Surgical Treatment of a Large Choroidal Melanoma

Purpose@#We report successful eyeball-preserving management of a patient with a large choroidal melanoma. We combined partial lamellar sclerouvectomy (PLSU) with ruthenium (Ru)-106 plaque brachytherapy.Case summary: A 48-year-old woman with a history of asthma visited our clinic with a chief complaint of gradual loss of vision at the nasal side of her right eye (best-corrected visual acuity 0.6). Fundus examination revealed a mushroom-shaped, dark choroidal mass 17.1 mm (basal diameter) × 14.2 mm (apical height). There was no evidence of distant metastasis. To remove the tumor while preserving the eyeball, we combined PLSU and simultaneous Ru-106 plaque brachytherapy with the patient under hypotensive general anesthesia. At 6 weeks postoperatively, trans pars plana vitrectomy with silicone oil injection was performed to remove the vitreous hemorrhage and treat the retinal detachment. Intravitreal bevacizumab (Avastin, Genentech Inc., San Francisco, CA, USA) (0.05 mL, 1.25 mg) was injected every 2 months to prevent the development of radiation retinopathy. No residual tumor, recurrence, or distant metastasis was noted during follow-up of 2 years. The patient was stable with no ocular complications at her last visit (2 years postoperatively). @*Conclusions@#Contrary to what we expected and despite the surgical difficulties, PLSU combined with Ru-106 plaque brachytherapy is a useful eyeball-preserving strategy even when encountering a very large choroidal melanoma (diameter > 16 mm and apical height > 10 mm). Such a melanoma was previously believed to be treatable only via enucleation.

Deep Vein Thrombosis Following Prolonged Prone Position Maintenance after Vitrectomy for Rhegmatogenous Retinal Detachment

Purpose@#We report a rare case of deep vein thrombosis and pulmonary embolism that occurred following 2 weeks in the prone position after a trans pars plana vitrectomy with gas tamponade to treat rhegmatogenous retinal detachment.Case Summary: A 49-year-old man without a remarkable medical history visited our clinic complaining of gradual vision loss on the inferior side of the left eye. In fundus examinations, rhegmatogenous retinal detachment involving the macula with multiple tears was noted. After trans pars plana vitrectomy with gas tamponade, the patient was encouraged to maintain a prone position for retinal reattachment. However, after 2 weeks in the prone position, he complained of right calf pain and swelling. The department of cardiovascular surgery was consulted immediately and deep vein thrombosis and pulmonary embolism were diagnosed. After deep vein thrombectomy and anticoagulation therapy, the lower extremity symptoms improved and the patient was stable during follow-up with a well attached retina. @*Conclusions@#When prolonged prone positioning after retina surgery is necessary, careful monitoring for the possibility of deep vein thrombosis and pulmonary embolism is required, especially in high-risk patients.

Retrospective Analysis of the Efficacy and Safety of Omidenepag Isopropyl 0.002% Ophthalmic Solution in Korean Patients

Purpose@#This study aimed to analyze the clinical efficacy and safety of omidenepag isopropyl (OMDI) 0.002% in Korean patients. @*Methods@#A retrospective study was conducted involving 306 patients diagnosed with glaucoma or ocular hypertension, who were administered OMDI 0.002% from May 2021 to June 2022. The primary outcomes were the change in intraocular pressure (IOP) at months 1, 3, and 6 compared to the baseline IOP, and the reactions to the OMDI drug. @*Results@#Out of 235 patients who met the study inclusion criteria, the mean IOP was 16.5 ± 3.4 mmHg at baseline, 14.5 ± 3.0 mmHg at month 1, 14.3 ± 2.7 mmHg at month 3, and 14.7 ± 3.1 mmHg at month 6. The mean IOP reduction at month 6 was -1.6 ± 2.8 mmHg (p < 0.001). On analyzing the IOP by types of glaucoma, the mean IOP change at the 6-month point showed statistically significant results in all types, including normal tension glaucoma, primary open-angle glaucoma, and ocular hypertension (p < 0.05). The frequency of side effects in all patients was 29.8%, with the most commonly reported adverse drug reaction being hyperemia in 18.7% of the total patients. There was one case (0.4%) of uveitis after OMDI administration, but no other systemic adverse drug reactions were reported. @*Conclusions@#Omidenepag isopropyl demonstrated a statistically significant IOP-lowering effect in Korean patients with various types of glaucoma. This suggests that OMDI could potentially serve as a first-line treatment for glaucoma.

