Pub Date : 2020-01-01DOI: 10.35248/2155-9570.20.11.859
James F. Young, K. Harron, Loreena Bilal, Jay Richardson, F. Dhawahir-Scala
Aim: This study assesses the impact of the UK COVID-19 lockdown on Ophthalmology Emergency Services at one of the largest dedicated Emergency Eye Departments in the UK. Methods: We evaluated differences in attendances between 2019 and 2020 according to ethnicity, deprivation scores, age, clinician grade, diagnosis, discharge rate and follow up length. Results: The mean number of attendances started to drop on the 17th March 2020. The mean number of attendances before versus after 17th March decreased by a factor of 2.2 with a 95% (CR) of (2.1,2.3); from 72 (95%CR 70,75) per day to 33 (95%CR 31,35). Attendance rates to the Emergency Eye Department during a 9-week period of lockdown dropped by 51% (95%CI 47-52%) compared with the same period in 2019 and 48% (95% CI50-54%) compared with 2018. There was no significant difference in patient age, ethnicity or index of deprivation quintile between 2019 and 2020. There was a 61% drop (95% CI 48-70%) in the number of eye emergencies presenting in the second week of lockdown (30/04/2020–05/04/2020) compared to the corresponding period in 2019. Community eye emergencies dropped by 74% (95%CI 64-80%) and non-eye emergencies dropped by 64% (95%CI 47-75%). Conclusion: Government measures to reduce the transmission of COVID-19 have had a significant impact on the attendance of patients to our Emergency Eye Department. Severe blinding conditions are not presenting as frequently. This raises the concern that once the restrictions of COVID-19 are fully lifted some patients might start to present with potentially incurable chronic ocular conditions with devastating secondary complications.
目的:本研究评估了英国COVID-19封锁对英国最大的专门眼科急诊部门之一的眼科急诊服务的影响。方法:我们根据种族、剥夺评分、年龄、临床医生分级、诊断、出院率和随访时间评估2019年至2020年的就诊差异。结果:2020年3月17日，平均出勤率开始下降。3月17日之前和之后的平均出席人数减少了2.2倍，95% (CR)为(2.1,2.3);从每天72 (95%CR 70,75)到33 (95%CR 31,35)。在为期9周的封锁期间，急诊眼科的就诊率与2019年同期相比下降了51% (95% ci 47-52%)，与2018年相比下降了48% (95% CI50-54%)。2019年和2020年之间，患者年龄、种族或剥夺指数五分位数没有显著差异。与2019年同期相比，封锁第二周(2020年4月30日至2020年4月5日)出现的眼部紧急情况数量下降了61% (95% CI 48-70%)。社区眼科急诊下降了74% (95%CI 64-80%)，非眼科急诊下降了64% (95%CI 47-75%)。结论:政府减少COVID-19传播的措施对急诊眼科患者的就诊率产生了重大影响。严重的致盲情况并不常见。这引发了人们的担忧，即一旦COVID-19的限制完全解除，一些患者可能会开始出现可能无法治愈的慢性眼部疾病，并伴有破坏性的继发性并发症。
{"title":"The Effect of Lockdown due to COVID-19 on a Large Emergency Eye Department: The Manchester Experience","authors":"James F. Young, K. Harron, Loreena Bilal, Jay Richardson, F. Dhawahir-Scala","doi":"10.35248/2155-9570.20.11.859","DOIUrl":"https://doi.org/10.35248/2155-9570.20.11.859","url":null,"abstract":"Aim: This study assesses the impact of the UK COVID-19 lockdown on Ophthalmology Emergency Services at one of the largest dedicated Emergency Eye Departments in the UK. Methods: We evaluated differences in attendances between 2019 and 2020 according to ethnicity, deprivation scores, age, clinician grade, diagnosis, discharge rate and follow up length. Results: The mean number of attendances started to drop on the 17th March 2020. The mean number of attendances before versus after 17th March decreased by a factor of 2.2 with a 95% (CR) of (2.1,2.3); from 72 (95%CR 70,75) per day to 33 (95%CR 31,35). Attendance rates to the Emergency Eye Department during a 9-week period of lockdown dropped by 51% (95%CI 47-52%) compared with the same period in 2019 and 48% (95% CI50-54%) compared with 2018. There was no significant difference in patient age, ethnicity or index of deprivation quintile between 2019 and 2020. There was a 61% drop (95% CI 48-70%) in the number of eye emergencies presenting in the second week of lockdown (30/04/2020–05/04/2020) compared to the corresponding period in 2019. Community eye emergencies dropped by 74% (95%CI 64-80%) and non-eye emergencies dropped by 64% (95%CI 47-75%). Conclusion: Government measures to reduce the transmission of COVID-19 have had a significant impact on the attendance of patients to our Emergency Eye Department. Severe blinding conditions are not presenting as frequently. This raises the concern that once the restrictions of COVID-19 are fully lifted some patients might start to present with potentially incurable chronic ocular conditions with devastating secondary complications.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"15 4","pages":"5-5"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91421069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.35248/2155-9570.20.11.826
