Short-term outcomes of minimally invasive retromuscular ventral hernia repair using an enhanced view totally extraperitoneal (eTEP) approach: systematic review and meta-analysis.

BACKGROUND: The enhanced view totally extraperitoneal (eTEP) approach is becoming increasingly more widely accepted as a promising technique in the treatment of ventral hernia. However, evidence is still lacking regarding the perioperative, postoperative and long-term outcomes of this technique. The aim of this meta-analysis is to summarize the current available evidence regarding the perioperative and short-term outcomes of ventral hernia repair using eTEP. STUDY DESIGN: A systematic search was performed of PubMed, EMBASE, Cochrane Library and Web of Science electronic databases to identify studies on the laparoscopic or robotic-enhanced view totally extraperitoneal (eTEP) approach for the treatment of ventral hernia. A pooled meta-analysis was performed. The primary end point was focused on short-term outcomes regarding perioperative characteristics and postoperative parameters. RESULTS: A total of 13 studies were identified involving 918 patients. Minimally invasive eTEP resulted in a rate of surgical site infection of 0% [95% CI 0.0-1.0%], a rate of seroma of 5% [95% CI 2.0-8.0%] and a rate of major complications (Clavien-Dindo III-IV) of 1% [95% CI 0.0-3.0%]. The rate of intraoperative complications was 2% [95% CI 0.0-4.0%] with a conversion rate of 1.0% [95% CI 0.0-3.0%]. Mean hospital length of stay was 1.77 days [95% CI 1.21-2.24]. After a median follow-up of 6.6 months (1-24), the rate of recurrence was 1% [95% CI 0.0-1.0%]. CONCLUSION: Minimally invasive eTEP is a safe and effective approach for ventral hernia repair, with low reported intraoperative complications and good outcomes.

[Outbreak of toxic anterior segment syndrome after vitreous surgery]. / Brote de síndrome tóxico del segmento anterior después de cirugía vítrea.

CASE REPORT: An outbreak of Toxic Anterior Segment Syndrome after vitreoretinal surgery is reported. Two patients underwent exclusively vitrectomy while the other three patients were operated of vitrectomy and some other anterior segment procedure. DISCUSSION: Toxic Anterior Segment Syndrome is a sterile postoperative inflammation due to any non infectious substance that reaches the anterior segment during surgery. It occurs in outbreaks and while most of the cases have been reported after anterior segment procedures, this case demonstrates that development after vitreoretinal surgery is also a possibility.

[Inflammatory optic neuritis]. / Neuritis óptica inflamatoria.

Inflammatory Optic Neuritis (ON) is the most frequent cause of acute visual loss in young adults. Although the visual prognosis is excellent in the majority of cases, many patients develop pathology, such as multiple sclerosis, in its subsequent evolution. The natural history of ON has been studied in numerous works in recent years; one of the most important of which is Optic Neuritis Treatment Trial. Magnetic Resonance plays a fundamental role in the etiological diagnosis of ON and in predicting the risk of conversion into multiple sclerosis. New exploratory techniques have recently been incorporated, such as optical coherence tomography, useful for diagnosis and prognosis; serum biomarkers have been identified in the diagnosis of other pathologies with an autoimmune nature that produce ON. A better understanding of the clinical and exploratory data of typical ON will make a more rapid and accurate diagnostic study possible. Treatment of ON with steroids must be individualised bearing in mind that they do not alter the long-term prognosis and an immunomodulating therapy must be proposed for patients with a high risk of conversion into multiple sclerosis. This article reviews the existing data in the literature on its clinical manifestations, its etiological and differential diagnosis, and the treatment of inflammatory ON.

[Agreement among ophthalmologists and primary care physicians in the evaluation of retinographies of diabetic patients]. / Concordancia en el estudio de retinografías en diabéticos: oftalmólogos vs médicos de familia.

