GI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine
Abstract
Background. Uveal melanoma takes place in 80–88.7 % of cases with all intraocular tumors. According to high malignancy 5-year mortality reach 16.5 %, 10-year – 58 % and in cases with the extrascleral growth it can reach 73 %.
Purpose. The purpose of this study was to demonstrate the clinical and instrumental possibility for early revealing and treatment of uveal melanomas in different stages and localization.
Material and methods. The article presents the different cases of uveal melanomas and methods of therapy.
Results. There were demonstrated different cases of malignant process in uveal tissue of the eye and the results of treatment with different well-known and new original methods in different stages of disease. It was described the modern conventional techniques of ablative surgery and methods of treatment of intraocular melanoma (adjuvant interferonotherapy, selective intra-arterial chemotherapy, resection of melanoma with the use of radiofrequency knife, intraocular tumors endoresection using the high-frequency electric welding).
Conclusions. The efficiency of uveal melanoma diagnostic depends on the possibility of use of the most informative and modern clinical and instrumental methods of diagnostic and treatment. There are the encouraging results of the application of high-electric-sparing surgery of uveal melanomas. The vital prognosis and choice of one of the modern methods of treatment determined by the stage of the disease and require the earliest revealing of the tumor with subsequent regular control by ophthalmologist and oncologist.
Keywords: intraocular melanoma, diagnosis, treatment, photocoagulation, transpupillary thermotherapy, brachytherapy, transscleral and endoresection of tumor, adjuvant interferonothyerapy and selective intra-arterial chemotherapy.
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Abysheva L. D.1, Alexandrov A. S.2, Arapiev M. U.3, Ardzheneshvily T. D.4, Bakunina N. A.5, Basinsky A. S.6, Brezhnev A. Yu.7, Gazizova I. R.8, Galimova A. B.9, Gapon’ko O. V.2, 5, Garkavenko V. V.10, Gorodnichy V. V.2, Gorshkova M. S.5, 12, Gusarevitch A. A.12, Dorofeev D. A.13, Zavadsky P. Ch.14, Zakharova M. A.2, 5, Zakhidov A. B.15, Zvereva O. G.16, Karimov U. R.17, Kondrakova I. V.5, Kuroyedov A. V.2, 5, Lanin S. N.18, Lipatov D. V.19, Lovpache Dzh. N.3, Loskutov I. A.20, Molchanova E. V.21, Ogorodnikova V. Yu.2, Onufriychuk O. N.22, Petrov S. Yu.23, Rozhko Yu. I.24, Tashtitova L. B.1, Khohlova A. S.25, Shaposhnikova I. V.26, Shahalova A. P.27
1Scientific State Ophthalmology Institute, Almaty, Kazakhstan; 2Mandryka Central Clinical Hospital, Moscow, Russia; 3Helmgoltz State Research Ophthalmology Institute, Moscow, Russia; 4Federal Clinical Hospital no. 86, Moscow, Russia; 5Pirogov City State Clinical Hospital no. 1, Moscow, Russia; 6Prof. Basynsky Private Ophthalmology Center, Ltd., Orel, Russia; 7State Medical University, Kursk, Russia; 8North-West Federal Medical and Research Center, Saint-Petersburg, Russia; 9All-Russian Eye and Plastic Surgery Center, Ufa, Russia; 10Voyno-Yasenetsky State Medical University, Krasnoyarsk, Russia; 11Filatov City State Clinical Hospital no. 15, Moscow, Russia; 12Regional Railroad Clinical Hospital, Novosibirsk, Russia; 13Regional Ophthalmology Clinical Hospital no. 3, Chelyabinsk, Russia; 14Medical Center “New Vision” Minsk, Belarus; 15Ophthalmosurgery Medical Center “SAIF-OPTIMA”, Tashkent, Uzbekistan; 16Region Clinical Ophthalmology Hospital, Kazan, Russia; 17Region Ophthalmology Hospital, Gulistan, Uzbekistan; 18Makarov Ophthalmology Clinical Hospital, Krasnoyarsk, Russia; 19Federal Medical Center of Endocrinology, Moscow, Russia; 20Russian Railways Clinical and Research Medical Center, Moscow, Russia; 21State Medical Academy, Omsk, Russia; 22Ophthalmic Diagnostic City Center no. 7, Saint-Petersburg, Russia; 23Scientific and Research State Ophthalmology Institute, Moscow, Russia; 24State Hospital, Gomel, Belarus; 25Pacific State Medical University, Vladivostok, Russia; 26Medical Clinical Center “Good Vision”, Kemerovo, Russia; 27Medical Clinical Center “Tonus Amaris”, Nizhny Novgorod, Russia
Abstract
Purpose. To create an optimal scientifically based system of management of diagnosis and treatment process (diagnosis, follow-up, rational medication treatment, surgical treatment) in patients with primary open-angle glaucoma.
