Celdric LABOURDETTE’s Post

Ophthopedia Update:Intraocular pressure reduction and progression of highly myopic glaucoma: a 12-year follow-up cohort study: Aims To investigate any association between intraocular pressure (IOP) reduction amount and open-angle glaucoma (OAG) progression in highly myopic eyes and to determine the associated risk factors.Methods One hundred and thirty-one (131) eyes of 131 patients with highly myopic OAG, all of whom had received topical medications and been followed for 5 years or longer, were enrolled. Based on the IOP reduction percentage, patients were categorised into tertile groups, and subsequently, the upper-tertile and lower-tertile groups were compared for the cumulative probability of glaucoma progression. Kaplan-Meier survival analysis and log-rank testing were applied in the comparison, and multivariate analysis with Cox’s proportional hazard model, additionally, was performed to identify progression risk factors.Results Throughout the average 11.6±4.4 year follow-up on the 131 eyes (mean age, 41.2 years at initial visit; baseline IOP, 16.4 mm Hg), 72 eyes (55.0%) showed glaucoma progression. The upper-tertile group (IOP reduction percentage>23.7%) showed a high cumulative probability of non-progression relative to the lower-tertile group (IOP reduction percentage #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Influencing factors of effective lens position in patients with Marfan syndrome and ectopia lentis: Aims The aim of this study was to analyse the effective lens position (ELP) in patients with Marfan syndrome (MFS) and ectopia lentis (EL).Methods Patients with MFS undergoing lens removal and primary intraocular lens (IOL) implantation were enrolled in the study. The back-calculated ELP was obtained with the vergence formula and compared with the theoretical ELPs. The back-calculated ELP and ELP error were evaluated among demographic and biometric parameters, including axial length (AL), corneal curvature radius (CCR) and white-to-white (WTW).Results A total of 292 eyes from 200 patients were included. The back-calculated ELP was lower in patients undergoing scleral-fixated IOL than those receiving in-the-bag IOL implantation (4.54 (IQR 3.65–5.20) mm vs 4.98 (IQR 4.56–5.67) mm, p #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Posner-Schlossman Syndrome European Study Group: study protocol and baseline patients characteristics of a multicentre study: Background The aim of the Posner-Schlossman Syndrome European Study Group (PSS-ESG) is to acquire a comprehensive dataset of European patients with PSS. Here, we present the first report on the study protocol and the clinical findings of the patients at baseline. Methods The PSS-ESG is a retrospective, multicentre study designed to evaluate patients with PSS. The study, designed and driven by a European Expert Committee includes three datasets: (1) the baseline, (2) the follow-up and (3) the intraocular pressure (IOP)/glaucoma dataset. Results A total of 11 centres adhered to the PSS-ESG and 107 patients were included (68 males, 39 females) mostly Caucasian (93.4%). At uveitis onset, the patient’s age ranged between 11 and 76 years, (mean age: 42±15 years). Best-corrected visual acuity was >0.5 in 80.3% of the eyes, IOP was >40 mm Hg in 44% of the eyes. Keratic precipitates were found in 78.5% of the eyes. No flare or cells in anterior chamber were detected in 56% and 53% of the cases, respectively. PCR analysis on aqueous sample was positive for cytomegalovirus-DNA in 50.6% out of the 81 tested patients. Conclusions The PSS-ESG is the first multicentre study aimed to collect a comprehensive dataset of patients with PSS in non-Asian countries. A middlde-aged Caucasian male with a low-grade anterior chamber inflammation, keratic precipitates, preserved visual acuity and marked increased in IOP seemed to be the standard PSS patient across the 11 uveitis and glaucoma centres participating in the PSS-ESG. #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Posner-Schlossman Syndrome European Study Group: study protocol and baseline patients characteristics of a multicentre study: Background The aim of the Posner-Schlossman Syndrome European Study Group (PSS-ESG) is to acquire a comprehensive dataset of European patients with PSS. Here, we present the first report on the study protocol and the clinical findings of the patients at baseline.Methods The PSS-ESG is a retrospective, multicentre study designed to evaluate patients with PSS. The study, designed and driven by a European Expert Committee includes three datasets: (1) the baseline, (2) the follow-up and (3) the intraocular pressure (IOP)/glaucoma dataset.Results A total of 11 centres adhered to the PSS-ESG and 107 patients were included (68 males, 39 females) mostly Caucasian (93.4%). At uveitis onset, the patient’s age ranged between 11 and 76 years, (mean age: 42±15 years). Best-corrected visual acuity was >0.5 in 80.3% of the eyes, IOP was >40 mm Hg in 44% of the eyes. Keratic precipitates were found in 78.5% of the eyes. No flare or cells in anterior chamber were detected in 56% and 53% of the cases, respectively. PCR analysis on aqueous sample was positive for cytomegalovirus-DNA in 50.6% out of the 81 tested patients.Conclusions The PSS-ESG is the first multicentre study aimed to collect a comprehensive dataset of patients with PSS in non-Asian countries. A middlde-aged Caucasian male with a low-grade anterior chamber inflammation, keratic precipitates, preserved visual acuity and marked increased in IOP seemed to be the standard PSS patient across the 11 uveitis and glaucoma centres participating in the PSS-ESG. #Ophthalmology #Ophthotwitter #BJO

