: The main outcome measures were retinal and retinal pigment epithelium (RPE) thickness relative to normal tissue and the status of the retinal layers, in particular the photoreceptor layer. RESULTS: The median patient age was 36 years (mean, 34 years; range, 7-56 years). The CHRPE was within 6 mm of the optic disc or foveola in all patients. All patients showed retinal thinning and complete photoreceptor loss overlying the CHRPE. The sensory retina measured a mean of 68% of normal thickness (range, 47%-87%). Of the 8 patients with pigmented CHRPE, the CHRPE was 52% thicker than adjacent RPE. All 8 patients with pigmented CHRPE showed moderate relative shadowing of the underlying choroid. The 2 patients with nonpigmented CHRPE, presumed to represent large lacunae with thin CHRPE rim, showed absent RPE and increased transmission of light, not shadowing, into the choroid by OCT. Both patients with visual field testing showed a visual field defect corresponding to the photoreceptor loss. CONCLUSIONS: Using OCT, overlying retinal thinning and photoreceptor loss directly over CHRPE was found in 10 consecutive patients. These findings likely account for related visual field loss.

Authors
Shields, CL; Materin, MA; Walker, C; Marr, BP; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Walker, C, Marr, BP, and Shields, JA. "Photoreceptor loss overlying congenital hypertrophy of the retinal pigment epithelium by optical coherence tomography." Ophthalmology 113.4 (April 2006): 661-665.
PMID
16581426
Source
epmc
Published In
Ophthalmology: Journal of The American Academy of Ophthalmology
Volume
113
Issue
4
Publish Date
2006
Start Page
661
End Page
665
DOI
10.1016/j.ophtha.2005.10.057

Optical coherence tomographic findings of combined hamartoma of the retina and retinal pigment epithelium in 11 patients.

Authors
Shields, CL; Mashayekhi, A; Dai, VV; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Mashayekhi, A, Dai, VV, Materin, MA, and Shields, JA. "Optical coherence tomographic findings of combined hamartoma of the retina and retinal pigment epithelium in 11 patients." Archives of ophthalmology (Chicago, Ill. : 1960) 123.12 (December 2005): 1746-1750.
PMID
16344451
Source
epmc
Published In
Archives of Ophthalmology
Volume
123
Issue
12
Publish Date
2005
Start Page
1746
End Page
1750
DOI
10.1001/archopht.123.12.1746

Restoration of foveal anatomy and function following chemoreduction for bilateral advanced retinoblastoma with total retinal detachment.

Authors
Shields, CL; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Materin, MA, and Shields, JA. "Restoration of foveal anatomy and function following chemoreduction for bilateral advanced retinoblastoma with total retinal detachment." Archives of ophthalmology (Chicago, Ill. : 1960) 123.11 (November 2005): 1610-1612.
PMID
16286630
Source
epmc
Published In
Archives of Ophthalmology
Volume
123
Issue
11
Publish Date
2005
Start Page
1610
End Page
1612
DOI
10.1001/archopht.123.11.1610

Retinal racemose hemangioma.

Authors
Materin, MA; Shields, CL; Marr, BP; Demirci, H; Shields, JA
MLA Citation
Materin, MA, Shields, CL, Marr, BP, Demirci, H, and Shields, JA. "Retinal racemose hemangioma." Retina (Philadelphia, Pa.) 25.7 (October 2005): 936-937.
PMID
16205575
Source
epmc
Published In
Retina
Volume
25
Issue
7
Publish Date
2005
Start Page
936
End Page
937
DOI
10.1097/00006982-200510000-00018

Intravitreal triamcinolone acetonide for radiation maculopathy after plaque radiotherapy for choroidal melanoma.

