Indocyanine green for leakage control in isolated limb perfusion

Objective

Sarcomas are characterized by a high metastatic potential and aggressive growth. Despite surgery, chemotherapy plays an important role in the treatment of these tumors. Optimal anti-cancer therapy with maximized local efficacy and minimized systemic side effects has been the object of many studies for a long time. To improve the local efficacy of anti-tumor therapy, isolated limb perfusion with high-dose cytostatic agents has been introduced in surgical oncology. In order to control the local distribution of substances, radiolabeled cytostatic drugs or perfusion solutions have been applied but often require the presence of specialized personnel and result in a certain exposure to radiation. In this study, we present a novel strategy using indocyanine green to track tumor perfusion with high-dose cytostatic therapy.

Methods

In a rat cadaver model, the femoral vessels were cannulated and connected to a peristaltic pump to provide circulation within the selected limb. The perfusion solution contained indocyanine green and high-dose doxorubicin. An infrared camera enabled the visualization of indocyanine green during limb perfusion, and subsequent leakage control was successfully performed.

Results

Histologic analysis of sections derived proximally from the injection site excluded systemic drug dispersion.

Conclusion

In this study, the application of indocyanine green was proven to be a safe and cost- and time-efficient method for precise leakage control in isolated limb perfusion with a high-dose cytostatic agent.

Uni-vs. bilateral DIEP flap reconstruction - A multicenter outcome analysis

OBJECTIVE

Over the past decade numbers of bilateral mastectomy have increased steadily. As a result, bilateral breast reconstruction is gaining popularity. The presented study compares complications and outcomes of unilateral and bilateral DIEP free-flap breast reconstructions using the largest database available in Europe.

METHODS

Female breast cancer patients (n = 3926) receiving DIEP flap breast reconstructions (n = 4577 free flaps) at 22 different centers were included in this study. Free flaps were stratified into two groups: a unilateral- (UL) and a bilateral- (BL) breast reconstruction group. Groups were compared with regard to surgical complications and free flap outcome.

RESULTS

Mean operative time was significantly longer in the BL group (UL: 285.2 ± 107.7 vs. BL: 399.1 ± 136.8 min; p < 0.001). Mean ischemia time was comparable between groups (p = 0.741). There was no significant difference with regard to total (UL 1.8% vs. BL 2.6%, p = 0.081) or partial flap loss (UL 1.2% vs. BL 0.9%, p = 0.45) between both groups. Rates of venous or arterial thrombosis were comparable between both groups (venous: UL 2.9% vs. BL 2.2%, p = 0.189; arterial: UL 1.8% vs. BL 1.2%, p = 0.182). However, significantly higher rates of hematoma at the donor and recipient site were observed in the UL group (donor site: UL 1.1% vs. BL 0.1%, p = 0.001; recipient site UL 3.9% vs. BL 1.7%, p < 0.001).

CONCLUSIONS

The data underline the feasibility of bilateral DIEP flap reconstruction, when performed in a setting of specialized centers.

Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome

BACKGROUND

Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome.

PATIENTS AND METHODS

Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method.

RESULTS

In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission.

CONCLUSION

Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.

Effect of HBO therapy on adipose-derived stem cells, fibroblasts and co-cultures: In vitro study of oxidative stress, angiogenic potential and production of pro-inflammatory growth factors in co-cultures1

