Treating Severe Pediatric Keratoconjunctivitis with Topical Cyclosporine A

2021 ◽  
Author(s):  
Julia Biermann ◽  
Friederike Bosche ◽  
Nicole Eter ◽  
Flemming Beisse
Keyword(s):  
Cyclosporine A ◽  
Treatment Plan ◽  
Corneal Opacity ◽  
Corneal Neovascularization ◽  
Visual Development ◽  
Vernal Keratoconjunctivitis ◽  
Upper Eyelid ◽  
Sparing Effect ◽  
One Year

AbstractThe incidence of chronic keratoconjunctivitis, which potentially causes long-term loss of visual acuity due to corneal opacity, is considerably less common in children than in adults. It is therefore in danger of being overlooked. In children the appropriate treatment is therefore often introduced too late, or to an insufficient extent. In this article we would like to raise awareness about the diagnosis of chronic keratoconjunctivitis in children, and to present an effective treatment plan for severe stages of the disease. There are two forms of chronic keratoconjunctivitis that occur most frequently in children: hyperergic blepharokeratoconjunctivitis (hBKC) and vernal keratoconjunctivitis (VKC). With hBKC, the patient often has a history of recurring hordeolum and also presents with blepharitis; it is characterized by the marked presence of corneal neovascularization in the lower circumference of the cornea. VKC is typically characterized by changes under the upper eyelid, with marked changes to the superior limbus. If there is a risk of complications involving the cornea, or in the presence of such complications, a consistent long-term topical immunosuppressive and anti-inflammatory treatment is required. Both of these properties are combined in the active ingredient cyclosporine A. Other advantages of topical CSA treatment are its steroid-sparing effect and the long-term reduction of exacerbations. Parents need to be informed about the chronic nature of these two diseases and their tendency to recur; because of these characteristics, treatment, in most cases, should be envisaged for at least one year in order to effectively disrupt the complex immunologic processes. This safeguards the childʼs visual development and prevents amblyopia caused by scarring and astigmatism. We hope that the data presented will lower the barriers related to prescribing CSA for topical eye application in children.

scholarly journals Efficacy, Safety and Steroid-sparing Effect of Topical Cyclosporine A 0.05% for Vernal Keratoconjunctivitis in Indian Children

2019 ◽  
Author(s):  
Arkendu Chatterjee ◽  
Sabyasachi Bandyopadhyay ◽  
Samir Kumar Bandyopadhyay
Keyword(s):  
Placebo Group ◽  
Side Effects ◽  
Cyclosporine A ◽  
Controlled Study ◽  
Vernal Keratoconjunctivitis ◽  
Indian Children ◽  
Steroid Dependent ◽  
Sparing Effect ◽  
Steroid Sparing

Purpose: To evaluate the efficacy, safety, and steroid-sparing effect of topical cyclosporine A (Cs A) 0.05% in patients with moderate to severe steroid dependent vernal keratoconjunctivitis (VKC). Methods: A prospective, comparative, placebo controlled study was carried out on 68 VKC patients, with 34 patients treated with topical Cs A 0.05% and the remaining 34 with topical carboxymethyl cellulose 0.5% (placebo). Both groups also received topical loteprednol etabonate 0.5%. Symptom (itching, photophobia, tearing, and discharge) score, sign (tarsal and limbal papillae, corneal involvement, and conjunctival hyperemia) score, and drug score (steroid drop usage/day/eye) were recorded at baseline and each followup visit. The intraocular pressure (IOP) measurement and evaluation of any ocular side effects were carried out. Results: Significant reduction in symptom score and sign score was seen in both groups. Cs A group significantly showed more reduction in symptom (P < 0.0001 in all follow-up visits) and sign (P < 0.0001 in all follow-up visits) scores compared to the placebo group. At day 7, mean steroid usage reduced from 4 to 3.44 ± 0.5 and 3.79 ± 0.4 in Cs A and placebo groups, respectively (P < 0.0001). Steroid drops completely stopped in 21 patients at day 60 in the Cs A group compared to none in the placebo group. No significant rise in IOP or any side effects were noted in either group. Conclusion: Topical Cs A 0.05% is effective and safe in patients with moderate to severe VKC with good steroid-sparing effect.

