Tafasitamab and lenalidomide in large B-cell lymphoma: real-world outcomes in a multicenter retrospective study.

ABSTRACT: In this real-world evaluation of tafasitamab-lenalidomide (TL) in relapsed or refractory LBCL, patients receiving TL had higher rates of comorbidities and high-risk disease characteristics, and substantially lower progression-free survival and overall survival, compared with the L-MIND registration clinical trial for TL.

Impact of profession and wards on moral distress in a community hospital.

BACKGROUND: Recently, a singular survey titled "Measure of Moral Distress-Healthcare Professionals," which addresses shortcomings of previous instruments, has been validated. AIM: To determine how moral distress affects nurses and physicians differently across the various wards of a community hospital. PARTICIPANT AND RESEARCH CONTEXT: We distributed a self-administered, validated survey titled "Measure of Moral Distress-Healthcare Professionals" to all nurses and physicians in the medical/surgical ward, telemetry ward, intensive care units, and emergency rooms of a community hospital. FINDINGS: A total of 101 surveys were included in the study. The mean Measure of Moral Distress-Healthcare Professionals score for all respondents was 143.0 (standard deviation = 79.8). The mean Measure of Moral Distress-Healthcare Professionals score was 1.75 greater for nurses than for physicians (92.5 vs 161.5, p < .001), and nurses were 2.52 times more likely to consider leaving their position due to moral distress (68% vs 27%). The mean Measure of Moral Distress-Healthcare Professionals score for moral distress was least prevalent in the medical/surgical ward (92.5, SD = 38.2) and highest in the telemetry ward (197.7, SD = 83.6). The intensive care unit ward had a mean Measure of Moral Distress-Healthcare Professionals score mildly greater than the emergency room. ETHICAL CONSIDERATIONS: No participant identifying information or information connecting a survey response to an individual was collected. This study was approved by the Raritan Bay Medical Center's Institutional Review Board. DISCUSSION: This study provides insight into the level of moral distress in the community hospital setting. Telemetry nurses experience significantly more than nurses in other wards. Telemetry nurses typically manage patients sicker than medical/surgical wards, however do not have the resources of the critical care units. This scenario presents challenges for telemetry nurses and may explain their elevated moral distress. CONCLUSION: In community hospitals, telemetry nurses experience a considerably greater amount of moral distress compared to their colleagues in other wards. As measured by the Measure of Moral Distress-Healthcare Professionals questionnaire, moral distress continues to be higher among nurses compared to physicians.

Cholecystitis Masquerading as Cardiac Chest Pain: A Case Report.

BACKGROUND Cope's sign is the association of bradycardia with symptoms of acute cholecystitis, which can occur due to a vagal cardiobiliary reflex. The clinical and electrocardiographic changes of bradycardia or complete heart block can mimic the presentation of acute coronary syndrome. This report highlights the unique possibility that bradycardia in patients with abdominal pain and gallstones can be due to this reflex. CASE REPORT A 46-year-old obese man with hyperlipidemia and gallstones presented with chest pain suggestive of cardiac ischemia. The initial electrocardiography (EKG) was normal, although the patient subsequently developed bradycardia and a 2nd-degree atrioventricular (AV) block. The results of further cardiothoracic investigations (including echocardiography and pharmacologic stress testing) were normal. An ultrasound of the abdomen revealed acute cholecystitis. After he underwent a laparoscopic cholecystectomy, the chest pain resolved completely, and the EKG reverted to its normal sinus rhythm. CONCLUSIONS Acute cholecystitis rarely presents with cardiac chest pain and EKG changes due to triggering of the vagal cardiobiliary reflex. Given this atypical presentation, patients often undergo invasive cardiac procedures in search of a nonexistent cardiac etiology coupled with the possibility of a missed diagnosis of cholecystitis. When clinicians consider a diagnosis of acute coronary syndrome in patients with bradycardia, T-wave inversion, and ST-segment elevation (especially in the inferior leads), they should add the possibility of intra-abdominal pathologies (including cholecystitis) in the differential diagnosis.

Blastic Plasmacytoid Dendritic Cell Neoplasm without Cutaneous Manifestation: A Case Report.

