Incidence of ocular surface squamous neoplasia in pterygium specimens.

OBJECTIVE: Pterygium and ocular surface squamous neoplasia (OSSN) have been recognized as likely related conditions and share similar risk factors such as ultraviolet radiation and chronic inflammation. The purpose of this study is to review the incidence of OSSN in pathology specimens sent as pterygium at a single tertiary centre between 2010 and 2022. METHODS: This is a retrospective chart review of patients operated on for pterygium between 2010 and 2022 at the University of Montreal Health Centre. Data collected include baseline demographics, results of pathology specimen, and clinical information for cases diagnosed as OSSN on pathology. RESULTS: A total of 1559 patients were operated on for a clinical diagnosis of pterygium between 2010 and 2022, of which 854 patients (55%) were male. A total of 1142 specimens had available pathology reports, and most of the specimens were consistent with pterygium on pathology (1105 of 1142; 97%). There was an unexpected finding of 3 cases of OSSN (3 of 1142; 0.3%). Other diagnosis besides pterygium were seen in 3% of specimens (34 of 1142), including nevus (n = 12), spheroidal degeneration (n = 3), pyogenic granuloma (n = 3), and lymphangiectasia (n = 2). The 3 cases of OSSN included an 81-year-old male of French-Canadian background, a 52-year-old male of South Asian background, and a 59-year-old female of French-Canadian background. The pathology was diagnosed as conjunctival intraepithelial neoplasia (CIN) grade 3, CIN grade 2, and CIN grade 2, respectively. CONCLUSION: The finding of OSSN in pterygium is rare in our population but can be clinically difficult to distinguish. It is important to send all pterygium specimens for pathology.

Toric Trifocal Intraocular Lens for Refractive Lens Exchange: A Multi-center, Multi-surgeon Large Cohort Study.

PURPOSE: To assess the outcomes of a novel toric trifocal intraocular lens (IOL) for refractive lens exchange (RLE) in a large series of eyes with corneal astigmatism. METHODS: Consecutive eyes that underwent RLE with the PanOptix Toric IOL (Alcon Laboratories, Inc) were included. Outcomes measures included postoperative distance (UDVA), 60 cm intermediate (UIVA), and 40 cm near (UNVA) uncorrected visual acuity, manifest refraction, spherical and defocus equivalent, efficacy and safety indices, and vector analyses of refractive and toric IOL accuracy. RESULTS: A total of 4,933 eyes had a median follow-up of 3 months. UDVA of 20/20 and 20/40 was obtained in 65% and 99% of eyes monocularly and 87% and 100% binocularly, respectively. UIVA at 60 cm of 20/25 and 20/40 was achieved in 70% and 99% of eyes monocularly and in 77% and 100% binocularly, respectively. UNVA at 40 cm of 20/25 and 20/40 was achieved in 85% and 96% of eyes monocularly and in 95% and 100% binocularly, respectively. A total of 67%, 89%, 97%, and 99% of eyes had a SEQ within 0.25, 0.50, 0.75, and 1.00 diopter (D) of intended target (R2 = 0.99). Postoperative refractive astigmatism of 0.50, 0.75, and 1.00 D or less was achieved in 86%, 95%, and 98% of eyes. The vector analysis correction index and index of success were 1.04 ± 0.35 and 0.41 ± 0.31 for toric IOL accuracy and 1.00 ± 0.46 and 0.36 ± 0.55 for refractive accuracy, respectively. The 3- and 12-month post-RLE excimer laser enhancement rates were 1.1% (95% CI: 0.8% to 1.4%) and 7.6% (95% CI: 6.9% to 8.3%), respectively. CONCLUSIONS: The PanOptix Toric IOL performed well for a wide range of axial lengths and corneal astigmatism in eyes that had RLE. Most patients achieved effective uncorrected binocular near, intermediate, and distance vision for daily functioning. [J Refract Surg. 2023;39(5):302-310.].

Hypo-osmolar accelerated corneal crosslinking on resultant sub-400 µm topography-guided excimer regularized keratoconus corneas.

