Ophthalmic Oncology (eBook)

Preface 5
Contents 6
Contributors 10
Part I Orbital and Adnexal Oncology 14
1 Primary Orbital Cancers in Adults 15
1.1 Lymphoproliferative Disorders 15
1.1.1 Presenting Signs and Symptoms, Histopathologic and Molecular Genetic Characteristics, and Diagnosis 16
1.1.2 Treatment 18
1.1.3 Follow-up 20
1.2 Mesenchymal Tumors 20
1.2.1 Fibrous Histiocytoma 20
1.2.2 Solitary Fibrous Tumor 21
1.2.3 Hemangiopericytoma 21
1.2.4 Other Mesenchymal Tumors 21
1.3 Lacrimal Gland Tumors 22
References 23
2 Nonmalignant Tumors of the Orbit 25
2.1 Presentation 25
2.2 Cystic Lesions 26
2.3 Vascular Tumors 27
2.4 Lymphoproliferative Masses 29
2.5 Inflammatory Masses 30
2.6 Mesenchymal Tumors 31
2.7 Neurogenic Tumors 31
2.8 Lacrimal Gland Tumors 33
References 34
3 Pediatric Orbital Tumors 35
3.1 Introduction 35
3.2 Cystic Lesions 37
3.2.1 Dermoid Cyst 37
3.2.1.1 Clinical Presentation 37
3.2.1.2 Imaging 38
3.2.1.3 Histopathology 39
3.2.1.4 Treatment 39
3.2.1.5 Prognosis 39
3.2.2 Teratoma 39
3.2.2.1 Clinical Presentation 40
3.2.2.2 Imaging 40
3.2.2.3 Histopathology 41
3.2.2.4 Treatment 41
3.2.2.5 Prognosis 41
3.3 Vascular Tumors 42
3.3.1 Capillary Hemangioma 42
3.3.1.1 Clinical Presentation 42
3.3.1.2 Imaging 42
3.3.1.3 Histopathology 43
3.3.1.4 Treatment 43
3.3.1.5 Prognosis 44
3.3.2 Lymphangioma 44
3.3.2.1 Clinical Presentation 44
3.3.2.2 Imaging 45
3.3.2.3 Histopathology 46
3.3.2.4 Treatment 46
3.3.2.5 Prognosis 47
3.4 Histiocytic Lesions 47
3.4.1 Eosinophilic Granuloma 47
3.4.1.1 Clinical Presentation 47
3.4.1.2 Imaging 48
3.4.1.3 Histopathology 48
3.4.1.4 Treatment 49
3.4.1.5 Prognosis 49
3.5 Neural Tumors 49
3.5.1 Optic Nerve Glioma 49
3.5.1.1 Clinical Presentation 50
3.5.1.2 Imaging 50
3.5.1.3 Histopathology 51
3.5.1.4 Treatment 51
3.5.1.5 Prognosis 52
3.5.2 Plexiform Neurofibroma 52
3.5.2.1 Clinical Presentation 52
3.5.2.2 Imaging 53
3.5.2.3 Histopathology 53
3.5.2.4 Treatment 54
3.5.2.5 Prognosis 54
3.6 Malignant Lesions 54
3.6.1 Ewing Sarcoma 55
3.6.1.1 Clinical Presentation 55
3.6.1.2 Imaging 56
3.6.1.3 Histopathology 56
3.6.1.4 Treatment 56
3.6.1.5 Prognosis 56
3.6.2 Neuroblastoma 57
3.6.2.1 Clinical Presentation 57
3.6.2.2 Imaging 58
3.6.2.3 Histopathology 58
3.6.2.4 Treatment 59
3.6.2.5 Prognosis 59
3.6.3 Retinoblastoma 59
3.6.3.1 Clinical Presentation 60
3.6.3.2 Imaging 61
3.6.3.3 Histopathology 61
3.6.3.4 Treatment 61
3.6.3.5 Prognosis 61
3.6.4 Granulocytic Sarcoma 62
3.6.4.1 Clinical Presentation 62
3.6.4.2 Imaging 62
3.6.4.3 Histopathology 63
3.6.4.4 Treatment 63
3.6.4.5 Prognosis 63
3.6.5 Rhabdomyosarcoma 64
References 64
4 Multidisciplinary Management of Orbital Rhabdomyosarcoma 72
4.1 Introduction 72
4.2 Clinical and Radiological Presentation 73
4.3 Staging 74
4.4 Surgery 75
4.5 Chemotherapy 76
4.6 Radiation Therapy 76
4.7 Conclusions and Future Directions 77
References 77
5 Metastatic Orbital Tumors 79
5.1 Introduction 79
5.2 Incidence 80
5.3 Anatomical Considerations 80
5.4 Presentation and Clinical Features 81
5.5 Diagnosis 81
5.6 Treatment 83
5.7 Types of Cancer Metastatic to the Orbit 83
5.7.1 Breast Carcinoma 83
