Extramedullary plasmacytoma of the orbit with intracranial invasion: A case report.

RATIONALE: Plasmacytoma is a disease caused by the proliferation of monoclonal immunoglobulin-producing plasma cells and divided into multiple myeloma, solitary bone plasmacytoma, and extramedullary plasmacytoma. We report a case of orbital extramedullary plasmacytoma invading the dura mater in a patient with exophthalmos and diplopia. PATIENT CONCERNS: A 35-year-old female patient with exophthalmos in the right eye and diplopia visited the clinic. DIAGNOSES: The thyroid function tests showed nonspecific results. Orbital computed tomography and magnetic resonance imaging revealed a homogeneously enhancing orbital mass infiltrating the right maxillary sinus and adjacent brain tissue in the middle cranial fossa through the superior orbital fissure. INTERVENTIONS: To diagnose and alleviate the symptoms, an excisional biopsy was performed, which revealed a plasmacytoma. OUTCOMES: One month after the surgery, the protruding symptoms and eye movement restriction in the right eye improved, and the visual acuity in the right eye was restored. LESSONS: In this case report, we present a case of an extramedullary plasmacytoma that originated in the inferior wall of the orbit and invaded the cranial cavity. To our knowledge, no previous reports have described a solitary plasmacytoma that originated in the orbit, causing exophthalmos and invading the cranial cavity at the same time.

Influence of 0.002% Omidenepag Isopropyl on Intraocular Pressure and the Cornea in Normal Tension Glaucoma.

PRCIS: Although Omidenepag isopropyl drops elicited stable intraocular pressure reductions in NTG patients, transient changes in refraction and corneal endothelial cells, significant increase of central corneal thickness, and corneal erosion should be considered. PURPOSE: To analyze the efficacy and safety of 0.002% omidenepag Isopropyl (OMDI) eye drops in patients with normal tension glaucoma (NTG). METHODS: Medical records for 62 eyes treated with OMDI for ≥6 months were analyzed. Intraocular pressure (IOP), refraction, keratometry, central corneal thickness (CCT), endothelial cell count, coefficient of variation of endothelial cell area (CV), corneal erosion, and central retinal thickness were compared at baseline and 1, 3, and 6 months. RESULTS: IOP significantly decreased from 13.4±3.8 to 11.9±3.0, 11.7±2.9, and 12.2±3.3 mm Hg at each follow-up ( P <0.001). Endothelial cell count did not change, but CV transiently increased from 12.6 to 17.0 at 1 month, CCT increased from 531.5 to 538.4 µm, myopia changed from -1.5 to -1.9 D, and keratometry changed from 44.5 to 44.7 D. CV, myopia, and keratometry recovered to baseline at 6 months; however, CCT remained high. Significant corneal erosion was observed at 6 months. Central retinal thickness changes were not observed. There were improvements in prostaglandin-associated skin pigmentation (86.7%), eyelash elongation (40.0%), and deepening of the upper eyelid sulcus and ptosis (~30%) at 3 months after exchange to OMDI. Adverse reactions were corneal erosion (27.4%), corneal thickening (21.0%), conjunctival hyperemia (11.3%), photophobia (5.7%), blurred vision (5.7%), and anterior chamber cells (4.8%). CONCLUSIONS: OMDI eye drops elicited significant and stable IOP reductions after 6 months in NTG patients with low IOP. However, transient myopic and corneal endothelial cell changes, development of corneal thickening, and corneal erosion should be considered when using OMDI.

Comparison of Superior and Inferior Visual Field Asymmetry Between Normal-tension and High-tension Glaucoma.

