Ocular adnexal lymphoma classified using the WHO classification: not only histology and stage, but also gender is a predictor of outcome.

INTRODUCTION: Ocular adnexal lymphomas (OAL) belong to the most common malignancies of the orbit and eyelids and are now classified according to the WHO classification system. MALT lymphoma appears to be the most frequent OAL. Histology type and stage of OAL have been found predictors of patient survival. PURPOSE: To evaluate the outcome of a cohort of patients with OAL using the WHO classification and to compare outcome predictors with those of other studies using the WHO classification. DESIGN: Retrospective, cohort study. MATERIALS AND METHODS: Clinical profile at presentation, initial complaints and findings, classification and stage, treatment and outcome of 54 patients with biopsy proven and re-analyzed OAL seen between 1 January 1992 and 1 January 2002 at the UMC Utrecht, NL, were evaluated. Kaplan-Meier survival analysis and multivariate Cox-regression survival analysis were applied to assess predictors of outcome. RESULTS: Forty nine patients were found to have primary and five secondary lymphomas. Of those with primary OAL, 27 had MALT, eight diffuse large B-cell, six mantle cell and eight follicular cell lymphoma. Histology and stage showed a significant association with survival (Log-rank test: p = 0.001 and p = 0.002, respectively). A multivariate Cox-regression survival analysis showed histological type to be the only significant predictor for outcome. Looking at the dichotomy full remission versus not completely cured, gender was found to be a significant predictor (Log-rank test: p = 0.005). CONCLUSION: This study showed that not only histology type and stage, but also gender is a predictor of outcome.

Reactivations of ocular toxoplasmosis after cataract extraction.

PURPOSE: To determine the risk of reactivation of ocular toxoplasmosis following cataract extraction. DESIGN: Retrospective case-control study. PARTICIPANTS: Out of 154 patients with ocular toxoplasmosis, 14 patients (15 eyes) who had undergone a cataract extraction and 45 age- and sex- matched controls without cataract were selected. INTERVENTION: A review of the medical records of 14 patients with ocular toxoplasmosis and cataract and 45 control patients with ocular toxoplasmosis but without cataract. The clinical records of the controls and patients were assessed for an identical 4-month period following the date of the cataract extraction in the index patients. MAIN OUTCOME MEASURES: Development of a new active retinal lesion within 4 months after cataract surgery in patients and age -and sex matched-controls. The presence of risk factors such as sex, congenital or postnatal acquisition of ocular toxoplasmosis, age at first clinical manifestation of ocular toxoplasmosis, total number of attacks per affected eye, type of cataract, age at the time of cataract surgery and the intervals between surgery and first clinical manifestation of ocular toxoplasmosis and between surgery and the last recurrence of ocular toxoplasmosis, as well as the use of antiparasitic medication during surgery, type and complications of surgery and optimal visual acuity before and after cataract surgery. RESULTS: Reactivations of ocular toxoplasmosis following cataract extraction occurred in 5/14 patients (5/15 eyes), which was higher than the incidence of recurrences in age -and sex-matched controls (p < 0.001). No additional risk factors for the development of recurrences of ocular toxoplasmosis after cataract surgery were found. Incidence of recurrences preceding surgery did not differ between patients and controls. CONCLUSION: We identified an increased risk of reactivation of ocular toxoplasmosis following cataract extraction which implies that prophylactic treatment with antiparasitic drugs during and after the cataract surgery might be worthwhile for patients at risk of visual loss.