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Alan W Kong, Adrian Au, Weilin Song, Angela J Oh, Tara A McCannel Department of Ophthalmology, Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USACorrespondence: Tara A McCannel, Department of Ophthalmology, University of California Los Angeles, 100 Stein Plaza, Los Angeles, CA, 90095, USA, Email TMcCannel@jsei.ucla.eduPurpose: Distinguishing an iris melanoma from an iris nevus can be challenging as few clinical features other than documented growth are helpful in making the diagnosis. In this study, we compared the presenting intraocular pressure (IOP) and cup-to-disc ratio (CDR) between affected and unaffected eyes in patients with iris melanoma and iris nevus.Patients and methods: This was a single-institution retrospective case series of patients treated for iris melanoma and iris nevus from January 2013 to October 2022. Thirty-nine subjects with iris melanoma and forty age-matched patients with iris nevus were included. We analyzed the difference in IOP, CDR, and diagnosis of glaucoma between affected and unaffected eyes in patients with iris melanoma and control iris nevus cohort.Results: The average IOP for eyes with iris melanoma and iris nevus was 18.8± 6.1 mmHg and 14.6± 3.5 mmHg (P< 0.001), respectively. The average CDR was 0.36± 0.27 and 0.24± 0.14 (P=0.02), respectively. The average IOP of the contralateral unaffected eye in iris melanoma patients was 16.3± 3.5 mmHg, significantly less than the affected eye (P=0.03). The average CDR of the contralateral unaffected eye in iris melanoma was 0.25± 0.15, which was trending towards being less than the affected eye (P=0.05). There was no difference in the average IOP (P=0.89) or average CDR (P=0.49) between the affected and unaffected eye in patients with iris nevus.Conclusion: We demonstrate that patients with iris melanoma are more likely to have greater IOP and CDR in the affected eye compared to the unaffected eye, and a diagnosis of unilateral glaucoma than eyes with iris nevus. Patients with iris melanoma had greater IOP asymmetry between the affected and unaffected eye. Therefore, IOP and CDR asymmetry may suggest a diagnosis of iris melanoma.Keywords: iris melanoma, iris nevus, secondary glaucoma, intraocular pressure, cup to disc ratio

PURPOSE Congenital hypertrophy of the retinal pigment epithelium (CHRPE) may simulate choroidal melanoma in certain cases. We report unique clinical features we have observed in cases of CHRPE in young myopic pigmented patients.METHODS Patients who were referred for evaluation of a suspicious choroidal lesion and found to have a CHRPE lesion with the clinical appearance of lesion elevation and a subretinal fluid-like 'shadow sign' were included. Patient and lesion characteristics were tabulated. Available images, including fundus photography, ultrasonography, optical coherence tomography (OCT), and fluorescein angiography (FA) were reviewed.ResultsSix patients were included. The 'shadow sign' was anterior to the CHRPE lesion in all cases. The mean age of the patients was 27.3 years. The ethnicities of the patients were Chinese (n=1), Hispanic (n=3), or African-American (n=2). Five of six patients were myopic.CONCLUSIONS Although most CHRPE lesions appear flat on ophthalmoscopy, lesions in young myopic patients of pigmented ethnicities may appear elevated with a 'shadow sign' due to 'dark without pressure.' This new finding may be related to the vitreoretinal interface in young myopic pigmented patients and must be distinguished from true subretinal fluid and lesion thickness, which are often observed in choroidal melanoma.

Purpose: To describe a case of a serous choroidal detachment which resulted after discontinuation of furosemide and illustrate the utility of ultrawide-angle fundus imaging in documenting this lesion in the retinal periphery. Design: Observational case report. Method: An 85 year old female presented with symptoms of a 'brown curtain' descending over the left eye which was temporally related to recent discontinuation of oral furosemide. Ultrawide-field photography allowed for accurate documentaton of the choroidal detachments. Result: After resuming furosemide, the serous choroidal detachments resolved. Conclusion: We hypothesize a shift of free water following discontinuation of furosemide as a novel etiology for the development of serous chordoidal detachments. Ultrawide-field fundus photography was useful to document this lesion. [ABSTRACT FROM AUTHOR]

Purpose: To illustrate the utility of ultrawide-angle fundus imaging in documenting a suspicous lesion in the far retinal periphery. Design: Observational case report. Method: A 48 year-old female with new onset floaters in the left eye was noted to have an elevated and heavily pigmented lesion in the far retinal periphery. Optos Panoramic200MA ultrawide-field photography and fluorescein angiography allowed for accurate serial documentaton of the lesion which was determined to be a retinal pigment epithelial adenoma. Result: Over a four year period of observation, Optos ultrawide-field photography of the retinal pigment epithelial adenoma demonstrated stability of the lesion size and mild lesion depigmentation with overlying vitreous pigmentation. Conclusion: The Optos ultra-widefield system demonstrates the ability to rapidly and reproducibily obtain images to monitor a peripheral retinal pigment epithelial adenoma for objective and comparitive detection of change. [ABSTRACT FROM AUTHOR]

Purpose: Suspicious elevated choroidal lesions require close monitoring for potential malignant transformation. We describe a case of a large choroidal lesion in which conventional digital photography was not optimal for documenting baseline clinical features. The Optos Panoramic 200MA system documented the lesion in its entirety. Design: Observational case report. Method: A 75 year old female presented with decreased vision and a large pigmented choroidal lesion (> 10 mm in diameter). Result: Standard 30 degree fundus photography yielded poor images due to the large size of the lesion and media opacity from cataract. The Optos system allowed for the entire lesion to be readily captured in a single photograph for serial evaluations over time. Conclusion: Large dimension choroidal lesions of the fundus may be more easily and accurately documented with Optos ultrawide-field imaging. [ABSTRACT FROM AUTHOR]

Abstract Background TAK733 is a novel allosteric, non-ATP-binding, inhibitor of the BRAF substrates MEK-1/2. Methods The growth inhibitory effects of TAK733 were assessed in a panel of 27 cutaneous and five uveal melanoma cell lines genotyped for driver oncogenic mutations. Flow cytometry, Western blots and metabolic tracer uptake assays were used to characterize the changes induced by exposure to TAK733. Results Fourteen cutaneous melanoma cell lines with different driver mutations were sensitive to the antiproliferative effects of TAK733, with a higher proportion of BRAFV600E mutant cell lines being highly sensitive with IC50s below 1 nM. The five uveal melanoma cell lines had GNAQ or GNA11 mutations and were either moderately or highly sensitive to TAK733. The tested cell lines wild type for NRAS, BRAF, GNAQ and GNA11 driver mutations were moderately to highly resistant to TAK733. TAK733 led to a decrease in pERK and G1 arrest in most of these melanoma cell lines regardless of their origin, driver oncogenic mutations and in vitro sensitivity to TAK733. MEK inhibition resulted in increase in pMEK more prominently in NRASQ61L mutant and GNAQ mutant cell lines than in BRAFV600E mutant cell lines. Uptake of the metabolic tracers FDG and FLT was inhibited by TAK733 in a manner that closely paralleled the in vitro sensitivity assays. Conclusions The MEK inhibitor TAK733 has antitumor properties in melanoma cell lines with different oncogenic mutations and these effects could be detectable by differential metabolic tracer uptake.

