bluuebunny/crossref_metadata_2025 huggingface dataset:
New Treatment Approaches in Chronic Kidney Disease-associated Anaemia
Authors: Vecchio Lucia Del , Locatelli Francesco ,   Clinical Staff Member,   Head, Department of Nephrology, Dialysis, and Renal Transplant, Alessandro Manzoni Hospital
Published: October 2015

Recombinant human erythropoietin (rHuEPO) is an effective agent for the treatment of anaemia in patients with chronic kidney disease. However, given its relatively short half-life, it requires a relatively frequent administration schedule. Moreover, it can be administered only subcutaneously or intravenously and is unstable at room temperature, making a strict cold chain control necessary. Pharmacological research has focused on the development of new agents to circumvent these relative disadvantages. Some long-acting erythropoietin-stimulating agents (ESAs) are already available for clinical use that require a less-frequent administration schedule. Peginesatide (Hematide), which is a small dimeric peptide with a chemical structure unrelated to EPO, has recently ended phase III clinical trials. Other new molecules undergoing clinical development are CNTO 530 and CNTO 528, ACE-011 and hypoxia-inducible transcription factor stabilisers. The latter have the advantage that they can be administered orally but their clinical development faces a significant hurdle following a case of fatal hepatitis. Newer molecules in this class are undergoing clinical evaluation. Other strategies, such as EPO fusion proteins, agonistic antibodies targeting the EPO receptor and gene therapy have only been tested in animal models or are undergoing pre-clinical evaluations. Before clinical approval, all these new strategies need to address safety concerns raised recently about the use of ESAs regarding possible increased cardiovascular risks following targeting to high haemoglobin levels and/or exposure to excessive doses without reaching a target in both higher and lower haemoglobin groups, and reduced survival and tumour control in the oncology setting. Many of these molecules will also need careful evaluation for possible immunogenicity.
Fertility-preserving Management of Endometrial Carcinoma
Authors: Chiva Luis M , Alonso Sonsoles ,   Head,   Fellow, Department of Oncological Gynaecology, MD Anderson International, Madrid
Published: October 2015

Endometrial cancer is the most common gynaecological malignancy, usually diagnosed in post-menopausal women. However, an incidence of 214 % of cases occurring in women <45 years of age has been reported. In this group of younger patients, because of the childbearing challenges, there is an increased percentage of nulliparity. Due to the early disease stage and the low grade of differentiation at the time of diagnosis, an improved prognosis has been reported in this group of patients. Many reports have described conservative treatment of this tumour in selected patients with the aim of preserving fertility. In this article, we review the literature for a better assessment of selection criteria, risk of concomitant neoplasias, hormonal treatment and clinical and reproductive outcome. We have concluded that fertility-preserving management of endometrial cancer is feasible in selected patients with an acceptable clinical and reproductive outcome.
Current Epidemiology and Prevention of Infectious Complications in Cancer Patients
Authors: Girmenia Corrado , Menichetti Francesco ,   Assistant, Department of Haematology, Azienda Policlinico Umberto I, Rome,   Head, Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa
Published: October 2015

Infections represent an important cause of morbidity and mortality in cancer patients, especially those patients receiving intensive chemotherapy or undergoing stem cell transplant. The changing epidemiological patterns of infections in cancer patients are characterised not only by the increasing incidence of some opportunistic pathogens, but also by the wide emergence of resistance to antimicrobials, particularly in bacteria. The management of these complications has improved greatly during the past decades, especially in the field of antimicrobial prophylaxis. In the last few years, new antimicrobial drugs have been investigated, with the aim of defining new strategies for prophylaxis against bacterial, fungal and viral infections. Based on the new evidence, international guidelines on antimicrobial prophylaxis have been recently updated, and targeted prophylaxis schedules have been proposed for different clinical settings. In the practice of antimicrobial prophylaxis, it is crucial to continuously keep abreast of new epidemiological data in order to monitor the emerging antimicrobial resistances and define tailored prevention strategies.
The Use of Prophylactic Granulocyte-colony Stimulating Factor for Chemotherapy-induced Febrile Neutropenia
Authors: Natarajan Shiva , Narayan Shruthi , Liu Yin John A , Chan Angela ,   Clinical Research Fellow, Department of Haematology, Manchester Royal Infirmary,   Specialist Registrar, Department of Haematology, Manchester Royal Infirmary,   Consultant Haematologist, Department of Haematology, Manchester Royal Infirmary,   Medical Writer, Touch Briefings
Published: October 2015

