Radical prostatectomy and quality of life : results in a center of high complexity

Introducción La prostatectomía radical (PR) es el patrón de oro para el manejo quirúrgico con intención curativa del cáncer de próstata. Sin embargo, tiene secuelas importantes como la incontinencia urinaria y la disfunción eréctil. El objetivo de este estudio es describir la prevalencia de las secuelas y el compromiso de calidad de vida de los pacientes llevados a PR abierta en un centro de alta complejidad. Materiales y Métodos Se revisaron los datos de los pacientes llevados a prostatectomía radical en el Hospital Universitario San Ignacio desde el año 2005 hasta el año 2015. Se seleccionaron aquellos que tuvieran más de 12 meses de postoperatorio, previo consentimiento informado verbal por vía telefónica se aplicó el cuestionario UCLA PCI. La información fue organizada para su análisis en una base de datos construida con ese fin para posterior aplicación de las estadísticas descriptivas que permitieran resumir y describir los resultados. Resultados Durante los años analizados, se realizaron 231 prostatectomías radicales. Se logró tener contacto con 112 de ellos a los cuales se les aplicó el cuestionario UCLA PCI. En el dominio de función urinaria, 57% de los pacientes reportan tener “control total de la orina,” 53% nunca tienen escape involuntario de la orina, 82% no requieren el uso de protectores y 62% presentan goteo de orina menos de 1 vez por semana. En cuanto a la función sexual, 69,3% califican su habilidad para tener una erección como pobre o muy pobre, 25% regular y 7% buena o muy buena. Para 20% la erección es suficiente para lograr el coito. Y para 52% esa función implica un problema en su vida. El impacto en la calidad de vida mostró que un 91,8% de los pacientes consideran que su salud es en general buena muy buena o excelente y un 70% no tienen ningún tipo de limitación física. Conclusiones La prostatectomía radical tiene un impacto importante no despreciable en la calidad de vida de los pacientes, especialmente en lo referente a la función urinaria y sexual. Su impacto en la calidad de vida debe ser considerado al momento de realizar la consejería previa a la toma de decisiones en el manejo definitivo del cáncer de próstata con el fin de que el paciente tenga unas expectativas claras en ese sentido.141-146Introduction Radical prostatectomy (RP) is the gold standard in curative surgical treatment for prostate cancer. However, it has significant consequences such as urinary incontinence and erectile dysfunction. The aim of this study is to describe the prevalence of complications and its effects on quality of life of patients undergoing an open RP in a reference center. Materials and Methods The data of patients who underwent RP at Hospital Universitario San Ignacio from 2005 to 2015 was reviewed. Patients who underwent RP more than 12 months ago where selected and with previous verbal consent a UCLA PCI questionnaire was completed by phone. The information was organized in a database to apply descriptive statistics which allowed to summarize and analyze the results. Results During the years analyzed there were performed 231 radical prostatectomies. It was possible to contact 112 by phone to get the UCLA PCI questionnaire completed. In the urinary function domain, 57% of patients report to “have total control of urine,” 53% never leak, 82% of them do not require the use of pads and 62% have urine leakage less than once a week. Regarding sexual function, 69,3% scored their ability to have an erection as poor or very poor, 25% medium and 7% good or very good. For 20% it was sufficient to achieve coitus. And for 52% this function means a problem in their life. The impact on life quality showed that 91.8% of patients felt that their health in general was very good, good or excellent and 70% did not have any physical limitation. Conclusions Radical prostatectomy has an important and no insignificant impact in patients' quality of life, especially regarding urinary function and sexual function. It́s impact in quality of life should be considered at the moment of counseling the patients when taking decisions about curative prostate cancer treatmen

Analytical model for managing hypotony after implantation surgery of a glaucoma drainage device

