Intravitreal injections primary prevention: a case-control study

OBJECTIVE: Intravitreal injec tions (IVI) of therapeutic substances are one of the most common procedures in ophthalmol ogy and, for sure, the most feared complica tion of them is endophthalmitis. Nowadays, a precise prophylactic protocol does not exist to avoid these infections, and the role of new anti septic drops is an interesting field of research in this regard. In this article we are going to dis cuss the tolerability and the efficacy of a new antiseptic drop based on a solution of hexam idine diisethionate 0.05% (Keratosept®; Brus chettini Srl, Genoa, Italy). PATIENTS AND METHODS: This was a sin gle-center, case-control study, comparing the in vivo effect of hexamidine diisethionate 0.05% with povidone iodine 0.6% solution during IVI program. Ocular bacterial flora composition was analyzed with a conjunctival swab on day 0. After injection patients underwent antibac terial prophylaxis with Keratosept for 3 days or povidone iodine 0.6%. A second conjunctival swab was collected on day 4 and patients were asked to fulfill a questionnaire based on the OS Di model, to investigate the ocular tolerability of the drug administered. RESULTS: Efficacy was tested on 50 patients, 25 of whom received hexamidine diisethionate 0.05% drops and the other 25 received povidone iodine 0.6% solution drops, 100 total conjuncti val swabs, 18 positive swabs before and 9 after treatment for the first group and 13 before and 5 after for the second one. Tolerability was tested on 104 patients, 55 underwent Keratosept thera py and 49 povidone iodine one. CONCLUSIONS: Keratosept demonstrated a good efficacy profile with better tolerability against povidone iodine in the analyzed sample

Double hit: mantle cell lymphoma associated with squamous cell carcinoma or chalazion? A case report

A few cases of ocular adnexal neoformations related with MCL have been reported in the literature. We present a rare case of tumour duplicity: mantle cell lymphomas (MCL) associated with squamous cell carcinoma (SCC) localised at the level of the ocular adnexa, on left upper eye lid mass since two years of 18 mounth duration in a 57-year-old man who had previously been diagnosed with stage IV MCL for 14 months. The patient had been treated according to the R-DHAP scheme for 4 cycles, in anticipation of a possible autologous HSC transplant, which was not carried out due to a positive diagnosis at the end-of-cycle osteomedullary biopsy (BOM) check. Ophthalmological examination was performed, and afther surgical removal histological examination proved to be squamous cell carcinoma (SCC). The aim of this case report is to decode the signs, symptoms and factors associated with the formation, that appear to be a chalazion, at an early stage in order to prevent the overgrowth of the mass that could invade the surrounding tissues by infiltrating them, as well as negative aesthetic outcomes of the surgery due to the excessive size of the mass, which could compromise the patient's quality of life

Efficacy of 190 mcg fluocinolone acetonide intravitreal implant: microperimetry and OCT real-life data

Objective: Fluocinolone acetonide is a valid alternative treatment for patients with chronic diabetic macular edema (DME) with poor response to anti-vascular endothelial growth factor (VEGF) therapy. The purpose of this study is to report the efficacy and safety of ILUVIEN® implant in pseudophakic eyes with persistent DME. Patients and methods: This is a single-centre pilot-study of 8 patients with persistent DME treated with the ILUVIEN implant, despite previous anti-vascular endothelial growth factor and/or steroid treatment. Best-corrected visual acuity (BCVA), optical coherence tomography (OCT) central retinal thickness, intraocular pressure (IOP) and microperimetric data were evaluated at baseline and month 1, 3 and 6 post treatment. Results: All data are presented as mean and standard deviation. At baseline, 1, 3 and 6 months, we had BCVA of 0.26±0.22, 0.38±0.27, 0.48±0.27 and 0.46±0.24; IOP of 15.00±2.67, 15.50±3.16, 14.88±2.42 and 15.63±2.67 mmHg; macular thickness of 652±231, 487±278, 475±287 and 413±211 µm; macular sensitivity of 6.83±4.20, 6.13±3.72, 7.68±3.40 and 7.71±3.33 dB; bivariate contour elliptic area (BCEA) 95.4% 3.8±3.42, 6.06±10.06, 3.05±2.46 and 2.59±2.19°2. Conclusions: According to the results of our study, fluocinolone acetonide (FAc) is a valid therapy option despite some limitations. It has been evidenced that FAc is more effective in patients with mild central macular thickening, while in those with modest to severe central macular thickness (CMT), different therapy strategies should be considered

Interventional Radiology Approaches for Liver Metastases from Thyroid Cancer: A Case Series and Overview of the Literature

