Baerveldt tube implantation following failed deep sclerectomy versus repeat deep sclerectomy.

PURPOSE: To compare the surgical outcomes of repeat deep sclerectomy (DS) and the Baerveldt glaucoma implant (BGI) in eyes with failed primary deep sclerectomy. DESIGN: A retrospective comparative case-control study. METHODS: Fifty-eight eyes of 56 glaucoma patients with previously failed DS underwent BGI (group BGI) and 58 eyes of 55 patients underwent repeat DS (group DS) at a tertiary referral centre. Visual acuity, intraocular pressure (IOP), number of glaucoma medications, surgical failure rates and complication rates were compared between groups. Surgical failure was defined as loss of IOP control, loss of light perception, or need for further glaucoma surgery. RESULTS: Baseline demographics were similar between groups. Preoperatively, median IOP was lower in the DS than the BGI group (19 mmHg versus 21 mmHg, p = 0.10). Postoperatively at year 1, median IOP was significantly higher in the DS than BGI group (14 mmHg versus 11 mmHg, p = 0.02). There were no differences between the DS and BGI groups in mean number of medications preoperatively (2.3 versus 2.6) or postoperatively (1.3 versus 1.1). Complication rates were significantly higher in the DS group [41 % (n = 24) versus 14 % (n = 8); p = 0.01]. The failure rate at 1 year was higher in eyes with repeat DS than in eyes with BGI (30 vs. 21 %, respectively; p = 0.07). CONCLUSIONS: Baerveldt implants were more effective in lowering IOP and resulted in significantly fewer complications than repeat deep sclerectomy in eyes with previously failed deep sclerectomy

Systematic Occlusion of Shunts: Control of Early Postoperative IOP and Hypotony-related Complications Following Glaucoma Shunt Surgery.

OBJECTIVE: Evaluation of a protocol of total intraluminal occlusion of Baerveldt shunts and its effects on early postoperative intraocular pressure (IOP) control and hypotony-related complications. DESIGN: This was a noncomparative, prospective, and interventional study. PARTICIPANTS: Glaucoma patients were recruited to undergo Baerveldt shunt surgery. A total of 116 eyes of 112 patients were enrolled. INTERVENTION: During shunt implantation, aqueous outflow was restricted using an intraluminal occluding stent inserted through the entire tube length, with and without external ligation, to halt aqueous flow. Postoperatively, eyes underwent ligature laser suture lysis and partial or complete stent removals, at predetermined time intervals. MAIN OUTCOME MEASURE: Loss of postoperative IOP control was categorized as transient or persistent hypotony (IOP≤5 mm Hg) or hypertony (IOP>21 mm Hg). Patients were followed up for 1 year. RESULTS: Preoperatively median IOP was 23 mm Hg (mean 26 mm Hg, SD 12 mm Hg), median number of glaucoma medications was 3.0 (mean 3.0, SD 1.2). During year 1, laser suture lysis was performed in 30 eyes (26%) and stent removal in 93 eyes (80%) (23 partial; 70 complete). There was 1 case of transient hypotony, no cases of persistent hypotony, 10 of transient hypertony, and 3 of persistent hypertony. Nine eyes had IOP≤5 mm Hg at ≥1 time points and hypotony-related complications occurred in 8 eyes (7%). At 1 year, median IOP was 12 mm Hg (mean 13 mm Hg, SD 4 mm Hg) with a median of 1.0 glaucoma medications (mean 1.1, SD 1.3). The cumulative probability of failure during the first 12 months follow-up was 6% (n=7). Overall postoperative complications occurred in 11 eyes (9%). CONCLUSIONS: The surgical and postoperative protocol resulted in controlled, step-wise reductions of IOP with low rates of hypotony and related complications

Outcomes of gonioscopy-assisted transluminal trabeculotomy in pseudoexfoliative glaucoma: 24-month follow-up

AimTo report on outcomes of gonioscopy-assisted transluminal trabeculotomy (GATT) in eyes with pseudoexfoliative glaucoma (PXG).MethodsProspective, interventional, non-comparative case series. A total of 103 eyes from 84 patients with PXG were enrolled to undergo a 360-degree ab interno trabeculotomy with gonioscopic assistance using either a 5.0 polypropylene suture or an illuminated microcatheter with up to 24 months of follow-up. Main outcome measures were intraocular pressure (IOP), number of antiglaucoma medications, success rate (IOP reduction ≥20% from baseline or IOP between 6 and 21 mm Hg, without further glaucoma surgery) and complication rate.ResultsMean preoperative IOP was 27.1 mm Hg (95% CI 25.5 to 28.7) using 2.9 (SD 1.1) glaucoma medications which decreased postoperatively to 13.0 mm Hg (95% CI 11.5 to 14.4) and 1.0 (SD 1.1) medications at 24 months (p&lt;0.001). Success rate was 89.2% at 24 months of follow-up, and complication rate was 2.9%.ConclusionAt 24 months of follow-up, our results for GATT in PXG demonstrate that this conjunctival sparing procedure effectively lowers IOP and reduces the medications with a low complication rate, in this relatively aggressive glaucoma subtype.</jats:sec