This article has been updated.The main aim of glaucoma treatment is to reduce the intraocular pressure (IOP). One of the most common surgical treatments of glaucoma is the implantation of a glaucoma drainage device to drain the aqueous humor from the anterior chamber to a filtration bleb, where the aqueous humor is absorbed. In some cases, the excess of drainage causes ocular hypotony, which constitutes a sight-threatening complication. To prevent hypotony after this intervention, surgeons frequently introduce a suture into the device tube, which increases the hydraulic resistance of the tube and, therefore, the IOP. This study aims to provide an analytical model to correct hypotony following implantation surgery of a glaucoma drainage device, which may help glaucoma surgeons decide on hypotony treatment. The results indicate that the IOP after implanting a cylindrical tube around 300 μm in diameter is essentially the same as that built up in the filtering bleb and can hardly be controlled by introducing a straight suture unless the suture diameter is slightly lower than that of the tube. On the contrary, when the tube diameter is smaller than, for example, 100 μm, significant reductions of the IOP can be obtained by introducing a thin suture into the tube.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Partial support from the Junta de Extremadura through Grant No. GR18175 (partially financed by FEDER funds) is gratefully acknowledged. The work has been funded by a research grant from the San Carlos Clinical Hospital, Health Research Institute (IdISSC), Madrid, Spain.peerReviewe

Numerical model to predict and compare the hypotensive efficacy and safety of minimally invasive glaucoma surgery devices.

PurposeTo predict and compare the hypotensive efficacy of three minimally-invasive glaucoma surgery (MIGS) implants through a numerical model.MethodsPost-implant hypotensive efficacy was evaluated by using a numerical model and a computational fluid dynamics simulation. Three different devices were compared: the XEN 45 stent (tube diameter, 45 μm), the XEN 63 stent (63 μm) and the PreserFlo microshunt (70 μm). The influence of the filtration bleb pressure (Bp) and tube diameter, length, and position within the anterior chamber (AC) on intraocular pressure (IOP) were evaluated.ResultsUsing baseline IOPs of 25, 30 and 50 mmHg, respectively, the corresponding computed post-implant IOPs for each device were as follows: XEN 45: 17 mmHg (29% decrease), 19 mmHg (45%) and 20 mmHg (59%) respectively; XEN 63: 13 mmHg (48%), 13 mmHg (62%), and 13 mmHg (73%); PreserFlo: 12 mmHg (59%), 13 mmHg (73%) and 13 mmHg (73%). At a baseline IOP of 35 mmHg with an increase in the outflow resistance within the Bp from 5 to 17 mmHg, the hypotensive efficacy for each device was reduced as follows: XEN45: 54% to 37%; XEN 63: 74% to 46%; and PreserFlo: 75% to 47%. The length and the position of the tube in the AC had only a minimal (non-significant) effect on IOP (ConclusionsThis hydrodynamic/numerical model showed that implant diameter and bleb pressure are the two most pertinent determinants of hypotensive efficacy. In distinction, tube length and position in the AC do not significantly influence IOP

Fourier domain optical coherence tomography to assess the iridocorneal angle and correlation study in a large Caucasian population

Background: Recently, novel anatomic parameters that can be measured by optical coherence tomography (OCT), have been identified as a more objective and accurate method of defining the iridocorneal angle. The aim of the present study is to measure the iridocorneal angle by Fourier domain (FD) OCT and to identify correlations between angle measurements and subject factors in a large healthy Caucasian population. Methods: A cross sectional study was performed in 989 left eyes of 989 healthy subjects. The iridocorneal angle measurements: trabecular-iris angle (TIA), angle opening distance (AOD500) and trabecular-iris space area (TISA500) 500 μm from the scleral spur, were made using the FD-OCT RTVue®. Iris thickness was also measured. Correlations were examined between angle measurements and demographic and ocular factors. The main determinants of angle width were identified by multivariate linear regression. Results: TIA could be measured in 94 % of the eyes, and AOD500 and TISA500 in 92 %. The means recorded were TIA 35.8 ± 12.2 degrees (range 1.5 to 76.1), AOD500 542.6 ± 285.4 μm (range 15 to 1755), and TISA500 0.195 ± 0.104 mm2 (range 0.02 to 0.62). The correlation between the temporal and nasal quadrant was R = 0.902 for TIA. The reproducibility of measurements was excellent (intraclass correlation coefficient >0.947). Mean angle width measurements were smaller in women (p = 0.02). Correlation was detected between angle means and anterior chamber volume (ACV; R = 0.848), anterior chamber depth (ACD; R = 0.818), spherical error (R = -0.619) and age (R= -0.487), while no correlation was observed with Intraocular pressure (R = -0.052). ACV emerged as the main determinant of TIA (R2 = 0.705; p < 0.001). Conclusions: In this Caucasian population, strong correlation was detected between FD-OCT anterior angle measurements and ACV, ACD, spherical refractive error and sex, emerging the ACV as the main determinant of TIA.peerReviewe

