Phacoemulsification with and without iStent: A Systematic Review and Meta-Analysis of Comparative Studies.

BACKGROUND: The iStent (Glaukos Corporation; Laguna Hills, CA, USA) is one of the minimally invasive glaucoma devices. It can be inserted at the time of phacoemulsification or as a stand-alone procedure to lower the intraocular pressure (IOP). OBJECTIVE: Our aim was to conduct a systematic review and meta-analysis comparing the effect of iStent insertion at the time of phacoemulsification with phacoemulsification alone in patients with ocular hypertension or open-angle glaucoma. METHODS: We searched EMBASE, MEDLINE (OVID and PubMed), CINAHL, and Cochrane Library for articles published between 2008 and June 2022 (PRISMA 2020 for the checklist). Studies comparing the IOP-lowering effect of iStent with phacoemulsification versus phacoemulsification alone were included. The endpoints were IOP reduction (IOPR) and the mean reduction in the number of glaucoma drops. A quality-effects model was used to compare both surgical groups. RESULTS: Ten studies were included, reporting on 1,453 eyes. Eight hundred fifty three eyes had the combined iStent and phacoemulsification, and 600 eyes underwent phacoemulsification alone. IOPR was higher in the combined surgery at of 4.7 ± 2 mm Hg compared to 2.8 ± 1.9 mm Hg in phacoemulsification alone. A greater decrease in postoperative eye drops was noted in the combined group having a decrease of 1.2 ± 0.3 eye drops versus of 0.6 ± 0.6 drops in isolated phacoemulsification. The quality effect model showed an IOPR weighted mean difference (WMD) of 1.22 mm Hg (confidence interval [CI]: [-0.43, 2.87]; Q = 315.64; p < 0.01; I2 = 97%) and decreased eye drops WMD 0.42 drops (CI: [0.22, 0.62]; Q = 42.6; p < 0.01; I2 = 84%) between both surgical groups. Subgroup analysis shows that the new generation iStent may be more effective in reducing IOP. CONCLUSION: iStent has a synergetic effect with phacoemulsification. The reduction of IOP and glaucoma eye drops was higher when iStent is combined with phacoemulsification compared with isolated phacoemulsification.

Current State of the Medical Student Performance Evaluation: A Tool for Reflection for Residency Programs.

BACKGROUND: The Medical Student Performance Evaluation (MSPE) provides important information to residency programs. Despite recent recommendations for standardization, it is not clear how much variation exists in MSPE content among schools. OBJECTIVES: We describe the current section content of the MSPE in US allopathic medical schools, with a particular focus on variations in the presentation of student performance. METHODS: A representative MSPE was obtained from 95.3% (143 of 150) of allopathic US medical schools through residency applications to the Zucker School of Medicine at Hofstra/Northwell in select programs for the 2019-2020 academic year. A manual data abstraction tool was piloted in 2018-2019. After training, it was used to code all portions of the MSPE in this study. The results were analyzed, and descriptive statistics were reported. RESULTS: In preclinical years, 30.8% of MSPEs reported data regarding performance of students beyond achieving "passes" in a pass/fail curriculum. Only half referenced performance in the fourth year including electives, acting internships, or both. About two-thirds of schools included an overall descriptor of comparative performance in the final paragraph. Among these schools, a majority provided adjectives such as "outstanding/excellent/very good/good," while one-quarter reported numerical data categories. Regarding clerkship grades, there were numerous nomenclature systems used. CONCLUSIONS: This analysis demonstrates the existence of extreme variability in the content of MSPEs submitted by US allopathic medical schools in the 2019-2020 cycle, including the components and nomenclature of grades and descriptors of comparative performance, display of data, and inclusion of data across all years of the medical education program.

The effect of low predicted/calculated postoperative keratometry on corrected distance visual acuity after LASIK.

