Comparison of central topographic maps from a swept-source OCT biometer and a Placido disk-dual Scheimpflug tomographer.

PURPOSE: To compare central topography (CT) from IOLMaster 700 with predicate topographic (PT) maps from a Placido disk-dual Scheimpflug tomographer in detection of irregularities that would influence the decision-making for implanting premium intraocular lenses (IOLs) (toric, multifocal, or extended depth-of-focus). SETTING: Cullen Eye Institute, Baylor College of Medicine, Houston, Texas. DESIGN: Prospective comparative case series. METHODS: Eyes with various corneal conditions were randomly selected: regular/irregular corneas, previous corneal refractive surgery, and keratoconus or pellucid marginal degeneration. Three observers compared the CT and PT maps and answered a questionnaire for each eye. The questionnaire focused on (1) overall shape similarity between CT and PT and (2) decision-making for premium IOL implantation based on CT and PT. Answers to the questionnaire and agreement in answers among observers were evaluated. RESULTS: The study included 105 eyes. Comparing CT and PT, similar shape was observed in 68.6% to 89.5% of cases, and comparable map symmetries were reported in 60.0% to 83.8%; the same decision regarding premium IOL implantation was made in 75.2% to 97.1% of cases. There were significant interobserver agreements among 3 observers for all questions, with Fleiss κ values ranging from 0.141 to 0.450 (all P < .05). Peripheral corneal steeping or flattening was the primary finding that was visible on PT but not on CT. CONCLUSIONS: Compared with the PT, CT provided similar overall shape and comparable symmetries in most cases. The same decision was made whether to recommend a premium IOL based on CT and PT in 75% to 97% of cases.

Comparison of Intraocular Pressure, Usage of Topical Steroids, Need for Intraocular Pressure Lowering Drops, and Incidence of Glaucoma Surgery Up to 2 Years After Penetrating Keratoplasty and Endothelial Keratoplasty.

PRECIS: A retrospective review of 239 eyes comparing intraocular pressure (IOP), steroid needs, IOP-lowering drop needs, and incidence of glaucoma surgery between endothelial keratoplasty and penetrating keratoplasties (PKP) at multiple timepoints postoperatively up to 2 years. PURPOSE: The purpose of this study was to compare postoperative IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery between PKP, Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSEK). MATERIALS AND METHODS: A retrospective chart review of all PKP, DMEK, and DSEK surgeries was performed between July 1, 2012 and July 1, 2017 at the University of California, Irvine. Patients with a prior history of glaucoma, corneal or glaucoma surgery, concurrent major or emergent surgery, active infection, and eye disease with synechiae were excluded. A total of 239 patients who underwent PKP (N=127), DMEK (N=46), or DSEK (N=66) were included. IOP, steroid use, IOP-lowering drop use, and need for glaucoma surgery were compared at postoperative day 1, postoperative week 1 (POW1), and postoperative month 1 to 24 (POM1-24). RESULTS: IOP for PKP was higher than DMEK and DSEK at POW1, POM1, POM6, and POM24 (P<0.05). IOP for PKP was higher than DMEK at POM12 (P=0.028). There was no significant difference in IOP between DMEK and DSEK for all timepoints. PKP required more steroids than DSEK and DMEK at POM3, POM6, POM12, and POM24 (P<0.05). More IOP-lowering drops were required for DSEK than DMEK and PKP at postoperative day 1 and POW1 (P<0.05). More IOP-lowering medications were used for DSEK than DMEK at POM3 and POM12 (P<0.05). About 6% to 7% of patients needed glaucoma surgery by POM24. CONCLUSIONS: Endothelial keratoplasties had decreased IOP and steroid needs compared with PKPs postoperatively up to 2 years. The rate of glaucoma surgery and IOP-lowering drop needs were similar between the groups.

A Case of Melanoma-Associated Retinopathy, Uveitis, and Optic Neuritis Associated With Pembrolizumab, Managed With Topical, Intravitreal, and Intravenous Steroids.

Purpose: We report a case of advanced metastatic cutaneous melanoma with melanoma-associated retinopathy and pembrolizumab-related panuveitis and optic neuritis. Methods: The patient's condition was managed by systemic, topical, and intravitreal corticosteroids without discontinuing pembrolizumab. Results: After initiation of systemic and topical steroid treatment, optic nerve edema improved. He developed chronic uveitis with cystoid macular edema with improvement in symptoms with intravitreal dexamethasone implants. The patient demonstrated a decrease in all metastatic lesions and improvement in melanoma-associated retinopathy. Conclusions: The new checkpoint inhibitor class including pembrolizumab shows promise as a therapy for advanced metastatic melanoma in patients resistant to all other forms of chemotherapy. In general, immune-related adverse effects are responsive to steroid therapy. The trend for treatment of posterior uveitis due to pembrolizumab is to discontinue pembrolizumab. Our case suggests that even severe cases of uveitis may be sufficiently ameliorated by concurrent systemic, intravitreal, and topical therapy to allow continuation of treatment.

Granulomatous Uveitis and Conjunctivitis Due to Common Variable Immune Deficiency: A Case Report.

