Chronic Edema Research Articles

Severe Corneal Flattening After Endothelial Keratoplasty: Collagen Compaction Syndrome.

The purpose of this study was to present a case series of patients with extreme corneal flattening after uneventful endothelial keratoplasty (EK): collagen compaction syndrome. Four patients (2 men, 2 women, mean age 64.8 ± 11.8 years) underwent successful EK after a period of chronic corneal edema (4-7.5 months): 3 received Descemet membrane endothelial keratoplasty after unsuccessful Descemet stripping only for Fuchs dystrophy and 1 received Descemet automated endothelial keratoplasty after prolonged pseudophakic bullous keratopathy. All patients developed significant corneal flattening, affecting their vision and inducing a large hyperopic refractive outcome, best-corrected visual acuities ranging from 20/40 to 20/200. Chronic corneal edema may result in severe corneal flattening after EK. Preoperative duration of stromal edema might affect the outcome of EK and should, therefore, be considered in the timing of surgery. In cases of dense focal edema, including post-Descemet stripping only surgery, rescue treatment at week 8 should be considered.

A Novel Artificial Endothelial Replacement Membrane for the Treatment of Chronic Corneal Edema.

The purpose of this study was to report the safety and efficacy results of an artificial lamellar implant for the treatment of chronic corneal edema. The EndoArt (EyeYon Medical, Ness Ziona, Israel), an artificial endothelial replacement membrane designed to treat corneal edema, was implanted in 24 eyes of 24 patients with low-to-normal visual potential. We present the safety and efficacy results from a prospective, open-label, single-arm, multicenter study conducted over a 12-month period. Twenty-four patients were enrolled, with no device-related serious adverse events reported. Seventeen patients completed 12-month follow-up, showing a reduction in average central corneal thickness from 759 ± 116 μm to 613 ± 135 μm. Best-corrected distance visual acuity improved from 1.88 ± 0.79 logarithmic minimum angle of resolution (logMAR) to 1.34 ± 0.57 logMAR. Sixty percent gained at least 3 early treatment diabetic retinopathy study (ETDRS) lines. The EndoArt was removed in 5 cases due to incomplete attachment and replaced by corneal transplants; 1 patient was lost to follow-up, and 1 had a procedure failure. No device-related long-term complications, infections, or inflammations were reported. The implants remained transparent throughout the study. The first-in-human results of EndoArt implantation demonstrated the device's potential to treat patients suffering from corneal edema with a favorable safety profile and effective edema reduction in most subjects, with no device-related serious adverse event. The EndoArt may offer a viable solution in regions facing a shortage of donor corneas, as well as for patients who have poor prognosis with human tissue.

Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.

Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women. 51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase. Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement. Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.

Corneal Artificial Endothelial Layer (EndoArt): Literature Review and Our Experience.

Background/Objectives: The objective of this study was to examine the morphological corneal changes and outcomes following the implantation of an artificial endothelial layer (EndoArt) in patients with chronic corneal oedema. Methods: A systematic review of the literature was conducted alongside a detailed analysis of two clinical cases with chronic corneal oedema that were treated using EndoArt. Our experience with these two cases is included to provide practical insights and real-world outcomes. Results: Across the 24 cases reported (including the two presented here), an analysis was possible in 23 cases. Notably, 82% of patients had undergone at least one previous corneal transplant, with 39% having undergone three or more transplants. Additionally, 78% of cases had ocular comorbidities, with glaucoma surgery being the most prevalent (83%), which could have impacted visual outcomes. The follow-up period ranged from 3 to 17 months with a median of 3 months. After EndoArt implantation, the average reduction in the central corneal thickness (CCT) was 29%, and the rebubbling rate was 47.8%, with some cases requiring no rebubbling, while others required it up to 100% of the time. Visual acuity significantly improved from a mean best-corrected visual acuity (BCVA) value of 1.61 ± 0.5 logMAR to 1.07 ± 0.59 logMAR (p < 0.001). The CCT decreased from 771 ± 146 µm to 580 ± 134 µm (p < 0.001). These findings are consistent with our experience. Conclusions: EndoArt shows promise as an alternative treatment for chronic corneal oedema in complex cases where conventional corneal transplantation has failed or carries a high risk of failure. The morphological changes observed using anterior segment optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM) were similar to those reported after endothelial keratoplasty, with the notable exception of the absence of the hyper-reflective donor-host interface.