Competing Interests: Conflict of Interest No Conflict.

Background: A rare cancer, uveal melanoma (UM) affects 5 in 1 million adults annually. Research on predictors of mental health in UM survivors is scarce., Purpose: In this prospective study, we tested models that postulate interactions between illness perceptions and coping processes in predicting depressive symptoms 1 year following UM diagnosis., Methods: Participants' approach- and avoidance-oriented coping processes and illness perceptions specific to control and chronicity were assessed. Participants (N = 107) completed assessments prior to diagnosis (T0), and 1 week (T1), 3 months (T2), and 12 months after UM diagnosis (T3)., Results: At T1, a significant avoidance coping × chronicity perception interaction (b = 1.84, p = .03) indicated that the link between higher avoidance coping and greater T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions (b = 17.13, p < .001). Chronicity perceptions at T2 interacted significantly with approach-oriented coping at all time points; the link between higher approach coping and lower T3 depressive symptoms was stronger for participants with prolonged chronicity perceptions at T2. Interactions between control perceptions and coping did not significantly predict T3 depressive symptoms., Conclusions: Findings lend partial support to predictive models that consider the combined, interacting influence of chronicity perceptions and coping processes on depressive symptoms in survivors of eye cancer., (© Society of Behavioral Medicine 2023. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background/objectives: The purpose of this study is to report cases of choroidal melanoma that developed extrascleral tumour recurrence after treatment with iodine-125 brachytherapy., Subjects/methods: In this single-institution retrospective observational case series, all instances of biopsy-confirmed orbital melanoma after known intraocular melanoma were reviewed. Tumour characteristics, clinical course, time to recurrence, cytogenetics of initial tumour and recurrence, and presence of intraocular recurrence were documented., Results: Five cases of orbital melanoma following treatment with plaque radiotherapy are described. Tumour staging was Ia (1), IIa (2), and IIb (2). The primary lesion in four of the five appeared to have undergone complete regression for an average of 2 years, with the orbital melanoma developing after this interval. Recurrence of the intraocular tumour was seen in conjunction with an extrascleral component in two cases. Four cases ultimately underwent enucleation or exenteration; three had evidence of direct extension of tumour through the sclera. Four cases in this series had molecular characteristics associated with high metastatic risk (three patients with monosomy 3, one with BAP1 mutation)., Conclusions: High-risk tumour biology may predispose to late appearance of extrascleral melanoma despite optimal treatment and adequate control of the intraocular tumour. Extended follow-up with detailed orbital examination and imaging is recommended for this population., (© 2022. The Author(s), under exclusive licence to The Royal College of Ophthalmologists.)

Purpose: To evaluate the mid-term outcomes of pars plana vitrectomy performed for retinal detachment (RD) repair after Boston Type 1 keratoprosthesis (KPro) implantation., Methods: Retrospective review of medical records of KPro implanted at the Stein Eye Institute presenting with RD and treated by pars plana vitrectomy. Functional success was defined as a postoperative visual acuity maintained within 2 Snellen lines of the corrected distance visual acuity measured before the development of the RD (baseline) and anatomical success as an attached retina after the pars plana vitrectomy. Kaplan-Meyer survival analyses were performed., Results: Among the 224 KPro performed, 28 (15.2%) RD were identified; of which, 21 (9.4%) were included. The mean follow-up was 42.5 ± 27.3 months. Vitreoretinal proliferation was present in 18 of 21 eyes (85.7%). Surgical techniques were adapted to the complex anterior segment anatomy of KPro eyes. Anatomical success was achieved in 18 of 21 eyes (85.7%). Functional success occurred in 17 of 21 eyes (81.0%), and 5 of 21 eyes (23.8%) reached 20/400 or better visual acuity at the final follow-up. The KPro was retained in 11 in 21 eyes (52.4%). The retention rate decreased from 94.7% at 1 year to 53.5% at 5 years. The most frequent complications were retroprosthetic membrane (47.6%) and corneal melt (23.8%)., Conclusion: Modified pars plana vitrectomy techniques resulted in relatively good mid-term anatomical, functional, and retention rate outcomes, given the severity of RD at presentation and the numerous preoperative comorbidities of KPro eyes.

Objective: Uveal melanoma, a rare eye cancer, presents potential vision loss and life threat. This prospective, longitudinal study interrogated the predictive utility of visual impairment, as moderated by optimism/pessimism, on depressive symptoms in 299 adults undergoing diagnostic evaluation., Method: Depressive symptoms (Center for Epidemiologic Studies Depression Scale), subjective (Measure of Outcome in Ocular Disease vision subscale) and objective (logarithm of the minimum angle of resolution) visual impairment, and optimism/pessimism (Life Orientation Test-Revised) were assessed before diagnostic evaluation and 1 week, 3 months, and 12 months after diagnosis. Multilevel modeling, with repeated measures (Level 1) nested within individuals (Level 2) and imputation of missing data (Blimp software), was performed., Results: Depressive symptoms were significantly more elevated 1 week after diagnosis in cancer patients (n = 107) versus patients not diagnosed with cancer (n = 192). Higher subjective (but not objective) visual impairment predicted greater depressive symptoms (p < .001). Across the entire sample, the two-way (Optimism/Pessimism × Subjective Visual Impairment) interactions were statistically significant (ps < .05), but not the three-way interaction (with diagnosis). The positive association between subjective visual impairment and depressive symptoms was significant at low and moderate levels of optimism (ps < .001), but not at high optimism (p > .05). The association was significant at high and moderate levels (ps < .001), but not low (p > .05) levels of pessimism., Conclusions: Elevated depressive symptoms are evident in adults who do (vs. do not) receive a diagnosis of uveal melanoma but appear to remit within 3 months. Perceived impaired vision, especially coupled with low optimism or high pessimism, predicts depressive symptoms over time, with implications for intervention. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Little is known about contributors to the psychosocial impact of uveal melanoma, a rare cancer. Predictors and outcomes of benefit finding, a potentially favorable outcome, were investigated. Adults (n = 107) completed assessments prior to diagnosis of uveal melanoma and one week, three months and 12 months after diagnosis. Path analyses with the full information maximum likelihood estimation method were conducted. Objective disease impact on vision did not predict benefit finding (p > .05). Approach-oriented coping prior to diagnosis and one week later significantly predicted greater benefit finding 12 months later (p < .01). Avoidance-oriented coping at three months moderated the concurrent relationship of benefit finding and positive affect at 12 months (p < .001). This first study of predictors of benefit finding in uveal melanoma patients suggests that greater approach-oriented coping prospectively predicts higher benefit finding. Further, avoidance may condition the association of benefit finding with psychosocial outcomes.

