GLP-1 Agonists: A Practical Overview for Plastic and Reconstructive Surgeons.

BACKGROUND: Glucagon-like peptide-1 (GLP-1) agonists, such as exenatide, liraglutide, dulaglutide, semaglutide, and tirzepatide, effectively manage type 2 diabetes by promoting insulin release, suppressing glucagon secretion, and enhancing glucose metabolism. They also aid weight reduction and cardiovascular health, potentially broadening their therapeutic scope. In plastic surgery, they hold promise for perioperative weight management and glycemic control, potentially impacting surgical outcomes. METHODS: A comprehensive review was conducted to assess GLP-1 agonists' utilization in plastic surgery. We analyzed relevant studies, meta-analyses, and trials to evaluate their benefits and limitations across surgical contexts, focusing on weight reduction, glycemic control, cardiovascular risk factors, and potential complications. RESULTS: Studies demonstrate GLP-1 agonists' versatility, spanning weight management, cardiovascular health, neurological disorders, and metabolic dysfunction-associated liver diseases. Comparative analyses highlight variations in glycemic control, weight loss, and cardiometabolic risk. Meta-analyses reveal significant reductions in hemoglobin A1C levels, especially with high-dose semaglutide (2 mg) and tirzepatide (15 mg). However, increased dosing may lead to gastrointestinal side effects and serious complications like pancreatitis and bowel obstruction. Notably, GLP-1 agonists' efficacy in weight reduction and glycemic control may impact perioperative management in plastic surgery, potentially expanding surgical candidacy for procedures like autologous flap-based breast reconstruction and influencing outcomes related to lymphedema. Concerns persist regarding venous thromboembolism and delayed gastric emptying, necessitating further investigation into bleeding and aspiration risk with anesthesia. CONCLUSIONS: GLP-1 agonists offer advantages in perioperative weight management and glycemic control in plastic surgery patients. They may broaden surgical candidacy and mitigate lymphedema risk but require careful consideration of complications, particularly perioperative aspiration risk. Future research should focus on their specific impacts on surgical outcomes to optimize their integration into perioperative protocols effectively. Despite challenges, GLP-1 agonists promise to enhance surgical outcomes and patient care in plastic surgery.

Peripapillary nerve fibre layer thickness and macular thickness in children with anisometropic amblyopia attending a referral centre in Eastern India.

To study the macular thickness and peripapillary nerve fibre layer thickness in children with anisometropic amblyopia, a prospective non-randomised case series study was undertaken among 39 children (25 boys and 14 girls) aged between 5 and 16 years. This study was carried out between January 2010 and April 2011. The peripapillary retinal nerve fibre layer (RNFL) thickness and macular layer thickness was measured using optical coherence tomography (OCT), the RNFL thickness and the macular layer thickness of the amblyopic eye was assessed and compared to the normal eye of the same subject. It was found that macular layer thickness in the amblyopic eye was greater than that of the macular thickness in the normal eye. The mean macular layer thickness in the amblyopic eyes was 229.589 microm with a standard deviation of -+/- 31.9149 microm. The mean macular layer thickness in the normal eyes of these children was 206.8717 microm with a standard deviation of +/- 28.490 microm, the p-value was 0.00141 which is much lesser than 0.005 and hence is strongly statistically significant. However the mean RNFL thickness in the amblyopic eye was 104.454 microm with a standard deviation of +/- 22.244 microm. The mean RNFL thickness of the normal eye was 108.2746 microm with a SD of +/- 19.370 microm. The p-value in this case being 0.4246 which is statistically insignificant. It is conducted that macular layer thickness is raised in the amblyopic eye of children with anisometropic amblyopia though the RNFL thickness is not.

Ocular involvement in diabetes mellitus.

Diabetes is a worldwide medical problem and is a significant cause of morbidity and mortality. It has considerable impact on both the patient and the society because it typically affects individuals in their most productive years. It is also one of the leading causes of blindness and visual impairment. A person with diabetes has 25 times the risk of blindness compared to a non-diabetic. This article reviews the variety of ways in which the eye and its adnexa can be involved in diabetes mellitus.