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Overview of Lipid Metabolism01:24

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Lipid metabolism is a crucial process in the human body that involves the synthesis and degradation of lipids. This process is essential for energy production, cell membrane formation, and hormone production, among other functions.
Lipolysis: The Breakdown of Lipids:
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Lipid Dominant Toxic Tumor Syndrome.

Jose Cijin Puthussery1, William Wagner1, Arun D Singh2

  • 1Cleveland Clinic, Cleveland, OH, USA.

Ocular Oncology and Pathology
|April 14, 2025
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Summary

Lipid-dominant toxic tumor syndrome (TTS) after radiation for choroidal melanoma can be treated with intravitreal steroids, improving vision. This chronic variant of TTS shows positive response to steroids, potentially avoiding enucleation.

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Area of Science:

  • Ophthalmology
  • Oncology
  • Medical Imaging

Background:

  • Toxic Tumor Syndrome (TTS) can occur after radiation therapy for choroidal melanoma.
  • Lipid-dominant TTS is a specific subtype characterized by lipid exudates.
  • Episcleral plaque brachytherapy (EPB) is a common treatment for choroidal melanoma.

Purpose of the Study:

  • To describe the clinical features of lipid-dominant TTS following EPB for choroidal melanoma.
  • To evaluate the outcomes of intravitreal steroid treatment for this condition.

Main Methods:

  • Retrospective review of 13 patients with lipid-dominant TTS post-EPB.
  • Assessment of clinical features including lipid exudates, macular edema, and subretinal fluid.
  • Evaluation of treatment response to intravitreal steroids (triamcinolone) versus observation.

Main Results:

  • Lipid-dominant TTS occurred a median of 22 months post-EPB, often associated with dyslipidemia.
  • Intravitreal steroids were administered to 8 patients, with 7 (88%) showing significant improvement.
  • Positive responses included reduction in lipid exudates, subretinal fluid, and cystoid macular edema; however, cataracts and ocular hypertension were noted side effects.

Conclusions:

  • Lipid-dominant TTS around the tumor base is a chronic variant of TTS.
  • Intravitreal steroids can effectively manage this condition, stabilizing or improving vision and potentially preventing enucleation.
  • Further prospective studies are needed to validate these findings.