Evaluation of the Association between the Risk of Central Retinal Artery Occlusion and the Concentration of Environmental Air Pollutants.

The purpose of the retrospective, population-based study was to assess the relationship between the risk of central retinal artery occlusion (CRAO) and the level of air pollutants. This study identified 2.272 cases of newly diagnosed CRAO registered in the Polish National Health Service database. The study authors gathered hourly ambient concentrations of particulate matter-PM 2.5, PM 10, benzene, carbon monoxide, nitrogen dioxide, ozone, and sulfur dioxide from pollution monitoring stations. Data on average daily temperature and atmospheric pressure were also obtained. In the statistical analyses, single- and multi-factor Poisson negative binomial regression models were carried out, controlling also for ambient temperature and atmospheric pressure with seasonality set at a level of 4. This study has shown a positive association between CRAO onset and short-term, daily changes in PM 10, NO2, SO2, O3, and CO concentrations, as well as with air temperature, in the days preceding the diagnosis.

Thrombosis of atypical location: how to treat patients in the era of direct oral anticoagulants?

In 4% of cases, venous thromboembolism (VTE) involves organ­related venous territories such as splanchnic, renal, gonadal, and cerebral venous segments, and is often called venous thromboembolism of atypical location (VTE­AL). Recommendations regarding the method, intensity, and duration of anticoagulant therapy for VTE­AL are not well established. Direct oral anticoagulants (DOACs) have been a promising alternative to vitamin K antagonists in the treatment of acute VTE. However, all major clinical trials on DOACs excluded patients with VTE­AL. Therefore, data on the use of DOACs in patients with VTE­AL are still limited to case reports and small clinical series, with a relative predominance of publications on splanchnic vein thrombosis including mesenteric, splenic, portal, and hepatic vein thrombosis. The only randomized clinical trial comparing a clinical outcome of patients with acute portal vein thrombosis randomized to either rivaroxaban or warfarin treatment yielded significantly impaired results due to the use of an atypical rivaroxaban dose. A prospective registration of clinical outcome for DOACs used in patients with VTE­AL, in those with VTE of typical location, and in those with VTE­AL treated with enoxaparin showed similar VTE recurrence and major bleeding rates in all 3 groups. High cancer prevalence, typical for VTE­AL, significantly impacted survival as well as VTE recurrence rates and major bleeding outcomes in this study. In general, although still limited, the results for DOAC use in VTE­AL are encouraging and we do not hesitate to use DOACs, particularly rivaroxaban or apixaban, in selected patients with VTE­AL.

A comparison of intraocular pressure values obtained using a Goldmann applanation tonometer and a handheld version of applanation resonance tonometer: A preliminary report.

BACKGROUND: Despite the development of various methods of intraocular pressure (IOP) measurement, Goldmann applanation tonometry (GAT) is still the most popular. The measurement using GAT depends on the biomechanical properties of the cornea, such as the thickness, the radius of curvature, as well as the amount of the fluorescein used. OBJECTIVES: The aim of the study was to compare IOP values measured by GAT with those measured by applanation resonance tonometry (ART). MATERIAL AND METHODS: A total of 47 patients (94 eyes), including 28 patients with primary open-angle glaucoma (POAG) and 19 subjects from the control group, were examined at the Glaucoma Outpatient Clinic of the Department and Clinic of Ophthalmology at Wroclaw Medical University (Poland). The measurements of IOP were performed using GAT and a handheld version of ART. Also, the central corneal thickness (CCT) of all patients was measured. RESULTS: The study showed that the IOP values measured by both tonometers were comparable, but ARTacquired values were higher than GAT-obtained values both in the glaucomatous group and in the control group. CCT had little impact on mean IOP difference between GATand ART-obtained values. CONCLUSIONS: Applanation resonance tonometry is a precise method of IOP measurement and is less affected by biomechanical properties of the cornea than GAT. Our results show that ART is a new, promising, comfortable for both patients and doctors method of IOP measurement, which, in the future, can replace GAT.

Rivaroxaban and Apixaban for Initial Treatment of Acute Venous Thromboembolism of Atypical Location.

