1,720,985 research outputs found
Intravitreal dexamethasone implant for acute exudative polymorphous vitelliform maculopathy
No full textAcute exudative polymorphous vitelliform maculopathy is a rare retinal disease characterized by bilateral serous macular detachment and subretinal accumulation of yellowish deposits resembling Best dystrophy lesions. Corticosteroid systemic therapy has been used empirically in the attempt to treat this retinal disorder with mixed results. Thus, the benefit of corticosteroid remains undetermined. To our knowledge, we report the first case of acute exudative polymorphous vitelliform maculopathy (AEPVM) treated in one eye with intravitreal dexamethasone implant (Ozurdex; Allergan, Inc., Irvine, California, USA)
Pars Plana Vitrectomy with External Drainage for Non Exudative Retinal Detachment
No full textPurpose:To describe a surgical technique for retinal detachment (RD) with undetected retinal breaks, which combines pars plana vitrectomy (PPV) and external subretinal fluid (SRF) drainage.Methods:In this retrospective observational study, patients with diagnosis of RD with undetected retinal breaks were enrolled. Standard three-port 25 Gauge (G) core and peripheral PPV was performed. Perfluorocarbon liquid was injected in the vitreous cavity to obtain posterior retinal flattening. Trans scleral 27G needle external drainage was performed approximately at 8 mm from limbus to drain SRF sub-conjunctivally. Prophylactic peripheral endolaser was performed on 360°. Sulfur hexafluoride 20% was used as tamponade.Results:In fourteen out of 15 patients complete SRF drainage was obtained. In only one case SRF did not leak out in the sub-conjunctival space. Neither intraoperative nor postsurgical complications were recorded. Flat retina with no SRF was observed in all sample and no RD relapses were reported at each follow up.Conclusion:External drainage combined to PPV may represent a valid and safe option to drain SRF in RD cases with undetected retinal breaks. The advantages of the technique consisted in absence of retinal pigment epithelium cells dispersion in the vitreous chamber, prompt dry retina, low risk of postoperative retinal folds
Pars Plana Vitrectomy With External Drainage for Nonexudative Retinal Detachment
No full textPurpose: To describe a surgical technique for retinal detachment with undetected retinal breaks, which combines pars plana vitrectomy and external subretinal fluid (SRF) drainage. Methods: In this retrospective observational study, patients with a diagnosis of retinal detachment with undetected retinal breaks were enrolled. Standard three-port 25-gauge (G) core and peripheral pars plana vitrectomy was performed. Perfluorocarbon liquid was injected into the vitreous cavity to obtain posterior retinal flattening. Trans-scleral 27-G needle external drainage was performed approximately at 8 mm from limbus to drain SRF subconjunctivally. Prophylactic peripheral endolaser was performed on 360°. Sulfur hexafluoride 20% was used as tamponade. Results: In 14 of 15 patients, complete SRF drainage was obtained. In only one case, SRF did not leak out in the subconjunctival space. Neither intraoperative nor postsurgical complications were recorded. Flat retina with no SRF was observed in all samples, and no retinal detachment relapses were reported at each follow-up. Conclusion: External drainage combined with pars plana vitrectomy may represent a valid and safe option to drain SRF in retinal detachment cases with undetected retinal breaks. The advantages of the technique include the absence of dispersion of retinal pigment epithelium cells in the vitreous chamber, prompt dry retina, and low risk of postoperative retinal folds
Combined deep sclerectomy and descemet stripping automated endothelial keratoplasty
No full textPURPOSE:
The aim of this study was to evaluate a novel surgical combination of Descemet stripping automated endothelial keratoplasty (DSAEK) and deep sclerectomy (DS) for the management of concomitant corneal endothelial decompensation and uncontrolled glaucoma.
METHODS:
This retrospective case series noncomparative study included 9 eyes of 6 consecutive patients with coexistence of corneal edema resulting from Fuchs dystrophy or pseudoexfoliation keratopathy and medically uncompensated glaucoma; these patients underwent combined DSAEK and DS with mitomycin C and an absorbable collagen implant. Corneal graft clarity, endothelial cell density, visual acuity, intraocular pressure (IOP), and identification of complications were assessed over a 2-year follow-up.
RESULTS:
All eyes obtained graft clarity throughout the follow-up, with a final average endothelial cell decrease of -36% from baseline, and showed improved vision and good IOP control without hypotensive therapy. Measured at 3 and 24 months postoperation, the mean visual acuity improvement was 154% and 372% and IOP decrease was 51.1% and 46.4%, respectively. Two anterior segment complications occurred in 2 (22%) patients' eyes. This consisted of a graft dislocation and a modest IOP elevation, treated successfully.
CONCLUSIONS:
Combined DSAEK and DS was longitudinally associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a viable option for patients with coexisting glaucoma and corneal endothelial dysfunction. Our study should stimulate a multicenter, randomized, controlled trial of our technique
Lymphoepithelioma-like carcinoma involving the lacrimal gland and infiltrating the eyelids.
