Hematologic manifestations of SARS-CoV-2 infection and MIS-C in hospitalized children. Results of the PICNIC registry.

Introduction: Hematologic complications of SARS-CoV-2 infection are well described in hospitalized adults with correlation to adverse outcomes. Information published in children has been limited. Methods: An international multi-centered retrospective registry was established to collect data on the clinical manifestations of SARS-CoV-2 or multisystem inflammatory syndrome (MIS-C) in hospitalized children between February 1, 2020 – May 31, 2021. This sub-study focused on hematologic manifestations. Study variables included patient demographics, comorbidities, clinical presentation, course, laboratory parameters, management, and outcomes. Results: Nine hundred and eighty-five children were enrolled and 915 (93%) had clinical information available; 385 (42%) had symptomatic SARS-CoV-2 infection upon admission, 288 had MIS-C (31.4%) and 242 (26.4%) had alternate diagnosis with SARS-CoV-2 identified incidentally. During hospitalization, 10 children (1%) experienced a thrombotic event, 16 (1.7%) had hemorrhage and 2 (0.2%) had both thrombotic and hemorrhagic episodes. Significant prothrombotic comorbidities included congenital heart disease (p-value = 0.007), central venous catheter (p = 0.04) in children with primary SARS-CoV-2 infection; and obesity (p-value= 0.002), cytokine storm (p= 0.012) in those with MIS-C. Significant pro- hemorrhagic conditions included age > 10 years (p = 0.04), CVC (p= 0.03) in children with primary SARS-CoV-2infection; and thrombocytopenia (0.001), cytokine storm (0.02) in those with MIS-C. Eleven patients died (1.2 %) with no deaths attributed to thrombosis or hemorrhage Conclusion: Thrombotic and hemorrhagic complications are uncommon in children with SARS-CoV-2 infection and observed with underlying co-morbid conditions. Understanding the complete spectrum of hematologic complications in children with SARS-CoV-2 infection or MIS-C requires ongoing multi-center studies.

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Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

Operative Neurosurgery ◽

10.1093/ons/opab087 ◽

2021 ◽

Author(s):

Serge Marbacher ◽

Matthias Halter ◽

Deborah R Vogt ◽

Jenny C Kienzler ◽

Christian T J Magyar ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Digital Subtraction Angiography ◽

Diagnostic Yield ◽

Three Dimensional ◽

P Value ◽

Digital Subtraction ◽

Patient Demographics ◽

Included Patient ◽

2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = <.001), and more often missed grade 1 (< 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

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Role of Low Albumin Levels in Pediatric Patients with Central Venous Catheters at Risk for Thrombosis

Blood ◽

10.1182/blood-2019-124858 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3650-3650

Author(s):

Neha Bhasin ◽

Denise Roe ◽

Janna M. Journeycake ◽

Chelsea Large ◽

Kathylynn Saboda ◽

...

Keyword(s):

