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PURPOSE To compare the accuracy of the Barrett Universal II (BUII) five-variable formula to previous generation formulae in calculating intraocular lens (IOL) power following paediatric cataract extraction. METHODS Retrospective study of consecutive paediatric patients who underwent uneventful cataract extraction surgery along with in-the-bag IOL implantation between 2012 and 2018 in the Hospital for Sick Children, Toronto, Ontario, Canada. The accuracy of five different IOL formulae, including the BUII, Sanders-Retzlaff-Kraff Theoretical (SRK/T), Holladay I, Hoffer Q and Haigis, was evaluated. Constant optimization was performed for each IOL and for each formula separately. Mean prediction error (PE) and the mean and median absolute PE (APE) were calculated for the five different IOL formulae investigated. RESULTS Sixty-six eyes of 66 children (59% males) with a median age at surgery of 6.2 years (IQR, 3.2-9.2 years) were included in the study. The mean IOL power that was implanted was 23.3 ± 5.1 D (range; 12.0-39.0 D). Overall, the BUII had a comparable median APE to the Hoffer Q, Holladay I, SRK/T and Haigis formulae (BUII: 0.49D versus 0.48D, 0.61D, 0.74D and 0.58D respectively; p = 0.205). The BUII, together with Hoffer Q, produced better predictability within 0.5D from target refraction compared with the SRK/T formula (BUII:51.5%, Hoffer Q:51.5% versus SRK/T:31.8%, p = 0.002 for both). CONCLUSION The BUII formula had comparable accuracy to other tested formulae and outperformed the SRK/T formula, when calculating IOL power within the 0.5D range from target refraction in paediatric eyes undergoing cataract surgery with in-the-bag IOL implantation.

Introduction: The purpose of this study is to evaluate the effect of intravitreal injection of tissue plasminogen activator (tPA) on proliferative vitreoretinopathy (PVR). Methods: PVR was induced in a rabbit model by intraocular injection of dispase (0.05 U/0.1 mL). Progression of PVR was followed by indirect ophthalmic examination. Following 6 weeks, five animals received intravitreal injection of 25 µg/0.1 mL tPA and four were injected with balanced salt solution (BSS). Animals were euthanized at 48 hours following tPA/BSS injection and eyes were enucleated for histological evaluation and staining with α-smooth muscle actin (αSMA) and Sirius Red. Results: Following tPA injection, one eye had a reduction in PVR from grade 2 to 1 and three eyes remained stable. Following BSS, PVR grade was unchanged in three eyes. In one eye in each group, the severity of PVR couldn't be assessed due to limited view. Staining with αSMA showed reduced presence of fibroblasts in eyes injected with tPA compared with those injected with BSS. Collagen type I and III, demonstrated by Sirius Red staining, was reduced in the tPA group in comparison to controls. Conclusion: Our results suggest that intravitreally injected tPA may show an inhibitory effect on PVR progression. Further exploration in clinical trials is desired.

Purpose To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population. Setting Shiley Eye Institute, University of California San Diego, USA. Design Retrospective cohort. Methods Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75-84 and ≥85 years old) was performed. Results Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group. Conclusions To the authors' knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.

To describe the first clinical implantation of the CorNeat™ keratoprosthesis, which utilizes a polymeric scaffold for biointegration within ocular tissue.The CorNeat keratoprosthesis was implanted in the right eye of a patient with bilateral corneal opacification and neovascularization secondary to multiple failed grafts. The following surgical technique was used: 360 degree peritomy; epithelial scraping and corneal marking; pre-placement of three corneo-scleral sutures through the implant; central trephination using a 7 mm trephine and host cornea removal; keratoprosthesis placement and sutures tightening while fitting the corneal edge into the posterior groove of the CorNeat keratoprosthesis; and repositioning of the conjunctiva over the implant skirt and fixation with sutures and Fibrin sealant.Twelve months postoperatively visual acuity improved to 1/16 from hand movement. The keratoprosthesis was properly positioned. Tactile intraocular pressure was assessed as normal. Regional, mostly nasal, conjunctival retraction of 4-5 mm over the nano-fibre skirt was seen throughout follow-up. The anterior chamber was quiet and well-formed. No other postoperative complications were observed.This initial case may imply a potential breakthrough in the treatment of corneal disease not amenable to standard corneal transplant. Long follow-up and additional implantations are desired to prove the long-term safety and efficacy of this device.

