Bilateral Scarring Research Articles

The Effectiveness of 595-nm Pulsed Dye Laser for the Treatment of Bilateral Cleft-Lip Scars in Asian Patients: A 6-Month Prospective, Randomized, Self-Controlled Trial.

Objective: This study is the first prospective within-patient self-controlled research seeking to investigate the safety and efficacy of 595 nm pulsed-dye laser (PDL) for the treatment of cleft-lip scars. Approach: This prospective, randomized, self-controlled study is based on the clinical records of the patients who received laser-assisted treatment due to bilateral cleft-lip scars. The bilateral scars were randomly assigned to the 595 nm PDL group with five consecutive sessions at 2-week intervals or control group in a blinded manner of evaluators, with subsequent follow-up for 6 months after the final treatment. Clinical efficacy and safety outcomes were evaluated by Vancouver Scar Scale (VSS), Patient Scar Assessment Questionnaire (PSAQ), and other objective evaluations. Results: A total of 18 patients were included. The 595 nm PDL-treated sides showed statistically significant improvement in VSS after treatment at follow-up compared with the baseline (p < 0.05). Interestingly, the 595 nm-PDL-treated side achieved significantly better improvement in scar pigmentation and pliability (p < 0.05). Though there was statistically significant difference between two groups (p < 0.05), the gap in overall PSAQ is not obvious. And comparison by area and coloring evaluation (E/M index) also suggests that the responses of scars to treatment by PDL were slightly improved (p < 0.05). Innovation and Conclusion: It is the first time to apply the 595nm PDL for cleft-lip scars. It would be a better choice for the early treatment of red scar with proliferative tendency after cleft-lip surgery.

Clinical Study of Liposuction Combined with Subareolar Incision Adenectomy for Gynecomastia

Objective: To investigate the clinical effect of liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular gynecomastia (GYN). Methods: From March 2021 to March 2022, the data of patients with Simon Grade Ⅲ adipo-glandular GYN treated by liposuction combined with glandectomy in the Department of Plastic Surgery, Zhongshan Hospital Affiliated to Dalian University and Henan Plastic Surgery and Aesthetic Hospital were retrospectively analyzed. Based on the medical records, color ultrasound was performed on the patient’s breast before surgery, which was determined to be GYN (more than 50% glandular tissue). A 3 mm long incision was made at the lower boundary of the surgical range, through which the adipose tissue in the hypertrophic region of the breast was repeatedly aspirated until a satisfactory thickness was achieved. The residual glandular tissue was removed by a semicircular arc incision under the areola, and then the areola incision was sutured in position. The blood flow, sensation, and wound healing of bilateral nipples and areola were observed after surgery, and the morphology of bilateral thorax and scar of incision were followed up. Results: A total of 15 GYN patients aged 18 to 35 years with body mass index of 23.8 to 26.5 kg/m2 (mean = 24.8 kg/m2) were included in this study. The average intraoperative liposuction volume of unilateral breast was 170 mL (150–200 mL), the average glandectomy volume was 115 g (95–125 g), and the average blood loss was about 40 mL (15–75 mL). Postoperative hypertrophic breast volume decreased significantly, and no complications such as hematoma, infection, skin ischemic necrosis, or sensory disturbance occurred in the nipple and areola, during the healing process. The patients were followed up for 3 to 6 months, and the bilateral thorax was smooth, symmetrical, and natural in contour. The incision was concealed, and the scar was not obvious. Conclusion: Liposuction combined with subareolar incision glandectomy in the treatment of Simon Grade Ⅲ adipo-glandular GYN is safe. The postoperative chest contour is smooth and natural, and the scar is small and invisible, which achieves good aesthetics.

Treatment and Management of Ectrodactyly-Ectodermal Dysplasia-Clefting Syndrome With Scleral Prosthetic Devices.