BACKGROUND As an uncommon malignancy with the highest prevalence in the elderly population, blastic plasmacytoid dendritic cell neoplasm or BPDCN is a hematologic disorder with unknown pathogenesis and devastating outcomes. This neoplasm usually manifests in the skin but can also involve the bone marrow, and less frequently the central nervous system (CNS). However, it does not exclude other organs and can even be associated with other malignancies. CASE REPORT Here, we discuss an interesting case of BPDCN in an 85-year-old man who mainly presented with dizziness and weakness. Physical examination revealed splenomegaly, laboratory tests showed pancytopenia, and peripheral blood smear depicted metamyelocytes. Further workup including bone marrow biopsy revealed atypical cells and flow cytometry disclosed 84% blasts positive for cluster of differentiation (CD) 4, CD53, and CD156 suggestive of BPDCN. Moreover, cerebrospinal fluid (CSF) studies came back positive for tumor plasmacytoid dendritic cells. The patient underwent chemotherapy with CHOP, mini-CHOP regimens, and venetoclax, as well as treatment for CNS involvement. He achieved remission, but unfortunately had a recurrence of the disease. Later he was admitted due to pneumonia with concomitant recurrent pulmonary effusions complicated by multiorgan dysfunction and subsequently died. CONCLUSIONS The diagnosis of BPDCN can be very challenging, and high clinical suspicion and intuition are required to reach the diagnosis, especially when patients do not present with cutaneous involvement. Concerning treatment options, novel therapies such as tagraxofusp, a CD123-directed cytotoxin, are emerging in the hope of decreasing the rate of mortality for this aggressive malignancy.

Trimetazidine reduces contrast-induced nephropathy in patients with renal insufficiency undergoing coronary angiography and angioplasty: A systematic review and meta-analysis (PRISMA).

OBJECTIVES: This systematic review and meta-analysis assesses the utility of trimetazidine (TMZ) to prevent contrast induced nephropathy (CIN) in patients with renal insufficiency undergoing coronary angiography and angioplasty. MATERIALS AND METHODS: This meta-analysis was formulated and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search of databases was conducted by 2 researchers independently for clinical trials, comparing hydration plus TMZ vs conventional hydration alone for prevention of CIN through January 2020. All patients had renal insufficiency (defined as GFR < 89 ml/minute/1.73 m2) and the outcome of interest was the incidence of contrast induced acute kidney injury. The odds ratio (OR) was estimated with 95% confidence interval (CI). Heterogeneity was reported with the I2 statistic, using a fixed-effects model, and >50% of I2 was considered to be statistically significant. RESULTS: Eleven studies, 1611 patients, met the inclusion/exclusion criteria: 797 patients comprised the TMZ plus hydration group and the remaining 814 patients comprised the control (hydration only) group. Heterogeneity was low I2 = 0%, P = .84, and the heterogeneity of each study was also low. The incidence of CIN in the TMZ plus hydration group was 6.6% (53/797), while the incidence of CIN in the control (hydration only) group was 20% (165/814). Pooled analysis of all studies showed TMZ reduced incidence of CIN compared to saline hydration alone (OR risk 0.30, 95% CI 0.21, 0.42, P < .0001). CONCLUSION: TMZ added to hydration reduces CIN in renal insufficiency patients undergoing coronary angiography.

Presentation of Diffuse Large B-Cell Lymphoma with Shoulder Pain: A Case Report.

BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a type of aggressive lymphoid malignancy, which can present with an array of clinical features. DLBCL is notorious for having the highest rate of mortality in the developed areas of the world among the non-Hodgkin lymphomas (NHL). Although lymph node involvement is most commonly encountered, extranodal occurrence is also seen in up to 30% of the cases with involvement of structures such as the skin, lung, gastrointestinal tract, and musculoskeletal tissues. In view of the high mortality, especially in patients with delayed diagnoses, recognizing symptoms of this disease is vital for timely diagnosis and successful treatment. CASE REPORT We present the case of a 31-year-old white man with isolated shoulder pain. After the most common causes of shoulder pain were investigated and ruled out, further evaluation with an X-Ray, magnetic resonance imaging (MRI) scan, and biopsy revealed that B-cell lymphoma was the unlikely source of the pain. The patient received appropriate chemotherapy and achieved remission, as confirmed by a positron emission tomography scan. CONCLUSIONS This case highlights the uncommon clinical presentation of DLBCL with isolated shoulder pain. With primary bone DLBCL accounting for less than 2% of bone malignancies involving structures such as the femur, humerus, vertebra, and pelvis, this case reiterates the importance of further investigations and the possibility that bone pain may be the only clinical presentation of an underlying lymphoma. Examination by X-ray, MRI, and bone biopsy should be done to confirm diagnosis, followed by treatment with combined chemotherapy and immunotherapy.

