Phenylephrine, tropicamide, fluorescein–proparacaine eyedrops, and GAT did not significantly affect predicted postoperative refraction as measured by the Lenstar optical biometer.
Anti-vascular endothelial growth factor (anti-VEGF) injections are the most effective treatment for exudative age-related macular degeneration (AMD). However, both bevacizumab and ranibizumab have been reported to cause submacular hemorrhage (SMH) in the treatment of exudative AMD. Aflibercept has also been reported to cause SMH but only in the treatment of polypoidal choroidal vasculopathy and not exudative AMD. This case series presents two patients with exudative AMD who developed SMH after treatment with aflibercept injections. The first patient is an 84-year-old female with exudative AMD in both eyes who presented with SMH four days after an aflibercept injection in her right eye. The second patient is a 77-yearold female who presented with exudative AMD in her left eye and SMH one month following an aflibercept injection. This case series shows that SMH in patients treated for exudative AMD is a rare yet possible complication of aflibercept injection that requires further research to establish its incidence and risk factors.
INTRODUCTION: Diffuse intrinsic pontine glioma (DIPG) carries a high mortality rate secondary to its aggressive molecular characteristics, infiltrative nature, and lack of effective treatment options. Overall survival is only 9-11 months and median time to progression after radiotherapy is 5-6 months. Convection-enhanced delivery (CED) has demonstrated safety in phase-1 trials, but efficacy is indeterminate.METHODS: Sixty-three children with DIPG treated between 2010-2022 were retrospectively reviewed for first radiographic progression. All were treated using conventional external beam radiation (EBRT) and 31 (49%) were treated with CED of radiolabeled 124-Iodine-Omburtamab following EBRT (NCT01502917). Progression was codified by independent neuroradiologists according to anatomic location (local, contiguous, medulla, midbrain, middle cerebellar peduncle (MCP), and/or distant). Overall survival (OS) was assessed with Kaplan-Meier methodology and cumulative incidence of progression at each anatomic site was assessed in a cause-specific competing risk analysis with death as a competing event and were stratified based on CED treatment.RESULTS: Mean age at diagnosis was 7.1 (+/-3.4 years) with a median OS of 1.22 years for the cohort. Patients receiving CED demonstrated higher rates of progression in general, when considering progression at all anatomical sites (HR 1.79, p = 0.047) and no statistically significant difference was found in OS when stratified by CED treatment (p = 0.22). However, CED treatment was associated with significantly lower cumulative incidence of pontine and medullary progression (HR 0.43, p = 0.03; HR 0.15, p = 0.01, respectively) relative to non-CED treated patients. No statistically significant differences in progression were identified at other sites (contiguous, midbrain, MCP, or distant).CONCLUSIONS: MR-defined patterns of relapse provide evidence for locoregional control in children with DIPG treated with radioimmunotherapy administered by CED. These results prompt a consideration for modifying the design of future clinical trials by supplementing brain stem CED with whole neuroaxis treatment.
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