PRéCIS:: A single-center retrospective review over a 10-year period discovered an 8.6% risk of developing secondary open-angle glaucoma, and a 6.7% risk of neovascular glaucoma after brachytherapy for uveal melanoma. Additional risk factors were identified., Purpose: To report the incidence and identify risk factors for secondary open-angle glaucoma and neovascular glaucoma after iodine-125 brachytherapy for uveal melanoma in a tertiary ocular oncology and glaucoma practice., Patients and Methods: Eyes of patients who had been diagnosed and treated with iodine-12 brachytherapy for uveal melanoma over a 10-year period were included for review. Secondary open-angle glaucoma was defined as meeting the following criteria: at least 3 measurements of intraocular pressure (IOP) ≥21 mm Hg after the removal of the iodine-125 plaque and an open angle on gonioscopy. Neovascular glaucoma was defined as meeting the following criteria: at least 3 measurements of IOP ≥21 mm Hg and neovascularization of the iris or anterior chamber angle. Cumulative incidence was calculated and survival analysis was used to analyze risk factors for both secondary open-angle glaucoma and neovascular glaucoma., Results: A total of 374 eyes in patients diagnosed with uveal melanoma and treated with Iodine-125 brachytherapy were included in the study. Thirty-one eyes (8.6%) were diagnosed with secondary open-angle glaucoma and 25 eyes (6.7%) were diagnosed with neovascular glaucoma. Multivariate analysis identified the following risk factors for secondary open-angle glaucoma: older age, greater tumor size, iris location of uveal melanoma, higher baseline IOP, ciliary body involvement, and eyes having undergone combined brachytherapy with vitrectomy and silicone oil placement for radiation attenuation. The risk factors for neovascular glaucoma were as follows: greater tumor size, greater number of pack-years smoking history, pseudophakia, and higher grade of radiation retinopathy severity by fluorescein angiogram., Conclusions: We have identified additional risk factors for the development of both secondary open-angle glaucoma and neovascular glaucoma in patients with uveal melanoma who have undergone iodine-125 brachytherapy for local tumor control. The risk of secondary glaucoma is substantial. Close ophthalmic monitoring of patients is necessary for detection and timely treatment of glaucoma to maximize visual outcome.

Background: Pediatric retinal disorders, although uncommon, can be challenging to assess in the clinic setting and often requires an exam under anesthesia. The purpose of our study was to evaluate the use of ultra-wide field retinal imaging in children without sedation in an outpatient clinic., Methods: We performed a retrospective case series of patients 18 years or younger who received ultra-wide field imaging over a one year period. The age, gender, and clinical course were documented. Color fundus and red-free images were reviewed to assess field of view. Ultra-wide field autofluorescence (UWF-FAF) was evaluated for abnormal autofluorescence patterns and ultra-wide field fluorescein angiography (UWF-FA) was assessed for angiographic phase and field of view., Results: A total of 107 eyes of 55 patients with a mean age of 11.1 years (SD 3.7 years, range 3-18 years) were evaluated. Twenty-seven (49%) patients were male. The most common diagnosis was retinopathy of prematurity (7 of 55 patients, 12.7%) followed by trauma (7.4%), Coats disease (7.4%), and rhegmatogenous retinal detachment (7.4%). The number of quadrants visualized anterior to the equator correlated with patient age (r = 0.4, p  < 0.01). On UWF-FA, 6 of 14 patients (43%) had images of the arterial phase captured and 14 of 14 patients (100%) had images of the venous phase or later captured., Conclusions: We demonstrated that UWF imaging is obtainable in children as young as 3 years old without sedation. UWF fundus photography, UWF-FAF and UWF-FA were useful clinical adjuvants to examination and provide additional information for documenting and monitoring pediatric retinal diseases., Competing Interests: The authors declare that they have no competing interests., (© The Author(s) 2019.)

Purpose: Metastatic uveal melanoma (UM) has a very poor prognosis and no effective therapy. Despite remarkable advances in treatment of cutaneous melanoma, UM remains recalcitrant to chemotherapy, small-molecule kinase inhibitors, and immune-based therapy., Methods: We assessed two sets of oxidative phosphorylation (OxPhos) genes within 9858 tumors across 31 cancer types. An OxPhos inhibitor was used to characterize differential metabolic programming of highly metastatic monosomy 3 (M3) UM. Seahorse analysis and global metabolomics profiling were done to identify metabolic vulnerabilities. Analyses of UM TCGA data set were performed to determine expressions of key OxPhos effectors in M3 and non-M3 UM. We used targeted knockdown of succinate dehydrogenase A (SDHA) to determine the role of SDHA in M3 UM in conferring resistance to OxPhos inhibition., Results: We identified UM to have among the highest median OxPhos levels and showed that M3 UM exhibits a distinct metabolic profile. M3 UM shows markedly low succinate levels and has highly increased levels of SDHA, the enzyme that couples the tricarboxylic acid cycle with OxPhos by oxidizing (lowering) succinate. We showed that SDHA-high M3 UM have elevated expression of key OxPhos molecules, exhibit abundant mitochondrial reserve respiratory capacity, and are resistant to OxPhos antagonism, which can be reversed by SDHA knockdown., Conclusions: Our study has identified a critical metabolic program within poor prognostic M3 UM. In addition to the heightened mitochondrial functional capacity due to elevated SDHA, M3 UM SDHA-high mediate resistance to therapy that is reversible with targeted treatment.

Purpose: Episcleral eye plaques provide excellent local control of ocular melanoma, but vision sparing remains a significant problem with 30% or more of patients experiencing significant visual acuity degradation. The use of silicone oil shielding with Iodine-125 plaques has previously been reported to improve critical structure sparing. We hypothesized that the use of Palladium-103 would improve the shielding effectiveness of silicone oil due to the strong energy dependence of the photoelectric effect. This Monte Carlo simulation study reports a comparison of the shielding effects of silicone oil when used in conjunction with Pd-103 and with I-125 plaques., Materials and Methods: GEANT4 was used to simulate eye plaque treatments to an eye with either water-equivalent vitreous humor, or silicone oil in place of the vitreous humor. Two solid gold plaques, 15 and 23 mm, were simulated loaded with I-125 and with Pd-103 source seeds. Seed activity was normalized such that 85 Gy was delivered to the tumor apex in the water-equivalent cases. Tumor apex dose, central axis dose, and inner sclera dose reductions with silicone oil were evaluated., Results: Silicone oil resulted in an underdosing to the tumor apex of 6.1% and 7.5% in the 15 mm plaque for I-125 and Pd-103, respectively, and 3.4% and 4.3% in the 23 mm plaque for I-125 and Pd-103, respectively. When renormalized to 85 Gy to the tumor apex in all scenarios, silicone oil reduced the dose to the inner sclera 90° from the plaque by 19-32% for the 15 and 23 mm plaques using I-125, and by 33-65% for the 15 and 23 mm plaques using Pd-103., Conclusions: The combination of silicone oil and Pd-103 eye plaques offers the potential for greatly improved sparing to normal structures compared to Pd-103 plaques alone or I-125 plaques with or without silicone oil., (© 2018 American Association of Physicists in Medicine.)