Variable outcome and methylation status according to CEBPA mutant type in double-mutated acute myeloid leukemia patients and the possible implications for treatment

Although CEBPA double-mutated (CEBPA^{DM}) acute myeloid leukemia is considered to be a favorable-risk disease, relapse remains a major cause of treatment failure. Most CEBPA^{DM} patients have a classic biallelic mutant combination with an N-terminal mutation leading to production of p30 protein plus a C-terminal loss-of-function in-frame indel mutation (CEBPA^{Classic-DM}), but approximately one-third of cases have one or more non-classic mutations, with diverse combinations reported, and there is little information on the consequences of such mutants. We evaluated outcome in a cohort of 104 CEBPA^{DM} patients, 79 CEBPA^{Classic-DM} and 25 with non-classic mutants, and found that the latter may have poorer survival (5-year overall survival 64% vs. 46%; P=0.05), particularly post relapse (41% vs. 0%; P=0.02). However, for this analysis, all non-classic cases were grouped together, irrespective of mutant combination. As CEBPA^{DM} cases have been reported to be hypermethylated, we used methylation profiling to assess whether this could segregate the different mutants. We developed a CEBPA^{Classic-DM} methylation signature from a preliminary cohort of 10 CEBPA^{DM} (including 8 CEBPA^{Classic-DM}) and 30 CEBPA wild-type (CEBPA^{WT}) samples, and independently validated the signature in 17 CEBPA^{Classic-DM} cases. Assessment of the signature in 16 CEBPA^{DM} cases with different non-classic mutant combinations showed that only 31% had a methylation profile equivalent to CEBPA^{Classic-DM} whereas for 69% the profile was either intermediate between CEBPA^{Classic-DM} and CEBPA^{WT} or equivalent to CEBPA^{WT}. These results suggest that CEBPA^{DM} cases with non-classic mutants may be functionally different from those with CEBPA^{Classic-DM} mutants, and should not automatically be included in the same prognostic group. (AML12 is registered under ISRCTN17833622 and AML15 under ISRCTN17161961)

Results of a United Kingdom real-world study of polatuzumab vedotin, bendamustine, and rituximab for relapsed/refractory DLBCL

The addition of polatuzumab vedotin to bendamustine and rituximab (Pola-BR) has been shown to improve overall survival (OS) in stem cell transplant (SCT)-ineligible patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). It is also increasingly used as bridging to CAR T-cell therapy (CAR-T). We retrospectively analysed the efficacy of Pola-BR in 133 patients at 28 UK institutions. Treatment intent was bridging to CAR-T for N=40, re-induction with planned SCT for N=13 and stand-alone treatment for N=78. The overall response rate (ORR) was 57.0% (complete response (CR) 32.8%). After median 7.7 months follow-up, median PFS and OS were 4.8 months and 8.2 months respectively. For stand-alone treatment shortened PFS was associated with bulk disease (>7.5cm) (HR 2.32 (95% CI 1.23-4.38), p=0.009), >1 prior treatment (HR 2.17 (95% CI 1.19-3.95), p=0.01) and refractoriness to the last treatment (HR 3.48 (95% CI 1.79-6.76), p<0.001). For CAR-T bridging the ORR was 42.1% (CR 18.4%) and for treatment after CAR-T failure the ORR was 43.8% (CR 18.8%). These data demonstrate efficacy for Pola-BR as a treatment for SCT-ineligible patients with R/R DLBCL, help to delineate which patients may benefit most, and provide preliminary evidence of efficacy as bridging to CAR-T and after CAR-T failure

Effects of Therapy in Oropharyngeal Dysphagia by Speech and Language Therapists: A Systematic Review

Medical and paramedical treatments should be evaluated according to current standards of evidence-based medicine. Evaluation of therapy in oropharyngeal dysphagia fits into this growing interest. A systematic review is given of the literature on the effects of therapy in oropharyngeal dysphagia carried out by speech therapists. Thus, the review excludes reports of surgical or pharmacological treatments. The literature search was performed using the electronic databases PubMed and Embase. All available inclusion dates up to November 2008 were used. The search was limited to English, German, French, Spanish, and Dutch publications. MESH terms were supplemented by using free-text words (for the period after January 2005). Fifty-nine studies were included. In general, statistically significant positive therapy effects were found. However, the number of papers was rather small. Moreover, diverse methodological problems were found in many of these studies. For most studies, the conclusions could not be generalized; comparison was hindered by the range of diagnoses, types of therapies, and evaluation techniques. Many questions remain about the effects of therapy in oropharyngeal dysphagia as performed by speech and language therapists. Although some positive significant outcome studies have been published, further research based on randomized controlled trials is needed