5.7.2 Lung Carcinoma 84
5.7.3 Prostate Carcinoma 85
5.7.4 Melanoma 85
5.7.5 Carcinoid Tumors 86
5.7.6 Other Cancers 86
5.8 Conclusion 86
References 87
6 Secondary Orbital Tumors Extending from Ocularor Periorbital Structures 89
6.1 Tumors of Intraocular and Ocular Adnexal Origin 89
6.1.1 Eyelid Tumors 89
6.1.2 Intraocular Tumors 90
6.2 Tumors of Sinus and Nasopharyngeal Origin 91
6.2.1 Squamous Cell Carcinoma 91
6.2.2 Other Tumors of Sinus and Nasopharyngeal Origin 93
6.3 Tumors of Brain Origin 94
6.3.1 Meningioma 94
6.3.2 Other Intracranial Tumors 96
References 96
7 Lacrimal Gland Tumors 98
7.1 Introduction 98
7.2 Lymphoproliferative Lesions of the Lacrimal Gland 99
7.3 Benign Epithelial Tumors of the Lacrimal Gland 101
7.3.1 Pleomorphic Adenoma 101
7.3.2 Other Benign Epithelial Tumors 103
7.4 Malignant Epithelial Tumors of the Lacrimal Gland 103
7.4.1 Adenoid Cystic Carcinoma 103
7.4.2 Other Malignant Epithelial Tumors 105
7.5 AJCC Staging for Lacrimal Gland Tumors 106
References 107
8 Optic Nerve Sheath Fenestration in Cancer Patients: Indications and Surgical Technique 111
8.1 Introduction 111
8.2 Indications 112
8.3 Surgical Techniques 113
8.3.1 Medial Orbitotomy Approach 113
8.3.2 Medial Eyelid Crease Approach 114
8.3.3 Lateral Orbitotomy Approach 115
8.3.4 Lateral Canthotomy Approach 115
8.4 Possible Indications for ONSF in Cancer Patients 115
8.4.1 Metastatic Breast Cancer 116
8.4.2 Lymphomatous Optic Neuropathy Diagnosed by Optic Nerve Biopsy 116
8.4.3 Adjuvant Therapy in Optic Nerve Sheath Meningioma 116
8.4.4 Papilledema Associated with Brain Tumors 117
8.4.5 Radiation-Induced Optic Neuropathy 117
8.5 Complications of ONSF 117
8.6 Future Research 118
References 118
9 Management of Primary Eyelid Cancers 120
9.1 Introduction 120
9.2 Types of Eyelid Malignancies 120
9.2.1 Basal Cell Carcinoma 120
9.2.2 Squamous Cell Carcinoma 121
9.2.3 Melanoma 123
9.2.4 Sebaceous Gland Carcinoma 123
9.2.5 Other Primary Eyelid Malignancies 124
9.3 Management 124
9.3.1 Evaluation 125
9.3.2 Tumor Excision and Eyelid Reconstruction 126
9.3.3 Sentinel Lymph Node Biopsy 128
9.3.4 Nonsurgical Treatment 129
9.3.5 Follow-up 130
References 130
10 Management of Conjunctival Neoplasms 133
10.1 Introduction 133
10.2 Squamous Cell Neoplasms of the Conjunctiva 134
10.2.1 Conjunctival Intraepithelial Neoplasia 134
10.2.2 Invasive Squamous Cell Carcinoma 134
10.2.3 Management 135
10.2.3.1 Local Excision and Cryotherapy 135
10.2.3.2 Treatment of More Advanced Disease 135
10.2.4 Surveillance 136
10.3 Melanocytic Neoplasms 136
10.3.1 Nevus 137
10.3.2 Primary Acquired Melanosis 138
10.3.3 Conjunctival Melanoma 139
References 142
11 Surgical Specimen Handling for Conjunctival and Eyelid Tumors 145
11.1 Introduction 145
11.2 Communication with the Pathologist 146
11.3 Conjunctival Specimens 147
11.4 Eyelid Specimens 150
11.5 Mohs Micrographic Surgery 151
11.6 Summary 152
References 153
12 Neuroradiology of Ocular and Orbital Tumors 154
12.1 Introduction: Imaging and Protocol 154
12.2 Anatomy 155
12.3 Intraocular Lesions 156
12.3.1 Retinoblastoma 156
