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Background: Early confirmation of the effect of brachytherapy for choroidal melanoma showing that tumour coverage is valuable. The irradiated retinal pigment epithelium (RPE) commonly develops atrophy. This study compares the fundus autofluorescence (AF) changes to the development of RPE atrophy following brachytherapy. Methods: Retrospective study of 19 patients treated with 106Ru and 2 with 125I plaques with either a 3- or 6-month follow-up period. Ultra-widefield (UW) composite colour and AF images were obtained with Optomap 200Tx and interpreted as complete, partial, or no RPE changes and complete or partial hyperautofluorescence, hypoautofluorescence, or isoautofluorescence. Results: At the 3-month follow-up, 9 of 13 patients (69%) (95% confidence interval [CI], 0.389–0.896) treated with 106Ru plaques developed complete homogenous hyperautofluorescence surrounding the tumour, but only 1 of 13 (8%) (95% CI, 0.004–0.379) developed complete RPE atrophy at the same time point. Six patients in the 106Ru plaque group had their first follow-up with UW imaging at 6 months. Four of them developed homogenous hyperautofluorescence and none developed complete RPE atrophy around the tumour. The 2 patients treated with 125I did not demonstrate any clear RPE or AF changes. Conclusion: The effect of 106Ru plaque treatment on fundus UW imaging is detected as homogenous and well-demarcated hyperautofluorescence before visible RPE atrophy.

Purpose To collect comprehensive data on choroidal and ciliary body melanoma (CCBM) in children and to validate hypotheses regarding pediatric CCBM: children younger than 18 years, males, and those without ciliary body involvement (CBI) have more favorable survival prognosis than young adults 18 to 24 years of age, females, and those with CBI. Design Retrospective, multicenter observational study. Participants Two hundred ninety-nine patients from 24 ocular oncology centers, of whom 114 were children (median age, 15.1 years; range, 2.7–17.9 years) and 185 were young adults. Methods Data were entered through a secure website and were reviewed centrally. Survival was analyzed using Kaplan-Meier analysis and Cox proportional hazards regression. Main Outcome Measures Proportion of females, tumor-node-metastasis (TNM) stage, cell type, and melanoma-related mortality. Results Cumulative frequency of having CCBM diagnosed increased steadily by 0.8% per year of age between 5 and 10 years of age and, after a 6-year transition period, by 8.8% per year from age 17 years onward. Of children and young adults, 57% and 63% were female, respectively, which exceeded the expected 51% among young adults. Cell type, known for 35% of tumors, and TNM stage (I in 22% and 21%, II in 49% and 52%, III in 30% and 28%, respectively) were comparable for children and young adults. Melanoma-related survival was 97% and 90% at 5 years and 92% and 80% at 10 years for children compared with young adults, respectively ( P = 0.013). Males tended to have a more favorable survival than females among children (100% vs. 85% at 10 years; P = 0.058). Increasing TNM stage was associated with poorer survival (stages I, II, and III: 100% vs. 86% vs. 76%, respectively; P = 0.0011). By multivariate analysis, being a young adult (adjusted hazard rate [HR], 2.57), a higher TNM stage (HR, 2.88 and 8.38 for stages II and III, respectively), and female gender (HR, 2.38) independently predicted less favorable survival. Ciliary body involvement and cell type were not associated with survival. Conclusions This study confirms that children with CCBM have a more favorable survival than young adults 18 to 25 years of age, adjusting for TNM stage and gender. The association between gender and survival varies between age groups.

Purpose To report a bilateral uveal melanoma detected in a micrometastasis study. Method Case report. Results At enucleation of a circumpapillary amelanotic mixed melanoma in a patient with ocular melanocytosis, a pigmented lesion in the other eye was detected, thought to be a naevus. BAP1 was positive showing nuclear staining of the tumour cells. Seven years later the naevus showed growth and development of a retinal detachment. FNAB disclosed monosomy 3 in the spindle tumour cells. Conclusion A case of bilateral melanoma with long-term survival without metastatic diseases is reported. Different gene expressions in the two eyes were revealed. The case is a reminder that follow-up over years is essential in patients with a uveal melanoma, especially with ocular melanocytosis.

