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Publications (7)12.83 Total impact

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    ABSTRACT: To describe the evolution and management over time of scleral necrosis as a complication after radiation therapy for uveal melanomas. Retrospective nonrandomized case series. Twenty-three patients (12 male, 11 female; median age 56.4 years; range, 30-73 years) treated with a single plaque therapy (cobalt-60 (Co(60)) or iodine-125 (I(125)) (1.5% of treated patients) or proton beam radiotherapy (0.45% of treated patients) for choroidal or ciliary body melanoma, presenting scleral necrosis as a post-radiation complication, were studied. Tumor characteristics, intraocular pressure, location and size of scleral necrosis were recorded during visits after radiation therapy. The median maximal tumour base and thickness at diagnosis were 14.6 +/- 4.4 mm and 7.2 +/- 2.3 mm respectively. Median radiation dose to tumor base and tumor apex was 223 Gy and 88.3 Gy respectively. The mean time of scleral necrosis onset after radiation therapy was 70.4 months (range 11-257 months); the mean scleral necrosis diameter at its onset was 4.4 mm (range 1-10 mm). Out of 23 affected eyes, 17 presented a stability of scleral necrosis; in three cases there was partial regression of scleral necrosis; in two cases there was a progressive extension of scleral necrosis until a pre-perforation stade. In two cases, a secondary enucleation was necessary due to a severe neovascular glaucoma. Scleral necrosis is a rare complication of radiotherapy for uveal melanomas. Relapse with extrascleral extension of the primary tumor has to be ruled out in order to avoid unnecessary enuclations. In most patients, the scleral necrosis remains stable and does not need any further treatment.
    Albrecht von Graæes Archiv für Ophthalmologie 10/2008; 246(12):1731-6. · 1.93 Impact Factor
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    ABSTRACT: To evaluate prospectively, on a long-term range, the clinical outcomes of transpupillary thermotherapy (TTT) as primary treatment of selected choroidal melanoma. Seventy-seven eyes of 77 patients affected by small posterior choroidal melanoma were treated with TTT as a sole treatment, using an infrared diode laser at 810 nm according to a standard procedure. Follow-up was longer than 36 months. Seventeen tumours (22%) were parapapillary (PP) and 60 tumours (78%) were non-parapapillary (NPP) in location. Mean follow-up was 55.2 ± 17.9 months in PP tumours and 44.3 ± 23.7 months in NPP tumours. Thirteen (76%) PP tumours and 55 (92%) NPP tumours regressed (P > 0.05). Nine tumours recurred: seven were retreated using Iodine-125 brachytherapy and two were enucleated (both parapapillary). Four patients (5%) developed liver metastasis and died during follow-up. Tumour thickness was found to be predictive of recurrence (odds ratio: 4.3). Complications were found in 20 eyes (26%): macular pucker in 11 (14%), macular oedema in three (4%), retinal vein occlusion in six (8%), vitreous and subretinal haemorrhage in two (3%) and neovascular glaucoma in three (4%). PP tumours had more local complications (but this was not statistically significant; P > 0.05). Complications appeared more frequently in tumours treated with more than one TTT session (P = 0.01), and time-risk to develop intraocular complications seems longer in the PP group, without reaching statistical significance (P = 0.07). TTT may be a clinically effective method for conservative treatment of selected, non-parapapillary, small posterior choroidal melanoma.
    Acta ophthalmologica 09/2008; 87(7):789-92. · 2.44 Impact Factor
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    ABSTRACT: Monosomy 3 is a highly specific marker for poor prognosis in posterior uveal melanoma. Unfortunately, cytogenetic prognostication is limited to enucleated eyes or resected tumors. The aim of this study was to evaluate mid-term natural history and safety of in vivo detection of chromosome 3 status in posterior uveal melanomas undergoing plaque brachytherapy. A 25-gauge transscleral fine needle aspiration biopsy (FNAB) was performed in 32 eyes affected by posterior uveal melanoma undergoing plaque brachytherapy, just before applying the radioactive plaque. Sampled material underwent fluorescence in situ hybridization (FISH) with centromeric probes for chromosome 3. All patients had a follow-up of at least 36 months. Mean follow-up was 47.1 +/- 8.5 months. Mean largest basal diameter and mean thickness of the tumors were 12.5 +/- 2.7 mm and 8 +/- 2.3 mm respectively. FNAB yielded sufficient material in 26 of 32 cases (81.2%). Adequacy of the sample ranged from 91.1% (ciliary body tumors) to 76.8% (choroidal tumors). Seventeen cases had monosomy 3 (65.3%). No correlation was found between monosomy 3 and tumor dimensions or location (ciliary body vs choroidal tumors). No early and mid-term local complications were documented. Seven patients (21.8%) died during follow-up: five (15.6%) of them died due to metastatic disease (all had monosomy 3 tumors). Posterior uveal melanomas may be adequately and safely sampled, by intra-operative transscleral FNAB, to detect in vivo monosomy 3.
