Biomedical subjects

Paul T Finger

Publications and source records attributed to Paul T Finger.

At least 37 records · Page 2Linked to original sources

PubMed2004

High-frequency ultrasound of anterior segment retinoblastoma.

PURPOSE: To evaluate anterior segment retinoblastoma with high-frequency ultrasound. DESIGN: Interventional case report. METHODS: An 11-year-old boy with a total retinal detachment and multiple white anterior chamber nodules was examined with high-frequency ultrasound before enucleation of the globe. RESULTS: Multiple solid and cystic nodular tumors were found in the anterior chamber angle. With high-frequency ultrasound, tumor was discovered posterior to the iris, over the ciliary processes, and on the lens capsule. No calcifications were noted. Other findings included angle closure related to iris neovascularization and uveal thickening. CONCLUSION: High-frequency ultrasound can be used to evaluate retinoblastoma extension into the anterior segment. These images may be used for comparison in future cases of retinoblastoma with anterior chamber invasion.

Anterior Eye Segment↗

PubMed2004

Radiation-blocking glasses allow vision during ophthalmic plaque radiation therapy.

PURPOSE: To evaluate the use of leaded safety glasses to block radiation and allow for vision during ophthalmic plaque radiation therapy. DESIGN: Interventional case series. METHODS: Eight patients were treated with palladium 103 ophthalmic plaque radiotherapy and measured for emitted radiation while wearing leaded glasses or a lead patch. Radiation emission was measured at 1 m so as to compare the glasses' ability to block radiation in vivo. RESULTS: In two patients the tumor was in the patients' only seeing eye, and the leaded radiation safety glasses allowed them to function (feed themselves and walk to the bathroom unassisted). In two additional patients, the glasses allowed binocularity and were preferred over the patch. Measurements revealed that both the lead patch and leaded radiation safety glasses reduced exposure to levels acceptable for discharge to home in New York City. CONCLUSIONS: Leaded radiation safety glasses improved patients' quality of life without sacrificing radiation safety.

Brachytherapy↗

PubMed2004

Visual recovery after radiation therapy for bilateral subfoveal acute myelogenous leukemia (AML).

PURPOSE: Present a case of bilateral foveal acute myelogenous leukemic tumors that responded to radiation therapy. DESIGN: Case report. METHODS: A patient was diagnosed with bilateral subfoveal infiltration of known systemic acute myelogenous leukemia. He received a standard induction chemotherapy, followed by consolidation therapy for his systemic leukemia. However, despite a complete marrow response, the intraocular tumors did not regress. Therefore, he was given low dose (1950-cGy) ocular external beam radiation therapy. RESULTS: One course of systemic cytarabine chemotherapy failed to control the subfoveal tumors, leaving the patient at risk for permanent vision loss. In contrast, external beam radiation therapy improved his vision from 20/60 in his right eye to 20/20 and from 20/70 in his left eye to 20/25. CONCLUSION: Although systemic chemotherapy can be used to treat intraocular metastasis, external beam radiation may provide more prompt resolution of vision-threatening tumors.

Adult↗

PubMed2004

A 3-dimensional ultrasound C-scan imaging technique for optic nerve measurements.

PURPOSE: To evaluate the use of 3-dimensional ultrasound C-scan imaging for optic nerve diameter measurements. DESIGN: Prospective observational case series. PARTICIPANTS: Thirty-eight normal eyes of 32 healthy adults. METHODS: Coronal C-scans of 38 normal optic nerves were imaged 3 mm behind the globe. MAIN OUTCOME MEASURES: Optic nerve sheath diameter (ONSD) and optic nerve diameter (OND). RESULTS: Mean ONSD was 4.8 mm (range: 3.9-5.9; SD 0.6), whereas mean optic OND was 1.9 mm (range: 1.8-2.1; SD 0.1). Mean ONSDs were 4.9 mm (male), 4.5 mm (female), 5.0 mm (subjects younger than 50 years), and 4.6 mm (subjects 50 and older). CONCLUSION: Coronal C-scans generated from 3-dimensional ultrasound can be used to measure the optic nerve diameters in adult eyes.

