Brachytherapy – Optional Treatment for Choroidal Neovascularization Secondary to Age-Related Macular Degeneration

Age-related macular degeneration (ARMD) presents the main cause of irreversible loss of central vision in older population, due to a progressive neuroretinal damage and damage of retinal pigment epithelium of foveal area. This observation emphasizes the insufficiency of all presently used therapeutic procedures. Therefore, investigation has been conducted at the University Eye Clinic Zagreb for the last three years testing the effects of brachytherapy with direct episcleral application of ruthenium applicators to the posterior pole of the globe. Forty-two patients aged 58–79 were followed for a min. of 12 months. During this period their central visual acuities remained stable. Six patients showed one-line improvement of visual acuity and 8 patients showed no changes. Twenty-one patient lost 1–2 lines of visual acuity and 7 patients lost more than 2 lines. According to this we can conclude that patients treated with brachytherapy showed significantly better results compared to the control subjects, which is very encouraging

Types of Central Serous Retinopathy, Analysis of Shape, Topographic Distribution and Number of Leakage Sites

The analysis of 212 fluorescein angiograms of the same number of eyes showed that Type I is by far the most prevalent form of central serous retinopathy. Type I appeared in 92.45%, Type II in 6.60% and the Intermediate type in 0.95% of the examined eyes. The patients were mostly male (81.13%) between 30 and 49 years of age (95.28%). The number of leakage sites in Type I central serous retinopathy varied from 1 (83.67%) to 5 (1.02%). Solitary leakage appeared in 83.67%, while uniform spreading of fluorescein into the subretinal blister in Type I central serous retinopathy appeared in 85.71% of eyes. Most leakage sites (32.50%) were located in the upper nasal quadrant, while the lower temporal quadrant was least affected (15.83%). The foveal avascular zone was affected in 4.14% and the papillomacular bundle in 20.83% of the examined eyes

Corneal Transplantation in Children

The main purpose of the study was to describe the surgical success rate and visual results of penetrating keratoplasty in children. This retrospective study included children that underwent corneal transplantation at the Department of Ophthalmology, General Hospital »Sveti Duh«, in the period 1994–1999. Patients’ age ranged from 6 to 16 years. Twenty-five corneal transplants were performed in 24 eyes. Corneal pathologies were corneal leucoma, congenital dystrophy, corneal combustion, corneal scar after perforating injury, keratoconus, corneal melting, hematocornea and rekeratoplasty. The follow-up period was at least 6 months. The rate of graft survival was 1 year in 75% of eyes with congenital dystrophy and keratoconus. Hematocornea and rekeratoplasty ended with graft failure. Postoperative visual acuity improvement was recorded in 14 out of 25 eyes. Penetrating keratoplasty in children showed very good surgical success. The final visual outcome was affected by irreversible amblyopia

Multilayer vs. Monolayer Amniotic Membrane Transplantation for Deep Corneal Ulcer Treatment

The purpose of the study was to evaluate the efficacy of multilayer amniotic transplantation (AMT) for reconstruction of corneal stroma and epithelium. Corneal ulcer (28) was a consequence of a previous infectious or neurotrophic keratitis. In the first group (17) ulcer was covered with monolayer AM, while in the other group (11) there were two or more layers of AM situated in the ulcer and the whole cornea was covered with AM sheet. Monolayer AMT was successful in 64% while the multilayer AMT success rate was 72%. AM gradually dissolved within 3–6 postoperative weeks. AM transplantation facilitates rapid healing of corneal epithelium, reduces inflammation and stimulates epithelial cell regrowth. In eyes with deep corneal ulcer multilayer technique proved to be better then monolayer procedure

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

Aim The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusion One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index [removed]60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services