Abstract Background: The course of chronic spontaneous urticaria (CSU) can be influenced by infections, depression, and stress. Objectives: Our aim was to investigate the impact of the COVID-19 pandemic on the course of refractory CSU together with patient adherence to omalizumab and treatment adjustments. Methods: Urticaria Activity Score (UAS7) was used to assess disease activity. Fear of COVID-19 Scale (FC-19s), and Depression Anxiety Stress Scale (DASS-21s) were performed to assess mental health status. All scales were performed during the Quarantine Period (QP) and Return to the Normal Period (RTNP). UAS7 Before Pandemic (BP) was recorded from the patients medical records. Results: The authors evaluated 104 omalizumab-receiving CSU patients. UAS7 scores during QP were significantly higher than those in RTNP and BP (p < 0.01). DASS-21 and FC-19 scores were significantly higher during QP compared to RTNP (p < 0.01). Nineteen (18.2%) patients ceased omalizumab, 9 patients prolonged the intervals between subsequent doses during the pandemic. UAS7 scores in QP were significantly higher in patients who ceased omalizumab than in those who continued (p < 0.001). Among patients who continued omalizumab, 22.4% had an increase in urticaria activity and higher FC-19 scores in comparison with those with stable disease activity (p = 0.008). Study limitations: The small sample size of patients with prolonged intervals of omalizumab and the lack of mental health evaluation with the same tools prior to the study. Conclusions: Fear induced by COVID-19 can determine an increase in disease activity. Therefore, patients on omalizumab should continue their treatment and prolonged interval without omalizumab can be considered in patients with good urticaria control.

Abstract Background In daily practice, atopic patients and those who have other drug allergies are referred to allergy clinics for evaluation of possible general anesthetic allergy despite the fact that it is not recommended in recent guidelines. Objective The aim of this prospective study is to determine the negative predictive value of skin tests for common general anesthetic drugs prior to general anesthesia in atopic patients and in patients who had drug allergies by including the data of those who had previously tolerated or reacted to general anesthesia. Methods A database program was constituted to collect the preoperative skin test data of patients referred to our clinic between 2013 and 2018. Demographic and clinical history, medications implemented during perioperative period, reactions, and results of skin tests performed with anesthetic drugs and latex were evaluated. Results Four hundred fifty-nine out of the total 1167 patients referred fulfilled the inclusion criteria for further evaluation. Nearly 75% of the patients were female and mean age was 46.3 ± 14.3 years. History of hypersensitivity reactions (HRs) due to NSAIDs and/or antibiotics, radiocontrast agents, local anesthetics, and food were present in the 53.1%, 4.1%, 1.5%, and 2.0%, respectively. The negative predictive values of skin tests for general anesthetics were in the range of 80-100%. Only 4 patients (0,87%) experienced HRs during operation. Conclusion These real-life data reveal high rates of negative predictive value of skin tests with general anesthetic drugs and a low reaction rate in atopic patients and in patients with allergy to other drugs.

RESUMO Objetivos: Identificar os problemas causados pelo desequilíbrio do volume da cavidade da prótese em cavidades anoftálmicas, e avaliar a reabilitação com enxerto de dermofato como solução. Métodos: Revisamos retrospectivamente os prontuários de pacientes operados em nossa clínica (entre maio de 2011 e junho de 2016) com enxertos de dermofato para tratar problemas relacionados a cavidades anoftálmicas. Durante os exames pré-operatórios, os oftalmologistas registraram a presença de problemas palpebrais devido ao déficit de volume, deficiência de fórnice superior e inferior, aprofundamento no sulco palpebral superior, a epífora e secreção, flacidez palpebral inferior, ptose, entrópio e ectrópio. Após a cirurgia, novas próteses adequadas para a área de encaixe foram implementadas em todos os pacientes. O tempo médio de acompanhamento foi de 27,42 ± 16 meses (variando de 10 a 62 meses). Nos últimos exames de controle, os oftalmologistas registraram problemas corrigidos e não corrigidos da cavidade que estavam presentes no pré-operatório. Resultados: Foram incluídos 16 homens e 5 mulheres neste estudo. A média de idade foi de 38,3 ± 18,4 anos (variação de 5-75 anos). A duração média do uso de prótese pré-operatória foi de 9,4 ± 6,8 anos (variação de 1 a 30 anos). No pré-operatório, 7 pacientes apresentavam apenas déficit orbitais e 14 tinham desvios de volume, além dos déficits de volume. Após os implantes de enxerto de dermoadipação, os déficits remanescentes foram corrigidos durante outra sessão cirúrgica: 6 pacientes foram submetidos a correção de ptose, 5 suspensões de cantal lateral, 5 fórnix inferior com enxerto de mucosa e 2 formações de fórnice superior com enxerto de mucosa. Todos os pacientes foram capazes de usar prótese no pós-operatório. Conclusão: A utilização de enxertos de dermofato para corrigir problemas de anoftalmia causados por déficits de volume orbital ou deslocamento de volume é um método cirúrgico eficaz, confiável e reprodutível.

