XEN-45 in the management of early glaucoma surgery: A national Delphi consensus study

BACKGROUND AND OBJECTIVE

Recommendations on general glaucoma management and the use of early minimally invasive and microincisional surgeries are limited. This study aimed to establish consensus regarding glaucoma management, focusing on the XEN-45 gel stent implant.

METHODS

A Delphi consensus-driven process was used. The scientific committee led the study, identified the expert panel, and participated in elaborating the questionnaire. Fifty-one panelists were invited to complete, on a nine-point Likert scale, an 89-item questionnaire covering three topic blocks. Two Delphi rounds were performed. Consensus was achieved if ≥66.6% of panelists reached agreement or disagreement.

RESULTS

Panelists agreed on 84 items related to the patients' quality of life, the therapeutic algorithm and patient profile, and surgical and pre- and post-operative management. Panelists agreed on the suitability of XEN stent implants to treat glaucoma at different stages and for different patient profiles: young patients, elderly or with significant comorbidities, and with myopic glaucoma, patients who failed previous surgeries, and with previous poor post-operative experience. XEN surgery was considered a therapeutic step prior to classic filtering surgery and a possible first surgical option in elderly patients with comorbidities and uncontrolled intraocular pressure. XEN surgery allows the patient to return to routine daily activities faster than conventional filtering surgeries and to reduce and/or eliminate topical treatments.

CONCLUSIONS

This Delphi-driven consensus resulted in a series of general recommendations for glaucoma management, including those related to patient quality of life, therapeutic algorithm, and patient profile, and specific ones regarding the use of XEN stent gel surgery.

Echocardiographic Characteristics of Patients with Anti‐synthetase Syndrome

Right ventricular (RV) dysfunction and pulmonary hypertension (PH) occurs in approximately one‐third of patients with interstitial lung disease (ILD) and is associated with reduced 6‐minute walk distance (6MWD), and increased hospitalizations and mortality. Although the impact of RV dysfunction and PH has been well described in several types of ILD, data is scarce on antisynthetase syndrome. Therefore, we sought to examine the presence of RV dysfunction and PH in patients with antisynthetase syndrome and the impact on clinical outcomes. We conducted a retrospective study of patients with antisynthetase syndrome. Seventy‐five subjects were identified. Fifty‐one (68%) subjects had echocardiographic data. Patients were grouped into those with normal fractional area change (FAC) ≥ 35% and reduced FAC < 35%. Clinical, echocardiographic, and right heart catheterization data were compared between the two groups. Subjects with FAC < 35% had lower diffusion capacity of the lung for carbon monoxide (29% vs. 47%, p = 0.004), fibrotic features on computed tomography of the chest (79% vs. 33%, p = 0.005), larger RV diameter (5.4 vs. 3.9 cm, p < 0.001), higher right atrial pressures (8 vs. 5 mmHg, p = 0.02), and required supplemental oxygen more frequently (100% vs. 44%, p < 0.001) compared to those with FAC ≥ 35%. We found no difference in 6MWD and hospitalizations between the two groups. The presence of RV dysfunction in antisynthetase syndrome may identify patients at risk of poor outcomes.

[Comparison of Goldmann tonometry, pneumotonometry and the effect of the central corneal thickness]

PURPOSE

To compare the intraocular pressure (IOP) measurements using the Goldmann applanation tonometer (GAT) and contact pneumotonometer (NTC), and to evaluate the effects of central corneal thickness (CCT) on the readings.

METHODS

This was a prospective, observational clinical study, which included 96 eyes of 49 patients, 40 glaucomatous, 29 ocular hypertensive and 27 normal subjects. The IOP measurements were performed with each tonometer. The CCT was also measured.

RESULTS

A strong correlation coefficient between GAT and the NTC was found (Pearson=0.922, p<0.001). The mean of paired differences between GAT and NTC was 0.72 ± 2.82 mmHg. The mean difference between GAT and NTC was low at lower levels of PIO and higher at higher levels of IOP. Readings with the GAT showed a mean increase in IOP of 0.47 mmHg for every 10 μm of CCT, and the NTC 0.34 mmHg for every 10 μm, the diference was not statistically significant.

