Search

Purpose: Uveal melanoma (UM) is the most common primary ocular malignancy. The size and location of the tumor are decisive for brachytherapy with the β-emitting ruthenium-106 (Ru-106) plaque. The treatment of juxtapapillary and juxtafoveolar UM may be challenging because of the proximity or involvement of the macula and optic nerve and high recurrence rates., Methods: Central UMs were defined as lesions up to 5 mm off the optic disc or fovea radius of 5 mm. Between January 2011 and July 2020, we treated 56 patients with Ru-106-brachytherapy. The clinical outcomes for recurrence, visual acuity, and radiation-related toxicity were assessed. The follow-up was 66 (6-136) months., Results: Of the 56 patients (56 eyes), 8 (14%) suffered from local recurrence. Six relapsing UM in 19 (32%) patients were located close to the optic disc, and two patients had UM close to the macula (2/37, 5%) (p > 0.05). The overall eye-preservation rate was 89%. The pretreatment visual acuity (VA) was 0.45 and reduced to 0.26 after brachytherapy. Radiation retinopathy or optic neuropathy was detected in 7 (13%) patients and radiation maculopathy in 10 (17.9%). Six patients (11%) underwent enucleation for recurrence or radiation-induced ophthalmopathy., Conclusion: Central UMs are challenging to treat. UMs should be categorized as lesions laterally or medially to the fovea because of different long-term control rates. Localization near the optic disc requires thoughtful management., Competing Interests: Declarations. Conflict of interests: The authors have no relevant financial or non-financial interests to disclose. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images (Figs. 1, 5a and b). Ethics approval: This is an observational retrospective study. Therefore no ethical approval is required in Germany., (© 2025. The Author(s).)

Study Objective: We hypothesize that personalized perioperative blood pressure management maintaining intraoperative mean arterial pressure (MAP) above the preoperative mean nighttime MAP reduces perfusion-related organ injury compared to maintaining intraoperative MAP above 65 mmHg in patients having major non-cardiac surgery. Before testing this hypothesis in a large-scale trial, we performed this bicentric pilot trial to determine a) if performing preoperative automated nighttime blood pressure monitoring to calculate personalized intraoperative MAP targets is feasible; b) in what proportion of patients the preoperative mean nighttime MAP clinically meaningfully differs from a MAP of 65 mmHg; and c) if maintaining intraoperative MAP above the preoperative mean nighttime MAP is feasible in patients having major non-cardiac surgery., Design: Bicentric pilot randomized trial., Setting: University Medical Center Hamburg-Eppendorf, Hamburg, Germany, and RWTH Aachen University Hospital, Aachen, Germany., Patients: Patients ≥ 45 years old having major non-cardiac surgery., Interventions: Personalized blood pressure management., Measurements: Proportion of patients in whom preoperative automated nighttime blood pressure monitoring was possible; proportion of patients in whom the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg (difference > ±10 mmHg); intraoperative time-weighted average MAP below the preoperative mean nighttime MAP., Main Results: We enrolled 105 patients and randomized 98 patients. In 98 patients (93 %), preoperative automated nighttime blood pressure monitoring was possible. In 83 patients (85 %), the preoperative mean nighttime MAP clinically meaningfully differed from a MAP of 65 mmHg. The median time-weighted average MAP below the preoperative mean nighttime MAP was 3.29 (1.64, 6.82) mmHg in patients assigned to personalized blood pressure management., Conclusions: It seems feasible to determine the effect of personalized perioperative blood pressure management maintaining intraoperative MAP above the preoperative mean nighttime MAP on postoperative complications in a large multicenter trial., Competing Interests: Declaration of competing interest AB, LG, WTAKK, PS, LK, MH, JW, SZ, KKT, PB, MW, and AK declare that they have no conflict of interest related to this trial. MF is a consultant for Edwards Lifesciences (Irvine, CA, USA) and has received honoraria for consulting and giving lectures from CNSystems Medizintechnik (Graz, Austria). KK is a consultant for and has received honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). KK is a consultant for Vygon (Aachen, Germany). MC is a speaker of the Trials Center (Studien Zentrum), German Society of Anaesthesiology and Intensive Care Medicine (DGAI) and Chair of the Reseach Committee of the European Society of Anesthesiology and Intensive Care (ESAIC). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Edwards Lifesciences (Irvine, CA, USA). BS is a consultant for Philips North America (Cambridge, MA, USA) and has received honoraria for giving lectures from Philips Medizin Systeme Böblingen (Böblingen, Germany). BS has received institutional restricted research grants and honoraria for giving lectures from Baxter (Deerfield, IL, USA). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from GE Healthcare (Chicago, IL, USA). BS has received institutional restricted research grants and honoraria for giving lectures from CNSystems Medizintechnik (Graz, Austria). BS is a consultant for Maquet Critical Care (Solna, Sweden). BS has received honoraria for giving lectures from Getinge (Gothenburg, Sweden). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Pulsion Medical Systems (Feldkirchen, Germany). BS is a consultant for and has received institutional restricted research grants and honoraria for giving lectures from Vygon (Aachen, Germany). BS is a consultant for and has received institutional restricted research grants from Retia Medical (Valhalla, NY, USA). BS has received honoraria for giving lectures from Masimo (Neuchâtel, Switzerland). BS is a consultant for Dynocardia (Cambridge, MA, USA). BS has received institutional restricted research grants from Osypka Medical (Berlin, Germany). BS received honoraria for giving lectures from Ratiopharm (Ulm, Germany). BS was a consultant for and has received institutional restricted research grants from Tensys Medical (San Diego, CA, USA). BS is an Editor of the British Journal of Anaesthesia., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)