bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Polyurethane and Acellular Dermal Matrix Implant Cover in Prepectoral Breast Reconstruction: Short-term Complications
Authors: Correia-Pinto Jorge M. , Poleri Filipa , Barbosa José P. , Casimiro Rui , Azevedo Marta S. , Andresen Carolina , Coelho Gustavo , Cunha Cristina S. , Costa Horácio
Published: February 2023

Background:

Implant covering with an interface material is the standard in prepectoral breast reconstruction. Acellular dermal matrix (ADM) is frequently used, but it is expensive and associated with complications. Alternatively, we have been using integrated devices consisting of a silicone implant coated with polyurethane (PU) foam. We aimed to compare both techniques in terms of acute complications.

Methods:

The authors retrospectively reviewed patients undergoing prepectoral direct-to-implant reconstruction from June 2018 to January 2022. Two cohorts were defined based on the interface material used: ADM versus PU. Total drainage volume, time to drain removal, and acute complications (hematoma, seroma, infection, and explantation) were analyzed.

Results:

Forty-four breast reconstructions were performed in 35 patients (10 bilateral); implants were covered with ADM in 23 cases and with PU foam in 21. Median total drainage volume (500 versus 515 cc for ADM and PU, respectively) and time to drain removal (9 versus 8 days) were not affected by the interface material used, but seromas and infections occurred exclusively in the ADM cohort (seromas in four of 23 of cases, P = 0.109; infections in three of 23 cases, P = 0.234). Overall complications occurred more often in cases reconstructed with ADM, but the difference was nonsignificant (P = 0.245).

Conclusions:

The use of interface materials is generally considered a prerequisite for state-of-the-art prepectoral breast reconstruction for a variety of reasons, including the prevention of capsular contracture. In this study, PU coating tended to be associated with fewer short-term complications than ADM, including seroma and infection.
Varicella Manifestation after Mastopexy with Simultaneous Breast Augmentation
Authors: Melnikov Dmitry , Tomova Alina , Kovaleva Ksenia , Venediktov Maxim
Published: February 2023

We report on a rare case of primary varicella infection manifestation in the early postoperative period after mastopexy with simultaneous breast augmentation that caused dehiscence of surgical wound edges and spread of infection to a subcutaneous fat layer, leading to unaesthetic scarring. Whether such dehiscence in the background of varicella occurred coincidentally or was specifically triggered by the infection is unknown. The treatment is comprised of oral antiviral therapy, surgical wound debridement, and topical application of antiseptic solutions and ointments. We would like to raise awareness of the existence of such a rare case of chickenpox in an early postoperative period of a plastic surgery patient. Thereby, physicians can recognize it, test for it, and treat it promptly and appropriately. Also, we recommend taking a detailed history of infectious diseases.
Factor XI inhibitors: what should clinicians know
Authors: Pandey Arjun , Verma Raj , Eikelboom John , Verma Subodh
Published: January 2023

Purpose of review

Factor XI (FXI) inhibitors were developed to address unmet needs and limitations of current anticoagulants and are currently being studied in several indications. In this paper, we review the rationale for the development of these agents and summarize what clinicians should know about drugs that target FXI.

Recent findings

Patients with FXI deficiency may have a lower risk of venous thromboembolism and cardiovascular events and have a variable but generally mild bleeding diathesis. FXI has been proposed as a target for anticoagulants due to the potential for reduction in thrombosis with a lower risk of bleeding than current anticoagulant agents. Several classes of drugs that target FXI are under development, of which three classes (small molecule inhibitors, antisense oligonucleotides and monoclonal antibodies) have been studied in Phase II trials. At least three large Phase III trial programs are planned or are underway, and will study the efficacy and safety of FXI inhibitors in tens of thousands of patients across a variety of indications including atrial fibrillation, stroke and cancer-associated venous thromboembolism.

FXI inhibitors were developed with the hope of attenuating thrombosis with reduced bleeding/impairment of haemostasis. These agents have shown promise in preliminary trials with a low rate of bleeding. Ongoing Phase III investigations will inform the utility of these agents in clinical practice.
Influenza vaccination in mitigating vascular events and risk
Authors: Mares Adriana C. , Mukherjee Debabrata
Published: February 2023

Purpose of review

Influenza imparts a significant health burden on the United States and global population. Furthermore, influenza is associated with acute cardiovascular events, including heart failure exacerbations, acute coronary syndromes, strokes, and overall cardiovascular mortality. We review the role of seasonal influenza vaccination in mitigating cardiovascular risk.

Recent findings

A large study assessed the impact of influenza vaccine on cardiovascular outcomes and mortality using the US National Inpatient Sample (NIS) database. This study included 22 634 643 hospitalizations. Vaccination against influenza was associated with a reduction in myocardial infarctions (MI) [relative risk (RR) = 0.84, 95% CI 0.82–0.87, P < 0.001], transient ischemic attacks (RR = 0.93, 95% CI 0.9–0.96, P < 0.001), cardiac arrests (RR = 0.36, 95% CI 0.33–0.39, P < 0.001), strokes (RR = 0.94, 95% CI 0.91–0.97, P < 0.001), and overall mortality (RR = 0.38, 95% CI 0.36–0.4, P < 0.001).