Febrile neutropenia (FN) is a common and serious complication of cytotoxic chemotherapy. It impairs the immune system, placing the cancer patient at risk of infection and is a key contributor to chemotherapy-associated morbidity and mortality. Factors including therapeutic regimen, tumour type and individual characteristics influence susceptibility to myelosuppression. Over the years, several granulocyte-colony stimulating factors (G-CSFs) have been developed for primary prophylaxis of FN including filgrastim, lenograstim and pegfilgrastim. These agents have demonstrated safety and efficacy in reducing FN in patients allowing for administration of optimal treatment and thereby improving clinical outcomes. They also support the use of dose-dense and dose-intense chemotherapy regimens found to be beneficial in some patients. Recently, the introduction of biosimilars of G-CSFs with proven comparability with the originator filgrastim has expanded the prophylactic therapies available. Effective use of these drugs by physicians early in the chemotherapy schedule may lead to fewer adverse events and improved survival.
Docetaxel Rechallenge in Patients with Castration-resistant Prostate Cancer — A Review
Authors: Caffo Orazio , Pappagallo Giovanni , Russo Lucianna Maria , Veccia Antonello , Galligioni Enzo ,   Senior Assistant and Chief of Day Hospital, Department of Medical Oncology, Santa Chiara Hospital,   Chief, Epidemiology and Clinical Trials Office, Oncology and Haematology Unit, Mirano,   Assistant, Department of Medical Oncology, Santa Chiara Hospital,   Assistant, Department of Medical Oncology, Santa Chiara Hospital,   Chief of Department, Department of Medical Oncology, Santa Chiara Hospital
Published: October 2015

Docetaxel rechallenges are considered to be an option for patients with castration-resistant prostate cancer who responded to first-line docetaxel therapy. The strategy was developed to satisfy the clinical need of fit patients progressing after first-line discontinuation who required an active treatment when no new active drugs were available. A number of reports concerning everyday clinical practice have demonstrated that a rechallenge strategy is safe, feasible and well-tolerated, and improves disease control. The current availability of new second-line drugs that increase patient survival means that the need for rechallenges has been questioned. In this paper, the published data concerning rechallenges are reviewed, concentrating on their use in the light of the availability of new drugs.
Obesity in the Elderly — On the Role of Adipokines in Prostate Cancer Progression
Authors: Angelucci Adriano , Bologna Mauro ,   Assistant Professor of Immunology,   Professor of General Pathology, Department of Experimental Medicine, University of L’Aquila
Published: October 2015

The prostate is the most frequent site of cancer in men aged 68 years and older. Although prostate cancer is frequently a slow-progressing cancer, the increase in lifespan is posing new challenges in order to avoid prostate cancer-associated mortality. Epidemiological studies have clearly demonstrated that the westernised lifestyle and diet may fuel prostate cancer incidence and mortality, and the associated current pandemic of obesity is becoming one of the principal risk factors for age-related chronic diseases. Obesity and ageing seem to contribute independently to deregulating adipose tissue homoeostasis and in turn systemic metabolism. Nowadays, adipose tissue is recognised as an active and complex endocrine and immunological organ able to control the homoeostasis of different distant organs through the release of a variety of factors, collectively termed adipokines. These factors are master regulators of energy balance and immune response and may account for some of the most frequent obesity- and age-related health problems, including cancer. The dissection of mechanisms leading to altered metabolic control by adipose tissue will eventually indicate a new preventive strategy for prostate cancer.
Treatment of Relapsed or Refractory Multiple Myeloma in the Era of Novel Agents
Authors: Cavallo Federica , Lupo Barbara , Palumbo Antonio ,   Haematologist,   Intern,   Director, Myeloma Unit, Division of Haematology, University Hospital Giovanni Battista, Turin University, Italy
Published: October 2015

The introduction of highly effective novel agents has resulted in a significant improvement in the outcomes of patients with multiple myeloma. These agents, namely thalidomide, bortezomib and lenalidomide, have been extensively studied in the relapsed or refractory multiple myeloma (RRMM) setting and are now being increasingly incorporated into upfront treatment strategies. Second-generation novel agents such as carfilzomib and pomalidomide are being tested in early-phase studies, and preliminary results are encouraging. However, to date, there are no practical guidelines to help physicians choose the best approach for the treatment of RRMM, and direct comparisons between therapies at relapse are warranted. Moreover, despite the recent steps forward in the treatment of multiple myeloma, this disease remains incurable. This article provides an overview of the main studies incorporating novel agents as well as second-generation new drugs for the treatment of RRMM, and may guide physicians in the choice of the most appropriate treatment, associated with prolonged duration of remission and enhanced survival.
Meeting Educational Needs and Enhancing Adherence of Patients Receiving Oral Cancer Agents Through Use of the MASCC Oral Agent Teaching Tool©
Authors: Rittenberg Cynthia N ,   Rittenberg
Published: October 2015

Just as new discoveries are changing the approach to personalise cancer treatments, the medications to treat cancers have changed as well. Anticancer agents now include cytotoxics, thought of as traditional chemotherapy, and biologics, often referred to as targeted therapy, many of which are formulated as oral agents. This changing model has resulted in new challenges for oncology professionals to ensure that patients receive education in a comprehensive and consistent manner regarding oral agents. In response to published reports and studies citing the adherence and safety problems for people on these oral medications, along with the noted lack of systematic teaching strategies, the MASCC Oral Agent Teaching Tool© (MOATT), issued by the Multinational Association of Supportive Care in Cancer (MASCC), was designed by oncology nurses to meet the need for a complete and dependable approach to education.
Predictive Factors of Efficacy of Sunitinib Therapy in Gastrointestinal Stromal Tumours
Authors: Rutkowski Piotr , Jurkowska Monika ,   Associate Professor and Head of Department, Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology,   Assistant Professor, Department of Biochemistry, Institute of Rheumatology, Warsaw, Poland
Published: October 2015

