Chemotherapy plays an important role in treating ocular malignancies. It can be used as adjuvant therapy with surgery and radiation, as well as palliatively to decrease tumor load. Common agents include mitomycin C, 5-FU, interferons, and for retinoblastoma, vincristine, etoposide and carboplatin. Chemotherapy is indicated for eyelid, conjunctival, intraocular tumors and orbital tumors like rhabdomyosarcoma. Side effects depend on the agent but can include keratoconjunctivitis and corneal toxicity.
Anophthalmia is the absence of the eyeball and can be congenital or acquired. The optimal management of an anophthalmic socket involves maintaining adequate volume with a well-positioned implant, healthy conjunctiva, and symmetric eyelids. Complications after enucleation like enophthalmos, eyelid deformities, and socket contracture can be addressed through procedures like dermis fat grafts, fornix deepening sutures, and implant replacement. Proper prosthesis fitting and care is also important for optimal cosmetic and functional results.
This document summarizes limbal stem cell deficiency (LSCD), its causes, clinical manifestations, diagnosis, and treatment options. It discusses that limbal stem cells reside in the palisades of Vogt and are responsible for corneal epithelial renewal. LSCD can be caused by injuries or diseases and results in conjunctivalization of the cornea. Treatment options include conservative management, surgical removal of conjunctival epithelium and transplantation of limbal stem cells through various methods like conjunctival limbal autograft or cultured limbal stem cell transplantation.
A 20-year-old Saudi female presented with progressive gradual loss of vision in both eyes over two years. Examination found VA of 6/9 in the right eye and 6/18 in the left. Signs of keratoconus were seen including stromal thinning, Vogt's striae, and Munson's sign. Topography showed patterns characteristic of keratoconus such as inferior steepening and asymmetric bowtie patterns. She was diagnosed with keratoconus stage 2 based on findings. Contact lenses were recommended for management as spectacles could not adequately correct her vision.
Meibomian gland dysfunction (MGD) is a chronic abnormality of the meibomian glands characterized by terminal duct obstruction and changes in glandular secretion that can alter the tear film. It is a common cause of dry eye and estimated to affect 70% of Americans over age 60. Diagnosis involves examining the glands and assessing ocular surface damage. Treatment focuses on eyelid hygiene, warm compresses, and lubricating eye drops, with options for antibiotics, steroids, or procedures like probing, LipiFlow, or intense pulsed light. MGD is a chronic condition with periods of exacerbation and remission.
This document discusses various biological agents used to treat uveitis, including tumor necrosis factor inhibitors like infliximab, adalimumab, etanercept, golimumab, and certolizumab. It provides dosing information and potential adverse effects for each drug. Anti-interleukin therapies like daclizumab, anakinra, tocilizumab, rituximab, gevokizumab, and secukinumab are also summarized. Key points are provided on initiating and monitoring patients on biological therapies to help maximize efficacy and safety. Biologics are described as potent treatments for uveitis when conventional therapies have failed or been poorly tolerated.
The document discusses proliferative vitreoretinopathy (PVR), a non-angiogenic fibrocellular proliferation that results from abnormal vitreoretinal healing and is a major cause of failure of retinal detachment surgeries. It describes the pathophysiology and risk factors of PVR, including the roles of retinal pigment epithelium cells, glial cells, and growth factors. It summarizes two studies on evaluating predictive risk formulas for postoperative PVR and investigating adjuvant therapies like 5-FU and heparin or intravitreal aflibercept injections to improve surgical outcomes of retinal detachment repair in high-risk patients.
This presentation emphasizes the importance of screening for chloroquine retinopathy according to new AAO guidelines. While bull's eye maculopathy is a classic late-stage sign, initial photoreceptor damage typically occurs parafoveally in Europeans and peripherally near the arcades in Asians. Screening tests like automated visual fields and SD-OCT can detect toxicity before visible RPE damage, as irreversible progression often occurs by the time bull's eye maculopathy appears. Risk of toxicity depends on daily dose, with very thin patients at increased risk when dose is based on ideal rather than actual weight.
Anophthalmia is the absence of the eyeball and can be congenital or acquired. The optimal management of an anophthalmic socket involves maintaining adequate volume with a well-positioned implant, healthy conjunctiva, and symmetric eyelids. Complications after enucleation like enophthalmos, eyelid deformities, and socket contracture can be addressed through procedures like dermis fat grafts, fornix deepening sutures, and implant replacement. Proper prosthesis fitting and care is also important for optimal cosmetic and functional results.
This document summarizes limbal stem cell deficiency (LSCD), its causes, clinical manifestations, diagnosis, and treatment options. It discusses that limbal stem cells reside in the palisades of Vogt and are responsible for corneal epithelial renewal. LSCD can be caused by injuries or diseases and results in conjunctivalization of the cornea. Treatment options include conservative management, surgical removal of conjunctival epithelium and transplantation of limbal stem cells through various methods like conjunctival limbal autograft or cultured limbal stem cell transplantation.
A 20-year-old Saudi female presented with progressive gradual loss of vision in both eyes over two years. Examination found VA of 6/9 in the right eye and 6/18 in the left. Signs of keratoconus were seen including stromal thinning, Vogt's striae, and Munson's sign. Topography showed patterns characteristic of keratoconus such as inferior steepening and asymmetric bowtie patterns. She was diagnosed with keratoconus stage 2 based on findings. Contact lenses were recommended for management as spectacles could not adequately correct her vision.
Meibomian gland dysfunction (MGD) is a chronic abnormality of the meibomian glands characterized by terminal duct obstruction and changes in glandular secretion that can alter the tear film. It is a common cause of dry eye and estimated to affect 70% of Americans over age 60. Diagnosis involves examining the glands and assessing ocular surface damage. Treatment focuses on eyelid hygiene, warm compresses, and lubricating eye drops, with options for antibiotics, steroids, or procedures like probing, LipiFlow, or intense pulsed light. MGD is a chronic condition with periods of exacerbation and remission.
This document discusses various biological agents used to treat uveitis, including tumor necrosis factor inhibitors like infliximab, adalimumab, etanercept, golimumab, and certolizumab. It provides dosing information and potential adverse effects for each drug. Anti-interleukin therapies like daclizumab, anakinra, tocilizumab, rituximab, gevokizumab, and secukinumab are also summarized. Key points are provided on initiating and monitoring patients on biological therapies to help maximize efficacy and safety. Biologics are described as potent treatments for uveitis when conventional therapies have failed or been poorly tolerated.
The document discusses proliferative vitreoretinopathy (PVR), a non-angiogenic fibrocellular proliferation that results from abnormal vitreoretinal healing and is a major cause of failure of retinal detachment surgeries. It describes the pathophysiology and risk factors of PVR, including the roles of retinal pigment epithelium cells, glial cells, and growth factors. It summarizes two studies on evaluating predictive risk formulas for postoperative PVR and investigating adjuvant therapies like 5-FU and heparin or intravitreal aflibercept injections to improve surgical outcomes of retinal detachment repair in high-risk patients.
This presentation emphasizes the importance of screening for chloroquine retinopathy according to new AAO guidelines. While bull's eye maculopathy is a classic late-stage sign, initial photoreceptor damage typically occurs parafoveally in Europeans and peripherally near the arcades in Asians. Screening tests like automated visual fields and SD-OCT can detect toxicity before visible RPE damage, as irreversible progression often occurs by the time bull's eye maculopathy appears. Risk of toxicity depends on daily dose, with very thin patients at increased risk when dose is based on ideal rather than actual weight.
This document discusses the corneal endothelium and techniques for assessing its health and function. The corneal endothelium is a single layer of hexagonal cells that maintains corneal clarity by pumping fluid out of the stroma. Assessment techniques described include specular microscopy, which allows analysis of endothelial cell density, morphology, and patterns under high magnification; confocal microscopy; anterior segment OCT; and ultrasound pachymetry to measure corneal thickness as an indicator of endothelial function. Common indications for assessment include pre- and post-operative evaluation, and evaluation of donor corneas for transplantation.
1) The document discusses various malignant eyelid tumours including basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and rare tumours.
2) It describes the clinical features, risk factors, histology, signs and symptoms, and treatment options for each tumour type.
