Abstract:
Importance:Early detection of choroidal melanoma at a small tumor size is emphasized in the literature. However, there is little published information on the specific risks of plaque-irradiated small choroidal melanoma on visual acuity and metastasis. Objective:To analyze outcomes of plaque radiotherapy for small choroidal melanoma 3 mm in thickness or less. Design, Setting, and Participants:This retrospective noncomparative series at a tertiary referral center included 1780 consecutive patients who had received plaque radiotherapy treatment for small choroidal melanoma. Main Outcomes and Measures:Visual acuity outcomes and melanoma-associated metastasis, assessed by Kaplan-Meier analyses. Results:The mean (SD) patient age at melanoma diagnosis was 58 (14) years. Of 1780 patients, 908 were female (51.0%), and 1752 were white (98.4%). Visual acuity was 20/40 OU or better in 1276 of the patients (71.7%), and the mean (SD) visual acuity was 20/40 (20/50) OU (median, 20/30; range, 20/20 to counting fingers). The mean (SD) tumor basal dimension was 8.8 (2.9) mm (median, 8.0 mm; range, 2.0-20.0 mm) and mean (SD) tumor thickness was 2.6 (0.5) mm (median, 2.7; range, 0.2-3.4 mm). Mean (SD) distance to the foveola was 3.4 (3.9) mm and to the optic disc was 3.7 (3.7) mm. The Kaplan-Meier rate of visual acuity loss (≥3 Snellen lines) was 9.5% (95% CI, 8.2%-11.0%) at 1 year, 39.2% (95% CI, 36.5%-42.0%) at 5 years, and 48.9% (95% CI, 45.6%-52.3%) at 10 years, whereas poor visual acuity (≤20/200) was 7.1% (95% CI, 5.9%-8.4%) at 1 year, 38.2% (95% CI, 35.5%-41.1%) at 5 years, and 53.5% (95% CI, 50.1%-57.1%) at 10 years. Regarding melanoma-associated metastasis, the rate was 0.2% (95% CI, 0.09%-0.6%) at 1 year, 4.5% (95% CI, 3.4%-5.9%) at 5 years, and 8.8% (95% CI, 6.9%-11.1%) at 10 years. Using 1.0-mm thickness increments, the 10-year risk for metastasis was 25.0% (95% CI, 3.9%-87.2%) at 0-mm to 1.0-mm thickness, 5.9% (95% CI, 2.5%-13.5%) at 1.1-mm to 2.0-mm thickness, 8.1% (95% CI, 5.9%-11.0%) at 2.1-mm to 3.0-mm thickness, and 13.4% (95% CI, 8.7%-20.4%) at thicknesses greater than 3.0 mm. The greater relative risk (RR) for metastasis in thinnest tumors was 1.83 (95% CI, 1.09-3.07), which likely represented more aggressive diffuse (flat) melanoma. By multivariable analysis, clinical features predictive of melanoma-associated metastasis included increasing patient age (RR, 1.32 [95% CI, 1.07-1.63] per decade; P = .01), tumor diameter (RR, 1.15 [95% CI, 1.06-1.24] per mm; P < .001), tumor thickness (RR, 2.22 [95% CI, 1.22-4.05] per mm; P = .01), photopsia symptoms (RR, 2.45 [95% CI, 1.35-4.43]; P = .003), and prior treatment before plaque radiotherapy (RR, 3.31 [95% CI, 1.31-8.33]; P = .01). Conclusions and Relevance:This retrospective study suggests that small choroidal melanoma treated with plaque radiotherapy has a 10-year risk for visual acuity loss of 48.9% (95% CI, 45.6%-52.3%) and a 10-risk of systemic metastasis of 8.8% (95% CI, 6.9%-11.1%). In this analysis, each millimeter of increasing thickness and diameter contributed risk for metastatic disease.
