Minoru Furuta

L V Prasad Eye Institute, Bhaganagar, Andhra Pradesh, India

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Publications (14)46.81 Total impact

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    ABSTRACT: PURPOSE: To evaluate the clinical features and prognosis of posterior uveal (ciliary body and choroid) melanoma based on the American Joint Committee on Cancer (AJCC) classification (7th edition) of primary tumor (T). DESIGN: Retrospective, interventional case series. PARTICIPANTS: Seven thousand seven hundred thirty-one patients. INTERVENTION: Ocular management including plaque radiotherapy, enucleation, local resection, or laser therapy. MAIN OUTCOME MEASURES: Melanoma-related metastasis and death. RESULTS: Of 7731 patients with posterior uveal melanoma, the AJCC classification based on T was category T1 in 3557 (46%), T2 in 2082 (27%), T3 in 1599 (21%), and T4 in 493 (6%). Based on tumor categories T1, T2, T3, and T4, respectively, features that showed significant increase with tumor category included patient age at presentation (57, 58, 58, and 61 years; P<0.001), tumor base (8, 12, 15, and 20 mm; P<0.001), tumor thickness (3.5, 5.2, 8.9, and 11.4 mm; P<0.001), mushroom configuration (8%, 20%, 38%, and 39%; P<0.001), associated subretinal fluid (64%, 80%, 82%, and 83%; P<0.001), intraocular hemorrhage (5%, 12%, 17%, and 18%; P<0.001), rupture of Bruch's membrane (9%, 24%, 40%, and 40%; P<0.001), and extraocular extension (1%, <1%, 4%, and 12%; P<0.001). After therapy, Kaplan-Meier estimates of metastasis at 5, 10, and 20 years were 8%, 15%, and 25% for category T1, 14%, 25%, and 40% for category T2, 31%, 49%, and 62% for category T3, and 51%, 63%, and 69% for category T4, respectively (P<0.001). Kaplan-Meier estimates of death at 5, 10, and 20 years were 4%, 8%, and 11% for category T1, 8%, 13%, and 24% for category T2, 19%, 27%, and 36% for category T3, and 30%, 43%, and 51% for category T4, respectively (P<0.001). Compared with category T1, the hazard ratio for metastasis and death for T2 was 1.8 and 1.9, respectively, that for T3 was 4.5 and 4.7, respectively, and that for T4 was 8.2 and 8.8, respectively. CONCLUSIONS: Based on the AJCC classification, increasing tumor category was associated with older age, larger tumor, and greater incidence of subretinal fluid, hemorrhage, and extraocular extension. Compared with uveal melanoma classified as T1, the rate of metastasis and death was 2 times greater for T2, 4 times greater for T3, and 8 times greater for T4. The risk for metastasis and death increased 2-fold with each increasing melanoma category. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
    Ophthalmology 05/2013; · 5.56 Impact Factor
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    ABSTRACT: OBJECTIVE:: To determine prognosis of small choroidal melanoma (≤3 mm thickness) comparing diffuse versus nondiffuse variants. METHODS:: Retrospective chart review of 1,751 patients with small choroidal melanoma classified as diffuse (thickness/base ≤20%) versus nondiffuse (thickness/base >20%). RESULTS:: Of 1,751 patients with small choroidal melanoma, 297 (17%) were diffuse and 1,454 (83%) nondiffuse. Features with statistical differences (diffuse vs. nondiffuse) included mean distance to optic disk (3 vs. 4 mm), mean tumor base (12 vs. 8 mm), and mean tumor thickness (1.9 vs. 2.5 mm). Using Kaplan-Meier estimates, melanoma-related metastasis (diffuse vs. nondiffuse) was 8% versus 4% at 5 years, 16% versus 10% at 10 years, and 19% versus 16% at 15 years (P = 0.0344). Melanoma-related death was 6% versus 2% at 5 years, 11% versus 4% at 10 years, and 16% versus 6% at 15 years (P < 0.0001). In the subgroup of thin melanoma 2 mm or less in thickness, melanoma-related death was 7% versus 2% at 5 years, 10% versus 2% at 10 years, and 16% versus 4% at 15 years (P = 0.0077). By multivariate analysis, factors predictive of metastasis from diffuse melanoma included larger tumor basal dimension (P = 0.0027) and plateau/flat tumor configuration (P = 0.0257). CONCLUSION:: Of 1751 patients with small (≤3 mm thickness) choroidal melanoma, those with diffuse tumor show higher probability of metastasis and death than those with nondiffuse tumor. This finding is evident even in the thinnest melanomas (≤2 mm thickness).