Background The purpose of this study was to compare the h-index, and subsequently the research productivity, among different ophthalmic subspecialties in the United States. Methods A cohort of over 15,000 academic ophthalmologists residing in the United States (US) was identified out of the physician list of the American Academy of Ophthalmology. Of them, 1000 ophthalmologists with at least one publication were randomly retrieved, 100 in each of the following 10 subspecialties: cataract, cornea/external disease, glaucoma, medical retina, neuro-ophthalmology, pediatric ophthalmology, plastic/reconstructive ophthalmology, refractive surgery, retina/vitreous surgery and uveitis. Data collected included: number of published papers, h-index score, annual increase in h-index and the mean number of authors on each paper. Results The mean h-index amongst all subspecialties was 9.87 ± 13.90, and the mean average annual increase in h-index was 0.22 ± 0.21. The mean number of papers published was 37.20 ± 80.08 and the mean number of authors on each paper was 3.39 ± 0.84. Uveitis was the most prolific subspecialty in mean number of papers (74.78 ± 131.37), in mean h-index (16.69 ± 20.00) and in mean annual increase in h-index (0.35 ± 0.28). The least fertile subspecialty with regards to research was cataract with 11.06 ± 27.65 mean number of papers, a mean h-index of 3.89 ± 5.84, and a mean annual increase in h-index of 0.11 ± 0.11. Conclusions This study describes the research productivity in each ophthalmic subspecialty in the US, thus providing information on the research performance of each field and on the expected academic accomplishments within it.

Background: The relation between health investment and research has been portrayed previously in several medical fields, showing a positive relation between economic resources and academic yield. Purpose: To assess the relations between various economic and bibliometric parameters in otolaryngology - head and neck surgery (ORL-HNS) of the OECD countries. Methods: Data regarding bibliometric parameters in ORL-HNS; number of publications, citations, citations per document and H index, between the years 1996 and 2019, were gathered from the Scimago Journal and Country Rank source. These data were then analysed in several breakdowns – seldom county, regional and language comparisons, in order to assess variations in ORL-HNS scholar activity. Economic data regarding each OECD country; GDP per capita, total health expenditure as percent of the GDP and GERD as percent of the GDP were gathered from the OECD and World Bank websites. The correlation between economic and bibliometric indicators was analysed. Results: Among 209,949 documents analysed, a strong correlation was found between H index and health expenditure (r=0.734, p=0.000), and a moderate connection was found between H index and both GDP per capita (r=0.459, p=0.005) and GERD as percent of GDP (r=0.579, p=0.000). Health expenditure showed the strongest correlations to bibliometric parameters. Nonetheless, most data showed some degree of positive correlations between economics and scholar productivity. Conclusion: This study emphasizes the positive relation between scholar productivity and economic indicators, mostly health expenditure, in the OECD countries in the field of ORL-HNS, implying the importance of health investment to ORL-HNS research.

Background: We aimed to compare the safety and efficacy of two techniques for the correction of subluxated posterior intraocular lens (IOL): scleral fixation (SFIOL) and iris fixation of IOL (IFIOL). Methods: 112 eyes of 105 patients that underwent SFIOL or IFIOL at the Kaplan Medical Center between 2008 and 2018 were retrospectively included, 73 eyes had SFIOL and 39 eyes had IFIOL. The main outcome measures were: operation time, postoperative visual acuity and intra and post-operative complications. Results: There was no significant difference in the mean operation time between SFIOL and IFIOL. The mean follow-up time was significantly longer for the IFIOL compared with the SFIOL (34 ± 31 vs. 14 ± 20 months, respectively [p>0.001]).Postoperative distance corrected visual acuity (DCVA) at the last follow-up was significantly better than the preoperative DCVA in both groups (SFIOL: 0.52 ± 0.49 vs. 1.20 ± 0.84, [p