Serum Albumin ◽

Prospective Study ◽

Pediatric Patients ◽

Thrombotic Event ◽

Albumin Level ◽

Patient Demographics ◽

Included Patient ◽

Clinical Diagnoses ◽

A Prospective Study ◽

D Dimer

Introduction: The incidence of venous thromboembolism (VTE) in children has been increasing by about 10% per year for the past decade. This rise in VTE in children is attributed to improved survival of pediatric subspecialty patients as well as increased utilization of life-saving measures such as central venous catheters (CVCs) that can lead to catheter related thromboses (CRTs). More than 50% of venous thromboses in children and 90% of thromboses in neonates are CRTs, making catheter placement the single most significant risk factor for thrombosis in children. Association studies in adults have suggested an inverse relationship between serum albumin and risk of VTE. Given the paucity of data about albumin levels in pediatric patients in relation to VTE, we first performed a retrospective study to determine the prevalence of low albumin levels in pediatric patients with CRTs. We then initiated a prospective study to evaluate the incidence of hypoalbuminemia in pediatric patients at the time of CVC placement. Methods: We initially performed a retrospective study of 78 pediatric patients with a documented thrombotic event referred to the pediatric hematology service at University of Arizona between Aug 2014 and Jul 2017. Data collected included patient demographics, clinical diagnoses, type and location of thrombosis, presence or absence of a CVC, and albumin level within four days of the thrombotic event. We then designed a prospective study of pediatric patients undergoing CVC placement. Baseline data collected included patient demographics, clinical diagnoses, type of CVC placed, and laboratory results for albumin, factor VIII activity, D-dimer, and antithrombin activity within 4 days of CVC placement. Results: In the retrospective cohort of 78 consecutive pediatric patients with thrombosis, 84 thrombotic events were documented, of which 41 (49%) were CRTs. CRTs occurred in 22/35 (63%) patients less than 12 years of age and 14/42 (33%) patients aged 12 to 23 (P = 0.02). Serum albumin levels were available for 53 thrombotic events. Albumin levels were below the normal reference range in 27/30 (90%) of CRTs compared with 12/23 (52%) non-CRTs (P = 0.003). In the prospective study, data have been analyzed for the first 58 patients enrolled ages 2 months-17 years. At baseline, the prevalence of serum albumin below the lower limit of normal was 71% (41/58). Factor VIII activity was above 200% in 28/58 patients (48%), D-dimer was elevated in 48/58 patients (83%), and antithrombin was below 85% in 21/58 patients (36%). The mean duration of follow-up is 12 months. Four of the first 58 (6.9%) patients enrolled have had a CRT, all of whom had low albumin and elevated D-dimer levels at baseline. Conclusion: Hypoalbuminemia is highly prevalent in pediatric patients with thrombosis and also in patients with CVCs, who are at increased risk of thrombosis. In our retrospective analysis of pediatric patients with thrombosis, a low serum albumin level was documented in 74% of patients with thrombosis, including 90% of patients with a CRT. Preliminary analysis of the first 58 patients enrolled in a prospective study of patients with CVCs demonstrates a high prevalence (71%) of low albumin levels at the time of CVC placement. Further analysis is needed to define the value of serum albumin in thrombotic risk prediction and further explore potential prothrombotic mechanisms in CRT. Disclosures Lentz: Novo Nordisk Inc.: Consultancy, Honoraria, Research Funding.

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Expectations of Shoulder Surgery Are Not Altered by Surgeon Counseling of the Patient

Joints ◽

10.1055/s-0037-1605585 ◽

2017 ◽

Vol 05 (03) ◽

pp. 133-137 ◽

Cited By ~ 2

Author(s):

Cassandra Lawrence ◽

Benjamin Zmistowski ◽

Mark Lazarus ◽

Joseph Abboud ◽

Gerald Williams ◽

...

Keyword(s):

Postoperative Outcome ◽

Primary Objective ◽

Shoulder Surgery ◽

P Value ◽

Level Of Evidence ◽

Patient Demographics ◽

Included Patient ◽

Before And After ◽

The Mean ◽

Preoperative Counseling

Purpose The primary objective of this study was to evaluate if the current mechanisms of preoperative counseling influence patients' expectations of shoulder surgery. Methods Patients were asked to complete the Hospital for Special Surgery's (HSS) Shoulder Surgery Expectations Survey. The first survey was completed before the first appointment with one of four fellowship-trained shoulder surgeons. The second survey was completed after patients consented for surgery. Our analysis also included patient demographics and surgical factors. Results A total of 41 patients completed the HSS Shoulder Surgery Expectations Survey before and after their first appointment with the surgeon during which they consented to shoulder surgery. Before seeing the surgeon, the mean HSS Shoulder Surgery Expectations score was 72.5. After seeing the surgeon and being consented for surgery, the mean HSS Shoulder Surgery Expectations score was 74.8. The mean change in HSS Shoulder Surgery Expectations score (+2.3) was not statistically significant (p value = 0.242). We did not find any significant correlations between patients' expectations and demographics or surgical factors. Total HSS Shoulder Surgery Expectations scores and change in scores were not statistically different between the four surgeons (p = 0.146). Conclusion Patient expectations were not substantially altered after preoperative counseling. Further investigation is necessary to investigate factors correlated with expectations, the implication of unaltered expectations on the postoperative outcome, and methods for improving the preoperative counseling process. Level of Evidence Level II, prospective cohort study.

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HPV Prevalence and its Association with Perinatal Outcomes among Singleton Mothers: Analysis of Pregnancy Risk Assessment and Monitoring System (PRAMS) Data, 2004-2011

Current Women s Health Reviews ◽

10.2174/1573404814666180517085022 ◽

2019 ◽

Vol 15 (2) ◽

pp. 143-149 ◽

Cited By ~ 1

Author(s):

Harpriya Kaur ◽

Delf Schmidt-Grimminger ◽

Baojiang Chen ◽

K.M. Monirul Islam ◽

Steven W. Remmenga ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Pregnant Women ◽

