Multiple branch retinal artery occlusions following the new facial cosmetic filler (Poly-D, L-lactic Acid) injection a case report.

BACKGROUND: Poly-D, L-lactic acid is (PDLLA) a new cosmetic filler. We reported the first case of PDLLA-related devastating complication of multiple branch retinal artery occlusion (BRAO). CASE PRESENTATION: A 23-year-old female had sudden blindness after injection of PDLLA at the glabella. After emergency intraocular pressure-lowering medicine, ocular massage, steroid pulse therapy, heparin and alprostadil infusion, and subsequent treatments including acupuncture and 40 sessions of hyperbaric oxygen therapy, her best-corrected visual acuity improved from hand motion at 30 cm to 0.3 within 2 months. CONCLUSION: Although safety of PDLLA was evaluated in animal studies and in 16,000 human cases, it could still cause rare but devastating retinal artery occlusion as in the present case. Proper and immediate therapies could still improve patient's vision and scotoma. Surgeons should keep in mind the possibility of iatrogenic filler-related retinal artery occlusion.

Chlorhexidine gel topical application ameliorates inflammatory bone loss in experimental periodontitis.

OBJECTIVES: This study aimed to evaluate the impact of chlorhexidine (CHX) gel on inflammation-induced periodontal tissue destruction, osteoclastogenesis, subgingival microbiota, and on the modulation of the RANKL/OPG as well as inflammatory mediators during bone remodeling in vivo. MATERIALS AND METHODS: Ligation- and LPS injection-induced experimental periodontitis were created to investigate the effect of topical application of CHX gel in vivo. Alveolar bone loss, osteoclast number and gingival inflammation was evaluated by micro-CT, histological, immunohistochemistry and biochemical analysis. The composition of the subgingival microbiota was characterized by 16S rRNA gene sequencing. RESULTS: Data shows significant decreases in the alveolar bone destruction in rats from ligation-plus-CHX gel group compared to ligation group. In addition, significant decreases in the number of osteoclasts on bone surface and the protein level of receptor activator of nuclear factor κB ligand (RANKL) in gingival tissue were observed in rats from ligation-plus-CHX gel group. Moreover, data shows significantly decreased inflammatory cell infiltration and decreased expression of cyclooxygenase (COX-2) and inducible NO synthase (iNOS) in gingival tissue from ligation-plus-CHX gel group versus ligation group. Assessment of the subgingival microbiota revealed changes in rats with CHX gel application treatment. CONCLUSION: HX gel presents protective effect on gingival tissue inflammation, osteoclastogenesis, RANKL/OPG expression, inflammatory mediators, and alveolar bone loss in vivo, which may have a translational impact on the adjunctive use in the management of inflammation-induced alveolar bone loss.

Elevated serum levels of T-cell immunoglobulin and mucin-domain containing molecule 3 in patients with systemic inflammation following COVID-19 vaccination.

BACKGROUND: ChAdOx1 nCoV-19 vaccine has been widely used. Some unexpected adverse effects such as the development of systemic hyper inflammation with multiorgan involvement after vaccination, in rare cases, have been reported. However, its pathogenesis remains unclear. METHODS: This study recruited two cases who suffered from systemic inflammation following ChAdOx1 nCoV-19 vaccine and two 30-year-old male volunteers without underlying disease who have received ChAdOx1 nCoV-19 vaccine as control group. Blood samples were collected from our patients and healthy subjects before and after treatment with anti-inflammatory agent such as glucocorticoid and tocilizumab. The immune profile from our patients and healthy controls were measured using a human XL cytokine Proteome Profiler array (ARY022b, R&D Systems). RESULTS: Biochemical parameters revealed leukocytosis with segmented neutrophil dominance and elevated serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate, and ferritin in these two patients. The cytokine array revealed that mean levels of T cell immunoglobulin and mucin-domain containing-3 (TIM-3) (3640.3 vs 1580.5 pixels per inch [ppi]), B-cell activating factor (BAFF) (3036.8 vs 1471.0 ppi), urokinase plasminogen activator surface receptor (uPAR) (1043.1 vs 516.8 ppi), Resistin (1783.7 vs 711.3 ppi), platelet-derived growth factor (PDGF)-AB/BB (1980.7 vs 939.7 ppi), macrophage inflammatory protein-3-beta (MIP-3ß) (911.9 vs 346.2 ppi), and interferon-inducible T-cell alpha chemoattractant (I-TAC) (1026.3 vs 419.7 ppi) were 2-fold higher in the patients than in normal subjects who received ChAdOx1 nCoV-19 vaccine. CONCLUSION: We demonstrated that systemic inflammation may occur in subjects who have received the ChAdOx1 nCoV-19 vaccination. Moreover, we proposed immune markers, which may be implicated in the pathogenesis of systemic inflammation following COVID-19 vaccination as potential diagnostic biomarkers.

