Rhegmatogenous Retinal Detachment: Progression and Characteristics of Postoperative Demarcation Lines.

PURPOSE: To report the characteristics of retinal detachment demarcation lines on infrared (IR) imaging together with retinal detachment progression analysis. METHOD: We performed a retrospective case series of 25 eyes of 24 patients who underwent macula off Rhegmatogenous retinal detachment (RRD) repair and demonstrated a postoperative demarcation line on in(IR) imaging. All patients had an OCT imaging at baseline capturing the extent of the RRD. Criteria for demarcation lines diagnosis on infrared imaging included a line parallel and with the same contour of the RRD edge. These lines were not observed on IR imaging prior to RRD repair surgery. RESULTS: Demarcation lines' hyperreflectivity was situated in the interdigitation-ellipsoid zone complex. These lines were more obvious on the early postoperative week but faded over time (average disappearance time 2.6 ± 2.9 months). The analysis of retinal detachment progression showed that superior RRDs progressed more than inferior RRDs (611µ Vs 122µ, P=0.02). Among 13 cases with a superior RRD, the temporal border progressed more than the nasal side (697µ Vs 426µ, P=0.01, figure 1). The use of intraoperative perfluorocarbon was associated with less RRD progression (p=0.01). CONCLUSION: The study concludes that demarcation lines are distinct findings on IR imaging, appearing early but diminishing relatively quickly following RRD repair. It also revealed the characteristics of RRDs progression specifically that inferior RRDs and perfluorocarbon use were associated with less retinal progression.

The effect of timing of intravenous paracetamol on perioperative pain and cytokine levels following laparoscopic bariatric surgery, a randomized controlled trial.

OBJECTIVE: Bariatric surgeries involve manipulation of the viscera and are associated with significant postoperative pain. Paracetamol is a nonopioid analgesic with a rapid onset, and it is effective and safe. The study compared the effects of pre- and postincisional intravenous paracetamol administration for optimal postoperative pain management in patients undergoing bariatric surgeries. METHODS: This is a prospective, double-blinded, placebo-controlled randomized clinical trial of adult patients, admitted electively for laparoscopic bariatric surgery. The patients were randomly divided into two groups. One group of patients was given paracetamol at the beginning of the operation, prior to the surgical incision, the other group of patients received the same treatment at the end of the operation. RESULTS: Patients who were given preincisional intravenous paracetamol presented significantly lower visual analog scale (VAS) scores following the surgery compared with patients who were given intravenous paracetamol in the last 30 minutes of the operation (VAS, median [IQR] = 2 [2-3] vs. 5 [3-6]; p < 0.001). They also required fewer postoperative opioids and tramadol (in milligrams, respectively, 1 [0-5] vs. 7.5 [5-10] and 300 [100-400] vs. 400 [200-500]) compared with later analgesia administration (p < 0.001 and p = 0.03). The levels of inflammatory markers measured at fixed intervals from paracetamol administration were not statistically different between the study groups. CONCLUSION: Early analgesia with intravenous paracetamol, given before the surgical incision, may result in lower VAS scores postoperatively compared with the same treatment administered toward the end of the operation.