The Clinical Challenges of Diagnosing Acutely Decompensating Amyloidosis.

Advanced amyloidosis and related multi-organ manifestations are devastating clinical scenarios. Because ambiguous presentation of amyloidosis may occur, early diagnosis and prevention of organ damage, such as cardiac injury, is essential and requires high clinical intuition. Our patient was a middle-aged female with a past medical history of heart failure with several decompensation episodes who presented with jaundice, itchiness, and weight loss. Further workup revealed pulmonary hypertension, restrictive heart disease, possible underlying obstructive liver disorder, and hyperkalemia. During admission, the patient established bradycardia and required a pacemaker temporarily, and later she manifested atrial fibrillation. Liver biopsy primarily was suggestive of hepatic congestion. Unfortunately, the patient died during workup due to cardiac arrest. Premortem laboratory results were suggestive of amyloidosis, which was confirmed later by re-examining the liver biopsy with Congo red. Diagnosis of amyloidosis requires early clinical suspicion and workup to prevent its progression to fatal organ involvement such as cardiac complications.

Manifestation of Pleomorphic Undifferentiated Aortic Sarcoma with Splenic Infarction: A Case Report.

Aortic spindle cell sarcoma is a rare neoplasm with poor prognosis that is often found incidentally due to its adverse effects. CT and MRI with contrast are useful imaging modalities, but a tissue biopsy is the gold standard for diagnosis. Tumor resection is the ultimate treatment followed by chemotherapy. Our case was an adult female who presented mainly for shortness of breath, and further imaging workup demonstrated a soft tumor juxtaposed to a major vein with compressive effect. The patient's tumor was resected, and the pathology result confirmed undifferentiated aortic sarcoma. The patient's condition improved and she was discharged with outpatient oncology follow-up and possible treatment.

Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection: A case report.

RATIONALE: Infection with the severe acute respiratory coronavirus disease 2019 (COVID-19) has been shown to cause multi-organ involvement including cardiopulmonary serosal layers infection and inflammation. As a result, pericarditis and pericardial effusion may occur with or without COVID-19 related respiratory signs. Due to limitations in sensitivity and specificity of current COVID-19 diagnostic studies, cases that trigger high clinical intuition, even with negative serologic and polymerase chain reaction testing results, may necessitate further diagnostic workup to discover the underlying etiology. PATIENT CONCERNS: Here we present a rare case of pericardial effusion in the setting of asymptomatic COVID-19 infection manifesting with the chief complaint of chest pain. DIAGNOSIS: While undergoing diagnostic workup, the patients first 2 sets of COVID 19 reverse transcription-polymerase chain reaction (RT-PCR) were negative while a latter RT-PCR test, as well as serology, were positive, leading to the diagnosis of COVID-19 reinfection or subacute presentation of viral infection with pericardial effusion. Echocardiogram depicted large circumferential pericardial effusion with mildly thickened pericardium. INTERVENTIONS: The patient underwent pericardial window placement followed by ibuprofen administration and discharged from the hospital. OUTCOMES: During the follow-up visit patient had no symptoms and echocardiogram demonstrated complete resolution of the effusion. LESSONS: Due to the possible establishment of pericardial effusions and consecutively tamponade even without any COVID-19 related clinical presentation, it is crucial for clinicians to trust their intuition, conduct the appropriate diagnostic tests, find the underlying diagnosis and prevent the devastating consequences.

Spontaneous Recurrent Pneumoperitoneum due to Opioid-Induced Constipation: A Case Report.