    Retina (Philadelphia, Pa.) 04/2013; · 2.93 Impact Factor
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    ABSTRACT: Purpose. To determine the influence of patient age on life prognosis in patients with uveal melanoma.
Design. Matched retrospective cohort study of 122 patients in each age category (young [≤20 years], mid-adults [21-60 years], older adults [>60 years]).
Results. Kaplan-Meier estimates of tumor-related metastasis at 3, 5, and 10 years were 1%, 8%, and 8% in young; 8%, 11%, and 26% in mid-adults; and 13%, 16%, and 24% in older adults. After exclusion of iris melanoma, Kaplan-Meier estimates of tumor-related metastasis at 3, 5, and 10 years were 2%, 11%, and 18% in young; 9%, 14%, and 21% in mid-adults; and 9%, 34%, and 33% in older adults. Risk factors for metastasis based on multivariate analysis included increasing age in young (p=0.05, hazard ratio [HR] 1.33), male gender in mid-adults (p=0.046, HR 4.23), and larger tumor basal diameter in mid-adults (p=0.002, HR 1.37) and older adults (p=0.001, HR 1.30). After adjusting for tumor diameter, the metastatic rate was lower in young patients compared to mid-adults (0=0.042, HR 3.00) and older adults (p=0.007, HR 4.20). 
Conclusions. Younger patient age at the time of diagnosis of uveal melanoma is associated with lower rate of metastasis compared to mid-adults and older adults.
    European journal of ophthalmology 10/2012; · 0.91 Impact Factor
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    ABSTRACT: To evaluate clinical features and life prognosis of uveal melanoma based on age at presentation. Retrospective, nonrandomized, interventional case series. Of 8,033 eyes with uveal melanoma, 106 (1%) were in young patients (≤20 years), 4,287 (53%) in mid adults (21-60 years), and 3,640 (45%) in older adults (>60 years). Based on age (young, mid adults, and older adults) at presentation, tumor epicenter was located in iris (21, 4, 2%; P < 0.0001), ciliary body (8, 5, and 7%; P = 0.0225), or choroid (71, 91, and 90%; P < 0.0001). Mean tumor diameter (10.2, 10.8, 11.5 mm; P < 0.0001), mean tumor thickness (5.0, 5.3, 5.7 mm; P < 0.0001), and extraocular extension (1, 2, and 4%; P = 0.0004) increased with age. Kaplan-Meier estimates of tumor-related metastasis at 3, 5, 10, and 20 years were 2%, 9%, 9%, and 20% in young patients (P < 0.011); 6%, 12%, 23%, and 34% in mid adults (P < 0.0001); and 11%, 19%, 28%, and 39% in older adults. Kaplan-Meier estimate of tumor-related death at 3, 5, 10, and 20 years were 0%, 2%, 5%, and 17% in young patients (P = 0.08); 3%, 6%, 11%, and 17% in mid adults (P < 0.001); and 7%, 11%, 16%, and 20% in older adults. Compared with mid adults and older adults, young patients manifested a higher proportion of iris melanoma. Compared with older adults, young and mid adults showed smaller melanoma basal dimension and lower tumor-related metastasis and death.