PURPOSE: To investigate the efficacy and safety of phototherapeutic keratectomy (PTK) with topography-guided photorefractive keratectomy (T-PRK) corneal regularization followed by sequential hypo-osmolar riboflavin accelerated corneal crosslinking (CXL) in keratoconic (KC) eyes with <400 µm stromal bed thickness after excimer ablation. SETTING: Multisurgeon multicenter standardized protocol practice. DESIGN: Retrospective multicenter case series. METHODS: This study included progressive KC eyes that underwent PTK and T-PRK combined with accelerated CXL and had a corneal stromal bed thickness of <400 µm after excimer ablation before administration of hypo-osmolar riboflavin. Demographics and clinical measures were reviewed at baseline and every follow-up visit. RESULTS: 61 consecutive eyes had a mean corneal stromal bed thickness of 367 ± 21 µm after excimer laser normalization. Postoperatively, uncorrected distance visual acuity (UDVA) improved by 0.29 logMAR ( P < .0001), corrected distance visual acuity (CDVA) improved by 0.07 logMAR ( P = .0012), and maximum keratometry (Kmax) decreased by 4.67 diopters ( P < .0001). The safety index was favorable (1.29 ± 0.56), with stable manifest astigmatism, Kmax, and pachymetry at 12 months. 2 eyes (3%) showed evidence of keratometric progression on topography. CONCLUSIONS: In KC corneas thinner than 400 µm after excimer ablation, PTK epithelial removal followed by T-PRK and hypo-osmolar accelerated CXL decreases manifest astigmatism and Kmax, improves UDVA and CDVA, and halted disease progression in 97% of eyes at 12 months. These outcomes are comparable with thicker ablated corneas not requiring hypo-osmolar stromal swelling.

Ultrasound-guided transthoracic needle biopsy of the lung: sensitivity and safety variables.

OBJECTIVES: Variables affecting the performance of ultrasound-guided transthoracic needle biopsy (US-TTNB) are not well established. We examined clinical and imaging variables affecting the sensitivity and the complication rates of US-TTNB. METHODS: We retrospectively reviewed a consecutive series of 528 US-TTNBs performed from 2008 to 2017. Univariate analyses were used to assess the influence of clinical and imaging variables on sensitivity and complication rates. Multivariate logistic regression was used to account for possible confounding variables. RESULTS: In 397 malignant lesions, the sensitivity of US-TTNB was 72% (95% CI 68-77%; 285/397). The overall pneumothorax rate was 15% (95% CI 12-18%; 77/528), leading to a chest tube in 2% (95% CI 1-3%; 9/528). Multivariate analysis showed that increasing pleural contact length (up to 30 mm) was associated with increased sensitivity (OR 1.08 per mm; 95% CI 1.04-1.12; p < 0.001), and pleural contact length (OR 0.98 per mm; 95% CI 0.97-0.99; p = 0.013), lesion size (OR 0.98 per mm; 95% CI 0.96-0.99; p = 0.006), and core needle diameter of 18G (OR 0.47 as compared with 20G; 95% CI 0.26-0.83; p = 0.010) were associated with a decreased pneumothorax rate. Graphical inspection of cubic splines showed that the probability of a positive biopsy rose sharply with increasing pleural contact length up to 30 mm and was stable thereafter. A similar, but inverse, relationship was observed for the probability of a pneumothorax. CONCLUSION: Pleural contact length is a key variable predicting the sensitivity of US-TTNB and pneumothorax rate after US-TTNB. Lesion size also predicts pneumothorax rates. KEY POINTS: • US-TTNB has a high sensitivity and a low complication rate for pleural and pulmonary lesions with pleural contact. • Pleural contact length is a key variable predicting the sensitivity of US-TTNB and pneumothorax rate after US-TTNB. • This study suggests that relying on US-TTNB may not be optimal for lesions < 10 mm for which the risk of pneumothorax is as high as the chance of obtaining diagnosis.

Cyanoacrylate Tissue Adhesive for the Treatment of Corneal Thinning and Perforations: A Multicenter Study.

PURPOSE: To examine the outcomes of cyanoacrylate tissue adhesive (CTA) application for impending or frank corneal perforations and assess for predictors of treatment response. METHODS: A multicenter cohort study was conducted to assess the clinical outcomes of adult patients who underwent CTA gluing for impending or frank corneal perforations between 2013 and 2018. The primary outcome was the proportion of successful CTA applications, defined as tectonic stability of the globe without subsequent keratoplasty (KP). Secondary outcomes included visual acuity and success of subsequent surgical interventions, if performed. RESULTS: Fifty-three eyes of 52 patients were included in this study [56% women; mean age at presentation 70 ± 13 years; median length of follow-up of 387 days (interquartile range: 191-704)]. Medical comorbidities were present in 62% of patients. The most common etiologies for perforations included infections (43%) and Sjogren disease (9%). Of the CTA-treated eyes, 22% had a complete resolution of the corneal lesion. Fifty-four percent of patients underwent KP. Longer duration of CTA treatment was associated with CTA success (P = 0.04). For patients requiring KP, 71% were successful and 29% failed. There is no significant difference in the median time delay between patients with successful and failed KPs (P = 0.4). CONCLUSIONS: CTA may be considered a stand-alone treatment for corneal perforations. It yielded a success rate of 22%. Failed CTA treatment occurred quickly, largely because of the severity of presentation. In cases requiring KP, the delay between glue application and surgery did not influence the PK success.

