A case of hypertensive uveitis with intravitreal faricimab.

PURPOSE: To report a novel case of hypertensive uveitis with intravitreal faricimab. METHODS: This is a case report. A 69-year-old female undergoing treatment of bilateral diabetic macular oedema with intravitreal faricimab presented for routine review. Ophthalmic examination was performed including visual acuity, intraocular pressure (IOP), gonioscopy, and slit lamp examination. Findings consistent with hypertensive uveitis prompted further infectious/inflammatory/infiltrative uveitis screen. RESULTS: The patient developed hypertensive uveitis in the left eye (four weeks after the third injection) with an IOP of 42mmHg. Slit lamp examination revealed fine keratic precipitates and mild anterior uveitis. Anterior chamber angle was open on gonioscopy, and there was no vitritis or vasculitis. At review a week later, the patient had developed hypertensive uveitis in the right eye (six weeks after the fourth injection) with IOP of 35mmHg. Slit lamp examination revealed fine keratic precipitates, open angles, and mild vitritis. There was no vasculitis. At both presentations the patient had preserved visual acuity with no significant visual symptoms. The hypertensive uveitis resolved in both eyes with a course of steroid and antihypertensive eye drops. The uveitis screen was negative apart from elevated urine protein (negative beta-2 microglobulin) which could be explained by known diabetes and hypertension. CONCLUSION: Hypertensive uveitis is a potential adverse reaction to intravitreal faricimab. This case highlights the importance of monitoring intraocular pressure in patients undergoing treatment with faricimab and emphasises the need for reporting other cases in the community.

Projecting thyroid cancer risk to the general public from radiation exposure following hypothetical severe nuclear accidents in Canada.

INTRODUCTION: A robust emergency management framework can limit radiation exposures and effectively minimize the potentially devastating consequences of a nuclear emergency. We projected thyroid cancer risk resulting from two hypothetical severe nuclear accidents occurring at the Darlington nuclear power plant (NPP) located in Ontario, Canada. METHODS: Single- and multi-unit accidents were considered. A dose assessment was previously performed using the MELCOR Accident Consequences Code System. The generic criteria used to select the appropriate protective actions are described in the Ontario Provincial Nuclear Emergency Response Plan (PNERP). We hypothesized protection actions only within the 10 kilometre (km) radius of the NPP given the time sensitivity of iodine thyroid blocking. The excess risk of developing thyroid cancer was projected using the US National Cancer Institute's radiation risk assessment tool RadRAT. RESULTS: We projected zero dose, and subsequently zero risk of developing thyroid cancer for people living within 10 km of the NPP, due to effective implementation of selected protective actions. Based on centreline doses, at the 12 km radius, excess childhood thyroid cancer risks of approximately 600% and 130% compared to the baseline were projected for the single- and multi-unit scenarios, respectively. The risk of developing thyroid cancer was projected to be low for adults for both scenarios. DISCUSSION: The results of this modelling study provide insights into the effectiveness of protective actions in reducing radiation-related thyroid cancer risk when considering hypothetical severe nuclear accidents. Implementation of select protective actions protects the population living near the Darlington NPP. The projected increase of developing thyroid cancer for children living beyond 10 km could potentially be eliminated with additional mitigation measures specified in the PNERP.

Autologous neurosensory retinal flap for closure of refractory macular hole in a patient with macular telangiectasia.

PURPOSE: This study explores autologous neurosensory autograph for a patient with a chronic full-thickness macular hole (FTMH) and idiopathic macular telangiectasia type 2 (IMT2). OBSERVATIONS: The patient had a chronic 1355 µm FTMH and best corrected visual acuity (BCVA) of 2 logMAR units after two unsuccessful attempts to close the macular hole. Following a 25-gauge vitrectomy, a 2-disc diameter neurosensory autograft from the supertemporal retina was mobilized and secured with perfluoro-N-octane (PFO) tamponade. After being postured supine for one week, the PFO was exchanged for silicone oil. Two months later, silicone oil was exchanged for 20% sulphur hexafluoride (SF6). CONCLUSIONS AND IMPORTANCE: The graft achieved anatomical and functional success with BCVA of 0.6 logMAR units. This case supports autologous neurosensory autograph as a technique for achieving closure of chronic macular holes refractory to conventional treatment.

Three cases of ocular syphilis and the resurgence of the disease in Queensland.

The past few years has seen a resurgence of syphilis. It is predominantly associated within men who have sex with men and also within heterosexual Indigenous Australians. Possessing the ability to mimic a variety of ocular diseases, it typically manifests as uveitis, although it can affect any structure within the eye. Thus, a high degree of clinical suspicion by ophthalmologists is required to prevent disease progression and ocular morbidity. Patients require prolonged antibiotic treatment with intravenous benzylpenicillin and outpatient monitoring to successfully resolve the infection. We describe a case series of ocular syphilis presentations in Queensland, Australia.

Designing interchain and intrachain properties of conjugated polymers for latent optical information encoding.

Building molecular-design insights for controlling both the intrachain and the interchain properties of conjugated polymers (CPs) is essential to determine their characteristics and to optimize their performance in applications. However, most CP designs have focused on the conjugated main chain to control the intrachain properties, while the design of side chains is usually used to render CPs soluble, even though the side chains critically affect the interchain packing. Here, we present a straightforward and effective design strategy for modifying the optical and electrochemical properties of diketopyrrolopyrrole-based CPs by controlling both the intrachain and interchain properties in a single system. The synthesized polymers, P1, P2 and P3, show almost identical optical absorption spectra in solution, manifesting essentially the same intrachain properties of the three CPs having restricted effective conjugation along the main chain. However, the absorption spectra of CP films are gradually tuned by controlling the interchain packing through the side-chain design. Based on the tailored optical properties, we demonstrate the encoding of latent optical information utilizing the CPs as security inks on a silica substrate, which reveals and conceals hidden information upon the reversible aggregation/deaggregation of CPs.