Methods. The final protocol of combined analytical research and clinical multicenter study conducted from July to November 2015 included data from 591 patients (824 eyes). Age, disease duration, disease stage, the intraocular pressure (IOP) level and visual field parameters on the top of treatment regimens were analyzed. The term “regimen” included various combinations of medical, laser and surgical treatment used in the disease management.
Results. Average patients’ age at the diagnosis was 64.3 (57.5; 70.4). Mean disease duration was 4.1 years (2.0; 7.1). The administered regimen was considered to be effective when IOP level was below 20 mm hg. The IOP level between 21 and 25 mm hg was considered to be a sign of reduced treatment effectiveness and need for change of the regimen.
In total there were analyzed 8 regimen changes, though 90 % of cases had 1–5 regimen changes. The first three regimens were used for 1.2 (0.4; 2.6), 1.3 (0.5; 2.5) and 1.1 (0.5; 2.4) years respectively.
Prostaglandin analogues and β-blockers monotherapy was used as a first-line in 40.1 % and 20.8 % of cases respectively. Treatment was started with combination therapy in 27.82 % of cases. Proportion of surgical treatment was 9.9 % in regimen 2 and achieved 73 % in regimen 5. Laser treatment was started from regimen 3 though the frequency of administration did not exceed 20 %. Combination treatment using 3 and more components was found starting from regimen 5 (57.3 %).
Conclusion. First-line therapy choice is still not rational in many cases. Laser and surgical treatment are used ineffectively after 3–4 years from the diagnosis.
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Avdeev R. V., Aleksandrov A. S., Basinskiy A. S., Blyum Ye. A., Brezhnev A. Yu., Volkov Ye. N., Gazizova I. R., Galimova A. B., Gaponko O. V., Garkavenko V. V., Getmanova A. M., Gorodnichiy V. V., Gorshkova M. S., Gusarevich A. A., Diordiychuk S. V., Dorofeev D. A., Zhavoronkov S. A., Zavadskiy P. Ch., Zvereva O. G., Karimov U. R., Kulik A. V., Kuroedov A. V., Lanin S. N., Lovpache Dzh. N., Loskutov I. A., Molchanova Ye. V., Ogorodnikova V. Yu., Nefedov N. A., Ogorodnikova V. Yu., Onufriychuk O. N., Petrov S. Yu., Rozhko Yu. I., Sidenko T. A. Prediction of the duration of the disease and the age of patients with different stages of primary open-angle glaucoma. Natsional’nyi zhurnal glaucoma [National journal of glaucoma]. 2014; (13): 60–69. (in Russian).
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GI “The Filatov Institute of Eye Diseases and Tissue Therapy of the National Academy of Medical Sciences of Ukraine”, Odesa, Ukraine
Abstract
Introduction. The issue of efficiency of treatment of the senile cataract is one of the important issues in ophthalmology. The study is of particular importance in patients on background of glaucomatous process.
Purpose. The purpose was to study the processes of lipid peroxidation in the lens and chamber moisture in modeling age-related cataract in experimental ocular hypertension.
Methods. The studies were conducted on 39 rabbits which were divided into three experimental groups. The first group (9 animals) provided experimental simulation of the light cataract; the second group (8 animals) provided experimental modeling of the ocular hypertension; third (10 animals) was a group of combination of the light exposure and hypertension.
Results. It was found the differences in the characteristics of peroxidation in the lens material and in the fluid of anterior chamber in the groups of animals with ocular hypertension and experimental age-related cataracts. We revealed more expressed intensification of lipid peroxidation in the lens of experimental animals with ocular hypertension and simultaneous exposition of light energy.
Conclusions. Raised intraocular pressure significantly increase the intensity and terms of cataract development in the corresponding groups of experimental animals.
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