Pneumatic Vitreolysis using C3F8 Gas in Treatment Naive Patients with Vitreomacular Traction.

PURPOSE: Evaluation of the effectiveness of pneumatic vitreolysis in disrupting vitreomacular traction in our own cohort of patients. METHODOLOGY: Prospective follow-up of 21 eyes of 18 patients with focal VMT (adhesion width < 1500 µm) who underwent intravitreal injection of 0.3 ml of 100% perfluoropropane between January 2015 and December 2020. The patients were observed for 90 days. RESULTS: Release of VMT was achieved on the 28th day of observation in 15 out of 21 eyes (71.4%), and by the 90th day in 19 out of 21 eyes (90.5%). The average width of adhesion in our patients was 382 µm (±212 µm). Average best corrected visual acuity in our cohort was initially 0.77 (±0.21), after 28 days 0.74 (±0.30), and after 3 months 0.82 (±0.21). At the end of the follow-up period, we did not observe a statistically significant improvement in vision. Macular holes developed in two eyes, but spontaneously closed within 1 month of observation, and no more complications were observed in the cohort. CONCLUSION: Pneumatic vitreolysis by intravitreal injection of C3F8 gas is an effective and inexpensive option for the management of symptomatic vitreomacular traction. The incidence of serious adverse events in our follow-up was significantly lower than in recently published series. The method of management should be selected individually according to the parameters of adhesion, macular hole and associated ocular pathologies.

Nonadherence in inflammatory bowel disease: results of factor analysis.

BACKGROUND: The purpose of the study was to assess overall nonadherence to treatment among patients with Crohn's disease (CD) and ulcerative colitis (UC) in a single tertiary center. METHODS: A total of 177 patients were enrolled in this study (84 males, 93 females; 117 CD, 60 UC). Patients were interviewed about their nonadherent behavior and their answers were analyzed using factor analysis. Urine samples were collected from a subcohort of 47 patients treated by mesalamine to verify the presence of 5-ASA or its metabolites. RESULTS: Overall intentional nonadherence was reported by 38.9% of patients; 18.6% of the patients discontinued the treatment at least once. Intentional dose reduction was reported by 18% of patients; 14.7% of patients occasionally did not refill their medications on time. There were no differences in adherence between males and females, disease type, previous bowel surgery, or marital, smoking, and nonsmoking status. More than 38% of patients reported unintentional nonadherence. Factor analysis proved that nonadherence increased with a higher education level of the patients and decreased with older age. Adverse drug effects strongly contributed to nonadherence. Nonadherent patients were more likely to be chronically active or in relapse (tau = 0.212; P = 0.002). In the group of 47 patients whose urine was analyzed, 6 cases (12.7%) were negative for mesalamine or its metabolite. CONCLUSIONS: The overall intentional nonadherence with medical therapy is relatively high among IBD patients and should be taken into account when a patient's response to treatment is unsatisfactory. Therefore, problems of nonadherence should be discussed with all IBD patients.

Non-adherence to treatment in inflammatory bowel disease in Czech Republic.

OBJECTIVE: : To assess overall non-adherence to the treatment among patients with Crohn's disease (CD) and ulcerative colitis (UC). PATIENTS AND METHODS: : 396 inflammatory bowel disease (IBD) patients were enrolled in the study (200 males, 196 females, 210 CD, 186 UC) and fulfilled the questionnaire to assess their non-adherent behaviour during the treatment. The data was analysed using factor analysis. RESULTS: : Overall intentional non-adherence was reported by 32% of patients. A 12% of patients reported they at least once discontinued the treatment. Voluntary dose reducing was reported by 19% of patients. An 11% of patients occasionally non-refill the medication in time. There were no differences in intentional adherence between males and females, disease type, previous bowel surgery, marital, smoking and non-smoking statuses. A 42% of patients reported unintentional non-adherence. Factor analysis proved non-adherent patients are more likely to have a higher activity of the disease ( τ=0.109, p=0.008). CONCLUSIONS: : The overall intentional non-adherence is relatively high among IBD patients and a gastroenterologist's attention should be focused on it. Our results stimulate discussion how to improve education of the patients with inflammatory bowel disease and accent importance of the maintenance therapy to them.