Objectives/Hypothesis:
This study reviews the published outcomes related to surgical (open, endoscopic, and endoscopic‐assisted) and nonsurgical treatment for esthesioneuroblastoma.
Study design:
...Literature meta‐analysis.
Methods:
A meta‐analysis of individual patient data for esthesioneuroblastoma publications between 1992 (the earliest identified description of endoscopic resection) and 2008 was conducted. A total of 49 journal articles, comprising 1,170 cases of esthesioneuroblastoma, were included in the study. Criteria for meta‐analysis inclusion were five or more patients in a study with sufficient patient data resolution for analysis. Twenty‐three studies comprising 361 patients met all inclusion criteria. The overall treatment and outcome at final follow‐up of each patient was recorded. Patients were pooled according to treatment techniques and compared to one another using a Kaplan‐Meier survival curve and the Mann‐Whitney U test to examine differences in follow‐up times and publication years.
Results:
Log‐rank tests showed a greater published survival rate for endoscopic surgery compared to open surgery (P = .0019), even when stratifying for publication year (P = .0018). There was no significant difference in follow‐up time. Review of Kadish tumor staging for each modality showed larger tumors were more often treated with an open approach, but open and endoscopic survival measures were comparable.
Conclusions:
These results suggest that endoscopic surgery is a valid treatment method with comparable survival to open surgery. Further prospective analysis will be beneficial. Laryngoscope, 2009
Epidemiological trends in uveal melanoma Andreoli, Michael T; Mieler, William F; Leiderman, Yannek I
British journal of ophthalmology
99, Številka:
11
Journal Article
Recenzirano
There has been a recent evolution in the management of uveal melanoma in regard to prognostic evaluation and treatment modalities. This study aims to evaluate the epidemiological trends of uveal ...melanoma since 1973 by using the Surveillance, Epidemiology, and End Results (SEER) Registry.
A total of 7043 uveal melanoma cases from the SEER database were retrospectively analysed, spanning 1973 to 2009. The main outcome measures were disease specific and overall patient survival.
The mean patient age at diagnosis was 61.4 years, which has increased over the last 37 years. The mean follow-up interval was 85.9 months. The proportion of tumours demonstrating spindle cell histology has decreased. Spindle cell tumours yielded superior disease-specific survival to epithelioid and mixed tumours. The median age at diagnosis of spindle cell tumours (60 years) was significantly younger than epithelioid tumours (65 years) and mixed tumours (64 years old; p < 0.0001). In a Cox proportional hazards regression analysis, tumour histology, T stage and age at diagnosis were associated with disease-specific survival. The prevalence of cutaneous melanoma was increased in patients with uveal melanoma, but the lifetime prevalence of other primary cancers was not appreciably increased.
The SEER data set demonstrates epidemiological trends in patient age at diagnosis and tumour histology over the last 37 years. Several patient and tumour characteristics are predictors of disease-specific survival. These findings have implications for disease surveillance and prognostic counselling.
Purpose To describe the long-term surgical course of patients with open globe injury. Design Retrospective case series. Methods Patients with open globe injuries (848 in total) treated surgically at ...the Massachusetts Eye and Ear Infirmary between 2000 and 2009 were retrospectively reviewed. Data from presentation, initial repair, and follow-up surgery were analyzed. Results Among 848 injuries, 1415 surgical procedures were performed. The mean follow-up time was 19.7 months, including 6017 visits. On average, patients required 1.7 surgeries and 7.1 follow-up visits. Factors predicting follow-up surgery included more severe ocular trauma score, worse prerepair visual acuity, retinal hemorrhage, anterior vitrectomy at primary repair, pars plana vitrectomy at primary repair, and lensectomy at primary repair. Patients with zone II injury, hemorrhagic choroidal detachment, and a history of previous ocular surgery tended to require follow-up surgery less frequently. Patients requiring a second surgery tended to have worse visual acuity at presentation and postrepair. Postoperative visual outcomes were worse for patients who underwent vitreoretinal follow-up surgery, likely because of mechanism of injury. Variables associated with inferior visual outcome were worse prerepair visual acuity, postoperative afferent pupillary defect (APD), old age, scleral laceration, and retinal detachment. Conclusion Open globe injuries require significant surgical follow-up. Patients requiring multiple operations tended to have worse postoperative visual acuity. Patients who underwent vitreoretinal surgery had overall worse visual outcomes. While the first year of surveillance appears to be pivotal in the course of an open globe injury, these patients can expect long-term care from comprehensive and subspecialty ophthalmologists.
To describe epidemiological trends in lacrimal gland malignancies in the United States.
Retrospective database review.
Multicenter registry.
A total of 702 malignant tumors of the lacrimal gland from ...the Surveillance, Epidemiology, and End Results database were included in the study. Disease-specific and overall survival were the primary outcome measures. Kaplan-Meier survival curves were generated for multiple patient and tumor characteristics, including race, histology, TNM tumor stage, age at diagnosis, radiotherapy, gender, and tumor grade. Cox proportional hazards regression was performed to assess the impact of patient and tumor characteristics on survival.