Neurovascular-Nugget 25 Reading of this manuscript may reflect 🎹 Key Findings: 🎹 ### Main Points ### #### Study Overview 👆**Objective:** Evaluate the safety and effectiveness of single-stent assisted coiling (L-stenting) in treating wide-neck bifurcation aneurysms (WNBAs). 👆 **Methods:** Retrospective study of 128 patients treated between 2015-2019 at three academic institutions. Angiographic imaging was evaluated by a core lab for accuracy. 👆 **Results:** 👆 **Patients:** 128 patients; 124 had follow-up angiographic data. 👆 **Outcomes:** - 88.7% had adequate occlusion (mRR 1 or 2). - 14.8% required retreatment. - Complications in 9.4% of patients, with 6.25% intraoperative SAEs. - **Predictors of Success:** Smaller aneurysm size and use of the transcellular technique. - **Predictors of Retreatment:** Larger aneurysm size, neck size, and dome to neck ratio. 👆 **Follow-Up:** Mean follow-up of 15.8 months. ### Main Points 🛜. **Effectiveness:** - High rate of adequate occlusion (88.7%). - 59.4% complete occlusion at last follow-up. 🛜. **Safety:** - 17 complications in 12 patients (9.4%). - No intraoperative or periprocedural aneurysmal ruptures. 🛜. **Technique:** - Single-stent L-stenting is effective and reduces the amount of metal used compared to dual-stent techniques. 🛜. **Comparison:** - Favorable outcomes compared to other techniques like Y-stenting and new devices like the WEB device. 🛜. **Predictors:** - Smaller aneurysm size and transcellular technique predict better outcomes. - Larger size and dome to neck ratio predict higher retreatment rates. ### Clinical Implications ### ✅**Treatment Choice:** - Single-stent L-stenting presents a viable alternative to dual-stent techniques, potentially reducing thromboembolic complications and procedural costs. ✅ **Patient Selection:** - Patients with smaller aneurysms and those suitable for the transcellular technique may benefit most from L-stenting. ✅ **Procedure Planning:** - Understanding predictors of success and retreatment can aid in better patient selection and pre-procedural planning. ✅ **Benchmarking:** - This study provides a validated comparator for future studies on new devices and techniques for WNBAs, setting a benchmark for efficacy and safety. ✅ **Cost Considerations:** - L-stenting could be more cost-effective due to the reduced use of stents and lower complication rates, though further studies are needed to confirm this. https://lnkd.in/dU984vPT

Ophthopedia Update:Effectiveness of difluprednate in addition to systemic therapy for the treatment of anterior scleritis: Aim To describe the effectiveness and side-effect profile of adding difluprednate therapy to patients with anterior scleritis being treated systemically. Methods Retrospective chart review. Charts from all patients with anterior scleritis who were treated with topical difluprednate in addition to systemic therapy from 1 January 2018 to 1 January 2020 were reviewed. Data collected included: demographics, scleritis type, systemic diagnosis, presence of nodules or necrosis, changes in scleritis activity, intraocular pressure (IOP), number of difluprednate drops used, type of systemic treatment used, best-corrected visual acuity (BCVA) and lens status. The primary outcome was clinical resolution of scleritis. Secondary outcomes included BCVA loss ≥2 lines, change in lens status or cataract surgery and IOP ≥24 mm Hg. Results Thirty-two patients (44 eyes) were analysed. The median age was 57 years (IQR 52, 72); 59% were female; 72% were Caucasian. An associated systemic disease was present in 59%. Systemic therapies used when difluprednate was added were: 65% immunosuppressive agents, 43% prednisone and 25% non-steroidal anti-inflammatory drugs. The addition of difluprednate resulted in clinical resolution in 79.6% of the treated eyes. Median time to inactivity was 9 weeks (IQR 5, 20). Eyes initially using 2–4 drops per day had a higher response rate (89%, p=0.005). Over a median follow-up of 34 weeks (IQR 21, 74), 11 eyes had IOP elevation; 6 eyes lost ≥2 lines of BCVA, 5 eyes had cataract progression. Conclusion Most eyes treated with difluprednate achieved inactivity. The addition of difluprednate to systemic therapies provides an alternative to achieve control of inflammation. #Ophthalmology #Ophthotwitter #BJO