3) Reconstruction after tumour excision depends on the extent of tissue removed and may involve techniques such as direct closure, flaps, or free grafts to reconstruct the posterior or anterior lamellae as needed.
This document summarizes several studies and clinical trials related to the treatment of diabetic retinopathy and diabetic macular edema. It discusses the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS) which established laser photocoagulation as the standard treatment for proliferative diabetic retinopathy and diabetic macular edema. It also summarizes the Diabetic Retinopathy Clinical Research Network (DRCR.Net) which conducted several clinical trials comparing treatments for diabetic macular edema such as anti-VEGF injections and laser photocoagulation. The document provides high-level overviews of many landmark studies that helped advance the treatment of diabetic eye disease.
Choroidal neovascular membranes (CNVM)Md Riyaj Ali
Choroidal neovascularization (CNV) involves the abnormal growth of new blood vessels from the choroid layer of the eye through Bruch's membrane. This can cause vision loss and is a common cause of wet macular degeneration. CNV occurs due to alterations in Bruch's membrane and high levels of vascular endothelial growth factor. It is classified based on its location relative to the retinal pigment epithelium and fovea. Symptoms include sudden vision loss and visual distortions. CNV is diagnosed through imaging like optical coherence tomography and fluorescein angiography and treated with injections of anti-VEGF drugs to inhibit blood vessel growth.
Laser (introduction and indication in posterior segmentsMutahir Shah
The document discusses laser technology and its applications in ophthalmology. It begins by defining what a laser is and describing its key properties such as coherency, monochromaticity, collimation, and ability to concentrate energy. It then discusses different laser types (pulsed, continuous), operation modes (CW, Q-switched), wavelengths used, and basic laser components. The main laser tissue interactions - photocoagulation, photoablation, photodisruption, and photoactivation - are explained. Applications of laser treatment for various posterior segment diseases are covered, including diabetic retinopathy, CNV, CSR, and tumors.
This document provides information on macular dystrophies. It begins with the anatomical landmarks of the macula including the fovea and foveola. It then discusses various hereditary macular dystrophies including X-linked juvenile retinoschisis, Stargardt's disease, Best's disease, dominant familial drusen, and pattern dystrophy. For each condition, it provides information on genetics, symptoms, signs, imaging findings, and management. The document uses images to illustrate many of the clinical features described.
1. The document discusses Anterior Chamber Associated Immune Deviation (ACAID), where antigens injected into the anterior chamber lead to a suppression of delayed hypersensitivity responses but preservation of humoral immunity.
2. Specialized macrophages in the iris take up antigens and migrate to the spleen, where they alter CD4 T cell responses to downregulate delayed hypersensitivity to the antigen.
3. The major mechanism of ACAID is expression of Fas Ligand on iris and corneal endothelium tissues, which can trigger apoptosis and downregulate inflammation to ocular antigens.
This document summarizes ocular manifestations of HIV/AIDS. It discusses how HIV infects CD4+ T cells and establishes latency. Common opportunistic infections affecting the eye include CMV retinitis, which appears as cotton wool spots or granular lesions and can cause vision loss. Treatment involves antiviral drugs like ganciclovir, foscarnet, and cidofovir. Immune reconstitution inflammatory syndrome can also occur after starting HAART therapy. Other infections discussed are VZV retinitis, MAC, histoplasmosis, and toxoplasmosis.
Coats' disease is a rare eye condition characterized by abnormal blood vessels in the retina. It most commonly affects young boys under 10 years old. The document discusses the history, signs and symptoms, classification, diagnosis, differential diagnosis, and management of Coats' disease. Treatment options depend on the stage of the disease and aim to obliterate abnormal retinal vessels using laser photocoagulation, cryotherapy, surgery, or newer adjunct treatments like intravitreal anti-VEGF agents. Indian studies found Coats' disease patients often present with more severe vision loss and extensive retinal involvement compared to other populations.
Intracorneal ring segments, such as INTACS, are thin plastic rings that are implanted into the corneal stroma to flatten the cornea and reduce myopia. They are placed in a lamellar channel using either a mechanical or laser procedure. Thicker rings provide greater flattening and myopia correction. Potential risks include visual disturbances and complications requiring removal. Intracorneal rings have been used off-label to treat conditions like post-LASIK ectasia and keratectasia with some success in improving vision.
1. Corneal wound healing involves an epithelial phase, stromal phase, and endothelial phase. The epithelial phase begins within 12-48 hours as the surface epithelium slides and replicates to form a plug. The stromal phase lasts several weeks as keratocytes transform and synthesize new collagen to bridge the wound. The endothelial phase can take up to 30 days as the monolayer remodels to form a functional barrier.
This document summarizes recent advances in treating age-related macular degeneration (AMD). It discusses new drugs that aim to prevent retinal damage or slow AMD progression by inhibiting angiogenesis, inflammation, the complement pathway, oxidative stress, and retinal toxin accumulation. It also describes surgeries like maculoplasty and bionic eye implants, as well as rehabilitation techniques and low vision aids. Promising new drug classes discussed include anti-angiogenics, complement inhibitors, neurotrophic factors, and antioxidants.
This document discusses potential complications of trabeculectomy, both intraoperative and postoperative. Intraoperative complications include buttonholing of the conjunctiva, scleral flap tears, lens injury, vitreous prolapse, hyphema, and suprachoroidal hemorrhage. Postoperative complications can be early such as hypotony, elevated intraocular pressure, choroidal effusions or late such as thin blebs, infections, and cataracts. Management strategies are provided for addressing complications depending on the specific issue.
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
This document discusses characteristics, types, diagnosis, and treatment of choroidal neovascularization (CNV). It describes signs of CNV seen on examination including vision changes, scotomas, and drusen. Types of CNV identified on fluorescein angiography include classic, occult, and retinal angiomatosis proliferans. Treatment options discussed include anti-VEGF drugs like ranibizumab and aflibercept, as well as emerging therapies. Complications and differential diagnoses are also outlined.
Corneal Degenerations - Dr Arnav SaroyaDrArnavSaroya
Corneal degeneration refers to conditions where the normal corneal cells undergo degenerative changes due to age or pathology. There are many types of corneal degeneration classified based on etiology and location. Common types include arcus senilis, band keratopathy, lipid depositions, crocodile shagreen, and Terrien's marginal degeneration. Corneal degenerations can cause visual symptoms but often do not require treatment for mild cases. Severe degenerations may be treated with procedures like excimer laser, lamellar keratoplasty, or penetrating keratoplasty to improve vision or relieve discomfort.
Peripheral fundus & its disorders
Presented by Dr Rohit Rao
This document summarizes the key anatomical structures and pathologies of the peripheral retina. It describes the ora serrata, pars plana, vitreous base, dentate processes, meridional folds, and other peripheral features. It then discusses various degenerative conditions like lattice degeneration, retinoschisis, and pavingstone degeneration. Treatment options for retinal breaks including cryopexy and laser photocoagulation are also summarized.
This document provides an overview of the anatomy and development of the iris and some common congenital anomalies. It discusses the embryonic development of the iris from the optic cup and neural crest cells. The iris has 3 layers - an anterior limiting layer, iris stroma with muscles and blood vessels, and a posterior pigmented epithelial layer. The iris receives its arterial blood supply from the long and anterior ciliary arteries. It is innervated by both parasympathetic and sympathetic nerves that control the sphincter and dilator pupillae muscles. Common congenital anomalies discussed include heterochromia, aniridia, persistent pupillary membrane, and colobomata.
This document discusses the use of chemotherapy in orthopaedics, specifically for musculoskeletal tumors. It provides information on the different types and goals of chemotherapy, including neoadjuvant, adjuvant, and palliative chemotherapy. It discusses the mechanism of action, types of drugs used, and side effects. Treatment recommendations are provided for specific cancers like osteosarcoma, Ewing's sarcoma, multiple myeloma, and metastatic bone tumors. The overall goal of chemotherapy for these cancers is curative treatment, disease control, or palliation to improve quality of life.