Adult↗

PubMed2003

The American Brachytherapy Society recommendations for brachytherapy of uveal melanomas.

PURPOSE: This article presents the American Brachytherapy Society (ABS) guidelines for the use of brachytherapy for patients with choroidal melanomas. METHODS: Members of the ABS with expertise in choroidal melanoma formulated brachytherapy guidelines based upon their clinical experience and a review of the literature. The Board of Directors of the ABS approved the final report. RESULTS: Episcleral plaque brachytherapy is a complex procedure and should only be undertaken in specialized medical centers with expertise in this sophisticated treatment program. Recommendations were made for patient selection, techniques, dose rates, and dosages. Most patients with very small uveal melanomas (<2.5 mm height and <10 mm in largest basal dimension) should be observed for tumor growth before treatment. Patients with a clinical diagnosis of medium-sized choroidal melanoma (between 2.5 and 10 mm in height and <16 mm basal diameter) are candidates for episcleral plaques if the patient is otherwise healthy and without metastatic disease. A histopathologic verification is not required. Small melanomas may be candidates if there is documented growth; some patients with large melanomas (>10 mm height or >16 mm basal diameter) may also be candidates. Patients with large tumors or with tumors at peripapillary and macular locations have a poorer visual outcome and lower local control that must be taken into account in the patient decision-making process. Patients with gross extrascleral extension, ring melanoma, and tumor involvement of more than half of the ciliary body are not suitable for plaque therapy. For plaque fabrication, the ophthalmologist must provide the tumor size (including basal diameters and tumor height) and a detailed fundus diagram. The ABS recommends a minimum tumor (125)I dose of 85 Gy at a dose rate of 0.60-1.05 Gy/h using AAPM TG-43 formalism for the calculation of dose. NRC or state licensing guidelines regarding procedures for handling of radioisotopes must be followed. CONCLUSIONS: Brachytherapy represents an effective means of treating patients with choroidal melanomas. Guidelines are established for the use of brachytherapy in the treatment of choroidal melanomas. Practitioners and cooperative groups are encouraged to use these guidelines to formulate their treatment and dose reporting policies. These guidelines will be modified as further clinical results become available.

Brachytherapy↗

PubMed2003

High-frequency ultrasonographic evaluation of conjunctival intraepithelial neoplasia and squamous cell carcinoma.

OBJECTIVE: To evaluate the high-frequency B-scan ultrasonographic characteristics of squamous conjunctival neoplasia (conjunctival intraepithelial neoplasia and squamous cell carcinoma). METHODS: Each of 11 patients was examined with 20- and/or 50-MHz ultrasonography in a retrospective consecutive case series. MAIN OUTCOME MEASURES: Ultrasonographic findings with clinical and histopathologic correlations. RESULTS: Eleven eyes of 11 patients (8 men) were affected. Disease involved the right eye in 6 (55%) of the patients and the left eye in 5 (45%) of the patients; it was multifocal in 5 (45%) of the eyes. All tumors extended to, or primarily involved, the limbal conjunctiva. One patient developed superficial spread overlying a functioning partial-thickness filtering bleb, 1 developed intraocular extension, 1 developed scleral invasion, and 3 developed orbital involvement before treatment. Results of ultrasonographic examinations showed that the superficial aspect of the smaller limbal tumors appeared as fusiform thickening of the conjunctiva. In all patients, the tumor surface was highly reflective in contrast to the characteristically low reflectivity seen within the tumor stroma. Intraocular tumor extension was variably reflective, but evidenced by blunting of the anterior chamber angle and thickening of the uvea. Orbital extension was viewed as low reflective tumor extension into the relatively hyperechoic orbital tissues. CONCLUSIONS: High-frequency ultrasonography may be used to assess the extent of squamous conjunctival neoplasia. While the 50-MHz system offered better resolution, 20-MHz ultrasonography allowed for a wider and deeper field of view. High-frequency ultrasonography was useful in determining tumor thickness, shape, and internal reflectivity, and especially in revealing tumor extension into the sclera, eye, and orbit.

