Vitreous Seed Classification and Regression Patterns in Eyes With Retinoblastoma

2020 ◽  
pp. 247412642095198
Author(s):  
Pukhraj Rishi ◽  
Yamini Attiku ◽  
Pradeep T. Manchegowda ◽  
Ashutosh Agarwal ◽  
Minal Sharma
Keyword(s):  
Medical Records ◽  
Anterior Segment ◽  
Seed Morphology ◽  
Posterior Segment ◽  
Ocular Toxicity ◽  
Kaplan Meier ◽  
Regression Pattern ◽  
Free Status ◽  
Vitreous Seeds

Purpose: This work subclassifies retinoblastoma vitreous seeds and evaluates the efficacy, regression patterns, and adverse effects of combination intravitreal melphalan and topotecan chemotherapy for resistant and recurrent vitreous seeds. Methods: A retrospective review of medical records was conducted of patients with retinoblastoma and resistant or recurrent vitreous seeds who were treated with intravitreal melphalan and topotecan injections from August 2014 to July 2018. Main outcome measures included regression pattern, time for regression, time for recurrence of seeds, treatment outcomes, and ocular toxicity. Results: Nineteen eyes received 138 intravitreal injections over 74 treatment sessions (mean, 7.26 injections per eye); vitreous seeds regressed in 18 eyes. Of cloud vitreous seeds, curvilinear (n = 2) and sphero-linear (n = 2) subtypes were observed. During regression, some sphere seeds showed an intermediary streak-like pattern and took longer to regress (mean, 11.13 ± 14.05 months and 11.67 ± 8.62 injections) than those without the intermediary streak-like pattern (mean, 3.55 ± 2.57 months and 4.2 ± 1.87 injections). Mean follow-up was 34.87 ± 21.09 months (median, 35 months; range, 11-96 months). Anterior segment toxicity was seen in 10 (53%) eyes and posterior segment toxicity in 5 (26%) eyes. Kaplan-Meier survival estimates for globe salvage at 2 years was 94% and 73% at 5 years. Kaplan-Meier survival for vitreous seed–free status was 94% at 2 years and 65% at 5 years. Conclusions: An expanded vitreous seed classification system that further subcategorizes hitherto unrecognized vitreous seed morphology is needed. An intermediate streaking process results in a prolonged regression time for sphere vitreous seeds.

scholarly journals Complete reconstruction of anterior segment surgery for a patient with traumatic cataract and iris defects: a case report

2019 ◽  
Author(s):  
Zhenyu Wang ◽  
Xuemin Li
Keyword(s):  
Ocular Trauma ◽  
Anterior Segment ◽  
Posterior Segment ◽  
Traumatic Cataract ◽  
Case Presentation ◽  
Iris Defect ◽  
Uncorrected Visual Acuity ◽  
Posterior Synechia ◽  
Anterior Segment Surgery

Abstract Background: Ocular trauma has relationship with variable damage towards anterior segment or posterior segment. Among them, cornea, iris and lens are vulnerable to injury. For patients with traumatic cataract and other anterior segment trauma， complete reconstruction of anterior segment surgery can be a good option to restore patients’ anterior segment that helps them regain their vision. Case presentation: We presented a case of traumatic cataract with iris defects after explosive trauma. A surgery was done to fully reconstruct the anterior segment of the patient’s left eye including separating posterior synechia of iris, removing cataract and implantation of IOL. Postoperatively, the patient didn’t complain about photophobia anymore and the uncorrected visual acuity (UCVA) of the patient reached from counting fingers to 20/25 and remained stable on follow-up at 1 week and 1 month. Conclusion: Our case suggested the importance of completely reconstruct anterior segment for patients who have traumatic cataract with traumatic iris defects and its benefits for society. Keywords: Traumatic cataract; Traumatic iris defect; Surgery

scholarly journals Open-Globe Injury With Intraocular Foreign Body

2020 ◽  
pp. 247412642096503
Author(s):  
Filippos Vingopoulos ◽  
Yvonne Wang ◽  
Seanna Grob ◽  
Chloe Yang Ling Li ◽  
Dean Eliott ◽  
...  
Keyword(s):  
Foreign Body ◽  
Primary Repair ◽  
Anterior Segment ◽  
Case Series ◽  
Visual Outcome ◽  
Posterior Segment ◽  
Open Globe ◽  
Time From Injury