Purpose: To describe a case of granulomatous anterior uveitis and histologically confirmed chronic granulomatous conjunctivitis in the presence of common variable immune deficiency (CVID). Methods: Interventional case report. Results: A 72-year-old female with a history of CVID treated with regular intravenous immunoglobulin (IVIG) infusions developed chronic conjunctivitis and granulomatous anterior uveitis. She responded to topical steroids, but there was recurrence upon cessation of steroid therapy. Conjunctival biopsy demonstrated micro-granulomas in the stroma and epithelium. Treatment with IVIG was maintained throughout. Conclusion: Although rare, a diagnosis of CVID should be considered in patients with recurrent conjunctivitis and uveitis of unknown etiology, especially if there is a clinical history suggestive of defective immunity. They tend to respond well to continued steroid therapy, and IVIG therapy should not be stopped.

Visual field changes as an early indicator of glioblastoma multiforme progression: two cases of functional vision changes before MRI detection.

Glioblastoma multiforme is an aggressive tumor associated with a high rate of recurrence even after maximal therapy. In a disease with poor prognosis and rapid deterioration, early detection of tumor progression is necessary to make timely treatment decisions or to initiate end of life care. We identify two cases where Humphrey visual field testing predated magnetic resonance imaging and positron emission tomography findings of tumor progression by months in glioblastoma multiforme. New or worsening visual field defects may indicate signs of tumor progression in glioblastoma multiforme and should prompt further investigation.

Meta-analysis of preclinical studies of mesenchymal stromal cells for ischemic stroke.

OBJECTIVES: To evaluate the quality of preclinical evidence for mesenchymal stromal cell (MSC) treatment of ischemic stroke, determine effect size of MSC therapy, and identify clinical measures that correlate with differences in MSC effects. METHODS: A literature search identified studies of MSCs in animal models of cerebral ischemia. For each, a Quality Score was derived, and effect size of MSCs was determined for the most common behavioral and histologic endpoints. RESULTS: Of 46 studies, 44 reported that MSCs significantly improved outcome. The median Quality Score was 5.5 (of 10). The median effect size was 1.78 for modified Neurological Severity Score, 1.73 for the adhesive removal test, 1.02 for the rotarod test, and 0.93 for infarct volume reduction. Quality Score correlated significantly and positively with effect size for the modified Neurological Severity Score. Effect sizes varied significantly with clinical measures such as administration route (intracerebral > intra-arterial > IV, although effect size for IV was nonetheless very large at 1.55) and species receiving MSCs (primate > rat > mouse). Because many MSC mechanisms are restorative, analyses were repeated examining only the 36 preclinical studies administering MSCs ≥ 24 hours poststroke; results were overall very similar. CONCLUSIONS: In preclinical studies, MSCs have consistently improved multiple outcome measures, with very large effect sizes. Results were robust across species studied, administration route, species of MSC origin, timing, degree of immunogenicity, and dose, and in the presence of comorbidities. In contrast to meta-analyses of preclinical data for other stroke therapies, higher-quality MSC preclinical studies were associated with larger behavioral gains. These findings support the utility of further studies to translate MSCs in the treatment of ischemic stroke in humans.

Food rewards modulate the activity of song neurons in Bengalese finches.

Vocal learning, a critical component of speech acquisition, is a rare trait in animals. Songbirds are a well-established animal model in vocal learning research; male birds acquire novel vocal patterns and have a well-developed 'song system' in the brain. Although this system is unique to songbirds, anatomical and physiological studies have reported similarities between the song system and the thalamo-cortico-basal ganglia circuit that is conserved among reptiles, birds, and mammals. Here, we focused on the similarity of the neural response between these two systems while animals were engaging in operant tasks. Neurons in the basal ganglia of vertebrates are activated in response to food rewards and reward predictions in behavioral tasks. A striatal nucleus in the avian song system, Area X, is necessary for vocal learning and is considered specialized for singing. We found that the spiking activity of singing-related Area X neurons was modulated by food rewards and reward signals in an operant task. As previous studies showed that Area X is not critical for general cognitive tasks, the role of Area X in general learning might be limited and vestigial. However, our results provide a new viewpoint to investigate the independence of the vocal learning system from neural systems involved in other cognitive tasks.

Evidence for high translational potential of mesenchymal stromal cell therapy to improve recovery from ischemic stroke.

Although ischemic stroke is a major cause of morbidity and mortality, current therapies benefit only a small proportion of patients. Transplantation of mesenchymal stromal cells (MSC, also known as mesenchymal stem cells or multipotent stromal cells) has attracted attention as a regenerative therapy for numerous diseases, including stroke. Mesenchymal stromal cells may aid in reducing the long-term impact of stroke via multiple mechanisms that include induction of angiogenesis, promotion of neurogenesis, prevention of apoptosis, and immunomodulation. In this review, we discuss the clinical rationale of MSC for stroke therapy in the context of their emerging utility in other diseases, and their recent clinical approval for treatment of graft-versus-host disease. An analysis of preclinical studies examining the effects of MSC therapy after ischemic stroke indicates near-universal agreement that MSC have significant favorable effect on stroke recovery, across a range of doses and treatment time windows. These results are interpreted in the context of completed and ongoing human clinical trials, which provide support for MSC as a safe and potentially efficacious therapy for stroke recovery in humans. Finally, we consider principles of brain repair and manufacturing considerations that will be useful for effective translation of MSC from the bench to the bedside for stroke recovery.