    Retina (Philadelphia, Pa.) 03/2012; 32(7):1363-72. · 2.93 Impact Factor
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    ABSTRACT: The purpose of this article is to determine the incidence, etiology, management, and outcome of vitreous hemorrhage (VH) after plaque radiotherapy for uveal melanoma. Retrospective review of medical records. Of 3,707 eyes treated with plaque radiotherapy for uveal melanoma, VH developed in 4.1% at 1 year, 15.1% at 5 years, and 18.6% at 10 years by Kaplan-Meier analysis. Presumed causes of VH included tumor necrosis (29%), proliferative radiation retinopathy (24%), posterior vitreous detachment (16%), vascular occlusion (5%), and unknown (19%). Tumor necrosis was the most common cause of VH early in the follow-up period (3% at 1 year), while proliferative radiation retinopathy was the most common source of VH later (6.2% at 15 years). The most common initial management was conservative observation for resolution in 48%, laser photocoagulation in 24%, and vitrectomy in 18%. After a mean follow-up period of 5 years, the VH was completely resolved in 41%, partially resolved in 19%, unresolved in 20%, worsened in 5%, and enucleation was necessary in 15%. By multivariable analysis, risk factors for development of VH were the presence of diabetic retinopathy at first visit (relative risk, 6.64), shorter tumor distance to the optic disc (relative risk, 1.07), greater initial tumor thickness (relative risk, 1.1), and break in the Bruch membrane (relative risk, 2.93). The rates of local tumor recurrence, extraocular extension, and distant metastasis in 74 patients who underwent vitrectomy for VH removal after tumor regression were similar to those in patients who did not have vitrectomy for VH. Vitreous hemorrhage occurs after plaque radiotherapy for uveal melanoma in 15.1% of the patients by 5 years. The main factors predictive of VH included underlying diabetic retinopathy, closer tumor proximity to the disc, greater tumor thickness, and break in the Bruch membrane. After tumor regression, vitrectomy for blood removal appears to be safe.
    Retina (Philadelphia, Pa.) 02/2012; 32(6):1156-64. · 2.93 Impact Factor
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    ABSTRACT: To evaluate iris melanoma in children versus adults. Retrospective, nonrandomized clinical case series including all patients with a clinical diagnosis of iris melanoma managed at the Ocular Oncology Service at Wills Eye Institute over 40 years. Patients were divided into three age categories based on age at presentation: children (≤ 20 years), mid-adults (21-60 years), and older adults (>60 years). The clinical features, treatments, and outcomes were statistically analyzed based on patient age at presentation. The main outcome measures were melanoma features and related metastasis and death. Of 8,101 eyes with uveal melanoma, there were 317 (4%) with iris melanoma, including 24 (8%) children (≤ 20 years), 187 (59%) mid-adults (21-60 years), and 106 (33%) older adults (>60 years). There was no age-related difference in race, sex, tumor quadrant, thickness, pigmentation, associated corectopia, ectropion uveae, hyphema, or extraocular extension. Significant age-related differences were found with mean tumor basal diameter, tapioca appearance, mean intraocular pressure, secondary glaucoma, tumor seeding in angle, and mean number of clock hours of angle seeding. Multivariate analysis of factors predictive of metastasis included extraocular extension and high intraocular pressure. Factors predictive of death included increased tumor thickness and high intraocular pressure. There was no difference in metastasis or death by age group. Iris melanoma shows significant clinical differences in children versus adults, with smaller tumor size, less tumor seeding in angle, and lower incidence of secondary glaucoma. There was no significant difference in metastasis or death by age group.