Monitoring System ◽

Large Population ◽

Perinatal Outcomes ◽

Hpv Infection ◽

Adverse Outcomes ◽

P Value ◽

Pregnancy Risk

Background: Pregnancy may increase the risk of Human Papillomavirus (HPV) infection because of pregnancy induced immune suppression. The objective of this study was to use a large population-based dataset to estimate the prevalence of HPV infection and its association with adverse outcomes among pregnant women. Methods: We analyzed Pregnancy Risk Monitoring System data from 2004-2011 (N=26,085) to estimate the self-reported HPV infection. Survey logistic procedures were used to examine the relationship between HPV infection and adverse perinatal outcomes. Results: Approximately 1.4% of women were estimated to have HPV infection during their pregnancy. The prevalence of adverse outcomes in this sample was preterm birth (8.4%), preeclampsia (7.5%), low birth weight (6.3%) and premature rupture of membranes (2.8%). Compared to women without HPV infection, HPV infection positive women were much more likely to have had other infections such as chlamydia (9.23% vs. 2.12%, p-value <.0001), Group B Strep (21.7% vs. 10.04%, p-value <.0001), and herpes (7.17% vs. 1.07%, p-value <.0001). After adjusting for other risk factors including other infections, HPV infection was significantly associated with low birth weight (OR: 1.94, 95% CI: 1.14-3.30). Conclusion: The study indicated a potential association between HPV infection and low birth weight. Because pregnant women with HPV infection are at higher risk of other infections, future research may focus on the roles of co-infection in the development of adverse perinatal effects.

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Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01526-7 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Yan Le Ho ◽

Pui Fong Ng ◽

Sotheenathan Krishinan ◽

Basheer Ahamed Abdul Kareem

Keyword(s):

Right Atrium ◽

Clinical Manifestations ◽

Clinical Information ◽

Interatrial Septum ◽

Papillary Fibroelastoma ◽

Case Presentation ◽

Intracardiac Masses ◽

The Right ◽

Embolic Risk

Abstract Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

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Case of an unusual diagnosis of primary antiphospholipid syndrome with multiple clinical complications

Oxford Medical Case Reports ◽

10.1093/omcr/omaa117 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Stathis Tsiakas ◽

Chrysanthi Skalioti ◽

Paraskevi Kotsi ◽

Ioannis Boletis ◽

Smaragdi Marinaki

Keyword(s):

Antiphospholipid Syndrome ◽

Thrombotic Event ◽

Renal Involvement ◽

Clinical Manifestations ◽

Young Male ◽

Multiple Organ ◽

Systemic Autoimmune Disease ◽

Antiphospholipid Antibody ◽

Primary Antiphospholipid Syndrome ◽

Wide Range

ABSTRACT Antiphospholipid syndrome (APS) is a systemic autoimmune disease defined by the presence of antiphospholipid antibodies in association with thrombotic events and/or obstetric complications. Renal involvement is not infrequent in both primary and secondary APS. Kidney manifestations comprise a wide range of clinical features, including hypertension, major renal vessel thrombosis or microvascular endothelial injury, also described as APS nephropathy. In the absence of a thrombotic event, clinical manifestations of APS are often non-specific. We recently encountered a case of primary APS in a young male with newly diagnosed hypertension and renal impairment. The diagnosis of APS was initially suspected by his kidney biopsy findings, when electron microscopy examination showed the features of chronic microangiopathy, and was later confirmed by a triple positive antiphospholipid antibody profile and multiple organ involvement.

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The Systematic Effect of Mesenchymal Stem Cell Therapy in Critical COVID-19 Patients: A Prospective Double Controlled Trial

Cell Transplantation ◽

10.1177/09636897211024942 ◽

2021 ◽

Vol 30 ◽

pp. 096368972110249

Author(s):

G Adas ◽

Z Cukurova ◽

K Kart Yasar ◽

R Yilmaz ◽

N Isiksacan ◽

...

Keyword(s):