A. K. Toft-Kehler, Jeppe Vibæk, M. Kolko, G. Gazzard
Objective: Glaucoma is characterized by a progressive degeneration of retinal ganglion cells (RGC) and their axons leading to painless damage of the visual field and finally blindness. The exact pathophysiology of RGC loss remains unknown. Alterations in the microbiome may be linked to neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases, possibly due to associated chronic low-grade inflammation. A recent study linked alterations in the oral microbiome and glaucoma. Methods: We investigated the microbiome of salivary and fecal samples in patients with normal tension glaucoma (10), ocular hypertension (11) and controls (11) using a case-control design with 16S rDNA sequencing. Results: For controls, but not the patient groups, salivary and fecal microbiome diversity was correlated in a given patient, suggesting an uncoupled saliva and fecal microbiome in the diseased groups. Such findings suggest that normal tension glaucoma (NTG) and ocular hypertension (OHT) might have similar characteristics. However, ocular hypertension patients seem to be resistant to neurodegenerative disease progression indicating that the uncoupled microbiome might affect characteristics linking ocular hypertension and normal tension glaucoma together. Moreover, we found the salivary microbiome to contain more differential taxa-level abundances of microorganisms suggesting the salivary microbiome might be advantageous to use in future studies investigating novel biomarkers in ophthalmic neurodegenerative diseases. Conclusion: The finding of an uncoupled microbiome might indicate comparable characteristics among glaucoma patients and ocular hypertension patients.
{"title":"Investigation of the Association between the Oral and the Gut Microbiome inGlaucoma","authors":"A. K. Toft-Kehler, Jeppe Vibæk, M. Kolko, G. Gazzard","doi":"10.35248/2155-9570.20.11.826","DOIUrl":"https://doi.org/10.35248/2155-9570.20.11.826","url":null,"abstract":"Objective: Glaucoma is characterized by a progressive degeneration of retinal ganglion cells (RGC) and their axons leading to painless damage of the visual field and finally blindness. The exact pathophysiology of RGC loss remains unknown. Alterations in the microbiome may be linked to neurodegenerative conditions such as Alzheimer’s and Parkinson’s diseases, possibly due to associated chronic low-grade inflammation. A recent study linked alterations in the oral microbiome and glaucoma. Methods: We investigated the microbiome of salivary and fecal samples in patients with normal tension glaucoma (10), ocular hypertension (11) and controls (11) using a case-control design with 16S rDNA sequencing. Results: For controls, but not the patient groups, salivary and fecal microbiome diversity was correlated in a given patient, suggesting an uncoupled saliva and fecal microbiome in the diseased groups. Such findings suggest that normal tension glaucoma (NTG) and ocular hypertension (OHT) might have similar characteristics. However, ocular hypertension patients seem to be resistant to neurodegenerative disease progression indicating that the uncoupled microbiome might affect characteristics linking ocular hypertension and normal tension glaucoma together. Moreover, we found the salivary microbiome to contain more differential taxa-level abundances of microorganisms suggesting the salivary microbiome might be advantageous to use in future studies investigating novel biomarkers in ophthalmic neurodegenerative diseases. Conclusion: The finding of an uncoupled microbiome might indicate comparable characteristics among glaucoma patients and ocular hypertension patients.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"24 1","pages":"1-8"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90802511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-01DOI: 10.35248/2155-9570.20.11.852
C. Roșca
A 57-year-old male patient operated 5 years before for cataract, arrives in our emergency service complaining of sudden decrease of the visual acuity of the left eye. Slit lamp examination reveals aphakia, iridodonesis and nonreflective semi-mydriatic pupil. Volk ® lens examination of the fundus shows dislocation of the entire bag-IOL complex into the vitreous. Our approach was: pars plana posterior vitrectomy, IOL-capsular bag complex extraction and implantation of an iris-claw artificial IOL with good anatomical and functional results. Iris-Claw artificial IOL’s are in the authors’ opinion a good and less invasive method for treating afakia of any cause.