scholarly journals One-year postoperative skeletal stability of 3D planned bimaxillary osteotomies: maxilla-first versus mandible-first surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Jeroen Liebregts ◽  
Frank Baan ◽  
Pieter van Lierop ◽  
Martien de Koning ◽  
Stefaan Bergé ◽  
...  
Keyword(s):  
Treatment Plan ◽  
Long Term Results ◽  
Virtual Planning ◽  
Virtual Operation ◽  
3D Printed ◽  
Bimaxillary Surgery ◽  
Set Up ◽  
One Year ◽  
Skeletal Stability

Abstract Orthognathic surgery is carried out to correct jaw deformities and to improve facial aesthetics. However, controversy surrounds whether the maxilla- or mandible-first surgery approach leads to better surgical outcomes. In our previous study, we have shown that in most instances, the maxilla-first surgical approach yielded closer concordance with the 3D virtual treatment plan than a mandibular-first procedure. However, the post-operative stability of each approach has not been investigated. Therefore, this one-year follow-up study was set-up and investigated the postoperative skeletal stability of the 3D planned translations and rotations after either the maxilla- or mandible-first surgery. In total, 106 patients who underwent bimaxillary surgery and had an individualized 3D virtual operation plans, received either maxilla-first (n = 53) or mandible-first (n = 53) surgery. 3D printed interocclusal splints were used during surgery to position the jaws. One year postoperatively a cone-beam computed tomography (CBCT) scan was made to assess the effects using the OrthoGnathicAnalyser. The mean sagittal, vertical and transverse relapse was less than 1.8 mm and no significant differences were found in relapse between the maxilla-first or the mandibular-first surgical procedure. Overall, this study shows that 3D virtual planning in combination with an optimised sequencing of osteotomies provides predictable long-term results in bimaxillary surgery.

scholarly journals Congenital Upper Eyelid Coloboma: Clinical and Surgical Management

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
José María Ortega Molina ◽  
Eduardo Ramón Mora Horna ◽  
Andrés David Salgado Miranda ◽  
Rosa Rubio ◽  
Ana Solans Pérez de Larraya ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Surgical Management ◽  
Surgical Procedure ◽  
Visual Development ◽  
Early Age ◽  
Close Monitoring ◽  
Potential Threat ◽  
Upper Eyelid ◽  
One Year

Purpose. The goal was to describe our experience in the surgical management and treatment of four patients with congenital upper eyelid colobomas.Methods. A descriptive, observational, retrospective study was performed including patients with congenital eyelid colobomas referred to Asociación para Evitar la Ceguera en México I.A.P. “Dr. Luis Sánchez Bulnes” between 2004 and 2014 and assessed by the Oculoplastics and Orbit Service.Results. The four cases required surgical treatment of the eyelid defects before one year of age and their evolution was monitored from the time of referral to the present day. One of the patients needed a second surgical procedure to repair the eyelid defect and correct the strabismus.Conclusions. Eyelid colobomas are a potential threat to vision at an early age, which requires close monitoring of the visual development of patients.

Reduction of major amputations in the diabetic ischaemic foot: A strategy to "take control" with conservative care as well as revascularisation

VASA ◽  
2001 ◽  
Vol 30 (Supplement 58) ◽  
pp. 6-14 ◽  
Author(s):  
Edmonds ◽  
Foster
Keyword(s):  
Natural History ◽  
Treatment Plan ◽  
Staging System ◽  
Vascular Control ◽  
New Approach ◽  
Conservative Care ◽  
Arterial Bypass ◽  
Therapeutic Footwear ◽  
Frequent Problem