This case report highlights the unique application and long-term benefits of customized scleral devices in a patient with ocular complications from ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome over the span of 10 years. A 13-year-old girl with a history of EEC syndrome and ocular manifestations, including severe bilateral dry eye disease, corneal neovascularization and scarring, progressive fibrous pannus, and limbal stem cell deficiency, was examined and fitted with scleral devices. The goal of treatment was to stabilize the ocular surface, enhance vision, and improve ocular comfort. Throughout the course of treatment, there was minimal progression in ocular signs, despite interruptions in scleral device wear from application and removal challenges secondary to ectrodactyly. Customized scleral devices provided an optimal environment to support the ocular surface, improve comfort, and improve visual acuity. Further studies are required to demonstrate the benefits of scleral devices in larger populations of patients with EEC syndrome.

THE SUBSEQUENT IMPACT OF COVID-19 FOR BOTH IMMUNE DYSREGULATION AND OPPORTUNISTIC INFECTIONS

THE SUBSEQUENT IMPACT OF COVID-19 FOR BOTH IMMUNE DYSREGULATION AND OPPORTUNISTIC INFECTIONS

P330 A CASE OF SEVERE AORTIC STENOSIS IN A YOUNG PATIENT WITH BICUSPID AORTIC VALVE, FAMILIAL HYPERCHOLESTEROLEMIA AND CALCIFICATION AT THE SINOTUBULAR JUNCTION

Abstract Background Familial hypercholesterolemia (FH) is a disorder characterized by elevated LDL–C and premature vascular calcifications. Aortic stenosis (AS) is the most frequent complication of bicuspid aortic valve (BAV), often requiring aortic valve replacement. Cardiac surgery in patients with severely calcified ascending aorta is challenging. Case Presentation A 28 year old male from Albania presented to the ED for dyspnea and low–threshold angina. The patient had family history for CAD and a sister with known FH treated with PCSK9–i. He had BAV, known hypercholesterolemia (max cholesterol 660 mg/dL), treated since 2015 with rosuvastatin plus ezetimibe, with reported irregular intake. He was treated with PCI and bioresorbable vascular scaffold on LAD coronary artery. He underwent surgical removal of limb xanthomas. At admission, the patient was asymptomatic at rest. Cardiac auscultatory findings included an ejection murmur in the aortic area. He presented upper and inferior eyelid xanthelasmas, bilateral calcaneal tendon thickening, elbows and knee xanthoma removal scars. Blood tests were unremarkable, except for lipid profile (LDL–C 443 mg/dL, HDL 36 mg/dL, TG 73 mg/dL). The echocardiography showed BAV, severe AS (Vmax 4,2 m/s, MPG 41 mmHg, AVA 0.46 cm2/m2), EF 60%. A coronary angiography excluded significant stenosis in the epicardial coronary vessels. An aortic CT scan showed sinotubular junction with preserved diameters and severe multiple parietal calcifications, ascending aorta with diffuse atheromatous disease. The patient underwent mechanical aortic valve replacement, ascending aorta thromboendarterectomy, non–coronary sinus enlargement patch, double CABG (SVG–OM, SVG–LAD) due to diffuse hypokinesia of the left ventricle after the interruption of extracorporeal circulation. At a 3–month outpatient re–evaluation, due to the unsatisfactory response to the regular intake of rosuvastatin plus ezetimibe (TC 309 mg/dL, TG 52 mg/dL, HDL 34 mg/dL, LDL–C 264 mg/dL), a PCSK9–i was prescribed. Genetic studies for FH are ongoing. Discussion This case underlines the importance of aortic evaluation before aortic valve replacement, even in young FH patients, in which severe aortic calcification can influence surgical approach. Conclusion We described the multidisciplinary management of a severe symptomatic AS in a young male with FH and sinotubular junction parietal calcifications, which represented a challenging substrate for valve replacement.

Hereditary Sensory and Autonomic Neuropathy Type VIII: Congenital Insensitivity to Pain with Anhidrosis.

