Eckardt Keratoprosthesis for Tectonic Repair of a Large Corneal Perforation.

PURPOSE: To report on the use of the Eckardt keratoprosthesis as an emergency temporary tectonic seal for a full-thickness, large decentered corneal perforation. METHODS: Case report and review of the literature. RESULTS: A 47-year-old male patient with myotonic dystrophy presented with a large corneal perforation as a complication of chronic ulceration caused by lagophthalmia and recurrent herpetic keratitis. The perforation was triggered by a superinfection with Gram-positive bacteria. In an emergency setting where no donor cornea was available, the Eckardt keratoprosthesis was sutured into the debrided corneal defect as a tectonic measure. A secondary procedure, consisting of open sky cataract extraction combined with penetrating keratoplasty was performed 3 weeks later. During this period, the prosthesis was well tolerated and the anterior chamber stayed well formed. CONCLUSIONS: The Eckardt keratoprosthesis allowed us to convert what would have been an emergency à chaud keratoplasty into a well-controlled elective procedure. In our case, the silicone prosthesis was well tolerated during the 3-week period while awaiting final repair with a corneal donor button.

Feasibility of an interactive electronic self-report tool for oral cancer therapy in an outpatient setting.

BACKGROUND: The introduction of oral anti-cancer agents provides a convenient administration route for chronic cancer treatment to outpatients. Health information technology through web-based applications or other electronic tools can offer a platform to improve treatment compliance, symptom management, and patient-provider communication. PURPOSE: The purposes of this study were to test the feasibility and clinical utility of an electronic self-report device (RemeCoach) for patients or their caregivers and to register and prospectively evaluate the quality of data generated. PATIENTS AND METHODS: Patients using Teysuno® (S-1) for advanced gastrointestinal carcinoma used a pre-programmed device in order to register compliance to treatment and six clinical parameters. Real-time data were collected onto a central platform, which processed the data by an algorithm. This algorithm stratified the data into different grades based on the Common Terminology Criteria for Adverse Events (CTCAE v4.0). RESULTS: From December 2013 to March 2014, 11 patients (5 men, 6 women) were enrolled. Compliance to the device was high, six patients (55 %) registered timely intake of medication (demonstrating >95 % treatment compliance). Agreement between patients' and clinicians' reported toxicity was substantial for nausea, but discrepant for fatigue, hand-foot syndrome, and mucositis. CONCLUSION: The use of an interactive self-report tool is feasible, reliable, and acceptable to outpatients. The RemeCoach and the algorithm devised will be further developed as an interactive patient-reported outcome (PRO) system, to improve early detection of side effects in an outpatient setting. Further studies are needed to confirm these data and to explore the relationship between optimal patient support and efficacy of treatment.