[Posted 22/Aug/2022]

AUDIENCE: Ophthalmology, Family Medicine

KEY FINDINGS: Adherence to frequent postoperative eye drops was high and can be successfully monitored remotely. Surgical success was greater among eyes with nearly ideal adherence and was poorer in older persons and those with more advanced glaucoma.

BACKGROUND: Objective of this study was to compare electronically measured adherence with topical corticosteroid (CS) drops with outcomes of glaucoma surgery. This prospective cohort study included eyes undergoing surgery from August 2019 to January 2021 and followed for up to 1 year.

DETAILS: All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had primary open-angle or angle-closure glaucoma, were aged >=18 years, and underwent trabeculectomy (with or without cataract surgery) or tube-shunt implantation. All patients were recruited from the Glaucoma Center of Excellence at the Wilmer Eye Institute, Johns Hopkins. Eligible patients had primary open-angle or angle-closure glaucoma, were aged >=18 years, and underwent trabeculectomy (with or without cataract surgery) or tube-shunt implantation. Among 90 patients, adherence was 89.7% ± 13.7% overall and 80.9% ± 15.8% during dosing every 2 hours. Target IOP was achieved at the final visit (6 months or 1 year) in 81% (59/73) without reoperation. Eyes with a higher ratio of drops taken versus prescribed were significantly more likely to achieve target IOP at 6 months/1 year (P = 0.05). Total adherence was better in younger persons, eyes with less field loss, and patients of one particular surgeon (P < 0.03). Percent adherence during dosing every 2 hours was higher in eyes with higher target IOP (P = 0.01). No adherence outcome was significantly related to race, sex, bleb morphology, postoperative pain, or postoperative anterior chamber inflammation. Adherence values did not significantly correlate with adherence questionnaire data (predicted mean = 78% ± 17%, actual mean = 91% ± 13% adherent, P < 0.001).

Copyright © The American Academy of Ophthalmology. All rights reserved.

Source: McGlumphy, E. J., Doto, N. O., Johnson, T. V., et al. (2022). Electronically Monitored Corticosteroid Eye Drop Adherence after Trabeculectomy Compared to Surgical Success. Ophthalmology Glaucoma. 2022; 5(4): 379-387. Published: July 1, 2022. DOI: 10.1016/j.ogla.2021.12.007.

Results from the Phase 4 NEW DAY Study

[Posted 16/Jul/2026]

AUDIENCE: Ophthalmology, Internal Medicine

KEY FINDINGS: This randomized Phase 4 study demonstrated that baseline treatment with the fluocinolone acetonide implant achieved visual and anatomic outcomes comparable to aflibercept monotherapy while reducing the total number of intravitreal injections by more than half over 18 months. Although steroid-associated cataract and IOP events occurred more frequently, the overall safety profile was consistent with previous studies, supporting the FAc implant as a potential early treatment strategy for selected patients with DME.

BACKGROUND: Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy remains the standard treatment for diabetic macular edema (DME), but the need for frequent injections and clinic visits can create a substantial treatment burden. The fluocinolone acetonide (FAc) 0.19-mg intravitreal implant provides sustained corticosteroid delivery and has demonstrated efficacy in persistent DME. The Phase 4 NEW DAY study evaluated whether using the FAc implant as baseline therapy, supplemented with aflibercept only when needed, could reduce injection burden while maintaining visual and anatomic outcomes comparable with aflibercept monotherapy.

