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In this White Paper, we discuss the current state of microbial cancer therapy. This paper resulted from a meeting (‘Microbial Based Cancer Therapy’) at the US National Cancer Institute in the summer of 2017. Here, we define ‘Microbial Therapy’ to include both oncolytic viral therapy and bacterial anticancer therapy. Both of these fields exploit tumor-specific infectious microbes to treat cancer, have similar mechanisms of action, and are facing similar challenges to commercialization. We designed this paper to nucleate this growing field of microbial therapeutics and increase interactions between researchers in it and related fields. The authors of this paper include many primary researchers in this field. In this paper, we discuss the potential, status and opportunities for microbial therapy as well as strategies attempted to date and important questions that need to be addressed. The main areas that we think will have the greatest impact are immune stimulation, control of efficacy, control of delivery, and safety. There is much excitement about the potential of this field to treat currently intractable cancer. Much of the potential exists because these therapies utilize unique mechanisms of action, difficult to achieve with other biological or small molecule drugs. By better understanding and controlling these mechanisms, we will create new therapies that will become integral components of cancer care.

High speed and small gauge vitrectomy systems have made surgical intervention in complications of diabetic retinopathy (DR) safer. The availability of anti-vascular endothelial growth factor (anti-VEGF) compounds for use in DR has significantly improved intraoperative and postoperative outcomes. This review discusses the indications for surgical intervention in DR. The role of anti-VEGF compounds is discussed as surgical adjuvants with an emphasis on timing of treatment before surgery.

Objective Idiopathic Intracranial Hypertension (IIH) was first reported in 1897 as “Pseudo tumor Cerebri” when lumbar puncture was initiated in medicine. However, it is still a challenging diagnosis for many neurologists and ophthalmologists. Likewise, the sequela of IIH can be debilitating overall health and quality of life in most patients. This report presents the evolving diagnostic modalities that are different from mainstream IIH reports on gender, obesity and headaches ratios. We believe, using standard optical coherence tomography (OCT) can allow for a much earlier and more accurate diagnosis of IIH, with marked reduction in visual loss morbidity.Methods Retrospective, observational method was used to review 171 patients’ charts with suspected IIH over the past 12 years. The OCT of optic nerve and Macula was conducted by considering a list of signs and symptoms. Brain MRI, lumbar puncture, and our standard laboratory workups for optic neuropathies and visual fields were done. Visual Evoked Potentials were performed by neurologists. For purpose of this paper all IIH diagnosis fit Dandy diagnosis criteria of pseudo tumor cerebri as having a normal MRI.Results We evaluated 164 cases that had LPs done due to our proposed OCT Patterns to rule out IIH with no bio-microscopic evidence of overt papilledema. The majority of LP positive patients had some degree of visual field damage. Twenty out of 164 cases had false positive OCTs (with negative LPs) 88% accuracy in OCT diagnosis of IIH. No false positive OCT in Pattern-I.Conclusion Four different OCT diagnostic Patterns presented for IIH cases. The demographics of the patients considered having IIH by OCT Patterns I-IV and proven by positive LP; do not fit the classic demographic patterns. Classically, IIH has been reported to be observed in obese females with headaches and visible papilledema. Our findings put this classic set of presenting signs into question.

Objective:To evaluate the efficacy and ocular safety of bromfenac ophthalmic solution 0.09% dosed once daily for the treatment of ocular inflammation and pain following cataract extraction with posterior chamber intraocular lens implantation.Methods:A total of 455 subjects (455 study eyes: 230 bromfenac, 225 placebo) were enrolled in two randomized double-masked, placebo-controlled, clinical trials at 64 ophthalmology clinics in the United States. Subjects were randomized to receive either bromfenac 0.09% or placebo dosed once daily. Dosing began 1 day before cataract surgery (Day -1), continued on day of surgery (Day 0), and for 14 days following surgery. Evaluations were completed on Days 1, 3, 8, 15 and 22. The primary efficacy endpoint was cleared summed ocular inflammation score (SOIS) by Day 15. The secondary efficacy endpoint was the number of subjects who were pain-free at Day 1.Results:The bromfenac 0.09% group was significantly higher compared to the placebo group in the primary endpoint of the proportion of subjects who had cleared ocular inflammation by Day 15 (P < 0.0001). The mean SOIS for the bromfenac 0.09% group was lower than the placebo group at Days 3, 8, 15, and 22 (P < 0.0001). More bromfenac 0.09% subjects were pain free at Days 1, 3, 8, and 15 (P < 0.0001). Fewer subjects in the bromfenac 0.09% group withdrew from the clinical trials due to lack of efficacy at Day 15 (P < 0.0001). Fewer adverse events were reported in the bromfenac 0.09% group than the placebo group. Limitations included advanced age, female predominance, and surgical nuances among cataract surgeons, making cross-trial comparisons difficult.Conclusions:Bromfenac ophthalmic solution 0.09% dosed once daily is clinically safe and effective for the treatment of ocular inflammation and the reduction of ocular pain associated with cataract surgery.Trial registration: ClinicalTrials.gov identifier: NCT00704418.Trial registration: ClinicalTrials.gov identifier: NCT00853970.