The long-term postoperative trajectory of geriatric patients admitted for a hip fracture: A prospective observational cohort study.

BACKGROUND: Worldwide, 1.3 million patients sustain a hip fracture every year. In Canada, 23 621 patients over 60 have been admitted with a hip fracture in 2003. Few authors have yet investigated the full postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. HYPOTHESIS: Most geriatric patients undergoing surgery for a hip fracture will not be able to return to their original residence at one-year of follow-up. OBJECTIVE: To characterize the full one-year postoperative trajectory of patients admitted for a hip fracture, in terms of orientation. PATIENTS AND METHODS: This is a prospective observational cohort study of geriatric patients undergoing surgery for a hip fracture from 2011 to 2017 in an academic center. A total of 254 patients were enrolled in this cohort. Demographic data and scores were collected throughout the hospitalisation. Patients' residences were assessed pre-fracture and at 1, 3, 6 and 12-month post-hospitalisation. RESULTS: Most patients evolved in one of the following trajectories at one-year; (1) 30% (n=63) went back at home, (2) 11% (n=22) went back to a senior residence, (3) 16% (n=36) needed rehabillitation, (4) 13% (n=28) were discharged to a different location than prior to admission and (5) 18% (n=37) were deceased. Patients evolving in trajectory 1 were younger (mean, 80.8±11.1, p<0.0001). Patients evolving in trajectory 5 had lower MNA1 scores (mean, 19.9±5.2, p.<0.0001) and lower MMSE2 scores (mean, 16.0±10.9, p<0.0001). The delay between discharge from the attending staff and real departure from the hospital was correlated to low MNA scores (-0.35627, p<0.0001), low MMSE scores (-0.35910, p=0.0004) and associated with the need for a rehabilitation center (trajectory 3) (mean, 2.67±4.36 days, p=0.0002). DISCUSSION: The postoperative evolution of geriatric patients with a hip fracture will continue to worsen due to the aging of the population. However, this study highlights important issues such as nutritional assessment, cognitive disorders and access to rehabilitation centers. LEVEL OF EVIDENCE: II, prospective cohort study.

Image-guided high-dose-rate brachytherapy boost to the dominant intraprostatic lesion using multiparametric magnetic resonance imaging including spectroscopy: Results of a prospective study.

PURPOSE: To evaluate the long-term outcomes of image-guided high-dose-rate (HDR) brachytherapy boost to the dominant intraprostatic lesion (DIL) using multiparametric magnetic resonance imaging (MRI), including spectroscopy (MRI/magnetic resonance spectroscopy [MRS]). METHODS AND MATERIALS: Between December 2009 and March 2011, 20 patients with intermediate-risk prostate cancer underwent multiparametric MRI/MRS protocol before treatment. All patients were treated with an external beam radiotherapy dose of 40 Gy, combined with an HDR brachytherapy boost of 15 Gy. Concurrently, the DIL received a boost of 18 Gy. Missing data during followup were handled with multiple imputations. RESULTS: The median followup was 62 months (range, 23-71 months). Six patients (31%) were classified as favorable intermediate risk and 13 patients (69%) as unfavorable intermediate risk. One patient experienced a prostate-specific antigen biochemical failure, and the 5-year biochemical failure-free survival rate was of 94.7%. The mean International Prostate Symptom Score rose from 7, with respect to baseline, to 10.42 1 month after treatment, and rapidly decreased to 6.97 after 3 months. Grade 1, 2, and 3 acute genitourinary toxicities were reported in 13 (68%), 3 (16%), and 1 (5%) patients, respectively. Grade 1 and 2 late genitourinary toxicities were reported in 9 (53%) and 3 (18%) patients, respectively. Only grade 1 acute and late gastrointestinal toxicities were reported in 4 (21%) and 3 (18%) patients, respectively. CONCLUSIONS: Delivering an HDR brachytherapy boost to the DIL using image-guided multiparametric MRI/MRS is feasible with good outcomes for biochemical control, acute and late toxicities, and dosimetric constraints for critical organs.

Image-Guided High-Dose-Rate (HDR) Boost Localization Using MRI/MR Spectroscopy: A Correlation Study with Biopsy.

