Expert Panel Consensus for Addressing Anti-VEGF Treatment Challenges of Diabetic Macular Edema in Spain.

Purpose: The treatment of diabetic macular edema (DME) has evolved rapidly in the past decade, highlighting the need to address the challenges of routine clinical practice decision-making through expert consensus agreements. Methods: After a literature review and discussion of real-world experience on DME management, a group of ten retina specialists agreed on a consensus of recommendations for the most appropriate management of DME patients using vascular endothelial growth factor inhibitors (anti-VEGF) in Spain. Results: The panel recommended early treatment initiation in DME patients with worse baseline visual acuity (VA) to maintain or improve outcome. For patients with good VA, an observation strategy was recommended, considering the presence of diabetic retinopathy, optical coherence tomography biomarkers, and impact on patient's quality of life. Based on the available evidence and clinical experience, the panel recommended the use of anti-VEGF intensive loading doses with the objective of achieving anatomic and visual responses as soon as possible, followed by a Treat & Extend (T&E) strategy to maintain VA improvement. Aflibercept was recommended for patients with a baseline decimal VA <0.5, followed by a T&E strategy, including the possibility to extend frequency of injections up to 16 weeks. Conclusion: An expert panel proposes a consensus for the management of DME in Spain. Early treatment initiation with anti-VEGF in DME patients is recommended to maintain or improve VA; aflibercept is recommended for patients with a poor baseline VA.

Date of Admission during COVID-19 Pandemic Impacted Patient Outcomes in Addition to the Higher Efficacy of Tocilizumab Plus High-Dose Corticosteroid Therapy Compared to Tocilizumab Alone.

BACKGROUND: The evidence for the efficacy of glucocorticoids combined with tocilizumab (TCZ) in COVID-19 comes from observational studies or subgroup analysis. Our aim was to compare outcomes between hospitalized COVID-19 patients who received high-dose corticosteroid pulse therapy and TCZ and those who received TCZ. METHODS: A retrospective single-center study was performed on consecutive hospitalized patients with severe COVID-19 between 1 March and 23 April 2020. Patients treated with either TCZ (400-600 mg, one to two doses) and methylprednisolone pulses (MPD-TCZ group) or TCZ alone were analyzed for the occurrence of a combined endpoint of death and need for invasive mechanical ventilation during admission. The independence of both treatment groups was tested using machine learning classifiers, and relevant variables that were potentially different between the groups were measured through a mean decrease accuracy algorithm. RESULTS: An earlier date of admission was significantly associated with worse outcomes regardless of treatment type. Twenty patients died (27.0%) in the TCZ group, and 33 (44.6%) died or required intubation (n = 74), whereas in the MPD-TCZ group, 15 (11.0%) patients died and 29 (21.3%) patients reached the combined endpoint (n = 136; p = 0.006 and p < 0.001, respectively). Machine learning methodology using a random forest classifier confirmed significant differences between the treatment groups. CONCLUSIONS: MPD and TCZ improved outcomes (death and invasive mechanical ventilation) among hospitalized COVID-19 patients, but confounding variables such as the date of admission during the COVID-19 pandemic should be considered in observational studies.

Uveitis and Myositis as Immune Complications in Chemorefractory NK/T-Cell Nasal-Type Lymphoma Successfully Treated with Allogeneic Stem-Cell Transplant.

NK/T-cell lymphomas are a group of clonal proliferations of NK- or, rarely, T-cell types and have peculiar clinicopathologic features. Most common site of involvement is the upper aerodigestive tract (nasal cavity, nasopharynx, paranasal sinuses, and palate). Association of autoimmune paraneoplastic disorders with NK/T-cell lymphomas is not well studied. Our patient was diagnosed with NK/T-cell lymphoma stage IV with skin involvement and treated frontline with CHOEP regimen. While he was under treatment, two immune complications presented: anterior uveitis of autoimmune origin refractory to steroids and myositis in lower limbs muscles. Autologous transplantation was rejected due to confirmed early relapse after first-line treatment, and the patient received second-line treatment according to the SMILE scheme, reaching complete response after four cycles. The patient underwent allogeneic transplantation and at the time of manuscript preparation is alive despite multiple complications. The disease should be suspected in patients with rhinitis or recurrent sinusitis, and early biopsy is recommended for all patients to avoid a delay in diagnosis. Our patient also presented symptoms of disease progression after first-line treatment, representing a paraneoplastic process, a very rare phenomenon in T-type lymphomas. This case is novel for the appearance of an inflammatory myositis, a histologically verified paraneoplastic phenomenon that responded to treatment for lymphoma.

Ocular surface comfort during the day assessed by instant reporting in different types of contact and non-contact lens wearers.