A Method to Improve the Accuracy for the Comparison of Consecutively Determined Upper Limb Cross-Sectional Area Profiles of Test Subjects: Impact on (Segmental) Limb Volume and Local Limb Circumference.

Background: Chronic edema management depends on measuring small volume changes over time. Therefore, a highly sensitive, accurate, and reliable technique is needed to objectively judge sequential measurements. Methods and Results: The prototype of the Peracutus Aqua Meth (PAM), a new volumetric measuring device, was used in an experimental study. Thirty-nine healthy test subjects were measured three times. The measuring principle of the PAM is based on obtaining a profile of cross-sectional areas along the length of an object or limb. Besides total arm volumes, the volume of any chosen segment can be determined. The utmost tip of the middle finger appeared to be an unreliable reference point. Instead, the concept of "hand median" was introduced to align and compare profiles of cross-sectional areas of sequential measurements. Using the hand median strongly improved the measuring accuracy, rendering standard deviation values of 0.4%-1.3% for (segmental) volume determination. Conclusions: Measurements with the PAM show that accurate local/segmental volume determination of a limb is possible. Standard deviations of less than 1.3% are easily obtained for cross-sectional area and volume determination.

Injectable Intravitreal Fluocinolone Acetonide Implant for Chronic Postoperative CME in the Presence of Silicone Oil Tamponade

Purpose: This report describes the use of the injectable intravitreal fluocinolone acetonide 0.18mg implant (FAI) for chronic postoperative cystoid macular edema (CME) in an eye with a silicone oil-filled vitreous cavity. Methods: A retrospective chart review was performed including surgical, clinical, and imaging data. Results: The patient had multiple complicated vitreoretinal surgical procedures including long-term silicone oil tamponade. The eye developed chronic CME, which responded to intravitreal steroid therapies and subsequently received FAI for longer-term control. The eye had no complications related to FAI. Conclusion: FAI is a long-acting steroid that may be beneficial in controlling chronic CME. It can be considered for use in eyes with silicone oil tamponade, but further studies are required to better understand the pharmacokinetics and utility of the FAI when injected into silicone oil-filled vitreous cavities.

Direct Excision of Malar Bags: Back to the Basics.

The pursuit of periorbital rejuvenation to counteract signs of aging is a focal point in cosmetic surgery, with eyelid surgery being a prominent choice among patients. Addressing inferior blepharoplasty, especially in cases involving chronic malar edema, malar mounds, and festoons, presents unique challenges. The terminology and classification of these conditions vary, hindering effective management. In this study, we use the term "malar bags" to encompass the spectrum of fluid-associated mounds over the malar eminence. This study aims to demonstrate the effectiveness of direct excision as a surgical choice for treating the aesthetic concerns associated with malar bags. A retrospective study was conducted on 53 patients who underwent direct excision of malar bags between 2013 and 2023 at our clinic. No major complications were encountered, overall high level of satisfaction for both patients and surgeons. Direct excision of malar bags proved to be a safe and effective technique, yielding satisfactory results in terms of both aesthetic outcomes and patient satisfaction. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Higher proportion of cellulitis in severe lymphoedema.

We read with interest the article from Burian et al. which discussed the prevalence and risk factors of cellulitis in chronic leg oedema. We conducted a twelve-year service evaluation at the Norfolk and Norwich University Hospital to investigate the applicability of these results in a real-world setting. Our study found that episodes of cellulitis were more common in patients with more severe lymphoedema, reinforcing the findings of Burian et al. and highlighting the importance of controlling lymphatic swelling to reduce cellulitis risk.