DETAILS: NEW DAY was a prospective, randomized, single-masked, active-controlled, multicenter, 18-month Phase 4 trial conducted at 42 sites in the United States. A total of 517 participants were screened, and 306 adults with type 1 or type 2 diabetes and center-involving DME were randomized to receive either a 0.19-mg FAc implant (n = 154) followed by rescue aflibercept injections as needed or aflibercept (n = 152) administered as five loading doses every four weeks followed by rescue treatment when required. The primary endpoint was the mean number of rescue supplemental aflibercept injections during the study. Secondary outcomes included total intravitreal injections, time to first rescue injection, best-corrected visual acuity (BCVA), central subfield thickness (CST), cataract procedures, and intraocular pressure (IOP)-related safety outcomes. The primary endpoint was not met, with a similar mean number of rescue aflibercept injections in the FAc and aflibercept groups (2.4 ± 3.2 vs. 2.5 ± 3.1; P = 0.76). However, the FAc strategy substantially reduced overall treatment burden, requiring fewer total injections than aflibercept monotherapy (3.4 ± 3.2 vs. 7.2 ± 3.4; nominal P < 0.001). Time to first rescue injection was significantly longer with the FAc implant (185.4 ± 97.9 days vs. 132.8 ± 94.0 days; nominal P < 0.001). Approximately one-third of participants in both groups required no rescue injections throughout the study (32.5% vs. 30.3%; nominal P = 0.68). Improvements in visual acuity and retinal anatomy were comparable between groups, with mean BCVA changes of 1.8 letters and 5.5 letters (nominal P = 0.08) and mean CST reductions of -119 ± 112 µm and -114 ± 103 µm (nominal P = 0.71) in the FAc and aflibercept groups, respectively. Cataract procedures occurred more frequently with the FAc implant (27.9% vs. 6.6%), and increased IOP was reported in 15.6% of FAc-treated participants compared with 3.3% receiving aflibercept. Despite these steroid-related adverse events, incisional IOP procedures were uncommon, and no new safety signals were identified.

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Source: Singer, M. A., Wykoff, C. C., Riemann, C. D., et al. Fluocinolone Acetonide Implant as a Baseline Therapy for Diabetic Macular Edema. American Academy of Ophthalmology. 2026; 133(7): 837-851. Published: June 22, 2026. DOI: 10.1016/j.ophtha.2026.03.019.

[Posted 15/Jun/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.

BACKGROUND: Influenza outbreaks in nursing homes (NHs) pose a substantial threat to older adults, often resulting in morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) recommend prompt postexposure prophylaxis, also termed chemoprophylaxis or prophylaxis with oseltamivir, for all residents who are not ill to limit influenza spread in NHs. Purpose of the study is to examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.

DETAILS: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.

Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (>=70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents).

Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).

Among 404 outbreaks in 318 NHs, 35,086 resident-trial observations (29,683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17,155 observations; 17,931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.

Copyright © American Medical Association. All Rights Reserved.

Source: Silva, J. B. B., Hsieh, H. T., Howe, C. J., et al. Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks. JAMA Internal Medicine.. 2026; 186(6): 714-722. Published: June, 2026. DOI: 10.1001/jamainternmed.2026.0401

[Posted 10/Jun/2026]

AUDIENCE: Ophthalmology, Internal Medicine

KEY FINDINGS: Lower SES is associated with worse optic nerve damage and VF performance at presentation for eyes that eventually undergo trabeculectomy surgery.

BACKGROUND: Objective of this study is to evaluate the association between socioeconomic status (SES; represented by a patient's neighborhood area deprivation index) and structural and functional measurements of the eye at initial presentation for those who eventually underwent trabeculectomy. Authors identify patients who underwent a trabeculectomy and had at least 1 OCT scan and 1 visual field (VF) test before undergoing surgery. Patients of any age with either progressing glaucoma or uncontrolled intraocular pressure, or both, who underwent a trabeculectomy and were a part of the DOMAIN cohort study were included.

DETAILS: Authors use a subject's first recorded OCT scan and VF test to obtain baseline structural and functional measurements. We next use patient addresses to determine their census block, which is then matched to the corresponding proxy for SES. Univariate and multivariate regressions controlling for race, age, and gender were used to analyze the associations between SES and structural and functional measurements at baseline. Among the 154 eyes in the study, we find that living in an area with greater deprivation is associated with worse structural (larger cup volumes [CVs], thinner retinal nerve fiber layer, and ganglion cell-inner plexiform layer) and functional (lower visual field index [VFI] and mean deviation [MD]) measures at baseline. However, these associations only remained statistically significant in the multivariate analysis for CV, VFI, and MD after controlling for a patient's race, gender, and age. In addition, when comparing those living in the best and worst neighborhoods, we find that living in the area with the highest decile level of deprivation is associated with a 6.63 dB lower MD at presentation compared to those living in areas with the least deprivation.

Copyright © The American Academy of Ophthalmology. All rights reserved.

Source: Chen, J. L., Lavinsky, F., Lee, T., et al. The Association between Socioeconomic Status and Structural or Functional Baseline Measurements for Patients Receiving a Trabeculectomy. Ophthalmology Glaucoma. 2026; 9(3): 302-308. Published: May-Jun, 2026. DOI: 10.1016/j.ogla.2025.12.007.

