Neurotrophic Keratopathy after wide retinal endolaser and postoperative Ketorolac eye drops: A case series.

PURPOSE: We report a series of 5 cases, happened in a period of 5 months, who developed neurotrophic keratopathy (NK) following pars plana vitrectomy (PPV) and retinal endolaser for rhegmatogenous retinal detachment (RRD). In our several decennary experience of surgical center predominantly based on vitreoretinal surgery, we had rare cases of postoperative NK. These recent cases of post-surgical NK happened contextually to our change of postoperative non-steroidal anti-inflammatory drugs (NSAIDs) drops, based on Ketorolac Tromethamine 0.5% eye drops. CASES PRESENTATION: Five patients with a mean age of 61 ± 7.3 years were treated with one or more PPV with intraoperative peripheral endolaser for RRD. Nobody had previous herpetic keratitis, systemic disease like diabetes mellitus or other predisposing factors for NK. In the postoperative period, all patients received Ketorolac Tromethamine 0.5% eye drops for a mean period of 54 ± 25 days. During follow-up visits they developed NK and they were successfully treated with suspension of Ketorolac eye drops, application of therapeutic contact lens or amniotic membrane patch and topical lubricant therapy. CONCLUSIONS: Postoperative Ketorolac eye drops, in patients who underwent PPV with endolaser, may reduce the corneal sensitivity, predispose to epithelial disruption and NK development. Studies are needed to explore the effect of NSAIDs on corneal sensitivity reduction in patient who will undergo PPV and extensive endolaser.

Gastrointestinal Ultrasound in Emergency Setting.

Acute bowel diseases are responsible for more than one third of subjects who were referred to the emergency department for acute abdominal pain and gastrointestinal evaluation. Gastrointestinal ultrasound (GIUS) is often employed as the first imaging method, with a good diagnostic accuracy in the setting of acute abdomen, and it can be an optimal diagnostic strategy in young females due to the radiation exposure related to X-ray and computed tomography methods. The physician can examine the gastrointestinal system in the area with the greatest tenderness by ultrasound, thus obtaining more information and data on the pathology than the standard physical examination. In this comprehensive review, we have reported the most relevant indications and advantages to using ultrasound in the investigation of abdominal acute pain.

Venous thromboembolism prevention with low molecular weight heparin may reduce hemorrhagic transformation in acute ischemic stroke.

BACKGROUND: Subcutaneous heparin at a prophylactic dose (SHPD) is a rather common treatment in ischemic stroke, but whether it confers an increased risk of hemorrhagic transformation of cerebral infarct (HT) and whether its reduction or discontinuation favors HT regression are presently poorly understood. METHODS: Two samples of ischemic stroke patients with a cerebral lesion diameter ≥ 3 cm on brain CT scan, admitted over 7 years to our stroke unit, were retrospectively examined: (1) patients treated or not treated with SHPD (enoxaparin 4000 U/day), with subsequent assessment of possible HT appearance (N = 267, mean age 75.9 ± 12.8 years) and (2) patients treated with SHPD, with HT and subsequent reduction/discontinuation or maintenance of the initial dose, and subsequent assessment of HT evolution (N = 116, mean age 75.7 ± 11.1 years). HT severity was quantified according to the ECASS study (HT score). RESULTS: In the first sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and other possible confounders, SHPD was inversely associated with HT appearance (hazard ratio 0.62, 95% CI 0.39-0.98, P = 0.04). In the second sample, after adjustment for age, sex, stroke severity, cerebral lesion diameter, and initial HT severity, SHPD reduction/discontinuation had an inverse effect on both HT score improvement (odds ratio 0.42, 95% CI 0.18-0.99, P = 0.049) and HT improvement according to neuroradiological reports (odds ratio 0.34, 95% CI 0.14-0.82, P = 0.015). CONCLUSIONS: This retrospective study suggests that SHPD may play a protective role in HT appearance and evolution, which requires verification by a randomized clinical trial.

Accuracy of Lung Ultrasound in Patients with Acute Dyspnea: The Influence of Age, Multimorbidity and Cognitive and Motor Impairment.

Discriminating between causes of dyspnea may be difficult, particularly in the elderly. The aim of this retrospective study of 83 inpatients with acute dyspnea was to assess the influence of age, multimorbidity and cognitive or motor impairment on the diagnostic accuracy of lung ultrasound (LUS) in discriminating acute heart failure (AHF) from noncardiogenic dyspnea (NCD). Univariate analysis indicates that LUS misdiagnosis was associated with the following parameters: history of stroke (p = 0.037), lower activity of daily living (p = 0.039), higher modified-Rankin scale (mRS) (p = 0.027) and need of two operators to complete LUS because of reduced patient compliance (p = 0.030). Regression analysis identified only history of stroke (p = 0.048) as an independent predictor of LUS misdiagnosis. This study supports LUS usefulness to differentiate AHF from NCD. Our data suggest that diagnostic accuracy of LUS is affected by history of stroke as a proxy for severe motor impairment but not by age, cognitive impairment and multimorbidity.