The purpose of this study was to evaluate treatment response and complications of transarterial chemoembolization using drug-eluting beads loaded with irinotecan (DEBIRI) in patients with liver metastases from uveal melanoma (UM). Patients treated with DEBIRI (n = 14) were retrospectively analyzed regarding overall survival, compared to patients (n = 14) treated with intravenous dacarbazine (DTIC). Median overall survival was calculated from time of diagnosis of metastatic disease (OS1) and start of treatment (OS2). Radiological response for DEBIRI was assessed according to RECIST 1.1 on contrast-enhanced computed tomography (CT), obtained 1.5 months (range 1.2–3.7) post treatment. Major complications of DEBIRI were defined according to the Society of Interventional Radiology classification for complications by outcome. In the DEBIRI group, OS1 was 14.8 months (range 3.9–47.5), and OS2 was 9.4 months (range 1.7–39). Further, 11/13 (84.6 %) of these patients had progressive disease on first follow-up CT and new lesions were seen in nine. There were 12 major complications in nine patients, possibly including one case of mortality due to disseminated intravascular coagulation (DIC). For patients with liver metastases from UM, the effect on overall survival of DEBIRI alone is questionable. Compared to previous reports, the response rate of DEBIRI was poor, with new liver lesions observed in the majority of patients. Major complications possibly included one case of DIC.

Our objective was to study survival rates with the bone marrow (BM) results in a cohort of uveal melanoma patients with long follow-up.Mononuclear cell fractions isolated from BM were examined for tumour cells using our immunomagnetic separation (IMS) method. The patients were classified as BM positive or BM negative. Clinical follow-up, histopathological findings, vital status and cause of death were registered.The study included 328 consecutive patients with uveal melanoma from 1997 to 2006. Tumour cells were found in BM samples in 29% (95% CI, 25-34) at enrolment (96 cases). After a minimum follow-up time of 6 years, 156 (48%) (95% CI, 42-53) melanoma patients had died. The causes were as follows: melanoma metastases 92 (59%), another cancer 20 (13%) and non-cancer 44 (28%). Nine patients were still living with melanoma metastases. Until the latest work-up, 101(31%) (95% CI, 26-36) patients had developed melanoma metastases. Cyto- or histopathological verification of the metastatic lesions was obtained in 85 cases (84%). In the group with melanoma metastases, 28 tested BM positive at study entry (28%) (95% CI, 19-38). In total, 39 of 101 with metastases tested positive at least once after a maximum of three tests (39%) (95% CI, 29-49). The overall median survival from the first BM test was shorter for the BM negative patients (9.5 years) compared with the BM positive (14.4 years), p = 0.02, log rank test.Ocular melanoma cells detected in BM seem to have a positive prognostic impact on survival in contrast to our original hypothesis.

Approximately 50% of uveal melanoma patients develop metastases. We want to evaluate the effect of stricter criteria on our data from our previous study correlating survival and bone marrow (BM) micrometastasis results using our immunomagnetic separation (IMS) method. Mononuclear cell fractions (MNC) isolated from BM were examined for tumour cells and the patients were classified as BM positive (BM+) or BM negative (BM-). The study originally included 328 consecutive patients with uveal melanoma from 1997 to 2006. The cohort was limited to 217 patients when we introduced cyto- or histopathological verification of melanoma cells in the patient as a main new criterion for inclusion. Tumour cells were found in BM-samples in 38.7% (95% CI, 32–45) at enrolment. Until the latest work-up 43.8% (95% CI, 38–50) of patients had developed melanoma metastases. After a minimum follow-up time of 8.5 years, 60.4% (95% CI, 54–66) of patients had died. The causes were: melanoma metastases 69.5%, another type of cancer 5.4% and non-cancerous causes 19.5%. Overall median survival was shorter for the BM- patients (11.3 years) (95% CI, 10–12) compared to the BM+ (16.5 years) (95% CI, 12–14), p = 0.04, log rank test. All-cause mortality and specific melanoma mortality estimated after 12 year follow-up showed a highly significant difference comparing BM- and BM+, p = 0.010 and p = 0,017, respectively. IMS yields a high fraction of BM+ samples due to micrometastasis at diagnosis and these cells appear to have a positive prognostic impact strengthening our previous report. The late recurrences support the concept of tumour dormancy.