PRECIS: Increased severity of glaucoma heightened the hemispherical asymmetry in normal-tension and high-tension glaucoma (NTG/HTG), especially NTG. NTG showed localized superior defects in the central and paracentral areas whereas HTG showed mild asymmetry with diffuse defects. PURPOSE: The purpose of this study was to compare the patterns of visual field (VF) defects according to glaucoma severity in NTG and HTG. MATERIALS AND METHODS: A total of 1458 eyes with NTG (936) and HTG (522) were classified by mean deviation values into mild, moderate, and severe. The mean total deviation (mTD) values for each nasal, central, paracentral, arcuate 1, and arcuate 2 region of the Glaucoma Hemifield Test (GHT) were calculated. The differences in mTD between the superior and inferior hemifields of NTG and HTG were compared, and the degree of hemifield asymmetry was plotted. RESULTS: In NTG and HTG, the mTDs of the 5 regions of the superior GHT were significantly worse than those of the corresponding regions of the inferior GHT at all severity levels except for mild HTG. However, NTG showed significantly greater asymmetry than HTG in 2 regions at mild, 3 at moderate, and all 5 at severe. Moderate and severe NTG showed severe asymmetry with localized superior field defects concentrated at the central and paracentral areas with >8 dB asymmetry. However, in all HTG groups showed mild asymmetry with diffuse defects. CONCLUSIONS: The superior hemifield was more severely affected than the inferior hemifield in NTG and HTG. As the severity of glaucoma increased, so did the asymmetry in both groups, with NTG showing more profound asymmetric VF defects in the central and paracentral areas whereas HTG did not. Different VF patterns suggest differing pathologic mechanisms and possible need for different therapeutic strategies in NTG and HTG.

Pseudomyopia with paradoxical accommodation: a case report.

BACKGROUND: Pseudomyopia is caused by increased refractive power by ciliary muscle spasm. Most patients cannot overcome pseudomyopia spontaneously; therefore, treatment of pseudomyopia is fastidious and needs a multidisciplinary approach. We report a case of unusual pseudomyopia with paradoxical accommodation, straining eyes to induce emmetropia at far distance and relaxing eyes to focus at near objects, contrary to physiological accommodation. CASE PRESENTATION: A 33-year-old woman experienced intermittent distant vision discomfort. This occurred at least a few hundred times daily. She could see near objects clearly; however, distant objects could be seen clearly only when she strained her eyes. Uncorrected distance visual acuity was 20/20 and manifest refraction (MR) in both eyes in the relaxed state was approximately - 2.5 D. MR changed to approximately - 0.5 D when she grimaced and strained her eyes when attempting to focus on distant letters. Her response was contrary to the physiological accommodative response. Cycloplegic refraction was approximately 0.0 D. Binocular autorefractor/keratometer was used to objectively evaluate her refractive response and pupil reaction according to accommodative stimulation. The IOL Master was used to evaluate the anterior chamber depth (ACD), lens thickness (LT), and pupil diameter with relaxed and strained eyes. For stepwise static accommodative stimuli (1-5 D), the refractive responses were correspondingly stepwise, similar to those elicited by healthy individuals. However, contrary to physiological accommodation, she strained her eyes to see distant objects and relaxed them to see near objects. There was no change in pupil diameter despite the accommodative stimuli being maximum. Biometry results showed that ACD deepened and LT flattened with eye strain, which were contrary to those during physiological accommodation. CONCLUSIONS: We report a rare case with reverse of physiological accommodative response. When patients complain of unusual distant visual discomfort, pseudomyopia with paradoxical accommodation should be considered.

Incidental Hamartoma in an elderly patient: a case report.

BACKGROUND: Neuromuscular hamartoma is a very rare tumor; with only five cases reported in the orbit. It often occurs in infants and young children and involves large peripheral nerves, but there has been only few reports of occurrence in the orbit and adults. CASE PRESENTATION: This paper describes a 70-year-old man with an incidental orbital mass detected by an imaging test and who later developed associated symptoms. The mass was diagnosed as neuromuscular hamartoma. Superior rectus muscle recession and inferior rectus muscle resection were performed in the right eye for hypertropia secondary to postoperative inferior rectus muscle palsy. Hypertropia in the right eye and diplopia improved after surgery, and regular follow-up is underway. CONCLUSION: This is the first case of an incidentally detected orbital mass diagnosed by histologic examination as a neuromuscular hamartoma in an older patient whose proptosis progressed after a long period of inactivity.