{"title":"Retro Pupillary Iris-Claw IOL the Treatment for Traumatic IOL Capsular Bag Complex Dislocation","authors":"C. Roșca","doi":"10.35248/2155-9570.20.11.852","DOIUrl":"https://doi.org/10.35248/2155-9570.20.11.852","url":null,"abstract":"A 57-year-old male patient operated 5 years before for cataract, arrives in our emergency service complaining of sudden decrease of the visual acuity of the left eye. Slit lamp examination reveals aphakia, iridodonesis and nonreflective semi-mydriatic pupil. Volk ® lens examination of the fundus shows dislocation of the entire bag-IOL complex into the vitreous. Our approach was: pars plana posterior vitrectomy, IOL-capsular bag complex extraction and implantation of an iris-claw artificial IOL with good anatomical and functional results. Iris-Claw artificial IOL’s are in the authors’ opinion a good and less invasive method for treating afakia of any cause.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"8 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89943193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
1Undergraduate Student of Medicine, UnP Potiguar University, Laureate International Universities, Natal, Brazil 2Postgraduate Program in Biotechnology at Potiguar University/ UnP Laureate International Universities, Natal, Brazil. Ph.D. Health Science, Natal, RN, Brazil 3Postgraduate Program in Biotechnology, Potiguar University/ UnP Laureate International Universities, Full Professor Department of Surgery, Federal University of Rio Grande do Norte. Full Professor, Department of Surgery, Potiguar University, Ph.D, Health Science, Natal, RN, Brazil More Information
{"title":"Dry eye syndrome: Therapeutic challenges and future trends","authors":"Araújo-Neto Irami, Rêgo Amália Cinhtia Meneses, Araújo-Filho* Irami","doi":"10.29328/journal.ijceo.1001023","DOIUrl":"https://doi.org/10.29328/journal.ijceo.1001023","url":null,"abstract":"1Undergraduate Student of Medicine, UnP Potiguar University, Laureate International Universities, Natal, Brazil 2Postgraduate Program in Biotechnology at Potiguar University/ UnP Laureate International Universities, Natal, Brazil. Ph.D. Health Science, Natal, RN, Brazil 3Postgraduate Program in Biotechnology, Potiguar University/ UnP Laureate International Universities, Full Professor Department of Surgery, Federal University of Rio Grande do Norte. Full Professor, Department of Surgery, Potiguar University, Ph.D, Health Science, Natal, RN, Brazil More Information","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"103 1","pages":"030-034"},"PeriodicalIF":0.0,"publicationDate":"2019-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79084386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jina V Han, Dipika V. Patel, Kevin Liu, Bia Z. Kim, T. Sherwin, C. McGhee
Reduction of intraoperative complications in phacoemulsification cataract surgery.
白内障超声乳化手术术中并发症的减少。
{"title":"Auckland Cataract Study IV: Practical application of NZCRS cataract risk stratification to reduce phacoemulsification complications","authors":"Jina V Han, Dipika V. Patel, Kevin Liu, Bia Z. Kim, T. Sherwin, C. McGhee","doi":"10.1111/ceo.13696","DOIUrl":"https://doi.org/10.1111/ceo.13696","url":null,"abstract":"Reduction of intraoperative complications in phacoemulsification cataract surgery.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"29 1","pages":"311 - 318"},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85219995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
argued that even when severe, they cause very few person-years of morbidity if implanted in elderly patients. Multifocal lenses, however, are frequently implanted in middle-aged people, when the longer time in situ may result in more severe and significant grades of glistenings. Sometimes laser assisted enhancement is required in order to achieve optimal refractive outcome. This puts patients at risk of dry eye which will exacerbate the optical aberrations of a multifocal IOL if glistenings occur. Surgeons may reflect on the life expectancy of patients receiving these lenses as well as the increasing prevalence of dry eye with age. Non-chromophore lenses may be a prudent choice for young patients, particularly given the apparent absence of benefit found in recent major reviews. In the presence of severe glistenings, IOL exchange should be considered before a posterior capsulotomy is performed.
