• Andreassen From posted an update 6 months, 1 week ago

    PURPOSE To report a case of reversible corneal endothelial abnormalities following treatment with netarsudil. OBSERVATION A 68-year-old woman presented with the complaint of blurred vision soon after starting treatment with the fixed dose combination of netarsudil and latanoprost (FC-netarsudil-latanoprost). She had been receiving the fixed dose combination of dorzolamide and timolol and latanoprost for primary open-angle glaucoma until her ophthalmologist switched latanoprost to FC-netarsudil-latanoprost 2 months before referral to our center.Best-corrected visual acuity was 20/20-1 in the right eye and 20/20-3 in the left eye. find more Slit-lamp biomicroscopic examination was remarkable for a guttata-like abnormality of the corneal endothelium of both eyes. The intraocular pressures were 10 mmHg in both eyes. Specular microscopy revealed irregularly shaped corneal endothelial cells (CEC) with indistinct borders between cells. FC-netarsudil-latanoprost was replaced with latanoprost in the left eye but continued in the right eye. Nine weeks later, BCVA remained 20/20-1 in the right eye but it improved to 20/20 in the left eye. Repeat specular microscopy was unchanged in right eye and was normal in the left eye. CONCLUSION AND IMPORTANCE Topical therapy with netarsudi can result in guttata-like changes of the corneal endothelium and CEC abnormalities that can be detected with specular microscopy. These abnormalities appear to be transient and resolved upon the cessation of netarsudil. Ophthalmologists should consider the possibility of a corneal endothelial abnormality in patients treated with netarsudil who develop blurred vision.PRECIS Angle closure worsens with pharmacological dilatation in about 50.0% of the subjects diagnosed as primary angle closure suspects. PURPOSE To evaluate the changes in angle configuration with swept source anterior segment optical coherence tomography before and after pharmacological pupil dilatation in untreated primary angle closure suspects. PATIENTS & METHODS 106 subjects over the age of 50 years and diagnosed as primary angle closure suspects were included in this cross-sectional cohort study.360-degree scans of the angles were captured using swept source optical coherence tomography (SS-1000, Tomey Corporation, Nagoya, Japan) before and 1 hour after pharmacological dilatation. The angle scans from swept source optical coherence tomography were analyzed to calculate the iris-trabecular contact index. The main outcome measure was to evaluate the change in iris-trabecular contact index after dilatation. Multivariate linear and logistic regression analysis were performed to identify factors influencing change of iris-trabecular contact index and to identify factors associated with increase in iris-trabecular contact index after dilatation. RESULTS Majority of subjects were Chinese (93.4%) and female (79.2%).The overall mean pre-dilatation iris-trabecular contact index was 45.3% (±23.7) and post-dilatation iris-trabecular contact index was 46.05% (±25.9) with a mean change of 0.78% (±16.5;P=0.62). Fifty-three eyes (50.0%) showed an increase in iris-trabecular contact index (angle narrowing) after dilatation. An increase in iris-trabecular contact index was associated with shallower anterior chamber depth (odds ratio , 0.18; 95% confidence interval , 0.04-0.77) and bigger lens vault (OR,14.31; 95% CI,1.55- 132.34). CONCLUSION Pharmacological pupil dilatation worsened angle closure in 50.0% of subjects with narrow angles. Shallower anterior chamber and bigger lens vault were associated with greater angle narrowing in these subjects.PURPOSE In recent years, new technologies have emerged to better analyze and interpret IOP fluctuations. Amongst them is the progression report (PR), an algorithm based on continuous contact lens sensor (CLS) readings to estimate the likelihood of fast visual field (VF) glaucomatous progression. The objective of this study is to validate the PR. METHODS In this retrospective study, 30 open-angle glaucoma patients were enrolled. Twenty-four-hour intraocular pressure (IOP)-related variations were recorded using a CLS. Recordings were used to generate PR. The likelihood of fast VF progression ( less then -1▒dB/y mean deviation) was estimated by 2 masked assessors based on clinical parameters. At least 3 VF were performed over the 2 years following the initial assessment, to determine actual progression. RESULTS Mean age was 65.9±10.45 years, with a mean baseline MD of -5.4±5.1. After a mean follow-up of 29.5±12.9 months, 26.7% of eyes were assessed as fast progressors (-2.9±1.9▒dBs/y). The average risk-score attributed by the PR was 42% (41% vs. 44% ; P=0.035). Correlations between the 2 assessors were good (r=0.59), and identical to that between PR and the averaged assessors’ gradings. Correlations between MD progression rates and PR, Assessor 1 and Assessor 2’s gradings were respectively r=0.57, r=0.31, and r=0.43. CONCLUSIONS PR provided comparable predictions of the risk of fast VF progression as did physician estimates based on all available clinical data. With their relationship to the eye’s biomechanical properties and the ocular tissues’ response to pressure variations, CLS recordings may offer new information that complements conventional examinations.OBJECTIVES Could medical research and quality improvement studies be more productive with greater use of multifactor study designs? METHODS Drawing on new primary sources and the literature, we examine the roles of A. Bradford Hill and Ronald A. Fisher in introducing the design of experiments in medicine. RESULTS Hill did not create the randomized controlled trial, but he popularized the idea. His choice to set aside Fisher’s advanced study designs shaped the development of clinical research and helped the single-treatment trial to become a methodological standard. CONCLUSIONS Multifactor designs are not widely used in medicine despite their potential to make improvement initiatives and health services research more efficient and effective. Quality managers, health system leaders, and directors of research institutes could increase productivity and gain important insights by promoting a broader use of factorial designs to study multiple interventions simultaneously and to learn from interactions.

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