Background The incidence of malignant melanoma in Norway is among the highest in the world and rising, with approximately 1 500 persons receiving the diagnosis annually. Correct surgical primary treatment cures 80-90%, while 10-20% experience relapses. The treatment of a metastatic malignant melanoma has changed considerably in the last 1-2 years as a result of clinical experience with new drugs. The current publication provides an updated overview of the treatment of malignant melanoma in Norway. Method The article is based on a search in PubMed and on the authors' own research and clinical experience. Results After several decades with almost no change in the treatment of malignant melanoma, we have seen a positive development over the past couple of years. New treatment methods for malignant melanoma with distant spreading metastases have yielded favourable results in selected patients and are currently established in cancer departments in Norway. Interpretation Rapid and correct primary treatment is curing most patients with malignant melanoma. New drugs offer hope for selected patient groups with metastatic disease. Several new types of targeted treatment are being tested in clinical studies in Norway and elsewhere in the world.

Our objective was to introduce immunomagnetic separation (IMS) in ocular research by evaluating the possibility of detecting tumour cells in bone marrow (BM) and peripheral blood (PB) samples and validating the captured cells as melanocytic cells.Mononuclear cell (MNC) fractions isolated from BM and PB in uveal melanoma patients were examined for tumour cells using our IMS method. Sheep-anti-mouse IgG antibody-coated super paramagnetic particles were conjugated to an anti-melanoma antibody. Microscopy of the magnetic fraction isolated from MNCs was performed to identify and count the number of bead-rosetted cells. The finding of at least two rosettes with coated beads in a 20-microl fraction of a sample was registered as a positive test. The melanocytic nature of the tumour cells was ascertained with a double labelling procedure using fluorescent microparticles.Using IMS in a study of 328 patients, tumour cells were at initial diagnosis found in BM and PB in 29.9% and 1.6% of cases, respectively. In positive samples, a median of 56 tumour cells (range 2-500) were identified. The captured cells were documented to be of melanocytic origin by the simultaneous binding of fluorescent beads coated with another melanoma-associated antibody.The IMS method was sensitive and efficient in the detection of occult melanoma tumour cells in BM. The validity of the immunomagnetic technique was strengthened by verifying the melanocytic characteristics of the isolated cells. The IMS procedure identifies intact, vital tumour cells, permitting further molecular characterization, an advantage which makes this method attractive for extended use. The clinical relevance of the findings will be further investigated in follow-up studies with repeated sampling and characterization of the isolated tumour cells.

Ocular oncologists require a strong indication for intraocular biopsy before the procedure can be performed because it carries a risk for serious eye complications and the dissemination of malignant cells. The purpose of this review is to evaluate the extent to which this restricted practice is supported by evidence from previous reports and to outline our main indications and contraindications. The different intraocular biopsy techniques in the anterior and posterior segment are discussed with a focus on our preferred method, fine-needle aspiration biopsy (FNAB). In the literature, complications are typically under-reported, which reduces the possibilities of evaluating the risks correctly and of making fair comparisons with other biopsy methods. In FNAB, the exact placement of the needle is critical, as is an accurate assessment of the size of the lesion. Fine-needle aspiration biopsy is usually not a reliable diagnostic tool in lesions < 2 mm in thickness. It is very advantageous to have a cytopathologist present in the operating theatre or close by. This ensures adequate sampling and encourages repeated biopsy attempts if necessary. This approach reduces false negative results to < 3%. Adjunct immunocytochemistry is documented to increase specificity and is essential for diagnosis and management in about 10% of cases. In some rare pathological processes the diagnosis depends ultimately on the identification of specific cell markers. An accurate diagnosis may have a decisive influence on prognosis. The cytogenetic prognostications made possible after FNAB are reliable. Biopsy by FNA has a low complication rate. The calculated risk for retinal detachment is < 4%. Intraocular haemorrhage is frequently observed, but clears spontaneously in nearly all cases. Only a single case of epibulbar seeding of malignant cells at the scleral pars plana puncture site of transvitreal FNAB has been documented. Endophthalmitis has been reported and adequate standard preoperative preparation is obligatory. An open biopsy is still an option in the anterior segment, but has been abandoned in the posterior segment. Although vitrectomy-based procedures are becoming increasingly popular, we recommend using FNAB as part of a stepwise approach. A vitrectomy-assisted biopsy should be considered in cases where FNAB fails. In any adult patient with suspected intraocular malignancy in which enucleation is not the obvious treatment, the clinician should strive for a diagnosis based on biopsy. When the lesion is too small for biopsy or the risks related to the procedure are too great, it is reasonable to be reluctant to biopsy. The standards applied in the treatment of intraocular malignant diseases should be equivalent to those in other fields of oncology. Our view is controversial and contrary to opinion that supports current standards of care for this group of patients.