{"title":"Cardiovascular effects and safety of mannitol in treating raised intraocular pressure","authors":"Alp Atik, Elsie Chan, C. Crock, G. S. Ang","doi":"10.1111/ceo.13695","DOIUrl":"https://doi.org/10.1111/ceo.13695","url":null,"abstract":"argued that even when severe, they cause very few person-years of morbidity if implanted in elderly patients. Multifocal lenses, however, are frequently implanted in middle-aged people, when the longer time in situ may result in more severe and significant grades of glistenings. Sometimes laser assisted enhancement is required in order to achieve optimal refractive outcome. This puts patients at risk of dry eye which will exacerbate the optical aberrations of a multifocal IOL if glistenings occur. Surgeons may reflect on the life expectancy of patients receiving these lenses as well as the increasing prevalence of dry eye with age. Non-chromophore lenses may be a prudent choice for young patients, particularly given the apparent absence of benefit found in recent major reviews. In the presence of severe glistenings, IOL exchange should be considered before a posterior capsulotomy is performed.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"83 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82945436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Rowland, Graham A. Lee, Shabbir Mohamed, P. Shah
1. Ramenaden ER, Raiji VR. Clinical characteristics and visual outcomes in infectious scleritis: a review. Clin Ophthalmol. 2013;7: 2113-2122. 2. Oguz H, Sobaci G. The use of hyperbaric oxygen therapy in ophthalmology. Surv Ophthalmol. 2008;53(2):112-120. 3. Locher DH, Adesina A, Wolf TC, Imes CB, Chodosh J. Postoperative Rhizopus scleritis in a diabetic man. J Cataract Refract Surg. 1998;24(4):562-565. 4. Chong R, Ayer CJ, Francis IC, Coroneo MT, Wolfers DL. Adjunctive hyperbaric oxygen in pseudomonas keratitis. Br J Ophthalmol. 2007;91(4):560-561. 5. Bayer A, Mutlu FM, Sobaci G. Hyperbaric oxygen therapy for mitomycin C-induced scleral necrosis. Ophthalmic Surg Lasers. 2002;33(1):58-61.
1. Ramenaden ER, Raiji VR。传染性巩膜炎的临床特点和视觉效果:综述。中华眼科杂志，2013;7:2113-2122。2. 王志强，王志强。高压氧治疗在眼科中的应用。中华眼科杂志，2008;33(2):112-120。3.Locher DH, Adesina A, Wolf TC, Imes CB, Chodosh J.糖尿病患者术后根霉性巩膜炎1例。[J]中华白内障杂志，1998;24(4):562-565。4. Chong R, Ayer CJ, Francis IC, Coroneo MT, Wolfers DL。假单胞菌性角膜炎的辅助高压氧治疗。中华眼科杂志，2007;31(4):556 -561。5. 张建军，张建军，张建军，等。高压氧治疗丝裂霉素所致巩膜坏死的临床观察。眼科激光手术。2002;33(1):58-61。
{"title":"Progressive intraluminal stent migration into the anterior chamber","authors":"C. Rowland, Graham A. Lee, Shabbir Mohamed, P. Shah","doi":"10.1111/ceo.13692","DOIUrl":"https://doi.org/10.1111/ceo.13692","url":null,"abstract":"1. Ramenaden ER, Raiji VR. Clinical characteristics and visual outcomes in infectious scleritis: a review. Clin Ophthalmol. 2013;7: 2113-2122. 2. Oguz H, Sobaci G. The use of hyperbaric oxygen therapy in ophthalmology. Surv Ophthalmol. 2008;53(2):112-120. 3. Locher DH, Adesina A, Wolf TC, Imes CB, Chodosh J. Postoperative Rhizopus scleritis in a diabetic man. J Cataract Refract Surg. 1998;24(4):562-565. 4. Chong R, Ayer CJ, Francis IC, Coroneo MT, Wolfers DL. Adjunctive hyperbaric oxygen in pseudomonas keratitis. Br J Ophthalmol. 2007;91(4):560-561. 5. Bayer A, Mutlu FM, Sobaci G. Hyperbaric oxygen therapy for mitomycin C-induced scleral necrosis. Ophthalmic Surg Lasers. 2002;33(1):58-61.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"39 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86210781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hassan Hassan, R. Epstein, S. Cherepanoff, R. Conway
Conjunctival melanoma (CM) comprises 2% to 5% of all ocular tumours, and 5% to 7% of ocular melanomas. The annual incidence of CM is 0.2 to 0.8 per million amongst Caucasians, in which population the usual age range of presentation is 55 to 65 years. The standard of care for the initial management of localized CM is no-touch surgical excision with a minimum 2 to 4 mm margin. Locally advanced disease involving orbit invasion is more challenging to manage and has traditionally been regarded as an indication for radical curative-intent surgery (orbital exenteration). Here we report a case of locally advanced and recurrent CM that has been managed successfully for the last 3.5 years using systemic targeted therapy. A 53-year-old Caucasian male presented in January 2016 to the ocular oncology unit