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Intracorneal ring segment (ICRS) implantation represents a modern, minimally invasive, surgical option for visual improvement in patients with keratoconus. ICRS modify the corneal geometry in a manner that enhances its refractive properties and thereby, they improve visual acuity. It is well-documented that implantation of ICRS decreases the keratometric readings, spherical equivalent and cylinder, reduces high-order aberrations and improves uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCDVA) in patients with keratoconus. Success rate after ICRS implantation is high, depending on appropriate patient selection and adherence to suitable implantation nomograms, and most important, the overall complication rate is very low. This review is summarizing current indications/contra-indications for ICRS implantation, implantation techniques, clinical outcomes and potential complications, shedding light on myths and realities related to this innovative surgical option.

Background The impact of Body Mass Index (BMI) on efficacy of TNF blocking therapy in Rheumatoid Arthritis (RA) patients and therefore on control of the disease is an important question. Objectives The aim of this study is to determine the influence of BMI on the efficacy of TNF blocking therapy in terms of disease activity in patients with RA. Methods A retrospective, observational study of 168 consecutive RA patients who received subcutaneously (SC) TNF blocking treatment (adalimumab, etanercept, golimumab and certolizumab pegol). Their follow-up data, for at least 26 weeks, and their baseline BMIs were available. The WHO definition for normal weight, overweight and obesity was applied, whereas clinical response was compared by BMI subgroups. Results The average BMI was 26.83±4.34 kg/m 2 and the baseline Disease Activity Score in 28 joints (DAS28 [ESR]) was high at 5.72±0.84. Mean age was 63.47±12.58 years and 135 (80.36%) were female. The median disease duration was 13.01±8.57 years. Overall, patients with normal weight responded better to treatment regimen, followed by overweight and obese subgroups. After a follow-up period of 26 weeks, the obese group had significantly higher DAS28 (ESR) and Health Assessment Questionnaire (HAQ) than either normal or overweight subgroups (3.26±0.84 vs 2.72±0.78 vs 2.81±0.82, p vs 0.076±0.01 vs 0.178±0.01, p p :0.002 and normal HAQ (≤0.5) p : 0.003. Conclusions Patients with RA and higher BMIs demonstrated a diminished clinical response after 26 weeks of SC-administered TNF-blocking treatment compared with their counterparts with lower BMIs. References [1] Klaasen R1, et al. Body mass index and clinical response to infliximab in rheumatoid arthritis. Arthritis Rheum2011Feb;63(2):359–64. [2] Puig L1. Obesity and psoriasis: body weight and body mass index influence the response to biological treatment. J Eur Acad Dermatol Venereol2011Sep;25(9):1007–11. [3] Daien CI1, et al. Predictive factors of response to biological disease modifying antirheumatic drugs: towards personalized medicine. Mediators Inflamm2014;2014:386148. [4] Schulman E1, et al. Overweight and Obesity Reduce the Likelihood of Achieving Sustained Remission in Early Rheumatoid Arthritis: Results from the Canadian Early Arthritis Cohort Study. Arthritis Care Res (Hoboken)2017Nov 30. Disclosure of Interest None declared

Background Several risk factors for contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) have been identified. The cumulative effect of these risk factors on renal function has been assessed with the development of risk score models in a number of studies. However, concerns were raised that estimates of the risk attributable to individual factors may be unreliable. We sought to develop a simple risk score for developing CIN after PCI irrespective of use of prophylactic measures and also capturing the effect of pre-intervention medication and presence of various co-morbidities. Methods Consecutive patients treated with elective or urgent PCI at our cardiac catheterization laboratory were enrolled (derivation cohort n=488, validation cohort n=200). CIN was defined as increase ≥25% and/or ≥0.5mg/dl in serum creatinine at 48h after PCI vs baseline. Multivariable logistic regression analysis was then performed to identify independent predictors of CIN (pre-existing renal disease, metformin use, history of previous PCI, peripheral arterial disease and ≥300ml of contrast volume). Results The incidence of CIN in the development cohort was 10.2% with a significant trend across increasing score values (p Conclusions The proposed risk score is easily applicable and allows for practically simple risk assessment compared to other published scores while at the same time overcomes drawbacks of previous model designs.

Hereditary angioedema is a rare genetic disorder resulting from an inherited deficiency or dysfunction of the C1-esterase inhibitor of the classic complement pathway. It is characterised by recurrent episodes of angioedema, without urticaria or pruritus, most often affecting the skin or the mucosal tissues of the upper respiratory and gastrointestinal tracts. We describe the peri-operative care of a woman with hereditary angioedema undergoing laparoscopic cholecystectomy with emphasis on the role of anaesthetists as peri-operative physicians.