Lymphoma (58.0%), adenoid cystic carcinoma (13.4%), adenocarcinoma (3.8%), and mucoepidermoid carcinoma (3.6%) accounted for most tumors. Lymphoma was associated with more favorable survival rates, while adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma were associated with worse prognosis. There was a steady increase in the proportion of lymphoma diagnosed since 1973. In a multivariate Cox proportional hazards regression model, tumor histology remained as the only covariate correlated with disease-specific survival.
Patient characteristics and survival rates differ between lymphoma, adenoid cystic carcinoma, adenocarcinoma, and mucoepidermoid carcinoma. The proportion of lacrimal gland cancer diagnosed as lymphoma has steadily increased over time. Cox proportional hazards regression analysis demonstrated tumor histology as one of the most important factors in patient survival. These results augment our understanding of the expected disease course of lacrimal gland malignancies.
Purpose To evaluate the characteristics and outcomes of patients treated for open globe injuries sustained at work and to compare these results to patients injured outside of work. Design ...Retrospective chart review of 812 consecutive patients with open globe injuries treated at the Massachusetts Eye and Ear Infirmary between 1999 and 2008. Methods A total of 146 patients with open globe injuries sustained at work were identified and their characteristics and outcomes were compared with the rest of the patients in the database. Results Of the patients injured at work, 98% were men, and the average age of the patients was 35.8 years (17–72 years). The most common mechanism of injury was penetrating trauma (56%); 38 patients examined had intraocular foreign bodies (IOFB). Nine work-related open globe injuries resulted in enucleation. There was a higher incidence of IOFBs ( P = .0001) and penetrating injuries ( P = .0005) in patients injured at work. Both the preoperative ( P = .0001) and final best-corrected visual acuity ( P = .0001) was better in the work-related group. The final visual acuity was better than 20/200 in 74.1% of cases of work-related open globe injuries. However, there was no difference observed in the rate of enucleations ( P = .4). Conclusions Work-related injuries can cause significant morbidity in a young population of patients. Based on average patient follow-up and final visual acuity, those injured at work do at least as well as, if not potentially better than, those with open globe injuries sustained outside of work. While the statistically higher rate of IOFB in the work population is not surprising, it does emphasize the importance of strict adherence to the use of eye protection in the workplace.
To characterize the pattern of ocular trauma in the geriatric population.
Retrospective, comparative case series.
Eight hundred forty-six consecutive patients comprising 848 open globe injuries, of ...which 166 injuries occurred in geriatric patients (defined as 65 years old or older at the time of injury), with the remaining patients serving as control subjects.
Charts of open globe injuries (848 in total) treated surgically at the Massachusetts Eye and Ear Infirmary between January 2000 and April 2009 were retrospectively reviewed.
Ocular Trauma Score, age, gender, mechanism of injury, zone of injury, site of injury, time of day, visual acuity at presentation, and best post-repair visual acuity were analyzed.
Of 848 open globe injuries, 166 occurred in the geriatric population. The mean patient age in the geriatric group was 79.8 years. Females comprised most (58%) of this subpopulation. The most common mechanisms of injury were fall (65%), blunt trauma (16%), and motor vehicle accident (6%). The geriatric traumas tended to happen in late morning or late at night. There were no cases of endophthalmitis and fewer instances of enucleation in this group. The median raw Ocular Trauma Score was 47 in the geriatric population, compared with 70 in the younger subset (P < 0.0001). The injuries more often were in zones II and III in the geriatric population compared with the nongeriatric population (P < 0.0001). The geriatric patients were much more likely to have undergone previous intraocular surgery (P < 0.0001), which consisted of primarily cataract procedures. Visual acuity at presentation was significantly worse in the geriatric population than the nongeriatric population (P<0.0001). Similarly, the best postoperative visual acuity was worse in the elderly group than the younger group (P < 0.0001).
The elderly represent a unique, yet neglected ocular trauma population. The pattern of ophthalmic injury and outcome differs greatly between the geriatric and nongeriatric populations. A better understanding of these injuries is necessary to improve prevention and treatment strategies for potentially devastating open globe injuries in this susceptible population.
To determine the incidence of retinal redetachment due to proliferative vitreoretinopathy after open-globe trauma in smokers and nonsmokers.
A total of 892 patients comprising 893 open-globe ...injuries, in whom 255 eyes were diagnosed with a retinal detachment, and 138 underwent surgical repair were analyzed in a retrospective case-control study. Time to redetachment was examined using the Kaplan-Meier method and analysis of risk factors was analyzed using Cox proportional hazards modeling.
Within one year after retinal detachment surgery, 47% (95% CI, 39-56%) of all 138 repaired retinas redetached because of proliferative vitreoretinopathy. Being a smoker was associated with a higher rate of detachment (adjusted hazard ratio 1.96, P = 0.01). As shown in previous studies, the presence of proliferative vitreoretinopathy at the time of surgery was also an independent risk factor for failure (adjusted hazard ratio 2.13, P = 0.005). Treatment with vitrectomy-buckle compared favorably to vitrectomy alone (adjusted hazard ratio 0.58, P = 0.04). Only 8% of eyes that redetached achieved a best-corrected visual acuity of 20/200 or better, in comparison to 44% of eyes that did not redetach (P < 0.001).