Sixteen-and-a-half syndrome with metastatic pons tumor: A case report.

RATIONALE: One-and-a-half syndrome (OAAH) is characterized as the combination of ipsilateral horizontal gaze palsy and internuclear ophthalmoplegia. OAAH syndrome accompanied with 7th and 8th cranial nerve palsy is called 16-and-a-half syndrome. We aimed to report the case of 16-and-a-half syndrome with metastatic pons tumor. PATIENT CONCERNS: A 57-year-old male diagnosed with nonsmall-cell lung cancer (NSCLC) with brain metastasis occurring 15 months ago was referred to our clinic with the chief complaint of horizontal diplopia and right gaze palsy. DIAGNOSIS: According to the patient symptom, ocular examination, and radiographic findings, he was diagnosed as 16-and-a-half syndrome which was caused by brain tumor metastasis from NSCLC. INTERVENTIONS: We referred him to hemato-oncology department and he was treated with radiation and supportive therapy. OUTCOMES: Unfortunately, the patient passed away 1 month later without improvement of ophthalmoplegia. LESSONS: The clinical findings of our case indicate 16-and-a-half syndrome caused by brain tumor metastasis from NSCLC, which to our knowledge has not been previously reported. The case highlights a rare cause of OAAH spectrum disease and the importance of a systemic work-up including associated neurologic symptoms and brain imaging in patients with horizontal gaze palsy.

Objective Verification of Physiologic Changes during Accommodation under Binocular, Monocular, and Pinhole Conditions.

BACKGROUND: To objectively investigate accommodative response to various refractive stimuli in subjects with normal accommodation. METHODS: This prospective, non-randomized clinical trial included 64 eyes of 32 subjects with a mean spherical equivalent -1.4 diopters (D). We evaluated changes in accommodative power, pupil diameter, astigmatic value, and axis when visual stimuli were applied to binocular, monocular (dominant eye, non-dominant eye, ipsilateral, and contralateral), and pinhole conditions. Visual stimuli were given at 0.25 D (4 m), 2 D (50 cm), 3 D (33 cm), and 4 D (25 cm) and accommodative response was evaluated using open view binocular autorefractor/keratometer. RESULTS: The accommodative response to binocular stimulus was 90.9% of the actual refractive stimulus, while that of the monocular stimulus was 84.6%. The binocular stimulus induced a smaller pupil diameter than did the monocular stimulus. There was no difference in accommodative response between the dominant eye and non-dominant eye or between ipsilateral and contralateral stimuli. As the refractive stimuli became stronger, the absolute astigmatic value increased and the direction of the astigmatism axis became more horizontal. Pinhole glasses required 10%-15% less accommodative power compared with the monocular condition. CONCLUSION: Binocular stimuli enable more precise and effective accommodation than do monocular stimuli. Accommodative response is composed of 90% true accommodation and 10% pseudo-accommodation, and the refractive stimulus in one eye affects the contralateral eye to the same extent. This should be taken into account when developing guidelines for wearing smart glasses while driving, as visual stimulation is applied to only one eye, but far distance attention is constantly needed. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03557346.

Clinical feasibility of pinhole glasses in presbyopia.