PURPOSE: To compare refractive outcomes of eyes with flat keratometry (K) to matched controls after myopic laser in situ keratomileusis (LASIK). SETTING: Boston Eye Group, Brookline, Massachusetts, USA. DESIGN: Retrospective review. METHODS: Eyes that had LASIK between December 2008 and December 2018 were retrospectively analyzed and matched based on calculated postoperative flat K values. Stratified candidate subgroups (K < 38.0 diopters [D]) were compared with control subgroups (K ≥ 38.0 D). RESULTS: The study comprised 160 eyes (80 candidates and 80 controls). Statistical analyses showed no significant differences between candidates and controls in preoperative corrected distance visual acuity (CDVA) (P = .150) or postoperative CDVA (P = .290). There were no significant differences in the amount of tissue ablated between all candidate and control subgroups. Similarly, there was no significant change between preoperative and postoperative CDVA between the different candidate and respective subgroups. Three (3.75%) of 80 candidate eyes versus zero control eyes lost 1+ lines of CDVA after surgery. There was no difference in CDVA lost between these groups (P = .2453). CONCLUSION: There is no increased risk for loss of CDVA after LASIK attributable to flat K.

Early Surface Ablation on Aborted LASIK Flaps.

PURPOSE: To report the outcomes of a series of 16 patients who had secondary surface ablation within 4 weeks of an aborted femtosecond laser-assisted in situ keratomileusis (FS-LASIK) procedure. METHODS: A retrospective chart review of electronic medical record data from 2011 to 2015 was performed to identify eyes of patients who had an aborted FS-LASIK procedure followed by secondary surface ablation (photorefractive keratectomy or laser epithelial keratomileusis) within 4 weeks of the primary procedure. Patients were required to have at least three postoperative visits to be included in the study. RESULTS: The review identified 20 aborted FS-LASIK procedures of 7,142 eyes (0.003%), of which 16 met the inclusion criteria. The most common reasons for abortion were incomplete (10) and decentered (3) flaps. Thirteen of 16 eyes were treated within 2 weeks. A total of 11 of 16 eyes achieved uncorrected distance visual acuity (UDVA) of 20/20, 13 of 16 achieved UDVA of 20/25 or better, and 15 of 16 had a corrected distance visual acuity (CDVA) of 20/20. There were no intraoperative complications during the second procedure and there were no cases of diffuse lamellar keratitis. One patient developed postoperative haze with a CDVA of 20/25 and was lost to follow-up. CONCLUSIONS: This case series indicates that early surface ablation (within 4 weeks) after an aborted FS-LASIK procedure may be performed with good visual outcomes. [J Refract Surg. 2019;35(2):121-125.].

Correction to: Retinal complications of gout: a case report and review of the literature.

CORRECTION: After publication of the article [1], it has been brought to our attention that the images displayed in Figs. 1, 2 and 3 have been transposed.

Retinal complications of gout: a case report and review of the literature.

BACKGROUND: There have been few reported findings of posterior segment complications of gout. While exudative lesions, an increased risk of macular degeneration, and vascular occlusions have been previously reported, to our knowledge, refractile macular lesions have not been reported in a patient with chronic uncontrolled gout. CASE PRESENTATION: Highly refractile, crystal-like lesions were found in the macula of a 62 year old male patient with chronically uncontrolled gout. The lesions appeared at the termination of retinal arterioles and were located at the level of the retinal pigment epithelium. The lesions did not stain with fluorescein and were associated with larger areas geographic atrophy. Review of the patient's blood tests revealed well-controlled vasculopathic risk factors. Fundus appearance and best-corrected visual acuity remained stable over 12 months of follow-up during which the uric acid levels were well controlled. CONCLUSION: Retinopathy may be associated with chronically uncontrolled gout and patients with visual complaints should undergo a dilated examination in addition to the typical anterior segment slit-lamp exam.

Accuracy of Visual Estimation of LASIK Flap Thickness.

PURPOSE: To assess the accuracy of surgeons' visual estimation of LASIK flap thickness when created by a femtosecond laser by comparing it to ultrasound measurements. METHODS: Surgeons were asked to visually estimate the thickness of a femtosecond flap during the procedure. Total corneal thickness was measured by ultrasound pachymetry prior to the procedure and the stromal bed was similarly measured after flap lifting. The estimates from three experienced surgeons (cornea fellowship trained and more than 5 years in practice) were compared to those of three cornea fellows, with each surgeon evaluating 20 eyes (120 total). Surgeons were not told the thickness of the flaps unless required for safety reasons. RESULTS: The average difference between visual and ultrasonic estimation of LASIK flap thickness was 15.20 µm. The flap was 10 µm thicker than estimated in 37% of eyes, 20 µm thicker in 17% of eyes, and 30 µm thicker in 10% of eyes. The largest deviation was 53 µm. There was no statistically significant difference between the accuracy of experienced surgeons and fellows (P = .51). CONCLUSIONS: There are significant differences between surgeons' visual estimates and ultrasonic measurements of LASIK flap thickness. Relying on these visual estimates may lead to deeper excimer laser ablation than intended. This could lead to thinner residual stromal beds and higher percent tissue altered than planned. The authors recommend that surgeons measure flaps intraoperatively to maximize accuracy and safety. [J Refract Surg. 2017;33(11):765-767.].

