Long-term outcomes of prediction error after combined phacoemulsification and trabeculectomy in glaucoma patients.

BACKGROUND: To investigate long-term outcomes of prediction error after phacotrabeculectomy and to determine risk factors that may cause unstable prediction error after phacotrabeculectomy in glaucoma patients. METHODS: A total 120 eyes of 120 patients who had underwent uncomplicated phacotrabeculectomy (combined group) or phacoemulsification (phaco-only group) were included. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) were measured before and after surgery, and anterior segment parameters including anterior chamber depth (ACD), lens vault (LV), and anterior vault (AV) measured using anterior-segment optical coherence tomography were compared between the two groups. The mean absolute error (MAE) at 3, 6, 12, and 24 months postoperatively were compared. Risk factors associated with unstable prediction error (MAE ≥ 0.5) were investigated in the combined group. RESULTS: In both groups, BCVA was improved and IOP was decreased significantly. MAE at 3, 6, 12, 24 months postoperatively were not significantly different between two groups. The risk factors for unstable prediction error after 12 months of phacotrabeculectomy were old age and LV. Whereas, the only factor predicting unstable prediction error after 24 months of phacotrabeculectomy was LV. The cut-off value of LV for predicting unstable refractive error analyzed by the ROC curve was 0.855 mm. CONCLUSIONS: Phacotrabeculectomy may be an effective treatment with stable long-term outcomes of prediction error similar to phacoemulsification in patients with glaucoma. However, elderly patients or patients with large LV may be predisposed to unstable prediction error after phacotrabeculectomy.

Potential Role of Social Distancing in Mitigating Spread of Coronavirus Disease, South Korea.

In South Korea, the coronavirus disease outbreak peaked at the end of February and subsided in mid-March. We analyzed the likely roles of social distancing in reducing transmission. Our analysis indicated that although transmission might persist in some regions, epidemics can be suppressed with less extreme measures than those taken by China.

Early Results of Transcatheter Arterial Embolization for Relief of Chronic Shoulder or Elbow Pain Associated with Tendinopathy Refractory to Conservative Treatment.

PURPOSE: To evaluate the effectiveness and safety of transcatheter arterial embolization to relieve pain associated with shoulder and elbow tendinopathy refractory to conservative treatment. MATERIALS AND METHODS: This study included 13 patients (15 cases) who underwent embolization between November 2015 and December 2016 to treat chronic shoulder pain (6 with rotator-cuff tendinopathy, 2 with calcific tendinitis) or elbow pain (7 with lateral epicondylitis) refractory to conservative treatment. Microspheres were used in the first 4 cases, and imipenem/cilastatin sodium was used in the remaining 11. Visual analog scale (VAS) score changes were recorded. Decrease in VAS score and degree of enhancement on digital subtraction angiography were compared. RESULTS: The technical and clinical success rates were 100% (15/15) and 73% (11/15), respectively. The mean VAS scores at baseline, 1 day, 1 week, 1 month, and 4 months after embolization were 6.1, 5.8, 5.1, 4.3, and 2.5, respectively (P < .05 after 1 wk). Pain improved in 9 of 10 cases (90%) with "evident" enhancement and 3 of 5 cases (60%) with no evident enhancement. The VAS scores in the evident enhancement group decreased more than those in patients with no evident enhancement (4.5 vs 1.8; P < .05). Forearm cutaneous erythema was noted in 1 patient treated with microspheres. CONCLUSIONS: Transcatheter arterial embolization may be an option for relieving pain associated with chronic shoulder and elbow tendinopathy refractory to conservative treatment. The degree of angiographic enhancement might be a possible factor affecting the degree of pain relief after embolization.

Predicting the impact of COVID-19 non-pharmaceutical intervention on short- and medium-term dynamics of enterovirus D68 in the US.

Recent outbreaks of enterovirus D68 (EV-D68) infections, and their causal linkage with acute flaccid myelitis (AFM), continue to pose a serious public health concern. During 2020 and 2021, the dynamics of EV-D68 and other pathogens have been significantly perturbed by non-pharmaceutical interventions against COVID-19; this perturbation presents a powerful natural experiment for exploring the dynamics of these endemic infections. In this study, we analyzed publicly available data on EV-D68 infections, originally collected through the New Vaccine Surveillance Network, to predict their short- and long-term dynamics following the COVID-19 interventions. Although long-term predictions are sensitive to our assumptions about underlying dynamics and changes in contact rates during the NPI periods, the likelihood of a large outbreak in 2023 appears to be low. Comprehensive surveillance data are needed to accurately characterize future dynamics of EV-D68. The limited incidence of AFM cases in 2022, despite large EV-D68 outbreaks, poses further questions for the timing of the next AFM outbreaks.

The unmitigated profile of COVID-19 infectiousness.

Quantifying the temporal dynamics of infectiousness of individuals infected with SARS-CoV-2 is crucial for understanding the spread of COVID-19 and for evaluating the effectiveness of mitigation strategies. Many studies have estimated the infectiousness profile using observed serial intervals. However, statistical and epidemiological biases could lead to underestimation of the duration of infectiousness. We correct for these biases by curating data from the initial outbreak of the pandemic in China (when mitigation was minimal), and find that the infectiousness profile of the original strain is longer than previously thought. Sensitivity analysis shows our results are robust to model structure, assumed growth rate and potential observational biases. Although unmitigated transmission data is lacking for variants of concern (VOCs), previous analyses suggest that the alpha and delta variants have faster within-host kinetics, which we extrapolate to crude estimates of variant-specific unmitigated generation intervals. Knowing the unmitigated infectiousness profile of infected individuals can inform estimates of the effectiveness of isolation and quarantine measures. The framework presented here can help design better quarantine policies in early stages of future epidemics.

