Objective To isolate and purify the melanoma stem cells (MSC) in choroidal melanoma OCM-1 cells. Methods OCM-1 cells were resuscitated, and after cultured in standard Dubecco's modifided Eagle's medium (DMEM)/F12, they were cultured in serum-free medium (SFM). The cultured MSC were isolated and purified, and the positive rate of CD133, the specific markers of neurostem cells, was observed by flow cytometry (FCM). The 6th generation of the cells were stained by musashi-1 immunocytochemistry, and the rate of the positive cells was observed under the microscope. Results After the Adherent OCM-1 cells cultured in SFM, the number of the adherent number decreased obviously. The cells at the 6th generation grew as the suspended gobbets, which represented the typical grow manner of the stem cells. Positive CD133 could be found in the cells of different generations, which was 2.5％, 21.7％, and 57.8％ in the non-isolated OCM-1 cells, the 1st generation of isolated cells, and the 2nd generation cells, respectively. The positive rate of CD133 in the cells at the sixth generation was 79.8% with b positive expression of musashi-1. Conclusion MSC is in the human choroidal melanoma OCM-1 cells. The suspended stem cells may be purified by limited differentiation and serial passage in SFM. (Chin J Ocul Fundus Dis, 2007, 23: 87-90)
Objective To explore the clinicopathological features and misdiagnosed causes of choroidal hemangioma. Methods Seven misdiagnosed cases(7eyes) of choroidal hemangioma,which were enucleated,were analysed retrospectively. Results One of the 7 cases was misdiagnosed as absolute phase of the secondary glaucoma,and 6 of them as choroidal melanoma before the enucleation.The majority of cases in this series manifested themselves clinically and pathologically in progressive loss of visual acuity and a flat elevated tumor located at the posterior ocular fundus near the optic disc and associated with exudative retinal detachment.And also there were occasionally small focal or linear pigmentary deposites obser ved on the surface of the neoplasm. Conclusion A flat elevated discoid tumor in the posterior fundus with extensive exudative retinal detachment might be a clinicopathological feature of the choroidal hema ngioma. (Chin J Ocul Fundus Dis,1999,15:91-93)
ObjectiveTo explore the therapeutic effect of transpupillary thermotherapy (TTT) on patient with circumscribed choroidal hemangioma (CCH). MethodsThe clinical data of 16 patients (16 eyes) with circumscribed choroidal hemangioma (CCH) from December 2011 to December 2012, which had been diagnosed by clinical general examination, fundus fluorescein angiography (FFA), and B-scanning ultrasound examination were retrospectively analyzed. The follow-up period was 6-24 months (mean 14 months). ResultsAmong the 8 eyes with peripheral retinal detachment in 16 cases of CCH, the peripheral subretinal fluid was completely absorbed in 6 eyes, and partially absorbed in 2 eyes after TTT. The resultant visual acuity after treatment improved in 12 eyes, and maintained no change in 4 eyes. The results of B-scanning ultrasound examination showed that the thickness of tumor went down in 12 eyes obviously. The results of FFA revealed a significant decrease of the leakage in tumor in all of 16 cases and no complication was observed. ConclusionTTT is an effective therapy for CCH.
Intraocular tumors is a serious blinding eye disease, which has a serious impact on patients' vision and even life. At present, the main treatments include surgical treatment, radiation therapy, chemotherapy, laser therapy and combination therapy. In recent years, with the wide application of anti-vascular endothelial growth factor (VEGF) in the treatment of ocular diseases, many studies have confirmed that anti-VEGF drugs play an important auxiliary role in the treatment of intraocular tumors and its complications. In terms of the therapeutic effect, intravitreal anti-VEGF combined with other methods have a good prognosis in the treatment of choroidal metastatic carcinoma and retinoblastoma, while the therapeutic effect of uveal melanoma is still controversial. In the treatment of intraocular tumor complications, intravitreal anti-VEGF also has a good effect on the secondary lesions of choroidal osteoma and radiation retinopathy. As for drug safety, intravitreal anti-VEGF can significantly reduce the toxic and side effects of systemic chemotherapeutic therapy. However, the dosage and medication regimen of anti-VEGF drugs in the treatment of intraocular tumors and their complications have not been unified in current studies, and further basic and clinical trials are still needed to explore in the future.