Until the introduction of tyrosine kinase inhibitors, only limited treatment options were available for advanced/inoperable gastrointestinal stromal tumours (GISTs), the most common mesenchymal tumours of the gastrointestinal tract. Initially, it was imatinib mesylate that revolutionised patient outcomes in advanced cases, followed by sunitinib malate when the activity of imatinib turned out to be time-limited. There is substantial heterogeneity between GISTs in terms of response to targeted therapy. As was the case for imatinib, the efficacy of sunitinib depends on the primary tumour’sKIT/PDGFRA(platelet-derived growth factor receptor-alpha) genotype and on secondary mutations emerging during treatment. Interestingly, sunitinib-related adverse effects, such as arterial hypertension, may serve as biomarkers of the antitumour efficacy of the drug. Here we discuss possible mechanisms underlying these phenomena as well as data from our recently published study – the first to investigate the clinicopathologic and genetic characteristics associated with the results of sunitinib therapy in a large group of patients treated in routine clinical practice.
The Intriguing Role of Bevacizumab in Advanced Breast Cancer – The Search Continues
Authors: Leone José Pablo , Álvarez Ricardo H ,   Postgraduate Year IV Fellow, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania,   Assistant Professor of Medicine, Department of Breast Medical Oncology, The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, Texas, US
Published: October 2015

Angiogenesis plays an important role in the biology of tumour progression and therapies that target the vascular endothelial growth factor (VEGF) pathways – ligands, receptors and co-receptors – have become an important treatment for many types of cancer. Bevacizumab, a monoclonal antibody against VEGF, was explored in several randomised Phase III studies conducted in patients with metastatic breast cancer. However, despite bringing improvements in progression-free survival, the use of bevacizumab has not been associated with improvements in overall survival. Further improvements in predictive biomarkers and the development of biology-driven Phase II trials will be critical to help us understand which patients would benefit the most from anti-angiogenic therapy.
Aromatase Inhibitors as Neoadjuvant Treatment in Elderly Patients with Locally Advanced Breast Cancer
Authors: Borgato Lucia , Brunello Antonella , Zagonel Vittorina , Saibene Tania , Michieletto Silvia ,   Oncologist, Medical Oncology Unit 1,   Oncologist, Medical Oncology Unit 1,   Director of Medical Oncology, Medical Oncology Unit 1,   Surgeon, Surgical Oncology Unit, Veneto Oncological Institute, IRCCS Padova, Italy,   Surgeon, Surgical Oncology Unit, Veneto Oncological Institute, IRCCS Padova, Italy
Published: October 2015

Pre-operative volume reduction of locally advanced breast cancers (LABC) is an issue of great importance when approaching elderly women, who often present with extensive disease along with a burden of co-morbidity which increases the risk of complications and mortality from treatment. A comprehensive geriatric evaluation is a necessary requirement before recommending any treatment in older patients. Endocrine treatment in the neoadjuvant setting allows disease control and downstaging of tumours and is fairly well tolerated. Tamoxifen has been the mainstay of endocrine therapy for patients unable to undergo surgery, but resistance eventually develops. Aromatase inhibitors (AIs) are superior to tamoxifen in this setting, with greater downstaging of the tumour and disease control. AIs are now the treatment of choice in elderly patients with oestrogen receptor-positive breast cancer who are being considered for neoadjuvant endocrine therapy. There are some data that definitive treatment with an AI for LABC in unfit patients may guarantee long-term control of disease.
Temporary Ovarian Suppression in the Prevention of Chemotherapy-induced Premature Menopause in Early-stage Breast Cancer Patients
Authors: Nunzi Martina , Sabatini Silvia ,   Medical Oncologists, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy,   Medical Oncologists, Department of Medical Oncology, Santa Maria Hospital, Terni, Italy
Published: October 2015

Infertility and premature menopause are possible side effects of chemotherapy in young women with breast cancer and can affect their compliance to treatment. There is a lot of interest in maintaining ovarian function after chemotherapy in order to ensure fertility and delay the symptoms of early menopause. The use of a gonadotropin-releasing hormone (GnRH) analogue, administered in combination with chemotherapy to protect ovarian reserve against cytotoxic damage, is one of the approaches that has been evaluated, although the rationale for its use is based mainly on hypothesis. Several phase II studies have suggested a decreased incidence of amenorrhoea with the use of GnRH analogue concomitant with chemotherapy. However, the subsequent phase III studies have produced conflicting results. In particular, the temporary ovarian suppression in combination with modern (neo)adjuvant chemotherapy for preventing premature menopause showed no benefit in three studies and an advantage in two studies. This use of a GnRH analogue is appealing but further randomised controlled trials are needed to evaluate its efficacy.
Castration-resistant Prostate Cancer – Chemotherapies and Molecular Targets
Authors: Bahl Amit ,   Consultant Oncologist and Clinical Director, Bristol Haematology and Oncology Centre, University Hospitals Bristol UK.
Published: October 2015