PURPOSE:: To investigate the ocular physiologic changes and subjective symptoms of wearing multiple-pinhole glasses in subjects with presbyopia. METHODS:: This prospective study included 32 eligible subjects with presbyopia. Objective ocular functions and a survey of ocular discomfort were performed at baseline. All participants underwent the same examinations after reading while wearing the pinhole glasses and not wearing these glasses at a 1-week interval in random order. RESULTS:: The pinhole glasses improved uncorrected distance and near visual acuity in presbyopia. These glasses also required 15% less accommodative power over the near stimulus of 25 cm than did eyes without pinholes. Compared to reading without pinhole glasses, reading with pinhole glasses led to the following changes: increase in monocular near point of accommodation from 4.39 ± 0.78 diopter (D) to 5.19 ± 1.12 D, increase in depth of focus from 1.42 ± 0.44 D to 2.00 ± 0.33 D, and increase in amplitude of fusional convergence from 13.38 ± 6.88 prism D to 21.62 ± 10.00 prism D. In contrast, the reading speed decreased, inter-blink interval increased, tear break-up time shortened, and subjective ophthalmic symptoms worsened with pinhole glasses compared to without. CONCLUSION:: In presbyopia, pinhole glasses improve visual acuity and accommodation-related parameters by pseudo-accommodation and the pinhole effect. However, the low legibility, increased inter-blink interval, and shortened break-up time of pinhole glasses cause an uncomfortable feeling and excessive eye fatigue. Pinhole glasses have strengths and limitations that must be considered to provide appropriate guidance in patients with presbyopia. Clinical trial registration was done at www.ClinicalTrials.gov (identifier: NCT02722291).

One-year survivor of adult alveolar rhabdomyosarcoma of the maxillary sinus with orbital extension: Case report.

INTRODUCTION: Rhabdomyosarcoma is uncommon in adults. Adult and maxillary rhabomyosarcoma with direct orbital extension has been rarely reported. To our knowledge, there is no reported case about adult patient with alveolar maxillary rhabdomyosarcoma and orbital extension survived 1 year with intact ocular function. CASE PRESENTATION: A 21-year-old female presented with protrusion of the right eye and an obstructed nasal passage for the past month. Her symptoms were not relieved by oral antibiotic or irrigation. She was referred to our clinic. Computed tomography and magnetic resonance imaging showed a large homogenous well-enhanced mass with surrounding bony erosion and remodeling. The mass extended to the ipsilateral nasal cavity and orbit. Endoscopic biopsy of the nasal cavity confirmed alveolar rhabdomyosarcoma. The maxillary mass was excised using the Caldwell-Luc approach, and the orbital mass was excised using a transconjuctival and transcaruncular approach. A systemic work-up confirmed ipsilateral lymph node metastasis. The patient received 6 cycles of chemotherapy with vincristine, dactinomycin, and cyclophosphamide, as well as 5120 cGy radiotherapy. Her ocular function was intact 1 year after treatment, and magnetic resonance imaging showed complete regression of the tumor. CONCLUSION: Rhabdomyosarcoma, which is usually an aggressive malignancy, should be considered in the differential diagnosis of a rapidly growing orbital mass. Aggressive treatment, including surgery, chemotherapy, and radiation therapy, can increase local remission rates and improve the prognosis.

Comparison of Objective and Subjective Changes Induced by Multiple-Pinhole Glasses and Single-Pinhole Glasses.

Multiple-pinhole (MPH) glasses are currently sold in many countries with unproven advertisements; however, their objective and subjective effects have not been investigated. Therefore, to investigate the effects of MPH glasses excluding the single-pinhole (SPH) effect, we compared the visual functional changes, reading speed, and ocular discomfort after reading caused by MPH and SPH glasses. Healthy 36 participants with a mean age of 33.1 years underwent examinations of pupil size, visual acuity (VA), depth of focus (DOF), and near point accommodation (NPA); tests for visual field (VF), contrast sensitivity (CS), stereopsis, and reading speed; and a survey of ocular discomfort after reading. Both types of pinhole glasses enlarged pupil diameter and improved VA, DOF, and NPA. However, CS, stereopsis, and VF parameters deteriorated. In comparison with SPH glasses, MPH glasses induced smaller pupil dilation (5.3 and 5.9 mm, P < 0.001) and showed better VF parameters with preserved peripheral VF. However, no significant difference was observed for VA, DOF, NPA, stereopsis, and CS. Reading speed using pinhole glasses was significantly slower than baseline; SPH glasses showed the slowest reading speed. Both types of glasses caused significant ocular discomfort after reading compared with baseline, and symptoms were worst with MPH glasses. In conclusion, both types of pinhole glasses had positive effects due to the pinhole effect; however, they had negative effects on VF, CS, stereopsis, reading speed, and ocular discomfort. In spite of the increased luminance and preserved peripheral VF with MPHs, these glasses caused more severe ocular discomfort than SPH glasses.

