Postintravitreal Injection Endophthalmitis: Incidence, Characteristics, Management, and Outcome.

Purpose: Postintravitreal injection (IVI) endophthalmitis is a rare but devastating complication. Herein, we report the incidence ,and clinical and microbiological characteristics, as well as the visual outcome, in IVIs endophthalmitis in two medical centers. Methods: All patients undergoing intravitreal injections between 1/2018 and 12/2019 in two large medical centers were analyzed for post-IVI endophthalmitis. Results: Of the total of 51,356 IVIs performed, 23 cases of post-IVI endophthalmitis were diagnosed, yielding an overall incidence of 0.045%. The median interval from IVI to symptoms onset was 2 days (IQR: 1-5). Cultures were positive in 56% of the cases (100% Gram-positive bacteria and 76% coagulase-negative staphylococcus). Parameters associated with higher culture-positive rates included samples taken during vitrectomy, WBC on vitreous smear, the number of IVIs in the 12 months prior to presentation, and the time interval from last IVI to diagnostic sampling. At 6- and 12-month follow-up, the median change in VA (logMAR) was -1.10 (IQR: (-1.32)-(-0.40)) and -1.02 (IQR: (-1.10)-(-0.30)), respectively. Younger age and better BCVA at presentation were associated with better VA outcome, while positive culture result and systemic steroids treatment were each associated with the worse visual outcome. We found no difference in visual outcomes between PPV and TAI as a primary procedure. Conclusion: Post-IVI endophthalmitis is a rare complication, and most patients do not regain their initial VA. Certain parameters (clinical, microbiological, and therapeutic) may help anticipate the outcome and guide decision making regarding diagnosis and treatment.

Qualification of non-pediatric ophthalmologists in examining children.

BACKGROUND: This study is aimed to evaluate the clinical approach of non-pediatric ophthalmologists, working in community-based clinics towards Pediatric Patients and their management including referral rates to Pediatric Ophthalmologists and Orthoptists. METHODS: an online survey was sent to all community ophthalmologists through national society and social media platforms. The questionnaire included questions regarding the responders' professional experience as well as regarding the responders' approach to children younger than 8 years, and the level of confidence in 4 main aspects of children's management and referral rates. RESULTS: 93 physicians working as general ophthalmologists completed the questionnaire. Most respondents have been in practice for over 10 years (64/93, 68.8%) and over two-thirds were also hospital affiliated (65/93, 69.1%). The responders estimated on average that 35.1 ± 29.6% of patients under 8 years of age are referred for a consult to a pediatric ophthalmologist The level of confidence of three aspects unique to Pediatric Ophthalmology; cycloplegic refraction, strabismus evaluation, and prescribing glasses were significantly lower (p < 0.01) than confidence in performing a basic eye exam. CONCLUSIONS: many Ophthalmologists do not feel fully capable or experienced to perform the appropriate tests for the pediatric population, especially during the critical timeframe, before 8 years of age. The very high rate of referrals stands in contradiction to the reported low rate of eye pathologies in the pediatric population. These findings suggest that more pediatric-specific training is needed to improve the physician's skills to perform a comprehensive evaluation of pediatric patients in order to reduce the referral burden.

Surfboard Related Orbital and Periocular Injury.

PURPOSE: The objective of this study is to present the complexity of surfboard related orbital and periocular injuries and to discuss the different prevention aspects of such injuries. METHODS: A retrospective review was performed on surfing related orbital and periocular injuries cases in a single tertiary medical center over a period of 10 years. RESULTS: Six patients at a mean age of 34 (range 20-50) years were evaluated. All were amateur surfers. Five patients had an orbital fracture, 3 had a full thickness eyelid laceration, 3 had lacrimal drainage system damage and 3 had intraocular findings related to trauma, but no perforation of the globe was observed. Two patients had complete optic nerve avulsion or transection, 1 of them had extraocular muscle transection. Five patients underwent surgery and 2 required an additional surgical intervention. At the end of follow-up, 3 patients had an unrepairable lacrimal drainage damage, 2 had a malposition of an eyelid, 2 eyes remained blind, 1 patient had a hypoglobus, and 1 had hypoesthesia in distribution of infraorbital nerve. CONCLUSIONS: Surfboard related orbital injuries may cause a severe orbital injury, which may debilitate and disable a previously active and healthy group of young people. Hence, protective gear wear should be more vigorously encouraged as already been done in other sports.

