Orbital Center

Amsterdam, Netherlands

Orbital Center

Amsterdam, Netherlands
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Schoot R.A.,Emma Childrens Hospital | Slater O.,Great Ormond Street Hospital for Children NHS Foundation Trust | Ronckers C.M.,Emma Childrens Hospital | Balm A.J.M.,Netherlands Cancer Institute | And 22 more authors.
European Journal of Cancer | Year: 2015

Background: Radiotherapy is a well-known cause of adverse events (AEs). To reduce AEs, an innovative local treatment was developed in Amsterdam: Ablative surgery, MOuld brachytherapy and surgical REconstruction (AMORE). Aims: (1) to determine the prevalence of AEs in HNRMS survivors and (2) to compare AEs between survivors treated with the international standard: external beam radiotherapy (EBRT-based: London) and survivors treated with AMORE if feasible, otherwise EBRT (AMORE-based: Amsterdam). Methods: All HNRMS survivors, treated in London or Amsterdam between January 1990 and December 2010 (n = 153), and alive ≥2. years post-treatment were eligible (n = 113). A predefined list of AEs was assessed in a multidisciplinary clinic and graded according to the Common Terminology Criteria for Adverse Events. Results: Eighty HNRMS survivors attended the clinic (median follow-up 10.5. years); 63% experienced ≥1 severe or disabling event, and 76% had ≥5 AEs (any grade). Survivors with EBRT-based treatment were, after adjustment for site, age at diagnosis, and follow-up duration, at increased risk to develop any grade 3/4 event or ≥5 AEs (any grade) compared with survivors with AMORE-based treatments (p = 0.032 and 0.01, respectively). Five year overall survival (source population) after EBRT-based treatment was 75.0%, after AMORE-based treatment 76.9%, p = 0.56. Conclusion: This study may serve as a baseline inventory and can be used in future studies for prospective assessments of AEs following the introduction of novel local treatment modalities. AMORE-based local treatment resulted in similar overall survival and a reduction of AEs secondary to local treatment. © 2015 Elsevier Ltd.


Coumou A.D.,Academic Medical Center Amsterdam | Van Den Berg R.,Academic Medical Center Amsterdam | Bot J.C.,Academic Medical Center Amsterdam | Beetsma D.B.,Gelre Ziekenhuizen | Saeed P.,Orbital Center
Orbit | Year: 2014

A 37-year old male with a long history of a left orbital venous/lympathic malformation presented with ocular injection, increased proptosis and reduced left vision. Angiography demonstrated a carotid cavernous dural AV fistula combined with a concomitant venous/lymphatic malformation. After attempts at transvenous embolization, a direct uncomplicated transorbital puncture of the cavernous sinus via a lateral orbitotomy was performed with complete resolution of ocular symptoms. © 2014 Informa Healthcare USA, Inc. All rights reserved.


Purpose: To highlight the importance of Magnetic Resonance Imaging (MRI) and the use of propranolol as both a final diagnostic tool and adequate treatment for orbital Infantile Haemangiomas (IHs). Methods: A retrospective study was conducted using a case series of 5 infants diagnosed with orbital IH. All patients presented with progressive unilateral proptosis and were at high risk of developing amblyopia, some had combined swelling of the eyelid, impaired eye movements or exposure keratopathy. Propranolol was administered in an initial dose of 0.6mg/kg/day orally divided in three daily doses and increased in 4 days to 2.7mg/kg/day. MRI was performed in all children. Results: Striking MR characteristics of an IH lesion were seen in each of our 5 cases, including the presence of flow voids, high contrast enhancement, hypo-intense T1W signal, iso-to hyper intense T2W signal, and lobulated appearance. All patients showed a quick clinical response to treatment, resulting in significant reduction in tumour size within a range of 1-3 weeks and almost complete regression of the lesion at the end of the treatment schedule. Conclusions: Our study adds another 5 cases to the growing body of reports confirming the efficacy and safety-under controlled circumstances-of propranolol therapy in orbital IH management, in which we highlight the use of propranolol as both a final diagnostic tool and as an adequate treatment. © 2014 Informa Healthcare USA, Inc.