Purpose: To investigate characteristics of Open Globe Injuries (OGI) that presented with Intra-Ocular Foreign Body (IOFB), along with their long-term visual outcomes and complications. Methods: Retrospective interventional consecutive case series of OGIs with IOFBs that presented at Massachusetts Eye and Ear from 2010 to 2015. Data collected included time from injury to OGI repair, location of IOFB, retinal detachment (RD) rate, presenting and final visual acuity and subsequent surgeries. Results: Fifty-seven consecutive cases of OGIs with IOFBs were included. Mean follow-up was 28 months and median time from injury to OGI repair was 0 days. Overall, 38/57 (66.7%) eyes achieved final vision of 20/40 or better and 43/57 (75.4%) 20/150 or better. Thirty-three cases had IOFBs in the anterior segment only, 24 cases had posterior segment involvement. Thirty percent of cases (17/57) were complicated by an RD, 58.3% (14/24) in the posterior versus 9.1% (3/33) in the anterior IOFB group ( P = .01). There were no cases of endophthalmitis. Posterior IOFB and higher zone of injury were risk factors for RD both at presentation (both P < .001) and post-primary repair (both P < .001). Posterior IOFB was associated with higher vitrectomy rates both at presentation ( P < .001) and post-primary repair ( P = .002) and worse long-term visual outcome ( P = .01). Conclusions: OGIs with IOFB involving the posterior segment are associated with higher complication and re-operation rates and worse visual prognosis compared to those involving the anterior segment only.

Biopsy forceps disruption paired with bougie dilation of esophageal strictures lengthens time to repeat intervention

2020 ◽  
Author(s):  
Tricia Hengehold ◽  
Benjamin D Rogers ◽  
Farhan Quader ◽  
C Prakash Gyawali
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Care Center ◽  
Tertiary Care ◽  
Balloon Dilation ◽  
Biopsy Forceps ◽  
Kaplan Meier ◽  
Esophageal Strictures ◽  
Foregut Surgery

Summary Esophageal strictures commonly cause dysphagia and require treatment with endoscopic dilation using balloons or bougies. We aimed to determine whether biopsy forceps disruption of strictures at time of dilation increases time to repeat intervention or duration of intervention-free follow-up. We performed a retrospective analysis of 289 adults (age 61.0 ± 0.8 years, 66.4% female) who underwent dilation of an esophageal stricture at our tertiary care center between 2014 and 2016. Exclusions consisted of endoscopic intervention within the preceding 6 months, prior foregut neoplasia, achalasia, radiofrequency ablation, endoscopic mucosal resection, endoscopic submucosal dissection, or foregut surgery. Demographics, clinical presentation, dilation technique, and follow-up were abstracted from electronic medical records. We compared time to repeat dilation and duration of intervention-free follow-up between treatment subgroups. Balloon dilation was performed more often than bougie dilation (76.8 vs. 17.6%); biopsy forceps disruption was performed in 23.2%. Over a median follow-up of 52.9 months, 135 patients (46.7%) underwent repeat dilation. Age, body mass index, gender, and use of antisecretory medications did not influence need for repeat dilation (P = ns for each). Bougie dilation with biopsy forceps disruption prolonged time to repeat dilation in all patients (P ≤ 0.02), particularly in those with gastroesophageal reflux disease (P ≤ 0.03), compared with bougie dilation alone and balloon dilation with or without disruption. On Kaplan–Meier analysis, bougie dilation with biopsy forceps resulted in longer intervention-free follow-up compared with dilation alone (P = 0.03). We conclude that stricture disruption with biopsy forceps increases time to repeat intervention with bougie but not balloon dilation.

scholarly journals Cardiac Diagnostic Feature and Demographic Identification Models: A Futuristic Approach for Smart Healthcare Using Machine Learning