Visual outcomes and complications of scleral-fixated posterior chamber intraocular lenses.

PURPOSE: To report the long-term visual outcomes and complications after implantation of scleral-fixated posterior chamber intraocular lenses (PC IOLs). SETTING: Princess Alexandra Hospital, Mater Hospital, and Queensland Eye Institute, Brisbane, Australia. DESIGN: Case series. METHODS: This study reviewed the records of patients who had anterior vitrectomy and scleral-fixated PC IOL implantation between 1993 and 2008 and had a minimum follow-up of 6 months. RESULTS: The study comprised 82 eyes of 72 patients (47 men). The mean follow-up was 83.3 months (range 6.7 to 166.5 months) and the mean age at surgery, 62 years (range 15 to 97 years). The mean improvement in corrected distance visual acuity (CDVA) was 1.6 Snellen chart lines of vision, which was statistically significant; 59 eyes (72%) had an improved or unchanged CDVA, and 23 eyes (28%) had a reduced CDVA. The most common postoperative complication was ocular hypertension (25 eyes [30.5%]). Suture breakage occurred in 5 eyes (6%) after a mean of 4.9 years; 4 of these patients were younger than 40 years. Overall, 44 eyes (53.7%) had at least 1 complication, 36.4% within 1 week postoperatively and 63.6% after 1 week. Thirteen eyes (15.8%) required at least 1 further operation. CONCLUSIONS: Scleral-fixated PC IOL insertion provided favorable visual outcomes in many cases. Complications were common, and suture rupture is an important long-term complication, particularly in young patients. These issues affect IOL choice for the surgical treatment of aphakia and should be discussed with patients during the consent process. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.

Impedance compensated biphasic waveforms for transthoracic cardioversion of atrial fibrillation: a multi-centre comparison of antero-apical and antero-posterior pad positions.

AIMS: To compare the success rate for transthoracic direct current cardioversion (DCC) of atrial fibrillation (AF) with antero-posterior (AP) and antero-apical (AA) electrode positions using an impedance compensated biphasic (ICB) waveform. METHODS AND RESULTS: Three-hundred and seven patients [mean age 66 (SD+/-13), 195 male] with AF were recruited in three centres. Patients were randomized to an AA (n=150) or AP (n=144) pad position. Thirteen patients with implanted pacemakers were defaulted to the AP pad position. Cardioversion was performed using an ICB waveform with a 70, 100, 150, and 200 J energy selection protocol. If the fourth shock was unsuccessful, the pads were crossed over to the alternative position for a final 200 J shock. Shock 1 was successful in 54/150 (36%) AA and 45/144 (31%) AP patients, whereas success was achieved by shock 2 in 99/150 (66%) AA and 74/144 (51%) AP, by shock 3 in 123/150 (82%) AA and 109/144 (76%) AP, and by shock 4 in 143/150 (95%) AA and 127/144 (88%) AP and after cross-over in 144/150 (96%) AA and 135/144 (94%) AP. Overall success rate was higher than expected at 95%. Pad position was not associated significantly with success. There was a trend towards an improved outcome with the AA configuration (P=0.05). CONCLUSION: The influence of pad position for DCC of AF may be less pertinent with ICB waveforms than with monophasic waveforms.

Low- and standard-dose corticotropin and insulin hypoglycemia testing in the assessment of hypothalamic-pituitary-adrenal function after pituitary surgery.

The optimal means of assessing the integrity of the hypothalamic-pituitary-adrenal (HPA) axis after pituitary surgery remains controversial. We compared low-dose (1 micro g iv) and standard-dose (250 micro g im) corticotropin tests performed 1 and 4-6 wk after pituitary surgery with an insulin hypoglycemia test performed at 4-6 wk. Forty-one patients (21 male and 20 female; median age, 52 yr; range, 23-73 yr) who had undergone pituitary surgery were studied (Cushing's disease excluded). Twenty-two of the 41 patients had normal cortisol responses to all tests both at 1 and 4-6 wk after surgery. Eight patients had subnormal cortisol responses to all tests. Of the 11 patients with discrepant results, seven had subnormal responses only after the low-dose corticotropin test; the remaining four patients had borderline responses to one or more tests. At 4-6 wk after surgery, subjects with a 30-min serum cortisol after standard-dose corticotropin of less than 350 nmol/liter (12.7 micro g/dl) consistently had a subnormal response to hypoglycemia, and those with a serum cortisol greater than 650 nmol/liter (23.6 micro g/dl) had a normal response to hypoglycemia. Definitive testing of the HPA axis using the standard-dose corticotropin test can be carried out provided it is performed at least 4 wk after pituitary surgery. A 30-min cortisol level greater than 650 nmol/liter (23.6 micro g/dl) indicates adequacy of the HPA axis, and a level of less than 350 nmol/liter (12.7 micro g/dl) indicates ACTH deficiency. No further testing is then required. An intermediate level of 350-650 nmol/liter (12.7-23.6 micro g/dl) warrants further assessment using the insulin hypoglycemia test.