    Albrecht von Graæes Archiv für Ophthalmologie 05/2008; 246(4):609-14. · 1.93 Impact Factor
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    ABSTRACT: To compare the changes in macular sensitivity (microperimetry) and macular thickness with different degrees of diabetic macular edema. Sixty-one eyes of 32 consecutive diabetic patients were included in this cross-sectional study. All included eyes underwent functional and morphologic examination of the macular area. Best corrected visual acuity (ETDRS charts), macular sensitivity, and macular thickness were quantified. Lesion-related macular sensitivity and retinal fixation were investigated with an advanced, automatic microperimeter. Optical coherence tomography (OCT) was used to quantify macular thickness. The 61 included eyes were graded, by two retinal specialists, for diabetic macular edema as follows: 16 were graded as no macular edema (NE), 30 as non-clinically significant macular edema (NCSME), and 15 as clinically significant macular edema (CSME). Macular thickness significantly increased from the NE to the CSME group (P<0.0001), whereas macular sensitivity significantly decreased from the NE to the CSME group (P<0.0021). A significant correlation coefficient was noted between retinal sensitivity and normalized macular thickness (r=-0.37, P<0.0001). Linear regression analysis showed a decrease of 0.83 dB (P<0.0001) for every 10% of deviation of retinal thickness from normal values. Visual acuity and central macular sensitivity correlated significantly in the NCSME group (r=-0.6, P=0.0008), but not in the NE (r=-0.144, P=0.6) or in the CSME (r=-0.46, P=0.11) groups. Macular edema may be better documented by adding macular sensitivity mapping by microperimetry to macular thickness measurement by OCT and visual acuity determination because macular sensitivity seems to be a relevant explanatory variable of visual function, independent of macular thickness data. Moreover, microperimetry may be of value in predicting the outcome of diabetic macular edema, because it incorporates a functional measure that may supplement the predictive value of OCT and visual acuity.
    Investigative Ophthalmology &amp Visual Science 08/2006; 47(7):3044-51. · 3.44 Impact Factor
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    ABSTRACT: To describe the long term outcome of patients with subfoveal, occult choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) treated with subthreshold transpupillary thermotherapy. 82 eyes of 82 consecutive patients with subfoveal occult CNV secondary to AMD were treated with subthreshold transpupillary thermotherapy. Best corrected visual acuity, fundus photography, fluorescein and indocyanine green angiography were performed. All patients have been followed for at least 24 months. At the final follow-up visit, 75.6% of patients had stable or improved visual acuity and 24.4% had worsened visual acuity. No overtreatment side effects were found. Subthreshold transpupillary thermotherapy seems effective in stabilizing visual acuity in patients affected by occult, subfoveal CNV even on a long-term basis.
    Seminars in Ophthalmology 01/2004; 19(1-2):25-8. · 1.09 Impact Factor
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    ABSTRACT: To investigate the effects of subfoveal choroidal neovascularizzation (CNV) secondary to age-related macular degeneration (AMD) on macular functional parameters quantified with an automatic fundus perimeter. 118 eyes of 98 consecutive patients with subfoveal CNV secondary to AMD were evaluated. Best corrected visual acuity (ETDRS charts), fundus photography, and fluorescein angiography were performed. Microperimetry (fundus-related perimetry) was used to quantify macular sensitivity and fixation pattern (location and stability). Of 118 eyes: 26 (21.9%) had central, 18 (15.1%) poor central and 74 (63.0%) eccentric fixation; 31 (26.0%) had stable, 42 (35.6%) relatively unstable and 45 (38.4%) unstable fixation. In 75 eyes (63.4%) a dense central scotoma was found. Angiographic classification of subfoveal CNV (occult versus classic) was not significantly related to fixation pattern (location: P = 0.274; stability: P = 0.385), and presence of dense scotoma (P = 0.41). Microperimetric quantification of macular sensitivity and fixation pattern in eyes with subfoveal CNV secondary to AMD offers new data about the impact of visual impairment in these eyes. Moreover, microperimetry improves the functional evaluation of subfoveal CNV in AMD.
    Seminars in Ophthalmology 01/2004; 19(1-2):55-61. · 1.09 Impact Factor
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    ABSTRACT: To evaluate if retinal sensitivity threshold obtained with an automatic fundus perimeter may be compared with a standard perimeter retinal threshold. Automatic full-threshold fundus perimetry (microperimetry) of the macular area (10 degrees grid, 37 stimulated points) was quantified with a new automatic fundus perimeter (MP1 microperimeter) in nine normal subjects (18 eyes). Retinal threshold was also quantified using an identical grid projected with a standard Octopus 101 perimeter. Mean threshold registered by MP1 microperimeter was 19.7+/-0.8 dB (range 16-20 dB; 4.38+/-0.96 asb, range 4-10 asb) versus 33.1+/-1.7 dB (range 27-38 dB; 0.53+/-0.22 asb, range 0.16-2 asb) obtained with Octopus perimeter. Mean SD of intraindividual variation was 0.74 dB in MP1 and 1.51 dB in Octopus. No statistically significant differences were documented between right and left eye with both instruments (p=0.64). No reliable mathematical relationship between retinal thresholds could be obtained with the two perimeters. Fundus perimetry is a precise, functional fundus-related technique which allows threshold determination at selected retinal points even if fixation is unstable and visual acuity is low. This is beyond the possibility of any static standard perimetry. Normal threshold values obtained with MP1 automatic microperimeter cannot be currently compared with those obtained with standard Octopus perimeter.
    European journal of ophthalmology 17(1):63-8. · 0.91 Impact Factor