OBJECTIVE: To evaluate the effect of intravitreal triamcinolone acetonide on patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma. DESIGN: In this prospective, nonrandomized, single-center case series of 31 patients with visually symptomatic radiation-induced maculopathy after plaque radiotherapy for choroidal melanoma at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, triamcinolone acetonide (4 mg/1 mL) was injected through the pars plana into the vitreous cavity using sterile technique. Status of radiation maculopathy and final visual acuity were the main outcome measures. RESULTS: At the time of diagnosis of choroidal melanoma, visual acuity was 20/20 to 20/50 in 90% (n = 28), 20/60 to 20/200 in 10% (n = 3), and 20/400 or worse in none of the patients. The mean radiation dose to the foveola was 5,122 cGy (median, 3,280 cGy; range, 1,000-16,100 cGy). Radiation maculopathy developed at a mean of 22 months (median, 16 months; range, 6-96 months) after plaque radiotherapy. In all cases, the choroidal melanoma was regressed, and there was no retinal detachment or neovascularization of the retina, optic disk, or iris. At the time of diagnosis of radiation maculopathy, visual acuity was 20/20 to 20/50 in 19% (6/31), 20/60 to 20/200 in 58% (18/31), and 20/400 or worse in 23% (7/31) of patients. After intravitreal injection of triamcinolone acetonide, visual acuity was stable or improved in 91% (20/22) of patients by 1 month and 45% (14/31) by 6 months. Mean foveal thickness by optical coherence tomography was 417 microm at injection and 207 microm at 1 month and 292 microm at 6 months after injection. CONCLUSIONS: Intravitreal triamcinolone acetonide can stabilize or improve visual acuity in some patients with radiation-induced maculopathy, but its effect might not be lasting.

Authors
Shields, CL; Demirci, H; Dai, V; Marr, BP; Mashayekhi, A; Materin, MA; Manquez, ME; Shields, JA
MLA Citation
Shields, CL, Demirci, H, Dai, V, Marr, BP, Mashayekhi, A, Materin, MA, Manquez, ME, and Shields, JA. "Intravitreal triamcinolone acetonide for radiation maculopathy after plaque radiotherapy for choroidal melanoma." Retina (Philadelphia, Pa.) 25.7 (October 2005): 868-874.
PMID
16205566
Source
epmc
Published In
Retina
Volume
25
Issue
7
Publish Date
2005
Start Page
868
End Page
874
DOI
10.1097/00006982-200510000-00009

Changing concepts in management of circumscribed choroidal hemangioma: The 2003 J. Howard Stokes lecture, part 1

BACKGROUND AND OBJECTIVE: To review trends in the management of circumscribed choroidal hemangioma (CCH) and to propose treatment guidelines based on review of recent literature and the authors' personal experience with more than 250 cases. METHOD: The English-language literature on the management of CCH was reviewed, with emphasis on changing concepts in recent years. RESULTS: Xenon arc and argon laser photocoagulation and thermotherapy have been used to treat CCH with localized retinal detachment, but there has recently been enthusiasm for photodynamic therapy (PDT) using fluorescein angiography and optical coherence tomography to monitor subretinal fluid and cystoid retinal edema before and after treatment. Tumors with extensive retinal detachment have been managed by surgical attempts at retinal reattachment followed by photocoagulation or cryotherapy, and more recently by radiotherapy. Management currently includes observation, argon laser photocoagulation, transpupillary thermotherapy, PDT, and radiotherapy. Enucleation may be necessary in rare cases. The goal of treatment should be to induce resolution of existing retinal detachment and to improve or stabilize visual loss. CONCLUSIONS: There is increasing use of PDT for CCH with localized retinal detachment and radiotherapy for CCH with more extensive detachment. Although follow-up is short, current methods may achieve better tumor control and better visual outcome. However, caution is advised because long-term follow-up is still not available.