Growth Factors ◽

Critically Ill ◽

Inflammatory Cytokines ◽

Clinical Manifestations ◽

Systematic Effect ◽

Cytokine Storm ◽

Group 3 ◽

Anti Inflammatory ◽

Group 2 ◽

Group 1

The aim of this clinical trial was to control the cytokine storm by administering mesenchymal stem cells (MSCs) to critically-ill COVID-19 patients, to evaluate the healing effect, and to systematically investigate how the treatment works. Patients with moderate and critical COVID-19 clinical manifestations were separated as Group 1 (moderate cases, n = 10, treated conventionally), Group 2 (critical cases, n = 10, treated conventionally), and Group 3 (critical cases, n = 10, treated conventionally plus MSCs transplantation therapy of three consecutive doses on treatment days 0, 3, and 6, (as 3 × 106 cells/kg, intravenously). The treatment mechanism of action was investigated with evaluation markers of the cytokine storm, via biochemical parameters, levels of proinflammatory and anti-inflammatory cytokines, analyses of tissue regeneration via the levels of growth factors, apoptosis markers, chemokines, matrix metalloproteinases, and granzyme-B, and by the assessment of the immunomodulatory effects via total oxidant/antioxidant status markers and the levels of lymphocyte subsets. In the assessment of the overall mortality rates of all the cases, six patients in Group-2 and three patients in Group-3 died, and there was no loss in Group-1. Proinflammatory cytokines IFNγ, IL-6, IL-17A, IL-2, IL-12, anti-inflammatory cytokines IL-10, IL-13, IL-1ra, and growth factors TGF-β, VEGF, KGF, and NGF levels were found to be significant in Group-3. When Group-2 and Group-3 were compared, serum ferritin, fibrinogen and CRP levels in Group-3 had significantly decreased. CD45 +, CD3 +, CD4 +, CD8 +, CD19 +, HLA-DR +, and CD16 + / CD56 + levels were evaluated. In the statistical comparison of the groups, significance was only determined in respect of neutrophils. The results demonstrated the positive systematic and cellular effects of MSCs application on critically ill COVID-19 patients in a versatile way. This effect plays an important role in curing and reducing mortality in critically ill patients.

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POS1225 INFLUENCE OF COLCHICINE PRESCRIPTION IN COVID19-RELATED HOSPITAL ADMISSIONS: A SURVIVAL ANALYSIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2845 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 896.2-896

Author(s):

M. P. Álvarez ◽

A. Madrid García ◽

I. Perez-Sancristobal ◽

J. I. Colomer ◽

L. León ◽

...

Keyword(s):

Inflammatory Response ◽

Rheumatic Diseases ◽

Hospital Admissions ◽

Musculoskeletal Diseases ◽

Tertiary Care ◽

Secondary Outcome ◽

P Value ◽

Inflammatory Rheumatic Diseases ◽

Cytokine Storm ◽

Observation Period

Background:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggers the innate immune system, leading in severe cases, an excessive immune response, which can lead to high levels of pro-inflammatory cytokines promoting a “cytokine storm”.To modulate this exaggerated inflammatory response, several clinical trials with already approved and well-known therapeutic agents that inhibit the inflammatory response, are being carried out. However, none of these drugs seems to achieve the desired results when treating COVID19.Colchicine, a drug often used in the management of patients with Rheumatic and Musculoskeletal diseases (RMDs), is one of the several drugs that are being currently tested for efficacy in COVID19 due to its anti-inflammatory effects.Objectives:To analyze association between colchicine prescription and COVID19-related hospital admissions in patients with Rheumatic and Musculoskeletal diseases (RMDs).Methods:Patients attending a rheumatology outpatient clinic from a tertiary care center in Madrid, Spain, from 1st September 2019 to 29th February 2020 were included.Patients were assigned as exposed or unexposed based on whether they were prescribed with colchicine in their last visit to the clinic during the 6 months before the start of the observation period. Treatment changes during the observation period were also considered. The primary outcome was COVID19-related hospital admissions occurring between March 1st and May 20th, 2020. Secondary outcome included COVID19-related mortality. Several weighting techniques for data balancing, based and non-based on the propensity score, followed by Cox regressions were performed to estimate the association of colchicine prescription on both outcomes.Results:9,379 patients entered in the study, with 406 and 9,002 exposed and unexposed follow-up periods, respectively. Generalized Boosted Models (GBM) and Empirical Balancing Calibration Weighting (EBCW) methods showed the best balance for COVID19-related hospital admissions. Colchicine prescription did not show a statistically significant association after covariable balancing (p-value = 0.195 and 0.059 for GBM and EBCW, respectively). Regarding mortality, the low number of events prevented a success variable balancing and analysis.Conclusion:Colchicine prescription does not play a significant protective or risk role in RMD patients regarding COVID19-related hospital admissions. Our observations could support the maintenance of colchicine prescription in those patients already being treated, as it is not associated with a worse prognosis.References:[1]Fernandez-Gutierrez B. COVID-19 with Pulmonary Involvement. An Autoimmune Disease of Known Cause. Reumatol Clin 2020; 16: 253–254.[2]Coperchini F, Chiovato L, Croce L, et al. The cytokine storm in COVID-19: An overview of the involvement of the chemokine/chemokine-receptor system. Cytokine Growth Factor Rev 2020; 53: 25–32.[3]Shaffer L. 15 drugs being tested to treat COVID-19 and how they would work. Nat Med. Epub ahead of print 15 May 2020. DOI: 10.1038/d41591-020-00019-9.[4]Fernandez-Gutierrez B, Leon L, Madrid A, et al. Hospital admissions in inflammatory rheumatic diseases during the COVID-19 pandemic: incidence and role of disease modifying agents. medRxiv 2020; 2020.05.21.20108696.[5]Freites Nuñez DD, Leon L, Mucientes A, et al. Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020; 1–7.Disclosure of Interests:None declared

