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Finger P.T.,New York Eye Cancer Center | Chin K.J.,New York Eye Cancer Center | Yu G.-P.,New York Eye and Ear Infirmary | Patel N.S.,New York Eye Cancer Center
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To examine how tumor characteristics and dose affect cataract development after plaque radiation therapy. Methods and Materials: Three hundred and eighty-four patients were diagnosed with uveal melanoma and treated with palladium-103 (103Pd) plaque radiation therapy. Of these, 282 (74%) inclusion met exclusion criteria for follow-up time, tumor location, and phakic status. Then patient-, ophthalmic-, and radiation-specific factors (patient age, diabetes, hypertension, tumor location, tumor dimensions, and lens dose) were examined (by a Cox proportional regression model) as predictors for the development of radiation-related cataract. Results: Radiation cataract developed in 76 (24%) of patients at a mean follow-up of 39.8 months (range, 1-192). Patients with anteriorly located tumors were noted to have a higher incidence of cataract at 43.0% (43 of 100 patients) vs. 18.1% (33 cataracts per 182 patients) for posteriorly located tumors (p <0.0001). However, multivariate Cox proportional modeling showed that increasing patient age at time of treatment (p for trend = 0.0003) and higher lens dose (p for trend = 0.001) were the best predictors (biomarkers) for radiation cataract. Conclusions: Although anterior tumor location, greater tumor height, and increased patient age (at treatment) were associated with significantly greater risk for radiation cataract, dose to lens was the most significant factor. © 2011 Elsevier Inc.


Barman M.,New York Eye Cancer Center | Finger P.T.,New York Eye Cancer Center | Milman T.,New York Eye and Ear Infirmary
Ophthalmology | Year: 2012

Objective: To evaluate the outcome of scleral patch grafts in a series of patients undergoing management for uveal and ocular surface tumors. Design: Case series. Participants: Ten patients underwent scleral patch grafting. Five patients had uveal melanoma with extrascleral extension, 2 patients had scleromalacia secondary to plaque radiotherapy for uveal melanoma, 2 patients had suspicious uveoscleral nevi, and 1 patient had invasive conjunctival squamous cell carcinoma with scleral necrosis. Methods: Retrospective, interventional, noncomparative chart review of patients undergoing treatment for ocular tumors followed by scleral grafts in a tertiary eye care center in the United States between September 2003 and January 2011. Sclera was reconstructed with allogenic scleral grafts. Clinical observations were performed after grafting. Main Outcome Measures: Structural integrity, appearance, and stability of the grafts. Results: Ten patients were reviewed. All melanoma cases received plaque radiotherapy with palladium 103. The cases with nevi and squamous cell carcinoma underwent local resection with cryotherapy as primary treatment. In 8 cases, scleral grafting was performed as part of the initial surgery. In all of these cases, satisfactory anatomic and functional outcomes were achieved. In 2 cases with scleromalacia secondary to radiotherapy for uveal melanoma, grafts were placed several years after the initial treatment. In these 2 cases, one showed signs of graft retraction, whereas another showed graft thinning. No patients experienced graft infection, rejection, or tumor recurrence. Conclusions: In this series, scleral grafts were well accepted when placed as part of the primary tumor management despite synchronous radiotherapy, scleral resection, or cryotherapy. Grafting was less successful when performed as a late procedure for radiation-induced scleromalacia. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Milman T.,New York Eye and Ear Infirmary | Petousis V.,New York Eye Cancer Center | McCormick S.A.,New York Eye and Ear Infirmary | Finger P.T.,New York Eye Cancer Center
American Journal of Ophthalmology | Year: 2011