A case report of a primary malignant melanoma of the lacrimal sac is presented. After excision a local recurrence appeared one year later. Wide, but incomplete excision and postoperative irradiation resulted in local tumour control for 4 years. The patient succumbed to a uremic death caused by a rectal cancer removed 3 years before the occurrence of the malignant melanoma.

A 28 year-old man with a spontaneous vitreous haemorrhage as the first sign of Leber's optic atrophy is presented. The blood collected in a central retrohyaloid area covering the left macula. The exact starting point of the haemorrhage was never positively identified, but it seemed to originate from an area of microangiopathy adjacent to the optic disc. For 8–10 months the vision of the left eye gradually decreased to counting fingers. A year later the visual acuity dropped to the same level on the right eye. The picture was compatible with Leber's optic atrophy. Other disorders causing bilateral optic neuropathy were excluded. A careful family history revealed several cases of visual problems for several generations. Vitreous haemorrhage as the first sign of Leber's optic atrophy has not previously been reported. Peripapillar microangiopathy, however, has been desribed in the asymptomatic stage of the disease.

Four patients with histologically verified uveal melanomas were examined with computed tomography (CT) scan. Ophthalmoscopy revealed a sharply deliminated tumour surrounded by a secondary retinal detachment. The clinically calculated size of the tumours corresponded well with the histological specimens. The CT-scan indicated a greater size of the tumours. The discrepancies were due to difficulties in differentiation between the tumour tissue and the subretinal fluid which have almost identical CT-numbers. By combining axial and coronal views it was possible to distinguish the tumour from the secondary retinal detachment.

The results of pars plana lensectomy (PPL) in 36 eyes are reported. The average follow-up time was 9 months (2-24). The optical media became clear in all eyes. Post-operative visual acuity (VA) was greater than or equal to 0.6 in 31 eyes. Two eyes developed serious complications (retinal detachment in 1 eye and neovascular glaucoma in 1 eye). PPL represents minimal risks for the anterior segment, excludes problems with secondary cataract, presents optimal conditions for early contact lens fitting and for necessary treatment in the posterior segment. In the hands of an experienced surgeon PPL is effective and safe and offers an alternative treatment for patients up to the age of 30-35 years.

This case report describes the clinical and histopathological findings in a 65-year-old woman enucleated for a malignant choroidal melanoma. Simultaneously, an excision was performed of a cutaneous melanoma together with a satellite nodule presumed to be a metastasis from the cutaneous, superficial spreading melanoma. Six months later, chemotherapy for liver metastasis was given without effect. There were no signs of dysplastic nevus syndrome. A 39-year-old cousin, however, had been enucleated for a malignant choroidal melanoma. This sporadic case might suggest a common etiologic factor in the pathogenesis of multicentric melanomas.

Purpose: To report an iris leiomyoma documented in accordance with today's stricter diagnostic criteria. Methods: Light microscopy, immunohistochemistry and electron microscopy were performed on the 3 mm ball-like, greyish-white vascularized tumour of the iris, close to the sphincter pupillae. Results: Light microscopy of the extirpated neoplasm showed the characteristic appearance of a leiomyoma with densely packed spindle-shaped cells, with oval nuclei and granular cytoplasm. On electron microscopic examination the tumour exhibited the characteristic features of a smooth muscle neoplasm. The immunohistochemistry was consistent with a myogenic tumour because the tumour cells were positive for smooth muscle actin and desmin, but negative for S-100 and melanin. Conclusion: The case illustrated the necessity of performing ancillary procedures such as electron microscopy and immunohistochemistry to substantiate a correct, although rare diagnosis.

Metastatic melanoma to the eye can show a number of unusual features. Two cases with intraocular metastases from primary cutaneous malignant melanoma, with a latency of 5 and 16 years, respectively, from excision to debut of ocular symptoms are reported. In the first case, tumour cell invasion of the chamber angle caused an advanced secondary glaucoma. This eye was enucleated some months later when the tumour extended through the sclera despite palliative external radiation therapy. In the other seeing eye, small melanoma metastases were treated with laser. The patient died of systemic involvement. In the second case, a probable melanoma metastasis was revealed by a vitrectomy of a thickened posterior vitreous membrane. Ophthalmoscopy and B-scan ultrasonography 8 months later showed growths projecting 2 mm into the vitreous cavity. Metastases from a malignant melanoma with infiltration of the retina forming nodules, but also affecting adjacent choroid and optic nerve, was disclosed by histology. The patient died of metastasis to the brain.

