Ophthalmic Tumours: Including lectures presented at the Boerhaave Course on “Ophthalmic Tumours” of the Leiden Medical Faculty, held in Leiden, The Netherlands, on February 2–3, 1984

338 Pages·1985·9.65 MB·English

by  J. A. Oosterhuis, D. de Wolff-Rouendaal (auth.), Jendo A. Oosterhuis (eds.)

Ophthalmic Tumours
MONOGRAPHS IN OPHTHALMOLOGY
P.C. Maudgal and L. Missotten (eds.), Superficial Keratitis. 1981.
ISBN 90-6193-801-5.
P. F. 1. Hoyng, Pharmacological Denervation and Glaucoma. A Clinical Trial Report with
Guanethidine and Adrenaline in One Eye Drop. 1981.
ISBN 90-6193-802-3.
N.W.H.M. Dekkers, The Cornea in Measles. 1981. ISBN 90-6193-803-1.
P. Leonard and 1. Rommel, Lens Implantation - 30 years of progress. 1982.
ISBN 90-6193-804-X.
C.E. van Nouhuys, Dominant Exudative Vitreoretinopathy and Other Vascular
Developmental Disorders of the Peripheral Retina. 1982. ISBN 90-6193-805-8.
L. Evens (ed.), Convergent Strabismus. 1982. ISBN 90-6193-806-6.
A. Neetens, A. Lowenthal and 1.1. Martin (eds.), The Visual System in Myelin Disorders.
1984. ISBN 90-6193-807-4.
H.l.M. Volker-Dieben, The Effect of Immunological and Non-Immunological Factors on
Corneal Graft Survival. 1984. ISBN 90-6193-808-2.
1.A. Oosterhuis, Ophthalmic Tumours. 1985. ISBN 90-6193-528-8.
Ophthalmic Tumours
Including lectures presented at the Boerhaave
Course on "Ophthalmic Tumours" of the Leiden
Medical Faculty, held in Leiden, The Netherlands,
on February 2-3, 1984
edited by
Jendo A. Oosterhuis
1985 DR w. JUNK PUBLISHERS ....
a member of the KLUWER ACADEMIC PUBLISHERS GROUP 1111
DORDRECHT / BOSTON / LANCASTER ."liliiii
Distributors
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P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging in Publication Data
Boerhaave Course on "Ophthalmic Tumours" (1984 :
Leiden, Netherlands)
Ophthalmic tumours.
(Monographs in ophthalmology ; 9)
1. Eye--Tumors--Congresses. 2. Eye-sockets--Tumors--
Congresses. 3. Adnexa oculi --Tumors--Congresses.
1. Oosterhuis, J. A. II. Rijksuniversiteit te Lcidcn.
faculteit der Geneeskunde. III. Title. IV. Series.
[DNlM: 1. Eye Neoplasms--congresses. Wl M0568D v.9 /
WW 149 66720 19841
RC280.E9664 1984 616.99'284 85-5605
ISBN-I 3 : 978-94-0 I 0-8936-4 e-ISBN-13: 978-94-009-5520-2
DOl: 10.1007/978-94-009-5520-2
Copyright
© 1985 by Dr W. Junk Publishers, Dordrecht.
Softcover reprint of the hardcover I st edition 1985
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of
the publishers,
Dr W. Junk Publishers, P.O. Box 163, 3300 AD Dordrecht, The Netherlands.
v
CONTENTS
Introductory remarks
J.A. Oosterhuis vii
Differential diagnosis of very small melanomas
and naevi of the choroid
J.A. Oosterhuis and D. de \\Tolff-Rouendaal 1
Five-year follow-up study of choroidal and
ciliary body melanomas after enucleation
H.M. Kakebeeke-Kemme, J.A. Oosterhuis and
D. de Wolff-Rouendaal 9
Conservative treatment modalities of choroidal
melanomas
J.A. Oosterhuis 27
Treatment of intraocular melanomas by
ruthenium-106 beta irradiation
D. Hallermann 55
Ruthenium plaque treatment of malignant
choroidal melanomas
A. Wessing, M. Foerster and N. Bornfeld 71
Cobalt plaque treatment of choroidal
melanomas
L. Zografos and Cl. Gailloud 87
Haematoporphyrin derivative photoradiation
treatment of malignant melanoma in the
anterior chamber of the rabbit
J.A. Oosterhuis 93
Differential diagnosis of non-pigmented
intraocular tumours
P.T.V.M. de Jong, G.S. Baarsma and B.C.P. Polak 105
Differential diagnosis of pigmented
intraocular tumours
P.T.V.M. de Jong, J.A. Oosterhuis and P.J. Ringens 131
Retinoblastoma
K.E.W.P. Tan and J. Schipper 143
Management of conjunctival tumours
D. de Wolff-Rouendaal 159
The diagnosis and management of tumours
of the iris and ciliary body
W.S. Foulds 173
VI
Treatment of orbital tumours. Principles
of oncolog{cal surgery
221
E.A. van Slooten
Management of malignant orbital tumours
229
J.E. Wright
Malignant ENT tumours and the orbit
241
E.N. Brons
Vascular disorders in the orbit and in the
orbi tal region
R.J.W. de Keizer 247
The otorhinolaryngeal aspects of the treatment
of benign orbital disorders
271
J.P.A. Gillissen
Chemotherapy of orbital tumours
279
F.J. Cleton
Radiotherapy of tumours of the orbit
and ocular adnexa
285
H.A. van Peperzeel
Diagnostic features of eyelid tumours with
special emphasis on epithelial tumours
293
E. Scheffer and W.A. van Vloten
Surgery of adnexal tumours
307
J. R. 0 . Co lli n
Liquid nitrogen cryosurgery of lid basaliomas
313
W. Buschmann
341
List of contributors
VII
INTRODUCTORY REMARKS
Tumours of the eye, orbit and adnexa are fields in
ophthalmology which in recent years have shown rapid
advances both in diagnostics and in treatment. This volume
deals with many questions, such as
which is the survival rate in choroidal melanoma in
relation to its clinical and histopathological
characteristics?
what treatment modalities alternative to enucleation are
currently being used, which of them have been abandoned,
and which of them show promise for the future?
what irradiation techniques are currently being used to
treat choroidal and ciliary body melanomas and which are