Smart radiotherapy aims to precisely target tumor cells while sparing healthy cells. New techniques described in the document include using hypoxic cell sensitizers to target hypoxic tumor regions, anti-angiogenic agents to inhibit tumor blood vessels, and nanoparticles to enhance radiation dose and selectively deliver drugs. Molecular imaging helps optimize treatment by identifying tumor characteristics. Combining radiotherapy with immunotherapy or targeted depletion of host cells may also improve outcomes. Overall, the document discusses developing more precise radiation approaches through better understanding of tumor biology and microenvironment.
This document discusses the corneal endothelium and techniques for assessing its health and function. The corneal endothelium is a single layer of hexagonal cells that maintains corneal clarity by pumping fluid out of the stroma. Assessment techniques described include specular microscopy, which allows analysis of endothelial cell density, morphology, and patterns under high magnification; confocal microscopy; anterior segment OCT; and ultrasound pachymetry to measure corneal thickness as an indicator of endothelial function. Common indications for assessment include pre- and post-operative evaluation, and evaluation of donor corneas for transplantation.
1) The document discusses various malignant eyelid tumours including basal cell carcinoma, squamous cell carcinoma, sebaceous gland carcinoma, melanoma, and rare tumours.
2) It describes the clinical features, risk factors, histology, signs and symptoms, and treatment options for each tumour type.
3) Reconstruction after tumour excision depends on the extent of tissue removed and may involve techniques such as direct closure, flaps, or free grafts to reconstruct the posterior or anterior lamellae as needed.
This document summarizes several studies and clinical trials related to the treatment of diabetic retinopathy and diabetic macular edema. It discusses the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS) which established laser photocoagulation as the standard treatment for proliferative diabetic retinopathy and diabetic macular edema. It also summarizes the Diabetic Retinopathy Clinical Research Network (DRCR.Net) which conducted several clinical trials comparing treatments for diabetic macular edema such as anti-VEGF injections and laser photocoagulation. The document provides high-level overviews of many landmark studies that helped advance the treatment of diabetic eye disease.
Choroidal neovascular membranes (CNVM)Md Riyaj Ali
Choroidal neovascularization (CNV) involves the abnormal growth of new blood vessels from the choroid layer of the eye through Bruch's membrane. This can cause vision loss and is a common cause of wet macular degeneration. CNV occurs due to alterations in Bruch's membrane and high levels of vascular endothelial growth factor. It is classified based on its location relative to the retinal pigment epithelium and fovea. Symptoms include sudden vision loss and visual distortions. CNV is diagnosed through imaging like optical coherence tomography and fluorescein angiography and treated with injections of anti-VEGF drugs to inhibit blood vessel growth.
Laser (introduction and indication in posterior segmentsMutahir Shah
The document discusses laser technology and its applications in ophthalmology. It begins by defining what a laser is and describing its key properties such as coherency, monochromaticity, collimation, and ability to concentrate energy. It then discusses different laser types (pulsed, continuous), operation modes (CW, Q-switched), wavelengths used, and basic laser components. The main laser tissue interactions - photocoagulation, photoablation, photodisruption, and photoactivation - are explained. Applications of laser treatment for various posterior segment diseases are covered, including diabetic retinopathy, CNV, CSR, and tumors.
This document provides information on macular dystrophies. It begins with the anatomical landmarks of the macula including the fovea and foveola. It then discusses various hereditary macular dystrophies including X-linked juvenile retinoschisis, Stargardt's disease, Best's disease, dominant familial drusen, and pattern dystrophy. For each condition, it provides information on genetics, symptoms, signs, imaging findings, and management. The document uses images to illustrate many of the clinical features described.
1. The document discusses Anterior Chamber Associated Immune Deviation (ACAID), where antigens injected into the anterior chamber lead to a suppression of delayed hypersensitivity responses but preservation of humoral immunity.
2. Specialized macrophages in the iris take up antigens and migrate to the spleen, where they alter CD4 T cell responses to downregulate delayed hypersensitivity to the antigen.
3. The major mechanism of ACAID is expression of Fas Ligand on iris and corneal endothelium tissues, which can trigger apoptosis and downregulate inflammation to ocular antigens.
This document summarizes ocular manifestations of HIV/AIDS. It discusses how HIV infects CD4+ T cells and establishes latency. Common opportunistic infections affecting the eye include CMV retinitis, which appears as cotton wool spots or granular lesions and can cause vision loss. Treatment involves antiviral drugs like ganciclovir, foscarnet, and cidofovir. Immune reconstitution inflammatory syndrome can also occur after starting HAART therapy. Other infections discussed are VZV retinitis, MAC, histoplasmosis, and toxoplasmosis.
Coats' disease is a rare eye condition characterized by abnormal blood vessels in the retina. It most commonly affects young boys under 10 years old. The document discusses the history, signs and symptoms, classification, diagnosis, differential diagnosis, and management of Coats' disease. Treatment options depend on the stage of the disease and aim to obliterate abnormal retinal vessels using laser photocoagulation, cryotherapy, surgery, or newer adjunct treatments like intravitreal anti-VEGF agents. Indian studies found Coats' disease patients often present with more severe vision loss and extensive retinal involvement compared to other populations.
Intracorneal ring segments, such as INTACS, are thin plastic rings that are implanted into the corneal stroma to flatten the cornea and reduce myopia. They are placed in a lamellar channel using either a mechanical or laser procedure. Thicker rings provide greater flattening and myopia correction. Potential risks include visual disturbances and complications requiring removal. Intracorneal rings have been used off-label to treat conditions like post-LASIK ectasia and keratectasia with some success in improving vision.
1. Corneal wound healing involves an epithelial phase, stromal phase, and endothelial phase. The epithelial phase begins within 12-48 hours as the surface epithelium slides and replicates to form a plug. The stromal phase lasts several weeks as keratocytes transform and synthesize new collagen to bridge the wound. The endothelial phase can take up to 30 days as the monolayer remodels to form a functional barrier.
This document summarizes recent advances in treating age-related macular degeneration (AMD). It discusses new drugs that aim to prevent retinal damage or slow AMD progression by inhibiting angiogenesis, inflammation, the complement pathway, oxidative stress, and retinal toxin accumulation. It also describes surgeries like maculoplasty and bionic eye implants, as well as rehabilitation techniques and low vision aids. Promising new drug classes discussed include anti-angiogenics, complement inhibitors, neurotrophic factors, and antioxidants.
This document discusses potential complications of trabeculectomy, both intraoperative and postoperative. Intraoperative complications include buttonholing of the conjunctiva, scleral flap tears, lens injury, vitreous prolapse, hyphema, and suprachoroidal hemorrhage. Postoperative complications can be early such as hypotony, elevated intraocular pressure, choroidal effusions or late such as thin blebs, infections, and cataracts. Management strategies are provided for addressing complications depending on the specific issue.
This presentation describes the nature of amniotic membrane grafts, Indications, and limitations with presentation of two cases of corneal perforations treated with it as a self experience
This document discusses characteristics, types, diagnosis, and treatment of choroidal neovascularization (CNV). It describes signs of CNV seen on examination including vision changes, scotomas, and drusen. Types of CNV identified on fluorescein angiography include classic, occult, and retinal angiomatosis proliferans. Treatment options discussed include anti-VEGF drugs like ranibizumab and aflibercept, as well as emerging therapies. Complications and differential diagnoses are also outlined.
Corneal Degenerations - Dr Arnav SaroyaDrArnavSaroya
Corneal degeneration refers to conditions where the normal corneal cells undergo degenerative changes due to age or pathology. There are many types of corneal degeneration classified based on etiology and location. Common types include arcus senilis, band keratopathy, lipid depositions, crocodile shagreen, and Terrien's marginal degeneration. Corneal degenerations can cause visual symptoms but often do not require treatment for mild cases. Severe degenerations may be treated with procedures like excimer laser, lamellar keratoplasty, or penetrating keratoplasty to improve vision or relieve discomfort.
Peripheral fundus & its disorders
Presented by Dr Rohit Rao
This document summarizes the key anatomical structures and pathologies of the peripheral retina. It describes the ora serrata, pars plana, vitreous base, dentate processes, meridional folds, and other peripheral features. It then discusses various degenerative conditions like lattice degeneration, retinoschisis, and pavingstone degeneration. Treatment options for retinal breaks including cryopexy and laser photocoagulation are also summarized.