12.3.2 Uveal Melanoma 158
12.3.3 Uveal Metastases 159
12.4 Orbital Lesions 159
12.4.1 Lymphoma 159
12.4.2 Orbital Rhabdomyosarcoma 159
12.4.3 Orbital Nerve Sheath Tumors 160
12.4.4 Mesenchymal Tumors of the Orbit 162
12.4.5 Orbital Pseudotumor 163
12.4.6 Orbital Metastases 163
12.5 Optic Nerve Tumors 165
12.5.1 Optic Nerve Glioma 165
12.5.2 Optic Nerve Sheath Meningiomas 165
12.6 Lacrimal Gland Tumors 166
12.7 Secondary Tumor Spread to the Orbit 168
12.8 Periorbital Skin Cancer and Perineural Spread 169
12.9 Conclusion 171
References 172
13 Radiation Therapy for Orbital and Adnexal Tumors 174
13.1 Indications 174
13.2 Radiation Therapy Terminology 175
13.3 Radiation Therapy Techniques 175
13.4 Radiation Therapy for Squamous Cell Carcinoma of the Eyelid 176
13.5 Adjuvant Radiation Therapy for Ocular Adnexal Tumors 177
13.6 Radiation Therapy for Optic Nerve Meningiomas and Orbital Rhabdomyosarcomas 178
13.7 Toxic Effects of Radiation Therapy 178
13.8 Summary 179
References 179
Part II Intraocular Tumors 181
14 Multidisciplinary Management of Retinoblastoma: Diagnosis, Treatment, and Future Direction 182
14.1 Historical Perspective 182
14.2 Presentation and Workup 183
14.3 Classification 184
14.4 Genetics 185
14.5 Pathologic Features 186
14.6 Treatment Options 187
14.6.1 General Considerations 187
14.6.2 Enucleation 187
14.6.3 Chemoreduction 188
14.6.4 Subtenon (Subconjunctival) Chemotherapy 192
14.6.5 Unilateral Disease 192
14.6.6 Bilateral Disease 193
14.7 Focal Therapies 194
14.7.1 Cryotherapy 194
14.7.2 Laser Photocoagulation 194
14.7.3 Brachytherapy 195
14.7.4 Thermotherapy 195
14.7.5 Radiation Therapy 195
14.8 Multi-institutional Clinical Trials 196
14.9 Animal Models of Retinoblastoma 198
14.10 Gene Transfer Technology for Treatment of Retinoblastoma 198
14.11 Future Development 199
References 199
15 Management of Uveal Melanoma 203
15.1 Epidemiology 203
15.2 Clinical Features 204
15.3 Diagnosis 204
15.4 Staging and Prognostic Factors 206
15.5 Background Studies 206
15.6 Overview of Management 207
15.7 Brachytherapy 208
15.8 Charged-Particle Radiotherapy 209
15.9 Surgical Techniques 210
15.9.1 Uveal Resection 210
15.9.2 Enucleation 211
15.9.3 Transpupillary Thermotherapy 211
15.9.4 Pathologic Assessment 211
15.9.5 Histologic Examination 213
15.10 Conclusion 213
References 214
16 Uveal Metastases from Solid Tumors 216
16.1 Introduction 216
16.2 Patient Characteristics 217
16.3 Symptoms 217
16.4 Clinical Features 218
16.5 Diagnosis 218
16.6 Treatment 219
16.6.1 Observation 220
16.6.2 External-Beam Radiation Therapy 220
16.6.3 Chemotherapy 220
16.6.4 Plaque Brachytherapy 221
16.6.5 Transpupillary Thermotherapy 221
16.6.6 Enucleation 221
16.7 Prognosis 222
16.8 Conclusions 222
References 222
17 Vascular Tumors of the Posterior Pole 224
17.1 Introduction 224
17.2 Retinal Capillary Hemangioma and von HippelLindau Disease 224
17.3 Circumscribed Choroidal Hemangioma 226
17.4 Management of Posterior Choroidal Hemangiomas 226
17.5 Acquired Vasoproliferative Tumors of the Retina 227
17.6 Conclusions 227
References 228