    Journal of AAPOS: the official publication of the American Association for Pediatric Ophthalmology and Strabismus / American Association for Pediatric Ophthalmology and Strabismus 02/2012; 16(1):10-6. · 1.07 Impact Factor
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    ABSTRACT: To determine risk factors, occurrence rate, management, and outcome of proliferative radiation retinopathy (PRR) after plaque radiotherapy for uveal melanoma. Case-control study. Three thousand eight hundred forty-one patients who underwent plaque radiotherapy for uveal melanoma were entered into the study. Retrospective review of medical records. Proliferative radiation retinopathy after plaque radiotherapy for uveal melanoma. Of 3841 eyes treated with plaque radiotherapy for uveal melanoma, PRR developed in 5.8% at 5 years and in 7% at 10 and 15 years using Kaplan-Meier analysis. The mean time to onset of PRR was 32 months (median, 30 months; range, 4-88 months). On univariate analysis, baseline factors predictive of PRR (P<0.05) included young age, diabetes, hypertension, Hispanic race, shorter tumor distance to the optic disc and to the foveola, Bruch's membrane rupture, choroidal location of the tumor, subretinal fluid, higher radiation dose to the optic nerve and to the foveola, higher radiation rate to the tumor apex and to the tumor base, additional transpupillary thermotherapy, and notched plaque. In the multivariate model, young age (odds ratio [OR], 1.44; 95% confidence interval [CI], 1.25-1.67, per decade decrease), diabetes mellitus (OR, 2.73; 95% CI, 1.69-4.40), and shorter tumor distance to the optic disc (OR, 1.10; 95% CI, 1.04-1.17) were related to the occurrence of PRR. The most common forms of management included panretinal photocoagulation (70%), vitrectomy (21%), and observation (17%). Resolution of the neovascularization was obtained in 63% of eyes after treatment. Proliferative radiation retinopathy developed in 7% of eyes by 10 years after plaque radiotherapy for uveal melanoma. The main factors for development of PRR included young age, preexistent diabetes mellitus, and shorter tumor distance to the optic disc.
    Ophthalmology 05/2010; 117(5):1005-12. · 5.56 Impact Factor
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    ABSTRACT: To determine the rate of metastasis of uveal melanoma on the basis of tumor thickness in millimeters. Retrospective medical record review. The mean (median) patient age was 58 (59) years. A total of 8033 eyes were examined. Of the 285 eyes with iris melanoma, the mean tumor thickness was 2.7 mm and metastasis occurred in 0.5%, 4%, and 7% at 3, 5, and 10 years, respectively. Of the 492 eyes with ciliary body melanoma, the mean tumor thickness was 6.6 mm and metastasis occurred in 12%, 19%, and 33% at 3, 5, and 10 years, respectively. Of the 7256 eyes with choroidal melanoma, the mean tumor thickness was 5.5 mm and metastasis occurred in 8%, 15%, and 25% at 3, 5, and 10 years, respectively. For all uveal melanoma, metastasis at 5, 10, and 20 years was 6%, 12%, and 20% for small melanoma (0-3.0 mm thickness), 14%, 26%, and 37% for medium melanoma (3.1-8.0 mm), and 35%, 49%, and 67% for large melanoma (>8.0 mm). More specifically, metastasis per millimeter increment at 10 years was 6% (0-1.0 mm thickness), 12% (1.1-2.0 mm), 12% (2.1-3.0 mm), 16% (3.1-4.0 mm), 27% (4.1-5.0 mm), 28% (5.1-6.0 mm), 29% (6.1-7.0 mm), 41% (7.1-8.0 mm), 50% (8.1-9.0 mm), 44% (9.1-10.0 mm), and 51% (>10.0 mm). Clinical factors predictive of metastasis by multivariate analysis included increasing patient age, ciliary body location, increasing tumor diameter, increasing tumor thickness, having a brown tumor, and the presence of subretinal fluid, intraocular hemorrhage, or extraocular extension. Increasing millimeter thickness of uveal melanoma is associated with increasing risk for metastasis.