BACKGROUND: Liver metastases (LMs) from thyroid cancer (TC) are relatively uncommon in clinical practice and their management is challenging. Interventional radiology loco-regional treatments (LRTs), including radiofrequency ablation (RFA) and trans-arterial chemoembolization (TACE), have been successfully employed to treat LMs from various types of cancer. METHODS: We analyzed the role of LRTs in the management of unresectable LMs from differentiated and medullary TCs performed at our institution from 2015 to 2020. A review of the available English literature regarding this topic was also performed. RESULTS: Six hepatic LRTs were performed in 4 TC patients with LMs, in 2 cases after the start of treatment with a tyrosine kinase inhibitor (TKI). A partial response was obtained in 2 patients; the diameter of the largest targeted lesion was 18 mm in both of them. The remaining procedures were performed on larger lesions and a stable disease was achieved in all but one case. Acute LRT-related complications were transient and mild. In literature, the largest studies were focused on TACE in LMs from MTC, showing good tolerance and remarkable disease control, especially in case of limited liver tumour involvement. CONCLUSION: LRTs for LMs represent a valuable option for the treatment of metastatic TC in case of isolated hepatic progression or for symptoms relief, also after the start of TKI treatment as part of a multimodal approach. The best disease control is obtained when hepatic metastatic burden is limited. These procedures are generally well tolerated; however, a cautious multidisciplinary selection of the candidates is mandatory

InGaAs/InAlAs single photon avalanche diode for 1550 nm photons.

A single photon avalanche diode (SPAD) with an InGaAs absorption region, and an InAlAs avalanche region was designed and demonstrated to detect 1550 nm wavelength photons. The characterization included leakage current, dark count rate and single photon detection efficiency as functions of temperature from 210 to 294 K. The SPAD exhibited good temperature stability, with breakdown voltage dependence of approximately 45 mV K(-1). Operating at 210 K and in a gated mode, the SPAD achieved a photon detection probability of 26% at 1550 nm with a dark count rate of 1 × 10(8) Hz. The time response of the SPAD showed decreasing timing jitter (full width at half maximum) with increasing overbias voltage, with 70 ps being the smallest timing jitter measured

Quantitative assessment of HCC wash-out on CT is a predictor of early complete response to TACE

OBJECTIVES: To investigate the predictive value of four-phase contrast-enhanced CT (CECT) for early complete response (CR) to drug-eluting-bead transarterial chemoembolization (DEB-TACE), with a particular focus on the quantitatively assessed wash-in and wash-out. METHODS: A retrospective analysis of preprocedural CECTs was performed for 129 HCC nodules consecutively subjected to DEB-TACE as first-line therapy. Lesion size, location, and margins were recorded. For the quantitative analysis, the following parameters were computed: contrast enhancement ratio (CER) and lesion-to-liver contrast ratio (LLC) as estimates of wash-in; absolute and relative wash-out (WO(abs) and WO(rel)) and delayed percentage attenuation ratio (DPAR) as estimates of wash-out. The early radiological response of each lesion was assessed by the mRECIST criteria and dichotomized in CR versus others (partial response, stable disease, and progressive disease). RESULTS: All quantitatively assessed wash-out variables had significantly higher rates for CR lesions (WO(abs) p = 0.01, WO(rel) p = 0.01, and DPAR p = 0.00002). However, only DPAR demonstrated an acceptable discriminating ability, quantified by AUC = 0.80 (95% CI0.73–0.88). In particular, nodules with DPAR ≥ 120 showed an odds ratio of 3.3(1.5–7.2) for CR (p = 0.0026). When accompanied by smooth lesion margins, DPAR ≥ 120 lesions showed a 78% CR rate at first follow-up imaging. No significative association with CR was found for quantitative wash-in estimates (CER and LLC). CONCLUSIONS: Based on preprocedural CECT, the quantitative assessment of HCC wash-out is useful in predicting early CR after DEB-TACE. Among the different formulas for wash-out quantification, DPAR has the best discriminating ability. When associated, DPAR ≥ 120 and smooth lesion margins are related to relatively high CR rates. KEY POINTS: • A high wash-out rate, quantitatively assessed during preprocedural four-phase contrast-enhanced CT (CECT), is a favorable predictor for early radiological complete response of HCC to drug-eluting-bead chemoembolization (DEB-TACE). • The arterial phase of CECT shows great dispersion of attenuation values among different lesions, even when a standardized protocol is used, limiting its usefulness for quantitative analyses. • Among the different formulas used to quantify the wash-out rate (absolute wash-out, relative wash-out, and delayed percentage attenuation ratio), the latter (DPAR), based only on the delayed phase, is the most predictive (AUC = 0.80), showing a significant association with complete response for values above 120