Jellema H.M.,Orthoptic Unit | Baader A.,Johannes Gutenberg University Mainz | Pitz S.,Johannes Gutenberg University Mainz | Prick L.,Orthoptic Unit | Mourits M.P.,Orbital Center
Strabismus | Year: 2011

Purpose: To compare measurement outcomes of different devices measuring cyclodeviation and ductions in Graves' orbitopathy (GO) patients. Methods and materials: Cyclodeviation in GO patients was measured using the Harms tangent screen (HTS), the cycloforometer of Franceschetti, and the synoptometer. Ductions were measured using the modified perimeter, the Goldmann perimeter and the Maddox tangent scale (MTS). Results: In 13 patients, cyclodeviation in primary position, up-, and downgaze was measured with the above-mentioned devices. The mean differences ranged from 0.3° to 3.1° and were smallest between the HTS and the cycloforometer (89% of all measurements within 2° difference). Measurement of abduction, adduction, elevation, and depression using the modified perimeter, Goldmann perimeter, and MTS were obtained in another 13 patients. The mean differences ranged from 1.2° to 12.9° and were smallest between the modified perimeter and the Goldmann perimeter (92% of all measurements ≤ 8°). Conclusions: The HTS and cycloforometer produce interchangeable measurement outcomes. The modified perimeter and the Goldmann perimeter are interchangeable as well. However, the synoptometer and the MTS are not suitable for comparative analysis. © 2011 Informa Healthcare USA, Inc.


Clement S.C.,Emma Childrens Hospital | Clement S.C.,University Utrecht | Schoot R.A.,Emma Childrens Hospital | Slater O.,Great Ormond Street Hospital | And 21 more authors.
European Journal of Cancer | Year: 2016

Purpose Head and neck rhabdomyosarcoma (HNRMS) survivors are at increased risk of developing pituitary dysfunction as an adverse event of radiotherapy. Our aim was to investigate the frequency and risk factors for pituitary dysfunction in these survivors. Secondly, we aimed to compare the prevalence of pituitary dysfunction between survivors treated with external beam radiation therapy (EBRT) and survivors treated with the ablative surgery, moulage technique after loading brachytherapy, and surgical reconstruction (AMORE) procedure. Methods Eighty HNRMS survivors treated in London (EBRT based) and Amsterdam (AMORE based: AMORE if feasible, otherwise EBRT) in the period 1990-2010 and alive ≥2 years post-treatment were evaluated. Survivors were evaluated in multidisciplinary late-effects clinics, with measurement of linear growth, determination of thyroid function, and growth hormone parameters. Additional data, such as baseline characteristics, anthropometrics, pubertal stage, and the results of additional laboratory investigations, were retrieved from patient charts. Results Pituitary dysfunction was diagnosed in 24 in 80 (30%) survivors, after a median follow-up time of 11 years. Median time to develop pituitary dysfunction after HNRMS diagnosis was 3.0 years. Risk factors were EBRT-based therapy (odds ratio [OR] 2.06; 95% confidence interval [CI] 1.79-2.46), parameningeal tumour site (OR 1.83; 95% CI 1.60-2.17) and embryonal RMS histology (OR 1.49; 95% CI 1.19-1.90). Conclusions Radiotherapy used for the treatment of HNRMS confers a significant risk of the development of pituitary dysfunction. AMORE-based treatment in children with HNRMS resulted in less pituitary dysfunction than treatment with conventional EBRT. Our findings underscore the importance of routine early endocrine follow-up in this specific population. © 2015 Elsevier Ltd. All rights reserved.


PubMed | The Royal Marsden NHS Foundation Trust, University Utrecht, Netherlands Cancer Institute, Royal Marsden Hospital and 4 more.
Type: | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2016

Head and neck rhabdomyosarcoma (HNRMS) survivors are at increased risk of developing pituitary dysfunction as an adverse event of radiotherapy. Our aim was to investigate the frequency and risk factors for pituitary dysfunction in these survivors. Secondly, we aimed to compare the prevalence of pituitary dysfunction between survivors treated with external beam radiation therapy (EBRT) and survivors treated with the ablative surgery, moulage technique after loading brachytherapy, and surgical reconstruction (AMORE) procedure.Eighty HNRMS survivors treated in London (EBRT based) and Amsterdam (AMORE based: AMORE if feasible, otherwise EBRT) in the period 1990-2010 and alive 2 years post-treatment were evaluated. Survivors were evaluated in multidisciplinary late-effects clinics, with measurement of linear growth, determination of thyroid function, and growth hormone parameters. Additional data, such as baseline characteristics, anthropometrics, pubertal stage, and the results of additional laboratory investigations, were retrieved from patient charts.Pituitary dysfunction was diagnosed in 24 in 80 (30%) survivors, after a median follow-up time of 11 years. Median time to develop pituitary dysfunction after HNRMS diagnosis was 3.0 years. Risk factors were EBRT-based therapy (odds ratio [OR] 2.06; 95% confidence interval [CI] 1.79-2.46), parameningeal tumour site (OR 1.83; 95% CI 1.60-2.17) and embryonal RMS histology (OR 1.49; 95% CI 1.19-1.90).Radiotherapy used for the treatment of HNRMS confers a significant risk of the development of pituitary dysfunction. AMORE-based treatment in children with HNRMS resulted in less pituitary dysfunction than treatment with conventional EBRT. Our findings underscore the importance of routine early endocrine follow-up in this specific population.


