Central corneal thickness and anterior chamber depth measurement by Sirius® Scheimpfug tomography and ultrasound

Background: The purpose of this study was to compare the accuracy of the new Sirius® Scheimpflug anterior segment examination device for measurement of central corneal thickness (CCT) and anterior chamber depth (ACD) with that of CCT measurements obtained by ultrasound pachymetry and ACD measurements obtained by ultrasound biometry, respectively. Methods: CCT and ACD was measured in 50 right eyes from 50 healthy subjects using a Sirius Scheimpflug camera, SP100 ultrasound pachymetry, and US800 ultrasound biometry. Results: CCT measured with the Sirius was 546 ± 39 μm and 541 ± 35 μm with SP100 ultrasound pachymetry (P = 0.003). The difference was statistically significant (mean difference 4.68 ± 10.5 μm; limits of agreement −15.8 to 25.20 μm). ACD measured with the Sirius was 2.96 ± 0.3 mm compared with 3.36 ± 0.29 mm using US800 ultrasound biometry (P , 0.001). The difference was statistically significant (mean difference -0.40 ± 0.16 mm; limits of agreement -0.72 to 0.07 mm). When the ACD values obtained using ultrasound biometry were corrected according to the values for CCT measured by ultrasound, the agreement increased significantly between both technologies for ACD measurements (mean difference 0.15 ± 0.16 mm; limits of agreement -0.16 to 0.45 mm). Conclusion: CCT and ACD measured by Sirius and ultrasound methods showing good agreement between repeated measurements obtained in the same subjects (repeatability) with either instrument. However, CCT and ACD values, even after correcting ultrasound ACD by subtracting the CCT value obtained with either technology should not be used interchangeably. Keywords: Scheimpflug corneal tomography, ultrasound biometry, ultrasound pachymetry, limits of agreement

Pigmented corneal ring associated with orthokeratology in caucasians : case reports

BACKGROUND: The aim was to report the appearance of a pigmented ring in both eyes of two patients undergoing overnight orthokeratology. METHODS: Two Caucasian patients, one male and one female, were fitted with orthokeratology lenses to correct myopia between -2.00 and -2.50 DS with Paragon corneal refractive therapy lenses worn overnight. Treatment was successful in both patients achieving uncorrected vision of 6/6 or better monocularly under high (100 per cent) and low (10 per cent) contrast conditions. RESULTS: At the six-month visit both patients presented with pigmented rings under slitlamp examination in both eyes. The location of the ring was consistent with the corneal area being flattened for myopic correction. Clinical examination was otherwise normal. CONCLUSIONS: Despite being initially reported in Asian patients from Hong Kong, a pigmented ring related to orthokeratology treatment is also present in Caucasian patients, reducing the potential role of an ethnic link. Further large-scale studies need to be done to estimate the actual incidence of this condition and the potential implications for corneal health

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Morformetría corneal en queratoconos, lentes de contacto y cirugía refractiva