Available data suggests that seasonal influenza vaccination is very effective in mitigating cardiovascular risk. Increasing the rates of influenza vaccination, especially among those with cardiovascular risk factors, is critical in preventing infection and attenuating influenza-related cardiovascular complications and adverse outcomes.
Advances in contemporary medical management to treat patients with heart failure
Authors: Velez Mauricio
Published: January 2023

Purpose of Review

Neurohormonal blockade and device-based therapies for heart failure (HF) greatly reduce morbidity and mortality. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have demonstrated benefits in patients with HF across a broad range of phenotypes. In addition to SGLT2i, drugs targeting novel pathways have demonstrated benefit in heart failure with reduced ejection fraction (HFrEF). This review will provide an update on recent advances in the medical management of HF, highlighting the role of SGLT2i, vericiguat and omecamtiv mecarbil, along with new evidence on the benefit of rapid up-titration of guideline-directed medical therapy (GDMT) in patients with acute HF.

Recent Findings

Dapagliflozin and empagliflozin reduce the risk of HF hospitalization and cardiovascular (CV) death in HF patients regardless of left ventricular ejection fraction (LVEF) and diabetes status. Their true mechanism of action in HF is not yet defined. Vericiguat, a stimulator of guanylate cyclase, and omecamtiv mecarbil, a cardiac myotrope, have shown benefit in HFrEF. Rapid up-titration of GDMT in patients hospitalized with HF is safe and results in improved clinical outcomes.

SGLT2i have earned their place as the fourth pillar of HF medical therapy alongside sacubitril-valsartan, evidence-based beta-blockers and mineralocorticoid receptor antagonists. They should be considered for the treatment of all symptomatic patients across the entire range of HF phenotypes, including patients hospitalized with HF. Vericiguat benefits high risk patients with worsening HF clinical profile. Most patients hospitalized with HF can be up-titrated to high doses of GDMT within weeks and this approach reduces the likelihood of adverse HF outcomes.
Dose Estimation for Extravasation of 177Lu, 99mTc, and 18F
Authors: Tsorxe Innocent Y. , Hayes Robert B.
Published: January 2023

Extravasation is the situation in which a nuclear medicine injection deposits some fraction of its radioactivity into the soft tissue rather than the bloodstream and may result in a large local radiation dose to tissue. An understanding of localized radiation dose from such unexpected events can be an important aspect of clinical radiation protection. The aim of this study was to estimate and assess absorbed radiation dose to localized soft tissue for hypothetical scenarios of radiopharmaceutical extravasation. Specifically, the goal was to understand whether a radiopharmaceutical extravasation could exceed the US Nuclear Regulatory Commission’s medical event reporting limit of 0.5 Sv dose equivalent to tissue or levels at which tissue damage would be anticipated (1.0 Sv dose equivalent). We used the GATE Monte Carlo simulation software to calculate self-dose to spherical volumes containing uniformly distributed amounts of common radiopharmaceutical isotopes. Simulated volumes, radioactivity levels, and effective half-lives represented real-world nuclear medicine procedures. Chosen scenarios consisted of 50 mCi and 100 mCi 177Lu within 20 cm3 and 40 cm3 tissue volumes and a 60 min biological clearance half-time (59.6 min effective half-life), 6 mCi and 12 mCi 99mTc within 1 cm3 and 5 cm3 tissue volumes and a 120 min biological clearance half-time (90 min effective half-life), and 3 mCi and 6 mCi 18F within 1 cm3 and 5 cm3 tissue volumes with a 30 min biological clearance half-time (23.6 min effective half-life). We calculated absorbed doses to be between 5.5 Gy and 23.5 Gy for 177Lu, between 0.9 Gy and 12.4 Gy for 99mTc, and between 1.5 Gy and 16.2 Gy for 18F. Radiopharmaceutical extravasations can result in tissue doses that surpass both medical event reporting limits and levels at which deterministic effects are expected. Radiation safety programs should include identification, mitigation, dosimetry, and documentation of significant extravasation events.
DISTINCT CHARACTERISTICS OF SIMPLE VERSUS COMPLEX CENTRAL SEROUS CHORIORETINOPATHY
Authors: Yoneyama Seigo , Fukui Ayumi , Sakurada Yoichi , Terao Nobuhiro , Shijo Taiyo , Kusada Natsuki , Sugiyama ATSUSHI , Matsubara Mio , Fukuda Yoshiko , Kikushima Wataru , Mabuchi Fumihiko , Sotozono Chie , Kashiwagi Kenji
Published: February 2023

Purpose:

To compare the clinical and genetic characteristics of simple and complex central serous chorioretinopathy using central serous chorioretinopathy international group criteria.

Methods:

Patients with idiopathic central serous chorioretinopathy were included. Depending on the presence or absence of retinal pigment alterations greater than 2-disc areas in either eye, patients were classified into complex or simple types. Demographic factors and clinical findings were compared between groups.CFHvariants, including rs800292 and rs1329428, were genotyped using TaqMan technology.

Results:

A total of 319 consecutive patients were evaluated at the initial presentation. Of them, 53 (16.6%) had the complex type. The complex type was exclusively seen in men (100% vs. 79.0%,P= 2.0 × 10−4) and demonstrated a significantly higher proportion of bilateral involvement (75.5% vs. 17.7%,P= 6.2 × 10−18) and descending tract(s) (83.0% vs. 0%,P= 1.2 × 10−57) than the simple type. Increased choroidal thickness (425 ± 131 vs. 382 ± 110,P= 0.02) and decreased central retinal thickness (274 ± 151 vs. 337 ± 136,P= 2.9 × 10−4) were observed for the complex versus simple type. The risk allele frequencies of both variants were significantly higher in the complex versus simple type (rs800292: 61.3% vs. 48.7%,P= 0.018; rs1329428: 65.1% vs. 54.3%,P= 0.04).