Background: The aim of this study was to determine the known radiation exposure, attitudes, and consequent risk modifications among female ocular oncologists in North America who routinely administer radioactive plaque brachytherapy treatment and are members of the International Society of Ocular Oncology., Methods: Nineteen female ocular oncologists completed an anonymous 17-question radiation exposure survey., Results: Eleven of the participants chose to routinely wear lead protection during surgery; 8 did not. Fifteen of 19 participants reported using an unloaded "nonactive" template to prepare for plaque implantation. During pregnancy, 11 of 13 participants continued to perform plaque brachytherapy. Eight of these 11 undertook measures to decrease radiation exposure self-reported as lead wear and other. The average reported anxiety regarding fertility was 2.1 (SD, 2.2) on a scale from 1 to 10., Conclusion: This study corroborates prior literature that surgeons' exposure to radiation during plaque brachytherapy is minimal. Nonetheless, there remains some anxiety regarding exposure risk to women, due to potential effects on fertility and fetal health. We found variability in exposure monitoring, required training, and precautions during pregnancy amongst this group of surgeons. Improved education and clearer pregnancy guidelines may equip female ocular oncologists with optimal knowledge regarding risk of radiation exposure.

Aim: We report patient safety and intraocular pressure (IOP) control after placement of a glaucoma drainage device (GDD) in eyes with a history of treated malignant uveal melanoma., Methods: A retrospective review of the records of patients with uveal melanoma was performed. Outcomes were local tumor recurrence, rate of metastases, and to-nometric success, based on survival curves, defined as IOP < 21 mm Hg., Results: Eleven eyes with choroidal melanoma, 4 with iris melanoma, and 1 with ciliary body melanoma were followed for a median (interquartile range) of 2.1 (1.1-3.2) years. Two subjects developed liver metastases; one had monosomy 3 and tumor gene expression profile class 2. The other case with ciliary body melanoma was negative for monosomy 3. There were no cases of local treatment failure. Mean preoperative IOP decreased from 30.5 ± 7.7 to 15.9 ± 8.1 mm Hg at 1 year after surgery (1-year success rate 80%)., Conclusions: Our case series with a median follow-up of 2 years shows that placing a GDD in patients with treated uveal melanoma does not expose patients to greater risk of local or extraocular recurrence. A larger series and longer follow-up time are required to fully evaluate the safety of GDDs in this clinical scenario.

Purpose: Radiation retinopathy remains incompletely characterized and may cause severe vision loss. Ultra-wide-field fluorescein angiography provides a pan-fundus view of vascular alterations caused by radiation treatment and may predict visual and ocular outcomes. We have developed a grading scheme to describe pan-fundus severity and to predict the progression of radiation retinopathy in patients treated for uveal melanoma with iodine-125 brachytherapy., Methods: A retrospective review of patients treated with standard iodine-125 brachytherapy for uveal melanoma at the Ophthalmic Oncology Center at the University of California, Los Angeles, who had undergone both baseline and postbrachytherapy ultra-wide-field fluorescein angiography. A grading scheme was devised based on observations of vascular leakage, retinal perfusion status, and retinal proliferation. The correlation of grade severity with patient characteristics, tumor features, visual acuity, optical coherence tomography findings, and neovascular glaucoma was measured with chi-square and one-way analysis of variance analyses., Results: Sixty-seven patients were identified for review. Consistent wide-field angiographic patterns after brachytherapy were observed and graded as follows: Grade 0: normal; Grade 1: late foveal leakage; Grade 2: late peripheral leakage; Grade 3: presence of nonperfusion; and Grade 4: retinal neovascularization. Six eyes (8.9%) were Grade 0; 16 (23.8%) were Grade 1; 25 (37.3%) were Grade 2; 16 (23.4%) were Grade 3; and 4 (6.0%) were Grade 4. Higher grade radiation severity correlated significantly with duration of follow-up (P < 0.02); younger age (P = 0.035); worse visual acuity (P = 0.001); cystoid macular edema or atrophy on optical coherence tomography (P < 0.0001); and neovascular glaucoma (P = 0.003)., Conclusion: Wide-field fluorescein angiography revealed distinct fundus-wide patterns of vascular damage, which were progressive in nature in eyes treated with iodine-125 brachytherapy for uveal melanoma and correlated with signs of progressive vascular injury. This grading scheme may have prognostic value to predict the progression of radiation retinopathy and to prognosticate visual outcomes in patients undergoing brachytherapy.

Purpose: To describe a case of macular microcysts associated with advanced secondary glaucoma from Schwartz-Matsuo syndrome., Methods: Clinical presentation, color fundus photography, optic disk photography, visual fields, and optical coherence tomography are presented., Results: A 32-year-old woman presented with advanced, unilateral secondary glaucoma associated with a macula-on rhegmatogenous retinal detachment. She was diagnosed with Schwartz-Matsuo syndrome. Spectral domain optical coherence tomography showed macular microcystic changes in the paracentral retina at the level of the inner nuclear layer., Conclusion: Macular microcystic changes in the paracentral inner nuclear layer on spectral domain optical coherence tomography have been described in eyes with optic atrophy associated with a variety of diseases. This is the first described case of macular microcysts associated with advanced secondary glaucoma from Schwartz-Matsuo syndrome and may offer insights into the pathogenesis of these microcysts.

Purpose: Prior studies have shown that nuclear reactivity for BRCA1-associated protein-1 (BAP1) yields prognostic information for paraffin-embedded uveal melanomas. Lacking are immunocytochemical studies of BAP1 on fine needle aspiration biopsies of uveal melanoma that correlate with prognosis or other markers of prognosis. Our purpose was to fill this gap., Design: Experimental laboratory study., Methods: Fine needle aspiration biopsies were performed prospectively on 113 patients with uveal melanomas, garnering limited subsets of cases for comparison. Agreement between immunocytochemistry for BAP1 nuclear staining vs chromosome 3 ploidy analysis and gene expression profiling was assessed by 2 × 2 contingency table analysis., Results: The presence or absence of suppression of nuclear expression of BAP1 was strongly associated (73%, P = .000002) with monosomy and disomy chromosome 3, respectively. BAP1 nuclear expression was also correlated with gene expression profiling. Chromosome 3 ploidy analysis correlated with gene expression profiles., Conclusion: When adequate material is obtained, immunocytology using BAP1 is a potentially informative tool for prognostication of uveal melanoma., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Importance: Understanding supportive care needs in patients with cancer is important for developing approaches that enhance quality of life and promote satisfaction with care., Objective: To characterize the nature and frequency of sociodemographic, medical, and psychosocial factors associated with unmet needs in patients with uveal melanoma 1 week and 3 months after diagnosis., Design, Setting, and Participants: This 3-month, prospective, longitudinal survey study was conducted at a university-based ophthalmology practice from June 1, 2007, to July 1, 2011. Data were analyzed in April 2017. Consecutive patients (n = 429) scheduled for diagnostic evaluation for an intraocular abnormality were assessed for eligibility. Participants were ineligible (n = 25) if they were younger than 18 years, had previous advanced cancer, or evidenced cognitive impairment. Of the patients who provided informed consent (n = 306), those subsequently diagnosed with uveal melanoma by an ophthalmologist (n = 107) were included in the analysis., Main Outcomes and Measures: Unmet needs (ie, desire for help in psychological, physical, health information, communication, or social domains) were assessed using the Cancer Needs Questionnaire. Multivariable regression analyses determined factors associated with unmet need severity across 3 months., Results: One hundred seven patients (58 [54%] men; mean [SD] age, 59.0 [12.8] years) completed the baseline assessment. At 1 week after diagnosis, nearly all patients (85 of 86 [99%]) expressed at least 1 unmet need, as did 68 of 79 (86%) 3 months later. The most frequently endorsed needs were in the health information and psychological domains. Patients' unmet needs declined significantly over 3 months (mean [SD] change, -10.0 [14.4]; 95% CI, -6.4 to -13.6; t = -5.6). Sociodemographic and medical characteristics were unrelated to unmet need severity. However, higher prediagnosis instrumental social support (b = -0.2; 95% CI, -0.3 to -0.1; z = -2.8) and lower neuroticism (b = 0.3; 95% CI, 0.1-0.5; z = 2.9) predicted lower unmet need severity 1 week after diagnosis. Having a smaller social network predicted lower unmet need severity 3 months after diagnosis (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.4) as well as a decline in needs from diagnosis to 3 months later (b < 0.1; 95% CI, <0.1 to <0.1; z = 2.3)., Conclusions and Relevance: Within 1 week after diagnosis and 3 months later, most patients with uveal melanoma cited important health information and psychological needs. These findings suggest that prior to or at diagnosis, the severity of such needs and psychosocial factors that may be associated can be identified for proactive supportive intervention.

