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Biomedical subjects

Devron H Char

Publications and source records attributed to Devron H Char.

15 recordsLinked to original sources
PubMed2006

Metaplastic squamous epithelial downgrowth after clear corneal cataract surgery.

PURPOSE: To report a case of metaplastic squamous epithelial downgrowth after cataract surgery. DESIGN: Interventional case report. METHODS: Clinical, laboratory, and histologic findings are presented. Our study is in compliance with institutional review board guidelines. RESULTS: A 76-year-old man developed anterior chamber inflammation five months after uncomplicated clear corneal cataract surgery. Despite antimicrobial and anti-inflammatory therapies, the inflammation persisted. An extensive examination failed to demonstrate an infectious etiology or lymphoma. Subsequently, the patient developed an incipient limbal lesion and iris mass. Immunostaining of a biopsy specimen from the iris mass indicated an epithelial-derived tumor. The prephthisical and painful eye was enucleated; histopathology of the globe revealed a contiguous lesion extending from the limbal mass to the iris tumor through the surgical incision site, a finding consistent with metaplastic squamous epithelial downgrowth. Systemic evaluation was negative. CONCLUSIONS: After intraocular surgery, metaplastic epithelial downgrowth may occur as a consequence of occult ocular surface squamous neoplasia and masquerade as chronic inflammation; clinicians should be aware of this rare complication.

Aged↗
PubMed2006

Prognostic testing in uveal melanoma by transcriptomic profiling of fine needle biopsy specimens.

Many uveal melanoma patients die of metastasis despite ocular treatment. Transcriptomic profiling of enucleated tumors can identify patients at high metastatic risk. Because most uveal melanomas do not require enucleation, a biopsy would be required for this analysis. Here, we establish the feasibility of transcriptomic analysis of uveal melanomas from fine needle aspirates. Transcriptomic profiles were analyzed from postenucleation "mock" needle biopsies and matching tumors from eight enucleated eyes and from fine needle aspirates in 17 uveal melanomas before radiotherapy. Predictive accuracy was assessed using a weighted voting classifier optimized for probe set selection using a minimal redundancy/maximum relevance algorithm. Transcriptomic profiles from mock biopsies were highly similar to those from their matching tumor samples (P < 0.0001). Transcriptomic profiles from fine needle aspirates clustered into two classes with discriminating probe sets that overlapped significantly with those for our published classification (P < 0.00001). No loss of predictive accuracy was identified among eight needle aspirates obtained from a distant location. Thus, it is feasible to obtain RNA of adequate quality and quantity to perform transcriptomic analysis on uveal melanoma samples obtained by fine needle biopsy. This method can be applied to specimens obtained from distant geographic locations and can stratify uveal melanoma patients based on metastatic risk.

Adult↗
PubMed2005

Intraocular biopsy.

This article discusses the indications for intraocular tumor biopsy, the techniques used for obtaining material, and the approaches for analysis of these specimens.

Biopsy, Fine-Needle↗
PubMed2004

Analysis of melanoma cell type in uveal melanoma following treatment failure.

PURPOSE: To determine whether an increase (or progression) in the degree of malignancy according to cytologic or histopathologic criteria corresponded with failure of intraocular melanoma control. DESIGN: Retrospective case control study from a single institution. METHODS: Uveal melanoma patients had either fine-needle aspiration biopsy followed by irradiation and later enucleation or an eyewall resection followed by enucleation. The observation procedures were serial histology or cytopathology and histology, reanalyzed in a masked manner. The main outcome measures were change in the predominant tumor cell type, local tumor control, and metastases. RESULTS: There was not a significant correlation between a change in melanoma cell type and failure to control intraocular melanoma. Similarly, the latency between treatment and enucleation was actually less (but not statistically so) in tumors that showed no increase in melanoma malignancy cell type compared with those that had a more malignant cell type on serial examination. CONCLUSIONS: There was no correlation between a change to more a malignant cell type and local control failure in patients treated either with radiation or eyewall resection for uveal melanoma.

Biopsy, Needle↗
PubMed2004

Nondiagnosed uveal melanomas.

PURPOSE: To determine the proportion of nondiagnosed uveal melanomas after evaluation by optometrists or ophthalmologists. DESIGN: Retrospective observational cohort study. PARTICIPANTS: Four hundred thirty-three ophthalmic oncology patients with uveal melanoma. METHODS: This was a retrospective study of uveal melanoma patients from a single ophthalmic oncology center. We sent questionnaires to living patients we had treated between 1980 and 2000 for uveal melanoma. Patients were divided into those who had an examination within 1 year before diagnosis of a melanoma in which the tumor was not detected, those patients who were being observed with a known pigmented uveal tumor, and those who had not had an eye examination for at least 10 years. MAIN OUTCOME MEASURE: The detection of unsuspected melanomas. RESULTS: We determined that 37% of patients referred to us with a newly discovered uveal melanoma had been examined within a year, without a uveal melanoma being detected. Of patients whose medical records were obtained, 71% had eyes that had been dilated and the tumor not found. The patients in whom the tumors were nondiagnosed within 1 year of referral to us had a mean tumor thickness of 6 mm and a mean tumor diameter of 12 mm. Ninety percent of the tumors were partially posterior to the equator. Patients who had been observed by their outside ophthalmologist with a choroidal pigmented tumor had significantly smaller tumors (P<0.005). CONCLUSIONS: There are a notable number of patients seen by general ophthalmologists with symptomatic uveal melanomas in whom the diagnosis is not established. It is likely that screening efforts for this relatively rare condition are often not efficacious.

