Papers by Vicktoria Vishnevskia-Dai
Seminars in ophthalmology, Feb 8, 2024
Clinical and Experimental Optometry, 2020
PubMed, Feb 1, 2019
A 49 years old patient with a history of brachytherapy for choroidal melanoma was referred to the... more A 49 years old patient with a history of brachytherapy for choroidal melanoma was referred to the ocular emergency room for suspected recurrence due to pigment in the vitreous cavity. On examination, pigmented vitreous secondary to posterior vitreous detachment with traction from the atrophic tumor was observed with no evidence of recurrence.
Retina-the Journal of Retinal and Vitreous Diseases, Aug 2, 2021
Clinical and Experimental Optometry, Mar 16, 2021
A 67-year-old female presented with severe pain and blurred vision in the right eye that had pers... more A 67-year-old female presented with severe pain and blurred vision in the right eye that had persisted for one month. Her medical history included colon-carcinoma and skin-melanoma treated with a Trametinib and Dabrafenib for 12 months before ocular presentation. On examination, visual acuity was R: 6/12 and L: 6/9. The anterior-chamber was infiltrated with cells and amorphousmaterial (Figure 1A). Rubeosis of the iris (Figure 1B) and vitreous haemorrhage and fibrin with no pigmented cells were observed. On gonioscopy, amorphous material was observed in the inferior-angle (Figure 1C). The patient underwent a diagnostic vitrectomy. On cytology examination, atypical cells were observed with eccentric, irregular nuclei, with a prominent nucleolus and a moderate amount of cytoplasm. On Melen-A staining, the atypical cells showed cytoplasmic positivity for Melan-A (Figure 1D,E). The patient was treated with an immune checkpoint inhibitor. Secondary glaucoma and cataract developed due to the massive cancer cell infiltration; however, full resolution of the ocular infiltration was achieved (Figure 1F). At the end of follow-up, visual acuity was R: hand motion and L: 6/9.
PubMed, Feb 1, 2018
Uveal melanoma, the most common primary intraocular malignancy in adults, is potentially a lethal... more Uveal melanoma, the most common primary intraocular malignancy in adults, is potentially a lethal tumour. Since the development of local radiotherapy, tumour control is achieved in the majority of cases and most eyes are salvaged. Despite this, more than 50% of patients develop distant metastatic spread, mainly to the liver, and in the absence of efficient treatments to extend life, die soon after. A great deal of effort has been put into developing prognostic markers for metastatic spread and survival. Novel genetic prognostic tests, recently introduced, are now being clinically used in many ocular oncology centres worldwide. In addition, in most centres, patients are referred for systemic surveillance programs for early detection of liver metastasis. Novel treatment modalities to battle metastatic uveal melanoma are being developed and used in clinical trials. Their efficacy is yet to be proved. This review summarizes the recent developments and current challenges related to uveal melanoma management.
Investigative Ophthalmology & Visual Science, May 1, 2004
ABSTRACT Retinal damage induced by mechanical trauma, ischemia or laser photocoagulation increase... more ABSTRACT Retinal damage induced by mechanical trauma, ischemia or laser photocoagulation increases considerably by secondary degeneration processes. The spread of damage may be ameliorated by neuroprotection that is aimed at reducing the extent of the secondary degeneration and promote healing processes. Hyperbaric oxygen (HBO) treatment consists of inspiration of oxygen at higher than one absolute atmospheric pressure. Improved neural function was observed in patients with acute brain trauma or ischemia treated with HBO. This study was designed to evaluate the neuroprotective effect of hyperbaric oxygen (HBO) on laser induced retinal damage in a rat model. Standard argon laser lesions were created in 25 pigmented rats divided into three groups: Ten rats were treated immediately after the irradiation with HBO three times during the first 24 hr followed by 12 consecutive daily treatments. Five rats received a shorter treatment regimen of 10 consecutive HBO treatments. The control group (10 rats) underwent the laser damage with no additional treatment. The retinal lesions were evaluated 20 days after the injury. All outcome measures were improved by the longer HBO treatment (P
PubMed, Feb 1, 2018
Background: The distribution of pathology and clinical characteristics of lacrimal gland diseases... more Background: The distribution of pathology and clinical characteristics of lacrimal gland diseases are different in different areas of the world. Objectives: To evaluate the incidence rate, patient characteristics, and indications for surgical intervention of lacrimal gland lesions in a tertiary care center in Israel. Methods: All biopsied or surgically removed lacrimal gland lesions at the Goldschleger Eye Institute from 2009 to 2015 were identified. The following data were collected: age, gender, indications for surgical intervention, diagnosis, treatment, and prognosis. Results: We evaluated 28 lacrimal gland biopsies from 26 patients (11 men, 15 women). Mean age at biopsy was 47.5 years old. The most common presenting symptoms were: eyelid swollenness (57.14%), ptosis (32.14%), and proptosis (10.71%). All patients underwent computed tomography and magnetic resonance imaging. In 28 cases, infiltrations of the lacrimal gland were found. In nine cases infiltration of muscles or orbital extension were found. The most common pathologies were non-specified inflammation (44.82%), lymphoma (20.68%), and immunoglobulin G4-related disease (10.34%). The treatment was diverse according to the patient diagnosis. Prognosis of lacrimal gland disease was good; however, in five patients the systemic disease progressed. Conclusions: Lesions of the lacrimal gland comprise a wide variety of pathological findings that require different treatment strategies. Lacrimal gland biopsies enable physicians to precisely recognize the pathology; therefore, it is important to consider this surgical method in any patient with lesions in the lacrimal gland.
