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Ophthalmic oncology






We opened a new direction for ophthalmic oncology, reconstructive and plastic surgery

St. Petersburg Branch of S.N. Fyodorov "Eye Microsurgery" started out a new direction - consultations, diagnostics and medical assistance concerning reconstructive and plastic ophthalmic surgery, and ophthalmic oncology with organ-preserving principle.

It is the first time we started to perform the most complicated operations using endovitreal micro surgery, transscleral and endolaser thermotherapy in case of intraocular neoplasms (director of St. Petersburg Branch Doctor of Medicine, Professor, Honored doctor of Russian Federation Boiko Ernest Vitalyevich as a surgeon). Direction is supervised by Deputy Director for Scientific and Research Work Doctor of Medicine, Professor, Honored doctor of Russian Federation Panova Irina Evgenyevna, a well-known specialist in the field of ophthalmic oncology.

Oncology in ophthalmology at St. Petersburg Branch

Types of treatment

  • Surgical treatment for benign and malignant tumors of the accessory apparatus of the eye and conjunctiva using radio surgery and simultaneous reconstructive plastic surgery
  • Laser treatment for eyelid tumors, intraocular melanomas, choroidal hemangiomas (laser coagulation, thermotherapy, photo destruction, photodynamic therapy)
  • Radiation treatment methods: gamma knife, radiotherapy, etc. (indications for these types of treatment can be determined both separately and as part of a combined treatment)
  • En bloc excision of iris and ciliary body tumors
  • Enucleation of the eye in case of intraocular melanoma with primary stump plastic surgery for subsequent individual ocular prosthetics
  • Orbital exenteration in case of malignant neoplasms of the organ of vision with simultaneous reconstructive plastic surgery
  • Orbitotomy, removal of orbit tumors
  • Plaque brachytherapy using ophthalmic applicators with radionuclides Ru-106 + Rh-106

PRELIMINARY CORRESPONDENCE CONSULTATION

For a preliminary correspondence consultation on the question of the feasibility of a diagnostic examination, consultation and subsequent hospitalization at St. Petersburg Branch patient should send the following information to our email address cmc@mntk.spb.ru:

  • Full name and date of birth
  • Photo (in case of eyelid skin diseases, orbit or fundus of the eye disorders)*
  • Results and images of ultrasound examinations of orbit and fundus of the eye (in case of intraocular and orbital tumors *
  • MRI (CT) of the orbits (with contrast, and tomograph step of at least 2 mm) – in case of orbital neoplasms *
  • Data of ophthalmologic examination, medical report (not older than 1 month) *
  • Email address for feedback.

All documentation sent by e-mail will be replied within 15 working days.

*- not more than 1 month old

Personal consultation

Personal consultations are carried out by Deputy Director for Scientific and Research Work, Doctor of Medicine, Professor, Honored doctor of Russian Federation Panova Irina Evgenyevna according to the schedule by appointment on Mondays 14.00-17.00. Appointment on consultation within CHI (compulsory health insurance) is made by information and reference unit of the Branch, fee-based consultations by phone 8 (812) 324-66-66 on work days 9.00 -17.00.

To make an appointment You need to present:

  • Medical report and results of ophthalmological examination*
  • Results and Ultrasound scan images of orbit and eye fundus (in case of intraocular and orbital tumors) *
  • MRT (CT) of orbits (with contrast and tomograph step not less than 2 mm) - in case of orbital tumors *
  • Passport
  • For examinations and treatment within CHI program You need the following:
    1. ophthalmologist’s referral from your local clinic;
    2. health insurance card,
    3. Individual insurance account number

(if one of these is missing, then consultation can be fee-based only)

* - not more than 1 month old

Malignant tumors of eyelid skin

Among all malignant ocular neoplasms eyelid skin tumors are most common. These can be pigmented tumors (melanoma) and non-pigmented (cancers) arising from epidermis and eyelid glands.

Pathology can occur on the background of various pre-cancerous diseases: cutaneous horn, senile keratosis, xeroderma pigmentosum, papilloma, as well as on the background of scars after burns. Melanoma more often develops from benign pigmented neoplasms (melanosis, nevi).

Risk factors for these diseases are solar insolation, heredity, ionizing radiation, chemical exposure.

TYPES OF EYELID CANCER

  • The most common malignant tumor of the eyelid skin (94%) is basal cell carcinoma. It is characterized by slow growth, absence of pain, an extremely rare metastasis. It goes in a form of a node or ulcer. Patients complain about the presence of tumor-like formation on skin, sometimes itching in the area of formation.
  • Базально-клеточный рак
  • Squamous cell carcinoma is characterized by pronounced formation growth (within a few months) and high metastasis activity. Patients complain about a tumor on skin, eyelashes loss, disruption of normal eyelids "architecture", sometimes tingling, itching, and burning feeling in the area of formation, if the tumor germinates inside the orbit, eyelid may prolapse (ptosis) and eyeball protrusion (exophthalmos) may appear. Tumor growth is accompanied by episodic bleeding.