PURPOSE: The purpose of this study is to compare the blind interpretations of magnetic resonance imaging (MRI) sequences, diffusion-weighted imaging (DWI), apparent diffusion coefficient (ADC), mapping, and magnetic resonance spectroscopy (MRS) of the prostate, in comparison to prostate biopsy to identify a valid dominant intraprostatic lesion (DIL) for dose escalation using high-dose rate brachytherapy. METHODS: MRI/MRS were performed on 20 patients with intermediate risk adenocarcinoma of the prostate. T1W, T2W, DWI-ADC, and MRS sequences were performed at 1.5 T with pelvic and endorectal coils. An experienced radiologist rated the presence of cancer in each sextant by using a dichotomic approach, first on MR standard acquisitions (T1W and T2W), then on DWI-ADC mapping, and later on MRS images. Areas under the receiver's operating characteristic curve were calculated using a sextant as the unit of analysis. The transrectal ultrasonography-guided biopsy results were used as the reference standard. A table summarizing the MRI/MRS findings was made and compared to the corresponding area in the prostate biopsy report. A perfect match was defined to be the presence of cancer in the same sextant of the MRI/MRS exam and the prostate biopsy. RESULTS: The interpretation of the MRI/MRS exams per sextant was compared to the diagnostic biopsy report. MRI readings were compared with the biopsy as a surrogate for the complete pathology specimen of the prostate. A sensitivity (Sn) of 98.6% (95% confidence interval, 92.2% - 99.9%) and specificity (Sp) of 60.8% (46.1% - 74.2%) were found. The positive and negative predictive values (PPV, NPV) were 77.3% (67.1% - 85.5%) and 96.9% (83.8% - 99.9%), respectively. When MRS readings were compared with biopsy, we found a Sn of 96.4% (87.7% - 99.6%) and Sp of 54.8% (38.7% - 70.2%). The PPV and NPV were 74% (62.4% - 83.6%) and 92% (74% - 99%), respectively. DWI-ADC mapping results were also compared with biopsy. We found a Sn and Sp of 93.7% (84.5% - 98.2%) and 82.1% (66.5% - 92.5%), respectively, and a PPV and NPV of 89.4% (79.4% - 95.6%) and 88.9% (73.9% - 96.9%), respectively. Finally, after combining MRI, MRS, and DWI-ADC mapping, compared with biopsy, we obtained a Sn, Sp, PPV, and NPV of 100% (94.8% - 100%), 49% (34.8% - 63.4%), 72.6% (62.5% - 81.3%), and 100% (86.3% - 100%), respectively. CONCLUSIONS: The combination of MRI/MRS is a sensitive tool for both the structural and metabolic evaluation of prostate cancer location. MRI/MRS exams are useful to delineate a DIL for high-dose-rate (HDR) intraprostatic boost.

Contribution of the corneal epithelium to anterior corneal topography in patients having myopic photorefractive keratectomy.

PURPOSE: To assess the variations in corneal topographic characteristics after removal of the epithelium in patients having myopic photorefractive keratectomy (PRK). SETTING: Rothschild Foundation, Paris, France. METHODS: Forty-four eyes of 25 patients with myopia had corneal topography examination with the Orbscan II device (Bausch & Lomb) before removal of the corneal epithelium preoperatively and after removal of the corneal epithelium during PRK. On each examination, elevation, curvature, and pachymetry parameters were recorded and analyzed (paired 2-sided Student t test). RESULTS: The mean difference in central pachymetry between preoperative and epithelial removal was 37.84 mum +/- 9.82 (SD) (range 19 to 58 mum). The mean best-fit spherical surface radius was 7.75 +/- 0.28 mm (range 7.25 to 8.42 mm) before removal of the epithelium and 7.92 +/- 0.29 mm (range 7.39 to 9.16 mm) after removal of the epithelium (P<.0001). The mean simulated K-value difference increased from 0.75 +/- 0.55 diopter (D) (range 0.1 to 4.7 D) before removal to 1.21 +/- 0.66 D (range 0.2 to 4.7 D) after removal (P<.0001). The mean simulated value decreased from 43.77 +/- 1.83 D (range 40.25 to 47.00 D) to 42.44 +/- 1.73 D (range 37.05 to 45.50 D), respectively. The mean power (3.0 mm) decreased from 44.42 +/- 1.59 D (range 40.4 to 47.2 D) before removal to 43.46 +/- 1.37 D (range 39.7 to 46.9 D) after removal. The mean irregularity index increased from 1.07 +/- 0.35 D (range 0.5 to 2.5 D) to 2.03 +/- 0.38 D (range 1.3 to 3.3 D), respectively (P<.0001). The mean asphericity value (Q) changed from -0.44 +/- 0.14 (range -0.72 to -0.20) to -0.65 +/- 0.46 (range -1.04 to 0.14), respectively (P = .003). CONCLUSIONS: The epithelium affected the topographic properties of the cornea by significantly reducing corneal topographic astigmatism and irregularity. This might prove to be important in the assessment of patient candidacy for and treatment planning in refractive surgery.