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AIM: To evaluate the incidence of increased intraocular pressure (IOP) and glaucomatous changes in systemic lupus erythematosus (SLE) patients in comparison with systemic steroids and immunosuppressive treatment. METHODS: Sixty-two women with SLE were divided into two groups: treated (n=47, 94 eyes) and not treated (n=15, 30 eyes) with systemic glucocorticosteroids (GC; GC-free). Twenty-one individuals in GC group were treated with immunosuppressive agents (immunomodulating and biologic). The visual acuity and IOP with ocular pulsatile amplitude (OPA) measurements, as well as scanning laser polarimetry (GDx) with nerve fiber index (NFI) measurement, spectral domain optical coherence tomography (SD-OCT) of the optic disk with retinal nerve fiber layer (RNFL) analysis and the macular region with ganglion cell analysis (GCA) were performed. RESULTS: Mean IOP values in group with combined GC and immunosuppressive therapy was 15.8±2.56 mm Hg and was significantly lower than in individuals with exclusive GC treatment (17.63±4.38 mm Hg, P=0.043). Contrary, no differences in mean IOP values between GC-free group and individuals treated with combined GC and immunosuppressive therapy were detected (P=0.563). Similarly, mean IOP in GC was 17.14±3.94 mm Hg and in GC-free patients was equal to 16.67±3.45 mm Hg (P=0.671). According to treatment regimen no statistical differences in optic disk SD-OCT for RNFL thickness, RNFL symmetry, cupping volume and the C/D ratio were observed. Similarly, no statistical differences for the mean and minimal ganglion cell layer (GCL) thickness measured in macular SD-OCT or NFI in GDx were detected. CONCLUSION: Combined immunosuppressive and systemic GC therapy in SLE patients may lower the risk of iatrogenic ocular hypertension. No relationship between treatment regimen and glaucomatous damage of optic nerve fibers in analyzed groups with SLE is detected.
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BACKGROUND: Male breast cancer (MBC) represents a rare cause of vertebral body compression fractures along with severe pain restricting the patient's daily functioning. Limited number of cases, lack of awareness among patients and physicians leading to delayed management, further increase the average age and disease progression at presentation, resulting in a poor prognosis. Additionally, studies on MBC treatment protocols and the use of female algorithms are unavailable. The implementation of vertebroplasty or kyphoplasty often results in unsatisfactory outcome due to recurrent pain and loss of vertebral height. Stentoplasty could become an alternative procedure, as described in the following case study. CASE REPORT: 54-yr-old male patient with history of breast carcinoma presented with pain in the vertebral column. Baseline X-ray and CT scan revealed multiple osteosclerotic and osteolytic metastatic lesions in the thoracic vertebrae along with a compression fracture at T9. Stentoplasty was performed to limit fracture progression. Intraoperative scan revealed restoration of the vertebral body shape. Following surgery, direct reduction in pain was obtained. Postoperative 1-year follow-up did not show any loss in height of the operated vertebra. Results of adjuvant chemotherapy administration and a new method of treatment of compression fractures caused by metastatic lesions were compared with previously published studies. CONCLUSIONS: Stentoplasty with Vertebral Body Stenting-System is an innovative method that can be applied in kyphoplasty for compression fractures caused by metastatic lesions. Nevertheless, further research on the systemic treatment of MBC is needed.