Prevalence and prediction of intraoperative floppy iris syndrome in patients with pseudoexfoliation syndrome.

OBJECTIVE: To investigate the incidence of intraoperative floppy iris syndrome (IFIS) in patients with pseudoexfoliation syndrome (PXF) and analyze preoperative ocular predicting factors. DESIGN: A retrospective case-control study METHODS: The study included 224 eyes with PXF and 287 control eyes without PXF. One eye per patient, who underwent cataract surgery at the Wolfson Medical Center between January 2020 to December 2021, was included. Medical records of the patients were reviewed. Data collected included demographic characteristics, medical history, preoperative comprehensive ophthalmic examination, biometry, surgical procedure details, and IFIS occurrence. The association of IFIS with preoperative ocular parameters was analyzed through both univariant and multivariant analyses. RESULTS: Patients with PXF were older and had a higher prevalence of glaucoma (77.6 ± 6.4 years vs 74.2±7.6 years; p < 0.001, and 20.1 % vs 9.8 %, p < 0.001, respectively). Prevalence of α-blockers treatment was similar in both groups. IFIS rate among the PXF group was 12.5% (n = 28) compared to 7.3% (n = 21) in the control group (p < 0.05). When omitting patients exposed to α-blockers, the PXF group exhibited a significantly higher IFIS rate (9.9% vs 4.8%; p < 0.05). Pupil dilation diameter was significantly lower among PXF patients (5.8 ± 1.1 mm vs 6.9 ± 0.99 mm; p < 0.001). Biometric evaluation revealed significant differences in anterior segment depth (ACD) and lens thickness (LT). Multivariate analysis indicated that PXF and decreased mydriatic pupil size remained significant predictors of IFIS. CONCLUSION: This study establishes an association between PXF and an increased risk of IFIS during cataract surgery, independent of α-blockers treatment.

Epidemiology of Pars Plana Vitrectomy in the Elderly: A Retrospective 10-Year Survey of 592 Cases.

PURPOSE: To report the epidemiology of the surgical indications of pars plana vitrectomy in patients aged 75 years or older. PATIENTS AND METHODS: The medical records of patients who underwent vitrectomy surgery in a single center between 2008 and 2018 were evaluated retrospectively for demographics, medical background, and surgical indications. Data on patients aged 75-85 were compared to those of patients older than 85 years and those recorded between 2008-2013 and 2014-2018. RESULTS: A total of 592 patients were included, of whom 55% were males. The mean±standard deviation age of the cohort at presentation was 80.4±4.60 years, and the mean visual acuity was 1.3±0.93 logMAR. The main indications for surgery were retinal detachment (n=117, 19.7%), epiretinal-membrane/vitreomacular traction (n=140, 23.6%), dropped intraocular lens/retained lens (n=89, 15%), macular hole (n=64, 11%), submacular hemorrhage (n=40, 6.7%), diagnostic vitrectomy (n=37, 6.2%), non-diabetic vitreous hemorrhage (n=30, 5.1%), and diabetic vitreous hemorrhage and other diabetic complications (n=33, 5.6%). Patients aged 85 years and older had higher rates of urgent surgeries (65%), such as for submacular hemorrhage and trauma (p=0.0000039 and p=0.001, respectively), and lower rates of non-urgent surgeries, such as for epiretinal membrane and macular hole (p=0.000032 and p=0.02, respectively), compared to patients aged 75-84 years. Additionally, the surgical rate for submacular hemorrhage decreased during 2008-2014 compared to 2014-2018 (p=0.000014). CONCLUSION: Understanding the unique distribution of indications for vitrectomy among elderly patients is essential for appropriate management and treatment. Urgent cases represent 65% of the surgeries performed in the older population.

Long-term cardiovascular hospitalizations of small for gestational age (SGA) offspring born to women with and without gestational diabetes mellitus (GDM) ‡.

OBJECTIVE: To assess whether delivery of small for gestational age (SGA) neonates to mothers with gestational diabetes mellitus (GDM) increases the risk of long-term cardiovascular offspring hospitalizations compared to SGA neonates born to mothers without GDM. STUDY DESIGN: This is a population-based retrospective cohort study. The study group was SGA offspring born to mothers with GDM (n = 259), while the control group was SGA offspring born to mothers without GDM (n = 9053). The main factor evaluated was offspring cardiovascular hospitalizations up to the age of 18 years. Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. A Cox proportional hazards model was used to estimate the adjusted hazard ratios (HR) for cardiovascular hospitalizations. RESULTS: SGA children born to mothers with GDM had significantly higher rates of cardiovascular-related hospitalizations (1.9% vs. 0.7%, p = .026). A Kaplan-Meier survival curve demonstrated that SGA children born to GDM mothers had a higher cumulative incidence of cardiovascular hospitalizations (log-rank p = .037). The Cox regression model, while controlling for confounders, demonstrated that delivery of SGA neonates to mothers with GDM is independently associated with long-term cardiovascular offspring hospitalizations (adjusted HR =2.6; 95% CI 1.02-6.55 p = .045). CONCLUSION: Delivery of SGA neonates born to mothers with GDM is independently associated with long-term cardiovascular offspring hospitalizations.