Long-Term Consequences of COVID-19 Lockdown in Neovascular AMD Patients in Spain: Structural and Functional Outcomes after 1 Year of Standard Follow-Up and Treatment

Consequences of the COVID-19 pandemic on medical care have been extensively analyzed. Specifically, in ophthalmology practice, patients suffering age-related macular degeneration (AMD) represent one of the most affected subgroups. After reporting the acute consequences of treatment suspension in neovascular AMD, we have now evaluated these same 242 patients (270 eyes) to assess if prior functional and anatomical situations can be restored after twelve months of regular follow-up and treatment. We compared data from visits before COVID-19 outbreak and the first visit after lockdown with data obtained in subsequent visits, until one year of follow-up was achieved. For each patient, rate of visual loss per year before COVID-19 pandemic, considered “natural history of treated AMD”, was calculated. This rate of visual loss significantly increased during the lockdown period and now, after twelve months of regular follow-up, is still higher than before COVID outbreak (3.1 vs. 1.6 ETDRS letters/year, p p = 0.0017). Although anatomic deterioration, regarding signs of active disease, can be apparently fully restored, our results suggest that functional consequences of temporary anti-VEGF treatment suspension are not entirely reversible after 12 months of treatment, as BCVA remains lower and visual loss rate is still higher than before the COVID-19 pandemic

The Effect of a Triple Combination of Bevacizumab, Sodium Hyaluronate and a Collagen Matrix Implant in a Trabeculectomy Animal Model

Currently available anti-scarring treatments for glaucoma filtration surgery (GFS) have potentially blinding complications, so there is a need for alternative and safer agents. The effects of the intrableb administration of a new combination of the anti-VEGF bevacizumab, sodium hyaluronate and a collagen matrix implant were investigated in a rabbit model of GFS, with the purpose of modulating inflammation, angiogenesis, fibroblast migration and fibrogenesis in the wound healing process. A comparative-effectiveness study was performed with twenty-four rabbits, randomly assigned to the following treatments: (a) biodegradable collagen matrix implant (Olo), (b) bevacizumab-loaded collagen matrix implant (Olo-BVZ), (c) bevacizumab-loaded collagen matrix implant combined with sodium hyaluronate (Olo-BVZ-H5) and (d) sham-operated animals (control). Rabbits underwent a conventional trabeculectomy and were studied over 30 days in terms of intraocular pressure and bleb characterization (height, area and vascularity in central, peripheral and non-bleb zones). Histologic differences among groups were further evaluated at day 30 (inflammation, total cellularity and degree of fibrosis in the area of surgery). Local delivery of bevacizumab (Olo-BVZ and Olo-BVZ-H5) increased the survival of the filtering bleb by 21% and 31%, respectively, and generated a significant decrease in inflammation and cell infiltration histologically 30 days after surgery, without exhibiting any local toxic effects. Olo-BVZ-H5 showed less lymphocyte infiltration and inflammation than the rest of the treatments. Intraoperative intrableb implantation of bevacizumab, sodium hyaluronate and a collagen matrix may provide an improved trabeculectomy outcome in this model of intense wound healing. This study showed an effective procedure with few surgical complications and a novel combination of active compounds that offer new possibilities to improve the efficacy of filtration surgery

Computational simulation of aqueous humour dynamics in the presence of a posterior-chamber versus iris-fixed phakic intraocular lens.

PURPOSE:To compare aqueous humour (AH) dynamics in the presence of a precrystalline (Implantable Collamer Lens®; ICL) or iris-fixed (Artiflex®) phakic intraocular lens (PIOL). METHODS:By computational fluid dynamics simulation, AH flow was modelled through a peripheral iridotomy (PI) or central lens hole (both 360 μm) in the presence of an Artiflex or ICL lens, respectively. The impacts of AH flow were then determined in terms of wall shear stress (WSS) produced on the endothelium or crystalline lens. Effects were also modelled for different scenarios of pupil diameter (PD 3.5 or 5.5 mm), ICL vault (100, 350, 800 μm) and number of Artiflex iridotomies (1 or 2) and location (12 or 6 o'clock). RESULTS:For a PD of 3.5 mm, AH volumes flowing from the posterior to the anterior chamber were 37.6% of total flow through the lens hole (ICL) and 84.2% through PI (Artiflex). For an enlarged PD (5.5 mm), corresponding values were 10.3% and 81.9% respectively, so PI constitutes a very efficient way of evacuating AH. Central endothelial WSS in Pa was lower for the large vault ICL and the Artiflex (1-03 and 1.1-03 respectively) compared to the PIOL-free eye (1.6-03). Crystalline lens WSS was highest for the lowest vault ICL (1-04). CONCLUSIONS:AH flow varied according to the presence of a precrystalline or iris-fixed intraocular lens. Endothelial WSS was lower for an implanted ICL with large vault and Artiflex than in the PIOL-free eye, while highest crystalline WSS was recorded for the lowest vault ICL