Topographic analysis of eyelid position using digital image processing software.

PURPOSE: To propose a novel analysis technique for objective quantification of topographic eyelid position with an algorithmatically calculated scheme and to determine its feasibility. METHODS: One hundred normal eyelids from 100 patients were segmented using a graph cut algorithm, and 11 shape features of eyelids were semi-automatically quantified using in-house software. To evaluate the intra- and inter-examiner reliability of this software, intra-class correlation coefficients (ICCs) were used. To evaluate the diagnostic value of this scheme, the correlations between semi-automatic and manual measurements of margin reflex distance 1 (MRD1) and margin reflex distance 2 (MRD2) were analysed using a Bland-Altman analysis. To determine the degree of agreement according to manual MRD length, the relationship between the variance of semi-automatic measurements and the manual measurements was evaluated using linear regression. RESULTS: Intra- and inter-examiner reliability were excellent, with ICCs ranging from 0.913 to 0.980 in 11 shape features including MRD1, MRD2, palpebral fissure, lid perimeter, upper and lower lid lengths, roundness, total area, and medial, central, and lateral areas. The correlations between semi-automatic and manual MRDs were also excellent, with better correlation in MRD1 than in MRD2 (R = 0.893 and 0.823, respectively). In addition, significant positive relationships were observed between the variance and the length of MRD1 and 2; the longer the MRD length, the more the variance. CONCLUSION: The proposed novel optimized integrative scheme, which is shown to have high repeatability and reproducibility, is useful for topographic analysis of eyelid position.

Long-term Reliability of Diurnal Intraocular Pressure Patterns in Healthy Asians.

PURPOSE: To determine the long-term repeatability of diurnal intraocular pressure (IOP) patterns in healthy Asian subjects without glaucoma. METHODS: Twenty-three eyes in 23 healthy Asian subjects without glaucoma underwent diurnal IOP measurements using Goldmann applanation tonometry every 2 hours from 9 AM to 11 PM during two visits that were 8 weeks apart. To validate repeatability between visits, we calculated intra-class correlation coefficients (ICCs) mean IOP, peak IOP, minimum IOP, and IOP fluctuation at each time point and expressed the results as the difference between peak IOP and minimum IOP or as the standard deviation of all diurnal IOP values in the diurnal IOP curve. RESULTS: IOP repeatability was excellent at all time points, with ICCs ranging from 0.812 to 0.946 (p < 0.001). The 9 AM IOP showed the best repeatability between visits (ICCs, 0.946). Repeatability of mean IOP, peak IOP, and minimum IOP was also excellent (ICCs ranging from 0.899 to 0.929). However, IOP fluctuations showed poor repeatability, with an ICC lower than 0.15. CONCLUSIONS: Long-term repeatability of diurnal IOP patterns in healthy Asian subjects was excellent. These findings suggest that IOP measurements at standardized times of the day will be useful for assessing the effectiveness of glaucoma therapy.

Comparison of Impact of Monocular and Integrated Binocular Visual Fields on Vision-related Quality of Life.

PURPOSE OF THE STUDY: The purpose of the study was to investigate the relationship between vision-related quality of life (VRQOL) and mean deviation (MD) of the monocular visual field and integrated binocular visual field (IBVF). METHODS: One hundred eighty VFs (90 pairs) obtained from 90 patients with normal tension glaucoma were included. VRQOL was evaluated using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25). IBVF was calculated using maximal sensitivity and binocular summation and IBVF MD was calculated. Multiple linear regression analysis was used to assess the impact of IBVF deficit on VRQOL after adjusting for confounding factors. These results were compared to those of monocular visual field. RESULTS: Mean subject age was 59.4 years. The average MD of maximal sensitivity was significantly higher than that of binocular summation, the better eye, and the worse eye (-3.27, -3.78, -3.96, and -8.66 dB, respectively, P<0.001). Rasch-analyzed NEI VFQ-25 subscales and composite scores were significantly correlated with IBVF deficit. The impact that IBVF had on VRQOL was similar to that of the better eye (R of 0.431, 0.422, and 0.422 for MD of the better eye, binocular summation, and maximal sensitivity, respectively). In contrast, the worse eye showed the least correlation with VRQOL (0.363). CONCLUSIONS: The impact of IBVF on VRQOL was similar to that of the better eye irrespective of integration method. Therefore, better eye MD could be a good indicator for VRQOL.

