Canadian journal of ophthalmology. Journal canadien d'ophtalmologie最新文献

Objective: To determine the risk factors for subsequent intraocular lens (IOL) surgery among eyes undergoing either combined or sequential phacovitrectomy.

Design: Retrospective cohort study.

Participants: Adult patients undergoing phacoemulsification at 8 United Kingdom National Health Service clinical centers between July 2003 and March 2015. Patients undergoing surgery for a dropped nucleus fragment, glaucoma, or iris problems were excluded.

Methods: The eyes were categorized into 3 groups: with previous vitrectomy, undergoing combined phacovitrectomy, and with both previous vitrectomy and current combined phacovitrectomy. These groups were compared based on preoperative ocular and systemic factors, intraoperative findings, and the subsequent need for a second IOL surgery. The Poisson model was used to calculate adjusted relative risks (aRR).

Results: 5,215 eyes were included: 2,124 with previous vitrectomy, 2,512 with combined phacovitrectomy, and 579 eyes with previous vitrectomy and currently combined phacovitrectomy. The risk of subsequent IOL surgery was 0.6% (reference group) in eyes with previous vitrectomy, 1.6% (aRR 2.6, CI: 1.4-5.1) in eyes with current combined phacovitrectomy, and 3.3% (aRR 3.8, CI: 1.7-8.3) in eyes with previous plus current combined phacovitrectomy. Other significant risk factors were age (aRR 0.98/year), pseudoexfoliation (aRR 6.76, CI: 2-28), zonular dialysis (aRR 10.6, CI: 4.8-24), scleral buckle in the current surgery (aRR 8.05, CI: 4-14), and the use of silicone oil (aRR 3.6, CI: 1.6-8.4) compared to no tamponade.

Conclusions: Combined phacovitrectomy was associated with a higher risk of IOL complications than sequential surgery. This information is useful for planning surgery in patients requiring both cataract and retinal surgeries.

Objective: To investigate the clinical and prognostic features of uveal metastasis in a Chinese population and compare these features across different primary cancers.

Design: Retrospective cross-sectional study.

Participants: 161 patients with uveal metastasis at Beijing Tongren Hospital.

Methods: Clinical characteristics of the primary tumour and uveal metastasis, treatments and outcomes were reviewed. Tumor regression was assessed using B-scan ultrasonography to measure changes in tumor height.

Results: Among 161 patients, 185 eyes had uveal metastasis. Lung cancer was the most common primary tumour (49.4%), followed by breast cancer (22.4%), kidney cancer (4.3%). Uveal metastasis was the initial cancer manifestation in 39 patients (24.2%). Unilateral involvement was predominant (86.3%), with the choroid being the most common site (91%). Compared with lung cancer and other cancers, breast carcinoma patients developed uveal metastasis at a younger age (p < 0.001), had a longer interval to uveal metastasis diagnosis (0.67, 4.19, and 6.27 years, p < 0.0001), were prone to be bilateral (11.1%, 9.1%, and 27.8%; p < 0.05) and exhibited lower tumour height (4.47 ± 2.49 mm and 4.88 ± 3.01 mm, 3.09 ± 2.46 mm; p < 0.01). Local treatments (133 eyes) included plaque radiotherapy (PRT, brachytherapy), transpupillary thermotherapy (TTT), anti-VEGF and enucleation. The tumour regression correlated with increased tumor height (r = 0.5699; p < 0.05) in eyes treated with PRT (n = 15). Despite effective local tumour control, the 1-year, 3-year, and 5-year survival rates were 72.61%, 31.82%, and 19.84%, respectively (n = 103). Among the 54 deceased patients, 27 (50%) died within one year following the diagnosis of uveal metastasis. The mean survival was 18.84 months. Extraocular metastasis correlated with shorter survival (p < 0.05).

Conclusion: This study provides a comprehensive analysis of uveal metastasis in Chinese patients, highlighting the distinct characteristics from various primaries. Although survival rates remain uncertain, local therapies were effective at achieving ocular tumor control, which aligns with the expectations for patients battling metastatic cancers.

Objectives: Aim to develop a nomogram to effectively predict the potential for recurrence after surgical resection in patients with periocular basal cell carcinoma (BCC).

Methods: We conducted a retrospective study involving 329 patients with eyelid BCC. Univariate and multivariate Cox proportional risk regression was used to screen for independent factors affecting BCC recurrence. Kaplan-Meier survival curve analysis was performed to evaluate their impact on prognosis. On the basis of the results obtained from Cox regression analysis, a nomogram was established for the 1-, 2-, and 3-year recurrence-free survival (RFS) rates of BCC.

Results: In this study, a total of 15 patients out of 329 patients (4.6%) developed local recurrence. Multivariate analysis revealed that age, pathological type, previous history of BCC, and the number of surgeries were independent risk factors for BCC recurrence (p < 0.05, respectively). These risk factors were utilized to construct a nomogram to predict postoperative recurrence for these patients. The C-index of the nomogram was 0.867 (95% CI: 0.817-0.916), and the receiver operating characteristic curves were used to assess the discriminatory degree of the nomogram, with area under the curve values of 0.978, 0.870, and 0.916 at 1, 2, and 3 years, respectively. The calibration curves were basically fitted to the ideal curves.

Conclusions: Age, pathological type, previous history of BCC, and the number of surgeries are significant risk factors for periocular BCC recurrence. Establishing a nomogram related to recurrence risk factors can more accurately predict the recurrence-free survival of individual patients.