The diabetic ischaemic foot has become an increasingly frequent problem over the last decade. However, we report a new approach consisting of a basic classification, a simple staging system of the natural history and a treatment plan for each stage, within a multi-disciplinary framework. This approach of "taking control" consists of two parts: 1. long-term conservative care including debridement of ulcers (to obtain wound control), eradication of sepsis (micribiological control), and provision of therapeutic footwear (mechanical control), and 2. revascularisation by angioplasty and arterial bypass (vascular control). This approach has led to a 50% reduction in the rate of major amputations in patients attending with ischaemic ulceration and absent foot pulses from 1989 to 1999 (from 4.6% to 2.3% per year). Patients who underwent angioplasty increased from 6% to 13%. Arterial bypass similarly increased from 3% to 7% of cases. However, even with an increased rate of revascularisation, 80% of patients responded to conservative care alone. This,we conclude, is an essential part of the management of all patients with ischaemic feet.

scholarly journals A206 EVOLUTION OF PEDIATRIC AUTOIMMUNE CHOLANGITIS AND PRIMARY SCLEROSING CHOLANGITIS INTO ADULTHOOD

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 234-236
Author(s):  
P Willems ◽  
J Hercun ◽  
C Vincent ◽  
F Alvarez
Keyword(s):  
Primary Sclerosing Cholangitis ◽  
Sclerosing Cholangitis ◽  
Response To Treatment ◽  
Similar Proportion ◽  
Autoimmune Cholangitis ◽  
Significant Difference ◽  
One Year ◽  
Liver Tests

Abstract Background The natural history of primary sclerosing cholangitis (PSC) in children seems to differ from PSC in adults. However, studies on this matter have been limited by short follow-up periods and inconsistent classification of patients with autoimmune cholangitis (AIC) (or overlap syndrome). Consequently, it remains unclear if long-term outcomes are affected by the clinical phenotype. Aims The aims of this is study are to describe the long-term evolution of PSC and AIC in a pediatric cohort with extension of follow-up into adulthood and to evaluate the influence of phenotype on clinical outcomes. Methods This is a retrospective study of patients with AIC or PSC followed at CHU-Sainte-Justine, a pediatric referral center in Montreal. All charts between January 1998 and December 2019 were reviewed. Patients were classified as either AIC (duct disease on cholangiography with histological features of autoimmune hepatitis) or PSC (large or small duct disease on cholangiography and/or histology). Extension of follow-up after the age of 18 was done for patients followed at the Centre hospitalier de l’Université de Montréal. Clinical features at diagnosis, response to treatment at one year and liver-related outcomes were compared. Results 40 patients (27 PSC and 13 AIC) were followed for a median time of 71 months (range 2 to 347), with 52.5% followed into adulthood. 70% (28/40) had associated inflammatory bowel disease (IBD) (78% PSC vs 54% AIC; p=0.15). A similar proportion of patients had biopsy-proven significant fibrosis at diagnosis (45% PSC vs 67% AIC; p=0.23). Baseline liver tests were similar in both groups. At diagnosis, all patients were treated with ursodeoxycholic acid. Significantly more patients with AIC (77% AIC vs 30 % PSC; p=0.005) were initially treated with immunosuppressive drugs, without a significant difference in the use of Anti-TNF agents (0% AIC vs 15% PSC; p= 0.12). At one year, 55% (15/27) of patients in the PSC group had normal liver tests versus only 15% (2/13) in the AIC group (p=0.02). During follow-up, more liver-related events (cholangitis, liver transplant and cirrhosis) were reported in the AIC group (HR=3.7 (95% CI: 1.4–10), p=0.01). Abnormal liver tests at one year were a strong predictor of liver-related events during follow-up (HR=8.9(95% CI: 1.2–67.4), p=0.03), while having IBD was not (HR=0.48 (95% CI: 0.15–1.5), p=0.22). 5 patients required liver transplantation with no difference between both groups (8% CAI vs 15% CSP; p=0.53). Conclusions Pediatric patients with AIC and PSC show, at onset, similar stage of liver disease with comparable clinical and biochemical characteristics. However, patients with AIC receive more often immunosuppressive therapy and treatment response is less frequent. AIC is associated with more liver-related events and abnormal liver tests at one year are predictor of bad outcomes. Funding Agencies None

scholarly journals “The Looming, Crazy Stalker Coronavirus”: Fear Mongering, Fake News, and the Diffusion of Distrust