ObjectiveTo observe the OCT angiography (OCTA) imaging features of isolated choroidal hemangioma (CCH).MethodsA retrospective case study. From January 2017 to February 2019, 18 CCH patients (18 eyes) diagnosed in the Affiliated Eye Hospital of Nanjing Medical University were included in the study. There were 13 males (13 eyes) and 5 females (5 eyes), with the mean age of 44.5 years. All the tumors were orange-red, with clear boundaries, located at the posterior pole or around the optic disc. OCTA was used to scan the 6 mm×6 mm of macular area or in the range of 6 mm×6 mm. After automatic image processing, the system provided the blood flow map of shallow capillary plexus, deep capillary plexus, outer retina and choroidal capillary plexus, as well as the corresponding structure en-face image and B-scan image.ResultsOCTA examination found that when the stratification line was adjusted to the periphery of the choroidal capillary layer, the blood flow map showed clear boundary of the tumor, and the blood vessels on the surface of the tumor presented a network crisscross with different thickness. B-scan image showed that the whole layer of retinal choroid at the tumor presented a dome-shaped uplift, and the neurocortical layer could be accompanied by thickening, subretinal effusion, exudation and splitting. En-face image showed that the boundary of the tumor was clear, the surrounding exudation was strong reflection in spots or patches, local pigmentation showed weak reflection, and the signal reflection was uneven.ConclusionOCTA can clearly show the vascular morphology on the surface of CCH.
Objective To evaluate the efficacy of transpupillary thermotherapy（TTT）on three kinds of intraocular benign tumors. Methods Seventeen patients with 3 kinds of intraocular tumors，3 eyes of 3 patients with papillary hemangioma，9 eyes of 9 patients with choroidal hemangioma and 8 eyes of 5 patients with choroidal osteoma were treated with transpupillary thermotherapy.All patients underwent pretreatment ocular examination，including visual acuity，biomicroscopy for anterior segment and fundus examination，fundus fluorescein and indocyanine green angiography，optic coherence tomography，perimetry test，ultrasonography，and CT.TTT was conducted with infrared diode laser at810nm.with power of 360-1200 mW;beam diameter of 3 mm or combined 2-5 spots according to the tumor size;the exposure time was 60-80 seconds.The treatment was completed in one session，and another treatment was given 1-3 month later if active leakage demonstrated.The follow-up period was 6-36 months（mean 14.5 month）. Results The best corrected visual acuity with Snellen chart on average for papillary hemangioma was 0.17 before TTT and 0.27 after;for choroidal hemangioma was 0.39 before TTT and 0.46 after;for choroidal osteoma was 0.20 before TTT and 0.31 after.Three eyes with papillary hemangioma had operation to release subretinal fluid and intraocular laser coagulation;the tumor remained reddish color with dilated vessels and patches of hemorrhages on the surface.After TTT the color appeared pale yellowish，hemorrhages absorbed，subretinal fluid subsided，and choroidal retinal atrophy disclosed along the lower border of the tumor.In 9 eyes with choroidal hemangioma, the red-light area disappeared, subretinal fluid subsided, and the pigment proliferation in the treatment area was found.Eight eyes with choroidal osteoma had choroidal neovessels and macular hemorrhages;after TTT blood disappeared，subretinal fluid absorbed，and the color of tumor showed pale yellow with dark pigment and thin scar tissue.There was no significant complication associated with TTT. Conclusions Transpupillary thermotherapy is effective on papillary hemangioma，circumscribed choroidal hemangioma and choroidal osteoma either as preliminary or supplementary treatment. (Chin J Ocul Fundus Dis, 2006, 22:181-184)
Objective To observe the therapeutic efficacy and complications of plaque radiotherapy (PRT) combined with transpupillary thermotherapy (TTT) on choroidal melanoma (CM). Methods Thirty unilateral CM patients (30 eyes, including 15 males and 15 females) were treated by PRT and TTT. The visual acuity ranged from 0.1 to 0.8 with an average of 0.3plusmn;0.2. The largest base diameter of tumor ranged from 6.8 mm to 17.9 mm with an average of (11.3plusmn;2.8) mm；The tumor height ranged from 3.9 mm to 10.6 mm with an average of (7.2plusmn;2.4) mm. The criteria of controlled local tumor: based on B-scan ultrasound measurement, the tumor was considered as ldquo;growingrdquo; if tumor height increased 2 mm or tumor largest base diameter increased 250 mu;m, otherwise the tumor was considered ldquo;controlledrdquo;. The followup ranged from 15 to 57 months with an average (33.01plusmn;9.81) months. The local tumor control rate, enucleation rate and visual acuity, complications after treatment were observed.Results The tumor largest base diameter after treatment ranged from 4.6 mm to 17.0 mm with an average (9.79plusmn;3.35) mm, which had statistically significant difference（t=2.195，F=0.49；P=0.032) with that before treatment. The tumor height after treatment ranged from 2.7 mm to 11.9 mm with an average (5.19plusmn;2.57) mm, which had statistically significant difference（t=2.069，F=0.018；P=0.0435) with that before treatment. At the end of follow up, the tumor largest diameter and height increased in two eyes respectively compared with those before treatment. Local tumor control rate was 86.7%. Three eyeballs were enucleated after treatment，the enucleation rate was 10.0%. The visual acuity remained unchanged in 12 eyes，improved in one eye and decreased in 17 eyes. Treatment complications included radiation retinopathy in 12 eyes (40.0%), secondary retinal detachment in three eyes (10.0%), secondary glaucoma in one eye (3.3%), cataract in four eyes (13.3%) and dry eye syndrome in five eyes (16.7%). Conclusion PRT combined with TTT is an effective therapy for choroidal melanoma with less complications.