Hereditary sensory autonomic neuropathy type VIII (HSAN VIII) is a rare genetic disorder that characterized by insensitivity to pain, anhidrosis, self-mutilation, and absence of corneal reflex. We here report a 2-year-old female child presented with corneal opacity and was diagnosed HSAN VIII by its typical clinical features confirmed by gene analysis revealing the presence of homozygous mutation in the PRDM12 gene. Case Summary A 2-year-old female child was presented with complaint of corneal opacity in both eyes noticed 4 months ago [Figure 1a]. The mother also complained of missing both upper and lower front teeth [Figure 1b]. Frequent history of trauma either unknown or self-mutilated without any sign of discomfort was revealed. No lacrimation during cry, lack of sweating with dry skin, and recurrent episodes of unexplained fever were also noticed [Figure 1c]. She was the only child of consanguineous marriage with no similar disease in the family. General examination revealed evidence of mutilation such as multiple scars, well-defined nontender ulcers over face and limbs, and shortening of distal phalanges [Figure 1d-f]. Ocular examination showed absence of corneal sensation with corneal scar. Neurologic examination found generalized absence of pain and temperature perception with loss of reflexes. Gene analysis revealed the presence of homozygous mutation in the PRDM12 gene confirming the diagnosis of HSAN VIII.Figure 1: Composite picture depicting various manifestations of a child with hereditary sensory and autonomic neuropathy type VIII: (a) bilateral corneal scarring, (b) missing upper and lower front teeth, (c) dry skin, (d) painless ulcer on the right ankle, and (e and f) mutilated distal phalanges of hand and feetHSAN type VIII comprises a group of genetic disorders involving sensory and autonomic dysfunctions, described as a rare autosomal recessive disorder caused by homozygous mutation in the PRDM12 gene on chromosome 9q34.[12] It is characterized by insensitivity to pain and thermal stimuli, altered sweat and tear formation, self-mutilation behavior, absence of the corneal reflex resulting in corneal scarring and presence of repeated infections of the skin and bone that are also common [Table 1].[34] The diagnosis of HSAN is challenging due to its rarity and lack of simple diagnostic tests. The affected persons are vulnerable to severe complications and self-mutilation. Therefore, early identification and appropriate management are necessary to avoid severe injuries and its consequences.[5]Table 1: Reported cases of hereditary sensory autonomic neuropathy type VIII (HSAN VIII)Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Management of sexual dysfunction following poorly healed episiotomy in a multipara in low-income setting

Background: Episiotomy describes an incision made on the perineum to widen the vaginal orifice so as to aid delivery of the baby. Though not routinely recommended, it is a common during delivery. Despite the intended positive outcomes, complications like sexual dysfunction, urinary incontinence, chronic pelvic pain, perineal infection do occur following it. When sexual dysfunction occurs as sequelae as a result of poor episiotomy repair technique or poor healing, it can affect sexual intercourse and lead to marital disharmony especially in societies that tend to lean towards patriarchy Case presentation: A 31-year-old Nigerian multiparous lady with three living children presented on account of complaints of lax introitus and lack of sexual satisfaction by the partner. She had poorly healed bilateral episiotomy scar following her last delivery. She has been practicing Kegel’s exercise with no improvement. There was associated threat to their relationship by her partner. Perineolasty and vaginoplasty was done. She had successful recovery and improvement in the quality of sex. Conclusion: This is a rare case of a woman in our clime visiting the clinic to request for perineal reconstruction following complaints by her partner and threat to their relationship. Obstetricians should pay attention to any complaint or worry following episiotomy and offer appropriate care to meet the sexuality needs of the parous following childbirth. Keywords: episiotomy; Kegel’s exercise; perineoplasty; vaginoplasty.

Generation of a Biobank From Two Adult Thoroughbred Stallions for the Functional Annotation of Animal Genomes Initiative.