Comparison of the Intraocular Pressure-Lowering Effect and Safety of Preservative-Free And Preservative-Containing Brimonidine/Timolol Fixed-Combination Ophthalmic Solutions in Patients with Open-Angle Glaucoma.

Purpose: To compare the therapeutic efficacy and safety of newly developed preservative-free (PF) brimonidine/timolol fixed-combination (BTFC) ophthalmic solutions and a preservative-containing (PC) BTFC ophthalmic solution in patients with open-angle glaucoma.Methods: This study was conducted as a multicenter, randomized, open-label, parallel-group clinical trial to evaluate the efficacy and safety of PF BTFC as compared with PC BTFC in adult patients (aged ≥ 19 years) with open-angle glaucoma (OAG) and ocular hypertension (OHT). A total of the 106 patients were enrolled, with 53 patients each randomized to the two treatment groups and included in the analysis of the safety set (SS).After a washout period, patients with an IOP below 35 mmHg at 9 a.m. were enrolled. After a full ophthalmic and glaucoma examination, a total of 106 OAG and OHT patients were randomized to the PF group or PC group.All subjects were examined 4 and 12 weeks after first administration. At each follow-up visit, IOP was measured at 9 a.m. and 11 a.m. and the efficacy, safety, and compliance were evaluated. Throughout the study, all adverse events were recorded and monitored by the investigators.Results The mean IOP changes from baseline to 12 weeks at 11:00 a.m. were -3.45 ± 2.53 mmHg in the PF group and -3.65 ± 2.76 mmHg in the PC group (p < .0001 for both). The difference in mean IOP change between the two groups was 0.20 ± 2.65 mmHg, which was not significantly different. The proportion of patients with IOP reductions of ≥ 15% and ≥ 20% and IOP at all-time points in the PF group were not significantly different when compared with in the PC group. There were no specific differences between the two groups regarding the incidence of adverse events.Conclusions PF BTFC ophthalmic solution shows a similar efficacy and safety profile to that of PC BTFC.

Fluoroscopy-guided endovenous sclerotherapy using a microcatheter prior to endovenous laser ablation: comparison between liquid and foam sclerotherapy for varicose tributaries.

OBJECTIVE: To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. MATERIALS AND METHODS: From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. RESULTS: A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. CONCLUSION: Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.

Early results of endovenous ablation with a 980-nm diode laser for an incompetent vein of Giacomini.

OBJECTIVE: We wanted to evaluate the effectiveness of endovenous ablation of the incompetent vein of Giacomini using a 980-nm diode laser. MATERIALS AND METHODS: A total of 18 patients (18 limbs, 4%) had the incompetent vein of Giacomini. Retrograde reflux originating from the great saphenous vein was noted in sixteen limbs and paradoxical diastolic anterograde reflux from the saphenopopliteal junction was observed in two limbs. After tumescent anesthesia, laser ablation using a 980-nm wavelength laser fiber was performed under ultrasound and/or fluoroscopic guidance. Patients were evaluated clinically and with duplex ultrasound at one week and at one, three, six and twelve months after laser ablation for the technical and clinical success. RESULTS: In the 18 limbs, the technical success rate was 100%. Continued closure of the vein of Giacomini was seen in 18 of 18 limbs after one month, in 12 of 12 limbs after three and six months and in six of six limbs after twelve months. No recanalization of the vein and no major complications occurred. CONCLUSION: Endovenous laser ablation with a 980-nm wavelength is an effective and safe procedure for treating an incompetent vein of Giacomini.

Percutaneous sclerotherapy of lymphangiomas with acetic acid.

PURPOSE: To evaluate the efficacy of percutaneous image-guided sclerotherapy of lymphangiomas with use of acetic acid. MATERIALS AND METHODS: Twelve patients with lymphangiomas were treated with acetic acid as the sclerosant. There were eight male patients and four female patients, ranging in age from 1 to 29 years (mean, 11 years). The lymphangiomas were located at the neck (n = 5), upper extremity (n = 3), axilla (n = 1), cervicomediastinum (n = 1), anterior chest wall (n = 1), and retroperitoneum (n = 1). Two patients had recurrent lymphangiomas after surgery and two patients had undergone failed sclerotherapy with another sclerosant. The acetic acid used as the sclerosant was 40%-50% in concentration, and the amounts used ranged from 2 mL to 70 mL (mean, 11.3 mL), which was equivalent to 4.6%-50% (mean, 30.6%) of the aspirated lymphatics. All procedures were performed under ultrasonographic and fluoroscopic guidance. The sclerosant was removed after sclerotherapy. All patients except one underwent one treatment session. RESULTS: Complete resolution of the lymphangioma was achieved in eight patients (66.7%), good resolution (>50% reduction) was achieved in three (25.0%), and poor resolution (<50% reduction) was seen in one (8.3%). Complications encountered included pneumonitis adjacent to the lymphangioma (n = 1), pain (n = 2), hematuria (n = 1), and tingling sensation in the forearm (n = 1). CONCLUSION: Percutaneous sclerotherapy of the lymphangiomas with use of acetic acid is an effective method without serious complications.