Classic lattice corneal dystrophy: a brief review and summary of treatment modalities.

PURPOSE: To provide a brief summary and comparison of the most recent literature on available and theorized treatment modalities for classic lattice corneal dystrophy (LCD). This paper aims to support practitioners in their management of this disease. METHODS: A search was carried out on available literature through PubMed and Google Scholar of English language articles up to January 2023 that relate to the treatment of LCD. Due to scarcity of literature regarding specific novel therapies for LCD, results from other corneal pathologies (granular corneal dystrophy, corneal scarring) are sometimes included for contrast, which is clearly denoted. RESULTS: LCD is a slowly progressive disease that leads to recurrent epithelial corneal erosions, stromal haze, corneal opacification, substantial discomfort, and visual impairment. Due to its autosomal-dominant inheritance pattern, this disease can persist throughout ancestral lines and requires consistent treatment and follow-up. An optimal management plan is necessary to (1) prolong years of life with best achievable visual acuity; (2) treat painful recurrent corneal erosions as they occur; (3) ensure proper follow-up throughout the life of a patient, as well as monitor at-risk offspring; and (4) monitor efficacy of treatment. CONCLUSIONS: This paper addresses (1) treatment for early disease including corneal epithelial debridement, photo therapeutic keratectomy (PTK), femtosecond laser-assisted lamellar keratectomy (FLK), and others; (2) treatment for late disease including full thickness keratoplasties and anterior lamellar keratoplasties; and (3) potential future treatment considerations including a wide variety of topical/systemic, genetic, and regenerative approaches.

Hypofractionated Partial Breast Reirradiation in the Conservative Retreatment of Breast Cancer Local Recurrence.

PURPOSE: To evaluate the outcome of partial breast reirradiation (re-PBI) with intensity modulated radiation therapy using a hypofractionated scheme for breast cancer (BC) local relapse (LR) operated on with repeat breast-conservative surgery. METHODS AND MATERIALS: Intensity modulated radiation therapy-based re-PBI was performed using either helical or step-and-shoot modality to deliver 37.05 Gy in 13 fractions in 2.5 weeks. Cumulative incidence of second LR, toxicity, disease-free survival (DFS), BC-specific survival, and overall survival were evaluated. RESULTS: Between May 2012 and May 2021, 70 patients had re-PBI. The median follow-up (FU) was 6.3 years (quartiles 1-3, 4.0-8.1.). The median age at first LR was 62 years. The median primary BC first LR interval was 12.4 years (range, 1.6-26.7 years). Luminal A-like first LR accounted for 41% of the cases, and the median size was 0.8 cm. During FU, 18 (26%) patients showed a subsequent event: 3 second LRs (corresponding to an 8-year cumulative rate of 4%), 3 regional nodal recurrences, 7 distant metastases, and 5 other primary tumors. At 8 years, DFS, BC-specific survival, and overall survival were 76%, 90%, and 90%, respectively. At multivariate analysis, grade 3 and extensive intraductal components were independent predictors for DFS. For 51 and 46 patients, chronic toxicity and cosmesis were evaluated, respectively: 4% had grade 3 fibrosis, and cosmesis was deemed good/excellent in just >60% of the cases. CONCLUSIONS: Re-PBI after repeat breast-conservative surgery represents a feasible alternative to mastectomy with regard to local control, showing an acceptable toxicity profile. A long-term FU is crucial to better understand the pattern of relapse and consolidate the position of re-PBI in clinical practice.

Evidence-based cataract surgery teaching milestones: guide to evaluate resident achievement.

PURPOSE: To develop evidence-based milestones for cataract surgery teaching and identify performance indicators. SETTING: Royal Alexandra Hospital, Edmonton, Alberta, Canada. DESIGN: Retrospective cohort study. METHODS: Operative records from a single surgeon were reviewed for resident participation when learning cataract surgery over a 14-year period. Time to complete a resident's first complete case was the primary outcome. Secondary outcomes included mean time to perform each categorical step of the procedure, number of cases participated in, rate of participation, complex case involvement, and complications. Strong resident performance was defined as time to first complete a case 1 SD quicker than mean performance; weak performance was the opposite. RESULTS: Residents (n = 13) performed beginner steps for 3.1 ± 3.2 months and intermediate steps until month 4.3 ± 3.3, and by month, 5.1 ± 3.4 residents were able to do complete cases. Time to perform a complete case increased with lower case participation (P = .02); mean proportion of complex cases that a resident participated in was 7.9% (n = 17.6 ± 10.0); less than 1% of resident cases resulted in posterior capsular rupture (PCR; n = 1.4 ± 1.3 cases). Based on these data, weaker achievement was defined as failure to achieve beginner-step competency by month 6.3, intermediate step competency by month 7.6, or inability to perform a complete case by month 8.5. In this dataset, 23.1% of residents (n = 3) met this definition. CONCLUSIONS: Residents who train with multiple teachers during a focused cataract surgery rotation can perform complete cases after a mean of 5.1 ± 3.4 months with a low PCR rate.

Acute zonal occult outer retinopathy in a patient with retinitis pigmentosa.

A 30-year-old woman with a phenotypic presentation of retinitis pigmentosa (RP) presented with a 5-day history of painless, acute vision loss in her right eye, with visual acuity dropping from 20/30 to hand motions. Optical coherence tomography of the right macula showed near-complete loss of the ellipsoid layer. Treatment with a prolonged course of oral prednisone resulted in a complete structural regeneration of the ellipsoid layer and improvement of visual acuity to 20/50, with eccentric fixation. Tests for infectious diseases, autoimmune disorders, and rare RP mimic syndromes (eg, Refsum disease) were negative. The patient has remained stable since. We favor a diagnosis of two separate pathologies and suggest a designation of acute zonal occult outer retinopathy (AZOOR) in RP for this previously unreported presentation.