Adolescent↗
PubMed2003

Ocular melanoma.

This article reviews the current pathogenesis, molecular changes, diagnosis, and treatment of ocular melanomas. Ocular melanomas can involve the eyelid, conjunctiva, intraocular structures, and the orbit. The most common eye melanoma involves the uveal tract and is responsible for approximately 13% of melanoma deaths. Uveal melanomas account for 10% of all melanomas.

Conjunctival Neoplasms↗
PubMed2003

Laser and proton radiation to reduce uveal melanoma-associated exudative retinal detachments.

PURPOSE: To assess whether laser-induced hyperthermia with proton irradiation of choroidal melanoma may decrease exudative retinal detachments more rapidly. DESIGN: Case control study. METHODS: Patients treated with laser-induced hyperthermia and proton radiation; results were compared with similar patients treated with only protons. RESULTS: All 11 patients treated with combined laser and proton therapy had resorption of subretinal fluid with a mean duration of retinal detachment of 193 days compared with 263 days in the group treated with only proton therapy (P <.04). At 1 year, visual acuity was similar. CONCLUSIONS: Combined laser radiation more rapidly dissipates exudative detachments than radiation alone.

Case-Control Studies↗
PubMed2003

Laser and proton radiation to reduce uveal melanoma-associated exudative retinal detachments.

PURPOSE: To assess whether laser-induced hyperthermia in conjunction with proton irradiation of choroidal melanoma may more rapidly decrease exudative retinal detachments. DESIGN: Case-control study. METHODS: This was a single-center prospective phase 1 study of choroidal melanoma patients with exudative retinal detachments. These tumors did not overhang the optic disc, involve the fovea, or have greater than 40% involvement of the ciliary body. Patients were treated with laser-induced hyperthermia and proton radiation; results were compared with those of similar patients treated at the same institution with only proton radiation. Patients were followed up in an identical manner for loss of subretinal fluid, visual acuity change, and visual field alterations. RESULTS: All 11 patients treated with combined laser and proton therapy had resorption of subretinal fluid with a mean duration of retinal detachment of 193 days, compared with 263 days in the group treated with only proton therapy (P<.04). At 1 year, visual acuity was similar in both groups. CONCLUSIONS: Combined laser-induced hyperthermia and proton radiation may dissipate exudative detachments more rapidly than radiation alone.

Case-Control Studies↗
PubMed2002

Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy.

OBJECTIVE: To evaluate late (more than 5 years) radiation failures after uveal melanoma treatment. DESIGN: Comparison of three retrospective, interventional, partially randomized case series. PARTICIPANTS: Nine hundred ninety-six patients who were treated in several phase I, II, and III trials of uveal melanoma radiation. MAIN OUTCOME MEASURES: Follow-up period, treatment history, recurrence rates, type of recurrence, and mortality associated with late local recurrences. RESULTS: Eleven of 996 irradiated uveal melanoma patients experienced intraocular recurrence more than 5 years after radiation. All 11 of these patients were treated with iodine 125 ((125)I) brachytherapy. Late recurrences were detected between 5.5 to 15.3 years after treatment. These patients did not have either high-risk clinical parameters (thin, posterior tumors in proximity to the optic nerve) or radiation dosimetry characteristics (low dose-delivery radiation) associated with a known increased risk for tumor recurrence after radioactive plaques. The annualized incidence rate for regrowth was 1.9% per year between 5 and 15 years after (125)I brachytherapy. In contrast to charged particles, the risk of late recurrence after (125)I brachytherapy continued with increased follow-up. CONCLUSIONS: There was a significantly higher late recurrence rate with (125)I brachytherapy as compared with charged particle radiation. Although tumor enlargement 5 or more years after radiation can be the result of intratumor hemorrhage, in a patient treated with radioactive plaque, a late failure is a distinct possibility.

Brachytherapy↗
PubMed2002

Interactive image guidance for surgical localization of orbital apical tumors.

The surgical management of orbital apex tumors is difficult. Intervention in this small posterior space is fraught with complications. We have used an interactive image guidance system to successfully biopsy and resect three tumors at the orbital apex without significant surgical morbidity. These three cases are presented. These interactive image guidance systems have revolutionized skull-base surgery and have a role in the surgical management of orbital apex tumors.

Aged↗