OBJECTIVE: To compare instant reporting of comfort throughout the day in hydrogel, silicone-hydrogel, gas-permeable, and non-contact lens wearers. METHODS: More than twenty subjects were recruited per group. Comfort scores were recorded using short message service (text message) in the morning (9:00-11:00 am), afternoon (2:00-4:00 pm), and night (7:00-9:00 pm) using a 0 (causes pain) to 100 (excellent) scale. RESULTS: The pooled comfort scores across all groups and time periods revealed that data are skewed toward high values: 88% of the scores felt between >or=70 and 100, whereas the remaining 12% felt between >or=40 and <70. Comfort changed significantly over time (P=0.003), but no significant differences were found between groups (P=0.66) or in the interaction between time and group (P=0.79). Hydrogel and silicone-hydrogel contact lens-wearing groups showed similar reductions in afternoon (-4.5 +/- 11.8 and -4.5 +/- 8.6, respectively) and night comfort scores (-8.3 +/- 14.1 and -9.1 +/- 8.7, respectively), and these were greater than those found in gas-permeable and non-contact lens wearers both in the afternoon (-1.0 +/- 11.3 and -1.8 +/- 16.3, respectively) and night (-7.3 +/- 9.7 and -4.1 +/- 21.9, respectively). DISCUSSION: Hydrogel and silicone-hydrogel contact lens wearers' comfort scores are reduced at night compared with morning. The slight comfort reduction at night versus morning found in non-contact lens wearers might be related to ocular or general physical fatigue, which suggest the possibility that reduced end-of-day comfort reported by contact lens wearers might not be solely related to contact lens wear. The results of this study also suggest that interpretation of comfort scores should be carried out with caution.

Drug-induced ocular side-effects with isotretinoin.

Whereas there are numerous reported ocular side-effects from isotretinoin medication, we present the first case report of corneal steepening after systemic treatment with isotretinoin for seven and a half weeks. The case was associated with a significant drop in visual acuity which could not be explained from the refractive error change. All signs and symptoms were absent seven and a half weeks after the medication was withdrawn. The case indicates that eye care professionals need to be vigilant about the possibility of adverse ocular manifestations associated with the use of systemic medications.

Compatibility of two new silicone hydrogel contact lenses with three soft contact lens multipurpose solutions*.

PURPOSE: The purpose of this study is to assess corneal staining and subjective symptom ratings with six different silicone hydrogel contact lens/multipurpose solution combinations, including the recently launched Menicon PremiO silicone hydrogel contact lens, after the first night of soaking the lenses in solution. METHODS: This study is a prospective, single-centre, subject-masked, contralateral, crossover, daily wear clinical trial in which subjects were randomly fitted in the morning with a different lens/solution combination in each eye, asked to wear the lenses for the whole day (at least 12 h), soak each of the lenses overnight in one of the test solutions and insert the lenses on the following morning. Subjects were asked to come on that morning for assessment of corneal staining and subjective ratings. All subjects repeated this procedure on another two occasions in order to collect the results of the six different lens/solution combinations: Menicon PremiO/MeniCare Soft; Menicon PremiO/Complete 10; Menicon PremiO/OptiFree Express; Acuvue Oasys/MeniCare Soft; Acuvue Oasys/Complete 10; Acuvue Oasys/OptiFree Express. RESULTS: Menicon PremiO lenses were associated with a lower level of corneal staining overall, and in the nasal and temporal locations, compared with Acuvue Oasys lenses (p < 0.05). No significant differences were found in corneal staining between solutions (p > 0.05). An overall rate of solution-induced corneal staining per eye of 12% was found. Symptoms were very similar among the six different lens/solution combinations (p > 0.05). DISCUSSION: The lower level of corneal staining found with Menicon PremiO lenses compared with Acuvue Oasys lenses might be attributed to material, surface and design differences between lens types. The overall rate of solution-induced corneal staining and symptomatology found between the different lens/solutions combinations is consistent with previous studies.

The clinical investigation of the base curve and comfort rate of a new prototype silicone hydrogel contact lens.

PURPOSE: To compare the lens fitting characteristics and comfort rates between the two base curves of a prototype silicone hydrogel contact lens and between the prototype and a senofilcon A contact lens. METHODS: This study was a prospective, single-center, masked, controlled, randomized, contralateral-eye, short-term comparison clinical trial consisting of two different studies. In the first study, subjects were randomly fitted with the 8.3- and 8.6-mm base curves of a prototype contact lens in each eye. In the second study, subjects were randomly fitted with the more comfortable prototype lens found in the first study in one eye and a senolfilcon A lens in the other eye. In both studies, lens centration and movement, corneal coverage, and comfort were assessed in both eyes 15 minutes after insertion for each lens separately. RESULTS: The overall fit of the 8.3 base curve (8.08 +/- 1.98) was similar to that of the 8.6 base curve (8.15 +/- 2.09) (P=0.38). The mean comfort scores for the 8.3 and 8.6 base curves were 80.13 +/- 16.08 and 77.33 +/- 18.00, respectively (P=0.47). The overall fit of the prototype lens (8.79 +/- 1.56) was similar to that of the senofilcon A lens (8.63 +/- 1.20 mm) (P=0.29). The mean comfort scores for the prototype and senofilcon A lenses were 84.67 +/- 13.92 and 86.35 +/- 12.20, respectively (P=0.52). CONCLUSIONS: The slightly better lens fitting characteristics and comfort of the lens with the 8.3 base curve versus the 8.6 base curve are attributed to the lower movement of the lens with the 8.3 base curve. That the lens fitting characteristics and comfort rates of the prototype lens and the senofilcon A lens were similar is not surprising, because of their similarities in material and design.

