Trabeculectomy with mitomycin C for glaucoma secondary to emulsified silicone oil after pars plana vitrectomy: three-years follow up

Background/Aim: To evaluate the efficacy of trabeculectomy with mitomycin C (MMC) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO) after pars plana vitrectomy. Methods: A single-center, prospective study was conducted, from December 2014 to December 2019, on 56 consecutive patients with an uncontrolled elevation of IOP after SO removal. The primary end-point was the IOP at the three-years follow-up visit. Complete surgical success was defined as an IOP ranging from 7 mmHg to 18 mmHg without glaucoma medication. Qualified success was defined as IOP ? 21 mmHg with one or two topical medications. Results: Fifty-six patients with mean (standard deviation) age of 56.6 (13.1) years had a mean baseline IOP of 42.3 (39.3 to 45.3) mmHg, which reduced to 18.6 (17.9 to 19.3) mmHg at 3 years after surgery (P < 0.0001). 17 (30.4%) eyes were classified as complete success, 21 (37,5%) as qualified success, and 18 (32.1%) as failure. In all treated patients, the number of antiglaucoma medications was significantly reduced from 2.85 (0.77) to 1.63 (0.62), p<0.0001. Conclusion: Trabeculectomy with MMC may be an option for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

Cryotherapy with liquid nitrogen for chronic and recalcitrant intertrigo of toe webspaces

<p><strong>Background:</strong> The inflammation of the toe web spaces is known as foot intertrigo. Most commonly caused by candida. Important predisposing factors such as diabetes mellitus, obesity and immunosuppression lead to persistence and recurrence. Cryotherapy is a promising, safe, cost-effective, easily available therapeutic approach to treat recalcitrant intertrigo compared to available topical medications. Aim of the study was to observe the clinical improvement and therapeutic response of recalcitrant intertrigo and to observe treatment response based on photographs.</p><p><strong>Methods:</strong> A total of 30 patients who were clinically diagnosed with chronic candida intertrigo (CI) who fulfilled the inclusion and exclusion criteria were enrolled. Cryotherapy was administered with 3 cycles of freeze and thaw of 30 seconds each, every 2 weeks for a maximum of 3 treatment sessions. Follow-up of patients were done for 4 months.</p><p><strong>Results:</strong> Among 30 patients treated, 21 patients showed excellent clinical response, 6 patients showed good response. Only 2 patients showed poor response. Minimal side effects were observed, of which transient pain at the cryotherapy site is the most common. Diabetes was the most common comorbidity with poor response to treatment and recurrence.</p><p><strong>Conclusions:</strong> Cryotherapy can be used as a safe modality of treatment for recalcitrant CI cases unresponsive to topical therapy by providing faster therapeutic response and improving the quality of life in these patients. </p>

Topical Medication Therapy for Glaucoma and Ocular Hypertension

Glaucoma is one of the most common causes of blindness, thus seriously affecting people’s health and quality of life. The topical medical therapy is as the first line treatment in the management of glaucoma since it is inexpensive, convenient, effective, and safe. This review summarizes and compares extensive clinical trials on the topical medications for the treatment of glaucoma, including topical monotherapy agents, topical fixed-combination agents, topical non-fixed combination agents, and their composition, mechanism of action, efficacy, and adverse effects, which will provide reference for optimal choice of clinical medication. Fixed-combination therapeutics offer greater efficacy, reliable security, clinical compliance, and tolerance than non-fixed combination agents and monotherapy agents, which will become a prefer option for the treatment of glaucoma. Meanwhile, we also discuss new trends in the field of new fixed combinations of medications, which may better control IOP and treat glaucoma.

Success and Failure Factors for Trabeculectomy in Glaucomatous Patients in Southwest China: A 325 Eyes Analysis