Authors
Shields, JA; Shields, CL; Materin, MA; Marr, BP; Demirci, H; Mashayekhi, A
MLA Citation
Shields, JA, Shields, CL, Materin, MA, Marr, BP, Demirci, H, and Mashayekhi, A. "Changing concepts in management of circumscribed choroidal hemangioma: The 2003 J. Howard Stokes lecture, part 1." Ophthalmic Surgery and Lasers 35.5 (September 1, 2005): 383-394. (Review)
Source
scopus
Published In
Ophthalmic surgery and lasers
Volume
35
Issue
5
Publish Date
2005
Start Page
383
End Page
394

Review of optical coherence tomography for intraocular tumors.

PURPOSE OF REVIEW: Optical coherence tomography has assumed an important role in the management of numerous ocular conditions. With regard to ocular oncology, optical coherence tomography can illustrate retinal changes overlying choroidal tumors. Some of these features include photoreceptor loss, intraretinal edema, and retinal thinning overlying choroidal nevus; fresh subretinal fluid with preservation of photoreceptors overlying choroidal melanoma; and intraretinal edema, retinoschisis, and retinal thinning overlying irradiated choroidal melanoma. RECENT FINDINGS: The optical coherence tomography features of tumors of the retinal pigment epithelium include typical findings of peaked vitreoretinal traction and retinal disorganization with combined hamartoma of the retina and retinal pigment epithelium, full-thickness retinal shadowing with congenital simple hamartoma, and photoreceptor loss and retinal thinning overlying congenital hypertrophy of the retinal pigment epithelium. SUMMARY: Optical coherence tomography of retinal tumors, such as retinoblastoma and astrocytic hamartoma, reveals full-thickness replacement of the retinal anatomic layers with the tumor and shadowing corresponding to the intralesional calcification. For all intraocular tumors, optical coherence tomography provides valuable information regarding the status of the retina and the retinal pigment epithelium and can be useful in ascertaining reasons for visual loss.

Authors
Shields, CL; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Materin, MA, and Shields, JA. "Review of optical coherence tomography for intraocular tumors." Current opinion in ophthalmology 16.3 (June 2005): 141-154. (Review)
PMID
15870570
Source
epmc
Published In
Current Opinion in Ophthalmology
Volume
16
Issue
3
Publish Date
2005
Start Page
141
End Page
154
DOI
10.1097/01.icu.0000158258.01681.40

Resolution of advanced cystoid macular edema following photodynamic therapy for choroidal hemangioma.

A 45-year-old man was referred for 2 months of decreasing vision in his left eye. His visual acuity was 20/200 secondary to a subtle juxtapapillary choroidal hemangioma producing profound cystoid macular edema, with the affected retina measuring 330 microns thick by optical coherence tomography. Due to the severe cystoid macular edema, visual prognosis was judged to be poor. One month following photodynamic therapy to the tumor using verteporfin, the cystoid macular edema completely resolved, foveal anatomy returned to normal, optical coherence tomography thickness was 179 microns, and visual acuity recovered to 20/25. Photodynamic therapy of choroidal hemangioma may be effective in resolving associated cystoid macular edema and improving visual acuity.

Authors
Shields, CL; Materin, MA; Marr, BPF; Mashayekhi, A; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Marr, BPF, Mashayekhi, A, and Shields, JA. "Resolution of advanced cystoid macular edema following photodynamic therapy for choroidal hemangioma." Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye 36.3 (May 2005): 237-239.
PMID
15957481
Source
epmc
Published In
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Volume
36
Issue
3
Publish Date
2005
Start Page
237
End Page
239

Optical coherence tomography of choroidal nevus in 120 patients.

