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Resident Perspective: Subclinical ocular inflammation in patients with recurrent aphthous stomatitisRecurrent stomatitis is the most common oral mucosal ulcerative disease, primarily affecting buccal mucosa and tongue.1Akintoye SO Greenberg MS. Recurrent Aphthous Stomatitis.Dent Clin North Am. 2014; 58: 281-297Abstract Full Text PDF PubMed Scopus (121) Google Scholar This condition has been linked to several systemic, inflammatory, genetic, nutritional, microbial factors.1Akintoye Most notably, (RAS) noted be one of signs Behcet's present 97% 100% all diagnosed disease.2Cem M, Sevim A, Fresko İ, Tüzün Y. Behçet's disease as a systemic disease. 2014 [cited 2021 Aug 12]. Available from: http://dx.doi.org/10.1016/j.clindermatol.2013.11.012Google Given that RAS often presents initial sign which can have significant ophthalmic manifestations, it would beneficial understand possible features associated RAS. Gaining better understanding potential may help achieve earlier diagnosis improved patient outcomes those who go on develop meeting diagnostic criteria for disease.In this issue, Sereflican colleagues report their investigation findings RAS.3Sereflican B Dogan U. stomatitis.Can J Ophthalmol. 2021; 56Abstract (0) cross-sectional case control study included 34 healthy controls were matched by age, sex, smoking status. Corneal thickness, retinal nerve fiber layer foveal nasal, temporal, subfoveal choroidal thicknesses examined participants. The multivariate logistic regression analysis these values revealed thickness only statistically association Specifically, increased was found presence RAS, an odds ratio 1.922 95% confidence interval 0.820 3.915.This first investigating coherence tomography (OCT) evaluation authors suggest due changes vascularity, greater increase compared nasal temporal higher vascular density choroid. also suggests course, prior progression true finding contrast another negatively correlated panuveitis disease.4Yesilirmak N Lee WH Gur Gungor S Yaman Pinarci E Akkoyun I Yilmaz G Enhanced depth imaging optical different phases panuveitis.Can 2017; 52: 48-53Abstract (10) difference decrease progresses from subclinical manifestations involvement disease.There are, however, few limitations current should taken into consideration. As acknowledge, single center case-control small sample size. Prospective studies larger cohorts will add our inflammatory RAS.In summary, eloquently described clinical stomatitis. Studies such are important facilitate pathogenesis interesting entity utility screening examinations potentially allowing even more effective treatment future.Article being referenced: https://www.canadianjournalofophthalmology.ca/article/S0008-4182(20)30839-5/fulltext In 3.915. There future. Article many faces syphilisIn past 2 decades, there resurgence syphilis Canada United States. Although historically seen men sex men, increasingly across sexes sexual orientations. Patients not fit classic demographic group or disclose risk factors until after diagnosis, challenging. For instance, sometimes referred “Great Imitator” its wide variety presentations, include rash, neurologic symptoms, generalized lymphadenopathy. Its vary significantly well, leading misdiagnoses. issue CJO, Schulz series review syphilis.1Schulz DC Orr SMA Johnstone R Devlin MK Sheidow TG Bursztyn LLCD. syphilis: case-based update recognition, treatment.Can (1) ScholarThe cases identified individual databases specialists posterior uveitis, retina, neuro-ophthalmology, infectious 2010 2020. Each chart reviewed factors, HIV status, serology, treatment. Of 26 cases, 5 presented illustrative details.To summarize, middle-aged heterosexual women without typical alert examiner suspect syphilis. 44-year-old male optic neuritis, anterior vasculitis. He initially treated autoimmune high-dose prednisone. second 52-year-old hypertensive serous detachment, vitritis, Purtscher's retinopathy. third 56-year-old hypopyon, corneal edema, vitritis retinitis, suspected acute necrosis. fourth 53-year-old iris ciliary body granuloma, leptospirosis. last 49-year-old syphilitic placoid chorioretinitis, working zonal occult outer All appropriately Penicillin once confirmed. presentation followed comprehensive each finding—anterior/ intermediate/ posterior/ pan-uveitis, neuritis—present patients, along detailed description management intravenous G.This paper highlights diagnostically challenging nature demonstrates absent disclosed at consultation, contributing misdiagnoses turn leads inappropriate—for example, immunosuppressive antiviral—treatment. Inappropriate delayed lead poor visual prognoses permanent loss. Hence, advocates screening, especially era resurgence. Readers equipped consider differential non-straightforward vasculitis, neuritis. Furthermore, presenting varying presentations relevant pearls, benefit readers them good strategies.Article https://www.canadianjournalofophthalmology.ca/article/S0008-4182(21)00016-8/fulltext details. To G. strategies. Incremental effect topical moxifloxacin surgical intracameral prophylaxisPost-operative endophthalmitis (POE) rare but devastating complication cataract surgery. Among other aseptic