phosphorus-radioisotopes and Retinal-Detachment

Choroidal hemangioma, a benign vascular tumor of the choroid, can frequently develop an effusive secondary retinal detachment. When such retinal detachment involves the macula, reduction in central vision occurs. Fluorescein angiography and radioactive prosphorus tests are helpful in accurately diagnosing choroidal hemangioma. Transscleral cryopexy, freeze-thaw-refreeze method, results in complete destruction and scarring of the choroidal hemangioma. Following treatment, subretinal fluid disappears, the macula becomes reattached, and central vision is restored.

Topics: Adult; Choroid Neoplasms; Cryosurgery; Fluorescein Angiography; Follow-Up Studies; Hemangioma; Humans; Macula Lutea; Male; Phosphorus Radioisotopes; Retinal Detachment; Scotoma

We studied four patients with posterior brawny scleritis. Two underwent enucleation for suspected melanoma, and in the other two, the correct diagnosis was made and effective therapy begun. Of seven other eyes with brawny scleritis from other sources, five were enucleated after diagnosis of choroidal melanoma and one for suspected intraocular tumor. This experience and other previous reports indicate the high incidence of diagnostic confusion regarding brawny scleritis. We therefore emphasized clinical symptoms and signs of brawny scleritis: inflammation, tenderness or pain of the globe, history of collagen vascular disease, proptosis, bilaterality, and retinal and choroidal detachment. A preserved normal choroidal vascular pattern over an elevated subretinal mass may be indicative of posterior brawny scleritis. Scleral biopsy is useful for tissue diagnosis. Radioactive phosphorus uptake tests and ultrasonography may erroneously indicate choroidal melanoma and lead to enucleation of a potentially salvageable globe.

Topics: Adult; Aged; Choroid Neoplasms; Diagnosis, Differential; Diagnostic Errors; Exophthalmos; Female; Humans; Inflammation; Male; Melanoma; Middle Aged; Pain; Phosphorus Radioisotopes; Retinal Detachment; Sclera; Ultrasonography

Of 358 eyes enucleated between 1962 and 1975, and found to contain posterior uveal melanomas, 31 had opaque media (8.6%). Eighteen of these patients with opaque media were seen between 1962 and 1971, before the use of combined ultrasonography and the radioactive phosphorus uptake (32P) test. Melanoma was unsuspected at enucleation in one third of these patients and there was often a long delay in diagnosis. Of the 13 patients seen between 1971 and 1975, after the initiation of combined ultrasonography and 32P) test, there was no delay in diagnosis becuase a melanoma pattern was recognized immediately with ultrasonography and confirmed with a positive 32P test. During the latter part of this study, 19 patients with opaque media had a "melanoma pattern" with ultrasonography. The 32P test was positive in 12 cases and a melanoma was confirmed histologically in every instance. The 32P test was negative in seven cases and all were documented on follow-up to have benign lesions, such as subretinal hemorrhages.

Topics: Adolescent; Adult; Aged; Cataract; Diagnosis, Differential; Eye Neoplasms; Female; Glaucoma; Humans; Male; Melanoma; Middle Aged; Panophthalmitis; Phosphorus Radioisotopes; Retinal Detachment; Retinal Hemorrhage; Ultrasonography; Uveal Diseases

Topics: Adolescent; Adult; Aged; Cataract; Evaluation Studies as Topic; Eye Diseases; Eye Neoplasms; Female; Hemorrhage; Humans; Male; Melanoma; Middle Aged; Panophthalmitis; Phosphorus Radioisotopes; Retinal Detachment; Time Factors; Ultrasonography; Uveal Diseases; Vitreous Body

Six patients had hemorrhagic detachment of the peripheral retinal pigment epithelium. Abnormal neovascular nets in older individuals, under the retinal pigment epithelium and originating from the choriocapillaris, may well be the cause of such hemorrhagic detachments. This lesion must be differentiated from choroidal tumors, choroidal detachment, and uveal effusion.

Topics: Adult; Aged; Diagnosis, Differential; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Phosphorus Radioisotopes; Pigment Epithelium of Eye; Retinal Detachment; Retinal Hemorrhage; Ultrasonography; Visual Acuity; Visual Fields

Two false-negative results from 32P testing for histologically verified malignant melanomas of the choroid are reported. In the first case, a haemorrhagic choroidal detachment caused an increase in probe; additionally, the tumour was necrotic. Both factors are likely to have contributed to the false-negative result. A satisfactory explanation for the false-negative result in the second case was not determined, although it may have accurately reflected a period of minimal tumour activity, inasmuch as repeat 32P testing was strongly positive eight months later, when unequivocal evidence of tumour growth was present. An alternative explanation is that the orally administered 32P was incompletely absorbed. Since 32P testing is frequently accompanied by significant manipulation both in the manoeuvre associated with tumour localization and in that associated with the actual radioactive counting, it would seem desirable to perform indicated enucleation immediately after completion of the 32P testing. While the properly performed 32P test remains a valuable diagnostic test for helping to establish the presence or absence of malignancies of the posterior globe, it is important to guard against the tendency to underestimate careful clinical evaluation.

Topics: Aged; Choroid Neoplasms; False Negative Reactions; Female; Humans; Melanoma; Phosphorus Radioisotopes; Retinal Detachment

Topics: Eye Neoplasms; Humans; Phosphorus; Phosphorus Radioisotopes; Radioactivity; Retinal Detachment