OBJECTIVE: To describe the optical coherence tomography (OCT) findings of choroidal nevi. METHODS: Retrospective, single-center case series of 120 eyes of 120 consecutive patients with choroidal nevi who were evaluated by OCT. Diagnostic imaging was performed with a Zeiss StratusOCT Model 3000 (Carl Zeiss Ophthalmic Systems, Dublin, CA) using scan acquisition protocols of 6 radial lines and retinal thickness analysis overlying the nevus. RESULTS: The mean patient age was 59 years (median, 60 years; range, 14-87 years). The choroidal nevus was a mean of 5.2 mm in basal dimension and 1.7 mm in thickness and was located a mean of 2.7 mm from the optic disk and 2.5 mm from the foveola. Related retinal findings by ophthalmoscopic evaluation included overlying retina edema (3%), subretinal fluid (16%), retinal thinning (0%), drusen (58%), and retinal pigment epithelium (RPE) detachment (2%). In comparison, related retinal findings at the site of the nevus by OCT included overlying retina edema (15%), subretinal fluid (26%), retinal thinning (22%), drusen (41%), and RPE detachment (12%). Furthermore, OCT permitted classification of the overlying retinal edema as focal cystoid (3%), diffuse cystoid (8%), coalescent cystoid (3%), and noncystoid edema (1%). By OCT, the overlying retina was normal thickness (32%), thinned (22%), or thickened (45%), and photoreceptor loss or attenuation was noted in 51% of cases. Specific OCT findings of the choroidal nevus were limited to its anterior surface with minimal penetration into the mass. These findings included increased thickness of the RPE/choriocapillaris layer (68%) and optical qualities within the anterior portion of the nevus of hyporeflectivity (62%), isoreflectivity (29%), and hyperreflectivity (9%). Hyporeflectivity was observed in 68% of pigmented nevi and 18% of nonpigmented nevi. When comparing OCT with clinical examination, OCT was more sensitive in the detection of related retinal edema, subretinal fluid, retinal thinning, photoreceptor attenuation, and RPE detachment. CONCLUSIONS: OCT is a useful diagnostic modality for imaging the retina overlying a choroidal nevus. Numerous overlying changes such as subretinal fluid, retinal edema, retinal thinning, and photoreceptor attenuation are visible by OCT.

Authors
Shields, CL; Mashayekhi, A; Materin, MA; Luo, CK; Marr, BP; Demirci, H; Shields, JA
MLA Citation
Shields, CL, Mashayekhi, A, Materin, MA, Luo, CK, Marr, BP, Demirci, H, and Shields, JA. "Optical coherence tomography of choroidal nevus in 120 patients." Retina (Philadelphia, Pa.) 25.3 (April 2005): 243-252.
PMID
15805899
Source
epmc
Published In
Retina
Volume
25
Issue
3
Publish Date
2005
Start Page
243
End Page
252
DOI
10.1097/00006982-200504000-00001

Expanding MIRAgel scleral buckle simulating an orbital tumor in four cases.

PURPOSE: To describe four patients with an enlarging orbital mass from a swollen MIRAgel scleral buckle that simulated an orbital neoplasm. METHODS: In a retrospective, single-center case series at the Ocular Oncology Service at Wills Eye Hospital of Thomas Jefferson University, 4 eyes of 4 patients were referred for evaluation and treatment of a suspected orbital tumor. RESULTS: The initial presenting features were orbital mass (case 1), strabismus (case 2), and conjunctival mass with orbital extension (cases 3 and 4). Each patient vaguely recalled previous uncomplicated retinal detachment surgery 12 to 20 years earlier. Confirmation of the buckling implant material was made with the retina surgeon in 3 cases. A nontender, forniceal conjunctival mass, deep to the Tenon fascia and appearing as a translucent firm elevation was seen in all 4 cases. Axial CT (case 1) revealed a circumscribed anterior temporal orbital mass, believed to be a large inclusion cyst, 4 times thicker than the nasal scleral buckle. Ocular ultrasonography depicted an echolucent mass in the episcleral region (cases 3 and 4) that was 2 times thicker than the nasal scleral buckle (case 3). Excision was attempted in case 1, but only piecemeal removal was achieved, leading to extensive postoperative inflammation and decreased vision. The other 3 cases were followed conservatively without excision because they were each recognized to be a swollen MIRAgel implant and not an orbital tumor. CONCLUSIONS: MIRAgel scleral buckle material can greatly enlarge over a period of 10 years and simulate an orbital tumor or orbital cyst. Patients often do not recall details of the retinal surgery. Caution is advised regarding excision of this material because it is friable and can lead to extensive postoperative inflammation.