Carcinoma in Situ↗

PubMed2003

Choroidal metastasis from adenoid cystic carcinoma of the lung.

PURPOSE: We report a case of a choroidal metastasis from an adenoid cystic carcinoma of the lung. Interventional case report. DESIGN: A 40-year old man, 9 months' status postresection of a bronchial adenoid cystic carcinoma, was diagnosed by clinical evaluation and fine-needle aspiration biopsy and treated with palladium-103 ophthalmic plaque brachytherapy. RESULTS: This unusual patient with uveal metastasis from adenoid cystic carcinoma presented with decreased vision in the right eye and a diaphanous amelanotic choroidal tumor in the superotemporal macula. Ultrasound revealed a dome-shaped tumor that measured 4.0 mm in apical height and 11 x 10 mm in basal diameter. Fluorescein angiography revealed a double circulation and late intense subretinal fluorescence. Plaque brachytherapy provided local control and preservation of the eye. CONCLUSION: Bronchogenic adenoid cystic carcinoma can metastasize to the choroid.

Adult↗

PubMed2003

Conjunctival melanoma: is it increasing in the United States?

PURPOSE: While the incidence of cutaneous melanoma has been found to have increased over time, the evidence for conjunctival melanoma is not as clear. We applied a large cancer registry database to determine whether any changes had occurred in the incidence of conjunctival melanoma. DESIGN: Descriptive epidemiologic analysis. METHOD: Using population-based registry data from the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute (NCI), we identified 206 newly diagnosed patients with conjunctival melanoma from 1973 to 1999. For analysis purposes, we calculated age-adjusted incidence rates and described temporal changes, using joinpoint regression model. RESULTS: Overall estimated biannual percent change (EBAPC) was 5.5 (95% confidence interval [CI] = 2.3, 8.8; P <.001). The significant elevated trend was observed for white men (EBAPC = 11.2; 95% CI = 6.3, 16.3; P <.001) but not for white women (EBAPC = 0.3; 95% CI = -4.1, 4.9; P >.05). In white men, the incidence rate increased 295% within the 27 years. Our analysis also showed a significant upward trend in the age group aged 60 years or more (EBAPC = 7.6; 95% CI = 3.9, 11.3; P <.001). Incidence tended to rise in the group aged 40 to 59 years, but it was not statistically significant (EBAPC = 4.4; 95% CI = -2.3, 11.6; P =.1536). CONCLUSIONS: Substantial temporal changes in the incidence of conjunctival melanoma have occurred in the United States in recent years. The changing incidence patterns coincide with those seen in cutaneous melanoma, suggesting a possible link to a sunlight-related etiology.

Adult↗

PubMed2003

Do you speak ocular tumor?

Explore the source record for details and available documents.

Eye Neoplasms↗

PubMed2003

Efficacy and wound-temperature gradient of whitestar phacoemulsification through a 1.2 mm incision.

PURPOSE: To evaluate the efficacy and wound-temperature gradients of WhiteStar micropulse technology using bimanual phacoemulsification without an irrigation sleeve through a 1.2 mm incision. SETTING: Island Eye Surgicenter, Carle Place, New York, USA. METHODS: Ten patients had bimanual phacoemulsification using micropulse technology without an irrigation sleeve through a 1.2 mm clear corneal incision. A thermocouple consisting of a 30-gauge copper wire was inserted into clear cornea directly adjacent to the wound to digitally record temperature gradients at the wound. Endothelial cell counts were evaluated preoperatively and postoperatively in all patients. RESULTS: All 10 patients maintained corneal clarity with no sign of thermal damage to the wound. The maximum corneal wound temperatures during phacoemulsification ranged from 24 degrees C to 34 degrees C, well below the temperature of collagen shrinkage. The endothelial cell loss at 3 months was 7%. CONCLUSIONS: Because of the decreased thermal effect with WhiteStar technology, an irrigation sleeve over the phacoemulsification needle is superfluous. As a result, bimanual phacoemulsification can be safely performed through a 1.2 mm incision.