Spinal Sagittal Imbalance is Associated with Vertebral Fracture without a Definite History of Falls: Cross-Sectional, Comparative Study of Cohort with and without a Distal Radius Fracture

Background@#Treating osteoporosis in patients with a distal radius fracture (DRF) became paramount at the Fracture Liaison Service. Spinal sagittal imbalance emerged as a risk factor for subsequent fractures. Therefore, here we investigated the spinal profile of patients with DRF to investigate its association with a history of falls and prevalent vertebral fractures. @*Methods@#We reviewed the cases of 162 women presenting with DRF and 162 age-matched women without fracture who underwent an osteoporosis evaluation including bone mineral density (BMD) and lateral spine imaging. We compared the incidence of prevalent vertebral fracture and sagittal vertical axis (SVA) to measure spinal sagittal imbalance. We also performed a regression analysis of the risks of prevalent vertebral fracture, such as age, body mass index (BMI), BMD, and SVA. @*Results@#The SVA was significantly smaller (indicating more stable sagittal balance) in patients with a DRF versus controls (16 mm vs. 34 mm, respectively; p<0.001). The incidence of a prevalent vertebral fracture was similar between groups (12% vs. 15%, respectively; p=0.332). In both groups, the SVA was significantly greater in those with versus without a vertebral fracture. The vertebral fracture was significantly associated with age and SVA but not BMI or spinal BMD. @*Conclusions@#Spinal sagittal balance was superior in DRF patients, yet the frequency of prevalent vertebral fractures was similar. The identification of this unique spinal profile in patients with DRF may increase our understanding of osteoporotic fractures.

Radiation Therapy Outcome and Clinical Features of Duodenal-Type Follicular Lymphoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Duodenal-type follicular lymphoma (FL) is a rare variant of FL. There is still no consensus on the initial treatment, and clinical features including endoscopic findings are not familiar to most physicians. The objective of this study was to evaluate the outcome of patients who were initially treated with radiation therapy for duodenal-type FL. MATERIALS AND METHODS: We retrospectively analyzed 20 patients who were consecutively diagnosed with duodenal-type FL between 2008 and 2017. All patients received radiation therapywith curative intent. RESULTS: The median age of the patients was 52 years (range, 26 to 66 years), and females were predominant. Most patients (n=18, 90%) had stage I disease, and were diagnosed by a regular health examination in an asymptomatic state. The histological grade was one in 19 patients (95%), and the endoscopic findings were diffuse nodular (n=8), whitish granular (n=8), and mixed pattern (n=4). Radiation therapy was delivered to 17 patients with 24 Gy in 12 fractions, and to three patients with 30.6-36 Gy in 18 fractions. All patients were evaluated with endoscopy for response to radiation therapy, and complete response was achieved in 19 patients (95%). At the time of analysis, all patients survived without any evidence of late toxicities related with radiation therapy. CONCLUSION: Taken together, radiation therapy alone could be effective in controlling duodenal lesion. A further study with longer follow-up duration is warranted to confirm our findings.

Clinical activity of fulvestrant in metastatic breast cancer previously treated with endocrine therapy and/or chemotherapy

BACKGROUND/AIMS@#We conducted a retrospective analysis of the clinical activity of fulvestrant in postmenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer (MBC) previously treated with endocrine therapy and/or chemotherapy.@*METHODS@#We reviewed the medical records of all patients with MBC treated at Samsung Medical Center between January 2009 and August 2016. Patients received fulvestrant 250 mg intramuscularly every 28 days (from January 2009 to November 2010) or 500 mg intramuscularly every 28 days (from December 2010 to August 2016). Tumor responses were assessed every 8 weeks and at the end of treatment, as well as when disease progression was suspected.@*RESULTS@#A total of 84 patients were included in this study. A median of two previous endocrine treatments had been performed; 79% of the patients had received two or more endocrine treatments. Forty-five patients (54%) had been treated with chemotherapy for MBC before the fulvestrant treatment course. Visceral metastasis was found in 49 patients (58%). The estimated median progression-free survival and overall survival were 4.4 months (95% confidence interval [CI], 3.4 to 5.5) and 32.5 months (95% CI, 17.6 to 47.4), respectively. The disease control rate was 40.5% (95% CI, 30.5 to 51.5); partial response was observed in 16% of the patients and stable disease was observed in 25% of the patients. The most frequently reported adverse reactions were mild-to-moderate grade myalgia (10.5% of the patients), injection site pain (7%), and fatigue (7%). Fulvestrant was generally well tolerated.@*CONCLUSIONS@#Fulvestrant showed encouraging clinical activity and favorable feasibility in postmenopausal women with MBC who had been treated with multiple endocrine therapies and/or cytotoxic chemotherapies.