Purpose: To report pathologic evaluation and diagnostic yield of an aspiration cutter-assisted biopsy of anterior segment tumors. Design: Retrospective, consecutive, interventional case series. Methods: Fifty-five eyes of 55 patients with iris and iridociliary tumors underwent an aspiration cutter-assisted biopsy at a single institution. Cytospin and cell-block preparations were performed on all biopsy samples. Bleached preparations and a panel of immunohistochemical stains were performed in selected cases. Cytologic diagnosis was correlated with clinical diagnosis and with histopathologic diagnosis, when available. Main outcome measures were (1) specimen cellularity, (2) diagnostic studies performed, (3) cytopathologic diagnosis, and (4) concordance with histopathologic diagnosis. Results: Specimen cellularity was adequate for cytopathologic interpretation of cytospin preparations in 55 (98.2%) of 56 biopsies. Twenty-three (41%) of 56 biopsy samples had diagnostic material in cell-block preparations. The most common cytopathologic diagnoses were melanoma (n = 39/56; 69.6%), melanocytoma (n = 4/56; 7.1%), nevus (n = 4/56; 7.1%), lymphoma (n = 2/56; 3.6%), and epithelial implantation cyst (n = 2/56; 3.6%). One biopsy sample (1.8%) yielded nondiagnostic material. Wide incisional or excisional biopsy confirmation was available in 13 (23.2%) of 56 aspiration cutter-assisted biopsy cases. Cytopathologic diagnoses were consistent with histopathologic diagnosis in 12 (92.3%) of 13 cases. Conclusions: Although specialized pathologic techniques were necessary to maximize material available for diagnosis, all biopsies yielded cellular material and 41% yielded diagnostic tissue in cell block preparation. Although lower than the yield of wide incisional or excisional biopsy, aspiration cutter-assisted biopsy of anterior segment tumors achieved a diagnostic yield of 98.2%. © 2011 Elsevier Inc. All rights reserved.


Finger P.T.,New York Eye Cancer Center | Finger P.T.,Beth Israel Comprehensive Cancer Center | Chin K.J.,New York Eye Cancer Center | Tena L.B.,New York Eye Cancer Center | Tena L.B.,Beth Israel Comprehensive Cancer Center
Ophthalmology | Year: 2012

Objective: To evaluate slotted eye plaque radiation therapy for choroidal melanomas near the optic disc. Design: A clinical case series. Participants: Twenty-four consecutive patients with uveal melanomas that were near, touching, or surrounding the optic disc. Intervention: Slotted eye plaque radiation therapy. Main Outcome Measures: Recorded characteristics were related to patient, clinical, and ophthalmic imaging. Data included change in visual acuity, tumor size, recurrence, eye retention, and metastasis. Results: From 2005 to 2010, 24 consecutive patients were treated with custom-sized plaques with 8-mmwide, variable-depth slots. Radiation doses ranged from 69.3 to 163.8 Gy (mean, 85.0 Gy) based on delivering a minimum tumor dose of 85 Gy. All treatments were continuously delivered over 5 to 7 days. Mean patient age at presentation was 57 years. Tumors were within 1.5 mm of the optic nerve (n = 3, 13%), juxtapapillary (n = 6, 25%), touching <180 degrees (n = 7, 29%), or circumpapillary (n = 8, 33%). Ultrasound revealed dome-shaped tumors in 79% of patients, collar-button tumors in 17% of patients, irregular tumor in 1 patient (4%), and intraneural invasion in 2 patients. Mean initial largest basal dimension was 11.0 mm (standard deviation [SD] ± 3.5 mm; median, 11.4 mm; range, 5.916.4 mm). Mean initial tumor thickness was 3.5 mm (SD ± 1.7 mm; median, 3.0 mm; range, 1.46.9 mm). Initial visual acuities were a median 20/25 (range, 20/20 to hand motions) and decreased to a median 20/40 (range, 20/20 to no light perception). At a mean follow-up of 23 months, 12 patients required periodic intravitreal bevacizumab to suppress radiation optic neuropathy (RON) or maculopathy. To date, there has been a 100% local control rate. No patients have required secondary enucleation for recurrence or neovascular glaucoma. No patients have developed metastasis. Conclusions: Slotted plaque radiation therapy allows peripapillary, juxtapapilary, and circumpapillary choroidal melanomas (and a safety margin) to be included in the radiation targeted zone. Normalization of the plaque position beneath the tumor appears to increase RON and improve local control. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2012 American Academy of Ophthalmology.


Nagendran S.T.,New York Eye Cancer Center | Finger P.T.,New York Eye Cancer Center | Finger P.T.,New York University
Ophthalmic Surgery Lasers and Imaging Retina | Year: 2015