Fluocinolone acetonide 0.18-mg implant for treatment of recurrent inflammation due to non-infectious uveitis: a case series of 15 patients

IntroductionUncontrolled non-infectious uveitis affecting the posterior segment (NIU-PS) can lead to vision loss due to repeated bouts of inflammation and consequent tissue damage. Patients with chronic NIU-PS who experience recurrent uveitis after being treated with systemic and short-acting local corticosteroids may benefit from the sustained-release 0.18-mg fluocinolone acetonide implant (FAi).MethodsIn this case series, 18 eyes with chronic, recurrent NIU-PS and cystoid macular edema (CME) treated with the 0.18-mg FAi were analyzed retrospectively. Data on patient demographics, clinical history, previous and concomitant treatments for uveitis recurrence, time to and number of uveitis recurrences, intraocular pressure (IOP), central subfield thickness (CST), and visual acuity (VA) were collected and summarized.ResultsA majority of patients (14/15 [93%]) had a history of ocular surgery, largely cataract extraction, and all developed chronic and recurrent NIU-PS and CME. At baseline, patients had a mean age of 72 years (range: 46 to 93), were 53% male, and had a mean duration of NIU-PS of 3 years (range: 1 to 19). Patients were followed for an average of 16.5 months (range: 2 to 42.5 months) post FAi. Eleven of the 18 eyes (61%) had ≥ 5 recurrences of uveitis since diagnosis, with an average time to recurrence of approximately 12 weeks (range: 1 to 27). All eyes treated with the 0.18-mg FAi showed reduced NIU-PS recurrence and visual and anatomical improvement, as measured by VA and CST, respectively. Two eyes had an IOP elevation that was managed with topical therapy, and one eye was treated with topical prednisolone for additional inflammation management. Two eyes required adjunct therapy with short-acting intravitreal corticosteroids at 7 and 16 weeks for NIU-PS recurrence after 0.18-mg FAi insertion.ConclusionAfter receiving the 0.18-mg FAi, eyes with uncontrolled NIU-PS had sustained resolution of CME and inflammation with limited need for supplementary steroid drops or injections and minimal steroid class-specific adverse effects; none required incisional IOP-lowering surgery.

A Patent-Pending Ointment Containing Extracts of Five Different Plants Showed Antinociceptive and Anti-Inflammatory Mechanisms in Preclinical Studies.

Background/Objectives: The antinociceptive and anti-inflammatory effects of a patent-pending ointment containing plant extracts from Eucalyptus globulus, Curcuma longa, Hamamelis virginiana, Echinacea purpurea, and Zingiber officinale were evaluated. Methods: Plant extracts were chemically characterized by gas chromatography-mass spectroscopy. The antinociceptive activity of the ointment was assessed using the hot plate, tail flick, and formalin tests, whereas the anti-inflammatory activity was measured using the acute and chronic TPA-induced ear edema tests. Mechanisms of action were evaluated using inhibitors from signaling pathways related to pain response and by using histological analysis and assessing the expression and activity of pro-inflammatory mediators. Results: The ointment showed antinociceptive and anti-inflammatory effects like those observed with diclofenac gel (1.16% v/v) and ketoprofen gel (2.5% v/v). The antinociceptive actions of the ointment are mediated by the possible participation of the opiodergic system and the nitric oxide pathway. The anti-inflammatory response was characterized by a decrease in myeloperoxidase (MPO) activity and by a reduction in ear swelling and monocyte infiltration in the acute inflammation model. In the chronic model, the mechanism of action relied on a decrease in pro-inflammatory mediators such as COX-2, IL-1β, TNF-α, and MPO. An in-silico study with myristic acid, one of the compounds identified in the ointment's plant mixture, corroborated the in vivo results. Conclusions: The ointment showed antinociceptive activities mediated by the decrease in COX-2 and NO levels, and anti-inflammatory activity due to the reduction in IL-1β and TNFα levels, a reduction in MPO activity, and a decrease in NF-κB and COX-2 expression.

Optical coherence tomography angiography for microaneurysms in anti-vascular endothelial growth factor treated diabetic macular edema