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Epidural analgesia in a paediatric teaching hospital: Trends, developments, and a brief review of literature

Proceedings of Singapore Healthcare ◽

10.1177/2010105817733997 ◽

2017 ◽

Vol 27 (1) ◽

pp. 49-54 ◽

Cited By ~ 3

Author(s):

Jolin Wong ◽

Serene Siu Tin Lim

Keyword(s):

Epidural Analgesia ◽

Teaching Hospital ◽

Perioperative Period ◽

Review Of Literature ◽

Good Tool ◽

Patient Demographics ◽

Included Patient ◽

Continuous Epidural Analgesia ◽

Continued Use

Introduction: Continuous epidural analgesia has proven to be a good tool in the anaesthetist’s quest to provide excellent pain relief for an extended perioperative period. Pharmaceutical advances provide us with a larger array of both local anaesthetic (LA) drugs and additives that can prolong the duration or enhance the quality of analgesia, or both. The avoidance of LA toxicity is of paramount importance for safe prescription, especially in the high-risk neonatal and infant cohort, and all patients stand to benefit from ‘safer’ LA agents and adjuvants that promote the use of a lowered concentration of epidural LA infusions. We present a descriptive review of trends in epidural prescription and technique in our hospital. Methods: Our observational study was conducted over a period of 19 years in a tertiary paediatric teaching hospital. Prospectively collected data that included patient demographics, level of epidural catheter insertion, LA drugs and adjuvants used, as well as postoperative infusion rates, were then analysed retrospectively. Results: There was a decline in the use of paediatric epidural analgesia. Over the study period, we also observed a shift in preference of LAs and adjuvant drugs toward safer alternatives. Conclusion: Paediatric epidural analgesia is gradually being superseded by other analgesic modalities with superior safety profiles (e.g. peripheral neural blockade). However, indications remain for its continued use, and anaesthetists should be familiar with its technical aspects and pitfalls.

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Baerveldt shunt surgery versus combined Baerveldt shunt and phacoemulsification: a prospective comparative study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2017-310698 ◽

2017 ◽

Vol 102 (9) ◽

pp. 1248-1253 ◽

Cited By ~ 1

Author(s):

Mohamad El Wardani ◽

Ciara Bergin ◽

Kenza Bradly ◽

Eamon Sharkawi

Keyword(s):

Complication Rates ◽

Failure Rates ◽

Shunt Surgery ◽

Patient Demographics ◽

Aqueous Shunt ◽

Included Patient ◽

Significant Difference ◽

Negative Effect ◽

Prospective Comparative Study ◽

Baerveldt Tube

AimTo examine the efficacy and safety of Baerveldt tube (BT) implantation compared with combined phacoemulsification and Baerveldt tube (PBT) implantation in patients with refractory glaucoma.MethodsSeventy-six eyes of 76 patients were enrolled, 38 pseudophakic eyes underwent BT implantation alone and 38 phakic eyes underwent the BT implantation combined with phacoemulsification. Groups were matched for preoperative intraocular pressure (IOP) and number of glaucoma medications. Preoperative and postoperative measures recorded included patient demographics, visual acuity (VA), IOP, number of antiglaucoma medications and all complications. Patients were followed up for a minimum of 36 months. Failure was defined as: inadequate IOP control (IOP≤5 mm Hg/>21 mm Hg/<20% reduction from baseline, reoperation for glaucoma, loss of light perception vision, or removal of the implant).ResultsThere was a significant difference in failure rates between groups at 36 months (PBT 37% vs BT 15%, P=0.02). There was no significant difference for PBT versus BT in preoperative baseline ocular characteristics. At 36 months: median IOP=14 mm Hg vs 12 mm Hg, P=0.04; mean number of antiglaucomatous medications=1.7 vs 1.3, P=0.61; median VA=0.8 vs 0.7, P=0.44. Postoperative complication rates were similar in both groups (n=5 vs 5; 13% vs 13%).ConclusionsFailure rates were significantly greater in the PBT group at 3 years. Median IOP was also significantly higher in the PBT group. These results suggest that combining phacoemulsification with aqueous shunt surgery may have a negative effect on long-term shunt bleb survival.

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