BACKGROUND: A key moderator of wound healing is oxygen. Wound healing is a dynamic and carefully orchestrated process involving blood cells, cytokines, parenchymal cells (i.e. fibroblasts and mesenchymal stem cells) and extracellular matrix reorganization. Human adipose derived stem cells as well as human fibroblasts produce soluble factors, exhibit diverse effects on inflammation and anti inflammation response and are involved in wound healing processes. Hyperbaric oxygen therapy is an effective adjunct treatment for ischemic disorders such as chronic infection or chronic wounds. In vitro effects of hyperbaric oxygen therapy on human cells were presented in many studies except for those on mono- and co-cultures of human adipose derived stem cells and fibroblasts. OBJECTIVE: The aim of this study was to investigate the effects of hyperbaric oxygen therapy on mono- and co-cultures of human adipose derived stem cells and fibroblasts. METHODS: Mono- and co-cultures from human adipose derived stem cells and fibroblasts were established. These cultures were exposed to hyperbaric oxygen therapy every 24 h for five consecutive days. Measuring experiments were performed on the first, third and fifth day. Therapy effects on the expression of VEGF, IL 6 and reactive oxygen species were investigated. RESULTS: After exposure to hyperbaric oxygen, cell culturess showed a significant increase in the expression of VEGF after 3 and 5 days. All cultures showed significantly reduced formation of reactive oxygen species throughout the experiments. The expression of IL-6 decreased during the experiment in mono-cultures of human adipose derived stem cells and co-cultures. In contrast, mono-cultures of human skin fibroblasts showed an overall significantly increased expression of IL-6. CONCLUSIONS: Hyperbaric oxygen therapy leads to immunmodulatory and proangiogenetic effects in a wound-like enviroment of adipose derived stem cells and fibroblasts.

Cross-sectional Study on Assessment of First-pass Success of Video Laryngoscope Intubation in General Anesthesia Patients

Traditional Direct laryngoscope (DL) has been used by anesthesiologist during intubation for general anesthesia patients for more than a century. Video laryngoscope (VL) helps in better visualization of laryngeal orifice during intubation and reduces intubation time. This was a cross sectional study conducted in two Asian Hospitals Queen Elizabeth II hospital of Kotakinabalu, Malaysia and King Faisal Hospital Taif of Saudi Arabia to assess the first-pass success of video laryngoscope and to compare with direct laryngoscope from July 2015 to December 2017. Random lottery technique was applied for sampling. Participants of both groups (VL and DL) were enrolled by simple lottery method. Total 146 patients were enrolled with a set inclusion criterion. Mallampati class, mouth opening, thyromental distance and mobility of atlantooccipital junction were set as predictors of first-pass success. The first-pass success was 98.7% in mallampati II patients and 92.8% in mallampati III patients. Average success rate was 95.75%. The mean success rate of VL and DL was compared and was found VL had a significantly better first-pass success rate than DL (p<0.05).

WITHDRAWN: The use of integrated indocyanine green fluorescence microscope camera for intraoperative lymphography of supermicrosurgery

Ahead of Print article withdrawn by publisher.

Why the Cost of Purchasing the careHPV Test in Myanmar Was Many Times Greater Than That Reported in the International Literature

Background: Human papillomavirus (HPV) testing is recommended for primary or coprimary screening for cervical cancer (CC screening) in countries of all income levels. Inclusion of low-income countries (LICs) in these recommendations was in part due to development and evaluation of the careHPV test kit (QIAGEN, supported by PATH), a simple, accurate, affordable HPV screening test. In numerous published economic analyses, cost of equipment and supplies (E&S) and conducting a careHPV test in LICs was estimated to be $US5/test. When we sought to purchase the E&S for 1000 careHPV tests in Myanmar to begin a pilot test of HPV-based CC screening in a Ministry of Health and Sports (MOHS) women's hospital, we were quoted a price of US$42/test. Aim: Determine why the price for the careHPV test in Myanmar was so much greater than that reported in the literature. Methods: We reviewed published economic analyses and conducted a cost analysis of E&S purchased for careHPV testing in Myanmar. We obtained assistance from QIAGEN and PATH to negotiate the lowest possible price for proprietary E&S, and nonproprietary E&S was purchased at the lowest domestic or international price. Standard methods of economic evaluation were used, classifying E&S as capital (C) or recurrent (R). We converted costs to United States dollars ($), calculated $/test and obtained the charge to patients for other CC screening tests in Myanmar. Results: QIAGEN only sold the careHPV test through a local distributor, who added a larger profit than permitted. We negotiated a purchase price of $36/test for proprietary E&S, including test system hardware ($25,555 [C]), training panel ($1540 [C]), cervical brushes ($788 [R]), transport medium ($788 [R]), and microtiter plates ($6982 [R]). R included a 38% markup for transportation, duties, and profits. Required nonproprietary E&S purchased included: refrigerator ($1081 [C]), two pipetters ($1100 [C]), power source ($150 [C]), pipette tips ($156 [R]), and plate sealers ($38 [R]). The final cost was $38,294 ($38/test; C: $29,426 [$29/test]; R: $8,868 [$9/test]). If no additional C was required, the E&S for 20,000 tests would cost $10/test. Although the charge for careHPV has not been set, the MOHS charge for a conventional Pap is $1.50. In the private sector, the charge for Pap is $8 (conventional) to $20 (automated), and between $50 and $125 for HPV tests. Conclusion: Our $38 cost/test is conservative since it was negotiated and did not include patient time, MOHS labor or other program implementation costs. The reported $5/test did not include some required E&S and assumed purchase and scale-up to 20,000 tests in the first year, further reducing cost/test. In contrast, in Myanmar and other LICs, scale-up of CC screening programs has been slow, costly, and problematic. Advocates for careHPV based CC screening should be aware that initial costs may be high. Cost-effectiveness models should be adjusted to include a wider possible range of costs.