BackgroundWe aimed to evaluate microaneurysms (MAs) after treatment with anti-vascular endothelial growth factor (anti-VEGF) therapy to understand causes of chronic edema and anti-VEGF resistance.MethodsPatients with non-proliferative diabetic retinopathy, with or without macular edema were recruited. Optical coherence tomography angiography (OCTA) MAs-related parameters were observed, including the maximum diameter of overall dimensions, material presence, and flow signal within the lumen. OCTA parameters also included central macular thickness (CMT), foveal avascular zone, superficial and deep capillary plexuses, and non-flow area measurements on the superficial retinal slab.ResultsOverall, 48 eyes from 43 patients were evaluated. CMT differed significantly between the diabetic macular edema (DME ) and non-DME (NDME) groups at 1st, 2nd, 3rd, and 6th months of follow-up (P < 0.001; <0.001; 0.003; <0.001, respectively). A total of 55 and 59 MAs were observed in the DME (mean = 99.40 ± 3.18 μm) and NDME (mean maximum diameter = 74.70 ± 2.86 μm) groups at baseline, respectively (significant between-group difference: P < 0.001). Blood flow signal was measurable for 46 (83.6%) and 34 (59.3%) eyes in the DME and NDME groups, respectively (significant between-group difference: P < 0.001).ConclusionsCompared to the NDME group, the DME group had larger MAs and a higher blood-flow signal ratio. Following anti-VEGF therapy, changes in the diameter of MAs were observed before changes in CMT thickness.Graphical

Incidence and outcomes of post-operative endophthalmitis following elective phacoemulsification cataract surgery, between 2015 and 2022.

Cataract surgery remains the commonest ophthalmic surgical procedure in the UK. Post-operative endophthalmitis (POE) is a sight-threatening complication. This study presents the incidence and outcomes of POE within Moorfields Eye Hospital NHS Foundation Trust (MEH) in London, UK. We conducted a retrospective, tertiary-centre study of the incidence and outcomes of POE following elective phacoemulsification cataract surgery between 2015 and 2022. We report a rate of 18 out of 154 826 (0.012%) cases of POE within seven weeks of cataract surgery. The age range was 43-87 years (mean age 67.1 years), and the male-to-female ratio was 1:1. Two cases were associated with intraoperative vitreous loss, one with anterior capsular tear extending to posterior capsular tear and the other with posterior capsular tear and dropped fragment. Two cases had a concomitant intravitreal injection, one of Triamcinolone Acetonide and the other of Dexamethasone implant (Ozurdex®), to manage chronic uveitic macular oedema. The majority of samples (89.9%) resulted in Gram-positive species. A final best corrected visual acuity (BCVA) of Snellen 6/36 or better was achieved in 12/18 (66.67%). The time from cataract surgery to suspicion of POE ranged from 3 to 44 days (mean 15.8 days). Eight cases (44.4%) required pars plana vitrectomy (PPV). We demonstrate an incidence of POE of 0.012% following phacoemulsification at MEH from January 2015 to December 2022. Such results are a testament to high-quality surgery, training supervision and post-operative care whilst adhering to local and international standards.

Tailoring Management of May-Thurner Syndrome : Case Comparison

Background: May-Thurner syndrome (MTS) is a post-thrombosis syndrome (PTS) of the lower extremity. This disorder results from compression and/or irritation from adjacent crossing the right common iliac artery to the left iliac venous. In this report, we present two management comparisons of patients with left lower DVT with consideration of MTS. Case Illustration: The first patient is a 49-year-old male soldier presented with chronic unilateral left leg edema and a mild clinical presentation for 9 months. Previous Doppler ultrasonography (DUS) revealed a thrombus in the left venous femoralis. Anticoagulant was given for six months. DUS and CT venography following anticoagulant treatment revealed a thrombus in the left venous femoralis. Venography revealed entire blockage of the left common femoral and left iliac veins, with adequate collateral flow. PTV was attempted twice and failed both times. The patient was following a conservative therapy (walking exercise and stocking compression) that yielded positive outcomes. The second patient is a 53-year-old male soldier has had unilateral left leg edema for three years, which has increased during the previous three months with ulceration and active bleeding. Previous Doppler ultrasonography revealed a thrombus in the left iliac externa. Anticoagulants and compression stockings were given for eight months, but the symptoms persisted. CT and venography revealed a complete blockage from the left popliteal vein to the iliac vein. Femoral crossover bypass surgery yielded favorable results. Conclusion: Clinically moderate MTS demonstrated fair results with conservative treatment, whereas clinically severe MTS showed superior results with bypass surgery. Keyword: Anticoagulant, May-Thurner Syndrome, Palma Procedure.