A Randomized Controlled Comparative Study

[Posted 19/May/2026]

AUDIENCE: General Surgery, Family Medicine

KEY FINDINGS: Early active treatment with isotretinoin and FMRF is safe and better than isotretinoin monotherapy over 44 weeks regarding severity, reduced erythema, and improved surface roughness in moderate-to-severe acne vulgaris. This encourages early and effective treatment of acne to mitigate acne scarring and improve patients' quality of life.

BACKGROUND: Oral isotretinoin is the standard therapy for severe acne. However, scarring may persist. Fractional microneedling radiofrequency (FMRF) improves both inflammatory lesions and scars with minimal downtime. In this study, we compare isotretinoin monotherapy and concurrent isotretinoin and FMRF for active acne regarding clinical outcomes. The GAGS scores of isotretinoin and FMRF were significantly lower than those of isotretinoin monotherapy from weeks 12-44 (-79.69% vs. -60.34% at week 44, respectively; p < 0.001). Isotretinoin and FMRF showed significantly greater lesion count reductions than isotretinoin monotherapy at follow-up visits from weeks 12-44. Isotretinoin and FMRF showed significantly lower hemoglobin levels than isotretinoin monotherapy at weeks 32 and 44 (p = 0.029 and p < 0.001, respectively). Skin surface roughness improved substantially and persistently from week 12-44.

DETAILS: In this parallel two-group comparative study, patients received either low-dose isotretinoin monotherapy for 20 weeks (n = 34) or low-dose isotretinoin concurrently with 5 monthly FMRF sessions (n = 36). Outcomes were assessed at baseline and weeks 12, 20, 24, 32, and 44. The primary endpoints were Global Acne Grading System (GAGS) scores and inflammatory/non-inflammatory lesion counts. Secondary endpoints were hemoglobin indices and skin roughness.

Copyright © Wiley Periodicals LLC. All rights reserved

Source: Disphanurat, W., Leeyangyuen, P,, and Srisantithum, B. Efficacy of Low-Dose Oral Isotretinoin Combined With Fractional Microneedle Radiofrequency Versus Low-Dose Oral Isotretinoin Monotherapy in the Treatment of Moderate-To-Severe Acne Vulgaris: A Randomized Controlled Comparative Study. Lasers in Surgery and Medicine. 2026; 58(4): 321-330. Published: April, 2026. DOI: 10.1002/lsm.70120.

A Multinational Self-Controlled Case Series Study

[Posted 2/Apr/2026]

AUDIENCE: Internal Medicine, Neurology

KEY FINDINGS: In this multinational SCCS study, statin initiation may be associated with increased risk of new-onset MG during the first 6-12 months, with greater magnitude of risk elevation for higher intensity statin therapy. Consideration of the possibility of new-onset MG may be advisable within first 6-12 months after initiating statins, especially for medium-to-high-intensity statin therapy.

BACKGROUND: Evidence regarding the risk of new-onset myasthenia gravis (MG) following statin therapy initiation is limited. Purpose of this study is to investigate this potential adverse effect using multinational real-world population-based data.

DETAILS: A self-controlled case series (SCCS) study was conducted using electronic medical records and claims databases from Hong Kong, the United Kingdom (UK) and Japan. Individuals aged >=18 years with first diagnosis of MG and initiated statins were included. Conditional Poisson regression compared the risk of MG in different risk periods (up to 2 years after initiation) with non-exposure period, adjusted for age. Pooled results based on meta-analysis across all study sites were reported. In total, 2267 MG cases were analysed. Combined across all study sites, a significantly increased risk of incident MG was observed during the first year after statin initiation compared to non-exposure period, with a higher risk from Days 0-179 (pooled incidence rate ratio [IRR] [95% CI]: 2.662 [1.276-5.553]) than Days 180-364 (1.407 [1.014-1.954]). No increased risk of MG was observed more than 1 year after statin initiation (1.011 [0.848-1.206]). Moreover, the magnitude of MG risk elevation within the first 180 days after statin initiation was more pronounced with higher intensity statin regimens.

Copyright © John Wiley & Sons, Inc. All rights reserved

Source: Ka Chun Yan, V., Xu, W., Taniguchi, Y., et al. Myasthenia Gravis Following the Initiation of Statin Therapy: A Multinational Self-Controlled Case Series Study. Journal of Internal Medicine. 2026; 299(4):502-514. Published: April, 2026. DOI: 10.1111/joim.70072Digital Object Identifier (DOI)