Objective To observe the macular morphological changes of choroidal melanoma with coherence tomography (OCT) after plaque radiotherapy (PRT). Methods A total of 48 patients (48 eyes) with choroidal melanoma who underwent125I PRT were enrolled in this study. All the patients were examined documenting OCT to get the image of macula. The macula of all the patients was not involved. The median visual acuity was 0.4plusmn;0.2, which ranged from 0.02 to 1.0. There were 18 eyes (37.5%) with retinal detachment, 12 eyes (25.0%) with retinal pigment epithelium (RPE) changes, seven eyes (14.6%) with macular edema, epimacular membrane, detachment combined with edema, exudation and RPE changes, 11 eyes (22.9%) with normal macular structure. The median follow-up time was (10.4plusmn;5.9) months, which ranged from one to 24 months. The tumor control situation and visual acuity were observed in follow-up period. The same equipment and methods of OCT were used to return visit in follow-up period. The macular morphological changes at the final visit and its relationship with PRT and visual acuity were contrastively analyzed. Results All the patients had good control of tumor. The vision acuity improved in two eyes (4.2%), unchanged in 10 eyes (20.8%), and decreased in 36 eyes (75.0%). The differences of the visual acuity was statistically significant between before and after treatment (Z=-3.778,P＜0.05). There were 13 eyes (27.1%) with retinal detachment; nine eyes (18.8%) with RPE changes; 17 eyes (35.4%) with macular edema, detachment combined with edema, exudation and RPE changes; six eyes (12.5%) with proliferation, atrophy, detachment combined with edema, exudation and epimacular membrane;three eyes (6.3%) with normal macular structure. There were 15 patients (31.3%) with two or more abnormal macular morphology after PRT. Conclusions Retinal detachment, RPE changes, macular edema and exudation are common abnormal macular morphology after PRT. The incidence rate of abnormal macular morphology is increased. There are 31.3% patients with two or more abnormal macular morphology.
ObjectiveTo comparatively observe features of choroidal osteoma by multimodal fundus imaging methods. MethodsThis is a retrospective case study. Sixteen patients (16 eyes) with choroidal osteoma were enrolled in this study. The patients included 6 males (6 eyes) and 10 females (10 eyes), with an average age of (30.5±2.4) years. All patients received examination of best-corrected visual acuity, slit lamp microscope, indirect ophthalmoscopy, fundus color photography, fundus autofluorescence (AF), fundus fluorescein angiography (FFA) and spectral domain optical coherence tomography (SD-OCT). The tumors were classified as fresh lesion (clear boundary and rosy tumor with smooth surface) and obsolete lesions (pale and flat tumor with obvious patches). The tumor features of color fundus photography, AF, FFA and SD-OCT were comparatively observed. ResultsThere were 5 fresh lesions and 11 obsolete lesions. Color fundus photography showed the tumor color was orange-red or yellow-white with clear boundary and retinal blood vessels on the surface of the tumor. The color of fresh lesion was rosy. In general, choroidal osteoma shown weak AF, however AF of fresh tumor was slightly stronger than the obsolete tumor, and retinal detachment region showed relatively stronger AF. FFA of fresh tumor indicated uniform intense fluorescence with clear boundary at late stage, much stronger than obsolete tumor. SD-OCT showed mesh-like reflected signal in the choroidal layer, but different from the surrounding choroidal vascular structures. ConclusionsThe tumor color is orange-red or yellow-white in color funds photography, which shown weak AF. FFA showed mottled hyperfluorescence in the early stage and tissue staining at the late stage. SD-OCT showed mesh-like reflected signal in the choroidal layer.
Objective To investigate the effects,safety and indications of local resection of choroidal melanoma with vitreoretinal surgery. Methods Eight patients with choroidal melanoma were treated with surgery.The range of the diameters of tumors was 5～20 mm and of the thickness was 4～12 mm.Retinal detachment was detected in 4 eyes.The local tumors were endoresected in 2 eyes,and managed by partial lamellar sclerouvectomy in 6 eyes.Vitreoretinal surgery,including vitrectomy,using perfluorocarbon liquid,endolaser and gases or silicone oil tamponde were performed in all eyes.Pathologic tests were performed for removed tissues. Results All tumors were resected completely.Among them,7 were histologically identified as choroidal melanomas,five were classified as spindle-cell type,2 as mixed-cell type.The ciliary body was involved in 3 tumors.The other one was choroidal melanocytoma.There was no tumor recurrence and metastasis during follow-up(average 9 .1 months).All eyeballs had no obvious changes in contour.Visual acuities werege;0.1 in 5 eyes. Conclusion In local resection cases of choroidal melanoma the affected eyeballs and their vision are saved,and the accurate diagnosis can also be made from the excisional biopsy. (Chin J Ocul Fundus Dis，2000，16：139-212)