2021 ◽  
Vol 7 ◽  
pp. 237802312110247
Author(s):  
Alexandrea J. Ravenelle ◽  
Abigail Newell ◽  
Ken Cai Kowalski
Keyword(s):  
Mental Health ◽  
Media Coverage ◽  
Media Consumption ◽  
Fake News ◽  
Compensatory Control ◽  
The Media ◽  
Good For ◽  
Fear Mongering ◽  
One Year

The authors explore media distrust among a sample of precarious and gig workers interviewed during the COVID-19 pandemic. Although these left-leaning respondents initially increased their media consumption at the outset of the pandemic, they soon complained of media sensationalism and repurposed a readily available cultural tool: claims of “fake news.” As a result, these unsettled times have resulted in a “diffusion of distrust,” in which an elite conservative discourse of skepticism toward the media has also become a popular form of compensatory control among self-identified liberals. Perceiving “fake news” and media sensationalism as “not good” for their mental health, respondents also reported experiencing media burnout and withdrawing from media consumption. As the pandemic passes its one-year anniversary, this research has implications for long-term media coverage on COVID-19 and ongoing media trust and consumption.

scholarly journals Short- and long-term effects of ponderosa pine fuel treatments intersected by the Egley Fire Complex, Oregon, USA

Fire Ecology ◽  
2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Jessie M. Dodge ◽  
Eva K. Strand ◽  
Andrew T. Hudak ◽  
Benjamin C. Bright ◽  
Darcy H. Hammond ◽  
...  
Keyword(s):  
Prescribed Fire ◽  
Vegetation Cover ◽  
Tree Density ◽  
Tree Canopy ◽  
Fuel Treatments ◽  
Dead Tree ◽  
High Severity ◽  
Short And Long Term ◽  
One Year

Abstract Background Fuel treatments are widely used to alter fuels in forested ecosystems to mitigate wildfire behavior and effects. However, few studies have examined long-term ecological effects of interacting fuel treatments (commercial harvests, pre-commercial thinnings, pile and burning, and prescribed fire) and wildfire. Using annually fitted Landsat satellite-derived Normalized Burn Ratio (NBR) curves and paired pre-fire treated and untreated field sites, we tested changes in the differenced NBR (dNBR) and years since treatment as predictors of biophysical attributes one and nine years after the 2007 Egley Fire Complex in Oregon, USA. We also assessed short- and long-term fuel treatment impacts on field-measured attributes one and nine years post fire. Results One-year post-fire burn severity (dNBR) was lower in treated than in untreated sites across the Egley Fire Complex. Annual NBR trends showed that treated sites nearly recovered to pre-fire values four years post fire, while untreated sites had a slower recovery rate. Time since treatment and dNBR significantly predicted tree canopy and understory green vegetation cover in 2008, suggesting that tree canopy and understory vegetation cover increased in areas that were treated recently pre fire. Live tree density was more affected by severity than by pre-fire treatment in either year, as was dead tree density one year post fire. In 2008, neither treatment nor severity affected percent cover of functional groups (shrub, graminoid, forb, invasive, and moss–lichen–fungi); however, by 2016, shrub, graminoid, forb, and invasive cover were higher in high-severity burn sites than in low-severity burn sites. Total fuel loads nine years post fire were higher in untreated, high-severity burn sites than any other sites. Tree canopy cover and density of trees, saplings, and seedlings were lower nine years post fire than one year post fire across treatments and severity, whereas live and dead tree basal area, understory surface cover, and fuel loads increased. Conclusions Pre-fire fuel treatments effectively lowered the occurrence of high-severity wildfire, likely due to successful pre-fire tree and sapling density and surface fuels reduction. This study also quantified the changes in vegetation and fuels from one to nine years post fire. We suggest that low-severity wildfire can meet prescribed fire management objectives of lowering surface fuel accumulations while not increasing overstory tree mortality.

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