Conclusion:

In this new classification system, the complex type has distinct genetic and clinical characteristics compared with the simple type.
UNITED KINGDOM DATABASE STUDY OF INTRAVITREAL DEXAMETHASONE IMPLANT (OZURDEX) FOR MACULAR EDEMA RELATED TO RETINAL VEIN OCCLUSION
Authors: Soliman Mohamed Kamel , Zarranz-Ventura Javier , Chakravarthy Usha , McKibbin Martin , Brand Christopher , Menon Geeta , Cilliers Helena , Natha Salim , Ross Adam , Sarhan Mahmoud , Lobo Aires , Chong Victor , Mahmood Sajjad , Islam Niaz , Akerele Toks , Shakarchi Ahmed , Sallam Ahmed ,   for the United Kingdom Ozurdex in Retinal Vein Occlusion Electronic Medical Records (UK Ozurdex RVO EMR) Users Group
Published: February 2023

Purpose:

To study the treatment patterns, visual outcomes and safety profile of intravitreal dexamethasone implant (IDI) used for the treatment of macular edema secondary to retinal vein occlusion.

Methods:

Up to 2 years of routinely collected anonymized data within electronic medical record systems were remotely extracted from 16 centers. The outcome measures include visual outcome, number of injections, and safety measures, including the rate of intraocular pressure (IOP) rise, frequency of IOP-lowering medication usage, and cataract surgery rates.

Results:

The study included 688 eyes (44.4%) with central retinal vein occlusion and 862 eyes (55.6%) with branch retinal vein occlusion; 1,250 eyes (80.6%) were treatment naive and 28% (275/989) had high IOP or were on IOP-lowering medications before IDI use. It was found that 31% (476) of eyes received two injections, and 11.7% (182) and 3.7% (58) of eyes received three and four injections, respectively. The mean baseline Snellen visual acuity improved from 20/125 to 20/40 after the first injection. The probability of cataract surgery was 15% at 24 months. The proportion of eyes with ≥10 mmHg change from baseline was higher in phakic (14.2%) compared with pseudophakic eyes (5.4%, P = 0.004). Three eyes required IOP filtering surgery (0.2%).

Conclusion:

The visual results of IDI in eyes with macular edema secondary to retinal vein occlusion in the real world are comparable to those of clinical trial setting. Increased IOP in eyes with preexisting ocular hypertension or glaucoma can be controlled with additional medical treatment. Intraocular pressure rise with IDI may be more frequent in phakic than in pseudophakic eyes.
PERIPHERAL EXUDATIVE HEMORRHAGIC CHORIORETINOPATHY IN ASIAN POPULATIONS
Authors: Choi Seonghee , Lee Sung Chul , Byeon Seok Ho , Kim Sung Soo , Lee Christopher Seungkyu
Published: February 2023

Purpose:

Peripheral exudative hemorrhagic chorioretinopathy (PEHCR) is a rare degenerative disease that affects the peripheral retina. Reports of PEHCR in Asian patients are rare. Thus, the aim of this study was to investigate the clinical characteristics and outcomes of PEHCR in Asian patients.

Methods:

A retrospective chart review of 33 eyes of 29 Asian patients with PEHCR.

Results:

The mean age of the patients was 70 years, and 75.9% of them were women. Vitreous hemorrhage occurred in 51.5% of eyes during a mean follow-up of 43.1 months. The occurrence of vitreous hemorrhage was associated with a thicker baseline subfoveal choroid (P = 0.001) and the male sex (P = 0.005). Final visual acuity was less than 20/200 in 29.2% of eyes. The predictive factors for a final visual acuity worse than 20/200 included poor initial visual acuity (P = 0.002), initial lesion involvement of more than 180° of the peripheral retina (P = 0.03), an extension of subretinal hemorrhage to the macula (P = 0.040), and absence of complete tumor regression (P = 0.02).

Conclusion:

Asian PEHCR patients seem to be more frequently associated with vitreous hemorrhages, especially in male patients with thicker choroids. Although PEHCR was largely self-limiting, approximately one-third of the eyes ended up with a visual acuity of less than 20/200 with extensive lesion involvement.
THE STATE OF PEDIATRIC RETINAL DETACHMENT SURGERY IN THE UNITED STATES
Authors: Starr Matthew R. , Boucher Nicholas , Sharma Chakshu , Wakabayashi Taku , Sivalingam Meera , Klufas Michael A. , Spirn Marc , Yonekawa Yoshihiro
Published: February 2023

Purpose:

In this study, the authors aimed to identify the demographics of retinal detachment in children in the United States and to report the treatment modalities chosen by vitreoretinal surgeons and associated outcomes.

Methods:

This was a multicenter cohort analysis of the Vestrum Health LLC Database (Naperville, IL). Children (1–17 years) with rhegmatogenous retinal detachment, as identified by ICD10 and CPT codes, between January 2015 and August 2021 were enrolled. Demographic, comorbidity, visual acuity, and treatment modality data were analyzed.

Results:

A total of 168,152 RRDs were identified, of which 2,200 (1.3%) were aged 1 to 17 years. The mean age was 12.7 years, and 821 (37%) were women. The prevalence of rhegmatogenous retinal detachment increased with age (P = 0.009). Associated comorbidities included myopia (17.3%), ocular trauma (7.5%), and history of prematurity (5.7%). Laser retinopexy alone was used as the initial treatment modality in 19%, primary vitrectomy in 23%, primary scleral buckle in 25%, and vitrectomy with scleral buckle in 33%. The single surgery success rate for all procedures was 73.3%. Of the incisional surgical modalities, primary scleral buckling had the best single surgery success rate (79.0%) compared with vitrectomy alone (64.5%) and vitrectomy with scleral buckle (67.2%) (P < 0.001 and P = 0.004, respectively). Younger age resulted in worse SSSR overall (coefficient = 0.151, R2 = 0.746, P = 0.027).

