Purpose:
To analyze a case series of retinal vasculitis reported to the American Society of Retina Specialists (ASRS) following Food and Drug Administration approval of brolucizumab for treatment of ...neovascular age-related macular degeneration.
Methods:
The ASRS Research and Safety in Therapeutics Committee analyzed clinical and imaging characteristics from submitted reports of retinal vasculitis after brolucizumab.
Results:
Retinal vasculitis was reported in 26 eyes of 25 patients (22 88% female) after treatment with brolucizumab. Imaging studies were available for 24 of 26 eyes. Most cases (92%) were associated with intraocular inflammation, which presented at a mean of 25 days (range, 3-63 days) after the most recent brolucizumab injection. Mean visual acuity (VA) was 20/52 (range, 20/25-4/200) before the adverse event, 20/151 (range, 20/25-hand motion) at presentation of the adverse event, and 20/243 (range, 20/30-light perception) at last follow-up. Twelve eyes (46%) had a greater than 3-line decrease in VA at final follow-up, and 12 eyes (46%) had a final VA of 20/200 or worse. Analysis of retinal imaging identified vasculopathy that involved retinal arteries (91%), retinal veins (79%), and choroidal vessels (48%). Occlusive disease was apparent on imaging in 83% of eyes. Treatment approaches were varied.
Conclusions:
Retinal vasculitis has been identified in a series of eyes following brolucizumab. Although a few eyes in this series were asymptomatic or minimally symptomatic, some eyes had significant vision loss. A careful examination for signs of active inflammation prior to brolucizumab injection is recommended. Once vasculopathy is suspected, angiographic imaging may help define the spectrum of involvement. Optimal treatment strategies remain unknown.
Purpose:
This work analyzes a series of eyes with brolucizumab-associated intraocular inflammation (IOI) without retinal vasculitis reported to the American Society of Retina Specialists.
Methods:
...The American Society of Retina Specialists Research and Safety in Therapeutics Committee analyzed clinical characteristics from submitted reports of IOI after brolucizumab. Eyes with retinal vasculitis or that received intraocular antibiotics were excluded.
Results:
Forty-nine eyes of 45 patients were collected. Mean visual acuity (VA) at baseline was 20/49 (range, 20/20-5/200). Patients presented with IOI a mean of 24 days (range, 3-63 days) after their most recent brolucizumab injection; 61% presented for an unscheduled visit while 39% presented at routine follow-up. Mean VA at IOI presentation was 20/67 (range, 20/20-3/200). The most common symptoms were floaters (78%) and blurry vision (76%). Pain (20%) and redness (16%) were less common; 3 (6%) eyes were asymptomatic. IOI was anterior only in 18%, posterior only in 31%, and both anterior and posterior in 51% of eyes. Treatment included topical steroids alone in 67% of eyes, whereas 10% of eyes received no treatment. Mean VA at last follow-up was 20/56 (range, 20/20-1/200). Three (6%) eyes lost 3 or more lines and 1 (2%) eye lost 6 or more lines.
Conclusions:
Brolucizumab-associated IOI without retinal vasculitis typically presented with a delayed onset of a few weeks. Often, VA decline was relatively mild. Most symptoms resolved and nearly all had a return-to-baseline VA, but a small percentage of patients had a significant decrease in VA at last follow-up.
To determine factors associated with loss of good vision (defined as Snellen visual acuity VA < 20/40) after surgery among eyes presenting with macula-on primary rhegmatogenous retinal detachment ...(RRD) with initial VA ≥20/40.
Multicenter, retrospective, cohort study of eyes undergoing scleral buckle (SB), pars plana vitrectomy (PPV), or combined pars plana vitrectomy/scleral buckle (PPV/SB) for non-complex macula-on RRD with initial VA ≥20/40.
Among 646 eyes with macula-on RRDs with initial VA ≥20/40, 106 (16.4%) had VA <20/40 (i.e. lost good vision) at final follow-up. Eyes losing good vision had slightly worse pre-operative logMAR VA (mean 0.15 ± 0.10 20/28) compared to eyes that preserved good vision (mean 0.11 ± 0.10 20/26) (p = 0.004). RRDs extending greater than 6 clock-hours were more likely to lose good vision than smaller detachments (multivariate OR 4.57 95% CI 1.44-14.51; p = 0.0099). Compared to eyes repaired with SB alone, eyes undergoing PPV (multivariate OR 7.22 95% CI 2.10-24.90; p = 0.0017) or PPV/SB (multivariate OR 10.74 95% CI 3.20-36.11; p = 0.0001) were each more likely to lose good vision. Eyes requiring further RRD-related (multivariate OR 8.64 95% CI 1.47-50.66; p < 0.017) and non-RRD related vitreoretinal surgery (multivariate OR 14.35 95% CI 5.39-38.21; p < 0.0001) were more likely to lose good vision.