“You Can Breast Health Club” Empowering Healthy Women of Myanmar to Enhance Breast Cancer Awareness and Take Action

Background and context: Pun Hlaing Siloam Hospital (PHSH), the only Joint Commission International (JCI) accredited hospital in Myanmar, is committed to provide comprehensive breast health services through “You Can Breast Health Club” in accordance with its vision; international quality, reach, scale and compassion. A free of charge membership-based club led by a dedicated medical oncology team that includes health care personnel, family members of breast cancer patients and healthy women of all walks of life. Aim: To promote awareness and take action on breast health and breast cancer so as to empower women to commit to lifelong breast health. Strategy/Tactics: The club executed its strategy through three pillars: 1) hospital-based comprehensive breast cancer care services, 2) community-based breast cancer education programs and 3) partnership with local and international organizations. The theme is “You can prevent the preventable; you can check for early detection; you can survive with effective treatment” with an aim to encourage women to play an active role in their own health. Program/Policy process: As part of a comprehensive approach to breast health, “one stop” hospital-based program provides breast health education on basic breast health and breast cancer facts, teaching breast self-exam, personal risk assessment and advise on risk reduction and to make healthy life choices. Interdisciplinary breast clinic provides clinical breast exam, state-of-the art breast imaging, diagnostic evaluation, referral for surgical and treatment options and patient family education. A training-of-trainers workshop on breast health was conducted for the hospital staff to facilitate program participants in turn to educate other club members and women in the local community. The club was launched in October Breast Cancer Awareness Month campaign held in October 2017 at PHSH. As a strategic partnership supported Shwe Yaung Hnin Si Cancer Foundation to host the World Cancer Day 2018 Community Cancer Awareness campaign held in Yangon. Outcomes: The number of club members increased to (282) within five months. Among the members, (204) women are from the community including family members of breast cancer patients, office staff, industry workers, and housewives reflecting the various socioeconomic status. The outcome was encouraging given that 60% of members are below the age of 40. What was learned: Community outreach breast cancer education programs combined with access to hospital-based services at affordable prices enhanced interest in club membership. The hospital-based strategy readily provides healthy women the facilities for early diagnosis and prompt access to quality care without any delays. Partnership with other advocacy groups accelerated the club process.

Presentation of a variation of the chorioallantoic membrane set up as a potential model for individual therapy for squamous cell carcinoma of the oropharynx

The chorioallantoic membrane of fertilized chicken eggs in an early phase of breeding presents an approved test situation for the growth and treatment of human cancer cells.These models work due to the inoculation of cells into the membrane that stays within the egg shell during the time of investigation. In this study a modification of this model is presented. Samples of native tumors, rather than cell lines, are transplanted into the membrane and the body of the egg is taken out of the shell and placed in a plastic bowl. These modifications lead to an enhanced accessibility to the chorioallantoic membrane and the surrounding vessels thus facilitating intra venous access and application of pharmaceuticals and a focused radiotherapy. With the current modifications the embryo was kept alive and additionally, the vascularized tumor environment was preserved.