2021 ◽  
Author(s):  
Deepak Kumar ◽  
Chaman Verma ◽  
Sanjay Dahiya ◽  
Pradeep Kumar Singh ◽  
Maria Simona Raboaca
Keyword(s):  
Machine Learning ◽  
Medical Records ◽  
Supervised Machine Learning ◽  
Age Group ◽  
Heart Patients ◽  
Kaplan Meier ◽  
And Gender ◽  
Clinical Records ◽  
The Impact

Around the world, every year, about 17 million people death cause happen due to CardioVascular Diseases (CVD). As per clinical records, primarily sufferers exhibit myocardial infarctions and Heart Failures (HF). Creatinine is a Musculo - skeletal waste product. The kidneys filter creatinine from the blood and excrete it through the urine in a healthy body. High creatinine levels can suggest renal problems. Elevated Serum Creatinine (SC) has been well established in the HF. Patients&rsquo; electronic medical records can be used to quantify symptoms and other related clinical laboratory test values, which would then be utilized to direct biostatistics exploration to uncover patterns and associations that doctors would otherwise miss. The latest American Heart Association guidelines for 1500 mg/d sodium tend to be sufficiently relevant for patients with stage A and B with HF. In this article, we used a dataset of the year 2015 of heart patients records of 299 patients. The present paper used the data analytic and statistical tools to verify the significant differences between alive and dead patients&rsquo; SC and Serum Sodium (SS). It also demonstrates the impact of significant features on abnormal SC and SS on the Survival-Status levels. The Age-Group feature, which is derived from age attribute and, Ejection Fraction (EF), anemia, platelets, Creatinine Phosphokinase (CPK), Blood-Pressure (BP), gender, diabetes, and smoking-status were utilized to determine the potential contributing features to mortality with Cox regression model. The Kaplan Meier plot was used to investigate the overall pattern of survival concerning age-group. During pre-processing of the dataset, Age and SS were removed due to multicollinear features during performing machine learning algorithms experiments. This paper also predicted patients&rsquo; survival, age group, and gender using supervised machine learning classifiers. Detection of significant features would help in making informed decisions to balance the lifestyle of heart patients. The author revealed that the patient&rsquo;s follow-up months, as well as SC, EF, CPK, and platelets, are sufficient key features to predict heart patient survival using Random Forest (RF) stratified 10-fold CV method with accuracy (96%) with 5% Standard Deviation (SD) from medical records dataset. We identified the age-group and gender of the patient, and the RF model outperformed others with the best accuracy 96% and 94% in both cases having 11% SD. Also, prominent features such as CPK, SC, follow-up month, platelets, and ejection were found to be significant factors in predicting the patient&rsquo;s age-group. Smoking habits, CPK, platelets, follow-up month, and SC of each patient were discovered to be significant predictors of patient gender. The hypothetical study proved that SC and SS making substantial differences in the survival of patients (p &amp;lt; 0.05) and failed to reject that anemia, diabetes, and BP making a significant impact on the creatinine and sodium of each patient (p &amp;gt; 0.05). With &chi;2(1) = 8.565, the Kaplan Meier plot revealed that mortality was high in the extremely elder age-group. The finding has possible effects on clinical practice and becomes a new medical support system when predicting whether a patient can survive a heart attack or not. The doctor should primarily concentrate on follow-up month, SC and EF, CPK, and platelet count since the aim is to understand whether a patient survives after HF.

Clinical outcomes in ER+ HER2-negative breast cancer (BC) where treatment decisions incorporated the 21-gene recurrence score (RS): Elderly (≥70 yrs) vs younger patients (Pts).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 543-543
Author(s):  
Salomon M. Stemmer ◽  
Mariana Steiner ◽  
Shulamith Rizel ◽  
Noa Ben Baruch ◽  
Lior Soussan-Gutman ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Medical Records ◽  
Age Groups ◽  
Recurrence Score ◽  
The Elderly ◽  
Distant Recurrence ◽  
Median Tumor Size ◽  
Kaplan Meier ◽  
Significant Difference