Purpose: To study the use of ultra-widefield fluorescein angiography (UWF FA) in the detection and management of retinal capillary hemangioblastomas in patients with von Hippel-Lindau disease., Methods: This is a retrospective study of patients with von Hippel-Lindau disease who underwent UWF FA using the Optos camera at a single center from June 2009 to May 2015. The clinical use of UWF FA was reviewed, and the number of hemangioblastomas identified on UWF FA was compared with ophthalmoscopy and a simulated seven standard field (7SF) FA montage., Results: Twenty eyes of 10 patients were identified. Only 33% of lesions seen on UWF FA were also found on ophthalmoscopy, and 88% of lesions visualized on UWF FA were located outside the 7SF overlay. In 5 eyes that had gaze steering, 18% of lesions could be visualized only on gaze-steered images. For the 14 eyes with data available, 6 had procedures recommended and 8 eyes observed based on data from UWF FA. One of 20 eyes had a lesion on ophthalmoscopy that was missed by imaging., Conclusion: Ultra-widefield FA using the Optos camera is helpful for the evaluation and management of patients with von Hippel-Lindau disease. The UWF FA with gaze steering appears to detect more hemangioblastomas than ophthalmoscopy and conventional angiography.

Purpose: To evaluate visual and surgical outcomes of cataract surgery in eyes with a history of iodine-125 (I 125 ) brachytherapy for ocular melanoma., Setting: Department of Ophthalmology, David Geffen School of Medicine at UCLA and the Stein Eye Institute, Los Angeles, California, USA., Design: Retrospective case series., Methods: Patients with ocular melanoma treated by I 125 brachytherapy who subsequently had cataract surgery were evaluated. The recorded data included tumor size, location, preoperative ocular comorbidities, corrected distance visual acuity (CDVA), operative complications, and brachytherapy-related maculopathy before and after surgery., Results: Thirty-two eyes of 32 patients were included. The mean age at the time of cataract surgery was 66.1 years. The median follow-up was 53.5 months. There were no intraoperative complications. Eighteen eyes (56.3%) had a history of preoperative radiation retinopathy, 10 involving the macula. Between 2 weeks and 4 weeks postoperatively, 22 eyes (68.8%) had an improvement in CDVA (≥2 lines). Seven of 10 eyes that failed to improve had radiation maculopathy. By the last follow-up examination, 13 eyes (40.6%) had improved CDVA, 9 eyes (28.1%) were worse (≥2 lines), and 10 eyes (31.3%) were unchanged (within ±1 line). Of 15 eyes that lost CDVA gains achieved between 2 weeks and 4 weeks postoperatively, 9 eyes had new-onset or worsening maculopathy. Cataract surgery had no effect on local tumor control or distant metastasis., Conclusions: Cataract surgery after I 125 brachytherapy for ocular melanoma improved CDVA in most eyes during the immediate postoperative period. Gains were often lost with further follow-up. Progression of radiation maculopathy was primarily responsible for subsequent visual decline., (Copyright © 2018 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this paper was to assess the concordance between results of DecisionDx-UM specific gene expression profiling (GEP) and fluorescence in situ hybridization (FISH) for chromosome 3 analysis, and between DecisionDx-UM GEP and multiplex ligation probe amplification (MLPA) in uveal melanoma undergoing intraoperative fine-needle aspiration biopsy (FNAB) for metastatic prognostication during brachytherapy., Methods: We retrospectively reviewed consecutive patients diagnosed with posterior uveal melanoma who underwent intraoperative FNAB prior to placement of an iodine-125 radioactive plaque between 2012 and 2014. Two cohorts of patients were identified: Cohort 1 - tumors in which both GEP and FISH results were obtained, and Cohort 2 - tumors in which both GEP and MLPA results were obtained., Results: Forty-four patients were identified for Cohort 1. FISH and GEP results were discordant in 7 tumors (15.9%). Forty-three patients were identified for Cohort 2. MLPA and GEP were discordant in 7 tumors (16.3%)., Conclusions: Discordance between GEP and chromosome 3 status by FISH and MLPA occurred in our series at a rate of 15.9 and 16.3%, respectively. Caution must be advised when counseling a patient with a good-prognosis GEP "Class 1" result that the uveal tumor may actually harbor monosomy 3, which is associated with a poor prognosis for metastasis in nearly 20% of the patients.

Purpose: Managing juxtapapillary and circumpapillary choroidal melanoma with brachytherapy is challenging because of technical complications with accurate plaque placement and high radiation toxicity given tumor proximity to the optic nerve. We evaluated our center's experience using ultrasound-guided, Iodine (I)-125 notched plaque brachytherapy for treating choroidal melanoma contiguous with (juxtapapillary) and at least partially surrounding the optic disc (circumpapillary)., Methods: All cases of choroidal melanoma treated with I-125 notched plaque brachytherapy at our center from September 2003-December 2013 were retrospectively reviewed. Only patients with ≥18 months of follow-up who had lesions contiguous with the optic disc (0 mm of separation) were included. The tumor apex prescription dose was 85 Gy. Outcomes evaluated included local control, distant metastasis-free survival (DMFS), cancer-specific survival (CSS), overall survival (OS), visual acuity, and radiation toxicity., Results: Thirty-four patients were included with a median follow-up of 44.1 months (range 18.2-129.0). AJCC T-category was T1 in 58.8%, T2 in 26.5%, and T3 in 14.7%. Median circumferential optic disc involvement was 50% (range 10%-100%). Eye retention was achieved in 94.1%. Actuarial 2- and 4-year rates of local recurrence were 3.1% and 7.6%, DMFS were 97.0% and 88.5%, CSS were 97.0% and 92.8%, and OS were 97.0% and 88.9%, respectively. In addition, 23.5% had visual acuity ≥20/200 at last follow-up., Conclusions: I-125 notched plaque brachytherapy provides high eye preservation rates with acceptable longer-term post-treatment visual outcomes. Based on our experience, choroidal melanoma directly contiguous with and partially encasing the optic disc may be effectively treated with this technique.