Conclusion:

Rhegmatogenous retinal detachments in children increased with age. Myopia, trauma, and history of retinopathy of prematurity were common risk factors. Treatment techniques varied, but primary scleral buckling had the best anatomical and visual outcomes.
Topical Anesthetics for Analgesia in Acute Corneal Abrasion: Eye Care Providers Survey
Authors: Anderson-Quiñones Catherine , Zhu Rongshun , Tolley Elizabeth A. , Vestal Robert , Asbell Penny
Published: January 2023

Study Objectives:

To evaluate the current attitudes of ophthalmologists and optometrists regarding topical anesthetic (TA) use in the emergency department (ED) for analgesia in corneal abrasions.

Methods:

A survey was distributed through email to ophthalmologists and optometrists, and their responses were deidentified. Three scenarios were presented involving the addition of tetracaine in addition to usual care in the setting of uncomplicated corneal abrasion. A 250-character space for comments and demographic questionnaire followed. A chi-square test, Fisher exact test, or sign test, at a significance level of 0.05, was used.

Results:

Of the 978 individuals surveyed, 486 responded (MD/DOs: 47.1% and ODs: 52.9%). Topical anesthetic favorability significantly decreased with shorter practice length when the patient was only examined by an ED provider. Topical anesthetic favorability was significantly impacted by respondents' degree type. When respondents were posed with using TAs if the respondents were the patient, the respondents were 22.6% more likely to use TA when compared with their answers in the scenario where the ED provider examined the patient and 20.0% more likely when compared with the scenario where a MD/OD examined the patient. Most did not support tetracaine use.

Conclusions:

Although treating pain is associated with improved quality of life, most respondents did not support TA use in the ED. Practice length and degree type significantly impacted responses. Respondents were more inclined to use TAs when the respondents were the patient. Results suggest that eye care providers need additional research data supporting safety before routine use in the ED, given the potential for adverse events with TAs.
Umbilical Cord Graft for Refractory Neurotrophic Keratopathy
Authors: Joiner Devon , Steinberg Yael , Kang Joann J.
Published: February 2023

Purpose:

The purpose of this study was to evaluate whether an umbilical cord tissue graft (UCG) could promote reepithelialization in refractory cases of neurotrophic keratopathy, which failed traditional treatment modalities including amniotic membrane grafts.

Methods:

This retrospective case series included 3 eyes of 3 patients who underwent UCG placement for refractory stage 3 neurotrophic keratopathy. Records were reviewed to evaluate the clinical course including previous treatments, time to UCG dissolution, time to corneal epithelialization, and recurrence of epithelial defects.

Results:

The time of a nonhealing epithelial defect before UCG placement ranged from 7.7 to 30 weeks (mean 21.0). UCG dissolution time ranged from 1.7 to 8.1 weeks (mean 5.0) compared with the previous failed amniotic membrane dissolution time of 0.3 to 1.6 weeks (mean 0.95). The time to complete epithelialization after UCG placement was 7.7 and 8.1 weeks, respectively, for the first 2 cases, whereas the third case did not fully epithelialize. Only 1 eye did not have recurrence of an epithelial defect. The maximum time of maintained epithelialization without recurrence ranged from 5 to 86 weeks (mean 42.7). Follow-up time was 37 to 108.1 weeks (mean 62.2) after first UCG placement.

Conclusions:

UCG may allow for longer retention time of tissue grafts, provide a mechanical barrier for protection, and aid in regeneration of the ocular surface. UCG may be an option for re-epithelialization in recalcitrant cases of neurotrophic keratopathy, after conventional treatments such as amniotic membrane grafts have failed.
Graft Outcomes After Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery
Authors: Yu Julia , Shalaby Wesam Shamseldin , Shiuey Eric J. , Rapuano Christopher J. , Yonekawa Yoshihiro , Hammersmith Kristin M. , Nagra Parveen K. , Syed Zeba A.
Published: February 2023

Purpose:

Corneal pathology can obstruct the visualization required for surgical management of coexisting posterior segment diseases, and use of a temporary keratoprosthesis (TKP) permits combined penetrating keratoplasty (PK) and vitreoretinal surgery. We evaluated graft outcomes after TKP for combined PK and vitreoretinal surgery and analyzed risk factors for graft failure.

Methods:

We reviewed the electronic medical records for patients who underwent TKP for PK combined with vitreoretinal surgery at Wills Eye Hospital between May 2007 and April 2021. Overall, 28 variables were analyzed. The main outcome measure was corneal graft failure, defined as irreversible graft edema or opacification.

Results:

A total of 46 eyes of 46 patients underwent combined surgery and were included in the study. The mean age at surgery was 55.7 ± 18.6 years (range 19–86 years), and the mean follow-up was 31.8 ± 30.5 months (range 1.6–114.0 months). Multivariable analysis revealed 2 factors significantly associated with graft failure: history of trauma (hazard ratio = 5.38; 95% confidence interval, 1.53–18.91; P = 0.009) and intraocular silicone oil after transplant (hazard ratio = 5.67; confidence interval 1.66–19.44; P = 0.006). Corneal graft failure occurred in 60.9% of all cases over the course of follow-up, but the absence of both variables yielded a 33.3% failure rate.

Conclusions:

Although outcomes vary, previous ocular trauma and the presence of intraocular silicone oil are risk factors for failure that may facilitate patient selection and improve counseling about long-term graft potential after TKP for combined PK and vitreoretinal surgery.
Demographic and Socioeconomic Determinants of Penetrating Keratoplasty Outcomes
Authors: Shalaby Wesam Shamseldin , Shukla Aakriti Garg , Shiuey Eric J. , Rapuano Christopher J. , Nagra Parveen K. , Syed Zeba A.
Published: February 2023

Purpose:

The aim of this study was to determine possible associations between demographic and socioeconomic factors and graft survival after penetrating keratoplasty (PK).