Patients with carotid artery occlusive disease may develop ocular changes in both the anterior and posterior segments of the eye caused by chronic ischaemia. Four cases are reported with a wide variety of the characteristic ocular ischaemic symptoms and signs. Pulsed Doppler spectral analysis of the precerebral carotid arteries was used to detect the presence of relevant carotid occlusive disease. Diagnosis and therapy require an interdisciplinary approach, to prevent cerebral stroke and to preserve ocular function.

Purpose Uveal melanoma (UM) is the most common intraocular malignancy and is fatal in approximately 50% of the cases. Cancer relapse can be seen years after treatment. Diverse mechanisms have been proposed to explain the late relapse of UM e.g cancer dormancy and the presence of cancers stem cells (CSCs). UM has the disadvantage of being difficult to culture, thus a limited number of cell lines are available. 3D sphere cultures of early passages offer a lower degree of clonal selection and perhaps a more accurate reflection of the primary tumours. The propagation of cells as spheres is believed to enrich for a CSC-like population. Methods 2D cultures were expanded in RPMI 1640 with 10% FBS, while 3D sphere cultures were expanded in hESC + MEF for 7–10 days. We compared UM primary tumours fresh frozen vs. 2D culture and 3D sphere culture of the same donors by microarray, qRT-PCR, transmission electron microscopy (TEM), immunohistochemistry (IHC) and chromatin immunoprecipitation (ChIP). Results 3D sphere cultures induce signalling pathways that enhance survival and increase oncogenic activity. They show ultrastructural resemblance to in vivo UMs. The metabolic shift seen in 3D cultures could reflect the survival patterns of pre-metastatic cancer cells. Conclusions The molecular signature of the 3D cultures reveals the presence of attractive targets for future epigenetic modulation or cancer cell vaccines.

Nordic ophthalmologists and vision scientists are active in many fields of eye research. This is most evident at the biannual Nordic Congress of Ophthalmology, most recently held in Malmo in June 2004. The authors here review some of the research in vision and ophthalmology presented at this meeting or published recently by Nordic scientists. This paper does not represent a comprehensive review of all Nordic research in the field, but attempts to give an overview of some of the activities underway in eye research in this part of the world.

Purpose: To report findings and evaluate the results of vitrectomy in 22 eyes with Terson syndrome. Methods: We reviewed retrospectively the records of patients who underwent pars plana vitrectomy as a result of vitreous haemorrhage. Twelve cases concerned unilateral vitrectomy and five concerned bilateral vitrectomy. The time interval between intracranial haemorrhage and vitrectomy was 1–10 months (mean 5.9 months). Results: During a mean follow-up of 23.3 months (range 1–69 months) visual acuity (VA) improved in 21 of 22 eyes. Preoperative VA was ≤ 0.1 in 20 of 22 eyes, while postoperative VA was ≥ 0.5 in 16 of 21 eyes. Poor visual outcomes were mainly caused by retinal detachments (seven eyes, in which three were caused by proliferative vitreoretinopathy), epiretinal membranes (seven eyes) and optic atrophy (one eye). Our study concurs with recent reports suggesting early vitrectomy in bilateral cases and in cases where ultrasonography shows epiretinal membrane or proliferative retinopathy formation.

Purpose Optic disc melanocytoma (ODM) is a benign tumour that usually occurs on or adjacent to the optic nerve head. The aim of the study was to evaluate fundus autofluorescence (FAF) imaging as a diagnostic tool in ODM. Methods Retrospective comparative case series study of six patients with ODM and a comparing group of four patients with juxtapapillary choroidal nevus (JCN) and four with juxtapapillary uveal melanoma (JUM). Clinical examination was supplemented with ultrasound B-scan examination and spectral-domain optical coherence tomography. FAF images were obtained with the 532-nm laser (Optomap P200Tx) from all patients. Results Clinical examination in the ODM group revealed a dome-shaped, darkly pigmented tumour on or adjacent to the optic disc in all patients, with a mean tumour basal dimension 1.4 mm and mean tumour thickness by ultrasonography of 1.0 mm. FAF revealed a totally hypofluorescent mass with sharply demarcated, feathery edges. No hyperfluorescent changes due to orange pigment or subretinal fluid were seen. In contrast, patients with JCN and JUM manifested focal hyperfluorescence as well as larger hyperfluorescent areas at the tumour and its borders. Conclusion Fundus autofluorescence imaging is a non-invasive adjuvant tool in the differential diagnosis of ODM characterized by lack of hyperfluorescence compared to JCN and JUM.

