Immunogenicity of Intradermal Versus Intramuscular BNT162b2 COVID-19 Booster Vaccine in Patients with Immune-Mediated Dermatologic Diseases: A Non-Inferiority Randomized Controlled Trial.

The intradermal route has emerged as a dose-sparing alternative during the coronavirus disease 2019 (COVID-19) pandemic. Despite its efficacy in healthy populations, its immunogenicity has not been tested in immune-mediated dermatologic disease (IMDD) patients. This assessor-blinded, randomized-controlled, non-inferiority trial recruited patients with two representative IMDDs (i.e., psoriasis and autoimmune bullous diseases) to vaccinate with fractionated-dose intradermal (fID) or standard intramuscular (sIM) BNT162b2 vaccines as a fourth booster dose under block randomization stratified by age, sex, and their skin diseases. Post-vaccination SARS-CoV-2-specific IgG and interferon-γ responses measured 4 and 12 weeks post-intervention were serological surrogates used for demonstrating treatment effects. Mean differences in log-normalized outcome estimates were calculated with multivariable linear regression adjusting for their baseline values, systemic immunosuppressants used, and prior COVID-19 vaccination history. The non-inferiority margin was set for fID to retain >80% immunogenicity of sIM. With 109 participants included, 53 received fID (all entered an intention-to-treat analysis). The fID demonstrated non-inferiority to sIM in humoral (mean outcome estimates of sIM: 3.3, ΔfID-sIM [mean, 95%CI]: -0.1, -0.3 to 0.0) and cellular (mean outcome estimates of sIM: 3.2, ΔfID-sIM [mean, 95%CI]: 0.1, -0.2 to 0.3) immunogenicity outcomes. Two psoriasis patients from the fID arm (3.8%) developed injection-site Koebner's phenomenon. Fewer fID recipients experienced post-vaccination fever (fID vs. sIM: 1.9% vs. 12.5%, p = 0.027). The overall incidence of disease flare-ups was low without a statistically significant difference between groups. The intradermal BNT162b2 vaccine is a viable booster option for IMDD patients troubled by post-vaccination fever; its role in mitigating the risk of flare-ups remains unclear.

Extemporaneous Preparation of 20 mg/mL Ganciclovir in Artificial Tears in Comparison with Sterile Water for Ophthalmic Administration: Formulation and Stability Study.

Ganciclovir is available as a lyophilized powder for reconstitution and is normally used to treat ophthalmic viral infections. The use of ganciclovir in artificial tears containing hydrocolloid polymers may prove beneficial to patients during drug application, by prolonging contact time and providing a moistening effect. Therefore, this study aimed to extemporaneously prepare 20 mg/mL ganciclovir in artificial tears and compare its stability with that of a similar concentration of ganciclovir in sterile water (SWI) for ophthalmic administration. First, a compatibility study of the drug with commercial artificial tears found that it was compatible with artificial tears containing sodium hyaluronate (HYA). Subsequently, ganciclovir/0.1% HYA (HYA0.1) and ganciclovir/SWI eyedrops (EDs) in low-density polyethylene (LDPE) eyedrop bottles packed in light-shielded zipper bags were evaluated for their stability at 5 ± 3 °C and 30 ± 2 °C. The results revealed that ganciclovir/SWI ED had good physicochemical and microbiological stability when stored at 5 ± 3 °C for 12 weeks and at 30 ± 2 °C for 8 weeks. Meanwhile, ganciclovir/HYA0.1 ED was stable for 8 weeks when kept at 5 ± 3 °C and at 30 ± 2 °C, but ganciclovir in 0.3% HYA ED could be stored at 5 ± 3 °C for 8 weeks. Nevertheless, particulate matter may need to be investigated using a suitable method to ensure the absence of invisible particles in these preparations. Of these results, ganciclovir/HYA artificial tears and SWI EDs show potential for use as home medications for the treatment of ophthalmic viral infections.

Modified Surgical Techniques for Managing Intraoperative Floppy Iris Syndrome.

Purpose. To report a modified surgical strategy in the management of intraoperative floppy iris syndrome-associated iris prolapse. Methods. Prolapsed iris is left as is and a new corneal incision near the original wound but at a different site is created. Depending on the location of the original incision and the surgeon's preference, this additional incision can be used as a new port for phacoemulsification tip or can be the new site for the iris to securely prolapse, allowing for the surgery to proceed safely. Results. We present 2 cases of iris prolapse and inadequate pupil dilation in patients with IFIS. Along with our modified technique, additional iris retractors were placed to increase the workspace for the phacoemulsification tip. The cataract surgery was performed successfully without further complications in both cases. Conclusion. This surgical technique could be an adjunct to allow the surgeons to expand the armamentarium for the management of IFIS-associated iris prolapse.

Pseudophakic angle-closure from a Soemmering ring.