BACKGROUND AND OBJECTIVE: To report outcomes of intravitreal bevacizumab therapy in radiationassociated neovascular glaucoma (NVG). PATIENTS AND METHODS: In this retrospective interventional case series, 12 eyes with NVG after radiation therapy for ocular malignancy were treated with periodic intravitreal injections of 1.25 mg bevacizumab. Outcome measures included changes in iris neovascularization, intraocular pressure (IOP), visual acuity, and pain. RESULTS: One month after the first injection, iris neovascularization regressed in nine of 12 eyes (75%), and IOP decreased in eight of 12 eyes (67%) by a mean of 10.1 mm Hg. Patients were monitored for a mean of 26.5 months after their first injection. Six eyes subsequently underwent enucleation for pain control (four eyes; 66%), chronic uveitis (one eye; 17%), and tumor recurrence (one eye; 17%). All remaining patients experienced deterioration in visual acuity (range: 20/160 to no light perception), but pain control was good and IOP normalized in four patients. CONCLUSION: Intravitreal bevacizumab therapy should be considered for patients with radiationassociated NVG who wish to avoid enucleation.


Finger P.T.,New York Eye Cancer Center | Chin K.J.,New York Eye Cancer Center
Ophthalmic Plastic and Reconstructive Surgery | Year: 2012

Purpose: To test the safety, tolerability, and efficacy of subconjunctival ranibizumab (Lucentis [Genentech, Inc.]) for squamous cell carcinoma of the conjunctiva and cornea. Methods: Five patients with recurrent squamous cell carcinoma of the conjunctiva and cornea enrolled in this nonrandomized, single center, phase I pilot study as an alternative to radiation or exenteration. Subconjunctival ranibizumab (0.5 mg) was given on a monthly or twice monthly basis. Patients were examined for safety, tolerability, and efficacy using visual acuity, blood pressure, urinalysis, comparative slit lamp biomicroscopy with photography, and high frequency ultrasound imaging. Results: Five male patients with biopsy-proven squamous conjunctival carcinoma were found to have recurrent disease. Each patient had been initially treated with combinations of primary excision (n = 1) or excision and cryotherapy (n = 4), and all (n = 5) had failed separate courses of both topical interferon × and mitomycin 0.02%. Tumors were multifocal and involved between 8 and 12 clock hours of the limbus. A median of 22 injections (range 12-27) was given over a mean 19 months (range 6-24). Three patients had a complete response (no clinically apparent disease) during the 2-year study, while 2 failed treatment despite demonstrating an initial partial response. Treatment was well-tolerated, as 4 patients demonstrated stable or improved visual acuity, and none had significant systemic or ocular side effects. Conclusions: This 2-year study demonstrated that subconjunctival ranibizumab induced regression of squamous cell carcinoma of the conjunctiva and cornea. Therefore, antivascular endothelial growth factor chemotherapy may offer a new strategy, complement excision and cryotherapy, or provide an alternative to radiation and/or exenteration. Further, larger investigations utilizing a larger group of patients are needed to determine the ideal dose, route of drug delivery, and case selection. © 2012 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.


Finger P.T.,New York Eye Cancer Center | Chin K.J.,New York Eye Cancer Center
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To evaluate the intravitreal antivascular endothelial growth factor, bevacizumab, for treatment of radiation optic neuropathy (RON). Methods and Materials: A prospective interventional clinical case series was performed of 14 patients with RON related to plaque radiotherapy for choroidal melanoma. The RON was characterized by optic disc edema, hemorrhages, microangiopathy, and neovascularization. The entry criteria included a subjective or objective loss of vision, coupled with findings of RON. The study subjects received a minimum of two initial injections of intravitreal bevacizumab (1.25 mg in 0.05 mL) every 6-8 weeks. The primary objectives included safety and tolerability. The secondary objectives included the efficacy as measured using the Early Treatment Diabetic Retinopathy Study chart for visual acuity, fundus photography, angiography, and optical coherence tomography/scanning laser ophthalmoscopy. Results: Reductions in optic disc hemorrhage and edema were noted in all patients. The visual acuity was stable or improved in 9 (64%) of the 14 patients. Of the 5 patients who had lost vision, 2 had relatively large posterior tumors, 1 had had the vision decrease because of intraocular hemorrhage, and 1 had developed optic atrophy. The fifth patient who lost vision was noncompliant. No treatment-related ocular or systemic side effects were observed. Conclusions: Intravitreal antivascular endothelial growth factor bevacizumab was tolerated and generally associated with improved vision, reduced papillary hemorrhage, and resolution of optic disc edema. Persistent optic disc neovascularization and fluorescein angiographic leakage were invariably noted. The results of the present study support additional evaluation of antivascular endothelial growth factor medications as treatment of RON. © 2012 Elsevier Inc.