OBJECTIVES: To assess the outcome of direct oral anticoagulants (DOACs), specifically Xa inhibitors: rivaroxaban and apixaban, for the treatment of venous thromboembolism (VTE) of atypical location (VTE-AL), portal, mesenteric, hepatic, splenic, gonadal, renal, and cerebral veins, prospectively collected data of Mayo Thrombophilia Clinic Registry were used. METHODS: Patients with acute VTE-AL treated with DOACs, enrolled between March 1, 2013, and February 1, 2017, were compared with patients with VTE of typical location (VTE-TL: deep vein thrombosis of extremities and/or pulmonary embolism) receiving DOACs and with patients with VTE-AL treated with enoxaparin. RESULTS: Out of 623 patients with acute VTE receiving the study drug within 14 days of diagnosis, there were 63 with VTE-AL: 36 on DOAC, 23 on enoxaparin, and 4 on warfarin; 352 received DOAC for VTE-TL. The VTE-AL treated with DOAC/enoxaparin included the following: splanchnic (26/22), ovarian (8/2), renal (3/5), and cerebral veins (1/1), respectively. Recurrence rate (per 100 person-years) for the VTE-AL group receiving DOAC was 7.3, which was not different when compared with those for VTE-TL (2.4; P=.13) and VTE-AL groups receiving enoxaparin (23.7; P=.37). Major bleeding rate in the VTE-AL group receiving DOAC was not different compared with those for VTE-TL (7.2 vs 3.0; P=.26) and VTE-AL groups on enoxaparin (22.4; P=.31). Mortality was higher in the VTE-AL group on DOAC compared with the VTE-TL group (21.45 [95% CI, 7.87-46.69] vs 8.26 [95% CI, 5.35, 12.20]; P=.03). All patients with VTE-AL with events had cancer. CONCLUSION: The VTE recurrence and bleeding rates for rivaroxaban and apixaban used in VTE-AL are not different from those in patients with VTE-TL and similar to that for enoxaparin.

Testicular vein thrombosis: Incidence of recurrent venous thromboembolism and survival.

PURPOSE: Testicular vein thrombosis (TVT) etiology, recurrence, and survival were compared with lower extremity deep vein thrombosis (DVT) in order to determine whether treatment guidelines for DVT could be applied to TVT. PATIENTS AND METHODS: An inception cohort of patients with confirmed TVT (January 1995-October 2015) was compared to a control group of patients with lower extremity DVT matched by age, gender, and diagnosis date. RESULTS: Thirty-nine men with TVT were identified; 15 (38%) with isolated TVT. Left testicular vein was affected in 77% patients; there were no cases of bilateral TVT. Cancer was over twofold more common in TVT patients (59% vs 28%, P = .01). Most cancers (78%) involved organs in proximity to the testicular vein. Although TVT patients were less frequently treated with anticoagulants (49% vs 97%, P = .0001), recurrence rates were similar to DVT group (TVT 4.2 vs DVT 1.1 per 100 patient-years, P = .11). Despite higher cancer prevalence, survival rates were similar between groups (31% vs 28%; P = .34). Major bleeding events were rare (one patient per group). CONCLUSIONS: Identifying TVT should prompt a search for a regional malignancy. Despite the high cancer prevalence and low utilization of anticoagulants, recurrent venous thrombosis and mortality rates are similar to DVT patients.

Disease activity in axial spondyloarthritis after discontinuation of TNF inhibitors therapy.

OBJECTIVE: Use of tumour necrosis factor inhibitors (TNFi) has proved to be an important step forward in the treatment of axial spondyloarthritis (axSpA), but the duration of the therapy as well as the management in case of low disease activity (LDA) or remission are not clearly established. Currently, the identification of potential predictors associated with the treatment discontinuation is the basic purpose of many clinical studies. The aim of this study was to analyze the influence of the discontinuation of TNFi therapy on the disease activity in patients with low disease activity. MATERIAL AND METHODS: The study included 65 patients; 47 of patients (72%) were treated with etanercept, 16 (2%) with adalimumab and 2 (3%) with infliximab. RESULTS: The mean age of the patients was 45 years, the mean BASDAI score was 6.8 and VAS for low back pain was 76 mm at baseline. 54 patients with axSpA (83%) achieved LDA after 9 months of anti-TNF therapy. During follow-up 40 patients (74% of patients with LDA) had an increase of the disease activity after mean 14 weeks and needed to restart the treatment with TNFi. After restart of the therapy LDA was regained in all patients after mean 7 weeks. 11 patients (17%) have never achieved LDA and 14 patients (22%) had LDA longer than 6 months without relapse. At baseline higher levels of CRP and ESR were observed in patients with relapse of the disease at the end of treatment and with LDA shorter than 6 months. CONCLUSIONS: Changes in the values of disease activity indicators (CRP, ESR) correlated with more stable response to TNFi therapy. Over 50% of patients who were treated with TNFi needed to restart the therapy. Treatment resumption allowed to regain a good clinical effect among affected patients.

Management of corneal melting in a patient with long-standing rheumatoid arthritis ­ case report.

Corneal melting is a rare ocular complication of rheumatoid arthritis, associated with poor prognosis. Rapid course of the disease and unpredicted treatment response, which depends on a patient general state and disease severity, make every case a challenge and requires a cooperation between ophthalmologists and rheumatologists. We present a case of a 58-year-old woman with corneal melting, who was successfully treated with systemic corticosteroids and methotrexate, along with ocular surgery.