The Essential Eye Cancer Podcast
There are many different types of vascular tumors within the eye. In the uvea or vascular layer beneath the retina, there occur both circumscribed and diffuse hemangiomas. The latter or diffuse variant is commonly associated with the congenital neurologic disorder Sturge-Weber Syndrome (encephalotrigeminal angiomatosis). It is associated with Port-Wine skin coloration, glaucoma, seizures, intellectual disability, and ipsilateral leptomeningeal angiomas. Within the eye, both circumscribed and diffuse hemangiomas may leak causing secondary retinal detachments. Vision changes can also be due to physical displacement of the retina, cystoid retinopathy, and secondary glaucoma. Vascular tumors also occur in the retina. These include capillary hemangioma with or without Von Hippel-Landau Syndrome, cavernous retinal hemangioma, and Racemose hemangioma. Though none of these tumors spread to other parts of the body, each can be differentiated by clinical characteristics and methods of management discussed in this Podcast.
Cancer textbooks tell us to remove or destroy primary cancers to prevent spread (metastasis) to other parts of the body. In the 1950s, most eyes with choroidal melanoma were removed. Some small anterior choroidal, ciliary body and iris melanomas were locally resected. However, The multicenter, international, Collaborative Ocular Melanoma Study taught us that removal of the eye was not necessary for moderately sized choroidal melanomas. That eye and vision sparing plaque radiation therapy was statistically equivalent for the prevention of metastatic disease. However, surgical removal, including local resection names PLSU or partial lamellar sclerouvectomy continued to be used around the world. Meanwhile, others expanded the use of plaque radiation to anterior uveal, ciliary body and iris melanomas. This podcast compares and contrasts resection versus plaque therapy for treatment of anterior uveal melanoma.
Iris tumors are visible. Patients see them in the mirror and eye care specialists view them through the clear cornea. We use specialized ultrasound (UBM) and anterior segment OCT tests to reveal the contents, distribution, and size of these tumors. Most are benign and thus can be observed for growth prior to intervention. Others are either clinically diagnosed and treated or undergo biopsy. We review the differences between biopsy methods. In this Podcast, we will explore iris tumors, their diagnosis, and treatment.
This podcast discusses a technique I introduced to ophthalmic oncology. Sometimes, when eye cancer specialists have to remove a large tumor from the surface of the eye, we created a large tissue-defect on its surface. The surgeon cannot leave it grow on its own because the eyelid can scar and stick to the eyeball (called symblepharon). This scarring can hamper the movement of the eye and doesn't look normal. So, decades ago, I used to borrow some mucus membrane tissue from the inside of the cheek (mouth). This was a second surgery that left the patient's mouth sore and swollen for a week or two. Thankfully, super-thick amniotic membranes became commercially available. These large thick pieces of donor amniotic membrane were easily sewn into place and helped the eye heal without symblepharon scarring. This podcast describes my technique of Super-thick amniotic membrane grafting for ocular surface reconstruction.
This podcast takes a closer look at what I do to maximize eye radiation outcomes and minimize patient risk. Until we have a treatment for metastatic ocular melanoma, destruction of the intraocular tumor will be the best way to prevent and thus "treat" metastasis. Across the world, each eye cancer center has its own radiation methods to destroy choroidal melanomas. However, a closer look at the methods of plaque selection and implementation reveals significant differences. This Podcast discusses basic plaque design, construction, and dose calculations. I explain why certain methods/plaques are more likely to result in eye cancer control. This Podcast is targeted to help eye cancer specialists improve their results.
Tumors and cancers commonly occur on the conjunctiva and often grow onto the corneal surface. Both conjunctival melanoma and squamous carcinoma have been associated with sun (ultraviolet UV-ray) exposure, so Dr. Finger says, "Think of Sunglasses as Sunblock for your Eyes.®" Commonly treated with observation for growth, surgical removal or a combination of surgery and freezing "cryotherapy," over the last 10 years more and more patients are treated with immunotherapy or chemotherapy eye drops. Of course, your doctor may need to biopsy first, but at The New York Eye Cancer Center, most patients don't need extensive surgery.