Vascular malformations of upper and lower extremity - from radiological interventional therapy to surgical soft tissue reconstruction - an interdisciplinary treatment

This article presents our experience in managing peripheral vascular malformations of upper and lower extremities over a 4-year period in a series of 46 patients of the Department of Plastic Surgery treated in the Interdisciplinary Center of Vascular Anomalies (ICVA) at the University of Regensburg. The patients presented vascular malformations of upper and lower extremity and were selected from our prospective vascular anomalies file archive from 2012 to 2016. During this period in the ICVA at University of Regensburg were performed more than 1400 radiological interventional treatments in patients with vascular malformations.The purpose of this retrospective study was to review combined embolotherapy, sclerotherapy (embolo/sclerotherapy), and surgical procedures (surgical excision and soft tissue reconstruction) to manage vascular malformations. Treatments were principally induced to reduce pain, daily physical limitations, social discomfort and recover tegument continuity after ulceration.The 46 patients were first examined with noninvasive radiological procedures. After diagnosis was posed, embolo/sclerotherapy, surgical procedures and clinically as well as radiological follow-ups were coordinated and established by the multidisciplinary team. All vascular malformations were categorized according to the classification approved at the April 2014 General Assembly of International Society for the Study of Vascular Anomalies (ISSVA) in Melbourne, Australia. Arteriovenous malformations (AVMs) were further classified following the Cho-Do and Schobinger classification.Embolo/sclerotherapy shows to be the most appropriate procedure in vascular malformations treatment. Nevertheless was found that in case of complications or lack of improvement as well as to improve functional or aesthetical results, a following partial or complete surgical excision and immediate soft tissue reconstruction seems to be the gold-standard treatment. In addition, the precise clinical and radiological diagnosis as well as an intensive postoperative patient care have a significant positive influence on the clinical outcome and patient satisfaction while decreasing morbidity and recurrence during early and late follow-up.Vascular malformations require a multidisciplinary approach and individual treatment after complex excision and indispensable reconstruction.

Vascularized transfer of two coherent toe joints in simultaneously reconstructing MCP and PIP of a mutilated finger

BACKGROUND

The reconstruction of metacarpal- and interphalangeal joints after severe hand injuries has been proven to be challenging. Commonly used procedures like arthrodesis, amputation or ray resection of the finger compromise the functionality of the injured finger. Especially for young patients, the restoration of all functions of the fingers is a priority. Local tissue transfers for finger joint reconstructions is not an option due to inacceptable donor site morbidity; microsurgical tissue transfers in terms of free toe joint transfers have proven to be a valuable method.

METHODS

We present the case of a patient who suffered an excessive injury from a circular saw to his dominant hand. The MCP Joints of D2-D4 were fully destroyed, along with the PIP joint of a subtotally amputated D4. Arteries, nerves and tendons could be coapted directly, while primarily reconstructing of the finger joints was impossible. To ensure a possible regain of full functionality, two coherent joints, the MTP and the PIP of one toe, were transferred to the ring finger as a single transplant, reconstructing the MCP and the PIP joints of the injured finger in a one step procedure. Additionally the MCP joint of the D2 was reconstructed by the use of a free PIP-joint transfer, further the MCP joint of the D3 was replaced by an MCP endoprosthesis.

RESULTS

After a follow up of 3 years the patient displayed full function of his dominant hand including sensitivity, and has gone back to manual work without limitations. The result was cosmetically acceptable and the donor site defect was easily being tolerated by the patient who is playing soccer in the regional soccer league.