Journal of Ophthalmology, 2016
Purpose. To investigate the value of optical coherence tomography (OCT) for differentiation betwe... more Purpose. To investigate the value of optical coherence tomography (OCT) for differentiation between choroidal melanoma and metastasis based on characteristics of the anterior choroidal surface and the chorioretinal interface. Methods. This retrospective observational case series included 29 patients with untreated choroidal melanomas and 21 patients with untreated choroidal metastases. Regularity and lobularity characteristics of the anterior choroidal surface were evaluated in a masked manner. Retinal and retinal pigment epithelium (RPE) findings were documented as well. Results. OCT demonstrated a regular and smooth anterior choroidal surface in 89.7% of the eyes with melanoma and in 47.6% of the eyes with metastasis (= 0.002; sensitivity = 89.7%; specificity = 52.4%). The anterior choroidal contour was lobulated in 81.0% of the eyes with metastasis versus 17.2% of the eyes with melanoma (< 0.001; sensitivity = 82.8%; specificity = 81.0%). RPE thickness and neuroretinal characteristics (e.g., retinal thickness, the presence of cysts, and the presence of subretinal fluid) were similar in both choroidal tumors. Conclusion. OCT may serve as a noninvasive adjunctive tool for the differential diagnosis of choroidal tumors. Choroidal melanomas usually demonstrate regular surfaces on OCT, while choroidal metastases usually have an irregular and lobulated surface.
Ophthalmology, Apr 1, 1998
To study the efficacy of photoastigmatic refractive keratectomy (PARK) by the MEL 60 (Aesculap-Me... more To study the efficacy of photoastigmatic refractive keratectomy (PARK) by the MEL 60 (Aesculap-Meditec, Jana, Germany) scanning excimer laser for the treatment of myopic astigmatism, with follow-up of 18 months. Patients and Methods: One hundred and twenty-eight eyes of 102 patients with different degrees of myopic astigmatism were treated by PARK and followed prospectively in an open study. Ablations were performed with an MEL 60 excimer laser using an astigmatic module. Results: Mean preoperative refractive cylinder improved from a preoperative value of-1.8 + 0.8 diopters (D; range,-1 .O to-6.0 D) to-0.3 t 0.5 D (range, f1.0 to-2.5 D) at 18 months. The mean reduction in cylindrical correction alone was 84 ? 37% in the low astigmatism group (-1 .O to-1.5 D); 91 ? 21% in the moderate astigmatism group (-1.75 to-2.5 D); and 75 + 25% in the high astigmatism group (-2.75 to-6.0 D). One hundred and three eyes (80%) at 12 months and 100 eyes (85%) at 18 months were within +0.5 D of the intended astigmatic correction, with more eyes in the low astigmatic group. One hundred and nineteen eyes (93%) and 114 eyes (97%) at 12 and 18 months, respectively, were within +l .O D of the intended correction. Ninety-two percent to 95.7% of the eyes in the different groups had a postoperative axis less than 10 degrees of the preoperative and intended axis at 12 and 18 months after PARK. Uncorrected visual acuity (UCVA) of 20/40 or better was achieved in nearly 84% of the eyes 12 and 18 months after PARK. A UCVA of 20/20 was achieved in 49% of eyes 18 months after PARK. Ten eyes (8%) underwent reoperation at the end of 12 months. Conclusions: The data indicate that PARK is an effective surgical tool for correcting astigmatism, especially astigmatism of 1 .O to-2.5 D, with a success rate of approximately 70%. Ophthalmology 1998; 105:620-623 The evolving technology of excimer laser offers an alternative treatment for refractive defects previously corrected by spectacles and contact lenses and by incisional techniques.' The few studies published on the correction of astigmatism by photoastigmatic refractive keratectomy (PARK)253 report more predictable results than those obtained with incisional surgery, but follow-up in both of these studies was short. We report here the results of PARK in 128 eyes after 18 months and provide evidence of the efficacy of this procedure for correction of astigmatism.
