To evaluate the clinical features, treatment, and prognosis of patients with uveal metastasis from lung cancer.
Retrospective chart review.
There were 194 patients with a diagnosis of uveal ...metastasis from lung cancer.
Radiotherapy, chemotherapy, enucleation, or observation.
Ocular tumor control, final visual acuity, and tumor-related death.
There were 374 uveal metastatic tumors originating from primary lung cancer in 229 eyes of 194 patients. Tumor location included choroid (88%), ciliary body (2%), and iris (10%), with bilateral involvement in 18%. Diagnosis of uveal metastasis preceded the diagnosis of primary lung cancer in 44% of patients. The choroidal metastatic focus had a mean basal diameter of 8 mm and mean thickness of 3 mm, and were mostly located posterior to the equator (91%). The choroidal metastasis commonly had yellow or orange color (98%), had plateau (61%) or dome (38%) configuration, and displayed associated subretinal fluid (85%). Choroidal tumors were multifocal in 49 cases (23%). Ciliary body tumors were commonly dome shaped (75%) with an episcleral sentinel vessel (75%). Iris tumors were multifocal in 2 cases (13%), had visible intrinsic vessels (97%), and were associated with tumor seeding in the angle (38%) or on the iris stroma (25%). The uveal metastases were treated with teletherapy (31%), chemotherapy (18%), brachytherapy (9%), chemotherapy combined with teletherapy or brachytherapy (14%), enucleation (3%), or observation (21%). At last visit, eyes with follow-up showed tumor regression (66%), stability (12%), growth (14%), recurrence (3%), or new metastasis (5%). Visual acuity improved or remained stable in 59% eyes. One-year mortality from the time of detection of uveal metastasis was 54%.
Of 194 patients with uveal metastasis from lung cancer, 44% did not have a history of known lung cancer. Current methods of ocular treatment allow globe salvage in 92% of patients and improved/stable vision in 59% of patients. Systemic prognosis remains poor with tumor-related death in 54% of patients at 1 year.
About one-third of patients suffering from systemic lupus erythematosus have ocular manifestations. The most common manifestation is keratoconjunctivitis sicca. The most vision threatening are ...retinal vasculitis and optic neuritis/neuropathy. Prompt diagnosis and treatment of eye disease is paramount as they are often associated with high levels of systemic inflammation and end-organ damage. Initial management with high-dose oral or IV corticosteroids is often necessary. Multiple “steroid-sparing” treatment options exist with the most recently studied being biologic agents.
To evaluate the frequency and type of perioperative hemorrhagic complications associated with vitreoretinal surgery in patients undergoing systemic treatment with the newer anticoagulant and ...antiplatelet agents including rivaroxaban, apixaban, dabigatran, and prasugrel.
Retrospective review of a cohort of patients being treated with anticoagulant and antiplatelet drugs, who underwent any vitreoretinal surgical procedure over a 2-year period.
Thirty-six eyes of 33 patients were identified who underwent vitreoretinal surgical operations while being treated systemically with anticoagulant and antiplatelet therapy. No eyes suffered perioperative complications of retrobulbar hemorrhage, suprachoroidal hemorrhage, or subretinal hemorrhage. Four eyes (11.1%) experienced postoperative vitreous cavity hemorrhage after which two eyes (5.5%) required repeat surgical intervention and two eyes (5.5%) cleared spontaneously.
Although there is a relative risk to such surgery in patients who are taking novel oral anticoagulants, these findings suggest that patients may safely undergo vitreoretinal surgery while maintaining therapy with rivaroxaban, apixaban, dabigatran, and prasugrel.
Abstract
Roylea cinerea
(D.Don) Baillon an indigenous medicinal plant of
Lamiaceae
family used for the treatment of several diseases. In the present study, its aqueous (leaves) extract was tested for ...genoprotective action against atrazine-induced chromosomal aberrations in the root tip cells of
Allium cepa
. Atrazine is a herbicide of triazine class commonly used to inhibit the growth of broad leaf and grassy weeds. In order to find the concentration of atrazine that exhibits maximum toxicity, its different concentrations (1, 5 and 10 µg/mL) were tested. It was observed that 10 µg/mL concentration was more toxic as it reduced the mitotic index and also increased the chromosomal aberrations. Among all the tested concentrations of aqueous (leaves) extracts (0.25. 0.5, 1.0, 1.5 and 3.0 µg/mL), the3.0 µg/mL concentration in both modes of experiments i.e. pre and post showed a significant reduction in chromosomal aberrations induced by atrazine. To understand the mechanism of protection by plant extract on atrazine-induced chromosomal abnormalities the RT-qPCR studies were conducted to observe the expression of marker genes Cyclin-dependent kinases (CDKs) (CDKA:1, CDKB2:1 and CDKD1:1. For this, the RNA was extracted from root tips treated with extract along with atrazine by TRIzol
®
. It was observed that aqueous extract of
Roylea cinerea
(D.Don) Baillon leaves upregulated the CDKs gene expression in both the modes i.e. pre and post treatments. A critical analysis of results indicated that aqueous extract ameliorated the chromosomal aberrations caused by atrazine which may be be due to the increased expression level of CDKs genes.