Body Temperature↗

PubMed2003

High-frequency ultrasound imaging of periocular hidrocystomas.

BACKGROUND: High-frequency ultrasound has improved our ability to manage and diagnose anterior segment tumors. Hidrocystomas are unusual cystic tumors that can affect the conjunctiva and eyelid. When they appear pigmented and rapid in onset, it is important to differentiate them from malignant tumors, such as melanoma. CASE REPORTS: Three patients were referred to The New York Eye Cancer Center for evaluation of pigmented lesions on their eyes. The tumors affected the conjunctiva or eyelid and were of recent onset ranging from 1 week to 6 months. The hidrocystomas displayed hypoechoic high-frequency ultrasound patterns, which corresponded to the cystic nature revealed through histopathological analysis. Differential diagnoses are discussed and include benign and malignant tumors. CONCLUSION: Cystic tumors are a common finding of the eye; however, pigmented hidrocystoma is an uncommon diagnosis. Although histopathological study is often required for definitive diagnosis of these lesions, much information can be gained through pre-surgical evaluation, particularly high-frequency ultrasound. Intra-lesional cyst formation was characteristic in these three tumors. Further study of the high-frequency ultrasound characteristics of pigmented eyelid and conjunctival tumors will help determine if these ultrasound characteristics are diagnostic.

Adult↗

PubMed2002

Palladium-103 plaque radiotherapy for choroidal melanoma: an 11-year study.

PURPOSE: To describe 11 years of experience with 103Pd ophthalmic plaque brachytherapy for intraocular melanoma. METHODS AND MATERIALS: Since 1990, 152 patients have been diagnosed with uveal melanoma, found to be negative for metastatic disease, and treated with 103Pd radioactive plaque radiotherapy. This study presents the first 100 patients treated with 103Pd and followed for > or = 2 years. Plaques were sewn to the episclera to cover the base of the intraocular tumor. Treatment involved delivery of a mean apical radiation dose of 80.5 Gy during 5-7 days' continuous treatment. Patients were evaluated for local tumor control, visual acuity, radiation damage (retinopathy, optic neuropathy, cataract), and metastatic disease. RESULTS: Patients in this series were followed for a mean of 4.6 years (55.4 months). 103Pd seeds were found to be equivalent to 125I with respect to plaque manufacture and ease of dosimetric calculations. We noted a local control rate of 96% and six secondary enucleations. Including the enucleated patients, the visual acuity evaluations revealed that 35% lost six or more lines of vision and 73% had vision of 20/200 or better. CONCLUSION: Long-term results now exist describing the use of 103Pd plaque radiotherapy for uveal (iris, ciliary body, and choroidal) melanoma. Compared with the results from centers using 125I, patients in this series experienced equivalent local control rates and better visual function.

Brachytherapy↗

PubMed2002

The COMS randomized trial of iodine 125 brachytherapy for choroidal melanoma: IV. Local treatment failure and enucleation in the first 5 years after brachytherapy. COMS report no. 19.

