ABSTRACT
BACKGROUND: Ocular ischemic syndrome is a rare disease, which must be considered as a differential diagnosis in cases of painful loss of vision. CASE REPORT: A 63-year-old male patient presented as an emergency in our consultation with hyphemia and decompensated intraocular pressure of the right eye. The right eye had been painful for 3 weeks. Apart from nicotine abuse, no relevant pre-existing medical conditions were known. With suspected iritis, the initial treatment was performed with eye drops containing a corticosteroid. After initial improvement in symptoms, an acute deterioration occurred with decrease in visual acuity and increased pain starting 2 days previously. Biomicroscopic examination revealed rubeosis iridis with hyphemia. Due to the hyphemia the view of the fundus was greatly reduced but there were no indications for retinal bleeding. In gonioscopy a chamber angle closure was evident. Fluorescence angiography showed a significantly longer arm-retina time, a delayed arteriovenous passage, peripheral vascular leaks and reduced fluorescence of the choroid. An ocular ischemic syndrome was suspected, therefore, duplex sonography of the carotid arteries and computed tomography angiography were performed and showed complete stenosis of the right internal carotid artery and moderate stenosis of the left internal carotid artery. An intravitreal administration of anti-VEGF and panretinal laser photocoagulation were carried out. Furthermore, an evaluation of the cardiovascular risk factors was initiated as part of the interdisciplinary investigation.
Subject(s)
Carotid Stenosis , Eye Diseases/diagnosis , Ischemia , Carotid Artery, Internal , Carotid Stenosis/diagnosis , Diagnosis, Differential , Humans , Ischemia/diagnosis , Ischemia/therapy , Male , Middle Aged , Vitreous BodyABSTRACT
BACKGROUND: Marginal zone lymphoma (MZL) is a non-Hodgkin lymphoma that occurs as extra nodal, nodal, or splenic. While MZL is generally considered an indolent disease, a substantial percentage of patients follow an unfavorable course. The objective of this retrospective analysis was to identify predictors for a reduced overall survival (OS), or conversely an increased OS. PATIENTS AND METHODS: One hundred and ninety-seven MZL patients were analyzed. Apart from assessing previously published risk factors, concomitant morbidity at diagnosis, transformation into aggressive lymphoma, and occurrence of additional malignancies were evaluated. RESULTS: Next to the known risk factors, i.e. above 60 years of age and elevated serum lactate dehydrogenase (LDH), we demonstrate that transformation into aggressive lymphoma, as well as additional malignancies, are important independent risk factors for a shortened OS in a multivariate analysis, irrespective of the MZL localization. Impressively, in the group of patients lacking LDH elevation, transformation, and/or additional malignancies, only 1 of 63 patients died during follow-up compared with 37 of 87 patients in the high-risk group (HR = 22.8; 95% confidence interval 3.1-167.0; P = 0.002). CONCLUSIONS: Our analysis proposes novel risk factors and warrants for a continuous follow-up to detect the occurrence of transformation and additional malignancies early on.
