Positron emission tomography has a high negative predictive value for progression or early relapse for patients with residual disease after first-line chemotherapy in advanced-stage Hodgkin lymphoma

In the HD15 trial of the German Hodgkin Study Group, the negative predictive value (NPV) of positron emission tomography (PET) using [(18)F]-fluorodeoxyglucose in advanced-stage Hodgkin lymphoma (HL) was evaluated. A total of 817 patients were enrolled and randomly assigned to receive BEACOPP-based chemotherapy. After completion of chemotherapy, residual disease measuring more than or equal to 2.5 cm in diameter was assessed by PET in 311 patients. The NPV of PET was defined as the proportion of PET(-) patients without progression, relapse, or irradiation within 12 months after PET review panel. The progression-free survival was 96% for PET(-) patients (95% confidence interval [CI], 94%-99%) and 86% for PET(+) patients (95% CI, 78%-95%, P = .011). The NPV for PET in this analysis was 94% (95% CI, 91%-97%). Thus, consolidation radiotherapy can be omitted in PET(-) patients with residual disease without increasing the risk for progression or early relapse compared with patients in complete remission. The impact of this finding on the overall survival at 5 years must be awaited. Until then, response adapted therapy guided by PET for HL patients seems to be a promising approach that should be further evaluated in clinical trials. This trial is registered at http://isrctn.org study as #ISRCTN32443041.     

Neodymium:YAG laser capsulotomy in vitrectomized pseudophakic eyes with persistent endotamponade

PURPOSE: To evaluate the feasibility and limits of neodymium:YAG (Nd:YAG) laser capsulotomy in eyes with persistent endotamponade. SETTING: Department of Ophthalmology, University Cologne, Cologne, Germany. METHODS: In this consecutive series, an Nd:YAG laser capsulotomy was performed by 1 surgeon in 6 eyes with posterior capsule opacification (PCO) and persistent endotamponade caused by proliferative vitreoretinopathy. The endotamponade was with silicone oil (5000 centistokes) in 5 eyes and with perfluorohexyloctane (F(6)H(8)) in 1 eye. Also evaluated were 6 vitrectomized eyes without endotamponade that had an Nd:YAG laser capsulotomy for PCO by the same surgeon. All 12 eyes were pseudophakic. The mean follow-up after capsulotomy was approximately 6 months (range 2 to 12 months). Follow-up examinations included visual acuity, intraocular pressure measurement, and IOL centration and capsule reopacification evaluation. RESULTS: The total energy required was higher in eyes with persistent endotamponade. In 3 of these eyes, the laser capsulotomy could not be successfully completed and was surgically enhanced. The laser capsulotomy in eyes without endotamponade was successful in all cases. Complete reopacification occurred in 2 eyes with persistent endotamponade within 2 months and in no eye without endotamponade. Improvement in visual acuity was limited in all eyes because of retinal pathology. CONCLUSIONS: Neodymium:YAG laser capsulotomy in pseudophakic eyes with persistent endotamponade was successful but had a relatively high reintervention rate. The visual prognosis was limited in all cases because of retinal pathology.     

Is canaloplasty with mitomycin c a safe procedure in myopic glaucoma?

Graefe's Archive for Clinical and Experimental Ophthalmology - Myopic glaucoma patients display a considerable risk of complications following antiglaucomatous filtering surgery, e.g.,...     

PROLARA: prognosis-based lifetime attributable risk approximation for cancer from diagnostic radiation exposure

Purpose  

To evaluate the impact of the reduced life expectancy of patients (compared to a nonpatient group with the same age distribution) on their nominal risk of developing cancer from the diagnostic use of radiation.     

Epithelimplantationszysten – 48 Jahre nach Bulbuspenetration

Background

Epithelial invasion is a rare but severe complication after penetrating eye trauma or intraocular surgery. Cystic ingrowth can occur even after decades.

Casuistics

A 53-year-old woman developed two epithelial cysts in the left eye 48 years after penetrating trauma with a dart. After primary wound closure the intraocular status remained stable for 48 years before symptoms appeared. Preoperative diagnostics (e.g. ultrasound biomicroscopy) detected the origin of the epithelial downgrowth from an intracorneal cyst. Histology confirmed the clinical suspicion of a cystic epithelial ingrowth.

Conclusion

The latency of our case is the longest reported interval between penetrating eye trauma and appearance of epithelial ingrowth to be described in detail. Ultrasound biomicroscopy is able to detect the origin of epithelial ingrowth.     

Quantifizierung der subjektiven visuellen Lebensqualit?t bei Glaukompatienten

Background

There is an increasing interest in assessing the quality of life as an additional guide for therapeutic choices, especially in patients with chronic diseases, e.g. glaucoma. Most standardized questionnaires are available in English making them inapplicable for daily use in non-English-speaking environments. The ??Glaucoma Quality of Life 15 Questionnaire?? (GQL-15) is a test designed for glaucoma patients in English and was translated into German in order to analyze its practicability in a daily clinical setting.

Patients and methods

The GQL-15 was handed out to glaucoma patients during the hospital stay. The questionnaires were analyzed retrospectively and correlated to clinical indices, such as age, visual acuity, visual field, parametric mean deviation (MD) and frequency of pharmacologic treatment.

Results

A total of 31 patients were evaluated. It could be demonstrated that the quality of life summary scores correlated with visual field loss. Evaluation of subscale scores of visual function revealed that glare and dark adaptation were correlated with glaucoma severity especially in the early stages of the disease.

Conclusions

The German translation of the GQL-15 was well accepted by glaucoma patients. In our analysis disability of vision-related activities as expressed in the translated GQL-15 correlated with glaucoma severity. This first use of the translated GQL-15 encourages further studies in German glaucoma patients and their quality of life.     

Panik nach LASIK

We report a case of acute myopic recurrence in a 38-year-old patient in a state of panic with a condition corresponding to LASIK 4 months earlier. The patient had commenced topiramate treatment 1 week previously, which is an antiepileptic drug also approved for migraine treatment. The symptoms were due to a rare topiramate-induced side effect (SE) with ciliochoroidal effusion, anterior shift of the lens-iris diaphragm and induced myopia. Cessation of topiramate led to complete remission of this idiosyncratic reaction, however, the patient's anxiety was impressive. Ocular administration of Topiramat-SE should thus be clarified.     

A new rebound tonometer for home monitoring of intraocular pressure

Background  

To compare intraocular pressure (IOP) measurements obtained by the Icare ONE rebound tonometer (RTONE) and the Goldmann applanation tonometer (GAT) in healthy persons and glaucoma patients in a prospective study, and to investigate the influence of central corneal thickness (CCT).