This document provides an overview of the anatomy and development of the iris and some common congenital anomalies. It discusses the embryonic development of the iris from the optic cup and neural crest cells. The iris has 3 layers - an anterior limiting layer, iris stroma with muscles and blood vessels, and a posterior pigmented epithelial layer. The iris receives its arterial blood supply from the long and anterior ciliary arteries. It is innervated by both parasympathetic and sympathetic nerves that control the sphincter and dilator pupillae muscles. Common congenital anomalies discussed include heterochromia, aniridia, persistent pupillary membrane, and colobomata.
This document discusses the use of chemotherapy in orthopaedics, specifically for musculoskeletal tumors. It provides information on the different types and goals of chemotherapy, including neoadjuvant, adjuvant, and palliative chemotherapy. It discusses the mechanism of action, types of drugs used, and side effects. Treatment recommendations are provided for specific cancers like osteosarcoma, Ewing's sarcoma, multiple myeloma, and metastatic bone tumors. The overall goal of chemotherapy for these cancers is curative treatment, disease control, or palliation to improve quality of life.
Smart radiotherapy aims to precisely target tumor cells while sparing healthy cells. New techniques described in the document include using hypoxic cell sensitizers to target hypoxic tumor regions, anti-angiogenic agents to inhibit tumor blood vessels, and nanoparticles to enhance radiation dose and selectively deliver drugs. Molecular imaging helps optimize treatment by identifying tumor characteristics. Combining radiotherapy with immunotherapy or targeted depletion of host cells may also improve outcomes. Overall, the document discusses developing more precise radiation approaches through better understanding of tumor biology and microenvironment.
Surgical Excision Of Limbal Squamous Cell Carcinoma With Cryotherapy And Mito...Dr. Jagannath Boramani
This case report describes the surgical excision of a squamous cell carcinoma located at the limbus of a patient's right eye, along with cryotherapy and topical Mitomycin-C to prevent recurrence. A 40-year old male presented with a reddish, irregular limbal mass in his right eye. The mass was excised locally under anesthesia along with cryotherapy. Topical Mitomycin-C drops were administered post-operatively to prevent recurrence, which was successful. Wide excision along with cryotherapy and Mitomycin-C is an effective treatment for limbal squamous cell carcinoma to cure the cancer and prevent recurrence.
Thank you for the detailed case presentation. Based on the investigations:
- Serum monoclonal protein >2g/dL
- Clonal BM plasma cells >20%
- FLC ratio >20
The patient meets criteria for high risk smoldering myeloma as per Mayo 2018 criteria.
Diagnosis is high risk smoldering myeloma.
Treatment options would include enrollment in a clinical trial or treatment with a proteasome inhibitor like bortezomib or immunomodulatory drug like lenalidomide. Close monitoring at 3 monthly intervals would also be recommended.
- Chemotherapy began during WWII after observing bone marrow aplasia and lymphoid tissue dissolution in soldiers exposed to nitrogen mustard.
- Chemotherapy can be used definitively, as neoadjuvant therapy before surgery/radiation, adjuvantly after other treatments, or concurrently with radiation therapy.
- Common drugs include alkylating agents, antimetabolites, platinum compounds, taxanes, and antibiotics. They work by alkylating DNA, inhibiting DNA/RNA synthesis, or interfering with microtubule formation.
- Major toxicities include bone marrow suppression, gastrointestinal issues like mucositis, alopecia, and increased risk of infection. Careful patient monitoring is important during chemotherapy treatment.
1. Combined modality cancer treatment uses multiple treatment types like surgery, radiation, and chemotherapy to improve tumor control while limiting side effects.
2. Chemoradiation works through spatial cooperation of the modalities, independent toxicity profiles, enhanced tumor response, and protection of normal tissues.
3. Combining chemotherapy with radiation can improve tumor response through increasing radiation damage, inhibiting cellular repair, redistributing the cell cycle, counteracting tumor hypoxia, and inhibiting tumor repopulation. The timing, specific drugs used, and their mechanisms of radiosensitization are important considerations in multimodality regimens.
1. Oral cavity cancers are relatively common in South Asia, constituting nearly 40% of malignancies. Tobacco and alcohol are the main risk factors, with tobacco being the most significant causative factor.
2. Squamous cell carcinoma is the predominant tumor type. It usually presents in elderly males with a history of tobacco and alcohol use as an oral lesion. Common sites are the lip, tongue, floor of mouth, and buccal mucosa.
3. Treatment depends on the site and stage of the cancer. It involves surgery, radiation therapy or a combination for early-stage cancers. Advanced cancers require more extensive surgery and chemoradiation. Close follow-up is needed after treatment to monitor for
This document discusses various modalities for treating cancer including chemotherapy. It provides details on the mechanisms of action, goals and classifications of different chemotherapeutic agents. It describes how certain drugs like methotrexate, cyclophosphamide and cisplatin directly damage DNA to inhibit cell proliferation. It also discusses concepts like drug resistance, cell cycle specificity and overcoming resistance through combination therapy. The document concludes by summarizing adverse effects of major drug classes and approaches to manage toxicities.
This document summarizes cancer chemotherapy and the various classes of chemotherapeutic drugs. It describes the mechanisms of action, indications, and side effects of alkylating agents, antimetabolites, plant alkaloids, antibiotics, and other classes of drugs. The principles of cancer chemotherapy are to arrest tumor progression by causing cytotoxicity or apoptosis in cancer cells, often targeting DNA or metabolic pathways essential for cell replication. Drugs are generally used in combination to achieve maximal cell killing while remaining within a tolerable toxicity range.
This document summarizes skin cancer prevention strategies for solid organ transplant recipients. It finds that skin cancer is the most common malignancy after transplantation, with non-melanoma skin cancers accounting for 95% of cases. Topical therapies like 5-fluorouracil, imiquimod, diclofenac and photodynamic therapy can effectively treat pre-cancerous lesions and reduce skin cancer risk. For patients with multiple skin cancers, low-dose systemic retinoids or capecitabine may be used for chemoprevention. Both the intensity and duration of a patient's immunosuppression regimen impact their risk of developing skin cancer after transplantation.
The document discusses the applications of nanotechnology in cancer diagnosis and treatment. It describes how nanoparticles can be engineered for passive and active tumor targeting via the enhanced permeability and retention effect or by attaching targeting ligands. Various nanocarriers including dendrimers, liposomes, quantum dots, iron oxide nanoparticles, and multifunctional nanoparticles are summarized. The document also discusses how nanotechnology enables targeted delivery of drugs, genes, photosensitizers and hyperthermia for cancer therapy. Nanoparticles can also be used as contrast agents for improved cancer imaging and detection. While nanotechnology has made progress in oncology, more clinical studies are still needed to prove the efficacy and safety of nanomedicine applications for cancer patients.
This document discusses cancers of the skin, focusing on nonmelanoma skin cancers (NMSC) including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). It covers risk factors, clinical presentation, diagnosis, staging, prognosis and management options for BCC and SCC. Management typically involves surgical excision or destruction, with Mohs micrographic surgery (MMS) and radiation therapy (RT) used for higher risk cases. Topical therapies like imiquimod and 5-FU are also discussed.
This document discusses cancer and chemotherapy. It defines cancer as uncontrolled cell growth and describes its characteristics. Cancer treatment may involve surgery, radiation, chemotherapy, or combinations. Chemotherapy uses chemical agents to kill cancer cells and can be used as adjuvant therapy after other treatments or as neo-adjuvant therapy before the main treatment. The document then describes the cell cycle, principles of chemotherapy including drug mechanisms and scheduling, problems like resistance and toxicities, and examples of different classes of chemotherapeutic agents including alkylating agents, antimetabolites, microtubule inhibitors, antibiotics, hormonal agents, and monoclonal antibodies.
1) Trabeculectomy is a glaucoma surgery that creates an opening in the eye to drain fluid from the anterior chamber and reduce intraocular pressure.
2) It involves making a partial thickness scleral flap, removing a block of tissue underneath, and suturing the flap loosely to allow fluid drainage.
3) Antifibrotic agents like mitomycin C or 5-fluorouracil are often applied to reduce scarring and improve surgical success rates.