Purpose: To characterize intraoperative findings, surgical approach, and postoperative outcomes in patients undergoing strabismus surgery following plaque brachytherapy for ocular melanoma., Methods: The records of all patients who underwent plaque brachytherapy for choroidal melanoma between May 2007 and June 2016 were reviewed retrospectively to identify those who subsequently required strabismus surgery., Results: Of the 461 patients who underwent plaque brachytherapy during the study period, 13 (2.8%) met inclusion criteria. Visual acuity of the affected eye was 20/40 or better in 9 patients (69%). Preoperative horizontal deviation ranged from 0 Δ to 52 Δ ; vertical deviation, from 2 Δ to 25 Δ . At final follow-up mean horizontal deviation ranged from 0 to 4 Δ ; vertical deviation, from 0 Δ to 12 Δ . Intraoperatively, all muscles directly adjacent to the treated area appeared macroscopically thicker than normal despite being functionally underacting. Magnetic resonance imaging showed enlarged muscles adjacent to the plaque radiotherapy. Microscopic examination of muscles in 2 patients showed reactive enlargement of the muscle fibers, granulation tissue, and inflammation., Conclusions: Persistent strabismus after plaque brachytherapy is rare. Typical findings include enlarged, underacting rectus muscles adjacent to the area of the plaque, restrictive connective tissue, and incomitant strabismus. Previously disinserted muscles may be found in abnormal locations. In this patient cohort scar tissue removal in conjunction with tightening procedures on the muscle adjacent to the plaque combined with recession of the antagonist muscle frequently resulted in good anatomical outcome., (Copyright © 2017 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: Fine-needle aspiration biopsy of small choroidal melanomas 2 mm or less in thickness may be associated with a low biopsy yield. This report describes our center's experience using the 27-gauge vitreous cutter to perform tumor sampling in these small melanomas., Methods: This was a retrospective analysis of all patients who underwent a 27-gauge vitreous cutter biopsy for molecular prognostication at the time of iodine-125 plaque placement for local treatment of choroidal melanoma ≤2.0 mm in height., Results: Seventeen consecutive patients with a mean baseline tumor height of 1.67 mm (range, 1.31-2.03 mm) and median follow-up time of 7.0 months (range, 3.3-19.5 months) were included. The 27-gauge cutter biopsy yielded sufficient material for multiplex-ligation probe amplification (MLPA) or gene expression profiling (GEP) in 17/17 (100%) patients. Complications were limited to focal vitreous hemorrhage in 13/17 patients and diffuse vitreous hemorrhage in 1/17 patients, with no instance of retinal detachment or nonclearing vitreous hemorrhage., Conclusion: Tumor sampling of small choroidal melanoma with a 27-gauge vitreous cutter is safe and offers excellent biopsy yield for molecular prognostication when cancer prognosis is desired by patients.

Purpose: To demonstrate the utility of Optos ultra-wide field imaging in the diagnosis and management of choroidal melanoma in the setting of asteroid hyalosis., Design: Observational case report., Method: A 52-year-old female was referred for evaluation of floaters, photopsias, and blurry vision in the right eye. Clinical examination revealed dense asteroid hyalosis obscuring the fundus, and a limited view of a pigmented choroidal lesion in the nasal periphery. Optos ultra-wide field fluorescein angiography and ultrasonography facilitated the diagnosis of a choroidal melanoma., Results: The patient underwent Iodine-125 brachytherapy for local tumor control and excellent tumor response was confirmed with serial follow-up Optos imaging and ultrasonography., Conclusion: Ultra-wide field fundus fluorescein angiography facilitated the diagnosis of a choroidal melanoma, which was obscured by dense asteroid hyalosis, allowing for local tumor control with brachytherapy. Optos wide-field imaging may be a valuable tool for detecting potentially life-threatening lesions in the setting of asteroid hyalosis.

Background: To illustrate the evolution of paraneoplastic vitelliform maculopathy over one year using optical coherence tomography., Methods: Observational case report., Results: A 65-year-old man with a history of ocular melanocytosis and choroidal melanoma of the left eye treated with plaque brachytherapy 3 years prior returned for his yearly follow-up visit. The visual acuity in the right eye was 20/20. Subtle thickening of the interdigitation zone layer was noted on optical coherence tomography. Over the following year, multifocal vitelliform detachments developed with progressive enlargement and coalescence of the lesions. Paraneoplastic vitelliform maculopathy developed in the fellow eye of a patient with local recurrence of previously treated choroidal melanoma., Conclusion: Paraneoplastic vitelliform maculopathy may develop in the fellow eye of a patient with local recurrence of their previously treated choroidal melanoma with no clinical evidence of systemic metastasis.

Purpose: To describe a case of a ciliochoroidal melanoma arising from the site of a scleral buckle., Design: Observational case report., Method: A 69-year-old female was referred for evaluation of decreased vision and occasional floaters in the left eye for two months. Eight years previously, she had undergone vitrectomy and scleral buckling for rhegmatogenous retinal detachment repair in the same eye. Clinical examination revealed an elevated, pigmented choroidal mass in the inferonasal periphery at the crest of the scleral buckle. Clinical and ultrasonographic features were consistent with ciliochoroidal melanoma., Results: The patient underwent Iodine-125 brachytherapy with plaque placement directly on the scleral buckle. Intraoperative ultrasonography confirmed accurate plaque position. Appropriate tumor response was demonstrated at serial follow up-evaluations; however, over 48 months, the patient developed gradual decline in vision secondary to radiation retinopathy., Conclusion: Choroidal melanomas may arise from the same location as a scleral buckle and local tumor control with brachytherapy can be achieved without manipulation or removal of the buckle element. However, we encourage orbital surgeons to consider the radiation attenuating effect of silicone, found in the buckle, in order to prevent undertreatment of these melanomas.