Castration-resistant prostate cancer has a poor prognosis: current chemotherapeutic approaches ultimately result in resistance and are associated with survival rates of less than 2 years. However, the last decade has seen an expansion in the number of therapeutic options for CRPC and the regulatory approval of several agents, including the chemotherapy drug cabazitaxel and the targeted agents abiraterone acetate, enzalatumide and denosumab. Novel targeted agents inhibit androgen receptor-mediated signalling, and non-hormonal targets, including apoptosis, signal transduction pathway inhibitors, angiogenesis and bone and immune microenvironments. Clinical trials of these agents, however, have demonstrated varied efficacy. Among the drugs in clinical development, custirsen, cabozantinib and dasatinib are among the most promising. There is a requirement for studies directly comparing agents, and for improved patient selection to identify patients benefitting from a particular therapy.
A Review of the Prevention of Nausea and Vomiting Induced by Chemotherapy
Authors: Navari Rudolph M ,   Professor of Medicine, Associate Dean and Director, Indiana University School of Medicine, South Bend and Clinical Director, Harper Cancer Research Institute, South Bend, Indiana, US
Published: October 2015

Chemotherapy-induced nausea and vomiting (CINV) is associated with a significant deterioration in quality of life. The emetogenicity of the chemotherapeutic agents, repeated chemotherapy cycles and patient risk factors significantly influence CINV. The use of a combination of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists, dexamethasone and a neurokinin-1 (NK-1) receptor antagonist has significantly improved the control of acute and delayed emesis in single-day chemotherapy. Palonosetron, a second-generation 5-HT3 receptor antagonist with a unique mechanism of action, appears to be the most effective agent in its class. Aprepitant, the only agent clinically available in the drug class of NK-1 receptor antagonists, has been used effectively as an additive agent to the 5-HT3 receptor antagonists and dexamethasone. Despite the control of emesis, nausea has not been well controlled by current agents. Olanzapine, a US Food and Drug Administration-approved antipsychotic, has emerged in recent trials as effective for the prevention of chemotherapy-induced emesis and nausea and for the treatment of breakthrough emesis and nausea. Additional studies are necessary for the control of nausea and for the control of CINV in the clinical settings of multi-day chemotherapy and bone marrow transplantation.
Radiation Therapy in Male Breast Cancer
Authors: Bagshaw Hilary P , Cloyd Jordan M , Poppe Matthew M , Wapnir Irene L ,   Resident Physician, Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, US,   Resident Physician, Department of Surgery, Stanford University, California, US,   Assistant Professor, Department of Radiation Oncology, University of Utah, Salt Lake City, Utah, US,   Professor, Department of Surgery, Stanford University, California,US
Published: October 2015

Male breast cancer (MBC) is a relatively rare disease and because the dedicated literature on MBC is limited, management typically follows guidelines established for female breast cancer (FBC). Although radiation therapy (RT) comprises a critical role in the treatment of MBC, several unique challenges influence its use. Most men with breast cancer present at an older age with more extensive and advanced stage disease than women. In contrast to the predominance of breast conservation therapy in women with breast cancer, the majority of men are treated with mastectomy, with or without post-mastectomy radiation. Although no prospective or randomised trials are available, retrospective data suggests that surgery followed by adjuvant RT significantly improves locoregional control (LRC) in men. This article reviews the utilisation, efficacy and complications associated with adjuvant RT in MBC.
Management of Isolated Nodal Recurrence after Head and Neck Cancer Treatment
Authors: Chow Velda Ling-yu , Chan Jimmy Yu-wai ,   Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong SAR,   Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong SAR
Published: October 2015

The status of the regional cervical lymphatics is one of the most significant prognostic indicators in head and neck cancers. The traditional treatment for cancers with cervical nodal metastasis has been surgical. With the global trend towards organ-preserving therapy, chemoradiation has gained increasing popularity over primary surgical therapies for cancers in the head and neck region. The subsequent management of the neck for those with residual or recurrent nodal metastasis, however, has become one of the most debated topics in the field of head and neck oncology. This review addresses several important controversies, including the optimal assessment of the nodal response to chemoradiation, the potential role and the oncological results of planned and salvage neck dissection after chemoradiation and the type and extent of neck dissection required in order to achieve the optimal balance between tumour control and surgical morbidities. Further clinical trials and ongoing researches will help us to define the best therapeutic option in such circumstances.
Lynch Syndrome and Long QT Syndrome – As If One Syndrome is Not Already Enough
Authors: Lim Ju Yee , Newell Barry , Ezzat Vivienne A , Samol Jens ,   Medical Student, St George’s University, London, UK,   Consultant Pathologist, Department of Medical Oncology and Department of Pathology, St George’s Hospital, London, UK,   Specialist Registrar in Cardiology, The Heart Hospital, University College London Hospitals, London, UK,   Consultant Medical Oncologist, St George’s University, London, UK
Published: October 2015