No full textPURPOSE:
To report a case of a lymphoepithelioma-like carcinoma (LELC), which is a variant of carcinoma most commonly involving the nasopharynx and rarely occurring in a variety of sites outside its typical location.
METHODS:
We present the case of a 79-year-old Caucasian man with LELC of the lacrimal gland undergoing surgical resection of the mass.
RESULTS:
The patient had remained disease-free for 2 years, and then he developed homolateral metastases in latero-cervical and parotid lymph nodes, detected by computed tomography and confirmed by fine-needle aspiration biopsy. He did not receive any surgical treatment, radiotherapy, or chemotherapy because of the advanced stage of the disease and poor health condition.
CONCLUSIONS:
This case report suggests that a diagnosis of lacrimal gland LELC makes combined early and radical therapy necessary
Brolucizumab for Wet Age-related Macular Degeneration in Switch Patients: Long-Term Real-World Experience from a Tertiary Center
No full textObjective: To evaluate the three-year real-world efficacy and safety of intravitreal brolucizumab injections in patients with neovascular age-related macular degeneration (nAMD) who switched from other anti-vascular endothelial growth factor (VEGF) therapies. Design: Retrospective, single-center, observational cohort study. Subjects: The study included 97 eyes of 91 patients with nAMD previously treated with anti-VEGF therapies who completed three years of follow-up. Methods: Patients received intravitreal injections of 6 mg brolucizumab. Data on Best Corrected Visual Acuity (BCVA), Central Subfield Thickness (CST), Intraretinal Fluid (IRF), Subretinal Fluid (SRF), sub-Retinal Pigment Epithelium Fluid (sRPEF), treatment intervals, and adverse events were collected over a three-year follow-up period. Results: The mean age of patients was 78.9±8.2 years, with a mean follow-up of 161.3 weeks. At three-year follow up, mean BCVA significantly improved, from 41.1±6.5 at baseline to 50.7±7.5 ETDRS letters (p<0.001), and mean CST significantly decreased from 371.3±136.7 to 299.1±137.81 (p<0.001). Significant reductions were observed in IRF (p<0.001), SRF (p<0.001), and sRPEF (p=0.004). Mean injections per year were 4.7±1.9, 3.9±1.7, and 3.6±1.9 in the first, second, and third years, respectively. Adverse events were noted in four patients after either the first or second injection, with no further events reported. Conclusion: This study reports that brolucizumab provides favorable anatomical and functional outcomes and can reduce treatment burden in patients with nAMD due to its rapid and sustained efficacy and favorable safety profile
Supportive treatment to chemotherapy with MMC, in patients with ocular surface squamous neoplasia or conjunctival melanocytic tumor
No full textPurpose: Since there is a lack of clear information regarding the benefit to combine supportive therapies (such as artificial tears) to mitomycin C (MMC) in the treatment of ocular surface neoplasia, the primary purpose of the study was to evaluate hyaluronic acid eye drops and hyaluronic acid-conjugated lactobionic acid (LACTOyal FREE) eye drops as supportive therapy. Methods: Retrospective evaluation of patients with ocular surface squamous neoplasia or conjunctival melanocytic tumor treated with MMC, who had used also artificial tears as supportive treatment. A 6-month follow-up with evaluation of subjective and objective tests for ocular surface integrity was conducted. Results: A total of 35 patients were analyzed, most of them with squamous disease (71.4%). The break-up time (BUT), Ocular Surface Disease Index (OSDI) and Schirmer test values showed a significant difference at any time point with overall population. No statistical difference was found among subgroups (Lactoyal vs No Lactoyal). Conclusion: The use of an ancillary therapy based on hyaluronic acid allows to improve both subjective and objective ocular parameters, reducing MMC induced adverse effects. Meantime, hyaluronic acid-conjugated lactobionic acid eye drops highlighted the same advantages with a more positive trend in OSDI results
New combined treatments, surgery and high-dose-rate interventional radiotherapy (brachytherapy), in advanced ocular surface and eyelid cancers
Full text linkPurpose: To evaluate the clinicopathological characteristics and the effectiveness of post-operative high-dose-rate (HDR) interventional radiotherapy (IRT - brachytherapy) in managing advanced ocular surface squamous neoplasia (OSSN) and eyelid tumors. Methods: Nineteen patients with advanced malignancies affecting the ocular surface (stage ≥ T2) and eyelids (staging ≥ T3) were enrolled. Post-operative HDR-IRT treatment followed surgery after multidisciplinary discussion. In our series a total dose of 49 Gy was administered in 14 fractions of 3.5 Gy each, 2 doses per day. Local disease control is the study's main outcome. Death rate, total survival, disease-free survival, and toxicity are secondary outcomes. Results: Local recurrence was observed in 4 cases, 2 were conjunctival melanomas and 2 were conjunctival squamous cell