Purpose: To review outcomes in mostly large uveal melanoma treated with a 23-mm-diameter iodine-125 plaque, the largest size available at our center, and the influence of vitrectomy and silicone oil 1000 centistokes for radiation attenuation., Methods: A one-to-one matched case-control comparison was performed. Case patients were treated with a 23-mm-diameter iodine-125 plaque and vitrectomy with silicone oil 1000-cSt placement. Control cases, treated with 23-mm plaque alone, were matched to cases with respect to tumor size and distance from tumor apex to optic nerve and fovea. Postoperative complications, visual acuity and metastasis were reviewed., Results: Twenty case patients with uveal melanoma treated with a 23-mm plaque were identified. The final logMAR vision was 0.83 in case patients and 2.06 in control patients (P = 0.0064); the change from pre-treatment to last follow-up logMAR vision was 0.70 in cases and 1.62 in controls (P = 0.019). Of good vision outcomes, 65 % of cases and 25 % of controls achieved vision ≥20/200 (P = 0.025). Of poor vision outcomes, 35 % of cases and 80 % of controls achieved vision <20/200 (P = 0.0053), and 5 % of cases and 35 % of controls achieved "light perception" or "no light perception" vision (P = 0.044). Thirty-nine of the 40 eyes (98 %) achieved local tumor control. Metastasis occurred in 15 % of cases and 45 % of controls (P = 0.082)., Conclusions: Iodine-125 brachytherapy for mostly large uveal melanoma is effective in achieving local tumor control. Furthermore, combining brachytherapy with vitrectomy and silicone oil 1000-cSt for radiation attenuation significantly improves vision over the use of plaque alone.

Purpose: To describe a case of iris melanoma for which a patient refused treatment for 15 years, and the complications that resulted., Methods: Single case report., Results: A 52-year-old white man was evaluated for a suspicious pigmented lesion of the left iris. He was followed closely with serial examinations and ultrasound biomicroscopy, and he refused therapy when the lesion showed growth 15 years after presentation. The patient subsequently developed recurrent hyphema, intraocular pressure up to 55 mmHg, and glaucomatous optic neuropathy. He eventually underwent iodine-125 brachytherapy resulting in tumor regression and improvement of intraocular pressure., Conclusion: Untreated iris melanoma can develop complications such as recurrent hyphema and glaucoma with irreversible optic nerve damage. Treatment of slow-growing iris melanoma must be considered to prevent complications.

Purpose: To evaluate the relationship between choroidal melanoma regression rate and its gene expression profile class after iodine-125 brachytherapy at 3 and 6 months, controlling for baseline tumor height., Methods: Patients from October 2012 to January 2015 at a single Ophthalmic Oncology Center who had undergone iodine-125 brachytherapy for the treatment of choroidal melanoma and who had a gene expression profile test result obtained from intraoperative fine-needle aspiration biopsy at the time of plaque surgery were retrospectively reviewed. Baseline patient and tumor characteristics were obtained, including tumor height and gene expression profile test result. Tumor height at 3 and 6 months following treatment was obtained. Regression rate was analyzed with two-way analysis of variance to class type and baseline pre-operative tumor height. Class 2 patients were matched to class 1 patients by tumor height and resulting distributions of paired regression rate differences were compared., Results: A total of 114 patients were studied. When preoperative tumor height was controlled for in the comparative analysis, neither group of patients at 3 or 6 months had a significant dependency between gene expression profile class and tumor regression rate. Additionally, class 1 and class 2 patients matched for pre-operative tumor height did not express different regression rates., Conclusions: Our study adds to a growing body of evidence that tumor regression rate does not necessarily depend on gene expression profile class type in choroidal melanoma after brachytherapy at 3 and 6 months when controlling for baseline tumor height.

Purpose: To report a case of choroidal malignant melanoma in a patient with Waardenburg syndrome and bilateral choroidal pigmentary abnormalities., Methods: Clinical examination and multimodal imaging of the case., Results: A 45-year-old woman presented with asymptomatic flat choroidal pigmentation abnormalities in both eyes. A choroidal lesion was identified in the inferotemporal periphery of the left eye arising from an area of hyperpigmentation; ultrasonography findings were consistent with a choroidal melanoma. The patient endorsed a personal and family history of premature graying of hair and was identified to have dystopia canthorum consistent with the diagnosis of Waardenburg syndrome., Conclusion: The authors present the first reported case of concurrent Waardenburg syndrome and choroidal malignant melanoma. This cooccurrence may suggest that the relative hyperpigmented regions in affected fundi may be abnormal and should be monitored closely for the development of choroidal melanoma.

Importance: We report our experience with uveal melanoma-specific gene expression profile (GEP) testing on a series of choroidal metastatic tumors confirmed by cytopathology so that clinicians may be aware that receiving a class 1 or class 2 test result in nonmelanoma is possible., Observations: Retrospective review of all cytopathology and DecisionDx-UM GEP reports between January 2012 to December 2014 from intraoperative fine-needle aspiration biopsy of choroidal tumors undergoing brachytherapy. Four patients were identified to have cytopathology consistent with a nonmelanoma primary. All 4 patients presented with a unilateral, single choroidal tumor, which was treated with iodine-125 brachytherapy and underwent intraoperative fine-needle aspiration biopsy for cytopathology and uveal melanoma-specific GEP testing for molecular prognostication. Gene expression profile testing of the choroidal tumor in each patient revealed class 1A in 3 patients and class 2 in 1 patient., Conclusions and Relevance: DecisionDx-UM GEP may be a helpful test for molecular prognostication in patients with uveal melanoma; however, class 1 and class 2 test results are indeed possible in the setting of a nonmelanoma malignancy. We recommend that cytopathology and/or other melanoma-specific testing be performed in all cases of suspected choroidal melanoma because GEP with this assay is unable to rule out the diagnosis of a choroidal melanoma.

Purpose: To report visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after iodine-125 brachytherapy for choroidal and ciliary body melanoma (CCM)., Design: Prospective interventional case series., Participants: Thirty-seven patients (37 eyes) with CCM., Methods: Patients had best-corrected Early Treatment Diabetic Retinopathy Study (ETDRS) visual acuity, Pelli-Robson contrast sensitivity and Hardy-Rand-Rittler color vision measurement; comprehensive ophthalmology examination; optical coherence tomography; and ultrasonography at baseline prior to, 1 year after, 2 years after and 3 years after I-125 brachytherapy., Main Outcome Measures: Visual acuity, contrast sensitivity and color vision prior to, 1 year after, 2 years after and 3 years after brachytherapy., Results: Nineteen (19) men and 18 women with mean age of 58 years (SD 13, range 30-78) prior to, 1 year after, 2 years after and 3 years after brachytherapy had mean best-corrected visual acuity of 77 letters (20/32), 65 letters (20/50), 56 letters (20/80) and 47 letters (20/125); contrast sensitivity of 30, 26, 22 and 19 letters; color vision of 26, 20, 17 and 14 test figures, respectively. Decrease in visual acuity, contrast sensitivity and color vision was statistically significant from baseline at 1 year, 2 years, and 3 years after brachytherapy. Decreased acuity at 3 years was associated with mid-choroid and macula melanoma location, ≥ 4.1 mm melanoma height, radiation maculopathy and radiation optic neuropathy., Conclusion: 1, 2 and 3 years after brachytherapy, eyes with CCM had significantly decreased visual acuity, contrast sensitivity and color vision.