A 51-year-old patient was treated with chemotherapy for two synchronous colon cancers and was diagnosed with Lynch syndrome. The patient also suffered a cardiac arrest and was also diagnosed with a long QT syndrome (LQTS) subsequently. This is the first case of a co-existence of Lynch syndrome and LQTS.
A Rare Condition in Haematological Practice – Gaucher Disease
Authors: Cappellini Maria-Domenica ,   Centro Anemie Congenite, Ospedale Maggiore Policlinico IRCCS, University of Milan, Italy
Published: October 2015

Gaucher disease, which is caused by an inherited glucocerebrosidase deficiency, is the most prevalent lysosomal storage disease worldwide. Estimated prevalence of Gaucher disease is 1:50,000 in most countries and the disease has its highest incidence in the Ashkenazi Jewish population. Type 1 (non-neuropathic) Gaucher disease is by far the most common form. Gaucher disease type 1 should be considered in cases of unexplained splenomegaly with or without bleeding diathesis, skeletal manifestations or hepatomegaly. Diagnosis is made by demonstrating decreased glucocerebrosidase activity in peripheral blood leucocytes. Dried blood spots can be used for screening but conventional enzyme assay on heparinised blood is essential. Patients with Gaucher disease may have extensive organ involvement despite relatively minor overt symptomatology. Evidence suggests that Gaucher disease may remain undiagnosed for years, leading to severe complications that are preventable or reversible with enzyme replacement therapy. These complications include avascular necrosis, severe bleeding, chronic bone pain, pathological fractures, growth failure, liver pathology and life-threatening sepsis. Most patients with Gaucher disease are initially evaluated by a haematologist–oncologist. Improved education is needed to enable prompt detection of Gaucher disease. An increased risk of multiple myeloma and haematological and non-haematological malignancies has been reported in type 1 Gaucher disease. This review aims to offer familiarisation with a rare disorder in haematological practice, focusing on adult patient management.
The Treatment of Chronic Myeloid Leukaemia (CML) in the Era of Tyrosine Kinase Inhibitors – What is New in the Battle of CML?
Authors: Keskin Dilek , Eskazan Ahmet Emre ,   Fellow of Hematology,   Associate Professor, Division of Hematology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
Published: October 2015

As the development of BCR-ABL1 targeting treatments has proceeded – first imatinib, then nilotinib and dasatinib – the treatment of chronic myeloid leukaemia (CML) has been revolutionised, and most patients live longer. Since tyrosine kinase inhibitors (TKIs) are expensive, generic imatinibs were introduced in order to overcome this matter. Allogeneic haematopoietic stem cell transplantation is still a treatment option in selected cases. Recent advances in targeting the CML stem cell suggested that this approach alone or together with TKIs could be an alternative therapeutic strategy for curing this disease.
Long-term Efficacy and Safety of Fixed-combination Timolol/Latanoprost
Authors: Harding Samantha AH , Montgomery Donald ,   Speciali ty Registrar in Ophthalmology, Tennent Institute of Ophthalmology, Glasgow,   Consultant Ophthalmologist, Glasgow Royal Infirmary
Published: October 2015

The fixed-combination preparation of timolol and latanoprost has been available in Europe since 2001. Evidence supporting its level of clinical efficacy has been slowly accumulating, with some studies suggesting clear benefit and others showing only a modest additional effect relative to its individual components. Studies demonstrating long-term protection of visual function are sparse and more work is required in this area. Several reports indicate that fixed-combination timolol/latanoprost is safe and well tolerated. Other similar combination products are now competing directly with fixed-combination timolol/latanoprost, and further comparative studies will be required to assess their relative merits.
Management of the Ruptured Eye
Authors: Kuhn Ferenc , Pelayes David E ,   Associate Professor, Clinical Ophthalmology, University of Alabama at Birmingham, and Director, Clinical Research, Helen Keller Foundation for Research and Education,   Associate Professor, Ophthalmology Department, School of Medicine, Buenos Aires University, and Co-ordinator, Laboratory of Ophthalmic Research and Visual Sciences, Department of Pathology, School of Medicine, Buenos Aires University
Published: October 2015

Rupture is the most severe form of mechanical globe trauma because of the tissue pathologies that occur at the time of injury and because of the post-injury destruction caused by scar formation as part of the body’s normal healing process. The diagnosis is usually straightforward because the wound is visible, often even to the naked eye. However, occult scleral ruptures – conjunctival integrity preserved – are not uncommon; any injury resulting from an impact by a large, blunt object therefore requires careful ocular evaluation. Due to the risk of expulsive choroidal haemorrhage wound closure is typically urgent, but all rules of proper wound toilette and suturing must be followed. The surgeon may elect to perform a staged approach, in which the initial wound-closure surgery is followed by intense topical corticosteroid therapy and then a second, comprehensive intraocular reconstruction a few days later, or to perform primary comprehensive surgery. All tissue pathologies must be properly addressed by an expert ocular traumatologist; in eyes with posterior scleral rupture, prophylactic chorioretinectomy should also be considered.
Treatment of Glaucoma with the Fixed Combination of Latanoprost 0.005% and Timolol 0.5%
Authors: Polo Vicente ,   Glaucoma Specialist, Department of Ophthalmology, Miguel Servet University Hospital, Zaragoza
Published: October 2015