The impact of obesity on chronic oedema/lymphoedema of the leg – an international multicenter cross-sectional study (LIMPRINT)

Background/ObjectivesObesity and chronic oedema/lymphoedema are two distinct but related conditions, rarely investigated together. The aim was to study the impact of increased weight on chronic oedema and related factors.Subjects/MethodsA cross-sectional study, 38 centers, nine countries. Patients with clinically confirmed chronic oedema/lymphoedema of the leg were included. Weight category was estimated as: normal weight (BMI 20–30), class I-II obesity (BMI 30–40), or class III obesity (BMI > 40). Factors were tested for an association with increased weight, using a multivariable model.ResultsA total of 7397 patients were included; 43% with normal weight, 36% class I-II obesity and 21% class III obesity. Increased weight was associated with more advanced stages of chronic oedema (ISL stage III; the most advanced form); affecting 14% in normal weight, 18% class I-II obesity and 39% class III obesity (p < 0.001). Ten factors were independently associated with increased weight: diabetes (OR 2.4), secondary lymphoedema (OR 2.7), cellulitis/erysipelas within 12 months (OR 1.2), bilateral lymphoedema (OR 3.6), compression therapy (OR 2.1), increased swelling duration (1–2 years OR 1.3, 2–5 years OR 2.5, 5–10 years OR 3.6, >10 years OR 3.5) decreased mobility (walking with aid OR 1.9, being chair bound OR 1.2) and age (reference<45 years; 45–64 years OR 1.5, 75–84 years OR 0.6, 85+ years OR 0.2). Increased weight was associated with a lower presentation of peripheral arterial disease (OR 0.7) and poorer chronic oedema control (OR 0.8). Patients with obesity had lower function, appearance and more severe symptoms (LYMQOL) and lower quality of life (EuroQol).ConclusionsObesity negatively impacts chronic oedema, leading to more advanced stages. Achieving good control of swelling with compression is more difficult in these patients. Increased awareness of chronic oedema/lymphoedema as a complication of obesity is important for early detection and for developing effective strategies to prevent and manage them.

Integration of Lipofilling with Blepharoplasty to Optimize Periorbital Rejuvenation: A Retrospective Study

Background: Surgical blepharoplasty has traditionally been used to rejuvenate the periorbita by removing excess tissue. While this often enhances appearance, it does not address the volume loss associated with aging. Hyaluronic acid (HA) fillers have been used to address volume loss; however, issues such as the Tyndall effect, chronic edema, and the cost of repeated injections make them less than ideal. Advances in contemporary surgery have made autologous fat a natural alternative for filling volume loss in the periorbita. Fat grafting, whether using macrofat, microfat, or nanofat, can provide excellent results, but a separate procedure is required to harvest the fat from the patient. Objectives: The aim of this study was to analyze and describe complications and patient satisfaction by comparing blepharoplasty alone with blepharoplasty combined with lipofilling. Methods: A retrospective review of a single surgeon's private practice cases was performed on 45 consecutive patients who underwent surgical blepharoplasty alone and 64 patients who had surgical blepharoplasty combined with lipofilling from 2002 to 2021. Complications, pain scores, and patient satisfaction reports were assessed. Results: Upon comparing the blepharoplasty alone group to the blepharoplasty with lipofilling group, the 109 patients did not differ significantly in age. Both groups were predominantly female. There were no major complications, only minor ones, and though the blepharoplasty alone group had a higher complication rate, this was not statistically significant. Lipofilling added approximately 30 minutes to the 60-minute blepharoplasty procedure, but pain scores were higher in the combination group. However, pain dissipated quickly and, while statistically significant, was not clinically significant. Patient satisfaction with the additional lipofilling was high, which resulted in lipofilling being added to all blepharoplasty procedures. Conclusions: Traditional surgical blepharoplasty can be combined with fat grafting techniques to address tissue loss and descent. Lipofilling integrated with blepharoplasty is a safe procedure. It is well tolerated by patients and provides high satisfaction with good aesthetic outcomes. The use of autologous fat offers an economical and effective advantage for patients.

SUSTAINED-RELEASE LOW-DOSE FLUOCINOLONE ACETONIDE INTRAVITREAL IMPLANT FOR CHRONIC POSTOPERATIVE CYSTOID MACULAR EDEMA: TWO CASE REPORTS.