Bilateral diffuse uveal melanocytic proliferation (BDUMP) is a rare, intraocular paraneoplastic syndrome characterized by multiple, elevated, pigmented uveal lesions, diffuse thickening of the uveal tract, and rapidly progressive cataracts. We report a 70-year-old Caucasian male with an inferotemporal conjunctival-scleral pigmented lesion of the right eye. Funduscopy and ultrasonography revealed multiple elevated pigmented choroidal lesions in both eyes. Genome-wide single nucleotide polymorphism (SNP) analysis of intraoperative transscleral fine-needle aspiration biopsies from both eyes revealed a whole gain on chromosome 5. BDUMP was diagnosed, and the patient underwent a thorough systemic investigation, which was negative for an underlying malignancy; however, by maintaining a high index of suspicion, multiple malignancies were uncovered and appropriately treated over the ensuing years. This report presents the clinical, cytologic, and cytogenetic features of BDUMP, and is the first to demonstrate a novel finding of a whole gain in chromosome 5 by SNP analysis of the choroidal lesions. Additionally, this is the first case to potentially associate BDUMP and both transitional cell carcinoma of the bladder as well as renal clear cell carcinoma.

Background/aims: Fine needle aspiration biopsy has become a standard technique to obtain material from primary uveal melanoma for diagnosis, prognostication and research. Cytopathology requires a significantly greater tissue yield for a positive diagnosis compared to other molecular tests. The purpose of this report was to compare sample retrieval for cytopathology between trans-scleral and vitrectomy-assisted transvitreal biopsy in the same tumour in patients who underwent iodine-125 brachytherapy., Methods: All clinical records of patients who underwent iodine-125 brachytherapy for the treatment of uveal melanoma in conjunction with pars plana vitrectomy from whom trans-scleral and vitrectomy-assisted transvitreal fine needle biopsies were obtained, were reviewed. Baseline patient and tumour characteristics, biopsy sample yield for cytopathology, and surgical outcomes were reviewed., Results: Thirty-eight patients with a median follow-up time of 2 months were included. Overall, 27 of 38 (71%) of transvitreal biopsies, and 25 of 38 (66%) of trans-scleral biopsies yielded sufficient material for cytopathologic analysis (p=0.62). For transvitreal and trans-scleral biopsies, larger tumours were associated with significantly higher cytopathologic yield, but tumour location did not significantly affect cytopathologic yield., Conclusions: Trans-scleral and vitrectomy-assisted transvitreal fine needle aspiration biopsy resulted in similar tissue yield for cytopathologic analysis. As molecular prognostication becomes the standard of care for obtaining patient information and directing clinical management, further investigation of biopsy techniques is warranted., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Importance: Bilateral central serous retinopathy-like events have been described in patients receiving drugs that inhibit the mitogen-activated protein kinase enzyme MEK for metastatic cancer. To date, the clinical details of this ocular adverse effect have not been adequately described in the literature. We report on a series of bilateral subfoveal neurosensory retinal detachments in patients with metastatic cancer undergoing systemic therapy with MEK inhibitors enrolled in clinical trials at our center., Observations: The clinical records of all patients with metastatic cancer enrolled in clinical trials requiring protocol ophthalmologic evaluation at our center were reviewed. Patients were excluded if they were receiving a non-MEK inhibitor, such as a BRAF inhibitor. Results of visual acuity and ophthalmic diagnostic tests, as well as clinical course and management, were determined. Three patients who received oral MEK inhibitors developed bilateral subfoveal neurosensory retinal detachment. Patient 1 had metastatic uveal melanoma; the findings resolved without intervention, and subsequent mild uveitis was responsive to topical corticosteroids. Patient 2 had metastatic cholangiocarcinoma, and his findings resolved after 2 weeks of observation. Patient 3 had metastatic rectal cancer, with bilateral uveitis and bilateral subfoveal retinal detachment. Her findings resolved with observation and topical corticosteroids for uveitis. No patient developed permanent ocular sequelae, and none withdrew from the clinical trial of MEK inhibitor therapy., Conclusions and Relevance: In this series, we report the detailed clinical findings of bilateral subfoveal neurosensory retinal detachment associated with MEK inhibitor use for treatment of metastatic cancer. A clinical finding of uveitis may prompt the ophthalmologist to consider subfoveal neurosensory retinal detachment.

Background: Retinal pigment epithelium (RPE) adenoma is an extremely rare tumor of the posterior segment which must be differentiated from other choroidal tumors, such as choroidal nevus or melanoma. We report the case of a patient with RPE adenoma coincident with macular pucker who underwent successful pars plana vitrectomy and membrane peeling., Patient and Methods: A 58-year-old female patient was diagnosed with RPE adenoma and epiretinal membrane and subsequently underwent pars plana vitrectomy and epiretinal membrane peeling., Results: RPE adenoma was diagnosed and, following vitrectomy with membrane peeling vision, improved to 20/20 with resolution of symptoms of distortion. Sixteen months of follow-up revealed no clinical change in the RPE adenoma and stable vision., Conclusion: The diagnosis of RPE adenoma can be made upon consideration of unique clinical characteristics of these benign tumors. RPE adenoma may be more closely associated with epiretinal membrane than previously believed, given recent advances in imaging technology. We describe our management strategy, which included observation of the adenoma and surgical removal of the epiretinal membrane.

Purpose: We initially reported the radiation-attenuating effect of silicone oil 1000 centistokes for iodine 125. The purpose of this report was to compare the clinical outcomes in case patients who had iodine 125 brachytherapy with vitrectomy and silicone oil 1000 centistokes with the outcomes in matched control patients who underwent brachytherapy alone., Methods and Materials: Consecutive patients with uveal melanoma who were treated with iodine 125 plaque brachytherapy and vitrectomy with silicone oil with minimum 1-year follow-up were included. Control patients who underwent brachytherapy alone were matched for tumor size, location, and sex. Baseline patient and tumor characteristics and tumor response to radiation, final visual acuity, macular status, central macular thickness by ocular coherence tomography (OCT), cataract progression, and metastasis at last follow-up visit were compared. Surgical complications were also determined., Results: Twenty case patients met the inclusion criteria. The average follow-up time was 22.1 months in case patients and 19.4 months in control patients. The final logMAR vision was 0.81 in case patients and 1.1 in control patients (P=.071); 8 case patients and 16 control patients had abnormal macular findings (P=.011); and the average central macular thickness by OCT was 293.2 μm in case patients and 408.5 μm in control patients (P=.016). Eleven case patients (55%) and 1 control patient (5%) had required cataract surgery at last follow-up (P=.002). Four patients in the case group and 1 patient in the control group experienced metastasis (P=.18). Among the cases, intraoperative retinal tear occurred in 3 patients; total serous retinal detachment and macular hole developed in 1 case patient each. There was no case of rhegmatogenous retinal detachment, treatment failure, or local tumor dissemination in case patients or control patients., Conclusions: With up to 3 years of clinical follow-up, silicone oil during brachytherapy for the treatment of uveal melanoma resulted in fewer abnormal maculas, lower central macular thickness on OCT, and a trend toward better final visual acuity in comparison with matched control patients who underwent brachytherapy alone., (Copyright © 2014 Elsevier Inc. All rights reserved.)