Methods:

This study was a retrospective chart review of patients undergoing PK at a tertiary-care corneal practice at Wills Eye Hospital between May 1, 2007, and September 1, 2018. The first PK of the first eye was included. The primary outcome measure was graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Demographic and socioeconomic factors included yearly average adjusted gross income (AGI) based on residential zip code, age, sex, and race. Two income groups were created: 1) individuals from neighborhoods with the lowest 10% of AGI (N = 82, AGI=$32,100 ± 4000) and 2) the remaining 90% of individuals (N = 740, AGI=$86,900 ± 52,200). Logistic regression analysis was performed to identify factors predictive of graft prognosis.

Results:

The 822 patients (822 eyes) included had a mean age of 57.1 ± 22.1 years at the time of PK. Over an average of 4.2 ± 3.1 years of follow-up, graft failure occurred in 35.3%. Age, sex, and follow-up duration were comparable between income groups (all P > 0.05). Black race was disproportionately represented in the lower-income group (50.0% vs. 11.5%, P < 0.001). Multivariable analysis identified predictors of graft failure including residing in a lower-income neighborhood [hazard ratio (HR) = 2.27, 95% confidence interval (CI) = 1.24-4.19, P = 0.008], younger age (HR = 0.99, 95% CI = 0.98–1.00, P = 0.046), and Black race (HR = 1.63, 95% CI = 1.03–2.56, P = 0.035).

Conclusions:

Individuals with a lower income, younger age, and Black race may be more vulnerable to graft failure after PK. Further studies are warranted to identify reasons for these associations.
Microsporidia-Associated Anterior Uveitis After Keratoconjunctivitis
Authors: Mohanty Amrita , Kelgaonkar Anup , Behera Himansu Shekhar , Mallick Aparajita , Das Sujata , Rekha Priyadarshini Smruti , Chaurasia Sunita , Sahu Srikant K.
Published: February 2023

Objective:

The aim of this study was to describe the clinical features and management of uveitis associated with microsporidial keratoconjunctivitis (MKC).

Methods:

The medical records of clinically diagnosed or microbiologically proven patients with MKC between July 2016 and August 2021 were reviewed. Patients with documented evidence of keratic precipitates (KPs) or anterior chamber cells were analyzed for their demography, clinical features, and treatment. Patients with microsporidial stromal keratitis and herpes simplex virus keratouveitis were excluded from the study.

Results:

Of the 2212 patients reviewed within the study period 171 of 172 eyes (7.7%) had documented evidence of KPs and/or anterior chamber cells. The patients' mean age was 43.8 ± 13.8 years, and there were more men (n = 120). The mean duration of appearance of KPs was 6.9 ± 5.5 days, and 28% (n = 48 of 171) appeared on the day of presentation. Superficial punctate keratitis was central and diffuse in 48 and 49 patients, respectively. The treatment was either lubricant alone (45.3%; 78 eyes) or combined with topical steroids (54.7%; 94 eyes). The mean duration of the resolution was longer in the “corticosteroid” than “no corticosteroid” group: KPs: 15.3 ± 6.5 days versus 12.3 ± 5.8 days (P = 0.007) and superficial punctate keratitises: 15.4 ± 9.4 days versus 11.7 ± 6.2 days (P = 0.01). The presenting visual acuity with a pinhole was 0.26 ± 0.26 (logMAR) and it improved to 0.03 ± 0.07 on resolution (P < 0.0001, paired t test).

Conclusions:

Uveitis after MKC is a self-limiting entity that often resolves without corticosteroid. One must exercise caution in using steroids in the presence of active corneal lesions.
Risk factors and management of choroidal effusions
Authors: Ying Stephanie , Sidoti Paul A. , Panarelli Joseph F.
Published: February 2023

Purpose of review

Choroidal effusions are recognized as a common early postoperative complication of glaucoma surgery, and although often benign, they may cause significant ocular morbidity. This article aims to summarize current research on the risk factors and management of choroidal effusions.

Recent findings

Glaucoma drainage device (GDD) implantation and trabeculectomy are the most commonly performed surgeries for the management of moderate to severe glaucoma. Common postoperative complications of these procedures include hypotony and the development of choroidal effusions. Choroidal effusions have recently been associated with the oral administration of certain drugs, including select monoclonal antibody, antiseizure and bisphosphonate medications. Risk factors for effusion development include specific patient characteristics such as pseudoexfoliative glaucoma, older age and hypertension. Although choroidal effusions typically resolve with medical therapy alone, surgical intervention may be required. Various methods of surgical intervention, such as surgical drainage or GDD tube ligation, can be utilized to treat choroidal effusions when conservative management with medical treatment fails, but themselves carry alternative risks that must be considered.

Minimizing the incidence and duration of hypotony following ophthalmic surgery and careful monitoring of patients starting certain oral medications are important in limiting the occurrence of choroidal effusions. Risk factors for choroidal effusions have been recently identified in the literature. A better understanding of these risk factors, as well as the outcomes of choroidal effusion management, can help to reduce the occurrence of effusions overall and minimize ocular morbidity.
New glaucoma drainage implants available to glaucoma surgeons
Authors: Khodeiry Mohamed , Sayed Mohamed S.
Published: January 2023

Purpose of the review

Glaucoma drainage device (GDD) implantation surgery is commonly performed by glaucoma specialists to treat complex and refractory glaucomas. Relative safety and efficacy data from randomized controlled trials conducted in the last two decades have sparked the interest in GDDs as possible surgical options earlier in the course of the disease than has traditionally been practiced. However, until recently, advances in the design and techniques of GDD surgery have fallen short of this increasing interest.