This document discusses principles of chemotherapy and classification of anticancer drugs. It begins by defining cancer and its differences from normal cells. The main principles of chemotherapy discussed are the cell kill hypothesis of Skipper and the Norton Simon hypothesis. It then covers classification of anticancer drugs based on cell cycle specificity and mechanism of action. Specific drug classes discussed in detail include alkylating agents, antimetabolites, antibiotics, and cisplatin.
Chemotherapy is the main treatment for disseminated cancers. It involves using multiple drugs in cycles to target rapidly dividing cancer cells. Common drugs include alkylating agents, antimetabolites, microtubule inhibitors, and monoclonal antibodies. Combination chemotherapy aims to maximize responses while avoiding overlapping toxicities. Doses are based on body surface area and adjusted for individual factors. Treatment intervals allow time for normal tissues to recover between cycles. Toxicities include myelosuppression, nausea/vomiting, and alopecia. Response is evaluated based on tumor shrinkage or progression.
This document provides information about brachytherapy treatment for lip cancer. It discusses that lip cancer most commonly affects men over 50 and is usually located on the lower lip. Brachytherapy involves placing radioactive sources inside or near the tumor and is commonly used to treat lip cancers from T1-T3 in size. The document describes the brachytherapy technique which involves inserting applicators such as needles or tubes into the lip under local anesthesia. A dosimetry study is then performed to plan radioactive source placement and treatment times/doses. Brachytherapy allows high dose delivery to the tumor while sparing surrounding healthy tissues.
Chemotherapy uses chemical agents to treat cancer. The document discusses the goals of chemotherapy as cure, control or palliation of cancer. It describes common chemo agents like alkylating agents and antimetabolites. It also covers safety measures for administering chemo and common adverse effects like bone marrow suppression, alopecia and nausea. Radiation therapy uses radiation to damage cancer cell DNA and stop growth and division. It aims to cure early-stage cancer or control recurrence. Surgical treatments for cancer include diagnostic, curative and palliative procedures. Less invasive options like cryosurgery, laser surgery and laparoscopic surgery are also discussed.
Depositions and Degenerations of Conjuctiva and Cornea.docxIddi Ndyabawe
This document provides an overview of degenerative changes that can occur in the conjunctiva, cornea, and sclera. It describes age-related changes such as thinning and loss of transparency in the conjunctiva. Specific conditions discussed include pinguecula, pterygium, conjunctival concretions, and conjunctivochalasis. Corneal degenerations covered include Coats white ring, spheroidal degeneration, iron deposition, and calcific band keratopathy. The document also briefly outlines degenerations of the sclera and endothelium and their causes, signs, and treatments.
Central corneal ulcers are local epithelial defects with underlying corneal tissue degradation or inflammation. Common causes include bacterial and fungal infections related to contact lens use or exposure. Diagnosis involves history, exam noting epithelial loss and infiltrate size/density, and corneal cultures. Treatment begins with frequent topical fluoroquinolone or fortified antibiotics based on culture results. Referral is needed if unable to culture, no response to treatment, progressive lesion, or atypical infiltrate. Daily follow up is required until the lesion stabilizes, indicated by epithelial healing and resolution of symptoms and signs of infection.
1. Acute viral conjunctivitis is caused primarily by adenovirus and presents as a bilateral red eye with watery discharge. It affects both children and adults and has no genetic predisposition.
2. Diagnosis is based on symptoms and physical exam findings like injection and follicular reaction. Point of care immunoassays can rapidly detect adenovirus but culture and PCR are also options.
3. Treatment focuses on supportive care with artificial tears since antiviral medications are generally not effective. Most cases resolve spontaneously in 10 days but some may develop subepithelial infiltrates requiring follow up.
The science of refractive surgery by Dr. Iddi.pptxIddi Ndyabawe
This document provides an overview of refractive surgery and corneal optics. It discusses topics such as corneal biomechanics, imaging, and the effects of different keratorefractive surgical procedures. Laser refractive techniques like LASIK, PRK, and conductive keratoplasty are outlined. The importance of preoperative imaging and wavefront analysis is emphasized to detect contraindications like keratoconus and optimize outcomes. Key principles of excimer laser photoablation and factors influencing postoperative visual quality are also summarized.
Surgeries for glaucoma An Overview by Dr. Iddi.pptxIddi Ndyabawe
This document provides an overview of surgeries for glaucoma, including their evolution and mechanisms. It discusses non-filtering surgeries like iridotomy and trabeculotomy, as well as filtering surgeries like trabeculectomy. The document also covers combined cataract extraction and trabeculectomy, cyclo-destructive procedures, and the use of surgery in specific glaucoma subtypes. It aims to educate physicians on the various surgical options available to treat glaucoma.
This document summarizes a presentation on orbital surgery. It discusses various surgical approaches to the orbit including lid crease incisions, lateral orbitotomies, and endoscopic decompression. It also covers orbital decompression techniques like superior, medial, inferior and lateral decompression to treat conditions like Graves' orbitopathy. Potential complications of orbital surgery are discussed such as diplopia, optic neuropathy, and hypoesthesia, as well as techniques to avoid complications by careful patient evaluation, approach selection, exposure and hemostasis.
Lasers are commonly used in the treatment of glaucoma. ND:YAG lasers are well suited for procedures like peripheral iridotomy due to their wavelength of 1064nm which is absorbed by pigment in the iris but transmits through aqueous and lens. Laser trabeculoplasty procedures like ALT and more selectively SLT are used to lower intraocular pressure by modifying outflow pathways in the trabecular meshwork. Other laser applications include iridoplasty/gonioplasty to surgically treat angle closure glaucoma and malignant glaucoma, as well as revision of failed glaucoma surgeries through techniques like suturolysis. While highly effective, lasers require precision to avoid
Introduction to ocular trauma Dr. Iddi Slides.pptxIddi Ndyabawe
This document provides an introduction to ocular trauma, including common causes, populations affected, assessment of injuries, and management principles. It discusses various types of injuries like mechanical, chemical, thermal, radiation and injuries from organic and non-organic materials. Modes of injury include tools/machinery, assaults, sports activities and war injuries. Assessment involves history, examination, and investigations like x-ray and CT. Injuries can range from mild to severe, with moderate and severe cases threatening vision.
This document summarizes corneal collagen shrinkage and collagen crosslinking techniques. It discusses how collagen shrinkage was initially used to treat keratoconus through heating methods but had limitations due to necrosis. Collagen crosslinking was developed to strengthen corneal collagen through riboflavin and UV light exposure based on the Dresden Protocol. Variations including accelerated and customized protocols aim to treat thinner corneas and focal disease. While generally safe and effective for keratoconus, complications can include haze, infection, and continued progression requiring proper technique. New applications investigate refractive corrections and other corneal conditions.
Approach to a patient with ectropion, entropion, symblepharon.pptxIddi Ndyabawe
This document discusses approaches to treating ectropion, entropion, and symblepharon. It describes the anatomy and causes of ectropion and entropion, including involutional, cicatricial, paralytis, and congenital types. Clinical features, grading scales, and surgical management techniques are outlined for different types and severities of ectropion and entropion. Symblepharon is defined as an adhesion between conjunctival surfaces, with treatment involving conjunctival grafts or flaps.
This document outlines the procedure for enucleation to treat retinoblastoma. There are three main goals: save the child's life, keep the eye, and preserve vision. Enucleation is indicated for advanced intraocular retinoblastoma, when saving the globe has failed, or for a phthisical eye after chemotherapy. The procedure involves 30 steps, including confirming the correct eye, administering anesthesia, cutting the extraocular muscles, removing the globe, and closing the conjunctiva. Post-operative care includes antibiotics, steroids, checking for high-risk histopathology findings, and fitting an ocular prosthesis.
This document provides a 10 step standard operating procedure for cleansing and caring for ophthalmic surgical instruments:
1) Wipe off blood and debris using gauze and saline.
2) Soak instruments in jik water for 5 minutes to disinfect.
3) Clean instruments using soapy water and a soft toothbrush.
4) Rinse instruments with distilled water to remove soap and dry thoroughly before storage.
5) Lubricate hinged instruments to prevent corrosion.