Long-term treatment with or addiction to methadone and other opiates can lead to serious complications such as opioid-induced constipation (OIC). Here we report a case where a long-term opioid user presents in the ER in respiratory distress. Radiographic findings concerning pneumoperitoneum and cooperation with specialists lead to a diagnosis of stercoral colitis with possible micro-perforations. Through fecal disimpaction and counseling on chronic opioid use, the patient initially improved, but consecutively had a fatal outcome.

Unilateral Purple Urine Bag Syndrome in an Elderly Man with Nephrostomy.

Purple urine bag syndrome, or PUBS, is a manifestation of a complicated urinary tract infection. Organisms such as Escherichia coli (E. coli) and Enterococcus can reside in urinary catheters and exhibit the purple color detected in this phenomenon. Risk factors described for this syndrome include the use of plastic urinary catheterization, the malfunctioning of the catheter, and long-term institutionalization. This disorder could be the earliest presentation of a urinary catheter flaw and requires immediate intervention and revision. In our case, a male resident of nursing home presented with urosepsis and appropriate antibiotics were initiated. Computed tomography (CT) urogram was done and showed left kidney hydronephrosis and bilateral staghorn calculi. To address the source of infection, a nephroureteral drain was placed in both kidneys. A few days after the initiation of treatment and urological intervention, urine on the left side became purple. The urologist re-evaluated the nephroureteral drainage tubes and replaced them. The purple color in the urine resolved later. In our case, PUBS was the earliest sign of urinary drainage malfunctioning and required early intervention and treatment.

Primary Pyomyositis: Contact Sports as the Rare Risk Factors.

Primary pyomyositis is an infectious disorder that mostly involves children and adults. Direct injury to the muscle or any traumatic process that can cause bacteremia has been described as the common risk factor. Contact sports without direct contusion or injury to the muscle is an uncommon culprit for the manifestation of this disease. In our case, a young male athlete presented to the emergency room with vague signs and symptoms including right leg muscle pain and fever. He denied any direct injury or contusion of the muscle. CT scan was done and showed edematous gluteus minimus muscle. MRI as one of the best tools for investigating soft tissues was done and exhibited myositis. Blood culture became positive for the methicillin-susceptible Staphylococcus aureus. Appropriate antibiotics were started, and the patient condition was improved. Considering prominent risk factors, early diagnosis and treatment of pyomyositis are major key factors for the management of these infectious conditions as it may cause loss of the limb or even result in mortality.

Comparison between pars plana and anterior endoscopic cyclophotocoagulation for the treatment of glaucoma.

IMPORTANCE: This is the first study to compare the efficacy and safety of endocyclophotocoagulation (ECP) via pars plana (ECP-plus) with ECP via limbus (anterior ECP) for treating glaucoma. BACKGROUND: There is no direct comparison of treatment outcomes between ECP-plus and anterior ECP. DESIGN: Retrospective study. PARTICIPANTS: Fifty-four consecutive patients. METHODS: Fifty-eight eyes from 54 consecutive patients underwent anterior ECP (33 eyes) or ECP-plus (25 eyes) with 2-year follow-up. Linear mixed model was used to analyse the surgical outcomes. MAIN OUTCOME MEASURES: Intraocular Pressure (IOP) was the primary outcome. Secondary outcomes were best-corrected visual acuity, number of glaucoma medications, complications and success rate. RESULTS: Compared to anterior ECP, patients in the ECP-plus group had lower IOP (estimate of effect size [EES] = -3.7 mmHg, P = 0.023) and used fewer number of glaucoma medications (EES = -1.11, P = 0.003), after adjusting for degrees of treatment, preoperative IOP, and presence of combined ECP and phacoemulsification procedure. Patients with ECP-plus achieved a higher success rate at 2 years postoperatively (80% vs 33.3%, P < 0.001). The decrease in IOP between the preoperative and last follow-up visit was greater in the ECP-plus group compared to the anterior ECP group (14.3 mmHg (52%) vs 5.2 mmHg (24%), P = 0.001). There was no significant difference in complication rates between the two groups (28% vs 33%, P = 0.561). CONCLUSIONS AND RELEVANCE: Anterior ECP and ECP-plus have a similar safety profile, and ECP-plus may offer superior IOP control for the management of glaucoma.