Corneal sensitivity after small-incision lenticule extraction and laser in situ keratomileusis.

PURPOSE: To longitudinally evaluate corneal sensitivity after small-incision lenticule extraction and compare the results with those in previous studies. SETTING: London Vision Clinic, London, United Kingdom. DESIGN: Retrospective case series. METHODS: Consecutive myopic eyes treated with small-incision lenticule extraction using the Visumax femtosecond laser were studied. Corneal sensitivity was measured centrally and at 4 paracentral locations using a Cochet-Bonnet esthesiometer preoperatively and 1 day, 1 week, and 1, 3, 6, and 12 months postoperatively. Results were compared with averaged results from previous laser in situ keratomileusis (LASIK) and small-incision lenticule extraction studies. RESULTS: The mean spherical equivalent was -6.85 diopters (D) ± 2.57 (SD). The mean age was 36 ± 11 years. After small-incision lenticule extraction, the preoperative mean central corneal sensitivity dropped from 54 mm preoperatively to 33 mm 1 day postoperatively, rising to 40 mm, 45 mm, 48 mm, 54 mm, and 55 mm over 12 months; it reached baseline at 6 months (P > .05). For 21 LASIK studies, the mean central corneal sensitivity dropped from 56 mm preoperatively to 6 mm at 1 day, rising to 14 mm, 23 mm, 34 mm, 45 mm, and 51 mm over 12 months. For 8 small-incision lenticule extraction studies, central corneal sensitivity dropped from 57 mm preoperatively to 39 mm at 1 week, then rose to 39 mm, 42 mm, 49 mm, 52 mm, and 54 mm over 12 months; it was higher than after LASIK at 1 week and 1, 3, and 6 months (P < .05). CONCLUSION: Recovery of central corneal sensitivity to baseline was reached by 6 months after small-incision lenticule extraction and was higher than after LASIK for the first 6 months after surgery. FINANCIAL DISCLOSURE: Dr. Reinstein is a consultant to Carl Zeiss Meditec AG, has a proprietary interest in the Artemis technology (Arcscan, Inc.), and is an author of patents related to very high-frequency digital ultrasound administered by the Center for Technology Licensing at Cornell University, Ithaca, New York, USA. No other author has a financial or proprietary interest in any material or method mentioned.

Total spherical aberration of the cornea in patients with cataract.

PURPOSE: To investigate the distribution of corneal spherical aberration in patients with cataract using the Pentacam HR. METHODS: Consecutive cataract patients were examined using the Pentacam HR high-resolution rotating Scheimpflug camera (Oculus, Wetzlar, Germany). In one eye of each patient, the root-mean-square (RMS) of anterior, posterior, and total corneal spherical aberration Z4(0) was calculated by ray-tracing on an area of 6 mm diameter. The Pearson correlation coefficient (r) was used to assess correlations between Z4(0) RMS values and age/total corneal refractive power. The χ2 test was used to compare the proportion of eyes qualifying for spherically neutral or negatively aspheric (-0.17 and -0.27 µm) intraocular lenses (IOLs) by targeted level of residual spherical aberration. RESULTS: Fifty-seven men and 92 women were included (mean [±SD] age, 71.73 [±9.12] years). The RMS mean (±SD) values of Z4(0) were +0.353 (±0.132) µm, -0.121 (±0.034) µm, and +0.328 (±0.132) µm, respectively, for the anterior, posterior, and total cornea. The anterior, posterior, and total Z4(0) were on average significantly higher (p < 0.001) in women than in men. In both sexes, statistically significant (p < 0.05) age-related changes were found for the anterior and total Z4(0) but not for the posterior Z4(0) (p > 0.05). The total Z4(0) and total corneal refractive power were significantly correlated in men (p = 0.01) but not in women (p = 0.14). For postoperative targets of 0 ± 0.05/+0.10 ± 0.05 µm residual Z4(0), the proportion of eyes that would have qualified for implantation of negatively aspheric IOLs with -0.17 and with -0.27 µm was similar (61.1 and 56.3%, respectively; p = 0.09); significantly fewer eyes (6.7%) would have qualified for implantation of neutrally aspheric IOLs (p > 0.05). CONCLUSIONS: Total corneal Z4(0) measured by Pentacam HR might be higher than that reported in previous studies. In most patients, the implantation of commercially available negatively aspheric IOLs would partially compensate for the positive total corneal Z4(0).