3 research outputs found
Ahmed vs Baerveldt Glaucoma Drainage Device in Uveitic Glaucoma
Introduction: Uveitis is an inflammatory eye disorder which may elevate intraocular pressure (IOP), causing sight-threatening glaucoma. Treatment of refractory uveitic glaucoma involves implantation of a glaucoma drainage device (GDD). Uveitic glaucoma has been a minority diagnosis in prior studies comparing the valved Ahmed GDD and non-valved Baerveldt GDD. Here we compare the safety and efficacy of the Ahmed and Baerveldt GDD in uveitic glaucoma.
Methods: This retrospective comparative study was conducted on patients with uveitic glaucoma (≥14 years old) who underwent Ahmed or Baerveldt GDD implantation between 2006–2018 with a minimum follow-up of 3 months. Success was defined as IOP of 6-21 mmHg with (complete success) or without (qualified success) medications, with at least light perception vision and no further glaucoma surgery. Pearson Chi-squared test, independent t test, and Kaplan-Meier survival model were utilized for statistical analysis.
Results: 137 eyes of 122 patients (67 Ahmed and 70 Baerveldt) were included. Baseline characteristics were comparable in both groups. The Baerveldt group experienced greater IOP reduction (60.3% vs. 44.5%), higher complete success rate (28.6% vs. 10.4%), higher complication rate (44.3% vs. 20.9%), and higher hypotony rate (10% vs. 0%) than the Ahmed group (all p values \u3c0.05).
Discussion: Our results are in line with pooled analysis of previous GDD comparison studies on various types of glaucoma. For patients with uveitic glaucoma, the Baerveldt implant provided a significantly higher success rate and greater IOP reduction with fewer medications, but was associated with a higher complication rate, compared to the Ahmed implant
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Prospective investigation of patent foramen ovale as a mechanism for brain metastasis in patients without prior lung involvement.
e14510
Background: Brain metastases can lead to significant morbidity and mortality in patients with advanced cancer. Preventing metastatic disease to the brain could thus substantially improve outcomes. The mechanism of brain metastasis is incompletely understood. Circulating tumor cells drain to the right heart and through the pulmonary circulation, where they may manifest as lung metastases, and can circulate further to the left heart and then to the brain. However, in patients who develop brain metastases without prior lung involvement, metastatic cells may take an alternate route. We hypothesized that cancer cells may pass directly from the right to left heart via a patent foramen ovale (PFO), akin to paradoxical embolism. The prevalence of PFO is approximately 20-30% in the general population; if further elevated in this population, PFO may play a role in brain metastasis development, and ultimately, prophylactic PFO closure may provide benefit. We conducted a pilot study to investigate whether PFO is associated with brain metastases in patients without prior lung involvement. Methods: We prospectively identified patients with brain metastases from a non-lung primary cancer with no preceding lung metastases. Participants underwent a transcranial Doppler study to assess for PFO. Agitated saline was injected intravenously at rest and with Valsalva maneuver. High intensity signals were counted in the middle cerebral arteries for 1 minute after each injection. Spencer grade ≥3 indicated a positive study, consistent with the presence of PFO. Results: We accrued 9 participants who met inclusion criteria. Primary cancers were breast (6 participants), upper gastrointestinal (2 participants), and thyroid (1 participant). A positive study was identified in 2/9 (22.2%) participants. One individual was a female with breast cancer who had no preceding extracranial metastases, and the other individual was a male with duodenal adenocarcinoma whose only prior metastatic disease was distant lymphadenopathy, not active at brain metastasis diagnosis. No participants have developed lung metastases as of their most recent imaging. Conclusions: In this prospective pilot study, we found no increased prevalence of PFO in patients who develop brain metastases without preceding lung involvement compared to estimates for the general population. Though a larger study is needed, the development of brain metastases in these patients may reflect tumors’ biological factors directing metastasis organotropism, rather than a structural pathway