Taxane-Induced Neuropathy and Its Ocular Effects—A Longitudinal Follow-up Study in Breast Cancer Patients

A common severe neurotoxic side effect of breast cancer (BC) therapy is chemotherapy-induced peripheral neuropathy (CIPN) and intervention is highly needed for the detection, prevention, and treatment of CIPN at an early stage. As the eye is susceptible to neurotoxic stimuli, the present study aims to determine whether CIPN signs in paclitaxel-treated BC patients correlate with ocular changes by applying advanced non-invasive biophotonic in vivo imaging. Patients (n = 14, 10 controls) underwent monitoring sessions after diagnosis, during, and after therapy (T0-T3). Monitoring sessions included general anamnesis, assessment of their quality of life, neurological scores, ophthalmological status, macular optical coherence tomography (OCT), and imaging of their subbasal nerve plexus (SNP) by large-area confocal laser-scanning microscopy (CLSM). At T0, no significant differences were detected between patients and controls. During treatment, patients’ scores significantly changed while the greatest differences were found between T0 and T3. None of the patients developed severe CIPN but retinal thickenings could be detected. CLSM revealed large SNP mosaics with identical areas while corneal nerves remained stable. The study represents the first longitudinal study combining oncological examinations with advanced biophotonic imaging techniques, demonstrating a powerful tool for the objective assessment of the severity of neurotoxic events with ocular structures acting as potential biomarkers

A time-saving method for recording chemosensory event-related potentials

The objective of this study was to reduce the recording duration of chemosensory event-related potentials (CSERP) and thereby to make the method more suitable for routine clinical use. Measurements were performed in the Department of Otorhinolaryngology of the university hospital of Cologne. Two protocols with different sequences [inter-stimulus intervals (ISI)-standard sequence: 30 s; PRS-15: pseudo-randomized sequence, mean ISI of 15 s] were applied to 40 volunteers to record CSERPs. To compare CSERP recordings under optimal and adverse test conditions, 20 younger/normosmic adults and 20 older/hyposmic participants were included in this study. Olfactory function was gauged using the Sniffin'Sticks test. For CSERP recordings, phenylethyl alcohol, hydrogen sulfide and carbon dioxide were used for olfactory or trigeminal stimulation, respectively. Both ISI protocols allowed recording CSERPs under optimal and adverse test conditions and distinguishing both groups by latencies (p a parts per thousand currency sign 0.015). The time requirement for the recording of CSERPs with the PRS-15 sequence was less than 30 min. The pseudo-randomized sequence allowed the recording of diagnostically conclusive CSERPs in both groups and saved approximately 40% of the measuring time. This seems to be especially useful in cases where a yes/no answer (e.g., medical reports, exclusion of anosmia) is required. Shortening the time requirement significantly allows applying CSERPs to larger populations of patients with olfactory impairment

Retinal Detachment Part 2 Treatment Strategies

Zusammenfassung Dieser Beitrag beschaftigt sich mit der Behandlung der Netzhautablosung. Hier wird unterschieden zwischen behandlungsbedurftigen Ablatiovorstufen, die retinopexiert werden, und der manifesten Netzhautablosung, welche weiterfuhrender Chirurgie bedarf. Nicht immer bedeutet ein anatomischer Erfolg zugleich auch einen funktionellen Erfolg. Typische postoperative Komplikationen und Einflussfaktoren auf das anatomische und funktionelle Ergebnis werden vorgestellt und diskutiert. Abstract This review article summarizes the relevant surgical strategies for retinal detachment repair and discusses common postoperative complications, as well as factors influencing the functional and anatomical results. Treatment of retinal detachment requires surgery. In most cases, pars plana vitrectomy is performed. In phakic patients with a clear lens scleral buckling can be considered as an alternative. Laser and cryotherapy are still the standard for treatment in symptomatic retinal tears or degenerations without retinal detachment. Postoperatively, the occurrence of a re-detachment as well as the development of proliferative vitreoretinopathy can have a negative influence on postoperative results. Furthermore, typical complications include the occurrence of a cystoid macular edema, epiretinal membrane or even persistent neurosensory detachment. Functional results are significantly influenced by macular involvement and the primary anatomical success rate

Does anterior chamber-associated immune deviation (ACAID) play a role in posterior lamellar keratoplasty? Case report of a splenectomized patient

BackgroundIt has been shown experimentally in rodents that removal of the spleen leads to increased rejection of corneal allografts after corneal transplantation (keratoplasty).Case presentationHere, we report a unique case of a splenectomized patient with corneal endothelial dystrophy who underwent posterior lamellar keratoplasty. During follow-up of 4years, we did not detect any signs of corneal allograft rejection.ConclusionsOur report indicates that an intact spleen is not necessary for allograft acceptance after posterior lamellar keratoplasty. To the best of our knowledge, this is the first report of a splenectomized patient receiving a (lamellar) corneal transplant

Indications for Retinal Laser Therapy Revisited

Laser therapy is an important treatment option in retinal diseases, especially in cases of vascular involvement. Most approaches are based on coagulation of retinal structures. As there is increasing use of agents targetting vascular endothelial growth factor in the treatment of macular diseases, indications for the use of laser treatment need to be reviewed carefully, especially with respect to their significance in first line therapy. This article explains recent strategies and treatment protocols. Retinal laser therapy is still widely used within retinal ophthalmology and covers a large spectrum of indications. Despite the success of medical approaches, retinal laser therapy remains an indispensable treatment option for proliferative diabetic retinopathy, central or peripheral vein occlusion and less frequent pathologies, such as retinopathy of prematurity or Coatss disease

Keratoprostheses: Last Hope for the Most Severe Corneal Diseases

Corneal blindness affects over 8 million adults and 1.5 million children worldwide, making it one of the top 5 causes of blindness. Depending on the recipient's corneal condition corneal transplantation may not be a viable treatment option. In such seemingly no-alternative situations, keratoprosthesis implantation can be an option in some patients. In terms of numbers, two types of keratoprostheses are currently used: 1. Keratoprostheses with biological haptics made of tooth or tibia bone. 2. The Boston type I-keratoprosthesis. Both types have optics made of PMMA. The most common complication is the formation of an optically disturbing retroprosthetic membrane behind the optic, which can usually be removed with YAG laser. Causes of blindness after keratoprosthesis implantation are glaucoma, endophthalmitis and retinal detachment. The extrusion rate of the Boston type I-keratoprosthesis seems to be higher than after keratoprosthesis implantation with biological haptic. Autoimmunological corneal diseases have increased extrusion rates and higher rates of endophthalmitis when compared to non-autoimmunological diseases. Visual outcomes after keratoprosthesis implantation are potentially very good and usually limited by extracorneal concomitant diseases. Advances in glaucoma diagnostic (OCT, implantation of intraocular pressure sensors), standard glaucoma prophylaxis by medication or surgery, modern retinal surgery and better treatment options in case of extrusion improve the prognosis of keratoprosthesis surgery. Still, the ideal technique for permanent anchoring of artifical optics in biological tissue has yet to be developed