Neurotrophic keratopathy: General features and new therapies.

Neurotrophic keratopathy is an uncommon degenerative corneal disorder characterized by compromised corneal sensory innervation resulting in the formation of epithelial defects and nonhealing corneal ulcers. Various treatment modalities are available to stabilize disease progression, improve patient well-being, and prevent vision loss. For eligible patients, medical and surgical reinnervation have emerged as pioneering therapies, holding promise for better management. We present a comprehensive review of the disorder, providing an update relevant to ophthalmologists on pathogenesis, diagnosis, treatment options, and novel therapies targeting pathophysiological pathways.

Risk-Benefit Comparison Between Endoloop and Endostapler Devices for the Closure of Appendiceal Stumps in Laparoscopic Appendectomy.

Introduction Acute appendicitis is a common cause of acute abdomen and the most frequent surgical emergency in the world. Since the nineteenth century, surgical resolution has been the most accepted treatment worldwide, and laparoscopic appendectomy is currently preferred as the treatment of choice because it has several benefits. The closure of the appendiceal stump is the most crucial step during appendectomy since its inadequate management can cause post-surgical complications. Throughout recent years, several methods have been proposed to perform this closure. This study was performed to compare the post-surgical outcomes of the use of endoloop and endostapler devices. Methods This is a retrospective study of 290 patients aged 18 to 83 who underwent laparoscopic appendectomy between 2016 and 2020. Demographic data, clinical history, tomographic findings, and laboratory data were collected, as well as appendicular base management technique, severity degree of appendicitis at hospital admission, postoperative complications at 30 days, hospital readmission, and in-hospital stay. Statistical tests and binary logistic regression analyses were used to identify risk factors, with a significance level of p<0.05. Results Demographic data and clinical history did not show statistically significant differences. The presence of a pre-surgical abscess with tomography was 1.58 times higher in the endostapler group. Post-surgical results showed that the use of endostapler devices represented a 2.7 times higher risk of post-surgical abscess. The endostapler group was also found to have 1.87 times the risk of post-surgical sepsis. Conclusion Our study shows that the use of an endoloop reduces the risk of postoperative abscess by 16.5% and protects against the development of post-surgical sepsis by 30%.

Doppler de la arteria oftálmica: un modelo para predicción de preeclampsia / Ophthalmic artery Doppler: a model for the prediction of preeclampsia

Resumen ANTECEDENTES: En México, la preeclampsia sigue siendo un problema de salud pública; en la actualidad es la principal causa de muerte materna. Su incidencia es de 47.3 casos por cada 1000 nacimientos. La preeclampsia trae consigo repercusiones en la madre y el feto; de ahí la necesidad de la validación de modelos de tamizaje efectivos que permitan su diagnóstico oportuno. La evaluación Doppler de la arteria oftálmica sigue siendo motivo de diversas investigaciones porque aporta información valiosa de los cambios hemodinámicos intracraneales que suceden, incluso, antes del curso sintomático de la enfermedad. OBJETIVO: Analizar las recomendaciones emitidas por diferentes autores que han evaluado la utilización del Doppler de la arteria oftálmica como modelo de tamizaje para la predicción y diagnóstico tempranos de preeclampsia. METODOLOGÍA: Estudio retrospectivo basado en la búsqueda exhaustiva en diferentes bases de datos de metanálisis y estudios clínicos aleatorizados que describieran, detalladamente, la población estudiada y los parámetros de la arteria oftálmica evaluados. RESULTADOS: Se identificaron 22 publicaciones y en el cribado se excluyeron 8 artículos que estaban duplicados, 2 por no cumplir con los criterios de inclusión y 1 por encontrarse en otro idioma diferente al inglés; al final se revisaron 11 títulos y para complementar el tema de estudio se revisaron otros 60 artículos. CONCLUSIONES: La evaluación mediante Doppler de la arteria oftálmica es un examen simple, rápido, reproducible, seguro y no invasivo que puede incorporarse a la predicción y diagnóstico temprano de pacientes con alto riesgo de preeclampsia.