    Archives of ophthalmology 09/2009; 127(8):989-98. · 3.86 Impact Factor
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    ABSTRACT: To determine features that are predictive of growth of choroidal nevi into melanoma. This was a retrospective medical record review of 2514 consecutive eyes; Kaplan-Meier estimates and Cox regression analyses were used. The median tumor basal diameter was 5.0 mm and thickness was 1.5 mm. Nevus growth into melanoma occurred in 2%, 9%, and 13% of eyes at 1, 5, and 10 years, respectively. Factors predictive of growth into melanoma by multivariable analysis included tumor thickness greater than 2 mm (P < .001), subretinal fluid (P = .002), symptoms (P = .002), orange pigment (P < .001), tumor margin within 3 mm of the optic disc (P = .001), ultrasonographic hollowness (P < .001), and halo absence (P = .009). A mnemonic device to recall risk factors of ocular melanoma is "To find small ocular melanoma using helpful hints," representing thickness, fluid, symptoms, orange pigment, margin, ultrasonographic hollowness, and halo absence. The median hazard ratio for those with 1 to 2 risk factors was 3; for 3 or 4 factors, 5; for 5 to 6 factors, 9; and for all 7 factors, 21. In an analysis of 2514 choroidal nevi, factors predictive of growth into melanoma included greater thickness, subretinal fluid, symptoms, orange pigment, margin near disc, and 2 new features: ultrasonographic hollowness and absence of halo.
    Archives of ophthalmology 09/2009; 127(8):981-7. · 3.86 Impact Factor
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    ABSTRACT: To report three cases of vitreous seeding from retinal astrocytoma. Retrospective, single-center case series. An asymptomatic 8-year-old boy (Case 1) presented with a white juxtapapillary retinal tumor and extensive overlying large vitreous seeds. Fine-needle aspiration biopsy (FNAB) confirmed the diagnosis of benign retinal astrocytoma. A 5-year-old boy (Case 2) presented with a large, multilobulated, tan juxtapapillary retinal tumor. The mass had grown from 6.6 mm to 9.0 mm in thickness. Overlying localized vitreous seeds were present. FNAB revealed cells of astrocytic origin. Histopathologic analysis of the enucleated globe supported the diagnosis of retinal astrocytoma. A 14-year-old girl (Case 3) was referred with a white gelatinous mass overlying the optic disk and producing vitreous seeds. FNAB revealed cells of astrocytic origin. The tumor height increased from 2.5 mm to 5.5 mm, and total retinal detachment developed. After enucleation, the diagnosis of retinal astrocytoma was confirmed. In all three cases, the vitreous seeds were round to oblong and stringy in configuration. No patient manifested tuberous sclerosis. Retinal astrocytoma can produce vitreous seeds, sometimes associated with tumor growth. Care should be taken to exclude the diagnosis of retinoblastoma.
    Retina 07/2008; 28(6):884-8. · 2.83 Impact Factor
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    ABSTRACT: To evaluate the clinical features of choroidal nevi based on patient age at presentation and to investigate features of the nevi that are predictive of patient symptoms. Observational case series. Three thousand four hundred twenty-two consecutive eyes of 3187 patients. Retrospective clinic-based study of clinical features at referral. Cox proportional hazards regressions were used for evaluation of factors predictive of patient symptoms. Nevus features as related to patient age group at diagnosis (young [< or =20 years], mid-adult [21-50 years], older adult [>50 years]) and factors predictive of patient symptoms secondary to the nevus. Of the 3422 eyes with choroidal nevus, 63 (2%) were in young patients, 795 (23%) in mid-adults, and 2564 (75%) in older adults. The following factors showed no substantial increase or decrease by age category (young, mid-adult, older adult) at presentation: symptoms (14%, 12%, 13%), mean nevus base (5.6, 4.7, 5.2 mm), intrinsic nevus pigmentation (89%, 74%, 77%), related subretinal fluid (SRF) (11%, 15%, 9%), overlying orange pigment (6%, 10%, 6%), retinal pigment epithelial hyperplasia (0%, 9%, 7%), and retinal pigment epithelial atrophy (2%, 13%, 10%). The following factors statistically increased with age category: multiple nevi per eye (2%, 8%, 10%) (P = 0.0001), mean nevus thickness (1.2, 1.5, 1.6 mm) (P<0.0001), and overlying drusen (11%, 40%, 58%) (P<0.0001). Using multivariate analysis of the entire group, factors predictive of any symptom included nonpigmented nevus (P<0.001), location < or = 3 mm to foveola (P = 0.001), subfoveolar fluid (P = 0.002), any SRF (P = 0.02), and subfoveolar nevus (P = 0.027). Choroidal nevi show similar clinical features regardless of age of presentation, with the exception of increasing number of nevi per eye, slightly increasing thickness, and increasing drusen in adults versus younger patients. Symptomatic nevi are more likely to be nonpigmented, beneath the foveola, and with subfoveolar fluid.