Among macula-on RRDs, loss of good vision was associated with worse vision on presentation, vitrectomy-based procedures, greater extent of detachment, and lack of single surgery success. Understanding predictors of visual outcome in macula-on RRD repair may guide pre-operative counseling regarding visual prognosis.
To compare outcomes of scleral buckle (SB), pars plana vitrectomy (PPV), and combined PPV-SB to treat rhegmatogenous retinal detachments (RRDs) with inferior retinal breaks (IRBs).
Rhegmatogenous ...retinal detachments with IRBs are not uncommon; their management is challenging with higher risk of failure. There is no consensus about their treatment, specifically whether SB, PPV, or PPV-SB should be performed.
Systematic review and meta-analysis. Randomized controlled trials, case-control, and prospective/retrospective series (if n > 50) in English were eligible. Medline, Embase, and Cochrane databases were searched up to January 23, 2023. Standard systematic review methods were followed. The following outcomes at 3 (± 1) and 12 (± 3) months were evaluated: number of eyes with retinal reattachment after ≥ 1 surgeries, change in best-corrected visual acuity from preoperative to postoperative levels, and number of eyes with improvement of > 10 and > 15 ETDRS letters after surgery. Authors of eligible studies were asked for individual participant data (IPD) and IPD meta-analysis was undertaken. Risk of bias was assessed using National Institutes of Health study quality assessment tools. This study was registered prospectively in PROSPERO (CRD42019145626).
A total of 542 studies were identified: 15 were eligible and included and 60% were retrospective. Individual participant data was obtained from 8 studies (1017 eyes). Given that only 26 patients had received SB alone, these data were not considered in the analysis. There was no evidence for differences between treatment groups (PPV versus PPV-SB) in the probability of having a flat retina at 3 or 12 months postoperatively after 1 (P = 0.067; odds ratio OR, 0.47; P = 0.408; OR 2.55; respectively) or > 1 (OR, 0.54; P = 0.21; OR, 0.89; P = 0.926; respectively) surgery. Pars plana vitrectomy-SB showed less improvement in vision postoperatively at 3 months (estimate, 0.18; 95% confidence interval, 0.01–0.35; P = 0.044), but this difference was no longer observed at 12 months (estimate, –0.07; 95% confidence interval, –0.27, 0.13; P = 0.479).
Available evidence suggests a lack of benefit of adding SB to PPV to treat RRDs with IRBs. Evidence, however, comes mainly from retrospective series and, thus, despite the large number of eyes included, should be interpreted with caution. Further research is needed.
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
This article describes lessons learned from a pilot project that delivers Restorative Justice (RJ) to victims of crime referred by agencies supporting victims and victim self-referrals. The project ...involves a partnership of agencies in the Thames Valley, working as part of a wider European Collaboration, to extend RJ services to victims at the post-sentencing level. We provide access to RJ for victims, whilst protecting their rights and preventing re-victimisation, in accordance with EU directive 2012/29/EU (European Commission, 2012). The context and methodology of pilot project are explained. Lessons learned from practice through team case discussion and supervision are then identified and described. The cases are summarised in a table which outlines their key features and acts as a point of reference in relation to the lessons learned. Cases are ongoing at the time of writing. The lessons may not always be clear cut and finalised. We hope that this approach will demonstrate the process of learning from experience and practice as the project develops. Whilst ours is not a rigorously scientific approach, we hope it offers a chance to understand the dilemmas and issues presented by a model which starts from a victim's request for RJ. Independent evaluation, involving interviews with victims, referrers and offenders who have participated in the pilot project, follows at a later stage. Adapted from the source document.
Ovaj članak opisuje lekcije naučene iz pilot-projekta koji restorativnu pravdu omogućuje žrtvama zločina na koje upućuju agencije za pomoć žrtvama te žrtvama koje se same prijave za takav program. ...Projekt uključuje partnerstvo agencija u regiji Thames Valley, koje djeluju u sklopu šire europske suradnje, kako bi se usluge restorativne pravde za žrtve proširile na razini nakon izricanja kazne. Žrtvama omogućujemo pristup restorativnoj pravdi, dok štitimo njihova prava i sprečavamo ponovnu viktimizaciju, u skladu s Direktivom 2012/29/EU (Europska komisija 2012.).
Objašnjeni su kontekst i metodologija našeg pilot-projekta, a potom su kroz timske rasprave o slučajevima i nadzor identificirane i opisane lekcije naučene iz prakse. Slučajevi su zatim sažeti u tablici koja navodi njihove ključne značajke i djeluje kao referentna točka u vezi s naučenim lekcijama.
