PURPOSE: To investigate whether topography-guided laser in situ keratomileusis (LASIK) with anterior corneal astigmatism measured on the WaveLight Contoura (Alcon Laboratories, Inc., Fort Worth, TX) leads to better refractive outcomes compared to treating on the clinically measured manifest refractive astigmatism axis in eyes with primary myopic astigmatism.
PURPOSE:
To characterize the preoperative vectorial difference between manifest refractive astigmatism and anterior corneal astigmatism, termed ocular residual astigmatism (ORA), and to investigate its influence on topography-guided laser in situ keratomileusis (LASIK) outcomes.
METHODS:
Comparative retrospective analysis of 21,581 consecutive eyes treated on the manifest refractive astigmatism. Standard outcomes of the 7,180 eyes with the lowest ORA (first tercile: 0.35 ± 0.13 diopters [D]) were compared to the 7,208 eyes with the highest ORA (last tercile: 1.13 ± 0.25 D).
RESULTS:
The ORA followed a right-skewed normal distribution (
R
2
= 0.99) with a mean ± standard deviation of 0.73 ± 0.36 D. The efficacy index of eyes with low versus high ORA was identical (0.98 ± 0.07 vs 0.98 ± 0.08;
P
= .99), with a similar percentage having a spherical equivalent within ±0.50 D of the intended target (94.7% vs 94.1%;
P
= .11). The safety index (1.00 ± 0.04 vs 1.00 ± 0.04;
P
= .99) and Alpins correction index (1.01 ± 0.37 vs 1.00 ± 0.43;
P
= .10) were identical. A greater number of eyes with high versus low ORA had postoperative residual astigmatism of 0.75 D or greater (6.1% vs 3.9%). Eyes with very high ORA (ORA ⩾ 1.50 D; 2.5% of the population) marginally reduced the efficacy index from 0.98 to 0.97 (
P
< .001).
CONCLUSIONS:
The contribution of ORA to topography-guided clinical outcomes in most virgin eyes is negligible, with excellent efficacy, accuracy, and safety in both low ORA and high ORA groups. Myopic eyes with high ORA treated on the manifest refraction should not be excluded from topography-guided LASIK.
[
J Refract Surg
. 2020;36(7):449–458.]
Objective
To evaluate consensus recommendations regarding management of rheumatoid arthritis (RA) in patients with cancer.
Methods
We searched electronic databases, guideline registries, and relevant web sites for cancer‐specific recommendations on RA management. Reviewers independently selected and appraised the recommendations according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. We identified similarities and discrepancies among recommendations.
Results
Of 4,077 unique citations, 39 recommendations were identified, of which half described their consensus process. Average scores for the AGREE II domains ranged from 33% to 87%. Cancer risk in RA was addressed in 79% of recommendations, with acknowledgement of increased overall cancer risk. Recommendations did not agree on the safety of using disease‐modifying antirheumatic drugs (DMARDs) in RA patients with cancer, except for the contraindication of tumor necrosis factor inhibitors in patients at risk for lymphoma. Most recommendations agreed that RA treatment should be stopped and re‐evaluated with a new diagnosis of cancer. Recommendations for patients with a history of cancer differed depending on the drug, cancer type, and time since cancer diagnosis. Few recommendations addressed all issues.
Conclusion
Recommendations for the treatment of RA in patients with cancer often fail to meet expected methodologic criteria. There was agreement on the need for caution when prescribing DMARDs to these patients. However, several areas continue to lack consensus, and given the paucity of evidence, there is an urgent need for research and expert opinion to guide and standardize the management of RA in patients with cancer.
There have been 9 cases of bilateral simultaneous postoperative endophthalmitis after immediately sequential bilateral cataract surgery over the past 50 years. Their common features are important to be aware of.
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