Conjunctival lymphoma is a type of extranodal lymphoma that originates in the conjunctiva without involving lymph nodes. It represents about 2% of extranodal lymphomas and 8% of all conjunctival tumors. Risk factors include immunosuppression and chronic infections. Symptoms include a painless pink conjunctival mass. Diagnosis involves biopsy and imaging to identify the lymphoma and rule out systemic involvement. Treatment options include surgical excision when possible followed by chemotherapy, radiation, or monoclonal antibodies. Patients require lifelong follow-up to monitor for recurrence or progression to systemic lymphoma, which occurs in up to 28% of cases over 10 years.
1. Herpes simplex virus (HSV) and varicella zoster virus (VZV) can cause ocular infections and disease. HSV commonly causes blepharoconjunctivitis but can also lead to recurrent epithelial, stromal, or endothelial keratitis. VZV reactivation causes herpes zoster ophthalmicus (HZO), presenting with rash in the V1 dermatome and potentially causing keratitis.
2. HSV keratitis presentations include punctate epithelial erosions, dendritic ulcers, or stromal infiltrates and opacities. Treatment involves topical antivirals like acyclovir and topical steroids. Recurrent disease may
Episcleritis is a benign inflammation of the outer layer of the eyeball (episclera) that causes redness and mild discomfort. It typically affects young adults and has no known cause, though it can be associated with conditions like gout. Scleritis is a more serious inflammation of the white part of the eyeball (sclera) that can cause vision loss if untreated. It usually occurs in older patients and has been linked to autoimmune disorders and infections. Scleritis is classified based on location and severity, with necrotizing forms requiring strong steroids or immunosuppressants to prevent complications like scleral thinning. Blue sclera is an asymptomatic condition where the sclera
1. Blepharitis is an inflammation of the eyelid margins that can be seborrheic, staphylococcal, mixed, or parasitic in nature. Seborrheic blepharitis involves scales on the lid margins and lashes falling out easily. Staphylococcal blepharitis features ulcers and crusts on the lid margins that can lead to complications like conjunctivitis if not treated promptly with antibiotic ointment and eyedrops. Posterior blepharitis or meibomitis presents with foam-like secretions and clogged glands, treated by expressing the glands and using antibiotics. Parasitic blepharitis involves nits
Ophthalmia neonatorum is inflammation of the conjunctiva in infants less than 30 days old, usually caused by infections transmitted during or after birth. Common causes include gonorrhea, chlamydia, staph, and strep bacteria. Left untreated, gonorrheal ophthalmia can lead to corneal ulceration and blindness. Prophylactic treatment with antibiotics like tetracycline or erythromycin ointment immediately after birth can prevent most cases. For diagnosed infections, treatment involves topical antibiotics, antivirals, or antiseptics as well as systemic antibiotics depending on the causative agent. Prompt and complete treatment is important to resolve symptoms and prevent complications.
1. Xerophthalmia refers to all ocular manifestations of vitamin A deficiency, including structural changes to the conjunctiva, cornea, and retina as well as disorders of retinal rod and cone function.
2. It is caused by dietary vitamin A deficiency or impaired absorption and often accompanies protein-energy malnutrition and infections.
3. The WHO classification includes stages from night blindness to corneal scarring. Treatment involves local eye care, high-dose vitamin A supplementation, and treating underlying illnesses.
This document discusses ocular surface squamous neoplasia (OSSN), a spectrum of conjunctival and corneal epithelial dysplasia ranging from intraepithelial dysplasia to invasive squamous cell carcinoma. It affects mostly older males with a history of sun exposure or smoking. Diagnosis involves examining the eyes for white or gray lesions and confirming with biopsy. Treatment is complete surgical excision to prevent recurrence, with referral to an ocular oncology service for invasive or difficult to remove cases.
R3 Stem Cell Therapy: A New Hope for Women with Ovarian FailureR3 Stem Cell
Discover the groundbreaking advancements in stem cell therapy by R3 Stem Cell, offering new hope for women with ovarian failure. This innovative treatment aims to restore ovarian function, improve fertility, and enhance overall well-being, revolutionizing reproductive health for women worldwide.
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
The best massage spa Ajman is Chandrima Spa Ajman, which was founded in 2023 and is exclusively for men 24 hours a day. As of right now, our parent firm has been providing massage services to over 50,000+ clients in Ajman for the past 10 years. It has about 8+ branches. This demonstrates that Chandrima Spa Ajman is among the most reasonably priced spas in Ajman and the ideal place to unwind and rejuvenate. We provide a wide range of Spa massage treatments, including Indian, Pakistani, Kerala, Malayali, and body-to-body massages. Numerous massage techniques are available, including deep tissue, Swedish, Thai, Russian, and hot stone massages. Our massage therapists produce genuinely unique treatments that generate a revitalized sense of inner serenely by fusing modern techniques, the cleanest natural substances, and traditional holistic therapists.
Unlocking the Secrets to Safe Patient Handling.pdfLift Ability
Furthermore, the time constraints and workload in healthcare settings can make it challenging for caregivers to prioritise safe patient handling Australia practices, leading to shortcuts and increased risks.
Michigan HealthTech Market Map 2024. Includes 7 categories: Policy Makers, Academic Innovation Centers, Digital Health Providers, Healthcare Providers, Payers / Insurance, Device Companies, Life Science Companies, Innovation Accelerators. Developed by the Michigan-Israel Business Accelerator
This particular slides consist of- what is hypotension,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is the summary of hypotension:
Hypotension, or low blood pressure, is when the pressure of blood circulating in the body is lower than normal or expected. It's only a problem if it negatively impacts the body and causes symptoms. Normal blood pressure is usually between 90/60 mmHg and 120/80 mmHg, but pressures below 90/60 are generally considered hypotensive.
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2024 HIPAA Compliance Training Guide to the Compliance OfficersConference Panel
Join us for a comprehensive 90-minute lesson designed specifically for Compliance Officers and Practice/Business Managers. This 2024 HIPAA Training session will guide you through the critical steps needed to ensure your practice is fully prepared for upcoming audits. Key updates and significant changes under the Omnibus Rule will be covered, along with the latest applicable updates for 2024.
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This particular slides consist of- what is Pneumothorax,what are it's causes and it's effect on body, risk factors, symptoms,complications, diagnosis and role of physiotherapy in it.
This slide is very helpful for physiotherapy students and also for other medical and healthcare students.
Here is a summary of Pneumothorax:
Pneumothorax, also known as a collapsed lung, is a condition that occurs when air leaks into the space between the lung and chest wall. This air buildup puts pressure on the lung, preventing it from expanding fully when you breathe. A pneumothorax can cause a complete or partial collapse of the lung.
PET CT beginners Guide covers some of the underrepresented topics in PET CTMiadAlsulami
This lecture briefly covers some of the underrepresented topics in Molecular imaging with cases , such as:
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- Distinguishing between MPM and Talc Pleurodesis.
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International Cancer Survivors Day is celebrated during June, placing the spotlight not only on cancer survivors, but also their caregivers.
CANSA has compiled a list of tips and guidelines of support:
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DECODING THE RISKS - ALCOHOL, TOBACCO & DRUGS.pdfDr Rachana Gujar
Introduction: Substance use education is crucial due to its prevalence and societal impact.
Alcohol Use: Immediate and long-term risks include impaired judgment, health issues, and social consequences.
Tobacco Use: Immediate effects include increased heart rate, while long-term risks encompass cancer and heart disease.
Drug Use: Risks vary depending on the drug type, including health and psychological implications.
Prevention Strategies: Education, healthy coping mechanisms, community support, and policies are vital in preventing substance use.
Harm Reduction Strategies: Safe use practices, medication-assisted treatment, and naloxone availability aim to reduce harm.
Seeking Help for Addiction: Recognizing signs, available treatments, support systems, and resources are essential for recovery.
Personal Stories: Real stories of recovery emphasize hope and resilience.
Interactive Q&A: Engage the audience and encourage discussion.
Conclusion: Recap key points and emphasize the importance of awareness, prevention, and seeking help.
