Chronic fatigue is a poorly managed problem in people with inflammatory rheumatic diseases. Cognitive behavioural approaches (CBA) and personalised exercise programmes (PEP) can be effective, but they are not often implemented because their effectivenesses across the different inflammatory rheumatic diseases are unknown and regular face-to-face sessions are often undesirable, especially during a pandemic. We hypothesised that remotely delivered CBA and PEP would effectively alleviate fatigue severity and life impact across inflammatory rheumatic diseases. LIFT is a multicentre, randomised, controlled, open-label, parallel-group trial to assess usual care alongside telephone-delivered CBA or PEP against usual care alone in UK hospitals. Patients with any stable inflammatory rheumatic disease were eligible if they reported clinically significant, persistent fatigue. Treatment allocation was assigned by a web-based randomisation system. CBA and PEP sessions were delivered over 6 months by trained health professionals in rheumatology. Coprimary outcomes were fatigue severity (Chalder Fatigue Scale) and impact (Fatigue Severity Scale) at 56 weeks. The primary analysis was by full analysis set. This study was registered at ClinicalTrials.gov (NCT03248518). From Sept 4, 2017, to Sept 30, 2019, we randomly assigned and treated 367 participants to PEP (n=124; one participant withdrew after being randomly assinged), CBA (n=121), or usual care alone (n=122), of whom 274 (75%) were women and 92 (25%) were men with an overall mean age of 57·5 (SD 12·7) years. Analyses for Chalder Fatigue Scale included 101 participants in the PEP group, 107 in the CBA group, and 107 in the usual care group and for Fatigue Severity Scale included 101 in PEP, 106 in CBA, and 107 in usual care groups. PEP and CBA significantly improved fatigue severity (Chalder Fatigue Scale; PEP: adjusted mean difference −3·03 [97·5% CI −5·05 to −1·02], p=0·0007; CBA: −2·36 [–4·28 to −0·44], p=0·0058) and fatigue impact (Fatigue Severity Scale; PEP: −0·64 [–0·95 to −0·33], p<0·0001; CBA: −0·58 [–0·87 to −0·28], p<0·0001); compared with usual care alone at 56 weeks. No trial-related serious adverse events were reported. Telephone-delivered CBA and PEP produced and maintained statistically and clinically significant reductions in the severity and impact of fatigue in a variety of inflammatory rheumatic diseases. These interventions should be considered as a key component of inflammatory rheumatic disease management in routine clinical practice. Versus Arthritis

The article presents a meticulous examination of the global microalgae market, analyzing opportunities and prospects rooted in the scientific and technical interest in products derived from microalgae. The research systematically assesses the potential commercialization of these products across diverse regions worldwide, identifies the most promising microalgae strains, product types themself, and their potential applications. An integral aspect of the research involves a forward-looking market forecast. The analysis of scientific and technical interest delves into publication activity, considering the yearly output of works in Scopus-indexed journals utilizing the main keyword "microalgae." This assessment is presented chronologically, categorically, and regionally, offering a nuanced perspective on the evolution of interest over time and in different geographical contexts. The commercialization potential is regionally scrutinized with a focus on key regions conducive to the development of microalgae-based products, namely the Americas (USA), Asia-Pacific (China, Japan), and Europe (Germany). This evaluation is interlinked with the prevailing market dynamics in each region, providing a holistic understanding of the market landscape. The article contributes original insights derived from the analysis, offering a nuanced perspective on the microalgae market. The paper introduces a distinctive and informed viewpoint, enriching the existing knowledge on microalgae markets. By categorizing the microalgae market based on applications, including nutraceuticals & pharmaceuticals, food & beverages, cosmetics, animal feed, and biofuels, the study identifies sectors exhibiting steady growth. Notably, each of these sectors contributes to the projected average annual growth rate of 6.8 % in the global microalgae market, forecasted to reach USD 2 billion by 2030. This growth trajectory emphasizes the growing importance and potential of microalgae-derived products in various industries and the importance of developing the bioeconomy as a whole.

The deep sclerectomy technique was modified to enhance aqueous humor (AH) outflow via the non-trabecular pathway. A pilot study was carried out to assess its safety and effectiveness. Thirty-eight patients were under observation. After superficial scleral flap (4 × 4 mm), deep scleral layers were divided into three parts by three parallel-to-limbus incisions. Deep sclerectomy without creating a window in the Descemetes’ membrane was carried out in the distal part. A collagen implant was placed under the sclera of the remaining two parts with one end in the intrascleral pool. The third proximal part was excised to expose the uvea and implant. A Nd:YAG laser trabeculotomy at the surgery site was made on postoperative days 7–10. Outcome measures were IOP change, use of hypotensive medication(s), complications, and the need for a second surgery. At six months, the mean IOP decreased from 29.1 ± 9.2 mm Hg to 14.0 ± 4.3 mm Hg (p = 1.4 × 10⁻⁹); hypotensive medication use reduced from 2.9 ± 0.9 to 0.6 ± 1.0 (p = 1.3 × 10⁻¹⁰); complete success was achieved in 68.4% of cases and partial success was achieved in 31.6% of cases. Intraoperative and postoperative complications were rare and manageable. The OCT of the surgery site revealed the absence of bleb in all cases. Lymphatic vessels with characteristic bicuspid valves in their lumen were detected in conjunctiva near the operation site and over it in 32 patients. IOP decrease in the proposed technique was achieved by activation of the uveolymphatic route of AH outflow.