OBJECTIVE: To describe the frequency and predictors of local treatment failure and enucleation after iodine 125 (I(125)) brachytherapy in patients with choroidal melanoma treated and followed up in a large randomized clinical trial. DESIGN: Prospective, noncomparative, interventional case series within a randomized, multicenter clinical trial. PARTICIPANTS: Patients enrolled in the Collaborative Ocular Melanoma Study (COMS) trial of enucleation versus brachytherapy between February 1987 and July 1998; tumors measured 2.5 to 10.0 mm in apical height and no more than 16.0 mm in longest basal dimension. METHODS: I(125) brachytherapy was administered via episcleral plaque according to a standard protocol. Follow-up ophthalmic evaluations, including ophthalmic ultrasound and fundus photography, were performed according to a standard protocol at baseline, every 6 months thereafter for 5 years, and subsequently at annual intervals. Survival analysis methods were used to estimate the cumulative risk of postirradiation treatment failure and enucleation. Factors associated with treatment failure and enucleation of plaqued eyes were evaluated using Cox proportional hazards analysis. MAIN OUTCOME MEASURES: Reports of enucleation and of local treatment failure, defined as tumor growth, recurrence, or extrascleral extension, derived from clinical reports based on echographic and photographic documentation. RESULTS: As of September 30, 2000, 638 of the 650 patients randomized to brachytherapy and so treated had been followed up for 1 year or longer, and 411 had been followed up for at least 5 years. Sixty-nine eyes were enucleated during the first 5 years after brachytherapy, and treatment failure was reported for 57 eyes. The Kaplan-Meier estimate of proportion of patients undergoing enucleation by 5 years was 12.5% (95% confidence interval [CI], 10.0%-15.6%); the risk of treatment failure was 10.3% (95% CI, 8.0%-13.2%). Treatment failure was the most common reason for enucleation within 3 years of treatment; beyond 3 years, ocular pain was most common. Risk factors for enucleation were greater tumor thickness, closer proximity of the posterior tumor border to the foveal avascular zone, and poorer baseline visual acuity in the affected eye. Risk factors for treatment failure were older age, greater tumor thickness, and proximity of the tumor to the foveal avascular zone. Local treatment failure was associated weakly with reduced survival after controlling for baseline tumor and personal characteristics (adjusted risk ratio, 1.5; P = 0.08). CONCLUSIONS: Local treatment failure and enucleation were relatively infrequent events after I(125) brachytherapy within the COMS. Treatment failure typically occurred early and was associated weakly with poorer survival. The COMS randomized trial documented the absence of a clinically or statistically significant difference in survival for patients randomly assigned to enucleation versus brachytherapy. This analysis documents the efficacy of brachytherapy to achieve sustained local tumor control and to conserve the globe.

Aged↗

PubMed2002

Adult wilms' tumor metastatic to the choroid of the eye.

BACKGROUND: Ocular manifestations of Wilms' tumor are rare, particularly in adults. We present the first reported case of a choroidal metastasis resulting from Wilms' tumor. DESIGN: Case report. PARTICIPANT: A 37-year-old white male with an adult-onset biopsy-proven Wilms' tumor with multiorgan metastatic disease. RESULTS: We report a unique case of uveal metastasis presumed from a Wilms' tumor. The patient's history included a primary Wilms' tumor with known disseminated metastasis, orbital pain, metamorphopsia, and decreased vision. Ophthalmoscopy revealed a unifocal choroidal tumor in the inferotemporal quadrant of the right eye. Ultrasonographic measurements of the tumor were 4.9 mm in apical height and 15 x 13 mm in basal diameter. Unusual ultrasound findings included echodense stromal opacities and retrobulbar edema. Fluorescein angiography revealed double circulation and late intratumoral fluorescence. CONCLUSIONS: This is the first reported case of a choroidal metastasis by a Wilms' tumor.

Adult↗

PubMedDate not supplied

Anterior segment tumors: current concepts and innovations.

