Characteristics of Developmental and Healing Process of Docetaxel-Induced Lower Limb Edema in Patients with Stage IV Breast Cancer: A Case Series

Background

Management of docetaxel-induced edema is important as severe edema may lead to discontinuation of chemotherapy. Patients with stage IV breast cancer (BC) treated with docetaxel have shown lower limb edema; however, details of its developmental and healing processes are unknown, and thus management strategies have not been established. The aim of this study was to investigate the characteristics of the development and healing process of docetaxel-induced lower limb edema in stage IV BC patients.

Methods

This prospective observational study was conducted on patients with BC who were administered docetaxel between September 2020 and September 2021 at a National Hospital in Japan. Skin changes such as pitting test, circumference, along with ultrasound images and subjective symptom changes were evaluated. The progression of these changes was compared between patients with stage IV and non-stage IV disease.

Results

Five patients were enrolled in the study, of which two and one patients with stage IV and non-stage IV disease, respectively, developed lower limb edema. Early signs of lower limb edema were observed in ultrasound images, 15 cm below the peroneal head, before edema was confirmed by the pitting test and subjective symptoms. In patients with stage IV disease, edema worsened to Grade 3, and reduced four months after the end of drug administration.

Conclusion

For patients with stage IV disease, care should be initiated from the time the early signs are observed using ultrasound and continued for up to four months after the end of docetaxel administration.

Frequency-domain phase-conjugate femtosecond pulse generation using frequency resolved crossphase modulation

Schemes to generate a frequency-domain phase-conjugate pulse by frequency mixing prechirped pulses are proposed. A femtosecond timereversed replica is generated by the temporal-frequency-converted optical parametric processes.

Enhanced disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema by topical timolol and its preservative in early postoperative pseudophakia

OBJECTIVE

To investigate the effects of timolol maleate with preservative and its preserved (PV) and nonpreserved vehicles (NPV) (benzalkonium chloride) on the blood-aqueous barrier and angiographic cystoid macular edema (CME) in early postoperative pseudophakia.

PATIENTS AND METHODS

Patients with ocular hypertension, normal tension glaucoma, and primary open-angle glaucoma who underwent surgery for cataracts. The study included a double-masked trial for timolol, PV, and NPV and a single-masked trial on the effect of diclofenac sodium and fluorometholone acetate on all three. The patients were divided into 6 groups, each of which were simultaneously administered the following different combinations of compounds: timolol and diclofenac (group A), timolol and fluorometholone (group B), PV and diclofenac (group C), PV and fluorometholone (group D), NPV and diclofenac (group E), and NPV and fluorometholone (group F). The 6 groups were then compared using a laser flare cell meter to determine the degree of disruption of the blood-aqueous barrier and fluorescein angiography to investigate angiographic CME. The differences in mean daily fluctuations in intraocular pressure were compared on the preoperative baseline day and for 5 weeks postoperatively. Twice daily administration of 0.5% timolol maleate or the vehicles was started 2 days before surgery, and continued until 5 weeks after surgery. Diclofenac or fluorometholone drops were instilled in the eyes 4 times preoperatively, on the day of surgery, and 3 times daily for 5 weeks postoperatively.

RESULTS

The flare amount was higher on the third and seventh days in group B than in group D, but was the same after the seventh day. The incidence of angiographic CME was the same between both groups. These 2 factors were significantly lower in group F. These 2 factors were also significantly lower in the 3 groups that received diclofenac instead of fluorometholone, with no difference among these groups. The intraocular pressure decline was significant in groups that received timolol compared with groups that received PV or NPV.

CONCLUSIONS

Timolol and its preservative, benzalkonium chloride, cause disruption of the blood-aqueous barrier in early postoperative pseudophakia and increased incidence of angiographic CME. The concurrent administration of nonsteroidal anti-inflammatory drug such as diclofenac prevents these adverse effects without interfering with the drop in intraocular pressure caused by timolol. The addition of benzalkonium chloride to timolol contributes considerably to these adverse effects.

CLINICAL RELEVANCE

The present results suggest the cause of similar complications produced by other antiglaucoma eyedrops containing similar preservatives.

Blood-retinal barrier and autofluorescence of the posterior polar retina in long-standing pseudophakia

PURPOSE

To study the physiological state of the retina in long-standing pseudophakic eyes using blood-retinal barrier (BRB) disruption and autofluorescence as parameters.

SETTING

Miyake Eye Hospital, Nagoya, Japan.

METHOD

This retrospective, case-controlled study sought to determine whether ultraviolet (UV)-light-filtering and blue-light-filtering intraocular lenses (IOLs) had different outcomes in severity of BRB disruption and autofluorescence of the posterior polar retina than clear (untreated) IOLs.