journal_name
JAMA Ophthalmoljournal_title
JAMA ophthalmologyauthors
Shields CL,Sioufi K,Srinivasan A,Di Nicola M,Masoomian B,Barna LE,Bekerman VP,Say EAT,Mashayekhi A,Emrich J,Komarnicky L,Shields JAdoi
10.1001/jamaophthalmol.2018.3881subject
Has Abstractpub_date
2018-12-01 00:00:00pages
1325-1333issue
12eissn
2168-6165issn
2168-6173pii
2704059journal_volume
136pub_type
杂志文章abstract:IMPORTANCE:Children with a history of amblyopia, even if resolved, exhibit impaired visual-auditory integration and perceive speech differently. OBJECTIVE:To determine whether a history of amblyopia is associated with abnormal visual-auditory speech integration. DESIGN, SETTING, AND PARTICIPANTS:Retrospective observa...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.3307
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:To assess the benefit of increased follow-up and treatment with ranibizumab between months 24 and 36 in the Ranibizumab for Edema of the Macula in Diabetes (READ-2) Study. DESIGN:Prospective, interventional, multicenter follow-up of a randomized clinical trial. METHODS:Patients who agreed to participate bet...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/2013.jamaophthalmol.91
更新日期:2013-02-01 00:00:00
abstract:Importance:To prevent blindness, repeated infant eye examinations are performed to detect severe retinopathy of prematurity (ROP), yet only a small fraction of those screened need treatment. Early individual risk stratification would improve screening timing and efficiency and potentially reduce the risk of blindness. ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.4502
更新日期:2019-11-07 00:00:00
abstract:IMPORTANCE:The publication of the US Physician Payments Sunshine Act provides insight into the financial relationship between physicians and the pharmaceutical industry. This added transparency creates new opportunities of using objective data to better understand prior research that implicates pharmaceutical promotion...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2016.1678
更新日期:2016-08-01 00:00:00
abstract:IMPORTANCE:The CX3CR1 gene is implicated as a candidate gene for age-related macular degeneration (AMD) through several lines of evidence. There is uncertainty, however, as to whether common genetic variants in CX3CR1 alter risk of AMD, since prior studies have been inconsistent and mostly limited to evaluation of 2 no...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,meta分析,随机对照试验
doi:10.1001/jamaophthalmol.2013.5506
更新日期:2014-01-01 00:00:00
abstract:OBJECTIVE:To determine whether treatment of choroidal melanoma influences survival by correlating age at death, cause of death, age at treatment, and survival predictors. DESIGN, SETTING, AND PARTICIPANTS:Prospective cohort study performed at the Liverpool Ocular Oncology Centre, a supraregional, tertiary referral ser...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.77
更新日期:2014-05-01 00:00:00
abstract:Importance:Examining costs and consequences of different low-vision (LV) programs provides important information about resources needed to expand treatment options efficiently. Objective:To examine the costs and consequences of LV rehabilitation or basic LV services. Design, Setting, and Participants:The US Departmen...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaophthalmol.2018.0797
更新日期:2018-05-01 00:00:00
abstract:Importance:Coronavirus disease 2019 (COVID-19) has been recognized as a pandemic by the World Health Organization. Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also infect tissues besides the respiratory system, such as the ocular tissues, remains unclear. Objective:To determine whether SAR...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.3962
更新日期:2020-10-08 00:00:00
abstract:Importance:Mutations in the myocilin (MYOC) gene are the most common molecularly defined cause of primary open-angle glaucoma that typically occurs in patients with high intraocular pressures (IOP). One MYOC mutation, p.Gln368Ter, has been associated with as many as 1.6% of primary open-angle glaucoma cases that had a ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.0005
更新日期:2019-05-01 00:00:00
abstract:Importance:β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). Objective:To test whether the association between the presence and...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamaophthalmol.2017.1082
更新日期:2017-06-01 00:00:00
abstract:Importance:Glaucoma-related adverse events constitute serious complications of cataract removal in infancy, yet long-term data on incidence and visual outcome remain lacking. Objective:To identify and characterize incident cases of glaucoma and glaucoma-related adverse events (glaucoma + glaucoma suspect) among childr...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.5664
更新日期:2020-12-17 00:00:00
abstract:IMPORTANCE:Orbital lymphangiomas, congenital hamartomas of the lymphovascular tissue, are often associated with significant ocular complications and can be challenging to treat. To date, therapeutic approaches have demonstrated variable results and have significant ocular and systemic risks. We present 2 cases of pedia...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2013.4201
更新日期:2013-09-01 00:00:00
abstract:IMPORTANCE:The Standard of Care vs Corticosteroid for Retinal Vein Occlusion (SCORE) Study showed that intravitreal triamcinolone acetonide (IVTA) is effective at reducing macular edema and improving visual acuity in participants with retinal vein occlusion. Secondary analysis of the incidence, risk factors, and timing...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2015.1823
更新日期:2015-09-01 00:00:00
abstract:Importance:The comparative clinical effectiveness of ranibizumab, aflibercept, and bevacizumab for the management of macular edema due to central retinal vein occlusion (CRVO) is unclear. Objective:To determine whether intravitreal aflibercept or bevacizumab compared with ranibizumab results in a noninferior mean chan...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.3305
更新日期:2019-08-29 00:00:00
abstract:IMPORTANCE:Increased lipofuscin accumulation is assumed to be an important factor in the pathogenesis of age-related macular degeneration (AMD), although direct evidence for this hypothesis is missing. OBJECTIVE:To quantitatively investigate lipofuscin-associated fundus autofluorescence (AF) in patients with early and...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2016.1475
更新日期:2016-07-01 00:00:00
abstract:IMPORTANCE:Anti-vascular endothelial growth factor (VEGF) medicines have revolutionized diabetic macular edema (DME) treatment. A recent randomized clinical trial comparing anti-VEGF agents for patients with decreased vision from DME found that at 1 year aflibercept (2.0 mg) achieved better visual outcomes than repacka...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2016.1669
更新日期:2016-08-01 00:00:00
abstract:Objective:To compare oral voriconazole with placebo in addition to topical antifungals in the treatment of filamentous fungal keratitis. Design, Setting, and Participants:The Mycotic Ulcer Treatment Trial II (MUTT II), a multicenter, double-masked, placebo-controlled, randomized clinical trial, was conducted in India ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1001/jamaophthalmol.2016.4096
更新日期:2016-12-01 00:00:00
abstract:Importance:Adding a laser-induced chorioretinal anastomosis (L-CRA) to current treatments for central retinal vein occlusion (CRVO) may improve outcomes and lessen therapy burdens. Objective:To determine the 2-year efficacy of intravitreal ranibizumab with an L-CRA vs ranibizumab alone for patients with macular edema ...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaophthalmol.2018.4973
更新日期:2018-12-01 00:00:00
abstract:Importance:Medical and surgical interventions for glaucoma are effective only if they are affordable to patients. Little is known about how affordable glaucoma interventions are in developing and developed countries. Objective:To compare the prices of topical glaucoma medications, laser trabeculoplasty, and trabeculec...