PubMed | The Royal Marsden NHS Foundation Trust, Netherlands Cancer Institute, Emma Childrens Hospital, Orbital Center and 3 more.
Type: Journal Article | Journal: European journal of cancer (Oxford, England : 1990) | Year: 2015

Radiotherapy is a well-known cause of adverse events (AEs). To reduce AEs, an innovative local treatment was developed in Amsterdam: Ablative surgery, MOuld brachytherapy and surgical REconstruction (AMORE).(1) to determine the prevalence of AEs in HNRMS survivors and (2) to compare AEs between survivors treated with the international standard: external beam radiotherapy (EBRT-based: London) and survivors treated with AMORE if feasible, otherwise EBRT (AMORE-based: Amsterdam).All HNRMS survivors, treated in London or Amsterdam between January 1990 and December 2010 (n = 153), and alive 2 years post-treatment were eligible (n = 113). A predefined list of AEs was assessed in a multidisciplinary clinic and graded according to the Common Terminology Criteria for Adverse Events.Eighty HNRMS survivors attended the clinic (median follow-up 10.5 years); 63% experienced 1 severe or disabling event, and 76% had 5 AEs (any grade). Survivors with EBRT-based treatment were, after adjustment for site, age at diagnosis, and follow-up duration, at increased risk to develop any grade 3/4 event or 5 AEs (any grade) compared with survivors with AMORE-based treatments (p = 0.032 and 0.01, respectively). Five year overall survival (source population) after EBRT-based treatment was 75.0%, after AMORE-based treatment 76.9%, p = 0.56.This study may serve as a baseline inventory and can be used in future studies for prospective assessments of AEs following the introduction of novel local treatment modalities. AMORE-based local treatment resulted in similar overall survival and a reduction of AEs secondary to local treatment.


Yang M.,Orbital Center | Yang M.,Singapore National Eye Center | Wiersinga W.M.,University of Amsterdam | Soeters M.R.,University of Amsterdam | Mourits M.P.,Orbital Center
Ophthalmic Plastic and Reconstructive Surgery | Year: 2014

PURPOSE:: The EUGOGO criteria and the clinical activity score (CAS) have been used as outcome measures to report response rates for patients after pulsed intravenous methylprednisolone (PIM) therapy. This study compares the results after PIM for both criteria and evaluates the number of rehabilitative surgeries performed in relation to treatment outcome. METHODS:: This was a retrospective review of patients with active moderate-to-severe Graves' orbitopathy (GO) treated with PIM (cumulative dose of 4.5 to 5 g). The EUGOGO criteria or improvement in CAS (≥2 points) was used as the primary outcome measure. Baseline characteristics were examined to evaluate any determinants of treatment response. Additional immunosuppressive therapy after PIM and rehabilitative surgical procedures for all patients within a 2-year period were also recorded. RESULTS:: Thirty-two patients were identified. Using the EUGOGO criteria, an improvement was seen in 38%, no change (stabilization) in 47%, and worsening of the disease in 15%. The response rate using the CAS was 63%. According to the EUGOGO criteria and the CAS, 20% (4/20) and 33% (4/12) of nonresponders required additional immunosuppressive treatment after PIM. None of the responders required additional immunosuppressive therapy. There was a reduction of 0.5 surgeries per patient for responders using either outcome measures. CONCLUSIONS:: In this study, PIM alone stabilizes active GO in 85% and reduces the severity of GO in 38% of the patients. Despite incongruent response rates obtained using the EUGOGO criteria and the CAS, both outcome measures were good predictors for additional immunosuppressive treatment and additional rehabilitative surgeries in nonresponders. © 2014 The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc.

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