American Journal of Ophthalmology Case Reports, Mar 1, 2023
PLOS ONE, Sep 27, 2022
To describe clinical and imaging characteristics of patients with Peripheral Exudative Hemorrhagi... more To describe clinical and imaging characteristics of patients with Peripheral Exudative Hemorrhagic Chorioretinopathy (PEHCR), prognosis and treatment response. Methods In this retrospective cohort study medical records of patients diagnosed with PEHCR in a tertiary medical center between 2008 and 2018 were reviewed. Collected data included demographics, medical history, ophthalmologic examination and multi-modal imaging including fundus autofluorescence, optical coherence tomography (OCT), ultrasound (US), fluorescein angiography and indocyanine green angiography when available. Bevacizumab treatment results were analyzed when applied. Results 35 eyes of 32 patients were included, with a female predominance (56.25%) and an average age of 79.0±9.87 years at presentation. Most common OCT and US findings were subretinal mass (68.75%), pigment epithelial detachment (30.00%) and atrophic changes (21.86%). Median follow-up period was 18.00 months (range 0-102). Visual acuity (VA) remained stable (39.29%) or improved (25.00%) in most cases available for follow-up. Treatment with intravitreal bevacizumab induced a statistically significant clinical resolution in 88.89% of eyes available for follow-up (8/9 eyes) (p = 0.02). Conclusions PEHCR is presented with high clinical variability and generally good prognosis. This is the first publication demonstrating a statistically significant clinical resolution of disease following intravitreal bevacizumab injections.
Scientific Reports, Jan 12, 2021
To examine the ocular side effects of selected biological anti-cancer therapies and the ocular an... more To examine the ocular side effects of selected biological anti-cancer therapies and the ocular and systemic prognosis of patients receiving them. We retrospectively reviewed all medical records of patients who received biological anti-cancer treatment from 1/2012 to 12/2017 and who were treated at our ocular oncology service. The following data was retrieved: primary malignancy, metastasis, type of biological therapy, ocular side effects, ophthalmic treatment, non-ocular side effects, and ocular and systemic disease prognoses. Twenty-two patients received biological therapies and reported ocular side effects. Eighteen patients (81.8%) had bilateral ocular side effects, including uveitis (40.9%), dry eye (22.7%), and central serous retinopathy (22.7%). One patient (4.5%) had central retinal artery occlusion (CRAO), and one patient (4.5%) had branch retinal vein occlusion (BRVO). At the end of follow-up, 6 patients (27.27%) had resolution of the ocular disease, 13 patients (59.09%) had stable ocular disease, and 3 patients (13.64%) had progression of the ocular disease. Visual acuity improved significantly at the end of follow-up compared to initial values. Eighteen patients (81.8%) were alive at study closure. Biological therapies can cause a wide range of ocular side effects ranging from dry eye symptoms to severe pathologies that may cause ocular morbidity and vision loss, such as uveitis, CRAO and BRVO. All patients receiving biological treatments should be screened by ophthalmologists before treatment, re-screened every 4-6 months during treatment, and again at the end of treatment. Patients on biological treatment who have ocular complaints should be urgently referred to ocular consultation for early identification and early intervention. Abbreviations ALK Anaplastic lymphoma kinase BRAO Branch retinal artery occlusion CTLA-4 Cytotoxic T-lymphocyte antigen-4 CRAO Central retinal artery occlusion EGFR Epidermal growth factor receptor Log MAR Log minimum angle of resolution MEK Mitogen-activated protein kinase OCT Optical coherence tomography PD-1 Programmed death protein 1 PD-L1 Programmed death ligand-1 RAF Rapidly accelerated fibrosarcoma kinase US Ultrasound VA Visual acuity Cancer is the leading cause of death in the developed world with a mortality case of over 10 million mortality cases annually 1. The traditional non-surgical treatments for cancer are radiation and chemotherapeutic drugs. However, those treatments also affect healthy cells, causing numerous side effects, some of which lead to severe morbidity 2. Therefore, the current trend is focused on finding targeted therapies that eliminate specifically cancerous cells only. In the last 2 decades, studies on the molecular basis, epigenetic changes, and gene expression in cancer, as well as new diagnostic technologies have led to advances in understanding the mechanism of cancer development and the discovery of new modalities of therapy 3,4. One of these novel modalities used for various cancer lines is biological therapy. Biological therapy stimulates the body's own immune system to act against cancer cells or interfere with tumor growth and progression by specific molecules or antibodies 5-7. The
Ophthalmology, Apr 1, 2015
In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple system... more In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple systemic conditions in the absence of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). These range from reports in apparently healthy individuals, through conditions rendering limited immune dysfunction such as advanced age and diabetes mellitus, and finally severe immune dysfunction such as in haematological and rheumatological conditions. Reports are also emerging, suggesting that induced local ocular immunosuppression is a risk factor for CMVR. We herein present a comprehensive collection of the accumulated findings regarding CMVR in non-HIV patients. We summarize the spectrum of underlying morbidity that has been associated with CMVR, its clinical presentation, diagnostic methods and treatment choice in the attempt to suggest the optimal treatment strategy in this complicated and diverse patient population which is still currently lacking a consensus.