A Case of Orbital Metastasis of Uterine Leiomyosarcoma With Intracranial Extension Presenting With Proptosis.

A 57-year-old woman presented with protrusion of the OS 2 months in duration and decreased vision 1 month in duration. The patient was diagnosed with uterine leiomyosarcoma approximately 3 years before presentation. Lung and liver metastases were diagnosed by biopsy 1 year prior to this visit. CT revealed a solid mass with central necrosis in the left lateral orbit that resulted in orbital shifting, bony destruction, and intracranial extension. The diagnosis was left orbital metastatic leiomyosarcoma, and the patient died 2 months after receiving the diagnosis.

Comparison of rates of change between binocular and monocular visual fields.

PURPOSE: To compare rates of change between binocular and monocular visual fields. METHODS: The study included 1264 visual fields from 62 normal-tension glaucoma patients with a minimum of nine pairs of visual fields for at least 5 years of follow-up. Integrated binocular visual fields (BVFs) were calculated from the two monocular visual fields using a binocular summation. Linear regression of mean deviation (MD) values was used to evaluate the rates of change of the BVFs and monocular visual fields. For each patient, the eye with the worse MD value at baseline was defined as the worse MD eye. The eye with the faster rate of change of monocular visual fields was defined as the faster-changing eye. RESULTS: The mean age of subjects was 61.8 years at baseline, the mean number of paired visual field tests was 10.2, and the mean follow-up was 8.1 years. The mean rate of change in the BVFs (-0.10 dB/y) was significantly slower than that of the faster-changing eyes (-0.34 dB/y) and faster than that of the slower-changing eyes (-0.06 dB/y; P < 0.001 for both comparisons). Forty-five eyes (64.5%) among the worse MD eyes at baseline were identified as faster-changing eyes at last follow-up, and having a worse MD value at baseline was a risk factor for being the faster-changing eye (P = 0.025). CONCLUSIONS: The rate of change in BVFs was intermediate between the rates of the faster-changing and slower-changing eyes.

Differences in end-of-life care decision making between patients with and without cancer.

BACKGROUND: Most patients and families do not want invasive life-sustaining procedures when recovery is unlikely. We compared the clinical features of advance directives (ADs) of patients with and without cancer. METHODS: The ADs were obtained from retrospectively reviewing electronic medical records of 699 consecutive patients who died from April 2011 to July 2012. RESULTS: Patients with cancer were more likely to have written ADs: 265 (85.8%) patients with cancer and 277 (71.0%) noncancer patients (P < .001). Significantly more noncancer patients were in the intensive care unit, indicating that they had received or were receiving invasive treatments. Noncancer patients requested life-sustaining treatment more frequently but symptom control less frequently than patients with cancer. CONCLUSION: Advance care planning in patients with incurable, noncancer disease is important to guarantee patient autonomy at the end of life.

Objective assessment of corneal staining using digital image analysis.

PURPOSE: To validate a new objective digital image analysis technique to evaluate corneal staining. METHODS: One hundred photographs of corneal staining from various ocular surface diseases in 100 patients were quantified by a new strategy: a combination of the difference of Gaussians (DoG) edge detection for morphologic properties of corneal erosions and the red-green-blue (RGB) systems and hue-saturation-value (HSV) color model for detection of color. To enhance the image, we adopted a median filter, Otsu thresholding, and contrast-limited adaptive histogram equalization (CLAHE). To validate the diagnostic value of this new strategy, the same photographs were also graded by two independent clinicians using the Oxford scheme and the National Eye Institute/Industry (NEI)-recommended guidelines. The correlation between the average subjective grade and objective image analysis measurement was evaluated using the Pearson's correlation coefficient. RESULTS: The new algorithm showed a strong correlation with the clinical grading scale in the Oxford scheme and the NEI-recommended guidelines (R = 0.850 and 0.903, P < 0.001, respectively). The repeatability of the objective measurement was excellent (R = 0.994). CONCLUSIONS: The new algorithm showed excellent correlation with the traditional subjective clinical grading scales. It may be useful for objective assessment of corneal staining, independent of disease conditions.