Part III Oculoplastic and Periocular Reconstructive Surgery in Cancer Patients 229
18 Reconstructive Surgery for Eyelid Defects 230
18.1 Introduction 230
18.2 General Principles 230
18.3 Eyelid Defects Not Involving the Eyelid Margin 231
18.4 Small Defects Involving the Lower Eyelid Margin 232
18.5 Moderate Defects Involving the Lower Eyelid Margin 233
18.6 Large Defects Involving the Lower Eyelid Margin 233
18.7 Small Defects Involving the Upper Eyelid Margin 236
18.8 Moderate Defects Involving the Upper Eyelid Margin 236
18.9 Large Defects Involving the Upper Eyelid Margin 236
18.10 Lateral Canthal Defects 238
18.11 Medial Canthal Defects 238
References 239
19 Nasolacrimal Duct Obstruction and Lacrimal Surgery in Cancer Patients 241
19.1 Introduction 241
19.2 Anatomy 241
19.3 Causes of Obstruction 242
19.4 Evaluation 245
19.5 Treatment 245
References 246
20 Eyelid Malposition: Unique Scenarios in Cancer Patients 248
20.1 Introduction 248
20.2 Ectropion 248
20.2.1 Ectropion Due to Facial Nerve Paralysis 248
20.2.2 Cicatricial Ectropion 249
20.3 Entropion 251
20.4 Ptosis 251
20.5 Eyelid Retraction 252
20.6 Periorbital Edema Secondary to Imatinib Mesylate 252
References 254
21 Craniofacial Surgery in the Orbit and Periorbital Region 255
21.1 Introduction 255
21.2 Anatomic Considerations 256
21.2.1 Orbital Margin 257
21.2.2 Nasal and Paranasal Sinuses 257
21.2.3 The Lacrimal System 258
21.2.4 Maxilla 258
21.3 Repair of Orbital Defects 259
21.3.1 Overview of Approaches 259
21.3.1.1 Maxillectomy with Orbital Exenteration 259
21.3.1.2 Maxillectomy Without Orbital Exenteration 260
21.3.2 Types of Maxillary Defects and Strategies for Their Repair 260
21.3.2.1 Type I Defect 260
21.3.2.2 Type II Defects 262
21.3.2.3 Type III Defects 262
21.3.2.4 Type IV Defects 264
21.3.3 Reconstruction After Orbital Exenteration 266
21.4 Conclusion 268
References 268
22 Enucleation, Evisceration, Orbital Implants, and Management of the Irradiated Socket 270
22.1 Introduction 270
22.2 Surgical Technique 271
22.2.1 Confirmation of Correct Eye 271
22.2.2 Resection of Optic Nerve in Patients with Retinoblastoma 271
22.2.3 Maintenance of Globe Integrity 272
22.3 Choice of Implant 272
22.4 Management of the Anophthalmic Socket After Enucleation and Radiation Therapy 274
22.4.1 Patients with Retinoblastoma 274
22.4.2 Patients with Uveal Melanoma with Microscopic Extrascleral Extension 275
22.4.3 Patients with Head and Neck Cancer 275
22.5 Evisceration 276
References 277
23 Orbital Exenteration and Rehabilitation of the Exenterated Socket 279
23.1 Definition 279
23.2 Indications 280
23.3 Preoperative Evaluation 280
23.4 Surgical Techniques of Orbital Exenteration 281
23.5 Reconstructive Options 283
23.6 Surgical Complications 286
23.7 Rehabilitation After Orbital Exenteration 287
Suggested Readings 287
24 Periorbital Surgical Rehabilitation After FacialNerve Paralysis 289
24.1 Introduction 289
24.2 Relevant Anatomy 290
24.3 Clinical Evaluation 292
24.3.1 Evaluation of Muscle Function 293
24.3.2 Evaluation of Lacrimal Gland and Lacrimal Drainage System Function 293
24.4 Medical Management 294
24.5 Surgical Management 295
