Methotrexate for chronic non-necrotizing anterior scleritis in Chinese patients.

AIM: To evaluate the effectiveness and corticosteroid-sparing capabilities of methotrexate (MTX) in the treatment of chronic non-necrotizing anterior scleritis in Chinese patients. METHODS: A retrospective chart review of all patients with active anterior scleritis between January 2015 and June 2019 was conducted. All patients received 10 to 15 mg/wk MTX orally, and corticosteroids (10 to 40 mg/d prednisolone or equivalent methylprednisolone) with slow tapering. Topical corticosteroid eye drops (1% prednisolone actate, 0.1% dexmathosone or 0.1% fluoromethalone) were applied to control comorbid anterior uveitis at presentation or during follow up. The main outcomes were inflammation control and corticosteroid-sparing success, and secondary outcomes were reduction of immunosuppression load and best-corrected visual acuity (BCVA). RESULTS: Thirty-two eyes (22 patients) were included. The proportion of patients who achieved corticosteroid-sparing success was 50.0% at 3mo and 77.3% at 12mo [8 (36.4%) patients discontinued corticosteroid]. The proportion of eyes that achieved inflammation control was 59.4% at 3mo and 78.1% at 12mo. The immunosuppression load was 5.14±0.87 at presentation and 2.76±2.34 at 12mo (P<0.01). BCVA maintained unchanged or improved in 29 (90.6%) of all affected eyes. One patient discontinued MTX treatment because of an abnormal liver function test, and no other serious adverse effects were observed. CONCLUSION: According to this pilot study, low dose MTX appear to be a well-tolerated and effective treatment for chronic non-necrotizing anterior scleritis patients in the Chinese population.

Efficacy and safety of non-penetrating glaucoma surgery with phacoemulsification versus non-penetrating glaucoma surgery: a Meta-analysis.

AIM: To compare the clinical efficacy and safety of non-penetrating glaucoma surgery (NPGS) plus phacoemulsification (Phaco-NPGS) and NPGS-alone. METHODS: We systematically searched various databases and reviewed studies that had evaluated the effects of Phaco-NPGS or NPGS-alone for patients with glaucoma. Primary outcomes included postoperative intraocular pressure (IOP) and the number of postoperative antiglaucoma medications. Secondary outcomes were the prevalence of complications, incidence of needling or goniopuncture, and surgical success rate. RESULTS: In total, 380 and 424 eyes in NPGS-alone and Phaco-NPGS groups respectively were included. Both postoperative IOP and number of medications were significantly lowered in the Phaco-NPGS group than that in the NPDS-alone group [weighted mean difference (WMD)=-1.12, 95% confidence interval (CI): -2.11 to -0.12, P=0.03; WMD=-0.31, 95%CI: -0.53 to -0.09, P=0.006]. Moreover, Phaco-NPGS had a significantly lower prevalence of complications and postoperative procedures compared to NPGS-alone, while no significant difference existed for surgical success. CONCLUSION: Phaco-NPGS superior to NPGS-alone in the reduction of IOP and medications. Phaco-NPGS can be recommended for glaucoma patients with coexisting cataracts owing to its superior efficacy, fewer complications, and postoperative procedures.

[Endophthalmitis Caused by Mixed Infections in Silicone Oil-filled Eye:One Case Report].

The incidence of endophthalmitis after vitrectomy is extremely low,especially lower in silicone oil-filled eyes.Silicone oil exerts a toxic effect on the cell membranes of microorganisms and leads to the lack of nutrients.It is thus believed to inhibit the growth of bacteria and fungi.Endophthalmitis induced by mixed bacteria in silicone oil-filled eye has been rarely reported.We reviewed the clinical manifestations,diagnosis,and treatment of a patient with endophthalmitis caused by mixed infection of Morganella morganii and Staphylococcus epidermidis in the silicone oil-filled eye,aiming to improve the understanding and diagnosis of mixed infections.

Subconjunctival injections of triamcinolone acetonide to treat uveitic macular edema.

AIM: To evaluate the efficacy and safety of subconjunctival triamcinolone acetonide (TA) injections for treating uveitic macular edema (UME). METHODS: This retrospective case series study included patients with UME who received subconjunctival TA injections with a minimum follow-up period of 6mo. The main outcome measure was central macular thickness (CMT). The secondary outcome measures included best-corrected visual acuity (BCVA), recurrence rate and intraocular pressure (IOP). RESULTS: In total, 65 patients (80 eyes), mainly including idiopathic uveitis in 33 patients (50.77%) and Vogt-Koyanagi-Harada (VKH) syndrome in 19 patients (29.23%), were enrolled in this study. The mean CMT decreased from 457.6±173.0 µm at baseline to 325.9±176.8, 302.7±148.2, 332.2±177.3 and 270.6±121.6 µm at 1-, 2-, 3- and 6-months postinjection, respectively (all P<0.001). BCVA increased from logMAR 0.5±0.3 at baseline to logMAR 0.4±0.3, 0.4±0.3, 0.4±0.4 and 0.4±0.3 at the 1-, 2-, 3- and 6-months postinjection visits, respectively (all P<0.001). Twenty-one (21/80, 26.25%) eyes underwent relapse of UME within 6mo. A total of 20/80 (25%) eyes exhibited elevated IOPs, of which 13 eyes were controlled with topical IOP-lowering agents and 7 eyes underwent surgical removal of subconjunctival TA deposit. CONCLUSION: Subconjunctival TA injections appear to be safe and effective for UME.

Treatment results of peritonectomy combined with perioperative chemotherapy for colorectal cancer-patients with peritoneal carcinomatosis.

Operation results of 81 colorecatal cancer-patients with peritoneal carcinomatosis (PC) treated with peritonectomy plus perioperative chemotherapy are reported. The patients who had the following evidences are considered to be eligible for peritonectomy: 1) No evidence of N3 lymph node involvement, 2) No evidence of hematogenous metastasis, 3) No progressive disease after preoperative chemotherapy, 4) No severe co-morbidities or no poor general condition. Complete cytoreduction resection is aimed for removing all macroscopic tumors by peritonectomy using electrosurgical techniques. The completeness of cytoreduction (CC scores) after peritonectomy is classified into the following 4 criteria: CC-0-no peritoneal seeding was exposed during the complete exploration, CC-1-residual tumor nodules are less than 2.5 mm in diameter, CC-2-nodules are between 2 .5 mm and 25 mm in diameter, CC-3-nodules are greater than 25 mm in diameter, CC-2 and CC-3 are regarded as incomplete cytoreduction. Operation time and blood loss were 237 ± 124 min. (799-90 min) and 1,598 ± 1,411 mL (6,500-20 mL), respectively. Postoperative complications developed in 37( 46%) patients. The patients received CC-0/ -1 resection survived significantly longer than those of CC-2/ -3 group. The patients with PCI ≤ 10 survived significantly longer than those with PCI≥ 11. CC and PCI scores are the independent prognostic factors. The relative risk for death of CC-2/-3 group was 4.6-fold higher than that of CC-0/ -1 group. Accordingly, peritonectomy is indicated for patients with PCI score≤ 10.