Incidence of nonarteritic ischemic optic neuropathy following topical clear corneal cataract surgery: survey and meta-analysis.

OBJECTIVE: We estimate the incidence and characteristics of post-cataract-surgery nonarteritic ischemic optic neuropathy (PCNAION) after topical clear corneal cataract extraction (CCCE) in Canada. DESIGN: Canada-wide internet survey and meta-analysis PARTICIPANTS: All certified Canadian ophthalmologists in the Canadian Ophthalmological Society directory, or belonging to a provincial ophthalmology internet group. METHODS: Identical surveys were distributed to 5 regions in Canada. CCCE surgeons were asked to estimate the number of CCCE they had performed in their career, and the number of PCNAION events that occurred within 1 year after CCCE. The results were analyzed using a random effects meta-analysis of proportions for rare events. RESULTS: The estimated survey response rate was 18%-32%. The 182 survey respondents performed a total of 1 499 694 CCCE with 107 events of PCNAION. Twenty-six percent of surgeons had at least one patient with PCNAION. Meta-analysis revealed a pooled estimate incidence of 2.8 PCNAION events (95% confidence interval 1.6-4.7) per 100 000 cataract procedures during the year after cataract surgery. Seventy-seven percent (82/107) of the PCNAION cases occurred within 3 weeks of surgery, and 7 patients had bilateral PCNAION. CONCLUSIONS: PCNAION is a rare complication after topical CCCE. Its incidence is important to estimate for patient care and epidemiologic reasons.

Therapeutic Use of Stem Cells in Treatment of Burn Injuries.

Burn injuries are one of the most common sources of trauma globally that comprise a significant drain on long-term personal and healthcare cost. Large surface area burn wounds are difficult to manage and may result in significant physiologic and psychologic sequelae. The goal of burn wound healing research is to fully repair and restore skin's original structure and functionality while minimizing problems such as hypertrophic scarring and contracture. One of the ways this can be achieved is through augmentation of the skin's natural healing process using the regenerative capability of stem cells. In this review, the authors highlight some recent developments in treatment of burn wounds employing stem cells. We compare and contrast the benefits and drawbacks to various sources of stem cells and techniques of delivery into damaged tissues that have been the focus of established and ongoing research, and avenues of exploration this burgeoning arena offers for the future.

One-Year Effectiveness Study of Intravitreous Ranibizumab in Wet (Neovascular) Age-Related Macular Degeneration: A Meta-Analysis.

PURPOSE: The clinical efficacy of ranibizumab has been examined by a large number of prospective and retrospective studies to date. This meta-analysis was conducted to summarize the current body of evidence on visual acuity (VA) changes with use of ranibizumab in the treatment of wet (neovascular) age-related macular degeneration (wAMD). METHODS: A literature review of multiple electronic databases (EMBASE, MEDLINE, MedMEME) was conducted to find randomized controlled trials (RCTs) and observational studies that reported changes in VA while patients with wAMD were on ranibizumab. Study factors analyzed were baseline patient characteristics, study type, sample size, and 12-month change in VA. Data were pooled in a meta-analysis with VA change as the main outcome. Data were then stratified by study design and a meta-regression was conducted to assess 12-month VA change against baseline VA and age. RESULTS: A total of 42 studies were included for analysis. An overall increase of 5.58 letters (95% confidence interval [CI]: 4.42-6.75; p heterogeneity, < 0.001) was shown with use of ranibizumab compared to baseline. Improvements in VA were larger for RCTs, at 7.71 letters (95% CI: 6.66-8.76; p heterogeneity, 0.013), compared to observational studies, at 4.85 letters (95% CI: 3.32-6.38; p heterogeneity, < 0.001). The meta-regression showed a significant decrease in effect size between baseline VA and 12-month VA change. CONCLUSION: This meta-analysis suggests visual improvements at 12 months of 0.5-mg ranibizumab use in patients with wAMD. A higher gain in VA was observed when pooling results from RCTs compared to those in observational studies.

Cough is less common and less severe in systemic sclerosis-associated interstitial lung disease compared to other fibrotic interstitial lung diseases.

BACKGROUND AND OBJECTIVE: The objectives of this study were to determine the prevalence and characteristics of cough in idiopathic pulmonary fibrosis (IPF), chronic hypersensitivity pneumonitis (HP) and systemic sclerosis-associated interstitial lung disease (SSc-ILD). METHODS: Cough severity was measured in consecutive patients with IPF (n = 77), HP (n = 32) and SSc-ILD (n = 67) using a 10-cm visual analogue scale (VAS). Dyspnoea and quality of life were measured using established questionnaires. Cough severity was compared across ILD subtypes and predictors of cough severity were determined using multivariate analysis. RESULTS: Cough was more common in IPF and chronic HP compared to SSc-ILD (87% and 83% vs 68%, P = 0.02). The median (interquartile range) VAS score was 39 (17-65) in the IPF cohort, 29 (11-48) in HP and 18 (0-33) in SSc-ILD (P < 0.0001). Cough was more often productive in chronic HP and IPF (63% and 43% vs 21%, P < 0.001). Cough severity was independently predicted only by ILD diagnosis and higher dyspnoea score. Cough severity was not associated with other common causes of cough. Cough was a significant predictor of quality of life in IPF and SSc-ILD with adjustment for age, sex, dyspnoea and ILD severity; however, cough was not associated with quality of life in chronic HP. CONCLUSION: Cough is more frequent, more severe and more often productive in IPF and chronic HP compared to SSc-ILD, despite similar ILD severity in these cohorts. Cough severity is strongly and independently associated with dyspnoea and pulmonary function, and is a significant contributor to reduced quality of life in both IPF and SSc-ILD.

Fluoroquinolone Use and Risk of Carpal Tunnel Syndrome: A Pharmacoepidemiologic Study.

Fluoroquinolone-induced peripheral neuropathies and tendinopathies are well documented, but there are no epidemiologic studies on the risk of carpal tunnel syndrome (CTS). We conducted a case-control study of >6 million patients. Fluoroquinolone use is associated with increased risk of CTS (rate ratio, 1.34 [95% confidence interval, 1.31-1.37]).