Hypercytokinemia in COVID-19: Tear cytokine profile in hospitalized COVID-19 patients

The aim of this study is to analyze the concentrations of cytokines in tear of hospitalized COVID-19 patients compared to healthy controls. Tear samples were obtained from 41 healthy controls and 62 COVID-19 patients. Twenty-seven cytokines were assessed: interleukin (IL)-1b, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL9, IL-10, IL-12, IL-13, IL-15, IL-17, eotaxin, fibroblast growth factor basic, granulocyte colony-stimulating factor (G-CSF), granulocyte-monocyte colony-stimulating factor (GM-CSF), interferon (IFN)-γ, interferon gamma-induced protein, monocyte chemo-attractant protein-1, macrophage inflammatory protein (MIP)-1a, MIP-1b, platelet-derived growth factor (PDGF), regulated on activation normal T cell expressed and secreted, tumor necrosis factor-α and vascular endothelial growth factor (VEGF). In tear samples of COVID-19 patients, an increase in IL-9, IL-15, G-CSF, GM-CSF, IFN-γ, PDGF and VEGF was observed, along with a decrease in eotaxin compared to the control group (p < 0.05). A poor correlation between IL-6 levels in tear and blood was found. IL-1RA and GM-CSF were significantly lower in severe patients and those who needed treatment targeting the immune system (p < 0.05). Tear cytokine levels corroborate the inflammatory nature of SARS-CoV-2.Peer reviewe

Whole-exome sequencing of congenital glaucoma patients reveals hypermorphic variants in GPATCH3, a new gene involved in ocular and craniofacial development

Congenital glaucoma (CG) is a heterogeneous, inherited and severe optical neuropathy that originates from maldevelopment of the anterior segment of the eye. To identify new disease genes, we performed whole-exome sequencing of 26 unrelated CG patients. In one patient we identified two rare, recessive and hypermorphic coding variants in GPATCH3, a gene of unidentified function, and 5% of a second group of 170 unrelated CG patients carried rare variants in this gene. The recombinant GPATCH3 protein activated in vitro the proximal promoter of CXCR4, a gene involved in embryo neural crest cell migration. The GPATCH3 protein was detected in human tissues relevant to glaucoma (e.g., ciliary body). This gene was expressed in the dermis, skeletal muscles, periocular mesenchymal-like cells and corneal endothelium of early zebrafish embryos. Morpholino-mediated knockdown and transient overexpression of gpatch3 led to varying degrees of goniodysgenesis and ocular and craniofacial abnormalities, recapitulating some of the features of zebrafish embryos deficient in the glaucoma-related genes pitx2 and foxc1. In conclusion, our data suggest the existence of high genetic heterogeneity in CG and provide evidence for the role of GPATCH3 in this disease. We also show that GPATCH3 is a new gene involved in ocular and craniofacial development.This study has been supported by research grants from the “Instituto de Salud Carlos III/FEDER” (RD12/0034/0003, PI11/00662, PI15/01193 to JE and CP12/03256 to MC), the Ministry of Economy and Competitiveness/FEDER (MINECO, SAF2013-46943-R to MC and PT13/0001/0044 to MG), Mutua Madrileña Foundation (to MC), and the Regional Ministry of Science and Technology of the Board of the Communities of “Castilla-La Mancha” (PEII-2014-002-P to JE). Jesús-José Ferre-Fernández is the recipient of a predoctoral fellowship from the “Instituto de Salud Carlos III” (FI12/00287). Miguel Coca-Prados is “Catedrático Rafael del Pino en Oftalmología” in the “Fundación de Investigación Oftalmológica, Instituto Oftalmológico Fernández-Vega” Oviedo, Spain. Marta Corton is sponsored by the Miguel Servet Program (CP12/03256) from Instituto de Salud Carlos III/FEDER)