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Copyright of Acta Ophthalmologica (1755375X) is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Medical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease). [ABSTRACT FROM AUTHOR]

Given the lack of current solutions, we aim to describe a method for correction of AL measurements in patients who need combined cataract surgery and removal of PFCL tamponade. The refractive considerations of cataract surgery with silicone oil in situ have been well documented.3 The refractive index of silicone oil (1.404) is higher than that of vitreous (1.336) which means that if not corrected for, the optically measured axial length (AL) becomes inaccurate. Post-vitrectomy short-term tamponade with perfluorocarbon liquids (PFCL) is a well-described technique for giant retinal tears (GRT). [Extracted from the article]

Purpose: Ultrasound cycloplasty (UCP) acts through the selective coagulation of the ciliary body using high‐intensity focused ultrasound (HIFU) technology. The aim of this study was to investigate whether the application of ultrasound beams targeting the ciliary body using an external probe influences astigmatism. Methods: Multicentre, prospective, single‐arm, open‐label study in adult patients with primary open‐angle glaucoma and moderately uncontrolled intraocular pressure (IOP) under glaucoma medication. The primary outcome was induced corneal astigmatism, calculated from topography, and assessed statistically through vector analysis. Secondary outcomes included induced total astigmatism and mean changes from baseline in best‐corrected visual acuity (logMAR) and IOP. Subgroup analysis was performed to assess the impact of device centring on corneal and total induced astigmatism. Results: Fifty eyes were enrolled. Mean age was 69.6 ± 11.3 years. At 1, 3 and 6 months postprocedure, HIFU‐induced corneal astigmatism was 0.88 D × 93°, 0.87 D × 106° and 1.16 D × 97°, respectively, while induced total astigmatism was 0.62 D × 103°, 0.42 × 106° and 0.39 × 107°. By the last follow‐up, the percentage of patients with <0.50, <1.00, <1.50 and <2.00 D of induced corneal versus total astigmatism was 8.3% versus 46%, 29% versus 66%, 62.5% versus 88% and 79% versus 94%. Visual acuity was statistically significantly impaired at 1 month, but no difference remained by 3 and 6 months postprocedure. Conclusion: Ultrasound cycloplasty procedure is associated with increased corneal astigmatism. However, its impact on total refractive astigmatism is less pronounced. [ABSTRACT FROM AUTHOR]

Purpose: The Baerveldt‐XEN technique is intended to reduce the risk of early hypotony after Baerveldt implant, while keeping a good long‐term intra‐ocular pressure (IOP) control. The aim of this study is to discuss the surgical success rate of the Baerveldt‐XEN and compare it with the commercially available flow‐restrictor device (Ahmed glaucoma valve – AGV). Methods: Single‐centre, cohort study. Consecutive glaucoma patients with uncontrolled IOP > 21 mmHg on maximum tolerated medical therapy, and who had an aqueous shunt as the planned surgical procedure. Patients underwent implantation of Baerveldt‐XEN. An age‐, gender‐ and glaucoma aetiology‐matched database of AGV patients was used for comparison. Complete surgical success was defined as a final IOP between 6 and 21 mmHg, and 20% reduction from baseline with no need for IOP‐lowering medication. Qualified success was the same criteria but resorting to medications. Results: Twenty‐four eyes from 24 subjects with glaucoma were included in this study, 12 patients underwent Baerveldt‐XEN implantation and 12 AGV. Twelve months after the Baerveldt‐XEN implant, the IOP reduced from 33 ± 9 mmHg to 14 ± 3 mmHg (p < 0.001). The qualified and complete success rate was 50% and 25%, respectively. With the AGV, the IOP reduced from 29 ± 7 mmHg to 16 ± 7 mmHg (p = 0.001). The matched AGV group compared to the Baerveldt‐XEN, presented a higher complete success rate (58.3%) and a qualified success rate of 33.3% (p = 0.72). No sight‐threatening complications were recorded in both groups. Conclusions: The Baerveldt‐XEN disclosed a low complete success rate at 1 year of follow‐up, although with no major safety concerns. While studies with a longer follow‐up are needed to demonstrate the potential advantages and disadvantages of the Baerveldt‐XEN, this technique may be less likely to achieve drop‐free efficacy when compared to other flow‐restrictor strategies. [ABSTRACT FROM AUTHOR]