Recent findings

Most recently, new GDDs that possess novel design features have become available to glaucoma specialists. Two of these new devices are the Ahmed ClearPath and the Paul glaucoma implant. These devices have demonstrated promising outcomes that are comparable to those of traditional implants. Additionally, given their unique respective features, these devices may streamline surgical technique due to ease of insertion and afford better safety and efficacy outcomes in certain patients.

The recent introduction of new GDDs has been long awaited by glaucoma surgeons. Although early results are promising, long-term data and comparison of outcomes to those of traditional filtering surgery and commonly implanted devices are needed before these devices can be the new standard of care in glaucoma tube shunt surgery.
Two-Year Outcomes of Trabeculectomy and Phacotrabeculectomy in Primary Open Angle Versus Primary Angle Closure Glaucoma
Authors: Winuntamalakul Yolradee , Chansangpetch Sunee , Ratanawongphaibul Kitiya , Itthipanichpong Rath , Manassakorn Anita , Tantisevi Visanee , Rojanapongpun Prin
Published: February 2023

Précis:

Phacotrabeculectomy had a significantly lower 24-month failure rate than the isolated trabeculectomy in both the primary open angle glaucoma (POAG) and primary angle closure glaucoma (PACG) patients. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.

Purpose:

The purpose of this study is to compare the 2-year outcomes of primary mitomycin C-augmented combined phacotrabeculectomy (Phaco+Trab) with isolated trabeculectomy (Trab) in phakic patients with POAG and PACG.

Materials and Methods:

We retrospectively reviewed primary glaucoma patients who underwent mitomycin C-augmented trabeculectomy and completed 2 years of follow-up. Failure rate, postoperative intraocular pressure (IOP), percentage of IOP reduction, and the number of glaucoma medications at 24 months after surgery were compared between the Phaco+Trab and Trab groups.

Results:

The study included 146 eyes of 121 patients; 74 underwent Trab and 72 underwent Phaco+Trab. POAG and PACG were present in 71 and 75 eyes, respectively. Defining a failure with IOP criteria of >18 mm Hg or IOP reduction of <30%, the failure rates were 42% and 62% for Phaco+Trab and Trab, respectively. The Phaco+Trab group had a significantly lower failure rate than the Trab group for all subjects [risk ratio (RR): 0.60, 95% CI, 0.44–0.81, P=0.001], POAG subgroup (RR: 0.61, 95% CI, 0.41–0.93, P=0.02), and PACG subgroup (RR: 0.53, 95% CI, 0.33–0.86, P=0.01). Differences in the postoperative IOP, percentage of IOP reduction, and number of glaucoma medications were not significant between the 2 groups for all subjects, POAG, and PACG (all P>0.05). The magnitude of the effects of adding phacoemulsification to the trabeculectomy was comparable for the POAG and PACG groups, for each outcome (all P>0.05).

Conclusions:

The final 24-month failure rate in the Phaco+Trab group was lower than that in the Trab group in both the POAG and PACG subjects. The impact of adding phacoemulsification to trabeculectomy was found to be similar between the eyes with POAG and PACG.
Global Transmission of the penA Allele 60.001–Containing High-Level Ceftriaxone-Resistant Gonococcal FC428 Clone and Antimicrobial Therapy of Associated Cases: A Review
Authors: van der Veen Stijn
Published: February 2023

Neisseria gonorrhoeae is a multidrug-resistant bacterial pathogen for which ceftriaxone is the only remaining recommended first-line therapy. However, ceftriaxone susceptibility has been waning in a number of countries over the last decade and ceftriaxone treatment failures have been reported, commonly as a result of sporadic high-level ceftriaxone-resistant strains. In recent years, N. gonorrhoeae strains associated with the high-level ceftriaxone-resistant FC428 clone or strains that acquired its main ceftriaxone resistance determinant, penA allele 60.001, have shown global transmission, resulting in ceftriaxone treatment failure in a number of cases. The FC428 clone was first encountered in Japan in 2015 and subsequently in China, Europe, Australia, North America and Southeast Asia afterward. Strains associated with the FC428 clone commonly display a ceftriaxone minimum inhibitory concentration of 0.5–1 mg/L. However, where penA alleles encountered in sporadic high-level ceftriaxone-resistant isolates induce an in vitro growth defect, penA allele 60.001 does not seem to affect in vitro growth. The limited impact of penA allele 60.001 on biological fitness might be associated with its successful global transmission. Although the FC428 clone displays high-level ceftriaxone resistance, most gonorrhea cases associated with this clone were still successfully cured with ceftriaxone when intramuscular or intravenous doses of 500 mg to 2 g were used. A successful alternative therapy seems to be ertapenem given at 1-g doses, although further clinical studies are required to validate ertapenem efficacy. This review summarizes the global transmission of strains associated with the FC428 clone and antimicrobial treatment of associated cases.
The role of ApoE-mediated microglial lipid metabolism in brain aging and disease
Authors: Yen Jui-Hung Jimmy , Yu I-Chen Ivorine
Published: January 2023

