Objective To observe the time-intensity curve characteristics of contrast agents in intraocular tumor. Methods A total of 236 patients (238 eyes) with intraocular tumor were enrolled in this study. All the patients received regular ophthalmologic examination, two dimensional ultrasound, color doppler ultrasonography and contrast-enhanced ultrasonography. There were 166 patients (166 eyes) with choroidal melanoma, 16 patients (18 eyes) with choroidal metastatic carcinoma, 52 patients (52 eyes) with choroidal hemangioma, two patients (two eyes) with retinal hemangioma. The whole process of contrast-enhanced ultrasound were recorded, and exported as t images of Dicom format. These images were processed by Sonoliver software (Tomteck Company, Germany) to drawn the time-intensity curve of contrast agents in the intraocular tumors. Results All intraocular lesions were completely filled with contrast agent, concentric filling from the periphery to the center can be documented in some cases. The time-intensity curve of choroidal hemangioma and retinal hemangioma were basically the same. The time-intensity curve of choroidal melanoma and choroidal metastatic carcinoma were also basically the same. In the filling phase, all tumors were rapid filling type. In the regression phase, contrast agent subsided earlier than in control tissue within the melanoma or metastatic carcinoma lesions, but subsided synchronous or slightly faster than in control tissue within the choroidal hemangioma and retinal hemangioma lesions. Among 166 eyes with choroidal melanoma, 138 eyes (83.1%) were in full compliance with the above changes, 28 eyes (16.9%) were largely in line with these changes. All the eyes (100.0%) with choroidal metastatic carcinoma, choroidal hemangioma and retinal hemangioma were in full compliance with the above changes. Conclusion Time-intensity curve is quickly filling and fast regression for malignant intraocular tumors, but is quickly filling and slow regression for benign intraocular tumors.
Objective To establish a new model of orthotopic-transplatation tumor of human malignant choroidal melanoma. Methods pEGFP-N1, the eukaryotic expressive plasmid of green fluorescent protein (GFP), was transfered into human malignant choroidal melanoma cell line (OCM-1) by liposome lipofectanine, then the cell clones with stable GFP expression were screened out by means of neomycin, fluorescence microscope, and flow cytometer. Two μl cell suspension of OCM-1 cells with GFP expression with the density of 4.5×107-5.5×107 cells/ml was injected into the subretinal space of right eyes of 40 nude mice (40 eyes) under binocular operating microscope with left eyes as the control ones. The growth of the transplanted malignant choroidal melanoma was observed in vivo using the fluorescence stereomicroscope. The mice were killed at different time after the operation to observe the metastasis of the tumor to optic nerve, brain and other organs including lung, liver, kidney and spleen. Moreover, pathological detection and immunohistochemical staining of GFP was carried out. Results At the postoperative 10th-12th days, the growths of the transplanted malignant choroidal melanoma with dilated and distorted blood vessels and neovascularization were observed; at the postope rative 20th-22nd days, the melanoma occupied the whole cavity of vitreous body; and at the postoperative 24th-26th days, the transplanted tumor grew out of the eye. Metastases of the carcinoma to olfactory bulb, kidney, lung and liver were seen at the failure phase soon after the extra-ocular phase. The histopathological characteristics of the transplanted tumor were similar to those of human, and the results of immunohistochemical staining showed positive expression of GFP in the tumor cells. Conclusion The orthotopic model of malignant choroidal melanoma set up via injection of human malignant choroidal melanoma cells labeled by GFP into the subretinal space of nude mice may provide a new approach to investigate the natural courses of growth and metastasis of malignant choroidal melanoma. (Chin J Ocul Fundus Dis，2004，20：245-248)
Objective To establish an allogenic intraocular melanoma model and observe its pathological features.Methods Thirty-six kunming mice were devided randomly into 3 groups with 12 ones in each, and allogeneic melanoma cells B16F10(C57BL16) were inoculated into the anterior chamber (AC), vitreous cavity (VC) of right eyes and under the skin (subcutaneous, SC) of the back of right feet of each grup respectively. The incidence of tumor occurance, time of breaking through the eyeball and other general pathologic features of the tumor were observed by slip-lamp biomicroscopy and operating microscopy for continuous 32 days, and the results were statistically analyzed. Pathological examination was given for tumors at last.Results The incidence of tumor occurance in both AC (12/1 2 eyes) and VC group (11/11 eyes) was higher than that in SC group (2/12 feet)（χ2=17.143, P＝0 .000；χ2=16.218, P=0.000）. The time of eyeball diabrosis was 11-13 days in AC group and 13-32 days in VC group, and there was significant difference between these two groups (Log Rank=18.22, P=0.000). The intraocular melanomas could grow progressively, but reduced and fell off when they broke through eyeball and grew in or bit for a period. The average diameter of the tumor after 32 days after inoculation was (2.27±1.97) mm in AC group，(3.82±1.85) mm in VC group and (0.94±2.27) mm in SC group. There was significant difference between VC and SC group (t=3.322，P=0.003). In pathohistological examination, tumor tissue necrosis could be observed at the center of the subcutaneous melanomas but not in intraocular melanomas.Conclusions Allogeneic intraocular melanoma model is successfully established which is convenient, repeatable, and helpful to studying the mechanism of genesis and development of this tumor. (Chin J Ocul Fundus Dis，2003，19：333-404)
