ABSTRACT
BACKGROUND: Radiotherapy of conjunctival melanoma has gained in importance in recent years compared to less invasive therapeutic approaches. This is due to the high recurrence rates achieved by omitting adjuvant therapy and to the increasing availability of suitable radiotherapeutic methods, so that tumors formerly not amenable to organ-preserving therapy can now be treated. OBJECTIVE: This article presents the current radiotherapeutic options for conjunctival melanoma. The aim is to describe the diagnostic and therapeutic strategies and the course of therapy of malignant conjunctival melanoma. It is the authors' intention to justify the necessity of the adjuvant therapy of conjunctival melanoma and to emphasize the need for interdisciplinary cooperation during the course of tumor therapy. METHODS: The article is based on results published in the literature as well as on data collected and experience gained in our centre.
Subject(s)
Brachytherapy/methods , Conjunctival Neoplasms/therapy , Melanoma/therapy , Ophthalmologic Surgical Procedures/methods , Proton Therapy/methods , Radiotherapy, Adjuvant/methods , Combined Modality Therapy/methods , Conjunctival Neoplasms/diagnosis , Evidence-Based Medicine , Humans , Treatment OutcomeABSTRACT
BACKGROUND AND PURPOSE: In September 2011 the cornea section of the German Ophthalmological Society (DOG) established the first German Acanthamoeba keratitis registry. The data of this multicenter survey are being collected, compiled and evaluated at the Department of Ophthalmology at the Saarland University. The aim of this article is to present an intermediate report. PATIENTS AND METHODS: Data from 172 eyes with Acanthamoeba keratitis were collected during the last 10 years. For this interim report we actually evaluated 121 eyes (60.2 % female patients, average age 41.3 years) and collected the following data: date of onset of symptoms, date and method of diagnosis, initial diagnosis, anamnestic data, clinical symptoms and signs at diagnosis and during follow-up, conservative and surgical therapy. Criteria for inclusion in the Acanthamoeba registry was the established diagnosis of an Acanthamoeba keratitis with at least one of the methods described in this article. RESULTS: Acanthamoeba keratitis could be histologically proven in 55.3 % of the cases, via PCR in 25.6 %, with confocal microscopy in 20.4 % and using in vitro cultivation in 15.5 %. Clinical symptoms and signs in Acanthamoeba keratitis were pain in 67.0 %, ring infiltrates in 53.4 %, pseudodendritiform epitheliopathy in 11.7 % and keratoneuritis in 5.8 %. In 47.6 % of the cases the initial diagnosis was herpes simplex virus keratitis followed by bacterial keratitis in 25.2 % and fungal keratitis in 3.9 %. Acanthamoeba keratitis was the correct initial diagnosis in only 23.2 % of cases. The average time period between first symptoms and diagnosis was 2.8 ± 4.0 months (range 0-23 months). A triple therapy with Brolene® Lavasept® and antibiotic eye drops at least 5 ×/day was used in 54.5 % of eyes (n = 66). Penetrating keratoplasty was performed in 40.4 %, in 18 cases in combination with cryotherapy of the cornea. The mean graft diameter was 7.9 ± 1.1 mm (range 3.5-11.0 mm). The final visual acuity (Snellen visual acuity chart at 5 m) was comparable in the two groups of eyes with (5/40 ± 5/25) and without (5/32 ± 5/25) keratoplasty. CONCLUSION: Acanthamoeba keratitis is a rare and often very late diagnosed disease and two thirds of the cases were initially misdiagnosed. The early recognition of the typical symptoms is crucial for the prognosis of the disease. All ophthalmological departments in Germany are invited to submit further data of all confirmed cases (berthold.seitz@uks.eu), whether retrospectively or prospectively in order to generate an adequate standardized diagnostic and therapeutic approach for this potentially devastating disease.
Subject(s)
Acanthamoeba Keratitis/diagnosis , Acanthamoeba Keratitis/therapy , Keratoplasty, Penetrating/statistics & numerical data , Registries , Symptom Assessment/statistics & numerical data , Acanthamoeba Keratitis/epidemiology , Female , Germany/epidemiology , Humans , Male , Pilot Projects , Prevalence , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: To analyze changes in visual acuity after cataract surgery in patients suffering from age-related maculopathy. MATERIAL AND METHODS: This retrospective case-control study included all patients who had consecutively undergone phacoemulsification from January 2000 to February 2006, had a preexisting diagnosis of early age-related macular degeneration (AMD), and were followed up for at least 1 year postoperatively (n=1,152 eyes of 696 patients). The control group comprised phakic patients diagnosed with early AMD from January 2000 to February 2006 who did not undergo eye surgery and were followed up for at least 1 year (n=334 eyes of 202 patients). RESULTS: In 62.1% of operated eyes, the best-corrected visual acuity was at least two logMAR units better than before surgery, and in 26.7% it was at least four logMAR units better. Deterioration of visual acuity of more than four logMAR units occurred in 1.3% of operated eyes and 1.5% of control eyes. CONCLUSION: Cataract surgery can markedly improve visual acuity in patients with age-related maculopathy.