PURPOSE: To compare ocular measurements of three optical biometry devices and their application in intraocular lens (IOL) power calculations. METHODS: One hundred and forty eyes which had undergone cataract extraction surgery with preoperative biometry with OA­-2000, IOLMaster-500, and Lenstar-LS900 were enrolled. Biometry measurements of the three devices were compared. The deviation of the postoperative refraction from the preoperative refractive target was calculated with different formulas (Barrett Universal II, Hoffer Q, Holladay I, and SRK/T). Errors in the predicted astigmatism using the Barrett toric calculator were calculated for the toric IOLs. Additional 6465 eyes in which the IOLMaster-500 failed to measure axial length (AL) were reviewed. The percentage of successful measurements using the OA-2000 in those eyes was calculated. RESULTS: High agreement was found between the three devices for AL, anterior chamber depth, and average keratometry measurements (interclass correlation confidents: 1.000, 0.970, and 0.998, respectively, P

Background Noninvasive or minimally invasive cosmetic dermatologic procedures are considered safe with low parentage of reported adverse events. However, reliable prevalence data regarding adverse event of such cosmetic procedures among patients with systemic autoimmune diseases are insufficient. Objectives To assess the occurrence of adverse events and disease exacerbation associated with noninvasive or minimally invasive cosmetic dermatologic procedures, including those involving hyaluronic acid fillers, botulinum toxins and laser application among patients with systemic autoimmune diseases. Methods Consecutive cases of patients suffering from autoimmune diseases and attending the rheumatology clinic for regular follow-ups, were asked about receiving cosmetic procedures during the last two years. Medical history, including clinical and laboratory signs of disease exacerbation after the date of the procedure, was retrospectively obtained from medical files of the patients included in the study. Patients were also asked about subjective disease exacerbation and local adverse events after the procedure. Results During the three months of study period, 148 patients were inquired. Nineteen patients (89% females) underwent 23 cosmetic procedures in total. Thirty-nine percent had Rheumatoid arthritis (RA), 39% had Ankylosing spondylitis (AS) and 22% had other systemic connective tissue disease. Sixty seven percent were treated by Disease-modifying antirheumatic drugs (DMARDs), 28% by Biologic treatment and 5% did not receive any specific treatment. All patients were in remission during the cosmetic procedures. Forty three and a half percent of patients underwent hyaluronic acid injection, 21.7% botulinum toxin injection, 21.7% laser application, 8.7% mesotherapy and 4.3% silicon injection. None of the patients suffered from subjective disease exacerbation after the procedure. No changes in antibody titer and level of acute phase reactants (C-reactive protein and erythrocyte sedimentation rate) were noticed. Two patients (10.5%) experienced local oedema after filler injections. Both patients received Hydroxychloroquine treatment (one patient with RA and one with AS). Conclusions Our results suggest that noninvasive or minimally invasive cosmetic dermatologic procedures, including energy, neurotoxin, and filler procedures, may be safe among rheumatological patients, and do not cause autoimmune systemic disease exacerbation when performed in periods of remission. Hydroxychloroquine may predispose to a higher occurrence rate of local site injection adverse events. Further studied are desired to investigate this phenomena. Disclosure of Interest None declared

Prasugrel has proved its superiority over clopidogrel for reducing ischemic events among patients with ST elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). Data on switching of antiplatelet therapy in acute coronary syndrome patients in clinical practice are very limited. Importantly, the safety of in-hospital switching from clopidogrel to prasugrel following thrombolysis has not been addressed.We reviewed consecutive STEMI patients from February 2011 to April 2014 who were transferred to a tertiary center after receiving thrombolysis and a loading dose of clopidogrel in a non-PCI-capable center. If not contraindicated, these patients were reloaded and treated with prasugrel. A control group, three times larger, was selected from patients who underwent primary PCI and were initially treated with prasugrel. In-hospital outcomes were examined.Cases (n=45, 13% female, mean age 56 years) and controls (n=135, 11% female, mean age 54 years) did not differ significantly with respect to MI location, left ventricular systolic function, and extent of coronary artery disease. Mean time from thrombolysis to prasugrel loading was 32±19 hours. No significant differences were found between cases and controls in TIMI major or minor bleeding (0% vs. 3%), overall mortality (0% vs. 1.5%), and hospitalization length (4.8 vs. 5.5 days).In-hospital reloading and subsequent maintenance therapy with prasugrel in patients who received thrombolysis and a loading dose of clopidogrel appears to be as safe as in STEMI patients managed by primary PCI; however, larger studies are needed to verify these results.