Glaucoma is a serious eye disease that affects a large number of people and potentially leads to permanent visual impairment. Currently, the first-line therapy is the use of topical medications in an attempt to control intraocular pressure levels and prevent further damage to ganglion cells. Over the decades, a number of agents have been introduced; most recently, the development of fixed combination therapies has signalled a new era in treating glaucoma. Although these formulations provide advantages in terms of convenience and increased quality of life, they are also associated with certain drawbacks. The novel fixed combination of latanoprost 0.005% and timolol 0.5% has been studied extensively, and overall this medication has proved effective in controlling symptoms and has become a viable option for the treatment of glaucoma.
Prevalence of Dry Eye Disease in Glaucoma
Authors: Erb Carl ,   Medical Director, Ophthalmology Department, Schlosspark Clinic, Berlin
Published: October 2015

Data from over 20,000 German patients with glaucoma have provided valuable information regarding the prevalence of dry eye disease (DED) in these patients. Overall, more women develop DED with glaucoma than men (56.9 versus 45.7%), and the prevalence increases with age, with more than half of patients 60 years of age having symptoms. Hypertension co-exists with glaucoma in 48.1% of patients, and the highest level of DED is found in patients with dry mouth, nose and skin (75.5%). DED occurs more often when three or more antiglaucoma eyedrops are used, and with longer disease duration. This suggests that it is related to the presence of the preservative benzalkonium chloride, and that using preservative-free eyedrops to break the vicious circle of DED is likely to enhance patient compliance and improve the care of glaucoma patients.
Mini- and Micro-incision Cataract Surgery – A Critical Review of Current Technologies
Authors: Menapace Rupert ,   Professor, and Head, Day Surgery Centre and Intraocular Lens Service, University of Vienna Medical School and Vienna General Hospital
Published: October 2015

Modern cataract surgery is striving for smaller and smaller incisions with the aim of making clear corneal incisions that are as safe and topographically stable as possible. Recent innovations in both phacoemulsification (phaco) and intraocular lens (IOL) technology have made micro-incision cataract surgery, defined as <2mm incision, safe and effective. Bi-axial sleeveless micro-phaco has recently been joined by sleeve-armed micro-co-axial micro-phaco, made possible by the development of slim-shaft strong-bevel phaco needles armed with micro-sleeves that run flush with an enlarged needle head. Such tip technology allows for a highly efficient and safe high-flow, high-vacuum phaco through incisions as small as 1.4mm by providing high influx and suppressing surge while avoiding mechanical and thermal tissue damage. Two tips have so far been made available for mini- (2.2–2.4mm) and micro-incision cataract surgery (MICS) (1.4–1.6mm, depending on the incision architecture used). With the micro-tip supplemented by additional flow through an infusion spatula (‘infusion-assisted’ or ‘hybrid’ phaco), excessive flow and vacuum rates may be used, resulting in a two-fold efficiency as mirrored by the reduced phaco power required. IOL technology is lagging behind phaco technology. The challenge is to avoid trade-offs with regard to implant stability and aftercataract formation, as well as optical performance. Current MICS-IOLs are mostly hydrophilic acrylic one-piece constructions with insufficiently sharp posterior optic edges and broad haptic–optic junctions, both of which features compromise the optic-edge barrier effect. Recently, a hydrophobic three-piece IOL has been made available, which features a slim haptic junction and an exquisitely sharp optic edge and also allows for optional optic entrapment into a posterior capsulorhexis for lasting eradication of after-cataracts.
Yellow Intraocular Lenses – To Block or Not to Block
Authors: Wenzl Elfriede , Wirtitsch Matthias G , Ardjomand Navid ,   Department of Ophthalmology, Medical University Graz,   Department of Ophthalmology, Medical University Graz,   Department of Ophthalmology, Hietzing Hospital, Vienna,   Department of Ophthalmology, Medical University Graz
Published: October 2015

Yellow filters for the eye have been of interest to ophthalmologists and optometrists for the last 30 years. Certain fish species can change the colour of the cornea in response to the level of illumination and regulate the amount of short-wavelength light reaching the retina. A positive influence of yellow eye filters on reduction of chromatic aberration has been found in a fish eye model. Blue-light-filter (yellow) intraocular lenses (IOLs) were introduced for cataract surgery almost 20 years ago. The main advantage of yellow IOLs is thought to be the reduction of chromatic aberration under photopic conditions and protection of the retina from phototoxic short-wavelength light, especially in eyes at risk of age-related macular degeneration (AMD). This article highlights the importance of yellow IOLs for cataract surgery in terms of quality of vision and AMD protection.
Recent Optical Coherence Tomography Imaging of Vitreomacular Disorders
Authors: Shunmugam Manoharan , Williamson Tom H ,   Department of Ophthalmology, St Thomas’ Hospital, London,   Department of Ophthalmology, St Thomas’ Hospital, London
Published: October 2015