Quantitative analysis of functional changes caused by pinhole glasses.

PURPOSE: To quantify the visual functional changes caused by pinhole glasses. METHODS: Healthy subjects underwent ophthalmic examinations including uncorrected distance visual acuity (UDVA) and corrected near visual acuity (CNVA), pupil size, depth of focus (DOF), accommodative amplitude, visual field (VF) test, contrast sensitivity (CS), and stereopsis. Subjects underwent the same examinations while wearing pinhole glasses 1 week later. RESULTS: Forty-eight eyes of 48 subjects (24 male and 24 female) with a mean age of 35.5±6.7 years and a mean spherical equivalent of -2.4±3.3 diopters (D) were enrolled. The pinhole glasses significantly improved UDVA and CNVA (logMAR) from 0.44±0.46 and 0.26±0.40 to 0.19±0.25 and 0.14±0.22, respectively. The pinhole glasses markedly enlarged pupils from 3.6±0.5 mm photopic size to 6.0±0.5 mm, very close to the mesopic size of 6.2±0.6 mm. Mean DOF and accommodative amplitude also significantly increased by approximately 50%, while VF featured a general reduction of sensitivity. Mean deviation (MD) significantly decreased from -0.48±1.57 to -4.22±1.66 dB, and visual field index (VFI) decreased from 99.4±0.7% to 98.4±1.3%. The CS decreased significantly at all four spatial frequencies, and stereopsis deteriorated with pinhole glasses. CONCLUSIONS: The pinhole glasses improved visual acuity, DOF, and accommodative amplitude; however, they resulted in decreased visual quality including general reduction of VF sensitivity, CS, and stereopsis. Therefore, particular attention is needed when wearing pinhole glasses while driving, playing sports, or working with instruments. (ClinicalTrials.gov number, NCT02111356.).

A randomized phase II study to assess the effectiveness of fluid therapy or intensive nutritional support on survival in patients with advanced cancer who cannot be nourished via enteral route.

BACKGROUND: Experts advise against parenteral nutrition (PN) for patients with advanced cancer at the end of life. But because many patients and families fear starvation, many physicians administer PN to patients with terminal cancer in Korea. OBJECTIVE: We designed this study to investigate the effect of PN on survival in patients with terminal cancer at the end of life. DESIGN: We planned a randomized phase II study enrolling 116 patients randomized to receive either fluid or PN. SETTING/SUBJECTS: Eligible patients are who could not tolerate enteral feeding and had short life expectancies (<3 months) due to progressive cancer. Patients with functioning bowels were excluded. MEASUREMENTS: The primary end point was overall survival and the secondary end point was total administered calories. RESULTS: We prospectively enrolled 31 consecutive patients and 16 patients were assigned to the PN group. The study ended early because many patients and families were extremely concerned about starvation. The baseline characteristics, including nutritional parameters, were not significantly different between the two groups. The mean administered calories was 374.7 (± 71.7) kcal/d for the fluid group and 1286.8 (± 108.3) kcal/d for the PN group (p<0.001). Median survival was 8 days (95% confidence interval [CI], 5.7-10.3 days) in the fluid group and 13 days (95% CI: 3.1-22.9 days) in the PN group, and this difference was not statistically significant (p = 0.982 by Log-rank test). CONCLUSIONS: This study did not conclusively determine the role of PN for patients with advanced cancer, however, PN support failed to significantly prolong survival in these patients compared to similar patients receiving only fluid.