Tese de Doutoramento em CiênciasLos conocimientos de las características morfométricas, biomecánicas y fisiológicas de la córnea son básicos para el estudio de los cambios que se producen en la córnea con el sexo, la edad y el envejecimiento, para el seguimiento de procesos tales como la adaptación de lentes de contacto o la respuesta corneal a sus materiales y geometrías, para el estudio de determinadas patologías como el queratocono y para la corrección de ametropías mediante cirugía refractiva, que constituyen los objetivos de este trabajo. Para aproximarse a dicho conocimiento, este estudio analiza el espesor y la curvatura de la córnea en las muestras poblacionales más adecuadas según la finalidad, utilizando para ello la biometría ultrasónica, el sistema de análisis corneal Orbscan II y el videoqueratoscopio Eye Sys, fundamentalmente. Los resultados obtenidos permitieron constatar una reducción del espesor corneal con el envejecimiento, que es más marcada en las mujeres que en los hombres. En cuanto a la curvatura corneal, no mostró diferencias consistentes con la edad, ni fue sensiblemente diferente entre hombres y mujeres; ricamente, se aprecia que las mujeres menores de 50 años, examinadas en el 5º día del ciclo, presentas córneas ligeramente más curvas que el conjunto de la muestra, y también se observa que predomina el astigmatismo directo que con la edad evoluciona hacia un patrón inverso. Como resultado más evidente en los pacientes con queratocono cabe destacar que el porte de LC puede influir sobre la progresión de la ectasia. El porte prolongado de lentes de contacto de hidrogel de silicona no modifica el espesor en ninguna zona de la córnea, ni la curvatura corneal central. Sin embargo, produce un ligero aplanamiento en la periferia y medioperiferia. Finalmente, reseñar que el láser excimer Schwind es un instrumento muy fiable en cuanto a la corrección del defecto refractivo, pero su computador emite un informe de ablación que debe ser tomado con reservas en cuanto a la magnitud de la ablación.O conhecimento das características morfométricas, biomecânicas e fisiológicas da córnea é fundamental para o estudo das alterações nela produzidas pela idade, sexo, assim como para o seguimento de processos tais como a adaptação de lentes de contacto ou a resposta aos materiais e geometrias das referidas lentes. Sendo também importante para o estudo de determinadas patologias como o queratocone e a para a correcção de ametropias mediante cirurgia refractiva, que constituem os objectivos deste trabalho. Com o objectivo de obter os conhecimentos atrás descritos este estudo analisa a espessura e a curvatura da córnea em amostras populacionais mais adequadas para cada finalidade, sendo para isso utilizado fundamentalmente a biometria ultra-sónica, o sistema de análise corneal Orbscan II® e o videoqueratoscopio EyeSys®. Os resultados obtidos permitiram constatar a existência de uma redução da espessura corneal com o envelhecimento sendo mais acentuada nas mulheres que nos homens. Em relação à curvatura corneal, não se verificou diferenças com a idade nem entre a população masculina e feminina, tendo-se verificado apenas que para as mulheres com idades inferiores a 50 anos, examinadas no 5º dia do ciclo menstrual, apresentavam córneas ligeiramente mais curva que o conjunto da amostra. Verificouse ainda uma predominância do astigmatismo directo que com a idade evolui na direcção de um padrão inverso. Como resultado mais relevante nos pacientes de queratocone é necessário destacar que o uso de lentes de contacto pode influenciar na progressão da ectasia. O uso prolongado de lentes de contacto de hidrogel-silicone não altera a espessura da córnea em nenhuma zona, nem a espessura corneal central. No entanto, verificou-se um ligeiro aplanamento nas regiões paracentral e periférica. Finalmente, é importante realçar que o laser excimer de Schwind é um instrumento bastante fiável no que diz respeito à correcção do defeito refractivo, no entanto o relatório de ablação fornecido pelo equipamento deve ser analisado com alguma reserva no que diz respeito à magnitude da ablação

Binocular function parameters in elite football players

Background: To investigate the binocular function in elite football players, and to analyze the differences (i) between athletes who play in different positions and (ii) between players of different ethnicities. Methods: We screened 102 professional football players from four teams. The screening consisted of the measurement of refractive error. The binocular function parameters evaluated were: horizontal and vertical ocular alignment for distance (DF) and near fixation (NF), the values of break and recovery for negative and positive fusional vergences at DF and NF, vergence facility at NF, monocular accommodative facility at NF, near point of convergence (NPC) (break and recovery points), and NF stereopsis. All the athletes were men with a mean age of 24.6 ± 4.1 years. Results: No statistically significant differences were found based on the athletes’ ethnicity, except for ametropia prevalence, negative fusional vergences at DF, and NPC. We verified a statistically significant difference for the value of the break of negative fusional vergence at DF. The values found for Arab athletes are higher by more than 2 prism diopters than athletes of other ethnicities (p = .021). Arab athletes also show NPC values more distant than other athletes (p = .019, and p = .002 for break and recovery, respectively). Conclusion: Arab athletes have some binocular function parameters better than the remaining athletes, in particular when compared to Caucasian athletes. When compared to reference studies, athletes’ binocular function seems to be better than those of the general populationThis work was supported by the Portuguese Foundation for Science and Technology (FCT) in the framework of the Strategic Funding UIDB/04650/2020

Prevalence of binocular vision dysfunctions in professional football players

Background: The purpose of the study was to investigate the prevalence of binocular vision dysfunctions in elite soccer players. Methods One hundred and seven professional soccer players were evaluated. Refractive error was measured and the following binocular vision parameters were assessed: horizontal and vertical phoria for distance and near vision, the values of break and recovery for negative and positive fusional vergences at distance and near vision, vergence facility at distance and near vision, monocular accommodative facility at near vision, and near point of convergence (break and recovery points). All the athletes were men with a mean age of 24.4 +/- 4.8 years. Results No athlete was diagnosed with divergence excess, divergence insufficiency, or basic exophoria. About 13.0% of the athletes have binocular vision dysfunctions related to esophoria (0.9% with esophoria at near vision and 12.1% with esophoria at distance and near vision). About 10.3% have convergence insufficiency and 2.8% were diagnosed with fusional vergence dysfunction. The only accommodation-related parameter analysed was accommodative infacility, and 6.5% of the athletes had this dysfunction. Vertical phoria was present in 3.7% of the athletes. No statistically significant differences were found based on in athletes with respect to ethnicity, position occupied on the field, age, ametropia or laterality. Conclusion The overall prevalence of binocular vision dysfunction in elite soccer players was 36.4%. The most prevalent dysfunctions are related to the presence of esophoria (13.0%). The values found point out the need to include binocular vision assessment protocols in the visual assessment routine for athletes.- (undefined