Purpose To evaluate the outcomes and elucidate the success and failure factors for trabeculectomy with mitomycin C (MMC) in Southwest Chinese patients. Methods A retrospective correlational study was conducted on the glaucomatous patients who underwent initial trabeculectomy with MMC in Southwest Hospital and had been followed up for 1-3 years. A complete success for surgery is defined as a postoperative intraocular pressure (IOP) > 5 and ≤ 21 mmHg and 20% reduction of IOP compared to preoperative, without IOP-lowering medications. A qualified success for surgery is defined as the abovementioned postoperative IOP with or without IOP-lowering medications. The primary outcomes were IOP, the number of IOP-lowering medications, and cumulative success rate. The secondary outcomes included best corrected visual acuity (BCVA), mean deviation (MD) of visual field, major complications, and risk factors for surgical failure. Results A total of 325 eyes of 261 glaucomatous patients had been included in our study. Both the mean IOP and the number of IOP-lowering medications were significantly decreased from 32.9 ± 12.0 mmHg to 16.4 ± 5.7 mmHg (P<0.0001) and 3.0 ± 0.9 to 0.9 ± 1.0 (P<0.0001), respectively, at the last visit. The cumulative complete success rate and qualified success rate were 77.8% and 92.0% at 1-year follow-up, and 47.2% and 77.7% at 3-year follow up. There were no significant differences in surgical outcomes between primary angle-closure glaucoma (PACG) and primary open angle glaucoma (POAG). In PACG patients, the success rates of trabeculectomy were comparable with those of phacotrabeculectomy. Hypertension (HR=1.904, P=0.011), encapsulated bleb (HR=2.756, P<0.001), and more preoperative topical medications (HR=2.475, P=0.008) were risk factors for surgical failure. Conclusions The qualified success rate of trabeculectomy with MMC in glaucomatous patients in Southwest China is 92.0% at 1-year follow-up, and 77.7% at 3-year follow up. Hypertension, encapsulated bleb, and more preoperative topical medications are associated with surgical failure.

RADT-13. SPARE TRIAL: SCALP-SPARING RADIATION WITH CONCURRENT TEMOZOLOMIDE AND TUMOR TREATING FIELDS FOR PATIENTS WITH NEWLY DIAGNOSED GLIOBLASTOMA

INTRODUCTION Current adjuvant treatment for patients with newly diagnosed glioblastoma includes concurrent chemoradiation and maintenance temozolomide with Tumor Treating Fields (TTFields). We report our clinical trial evaluating feasibility and tolerability of scalp-sparing radiation with concurrent temozolomide and TTFields. METHODS Adult patients (age ≥ 18 years) with newly diagnosed glioblastoma with a KPS of ≥ 60 were eligible. All patients received concurrent scalp-sparing radiation (60 Gy in 30 fractions) with temozolomide (75 mg/m2 daily) and TTFields (200 kHz). Maintenance therapy included temozolomide and continuation of TTFields. Radiation treatment was delivered through TTFields arrays. The primary endpoint was safety and toxicity of tri-modality treatment within 30 days of completion of chemoradiation treatment. RESULTS Thirty patients were enrolled. Twenty were male and ten were female, with a median age of 58 years (range 19 to 77 years). Median follow-up was 10.8 months (range 1.6 to 21.3 months). Twenty (66.7%) patients had unmethylated MGMT promotor and ten (33.3%) patients had methylated promoter. Scalp dose constraints were achieved for all patients. Skin adverse events (erythema, dermatitis, irritation, folliculitis) were noted in 83.3% of patients, however, these were limited to Grade 1 or 2 events, which resolved spontaneously or with topical medications. No patient had radiation treatment interruption due to skin AEs. Other Grade 1 events included pruritus (33.3%), fatigue (30%), nausea (13.3%), headache (10%), dizziness (6.7%), and cognitive impairment (3.3%). Other Grade 2 events included headache (3.3%). The median PFS for the entire cohort was 9.1 months (at least 8.5 months, 95% confidence). The median PFS for patients with MGMT promoter methylation status was 11.4 months (at least 9.5 months, 95% confidence). Overall survival was not reached. CONCLUSIONS Concurrent TTFields with scalp-sparing chemoradiation is feasible treatment option with limited toxicity. Future randomized prospective trials are warranted to define therapeutic advantages of concurrent TTFields with chemoradiation.

Utility of Collagen Matrix Insertion during Ahmed Valve Implantation with Adjunctive Mitomycin-C: Outcomes at One-year

Purpose: To compare the surgical outcomes of adjunctive mitomycin-C (MMC) Ahmed valve implantation with and without collagen matrix insertion.Methods: We retrospectively reviewed 108 eyes of 108 patients who underwent Ahmed valve implant surgery with adjunctive MMC. Collagen matrix insertion/Ahmed valve implant surgery (CM-AGV) was performed on 55 eyes, while conventional Ahmed valve implant surgery (AGV) was performed on 53 eyes. We defined surgical failure as an intraocular pressure (IOP) > 18 mmHg or <5 mmHg on two or more consecutive visits, regardless of medication status.Results: After surgery, the IOP and number of topical medications required fell significantly (compared with the preoperative period) in both groups (both p < 0.001); these findings did not significantly differ between groups. The cumulative surgical success rates at 1 year did not significantly differ between groups (78.2% vs. 79.2%, p = 0.54). The only risk factor significantly associated with surgical failure was a postoperative hypertensive phase. Anterior chamber (compared with sulcus) tube placement was significantly associated with visual acuity loss at 1 year postoperatively, but this did not significantly differ between groups.Conclusions: At the 1-year follow-up after Ahmed implant surgery with adjunctive MMC, the success rates of surgery with and without collagen matrix insertion were similar.

