Relevance of gastrointestinal manifestations in a large Spanish cohort of patients with systemic lupus erythematosus: what do we know?

SLE can affect any part of the gastrointestinal (GI) tract. GI symptoms are reported to occur in >50% of SLE patients. To describe the GI manifestations of SLE in the RELESSER (Registry of SLE Patients of the Spanish Society of Rheumatology) cohort and to determine whether these are associated with a more severe disease, damage accrual and a worse prognosis. METHODS: We conducted a nationwide, retrospective, multicentre, cross-sectional cohort study of 3658 SLE patients who fulfil =4 ACR-97 criteria. Data on demographics, disease characteristics, activity (SLEDAI-2K or BILAG), damage (SLICC/ACR/DI) and therapies were collected. Demographic and clinical characteristics were compared between lupus patients with and without GI damage to establish whether GI damage is associated with a more severe disease. RESULTS: From 3654 lupus patients, 3.7% developed GI damage. Patients in this group (group 1) were older, they had longer disease duration, and were more likely to have vasculitis, renal disease and serositis than patients without GI damage (group 2). Hospitalizations and mortality were significantly higher in group 1. Patients in group 1 had higher modified SDI (SLICC Damage Index). The presence of oral ulcers reduced the risk of developing damage in 33% of patients. CONCLUSION: Having GI damage is associated with a worse prognosis. Patients on a high dose of glucocorticoids are at higher risk of developing GI damage which reinforces the strategy of minimizing glucocorticoids. Oral ulcers appear to decrease the risk of GI damage. © The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Rheumatology

Predictive value of visual evoked potentials, relative afferent pupillary defect, and orbital fractures in patients with traumatic optic neuropathy

Seyed Ali Tabatabaei1, Mohammad Soleimani2, Mahdi Alizadeh1, Morteza Movasat1, Mohammad Reza Mansoori1, Zakieh Alami1, Alireza Foroutan2, Mahmood Joshaghani2, Saeid Safari2, Arzhang Goldiz21Farabi Eye Research Centre, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; 2Iran Eye Research Centre, Rassul Akram Hospital, Tehran, IranBackground: The purpose of this study was to determine the predictive value of flash visual-evoked potentials (VEP), relative afferent pupillary defect, and presence of orbital fractures in patients with traumatic optic neuropathy.Methods: A prospective study was conducted in 15 patients with indirect traumatic optic neuropathy. All patients underwent a thorough ophthalmic examination. Initial visual acuity, final visual acuity, and relative afferent pupillary defect were determined, and visual acuity was converted into logMAR units. We performed flash VEP and an orbital computed tomography scan in all patients.Results: There was a good correlation between relative afferent pupillary defect and final visual acuity (r = −0.83), and better initial visual acuity could predict better final visual acuity (r = 0.92). According to findings from flash VEP parameters, there was a relationship between final visual acuity and amplitude ratio of the wave (r = 0.59) and latency ratio of the wave (r = −0.61). Neither primary visual acuity nor final visual acuity was related to the presence of orbital fractures in the orbital CT scan.Conclusion: Patients with traumatic optic neuropathy often present with severe vision loss. Flash VEP, poor initial visual acuity, and higher grade of relative afferent pupillary defect could predict final visual acuity in these patients. Presence of orbital fracture was not a predictive factor for primary visual acuity or final visual acuity.Keywords: visual acuity, flash VEP, RAPD, orbital fracture, CT sca

"PRIMARY VITRECTOMY VERSUS SCLERAL BUCKLING IN PATIENTS WITH RETINAL DETACHMENT AFTER CATARACT SURGERY"

The purpose of this study was to compare the anatomic and visual outcome of primary vitrectomy with scleral buckling in patients with retinal detachment following cataract surgery. Fifty-six consecutive patients with retinal detachment after cataract surgery were randomly assigned to two treatment groups: standard scleral buckling and standard three-port deep vitrectomy. Successful treatment was defined as improvement in vision (minimum of 2 lines in Snellen chart), anatomic reattachment and prevention of post-operative proliferative vitreo-retinopathy (PVR). The prognostic role of pre-operative and intra-operative conditions of the affected eye was also evaluated. Twenty-six of fifty-six eligible patients underwent scleral buckling and thirty had deep vitrectomy. Anatomic reattachment was achieved in 18 (69.2%) cases in scleral buckling group and 19 (63%) cases in vitrectomy group. Improvement in visual acuity was achieved in 76.9% and 83.3% and PVR occurred post-operatively in 23.1% and 16.7%, respectively. The differences were not statistically significant, and pre- and intra-operative ocular conditions did not prove to be prognostic factors, either. Scleral buckling and primary deep vitrectomy seem to have comparable outcomes in terms of anatomic reattachment and visual improvement in patients with pseudophakic and aphakic retinal detachment. Failure to achieve anatomic reattachment and visual improvement or PVR occurred in about one third and one fifth of the cases respectively, irrespective of the technique used. This warrants further research to improve treatment result

THE RESULTS OF RADIAL OPTIC NEUROTOMY FOR TREATMENT OF CENTRAL RETINAL VEIN OCCLUSION

"nCentral retinal vein occlusion (CRVO) is the third most common blinding vascular retinal disorder. As there is no proven treatment for CRVO, we performed this study to evaluate the effectiveness of radial optic neurotomy (RON) on visual acuity in eyes with CRVO. This study was designed as an interventional case series. Pars plana vitrectomy with RON was performed in 18 eyes of 16 patients with ischemic CRVO with visual acuities of 20/400 or less. Postoperative and preoperative visual acuities were compared using t paired test. Mean preoperative visual acuity was 20/1000 (range, 20/1600 to 20/630). Mean follow-up time was 3.6 months (range, 1 to 9 months). Mean postoperative visual acuity was 20/400 (range, 20/1600 to 20/50) at last follow-up and the difference was significant (P < 0.01; t paired test). Six patients (33%) improved to 20/200 postoperatively. There were no major complications intraoperatively. Chorioretinal shunts developed in neurotomy site in 9 cases (50%) 4 to 10 weeks after procedure which were associated with faster resolving of hemorrhage and venous dilation. There were no major complications noted with this procedure but vitreous hemorrhage and iris neovascularization was observed in the early postoperative period in 2 (11%) of 18 cases. RON may improve visual acuity in eyes with CRVO. It is a technically feasible and fairly safe procedure but postoperatively it may result in some complications such as vitreous hemorrhage, iris neovascularization and retinal detachment