Point-of-Care Arterio-Venous Fistula Ultrasound in the Outpatient Hemodialysis Unit-A Survey on the Nurses' Perspective.

The preservation of complication-free arterio-venous fistulas (AVF) for long-term hemodialysis (HD) use is associated with better overall patient outcomes, which is why this is a current goal in any HD center. Point-of-care ultrasound (POCUS) for in-center AVF assessment has proven its benefits in the identification of vascular access (VA) complications and as an additional tool to avoid blind cannulation. The current study aims to assess the change in the HD nurses' perceptions regarding AVF POCUS use in the HD center. The nursing staff anonymously answered a Likert scale questionnaire with five questions related to various aspects of AVF POCUS utility shortly after the technique had been implemented and at a 5-year follow-up. The results showed an overall positive attitude toward this method, both at implementation and at follow-up, with no statistically significant score changes for four out of the five items assessed. However, we found a statistically significant reduction in the nurses' cannulation confidence scores at the 5-year follow-up (p < 0.01). Overall, AVF POCUS implementation is regarded as a useful tool, with major benefits both for the patient and for the medical team. The current study results aim to support the introduction of AVF POCUS assessment as a standard practice from the nursing staff's viewpoint. This study was not registered.

C-reactive protein as a prognostic risk factor for loss of arteriovenous fistula patency in hemodialyzed patients.

BACKGROUND: Inflammation is a cardiovascular risk factor in hemodialysis patients, but its influence on vascular access patency is still debatable. Our prospective study investigated this issue. METHODS: A total of 258 patients receiving an arteriovenous fistula (AVF) between 2006 and 2016 at the Municipal Hospital Arad were included. Demographic, clinical, and laboratory characteristics were collected at the time of creation of the AVF. The primary study end point was AVF patency loss, defined as an event occurring at least 2 months after AVF formation and requiring surgical revision or replacement of the fistula. The patients were followed up for a median time of 26 months. RESULTS: In our group, the mean age was 59.7 ± 13.2 years (median, 62 years), and 60.1% were male. During follow-up, 134 patients (51.9%) maintained AVF patency, whereas 124 (48.1%) lost AVF patency within a mean time of 23.3 ± 28.1 months (median, 10.5 months). We found that age (hazard ratio [HR], 1.015; P = .035) and C-reactive protein (CRP) level (HR, 1.17; P < .0001) were associated with a higher risk of loss of AVF patency. The protective factors for AVF patency were autosomal dominant polycystic kidney disease (HR, 0.336; P = .009), pre-emptive AVF (HR, 0.648; P = .031), and higher level of triglycerides (HR, 0.998; P = .035). In the multivariate adjusted Cox model, CRP level remained an independent predictor for loss of AVF patency (HR, 1.17; 95% confidence interval, 1.1-1.3; P < .0001). CONCLUSIONS: In our study, CRP level was an independent predictor of AVF patency loss, whereas better AVF survival was independently associated with autosomal dominant polycystic kidney disease and pre-emptive AVF. As a simple noninvasive marker of chronic inflammation, CRP level may be a useful tool to predict AVF outcomes. Further research is needed to assess the protective effects of inflammation reduction on AVF survival.

Effect of nepafenac on the foveal profile of glaucomatous patients undergoing phacoemulsification.

PURPOSE: Retrospective, pilot study to determine whether nepafenac treatment pre- and postcataract surgery in glaucoma patients using topical hypotensive agents minimized cystoid macular edema by comparing pre- and postsurgical foveal characteristics, as in some cases these agents cannot be withdrawn and, hypothetically, their inflammatory effect on the fovea could be neutralized by the addition of nepafenac. METHODS: Patients were divided into two subgroups depending on whether or not topical nepafenac was added to the surgical protocol (NEP = nepafenac group and nNEP = non nepafenac group). All had undergone phacoemulsification and data on pre- and postoperative macular status were recorded. RESULTS: In the nNEP group, there was a significant increase in foveal thickness (FT) in the first month postoperative visit with respect to the preoperative status (p = 0.006), and this situation did not change at the third postoperative month (p = 0.9411). In the NEP group, the increase in FT was not significant at the first month after surgery (p = 0.056) nor at the final visit (p = 0.268), in contrast to the nNEP group. CONCLUSION: This study of the possible prophylactic effect of nepafenac on postoperative macular edema supports the results of other studies that confirm subclinical edema post phacoemulsification, and found a significantly lower gradient in the increase in FT in patients treated pre- and postoperatively with nepafenac.

Persistent Hypotony Associated with Immunosuppressive Therapy in Glaucoma Drainage Implant Surgery.