24.5.1 Treatment of Lagophthalmos and Exposure Keratopathy 295
24.5.2 Treatment of Lower Eyelid Laxity and Ectropion 297
24.5.3 Reanimation of the Midface 298
24.5.3.1 Static Reanimation 298
24.5.3.2 Dynamic Reanimation 299
24.5.4 Options for Correction of Brow Ptosis 300
24.5.5 Additional Procedures for Management of Facial Droop 301
24.6 Special Circumstances in Cancer Patients with Facial Nerve Paralysis 301
24.7 Conclusion 302
References 302
25 Psychosocial Aspects of Orbitofacial Disfigurement in Cancer Patients 304
25.1 Introduction 304
25.2 The Importance of the Face and Its Social Construction 305
25.3 State of the Psychosocial Research on Facial Disfigurement 306
25.3.1 Psychosocial Consequences of Facial Disfigurement Caused by Cancer and Cancer Treatment 306
25.3.2 Patient Factors Affecting the Psychosocial Impact of Facial Disfigurement 307
25.3.3 Safe Settings for Patients with Facial Disfigurement: the Family and the Hospital 308
25.3.4 Impact of Group Social Interactions on Patients with Facial Disfigurement 308
25.4 Conclusions and Recommendations 309
References 309
Part IV Ocular Side Effects of Cancer Therapy 312
26 Lacrimal and Canalicular Toxicity 313
26.1 Introduction 313
26.2 5-Fluorouracil 314
26.3 S-1 315
26.4 Docetaxel 315
26.5 Epiphora Associated with Other Chemotherapeutic Drugs 316
26.6 Conclusions 316
References 316
27 Orbital and Periorbital Side Effects of Chemotherapy 318
27.1 Introduction 318
27.2 Orbital, Periorbital, and Orbital Teratogenic Side Effects by Individual Drug 320
27.2.1 Busulfan 321
27.2.2 Capecitabine 321
27.2.3 Carmustine 322
27.2.4 Cetuximab 322
27.2.5 Cisplatin 322
27.2.6 Cyclophosphamide 323
27.2.7 Cytarabine 323
27.2.8 Docetaxel 323
27.2.9 Doxorubicin 323
27.2.10 Erlotinib 323
27.2.11 Etoposide 324
27.2.12 Fluorouracil 325
27.2.13 Imatinib Mesylate 325
27.2.14 Interferons 325
27.2.15 Interleukin-2, Interleukin-3, and Interleukin-6 325
27.2.16 6-Mercaptopurine 326
27.2.17 Methotrexate 326
27.2.18 Mitomycin C 326
27.2.19 Mitoxantrone Dihydrochloride 326
27.2.20 Plicamycin 326
27.2.21 Thiotepa 326
27.2.22 Vincristine 327
27.3 Summary 327
References 327
28 Ocular and Orbital Infections in the Immunocompromised Cancer Patient 329
28.1 Introduction 329
28.2 Epidemiology 330
28.2.1 Bacterial 330
28.2.2 Viral 331
28.2.3 Fungal 332
28.3 Pathogenesis and Host Defense 333
28.4 Ocular and Orbital Manifestations of Infection 334
28.4.1 Bacterial 334
28.4.2 Viral 336
28.4.3 Fungal 337
28.4.3.1 Candida Species 337
28.4.3.2 Aspergillus Species 337
28.4.3.3 Other Fungal Species 338
28.5 Conclusion 340
References 340
Part V Neuro-ophthalmic Manifestations of Cancer 343
29 Cranial Nerve III, IV, and VI Palsies in the Cancer Patient 344
29.1 Introduction 344
29.2 Ophthalmologic Findings with CN III, IV, and VI Palsies 345
29.3 CN III, IV, and VI Palsies due to Primary Cranial Nerve Neoplasms and Direct Extension from Primary Brain, Brain Stem, or Skull base Tumors 346
29.4 CN III, IV, and VI Palsies due to Metastasis to the Brain, Brain, Stem and Skull Base from Distant Sites 347