Following the successful creation of a biobank from two adult Thoroughbred mares, this study aimed to recapitulate sample collection in two adult Thoroughbred stallions as part of the Functional Annotation of the Animal Genome (FAANG) initiative. Both stallions underwent thorough physical, lameness, neurologic, and ophthalmic (including electroretinography) examinations prior to humane euthanasia. Epididymal sperm was recovered from both stallions immediately postmortem and cryopreserved. Aseptically collected full thickness skin biopsies were used to isolate, culture and cryopreserve dermal fibroblasts. Serum, plasma, cerebrospinal fluid, urine, and gastrointestinal content from various locations were collected and cryopreserved. Under guidance of a board-certified veterinary anatomic pathologist, 102 representative tissue samples were collected from both horses. Whole tissue samples were flash-frozen and prioritized tissues had nuclei isolated and cryopreserved. Spatially contemporaneous samples of each tissue were submitted for histologic examination. Antemortem and gross pathologic examination revealed mild abnormalities in both stallions. One stallion (ECA_UCD_AH3) had unilateral thoracic limb lameness and bilateral chorioretinal scars. The second stallion (ECA_UCD_AH4) had subtle symmetrical pelvic limb ataxia, symmetrical prostatomegally, and moderate gastrointestinal nematodiasis. DNA from each was whole-genome sequenced and genotyped using the GGP Equine 70K SNP array. The genomic resources and banked biological samples from these animals augments the existing resource available to the equine genomics community. Importantly we may now improve the resolution of tissue-specific gene regulation as affected by sex, as well as add sex-specific tissues and gametes.

Complete Fusion of Both Eyelids in Stevens-Johnson Syndrome: Case Report

Abstract An 18-year-old woman developed Stevens-Johnson syndrome (SJS) with ocular involvement after taking ibuprofen. She was admitted to another hospital, received saline flushes and bacitracin ophthalmic ointment to the eyes, and became unable to open them. Upon transfer to this burn center 3 weeks after symptom onset, there was complete fusion of both eyelids with no visible cornea or sclera. She underwent bilateral operative scar release. After opening the lids, meticulous debridement of cicatricial membranes and release of symblephara were performed with subsequent placement of amniotic membrane grafts. Her vision slowly improved, though her long-term visual prognosis remains guarded. Early recognition and treatment of SJS or toxic epidermal necrolysis (TEN) with ocular involvement is imperative. Even mild cases may require intensive topical lubrication, steroids, and antibiotics, with early placement of amniotic membrane grafts in severe cases. Prompt intervention and daily evaluation are paramount in preventing lifelong visual disability.

Disseminated Toxoplasmosis in a Child Following Allogeneic Hematopoietic Cell Transplantation

A 23-month old female with hypoplastic myelodysplastic syndrome underwent allogenic hematopoietic cell transplantation (HCT), complicated by development of acute exotropia. Bilateral chorioretinal scars and a ring enhancing brain lesion were identified in further workup. Disseminated toxoplasmosis post-allogeneic HCT was subsequently confirmed by serologic and polymerase chain reaction testing results.

Visual facial perception of postsurgical cleft lip scarring assessed by laypeople via eye-tracking.

OBJECTIVES:This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology.MATERIAL AND METHODS:Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05.RESULTS:Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars.CONCLUSIONS:The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring.

The Value of Conjunctival Immunohistochemistry Analysis for the Diagnosis of Ocular Mucous Membrane Pemphigoid

Ocular Mucous Membrane Pemphigoid (OMMP), a subset of Mucous Membrane Pemphigoid (MMP) is an autoimmunemediated progressive cicatrizing conjunctivitis with the potential for corneal blindness. Direct Immunofluorescence (DIF) is considered the gold standard for the diagnostic confirmation of this condition; nevertheless, in many cases, this immunopathological technique is inconclusive. A 54 years old female presented to our service complaining of progressive diminished visual acuity, foreign body sensation, and photophobia in both eyes. The slit-lamp examination showed bulbar and palpebral conjunctival hyperaemia, as well as bilateral corneal scarring. During clinical follow-up, progressive conjunctival scarring with inferior fornix foreshortening, symblepharon formation, and significant corneal opacity dramatically diminished her visual acuity. A conjunctival biopsy was negative for DIF; therefore, Immunohistochemical analysis (IHCA) for IgG, IgA, and C3 immune reactants linear deposition on the conjunctival Basement-membrane zone (BMZ) was necessary for diagnosis confirmation. The present clinical case highlights the utility of paraffin-embedded conjunctival IHCA as an alternative immunohistopathology tool for the diagnosis of OMMP when DIF is non-conclusive.