PURPOSE: To describe the histopathology of non-valved implant capsules in three cases of persistent postoperative hypotony after the restrictive tube ligature was released in patients receiving immunosuppressive therapy. OBSERVATIONS: The macroscopic appearance of the capsules 3 and 4 months postoperatively was immature and loose. Microscopic examination disclosed extremely irregular thin tissue, with thicknesses ranging from 0.02 to 0.6 mm, depending on the capsular location studied. Withdrawal of immunosuppressive therapy did not facilitate rebuilding of new capsules. Replacement with a valved implant device was necessary in two cases; the third case recovered with tapering of prednisone. CONCLUSIONS AND IMPORTANCE: The use of chronic systemic immunosuppressive therapy might interfere with capsular formation around the plates of drainage devices inducing persistent hypotony. In these cases, the use of valved implants might be safer.

A new technique for diode laser cyclophotocoagulation.

Destruction of the ciliary body, an option in glaucoma surgical treatment, can be performed using various methods. Laser energy, now the principle source for cyclodestruction, can be delivered in a transpupillar, transvitreal in conjunction with a vitrectomy and transscleral manner. The current technique for endocyclophotocoagulation requires of an endoscopic probe. We describe an accessible and inexpensive alternative. Gonioprism-assisted diode cyclophotocoagulation (GADC) with a peripheral corneal approach is a new surgical technique for pseudophakic and aphakic patients that uses a manual gonioprism, iris hooks, ophthalmic operating microscope, and an 810-nm laser diode probe. GADC is performed under topical and intracameral anesthesia, prior pupil dilation. First, 4 iris hooks are placed to expose the posterior chamber. The ciliary processes are viewed through a Swan-Jacob gonioprism and the diode laser probe is inserted through a peripheral corneal incision. The energy of the laser is set at 250 mW and the duration of the application to each process is variable, from 500 to 800 ms, until shrinkage and whitening occur. We apply this technique in approximately 360 degrees of the ciliary processes. Subconjunctival dexamethasone phosphate is administered at the end of the surgery prior subconjunctival injection of lidocaine. GADC has a relatively quick learning curve, allows direct visualization with less energy delivered to the ciliary processes and obviates the acquisition of a new endoscopic device.

Spanish multicenter tafluprost tolerability study.

AIM: To evaluate the ocular surface symptoms and signs associated with preservative-free 0.0015% tafluprost in patients with glaucoma or ocular hypertension (OHT). METHODS: Prospective non-interventional, multicentre, observational study on 134 patients, naive or on previous treatment with another prostaglandin analogue. In each visit (V1 baseline visit, V2 at 1 month and V3 at 3 months), patients evaluated five ocular surface symptoms as: absent, mild, moderate and severe. Parallelly, the ophthalmologist assessed the tear break-up time, keratitis, conjunctival hyperaemia, blepharitis, Schirmer test and tear meniscus. RESULTS: Patients with OHT (n=71, 53%) experienced a statistically significant improvement of all symptoms: stinging/burning/irritation, itching, foreign body sensation, tearing and dryness sensation at V3, while glaucoma patients improved all symptoms at both V2 and V3. In patients with OHT, all signs except Schirmer test improved and the decrease in hyperaemia was statistically significant. Eyes with glaucoma ameliorated the keratitis, hyperaemia and tear meniscus at V2 and V3 and the break-up time and blepharitis at V3. In the subset of patients with previous treatment (n=79, 58.9%), patients with OHT presented significant improvement of hyperaemia, yet the rest of signs did not decrease significantly or remained unchanged, while in patients with glaucoma all signs improved significantly at both visits. The intraocular pressure (IOP) drop in naive eyes was 22.2% (24.7-19.7 mm Hg) in OHT and 29.5% (33.7-25.3 mm Hg) in glaucoma eyes. In previously treated eyes, no statistically significant change in IOP was found. CONCLUSION: Preservative-free tafluprost is a well tolerated hypotensive agent that can be used in eyes with surface problems and in naive eyes.

The effects of Mozart's music on the performance of glaucoma patients on automated perimetry.