Purpose: To report two cases of invasive uveal melanomas, one of which showed multifocality. Methods: Clinical examination, ultrasonography, colour Doppler analysis, cytological and histopathological evaluations. Results: Transvitreal biopsy (case 1) or fine needle aspiration biopsy (FNAB) (case 2) revealed malignant melanomas in both patients. Light microscopy and immunohistochemical examinations substantiated the diagnosis of mixed cell type melanomas. In addition, one patient had a multifocal melanoma with papilloedema and colour Doppler findings suggestive of optic disc involvement. Conclusion: Transvitreal biopsy for histology or cytology is a reliable procedure to obtain an accurate diagnosis without delay of a lesion adjacent to the optic nerve head. In our two cases the biopsy findings led to enucleation.

Two cases of retinal breaks in areas with medullated nerve fibres are reported. The breaks were secured by argon laser treatment. A vitreous detachment may cause a slit-like tear by vitreoretinal traction in such areas.

Purpose: To evaluate the fine needle aspiration biopsy (FNAB) as a diagnostic tool in cases where it was impossible to make a definitive diagnosis with noninvasive techniques. Method: 80 consecutive patients with inconclusive diagnoses were examined by FNAB prior to decision of treatment. Biopsies were performed through a transscleral route in 50 eyes, an anterior chamber route in 16 eyes and a transvitreal approach in 14 eyes. The consequences of FNAB were analysed retrospectively. Results: FNAB confirmed malignancy in 59 eyes. Inconclusive material was obtained from 5 eyes judged clinically to be malignant disorders. One melanoma was misinterpreted as being a metastasis. In 47.5% of our patients this procedure altered the therapeutic plan and 25 patients were spared enucleation. The biopsy material was correctly diagnosed as benign in 16 cases. Conclusion: In eyes where the diagnosis remained uncertain after non-invasive tests, FNAB gave important information which greatly influenced our choice of treatment. FNAB contained sufficient tissue elements for cytological diagnosis in 77 eyes. Cytopathological interpretation failed once in relation to tumour type. The procedure of FNAB can be recommended for use in ambiguous tumour cases of the eye. Probably it should only be used in tumour centres with adequate cytology service.

PURPOSE To evaluate primary laser photocoagulation of "small" posterior choroidal melanomas in eyes with good vision. METHOD This study includes a case series comprising six patients treated with standard laser techniques for melanoma, which had a mean thickness of 3.1 mm (range 2.9-3.9 mm), largest basal diameter of 8.6 mm (mean, range 7.0-10.0 mm), and located 0.5-2 disk diameters from the fovea or 0.3-3 disk diameters from the optic nerve head. RESULTS No metastatic death was observed in the follow-up period (range 3 1/2-7 1/2 years). Two local recurrences appeared, both were treated with plaques, one eye was later enucleated. Two additional cases were also treated with plaques. Only two of the irradiated eyes retained reading vision. CONCLUSION Primary photocoagulation of "small" posterior choroidal melanomas with argon laser is not recommended.

PURPOSE: To report a rare tumour of the eye, and to illustrate the importance of performing a fine-needle aspiration biopsy. CASE REPORT: An 80-year-old woman suffering from general malaise, dyspnea and abdominal pain was found to have multiple lung metastases, a large tumour in the upper part of the mediastinum, and a large orange-brown tumour (19 x 15 x 11 mm) situated nasally in the left eye. Fine-needle aspiration biopsy of the uveal tumour and of the goitre was performed. Cytological examination from the two sites disclosed cells compatible with a follicular thyroid carcinoma of oxyfil cell-type. RESULTS: The patient underwent a total thyroidectomy and has so far had 2 series of 131I therapy. Additionally, the eye tumour was treated locally with a 125I plaque, and three months later the tumour thickness had decreased from 11.0 to 6.4 mm. Best-corrected visual acuity is still unchanged. The patient's general state improved as her dyspnea decreased significantly. CONCLUSION: The treatment has improved the patient's quality of life, and probably prolonged her life expectancy. Fine-needle aspiration biopsy was necessary to establish the diagnosis.

