Effects of Lifestyle and Educational Bridging Programs before Bariatric Surgery on Postoperative Weight Loss: A Systematic Review and Meta-Analysis.

OBJECTIVE: To fulfill the requirements for bariatric surgery, patients often need to participate in mandatory preoperative lifestyle interventions. Currently, the efficacy of multi-month preoperative lifestyle intervention programs on body mass index (BMI) reduction from the start of the program (T0) through the immediate preoperative time point (T1) to 1 year post-surgery (T2) and how the amount of preoperative BMI reduction affects postoperative outcome (T1 to T2) is unclear. The aim of this meta-analysis was to analyze the effects of preoperative lifestyle interventions on BMI 1 year post-surgery. METHOD: A systematic literature search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Randomized controlled trials that implemented preoperative lifestyle interventions lasting 1-8 months before bariatric surgery were included. The BMI of the intervention group was compared with that of a control group before participation in the preoperative lifestyle interventions (T0), after completion of the program before surgery (T1), and 1 year post-surgery (T2). Finally, the impact of successful BMI reduction at T1 on BMI at T2 was analyzed. RESULTS: N = 345 patients derived from 4 studies undergoing preoperative lifestyle interventions reduced their BMI at T1 by 1.5 units compared to the control group (95% CI: -2.73, -0.28). One year post-surgery, both groups had lost comparable BMI points. The influence of reduced BMI at T1 on weight status at T2 is unclear due to the lack of available studies. Other endpoints and subgroup analyses were rarely examined. CONCLUSIONS: Preoperative lifestyle interventions reduce BMI before bariatric surgery more effectively than usual care. These differences are not detectable 1 year post-surgery. Although a short-term energy reduction period before surgery is clearly important to minimize surgery risks, it is currently unclear whether, and if so, under what circumstances, participation in a preoperative lifestyle intervention is beneficial.

Conventional weight loss interventions across the different BMI obesity classes: A systematic review and quantitative comparative analysis.

OBJECTIVE: The recommendation for conventional body weight loss (BWL) treatment in obesity is 5-10%. It is not clear whether BWL is similar across the three different body mass index (BMI) obesity classes. The aim was to provide an overview on BWL across these classes in moderate lifestyle/diet intervention programs. METHOD: A systematic literature search was conducted and the evidence of randomized controlled trials (RCTs) and pre-post design studies synthesized. The outcome was BWL. RESULTS: For RCTs, mean BWL in the intervention group was 3.6 kg (class I) and 5.3 kg (class II), which equates to 4 and 5% BWL, respectively. None of the assessed class III obesity studies met the inclusion criteria. For pre-post design studies, mean BWL was 5.4 kg (class I), 5.5 kg (class II) and 7.9 kg (class III), with high variation within and across studies in the latter. This equates to 6, 5 and, 6% BWL, respectively. CONCLUSIONS: BWL of moderate BWL programs are similar across the different obesity classes. For class I obesity, the results differ between RCT and pre-post design studies by 2% BWL. The high variation of BWL in class III obesity might reflect different states of motivation such as the attitude towards bariatric surgery.

Spontaneous closure of anterior capsule tear.

We report a case of anterior capsule tear that was closed spontaneously by fibrotic tissue during the postoperative period. The tear was inadvertently created during intraocular lens (IOL) implantation in the capsular bag. The IOL remained stable in the postoperative period, with excellent centration and no compromise in vision.

Combined photodynamic therapy and intravitreal triamcinolone for choroidal neovascularization secondary to punctate inner choroidopathy or of idiopathic origin: one-year results of a prospective series.

PURPOSE: To evaluate the efficacy and safety of combined intravitreal triamcinolone (IVTA) and photodynamic therapy (PDT) with verteporfin in the treatment of subfoveal choroidal neovascularization (CNV) due to punctate inner choroidopathy (PIC) or of idiopathic cause. METHODS: Consecutive patients with subfoveal idiopathic and PIC CNV were prospectively recruited and received combined PDT and 4 mg IVTA injection. Patients were observed every 3 months for 1 year and retreatment was performed in the presence of angiographic leakage. Outcome measures included changes in the mean best-corrected visual acuity (BCVA), the proportion of patients who had stable or improved vision, and the mean number of treatments required during the 1-year period. RESULTS: Fourteen patients (14 eyes) were recruited and all completed the 1-year follow-up. The mean age of the patients was 34.7 years. The mean logMAR BCVA improved significantly from 0.52 at baseline to 0.20 at 1 year (Wilcoxon signed-ranks test, P = 0.003). For the entire group, 13 (92.9%) eyes had stable or improved vision with a mean improvement of 3.2 lines (range, -3-7 lines). The mean number of treatments during the 1-year study period was 1.1 sessions. No serious ocular or systemic complications were encountered. CONCLUSIONS: Combined PDT with IVTA seems to be a promising treatment strategy in the treatment of idiopathic CNV and CNV secondary to PIC as it resulted in fewer treatment sessions and superior visual improvement. Further study to assess its long-term safety and efficacy as the first line treatment is warranted.

Failure of systemic antibiotic in preventing sequential endogenous endophthalmitis of a bronchiectasis patient.

PURPOSE: To report a rare presentation of bilateral, sequential Pseudomonas aeruginosa endogenous endophthalmitis in a woman with bronchiectasis. DESIGN: Interventional case report. METHODS: A 69-year-old woman with bronchiectasis developed right and then left endogenous endophthalmitis with the microbial of P. aeruginosa, even though a course of 3-week intravenous ceftazidime antibiotic was prescribed. RESULTS: The presentation of endogenous endophthalmitis in the right eye was late, and final visual acuity was hand movements. The condition was recognized much earlier in the left eye, and the infection was treated early on with vitrectomy and intravitreal antibiotics. Visual acuity at 1 year was stable at 20/40. CONCLUSION: Systemic antibiotic failed to eradicate the primary source of Pseudomonas infection in the bronchiectasis patient. Unusual, painful red eye may be the presenting feature of endogenous endophthalmitis. Early vitrectomy may be considered in endogenous endophthalmitis caused by virulent pathogens such P. aeruginosa.