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ROLE OF CHEMOTHERAPY IN OCULAR MALIGNANCIES by IDDI.pptx
1. ROLE OF CHEMOTHERAPY
IN OCULAR MALIGNANCIES
PRESENTER: DR. IDDI NDYABAWE
MODERATOR: DR. AMPAIRE ANNE
DATE: 28/03/2022
DEPARTMENT OF OPHTHALMOLOGY
MAKERERE UNIVERSITY COLLEGE OF HEALTH SCIENCES
2. Outline
• Introduction
• Use of chemotherapy
• Classification of chemotherapeutic agents
• Mode of chemotherapy
• Chemotherapy in ophthalmology
• Side effects of chemotherapy
3. Introduction
• Chemotherapy:
-One of several treatment strategies used to halt the uncontrolled division,
proliferation and unpredictable growth patterns of malignant cells
• Chemotherapeutic drugs work by impairing mitosis at the DNA and/or RNA
level
• The drugs are cytotoxic and kill cells by promoting apoptosis or frank necrosis
4. .
Chemotherapy may be intended to be either:
• Curative therapy
• Palliative therapy
• Therefore used in several different ways
5. USES OF CHEMOTHERAPY
1. Adjunctive therapy with radiation therapy and surgery
2. Chemoreduction preoperatively, and postoperatively when there is residual
tumor or risk of recurrence
3. Palliative therapy to decrease the tumor load and increase life expectancy
6. CLASSIFICATION OF CHEMOTHERAPY AGENTS
1. DNA damaging
2. DNA repair inhibitos
3. Antitubulin agents
4. Other agents
-Biological response modifier
-Immunosuppressive agents
8. DNA REPAIR INHIBITORS
1. Epipodophyllotoxins
• Extract from the mandrake plant
• For example: etoposide
2. Cytotoxic antibiotics
• Doxorubicin (Adriamycin)
• Bleomycin
• Mitomycin C
• Dactinomycin (actinomycin D)
9. ANTITUBULIN AGENTS
1. Vinca alkanoids
• These act by binding to tubulin
and inhibiting microtubule
formation
• E.g vincristine (oncovin) and
vinblastine
2. Taxanes
• These bind to tubulin and prevent
assembly into microtubules
• E.g paclitaxel and docetazel
10. OTHER
1. Biological response modifier
• An example of this class of
chemotherapeutic agents is the
interferons
2. Immunosuppressive agents
• Most immunosuppressive agents
mostly affect T-cell functioning at an
intracellular level.
• E.g cyclosporin
11. MODE OF CHEMOTHERAPY
1. Primary chemotherapy
• Used as a sole anti-cancer treatment in highly sensitive tumor
• E.g CHOP for Non-Hodgkins Lymphoma
2. Adjuvant chemotherapy
• Given after surgery or irradiation to destroy micrometastasis or prevent development of secondary tumor
• E.g Adriamycin, Cyclophosmide, MMC, interferons
3. Neo-adjuvant chemotherapy
• Given before surgery or radiotherapy in order to shrink the volume of large primary tumor
• E.g Adriamycin, Ifosfamide
12. CHEMOTHERAPY IN OPHTHALMOLOGY
• Indications of chemotherapy
1. Eyelid malignancies
2. Conjuctival malignancies
3. Intraocular tumors
4. Orbital tumors
14. EYELID MALIGNANCIES
• The gold standard is surgical excision with clear tumor margins using the:
1. Mohs’ micrographic surgery technique or
2. Excisional biopsy with fresh frozen sections
15. EYELID MALIGANCIES
• These methods are not always curative with large, deeply invasive eyelid
lesions and pose management problems
• Chemotherapy has been reported to result in:
-Decrease in tumor size
-Allows for less extensive surgical resections
-Allows for less radiation therapy
16. EYELID MALIGANCIES
• 5-FU, cisplatinum, doxorubicin, bleomycin and interferon
• Have been used in some cases of extensive, deeply invasive lesions
• As intralesional or systemic chemotherapy
• But reports in the literature are scanty and outdated
17. CONJUCTIVAL MALIGANCIES
• Several benign and malignant lesions affect the conjunctiva.
• These include:
-Primary acquired melanosis (PAM)
-Melanoma conjunctiva/corneal intra-epithelial neoplasia (CCIN)
-Squamous cell carcinoma (SCC)
The therapeutic options include:
• Local excision with cryotherapy, radiotherapy and exenteration in some advanced cases
18. CONJUCTIVAL MALIGNANCIES
• Malignant melanoma may arise de novo, from a pre-existing naevus or from
PAM with atypia
• It may invade just the cornea or extend into the orbit and adnexa
• Lesions arising de novo are more localized, but those from PAM tend to be
more diffuse and challenging to treat
• Topical chemotherapy provides an alternative to extensive and repeated
surgery
19. MITOMYCIN C (MMC)
• Mitomycin-C is an alkylating, anti-tumor antibiotic
• One of mitomycin’s active metabolites cross-links with DNA, causing selective interruption of DNA replication,
thus inhibiting mitosis and protein synthesis
• This makes mitomycin cytotoxic for both fibroblasts and microvascular endothelial cells, so it not only reduces
the production of fibroblasts, but also the microvascular blood supply to the area treated.
• One reason mitomycin is so ef-fective is that it’s not dependent on the cell-cycle phase. In contrast, 5-FU is
only effective at certain phases of the cell’s life cycle.
20. MMC
• MMC is well known for its use in trabeculectomies to prevent bleb failure and in
pterygium to prevent recurrences
• MMC has been shown in several studies to be effective in the treatment of
conjunctival lesions
• In a 10 year retrospective review of ocular surface neoplasia:
• MMC was shown to have a highly effective role as primary therapy for PAM and CCIN
• As an adjunctive to surgery with cryotherapy, brachytherapy for SCC, melanoma and
SGC with pagetoid spread
21. MITOMYCIN C (MMC)
• Topical MMC chemotherapy used as a primary treatment has a higher
recurrence rate than if used as an adjunct to therapy
• The recurrence rate for CCIN and SCC when used as primary therapy is 0-22%
and for PAM with atypia 13-38%
• The results for melanoma are highly variable with one study reporting a
recurrence rate of 33-100% and another reporting 0-100%.
22. MMC
• Topical MMC, because of its potential toxicity
-Typically administered for short periods (1-2 weeks)
-With a drug holiday of 2-4 weeks between treatments
• Application of topical corticosteroids may help with the surface toxicity
• Placement of punctal plugs reduces the chance of systemic absorption and helps
prevent punctal stenosis
• It is relatively inexpensive and it works more quickly than topical interferon-a2b
23. SIDE-EFFECTS OF MMC
• Persistent keratoconjuctivitis
• Corneal endothelial cell loss
• Scleral melting
• Epiphora due to punctal stenosis and corneal changes
• Persistent corneal erosions due to limbal stem cell deficiency (LSCD) in 12% of
patients
24. To minimize MMC toxicity, the following are
titrated
• the concentration we use;
• the method of application (e.g., via sponge or injection);
• the duration of application;
• the surface area treated; and
• the amount of rinsing we do after the application is complete
26. 5-FLUOROURACIL (5-FU)
• Antimetabolite
• Has been shown to be effective in treatment of CCIN
• A dosing regimen of 1% 5-FU 4 times a day for 4 days, repeated every month for
4-6 cycles, to decrease toxicity and maintain efficacy
• This regimen seems to be better tolerated with fewer side effects than 1% 5-FU
4 times a day for 2 weeks
29. INTERERONS (IFN)
• Can be used as primary or adjunctive therapy
-Achieved control in 72% and reduction in size in 28%
• Regimen: Topical interferon-a2b is given at a dose of 1 million IU/ml 4 times
daily until clinical response occurs, usually within 2 to 4 months
30. IFNs Side effects
• Injection site reactions
• Flu-like symptoms (fever, headache, myalgia, arthralgia, sweating and
fatigue)
• Depression and suicidal intentions
• IFN –associated retinopathy: cotton wool spots and retinal hemorrhages
• Ishemic optic neuropathy
• Treatment involves: discontinuation of IFNs, proper hydration and prevention
of supine hypotension.
