Topic

#Ocular Oncology

8 articles
  1. Articles 20 Jul 2021 10 min read

    Ocular Oncology Basics: Diagnosis of Intraocular Malignancies

    “Declare the past, diagnose the present, foretell the future.” Hippocrates In this section, I will deal with various diagnostic methods which are common in practice for the diagnosis of mainly Intraocular malignancies. Diagnostic modalities used for extraocular malignancies will be considered in the respective chapters. 1.History Even though the twenty-first century has seen a boom in the diagnostic armamentarium available to the ophthalmologist, the art of good history taking can never be out of fashion. History of the present complaints, their duration, and associated complaints can provide multiple clues. If the duration of complaints has been seen over a long period of time with minimal change; a chronic condition can be anticipated. A sudden change in vision is an alerting sign. Personal history pertaining to the patient's occupation will provide us the visual needs of the concerned. Any previous history of other malignancies, its treatment history may provide clues with the etiol

    Dr. Bikramjit Pal
  2. Articles 20 Jul 2021 6 min read

    Ocular Oncology Basics: Salient Points from The Pandora's Box

    RETINOBLASTOMA Grouping: Clinical determination of the extent of disease with the focus being the eye. It is a preoperative evaluation with the main outcome being the salvagable status of vision or the eye. Staging: It combines clinical, various imaging, and post-operative histopathological results to determine the extent of the disease. The main outcome is focused on the survival of the patient. International Classification of Retinoblastoma ( grouping) [1] Group A: Tumours smaller than 3mm or less Should be 2DD ( 3mm) from the fovea Should be 1DD (1.5mm) from optic nerve head Group B: Tumours bigger than those in group A Located within 2DD from the fovea Located within 1DD from optic nerve head Localized cuff of subretinal fluid( < 5mm) No seeding is allowed in the group. Group C: Localized tumor dissemination Vitreous seeding not more than 3mm from the base of tumor Subretinal seeding not more than 3mm from the base of tumor Group D: Diffuse tumor dissemination Vitreous seeding may

    Dr. Bikramjit Pal
  3. Articles 20 Jul 2021 8 min read

    Ocular Oncology Basics: Genetics

    Twenty first century has seen a giant leap in the understanding of human genetics. Based on the human genome project humans are supposed to have roughly 20,000 to 25,000 genes. Genes are the fundamental units of heredity. To understand genetics involved in various ocular pathologies a basic understanding is essential. The following discussion will provide an overview of basic concepts in genetics and provide a glimpse into the genetics of Retinoblastoma and intraocular melanoma. The basic structure of a chromosome [1] Chromosomes are formed by a tight packaging of the DNA stored in the nucleus of a cell Each gene in humans are comprised of 2 copies ; one inherited from either parent. Forms of the same gene with differences on the basis of bases are known as alleles. A tightly regulated process of transcription and translation involves the production of basic building blocks called as amino acids to form proteins. Gene regulation is the process whereby certain genes are 'switched on' an

    Dr. Bikramjit Pal
  4. Articles 20 Jul 2021 13 min read

    Ocular Oncology Basics: Treatment Strategies In Intraocular Malignancies

    “Cancer can take away all of my physical abilities. It cannot touch my mind, it cannot touch my heart, and it cannot touch my soul.” Jim Valvano Treating malignancies I believe, brings the true human spirit forward of the treating physician. Breaking the news of malignancy to a patient is as heartbreaking for the physician as it is for the patient. Yet the doctor must keep his feelings aside and do his best. Even though the human eye forms a small fraction of the human body, malignancies of all sorts and sizes can be found inside. Treatment is complex and takes a lifetime to master. In this section, I will summarize the various treatment modalities used in intraocular malignancy with a small write-up on chemotherapy and radiotherapy. 1. CRYOTHERAPY Principle of cryotherapy [1],[2] Direct effect Indirect effects: Initial freezing causes vasoconstriction and then the process of thawing causes vasodilation leading to increased permeability and edema Secondary endothelial damage leads to f