  • Меланома кожи век


  • Eyelid skin melanoma – most severe of malignant skin tumors, metastasizing to regional lymph nodes, skin, liver, and lungs. Tumor can spread to the mucous membrane of the eyelids, conjunctiva and into the orbit. Patients may complain on appearance or increasing of the pigment formation, changes in pigmentation, bleeding, slight burning feeling, itching or pain in the area of tumor.
  • Additional symptoms include absence of the skin pattern, peeling, appearance of redensifications on the pigment tumor surface, increase of the lymph nodes closest to the tumor.

PREVENTION OF MALIGNANT TUMORS OF THE EYELID SKIN

  • regular checkups,
  • dosed exposure to sun radiation,
  • using high level UVP sunglasses for eyelid skin protection,
  • use SPF creams that block ultraviolet rays’ penetration

EYELID SKIN MALIGNANT TUMORS DIAGNOSTICS

Great importance for early diagnostics of melanoma and eyelid skin cancer is a self-diagnostics and regular examinations by ophthalmologist. Do not try to cure yourself! When eyelid neoplasms appear, you should consult an ophthalmic oncologist, who, after a visual inspection and additional examinations will confirm or exclude the tumor-like nature of eyelid skin neoplasm.

MALIGNANT EYELID TUMORS TREATMENT

Surgical treatment is the main for eyelid skin tumors. In St. Petersburg Branch we successfully perform microsurgical tumors removal using radio wave surgery (radio knife), and one-step with reconstructive and restorative stage.

During operation of the microscope allows you to evaluate the necessary boundaries of the excision of the tumor, which provides confidence in the complete removal of the tumor. Radiosurgery determines the minimal damage to the surrounding tissues and the best scarring, and the use of a wide variety of plastics results in a satisfactory functional and cosmetic result.

  • An important advantage of surgical treatment is the determination of the histological affiliation of the tumor, which makes it possible to determine the further treatment tactics and the need for the additional use of radiation or chemotherapy.
  • Less commonly used methods of exposure are cryogenic and laser photo destruction, the use of which is most justified in the treatment of benign eyelid skin tumors.

PROGNOSIS

  • Basal cell carcinoma prognosis is favorable. Full recovery after treatment is achieved in 95-97% cases, although recurrence is possible.
  • Squamous cell skin cancer prognosis is unfavorable, especially at advanced stages.
  • In case of eyelid skin melanoma prognosis is of vital importance and depends on thickness and depth of tumor invasion.

Melanoma

INTRAOCULAR MELANOMA

Intraocular melanoma is a malignant tumor that can appear in different parts of the vascular tract of the eye - iris, ciliary body and choroid. It develops due to malignant transformation of melanin pigment-forming cells. It is characterized by infiltrative growth, lymphogematogenous metastasis. Disease prevails in women, its peak occurs at the age of 55-60 years.

RISK FACTORS OF UVEAL MELANOMA

Uveal melanoma origin is still unknown, however, there are some factors that can affect the occurrence of the disease:

  • presence of pigment formations in the vascular tract,
  • melanoma among relatives of the first degree relationship,
  • living in places with unfavorable environmental conditions,
  • occupational hazards.

Clinical course of intraocular melanoma

Tumor belongs to the "hidden" locations and beginning of the disease may be asymptomatic. For early detection of iris melanoma it is very important to detect appearance or pigment spot growth on the iris, any changes in the shape of the pupil.

Ciliary body melanoma is asymptomatic. It is possible to make the diagnosis at early stages if there is a careful examination with maximum dilation of the pupil.

Choroid melanoma. Depending on localization (central, equatorial-peripheral) complaints will be about visual acuity decrease, “spots”, “sparks”, “veils” in the field of view, pain.

Progression leads to complications development such as retinal detachment, cataract, glaucoma, tumor germination beyond the eyeball with the development of exophthalmos, possible destruction of the walls of the orbit, germination in the surrounding structures (in the brain, paranasal sinuses). Generalization of the process is accompanied by the appearance of hematogenous metastases, most often metastases are detected in the liver (93%), lungs (24%), metastases to the lymph nodes, bones, brain, skin, subcutaneous tissue, spleen, other eye and orbit are less commonly diagnosed.

PREVENTIVE MEASURES FOR INTRAOCULAR MELANOMA

Systematic examination. Fundus examination with dilated pupil.

INTRAOCULAR MELANOMA DIAGNOSTICS

Diagnosis is usually made on the basis of specific signs. Ophthalmoscopy and biomicroscopy are the main diagnostic procedures. They are harmless and painless. Ultrasound examination of the eye is used as additional method according to indications, as well as optical coherent tomography, dye angiography, MRI or computed tomography. In exceptional cases, an aspiration biopsy from a tumor tissue is performed.

INTRAOCULAR MELANOMA TREATMENT

Treatment can be with organ preserved and with organ liquidation. Choice depends on disease stage. At early stages (1-2 stage) it is possible to perform organ-preserved treatment – brachytherapy (exposure of tumor to radiation using special radioactive sources), thermotherapy, and surgical methods - endoresections, one block tumor removal. Among liquidation methods should be mentioned eyeball enucleation and orbit evisceration. Introduction of plastic stump surgery using biomaterial after enucleation allows to get the best cosmetic effect while performing an individual eye prosthetics.