We present 3 patients diagnosed with myotonic dystrophy who developed recurrences of secondary opacification. One developed a dense posterior vitreous membrane. Patients with myotonic dystrophy may have an increased risk for recurrent secondary opacification and for developing intraocular fibrosis after cataract extraction.

To report findings and evaluate the results of vitrectomy in 22 eyes with Terson syndrome.We reviewed retrospectively the records of patients who underwent pars plana vitrectomy as a result of vitreous haemorrhage. Twelve cases concerned unilateral vitrectomy and five concerned bilateral vitrectomy. The time interval between intracranial haemorrhage and vitrectomy was 1-10 months (mean 5.9 months).During a mean follow-up of 23.3 months (range 1-69 months) visual acuity (VA) improved in 21 of 22 eyes. Preoperative VA wasor = 0.1 in 20 of 22 eyes, while postoperative VA wasor = 0.5 in 16 of 21 eyes. Poor visual outcomes were mainly caused by retinal detachments (seven eyes, in which three were caused by proliferative vitreoretinopathy), epiretinal membranes (seven eyes) and optic atrophy (one eye). Our study concurs with recent reports suggesting early vitrectomy in bilateral cases and in cases where ultrasonography shows epiretinal membrane or proliferative retinopathy formation.

Purpose: To evaluate the visual and anatomic results of radiation therapy in ten patients with choroidal haemangiomas. Methods: Nine patients with circumscribed choroidal haemangiomas and one with diffuse choroidal haemangioma have been reviewed retrospectively. They were treated by lens-sparing external beam radiation therapy (20‐24 Gy) (9 eyes) and plaque brachytherapy (25 Gy) (1 eye), respectively. Results: The visual acuity improved by two lines or more in 8 of 10 eyes. No eyes showed deterioration of visual acuity. In all cases the retinal detachment showed complete resolution. A regression in tumour thickness was observed in all cases, and a reduction of anisometropia in cases with submacular infiltration by the tumour. During follow-up (0.4‐8.8 years) there were no signs of radiation cataract, retinopathy or optic neuropathy. Conclusions: External beam radiation (20‐25 Gy) is a reasonable alternative for treatment of symptomatic choroidal haemangiomas.

Purpose: A registration and follow-up of patients who underwent pars plana vitrectomy after dislocated nuclear fragments to the vitreous following cataract extraction. Material and methods: A retrospective study of 125 patients referred to The National Hospital during the years 1991 to 1998. Phacoemulsification and extracapsular technique were used in 115 eyes and 10 eyes, respectively. A pars plana vitrectomy was performed within an average of 13 days (1–99 days) after cataract extraction. Average follow-up period was 9 months (0.5–35 months). Results: The visual acuity at follow-up was ≥ 0.5 in 67 eyes (55.4%), 0.1 in 32 eyes (26.4%), and ≤0.1 in 22 eyes (18.2%). The total number of retinal detachments was 26 (21.5%). Conclusion: Retained nuclear fragments in the vitreous is a serious complication and most eyes achieve acceptable visual results.

Purpose: To report a case of bilateral diffuse uveal melanocytic proliferation (BDUMP), a rare paraneoplastic syndrome causing visual loss in patients with systemic carcinoma. Results: A 70-year-old woman developed visual symptoms 13 months after surgery and local irradiation therapy for uterine cancer. Following bilateral external beam irradiation supplemented with subsequent drainage of subretinal fluid in the left eye, the visual acuity improved from 0.01 to 0.15 in this eye only. The visual acuity remained at this level until she died 4 1/4 years after the onset of eye symptoms. Conclusion: This is the fourth case that survived longer than 24 months after the onset of visual symptoms of the 22 previously reported cases with BDUMP. It demonstrates that radiotherapy may have a vision-preserving effect in this group of patients. The patient also developed two different paraneoplastic phenomena ‐ a nephrotic syndrome before and BDUMP after treatment for uterine cancer.

This report describes two cases of circumscribed choroidal haemangiomas involving the fovea, complicated by serous retinal detachment. Laser photocoagulation, generally accepted as the treatment of choice for choroidal haemangioma, was considered either to be of no visual benefit or a risk for jeopardizing vision further due to the subfoveolar lesions. Fractionated radiotherapy using a lens-sparing, modified retinoblastoma technique, was given, using circular fields of 15 mm diameter. The dose was 24 Gy in 8 fractions. In both eyes the retina reattached completely. The visual acuity improved markedly in the first, and was restored to the prior level in the second. Normalization of a high intraocular pressure was also achieved in the second case. We believe this method to be a reasonable and effective therapy for some choroidal haemangiomas after careful individual consideration.

