OPHTHALMOLOGY

Alongside orthopedics and skull trepanation, ophthalmology is one of the most ancient medical specialties. 

In this field, the Quinze-Vingts Hospital in Paris, was founded in 1260 by King St Louis to take care of the blind - for knights returning from crusades, whose sight had been severely damaged by the strong sun of the Middle East.  This tradition has continued over the centuries. The Quinze-Vingts Hospital is the most ancient hospital of its kind in the world, still operational today.

From the first cataract surgery by lens extraction in 1648 performed by the ophthalmologist Jacques Daviel, to cancer treatment by proton-therapy, the cornea transplant and the latest research to fight against AMD (Age-related Macular Degeneration), French hospitals and eye specialists are at the forefront in disciplines such as:

•   Cataract surgery 
•  Refractive surgery to correct vision defects : myopia, hyperopia, astigmatism, presbyopia, eye alterations caused by accident 
•   Treatment of illnesses : uveal cancers, malignant eye tumors
•   Ocular infectious disease care

Today, there are 708 hospitals and clinics dealing with cataract, 461 with glaucoma, 331 with retina, and 222 with cornea.

Among these, the Quinze-Vingts Hospital in Paris still plays a leading role alongside the European Institute of Vision, world-class international research cluster, gathering 200 researchers, 12 teams of ophthalmology experts and 8 international structures whose missions are to discover and test innovative treatments for ocular pathologies. 

C3Medical is proud to be a close partner with Hôpital des Quinze-Vingts for leading-edge care and Institut Curie for cancers, managing its international patient activity.

MALIGNANT EYE TUMORS

Conjunctival, palpebral and orbital tumors

Eye tumors require a multidisciplinary approach to optimize the chances of recovery.

  • Tumors of the eyelids include basal cell carcinomas, which are by far the most frequent, and which, in most cases, have an excellent prognosis. These tumors are malignant locally, but do not produce metastases. Initial surgery is the standard treatment. If performed early on, the patient can recover with minimal surgical after-effects. In more advanced forms, broader surgery with immediate reconstruction of the eyelid is recommended. The histological results are discussed in a multidisciplinary consultation meeting. Forms that are very advanced locally can also benefit from radiotherapy or in some cases targeted therapy.
  • Other malignant tumors of the eyelid are rarer and more aggressive, and can produce metastases, such as epidermoid carcinoma, sebaceous carcinoma or Merkel cell carcinoma. These tumors are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.
  • Malignant tumors of the conjunctiva include lymphoma, severe dysplasia and conjunctival carcinoma, pre-cancerous melanosis and conjunctival melanoma. These lesions are rare but potentially serious, and require early, appropriate treatment. Conjunctival carcinomas are epithelial tumors whose prognosis depends on the initial size, prior surgeries, the number of local relapses and the histological aggressiveness. When the tumor is treated using a combination of surgery and disc or proton radiotherapy, it can be very well controlled locally with few after-effects for the eye, and lymph node relapse and metastases can be prevented. These tumors may also benefit from chemotherapy or immunotherapy (Interferon alfa-2b), with collyrium in addition.
  • Conjunctival melanomas are aggressive malignant tumors. They are similar to skin melanomas, but a lot rarer. These tumors occur most frequently subsequent to a pre-cancerous state known as Reese melanosis or after degeneration of a former nevus or even de novo. The tumor is generally pigmented and grows rapidly on a subject with fair skin at the age of around 50. Treatment requires a specialized center and involves surgical removal followed by additional radiotherapy, the terms of which will be discussed in a multidisciplinary consultation meeting. The search for mutations (BRAD, RAS, KIT) means that, if there are metastases, targeted therapy or appropriate immunotherapy is administered. Research in conjunctival melanoma is being conducted on mutations found in tumors.
  • Conjunctival lymphoma usually has a good prognosis when associated with the mucous membranes (MALT lymphoma). There are rarer, more aggressive forms. The diagnosis is performed by simple biopsy, and treatment is then discussed in a multidisciplinary consultation meeting with hematologists and radiotherapists.
  • Tumors of the eye socket are rare and a lot more polymorphous. All types of tumor may be found in the eye socket. The diagnosis is often based on a biopsy or removal analyzed by a seasoned anatomopathologist.
  • Malignant eye tumors, strictly speaking, include primitive tumors (retinoblastoma in children, choroidal melanoma, primitive lymphoma of the eye socket in adults) and choroidal metastases from a cancer located elsewhere, such as the breast, lung or colon. The diagnosis is established by an ophthalmologist specializing in eye tumors based on clinical and echographical evidence. Biopsy of the eye is always a delicate endeavor, but is proposed in certain cases when the diagnosis is difficult.

Source: https://institut-curie.org/liste/different-types-cancer

UVEAL CANCERS

What is uveal melanoma?

Uveal melanoma is a rare tumour, but the most frequent primary malignant tumour of the eye in adults, with 500 to 600 new cases per year in France.

The main risk is the onset of hepatic metastases, other metastatic locations being rarer or occurring later. It may occur de novo or through degeneration of a choroidal naevus. This is why patients with a large choroidal naevus usually benefit from early detection and regular monitoring of the optical fundus.

Melanoma of the eye may be discovered during a routine examination of the fundus or via the occurrence of recent visual problems such as lowering of visual acuity, a spot in the visual field (scotoma), flashes of light, or visual field loss (retinal detachment).

Tumours posterior to or “straddling the equator” can be treated with proton therapy: under general anaesthetic in the operating theatre, the surgeon identifies the tumour and inserts tantalum clips which will serve to guide the proton beam. Whenever possible, a puncture is made with a fine needle during the operation to better characterise the tumour biologically.

