Summary
Advances in scleral lens technology have resulted in a surge of practitioners wanting to offer this modality for patients with ocular surface diseases and, increasingly, normal refractive ...issues. The current literature consists primarily of case reports and case series, with few prospective clinical trials. This leaves significant gaps in our understanding of how these devices interact with the tissues of the ocular surface, and offers significant opportunity for further study. Areas of research interest which could deepen our knowledge of how and when to fit (or avoid) scleral lenses will be reviewed in this lecture.
Summary
An IRB approved, internet based, 19 question survey was administered via email to 4633 eye care providers. A total of 989 responses were collected representing a total of 84,735 patients. 723 ...responses from individuals living in 14 countries who had fit at least 5 patients with scleral lenses were analyzed. A summary of findings from this survey will include descriptions of lens characteristics, recommendations for wear time, disinfection systems, types of solutions used for insertion, demographic characteristics of fitters and incidence of complications.
Neural substrates of emotion dysregulation in adolescent suicide attempters remain unexamined.
We used functional magnetic resonance imaging to measure neural activity to neutral, mild or intense ...(i.e., 0%, 50% or 100% intensity) emotion face morphs in two separate emotion-processing runs (angry and happy) in three adolescent groups: (1) history of suicide attempt and depression (ATT, n=14) ; (2) history of depression alone (NAT, n=15) ; and (3) healthy controls (HC, n=15). Post-hoc analyses were conducted on interactions from 3 group x 3 condition (intensities) whole-brain analyses (p<0.05, corrected) for each emotion run.
To 50% intensity angry faces, ATT showed significantly greater activity than NAT in anterior cingulate gyral–dorsolateral prefrontal cortical attentional control circuitry, primary sensory and temporal cortices; and significantly greater activity than HC in the primary sensory cortex, while NAT had significantly lower activity than HC in the anterior cingulate gyrus and ventromedial prefrontal cortex. To neutral faces during the angry emotion processing run, ATT had significantly lower activity than NAT in the fusiform gyrus. ATT also showed significantly lower activity than HC to 100% intensity happy faces in the primary sensory cortex, and to neutral faces in the happy run in the anterior cingulate and left medial frontal gyri (all p<0.006,corrected). Psychophysiological interaction analyses revealed significantly reduced anterior cingulate gyral–insula functional connectivity to 50% intensity angry faces in ATT v. NAT or HC.
Elevated activity in attention control circuitry, and reduced anterior cingulate gyral–insula functional connectivity, to 50% intensity angry faces in ATT than other groups suggest that ATT may show inefficient recruitment of attentional control neural circuitry when regulating attention to mild intensity angry faces, which may represent a potential biological marker for suicide risk.
Purpose
Local anaesthesia (LA) has proven effective for inguinal hernia repair in developed countries. Hernias in low to middle income countries represent a different issue. The aim of this study was ...to analyse the feasibility of LA for African hernia repairs in a limited resource environment.
Methods
Data from patients who underwent herniorrhaphy under LA or spinal anaesthesia (SA) by the 6th and 7th Forward Surgical Team were prospectively collected. All of the patients benefited from a transversus abdominis plane (TAP) block for postoperative analgesia. Primary endpoints concerned the pain response and conversion to general anaesthesia. Secondary endpoints concerned the complication and recurrence rates. Predictors of LA failure were then identified.
Results
In all, 189 inguinal hernias were operated during the study period, and 119 patients fulfilled the inclusion criteria: 57 LA and 62 SA. Forty-eight percent of patients presented with inguinoscrotal hernias. Local anaesthesia led to more pain during surgery and necessitated more administration of analgesics but resulted in fewer micturition difficulties and better postoperative pain control. Conversion rates were not different. Inguinoscrotal hernia and a time interval <50 min between the TAP block and skin incision were predictors of LA failure. Forty-four patients were followed-up at one month. No recurrence was noted.
Conclusions
Local anaesthesia is a safe alternative to SA. Small or medium hernias can easily be performed under LA in rural centres, but inguinoscrotal hernias required an ultrasound-guided TAP block performed 50 min before surgery to achieve optimal analgesia, and should be managed only in centres equipped with ultrasonography.