    Ophthalmology 04/2008; 115(3):546-552.e2. · 5.56 Impact Factor
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    ABSTRACT: To evaluate visual acuity in eyes with choroidal nevus. This was an observational case series. Of 3422 consecutive eyes with choroidal nevus, vision loss at 15 years occurred in 2% of eyes with extrafoveolar nevus and in 26% of eyes with subfoveolar nevus, particularly those with overlying retinal pigment epithelial detachment and foveal edema. A retrospective medical record review was conducted, with evaluation of visual acuity at presentation and at final examination. The main outcome measure was visual acuity. The median visual acuity at presentation was 20/20 for eyes with either extrafoveolar or subfoveolar choroidal nevus. Using Kaplan-Meier estimates, vision loss of 3 or more logarithm of the minimum angle of resolution (logMAR) lines at 5, 10, and 15 years occurred in less than 1%, 1%, and 2% of eyes with extrafoveolar nevus compared with 15%, 20%, and 26% of eyes with subfoveolar choroidal nevus, respectively. By multivariate analysis, factors predictive of visual loss of 3 or more logMAR lines included subfoveolar nevus location (relative risk [RR], 15.52), juxtapapillary nevus location (RR, 4.52), initial visual acuity of 20/50 or worse (RR, 15.40), overlying retinal pigment epithelial detachment (RR, 22.16), and foveal edema (RR, 9.02). Factors predictive of poor final visual acuity of 20/200 or worse included subfoveolar nevus location (RR, 11.32), overlying orange pigment (RR, 3.68), overlying retinal pigment epithelial detachment (RR, 12.80), and foveal edema (RR, 18.72). Mild vision loss over many years should be anticipated in patients with subfoveolar choroidal nevus, particularly those with overlying retinal pigment epithelial detachment, orange pigment, and foveal edema.
    Archives of Ophthalmology 12/2007; 125(11):1501-7. · 3.83 Impact Factor
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    ABSTRACT: CASE REPORT: A 58-year-old white female noted a lesion on her left lower eyelid, present for 3 months. Examination disclosed a dark-blue, subepithelial, smooth mass along the cilia near the punctum. The lesion did not transmit light and was thought to be a solid mass, such as a deep-blue nevus or melanoma versus a cystic mass with internal debris. Ultrasound biomicroscopy showed a fairly circumscribed echolucent mass measuring 3.2 x 3.5 mm suggestive of a cyst with numerous internal echo impedances. Following resection, histopathologic evaluation disclosed a cyst lined by a dual layer of eccrine sweat ductal epithelium, consistent with eccrine hidrocystoma. COMMENTS: Eyelid hidrocystomas can be pigmented and can be confused clinically with melanocytic tumors. Ultrasound biomicroscopy can provide helpful diagnostic information about the internal architecture of such lesions.
    Canadian Journal of Ophthalmology 11/2007; 42(5):750-1. · 1.15 Impact Factor
  • Archives of Ophthalmology 07/2007; 125(6):840-2. · 3.83 Impact Factor

Publication Stats

153 Citations
46.81 Total Impact Points

Institutions

  • 2013
    • L V Prasad Eye Institute
      Bhaganagar, Andhra Pradesh, India
  • 2007–2013
    • Thomas Jefferson University
      • Wills Eye Institute
      Philadelphia, PA, United States
  • 2007–2008
    • Wills Eye Institute
      Philadelphia, Pennsylvania, United States