An endoresection (surgical ablation of the tumour scar tissue) is sometimes carried out after proton therapy to avoid complications, in particular neovascular glaucoma. For small anterior tumours, brachytherapy treatment with iodine 125 may be proposed.

These radiotherapy treatments control the tumour locally in 95% of cases. Prolonged monitoring of the ocular scar is essential. Complications (cataracts, glaucoma, radiation retinopathy) are possible and require ophthalmological treatment.

Enucleation or surgical ablation of the eye is reserved for the largest tumours. An extended assessment is necessary to search for distant metastases, particularly involving the liver.

Conjunctival, palpebral and orbital tumours

These tumours are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.

Source: https://institut-curie.org/liste/different-types-cancer

QUINZE-VINGT HOSPITAL

More information coming soon. 

MALIGNANT EYE TUMORS

Conjunctival, palpebral and orbital tumors

Eye tumors require a multidisciplinary approach to optimize the chances of recovery.

  • Tumors of the eyelids include basal cell carcinomas, which are by far the most frequent, and which, in most cases, have an excellent prognosis. These tumors are malignant locally, but do not produce metastases. Initial surgery is the standard treatment. If performed early on, the patient can recover with minimal surgical after-effects. In more advanced forms, broader surgery with immediate reconstruction of the eyelid is recommended. The histological results are discussed in a multidisciplinary consultation meeting. Forms that are very advanced locally can also benefit from radiotherapy or in some cases targeted therapy.
  • Other malignant tumors of the eyelid are rarer and more aggressive, and can produce metastases, such as epidermoid carcinoma, sebaceous carcinoma or Merkel cell carcinoma. These tumors are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.
  • Malignant tumors of the conjunctiva include lymphoma, severe dysplasia and conjunctival carcinoma, pre-cancerous melanosis and conjunctival melanoma. These lesions are rare but potentially serious, and require early, appropriate treatment. Conjunctival carcinomas are epithelial tumors whose prognosis depends on the initial size, prior surgeries, the number of local relapses and the histological aggressiveness. When the tumor is treated using a combination of surgery and disc or proton radiotherapy, it can be very well controlled locally with few after-effects for the eye, and lymph node relapse and metastases can be prevented. These tumors may also benefit from chemotherapy or immunotherapy (Interferon alfa-2b), with collyrium in addition.
  • Conjunctival melanomas are aggressive malignant tumors. They are similar to skin melanomas, but a lot rarer. These tumors occur most frequently subsequent to a pre-cancerous state known as Reese melanosis or after degeneration of a former nevus or even de novo. The tumor is generally pigmented and grows rapidly on a subject with fair skin at the age of around 50. Treatment requires a specialized center and involves surgical removal followed by additional radiotherapy, the terms of which will be discussed in a multidisciplinary consultation meeting. The search for mutations (BRAD, RAS, KIT) means that, if there are metastases, targeted therapy or appropriate immunotherapy is administered. Research in conjunctival melanoma is being conducted on mutations found in tumors.
  • Conjunctival lymphoma usually has a good prognosis when associated with the mucous membranes (MALT lymphoma). There are rarer, more aggressive forms. The diagnosis is performed by simple biopsy, and treatment is then discussed in a multidisciplinary consultation meeting with hematologists and radiotherapists.
  • Tumors of the eye socket are rare and a lot more polymorphous. All types of tumor may be found in the eye socket. The diagnosis is often based on a biopsy or removal analyzed by a seasoned anatomopathologist.
  • Malignant eye tumors, strictly speaking, include primitive tumors (retinoblastoma in children, choroidal melanoma, primitive lymphoma of the eye socket in adults) and choroidal metastases from a cancer located elsewhere, such as the breast, lung or colon. The diagnosis is established by an ophthalmologist specializing in eye tumors based on clinical and echographical evidence. Biopsy of the eye is always a delicate endeavor, but is proposed in certain cases when the diagnosis is difficult.

Source: https://institut-curie.org/liste/different-types-cancer

UVEAL CANCERS

What is uveal melanoma?

Uveal melanoma is a rare tumour, but the most frequent primary malignant tumour of the eye in adults, with 500 to 600 new cases per year in France.

The main risk is the onset of hepatic metastases, other metastatic locations being rarer or occurring later. It may occur de novo or through degeneration of a choroidal naevus. This is why patients with a large choroidal naevus usually benefit from early detection and regular monitoring of the optical fundus.

Melanoma of the eye may be discovered during a routine examination of the fundus or via the occurrence of recent visual problems such as lowering of visual acuity, a spot in the visual field (scotoma), flashes of light, or visual field loss (retinal detachment).

Tumours posterior to or “straddling the equator” can be treated with proton therapy: under general anaesthetic in the operating theatre, the surgeon identifies the tumour and inserts tantalum clips which will serve to guide the proton beam. Whenever possible, a puncture is made with a fine needle during the operation to better characterise the tumour biologically.

An endoresection (surgical ablation of the tumour scar tissue) is sometimes carried out after proton therapy to avoid complications, in particular neovascular glaucoma. For small anterior tumours, brachytherapy treatment with iodine 125 may be proposed.

These radiotherapy treatments control the tumour locally in 95% of cases. Prolonged monitoring of the ocular scar is essential. Complications (cataracts, glaucoma, radiation retinopathy) are possible and require ophthalmological treatment.

Enucleation or surgical ablation of the eye is reserved for the largest tumours. An extended assessment is necessary to search for distant metastases, particularly involving the liver.

Conjunctival, palpebral and orbital tumours

These tumours are usually treated with a combination of surgery and radiotherapy. Here again, they benefit from a multidisciplinary approach and recent biological advances.

Source: https://institut-curie.org/liste/different-types-cancer

QUINZE-VINGT HOSPITAL

More information coming soon.