29.5 Cranial Nerve III, IV, and VI Palsies due to Head and Neck Cancers 348
29.6 Cranial Nerve III, IV, and VI Palsies due to Leptomeningeal Disease 349
29.7 Other Causes of CN III, IV, and VI Palsies in Cancer Patients 349
29.8 Conclusion 350
References 350
30 Skull Base Tumors 352
30.1 Introduction 352
30.2 Anatomy of the Skull Base 353
30.3 Imaging and Diagnosis of Skull Base Tumors 354
30.4 Skull Base Tumors and Neuro-ophthalmic Correlations 355
30.4.1 Esthesioneuroblastoma 355
30.4.2 Chordoma 356
30.4.3 Craniopharyngioma 357
30.4.4 Meningioma 358
30.4.5 Sinonasal and Nasopharyngeal Tumors 360
30.4.6 Schwannoma 362
30.4.7 Pituitary Tumors 363
30.4.8 Myeloma 365
30.4.9 Paraganglioma 365
30.4.10 Metastases 366
References 367
31 Optic Nerve Pathway Gliomas and Optic Nerve Meningiomas 371
31.1 Optic Pathway Gliomas 371
31.1.1 Demographics and Presentation 372
31.1.2 Histopathology 373
31.1.3 Imaging and Lesion Location 373
31.1.4 Differential Diagnosis 375
31.1.5 Management 375
31.1.6 Prognosis 376
31.2 Optic Nerve Sheath Meningiomas 377
31.2.1 Incidence 377
31.2.2 Histology and Pathophysiology 378
31.2.3 Clinical Presentation 378
31.2.4 Imaging 379
31.2.5 Treatment 380
References 381
32 Leptomeningeal Disease 382
32.1 Introduction 382
32.2 Epidemiology 383
32.3 Clinical Presentation 383
32.3.1 LMD due to Solid Tumors 384
32.3.2 LMD due to Hematogenous Tumors 384
32.3.3 LMD due to Primary Brain Tumors 385
32.4 Diagnosis 385
32.4.1 Radiographic Imaging 386
32.4.2 Optic Neuropathies in LMD 387
32.5 Treatment 389
32.6 Prognosis 390
32.7 Conclusion 390
References 391
33 Paraneoplastic Visual Syndromes 394
33.1 Introduction 394
33.2 Pathogenesis 395
33.3 Carcinoma-Associated Retinopathy 396
33.4 Carcinoma-Associated Cone Dysfunction Syndrome 397
33.5 Melanoma-Associated Retinopathy 397
33.6 Autoimmune Retinopathy 398
33.7 Paraneoplastic Optic Neuropathy 398
33.8 Diagnostic Testing 399
33.9 Differential Diagnosis 400
33.10 Treatment and Prognosis 400
33.11 Conclusion 401
References 401
34 Neurofibromatosis: Tumors of the Optic Pathway 405
34.1 Introduction 405
34.2 NF1 and the Optic Pathway 406
34.3 Periorbital and Orbital Neurofibroma 407
34.3.1 Description and Clinical Issues 407
34.3.2 Evaluation and Management 408
34.4 Intraorbital Optic Nerve Glioma 410
34.4.1 Description and Clinical Issues 410
34.4.2 Evaluation and Management 411
34.5 Chiasmal and Hypothalamic Glioma 412
34.5.1 Description and Clinical Issues 412
34.5.2 Evaluation and Management 412
34.6 Intraparenchymal Astrocytoma 413
34.6.1 Description and Clinical Issues 413
34.6.2 Evaluation and Management 415
34.7 Conclusion 415
References 416
35 Other Optic Nerve Maladies in Cancer Patients 418
35.1 Introduction 418
35.2 Optic Neuropathies Related to Elevated ICP 419
35.2.1 Causes of Elevated ICP 419
35.2.2 Treatment of Elevated ICP 420
35.3 Optic Neuropathies Caused by Nutritional Deficiencies 421
35.3.1 Vitamin B 12 Deficiency Optic Neuropathy 421
35.3.2 Folate Deficiency Optic Neuropathy 422
35.3.3 Vitamin B 1 (Thiamine) Deficiency Optic Neuropathy 423
35.3.4 Vitamin E Deficiency Optic Neuropathy 423
