Controversies in the Use of MIGS

Abstract Minimally invasive glaucoma surgery (MIGS) has fulfilled an unmet need in the management of glaucoma. This chapter highlights some controversial issues regarding the use of MIGS in clinical practice, including (1) whether there is sufficient evidence to advocate combining MIGS with cataract surgery over cataract surgery alone, (2) the merits and drawbacks of different approaches to trabecular bypass and canal-based MIGS procedures, (3) the effect of MIGS on endothelial cell loss, (4) suprachoroidal MIGS devices and whether there is still a role for these procedures, and (5) a comparison between subconjunctival MIGS and trabeculectomy. Several questions are still left unanswered and hopefully, further research and more clinical experience with these new technologies will help improve surgical outcomes for patients

IMPACT OF COVID-19 PANDEMIC ON IN-HOSPITAL ACUTE KIDNEY INJURY EPIDEMIOLOGY AND OUTCOMES: A RETROSPECTIVE COHORT STUDY

Background and Aims: Acute kidney injury (AKI) is a common complication in patients affected by Coronavirus disease-19 (COVID-19) and its development is associated with high mortality [1]. However, it is also clear that the COVID-19 pandemic has effects also on the management of diseases, not directly related to COVID-19 [2]. In this study, we investigated the impact of the COVID-19 pandemic on general intrahospital AKI incidence and outcomes. Method: We performed a retrospective cohort study comparing data on AKI epidemiology and outcomes of patients hospitalized from January 2016 to December 2019 (Pre-COVID-19 period) and from January to December 2020 (COVID-19 period, including both SARS-CoV-2 negative and positive patients). AKI was defined and classified evaluating the kinetics of intra-hospital creatinine (comparing the peak to the minimum serum creatinine level, considered as the basal value) [3]. The prevalence of chronic kidney disease (CKD) (i.e. eGFR <60 mL/min) was calculated in patients with previous creatinine values available. Patients with CKD stage 4-5 (i.e. eGFR<30 ml/min per 1.73 m2) and with a length of hospital stay> 30 days were excluded Results: 51,681 patients during the Pre-COVID-19 period and 10,062 during the COVID-19 period (9,026 SARS- CoV-2 negative and 1,036 SARS-CoV-2 positive patients) were analyzed. Patients admitted in the COVID-19 period were significantly older, with a higher prevalence of males and reduced prevalence of chronic conditions. In-hospital AKI incidence was 31.7% during the COVID-19 period (30.5% in SARS- CoV-2 negative patients and 42.2% in SARS-CoV-2 positive ones) as compared to 25.9% during the pre- COVID-19 period (p<0.0001) (Figure 1). Similarly, the COVID-19 period showed an increase in AKI stage 2-3 incidence both for AKI on CKD and for “de novo AKI”. In multivariate analysis, demographic characteristics, length of hospital stay, ICU admission, main comorbidities, basal sCr, admission period (Pre-COVID-19 or COVID-19) and SARS-CoV-2 infection were significantly associated with the risk of AKI. In particular, the admission in the COVID-19 period increased the risk of AKI (OR 1.18, IC 1.12- 2.25) regardless of SARS-CoV2 infection. Moreover, we found that in the COVID-19 period, there was an increased number of patients admitted to ICU, accompanied by a significant increase in the length of hospital stay and intrahospital mortality. At the multivariate analysis, development of AKI, admission in the COVID-19 period and active SARS-CoV-2 infection remained significantly and independently associated with mortality risk (Figure 2). Conclusion: Overall, we found that AKI was more common and severe in the COVID-19 period, regardless of SARS- CoV2 infection, when compared with patients admitted to the same hospital during the four years before the pandemic. So, we provide evidence that the COVID-19 pandemic has changed general in-hospital AKI epidemiology. These findings call attention to the need to adapt the resources dedicated to the prevention and management of the intrahospital AKI in response to health emergencies