.
Purpose: To investigate the ability of optical coherence tomography (OCT) parameters of macular thickness (MT) and peripapillary retinal nerve fibre layer (RNFL) thickness to differentiate eyes with nonarteritic anterior ischaemic optic neuropathy (NAION) from uninvolved eyes and to identify the relationship between macular and RNFL parameters and visual field sensitivity (VFS).
Methods: Thirty patients with unilateral NAION participated in a prospective observational cross‐sectional study. Patients underwent Humphrey visual field (SITA Standard 24‐2, HVF) testing and OCT to measure MT and RNFL. The contralateral uninvolved eye was used as controls. Areas under the receiver operating characteristic curves (AUROCs) of MT and RNFL for discriminating NAION from control eyes were also determined. The prespecified outcome measure was the correlation between RNFL, MT and mean deviation (MD).
Results: Average RNFL and MT were thinner in NAION eyes: 72.8 μm versus 98.9 μm (p < 0.0001) and 231.9 μm (SD, 21.4) vs. 251.1 μm (SD, 14.8; p = 0.0001), respectively. The largest AUROCs were for average MT (0.87) and average RNFL thickness (0.88). Overall, macular parameters showed stronger correlation with VFS than RNFL parameters. The highest correlation was average MT (0.71; p < 0.0001) followed by RNFL parameter nasal quadrant RNFL (0.40; p = 0.030).
Conclusion: Both MT and RNFL show strong correlations with level of VFS in NAION. Macular thickness showed more robust correlations with VF and provides strong surrogate marker of the level of damage in NAION.
Objective
Clozapine is the favoured antipsychotic for treatment‐refractory schizophrenia, but has a 1%‐2% incidence of agranulocytosis. Patients who require chemotherapy therefore pose a unique management dilemma for haematologists, oncologists and psychiatrists.
Methods
The Ovid MEDLINE and EMBASE databases were searched to identify reports describing use of clozapine concurrent with chemotherapy until 31 March 2019. The following terms (with variations) were used: neoplasm, cancer, tumour, malignancy, chemotherapy, antineoplastic and clozapine.
Results
Twenty‐seven cases were included after reviewing titles and abstracts for relevance. Fifteen patients had solid organ tumours, and 12 had haematological malignancies, including three who underwent autologous haematopoietic stem cell transplantation (AutoHSCT). Clozapine was continued in 14 cases (albeit dose reduced in 2), with a reported median neutropaenic nadir of 0.29 × 109/L (range 2.2 to <0.0 × 109/L). Clozapine was discontinued or substituted for another antipsychotic in the remaining 13 cases, all except one of whom experienced marked psychiatric deterioration. The only neutropenia‐related complication was one case of bacteraemia with high‐dose melphalan conditioning for AutoHSCT.
Conclusions
These findings argue in favour of clozapine continuation during chemotherapy. Further research is needed to develop guidance to minimise the risk of neutropenia‐related complications from concurrent treatment.
Additional supporting information may be found online in the Supporting Information section at the end of the article. Fig S1. (A) Unstimulated IFN-c levels (i.e. those measured in NIL Tube) of the 141 paediatric patients (age 0-18 years) tested with QFT-G in 2019 at Bambino Ges u Children's Hospital (red box indicates outliers). (B) Unstimulated IFNc levels of the 141 paediatric cases by age group (Brown-Forsythe ANOVA test).
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