31. IFNs
• IFN remain an attractive alternative owing to:
• Relative lack of corneal or conjunctival toxicities
• Preservation of limbal stem cells
• Patient comfort compared with topical chemotherapy
38. Systemic chemotherapy
• Systemic chemotherapy may be administered for chemoreduction or as an
adjuvant therapy
-It allows the management of intraocular disease and lower risk of metastasis
-Not effective in treating tumors associated with subretinal and vitreous seeds
• Due to their good intraocular penetration, the standard chemotherapy agents
used are Vincristine, etoposide and carboplatin (VEC protocol)
• Administered for at least six cycles at 28 days intervals
39. Systemic chemotherapy
• After two cycles of chemotherapy and the tumor size and sub retinal fluid have been
reduced
• Local treatment methods are used
• The most frequently used local treatment methods are:
-Cryotherapy
-Transpupillary thermotherapy (TTT)
-Plaque radiotherapy
• The most important problems that may arise after chemoreduction are tumor
unresponsiveness and recurrence
41. Subconjuctival chemotherapy
• Not used alone, but is administered in conjuction with systemic chemotherapy
in eye with advanced stages of diseases (group D and E) in order to increase
the intraocular concentration of chemotherapy agents
• Subconjuctival carboplatin is used at a dose of 10-20mg
• It may be administered after two cycles of chemoreduction up to three times
with one month intervals
• Vitreous concentration 30 minutes after administration is 10 fold greater with
systemic delivery
43. Subconjuctival chemotherapy
• The biggest limitation of subconjunctival chemotherapy is
ineffective control of subretinal tumor seeding
• Side effects include:
-Periorbital edema and cellulitis
-Orbital adipose tissue atrophy
-Fibrosis of EOMs and Tenon’s capsule
-Limitations of ocular motility
44. Intra-Arterial Chemotherapy
• As mentioned previously, chemotherapy has been highly effective in treating
patients
-But it seems to be less effective in treating group C and D eyes, which are
associated with subretinal and vitreous seeds
-These patients have been shown to have upto 45% recurrence of disease
following systemic chemotherapy
• Other authors have emphasized that, in the presence of vitreous seeds and
subretinal seeds, enucleation should be carried out
45. Intra-arterial chemotherapy
• The injection of chemotherapeutic agents into the carotid artery was first
attempted by Reese in 1957
• Japanese investigators have also catheterized the carotid artery to inject
melphalan.
• But they combined hyperthermia and external beam radiotherapy (EBRT) to
treat the patients in their study
46. Intra-arterial chemotherapy
• Despite intra-arterial chemotherapy requiring a trained interventional
radiologist and side effects associated with embolic events to the globe
• This form of treatment represents an exciting alternative to systemic
chemotherapy
48. Intravitreal chemotherapy
• He use of intravitreal drugs to treat a host o ocular conditions
-Has become standard practice over the last decade
-We have learned that complications associated with intravitreal injections are
rare
• The main concern with the use of intravitreal injections for RB is extraocular
spread due to tumor seeding into the needle track
49. Intravitreal chemotherapy
• Considered for patients with group C or D disease with recurrent and persistent
vitreal and subretinal seeds
• The technique involves intravitreal injection of (20-30)micrograms of
melphagan via a 32G needle
• After injection, 3 cycles of freeze and thaw cryotherapy are applied at the
injection site
50. Intravitreal chemotherapy
• The eye is carefully shaken in all directions to enable even distribution of the
drug
• The injection is repeated every 7 days for up to 6 injections
-If a response can be demonstrated and until complete seed fragmentation is
observed or complete response is achieved
• The side-effects are retinal toxicity at site of injection, salt and pepper
retinopathy, and transient vitreous hemorrhage
51. Intravitreal chemotherapy
• In summary, the main advantage of intravitreal chemotherapy would be not to
replace the standard treatment care for group C and D eyes
• But to reduce the exposure to systemic chemotherapy as well as indications for
enucleation and/or EBRT
53. Melanoma
• Malignant melanoma of the uvea is usually treated with:
1. Episcleral plaque brachytherapy
2. Charged particle radiation therapy
3. Enucleation
• Other interventions include:
-Hyperthermia and transpupillary thermotherapy
• To reduce radiation-related complications.
54. Melanoma
• Chemotherapy has no role in the management of primary uveal melanoma
• Metastatic choroidal melanoma usually occurs in 35-50% of patients within 5 years of
diagnosis of choroidal melanoma
• The sites of metastases are the liver, lung and brain
• Intra-arterial chemotherapy, for focal liver metastases, is used to control metastatic
spread
• But no standard chemotherapy protocol exists and treatment outcomes have been
consistently disappointing
55. LYMPHOMA
• Large cell lymphoma is the most common type of non-Hodgkin’s lymphoma to
involve the eye
-Usually accompanied by CNS involvement
• Treatment is challenging but consists of a combination of radiation and multi-
agent primary chemotherapy
• Intravitreal chemotherapy has been shown to be effective to treat primary
intraocular lymphoma
56. Disseminated disease
• Disseminated disease is treated with systemic chemotherapy that
consists of the CHOP regimen
1. Cyclophosphamide
2. Hydroxydaunorubicin (also called doxorubicin or Adriamycin)
3. Oncovin (vincristine)
4. Prednisolone
57. Lymphoma
• This regimen can also be combined with the monoclonal antibody rituximab if the
lymphoma is of B-cell origin
-This combination is called R-CHOP or CHOP-R
• In patients with a history of cardiovascular disease, doxorubicin (which is cardiotoxic)
is often deemed to be too great a risk and is omitted from the regimen
• The combination is then referred to as COP (Cyclophosphamide, Oncovin and
prednisolone)
59. RHABDOMYOSARCOMA
• Is the most common primary malignant neoplasm of the orbit in children
-It consists of malignant cells that demonstrate evidence of skeletal muscle
differentiation
-It can be challenging to treat as it arises in a large variety of primary sites
• The orbit is the primary site in 25% of cases
• Other areas of the head and neck, genito-urinary, trunk and extremities
making up the remaining locations
60. Rhabdomyosarcoma
• The tumor staging system is based on:
-The tumor site(s) involved
-Regional lymph node involvement
-Distant metastases
• Primary involvement of the orbit with rhabdomyosarcoma is considered a favourite
site
• Any primary tumor of the orbit without distant metastases is considered stage 1
according to the IRSG
61. Rhabdomyosarcoma
• Intergroup Rhabdomyosarcoma Study Group (IRSG) modified TNM staging
system
• After surgery the tumor will be grouped according to the IRSG clinical group
system
• Radiation and chemotherapy are carried out accordingly
63. Rhabdomyosarcoma
• Standard treatment according to the IRSG/STS COG trials n North America consists of
a combination of vincristine, dactinomycin and cyclophosphamide (VAC)
• Trials have shown comparable but not superior outcomes, with other combinations of
active agents
• Based on toxicity profile and the fact that VAC can be administered in a single day
• VAC has therefore remained the ‘standard’ of treatment in North America for the past
several decades
65. Possible side effects of chemotherapy
Systemic chemotherapy:
• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhoea and constipation
• Increased susceptibility to infections
• fatiguability
• Severe neutropenia
• Thrombocytopenia
• Hearing loss
• Increased risk of Acute
myelogenous leukemia
66. POSSIBLE SIDE EFFECTS: SPECIFIC S.Es
1. Cisplatin and Carboplatin
-Affect kidneys
-Hearing loss in children
2. Vincristine
-Tingling and numbness
3. Doxorubicin
-Damage the heart
4. cyclophosphamide
-Damage the bladder
67. S.Es of chemo
• S.Es of Subconjuctival chemo:
1. Periorbital edema and cellulitis
2. Orbital adipose tissue atrophy
3. Fibrosis of EOMs and Tenon’s capsule
4. Limitations of ocular motility
68. Possible side effects of chemotherapy
• Intra-arterial chemo
1. Swelling around the eye
2. Retinal detachment
3. Vitreous hemorrhage
4. Muscle weakness
5. Ptosis
6. Loss of eyelashes
69. Possible side effects of chemotherapy
• Intravitreal chemotherapy
-As with intra-arterial chemo, side effects limited to the eye and nearby area
• The side-effects are:
-Retinal toxicity
-Salt and pepper retinopathy
-Transient vitreous hemorrhage
70. References
• R. Dolland, Chemotherapy in eye cancer, 2013
• Eyewiki
• AAO, BSCS Book 8, 2017
• Kanski Clinical Ophthalmology 8th edition
• Comprehensive Ophthalmology, Khuranah, 4th edition