Microglia are a unique population of immune cells resident in the brain that integrate complex signals and dynamically change phenotypes in response to the brain microenvironment. In recent years, single-cell sequencing analyses have revealed profound cellular heterogeneity and context-specific transcriptional plasticity of microglia during brain development, aging, and disease. Emerging evidence suggests that microglia adapt phenotypic plasticity by flexibly reprogramming cellular metabolism to fulfill distinct immune functions. The control of lipid metabolism is central to the appropriate function and homeostasis of the brain. Microglial lipid metabolism regulated by apolipoprotein E (ApoE), a crucial lipid transporter in the brain, has emerged as a critical player in regulating neuroinflammation. The ApoE gene allelic variant, ε4, is associated with a greater risk for neurodegenerative diseases. In this review, we explore novel discoveries in microglial lipid metabolism mediated by ApoE. We elaborate on the functional impact of perturbed microglial lipid metabolism on the underlying pathogenesis of brain aging and disease.
Neonatal Toxic Shock Syndrome-like Exanthematous Disease: A Report of Two Cases
Authors: Bešić Hana , Paro-Panjan Darja , Nosan Gregor
Published: February 2023

Neonatal toxic shock syndrome (TSS)-like exanthematous disease is characterized by exanthema, thrombocytopenia and fever in neonates infected with TSS toxin-1 producing Staphylococcus aureus. Although the disease is rare, it should be known to neonatologists as it represents a differential diagnosis in neonates with exanthema and thrombocytopenia. Two presented neonates with Neonatal TSS-like exanthematous disease are rare European cases of this specific neonatal disease.
Petting Zoos as an Unsuspected Source of Pediatric Infections
Authors: Hall Jaimee M. , Falcon Isabelle Z. , Elward Alexis M. , Daniels Elizabeth A. , Greene Sarah E. , Cabler Stephanie S. , Reich Patrick J. , Storch Gregory A.
Published: February 2023

Children are at risk for infection following animal exposure at petting zoos owing to suboptimal hand hygiene and frequent hand-to-mucosal surface contact. Public health surveillance is limited, and infectious risk is likely underrecognized. Most reported infections are enteric. Here, we describe two children with unusual, nonenteric infections following petting zoo exposure.
ESCRS Clinical Trends Survey 2016-2021: A Six-Year Assessment of Practice Patterns Amongst Society Delegates
Authors: Kohnen Thomas , Findl Oliver , Nuijts Rudy , Ribeiro Filomena , Cochener-Lamard Béatrice
Published: January 2023

Purpose:

To evaluate clinical opinions and practice patterns of delegates to the European Society of Cataract and Refractive Surgeons (ESCRS).

Setting:

Clinical Trends Surveys were administered during annual ESCRS congresses held between 2016 to 2021, and data collected online and in-person.

Design:

Survey questions addressed several specialty areas, including cataract surgery, presbyopia-correcting and toric intraocular lenses (IOLs), ocular surface disease, and glaucoma.

Methods:

Survey results were compared and analyzed across 6 years. Four main profile questions were used for cross-tabulation analyses of questions pertaining to refractive surgery – practice location, years in practice, primary surgery setting, and average annual volume of cataract surgery.

Results:

The highest number of responses (3,019) was collected in 2019, with the lowest (569) received in 2020. The use of presbyopia-correcting and toric IOLs has increased significantly from 2016 to 2021, with certain respondent segments using them more frequently than others. While optical biometry remains the preferred method for obtaining preoperative measurements, the use of tomography (Scheimflug) has significantly increased. In 2021, 61.1% and 44.9% of respondents always performed preoperative checks of the ocular surface before refractive and cataract surgery, respectively. The proportion of respondents who perform glaucoma surgery has significantly decreased over the years, with an increasing number of delegates reporting having only a medical glaucoma practice. On average, 5.4% of patients with cataract and glaucoma underwent combined MIGS and cataract procedures in 2021.

Conclusions:

Evaluation of the Clinical Trends Survey data provides valuable insights into the shifting practice patterns and clinical opinions of ESCRS delegates.
Clinical outcome of a quadrifocal (trifocal) intraocular lens in Chinese patients: prospective, observational case series
Authors: Chang John S.M. , Liu Sylvia C.T. , Ma Nadine T.C. , Ng Jack C.M.
Published: February 2023

Purpose:

To report the visual outcomes and quality of vision and life after bilateral implantation of a single-piece trifocal intraocular lens (IOL) in Chinese patients.

Setting:

Hong Kong Sanatorium & Hospital, Hong Kong, China.

Design:

Prospective, observational case series.

Methods:

Patients with bilateral implantation of AcrySof IQ PanOptix multifocal IOL were included. Distance, intermediate (60 cm), and near (40 cm) visual acuities (VAs) and contrast sensitivity (CS), defocus curve, preoperative higher-order aberration (HOA), dysphotopsia (0 to 5), satisfaction (1 to 5), spectacle independence, and quality of life were evaluated. The association between preoperative HOA and postoperative halos was also assessed.

Results:

54 eyes of 27 patients were included. The mean binocular distance, intermediate, and near uncorrected VA was −0.05 ± 0.06 (20/18), 0.06 ± 0.10 (20/23), and 0.04 ± 0.05 (20/22), respectively. No eyes lost more than 1 line of vision. Binocular CS was comparable with the monocular population norm of older adults. The defocus curve demonstrated that the binocular VA of 20/25 or better was achieved at a power of −3.00 to +0.50 diopters. The mean scores for halos, glare, and starbursts were 2.4 ± 1.4, 0.2 ± 0.8, and 1.4 ± 1.4 (of 5), respectively. The mean satisfaction score was 4.3 ± 0.7 (of 5). All the patients (100%) reported total spectacle independence. The mean vision-targeted composite score of the vision-related quality-of-life questionnaire was 97.2 ± 9.7 (of 100). Preoperative HOA was not associated with postoperative halos.