Optical coherence tomography (OCT) has become a ubiquitous and invaluable tool in the retinal clinic as it provides the examiner with a 2D cross-section of the retina; newer machines are also able to reconstruct 3D images. The greater detail afforded by OCT scanning enhances diagnostic capabilities and advances vitreoretinal research. It has proved very useful in surgical planning and provides fine anatomical retinal detail, which can aid post-operative prognostication in certain vitreoretinal disorders. OCT operates on the same physical principles as an ultrasound scan, except it uses light as the carrier signal. First-generation OCTs are capable of resolutions only between 10 and 20μm. Second-generation OCTs improved this to 5–6μm. We await the commercial availability of third-generation and full-field OCTs, which yield resolutions as low as 1–3μm.
Combination Therapy for Wet Age-related Macular Degeneration
Authors: Augustin Albert J , Scholl Stephan ,   Department of Ophthalmology, Karlsruhe,   Department of Ophthalmology, Karlsruhe
Published: October 2015

Increasing appreciation of the complexity of the wet type of age-related macular degeneration (AMD) has made combination therapy an area of current intense interest. Administered in dual or triple combinations, the current therapeutic mainstays ߝ corticosteroids, verteporfin photodynamic therapy (V-PDT) and inhibitors of vascular endothelial growth factor (VEGF) ߝ have more potential to successfully treat the various pathogenetic factors contributing to wet AMD than any single-therapy approach. The different mechanisms of action involved in combination therapy are intended to reduce inflammation, eradicate current and future choroidal neovascularisation and lessen VEGF expression. Evidence from clinical trials demonstrates visual acuity benefits, lower re-treatment rates and longer treatment-free intervals with combination therapies compared with monotherapies. This article summarises the rationale and the clinical evidence that support the use of double and triple combination therapy in wet AMD.
Multimodal Physiological Medicine and Macular Degeneration
Authors: Rozakis George W , Dzugan Sergey A ,   Private Ophthalmology Practice, Westlake,   Chief, Science Office, Dzugan Method, Deerfield Beach
Published: October 2015

Multimodal physiological medicine is the art of restoring physiology to youthful levels for the purpose of preventing and treating age-related diseases. Age-related macular degeneration (AMD) is presented as a disease that is caused by multiple errors of physiology including deficiencies of the steroidal hormones dehydroepiandrosterone (DHEA), pregnenolone, oestriol, oestradiol, oestrone, testosterone and progesterone as well as deficiencies in melatonin, zinc and other nutrients. It is proposed that multiple steroidal deficiency results in a compensatory attempt to synthesise hormones from cholesterol in the macula and that this conversion is dysfunctional in AMD, resulting in cholesterol-laden drusen. Furthermore, it is suggested that physiological errors indirectly lead to retinal pigment epithelial cell failure due to a decline in stem cell function. It is suggested that macular degeneration can be safely and more efficaciously treated with combinations of hormones, nutrients and vitamins and that such treatment strikes at the underlying cause(s) of the disease and may reduce associated cardiovascular risk.
Preservative-free Treatment in Glaucoma Is a Sensible and Realistic Aim for the Future
Authors: Hopes Marina , Broadway David ,   Department of Ophthalmology, Norfolk and Norwich University Hospita,   Department of Ophthalmology, Norfolk and Norwich University Hospita
Published: October 2015

Medical therapy is usually the first-choice option in the management of glaucoma. However, adverse effects of ophthalmic preparations can potentially jeopardise the safety and efficacy of the treatment. Eye-drop bottles contain multiple components, all of which have the potential to cause adverse reactions, although it is the preservatives that are major culprits. The effect of preservatives on the eye has been studied extensively in both human and animal tissues. Benzalkonium chloride (BAC) is a highly effective preservative and the most commonly used in antiglaucoma medications; however, BAC is toxic to ocular tissue, having the potential to cause adverse effects. The use of less toxic preservatives or preservative-free medications has the potential to improve the management of glaucoma.
Freeze-controlled Crystallisation of the Aqueous Humour in Glaucomatous and Non-glaucomatous Patients
Authors: Faschinger Christoph , Dieter Franz Rabensteiner , Eberle Christian , Mossböck Georg , Schmut Otto ,   Department of Ophthalmology, Medical University of Graz,   Department of Ophthalmology, Medical University of Graz,   Department of Ophthalmology, Medical University of Graz,   Department of Ophthalmology, Medical University of Graz,   Department of Ophthalmology, Medical University of Graz
Published: October 2015

The purpose of this study was to investigate the aqueous humour of glaucomatous and non-glaucomatous patients by freeze-controlled crystallisation qualitatively to detect a possible difference. Aqueous humour was taken from 20 patients with different kinds of glaucoma (11 primary open-angle glaucoma, eight pseudo-exfoliation glaucoma, one pigmentary glaucoma) and compared with samples from 40 patients with cataracts and to samples from seven patients with cataract and glaucoma; 1μl of each sample was applied to a microscope slide and put in a deep-freezer at a constant temperature of -20°C for 24 hours. During this time, the water evaporated and distinct crystal patterns developed. These patterns were examined stereo-microscopically, stored digitally and compared with each other. Many distinct crystals of different sizes and formations were obtained. No obvious differences in the crystal patterns could be found between the three groups (patients with glaucoma, cataract or cataract and glaucoma). As a multifactorial disease, open-angle glaucoma is characterised by specific changes to the trabecular meshwork cells with an accumulation of deposits of extracellular matrix. Since the trabeculum is rinsed consistently by aqueous humour, changes of the compounds might influence these cells. Alterations concerning this were published. In contrast to the ferning test, one of several methods of examining fluids with patterns that are highly dependent on temperature and humidity, our examinations with freeze-controlled crystallisation at a constant and controlled temperature of – 20°C gave more valid results. In our study we could not find obvious differences in the crystal patterns of patients with cataract, glaucoma or cataract and glaucoma.
Tailoring Pharmacological Therapy for the Progressing Primary Open-angle Glaucoma Patient – What Is the Best Approach?
Authors: Pfeiffer Norbert ,   Head, Department of Ophthalmology, Johannes Gutenberg University, Mainz
Published: October 2015