To evaluate the safety and effectiveness of reverse meridional cyclodialysis (RMC) ab interno with implantation of a metallic implant into the supraciliary space for decreasing intraocular pressure in glaucoma patients. RMC was performed ab interno in 51 patients, among which 30 patients had a metallic implant inserted into the supraciliary space (implant group). Twenty-one patients who underwent RMC ab interno without implant comprised the control group. The outcomes were evaluated after 12 months. RMC was performed through a clear corneal incision using a special spatula at 4-5 o'clock reaching 5-6 mm deep, width of the cleft was 11-12o of the iridocorneal angle. The evaluation criteria included adverse events, postoperative IOP changes, need for hypotensive medications and repeat surgery. The results were analyzed using variational statistics. Baseline mean IOP was 28.8±4.7 mmHg and 30.2±7.2 mmHg in implant and control groups, respectively, and at 12 months it decreased by 28.7±12.0% and 29.1±17.1%. Baseline mean medication usage was 2.7±0.8 and 2.6±0.9 in respective groups, at 12 months it decreased to 1.1±0.9 and 0.8±0.9. In the implant group, overall success was achieved in 93.3% of cases (complete success - 33.3%, partial success - 60.0%), while in the control group it was 66.7% (complete success - 28.6%, partial success - 38.1%) (p=0.03). In terms of IOP decrease, medication usage and adverse events the difference between the groups was statistically insignificant. Repeat surgery was required 5 times more frequently in the control group (33.3% vs 6.7%, p=3E-05). Implantation of a metallic implant into the supraciliary space to keep the cyclodialysis cleft open is safe and effective and substantially decreases the need for repeat surgery.

Purpose: To test the intracameral safety of nepafenac and its efficacy in inhibiting prostaglandin synthesis during phacoemulsification surgery. Methods: The safety evaluation was conducted in normal eyes of rabbits, 0.1ml of 0.3% and 1% nepafenac was injected intracamerally. Extensive studies to detect adverse response ranged from a gross examination of eyes under slit lamp biomicroscope, fluorescein dye test, Schirmer tear test, test for corneal sensitivity, intraocular pressure measurement (IOP), specular microscopy, electroretinography(ERG), and histopathological examination of intraocular tissues. Efficacy of nepafenac was studied by intracameral injection of 0.1%, 0.3% nepafenac, nepafenac 0.3%+1% lignocaine, and 1% lignocaine alone, before phacoemulsification surgery and intraoperative mydriasis along with PGE2(ProstaglandinE2) secretion were recorded. Results: Single 0.1ml of 0.3% or 1% nepafenac did not significantly (p > 0.05) alter physiological parameters and histology of cornea, iris, and retina. Nepafenac 0.3% effectively inhibited PGE2 secretion. No significant (p > 0.05) prevention of miosis was recorded with 0.1% or 0.3% nepafenac. However, a combination of 0.3% nepafenac + 1% lignocaine and 1% lignocaine alone significantly (p < 0.05) arrested miosis during the intraoperative period. Conclusion: An intracameral concentration of up to 1% nepafenac does not adversely affect the rabbit eye. Nepafenac fails to prevent miosis but inhibits prostaglandin release during phacoemulsification surgery.

The authors propose a modified technique of non-penetrating filtering glaucoma surgery for primary open-angle glaucoma (POAG) to improve the uveoscleral outflow. The study enrolled 11 patients with POAG. A novel surgical technique included two steps. The first step was modified deep sclerectomy and cyclodyalysis with collagen implant placed into the supraciliary space. The second step (after 7–10 days) was YAG laser trabeculotomy. Surgical site and adjacent areas were examined by optical coherence tomography (OCT). After 6 months, mean IOP significantly reduced by 52% (from 30.0±10.3 mm Hg to 14.6±5.0 mm Hg, р=0.0004) while the number of IOP-lowering medications reduced by 79% (from 2.9±1.0 to 0.6±0.4, р=0.000001). The aqueous humor outflow occurred through conjunctival lymphatic vessels without filtering bleb formation, as illustrated by OCT. Postoperative complications were minor and easy-to-treat. Three case reports are discussed. Keywords: open-angle glaucoma, glaucoma surgery, conjunctival lymphatics, filtering bleb, non-penetrating glaucoma surgery, uveolymphatic outflow pathway. For citation: Kumar V., Abu Zaalan K.A., Frolov M.A. et al. Activation of uveolymphatic outflow pathway after non-penetrating glaucoma surgery without filtering bleb: case reports. Russian Journal of Clinical Ophthalmology. 2021;21(2):108–115. DOI: 10.32364/2311-7729-2021- 21-2-108-115.