CONCLUSION

Free double toe joint transfer has been proven feasible in this patient. While transferring a single toe joint to reconstruct a finger joint is a well-established method, our review of the latest literature showed no case of a free transfer of two coherent joints and three transplanted joints in one hand. The applied microsurgical technique should be considered by microsurgically trained hand surgeons for the treatment of comparable severe hand injuries. In comparison to the most common procedures described for the repair and reconstruction of severely injured finger joints this method showed superior results.

Global aesthetic surgery statistics: a closer look

INTRODUCTION

Obtaining quality global statistics about surgical procedures remains an important yet challenging task. The International Society of Aesthetic Plastic Surgery (ISAPS) reports the total number of surgical and non-surgical procedures performed worldwide on a yearly basis. While providing valuable insight, ISAPS' statistics leave two important factors unaccounted for: (1) the underlying base population, and (2) the number of surgeons performing the procedures.

METHODS

Statistics of the published ISAPS' 'International Survey on Aesthetic/Cosmetic Surgery' were analysed by country, taking into account the underlying national base population according to the official United Nations population estimates. Further, the number of surgeons per country was used to calculate the number of surgeries performed per surgeon.

RESULTS

In 2014, based on ISAPS statistics, national surgical procedures ranked in the following order: 1st USA, 2nd Brazil, 3rd South Korea, 4th Mexico, 5th Japan, 6th Germany, 7th Colombia, and 8th France. When considering the size of the underlying national populations, the demand for surgical procedures per 100,000 people changes the overall ranking substantially. It was also found that the rate of surgical procedures per surgeon shows great variation between the responding countries.

CONCLUSION

While the US and Brazil are often quoted as the countries with the highest demand for plastic surgery, according to the presented analysis, other countries surpass these countries in surgical procedures per capita. While data acquisition and quality should be improved in the future, valuable insight regarding the demand for surgical procedures can be gained by taking specific demographic and geographic factors into consideration.

A simple and non-contact optical imaging probe for evaluation of corneal diseases

Non-contact imaging techniques are preferred in ophthalmology. Corneal disease is one of the leading causes of blindness worldwide, and a possible way of detection is by analyzing the shape and optical quality of the cornea. Here, a simple and cost-effective, non-contact optical probe system is proposed and illustrated. The probe possesses high spatial resolutions and is non-dependent on coupling medium, which are significant for a clinician and patient friendly investigation. These parameters are crucial, when considering an imaging system for the objective diagnosis and management of corneal diseases. The imaging of the cornea is performed on ex vivo porcine samples and subsequently on small laboratory animals, in vivo. The clinical significance of the proposed study is validated by performing imaging of the New Zealand white rabbit's cornea infected with Pseudomonas.

Note: A gel based imaging technique of the iridocorneal angle for evaluation of angle-closure glaucoma

Noninvasive medical imaging techniques have high potential in the field of ocular imaging research. Angle closure glaucoma is a major disease causing blindness and a possible way of detection is the examination of the anterior chamber angle in eyes. Here, a simple optical method for the evaluation of angle-closure glaucoma is proposed and illustrated. The light propagation from the region associated with the iridocorneal angle to the exterior of eye is considered analytically. The design of the gel assisted probe prototype is carried out and the imaging of iridocorneal angle is performed on an eye model.

An interchromosomal reciprocal translocation in wheat involving leaf rust resistance gene Lr34

'Thatcher' backcross lines RL6058 and RL6077 have adult-plant leaf rust resistance and were believed to have Lr34. However, genetic analysis revealed that the genes in the two lines were independent of each other. Previous work demonstrated that Lr34 is located on chromosome 7D. The leaf rust resistance gene in RL6058 must be on chromosome 7DS because no recombinants were observed between it and gene Lr29, known to be on chromosome 7DS. It was also linked with Rc3 (30.25 +/- 2.88%), a gene for purple coleoptile on chromosome 7DS. It was independent of Lr19 and NS1 (nonsuppressor mutant), which are located on 7DL. The leaf rust resistance gene in RL6077 was independent of genes Lr19 and Lr29. The presence of quadrivalents in pollen mother cells of the RL6058/RL6077 hybrid indicates that the Lr34 gene in RL6077 may have been translocated onto another chromosome. Lr34 from RL6058 and RL6077 may have been combined in four F3 lines derived from their intercross.