Diabetic macular edema and proliferative diabetic retinopathy treated with anti-vascular endothelial growth factor under the reimbursement policy in Taiwan.

The purpose of this retrospective interventional case series is to compare the functional and anatomical outcomes in eyes with diabetic macular edema (DME) and proliferative diabetic retinopathy (PDR) treated intravitreally with aflibercept or ranibizumab under the Taiwan National Insurance Bureau reimbursement policy. 84 eyes were collected and all eyes were imaged with spectral-domain optical coherence tomography (SD-OCT), color fundus photographs (CFPs), and fluorescein angiography (FA). At 24 months after therapy initiation, the logMAR BCVA improved from 0.58 ± 0.33 to 0.47 ± 0.38 (p < 0.01), the CRT decreased from 423.92 ± 135.84 to 316.36 ± 90.02 (p < 0.01), and the number of microaneurysms decreased from 142.14 ± 57.23 to 75.32 ± 43.86 (p < 0.01). The mean injection count was 11.74 ± 5.44. There was no intergroup difference in logMAR BCVA (p = 0.96), CRT (p = 0.69), or injection count (p = 0.81). However, the mean number of microaneurysms was marginally reduced (p = 0.06) in eyes treated with aflibercept at the end of the follow-up, and the incidence rates of supplementary panretinal photocoagulation (PRP) (p = 0.04) and subthreshold micropulse laser (SMPL) therapy sessions (p = 0.01) were also reduced. Multivariate analysis revealed that only initial logMAR BCVA influenced the final VA improvements (odds ratio (OR) 0.49, 95% confidence interval (CI) 0.21 ~ 0.93, p < 0.01); in contrast, age (OR - 0.38, 95% CI - 6.97 ~ - 1.85, p < 0.01) and initial CRT (OR 0.56, 95% CI 0.34 ~ 0.84, p < 0.01) both influenced the final CRT reduction at 24 months. To sum up, both aflibercept and ranibizumab are effective in managing DME with PDR in terms of VA, CRT and MA count. Eyes receiving aflibercept required less supplementary PRP and SMPL treatment than those receiving ranibizumab. The initial VA influenced the final VA improvements at 24 months, while age and initial CRT were prognostic predictors of 24-month CRT reduction.

Management of complex retinal detachment from intraocular invasion of MIRAgel-a case report.

PURPOSE: To retrospectively report a case of complex retinal detachment secondary to an intraocular episcleral hydrogel explant (MIRAgel, MIRA Inc., Waltham, MA, USA) invasion. OBSERVATIONS: The severe vitreous inflammation, shifting nature of the subretinal fluid, and absence of proliferative vitreopathy 2 months following multiple surgeries for removal of fragmented MIRA gel in the present case made the diagnosis of complex retinal detachment. With the assistance of the fragmatome and Perfluorocarbon, the subretinal MIRA gel, and turbid, yellowish subretinal fluid were removed successfully. The retina was re-attached without recurrence. CONCLUSIONS AND IMPORTANCE: By using the pars plana ultrasonic fragmatome, the intraocular MIRAgel was able to be removed while maintaining the integrity of the retina and globe.

Bilateral corneal keloids after eyelid compression.

The purpose of this study is to present a case of bilateral corneal keloids after performing eyelid compression for half a year. This study was a retrospective case report. Visual acuity, as well as detailed high-resolution images of external eye photography, anterior segment optical coherence tomography (ASOCT), and topography were documented. Initially, the best-corrected visual acuities were 20/20 (OD) and 20/32 (OS). ASOCT revealed a characteristic irregular hyperplastic epithelium, a disrupted Bowman's layer, and an edematous stroma for both eyes. Topography exposed an irregular astigmatism of 2.1 diopters for the left eye, while the right eye had a relatively smooth surface. After 1 year of conservative treatment, the best-corrected visual acuity improved to 20/20 (OU), and astigmatism also decreased. Corneal keloid may be induced after long-term eyelid compression. ASOCT and topography are useful for detecting and monitoring disease progression. Conservative treatments are suggested as the first line of therapy, while the size, depth, and location of the lesions are tolerable.

Clinicomicrobiological profile, visual outcome and mortality of culture-proven endogenous endophthalmitis in Taiwan.