To describe two cases of patients diagnosed with chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis who had limited treatment response to previous corticosteroid modalities and then received a single intravitreal fluocinolone 0.18-mg implant. Chronic postoperative cystoid macular edema (CME) may occur after intraocular surgery and is a common cause of postoperative visual loss. Sometimes called Irvine-Gass syndrome or persistent pseudophakic CME, chronic postoperative CME complicates roughly 0.1% to 2.0% of low-risk, small-incision phacoemulsification surgeries. There are a number of conventional approaches to chronic postoperative CME management, including topical corticosteroids with or without nonsteroidal anti-inflammatory drugs, intravitreal corticosteroid injections, and vascular endothelial growth factor (VEGF) inhibitor injections, but these options have several limitations. A major shortcoming of conventional formulations of anti-inflammatory therapies for chronic postoperative CME (i.e., topical drops, intraocular, and periocular injections) is the need for repeated dosing in chronic cases, which is expensive and burdensome to patients. Series of two case reports. Patient 1, a 75-year-old Latina woman, presented with a history of longstanding, recurrent inflammation after cataract extraction and subsequent vitreoretinal surgeries. Patient 2, an 85-year-old white woman, presented with acute blurred vision, swelling, and pain 5 years after cataract surgery and laser peripheral iridotomy. Both were diagnosed with chronic postoperative CME and ultimately treated with the 3-year sustained-release fluocinolone acetonide intravitreal implant (FAi) 0.18 mg. Compared with baseline, both patients experienced resolution of their disease symptoms, >3 lines of visual acuity improvement, and macular edema reduction of 56.2% and 38.4% at 15 and 6 months, respectively, after the fluocinolone implant. No steroid related adverse events including any intraocular pressure measurement >25 mmHg were observed. A single intravitreal fluocinolone 0.18-mg implant can effectively and safely treat vision loss and increased central macular thickness because of chronic postoperative cystoid macular edema associated with noninfectious posterior uveitis. The FAi 0.18 mg provides a safe, long-acting, low-dose anti-inflammatory treatment in patients with noninfectious posterior-segment inflammation associated with chronic postoperative CME.

Chronic Edema Management of the Lower Extremities.

Peripheral edema is a prevalent condition affecting patients dealing with an assortment of health conditions, such as congestive heart failure (CHF), liver disease, venous insufficiency, and postoperative surgical complications. Edema can present in a variety of ways, ranging from mild localized symptoms to severely debilitating forms that impact patients' daily lives. Despite the vast number of publications addressing the underlying causes of peripheral edema, there seems to be an absence of literature that presents the effectiveness and compliance of current management techniques. This paper aims to condense the current literature on the effectiveness and compliance of current edema management approaches across various common etiologies, with the intentionof identifying alternative therapies that could enhance the quality of care for patients with chronic lower extremity edema. Several promising new therapies such as exogenous calf muscle stimulation, leg raise exercises, high-dose albumin injections, and device-based negative pressure lymph drainage (NPLD), deviate from the currentestablished standard of care. This scoping review revealed diverse treatment methods tailored to the specific underlying etiology of edema. The use of diuretics and vasodilators has shown benefits in treating CHF-induced edema but failed to alleviate and prevent the recurrence of edema in hospitalized and recently discharged patients. Albumin injections have emerged as a potential alternative treatment for edema due to liver disease, addressing hypoalbuminemia symptoms caused by liver failure. Patients with vascular causes of edema are efficaciously treated conservatively with compression stockings, although patient adherence remains a hurdle. For postoperative edema, device-based NPLD appears promising, with potential benefits over elastic bandage wraps and kinesiology taping.

Efficacy and Safety of 0.19-mg Fluocinolone Acetonide Implant in Postoperative Cystoid Macular Edema after Pars Plana Vitrectomy: The ILUvien in Postoperative CYstoid Macular eDema study