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pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.3672
更新日期:2018-11-01 00:00:00
abstract:Importance:The ocular surface is continuously exposed to the environment. Although studies have focused on associations between outdoor environmental conditions and dry eye, information on associations between the indoor environment and dry eye is lacking. Objective:To determine associations between the indoor environ...
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pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.2237
更新日期:2020-08-01 00:00:00
abstract:Importance:Contemporary data on use of eye care by US adults are critical, as the prevalence of age-related eye disease and vision impairment are projected to increase in the coming decades. Objectives:To provide nationally representative estimates on self-reported use of eye care by adults aged 50 to 80 years, and to...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2019.1927
更新日期:2019-06-20 00:00:00
abstract:IMPORTANCE:Myopia is a significant public health problem, making it important to determine whether a bifocal spectacle treatment involving near prism slows myopia progression in children. OBJECTIVE:To determine whether bifocal and prismatic bifocal spectacles control myopia in children with high rates of myopia progre...
journal_title:JAMA ophthalmology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamaophthalmol.2013.7623
更新日期:2014-03-01 00:00:00
abstract:Importance:Despite the existing country-specific strategies tackling social inequalities in visual health in adults, little is known about trends in visual function in childhood and its association with social position. Objective:To investigate the distribution of childhood visual function in the United Kingdom and as...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2017.2812
更新日期:2017-09-01 00:00:00
abstract:Importance:Many ophthalmology appointments have been converted to telemedicine assessments. The use of a printed vision chart for ophthalmology telemedicine appointments that can be used by people who are excluded from digital testing has yet to be validated. Objectives:To evaluate the repeatability of visual acuity m...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2020.5972
更新日期:2021-01-07 00:00:00
abstract:IMPORTANCE:The optic disc pit (ODP) has been considered a region of localized susceptibility to the damage of glaucoma. OBJECTIVE:To determine whether the rate of retinal nerve fiber layer (RNFL) thinning differs according to the presence and structural characteristics of an ODP in primary open-angle glaucoma. DESIGN...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2015.2453
更新日期:2015-10-01 00:00:00
abstract:IMPORTANCE:Eye and vision disease burden should help guide ophthalmologic research prioritization. The Global Burden of Disease (GBD) Study 2010 compiled data from 1990 to 2010 on 291 diseases and injuries, 1160 disease and injury sequelae, and 67 risk factors in 187 countries. The Cochrane Database of Systematic Revie...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2014.3527
更新日期:2015-01-01 00:00:00
abstract:Importance:Congenital stationary night blindness (CSNB) implies a stable condition, with the major symptom being nyctalopia present at birth. Pediatric clinical presentation and the course of different genetic subtypes of CSNB have not, to our knowledge, been well described in the era of molecular genetic diagnosis. O...
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pub_type: 杂志文章
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更新日期:2018-04-01 00:00:00
abstract:Importance:Vitreoretinal lymphoma is a diagnostic challenge and the pathophysiology is still unclear. Objective:To describe an imaging finding seen on optical coherence tomography (OCT) of patients with vitreoretinal lymphoma. Design, Setting, and Participants:This case series study was a retrospective medical record...
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更新日期:2019-02-01 00:00:00
abstract:Importance:To our knowledge, a set of well-defined diagnostic criteria is not yet developed for the diagnosis of Vogt-Koyanagi-Harada (VKH) disease. Objective:To develop and evaluate a set of diagnostic criteria for VKH disease using data from Chinese patients. Design, Setting, and Participants:This case-control stud...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
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更新日期:2018-09-01 00:00:00
abstract:Importance:Given the rarity of posterior uveal melanoma in patients younger than 21 years, reporting clinical experience in this area has relevance. Objective:To describe the baseline clinical features, treatment, and clinical course of a group of patients younger than 21 years who have primary posterior uveal melanom...
journal_title:JAMA ophthalmology
pub_type: 杂志文章
doi:10.1001/jamaophthalmol.2018.5132
更新日期:2019-01-01 00:00:00