This is a retrospective study in consecutive cases with cultured-proven endogenous endophthalmitis (EE) treated at the largest tertiary medical center in middle Taiwan in the past 10 years. 83 eyes of 70 patients were enrolled. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days. The mean initial visual acuity (VA) in the logarithm of minimal angle of resolution (logMAR) was 1.63 ± 0.87. Type 2 diabetes mellitus was the most common predisposing medical illness (N = 53, 63.86%). The most common infectious sources were intra-abdominal abscess (N = 36, 43.37%), and the second most reason was urinary tract infection. The causative pathogen was Gram-negative predominant (N = 64, 77.11%). After aggressive treatment, 34.94% of eyes regain useful vision, and only six eyes underwent enucleation or evisceration. The binary multivariate logistic regression model revealed that female gender (95% CI 1.002-19.036, p = 0.05, OR 4.37), initial VA logMAR (95% CI 0.089-0.550, p = 0.01, OR 0.22), and more intravitreal injections (95% CI 0.368-0.927, p = 0.023, OR 0.58) were independent risk factors influencing final outcomes. Based on the results mentioned above, early diagnosis is recommended to gain better outcomes. The mean interval between systemic diseases to the diagnosis of EE was 8.84 ± 6.94 days in our sample population, clinicians should maintain a higher index of suspicion during this period when encountering patients with bacteremia or fungemia.

Environmental Barriers to Participation of Preschool Children with and without Physical Disabilities.

Environment plays a vital role in affecting participation of young children in home, school, and community. Knowledge of environmental barriers helps to develop solutions or strategies that enable participation. The study compared the environmental barriers perceived by parents of preschool children with physical disabilities (PD, n = 142) and with typical development (TD, n = 192) in Taiwan. Parents identified environmental barriers by structured interview using the Chinese version of the Child and Adolescent Scale of Environment (CASE-C). The CASE-C is an 18-item measure of the impact of problems with physical, social, and attitudinal environmental features. Differences between the PD and TD groups in the summary scores for the CASE-C and the percentages of parents who perceived a problem for each item were examined by the analysis of covariance (ANCOVA) and Chi-square test. Parents of children with PD more often identified barriers related to family resources and community programs or services, social attitudes, assistance and supports outside of home, physical design of home and community, transportation, and assistive devices or equipment. Greater impacts of barriers were also reported by parents of preschool children with PD. Our findings provide evidence of environmental barriers that inform practice and policies to modify the barriers and provide an accessible and inclusive environment for families with young children.

Comparison of core-needle biopsy and fine-needle aspiration in screening for thyroid malignancy: a systematic review and meta-analysis.

OBJECTIVE: Core-needle biopsy (C.N.B.) is a procedure that is usually performed after repeated non-diagnostic fine-needle aspiration (F.N.A.) or in combination with F.N.A. in the detection of thyroid malignancy. The purpose of this study was to: (1) compare the accuracy of C.N.B. and F.N.A. in the detection of thyroid malignancy; (2) evaluate the accuracy of C.N.B. in nodules with prior non-diagnostic F.N.A. METHODS: Meta-analysis was performed with Comprehensive Meta-Analysis statistical software, version 2.0. A bivariate approach of hierarchical summary R.O.C. was performed using R software. Study quality was assessed with the Cochrane Risk of Bias Tool. Publication bias analysis was performed by funnel plot and Egger's test analysis. RESULTS: The main results of our study are as follows. 1) Overall C.N.B. had fewer non-diagnostic results than F.N.A. (pooled O.R. = 4.93, 95% C.I.: 2.17-11.19). Pooled sensitivities and specificities of C.N.B. and F.N.A. did not differ significantly. (2) There was no significant difference in the rates of non-diagnostic results of first-line F.N.A. and C.N.B. (O.R. = 2.42, 95% C.I. 0.95-6.18). Pooled sensitivities and specificities did not differ significantly. C.N.B. yielded fewer non-diagnostic results compared to repeated F.N.A. (O.R. = 19.13, 95% C.I. 7.08-51.65) for thyroid cancers with prior non-diagnostic F.N.A. RESULTS: The A.U.C.s of the hierarchical summary R.O.C. (H.S.R.O.C.) were 0.669 for repeated F.N.A. and 0.984 for C.N.B. with separated confidence regions for sensitivity and false positive rate. CONCLUSION: C.N.B. has higher diagnostic accuracy than repeat F.N.A. for thyroid nodules with prior non-diagnostic F.N.A. RESULTS: There is no significant difference in the diagnostic performance of C.N.B. and F.N.A. as first-line diagnostic tools.