I spoke to a woman in a hospital and she said her doctor said her ABS testing is drink a sugar drink and 3 hours later test for ethanol. If it's negative for alcohol, you don't have it. The woman in the hospital is overloaded with bacteria named in case studies for ABS in her stool and bladder. As much as I can't blame doctors for not learning about this disease in medical school, it pains me how many won't look up a case study or article on how to test and diagnose a patient when there is so much information readily available. We have over 200 formerly diagnosed cases when they followed our documented process and case studies. I provided a link below to learn how to test. The doctors who wrote this article also give the patient a high carb challenge with food as well (case studies are being updated to include this extra testing). They found some patients don't ferment with the glucose drink alone. They also found there is much more bacteria found in stool, and yeast in the upper intestines. Excerpt "In our provocative carbohydrate challenge test, we gave the patient 200 g of glucose by mouth after an overnight fast with blood drawn at timed intervals of 0, ½, 1, 2, 4, 8, 16, and 24 hours for glucose and blood alcohol levels." https://lnkd.in/eC7Hkc5V #AutoBrewerySyndrome #gutfermentation #AlcoholicsAnonymous #alcoholicbeverages #alcoholusedisorder #infectiousdisease #Gastroenterology #pulmonology #endocrinology #nephrology #urology #DistrictAttorney #DefenseAttorney #Policeman #EMS #paramedic #NAFLD #veterans #vahospital #legal

Ophthopedia Update:Repeat corneal collagen cross-linking after failure of primary cross-linking in keratoconus: Background Primary corneal collagen cross-linking (CXL) stabilises 96% of progressive keratoconus. There is limited evidence for the treatment of choice when this fails. We present 10 years of repeat CXL and compare with our published experience of primary CXL to (1) identify perioperative risk factors of primary CXL failure and (2) demonstrate the safety and efficacy of repeat CXL. Methods Patients undergoing repeat accelerated epithelium-off CXL at St James’s University Hospital, Leeds, UK January 2012–August 2022 were identified through electronic patient record, and compared with a previously published cohort of primary CXL patients at the same site. Results Twenty-one eyes underwent repeat CXL. The mean interval between primary and repeat CXL treatments was 47.1 months (SD 22.5). Twenty (95%) eyes stabilised after repeat CXL at a mean follow-up of 29.9 months. These cases were compared with 151 cases of primary CXL from our previous study. Patients failing primary CXL were significantly younger (21.3 years (SD 7.0) vs 26.7 years (SD 6.5), p=0.0008). Repeat CXL and primary CXL induced a similar amount of flattening of Kmax (–1.2 D (SD 3.9) vs –0.7 D (SD 4.4), p=0.22). A small, but clinically insignificant, improvement in best-corrected visual acuity was found in the repeat CXL group (–0.04 (SD 0.17) vs –0.05 (SD 0.13), p=0.04). No complications of repeat CXL were noted. Conclusion Younger age may be associated with failure of primary CXL. Repeat CXL is an effective and safe treatment for progressive keratoconus despite primary CXL. #Ophthalmology #Ophthotwitter #BJO

Ophthopedia Update:Proliferative vitreoretinopathy: a revised concept of retinal injury and response: Previous concepts for the pathogenesis of proliferative vitreoretinopathy (PVR) have focused on the central role of retinal pigment epithelium cells only, potentially contributing to the lack of clinical advances. More recent studies have demonstrated the essential role of retinal glial cells in the PVR healing response but failed to identify a consistent triggering mechanism. We propose a revised concept for the pathogenesis of PVR based on retinal injury and response. A posterior vitreous detachment (PVD) is invariably present in patients with rhegmatogenous retinal detachment and PVR. There is evidence to suggest that the shearing forces of acute PVD can cause mechanical injury to the inner retina and trigger a subsequent intraretinal glial healing response. That response is characterised by subclinical glial cell activation and proliferation that may then be amplified into full-blown PVR by coexisting pathology such as retinal breaks and detachment. Whether a PVD causes interface pathology depends on the plane of separation of the posterior vitreous and areas of increased vitreoretinal adhesions. If the vitreous separates in a plane or location that damages the inner retina then glial cell activation and proliferation are likely to develop. The severity of the subclinical inner retinal damage may then represent one of the missing links in our understanding of the pathogenesis of PVR and would explain many of the findings we encounter in clinical practice. Controlling the process of acute PVD and subsequent intraretinal response may be essential in the prevention and management of PVR. #Ophthalmology #Ophthotwitter #BJO