Anti‐tumour necrosis factor (TNF) drugs have been extensively used in non‐infectious uveitis (NIU), when corticosteroids or conventional immunosuppressive drugs cannot adequately control inflammation or intolerable side‐effects occur. However, systemic anti‐TNF therapies are also associated with a myriad of side‐effects. Therefore, intravitreal administration of anti‐TNF biologics has been employed to minimize patient morbidity and systemic adverse effects, while maintaining therapeutic effectivity. We undertook a systematic review to determine evidence of efficacy and safety of intravitreal administration of anti‐TNF drugs in adults with NIU. We conducted this systematic review according to the PRISMA guidelines. The protocol was registered with PROSPERO (CRD42016041946). We searched CENTRAL, MEDLINE and EMBASE, from inception to April 2017, as well as clinical trial registries and grey literature. The qualitative analysis included all studies of adult patients with a diagnosis of NIU and who received intravitreal anti‐TNF drugs with a 4‐week minimum follow‐up. A total of 4840 references were considered for title and abstract screening. Seven full texts were screened, and five studies were considered for analysis. All studies were open‐label, single‐centre, prospective, non‐randomized, interventional case series with a follow‐up between 4 and 26 weeks, employing either adalimumab in two studies and infliximab in three. Three studies showed a treatment effect of anti‐TNF intravitreal injections, while one study revealed short‐term improvement and one study revealed no efficacy of anti‐TNF intravitreal therapy. None of the studies reported ocular adverse effects but only two studies included electrophysiological assessment in the safety analysis and no study assessed systemic human anti‐drug antibodies. The available evidence is not sufficiently robust to conclude about the clinical effectivity of intravitreal anti‐TNF in NIU and so no recommendation can be made. In conclusion, intravitreal injection of anti‐TNF antibodies remains a possible treatment option to be explored through robust clinical investigation. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Previous studies report that the response of retinal vessels to a decrease in oxygen (hypoxia) is vasodilation, thus increasing blood flow. We aimed to characterize the changes in retinal microvasculature induced by a mild hypoxia stress test in a healthy population, using ocular coherence tomography angiography (OCT‐A) technology. Methods: Interventional repeated‐measures study. The standardized hypoxia challenge test (HCT) was performed to all volunteers, according to the British Thoracic Society protocol. Ocular coherence tomography angiography (OCT‐A) was performed at three time‐points (baseline, during HCT and 30′ posthypoxia). Macular and peripapillary vessel densities were assessed using the built‐in software. To minimize bias, analysis was performed separately in right (OD) and left (OS) eyes. Repeated‐measures anova and mean comparison analysis were used as statistical tests ( stata v13). Results: Studied population included 30 healthy subjects (14 women), with a mean age of 28.8 ± 4.2 [range 22–37] years. Baseline vessel density increased in hypoxic conditions and subsequently decreased to near‐baseline values in posthypoxia conditions. This pattern was observed for both eyes in both parafovea (OD: 55.3 ± 2.3 to 56.7 ± 1.9 to 55.8 ± 1.9, p < 0.05; OS: 56.9 ± 2.1 to 57.9 ± 1.9 to 57.3 ± 1.7, p < 0.05) and peripapillary (OD: 60.5 ± 0.5 to 62.6 ± 0.5 to 60.1 ± 0.4, p < 0.05; OS: 60.4 ± 0.4 to 62.3 ± 0.5 to 60.7 ± 0.4, p < 0.05) areas. Conclusion: To our knowledge, there are no published data specifically addressing mild hypoxia conditions and retinal microvasculature changes, using OCT‐A. This pilot study may pave way to better understand vascular responses in disease setting. [ABSTRACT FROM AUTHOR]

The article discusses a treatment laser peripheral iridotomy (LPI) for the treatment of pupillary block and iris plateau and its impact on pupillary changes. It presents the observation of patients under scotopic conditions and infrared automated pupillometer. Intraocular pressure, average pupil diameter and average pupil area are measured and results are obtained.