their indications, results and rate of complications?
how can one differentiate non-pigmented tumours in the
ocular fundus?
to what extent has the survival rate in retinoblastoma
patients improved over the years and what irradiation
technique offers minimal risk of side effects?
which are the rates of metastasis and survival in
conjuntival melanomas?
which are the general principles in oncological surgery
and how are they to be applied in the management of
orbital tumours?
how do ENT tumours affect the orbit?
which are the features of pseudo-tumours, vascular
tumours, and benign tumours of the orbit?
which is the significance of cytostatic or irradiation
treatment in tumours of the orbit and adnexa?
how does one diagnose and how does one treat adnexal
tumours?
which is the significance of cryotherapy in the treatment
of adnexal tumours?
If you know the answers to these questions you do not
need to buy this volume.
If you do not know the answers to these questions, you
will find them in this volume, together with a Lot of other
information on tumours of the eye, orbit and adnexa.
This volume includes lectures presented at a "Boerhaave
Course" of the Leiden University by experts in the various
fields.
I would especially like to thank Professor G.M. Bleeker,
the mentor of the wellknown Orbita Team of the Amsterdam
University Hospital, and his collaborators for their
contributions on the orbit, and Miss I.G. Jeltes for her
editorial assistance.
Jendo A. Oosterhuis
DIFFERENTIAL DIAGNOSIS OF VERY SMALL MELANOMAS AND NAEVI OF
THE CHOROID
J.A. Oosterhuis and D. de Wolff-Rouendaal
Diagnosis of large choroidal melanomas usually does not
present special problems, especially when the tumour is very
prominent and shows the characteristic features of a choro-
idal melanoma. The ophthalmologist must be familiar with the
various ophthalmologic aspects of the pigmented as well as
the amelanotic type of melanoma; the latter develops
especially when the tumour has perforated through Bruch's
membrane. The diagnosis can be confirmed by means of fluo-
rescein angiography and ultrasonography. When the diagnosis
remains doubtful the phosphor 32 test is a very reliable
examination method in the differential diagnosis.
In small melanocytic choroidal tumours situated near the
posterior pole clinical differentiation between choroidal
naevus and malignant melanoma can be very difficult.
Nowadays, when most of these tumours are not treated any
longer by enucleation of the eye but by irradiation, a
reliable assessment of the diagn.osis is more important than
ever as we have no histopathological confirmation of the
diagnosis any more. Irradiation mistakenly performed in
benign tumours may endanger vision because of irradiation
side effects and make statistic calculation of the results
unreliable.
We have studied the eyes of 41 patients with a small
choroidal pigmented lesion which on ophthalmoscopy did not
show the typical characteristics of a naevus or a melanoma
but had an aspect which could be associated with both types
of tumour.
Oosterhuis, JA. (ed.), Ophthalmic tumours
© 1985, Dr W. Junk Publishers, DordrechtlBostonlLancaster
ISBN 978-94-0/0-8936-4
2
Clinical examination
As parameters for differentiation we used: prominence of
the tumour, P32 uptake test, fluorescence angiography,
perimetry, and presence or absence of visual complaints.
Ophthalmoscopy is valuable in cases characteristic of
melanoma (Gass, 1974) or naevus (Oosterhuis & von Winning,
1979), but the fundus aspect of a naevus associated with
pigment-epithelial degeneration and subretinal leakage may
be difficult to differentiate from that of a small, flat
melanoma. We used ophthalmoscopy to determine the maximum
diameter and E~9~~~~~~~_9~_~Q~_~~~9~~' the presence or
absence of drusen, orange pigment, and pigment-epithelial
degeneration. Subretinal exudation was looked for by means
of binocular ophthalmoscopy, with slitlamp and Goldmann
contact lens. The degree of prominence of the tumour is
important, because the vast majority of naevi is flat or
shows a prominence of only 0.5-1.0 dioptre, in exceptional
cases 1-2 dioptres (Naumann, 1970); thus, a prominence of
more than 2 dioptres may indicate the tumour to be a mela-
noma.
The EQ9~EQ9~_~~_ig~~1_~E~~~~_~~~~ was carried out in all
our patients. A conjunctival incision was always required
and in some of the patients also a rectus muscle had to be
detached to give the probe access to the macular area. A
difference of more than 60% between tumour and control site
found 48 hours after administration of the P32 was consider-
ed to be suggestive of malignancy, a difference of more than
100% as a very strong indication of malignancy. The P32
isotope examination is the most reliable ancillary test
currently available for the diagnosis of choroidal melano-
cytic tumours.
In our series of 194 eyes with histopathologically proven
malignant melanoma the P32 test results were positive in 192
cases (99%) (Oosterhuis et al., 1980), which agrees with the
results of Shields (1978), who found a positive P32 test
result in 213 out of 226 melanoma eyes (98.7%). All our P32