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AIMS After initial treatment, glioblastoma multiforme (GBM) invariably reoccurs or progresses. When this happens, there is no established standard of care and treatment choice is made on a case-by-case basis. In our service, there is a multidisciplinary approach to progression, with oncologists and surgeons cooperating closely. This means that our cohort is ideal for studying treatment at progression. METHOD We performed a retrospective cohort service evaluation on patients diagnosed with isocitrate dehydrogenase wildtype GBM over a 4-year, 5-month period. We focused on patients who had received Stupp regimen treatment. Analysis was though a cox-proportional hazard model with multiple imputation analysis for missing data when appropriate. RESULTS The variable most strongly correlated with the treatment chosen at progression was patient performance status (Kruskal Wallis chi-squared = 22.804, p=0.00014). Some variables, such as age at progression or initial surgical management, were unexpectedly not correlated with the chosen treatment. Of the possible treatments at progression, only surgical management approached borderline significance for increasing survival relative to best supportive care (p=0.06). Performance status had at most a moderate, non-significant impact upon survival post-progression. The MGMT methylation status of the tumour emerged as a powerful predictor of survival post-progression (p=0.01). CONCLUSION A range of variables are correlated with which treatment is chosen at progression, but they do not always relate to the post-progression survival. Of all treatments, we can only demonstrate surgical management as having an impact upon survival, suggesting a more moderate effect of medical therapies relative to best supportive care.

Background Flow aneurysms (FAs) associated with brain arteriovenous malformations (AVMs) are thought to arise from increased hemodynamic stress due to high-flow shunting. This study aims to describe the changes in conservatively managed FAs after successful AVM treatment. Methods Patients with symptomatic AVMs and associated FAs who underwent successful treatment of the AVM between 2008 and 2017 were included. FA dimensions were measured on surveillance angiography to assess longitudinal changes. Results Thirty-two patients were identified with 48 FAs. Sixteen (33%) FAs were treated endovascularly; 18 (38%) FAs were treated surgically; and 14 (29%) FAs (11 patients) were monitored. FAs demonstrated a decrease in size from 5.0 mm to 3.8 mm (24%; P = 0.016) and 4.9 mm to 3.6 mm (27%; P = 0.013) in height and width, respectively, over a median 35 months. However, on subgroup analysis, only class IIb aneurysms demonstrated a significant decrease in size (51% reduction in largest diameter, P = 0.046) and only 3 FAs (21%) resolved. There were no hemorrhages observed during follow-up. Conclusions While conservatively managed FAs demonstrated a reduction in size after the culprit AVM was treated, this was only significant in FAs located close to an AVM nidus (class IIb). There were no hemorrhages during the median 35 months’ follow-up; however, long-term data are lacking. Our data support close observation of all conservatively managed aneurysms and a tailored approach based on the proximity to the nidus and observed changes in size.

Purpose To determine the degree of tolerance toward different magnitudes of residual refractive astigmatism and corneal astigmatism and the angles of corneal astigmatism after implantation of an asymmetric multifocal intraocular lens (IOL). Setting Cathedral Eye Clinic, Belfast, United Kingdom. Design Retrospective comparative case series. Methods The study enrolled patients having refractive lens exchange and implantation of a Lentis Mplus LS-312 MF30 IOL. Uncorrected (UDVA) and corrected distance visual acuities, uncorrected near and intermediate visual acuities, and quality-of-vision questionnaires were evaluated. Groups were categorized based on the magnitude of refractive astigmatism and corneal residual astigmatism. Refractive astigmatism of less than 0.50 diopter (D) and more than 0.50 D and corneal astigmatism of 0.50 D or less, 0.51 to 0.75 D, 0.76 to 1.00 D, and more than 1.00 D were categorized. Results The study comprised 117 patients (234 eyes). There was a significant difference in UDVA ( P = .003), refractive sphere ( P = .001), and defocus equivalent ( P ≤ .001) between the residual refractive astigmatism groups; however, there was no difference in quality of vision ( P = .28). The same was found for corneal astigmatism with UDVA ( P ≤ .001) and quality of vision ( P = .16). The angle of corneal astigmatism in relation to IOL placement did not statistically affect postoperative outcomes. Conclusions The IOL appeared to subjectively tolerate residual astigmatism well despite a statistically significant difference in UDVA with higher magnitudes of residual astigmatism. The angle of residual corneal astigmatism in relation to IOL placement did not have a significant effect on postoperative outcomes. Financial Disclosure None of the authors has a financial or proprietary interest in any material or method mentioned.