PURPOSE: The purpose of this study was to examine the impact of the Mozart effect on the reliability of the Humphrey visual field (HVF; Carl Zeiss Meditec, Dublin, CA) test in subjects with glaucoma. A previous study showed improved reliability in normal subjects undergoing HVF testing. METHODS: One hundred sixty subjects with glaucoma were randomized to three groups: control, headphones, or music for 10 minutes before HVF testing. The headphone group was provided noise-cancellation headphones but no music. The music group listened to Mozart's Sonata for Two Pianos in D Major. After treatment, subjects took an HVF test in both eyes. The reliability of the test was then compared between the groups and also to prior HVF results with regard to fixation losses, false positives, and false negatives. RESULTS: The rate of fixation losses did not differ significantly between the three groups (P = 0.30 right eye, P = 0.24 left eye). There were also no significant differences in the rate of false positives (P = 0.82 right eye, P = 0.18 left eye) or false negatives (P = 0.91 right eye, P = 0.97 left eye). The reliability of the subject's HVF result was also compared with past field results. No improvements were seen in fixation losses (P = 0.94 right eye, P = 0.17 left eye), false positives (P = 0.85 right eye, P = 0.38 left eye), and false negatives (P = 0.13 right eye, P = 0.50 left eye). CONCLUSIONS: The rate of fixation losses, false positives, and false negatives did not improve in subjects with glaucoma after they listened to Mozart's music. The Mozart effect did not enhance the reliability of the visual field test to a statistically significant degree (ClinicalTrials.gov number, NCT01027039).

Intravitreal voriconazole for the treatment of Aspergillus chorioretinitis.

The aim of this article is to report a case of Aspergillus chorioretinitis successfully treated with intravitreal voriconazole based on an interventional case report. An immunodeficient patient, 34 years old, receiving systemic antifungal treatment for 1 month for invasive aspergillosis with necrotizing pneumonia and brain metastasis, who presented with blurred vision in his left eye. Visual acuity (VA) was 20/20 in his right eye, and 8/20 in his left eye. Ophthalmological examination showed a paramacular nodular yellowish chorioretinal lesion with intraretinal hemorrhages, in the absence of vitritis or anterior uveitis. The patient was treated with one dose of intravitreal voriconazole (100 µg/0.1 ml). One week after the intravitreal injection, the patient's VA was 10/20, the retinal lesions had diminished, and the hemorrhages had disappeared. At 3-month follow-up, his AV was 20/20 with a residual retinal scar. The significant and rapid improvement in this patient suggests that early injection of intravitreal voriconazole may be the first therapeutic option in Aspergillus chorioretinitis, obviating the need for vitrectomy.

One-year analysis of the iStent trabecular microbypass in secondary glaucoma.

PURPOSE: To evaluate the midterm efficacy and safety of the iStent(®) glaucoma device in patients with secondary open-angle glaucoma. PATIENTS AND METHODS: A prospective, nonrandomized, interventional case series involving 10 patients with secondary open-angle glaucoma (traumatic, steroid, pseudoexfoliative, and pigmentary glaucoma) of recent onset who underwent ab interno implantation iStent. Patients were assessed following the procedure on days 1, 7, and 15 and months 1, 3, 6, and 12, and examinations included visual acuity, intraocular pressure (IOP) measurement using Goldmann tonometry, number of glaucoma medications, and complications. Wilcoxon rank-test for data with abnormal distribution was used for the analysis of IOP and glaucoma medications at baseline versus 3, 6, and 12 months following the procedure. RESULTS: The mean baseline IOP was 26.5 ± 7.9 (range 18-40) mmHg, and significantly decreased in 10.4 ± 9.2 mmHg at three months (P < 0.05), in 7.4 ± 4.9 mmHg at six months (P < 0.05), and in 6.6 ± 5.4 mmHg at 12 months (P < 0.05) following iStent implantation. The mean number of hypotensive medications at baseline was 2.9 ± 0.7 (range 2-4). Statistically significant reductions in the number of medications of 1.1 ± 1.1 were observed at three months (P < 0.05), 1.0 ± 0.7 at six months (P < 0.05), and 1.1 ± 0.6 at 12 months (P < 0.05). No significant changes in visual acuity were noted. The most common complications comprised mild hyphema in seven eyes and transient IOP ≥30 mmHg in three eyes on postoperative day 1. Obstruction of the lumen of the stent with a blood clot was seen in three eyes, and all instances resolved spontaneously. CONCLUSION: The iStent is a safe and effective treatment option in patients with secondary open-angle glaucoma, and reduces the topical treatment burden in one hypotensive medication.

Intracameral recombinant tissue plasminogen activator for refractory glaucoma secondary to a fungal corneal abscess.

We present a 78-year-old patient who developed refractory glaucoma following a fungal infection of the corneal incision after cataract extraction with posterior chamber intraocular lens implantation. An anterior chamber injection of 0.1 ml recombinant tissue plasminogen activator (25 mcg/0.1 mL) was performed to improve the trabecular meshwork outflow facility compromised secondary to fibrin blockade. The intraocular pressure dropped dramatically from 48 mmHg to 10 mmHg postoperatively, negating the need for glaucoma surgery.