Proliferative vitreoretinopathy is a common complication after the repair of retinal detachment associated with open-globe trauma, and being a smoker is a risk factor for redetachment. Further study is needed to understand the pathophysiologic mechanisms underlying this correlation.
Purpose To determine the percentage of patients in whom endophthalmitis developed after open globe injury. Design Retrospective, noncomparative, consecutive case series. Methods Charts of all ...patients (675 in total) treated surgically for open globe injury at the Massachusetts Eye and Ear Infirmary (MEEI) between January 1, 2000 and July 31, 2007 were reviewed. Cases with at least 30 days of follow-up were included in statistical analyses (558 in total). A standardized treatment protocol was used in all cases. Intravenous vancomycin and ceftazidime were started on admission and were stopped after 48 hours. Patients were discharged on topical antibiotics, corticosteroids, and cycloplegia. Surgical repairs were performed by the chief of trauma, a full-time position rotating yearly, who is on call for all open globe trauma. Data collection variables included timing of injury and repair, mechanism of injury, details of surgical repair, and details of follow-up such as duration, presence of complications, and vision. A primary outcome measure of endophthalmitis and secondary outcome measure of risk factors for endophthalmitis were studied. Results During 7.5 years, 675 open globe injuries were treated at MEEI. Of these, 558 had at least 30 days of follow-up (mean, 11 months) and were used in statistical analyses. The overall percentage of endophthalmitis was 0.9% (3 culture-positive cases and 2 culture-negative cases). Four of the 5 cases achieved final acuity of 20/80 or better. Risk factors for endophthalmitis included intraocular foreign body ( P = .03; odds ratio, 7.52) and primary intraocular lens placement ( P = .05). Conclusions A standardized protocol including surgical repair by a dedicated eye trauma service and 48 hours of intravenous antibiotics was associated with a posttraumatic endophthalmitis percentage of less than 1%.
Enucleation for Open Globe Injury Savar, Aaron; Andreoli, Michael T; Kloek, Carolyn E ...
American journal of ophthalmology,
04/2009, Letnik:
147, Številka:
4
Journal Article
Recenzirano
Purpose To report the experience of enucleation after open globe at an ophthalmic trauma referral center. Design Retrospective, observational study. Methods In an ophthalmic trauma referral center ...the charts of all patients having suffered an open globe injury between January 1, 2000 and June 30, 2007 were reviewed. Variables assessed were age, gender, type of injury (rupture or laceration penetrating, intraocular foreign body, or perforating), ocular trauma score, visual acuity, subsequent enucleation, indication for and timing of enucleation, presence of sympathetic ophthalmia, and length of follow-up. Results Among 660 open globe injuries, 55 have undergone enucleation (including 4 eviscerations), 11 primarily and 44 secondarily. Eyes with ruptures were significantly more likely to be enucleated than those with injuries attributable to lacerations ( P < .001). The most common reason for secondary enucleation was a blind, painful eye. Two patients (0.3%) developed sympathetic ophthalmia and have maintained good vision in the sympathizing eye. Conclusions The vast majority of open globes can be repaired without requiring primary enucleation. Secondary enucleation is most commonly carried out for pain. Eyes with no light perception can be closely observed if the patient chooses.
Purpose To analyze retinal thickness and volume measurements of X-linked retinoschisis patients by spectral-domain optical coherence tomography (SD OCT) and correlate these findings with visual ...acuity and patient age. Design Retrospective comparative case series. Methods Sixty-three eyes of 33 male patients with X-linked retinoschisis were gleaned from a SD OCT database at the University of Illinois at Chicago. Forty-one eyes of 21 patients with low refractive error, no visual impairment, and no known retinal disease served as age-similar controls. The mean age of the retinoschisis patients was 26.4 years. The mean age of patient controls was 30.0 years. Full-thickness, inner and outer retina thickness, and volume measurements were determined by SD OCT. Results Foveal schisis was observed in 81% of retinoschisis patients. Patients with foveal schisis tended to be younger than patients lacking foveal schisis. Inner and outer foveal thickness and volume measurements were increased in retinoschisis patients compared to controls. Outer retinal perifoveal and parafoveal thicknesses and volumes were consistently increased in retinoschisis patients relative to controls. In contrast, inner retinal perifoveal and parafoveal thickness and volume measurements were decreased in retinoschisis patients compared to controls. Worse visual acuity correlated with thinning of the temporal perifoveal inner retina and thickening of the inner fovea. Full-thickness measurements and inner retina and outer retina thickness and volume measurements tended to decrease with patient age. Conclusion Increased inner retinal foveal thickness and decreased perifoveal inner retinal thickness correlates with worse visual acuity and overall retinal thickness decreases with age in X-linked retinoschisis.
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