Visual deficit possibly caused by lutetium-177 PSMA treatment.

This report describes a case of a 54-year-old man who underwent lutetium-177-PSMA therapy in the setting of metastatic castration-resistant prostate cancer (mCRPC) in the University Medical Center Utrecht. Following administration of the second cycle, patient presented with a slowly impairing, bilateral visual loss. This clinical presentation was most likely the result of the high intracranial pressure due to impediment of cerebrospinal fluid circulation, possibly related to obstructive dural thickness, being either caused by dural and/or leptomeningeal metastases of advanced mCRPC or by local radiation effects following lutetium-177-PSMA therapy. Describing this case, we aim to add to the discussion on 177Lu-PSMA safety, in which prospective research will ultimately offer definite answers.

Nationwide reduction in the number of corneal transplantations for keratoconus following the implementation of cross-linking.

PURPOSE: Keratoconus is characterized by corneal ectasia and irregular astigmatism, which can lead to diminished vision and corneal scarring. Approximately 10-20% of patients with keratoconus eventually require a corneal transplant. Corneal cross-linking (CXL) is a relatively new treatment that may help prevent the need for corneal transplantation. Here, we investigated whether the introduction of CXL has reduced the number of corneal transplants performed annually. METHODS: Data regarding the transplantation procedures performed in patients under the age of 50 years were extracted from the Dutch National Organ Transplant Registry. The number of corneal transplants performed prior to (i.e. in 2005 through 2007) and following the introduction of CXL (i.e. in 2012 through 2014) were compared. Furthermore, a trend analysis on annual keratoplasties over time was performed. RESULTS: Approximately 25% fewer corneal transplants were performed in the 3-year period following the introduction of CXL compared to the 3-year period prior to the introduction of CXL (201 versus 269 transplants, respectively; p = 0.005). Age, gender and visual acuity were similar between the patient groups in the two time periods. Trend analysis also demonstrated a significant decrease in the amount of corneal transplants (p = 0.001). CONCLUSION: Significantly fewer corneal transplants were performed for treating keratoconus following the nationwide introduction of CXL. This reduction suggests that corneal cross-linking can significantly reduce the need for corneal transplantation.

Trends in penetrating and anterior lamellar corneal grafting techniques for keratoconus: a national registry study.

PURPOSE: Keratoconus is a progressive disorder and one of the primary indications for corneal transplantation. Anterior lamellar keratoplasty offers several advantages over other techniques, including endothelial preservation and longer graft survival. In this study, we examined the recent trend of using lamellar techniques for keratoconus at a national level. METHODS: Data were obtained from the Dutch national organ transplant database regarding corneal transplants for keratoconus performed in 2005 through 2014. Baseline characteristics for patients undergoing various techniques were obtained, and temporal trends were analysed. RESULTS: A total of 1041 operations were performed, including 736 penetrating keratoplasties (PKPs) and 297 anterior lamellar keratoplasties (ALKs). The mean age of the total surgical group was 37.4 ± 13.4 years, and 68% of patients were male (p = 0.0001). Preoperative patient characteristics were reported in all 1041 cases. The relative proportion of ALKs increased from 2005 (19% of cases) to 2010 (39% of cases) and remained approximately 30-40% thereafter. Descemet baring or deep anterior lamellar keratoplasty (DALK) was increasingly applied and was the predominant anterior lamellar technique performed from 2009 onwards. CONCLUSIONS: The number of corneal transplantations performed annually for keratoconus decreased during the past 10 years. Lamellar techniques were increasingly performed, accounting for approximately 35% of keratoplasties in 2010 and thereafter. Among ALK techniques, maximal depth DALK is the most prevalent keratoplasty performed for keratoconus in most recent years. Penetrating keratoplasty (PKP) is still common, with a stable frequency from 2010 onwards.

Cytokine Expression in Keratoconus and its Corneal Microenvironment: A Systematic Review.

Keratoconus (KC) is a progressive corneal ecstasia characterized by thinning and weakening of the cornea that leads to a cone-like appearance, scarring, and decreased vision. Despite the well-described clinical signs, the cause of KC is unknown. Nevertheless, various genes, proteinases, and environmental factors (eye-rubbing, contact lens wear, tear film composition) have been implicated in its etiology. Although classically defined as a predominantly degenerative disease, with mechanically induced trauma accelerating its course, accumulating evidence suggests a pivotal role for inflammation in the pathophysiology of KC. Several reports have linked various inflammatory mediators (cytokines) with KC, but with contradictory findings. The methods and materials used in these studies vary considerably and warrant critical evaluation to decipher the role of inflammatory mediators in KC. We performed a systematic review of current literature on cytokine expression studies in KC and discuss critical soluble and cellular inflammatory mediators that are implicated in its pathogenesis.