Conclusions:

Implantation of the trifocal IOL provided satisfactory visual outcomes and quality of vision and life, which resulted in a high rate of spectacle independence.
Ten-year prevalence of rhegmatogenous retinal detachment in myopic eyes after posterior chamber phakic implantable collamer lens
Authors: Arrevola-Velasco Luis , Beltrán Jaime , Rumbo Ana , Nieto Raquel , Druchkiv Vasyl , Martínez de la Casa José María , Ruiz-Moreno José María
Published: February 2023

Purpose:

To determine and compare the prevalence of rhegmatogenous retinal detachment (RRD) in myopic eyes operated of posterior chamber phakic implantable collamer lens (ICL) with a control group of nonoperated myopic eyes over 10 years of follow-up.

Setting:

Clinica Baviera, Madrid, Spain.

Design:

Retrospective cohort study.

Methods:

There were 2 study cohorts: one with patients operated with ICL and a control group of nonoperated patients. The primary outcome of RRD was measured retrospectively, first through chart review of ICL-operated patients with at least 10 years of follow-up, then secondarily through telephone questionnaires and specialist verification for those with incomplete follow-up. Prevalence and incidence were calculated and compared, as well as their possible association with other risk factors.

Results:

58 operated patients completed follow-up in our clinic. A survey of 3849 more patients was conducted for a total of 252 operated with a mean spherical equivalent (SEQ) of −12.6 diopters (D) and 221 nonoperated with a mean SEQ of −10.5 D. 7 eyes developed an RRD in the operated vs 5 eyes among the nonoperated (prevalence 1.71% vs 1.25%, respectively, P = .773). The equivalence tests, the two one-sided test and the null hypothesis test between groups, were within the 0.02 limits, confirming the null hypothesis, and compared survival curves did not show significant differences (P = .59).

Conclusions:

ICL implantation surgery for high myopia did not affect the prevalence of RRD in operated eyes compared with similar nonoperated eyes, in this long-term study.
Bilateral sequential small-incision lenticule extraction and LASIK result in similar short-term quality-of-life outcomes
Authors: Gan Alfred T.L. , Fenwick Eva K. , Ang Marcus , Mehta Jodhbir S. , Lamoureux Ecosse L.
Published: February 2023

Purpose:

To compare quality of life (QoL) between patients who receive bilateral small-incision lenticule extraction (SMILE) or laser in situ keratomileusis (LASIK) vs bilateral sequential SMILE–LASIK (BSSL) surgery.

Setting:

Singapore National Eye Centre, Singapore.

Design:

Retrospective cohort study.

Methods:

2 patient cohorts were recruited (2010-2012; 2014-2016). The bilateral SMILE (BS) and bilateral LASIK (BL) groups comprised patients (mean ± SD age: 30.3 ± 6.5, 50% male) from a prospective nonrandomized study who chose SMILE and LASIK, respectively. The BSSL group comprised patients (mean ± SD age: 28.6 ± 6.2, 64.3% male) randomized to receive SMILE in 1 eye and LASIK in the other. Rasch-scaled scores of the QoL Impact of Refractive Correction questionnaire between groups postoperatively at 1 and 3 months were compared.

Results:

At month 1, scores on 3 QoL without emotional well-being items were worse in the BSSL (n = 70) compared with the BL group (n = 25), specficially, “using sunglasses” (β: −20.6, 95% CI, −34.3 to −6.9), “reliance on refractive correction” (−23.1, 95% CI, −40.9 to −5.4), and “medical complications from optical correction” (β: −14.8, 95% CI, −27.9 to −1.7). Emotional well-being (overall), and items “feeling able to do things” (β: 11.0, 95% CI, 1.6-20.4) and “feeling eager to try new things” (β: 14.1, 95% CI, 3.6-24.6) were better in the BSSL compared with the BS group (n = 25). No substantive differences were observed at month 3.

Conclusions:

Refractive correction-related QoL differences at month 1 between BSSL and BS/BL patients attenuated by month 3. Bilateral sequential SMILE–LASIK surgery appeared unlikely to negatively affect QoL beyond 3 months.
Nd:YAG Laser Capsulotomy Rates in the Netherlands; Practice Variation and Association with Physician Practice Styles
Authors: Eggermont Rogier L. , Witteman Agnes M. , van Erkelens Judith A. , Vermeulen Karin , Vunderink Lydia , Reus Nicolaas J.
Published: February 2023

Purpose:

To determine the practice variation in rate of Nd:YAG laser capsulotomy within one year after cataract surgery and to identify possible associations with physician practice styles.

Setting:

All hospitals and private clinics in The Netherlands

Design:

Retrospective observational study

Methods:

In the national medical claims database, we identified all laser capsulotomies performed in the Netherlands within a year after cataract surgery in the years 2016 and 2017. Centres with the lowest and highest percentages of Nd:YAG laser capsulotomies were interviewed on their physician practice styles related to the development of posterior capsule opacification.

Results:

The incidence of Nd:YAG laser capsulotomy varied between 1.2% and 26.0% in 2016 (median 5.0%) and between 0.9% and 22.7% in 2017 (median 5.0%). The rate of capsulotomy was highly consistent over time for each centre (Pearson correlation coefficient, 0.89, P < 0.001). In general, ophthalmology centres with a high rate of Nd:YAG laser capsulotomy more often did not (routinely) polish the posterior lens capsule, performed cortex removal with coaxial irrigation/aspiration (instead of bimanual), and more often used hydrophilic IOLs (compared to only using hydrophobic IOLs).

Conclusions:

We found a significant practice variation in performing Nd:YAG laser capsulotomy within one year after cataract surgery in the Netherlands. Routinely polishing the posterior capsule, using bimanual I/A, and the use of hydrophobic IOLs are associated with a lower incidence in Nd:YAG laser capsulotomy. Incorporating these practice styles may lower the practice variation and thus prevent added medical burden for the patient and decrease costs.