Prize for Jon Durnian, Specialist Registar

Jon Durnian, Specialist Registrar in Ophthalmology, recently presented a case report at a national competition and won a free trip to the Annual Conference of the American Academy of Ophthalmology 2006, which is being held in Las Vegas.

Mr Durnian reported the case of a patient with an intraocular melanoma, who developed retinal detachment and severe glaucoma after proton beam radiotherapy.

Conventionally, this painful complication is treated by removal of the eye. This patient, however, did very well after successful local resection of the 'toxic tumour' by Professor Damato. The retinal detachment resolved completely within a day of the operation and the intraocular pressure eventually returned to normal, so that it was possible to discontinue all drops and tablets.

This case report is important because it demonstrates that many of the problems arising after radiotherapy of intraocular melanoma are caused by leakage of fluid and various noxious substances from the dying tumour. This discovery creates many new opportunities for conserving a comfortable, seeing eye after radiotherapy.

Local resection is not the only method of treating 'toxic tumour' after radiotherapy. We have also had success with transpupillary thermotherapy (TTT), which consists of infra-red laser treatment. Intraocular steroid injections have helped some patients. Very recently, we have started treating patients with intraocular injections of Avastin, which stops fluid leakage from abnormal blood vessels. These treatments are still being evaluated but our initial findings are encouraging and indicate that they all have a valuable role in reducing the side-effects of radiotherapy.

We hope that Jon Durnian learns a great deal at the conference and that he enjoys any spare time without being robbed by one-armed bandits.