ABSTRACT Purposes: To identify problems caused by prosthesis-socket volume imbalances in anophthalmic sockets; and to evaluate rehabilitation with dermofat graft as a solution. Methods: We retrospectively reviewed medical records of patients operated in our clinic (between May 2011 and June 2016) with dermofat grafts to treat anophthalmic socket-related problems. During the preoperative examinations, ophthalmologists recorded the presence of eyelid problems due to the socket volume deficit, upper and lower fornix deficiency, deepening in the upper eyelid sulcus, epiphora and secretion, lower eyelid laxity, ptosis, entropion, and ectropion. Following the surgical repair, new prosthesis suitable for the resulting socket area were implemented for all the patients. The mean follow-up period was 27.42±16 months (ranging from 10-62 months). On the last control examinations, ophthalmologists recorded solved and unsolved socket problems that were present preoperatively. Results: We included 16 men and 5 women in this study. The mean age was 38.3 ± 18.4 years (range, 5-75 years). The mean duration of preoperative prosthesis use was 9.4 ± 6.8 years (range, 1-30 years). Preoperatively, 7 patients had only orbital volume deficits, and 14 had socket volume displacements in addition to the volume deficits. After the dermofat graft implantations, the remaining deficits were corrected during another surgical session: 6 patients underwent ptosis corrections, 5 lateral canthal suspensions, 5 lower fornix with mucosal graft formations, and 2 upper fornix formations with mucosal grafts. All patients were able to use prosthesis postoperatively. Conclusion: The use of dermofat grafts to correct anophthalmic socket problems caused by orbital volume deficits or volume displacements is an effective, reliable, and reproducible surgical method.

RESUMO Objetivo: Avaliar as alterações da espessura coroide peripapilar em olhos contralaterais de pacientes submetidos à evisceração do olho doente. Métodos: Neste estudo retrospectivo, parâmetros da espessura coróide peripapilar de 34 olhos de 34 pacientes submetidos à evisceração, entre março de 2014 e maio de 2016, foram avaliados com tomografia de coerência óptica de domínio espectral. As varreduras foram manualmente delineadas para identificar as principais superfícies da membrana de Bruch, a abertura da membrana de Bruch e a esclera anterior. A espessura coroide peripapilar foi medida entre a membrana de Bruch e a esclera anterior a uma distância crescente da abertura da membrana de Bruch. Compararam-se os valores médios da espessura coroide peripapilar dos olhos contralaterais dos pacientes e do grupo controle. Resultados: A espessura coroide peripapilar média foi mais espessa nos olhos contralaterais dos pacientes, quando comparada com os olhos normais, em todas as distâncias da abertura da membrana de Bruch. Conclusão: O aumento da espessura coroide peripapilar foi notado nos olhos contralaterais dos pacientes. O espessamento da coroide pode ser resultante do distúrbio. Embora seja necessária uma investigação mais aprofundada para determinar a causalidade, esses achados podem apontar para um fator compensatório dos olhos contralaterais.