Essential Oils of Melaleuca, Citrus, Cupressus, and Litsea for the Management of Infections Caused by Candida Species: A Systematic Review

Candida is a common agent of infection in humans, which has a wide distribution and is a colonizer fungus of the body, occasionally assuming the role of a pathogen. The type of treatment depends on the site of infection and the clinical condition of the patient. Superficial infections, such as mucosal infections, can be treated with topical medications. So-called alternative therapies have rarely been studied, although the literature records the effectiveness of some treatments, especially as complementary therapy. The aims of this review were to analyze evidence of the anti-Candida inhibitory activity of essential oils of the Citrus, Cupressus, Litsea, and Melaleuca species; in addition to addressing the chemical composition, probable mechanisms of antifungal action and studies of toxicity, cytotoxicity, and genotoxicity were included. The literature from Medline/PubMed, Science Direct, Scopus, Web of Science, and the Brazilian database Periodic Capes was reviewed. Thirty-eight articles were selected, which included two articles on Litsea spp., seven on Cupressus spp., thirteen articles on Citrus spp., and twenty-one articles on Melaleuca spp. In conclusion, this study showed in vitro evidence for the use of essential oils of the plant species evaluated for the treatment of infections caused by different Candida species.

Prevalence, Co-morbidities and Management of Psoriasis in Saudi Arabia: A Review

Background: Psoriasis is a chronic inflammatory skin illness with an autoimmune pathogenic mannerisms and genetic tendency. It is regarded as erythematous plaques sheltered with silvery scales predominantly over the extensor exteriors, scalp, and lumbosacral region. The prevalence in Saudi Arabia was projected to be 5.3% (53% of psoriasis patients develop it before 30 years of age. Aim: The main objective of this study is to summarize the current evidence regarding prevalence, types, risk factors, associated comorbidities and management of psoriasis in Saudi Arabia. Methods: This is a systematic review was carried out, including PubMed, Google Scholar, and EBSCO that examining previous studies regarding psoriasis in KSA. Authors extracted the data, and then the author's names, year and region of publication, the study type, period of study, and the result were reported. Results: The review included 7 studies that illustrate prevalence, types, risk factors, associated comorbidities and management of psoriasis in Saudi Arabia. Conclusion: The incidence of psoriasis in Saudi Arabia is within previously reported figures worldwide. Family history seems to have a strong association with the occurrence of psoriasis. CVD and psychological disorders seem to be prevalent Saudi psoriatic patients. Topical medications are widely used and effective in psoriasis management in Saudi Arabia.

Endocyclophotocoagulation combined with phacoemulsification in surgically naive primary open-angle glaucoma: three-year results

Objective To assess the safety and efficacy of endocyclophotocoagulation with phacoemulsification (phaco-ECP) in surgically naive, primary open-angle glaucoma (POAG). Methods A retrospective case series of patients undergoing phaco-ECP between 2007 and 2017 at a single centre in London, UK. The primary outcome was intraocular pressure (IOP). Secondary outcomes were visual acuity, visual field global indices, topical medications and surgical complications. Failure criteria were: (1) IOP > 21 mmHg or <20% reduction at two consecutive visits, (2) IOP <5 mmHg and (3) further IOP-lowering surgery. Results Eighty-three eyes from 83 patients were eligible. Pre-operatively, mean IOP (±SD) was 18.4 ± 5.2 mmHg. The mean number of topical agents (±SD) was 2.7 ± 0.9. Mean IOP (±SD) significantly reduced to 14.3 ± 4.7 at 1 year, 14.1 ± 4.0 at 2 years and 13.6 ± 3.7 at 3 years (p < 0.0001). Topical medications were significantly reduced to 1.3 ± 1.2 at 1 year, 1.7 ± 1.2 at 2 years and 1.8 ± 1.3 at 3 years (p < 0.0001). Annual IOP ‘survival’ was 70%, 54% and 45% at year 1, 2 and 3, respectively. Complications included uveitis (6%), macular oedema (2%), IOP spikes (1%) and corneal decompensation (1%) with no episodes of hypotony or retinal detachment. One patient underwent filtration surgery within 3 years (1%). Conclusion Phaco-ECP facilitates significant IOP lowering and reduction of medication burden in surgically naive POAG requiring cataract extraction. The procedure is relatively safe and without the use of implants and their associated risks.