Profilaxis de la dehiscencia esternal en obesos mediante la aplicación sistemática del cerclaje de tipo Robicsek / Prophylaxis of sternal dehiscence in obese patients through systematic application of robicsek closure

Introducción. La dehiscencia esternal es una complicación relativamente frecuente de la esternotomía media y que causa gran morbimortalidad en cirugía cardiotorácica. La obesidad se considera uno de los factores de riesgo más importantes de dehiscencia e infección esternal, y su prevalencia cada vez mayor en la población sometida a cirugía cardíaca. En el presente estudio se evalúa el beneficio clínico del uso profiláctico del refuerzo esternal de tipo Robicsek en los pacientes de alto riesgo que son intervenidos de cirugía cardíaca mayor. Pacientes y método. Se analiza a 290 pacientes consecutivos intervenidos mediante esternotomía media en nuestro centro. La indicación de refuerzo profiláctico esternal se estableció en casos de osteoporosis esternal severa o índice de masa corporal (IMC) >= 30, empleándose la técnica en 105 pacientes, 54 varones y 51 mujeres, cuya edad media era de 67,7 ± 9,1 años y con un IMC medio de 31,8 ± 4,1. Resultados. No hubo dehiscencias no infecciosas en el grupo con refuerzo de tipo Robicsek; sólo se produjo un caso (1,7%) de dehiscencia esternal debida a osteomielitis en el grupo reforzado, con buena respuesta a desbridamiento quirúrgico asociado con antibioterapia por vía intravenosa. Conclusión. El refuerzo de tipo Robicsek reduce la incidencia de dehiscencia esternal en los pacientes de alto riesgo y su indicación profiláctica debe ser considerada en casos de osteroporosis severa o IMC >= 30 (AU)

Introduction. Sternal deshidence is a relatively frequent complication in median sternotomy and causes high morbidity and mortality in cardiothoracic surgery. Obesity is one of the most important risk factors for sternal infection and deshidence and its prevalence is increasingly frequent in patients undergoing cardiac surgery. The aim of the present study was to assess the clinical benefit of the prophylactic use of robicsek sternal reinforcement in high-risk patients undergoing cardiac surgery. Patient and method. Two hundred ninety ninety consecutive patients who underwent median sternotomy in our center were analysed. The indications for prophylactic sternal reinforcement were severe sternal osteoporosis or a body mass indez (BMI) of >= 30. The technique was used in 105 patients, 54 men and 51 women, with a mean age of 67.7 +/- 9.1 years and a mean BMI of 31.8+/-4.1. Results. None of the patients in the reinforcement group developed non-infectious dehiscence; only one patient (1.7%) in this group showed sternal dehiscence due to osteomyelitis with good response to surgical debridement and intravenous antibiotics. Conclusion. Robicsek reinforcement reduces the incidence of sternal dehiscence in high-risk patients and its prophylactic use should be considered in patients with severe osteoporosis or a BMI of >=30 (AU)

[Prophylaxis of sternal dehiscence in obese patients through systematic application of Robicsek closure]. / Profilaxis de la dehiscencia esternal en obesos mediante la aplicación sistemática del cerclaje de tipo Robicsek.

INTRODUCTION: Sternal dehiscence is a relatively frequent complication in median sternotomy and causes high morbidity and mortality in cardiothoracic surgery. Obesity is one of the most important risk factors for sternal infection and dehiscence and its prevalence is increasingly frequent in patients undergoing cardiac surgery. The aim of the present study was to assess the clinical benefit of the prophylactic use of Robicsek sternal reinforcement in high-risk patients undergoing cardiac surgery. PATIENTS AND METHOD: Two hundred ninety consecutive patients who underwent median sternotomy in our center were analyzed. The indications for prophylactic sternal reinforcement were severe sternal osteoporosis or a body mass index (BMI) of > or = 30. The technique was used in 105 patients, 54 men and 51 women, with a mean age of 67.7 +/- 9.1 years and a mean BMI of 31.8 +/- 4.1. RESULTS: None of the patients in the reinforcement group developed noninfectious dehiscence; only one patient (1.7%) in this group showed sternal dehiscence due to osteomyelitis with good response to surgical debridement and intravenous antibiotics. CONCLUSION: Robicsek reinforcement reduces the incidence of sternal dehiscence in high-risk patients and its prophylactic use should be considered in patients with severe osteoporosis or a BMI of > or = 30.