Abstract BACKGROUND: Preeclampsia remains a public health problem in Mexico and is currently the leading cause of maternal death. Its incidence is 47.3 cases per 1000 live births. Pre-eclampsia has consequences for the mother and the fetus, so there is a need to validate effective screening models for early diagnosis. Doppler assessment of the ophthalmic artery continues to be studied because it provides valuable information on intracranial hemodynamic changes that occur before the symptomatic course of the disease. OBJECTIVE: To analyze the recommendations of different authors who have evaluated the use of ophthalmic artery Doppler as a screening model in the prediction and early diagnosis of pre-eclampsia. METHODOLOGY: Retrospective study based on the search exhaustive search of different databases of meta-analyses and randomized clinical trials describing in detail the population studied and the ophthalmic artery parameters evaluated. RESULTS: Twenty-two publications were identified and after screening, 8 articles were excluded as duplicates, 2 for not meeting the inclusion criteria and 1 for being in a language other than English; finally, 11 titles were reviewed, and another 60 articles were reviewed to complement the study topic. CONCLUSIONS: Doppler evaluation of the ophthalmic artery is a simple, rapid, reproducible, safe, and noninvasive test that can be used to evaluate the ophthalmic artery.

Reliability, repeatability, and accordance between three different corneal diagnostic imaging devices for evaluating the ocular surface.

Purpose: To evaluate repeatability, reproducibility, and accordance between ocular surface measurements within three different imaging devices. Methods: We performed an observational study on 66 healthy eyes. Tear meniscus height, non-invasive tear break-up time (NITBUT) and meibography were measured using three corneal imaging devices: Keratograph 5M (Oculus, Wetzlar, Germany), Antares (Lumenis, Sidney, Australia), and LacryDiag (Quantel Medical, Cournon d'Auvergne, France). One-way ANOVAs with post hoc analyses were used to calculate accordance between the tear meniscus and NITBUT. Reproducibility was assessed through coefficients of variation and repeatability with intraclass correlation coefficients (ICC). Reliability of meibography classification was analyzed by calculating Fleiss' Kappa Index and presented in Venn diagrams. Results: Coefficients of variation were high and differed greatly depending on the device and measurement. ICCs showed moderate reliability of NITBUT and tear meniscus height measurements. We observed discordance between measurements of tear meniscus height between the three devices, F2, 195 = 15.24, p < 0.01. Measurements performed with Antares were higher; 0.365 ± 0.0851, than those with Keratograph 5M and LacryDiag; 0.293 ± 0.0790 and 0.306 ± 0.0731. NITBUT also showed discordance between devices, F2, 111 = 13.152, p < 0.01. Measurements performed with LacryDiag were lower (10.4 ± 1.82) compared to those of Keratograph 5M (12.6 ± 4.01) and Antares (12.6 ± 4.21). Fleiss' Kappa showed a value of -0.00487 for upper lid and 0.128 for inferior lid Meibography classification, suggesting discrete to poor agreement between measurements. Conclusion: Depending on the device used and parameter analyzed, measurements varied between each other, showing a difference in image processing.

Significant Association Between Variant in SGCD and Age-Related Macular Degeneration.

CFH and HTRA1 genes are traditional markers of increased risk of age-related macular degeneration (AMD) across populations. Recent findings suggest that additional genes-for instance, in the dystrophin-associated protein complex-might be promising markers for AMD. Here, we performed a case-control study to assess the effect of SGCD single nucleotide polymorphisms (SNPs), a member of this protein family, on AMD diagnosis and phenotype. We performed a case-control study of an under-studied population from Hispanics in Mexico City, with 134 cases with 134 unpaired controls. Cases were 60 years or older (Clinical Age-Related Maculopathy Staging (CARMS) grade 4⁻5, as assessed by experienced ophthalmologists following the American Association of Ophthalmology (AAO) guidelines), without other retinal disease or history of vitreous-retinal surgery. Controls were outpatients aged 60 years or older, with no drusen or retinal pigment epithelium (RPE) changes on a fundus exam and a negative family history of AMD. We examined SNPs in the SGCD gene (rs931798, rs140617, rs140616, and rs970476) by sequencing and real-time PCR. Genotyping quality checks and univariate analyses were performed with PLINK v1.90b3.42. Furthermore, logistic regression models were done in SAS v.9.4 and haplotype configurations in R v.3.3.1. After adjusting for clinical covariates, the G/A genotype of the SGCD gene (rs931798) significantly increases the odds of being diagnosed with AMD in 81% of cases (1.81; 95% CI 1.06⁻3.14; p = 0.031), especially the geographic atrophy phenotype (1.82; 95% CI 1.03⁻3.21; p = 0.038) compared to the G/G homozygous genotype. Moreover, the GATT haplotype in this gene (rs931798, rs140617, rs140616, and rs970476) is associated with lower odds of AMD (adjusted odds ratio (OR) 0.13; 95% CI 0.02⁻0.91; p = 0.041). SGCD is a promising gene for AMD research. Further corroboration in other populations is warranted, especially among other Hispanic ethnicities.