Today almost every possible treatment method is widely used in St. Petersburg Branch of S. Fyodorov “Eye microsurgery”.

Patients with intraocular melanoma are subjected to life-term supervision and regular check-ups once every three months approximately during the first year after treatment, once every 6 months during the next year with obligatory ultrasound orbits examination every checkup. Once a year CT/MRT of orbits is performed once a year if necessary. Overall clinical and instrumental examination of the patient is required to exclude the generalization of the process, with consultation by oncologist, at least once a year.

PROGNOSIS

Due to modern medicine achievements the possibility of full recovery in case of uveal melanoma is quite big if it was found at its earliest stages.

Malignant conjunctival tumors

Malignant conjunctival tumors usually occur as conjunctival cancer or melanoma developed primarily or together with benign tumors and precancerous diseases.

Tumors occur at the age of 40-60 and are characterized by extremely aggressive development course, quick growth, growth into the eyeball, through the orbit and surrounding tissues, and gives metastatic spreading to regional lymphatic glands.

PREVENTIVE MEASURES AGAINST MALIGNANT CONJUNCTIVAL TUMORS

  • Systematic medical examination.
  • Eye protection form UV radiation.

CLINICAL FORMS OF MALIGNANT CONJUNCTIVAL TUMORS



    Плоскоклеточный рак конъюнктивы


  • Squamous cell conjunctival carcinoma. Often develops when conjunctiva is somehow altered (burn, benign tumors, precancerous condition etc). Patient complain on conjunctival reddiness, a “foreign body” feeling, increased tear secretion, pain, a quickly growing tumor.

  • Злокачественная меланома конъюнктивы.

  • Conjunctival malignant melanoma. Mostly appears along with nevus or melanosis. Attention should be paid especially when there is a tumor which is growing, has a color from dark to pinky brown and is accompanied by reddiness of the eyeball and “foreign body” feeling.

MALIGNANT CONJUNCTIVAL TUMORS DIAGNOSTICS

Self-diagnostics and regular follow-up examinations by ophthalmologist have a great importance for early diagnostics of conjunctival tumors. You should not medicate yourself! When conjunctival neoplasms appear, you should consult an ophthalmic oncologist, who on the basis of a visual inspection and additional examinations, will confirm or exclude the tumor-like nature of the neoplasm.

MALIGNANT CONJUNCTIVAL TUMORS TREATMENT

Surgical method is the main treatment method for malignant tumors. Removal of tumors using radio wave surgery (a radio wave knife) is successfully used in St. Petersburg Branch of S. Fyodorov “Eye microsurgery” simultaneously with reconstructive and plastic stage.

Using microscope during operation helps to estimate the dissection borders for tumor and to be sure that it is fully removed. Radio surgery determines the minimum damage of surrounding tissues and formation of a delicate scar. Tissues volume recovery which were removed from the eyeball surface is a very important moment and for this purpose can be used patient’s own tissues or alloplants.

Determination of the tumor histological affiliation is an important advantage of surgical treatment, which allows to choose the further treatment tactics and determine the necessity for additional radiation or chemotherapy.

Cryogenic exposure is one of the less commonly used methods, which is justified in case of benign eyelid skin tumors.

FORECAST

The disease prognosis depends on the time when tumor was found, on stage of the process and its histological affiliation.

Orbital tumors

Orbit is a space behind the eye, separated by the bone walls of paranasal sinus and brain, filled with adipose tissue, blood vessels, nerves, eyeball.

Orbital tissues variety makes a wide range of tumors, of which benign hemangiomas are the most popular, and more seldom are malignant tumors – sarcomas, lymphomas, cancers. Recently malignant tumors have a tendency of “rejuvenation” – up to 25% of them occur at the age of under 20.

CLINICAL SYMPTOMS OF ORBITAL TUMORS

Main symptoms of a starting tumor are bulging of the eyeball (exophthalmos), doubling (diplopy), droopy eyelid (ptosis), limitation of motion, moderate pain. Mainly it is a one-sided process.

ORBITAL TUMOR DIAGNOSTICS

Apart from overall ophthalmic examination the most important thing for diagnostics is performance of additional examinations like ultrasound study of orbits, computer (CT) or magnetic resonance tomography (MRT), choosing the method of diagnostic examination is up to a specialist.

ORBITAL TUMOR TREATMENT

The main method of treatment is orbitotomy - to remove the tumor surgically.

Treatment is planned considering individual anatomical and topographic features of the orbit, size of the tumor, its type, its prevalence, state of bone walls and regional lymph nodes, and presence of distant metastases. Conservative organ preserving treatment is preferred. Wait-and-see strategy is not allowed!

In St. Petersburg Branch of S. Fyodorov "Eye Microsurgery" all possible surgery is used during this operation. In some cases, biopsy of the tumor may be required to check its histological affiliation and determine further treatment tactics (in particularly, if there is a need for radiation or chemotherapeutic stage).

PROGNOSIS

The prognosis depends on the type of tumor, time when it was found and on the extent of treatment.

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