AUTOIMMUNITY TRIGGERED BY IMMUNOTHERAPY: A CASE OF AUTOIMMUNE HEPATITIS-INDUCED BY NINTEDANIB TREATMENT FOR IPF

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) is an interstitial lung disease characterized by progressive loss of lung function, dyspnea and impairment in quality of life.1 Nintedanib is a tyrosine kinase inhibitor approved for treatment of IPF which can reduce the annual rate of decline in forced vital capacity.2 Nintedanib’s adverse effects are managed symptomatically, by dose reduction or treatment interruption.3 We present a case of drug induced autoimmune hepatitis associated with Nintedanib. CASE PRESENTATION: A 59-year-old male with 19 pack year smoking history, COPD GOLD group B, GERD and CAD who initially presented to his PCP 2 years prior with dyspnea. Patient underwent CABG and bio-prosthetic aortic valve replacement, but dyspnea persisted. PFTs showed a restrictive pattern and reduced DLCO. Chest CT showed mild centrilobular emphysema, coarse interstitial markings and bilateral pleural-parenchymal scarring with early honeycombing in the lung bases, highly suggestive of pulmonary fibrosis. Workup for secondary causes of fibrotic lung disease including connective tissue diseases and barium swallow test were negative. He was diagnosed with IPF and was started on Nintedanib within a month. Pretreatment liver function tests (LFTs) were normal. Three months into treatment, Nintedanib was discontinued due severe nausea, vomiting and diarrhea. LFTs at this time were significant for ALP 471, AST 139 and ALT 189. Liver ultrasound showed fatty infiltration and chronic liver disease workup was negative except for gamma-globulin elevation. Repeat LFTs 4 weeks after stopping Nintedanib were persistently elevated while liver biopsy showed active lobular, portal hepatitis and mild focal fibrosis. Patient was diagnosed with drug-induced autoimmune hepatitis and started on Prednisone which led to normalization of liver enzymes. Liver panel worsened when prednisone was tapered, and therefore Azathioprine was started as a steroid sparing agent. Patient continues to be on Prednisone and Azathioprine and is undergoing workup for lung transplant. LFTs improved to normal limits on current treatment. DISCUSSION: Hepatitis is a potential complication associated with Nintedanib use 4. Mechanism of hepatocellular injury remains unclear but is thought to be due to epidemiologic variances in tolerability.5 Current recommendations are to monitor LFTs every 3 months while on Nintedanib. CONCLUSIONS: A literature review did not yield other cases of Nintedanib causing drug induced autoimmune hepatitis. Nintedanib’s adverse events are still not well known, making the documentation of cases such as this one important to aid in the monitoring of patients undergoing therapy. Reference #1: Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.https://doi.org/10.1164/rccm.2009-040G. Reference #2: Richeldi L , Cottin V , du Bois RM , et al . Nintedanib in patients with idiopathic pulmonary fibrosis: Combined evidence from the TOMORROW and INPULSIS(®) trials. Respir Med 2016;:74–9.https://doi.org/10.1016/j.rmed.2016.02.001 Reference #3: Richeldi L , du Bois RM , Raghu G , et al . Efficacy and safety of nintedanib in idiopathic pulmonary fibrosis. N Engl J Med 2014 2071;370 82:2071–82.https://doi.org/10.1056/NEJMoa1402584 DISCLOSURES: Speaker/Speaker's Bureau relationship with boehringer ingleheim Please note: $20001 - $100000 Added 03/13/2019 by Tariq Cheema, source=Web Response, value=Honoraria No relevant relationships by Muhammad Asad Faruqi, source=Web Response No relevant relationships by Ayla Gordon, source=Web Response No relevant relationships by Melissa Mosley, source=Web Response No relevant relationships by Erica Rabold, source=Web Response

Our experiences regarding combined use of pedicle plication and dermal flap suspension in inferior pedicle inverted-T scar reduction mammaplasty