35.3.5 Zinc Deficiency Optic Neuropathy 424
35.4 Optic Neuropathies Caused by Drugs 424
35.4.1 Optic Disc Edema Secondary to Drug-Induced Elevated ICP 425
35.4.1.1 Retinoids 425
35.4.1.2 Imatinib Mesylate 425
35.4.1.3 Cyclosporine A 425
35.4.1.4 Cytarabine 426
35.4.2 Elevated ICP Secondary to Cerebral Venous Thrombosis 426
35.4.2.1 Cisplatin 426
35.4.2.2 L-Asparaginase 426
35.4.3 Optic Disc Edema Usually Without Elevated ICP 427
35.4.3.1 Cisplatin 427
35.4.3.2 Carboplatin 427
35.4.3.3 Carmustine 427
35.4.3.4 Vincristine 427
35.4.3.5 5-Fluorouracil 427
35.4.3.6 Cyclosporine A 428
35.4.3.7 Tacrolimus 428
35.4.4 Optic Neuropathy Without Disc Edema 428
35.4.4.1 Fludarabine 428
35.4.4.2 Tacrolimus 428
35.4.4.3 Paclitaxel 428
35.4.4.4 Methotrexate 428
35.4.4.5 Cytarabine 429
35.5 Optic Neuropathies Caused by Radiation 429
References 430
Part VI Common Vitreoretinal Conditions in Cancer Patients 432
36 Management of Endogenous Endophthalmitis 433
36.1 Introduction 433
36.2 Epidemiology 434
36.3 Microbiology 434
36.4 Clinical Manifestations and Diagnosis 435
36.5 Treatment 435
36.5.1 Bacterial Endophthalmitis 436
36.5.2 Fungal Endophthalmitis 437
36.5.2.1 Yeast Endophthalmitis 438
36.5.2.2 Mold Endophthalmitis 438
36.6 Prognosis 439
36.7 Summary 440
References 440
37 Viral Retinitis in the Cancer Patient 442
37.1 Introduction 442
37.2 Epidemiology 443
37.3 Clinical Features 443
37.3.1 CMV Retinitis 443
37.3.2 Acute Retinal Necrosis 445
37.3.3 Progressive Outer Retinal Necrosis 445
37.4 Treatment 446
37.4.1 CMV Retinitis 446
37.4.1.1 Intravitreal Injections 446
37.4.1.2 Ganciclovir Implant 447
37.4.2 Acute Retinal Necrosis 448
37.4.3 Progressive Outer Retinal Necrosis 449
37.5 Role of Vitreoretinal Surgery in Viral Retinitis 449
37.5.1 Argon Laser Photocoagulation 449
37.5.2 Retinal Detachment Repair 449
37.6 Prognosis 450
37.6.1 CMV Retinitis 450
37.6.2 Acute Retinal Necrosis 450
37.6.3 Progressive Outer Retinal Necrosis 450
37.7 Conclusion 451
References 451
38 Diagnostic Vitrectomy and the Cancer Patient: Special Considerations 453
38.1 Introduction 453
38.2 Indications for Diagnostic Vitrectomy 455
38.2.1 Vitreous Biopsy 455
38.2.2 Uveal Biopsy 455
38.3 Preoperative Considerations 456
38.3.1 Thrombocytopenia 456
38.3.2 Anesthesia 457
38.4 Vitreous Biopsy 457
38.4.1 Technique 457
38.4.2 Effect of Vitrector Gauge on Vitreous Sample 459
38.5 Uveal Biopsy 459
38.5.1 Technique 459
38.5.2 Complications 460
38.5.3 Collaboration with Pathology 460
38.6 Pathologic Processing 461
38.6.1 Cytology 461
38.6.2 Interleukin Measurement 461
38.6.3 Polymerase Chain Reaction 462
38.6.4 Genetic Analysis 462
38.6.5 Cytogenetic Uveal Melanoma Studies 462
38.7 Results of Diagnostic Vitrectomy 463
38.7.1 Common Diagnoses 463
38.7.2 Diagnostic Utility 463
38.8 Postoperative Considerations 464
38.9 Conclusion 464
References 464
39 Intraocular Lymphoma: Current Therapy and Future Trends 467
39.1 Introduction and Epidemiology 467
39.2 Presentation and Diagnosis 468
39.3 Management 469
39.4 Future Considerations 469
39.5 Conclusions 470
References 471
Index 472