Intraocular power calculation is challenging for patients who have previously undergone corneal refractive surgery. The sources of prediction errors for these eyes are well known; however, the numerous formulas and methods available for calculating intraocular lens power in these cases are eloquent testimony to the absence of a definitive solution. This review discusses some of the available methods for improving the accuracy for predicting the refractive outcome for these patients. It focuses mainly on the methods available on the American Society of Cataract and Refractive Surgery (ASCRS) online calculator and provides some practical guidelines for cataract surgeons who encounter these challenging cases.

Background: Combined therapy of weight loss and exercise provide today the best treatment for Knee Osteoarthritis. Most studies evaluating the effect of this therapy focus on the active intervention phase or immediately after the end of the treatment. Objectives: To describe the of long term effectiveness of weight loss and exercise treatment on Knee Osteoarthritis. Methods: Medical charts of 10 overweight women who suffered from Knee Osteoarthritis and had been treated for six months with a combined treatment of weight loss with Orlistat in the recommended dose, aerobic exercise and muscle mass strengthening, were retrospectively reviewed. Knee Osteoarthritis symptoms were assessed before treatment, at the end of treatment and following 6 months using the Western Ontario and McMaster Universities Osteoarthritis Index. Results: In comparison to baseline, we documented a statistically significant improvement in pain, stiffness, and function at the end of the treatment (37.0 vs. 21.0, P=0.007, 44.5 vs. 28.3, P=0.037 and 45.5 vs. 27.1, P=0.005, respectively) together with reduction in BMI (32.9 vs. 29.5, P=0.007). Six months later, although the mean BMI had returned to its baseline (31.1, P=0.126), the improvement in all parameters still existed (23.9, P=0.028, 27.1, P=0.028 and 32.9, P=0.037, respectively). Conclusions: Weight reduction together with muscle strengthening can improve function, stiffness, and pain symptoms in women with knee Osteoarthritis. Our case series suggest that this combined intervention may potentially maintain clinical improvement even when patients return to their baseline weight.

Case series Patient: Female, 56 • Male, 64 Final Diagnosis: Neutropenia after Rituximab Symptoms: Cough • diarrhea • fever • headache Medication: Rituximab Clinical Procedure: — Specialty: Rheumatology Objective: Unusual or unexpected effect of treatment Background: We describe here 2 patients who developed late-onset neutropenia after Rituximab treatment. While this phenomenon is well described among patients suffering from hematological malignancies, such adverse effects are rare among patients with rheumatic diseases. Case Report: Two patients, the first with rheumatoid arthritis and the second with granulomatosis with polyangiitis, were treated by Rituximab after all previous treatments failed. The patients developed late-onset neutropenia after several courses of treatment. The first patient, with symptomatic neutropenia, recovered after a single dose of granulocyte macrophage stimulating factor, and the second patient’s neutrophils increased spontaneously. Both patients were retreated by rituximab in their scheduled time without further complications. Conclusions: Our case series is unique because the same phenomenon appeared in patients with different rheumatic diseases. This case series confirms the possibility of continuing the treatment without further adverse effects.

Summary Background: Tumor necrosis factor-alpha inhibitors treatment is accosiated with several side effects. The most common are injection side reactions, headache, nausea and infections. The more rare are development of systemic autoimmune diseases. Case Report: We describe two patients, who developed ANCA associated vasculitis during Tumor necrosis factor alpha inhibitors treatment. The diagnosis was confirmed by appropriate tissue picture, CT scan and laboratory findings. Conclusions: Our case series are unique, because vasculitis appeared after many years of the treatment and during complete patient’s remission of there main illness.

We herewith report the rare case of a patient with juvenile rheumatoid arthritis who developed on 2 occasions the clinical picture of an isolated unilateral palsy of the inferior oblique muscle—Brown’s syndrome, following pregnancies, each time in a different eye. Although the eye is frequently involved in rheumatoid arthritis (RA), the Brown’s syndrome is seldom reported in literature with regards to RA.