Three-year outcomes of trabeculectomy and Ahmed valve implant in patients with prior failed filtering surgeries.

PURPOSE: To compare three-year surgical outcomes of trabeculectomy versus Ahmed valves in patients with prior failed trabeculectomy. METHODS: This is a longitudinal retrospective comparative study of one-hundred twenty adult patients with prior failed trabeculectomy who underwent a repeat trabeculectomy or Ahmed valve implant. Demographic and clinical data were collected up to 3 years on all study participants at the Kresge Eye Institute from 2004 to 2016. Visual acuity, intraocular pressure, number of intraocular pressure reducing medications, and success rates at various time points up to 3 years after repeat surgery were the main outcome variables. RESULTS: Sixty-five and sixty eyes were included in the trabeculectomy and the Ahmed valve groups, respectively. Baseline intraocular pressure significantly decreased in both groups at 3 years (p < 0.01). The number of medications was relatively similar to baseline in both study groups at 3 years (p > 0.05). There was no statistically significant difference between the two groups in visual acuity, percentage of intraocular pressure reduction, number of medications, or success rates at any follow-up time points (p > 0.05 for all). CONCLUSIONS AND RELEVANCE: After 3 years, both trabeculectomy and Ahmed valves significantly reduced intraocular pressure from baseline, but with relatively similar number of medications compared to baseline. There was no significant difference in any outcome measure between trabeculectomy and Ahmed valves at any follow-up time points. These results may suggest neither trabeculectomy or Ahmed valves are superior in patients with previously failed trabeculectomies.

Using Radiolabeled 3'-Deoxy-3'-18F-Fluorothymidine with PET to Monitor the Effect of Dexamethasone on Non-Small Cell Lung Cancer.

Non-small cell lung cancer (NSCLC) is a leading cause of cancer mortality in the United States, and pemetrexed-based therapies are regularly used to treat nonsquamous NSCLC. Despite widespread use, pemetrexed has a modest effect on progression-free survival, with varying efficacy between individuals. Recent work has indicated that dexamethasone, given to prevent pemetrexed toxicity, is able to protect a subset of NSCLC cells from pemetrexed cytotoxicity by temporarily suppressing the S phase of the cell cycle. Therefore, dexamethasone might block treatment efficacy in a subpopulation of patients and might be contributing to the variable response to pemetrexed. Methods: Differences in retention of the experimental PET tracer 3'-deoxy-3'-fluorothymidine (FLT) were used to monitor S-phase suppression by dexamethasone in NSCLC cell models, animals with tumor xenografts, and patients with advanced cancer. Results: Significant reductions in tracer uptake were observed after 24 h of dexamethasone treatment in NSCLC cell lines and xenograft models expressing high levels of glucocorticoid receptor α, coincident with pemetrexed resistance visualized by attenuation of the flare effect associated with pemetrexed activity. Two of 4 patients imaged in a pilot study with 18F-FLT PET after dexamethasone treatment demonstrated reductions in tracer uptake from baseline, with a variable response between individual tumor lesions. Conclusion:18F-FLT PET represents a useful method for the noninvasive monitoring of dexamethasone-mediated S-phase suppression in NSCLC and might provide a way to individualize chemotherapy in patients receiving pemetrexed-based regimens.