Central Corneal Thickness Variances Among Different Asian Ethnicities in Glaucoma and Nonglaucoma Patients.

OBJECTIVE: To compare the central corneal thickness (CCT) between different ethnicities and particularly Asian subethnic groups that may contribute to the different glaucoma diagnoses using the optical low-coherence reflectometry technique. METHODS: A retrospective study of 6 years including 1512 eyes of 929 patients of the Beckman vision center, University of California, San Francisco from 2011 to 2017 had their biometric parameters, including CCT, measured with the Lenstar. Patients were categorized into African Americans, Caucasians, Hispanics, Pacific Islanders, and Asians. Asians were further subcategorized into Chinese, Vietnamese, Koreans, Filipinos, and Japanese. RESULTS: Among 1356 patients who had their CCT measured by Lenstar from 2011 to 2017, 1512 eyes of 929 patients were included. The study population included 462 Caucasians (52.96%), 60 African Americans (6.46%), 92 Hispanics (9.9%), 32 Pacific Islanders (3.44%), 130 Chinese (13.99%), 52 Filipinos (5.6%), 37 Vietnamese (3.98%), 34 Koreans (3.66%), and 30 Japanese (3.23%). African Americans had the thinnest CCT with a mean of 518.62±40.3 followed by Asians with a mean of 539.29±34.1. Among the Asian study sample, the Chinese had the thinnest CCT with a mean of 537.66±32.5. CCT was adjusted for age, sex, glaucoma diagnosis, diabetes status, and prostaglandin analogs use for >12 months. CONCLUSIONS: Optical low-coherence reflectometry is a widely used technology, which can measure CCT. Our study confirms that African Americans have the thinnest corneas followed by Asians. In the latter group, relatively thin CCT may partly explain their high rates of normal-tension glaucoma.

Glaucoma severity and intraocular pressure reduction after cataract surgery in eyes with medically controlled glaucoma.

To investigate the relationship between glaucoma severity and intraocular pressure (IOP) reduction after cataract surgery in patients with medically controlled primary open-angle glaucoma (POAG).Retrospective case series.This study included glaucoma suspects (GS) and POAG patients who underwent cataract surgery and continued to use the same glaucoma medications during the postoperative period of 4 months. The main outcomes were percent and absolute IOP changes calculated using the preoperative IOP and the postoperative IOP at 3 months. Preoperative glaucoma medications, preoperative IOP, demographic information, biometric parameters and variables for glaucoma severity were evaluated as potential predictors of IOP change.The average IOP reduction was 3.3 ±â€Š2.4 mmHg (20.0%) and 2.2 ±â€Š2.5 mmHg (13.1%) from the preoperative mean of 16.0 ±â€Š2.9 mmHg and 15.2 ±â€Š3.3 mmHg in the GS and POAG groups, respectively. Preoperative IOP, preoperative IOP/anterior chamber depth (preoperative IOP/ACD [PD ratio]) and preoperative IOP/retinal nerve fiber layer (RNFL) thickness (preoperative IOP/RNFL [PNFL ratio]) and preoperative IOP score x MD score x number of glaucoma medications (glaucoma index) predicted absolute IOP change in the POAG group, whereas preoperative IOP, PD ratio, PNFL ratio, and axial length (AL) did in the GS group. Preoperative IOP, PD ratio, and PNFL ratio predicted %IOP change in the POAG group, whereas only AL did in the GS group.In medically controlled POAG eyes, structural or functional parameters for glaucoma severity did not independently predict IOP change following phacoemulsification. However, novel severity indices obtained by addition of preoperative IOP and/or glaucoma medications to the structural or functional parameter predicted IOP changes.

Differences in Optic Nerve Head, Retinal Nerve Fiber Layer, and Ganglion Cell Complex Parameters Between Caucasian and Chinese Subjects.