Authors
Shields, CL; Demirci, H; Marr, BP; Mashayekhi, A; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Demirci, H, Marr, BP, Mashayekhi, A, Materin, MA, and Shields, JA. "Expanding MIRAgel scleral buckle simulating an orbital tumor in four cases." Ophthalmic plastic and reconstructive surgery 21.1 (January 2005): 32-38.
PMID
15677950
Source
epmc
Published In
Ophthalmic Plastic and Reconstructive Surgery
Volume
21
Issue
1
Publish Date
2005
Start Page
32
End Page
38
DOI
10.1097/01.iop.0000148409.31127.f5

Optical coherence tomography of tumors of the retina and retinal pigment epithelium

Authors
Rodrigues, EB; Shields, CL; Materin, MA; Shields, JA
MLA Citation
Rodrigues, EB, Shields, CL, Materin, MA, and Shields, JA. "Optical coherence tomography of tumors of the retina and retinal pigment epithelium." 2005.
Source
wos-lite
Published In
Investigative Ophthalmology and Visual Science
Volume
46
Publish Date
2005

Optical coherence tomography in children: analysis of 44 eyes with intraocular tumors and simulating conditions.

PURPOSE: To investigate the role of optical coherence tomography (OCT) in the evaluation of fundus tumors and simulating lesions in children. PATIENTS AND METHODS: We report the results of a retrospective single-center case series of 44 eyes of 44 children younger than age 18 with fundus lesions who were evaluated with OCT. In comparison, 12 eyes of 12 children with a normal macula were evaluated with OCT. Main outcome measures were cooperation of children while undergoing OCT and correlation of OCT findings with clinical and ultrasonographic findings RESULTS: The OCT was performed without difficulty in all 56 children. Mean patient age was 12 years (median, 12 years; range, 4 to 17 years). The mean horizontal foveal thickness in the 12 normal eyes was 137 microm (median, 132 microm; range, 109 to 185 microm). Clinical diagnoses included retinoblastoma in 10 (23%) eyes, Coats' disease in 4 (9%) eyes, retinal capillary hemangioma in 3 (7%) eyes, astrocytic hamartoma of the retina in 3 (7%) eyes, toxocara granuloma in 2 (5%) eyes, and others. OCT was more sensitive than clinical examination in detection of macular pathology including shallow posterior vitreous detachment, surface wrinkling maculopathy, cystoid and noncystoid macular edema, subfoveal fluid, and retinal thinning. In comparison to ultrasonography, OCT was more sensitive in detection of surface wrinkling maculopathy, macular edema, and subfoveal fluid. Ultrasonography was more sensitive in detection of posterior vitreous detachment. CONCLUSIONS: OCT is a useful and well-tolerated diagnostic modality for macular evaluation in children. It is more sensitive than clinical examination and ultrasonography in the detection of surface wrinkling maculopathy, macular edema, and subfoveal fluid.

Authors
Shields, CL; Mashayekhi, A; Luo, CK; Materin, MA; Shields, JA
MLA Citation
Shields, CL, Mashayekhi, A, Luo, CK, Materin, MA, and Shields, JA. "Optical coherence tomography in children: analysis of 44 eyes with intraocular tumors and simulating conditions." Journal of pediatric ophthalmology and strabismus 41.6 (November 2004): 338-344.
PMID
15609518
Source
epmc
Published In
Journal of pediatric ophthalmology and strabismus
Volume
41
Issue
6
Publish Date
2004
Start Page
338
End Page
344

Changing concepts in management of circumscribed choroidal hemangioma: the 2003 J. Howard Stokes Lecture, Part 1.

