Intraocular Tumours
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Transcript of Intraocular Tumours
Intraocular tumours
Intraocular tumours
Uveal tract tumours – iris, ciliary body, and choiroidal melanomas
Retinal tumours – Retinoblastoma
Metastatic tumours
Uveal tract tumours
IRIS• Naevi – Benign – flat to slightly elevated
lesions .
• Melanoma – 5-10% of uveal melanomas – age 50-60 years, elevated and more pigmented
Treatment: local resection +/- radiotherapy – good prognosis
Uveal tract tumours
Iris naevus Iris melanoma
Ciliary body melanomas • 10% of uveal melanomas – only visualised when pupil is
widely dilated. • Presentation depends on size and location – lens
subluxation or localised lens opacities, sentinal vessels, erosion into anterior chamber, posterior extension retinal detachment.
• Ultrasound may be necessary • Treatment – enucleation, local resection, radiotherapy • Prognosis is poor as presentation is usually late
Ciliary body melanomaPicture on left showing black mass in red reflex
Picture on right showing tumour pushing on and displacing the lens
Choroidal melanoma/ Malignant melanoma
• 85% of uveal melanomas, most common during sixth decade of life
• Raised pigmented oval shaped mass(occasionally amelanotic)
• Commonly asymptomatic – found on routine fundal examination – may cause decreased visual acuity or defect in visual field – can cause an exudative retinal detachment, secondary glaucoma, cataract or uveitis
Choroidal melanoma MM
Peripheral MM MM at macula
Diagnosis of choroidal melanoma
• Ocular ultrasound – gives a measurement of size of tumour particularly the height, also differentiates between a normal retinal detachment (RD) and RD caused by tumour
• MRI of orbits and optic nerves to check for extra scleral spread
• Fluorescein angiography, shows increased vascularity and leakage from tumour
Differential diagnosis of choroidal melanoma
• Retinal detachment• Metastatic tumour• Neovascular ARMD• Large choroidal naevus
Medical evaluation of patient with choroidal melanoma
• Exclude a metastatic tumour – lung tumours in males and breast tumours in females are the commonest tumours that spread to the eye
• Detection of distant metastases – choroidal melanomas spread to the liver and lung
• Chest x ray, abdominal ultrasound, MRI, mamography
Management of choroidal melanoma
• Consider visual acuity of involved eye• Size, location, extent and apparent
activity of involved eye• State of fellow eye• General health and age of patient
Treatment of choroidal melanoma • Radioactive plaques • Enucleation• Cyclotron – generated charged particle
radiation• Photocoagulation• Trans pupillary thermotherapy• Localised resection• Exenteration• Palliation with chemotherapy
Retinoblastoma
• Tumours of primitive photoreceptor cells of eye.
• Most common primary malignant intraocular tumour in childhood – one in 20,000 live births
Retinoblastoma
• Average age at diagnosis 18 months – majority diagnosed by three years of age
• Early treatment can save vision, and the life of the patient
• Other primary tumours such as sarcomas may develop in about 10% of patients
Retinoblastoma
Children present most commonly with Leucocoria
and/or
Squint
Retinoblastoma
Fundal picturePinkish white raised lesions with blood vessels on
surface (may show calcification on Xray)or Retinal detachment
Left convergent squint and leucoria
Retinoblastoma
• 1/3 are bilateral –these present earlier than unilateral tumours. Most bilateral tumours are familial, autosomal dominant. Only 6% of patients have a positive family history. Patients with familial retinoblastoma have a 50% risk of transmitting the disease to their children.
• Sporadic cases usually uni-ocular but can be bilateral.
Retinoblastoma
These tumours spread trans sclerally to orbits, via the optic nerves to the brain and via blood to bone marrow
Investigations – ultrasound, CT, MRI,
Retinoblastoma
Treatment –• enucleation,• radiotherapy (external beam,
plaque),• thermotherapy,• cryotherapy,• chemotherapy
Retinoblastoma
Very important
Any child under 5 years of age who has leucocoria, a squint or loss of vision must be examined to out rule Retinoblastoma
Metastatic Tumours
More common than primary malignancies Common primary site in women – breast
In men – bronchus Less common sites kidney, testis, GIT.May present with decreased visual acuity in one or
both eyes• Solitary or multiple creamy white placoid or oval
lesions.• Treatment: Chemotherapy and/or radiotherapy
Metastatic tumour from breast cancer