Objective: T o present clinical outcomes and experiences regarding combined use of plication and dermal flap suspension of inferior pedicle in inverted-T scar reduction mammaplasty. Method: One hundred and twenty-one cases with bilateral macromastia were operated by using the present technique between March 2008 and November 2017. The cases were reviewed retrospectively regarding demographics, preoperative findings, and postoperative outcomes. Of the 121 cases, 22 were excluded from the study analysis. Results: The mean age of the cases was 39 . 77 years. The mean preoperative diameter of NAC and the mean preoperative distances of midclavicle-to-nipple, nipple-to-IMF and IMF were 6 .54, 33.48, 15. 98 and 25 . 09 cm, respectively. The mean weight of excised tissue per case was 2033 . 32 g. There were three cases with unilateral T-junction dehiscence and two cases with unilateral T-junction necrosis. Furthermore, one case presented with bilateral , and two cases presented with unilateral superficial partial necrosis of NAC. At long-term, six cases had a slight asymmetry, two had bilateral pseudoptosis, and three had bilateral hypertrophic scarring among the transverse incision of the inverted-T scar. One case underwent bilateral excision of lateral dog ears and one underwent surgery due to unilateral fat necrosis at postoperative 3 rd month . Two cases presented with unilateral loss of NAC sensation. The overall satisfaction with the operation was high. Conclusions: The outcomes of this study led us to conclude that the combined use of pedicle plication and dermal flap suspension improves the shape and position controllability of the inferior pedicle, produces a projectile and stabilized breast mound, aids in achieving satisfactory long-term cosmetic outcomes, and prevents breast deformities. Extended operative time can be considered as a disadvantage of the technique.

Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

BACKGROUND:Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.AIM:To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.METHODS:We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 ± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).RESULTS:Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.CONCLUSION:Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.

Visual acuity improvement in bilateral corneal scars following the use of rigid gas permeable contact lens : a case report

Visual acuity improvement in bilateral corneal scars following the use of rigid gas permeable contact lens : a case report

Symptoms, Signs and Long-term Prognosis of Vertically Transmitted Chlamydia trachomatis Infections.

Although Chlamydia trachomatis infection is common in pregnant women, such infections are rarely encountered in infants. To clarify the recognition of C. trachomatis infections in infants, we analyzed symptoms and signs of perinatally acquired chlamydial infection, together with its long-term prognosis in a large population-based patient series. A search through 2 national health registries covering 1996-2011, a cohort of 933,823 births, yielded 124 children with a microbiologically confirmed C. trachomatis infection. We then reviewed copies of the children's medical records up to 16 years of age. One-third of the infants with chlamydial conjunctivitis (33/110) had spontaneous blood-stained discharge from the infected eye. The infants with C. trachomatis lower respiratory tract infection were mostly afebrile (30/32), and 15/32 of them had wheezing. Staccato cough was not recorded in any of the infants. The median diagnostic delay from the onset of the symptoms was 13 (range 4-374) days for conjunctivitis and 25 (range 10-149) days for lower respiratory tract infection. One neglected child developed bilateral corneal scars because of an untreated C. trachomatis infection. Blood-stained discharge was a typical finding in C. trachomatis conjunctivitis. The C. trachomatis-infected infants had severe and prolonged symptoms, but long-term consequences were rare. The diagnostic delay was long, especially among the infants with a C. trachomatis lower respiratory tract infection.

A Placebo-controlled Study of PF-06473871 (Anti-Connective Tissue Growth Factor Antisense Oligonucleotide) in Reducing Hypertrophic Skin Scarring.