RESULTS

Mean sodium fluorescein transmittance in eyes with untreated IOLs was 3.7 ng/mL +/- 2.2 (SD) 3 years after surgery (n = 40) and 3.5 +/- 1.8 ng/mL 8 years after surgery (n = 18). In eyes with a UV-filtering IOL, the values were 2.4 +/- 1.5 ng/mL (n = 39) and 2.6 +/- 2.0 ng/mL (n = 14), respectively. Eyes with a UV-filtering IOL had significantly lower transmittance (P < .01-< .05). Mean transmittance 5 years after surgery was 4.2 +/- 1.9 ng/mL in eyes with an untreated IOL (n = 31), 3.2 +/- 2.1 ng/mL in eyes with a UV-filtering IOL (n = 30), 2.8 +/- 1.9 ng/mL in eyes with a Menicon blue-light-filtering IOL (n = 20), and 2.6 +/- 1.8 ng/mL in eyes with a Hoya blue-light-filtering IOL (n = 21). The eyes with a UV-filtering and the blue-light-filtering IOLs had significantly lower transmittance than those with an untreated IOL (P < .01-< .05); the eyes with a Hoya IOL had a statistically lower mean than those with the UV-filtering IOL (P < .05). Mean autofluorescence was 44.9 +/- 6.8 (n = 14), 49.5 +/- 6.1 (n = 6), 53.0 +/- 11.9 (n = 15), and 64.5 +/- 13.2 (n = 7) at 1, 4, 9, and 14 years after surgery, respectively; there was a significant difference between 1 and 9 years and between 1 and 14 years (P < .05).

CONCLUSION

Eyes with a UV-filtering or blue-light-filtering IOL had a lower incidence of BRB disruption than eyes with an untreated IOL. Autofluorescence increased with age, even in eyes with UV-filtering IOLs.

Latanoprost accelerates disruption of the blood-aqueous barrier and the incidence of angiographic cystoid macular edema in early postoperative pseudophakias

OBJECTIVE

To study the effect of latanoprost, a prostaglandin analog, on the blood-aqueous barrier and angiographic cystoid macular edema (CME) formation in early postoperative pseudophakias.

PATIENTS AND METHODS

Included in the study were eyes with ocular hypertension, normal-tension glaucoma, or primary open-angle glaucoma undergoing surgery for cataract. The study consisted of a randomized double-masked trial for latanoprost and an open-label controlled trial for determining the effects of diclofenac sodium or fluorometholone eyedrop use on latanoprost or its placebo. We compared 4 groups of eyes with concurrent application of latanoprost and diclofenac (group A), latanoprost and fluorometholone (group B), latanoprost placebo and diclofenac (group C), and latanoprost placebo and fluorometholone (group D). A laser flare cell meter was used to determine the severity of blood-aqueous barrier disruption, and fluorescein angiography was performed to determine angiographic CME formation. Mean diurnal intraocular pressure differences were compared on the preoperative baseline day and in the fifth postoperative week. Latanoprost (0.005%) or its placebo was given once a day starting 2 days before surgery until the fifth postoperative week. Diclofenac or fluorometholone eyedrops were given 4 times a day before surgery on the day of surgery and 3 times a day until the fifth postoperative week.

RESULTS

In group B compared with group D, the amount of flare 3 days and 1 and 2 weeks after surgery and the incidence of angiographic CME in the fifth postoperative week were significantly higher. These 2 factors were significantly higher in group B than in group A (P < .05) and in group D than in group C (P < .01). There was no significant difference in these factors between groups A and C. The intraocular pressure decline was significant in groups A and B compared with groups C and D (P < .05), but there was no significant difference between groups A and B and between groups C and D.

CONCLUSIONS

Latanoprost therapy enhances disruption of the blood-aqueous barrier and increases the incidence of angiographic CME formation in early postoperative pseudophakias. Because administration of nonsteroidal eyedrops such as diclofenac seems to prevent the adverse effects of latanoprost therapy while maintaining its effect to lower intraocular pressure, we suggest their concurrent application.

New classification of capsular block syndrome

PURPOSE

To propose a new classification of capsular block syndrome (CBS) to improve understanding of the etiology and provide effective treatment.

SETTING

Shohzankai Medical Foundation, Miyake Eye Hospital, Nagoya, and Japanese Red Cross Society, Wakayama Medical Center, Wakayama, Japan.

METHODS

Three groups of eyes with CBS were reviewed: eyes originally reported and diagnosed as having CBS; eyes experiencing CBS after hydrodissection and luxation of the lens nucleus; and eyes with CBS accompanying liquefied aftercataract or capsulorhexis-related lacteocrumenasia.

RESULTS

In all 3 groups, the CBS occurred in eyes with a continuous curvilinear capsulorhexis (CCC). It was characterized by accumulation of a liquefied substance within a closed chamber inside the capsular bag, formed because the lens nucleus or the posterior chamber intraocular lens (IOL) optic occluded the anterior capsular opening created by the CCC. Depending on the time of onset, CBS can be classified as intraoperative (CBS seen at the time of lens luxation following hydrodissection), early postoperative (original CBS), and late postoperative (CBS with liquefied aftercataract or lacteocrumenasia). The etiology of the accumulated substance and the method of treatment are different in each type.

CONCLUSION

Capsular block syndrome is a complication of cataract/IOL surgery that can occur during and after surgery. Correctly identifying the type of CBS is crucial to understanding the nature and effective treatment of this disorder.