PURPOSE: To assess the extent of agreement in the evaluation of non-mydriatic retinographies of diabetic patients among ophthalmologists and a group of primary care physicians with previous training. METHODS: The study was divided in two phases. In the first phase, the four participants were instructed in the interpretation of retinographies. The second phase involved the evaluation of 1000 images of 200 patients, 100 without retinopathy and 100 with signs of diabetic retinopathy. The four participants had to decide if the images did or did not show evidence of diabetic retinopathy. Kappa index was used to assess the extent of agreement. A percentage disagreement of 15% with a precision of 5% (+/-5%) with a confidence level of 95% was considered adequate. RESULTS: The percentage of coincident diagnoses among ophthalmologists and primary care physicians was between 89 and 97.5%. With respect to the assessment of the agreement, the kappa index was between 80 and 95%. In all cases the confidence interval was at least 85%. CONCLUSIONS: After an adequate training process, the reliability of evaluation of non-mydriatic retinographies of diabetic patients by primary care physicians was very high. This could allow the establishment of screening for diabetic retinopathy at the primary care level. Advantages of this system include a greater involvement of primary care physicians in the global management of diabetic patients and a lower demand for ophthalmic attention.

Optical coherence tomography evaluation of the corneal cap and stromal bed features after laser in situ keratomileusis for high myopia and astigmatism.

OBJECTIVE: To study the corneal microstructure by optical coherence tomography (OCT) after laser in situ keratomileusis (LASIK) for high myopia with and without astigmatism. DESIGN: Nonrandomized self-controlled comparative trial. PARTICIPANTS: Sixty-three consecutive LASIK eyes with spherical equivalent refraction between -6.0 and -17.0 diopters (D) and astigmatism between 0.0 and -5.0 D were prospectively recruited for examination. INTERVENTION: LASIK was performed with the Chiron Hansatome microkeratome (160-microm fixed plate) and Summit Apex Plus excimer laser using a 5.5/6.0/6.5-mm multizone pattern. Proper preoperative calculations were performed to ensure stromal beds thicker than 250 microm. MAIN OUTCOME MEASURES: OCT imaging and measurement of corneal thickness was performed preoperatively. In addition, corneal cap and stromal bed thickness measurements were performed 1 day, 1 month, and 3 months postoperatively. RESULTS: The average central corneal pachymetry was 538.9 +/- 26.2 microm preoperatively. Mean corneal cap thickness measured 124.8 +/- 18.5 microm 1-day postoperatively. Mean stromal bed thickness was 295.2 +/- 37.1 microm on the first postoperative day. Compared with the 1-day postoperative examination, the average stromal bed thickness increased significantly by 5.9 microm (P = 0.001) and 7.2 microm (P = 0.001) at the 1-month and 3-month postoperative examinations, respectively. Mean difference between actual (118.7 +/- 27.8 microm) and predicted (104.1 +/- 20.8 microm) central ablation depths was 14.6 +/- 16.7 microm (P = 0.0001). A weak but statistically significant positive association was found between preoperative refraction and the difference between expected and real ablation depth values (R = 0.26; P = 0.042). Posterior stromal beds were more than 250-microm thick in 58 eyes (89.9%) 1 day postoperatively. This safety requirement improved at the 1-month postoperative examination, when the partial regression accounted for slightly thicker stromal beds and only two cases (3.2%) exhibited posterior stromal tissue thinner than 250 microm. These two cases were seen only for corrections exceeding 12 D (P = 0.04). CONCLUSIONS: OCT appears to be a useful tool for the evaluation of both the qualitative and quantitative anatomic outcome of LASIK. Corrections of higher degrees of ametropia run a higher risk of producing a thinner than expected central cornea. Particularly, corrections greater than 12 D may lead eventually to stromal beds thinner than 250 microm, despite proper preoperative calculations. Because corneal flaps are usually thinner than expected with the microkeratome used herein, adequate posterior corneal stroma is preserved in most instances.