543 Background: Elderly BC pts are generally undertreated, despite evidence suggesting that they may benefit from adjuvant chemotherapy (CT). We compared treatments/clinical outcomes in elderly vs younger Clalit Health Services (CHS) pts undergoing RS testing. Methods: This exploratory analysis of the CHS registry included BC pts with N0/N1mi/N1 disease who were RS-tested from 1/2006 (CHS approval of the test) through 12/2010 (N0) or 12/2011 (N1mi/N1). Medical records were reviewed to verify treatments/recurrences/survival. Results: The analysis included 458 elderly and 2052 younger pts, with a median (range) follow-up of 5.7 (0.9-9.6) and 6.1 (0.1-10.3) yrs, respectively. In the elderly/younger pts, median age was 73/58 yrs, 48%/52% had grade 2 tumors, median tumor size was 1.6/1.5 cm, 70%/72% were N0 and 30%/28% were N1mi/N1. RS distribution (<18, 18-30, ≥31) among elderly pts was 56%, 33%, and 11%, respectively, compared to 49%, 41%, and 10%, respectively, in younger pts. In pts with RS 18-30 and RS≥31, CT use was significantly lower in the elderly ( P<.001). Kaplan-Meier estimates for 5-yr distant recurrence and BC death risk are presented (Table). Conclusions: In elderly pts, the proportion of those with RS≥31 was very similar to younger pts; however, overall CT use was significantly lower. Within each RS group, there was no statistically significant difference in clinical outcomes between the age groups; though, numerically, in RS 18-30 pts, outcomes were worse in the elderly. In pts with RS<18, outcomes were excellent regardless of age and despite very low rates of CT use. [Table: see text]

Incidence of Adjacent Segment Disease Requiring Reoperation After Lumbar Laminectomy Without Fusion

Neurosurgery ◽  
2015 ◽  
Vol 78 (2) ◽  
pp. 192-199 ◽  
Author(s):  
Mohamad Bydon ◽  
Mohamed Macki ◽  
Rafael De la Garza-Ramos ◽  
Kelly McGovern ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Medical Records ◽  
Adjacent Segment Disease ◽  
Rank Test ◽  
Adjacent Segment ◽  
Spinal Disease ◽  
Radiographic Evidence ◽  
Log Rank Test ◽  
Kaplan Meier ◽  
Degenerative Spinal Disease

ABSTRACT BACKGROUND: Adjacent segment disease (ASD) has not been described after laminectomy without fusion. OBJECTIVE: To determine the incidence of ASD after a 1- or 2-level lumbar laminectomy. METHODS: We retrospectively reviewed medical records of all patients who underwent 1- or 2-level, bilateral lumbar laminectomy without fusion for degenerative spinal disease (all follow-up ≥1 year). ASD was defined as clinical and/or radiographic evidence of degenerative spinal disease that required reoperation at the level above or below the index laminectomy. RESULTS: Of the 398 patients, the incidence of ASD requiring reoperation was 10%. The 39 ASD cases were almost equally distributed at L2-L3 (31%), L3-L4 (26%), and L5-S1 (31%), and to a lesser extent at L4-L5 (15%) (P = .51). The ASD incidences of 10% and 9% were equivalent after a 1- and 2-level laminectomy, respectively (P = .76). Rostral ASD was statistically more common than caudal ASD after both the 1- (P &lt; .001) and 2- (P &lt; .001) level laminectomy. Of the 39 ASD cases, 95% required laminectomy, 26% discectomy, and 49% fusion. Average time to ASD was 4 years. After a Kaplan-Meier analysis, time to reoperation for ASD was equivalent among the 1- and 2-level laminectomy cohorts (log-rank test, P = .13). CONCLUSION: The cumulative incidence of ASD requiring reoperation was 10% over a mean of 4 years. Both the 1- and 2-level laminectomy cohorts experienced equivalent incidences and rates of ASD. Of the 39 operations for ASD, about half required a fusion.