Therapeutic modulation of Akt activity and antitumor efficacy of interleukin-12 against orthotopic murine neuroblastoma.

BACKGROUND: Patients with advanced neuroblastoma have a poor prognosis. The antiapoptotic protein Akt has been implicated as a possible mediator of the resistance of human neuroblastoma cells to apoptosis; the proapoptotic protein Bid, is inhibited by activated Akt. Neuroblastoma has demonstrated responsiveness to immunotherapeutic approaches in preclinical studies, prompting investigation of new therapeutic strategies based on potentiation of the host immune response, including the use of systemic cytokines. METHODS: We examined the antitumor efficacy and mechanisms of action of the central immunoregulatory cytokine interleukin-12 (IL-12) in mice bearing established orthotopic neuroblastoma tumors derived from murine TBJ and Neuro-2a cells. Cohorts of mice (10 mice/group) bearing established orthotopic neuroblastoma tumors were injected intraperitoneally with IL-12 or vehicle and monitored for survival. IL-12-induced apoptosis within the tumor microenvironment was investigated using ribonuclease protection assays, nuclear staining, and electron microscopy. Protein expression was determined via Western blot analysis and enzyme-linked immunosorbent assays. Confocal microscopy was used to examine the distribution of overexpressed Bid-enhanced green fluorescent protein fusion protein (Bid-EGFP) in TBJ cells. All statistical tests were two-sided. RESULTS: IL-12 induced complete tumor regression and long-term survival of 8 (80%) of 10 mice bearing established neuroblastoma tumors compared with 1 (10%) of 10 control mice (P = .0055) and profound tumor cell apoptosis in vivo despite the fact that TBJ and Neuro-2a cells were resistant to receptor-mediated apoptosis in vitro. These cells expressed high levels of phosphorylated Akt, a key prosurvival molecule, and Akt inhibitors sensitized neuroblastoma cells to apoptosis mediated by IL-12-inducible cytokines including tumor necrosis factor-alpha and interferon-gamma in vitro. IL-12 increased the expression of proapoptotic genes and decreased Akt phosphorylation within established TBJ tumors in conjunction with activation and subcellular translocation of Bid. CONCLUSIONS: Our results suggest that IL-12 overcomes a potentially critical mechanism of tumor self-defense in vivo by inhibiting Akt activity and imply that IL-12 may possess unique therapeutic activity against tumors that express high levels of activated Akt.

Inhibition of Mycobacterium tuberculosis AhpD, an element of the peroxiredoxin defense against oxidative stress.

The resistance of Mycobacterium tuberculosis to isoniazid (INH) is largely linked to suppression of a catalase-peroxidase enzyme (KatG) that activates INH. In the absence of KatG, antioxidant protection is provided by enhanced expression of the peroxiredoxin AhpC, which is itself reduced by AhpD, a protein with low alkylhydroperoxidase activity of its own. Inhibition of AhpD might therefore impair the antioxidant protection afforded by AhpC and make KatG-negative strains more sensitive to oxidative stress. We report here that the 3(E),17-dioxime of testosterone is a potent competitive AhpD inhibitor, with a K(i) of 50 +/- 2 nM. The inhibitor is stereospecific, in that the 3(E) but not 3(Z) isomer is active. Computational studies provide support for a proposed AhpD substrate binding site. However, the inhibitor does not completely suppress the in vitro activity of AhpC/AhpD, because a low titer of AhpD suffices to maintain AhpC activity. This finding, and the low solubility of the inhibitor, explains its inability to suppress the growth of INH-resistant M. tuberculosis in infected mouse lungs.