Automatic glaucoma diagnosis from fundus image

Glaucoma is currently diagnosed by glaucoma specialists using specialized imaging devices like HRT and OCT. Fundus imaging is a modality widely used in primary healthcare. An automatic glaucoma diagnosis system based on fundus image can be deployed to primary healthcare clinics and has potential for early disease diagnosis. A mass glaucoma screening program can also be facilitated using such a system. We present an automatic fundus image based cup-to-disc ratio measurement system; and demonstrate its potential for automatic objective glaucoma diagnosis and screening. It provides strong support to use fundus image as the modality for automatic glaucoma diagnosis.

Review of key findings from the Singapore Malay Eye Study (SiMES-1)

INTRODUCTION

This study highlights the key epidemiological findings from the Singapore Malay Eye Study (SiMES-1).

METHODS

SiMES-1 was a cross-sectional, population-based epidemiological study on eye diseases. It was performed on 3,280 randomly selected Malay adults living in the south-western part of Singapore. All study participants underwent various validated questionnaires and detailed eye examinations. A review of all papers published from SiMES-1 was performed.

RESULTS

A total of 24.6% of the study population had myopia, while 35.3% had hyperopia and 39.4% had astigmatism. 20.4% of the population had under-corrected refractive error. 1,338 (45.7%) participants were diagnosed to have cataracts in at least one eye. 8.6% of the study population had undergone cataract surgery in either eye, while 4.7% had bilateral cataract surgery. 150 (4.6%) participants were diagnosed to have glaucoma, of which primary open angle glaucoma was the most common type (3.2% of the study population), followed by secondary glaucoma (0.8%) and primary angle closure glaucoma (0.2%). Pterygium was diagnosed in 508 out of 3,266 study participants, giving a prevalence rate of 15.6%. The presence of diabetic retinopathy was observed in 421 (12.9%) out of 3,265 study participants. 183 (5.6%) study participants had some degree of age-related macular degeneration (AMD), of which 23 (0.7%) were classified as having late AMD.

CONCLUSION

This paper provides a summary of the prevalence of common eye diseases among the Singaporean adult Malay population and provides data useful for public health education and disease prevention.

Increased iris thickness and association with primary angle closure glaucoma

AIMS

To investigate the relationship between quantitative iris parameters and angle closure disease. methods: Participants with angle closure were recruited prospectively from glaucoma clinics. Anterior segment optical coherence tomography (AS-OCT) was performed under standardised dark conditions. Customised software was used on horizontal AS-OCT scans to measure iris thickness at 750&emsp14;um (IT750) and 2000 um (IT2000) from the sclera spur, maximal iris thickness (ITM) and cross-sectional area of the iris (I-Area).

RESULTS

167 Angle closure (consisting of 50 primary angle-closure (PAC), 73 primary angle closure glaucoma (PACG) and 44 fellow eyes of acute PAC) and 1153 normal participants were examined. After adjusting for age, sex, pupil size and anterior chamber depth, mean IT750 (0.499 vs 0.451 mm, p<0.001), IT2000 (0.543 vs 0.479 mm, p<0.001), ITM (0.660 vs 0.602 mm, p<0.001) and I-Area (1.645 vs 1.570 mm(2), p=0.014) were significantly greater in angle closure (combined groups) versus normal eyes. Multivariate adjusted odd ratios (OR) of each parameter for the angle closure as compared with normal eyes were: IT750 OR1.7 (95% CI 1.1 to 2.7, p=0.032); IT2000 OR2.2 (95% CI 1.3 to 3.8, p=0.006) and ITM OR2.2 (95% CI 1.3 to 3.6, p=0.003), respectively, per 0.1 unit increase.

CONCLUSIONS

Increased iris thickness is associated with angle closure.