Objective To investigate the MRI characteristics of the tumor of optic pathway and damage degree of visual function. Methods Analysis of 119 cases surgically and pathologically proved tumor suffering from optic pathway was carried out retrospectively. The patients included:36 ones with tumors in anterior segment of optic pathway,70 ones in middle segment of optic pathway,and 13 ones in posterior segment of optic pathway. The MRI examination series were transverse T-1WI SE,transverse and coronal T-2WI TSE,coronal T-2WI SPIR,and transverse,sagittal,coronal T-1WI SE after Gd-DTPA enhancement. Results The tumors of optic pathway included:the primary tumors of the optic pathway and the tumors of any other part of the body which invaded the optic pathway. There was a special MRI feature on the each tumor suffering from optic pathway,but the pituitary adenoma which affects visual function was the most common tumor. Conclusion MRI is an effective method in the diagnosis of optic-pathway tumor. (Chin J Ocul Fundus Dis, 2002, 18: 101-103)
OBJECTIVE:To investigate the diagnostic meaning of MRI in intraocular tumors. METHODS:Forty-six cases of confirmed intraocular tumors,including choroidal melanoma(20 cases),retinoblastoma(18 cases),Coats disease(6 cases)and choroidal hemangioma(2 cases),were studied with MRI and compared with ultrasonography and CT. RESULTS:In making discoveries about intraocular tumors,there were no sighificant difference between MRI and B-ultrasonography or CT （P＞0.03，chi;2=1.0716）while there were highly statistic sighificance in dediding characters and position （P＜0.01，deceding character chi;2=29.8314，positionchi;2=13.659）of them. CONCLUSION:Among the examinations to find out about the position,character and secondary pathological insults of in traocular tumors MRI might be more available than CT and ultrasonography. （Chin J Ocul Fundus Dis,1997,13:93-95 ）
ObjectiveTo evaluate the safety and efficacy of the intravitreal methotrexate treatment in patients with primary vitreoretinal lymphoma (PVRL). MethodsRetrospective non-comparative interventional case series. Fourteen patients (26 eyes) with biopsy-proven PVRL were included in the study. All patients received examination of Snellen chart visual acuity, fundus color photography and optical coherence tomography (OCT). Among the 24 eyes with recordable visual acuity, 17 eyes has initial visual acuity≥0.1 (0.45±0.20) and 7 eyes with initial visual acuity ranged from light perception to hand movement. The vitreous opacities and (or) subretinal yellowish-white lesions and retinal pigment epitheliumuplift were observed in all eyes. All eyes were treated with intravitreal methotrexate (4000 μg/ml, 0.1 ml) injections according to a induction-consolidation-maintenance regimen. For 26 treated eyes, each received an average of (11.5±6.3) injections. Twenty eyes had finished theintraocular chemotherapy, while 6 eyes had not. Eight of 20 eyes were clinically confirmed free of tumor cells by diagnostic vitrectomy, 12 eyes were still with tumor cell involvement.The follow-up was ranged from 2 to 48 months, the mean time was 18 months. The examination of BCVA, fundus color photography and OCT were performed. No tumor cell was defined as clinical remission. Visual acuity was scored as improved or declined obviously (improved or declined 2 lines) or mild improved or declined (changed within 2 lines). ResultsTwenty eyes achieved clinical remission after (3.5±3.6) injections, 12 eyes of 20 eyes with tumor cell involvement before chemotherapy achieved clinical remission after (5.8±3.0) injections. The mean visual acuity of seventeen eyes with initial visual acuity 0.1 in induction phase and at the end of treatment were 0.36±0.23 and 0.56±0.20, respectively. Compared with before treatment, the visual acuity was mild declined in induction phase (t=1.541, P>0.05), but mild improved at the end of treatment (t=2.639, P<0.05). The visual acuity at the end of treatment in 7 eyes with initial visual acuity<0.1 was ranged from no light perception to 0.1. Of 14 patients, 2 patients have been fatal because of brain lesions progression at 42 and 48 months after diagnosis of primary central nervous system lymphoma. No ocular recurrence was noted during the follow-up in 20 eyes who finished intraocular chemotherapy. ConclusionsPVRL patients can achieve clinical remission after (3.5±3.6) injections by intravitreal chemotherapy of methotrexate, and the visual acuity improved mildly. No ocular recurrence was found during follow-up.
