e20105 Background: UM is the rarest subset of all melanomas and has a distinct molecular pathogenesis. Once metastasis develop, the prognosis becomes very poor, however, overall survival (OS) is not the same among all patients with metastatic UM and thus another multivariate prognostic index in metastatic disease is needed. Methods: In aim to identify multi-variables that can influence the OS in metastatic UM, we retrospectively reviewed patient’s and disease characteristics at the time of diagnosis and at the time of detecting metastasis including the intervals between events. Results: A cohort of 42 patients (22 male and 20 female) with mean age of 62 was studied. The primary tumor was exclusively choroidal in 59,5% and involving the ciliary body in 40,5% of patients. All patients had metastatic disease, 54,8% with only hepatic involvement, 26,2% with hepatic and extra-hepatic involvement and 9,5% with extra-hepatic involvement only. The mean interval between initial date of eye treatment and initial date of metastasis detection was 34,73 months while the mean interval from initial treatment until date of death or last follow up was 51 months. The median OS of this cohort was 9,5 months and was longer in females comparing to males (P = 0.0041). The patients with interval to metastasis detection of < 24 months had less survival comparing to patients with interval of > 24 months, (P = 0.0015). Having only extra-hepatic metastasis was associated with better survival comparing to only hepatic or hepatic and extra-hepatic disease, 29,6 months, 9,3 months and 9,8 months, respectively (P = 0.022). The influence of age at date of metastasis detection was not statistically significant. Furthermore, having exclusively choroidal versus tumor involving the ciliary body did not predict survival, 11.7 m and 9.3 m, respectively (P = 0.34). Conclusions: Metastatic UM is associated with a very poor prognosis. In our cohort, the short interval for development of metastasis and liver metastasis significantly worsened the OS, while patients with extra-hepatic lesions only and females had longer OS. Additional factors may prove to be univariate significant prognostic factors for survival time following detection of metastasis.
Context: Elderly patients with visual loss often have age-related macular degeneration, diabetic retinopathy, glaucoma, and cataract as common causes of visual loss. Other less common etiologies should be considered, especially in those presenting with systemic associations. Case Report: The patient discussed in our review is an 80-year-old female, with a history of diabetic retinopathy and macular degeneration who presented with a sudden deterioration of vision. While this was initially attributed to diabetic retinopathy, she was eventually noted to have a salmon patch lesion in her conjunctiva, diagnosed on biopsy to be a diffuse large B-cell lymphoma. Conclusion: Because of the significant rate of disseminated disease among patients with lymphomas in the orbit that carries a worse prognosis, early diagnosis is essential to promote better overall survival of these patients. We describe here a patient diagnosed with conjunctival lymphoma associated with pronounced visual loss and review the literature on this subject.
OBJETIVO: Apresentar um método novo, baseado no processamento computadorizado de imagens, para quantificar a distância reflexo margem (MRD). MÉTODOS: Selecionamos para o estudo pacientes do Setor de Lentes de Contato do Serviço de Oftalmologia da Santa Casa de Porto Alegre que foram divididos em dois grupos: o primeiro foi composto por pacientes usuários de lentes de contato rígidas (63 olhos) e o segundo por pacientes que foram encaminhados para adaptação de lentes de contato sem história prévia de uso das mesmas (30 olhos). Todos os pacientes foram fotografados com o auxílio de uma câmera fotográfica digital (Nikon Coolpix 4300). A distância reflexo margem foi medida por processamento computadorizado de imagens utilizando o programa Image J. Foram excluídos do estudo pacientes submetidos a cirurgias intra-oculares ou palpebrais, pacientes apresentando ptose congênita e pacientes que ao exame biomicroscópico apresentavam conjuntivite papilar gigante. RESULTADOS: O método utilizado para quantificar distância reflexo margem parece bastante simples e aparentemente mais sensível e específico. O valor médio da distância reflexo margem no grupo caso foi 2,46 mm e no grupo controle 2,72 mm. Dessa forma, observou-se uma tendência de diminuir a distância reflexo margem com o uso de lentes rígidas, embora esses dados não tenham sido estatisticamente significativos (p=0,22). Observa-se também que os valores de distância reflexo margem apresentam uma variabilidade muito maior no grupo caso (41,46%) do que no controle (28,96%), que se apresenta mais homogêneo. CONCLUSÃO: Esse estudo introduziu uma metodologia inovadora para medir a distância reflexo margem utilizando o processamento computadorizado de imagens. Esse método é acessível e pode auxiliar no acompanhamento da distância reflexo margem de pacientes usuários de lentes de contato, especialmente rígidas.
OBJETIVO: comparar os resultados de um teste de visão de cores padrão (teste de Ishihara) com um teste criado pelos autores (teste do giz de cera) na detecção da discromatopsia congênita. MÉTODOS: foi realizado um estudo transversal com 712 crianças da rede escolar pública (3 escolas) e privada (1 escola) de Porto Alegre, Rio Grande do Sul. Desta amostra aleatória, haviam sido excluídas crianças com dificuldades na alfabetização e doenças sistêmicas e oculares reconhecidas. Foram aplicados seqüencialmente os testes de Ishihara (versão resumida de 14 pranchas) e o teste do giz de cera (desenvolvido pelos autores). Cada teste foi aplicado por examinadores diferentes e avaliados por um terceiro examinador. RESULTADOS: o teste do giz de cera apresentou especificidade de 100% (99,3-100%) e sensibilidade de 38,5% (15,1-67,7%), quando comparado ao teste de Ishihara. A prevalência da discromatopsia congênita nesta amostra populacional foi de 2,6% nos meninos e 0,9% nas meninas. CONCLUSÕES: o teste do giz de cera apresentou especificidade superior ao teste de Ishihara no grupo estudado, mas sua sensibilidade não se mostrou adequada para um teste de rastreamento. Há necessidade de aperfeiçoá-lo para aumentar sua sensibilidade, isto é, sua capacidade de detectar a discromatopsia congênita.
Background/Objectives: To evaluate whether fine needle aspiration biopsy (FNAB) of melanocytic uveal tumors (MUT) using 27-gauge (27G) needles yields aspirates like those obtained using 25-gauge (25G) needles for cytology. Methods: A retrospective review conducted on 32 primary uveal melanomas. Tumors were sampled at three adjacent sites first using a 27G needle for gene expression profile (GEP) testing, the second and third with a 27G and 25G needles for cytology. The endpoints evaluated were the sufficiency of aspirates for cytopathology and GEP. Results: Among the 32 patients, 17 tumors were choroidal, 6 ciliochoroidal, 7 iridociliochoroidal, and 2 exclusively iridic. Tumor diameter ranged from 3.3 mm to 23 mm (mean 13.2 mm) and thickness from 0.5 mm to 12 mm (mean 6.4 mm). Aspirates from both needle sizes were sufficient for cytopathological diagnosis and GEP in 31 of 32 cases (96.9%). The single insufficient aspirate was insufficient with both the 27G and 25G needles. Cytopathology was identical in all other cases. Tumors were Class 1 in 22 cases (71.0%) and Class 2 in 9 cases (29.0%). Conclusions: FNAB aspirates of MUTs using 27G needles appear sufficient for cytology and GEP in most cases showing similar diagnostic yield compared to 25G needles.
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