BACKGROUND: Report of three patients with pseudophakic angle-closure from a Soemmering ring. Three mechanisms of the Soemmering ring induced pseudophakic angle-closure in three patients were demonstrated by meticulous anterior segment examination and ultrasound biomicroscopic (UBM) analysis. CASE PRESENTATION: In the first case, the Soemmering-capsule-IOL complex caused relative pupillary block similar to a phakic eye and was successfully treated with laser iridotomy alone. In the second case, an enlarged Soemmering ring provided posterior iris support in apposition to the anterior chamber angle. We performed a laser capsulotomy through the iridotomised hole. The last, a protruding Soemmering content causing absolute pupillary block became resolved after laser iridotomy and total Soemmering ring content removal. CONCLUSION: Angle-closure in pseudophakic eyes is uncommon. Several causes have been reported in the literatures including Soemmering ring. This is the first report on three different mechanisms of Soemmering ring related angle-closure in pseudophakic eyes. Ultrasound biomicroscopic analysis plays a crucial role as a diagnostic tool.

Anterior chamber contamination during phacoemulsification after povidone-iodine application.

OBJECTIVE: To determine the rate of anterior chamber contamination during phacoemulsification after applying 5% povidone-iodine prior to surgery. MATERIAL AND METHOD: One hundred eyes from 100 patients having phacoemulsification cataract surgery by a single surgeon at Ramathibodi Hospital between October 2010 and March 2011 were included in the present study. Povidone-iodine 5% solution eye drops were used in all patients at least three minutes before the operation. Anterior chamber fluid was aspirated at the end of the procedure for culture in chocolate agar RESULTS: Anterior chamber fluid cultures were positive in three eyes (Pseudomanas oryzihabitans in 1 eye, Klebsiella pneumoni in 1 eye, and yeast in 1 eye). These three patients had no exaggerated or prolonged postoperative intraocular inflammation compared to others. No patients in the present study developed endophthalmitis. CONCLUSION: Povidone-iodine 5% solution eye drops before operation may control microbial contamination during phacoemulsification.

Effects of intracameral triamcinolone and gentamicin injections following cataract surgery.

OBJECTIVE: Evaluate the anti-inflammatory efficacy of intracameral triamcinolone acetonide and gentamicin injections compared with topical dexamethasone and tobramycin combination eye drops in cataract surgery patients. MATERIAL AND METHOD: The present prospective study enrolled 60 patients scheduled to receive phacoemulsification surgery. After surgery, patients were randomized to receive either single intracameral injections of triamcinolone acetonide and gentamicin followed by topical tobramycin eye drops four times daily for one week (IC TA group, n=30), or topical dexamethasone-tobramycin combination eyedrops four times daily until no inflammation was seen (Topical group, n=30). Postoperative evaluations included grading of anterior chamber cells, log MAR best-corrected visual acuity (BCVA), intraocular pressure (IOP) and adverse effects. RESULTS: There was no significant difference between the treatment groups in anterior chamber cells at one day and one week after surgery (p = 0.50 and 0.328, respectively). However the anterior chamber cells were significantly less in the IC TA group than in the Topical group, one month postoperatively (p = 0.006). No significant between-group difference in mean BCVA or IOP was noted at any time point (p > 0.05). No adverse effects or endophthalmitis were observed. CONCLUSION: Intracameral injections of triamcinolone acetonide and gentamicin appear to be a promising treatment option for the control of post-operative inflammation following cataract surgery.

Choroidal effusion following continuous positive airway pressure treatment.

A 46-year-old man was diagnosed with obstructive sleep apnea and began using a nasal continuous positive airway pressure (CPAP) during sleep for a month. He presented with the complaint of a painful blurred vision in his left eye upon awakening two days earlier. His visual acuity was 20/25 both eyes. There was a mild anterior chamber reaction in the left eye. Fundus examination showed a localized choroidal effusion at the inferotemporal part of the left retina. The patient received topical 0.1% dexamethasone four times daily and temporarily discontinued the CPAP. By one week after treatment, the choroidal effusion was completely resolved

Effect of laser in situ keratomileusis on the corneal endothelium.

PURPOSE: To assess the effects of laser in situ keratomileusis (LASIK) on the corneal endothelium. METHODS: In a prospective study, preoperative and 12-month postoperative specular microscopy of the central corneal endothelium and corneal thickness assessment was done in 180 eyes of 105 patients (mean age 31.96 +/- 8.88 years; range 16 to 55 yr) who had LASIK to correct myopia. The central endothelium was analyzed for several parameters including cell density, coefficient of variation, and corneal thickness. Preoperative and postoperative data were compared. RESULTS: The mean preoperative endothelial cell density was 2,547.37 +/- 282.00 cells/mm2, mean coefficient of variation of cell size was 58.33 +/- 11.50%, and mean central corneal thickness was 558.90 +/- 28.42 microm. There was not a statistically significant change in mean endothelial cell density (2,508.24 +/- 289.57 cells/mm2) or mean coefficient of variation (58.61 +/- 9.89%) at 1 year after surgery (P >.05 ). Average endothelial cell loss was 1.54% at 1 year after surgery. Mean central corneal thickness at 12 months postoperatively was 493.24 +/- 52.55 microm (P<.01). CONCLUSION: LASIK did not appear to alter corneal endothelial cell density at 12 months postoperatively.