PURPOSE: To compare optic nerve head, peripapillary retinal nerve fiber layer (pRNFL), and ganglion cell complex (GCC) parameters between Caucasian and ethnic Chinese. MATERIALS AND METHODS: Normal subjects above 40 years old and self-identified as being Caucasian and Chinese were recruited. They were evaluated with spectral-domain optical coherence tomography (RTVue-100). Parameters related to the optic nerve head, pRNFL, and GCC analysis protocols were acquired. Multivariable linear regression was performed adjusting for potential confounders. RESULTS: Data from 116 Caucasian and 130 Chinese subjects were available for analysis. Mean age of all participants was 66.72 (SD 10.82) years. There were statistically significant differences for disc area (DA), area cup-to-disc, vertical cup-to-disc, and cup volume (P=0.02, 0.004, 0.02, and 0.03, respectively), greater in Chinese. After adjusting for age, sex, axial length (AL), intraocular pressure (IOP), DA, and GCC thickness, Chinese subjects had significantly greater thickness in all pRNFL parameters (mean differences ranged between 4.29 and 9.93 µm; all P<0.001) except the nasal quadrant. GCC outcomes were also adjusted for DA and pRNFL; Caucasians had significantly higher average GCC and inferior GCC (mean difference 2.97 and 3.45 µm, respectively; P<0.01), whereas the Chinese group had significantly higher ganglion cell global loss volume (mean difference 2.47 %, P<0.001). CONCLUSIONS: This study suggests there is significantly greater pRNFL thickness in Chinese, which were independent of age, AL, IOP, and DA, and possibly greater GCC in Caucasians after adjustment for age, AL, IOP, DA, and pRNFL thickness.

Outcome of Micropulse Laser Transscleral Cyclophotocoagulation on Pediatric Versus Adult Glaucoma Patients.

PURPOSE: To study and compare the outcome of micropulse transscelral cyclophotocoagulation in pediatric glaucoma patients to that in adult glaucoma patients. METHODS: Consecutive pediatric and adult patients who received micropulse transscelral cyclophotocoagulation between July 2015 and December 2016 at University of California, San Francisco were retrospectively analyzed. All cases had at least 12 months of follow-up. RESULTS: Nine eyes from 9 pediatric patients and 27 eyes from 25 adult patients were included. The sample size in pediatric group is small because MP-TCP was not offered to pediatric patients after unsatisfactory results in initial cases. Preoperatively, the mean intraocular pressure (IOP) was 28.41±8.32 mm Hg in adult patients and 34.28±9.92 mm Hg in pediatric patients. Postoperatively, the mean IOP in adult patients significantly decreased at all follow-up points (P<0.001). In pediatric patients, the mean IOP decreased to 20.44±13.41 mm Hg at 1 month (P=0.021), 23.56±10.10 mm Hg at 3 months (P=0.093), 23.00±8.31 mm Hg (P=0.018) at 6 months, and 27.20±15.68 mm Hg (P=0.15) at 12 months. No significant complications were noted in either group. The success rate in adults was 72.22% versus 22.22% in pediatric patients at 12 months (P=0.02). Seven of 9 pediatric patients required reoperation during the 12 months of follow-up. CONCLUSIONS: Micropulse transscelral cyclophotocoagulation is a safe procedure for pediatric as well as adult glaucoma patients. Its effect seems to be short lived in pediatric patients and the rate of reoperation was high.

Ethnic differences in lens parameters measured by ocular biometry in a cataract surgery population.

PURPOSE: To investigate whether differences exist in lens position and other lens parameters among major ethnic groups with cataractous eyes, which may help explain racial differences in angle closure risk. METHODS: This retrospective, cross-sectional study included 807 adult patients who had cataract surgery between years 2014 and 2016 at the University of California, San Francisco (UCSF). Adult patients of white, Asian, Hispanic and African-American ethnicity were included. Lens position (LP), defined as anterior chamber depth (ACD) + 1/2 lens thickness (LT), was assessed using measurements from optical biometry. Other assessed biometric parameters included axial length (AL), relative lens position (RLP) (defined as LP/AL), and anterior chamber depth (ACD). RESULTS: A total of 807 patients and 1361 eyes were included in this study from a database of patients having cataract surgery. Mean age was 69.2 years (age range from 18 to 101 years old), and 60.3% of patients were women. The mean LP measurements were 5.54±0.32 mm for white, 5.38±0.32 mm for Asian, 5.32±0.30 mm for Hispanic, and 5.40±0.28 mm for African-American participants. After adjusting for age, sex, and AL, significant differences were found when comparing LP in paired comparisons among White cohort with Asians (P<0.001), Hispanics (P<0.001) and African-Americans (P = 0.003). Additionally, when comparing RLP, similar significant results were found when comparing Whites with Asians (P<0.001), Hispanics (P<0.001) and African-Americans (P = 0.002). Lastly, pair-wise comparison of LT between ethnic groups showed significant differences while comparing Asians with Whites (P = 0.001) and Asians with African-Americans (P<0.001). CONCLUSION: The results of this study suggest that the LP of Hispanic, Asian, and African-American patients are significantly smaller than that of White patients, and among all ethnic groups, Hispanics and after Asians have the smallest LP (P<0.001) and RLP (P<0.001). These findings may have implications for the relative risk of angle closure and the potential IOP response after cataract surgery among different ethnic groups.