Short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy for failed Ahmed glaucoma valve.

AIM: To report short-term outcomes of mitomycin C-augmented excisional bleb revision with capsulectomy (ERC) after Ahmed glaucoma valve (AGV) failure. METHODS: Patients who underwent ERC procedures between January 2017 and December 2019 with a minimum follow-up of 6mo were evaluated retrospectively for indications of AGV and AGV implantation to ERC interval. The number of anti-glaucoma medications (AGMs), intraocular pressure (IOP) and best corrected visual acuity (BCVA) were recorded at baseline, 1, 7, 30, 90, and 180d. Intra- and postoperative complications were also recorded. Positive outcome was defined as IOP≤21 mm Hg with or without AGMs. RESULTS: Fourteen eyes [14 patients, median age 69.5y, interquartile range (IQR) 61.3-80] were included. Pseudoexfoliative glaucoma (n=5, 36%) was the most common form of glaucoma. The median AGV implantation to ERC interval was 8.8mo (IQR 3.91-43.67). At 6mo, the median number of AGMs decreased from 3.0 (IQR 3.0-4.0) to 2.0 (IQR 1.5-3), the median IOP decreased from 26 mm Hg (IQR 22-29) to 16.5 mm Hg (IQR 13.75-20) and there was no significant change in BCVA. The success rate at 6mo was 92.9%. The Kaplan-Meier cumulative probability of survival was 93%, 79%, 64%, and 64% at 1wk, and 1, 3, and 6mo, respectively. No intraoperative complications were identified. Postoperative complications were identified in 5 eyes (36%), which were resolved spontaneously during the first week following ERC. CONCLUSION: ERC has a high success rate for short-term management of AGV failure. A longer follow-up study is required to determine long-term cumulative failure rates.

The Hormone KL1: A Regulator of Breast Cancer Cell Metabolism.

BACKGROUND: Klotho is a transmembrane protein that can be shed and can act as a circulating hormone in three forms: soluble klotho (KL1 + KL2), KL1, and KL2. Klotho was discovered as a gene implicated in aging through inhibition of the IGF-I pathway. Our laboratory discovered the role of klotho as a tumor suppressor in breast cancer and other malignancies. Furthermore, we showed that the KL1 domain mediates this activity. Altered cancer cell metabolism is a hallmark of cancer and our lab demonstrated various effects of klotho on breast cancer cell metabolism. Thus, klotho inhibited glycolysis and activated adenosine monophosphate activating kinase (AMPK), an energy sensor pathway. Moreover, inhibition of AMPK reduced the tumor suppressor activity of klotho. OBJECTIVES: To assess the effect of KL1 on breast tumor cells metabolism, as KL1 possesses the tumor suppressor activity of klotho. METHODS: We used MCF-7 breast cancer cells treated with soluble or over-expressed KL1 and klotho. Glycolysis was assessed by measuring mRNA levels of key glycolytic enzymes using reverse transcription polymerase chain reaction and by measuring lactate and glucose levels in media. The AMPK pathway was studied by monitoring AMPK phosphorylation as well as its down-stream target, acetyl-CoA carboxylase, using western blotting. Wound healing assay was used to assess cell migration. RESULTS: KL1 treatment reduced glycolytic enzymes mRNA levels and the activity of hexokinase, similar to klotho treatment. Furthermore, KL1 reduced glucose uptake and decreased lactate production. KL1 elevated phosphorylated acetyl-CoA carboxylase and phosphorylated AMPK levels. Inhibition AMPK (using a mutant AMPK activator) stopped KL1 from inhibiting cell migration, suggesting AMPK underlies klotho's tumor suppressor activity. CONCLUSIONS: Our data indicate KL1 as a regulator of metabolic activity in breast cancer and suggest that metabolic alterations underlie KL1 tumor suppressor activities. Furthermore, as KL1 and klotho share a similar effect on cell metabolism, our results further support the central role KL1 domain plays in klotho's tumor suppressor activity.