CONCLUSIONS

The contact pneumotonometer is a reliable method in diagnosis and follow up of our population. The effect of the central corneal thickness was more important for the Goldmann applanation tonometer.

Bilateral optic papillitis following mycoplasma pneumoniae pneumonia

Mycoplasma pneumoniae is an atypical bacterium that can cause a great variety of respiratory infections and be responsible for ocular involvement such as conjunctivitis, anterior uveitis and very rarely optic neuropathy. We report herein an additional case of bilateral optic disc swelling with profound visual loss following Mycoplasma pneumoniae pneumonia and review the world literature on the ocular manifestations associated with this pathogen.

Time dependent and other possible changes of the intracellular D-glucose and Na+ concentration in the cortical tissue of rabbit kidney perfused "in vitro"

The mean intracellular D-glucose concentration (Gi), the ratio between Gi and the serosal extracellular concentration (Gi/Ge) and the cell Na+ (Nai+) were calculated on cortex slices at increasing times after their excision from two groups of kidneys perfused with blood containing 18.1 +/- 0.4 and 23.1 +/- 2.0 mmol.l-1 plasma glucose concentration. The distribution ratios Gi/Ge, always lower than 1, were substantially unchanged up to at least 50s after removal of the tissue from the organ. Between these time limits the calculated Gi and Gi/Ge does not seem to be affected by a rapid glucose breakdown in the isolated tissue. Neither such low values depend on a degrading of the intraextracellular Na+ concentration gradient, since this gradient seems to remain unchanged throughout the same time. In another group of experiments, in which phloretin was added to the perfusing blood (mean 0.6 X 10(-3) mol.l-1) at different glucose levels, the mean values of Gi/Ge in the cortical tissue were higher (in many cases greater than 1) than those obtained in a group of control kidneys perfused in absence of phloretin. According to the presented data, the mean Gi and Gi/Ge values, as calculated by us, seem to correspond to those existing in the functioning tissue just before its excision. The already suggested view that the low values of Gi and Gi/Ge could depend on the possible existence of a mechanism actively extruding glucose from the basolateral membrane of tubular cells seems to be reinforced.

Tubular extrusion of D-glucose in the isolated rabbit kidney perfused in vitro

The extrusion mechanism of d-glucose by tubular cells was investigated in isolated rabbit kidneys perfused with normal or hyperglicemic blood, added with 14C-inulin, by relating the values of the ratio between the intracellular and extracellular glucose concentration (Gi/Ge) in the cortical tissue to the respective plasma concentration Gp (= Ge). The apparent extracellular space was calculated in each experiment from the kinetics of the 14C-inulin efflux from cortical slices excised at the end of the perfusion period (mean value = 20.7 +/- 1.7 of the total vol.). The total intra and extracellular amount of glucose was measured in two contiguous slices excised from the cortex. The total water was expressed by the difference between the fresh and dry weight of the slice, the intracellular water by the difference between the total and extracellular water. From these volumes the respective apparent glucose concentrations could be found. The Gi/Ge values tend to 1, that is to a uniform intra and extracellular distribution of glucose, only at high plasma glucose levels. These results do not seem to be in agreement with a D-glucose transfer from the cell to the subepithelial spaces down a concentration gradient.

Basic ethers of cyclohexylphenols with beta-blocking activity: synthesis and pharmacological study of exaprolol

The paper describes the preparation and study of the pharmacological properties of a series of derivatives with the general formula. (see article) where R is a cyclohexyl or cyclohexenyl radical and R1 is a hydrogen, methyl or cyclohexyl. The compounds with a single cycloaliphatic radical ortho to the basic chain, and in particular the one with a cyclohexyl (exaprolol), were found to be particularly active in blocking the beta-adrenergic receptors, as antiarrhythmics and local anesthetics, while the introduction of a second radical or the shift of the cycloaliphatic radical to meta or para position caused the said pharmacological activities to disappear almost entirely, with the exception of the local anesthetic action.