Case Reports, Sep 15, 2009
Behçet disease is a chronic systemic relapsing vasculitis. Ocular clinical signs in Behçet diseas... more Behçet disease is a chronic systemic relapsing vasculitis. Ocular clinical signs in Behçet disease usually include signs of inflammation in the uvea, vitreous and retina. This report describes a rare case of a full-blown systemic exacerbation of Behçet disease with ocular involvement including conjunctival ulceration with the absence of uveal or retinal involvement.
Clinical Ophthalmology, Nov 1, 2011
Retinal astrocytic hamartomas are benign intraocular tumors classically associated with phacomato... more Retinal astrocytic hamartomas are benign intraocular tumors classically associated with phacomatoses. Their appearance in isolation is rare. An association between astrocytic hamartomas and retinitis pigmentosa (RP) has been described previously, but controversy still exists regarding the precise nature of these lesions in RP patients. The authors present a case report of a 24-year-old male with RP and multiple bilateral lesions clinically consistent with retinal astrocytic hamartomas. Optical coherence tomography revealed multiple bilateral hyper-reflective intraretinal masses, loss of retinal architecture, intralesional calcifications, and prominent optical posterior shadowing. Comprehensive systemic evaluation was negative for phacomatoses. However, given that a biopsy was not performed, the diagnosis of optic nerve head drusen could not be excluded.
Acta Ophthalmologica, Oct 25, 2017
In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple system... more In recent years, numerous reports have tied cytomegalovirus retinitis (CMVR) with multiple systemic conditions in the absence of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS). These range from reports in apparently healthy individuals, through conditions rendering limited immune dysfunction such as advanced age and diabetes mellitus, and finally severe immune dysfunction such as in haematological and rheumatological conditions. Reports are also emerging, suggesting that induced local ocular immunosuppression is a risk factor for CMVR. We herein present a comprehensive collection of the accumulated findings regarding CMVR in non-HIV patients. We summarize the spectrum of underlying morbidity that has been associated with CMVR, its clinical presentation, diagnostic methods and treatment choice in the attempt to suggest the optimal treatment strategy in this complicated and diverse patient population which is still currently lacking a consensus.
Case Reports, Feb 1, 2019
Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital disorder characterised by macrocephaly, ... more Bannayan-Riley-Ruvalcaba syndrome (BRRS) is a congenital disorder characterised by macrocephaly, multiple hamartomas, lipomas, and pigmented macules of the glans penis. Intermediate uveitis is characterised by chronic inflammatory cells aggregates on the pars plana (snowbanks) and within the vitreous cavity (snowballs). We describe what we believe to be the first case of intermediate uveitis associated with BRRS. Early examination under anaesthesia should be considered in the management of young children diagnosed with this syndrome in order to provide appropriate ocular evaluation, treatment and follow-up. Further research is needed to establish a better understanding of the ophthalmic manifestations of this syndrome.
Case Reports in Ophthalmology, Oct 7, 2015
To report a case of a patient with primary vitreoretinal lymphoma masquerading as retinitis. Meth... more To report a case of a patient with primary vitreoretinal lymphoma masquerading as retinitis. Methods: Retrospective review of the patient's clinical, histopathological and imaging records. Results: Cytopathology was negative for malignancy, and preliminary polymerase chain reaction results supported the diagnosis of varicella zoster virus retinitis. Therefore, the patient was treated with antiviral therapy. However, under this treatment, the retinitis progressed. As a result, primary vitreoretinal lymphoma was suspected, and empirical treatment with intravitreal methotrexate injections was started. Under this treatment, the ocular features improved. Five months after initial ocular presentation and ocular resolution, the patient presented with central nervous system lymphoma. Conclusion: This case should raise the awareness of the variable clinical presentations, the challenging diagnosis and treatment of primary vitreoretinal lymphoma. All cases should be continuously systemically evaluated.
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Papers by Vicktoria Vishnevskia-Dai