Final clear corneal incision size for AcrySof intraocular lenses.

PURPOSE: To evaluate clear corneal incision size variation in phacoemulsification surgery after the implantation of 2 models of AcrySof intraocular lenses (IOLs). SETTING: Departamento de Oftalmología, Clínica Universitaria de Navarra, Universidad de Navarra, Pamplona, Spain. METHODS: This prospective study comprised 108 eyes that had phacoemulsification and implantation of an Acrysof IOL model MA60BM (56 eyes) or MA30BA (52 eyes). Wound incision size was quantified using the Nordan incision size measurer. The incision size for each IOL model was evaluated before and after implantation and its relationship with the complications during implantation analyzed. RESULTS: Mean incision size varied from 3.7 mm +/- 0.14 (SD) before implantation to 3.9 +/- 0.11 mm after implantation for the MA60BM model (P = .001) and from 3.3 +/- 0.15 mm to 3.4 +/- 0.13 mm for the MA30BA model (P = .001). Intraoperative complications occurred in 14 eyes, and difficulty during IOL implantation, in 23 eyes. There was no association between final incision size and complications. CONCLUSIONS: Incision size increased after the implantation of the 2 AcrySof IOL models used in this study. Modifications to model MA30BA have led to an average decrease in wound size of 0.5 mm with respect to the MA60BM model. Most difficulties encountered were attributable to improper IOL unfolding.

Variation in clear cornea incision size after phacoemulsification and foldable lens implantation.

PURPOSE: To study the changes in clear cornea incision size after phacoemulsification and implantation of a three-piece, silicone, foldable intraocular lens (IOL). SETTING: Departamento de Oftalmologia, Clinica Universitaria de Navarra, Pamplona, Spain. METHODS: In this prospective study, phacoemulsification with implantation of a foldable IOL (AMO SI-30NB) was performed in 133 eyes. Surgery was carried out by four surgeons who implanted the IOL with the same forceps. The external incision size was measured before and after phacoemulsification and irrigation/aspiration and before and after IOL implantation. RESULTS: Before phacoemulsification the mean incision size was 3.07 mm; after phacoemulsification and irrigation/aspiration, it enlarged to 3.09 mm (P = .001). The mean incision size before foldable IOL implantation was 3.16 mm, and after implantation it increased to 3.32 mm (P = .0001). When the IOL was less than 22.0 diopters (D), the final incision size was 3.31 mm +/- 0.11 (SD); when the IOL was 22.0 to 26.0 D, the final size was 3.32 +/- 0.01 mm; and when the IOL was 26.0 D or more, the final size was 3.39 +/- 0.08 mm (P = .01). CONCLUSIONS: Phacoemulsification and foldable IOL implantation enlarged the size of the clear cornea incision in this study. The IOL power may be a significant factor in determining the minimal incision size prior to IOL insertion and the final incision size.

Medial canthus tumor surgery: a prospective study of microscopically controlled excision.

OBJECTIVES: We set out to demonstrate that medial canthus tumors are malignancies requiring microscopically-controlled excision for a high cure rate. We also aim to show that reconstruction can have good esthetic results with a few simple techniques. METHODS: During 1992, we treated 38 basal cell carcinomas of the medial canthus, employing our own two-step Mohs' surgery. All cases were reconstructed with five simple techniques: "laissez faire", full thickness graft, nasoglabellar flap, mild-line forehead flap or combination of flaps. RESULTS: No recurrent basal cell carcinomas have been observed in our patients during the last four years. All the medial canthus tumours were basal cell carcinomas, eight involving morpheiform infiltration. Perineural infiltration was observed in two cases. CONCLUSIONS: Micrographic surgery for medial canthus malignant tumors is the best resection technique. Infiltrating, basal cell carcinomas, are the most common tumors of medial canthus, but also have an excellent cure rate. Reconstruction with a small number of flaps and skin graft is generally an easy process, producing highly satisfactory results.