Our study explores the feasibility of quantum computing in emission tomography reconstruction, addressing a noisy ill-conditioned inverse problem. In current clinical practice, this is typically ...solved by iterative methods minimizing a L2 norm. After reviewing quantum computing principles, we propose the use of a commercially available quantum annealer and employ corresponding hybrid solvers, which combine quantum and classical computing to handle more significant problems. We demonstrate how to frame image reconstruction as a combinatorial optimization problem suited for these quantum annealers and hybrid systems. Using a toy problem, we analyze reconstructions of binary and integer-valued images with respect to their image size and compare them to conventional methods. Additionally, we test our method’s performance under noise and data underdetermination. In summary, our method demonstrates competitive performance with traditional algorithms for binary images up to an image size of 32×32 on the toy problem, even under noisy and underdetermined conditions. However, scalability challenges emerge as image size and pixel bit range increase, restricting hybrid quantum computing as a practical tool for emission tomography reconstruction until significant advancements are made to address this issue.
Introduction
While phacoemulsification cataract extraction is generally highly effective and safe, patients with a history of uveitis are at higher risk for postoperative complications and often ...require a modified perioperative medication regimen. No data exists on risks of postoperative complications and persistent anterior uveitis (PAU) in patients with non-ocular autoimmune disease.
Methods
Medical records were reviewed of patients who underwent phacoemulsification cataract surgery with intraocular lens implantation between January 1, 2014 and December 31, 2019 at the University of Colorado Hospital (UCH) as part of a retrospective cohort study. Exclusion criteria included patient history of ocular inflammation and cataract surgery combined with another intraocular surgery. Patients were only included as having autoimmune disease if the diagnosis was confirmed by a relevant specialist at UCH. Patients with autoimmune disease were then stratified into systemic versus organ-specific autoimmune disease, and patients with systemic autoimmune disease were further stratified into immunosuppressed and not immunosuppressed at the time of cataract surgery. Patients with PAU were identified according to the Standardization of Uveitis Nomenclature Working Group. Data including sex, race/ethnicity, intraoperative cumulative dissipated energy (CDE), and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP) were obtained.
Results
A total of 422 eyes from 248 patients had confirmed autoimmune disease, compared to a control group of 10,201 eyes. The autoimmune and systemic autoimmune disease groups were not more likely to have postoperative complications or PAU compared to the control group. Immunosuppression status among the systemic autoimmune disease group was also not associated with postoperative complications or PAU.
Conclusion
Patients with non-ocular autoimmune disease do not appear to be at higher risk for postoperative complications, including worse BCVA or increased rates of IOP elevation and PAU, following phacoemulsification cataract surgery. These patients do not appear to require modification of the typical perioperative medication regimen.
Summary
Scleral lenses have become a popular early treatment choice for patients with keratoconus. In a recent SCOPE (Scleral Lenses in Current Ophthalmic Practice: an Evaluation) study group ...finding, 34% of practitioners, of 629 survey respondents, chose scleral lenses as their first treatment option for patients with corneal irregularity. Among all treatment choices for corneal irregularity, scleral lenses ranked second only to corneal rigid gas permeable lenses, from those responding. The SCOPE study group then polled a group of keratoconus patients wearing scleral lenses. Of 79 keratoconus patients reporting scleral lens wear in both eyes, 85% were somewhat or very satisfied with their vision. However, these patients also reported experiencing cloudy vision (59%), lens discomfort (67%), and difficulty with lens handling (63%) at some time over the previous two years.
Dry eye disease is characterized by loss of tear film stability. OC-01 (varenicline solution) is a small-molecule nicotinic acetylcholine receptor agonist administered as a nasal spray that ...stimulates tear production.
In MYSTIC (NCT03873246) patients aged ≥22 years with dry eye disease were randomized 1:1:1 to OC-01 0.03 mg, OC-01 0.06 mg, or vehicle (n = 41 per group), administered twice daily via intranasal spray, for 12 weeks (84 days). Primary efficacy endpoint was mean change from baseline in anesthetized Schirmer's test score (STS) in study eye at day (D) 84.
Patients receiving OC-01 0.03 and 0.06 mg had statistically significantly increased tear production at D84 versus vehicle; least squares mean changes from baseline in STS were 10.8 mm and 11.0 mm for OC-01 0.03 and 0.06 mg, respectively. A trend toward a higher proportion of patients experiencing ≥10-mm improvement in STS from baseline was observed with OC-01 0.03 mg (36.6%; p > 0.05), and was significant for OC-01 0.06 mg (48.8%; p = 0.024), versus vehicle (24.4%). Non-ocular treatment-emergent adverse events (TEAEs) were reported by 21 patients; the most common was sneezing (OC-01 0.03 mg, 2 4.9%; OC-01 0.06 mg, 3 7.3%), with similar frequencies between treatment groups. No severe or serious TEAEs were reported.
OC-01 (varenicline solution) nasal spray improved tear production in patients with dry eye disease over a long-term (12-week) period, and represents a receptor neuro-activator with a nasal route of administration that spares the ocular surface to stimulate tear production.
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