Comparison of Visante and slit-lamp anterior segment optical coherence tomography in imaging the anterior chamber angle

AIMS

To compare the diagnostic performance of two anterior segment optical coherence tomography (AS-OCT) devices in assessing the anterior chamber angle (ACA).

METHODS

Visante-OCT and slit-lamp-OCT (SL-OCT) were performed on 101 patients by a single operator. The AS-OCT images were processed by customised 'dewarping' software and assessed by two glaucoma specialists masked to clinical findings. A closed ACA was defined by the presence of contact between the iris and angle anterior to the scleral spur. Measurements of the ACA, anterior chamber depth (ACD), and pupil diameter were analysed. Gonioscopy was performed by another examiner masked to AS-OCT findings.

RESULTS

Qualitative analysis could be carried out in 83 (83%) eyes and quantitative analysis in 61 (60%) eyes. A closed angle in at least one quadrant of the eye was observed in 30 eyes with gonioscopy; Visante-OCT imaging identified 29 of 30 (97%) and SL-OCT imaging identified 27 of 30 (90%) of these eyes (P=0.50, McNemar test). Visante-OCT detected more eyes with at least one closed quadrant than SL-OCT (55 vs46 eyes, respectively, P=0.01). Overall, SL-OCT had better agreement with gonioscopy than with Visante-OCT. Both AS-OCTs showed good agreement for ACD measurements; however, SL-OCT tended to provide consistently higher ACA measurements and smaller pupil diameters than did Visante-OCT.

CONCLUSIONS

Both AS-OCT devices detected most of the eyes with closed ACA on gonioscopy. However, Visante-OCT detected more closed ACAs than did SL-OCT. The better agreement between SL-OCT and gonioscopy is likely because of the use of visible light during both examinations. The ACA measurements obtained with each device are not interchangeable.

Circulating tumor cells (CTC), [18F]fluorodeoxyglucose positron emission tomography, and computed tomography (PET/CT) for treatment monitoring in patients with metastatic breast cancer (MBC)

e12007

Background: Use of [18F]-fluorodeoxyglucose PET /CT and/or CTC is being investigated to follow up response to treatment in patients with MBC. It is not clear if these tests can be a surrogate for one another. Methods: We retrospectively analyzed a database of female patients with MBC undergoing chemotherapy or hormonal therapy. Most of these patients received at least 2 lines of therapy. Standard CT scan tumor measurements were used to assess response to therapy. CTC were defined either low (0–5) or high (>5). Maximum standard uptake values (max SUV) on PET scan were defined either low (<3) or high (>3). Correlation between the max SUV and CTC counts was statistically analyzed. Sensitivity, specificity, positive and negative predictive values were calculated from 2 x 2 table. Results: A total of 9 female patients with MBC were identified (mean age of 52 years). The receptor status of these patients includes 67 % positive for ER and 33 % positive for HER-2/neu. Median follow up was 9.8 months. There were 59 time points (> or = 4 weeks apart) when either PET/CT or CTC were performed. The results of PET/CT scans were compared with CTC at 38 events. The sensitivity of CTC to detect metastatic disease shown on PET/CT was 32% and specificity of 100%. The positive and negative predictive values were 100% and 32% respectively. There was a positive correlation between the max SUV and CTC count (p = 0.001). However in three patients, despite of progression of disease per PET/CT, CTC were undetectable at three different time points. Interestingly, two out of these three patients were triple negative. Disease progression was confirmed by biopsy in two of these patients. Conclusions: Our data suggest positive correlation between PET/CT scan and CTC. However, CTC had poor sensitivity and negative predictive value to detect progressive metastatic disease. Normal CTC values have to be interpreted cautiously in patients with MBC. We are now planning to investigate the utility of these tests, prospectively, in a large cohort of MBC patients.

No significant financial relationships to disclose.

Surgical management and genetic analysis of a Chinese family with the S171P mutation in the UBIAD1 gene, the gene for Schnyder corneal dystrophy

BACKGROUND

To describe the underlying molecular genetic basis, surgical management and phenotypic variation of Schnyder corneal dystrophy (SCD) identified in a four-generation Chinese family.