with a biopsy confirming locally advanced CM (AJCC stage T3B) of the right eye invading the anterior orbit and upper tarsal plate. The tumour had been excised in December 2015. Visual acuities were 6/7.5 and 6/6 in the right and left eye, respectively. Staging investigations including fluorodeoxyglucosepositron emission tomography scanning revealed no metastatic disease. Mutation testing (Ion Torrent Ampliseq Cancer Gene Panel v2.0) of formalin-fixed paraffin-embedded tissue confirmed a classical BRAF (V600E) mutation. During the multidisciplinary discussion, three aspects of the patient's own preferences were identified: first, ocular removal may affect his employment as a licensed occupational operator of heavy equipment; second, satisfactory binocular vision as an enthusiastic recreational cricket player; and third, importance of normal cosmesis for lifestyle reasons. On the other hand, it was explained to the patient that surgical exenteration could well represent the only plausible curative intervention. Against that reasoning, however, it was also conceded that even proceeding to exenteration would not guarantee a cure, since subsequent locoregional and/or metastatic recurrence remained a possibility. After informed discussion and consent, the patient was offered initial management using systemic therapy targeting V600E-mutant BRAF, consisting of dabrafenib and trametinib. Patient understood that the provisional plan would be for substitution of immunotherapy (eg, anti-PD1 plus ipilimumab) with the aim of achieving a further period of long-term control, albeit not necessarily a cure. The possibility of using initial immunotherapy was also discussed, though it was pointed out that a rapid initial tumour shrinkage might be more reliably achieved using mutation-targeting kinase inhibitors, and hence this approach was chosen. Fortunately, a complete clinical and radiologic remission of disease was evident by April 2016 (Figure 1A,B). From May 2016, the clinical course was complicated by drug-related fever and abnormal liver function tests, which was at first managed with a combination of treatment delay, dose reduction, and/or steroid cover. A small recurr
{"title":"Effective conservative management of locally advanced conjunctival melanoma using initial systemic therapy","authors":"Hassan Hassan, R. Epstein, S. Cherepanoff, R. Conway","doi":"10.1111/ceo.13691","DOIUrl":"https://doi.org/10.1111/ceo.13691","url":null,"abstract":"Conjunctival melanoma (CM) comprises 2% to 5% of all ocular tumours, and 5% to 7% of ocular melanomas. The annual incidence of CM is 0.2 to 0.8 per million amongst Caucasians, in which population the usual age range of presentation is 55 to 65 years. The standard of care for the initial management of localized CM is no-touch surgical excision with a minimum 2 to 4 mm margin. Locally advanced disease involving orbit invasion is more challenging to manage and has traditionally been regarded as an indication for radical curative-intent surgery (orbital exenteration). Here we report a case of locally advanced and recurrent CM that has been managed successfully for the last 3.5 years using systemic targeted therapy. A 53-year-old Caucasian male presented in January 2016 to the ocular oncology unit with a biopsy confirming locally advanced CM (AJCC stage T3B) of the right eye invading the anterior orbit and upper tarsal plate. The tumour had been excised in December 2015. Visual acuities were 6/7.5 and 6/6 in the right and left eye, respectively. Staging investigations including fluorodeoxyglucosepositron emission tomography scanning revealed no metastatic disease. Mutation testing (Ion Torrent Ampliseq Cancer Gene Panel v2.0) of formalin-fixed paraffin-embedded tissue confirmed a classical BRAF (V600E) mutation. During the multidisciplinary discussion, three aspects of the patient's own preferences were identified: first, ocular removal may affect his employment as a licensed occupational operator of heavy equipment; second, satisfactory binocular vision as an enthusiastic recreational cricket player; and third, importance of normal cosmesis for lifestyle reasons. On the other hand, it was explained to the patient that surgical exenteration could well represent the only plausible curative intervention. Against that reasoning, however, it was also conceded that even proceeding to exenteration would not