ABSTRACT Purpose: To evaluate peripapillary choroidal thickness changes in contralateral eyes of patients who had undergone evisceration of their diseased eyes. Methods: In this retrospective study, peripapillary choroidal thickness parameters in 34 eyes of 34 patients who had undergone diseased-eye evisceration between March 2014 and May 2016 were evaluated using spectral domain optical coherence tomography. The scans were manually delineated to identify the principal surfaces of Bruch’s membrane, the Bruch’s membrane opening, and the anterior sclera. Peripapillary choroidal thickness was measured between the Bruch’s membrane and the anterior sclera at increasing distance away from the Bruch’s membrane opening. The mean peripapillary choroidal thickness values in the contralateral eyes of the patients and those of the control group were compared. Results: The mean peripapillary choroidal thickness was higher in the contralateral eyes of the patients compared with that of normal eyes at all distances from the Bruch’s membrane opening. Conclusion: Increased peripapillary choroidal thickness was noted in the contralateral eyes of the patients, potentially resulting in a thicker choroid. Although further investigation is required to determine the cause, these findings indicate the presence of a compensatory factor in the contralateral eyes.

RESUMO Objetivo: Compartilhar os resultados dos pacientes submetidos à rotação de retalho tarsal anterior, combinados com a reposição lamelar anterior devido à entrópio cicatricial da pálpebra superior e determinar a eficácia e a confiabilidade desta técnica cirúrgica. Métodos: Foram incluídos neste estudo quinze olhos de 11 pacientes em quem realizamos cirurgia de rotação de retalho tarsal anterior combinada com reposição lamelar anterior devido ao entrópio cicatricial. Os registros médicos dos pacientes foram analisados retrospectivamente e as causas da entrópio cicatricial, bem como os achados do exame oftalmológico pré-operatório e pós-operatório foram registrados. A integridade anatômica e funcional da pálpebra foi considerada como sucesso cirúrgico. Resultados: A idade média foi de 59,81 ± 18 anos. O período médio de seguimento foi de 21,72 ± 14 meses (intervalo 5-43 meses). As causas da entrópio cicatricial foram o desenvolvimento de cicatrizes pós-operatórias devido a eletrólises múltiplas para triquíase e/ou distiquiase em 7 olhos, tracoma em 6 olhos e trauma em 2 olhos. Todos os pacientes foram tiveram irritação e lacrimejamento pré-operatório, enquanto que 10 pacientes apresentavam opacidade e erosão da córnea e 1 paciente apresentava apenas erosão epitelial. O sucesso total anatômico e funcional foi alcançado em todos os casos. Conclusão: A rotação do retalho tarsal anterior combinada com a reposição lamelar anterior no reparo da entrópio cicatricial é um procedimento cirúrgico alternativo efetivo e confiável.

ABSTRACT Purpose: This study aimed to share the results of patients who underwent anterior tarsal flap rotation combined with anterior lamellar reposition because of cicatricial upper eyelid entropion, and to determine the effectiveness and reliability of this surgical technique. Methods: Fifteen eyes of 11 patients (2 right eyes; 5 left eyes; and 4 bilateral eyes) on whom we performed anterior tarsal flap rotation surgery combined with anterior lamellar reposition because of cicatricial entropion were included in this study. The medical records of the patients were analyzed retrospectively, and the causes of cicatricial entropion as well as the preoperative and postoperative ophthalmic examination findings were recorded. Normal anatomical appearance and function of eyelid were considered to have been achieved. Results: The mean age was 59.81 ± 18 years. The mean follow-up period was 21.72 ± 14 months (range, 5-43 months). The causes of cicatricial entropion were postoperative cicatrices development due to multiple electrolyzes for trichiasis and/or distichiasis in 7 eyes, trachoma in 6 eyes, and trauma in 2 eyes. Irritation and watering were detected in all patients preoperatively, whereas corneal opacity and erosion were detected in 10 patients and epithelial erosion was detected in one patient. Full anatomical and functional success was achieved for all patients. Conclusion: Anterior tarsal flap rotation combined with anterior lamellar reposition in the repair of cicatricial entropion was found to be an effective and reliable alternative surgical procedure.