Comparative effectiveness and persistence of TNFi and non-TNFi in juvenile idiopathic arthritis: a large pediatric rheumatology center in US

Rheumatology ◽  
2020 ◽  
Author(s):  
Xiaomeng Yue ◽  
Bin Huang ◽  
Ana L Hincapie ◽  
Patricia R Wigle ◽  
Yuxiang Li ◽  
...  
Keyword(s):  
Electronic Medical Records ◽  
Medical Records ◽  
Treatment Effectiveness ◽  
Biologic Treatment ◽  
Off Label ◽  
Kaplan Meier ◽  
Level Data ◽  
Necrosis Factor ◽  
Rheumatic Drug

Abstract Objective To evaluate the persistence and effectiveness of tumor necrosis factor inhibitors (TNFi) vs non-TNFi among newly diagnosed JIA patients after initiation of biologic disease-modifying anti-rheumatic drug (bDMARD). Methods Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009–2018, we identified JIA patients initiating TNFi and non-TNFi. Treatment effectiveness was assessed based on disease activity. Inverse probability of treatment weighting (IPTW) of propensity score was used to estimate the treatment effectiveness and Kaplan–Meier analysis were conducted to assess persistence. Results Of 667 JIA patients, most (92.0%) were prescribed one of the class of TNFi as their initial biologic treatment. Etanercept was the most frequently prescribed (67.1%) treatment, followed by adalimumab (27.5%). Only around 5% of patients were prescribed off-label bDMARDs as their first-course treatment; however, &gt;20% were prescribed off-label biologics as their second-course therapy. 7.3% of patients received four or more bDMARDs. The median persistence of the first-course bDMARD is 320 days, with TNFi being significantly longer than the non-TNFi (395 vs 320 days, p= 0.010). The cJADAS reduction was significant greater of TNFi users (6.6, 95% CI 5.7–7.5) compare to non-TNFi users (3.0, 95% CI 1.5–4.6, p&lt; 0.0001) at 6-month follow-up visit. Conclusion Persistence was significantly longer among patients initiating TNFi as their first biologic therapy than those receiving non-TNFi. Patients with TNF therapy had significant greater reduction of cJADAS at the 6-month follow-up visit compared with patient in non-TNF cohort.

scholarly journals Gamma Knife Radiosurgery for Tuberculum Sellae Meningiomas: A Series of 78 Consecutive Patients

2022 ◽  
Author(s):  
Yavuz Samanci ◽  
Gokce Deniz Ardor ◽  
Selcuk Peker
Keyword(s):  
Visual Acuity ◽  
Gamma Knife ◽  
Medical Records ◽  
Gamma Knife Radiosurgery ◽  
Target Volume ◽  
Imaging Studies ◽  
Kaplan Meier ◽  
Tuberculum Sellae ◽  
New Onset

Abstract Background: Outcomes of Gamma Knife Radiosurgery (GKRS) for tuberculum sellae meningiomas (TSMs) have not been reported explicitly within any meningioma series. We present the first and largest TSM series with clinical, radiosurgical, and outcome features for 78 consecutive patients managed with GKRS. Methods: Patients who underwent GKRS for TSMs between 2005 and 2021 and had a minimum of 6 months of follow-up were included. Medical records, imaging studies, and follow-up examinations were evaluated retrospectively.Results: A total of 78 patients with a median age of 50.5 years were included. SRS was conducted as an upfront treatment for 38 patients (48.7%). The median target volume was 1.7 cm3 (range, 0.1-14.6). During a median follow-up of 78.5 months, the cumulative PFS rates of the whole cohort at 1, 5, and 10 years by Kaplan-Meier analysis were 100%, 97.9%, and 94.5%, respectively. Of 47 patients with impaired vision, improvement and/or preservation of visual acuity and visual field were achieved in 55.3% and 42.6%, respectively. No new-onset hormonal deficits were observed.Conclusions: Based on our data, SRS represents an effective and safe modality for unresected or recurrent/residual TSMs. SRS should be offered to patients who are not willing or not ideal candidates for surgery.

Is intravitreal topotecan toxic to retinal function?