guarantee a cure, since subsequent locoregional and/or metastatic recurrence remained a possibility. After informed discussion and consent, the patient was offered initial management using systemic therapy targeting V600E-mutant BRAF, consisting of dabrafenib and trametinib. Patient understood that the provisional plan would be for substitution of immunotherapy (eg, anti-PD1 plus ipilimumab) with the aim of achieving a further period of long-term control, albeit not necessarily a cure. The possibility of using initial immunotherapy was also discussed, though it was pointed out that a rapid initial tumour shrinkage might be more reliably achieved using mutation-targeting kinase inhibitors, and hence this approach was chosen. Fortunately, a complete clinical and radiologic remission of disease was evident by April 2016 (Figure 1A,B). From May 2016, the clinical course was complicated by drug-related fever and abnormal liver function tests, which was at first managed with a combination of treatment delay, dose reduction, and/or steroid cover. A small recurr","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"18 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90502700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
for advanced local and systemic conjunctival melanoma: a clinical case series. J Immunother Cancer. 2019;7(1):83. https://doi. org/10.1186/s40425-019-0555-7. 4. Lake SL, Jmor F, Dopierala J, Taktak AFG, Coupland SE, Damato BE. Multiplex ligation-dependent probe amplification of conjunctival melanoma reveals common BRAF V600E gene mutation and gene copy number changes. Invest Ophthalmol Vis Sci. 2011;52:5598. https://doi.org/10.1167/iovs.10-6934. 5. Griewank KG, Westekemper H, Murali R, et al. Conjunctival melanomas harbor BRAF and NRAS mutations and copy number changes similar to cutaneous and mucosal melanomas. Clin Cancer Res. 2013;19:3143-3152. https://doi.org/10.1158/1078-0432.CCR-130163.
{"title":"Novel use of adjunctive hyperbaric therapy for fungal scleritis","authors":"Harry Yip, Elsie Chan","doi":"10.1111/ceo.13689","DOIUrl":"https://doi.org/10.1111/ceo.13689","url":null,"abstract":"for advanced local and systemic conjunctival melanoma: a clinical case series. J Immunother Cancer. 2019;7(1):83. https://doi. org/10.1186/s40425-019-0555-7. 4. Lake SL, Jmor F, Dopierala J, Taktak AFG, Coupland SE, Damato BE. Multiplex ligation-dependent probe amplification of conjunctival melanoma reveals common BRAF V600E gene mutation and gene copy number changes. Invest Ophthalmol Vis Sci. 2011;52:5598. https://doi.org/10.1167/iovs.10-6934. 5. Griewank KG, Westekemper H, Murali R, et al. Conjunctival melanomas harbor BRAF and NRAS mutations and copy number changes similar to cutaneous and mucosal melanomas. Clin Cancer Res. 2013;19:3143-3152. https://doi.org/10.1158/1078-0432.CCR-130163.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84680403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Familial exudative vitreoretinopathy (FEVR, OMIM 133780) is a severe hereditary retinal disease characterized by incomplete retinal vascular development and pathological neovascularization. It has been reported that variants in nine genes are associated with FEVR, but they can only explain approximately 50% of FEVR patients, suggesting that other FEVR‐associated variants or genes remain to be discovered.
{"title":"Identification of novel variants in the FZD4 gene associated with familial exudative vitreoretinopathy in Chinese families","authors":"Huijuan Xu, Shanshan Zhang, Lulin Huang, Peiquan Zhao, Xiang Zhang, Zhenglin Yang, Lin Zhang","doi":"10.1111/ceo.13690","DOIUrl":"https://doi.org/10.1111/ceo.13690","url":null,"abstract":"Familial exudative vitreoretinopathy (FEVR, OMIM 133780) is a severe hereditary retinal disease characterized by incomplete retinal vascular development and pathological neovascularization. It has been reported that variants in nine genes are associated with FEVR, but they can only explain approximately 50% of FEVR patients, suggesting that other FEVR‐associated variants or genes remain to be discovered.","PeriodicalId":15372,"journal":{"name":"Journal of Clinical & Experimental Ophthalmology","volume":"1967 1","pages":"356 - 365"},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91398227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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