Glaucoma progression can lead to a significant economic burden and reduction in quality of life. Primary open-angle glaucoma (POAG) is the most common form of this condition, and intraocular pressure (IOP) reduction in POAG patients can either delay or stop disease progression. POAG treatment aims to preserve visual function and quality of life (QoL) by lowering the IOP to the target level needed to limit progression. Importantly, the decision to treat and treatment choice should be based on a patient-tailored approach to optimise treatment outcomes. Commonly used IOP-lowering medications include the first-line prostaglandin analogues/prostamides and β-blockers. POAG patients are initially treated with monotherapy; however, they often experience disease progression due to inadequate IOP reduction. In such cases, combination therapy may be considered to achieve better IOP lowering. Fixed combinations of IOP-lowering medication are highly preferred over unfixed preparations as the former are associated with better patient compliance to treatment. Among the fixed combinations, long-term data for the latanoprost/timolol fixed combination (LTFC, once daily [QD]) is now available, showing LTFC to be effective, well-tolerated and safe over a three-year period in glaucoma patients who did not achieve the target IOP with monotherapy. In addition, LTFC may allow effective treatment tailoring as it has IOP-lowering effects whether dosed in the morning or the evening.
Innovations in Excimer Laser Refractive Technology – Focus on the WaveLight® EX500 Excimer Laser System
Authors: Cummings Arthur ,   Cataract and Refractive Surgeon, Wellington Eye Clinic and UPMC Beacon Hospital, Dublin
Published: October 2015

Excimer laser refractive surgery aims to correct lower order eye aberrations such as myopia, astigmatism and hyperopia by altering the shape of the corneal curvature through the ablation of corneal tissue. Early excimer systems were associated with concerns over post-operative complications, such as night-time driving problems, glare and halos. Furthermore, it was difficult to prevent or treat higher-order aberrations with these early systems (and conventional refractive surgery procedures). Innovations in excimer laser technology have led to the introduction of excimer laser systems with enhanced features, such as high repetition rates and customised ablation profiles, improving the safety and effectiveness of this type of surgery and allowing a broad range of patients to be treated, including those with higher-order aberrations. This article discusses these innovations in excimer laser refractive technology, focusing on the clinical use of the recently introduced WaveLight® EX500 Excimer Laser system.
Redefining the Treatment Paradigm for Post-operative Inflammation Control – The Role of Topical Non-steroidal Anti-inflammatory Drugs
Authors: Findl Oliver ,   Associate Professor of Ophthalmology and Director of Department of Ophthalmology, Hanusch Krankenhaus, Vienna
Published: October 2015

Topical ophthalmic non-steroidal anti-inflammatory drugs (NSAIDs) are used in the treatment of post-operative ocular inflammation and pain following cataract surgery and for some other clinical applications of ophthalmology, including cystoid macular oedema. Products vary by their pharmacological properties, clinical efficacy and tolerability, which affect their place in therapy for new agents in Europe. The pharmacological properties of topical ophthalmic NSAIDs and their place in current treatment of post-operative ocular inflammation are discussed in this article, focussing on bromfenac, which has been submitted for approval by the European Medicines Agency (EMEA).
Anterior Segment Imaging – Anterior Chamber Angle Assessment
Authors: Sakata Lisandro , Sakata Kenji ,   Glaucoma Service, Centro da Visão, Universidade Federal do Paraná, Brazil,   Glaucoma Service, Centro da Visão, Universidade Federal do Paraná, Brazil
Published: October 2015

Angle closure is a visually destructive form of glaucoma that accounts for approximately half of the worldwide blindness caused by this disease. Angle-closure glaucoma tends to occur in anatomically pre-disposed eyes, and the evaluation of the anterior segment morphology may help identify eyes at risk of angle closure. Ultrasound biomicroscopy is one of the devices developed for anterior-segment imaging, and it helped to provide better understanding of the mechanisms of angle closure. Recently, optical coherence tomography (OCT) technology became available for evaluating the anterior segment of the eye, enabling rapid non-contact imaging of the anterior chamber. Interestingly, anterior segment OCT (AS-OCT) technology appears to detect more eyes with angle closure compared with gonioscopy, and further studies should address how anterior segment imaging findings should be incorporated into the clinical decision-making process. In summary, this article reviews most of the previously published papers on the use of anterior segment imaging in angle-closure glaucoma and tackles some relevant points for the interpretation of imaging exams in daily clinical practice.