carcinoma. The median OS was 56.3 months. The 12, 24 and 36 months survival rate was respectively 100.00% (IQR: 100.00% - 100.00%), 100.00% (IQR: 100.00% - 100.00%), 100.00% (IQR: 100.00% - 100.00%) respectively. The median DFS was 56.3 months. The 12, 24 and 36 months disease survival rate was respectively 85.71% (IQR: 69.21% - 100.00%), 68.57% (IQR: 42.11% - 100.00%), 68.57% (IQR: 42.11% - 100.00%) respectively. In eyelid tumors, madarosis and eyelid abnormalities are the main side effects, while in OSSNs, dry eye symptoms are frequently reported. Conclusion: Postoperative HDR-IRT has been effective in advanced eyelid cancers control. More challenging appears instead an effective treatment of advanced OSSNs, particularly conjunctival melanomas. Multicenter studies are needed to get a larger patient sample and to evaluate different radiotherapy dosages by different histologic and T types of tumors
Exclusive Ru-106 brachytherapy for the management of a recurrent corneo: Conjunctival squamous cell carcinoma
Full text linkBACKGROUND: We report a case of personalized exclusive brachytherapy treatment for the management of a highly recurrent squamous cell conjunctival carcinoma with corneal invasion. CASE DESCRIPTION: This is a case of a Caucasian 81-years-old man who presented 10 years ago to our clinic with a pink-white para-limbal mass with dilated feeder arteries and mild leukoplakia. Excisional biopsy confirmed the presence of conjunctival intraepithelial neoplasia (CIN). Successively, he underwent two 4-weeks cycles of Mytomicin C topical therapy and a second excisional surgery, due to several recurrences of the lesion. At the last relapse, the pink-white peri-limbic mass which invaded the corneal limbus, determining corneal opacification from 5- to 7-clock hours, was confirmed by anterior segment optical coherence tomography (AS-OCT). Due to resistance to MMC therapy and chronic epitheliopathy, an AS-OCT guided exclusive radiotherapy plan was set: a Rhutenium-106 CCD plaque was applied directly over the afflicted corneal surface, the corneal limbus and the neighboring sclera for 24 hours. The remission of both conjunctival and corneal malignancy was complete 2 months after surgery and no signs of recurrence were highlighted at AS-OCT analysis at the 2-year follow up. CONCLUSION: Brachytherapy treatment showed optimal management of both corneal and conjunctival involvement, with a free-of-disease follow-up of 24-months. This result suggests that, in specific conditions, Ru-106 brachytherapy could be an effective option of treatment even if not associated with surgical excision
Artificial intelligence with ChatGPT 4: a large language model in support of ocular oncology cases
No full textPurpose: To evaluate ChatGPT’s ability to analyze comprehensive case descriptions of patients with uveal melanoma and provide recommendations for the most appropriate management. Design: Retrospective analysis of ocular oncology patients’ medical records. Subjects. Forty patients treated for uveal melanoma between May 2019 and October 2023. Methods: We uploaded each case description into the ChatGPT interface (version 4.0) and asked the model to provide realistic treatment options by asking the question, “What type of treatment do you recommend?” The accuracy of decisions produced by ChatGPT was compared to those recorded in patients’ files and the treatment recommendations provided by three ocular oncologists, each with more than 10 years of experience. Main outcome measures. The primary objective of this research was to assess the accuracy of ChatGPT replies in ocular oncology cases, analyzing its competence in both straightforward and intricate situations. Our secondary purpose was to assess the concordance between the responses of ChatGPT and those of ocular oncology specialists when faced with analogous clinical scenarios. Results: ChatGPT’s surgical choices matched those in patients’ files in 55% of cases (22 out of 40). ChatGPT options were agreed upon by 50%, 55%, and 57% of the three ocular oncology specialists. The investigation revealed significant differences between ChatGPT’s responses and those of the three cancer specialists when compared to patients’ files (p = 0.003, p = 0.001, and p = 0.001). ChatGPT’s surgical responses matched with patient data in 18 out of 24 cases (75%), excluding enucleation cases. The decisions matched with the three ocular oncology specialists in 17/24, 18/24, and 18/24 cases, reflecting agreements of 70%, 75%, and 75%, respectively. The decisions made by ChatGPT were not significantly different from those of the three professionals in this cohort (p = 0.50, p = 0.36, and p = 0.36 for ChatGPT compared to specialists 1, 2, and 3). Conclusion: ChatGPT exhibited a level of proficiency that was comparable to that of trained ocular oncology specialists. However, it exhibited its limitations when evaluating more complex scenarios, such as extrascleral extension or infiltration of the optic nerve, when a comprehensive evaluation of the patient is therefore necessary
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