Hydroxychloroquine (HCQ), an antimalarial drug in use since 1955, is still used with great success in the treatment of systemic lupus erythematosis and other rheumatological diseases. HCQ is ...generally well tolerated and its side effect profile confers many advantages over many other immunosuppressive agents. However, HCQ is known to induce retinopathy. Unfortunately, HCQ-induced retinopathy can present insidiously with subtle color vision changes and paracentral scotoma, which makes early detection difficult. Moreover, cessation of HCQ does not typically result in resolution of the visual loss, and vision loss may actually continue to progress even after HCQ is stopped. Therefore, identifying those patients most at risk for development of retinopathy is of the utmost importance, and adequate screening of patients taking HCQ is recommended. A brief case presentation of a patient who has developed retinal toxicity from hydroxychloroquine is provided along with a discussion regarding the characteristic retinopathy and review of current screening recommendations.
Walia et al report a case of a 65-year-old African American woman who was presented to the ophthalmology clinic reporting a 2-month history of painless bilateral proptosis with acute vision loss in ...her right eye. She denied any prior ophthalmic history. Her known medical history was remarkable for hypertension, for which she did not take medications. A lymph node biopsy was performed and revealed mantle cell lymphoma. In collaboration with the oncology service, the patient was offered chemotherapy with rituximab and cyclophosphamide. The patent refused treatment and left the hospital against medical advice. The patient missed her follow-up examination 1 month after discharge. Upon contacting her family, it was reported that she died 2 weeks after leaving the hospital.
Abstract Objective To assess the efficacy and safety of intravitreal aflibercept injection in the treatment of CNV secondary to presumed ocular histoplasmosis syndrome (POHS). Purpose To assess ...safety of intravitreal aflibercept for the treatment of CNV secondary to presumed ocular histoplasmosis syndrome. Methods Masked, open-label, prospective study. Five subjects will receive 2.0 mg aflibercept injection every 8 weeks with 3 initial monthly doses over a 12 month period. Results No adverse systemic or ocular were reported. At month six, the mean visual acuity improved by 7.8 ETDRS letters, mean central subfoveal thickness decreased by 38.8 microns and mean OCT volume decreased by 0.076 mm3 . At month twelve, the mean visual acuity improved by12.4 ETDRS letters, mean central subfoveal thickness decreased by 34.6 microns and mean OCT volume decreased by 0.576 mm3. Conclusion The use of intravitreal 2.0 mg aflibercept injection for the treatment of CNV secondary to presumed ocular histoplasmosis syndrome yielded no systemic or ocular adverse events and produced improvement in visual acuity and reduction of OCT thickness and volume.
A 17-year-old girl with a history of sickle cell anaemia undergoing chronic blood transfusions and iron-chelation therapy presented for multiple ophthalmic examinations. During treatment with ...deferoxamine, her examination remained stable but 2 years after changing to deferasirox she presented with decreased visual acuity and only mild funduscopic changes. Marked electrophysiological abnormalities were also evident. After cessation of deferasirox, her visual acuity improved and electrophysiological responses improved. No prior reports of deferasirox-related retinopathy are available. We suggest that oral deferasirox caused a reversible retinopathy in our patient and clinicians be aware of this entity.
BACKGROUND AND OBJECTIVE:
To compare efficacy of monthly treatment with bevacizumab or ranibizumab for macular edema due to retinal vein occlusion.
PATIENTS AND METHODS:
Randomized, multicenter, ...comparative trial (Randomized, multicenter, comparative trial (
ClinicalTrials.gov
identifier: NCT01428388). Participants were randomized 1:1 to receive monthly treatment with bevacizumab or ranibizumab. The primary outcome was change in central foveal thickness at 6 months compared to baseline.
RESULTS:
The trial randomized 98 patients to treatment with bevacizumab or ranibizumab. At 6 months, there were no differences in change in central foveal thickness between groups (bevacizumab: mean reduction of 212.6 µm, 95% confidence interval CI, −288.3 to −137.0; ranibizumab: mean reduction of 243.8 µm, 95% CI, −309.6 to −178.0; The trial randomized 98 patients to treatment with bevacizumab or ranibizumab. At 6 months, there were no differences in change in central foveal thickness between groups (bevacizumab: mean reduction of 212.6 µm, 95% confidence interval CI, −288.3 to −137.0; ranibizumab: mean reduction of 243.8 µm, 95% CI, −309.6 to −178.0;
P
= .72, analysis of variance ANOVA). Both groups showed similar functional outcomes (bevacizumab: 0.33 logMAR gain, 95% CI, −0.47 to −0.18; ranibizumab: 0.34 logMAR gain, 95% CI, −0.45 to −0.23;
P
= .38, ANOVA).
CONCLUSION:
In the treatment of retinal vein occlusion, bevacizumab and ranibizumab have similar effects on reducing macular thickness and improving visual acuity.
Ophthalmic Surg Lasers Imaging Retina
. 2015;46:844–850.
While copious data exist regarding the incidence, treatment, and prognosis of rhegmatogenous retinal detachment (RRD), fewer data exist regarding bilateral RRD.
The authors performed a retrospective ...review of patients with sequential bilateral rhegmatogenous retinal detachments over a 5-year period from January 1, 2009, through December 31, 2014, that were repaired at a single institution. Data were reviewed for 80 eyes of 40 patients, which is the largest series of sequential RRD reported.
In patients with sequential RRD, the subsequently affected eyes were more likely to present with better initial visual acuity, shorter duration of symptoms, less macula-off status, and less concurrent proliferative vitreoretinopathy. The subsequent eye had better final visual acuity and was less likely to re-detach. Subsequent eyes tended to progress to RRD despite prophylactic retinopexy.
The constellation of baseline characteristics in which subsequent eyes presented with better initial visual acuity, shorter duration of symptoms, less macula-detached status, and less concurrent proliferative vitreoretinopathy when compared to the initial eye correspond with the findings that subsequent eyes had more successful anatomical and better visual outcomes.
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