U vrijeme pisanja članka, slučajevi su u tijeku. Lekcije se ne mogu uvijek jasno definirati i finalizirati. Vjerujemo da će ovaj pristup pokazati proces učenja iz iskustva i prakse kako se projekt bude razvijao. Iako naš pristup nije strogo znanstven, nadamo se da čitateljima nudi priliku da razumiju dileme i pitanja predstavljene modelom koji počinje zahtjevom žrtve za restorativnom pravdom. Autori su voditelj projekta i voditelji restorativne pravde uključeni u izvršavanje usluga. Neovisna procjena, koja uključuje intervjue sa žrtvama, posrednicima i počiniteljima koji su sudjelovali u pilot-projektu, slijedi u kasnijoj fazi.
All-electronic transactions is the long-term trend in banking. However, the volume of paper checks will grow from 64 billion in 1995 to 74 billion in 2005. Check elimination to reduce costs is not ...likely. Electronic check presentment and check imaging are two technologies that can improve customer service and lower costs. These applications are now used in 40 of the largest 100 banks and will increase in the future.
Given today's other clear trend in banking - consolidation - the need to handle paper will be even greater among the surviving banks. While check volumes grew a modest 3% in 1994 across all U.S. ...financial institutions, check volumes for banks with greater than $4 billion in assets (those doing most of the acquiring) grew by 8%. So what can be done to lower costs and improve customer service? Two technologies that have attempted to accomplish this independently are electronic check presentment (ECP) and check imaging. Likewise, check imaging is not the whole answer to the paper dilemma. While it offers many benefits to banks and their customers for distributing checks, it fails to solve the paper-to-follow problem. This is due to the availability and price of transmission bandwidth; shipping more than 60 billion items per year at 50,000 bytes of data per item just isn't affordable.
Recent reports using historical controls or registry cohorts suggest, respectively, either an increase in the mortality or a decrease in the incidence of hepatic veno-occlusive disease (VOD) with the ...administration of intravenous immunoglobulin (i.v.Ig) after bone marrow transplantation. These divergent results prompted us to conduct a retrospective analysis of two randomized clinical trials conducted at our center to determine the effect of i.v.Ig infusions on the development and severity of VOD. Patients were randomized to receive (n=318) or not to receive (n=315) i.v.Ig prophylaxis after human leukocyte antigen-identical sibling (n=414), mismatched or unrelated (n=178), or autologous or syngeneic (n=41) marrow transplantation. To determine the relationship of i.v.Ig to the development and severity of VOD, a single observer reviewed data displays created for each patient for grading VOD without knowledge of patient i.v.Ig use. In this analysis, VOD was defined as hyperbilirubinemia > or =2.0 mg/dL before day 20 and abrupt weight gain > or =2% before day 14 posttransplant in the absence of other causes of liver disease. Hepatic VOD developed in 235 (37%) of the 633 randomized patients. No evidence for VOD was found in 230 (36%) patients. The remaining 168 (27%) patients were classified as having liver disease of uncertain etiology. Hepatic VOD was judged to be severe in 63 (10%) and mild or moderate in 172 (27%) patients. The number of patients developing any VOD or severe VOD was similar between those randomized to i.v.Ig prophylaxis and untreated controls (115 vs. 120 and 32 vs. 31, respectively). Logistic regression models identified several covariates as significant (p < 0.01) factors associated with the development of severe VOD. Increased risk occurred with elevated pretransplant serum aspartate aminotransferase (odds ratio OR = 2.64) and earlier year of transplant (OR = 3.73); decreased risk occurred with autologous or twin donors (OR = 0.09) and acute myeloid leukemia (OR = 0.39). The development of any VOD was associated with an elevated pretransplant alkaline phosphatase (OR = 4.1), pretransplant use of vancomycin (OR = 1.6) or amphotericin (OR = 3.0), posttransplant use of cyclosporine (OR = 2.5), older patient age (OR = 1.03), and obesity (OR = 0.78). We concluded from the controlled trials of 633 patients that the administration of i.v.Ig did not influence the development or severity of VOD after bone marrow transplantation.
Integrated surveillance of infectious multi-source diseases using a combination of epidemiology, ecology, genetics and evolution can provide a valuable risk-based approach for the control of ...important human pathogens. This includes a better understanding of transmission routes and the impact of human activities on the emergence of zoonoses. Until recently New Zealand had extraordinarily high and increasing rates of notified human campylobacteriosis, and our limited understanding of the source of these infections was hindering efforts to control this disease. Genetic and epidemiological modeling of a 3-year dataset comprising multilocus sequence typed isolates from human clinical cases, coupled with concurrent data on food and environmental sources, enabled us to estimate the relative importance of different sources of human disease. Our studies provided evidence that poultry was the leading cause of human campylobacteriosis in New Zealand, causing an estimated 58–76% of cases with widely varying contributions by individual poultry suppliers. These findings influenced national policy and, after the implementation of poultry industry-specific interventions, a dramatic decline in human notified cases was observed in 2008. The comparative-modeling and molecular sentinel surveillance approach proposed in this study provides new opportunities for the management of zoonotic diseases.
PDF
