Long-Term Outcomes of Ahmed Glaucoma Valve Surgery in a Scottish Cohort of Patients With Refractory Glaucoma.

Purpose The purpose of this study was to evaluate the long-term efficacy and safety profile of the Ahmed glaucoma valve (AGV) implantation in cases of refractory glaucoma. Methods We conducted a retrospective audit of patients that underwent AGV implantation between 2006 and 2017 by two glaucoma surgeons in a tertiary glaucoma centre (Glasgow, UK). Primary outcome measures included the post-operative intraocular pressure (IOP), number of glaucoma medications, best-corrected visual acuity, complications, re-operation rates, and failure (defined as IOP > 21 mmHg or not reduced by 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma, removal of implant, or loss of light perception) at pre-defined time points (years 1 to 8). Results A total of 111 eyes of 94 patients were identified with a mean follow-up of 48.5 months (SD: 31.5); 60.3% of eyes had undergone at least one previous glaucoma surgery. Mean presenting IOP was 31.7 mmHg (SD: 11.4), and it reduced to 13.9 mmHg (SD: 4.2) in year 5 and 16.3 mmHg in year 8 (p<0.05). The number of glaucoma medications reduced from 3.8 (SD: 1.4) to 2.4 (SD: 1.4) and 2.6 (SD: 1.4) in the above time points (p<0.05 except year 8). The five-year success rate was 65.2%, and the five-year reoperation rate was 37% excluding cataract surgery. The most common early complications were hyphaema (12.6%) and transient hypotony (8.1%), whereas the most common late complication was an encapsulated bleb (15.1%). Conclusions AGV implantation is an effective procedure for controlling IOP in the long term in cases of refractory glaucoma.

Evaluation of Clinical and Histological Outcomes of Adipose-Derived Mesenchymal Stem Cells in a Rabbit Corneal Alkali Burn Model.

To assess effects of adipose-derived mesenchymal stem cells (AMSCs) in corneal alkali injuries in an experimental animal model. Twenty white New Zealand rabbits were included in the study. The animal models were randomly divided into 2 groups. Rabbits in the AMSC group (n = 10) received an intrastromal, a subconjunctival injection, and topical instillation of 0.5 ml totally of phosphate-buffered saline (PBS) containing 2 × 106 AMSCs. In the control group (n = 10), rabbits received only 0.5 ml of PBS using the same methods. A masked investigator measured the corneal sensation, anterior chamber Inflammation (ACI), and conjunctival congestion. Additionally, a blind histological and immunohistochemical evaluation was made. In the AMSC group, the central corneal sensation was increased whereas ACI and conjunctival congestion were reduced compared to the control group in the 28 days of follow-up (p < 0.05). A statistically significant difference (p < 0.05) was noted between the two groups as recorded in the above parameters. Histological analysis showed that pathological vascularization was markedly reduced in the AMSC group which was consistent with the absence of factor VIII in the immunohistochemistry sections. There is a trend towards improved clinical outcomes including corneal sensation as well as acceleration in the restoration of normal corneal architecture in corneal alkali burns treated with AMSCs, results that support the need for further research in the field.

The incidence and management of persistent cystoid macular oedema following uncomplicated cataract surgery-a Scottish Ophthalmological Surveillance Unit study.

PURPOSE: Post-operative cystoid macular oedema (CMO) can cause deterioration of vision following routine cataract surgery. The incidence of persistent CMO (pCMO; defined as CMO present after 3 months) following uncomplicated surgery is uncertain. We wished to identify the incidence, management and visual outcomes of such patients. METHODS: A Scottish Ophthalmological Surveillance Unit (SOSU) questionnaire was sent monthly to every ophthalmic specialist in Scotland over an 18-month period from 1st January 2018 asking them to report all new patients with pCMO confirmed on OCT scanning following uncomplicated cataract surgery. A follow-up questionnaire was sent 9 months after initial presentation. RESULTS: Fourteen cases of pCMO were reported, giving an incidence of 2.2 cases of pCMO per 10,000 uncomplicated cataract surgeries. Mean age was 74.9 years (SD 10.2; range 44-86) with a male preponderance (72.7%). Two patients developed pCMO in each eye. Six cases (46.2%) had hypertension and one had diabetes. Three eyes required intracameral adjuncts (two iris hooks, one intracameral phenylephrine). Postoperative visual acuity (VA) at 3 months was logMAR 0.48 (0.2-0.8). Average mean central retinal thickness (CRT) at 3 months was 497microns (270-788). The most common initial treatment comprised topical steroids and topical NSAIDs (61.5%). Other management strategies included systemic steroids, intravitreal steroids and oral acetazolamide. At 1-year post-op, mean VA was logMAR 0.18 (0.1-0.3) with average mean CRT of 327microns (245-488). CONCLUSIONS: We identified a low incidence of pCMO following uncomplicated cataract surgery in Scotland (0.02%), with inconsistent and variable management regimes. A nationally agreed treatment protocol is required.

Twenty-four-month real-world visual outcomes of intravitreal aflibercept as monotherapy for the treatment of neovascular age-related macular degeneration.