technique various antibiotic protocols used reduce POE. However, no universally accepted prophylactic regimen. Debate exists optimal route administration (intracameral, topical, and/or oral), choice, duration frequency use.In Lukewich use mathematical model investigate theoretical efficacy supplementation antibiotics during surgery.1Lukewich Modabber M Hu A Arshinoff SA. prophylaxis.Can Moxifloxacin choice given confirmed intracamerally preferred topically. integrated data previous measuring chamber (AC) concentrations administration2Sharma T Kamath MM MG et al.Aqueous penetration orally topically administered moxifloxacin.Br 2015; 99: 1182-1185Crossref (14) estimating AC concentration abatement administration.3Arshinoff SA Felfeli M. Aqueous level profiles antibiotics: comparative moxifloxacin, cefuroxime, vancomycin determination relative efficacies.J Cataract Refract Surg. 2019; 45: 1568-1574Abstract (5) Concentrations studied relation threshold values, minimum inhibitory 90% (MIC90) POE pathogen (methicillin-sensitive Staphylococcus aureus [MSSA]) resistant POE-causing bacteria (coagulase negative Staphylcocci [CoNS] methicillin-resistant [MRSA]). mutant prevention (MPC), above reduces chance survival.AC (600 µg 0.4 mL) alone rapidly hour postoperatively, decreases linearly logarithmic dilution. It provided coverage MIC90 bacterial strains 7.5 hours, MSSA about 37 MPC 24 hours. Topical achieved drop. Q4h q6h dosing near MSSA, q8h produced levels just below MPC. drops didn't provide MRSA CoNS. Adding schedules IC enhanced 17 19 hours postoperatively. does much normal circumstances well-sealed incision. they useful if wound leak develops postoperatively.Oral (12 preoperatively immediately postoperatively) within 1 surgery sustained prolonged >50 But alone, like drops, did CoNS MRSA. supplemental 16 postoperatively maintained additional Again, under postoperative conditions, offer added benefit. exception bacteremia, where could prevent endogenous spread.A Creuzot-Garcher suggested between intraoperative decreased rates POE, though controversy remains whether techniques new regimens factors.4Creuzot-Garcher C Benzenine Mariet AS al.Incidence Acute Postoperative Endophthalmitis Surgery. Nationwide Study France 2005 2014.Ophthalmology. 2016; 123: 1414-1420Abstract (102) still remain commonly prophylaxis approach5Chang DF Braga-Mele Henderson BA Mamalis Vasavada A. Antibiotic surgery: Results ASCRS member survey.J 41: 1300-1305Abstract (128) demonstrated study, do when benefits specific combined use. preventing thoroughly established limited intraocular supplementation. inform approaches prevention, however future needed confirm accuracy clinically.Article https://www.canadianjournalofophthalmology.ca/article/S0008-4182(21)00005-3/fulltext Post-operative survival. Oral spread. clinically. Applications iodine-125 plaque radiotherapy residual retinoblastomaIn Soliman retinoblastoma (RB) following primary focal therapy regional chemotherapy.1Soliman SE Bansal De Nicola ML Bhambhwani V Laperriere Gallie BL Krema H. retinoblastoma.Can ScholarFrom trainee perspective, article worth reading multiple reasons. First, concisely summarize options available RB including recent historical developments. complex area, us little direct experience with. reflected International Classification Retinoblastoma, decisions must tumour size laterality, proximity tumor macula nerve, vitreous subretinal seeds, evidence invasion surrounding tissues.2Shields Shields J. Retinoblastoma management: advances enucleation, chemoreduction, intra-arterial chemotherapy.Curr Opin May; 21: 203-212Crossref (199) Options small, localized tumours laser photocoagulation, cryotherapy, thermotherapy radiotherapy. Whereas, extensive chemotherapy used. Though line external beam radiation now considered alternative because increases secondary malignancies children germline mutations. promising role brachytherapy RB. Figure particularly helpful summary guidelines treatment.Second, types salience recurrence These patterns therapy. Briefly, type 0 describes complete disappearance scar; refers calcification, appearing cottage cheese; completely non-calcified mass, fish flesh; 3 partially calcified mass; 4 flat atrophic scar.3Shields Palamar Sharma P Ramasubramanian Leahey Meadows al.Retinoblastoma chemoreduction adjuvant 557 tumors.Arch 2009 Mar; 127: 282-290Crossref (46) (fish flesh) local than observed (types 4). possibly explained that, chemotherapy, flesh contain large quantities actively dividing cells, tended regressed tumours.4Bechrakis Bornfeld Schueler Coupland Henze Foerster Clinicopathologic chemoreduction.Arch 1998 Jul; 116: 887-893Crossref (50) ScholarFinally, evidences research design oncology. That is, deciding appropriate unit analysis, person, eye, tumour. One aware analyzing pairs eyes, patient, necessary statistical methods account source correlation data.5Ying GS Maguire Glynn Rosner B. Tutorial Biostatistics: Statistical Analysis Correlated Binary Eye Data.Ophthalmic Epidemiol. 2018 Feb; 25 (Epub 2017 May 22): 1-12https://doi.org/10.1080/09286586.2017.1320413Crossref (42) ScholarArticle https://www.canadianjournalofophthalmology.ca/article/S0008-4182(21)00001-6/fulltext From Second, Finally,