Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome.

BACKGROUND: To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. METHODS: All patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. RESULTS: This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5 months (range: 5-127 months). CONCLUSION: TE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health-reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.

Gender distribution of North American professional radiology society award recipients.

PURPOSE: Women remain underrepresented in radiology and there is a paucity of literature examining the recognition of their professional contributions to the discipline. The purpose of this study was to examine the gender distribution of award winners across all North American radiology societies. METHODS: The gender distribution of 1923 award recipients from 21 North American radiology societies between 1960 and 2021 was examined. Awards were divided into four categories: leadership, teaching, contribution to radiology, and promising new/young societal member. Primary outcome was the total proportion of awards received by gender. All data was compared to the gender distribution of working radiologists in North America. RESULTS: A total of 1923 award recipients were identified between 1960 and 2021. Seventy-nine percent of award recipients were men (n = 1527) and 21 % were women (n = 396). As of 1970, the proportion of women award recipients increased 0.55 % ± 0.07 % each year. The proportion of women receiving radiological awards after 2018 is equal to or surpassing the percentage of women radiologists. Women received 36.4 % of leadership, 33.6 % of promising new member, 30.1 % of teaching, and 14.4 % of lifetime contribution awards. CONCLUSIONS: In the last five years, the proportion of women receiving awards was equal to or greater than the proportion of women radiologists. Women received more leadership awards and fewer lifetime contributor awards compared to men.

Molecular genetic diagnostics for inherited retinal dystrophies in the clinical setting.

OBJECTIVE: To evaluate the success of diagnostic genetic testing in inherited retinal dystrophy (IRD) patients in the clinical setting. DESIGN: Retrospective cohort analysis. PARTICIPANTS: A total of 446 consecutive participants from diverse ethnic backgrounds living in western Canada. METHODS: Clinical information was collected from participants, including family history, and they underwent a full ophthalmic examination with chart review. Those with a suspected IRD were offered panel-based genetic testing of 351 genes between March 1, 2019, and February 28, 2022. The main outcome measure was effect of the genetic testing results on clinical diagnosis. RESULTS: Genetic testing established a conclusive molecular diagnosis in 249 of 446 cases (55.8%), a clearly negative result in 90 of 446 cases (20.1%), and an inconclusive diagnosis in 108 of 446 cases (24.2%). Conclusive disease-causing variants were identified in 69 genes, and the most commonly affected genes were ABCA4 (31 variants), USH2A (25 variants), and RPGR (19 variants). The inconclusive group included likely novel autosomal dominant variants or a pathogenic variant with a variant of uncertain significance in the same gene for a recessive phenotype. Notably, an inconclusive molecular genetic diagnosis was seen in as many as 47.3% of East Asian participants with an outer retinal dystrophy. CONCLUSIONS: This study represents the largest review of molecular genetic testing in IRDs in Canada. That negative or inconclusive results obtained in approximately 45% of cases demonstrates that there is an important need for new research into molecular genetic causes of IRDs. This is particularly true in addressing the problem of interpreting a variant of uncertain significance in ethnic minorities.

Management of hypertrophic scars in adults: A systematic review and meta-analysis.

Hypertrophic scars (HTS) are elevated scars which occur due to abnormalities in wound healing after injury and may be associated with pain, pruritus and functional impairment. Despite multiple available treatment options, there is no universal approach to treating HTS. We searched the Web of Science (Core Collection), MEDLINE and EMBASE databases. Title, abstract and full-text screening, along with data extraction, were performed in duplicate. Risk of bias was assessed using the Cochrane risk-of-bias tool. The Vancouver Scar Scale (VSS) scores and mean differences were used for meta-analysis. We screened 3800 abstracts and included 34 randomised controlled trials evaluating treatments for HTS in adults. Silicone and laser modalities improved VSS scores by 5.06 (95% CI: 6.78, 3.34) and 3.56 (95% CI: 5.58, 1.54), respectively. Intralesional triamcinolone combined with silicone or 5-fluorouracil was superior to intralesional triamcinolone monotherapy. Limitations of this study include exclusion of studies which did not utilise VSS, and pooling of studies based on common modalities. Further studies are needed to examine the efficacy of existing and emerging treatment modalities for HTS. Our study supports the treatment of HTS in adults with silicone gel or sheets, injected triamcinolone (preferably combined with 5-fluorouracil or silicone products), pulsed dye laser and fractionated CO2 laser.

Testicular torsion in children.

QUESTION: As a family physician caring for a large pediatric population, I evaluate numerous adolescents with testicular pain. Given the gravity of prognosis for late treatment of children with testicular torsion, what are best practices for its assessment and management? ANSWER: The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score has been developed and validated to identify children at risk of testicular torsion. If the TWIST score is 0 and clinical suspicion is low in the office setting, a referral to urology for urgent consultation is not needed. If the TWIST score is 1 or higher or if the clinical presentation suggests torsion, manual detorsion should be attempted and the patient should be urgently sent to the nearest emergency department.

Torsion testiculaire chez l'enfant.

QUESTION: En tant que médecin de famille qui soigne une population pédiatrique nombreuse, j'évalue plusieurs adolescents souffrant de douleurs testiculaires. Compte tenu de la gravité du pronostic d'un retard dans le traitement des enfants ayant une torsion testiculaire, quelles sont les pratiques exemplaires pour son évaluation et sa prise en charge? RÉPONSE: L'outil TWIST (Testicular Workup for Ischemia and Suspected Torsion) a été développé et validé pour identifier les enfants à risque d'une torsion testiculaire. Si le score TWIST est de 0 et que la suspicion clinique est faible au bureau du médecin, il n'est pas nécessaire de demander une consultation urgente en urologie. Si le score TWIST est de 1 ou plus, ou si la présentation clinique laisse présager une torsion, il faudrait tenter une détorsion manuelle, et le patient devrait être envoyé immédiatement au service d'urgence le plus proche.