A novel flexible microfluidic meshwork to reduce fibrosis in glaucoma surgery.

PURPOSE/RELEVANCE: Fibrosis and hence capsule formation around the glaucoma implants are the main reasons for glaucoma implant failure. To address these issues, we designed a microfluidic meshwork and tested its biocompatibility in a rabbit eye model. The amount of fibrosis elicited by the microfluidic meshwork was compared to the amount elicited by the plate of conventional glaucoma drainage device. METHODS: Six eyes from 3 New Zealand albino rabbits were randomized to receive either the novel microfluidic meshwork or a plate of Ahmed glaucoma valve model PF7 (AGV PF7). The flexible microfluidic implant was made from negative photoresist SU-8 by using micro-fabrication techniques. The overall size of the meshwork was 7 mm × 7 mm with a grid period of 100 µm. Both implants were placed in the subtenon space at the supratemporal quadrant in a standard fashion. There was no communication between the implants and the anterior chamber via a tube. All animal eyes were examined for signs of infection and implant erosion on days 1, 3, 7, and 14 and then monthly. Exenterations were performed in which the entire orbital contents were removed at 3 months. Histology slides of the implant and the surrounding tissues were prepared and stained with hematoxylin-eosin. Thickness of the fibrous capsules beneath the implants were measured and compared with paired student's t-test between the two groups. RESULTS: The gross histological sections showed that nearly no capsule formed around the microfluidic meshwork in contrast to the thick capsule formed around the plate of AGV PF7. Thickness of the fibrotic capsules beneath the AGV PF7 plate from the 3 rabbit eyes was 90µm, 82µm, and 95 µm, respectively. The thickness at the bottom of fibrotic capsules around the new microfluidic implant were 1µm, 2µm, and 1µm, respectively. The difference in thickness of capsule between the two groups was significant (P = 0.002). No complications were noticed in the 6 eyes, and both implants were tolerated well by all rabbits. CONCLUSION: The microfluidic meshwork elicited minimal fibrosis and capsule formation after 3-months implantation in a rabbit model. This provides promising evidence to aid in future development of a new glaucoma drainage implant that will elicit minimal scar formation and provide better long-term surgical outcomes.

An update on therapeutic modalities for the prevention of angle closure glaucoma.

PURPOSE OF REVIEW: Angle closure glaucoma is a prominent burden for the worldwide health system. Because this disorder is commonly asymptomatic, and can lead to irreversible blindness, the proper screening and early management of this disease can be critical. The definitions of angle closure and consequently its treatment guidelines have been dynamically modified and updated in the past decades. Surgical and laser techniques have been adapted to address the different mechanisms involved in the manifestation of the disease and properly prevent its progression in different stages. In this review, we will assess the most recent techniques and their indications in the prevention and management of angle closure disorders. RECENT FINDINGS: Recent trends in surgical and laser procedures in the management of angle closure glaucoma are often geared toward combination strategies, to target different mechanisms. Targeting the lens and the angle structures and adjacent tissues simultaneously may be a promising approach in both the prevention of further angle closure, modulating the pressure, and prevention of cataract progression. SUMMARY: Modifying your therapeutic modalities and thresholds for treatment based on updated angle closure disorder definitions and guidelines, as well as innovative screening techniques, may be beneficial to your patients, in regards to both prevention and reduction of disease progression.