The most common anterior segment tumors are primary neuroepithelial cysts, uveal melanomas, metastatic tumors, and benign tumors. In the majority of cases, the diagnosis can be made utilizing a careful clinical history and ocular examination. Ultrasound examination (low and high frequency) has become an indispensable tool used to determine tumor extension and involvement of the surrounding structures. In particular, high-frequency ultrasound has been used to uncover iris pigment epithelial cysts, to allow for the diagnosis of small ciliary body melanomas, and to measure tumors for plaque radiation planning. Whereas fluorescein angiography and computerized tomography have come to play a limited role, fine-needle aspiration biopsy has been found to be quite helpful in selected cases. Once the diagnosis is established, treatment decisions depend on the tumors' location, size, local extension, patterns of growth, and secondary complications. Most anterior segment tumors can be observed for growth prior to treatment. Other options include local resection (iridectomy, lamellar sclerouvectomy, or eye-wall resection) and radiation (ophthalmic plaque or external beam). Enucleation is typically employed if these eye- and vision-sparing treatments are not possible and for uncontrollable secondary glaucoma. This review examines the unique role of high-frequency ultrasonography for the diagnosis and treatment of anterior segment tumors as well as an overview of clinical practice.

Anterior Eye Segment↗

PubMedDate not supplied

The kidney, cancer, and the eye: current concepts.

Herein, we review the associations between the kidney, renal cancers, and the eye. Renal cancers have been reported to metastasize to the eye and the orbit. As these tumors can be confused with other amelanotic or vascular tumors, a high index of suspicion is required for early detection and management of the primary tumor. We discuss the physiology of metastases, clinical features and management of metastatic disease. A variety of ocular anomalies have been associated with renal disease. Wilms tumor, a renal tumor of childhood, can present with aniridia, which may be the first clue leading to the diagnosis of the primary tumor. Paraneoplastic syndromes are common manifestations of renal cancers and can present as retinopathies and neuro-ophthalmic disorders. Multiple cancer syndromes involve both the eye and the kidney. For example, the diagnosis of von Hippel retinal tumors can lead to a systemic evaluation and discovery of associated visceral tumors. The prognosis, screening, and counseling of such patients is discussed. Newer systemic treatments available for renal tumors, such as interferon alfa, may lead to ocular side effects including retinopathy. These patients require periodic ophthalmic examinations. This review demonstrates the essential role of the ophthalmologist, for early diagnosis and treatment that can help reduce the morbidity and mortality associated with kidney tumors and renal-associated disease.

Carcinoma, Renal Cell↗

PubMedDate not supplied

Risk factors for metastasis in retinoblastoma.

Children with retinoblastoma typically survive their cancer due to advances in early diagnosis and treatment. Despite this success, risk factors persist for metastasis that are thought to be related to patient age, sex, laterality, treatment, genetics, histopathology, and extraocular extension. This review has found that invasion of the uvea, orbit, and optic nerve continue to be the most important predictors of metastatic retinoblastoma. Bilaterality and delays in diagnosis are also important factors. We examine molecular and genetic studies that offer the potential of predicting which tumors are likely to metastasize, which will recur within the eye, and which will undergo senescence. In this review, we describe which clinical evaluations, genetic studies, and histopathologic evaluations of retrieved specimens are currently used widely. This review has been performed to help those caring for patients with retinoblastoma and to aid informed consent.

Child, Preschool↗

PubMedDate not supplied

Optic nerve measurements by 3D ultrasound-based coronal "C-scan" imaging.

Twenty-three normal eyes were examined with the Intensity Profiling technique of 3D I-Scan and 52 normal eyes with the Automated technique of OTI-Scan 1000 ultrasound systems (Ophthalmic Technologies Inc., Toronto, Ontario, Canada). With the eye looking straight, the probe was applied on the temporal sclera. Scanning generated 3D image files. Coronal optic nerve measurements were obtained 3 mm behind the globe. The mean optic nerve sheath diameter was 4.8 mm (standard deviation = 0.6; range, 3.9 to 5.9 mm) with the Intensity Profiling technique, and 5.4 mm (standard deviation = 0.4; range, 4.4 to 6.0 mm) with the Automated technique. 3D ultrasound imaging can be used to obtain optic nerve measurements in vivo. Both the Intensity Profiling and the Automated techniques yielded measurements similar to current magnetic resonance imaging and computed tomography scan reports. Coronal "C-scan" sectioning can be used as a screening tool to measure optic nerve diameter prior to magnetic resonance imaging or computed tomography.

Adult↗