METHODS

This is an interventional case series of 13 members from a non-consanguineous Chinese family. All patients underwent complete ophthalmological examination and slit-lamp photography. Subsequent corneal transplantations were performed (n = 3). Blood samples were taken for DNA extraction and subsequent genetic analysis.

RESULTS

Genotyping indicated linkage to the locus at chromosome 1p36. Screening of the UBIAD1 gene identified a highly conserved mutation, Ser171Pro. Phenotypic variation in this large pedigree is similar to that seen in Caucasian patients. Surgical management of patients with anterior lamellar keratoplasty and deep anterior lamellar keratoplasty showed good visual outcomes.

CONCLUSIONS

The S171P mutation is described for the first time in a Chinese family. This is the largest non-Caucasian pedigree described with SCD. Visual rehabilitation may be performed successfully with lamellar surgical procedures as opposed to full-thickness corneal grafts.

Is measurement of adult height useful in screening for primary angle closure?

BACKGROUND

Adult height is independently related to ocular dimensions and shorter people have shorter globes and shallower anterior chambers. We investigated the relationship between adult height and angle dimensions to explore measuring height as a possible screening test for angle closure.

METHODS

A population-based, cross-sectional survey of adult Chinese living in the Tanjong Pagar district, Singapore was conducted. Anterior chamber depth, gonioscopic angle width and height were assessed using standardized protocols.

RESULTS

Data were available for 996 persons. Shorter people had shallower anterior chamber depth (2.35 mm for persons <144 cm vs 2.72 mm for persons >170 cm, P=0.008) and smaller gonioscopic angles (22 degrees for <144 cm vs 30 degrees for >170 cm, P=0.079). After controlling for age and gender, adult height was significantly related to anterior chamber depth (P=0.008) but not significantly related to gonioscopic angle width (P=0.079). Female sex and age > or = 50 years used together correctly identified 45/66 (68.2%) individuals with an occludable angle (sensitivity 68.2%, specificity 61.3%). Fewer people, 41/66 (62.1%), were correctly identified when height <160 cm was added to female sex and age 50 > or = years (sensitivity was 62.1% and specificity was 64.7%).

CONCLUSIONS

Shorter adult height is significantly associated with a shallower anterior chamber depth, but the addition of height contributed little to demographics (age and gender) as the preliminary screening criteria to identify individuals at risk of an occludable angle.

Prevalence of cataract surgery and post-surgical visual outcomes in an urban Asian population: the Singapore Malay Eye Study

AIM

The aim of the study was to describe the prevalence and visual outcomes of cataract surgery in an urban Asian population.

METHODS

This was a population-based study of 3280 Singapore Malays aged 40-80 years (response rate 78.7%). Participants had a standardised interview and comprehensive ocular examination. Poor post-operative visual outcome was defined as visual acuity </=20/60 in operated eyes of unilateral cataract extractions or in the better-seeing eye of bilateral cataract extractions. Factors associated with poor visual outcome were assessed.

RESULTS

Of 3280 participants, 284 (men 52.3%) had unilateral cataract extractions (age-standardised prevalence 4.7%, 95% CI 4.2% to 5.4%) and 154 persons (54%) had bilateral extractions. Older age, male sex and the presence of diabetes were significant factors associated with having had cataract surgery. Poor visual outcomes were present in 10.8% of the operated eyes using best-corrected visual acuity. Diabetic retinopathy (25.5%), glaucoma (17%), age-related macular degeneration (14.9%) and posterior capsular opacification (14.9%) were the main causes of poor visual outcome after surgery. Under-corrected refractive error accounted for 60% of patients with post-operative presenting visual acuity of </=20/60.

CONCLUSIONS

Five per cent of the sample of the Malay population aged 40-80 years in Singapore had cataract surgery. One in ten had post-operative best-corrected visual acuity of 20/60 or worse, largely related to concomitant retinal diseases.