The aim of this study was to report on results of uveal melanoma treatment with ruthenium-106 (
Ru) brachytherapy with long-term follow-up, in terms of local tumor control, eye retention rate, ...radiation retinopathy, and patients' survival.
Medical records of patients treated with ruthenium plaque due to uveal melanoma at the Department of Ophthalmology, Poznan University of Medical Sciences, Poland, between 1994 and 2014 were retrospectively reviewed.
We identified 126 patients: 53 men, 73 women, mean age 60.04 years (range, 21-89). The largest basal diameter ranged from 4.04 mm to 18.9 mm (median, 10.67 mm), tumor height was 1.9 mm to 7.42 mm (median, 4.8 mm). Median scleral radiation dose was 570 Gy (range, 235-1,500 Gy), median apical dose 100 Gy (range, 60-129 Gy). Median follow-up was 66.5 months (range, 2-261 months). We noted a total of 19 (15%) recurrences. The actuarial rate of recurrence was 9.5% at 3 years, and 13.5% at 5 years postoperatively. Nine (7%) eye globes were lost, median time to enucleation was 5 years. The eye retention rate at 5 years was 92.7% and 81% at 10 years. Forty-three (34%) patients died before the end of the study, 24 (19%) of them due to metastatic disease. Metastatic death was related to: tumor size and TNM stage at presentation (
= 0.002 vs.
= 0.0006, respectively) but not to age, gender, and plaque dosimetry.
Ru brachytherapy is an effective, globe sparing treatment that provides good tumor control and a high rate of survival. However, some ocular complications tend to appear late post-treatment, and therefore long-term follow-up is advised.
Ocular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by numerous migrating larvae ...of Toxocara parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of Toxocara infection in schoolboys.
Two children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with Toxocara species were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-Toxocara immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating Toxocara parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to Toxocara species in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite.
Wide promotion of sanitary education is strongly justified in children and adolescents in Toxocara endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.
Abstract
Introduction
Ocular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by ...numerous migrating larvae of
Toxocara
parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of
Toxocara
infection in schoolboys.
Case presentation
Two children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with
Toxocara species
were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-
Toxocara
immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating
Toxocara
parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to
Toxocara species
in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite.
Conclusions
Wide promotion of sanitary education is strongly justified in children and adolescents in
Toxocara
endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.
INTRODUCTIONOcular toxocarosis associated with high peripheral eosinophilia and together with systemic signs of visceral damage has been reported sporadically. Eye infections caused by numerous ...migrating larvae of Toxocara parasites, probably due to re-invasion or delayed reactivation, and leading to a progressive loss of vision is relatively rare. We report three atypical cases of toxocarosis with the co-existence of ocular larva migrans syndrome and generalized signs of Toxocara infection in schoolboys. CASE PRESENTATIONTwo children aged 8 and 14 years respectively, with symptomatic ocular and visceral larva migrans syndromes, and one 16-year-old adolescent with chronic multifocal eye invasion, characterized by severe granulomatous retinochoroiditis with unilateral blindness, chronic abdominal pain and generalized synthesis of total immunoglobulin E antibody are described. The three patients, heavily infected with Toxocara species were boys of Polish origin. Ocular location of the parasite was confirmed by the detection of intraocular synthesis of specific anti-Toxocara immunoglobulin G antibody in aqueous humour samples from the affected eyes. Immunological parameters of tissue eosinophilia, allergy or hypersensitivity reactions to the presence of the migrating Toxocara parasites were analysed. Irreversible eye complications were observed in the patients with high level of exposure to Toxocara species in a contaminated environment, with a suggestion of possible re-activation or re-infection by different species or strains of the parasite. CONCLUSIONSWide promotion of sanitary education is strongly justified in children and adolescents in Toxocara endemic areas in order to reduce the potential risk of primary invasion or re-infection with the parasites, which can lead to a severe course or progression of the disease. A long-term clinical follow-up and more intensive anti-parasitic treatment is recommended in patients with subclinical and overt forms of toxocarosis to prevent later reactivation of the migrating larvae in tissues.
High seroprevalence of Toxoplasma and Toxocara spp. in populations of children and adults in Poland constitutes a significant risk of supradiagnosed parasitic eye infections. We described the ...clinical characteristics in relation to the analysis of comparative immunological profiles of T. gondii-specific antibodies in aqueous humour and serum samples in patients with reactivated retinochoroiditis, and of Toxocara spp. ones in cases with posterior granuloma, fibrotic and calcified tumor-like masses simulating retinoblastoma, detected by ophthalmoscopy and echography. Intraocular synthesis of specific IgG antibodies was detected in anterior eye chamber fluid in 1/2 and 2/3 of patients respectively, strongly suspected of ocular toxoplasmosis or toxocarosis. The evidence of a local production of specific antibodies in intraocular fluid shown by the Western blot seems to be a valuable immunodiagnostic method for a final confirmation of eye lesions of parasitic origin and crucial in the choice of an appropriate treatment regimen.
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