Freton A.,New York Eye Cancer Center | Freton A.,New York University | Finger P.T.,New York Eye Cancer Center | Finger P.T.,New York University
British Journal of Ophthalmology | Year: 2012

Background/aims: To assess spectral domain-optical coherence tomography (SD-OCT) contribution to choroidal osteoma characterisation. Methods: A retrospective chart review of a series of patients diagnosed with choroidal osteoma, which included patient, clinical, ultrasonographic, photographic and SD-OCT imaging. Results: 11 patients were included in this series. Their mean age was 42.5 years (median=43.0; range, 14-73). Using statistical analysis, the mean basal diameters of tumours as derived from fundus photographs (5.2 mm) and ultrasound images (6.4 mm) were significantly different (paired t-test, p=0.03). Tumours were SD-OCT hyporeflective in two cases, isoreflective in seven cases and hyper-reflective in two cases. Intrinsic reflectivity of the tumour was inhomogeneous in four cases. The overlying choroid was compressed by the tumour in eight cases and the retina exhibited degenerative changes in five cases. Conclusion: This study revealed that SD-OCT provided deeper and higher resolution images of choroidal osteoma when compared with previous studies using time domain-OCT. These findings offer new insights into the pathophysiology and diagnosis of choroidal osteoma.


Semenova E.,New York Eye Cancer Center | Finger P.T.,New York Eye Cancer Center | Finger P.T.,New York University
Ophthalmology | Year: 2013

Purpose: To evaluate outcomes after ophthalmic plaque radiation therapy for small choroidal melanomas. Design: Retrospective study, case series. Participants: Seventy-two patients with choroidal melanomas ≥1.5 and ≤2.4 mm apical height and ≤10 mm width treated between 2002 and 2012, with a minimum follow-up of 8 months. Methods: All patients were treated with palladium-103 plaque brachytherapy. Mean radiation dose to the tumor apex was 82.4 Gy (range, 70.0-102 Gy). Main Outcome Measures: Local control, radiation complications, visual acuity, and metastatic rate. Results: Plaque radiotherapy provided 100% local tumor control and eye retention at a mean 54 months of observation (95% confidence interval, 46-63 months). The most common long-term brachytherapy-related complications were radiation maculopathy (43.1%) and radiation optic neuropathy (20.8%) developing at a mean of 27 months (range, 9-72 months) after irradiation. In this series, 94.4% of patients maintained 20/200 or better vision. There has been no small choroidal melanoma-related metastasis. Conclusions: Palladium-103 plaque radiation therapy offered excellent local control and visual acuity outcomes for patients with small choroidal melanoma. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. © 2013 by the American Academy of Ophthalmology.


Finger P.T.,New York Eye Cancer Center | Chin K.J.,New York Eye Cancer Center
International Journal of Radiation Oncology Biology Physics | Year: 2011

Purpose: To evaluate changes in [ 18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) standardized uptake values (SUV) in uveal melanoma before and after plaque brachytherapy. Methods and Materials: A cohort of 217 patients diagnosed with uveal melanoma and eligible for ophthalmic plaque brachytherapy underwent preoperative PET/CT to evaluate their intraocular tumor and screen for metastasis. Subsequent to undergoing plaque brachytherapy, patients' PET/CT SUV were periodically reevaluated over 42 months. Results: In this series, 37 (17%) choroidal melanoma patients were found to have an SUV of >2.0. Of these, 18 patients were able to undergo interval follow-up PET/CT scanning. There were 3 patients with T2, 11 patients with T3, and 4 patients with T4 melanomas according to 7th edition AJCC-UICC criteria. Mean apical thickness was 8.8 mm (range, 3-12.3 mm), and the largest mean tumor diameter was 15.1 mm (range, 12-19.9 mm). The mean initial SUV was 3.7 (range, 2.1-7.3). Patients were followed for a median 16 months (range, 6-42 months). The median time to a tumor SUV of 0 was 8.0 months (range, 6-18 months). There was one case of one interval increase in SUV that diminished after circumferential laser treatment. Conclusions: Intraocular PET/CT imaging provides a physiological assessment of tumor metabolism that can be used to evaluate changes after treatment. In this study, ophthalmic plaque radiation therapy was associated with extinguished tumor PET/CT SUV over time. PET/CT imaging can be used to assess choroidal melanomas for their response to treatment. © 2011 Elsevier Inc Printed in the USA. All rights reserved.

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