    Dr. Bikramjit Pal
  5. Articles 2 Apr 2021 17 min read

    Primary Intraocular Lymphoma

    Introduction Intraocular lymphoma, a great non-infective masquerader occurs intraocularly in either the vitreoretinal( primary vitreoretinal lymphoma PVRL)) or in the uveal space( primary choroidal, iris lymphoma). By definition, PVRL denotes the presence of pathology limited to vitreoretinal space without its occurrence in the central nervous system. The term ‘primary’ is however controversial as almost 56-90% of PVRL patients will ultimately go on to involve the CNS over few months to years( 8-29 months) and is considered a subset of primary CNS lymphoma( PCNSL) [1]. Incidentally, 25% of patients with PCNSL will have concurrent ocular involvement at presentation [2]. Primary choroidal and iridial lymphomas are rarer, less aggressive as compared to their vitreoretinal counterpart and due to their rarity, the following section will deal primarily with PVRL. Pathophysiology of Primary Vitreoretinal Lymphoma The origin of lymphoma cells in the retina is a point of debate. Two etiologies

    Dr. Bikramjit Pal
  6. Articles 1 Apr 2021 13 min read

    Choroidal Melanoma: Ready Reckoner for the Postgraduates

    Introduction Uveal melanoma is the most common primary intraocular malignant tumor in adults [1]. Second most common type of primary malignant melanoma after cutaneous melanoma. It arises from neuroectodermal melanocytes within the uveal tissue. Epidemiology There is strong racial variation in the incidence, with the white population most commonly affected. The mean age-adjusted incidence of uveal melanoma in the United States is 5.2 per million per year [2]. Males had a significantly higher age-adjusted incidence of 6.0 per million population compared to females, where the average age-adjusted incidence was 4.5 [3]. Malignant melanoma of the choroid is rare in dark pigmented races and has been reported infrequently in the Asian Indian population.[4] Ultraviolet (UV) radiation has been suggested as a major cause of malignant melanoma of the skin and uvea[5] because of the increased incidence and mortality among Caucasians living in tropical regions, where solar radiation is more intens

    Dr. Isha Agarwal · Dr. Vikas Khetan
  7. Articles 1 Apr 2021 8 min read

    Retinoblastoma : Top Ten Tenets for an Ophthalmologist

    1.Common and Curable Retinoblastoma is the most common childhood ocular malignancy. Annually there are about 6000 new cases worldwide. It is most commonly diagnosed at 15-18 months of age although in developing countries, older children also present with the disease. It is potentially curable if detected early and with proper management. Currently, the survival rate is as high as 95% with 90% eye salvage and 85% vision salvage. 2 The root of the Family Tree Retinoblastoma can be associated with germline mutation or somatic mutations of the RB1 gene on the long arm of chromosome 13. Heritable retinoblastoma constitutes 30-40% of all retinoblastomas while the rest are non- heritable. 25% of the germline mutations are familial with autosomal dominant inheritance and the remaining occur de novo. In heritable retinoblastoma, patients are prone to other second primary neoplasia including pinealoblastoma, osteosarcoma and soft tissue sarcomas. Genetic testing for germline mutations are availa

    Dr. Mrittika Sen · Dr. Santosh G Honavar, MD, FACS
  8. Articles 1 Apr 2021 28 min read

    Ocular Surface Squamous Neoplasia

    A. Introduction There have been multiple refinements in the terminology of the epithelial squamous neoplasia until the introduction of the term “Ocular surface squamous neoplasia” (OSSN) by Lee and Hirst in 19951. OSSN is an umbrella term and refers to a spectrum ranging from mild/moderate/severe dysplasia to carcinoma in situ to invasive squamous cell carcinoma involving the conjunctiva and/or cornea2-4. OSSN is the most common tumor of the ocular surface. According to the epidemiological studies, the worldwide incidence of OSSN is 0.02 to 3.5 cases per 100,000 people. Incidence increases with decreasing latitude, being higher in countries located close to the equator. OSSN predominantly occurs in the elderly age group (6th to 7th decade) and in male gender 5-9. B. Etiology and pathogenesis10-27 The presumptive risk factors implicated in the etiology of OSSN include: Excessive exposure to ultraviolet radiation Heavy cigarette smoking Immunosuppressive conditions: Human Immunodeficienc

    Dr. Kavya M Bejjanki · Dr. Swathi Kaliki

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