Ocular changes due to chronic ischaemia are described in 45 patients with hemodynamically significant carotid occlusive disease. Regarding the ophthalmic artery flow before and after vasodilatory stimulus, the patients were divided into four different groups. Eyes with permanent anterograde ophthalmic artery flow had evidence of embolic features, but no signs of chronic hypoperfusion. In the group where anterograde ophthalmic artery flow changed to retrograde after 1 g intravenous acetazolamide, the patients had symptoms of critical ocular perfusion, but only subtle structural changes could be demonstrated. Chronic ocular ischaemic syndromes were found in the cases with retrograde ophthalmic artery flow, especially where bilateral severe carotid obstruction was present.

A tumour of the iris with the morphological and immunohistochemical characteristics of a paraganglioma is presented. Neither this type of tumour, nor the specialized nerve cells giving rise to the tumour, have previously been reported in the eye. A successful local resection was performed. The diagnosis and concept of paragangliomas are discussed briefly.

Preoperative findings and postoperative results in 8 patients with retinal detachment after YAG-laser capsulotomy are described. In this period the over-all incidence of clinical retinal detachment in pseudophakic eyes after YAG capsulotomy in our hospital was 1.0% (2 of 193). Possible relationships between YAG-laser capsulotomy and retinal detachment are discussed. Two risk factors for developing retinal detachment were found in 6 of 8 patients. After surgical repair 7 retinas were re-attached. The final visual acuity was better than 0.5 in 5 patients.

We describe two cases of chiasmal optic neuritis. The presenting symptoms were reduced visual acuity and bitemporal visual field defects. The enlargement of the optic chiasm in the acute stage and normalization after recovery is demonstrated by magnetic resonance imaging (MRI).

We describe the clinical findings and natural history of an autosomal dominant form of partial lipodystrophy found in four affected individuals from three generations in the same family. The lipodystrophy was present from infancy/early childhood, involved primarily the face and local areas on the buttocks, and was nonprogressive. Affected individuals also had the Rieger anomaly, midface hypoplasia, short stature, retarded bone age, and hypotrichosis. An affected woman developed insulinopenic diabetes mellitus at 39 yr and another had glucose intolerance at 55 yr.

A case of neurosyphilis is described. The presenting symptoms were reduced visual acuity and impaired colour vision. The examination revealed bilateral optic atrophy and acquired red-green colour defect. A syphilitic aetiology was based on positive serological tests in blood and CSF, pleocytosis and increased total protein in the CSF. The abrupt decline in visual acuity was arrested by treatment with penicillin and systemic steroids, but normalization of vision was not obtained. All VER-records, of P2 latencies and morphologies were surprisingly normal, but the amplitudes were reduced.

The first published case from Norway of primary bilateral malignant melanoma of the choroid is presented. On the admission of a 73-year-old woman for a choroidal melanoma of the left eye, an asymptomatic tumour was detected in the periphery of her right eye. The left eye was enucleated. Histology confirmed the presence of a choroidal melanoma of the mixed type. After 3 1/2 years with regular follow-ups growth of the asymptomatic tumour was noticed. The fast growth was accompanied by a haemorrhage in the vitreous and a secondary retinal detachment. External radiation with a dose of 33.6 Gy resulted in a regression of the tumour, improvement of visual acuity to 0.5 and re-attachment of the retina, lasting the remaining 8 months of life. Multiple metastasis to the liver caused her death.

A case of neurosyphilis is described. The presenting symptoms were reduced vision and pain around the left eye. The examination revealed a juxtapapillary chorioretinitis and neurosyphilis with elevated total protein (0.84 g/l) and pleocytosis (250 cells X 10(6)/l) in the cerebrospinal fluid (CFS). Four months after treatment with penicillin for 10 days and prednisolone for 5 weeks, the ophthalmological signs had disappeared. There was no pleocytosis (4 cells X 10(6)/l), and the total protein content in CSF was almost normal (0.52 g/l). Treatment with 6 mill (IU) penicillin G intravenously every 6 h resulted in a concentration in serum and spinal fluid higher than the generally accepted treponemacidal level.