Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: ...Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and c linical data including the duration of preoperative visual loss, preoperative an d postoperative visual acuity, and the prevalence of postoperative foveal RPE at rophy were recorded for these patients, and these data were compared with simila r data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macula r Translocation Study, Duke University Eye Center, Durham, NC. Results: Four eye s in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Du ke Macular Translocation Study. The mean duration of preoperative visual loss wa s higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 mo nths) (P=.08). The prevalence of postoperative foveal RPE atrophy was significan tly higher in theGAgroup (n=3; 75.0%) than in the neovascularAMDgroup (n=5; 8.3 %) (P< .01); in the GA group, this corresponded to recurrence of the GA lesions . In contrast, the postoperative RPE atrophy seen in the neovascularAMD group wa s due to postoperative mechanical forces such as laser therapy or RPE tearing. T here was no significant difference in the mean preoperative or postoperative vis ual acuity in either group. Conclusions: Subfoveal RPE atrophy can reoccur follo wing MT360 in eyes with nonneovascularAMDandGA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD af ter MT360. Further research is needed to assess if the potential for visual reco very in eyes with endstage nonneovascular AMD is outweighed by the possibility o f postoperative recurrence of GA.展开更多
近年来,受到生活环境、工作压力等因素的影响,子宫颈癌的发生率越来越高。高级别鳞状上皮内病变是导致这种癌前病变的主要因素。当前,对于这种病变的治疗方式大多为宫颈环形电切术(英文全称:Loop electrocision of Cervix,简称:LEEP)。...近年来,受到生活环境、工作压力等因素的影响,子宫颈癌的发生率越来越高。高级别鳞状上皮内病变是导致这种癌前病变的主要因素。当前,对于这种病变的治疗方式大多为宫颈环形电切术(英文全称:Loop electrocision of Cervix,简称:LEEP)。从临床治疗效果来看,患者可能会在术后出现病变或者复发的风险。临床上认为,病变和复发的概率主要与患者的年龄、身体素质、生活习惯以及病毒感染情况有关。但是,也有一些临床研究认为与其他因素有关。本文主要对宫颈环形电切术后患者宫颈上皮内病变复发的高危因素进行研究和分析,以期形成有效的预防、控制及治疗宫颈上皮内病变复发方案,从而帮助患者减轻病痛折磨,提高生活质量。展开更多
OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for hi...OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure. RESULTS: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P < .001). Increasing age was independently associated with a 1.6-fold per decade (95%confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95%confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence. CONCLUSION: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease.展开更多
文摘Objective: To assess the prevalence of recurrence of macular geographic atroph y (GA) of the retinal pigment epithelium (RPE) after macular translocation with 360°retinectomy (MT360) in one institution. Methods: A retrospective review of all cases of GA that were treated with MT360 in 1 institution. Demographic and c linical data including the duration of preoperative visual loss, preoperative an d postoperative visual acuity, and the prevalence of postoperative foveal RPE at rophy were recorded for these patients, and these data were compared with simila r data from patients who underwent MT360 for neovascular age-related macular degeneration (AMD) as part of the prospective Duke Macula r Translocation Study, Duke University Eye Center, Durham, NC. Results: Four eye s in 4 patients with GA secondary to AMD underwent MT360 and were compared with 63 eyes in 63 patients who underwent MT360 for neovascular AMD as part of the Du ke Macular Translocation Study. The mean duration of preoperative visual loss wa s higher in the GA group (11.3 months) than in the neovascular AMD group (1.7 mo nths) (P=.08). The prevalence of postoperative foveal RPE atrophy was significan tly higher in theGAgroup (n=3; 75.0%) than in the neovascularAMDgroup (n=5; 8.3 %) (P< .01); in the GA group, this corresponded to recurrence of the GA lesions . In contrast, the postoperative RPE atrophy seen in the neovascularAMD group wa s due to postoperative mechanical forces such as laser therapy or RPE tearing. T here was no significant difference in the mean preoperative or postoperative vis ual acuity in either group. Conclusions: Subfoveal RPE atrophy can reoccur follo wing MT360 in eyes with nonneovascularAMDandGA; RPE atrophy similar to this has not been found in a large consecutive series of patients with neovascular AMD af ter MT360. Further research is needed to assess if the potential for visual reco very in eyes with endstage nonneovascular AMD is outweighed by the possibility o f postoperative recurrence of GA.
文摘近年来,受到生活环境、工作压力等因素的影响,子宫颈癌的发生率越来越高。高级别鳞状上皮内病变是导致这种癌前病变的主要因素。当前,对于这种病变的治疗方式大多为宫颈环形电切术(英文全称:Loop electrocision of Cervix,简称:LEEP)。从临床治疗效果来看,患者可能会在术后出现病变或者复发的风险。临床上认为,病变和复发的概率主要与患者的年龄、身体素质、生活习惯以及病毒感染情况有关。但是,也有一些临床研究认为与其他因素有关。本文主要对宫颈环形电切术后患者宫颈上皮内病变复发的高危因素进行研究和分析,以期形成有效的预防、控制及治疗宫颈上皮内病变复发方案,从而帮助患者减轻病痛折磨,提高生活质量。
文摘OBJECTIVE: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions could be improved. METHODS: Women treated in our dysplasia clinic for high-grade squamous intraepithelial lesions by loop excision between January 1990 and December 1999 were identified. Demographic information, pathologic diagnosis, and follow-up visits were extracted from medical records. Follow-up data included all Papanicolaou (Pap) tests and/or cervical biopsies performed in our clinic after the initial procedure. RESULTS: Women (n = 705) were treated for biopsy-proven high-grade dysplasia. Of those treated, 526 (74%) had at least 1 follow-up Pap test performed in our clinics within 2 years of their original procedure. During the 2 years of posttreatment surveillance, 70 (13.3%) women demonstrated recurrent cervical intraepithelial neoplasia 2 or 3. Recurrence was highest during the first 6 months and between months 22 and 24 of surveillance. This rate was noted to be dramatically lower during months 7 to 21 of surveillance (P < .001). Increasing age was independently associated with a 1.6-fold per decade (95%confidence interval 1.29, 1.9) increase in risk of recurrence. A negative margin status was independently associated with a 0.29-fold (95%confidence interval 0.17, 0.5) decrease in risk of recurrence. Race was not shown to have an influence on risk of recurrence. CONCLUSION: A clinically and financially optimal surveillance schedule for women treated for high-grade dysplasia with loop excision would be to obtain Pap tests every 6 months for 1 year and then return to annual screening. Lengthening the surveillance intervals could be beneficial to patients, while decreasing healthcare costs, without compromising the ability to detect and treat recurrent disease.