PurposeTo assess the efficacy and safety of 0.19-mg fluocinolone acetonide (FAc) intravitreal implant (Iluvien®) in treating chronic postoperative cystoid macular edema (PCME) after pars plana vitrectomy. DesignRetrospective multicentric case series in clinical settings. SubjectsPatients with chronic PCME who underwent vitrectomy in tertiary care centers in France. All eyes had a documented good response to the DEX implant prior to FAc implantation. MethodsReview of charts and OCT scans of patients treated with a FAc intravitreal implant. Main outcome measuresThe primary endpoints were the best-corrected visual acuity (BCVA) and central retinal thickness (CRT). Secondary endpoints were the intraocular pressure (IOP); proportion of patients maintaining a BCVA ≥20/40; need for additional non-study treatment; differences between eyes that underwent a single and multiple surgeries and OCT biomarkers of better BCVA. ResultsForty-nine eyes of 49 patients with a mean follow-up of 24.5 ± 3.9 months were included. The mean BCVA increased from 0.40 ± 0.26 logMAR at baseline to 0.32 ± 0.24 logMAR at month 24 (M24) (p=0.0035). The mean CRT decreased from 409.37 ± 139.43 μm at baseline to 340 ± 91 μm at M24 (p=0.0001). The mean IOP was 14.0 ± 4 mmHg at baseline and remained stable at 14.03 ± 4.1 mmHg at M24 (p=0.99). During the follow-up, the IOP exceeded 21 mmHg in 9 eyes. The IOP rise was controlled with topical therapy in all eyes except one, which required cyclophotocoagulation. The BCVA was ≥20/40 in 47% of eyes (95% CI: 34%-61%) at baseline and in 58% of eyes at M24 (95% CI: 41%-73%). At M18, the likelihood of achieving a BCVA ≥20/40 was higher in eyes with intact external limiting membrane and ellipsoid zone. Additional dexamethasone implant (DEXi) was injected in 14 eyes (28.57%). The treatment burden of 2.45 ± 1.35 DEXi/year was decreased to 0.57 ± 0.60 DEXi/year after FAc implantation (p=0.001). ConclusionFAc implant improved the BCVA and reduced the CRT in eyes with chronic PCME after vitrectomy. The IOP rise could be anticipated by the previous response to corticosteroids. FAc implant in eyes with chronic PCME also allowed reducing the treatment burden.

Benefits of an Adjustable Compression Garment System for the Reduction of Chronic Leg Oedema (ACROE Study)

This study aimed to assess whether a specific adjustable compression garment (ACG) system (Coolflex Standard Calf and Coolflex Standard Foot; Sigvaris Inc.) promotes self care in patients with chronic leg oedema. Secondary aims were to assess the effectiveness of this ACG in reducing oedema, improving patient reported outcomes, and determining the patients' degree of satisfaction with the handling of the wrap. This was a multicentre prospective observational study. The study included 99 adult patients aged between 18 and 90 years presenting with chronic oedema of the lower extremity, which encompasses conditions such as lymphoedema, venous oedema, and phlebolymphoedema. At baseline, all patients received an ACG. After two to three days and after six weeks, their overall satisfaction with the therapy was assessed. Leg volume was determined in a contactless manner during the baseline and follow up visits. All patients completed the cross-cultural adaptation of the Lymphoedema Functioning, Disability and Health Questionnaire for Patients with Lymphoedema of the Lower Extremity in Germany (Lymph-ICF-UG). A total of 86 patients completed the study and were followed up for six weeks. At the final six week follow up , 82 (95.3%) of the 86 subjects indicated that they were able to put on the wrap independently or with a little help from relatives. The overall satisfaction rate was 88.5% (95% confidence interval [CI], 80.4 - 94.1%). The mean leg volume reduction from baseline to six weeks was -4.7% (95% CI -6.3 - -3.0%; p < .001). Lymph-ICF-UG scores and scores in all domains improved significantly from baseline to the final follow up. The ACG used in this study was found to promote self care in a high proportion of patients with chronic leg oedema. A significant reduction in oedema was observed.

Iliopsoas Bursitis Compressing an External Iliac Vein Stent

We report a case of external iliac vein (EIV) compression due to iliopsoas bursitis. A 78-year-old man with a prior left total hip arthroplasty (THA) and left lower extremity (LLE) deep vein thrombus (DVT) presented with chronic LLE edema. Initial ultrasound examination revealed deep venous reflux and evidence of ipsilateral outflow vein obstruction. A left groin mass thought to be a hernia was noted. Conservative management was unsuccessful. Subsequent venography and intravascular ultrasound demonstrated severe stenosis of the distal EIV. A stent was placed but could not be fully expanded despite repeated venoplasty. Following the procedure, pelvic computed tomography (CT) showed extrinsic compression of the EIV and stent likely caused by iliopsoas bursitis.