Tranexamic acid in melasma: A focused review on drug administration routes

Background

Melasma is a disorder of hyperpigmentation and vascularization often found in women between the ages of 20 and 40. The pathogenesis is unknown, but melasma often occurs in sun-exposed areas of the face, forearms, and back. Risk factors include family history, increased estrogen/progesterone, certain medications, and UV exposure. Melasma is typically treated with topical hydroquinone (HQ); however, it is often refractory to treatment. Tranexamic acid (TXA) is a plasmin inhibitor used off-label in the treatment of melasma. TXA can be administered orally, topically, or intralesionally.

Aims

The purpose of this review is to characterize the wide variety of TXA delivery methods for melasma treatment and the efficacy of these methods compared with traditional treatments.

Patients/Methods

A comprehensive PubMed and Embase search was conducted in May 2022 using the phrases tranexamic acid and melasma. Forty-six articles were included in this review.

Results

Oral, intralesional, and topical TXA is safe and effective treatments for melasma. They have been studied in a variety of randomized controlled trials and have been compared with several traditional treatments. Overall, MASI scores in patients using TXA in any form improved.

Conclusions

Oral TXA was found to be the most effective, especially in cases of refractory melasma; however, it caused GI upset and menstrual irregularities in many patients. The pro-thrombotic nature of this drug must be considered before safely prescribing to patients. Intralesional injections and microneedling with topical TXA were found to be effective alternatives to oral treatment. Lastly, topical TXA alone was found to be the least effective method but can be combined with other cosmeceuticals to improve outcomes. Topical TXA was also found to be better tolerated than hydroquinone, a traditional topical melasma treatment.     

Does diagnosis affect the predictive accuracy of risk assessment tools for juvenile offenders: Conduct Disorder and Attention Deficit Hyperactivity Disorder

Studies have suggested an increased risk of criminality in juveniles if they suffer from co-morbid Attention Deficit Hyperactivity Disorder (ADHD) along with Conduct Disorder. The Structured Assessment of Violence Risk in Youth (SAVRY), the Psychopathy Checklist Youth Version (PCL:YV), and Youth Level of Service/Case Management Inventory (YLS/CMI) have been shown to be good predictors of violent and non-violent re-offending. The aim was to compare the accuracy of these tools to predict violent and non-violent re-offending in young people with co-morbid ADHD and Conduct Disorder and Conduct Disorder only. The sample included 109 White-British adolescent males in secure settings. Results revealed no significant differences between the groups for re-offending. SAVRY factors had better predictive values than PCL:YV or YLS/CMI. Tools generally had better predictive values for the Conduct Disorder only group than the co-morbid group. Possible reasons for these findings have been discussed along with limitations of the study.     

Monocular and binocular visual parameters associated to vision-related quality of life in patients with epiretinal membrane: a prospective cohort

Graefe's Archive for Clinical and Experimental Ophthalmology - Binocular visual impairment related to unilateral idiopathic epiretinal membranes (uiERM) and its association with vision-related...     

Profile of patients receiving intravitreal anti-vascular endothelial growth factor injections during COVID-19-related lockdown

Purpose:The aim of this study was to analyze the impact on vision due to delay in presentation of patients requiring intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections, consequent to COVID-19-related travel restrictions.Methods:Data were collected retrospectively of patients who received anti-VEGF injections during four months of the COVID-19 pandemic. Visual acuities, indication for treatment were noted along with basic demographic characteristics.Results:Data were analyzed for 303 eyes of 263 patients. The indication for treatment was age-related macular degeneration (AMD) in 60 eyes (19.8%), while 162 eyes (53.5%) had Diabetic Macular Edema, 71 eyes (23.4%) had Retinal Vein Occlusion and 10 eyes (3.3%) had other diagnosis. The visual acuity in the treatment naïve eyes (Group A, n = 168) was significantly worse (P < 0.001) than those who presented for retreatment (Group B, n = 135). In Group B, there was a significant decline in vision for the entire cohort (P = 0.009) and those with AMD (P = 0.036). Those in Group B presented at a mean interval of 19.1 ± 10.6 (range, 4–64) weeks for retreatment.Conclusion:The COVID-19 pandemic has led to a delay in patients receiving anti-VEGF injections. The visual acuity is worse in both treatment naïve as well as those requiring retreatment. This could have long-term impact on vision of patients requiring this vision preserving treatment.     

Agreement and diagnostic accuracy of vision screening in preschool children between vision technicians and spot vision screener

Purpose:Screening preschool children for vision-related disorders poses a challenge. This study is designed to determine the agreement and diagnostic accuracy of the spot vision screener (SVS) in screening preschool children compared to screening procedure by vision technicians (VT).Methods:This study was conducted as a part of the ongoing study titled “Initiative for Screening Children for Refractive Errors and other Eye Health Needs (I-SCREEN).” Children from 33 Anganwadis (preschools) in two districts, Adilabad district of Telangana and Krishna district of Andhra Pradesh, in South India, underwent eye health screening by a VT and by a trained community eye health workers (CEHW) using the SVS. Findings were compared for agreement and diagnostic accuracy of assessment.Results:A total of 976 preschool children were screened by the VT and separately by the CEHW using the SVS in Adilabad (15 schools) and Krishna (18 schools) districts. The overall mean age of these children was 2.5 years (SD ± 1.3 years). There were 48 (4.9%) referrals by VT compared to 105 (10.8%) referrals by CEHW using SVS. The overall sensitivity of SVS was 91.7% (95% CI: 80%–97.7%) and the specificity was 93.4% (95% CI: 91.6%–94.9%). Positive predictive value was 41.9% (95% CI: 32.3%–51.9%) and negative predictive value was 99.5% (95% CI: 98.8%–99.9%) with a moderate agreement (0.54; 95% CI 0.49–0.64) between VT screening and screening with SVS.Conclusion:The SVS showed good diagnostic accuracy and agreement in screening for possible vision-related disorders in preschool children.