Primary vitreoretinal lymphoma (PVRL) is a rare type of non-Hodgkin's lymphoma with poor prognosis and the optimal treatment has yet to be determined. Its treatment has evolved from enucleation to ocular radiotherapy, systemic chemotherapy and intravitreal chemotherapy. Radiotherapy can effectively eradicate tumor cells but ocular recurrences are common. Systemic chemotherapy has become the mainstream option but there are problems with only-partial response of PVRL and high rate of recurrence. Intravitreal chemotherapy, primarily used as adjunctive to systemic chemotherapy, has achieved high remission rate and low rate of recurrence as well as with limited ocular complications. The tumor cells were cleared and the visual function preserved. However, issues about the drug applied, treatment protocols and goals of intravitreal chemotherapy, whether for visual preservation or survival improvement, are worthy for further study.
Primary vitreoretinal lymphoma (PVRL) is a rare and aggressive high-grade non-Hodgkin lymphoma. PVRL always with non-specific symptoms and has therefore been called as masquerade syndrome. Thus, the early and correct diagnosis of PVRL is a difficulty. For PVRL, the imaging findings can be specific but variety, histological diagnosis is still the gold standard. Its diagnosis needs to be combined with clinical manifestations, imaging features, pathological diagnosis and molecular biology. With the advancement of technology, especially in the field of the cytokines detection and the gene expression profiling research, molecular biology diagnosis of PVRL is becoming a research hotspot and an important auxiliary diagnostic method.
ObjectiveTo observe the image characteristics of optical coherence tomography (OCT) in patients with primary vitreoretinal lymphoma (PVRL).MethodsA retrospective clinical study. Thirty-two eyes of 19 patients diagnosed with PVRL by vitreous pathology in the Department of Ophthalmology, Beijing Tongren Hospital from September 2016 to October 2019 were included in this study. There were 7 males and 12 females. The median age was 56 years. The mean time from symptom onset to final diagnosis was 6.1±3.8 months. The first diagnosis was uveitis in 12 cases (63.1%, 12/19), retinal vein occlusion in 2 cases (10.5%, 2/19), central retinal artery occlusion in 1 case (5.3%, 1/19), and suspected PVRL of camouflage syndrome in 4 cases (21.1%, 4/19). Routine ophthalmic examination and frequency-domain OCT examination were performed in all the patients, and typical images were stored for analysis. According to the examination results, PVRL OCT signs were divided into vitreous cells, inner retinal infiltration, outer retinal infiltration, retinal pigment epithelial (RPE) infiltration, sub-RPE infiltration, and subretinal fluid.ResultsVitreous cells were found in all eyes (100.0%, 32/32). RPE infiltrated were observed in 19 eyes (59.4%, 19/32), RPE infiltration in 16 eyes (50.0%, 16/32), outer retinal infiltration in 8 eyes (25.0%, 8/32), inner retinal infiltration in 16 eyes (50.0%, 16/32), and subretinal fluid in 4 eyes (12.5%, 4/32).ConclusionsPVRL OCT signs can involve vitreous and retinal anatomical levels, including vitreous cells, inner retinal infiltration, outer retinal infiltration, RPE infiltration, sub-RPE infiltration and subretinal fluid. The same patient can show multiple signs at the same time.
Ciliary body tumor is a rare intraocular tumor. Due to its unique anatomical location, its correct diagnosis and reasonable treatment are very difficult problems. In terms of diagnosis and differential diagnosis, ophthalmologists need to fully utilize the role of slit lamp microscope and transillumination experiment to capture secondary changes in the anterior segment caused by hidden ciliary body tumors, such as monocular localized cataract, lens indentation, and pigment dissemination, etc. Ophthalmological imaging methods, especially ultrasound biomicroscopy, can achieve the purpose of early detection and early diagnosis. According to the size, location and morphological characteristics of the tumor, a reasonable treatment plan is formulated. Since ciliary body tumors are mostly benign, the recurrence rate of local resection is low, which can satisfy the pathological diagnosis and preserve part of the patient's vision. Therefore, eye-preserving treatment should be advocated. However, enucleation remains the treatment of choice for tumors that are too large to be treated with local excision or radiation, eyes with refractory glaucoma, and tumors that do not respond to radiation therapy.