Connective tissue growth factor (CTGF) is a matricellular protein that plays a key role in wound healing and scar formation. Inhibition of CTGF by a specific antisense oligonucleotide significantly reduced scarring and fibrosis in animal models. This study examined whether an antisense oligonucleotide that inhibits human CTGF expression could reduce the severity of hypertrophic scar formation in patients following surgical revision of preexisting breast scars. This study was a 24-week multicenter, randomized, double-blind, within-subject, placebo-controlled phase 2b study evaluating the efficacy and safety of PF-06473871 in 2 regimens of either 3 or 4 intradermal injections (postsurgery weeks 2, 5, 8, and 11) of 5 mg/cm adjacent to the new surgical incision. One hundred subjects with bilateral hypertrophic scars resulting from prior breast surgery were randomized. Efficacy was determined by the Patient and Observer Scar Assessment Scale (POSAS). The Physician/Observer POSAS overall opinion score at (week 24) for the 4-injection regimen demonstrated a statistically significant (P = 0.022) treatment difference from placebo of 0.68, and the treatment difference for the 3-injection regimen was nonsignificant (P = 0.4). Physician evaluation of scar severity at (week 24) with the photo-guide in the 4-injection regimen had a significant reduction (point estimate of treatment difference of 0.43 favoring PF-06473871). The surgical effect was approximately 2.0 at week 24 and was nearly 3 times greater than the treatment effect. Patient evaluations using the POSAS and photo-guide were not significantly improved with either dose regimen. PF-06473871 was generally well tolerated systemically and locally. The 4-dose regimen of PF-06473871 provided statistically significant improvement, inhibiting severity of hypertrophic scar formation based on physician assessment. However, the effect of revision surgery alone is significant and may dominate the treatment effect of PF-06473871.

Effects of Corneal Scars and Their Treatment With Rigid Contact Lenses on Quality of Vision.

To study the effects of corneal scars and the treatment of these scars with rigid gas-permeable (RGP) contact lenses on quality of vision including straylight. Visual effects were related to scar characteristics such as size and grade. Straylight and best-corrected visual acuity were measured in 23 patients with corneal scars during and after RGP contact lens wear. Contralateral eyes were used as controls, and age-normal values in case of bilateral scars. Straylight measurements were performed using the compensation comparison method of the Oculus C-Quant instrument. Scarred eye straylight values were 1.53 log(s) without contact lens and 1.60 log(s) with contact lens (P=0.043). Healthy eyes without contact lens had a mean straylight value of 1.13 log(s), corresponding to age-normal values. Contact lens wear increased straylight in healthy eyes to 1.26 log(s) (P<0.001). Visual acuity improved from 0.66 logarithm of minimal angle of resolution (logMAR) to 0.19 logMAR with contact lens wear in eyes with a corneal scar (P<0.001). Corneal scars can have a strong effect on quality of vision by diminishing visual acuity and increasing straylight. The increase in straylight from corneal scars on its own can lead to a serious visual handicap. Contact lens treatment did not improve straylight, but showed a slight worsening. As the recovery of visual acuity with contact lens wear far exceeded straylight increase, contact lenses remain a clinically useful treatment option in most patients with corneal scars.

Adrenocorticotropic hormone analogue as novel treatment regimen in ocular cicatricial pemphigoid

PurposeTo report the clinical outcome of a patient with ocular cicatricial pemphigoid, treated with adrenocorticotropic hormone gel. ObservationsA 75-year-old female with a biopsy proven ocular cicatricial pemphigoid (OCP) presented with bilateral conjunctival inflammation, fornix shortening, subepithelial fibrosis and corneal scarring. The patient was previously treated with topical steroids, topical cyclosporine and lubricating drops, and had undergone several amniotic membrane transplants due to recurrent corneal erosions. Once OCP diagnosis was established, the patient was started on oral corticosteroids (60 mg daily). In order to wean the patient off from systemic steroids, other immunomodulatory agents had been tried, including mycophenolate mofetil (1000 mg twice daily) and methotrexate (up to 25 mg weekly). However, none of these agents adequately controlled the ocular surface inflammation, and the patient experienced bilateral progressive cicatrization and corneal decompensation, as well as the development of side effects from the systemic corticosteroids, methotrexate and mycophenolate mofetil therapies. Treatment with twice weekly subcutaneous adrenocorticotropic hormone (ACTH) gel was initiated, along with tapering of systemic corticosteroids. During the 19 months treatment period, the patient demonstrated significant improvement in the ocular surface inflammation, visual acuity was stable and no significant adverse effects were observed. Systemic corticosteroids dosage was successfully reduced from 10 mg/day to none at last follow up. Conclusions and importanceACTH gel has shown to be an effective and safe treatment option for chronic, refractory and progressive ocular inflammatory disease. To the best of our knowledge, this is the first case report of a patient with OCP, treated successfully with ACTH gel. This case report may encourage ophthalmologists to employ ACTH gel in the management of OCP.