BACKGROUND: Aflibercept is widely used as a treatment for neovascular age-related macular degeneration (nAMD). Nevertheless, there is no consensus in the optimal injection frequency in the 2nd year of treatment along with little real-world data on visual outcomes. On that basis, the primary aim of this study was to assess the visual acuity (VA) and the total number of injections needed on average for these patients during the 24-month follow-up. MATERIALS AND METHODS: This is a retrospective observational study from an electronic medical record of consecutive patients treated with intravitreal aflibercept (both naïve and nonnaïve eyes) who had completed the 24-month follow-up since the commencement of treatment. Patients followed the VIEW protocol in year 1 whereas in year 2, an as required approach/Pro Re Nata (PRN) was used. RESULTS: Eighty-seven eyes of 78 patients were analyzed. 43.7% were nonnaive eyes. Baseline VA for all eyes (logMAR) was 52.6 letters, improving to 56.2 letters at 12 months and 55 at 24 months. Almost 83.9% of the treated eyes (81.3% of the patients) did not experience any significant visual loss receiving on average of 9.9 injections in the 24 months of follow-up and attending the hospital eye service 20.3 times in total. CONCLUSIONS: Aflibercept as monotherapy for the treatment of nAMD is associated with good 2 nd year outcomes in a real-world setting using the PRN approach in year 2 and fewer injections comparing to the clinical studies, but a higher proportion of follow-up visits compared to the treat and extend regimen.

Allergic Conjunctivitis in Patients with Respiratory Allergic Symptoms; a Retrospective Study in Greece.

Here, we report on the prevalence of allergic conjunctivitis and positive skin prick test (SPT) results in relation to respiratory allergic conditions among patients with symptoms of allergies at a respiratory outpatient clinic. A questionnaire survey of symptoms (i.e., asthma-like, rhinitis, and conjunctivitis symptoms) involving 1522 patients was carried out. The responses of 1242 patients indicated that they had allergic conjunctivitis, asthma, rhinitis, or a combination of these conditions, and 869 of these patients underwent SPTs that assessed responses to 40 allergens. Allergic conjunctivitis was found to be very common (40%, 497 out of 1242 patients) among those with symptoms of allergies. Conjunctivitis was slightly more common among women, while rhinitis was more common among men. Patients with both conjunctivitis and rhinitis were more likely to undergo SPTs, and they had a higher rate of positive SPTs. The coexistence of two or more comorbidities increased the risk of having an immunoglobulin E (IgE)-mediated allergy (based on the SPT results) compared to having each of the conditions alone. In conclusion, allergic conjunctivitis can occur either alone or with asthma and/or rhinitis. It is not always accompanied by rhinitis, but the coexistence of these conditions was the strongest indicator of IgE-mediated allergies.

Allergic conjunctivitis and the most common allergens in Northern Greece.

BACKGROUND: Ocular allergies affect a great part of the general population and often co exist with other allergic manifestations. In the present study, the prevalence of allergic conjunctivitis and the commonest allergens in allergic patients at an outpatient unit in Thessaloniki, Greece were evaluated. METHODS: This is a retrospective study regarding allergic patients who referred to an outpatient clinic between the 1st of January of 1996 and the 31st of December 2010. They completed relative questionnaires concerning their allergic condition. The patients who were included in our study had allergic conjunctivitis confirmed by ophthalmologists and were divided into 4 groups. The criteria used were the existence of allergic conjunctivitis alone or with other allergic co- morbidities. The patients then underwent skin prick tests after consent according to current guidelines. RESULTS: The archives of 1239 allergic patients were evaluated and 497 patients (40,11%) who manifested eye allergic symptoms were included in our study. 448 patients (90.14%) had allergic conjunctivitis in conjunction with asthma or rhinitis or both. 370 patients underwent skin prick tests and 284 of them (124 males-160 females) were positive for at least 1 of the 8 tested allergens (76.75%). 166 were positive to a grass mix (58.45%), 130 to olea European (45.77%), 124 to dust mites mix (43.66%), 58 to cypress (20.42%), 71 to parietaria officinalis (25.00%), 67 to cat dander (23.59%), 35 to dog dander (12.32%) and 32 to Altenaria (11.26%). CONCLUSIONS: Symptoms of ocular allergy are very common in patients with allergic rhinitis and asthma. Men had slightly higher percentages of positive skin prick tests, except for dog dander and Altenaria. Conjunctivitis should not be overlooked as an allergic entity when evaluating allergic patients.

A para-canalicular abscess resembling an inflamed chalazion.

Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.

Hepatic ischemia and reperfusion injury and trauma: current concepts.

CONTEXT: Ischemia-reperfusion injury is a fascinating topic which has drawn a lot of interest in the last several years. Hepatic ischemia reperfusion injury may occur in a variety of clinical situations. These include transplantation, liver resection, trauma, and vascular surgery. EVIDENCE ACQUISITION: The purpose of this review was to outline the molecular mechanisms underlying hepatic I/R injury and present the latest approaches, both surgical and pharmacological, regarding the prevention of it. A comprehensive electronic literature search in MEDLINE/PubMed was performed to identify relative articles published within the last 2 years. RESULTS: The basic mechanism of hepatic ischemia - reperfusion injury is one of blood deprivation during ischemia, followed by the return of flow during reperfusion. It involves a complex series of events, such as mitochondrial deenergization, adenosine-5'-triphosphate depletion, alterations of electrolyte homeostasis, as well as Kupffer cell activation, oxidative stress changes and upregulation of proinflammatory cytokine signaling. The great number of variable pathways, with several mediators interacting with each other, leads to a high number of candidates for potential therapeutic intervention. As far as surgical approaches are concerned, the modification of existing clamping techniques and the ischemic preconditioning are the most promising techniques till recently. In the search for novel techniques of protecting against hepatic ischemia reperfusion injury, many different strategies have been used in experimental models. The biggest part of this research lies around antioxidant therapy, but other potential solutions have been explored as well. CONCLUSIONS: The management of hepatic trauma, in spite of the fact that it has become increasingly nonoperative, there still remains the possibility of hepatic resection in the hepatic trauma setting, especially in severe injuries. Hence, clinicians should be familiar with the concept of hepatic ischemia-reperfusion injury and respond appropriately and timely.