BACKGROUND AND OBJECTIVE: To review trends in the management of circumscribed choroidal hemangioma (CCH) and to propose treatment guidelines based on review of recent literature and the authors' personal experience with more than 250 METHOD: The English-language literature on the management of CCH was reviewed, with emphasis on changing concepts in recent years. RESULTS: Xenon arc and argon laser photocoagulation and thermotherapy have been used to treat CCH with localized retinal detachment, but there has recently been enthusiasm for photodynamic therapy (PDT) using fluorescein angiography and optical coherence tomography to monitor subretinal fluid and cystoid retinal edema before and after treatment. Tumors with extensive retinal detachment have been managed by surgical attempts at retinal reattachment followed by photocoagulation or cryotherapy, and more recently by radiotherapy. Management currently includes observation, argon laser photocoagulation, transpupillary thermotherapy, PDT, and radiotherapy. Enucleation may be necessary in rare cases. The goal of treatment should be to induce resolution of existing retinal detachment and to improve or stabilize visual loss. CONCLUSIONS: There is increasing use of PDT for CCH with localized retinal detachment and radiotherapy for CCH with more extensive detachment. Although follow-up is short, current methods may achieve better tumor control and better visual outcome. However, caution is advised because long-term follow-up is still not available.

Authors
Shields, JA; Shields, CL; Materin, MA; Marr, BP; Demirci, H; Mashayekhi, A
MLA Citation
Shields, JA, Shields, CL, Materin, MA, Marr, BP, Demirci, H, and Mashayekhi, A. "Changing concepts in management of circumscribed choroidal hemangioma: the 2003 J. Howard Stokes Lecture, Part 1." September 2004.
PMID
15497549
Source
epmc
Published In
Ophthalmic surgery, lasers & imaging : the official journal of the International Society for Imaging in the Eye
Volume
35
Issue
5
Publish Date
2004
Start Page
383
End Page
394

Clinical factors in the identification of small choroidal melanoma.

The detection and treatment of choroidal melanoma early in its natural course is critical to providing the patient with the best prognosis. Studies of tumour doubling time have indicated that metastasis from choroidal melanoma can occur quite early in the course of the disease, when the tumour is about 3.0 mm in basal dimension and 1.5 mm in thickness. Clinical studies have shown that, at 5 years, metastasis occurs in 16% of patients with small choroidal melanomas (less than 4 mm thick), compared with 32% of those with medium-sized (4-8 mm thick) choroidal melanomas and 53% of those with large (more than 8 mm thick) choroidal melanomas. The difficulty with early detection of choroidal melanoma relates to its clinical similarity to benign choroidal nevus. Factors that assist in differentiating small choroidal melanoma from choroidal nevus can be remembered using the mnemonic "TFSOM" (to find small ocular melanoma), where T = thickness greater than 2 mm, F = subretinal fluid, S = symptoms, O = orange pigment and M = margin touching optic disc. Choroidal melanocytic tumours that display none of these factors have a 3% risk of growth into melanoma at 5 years and most likely represent choroidal nevi. Tumours that display one factor have a 38% risk of growth, and those with two or more factors show growth in over 50% of cases. Most tumours with two or more risk factors probably represent small choroidal melanomas, and early treatment is generally indicated. Therefore, ophthalmologists should be aware of the clinical factors that identify small choroidal melanoma so that early treatment and better prognosis can be achieved for their patients.

Authors
Shields, CL; Demirci, H; Materin, MA; Marr, BP; Mashayekhi, A; Shields, JA
MLA Citation
Shields, CL, Demirci, H, Materin, MA, Marr, BP, Mashayekhi, A, and Shields, JA. "Clinical factors in the identification of small choroidal melanoma." Canadian journal of ophthalmology. Journal canadien d'ophtalmologie 39.4 (June 2004): 351-357. (Review)
PMID
15327099
Source
epmc
Published In
Canadian journal of ophthalmology. Journal canadien d'ophtalmologie
Volume
39
Issue
4
Publish Date
2004
Start Page
351
End Page
357

Optical coherence tomography of congenital simple hamartoma of the retinal pigment epithelium.