2020 ◽  
pp. bjophthalmol-2020-316588
Author(s):  
Jennifer Nadelmann ◽  
Jasmine H Francis ◽  
Scott E Brodie ◽  
Engjel Muca ◽  
David H Abramson
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Retinal Toxicity ◽  
Cancer Center ◽  
Ocular Toxicity ◽  
Significant Difference ◽  
Vitreous Seeds ◽  
Paired T Test

BackgroundIntravitreal injections of topotecan are used in the management of retinoblastoma with vitreous seeds. This study evaluated whether intravitreal topotecan was associated with retinal toxicity.MethodsRetrospective cohort study of patients with retinoblastoma who were treated with intravitreal topotecan at Memorial Sloan Kettering Cancer Center between December 2014 and May 2019. Electroretinogram (ERG) responses under anaesthesia were measured immediately before treatment with intravitreal topotecan and at the next visitor approximately one-month. Ocular toxicity was defined by a decrease in the ERG response at 30 Hz at follow-up.ResultsOcular toxicity was evaluated by ERG on 50 evaluable injections administered to 28 eyes. 22 (44.0%) injections were performed with concurrent intravitreal melphalan. The median time to ERG measurement following an injection was 27 days. By using a paired t-test, intravitreal topotecan combined with melphalan (n=22) at a dose of 25 μg or 30 μg was associated with a significant decrease in ERG amplitude at follow-up (p=0.046, 95% CI −20.4 μV to −0.2 μV). Among eyes that only received topotecan (n=28) at doses of 20 μg or 30 μg, there was not a significant difference in ERG amplitude measured (p=0.85, 95% CI −7.0 μV to 5.8 μV).ConclusionIntravitreal topotecan combined with intravitreal melphalan was associated with a decrease in ERG amplitude; there was not a significant decrease in ERG amplitude observed in patients who received topotecan alone. These findings suggest that intravitreal topotecan injections at doses of 20 μg or 30 μg are not associated with retinal toxicity in patients with retinoblastoma.

Outcomes and risk factors for failure after trabeculectomy in Taiwanese patients: medical chart reviews from 2006 to 2017

2020 ◽  
pp. bjophthalmol-2020-317303
Author(s):  
Hsun-I Chiu ◽  
Huan-I Su ◽  
Yu-Chieh Ko ◽  
Catherine Jui-Ling Liu
Keyword(s):  
Risk Factors ◽  
Visual Acuity ◽  
Medical Records ◽  
Success Rates ◽  
Long Term Outcomes ◽  
Kaplan Meier ◽  
Chinese Ethnicity ◽  
Preoperative Visual Acuity

AimsTo determine long-term outcomes and risk factors for failure after mitomycin C (MMC)-augmented initial trabeculectomy (IT) in Taiwanese patients.MethodsWe reviewed medical records of patients with glaucoma undergoing IT during December 2006–December 2016. We defined complete success as an intraocular pressure (IOP) of >5 or ≤21 mm Hg or IOP reduction of ≥20% from baseline without supplemental medications and qualified success as the aforementioned IOP levels with or without supplemental medications. Kaplan-Meier survival and Cox proportional analyses evaluated success rates and risk factors for failure, respectively.ResultsWe enrolled 190 patients (237 eyes; mean age: 54.0±15.3 years; mean postoperative follow-up period: 68.4±35.1 months). Mean IOP and glaucoma medications decreased from 22.2±10.8 to 14.4±5.2 mm Hg (p<0.001) and 3.0±0.7 to 1.8±1.2 (p=0.015), respectively, at the last visit. Cumulative qualified success rates were 93.9%, 93.0%, 86.5% and 67.1% at the 1, 2, 5 and 10 years follow-up, respectively; however, only 7.7% of the eyes reached complete success at the last visit. Eyes with poor preoperative visual acuity were associated with low qualified success rates (HR=1.689, p=0.027); patients aged >70 years had higher complete success rates than did those aged ≤70 years. Five cases (2.11%) exhibited bleb-associated complications.ConclusionDespite satisfactory long-term success rates, most eyes needed medication for IOP control, supporting the notion of predisposed scarring vitality in patients of Chinese ethnicity following MMC-augmented trabeculectomy.

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