Authors
Shields, CL; Materin, MA; Karatza, EC; Shields, JA
MLA Citation
Shields, CL, Materin, MA, Karatza, EC, and Shields, JA. "Optical coherence tomography of congenital simple hamartoma of the retinal pigment epithelium." Retina (Philadelphia, Pa.) 24.2 (April 2004): 327-328.
PMID
15097907
Source
epmc
Published In
Retina
Volume
24
Issue
2
Publish Date
2004
Start Page
327
End Page
328
DOI
10.1097/00006982-200404000-00031

Factors associated with elevated intraocular pressure in eyes with iris melanoma.

AIM: To identify clinical factors associated with secondary elevated intraocular pressure (IOP) in eyes with iris malignant melanoma METHODS: A retrospective case series of 169 consecutive patients with microscopically confirmed iris malignant melanoma. The main outcome measure was the presence of tumour induced secondary elevated IOP. Cox proportional regression models were used to calculate the relation of clinical features to elevated IOP. RESULTS: Of 169 patients with microscopically proved iris melanoma, 50 (30%) presented with tumour induced secondary elevated IOP. The mean pressure in those eyes with elevated IOP at diagnosis was 33 mm Hg (median 31 mm Hg, range 23-65 mm Hg). The tumour configuration was nodular in 23 (46%) and diffuse in 27 (54%) with a mean base dimension of 7.4 mm and thickness of 2.0 mm. Invasion of the angle structures by melanoma seeds was visible for a mean of 7 clock hours (median 7, range 0-12 clock hours). The mechanism of elevated IOP was judged to be outflow obstruction from tumour invasion into the trabecular meshwork. There were no cases of neovascular glaucoma. The tumour was ultimately managed with enucleation in 30 patients (60%), local resection (iridectomy, iridocyclectomy, or iridocyclogoniectomy) in 11 (22%), and plaque radiotherapy in five (10%). In four cases (8%), observation of cytologically low grade tumour was the patient's preference. Using multivariate analysis, the clinical factors at initial evaluation associated with tumour induced secondary elevated IOP from iris melanoma included increasing extent of tumour seeding in the anterior chamber angle (p=0.01) and poor visual acuity at presentation (p=0.02). CONCLUSIONS: Microscopically confirmed iris melanoma demonstrates tumour related elevated IOP in 30% cases at the time of presentation, usually secondary to tumour involvement of the trabecular meshwork obstructing aqueous outflow. Enucleation is necessary in the majority of these patients (60%) as opposed to those cases without elevated intraocular pressure (18%).

Authors
Shields, CL; Materin, MA; Shields, JA; Gershenbaum, E; Singh, AD; Smith, A
MLA Citation
Shields, CL, Materin, MA, Shields, JA, Gershenbaum, E, Singh, AD, and Smith, A. "Factors associated with elevated intraocular pressure in eyes with iris melanoma." The British journal of ophthalmology 85.6 (June 2001): 666-669.
PMID
11371484
Source
epmc
Published In
British Journal of Ophthalmology
Volume
85
Issue
6
Publish Date
2001
Start Page
666
End Page
669
DOI
10.1136/bjo.85.6.666

Diffuse infiltrating retinoblastoma simulating uveitis in a 7-year-old boy.

Authors
Materin, MA; Shields, CL; Shields, JA; Eagle, RC
MLA Citation
Materin, MA, Shields, CL, Shields, JA, and Eagle, RC. "Diffuse infiltrating retinoblastoma simulating uveitis in a 7-year-old boy." Archives of ophthalmology (Chicago, Ill. : 1960) 118.3 (March 2000): 442-443.
PMID
10721979
Source
epmc
Published In
Archives of Ophthalmology
Volume
118
Issue
3
Publish Date
2000
Start Page
442
End Page
443
DOI
10.1001/archopht.118.3.442
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