Transepithelial phototherapeutic keratectomy for treatment-resistant recurrent corneal erosion syndrome.

BACKGROUND: To evaluate the efficacy and safety of trans-epithelial phototherapeutic keratectomy (TE-PTK) as a treatment for recurrent corneal erosion syndrome (RCES) in patients with symptoms refractory to conventional treatments. METHODS: All patients who received TE-PTK treatment for RCES had failed 3 or more conventional treatments and were reviewed, and if met criteria, approved by healthcare workers of the British Columbia public health authority (Medical Services Plan (MSP). A retrospective chart review and telephone survey were conducted at the Pacific Laser Eye Centre (PLEC). Exclusion criteria were ocular co-morbidities potentially affecting treatment efficacy. RESULTS: This study included 593 eyes of 555 patients (46.2% male; 50.9 ± 14.2 years old) who underwent TE-PTK. The leading identified causes of RCES were trauma (45.7%) and anterior basement membrane dystrophy (44.2%). The most common pre-PTK interventions were ocular lubricants (90.9%), hypertonic solutions (77.9%), and bandage contact lenses (50.9%). Thirty-six eyes had undergone surgical interventions such as stromal puncture, epithelial debridement, or diamond burr polishing. Post-PTK, 78% of patients did not require any subsequent therapies and 20% required ongoing drops. Six patients (1.1%) reported no symptom improvement and required repeat TE-PTK for ongoing RCES symptoms after initial TE-PTK. All 6 eyes were successfully retreated with TE-PTK (average time to retreatment was 11.3 ± 14.9 months). There was no significant difference in best corrected visual acuity pre- vs. post-operatively. The mean post-operative follow-up was 60.5 months (range: 5-127 months). CONCLUSION: TE-PTK has a good efficacy and safety profile for treatment-resistant RCES. The third-party public health-reviewed nature of this study, the low recurrence rate of RCES, and the low PTK retreatment rate suggest that TE-PTK might be considered for wider use in the management of RCES.

Bilateral Anterior Capsulotomy for Treatment-Resistant Obsessive-Compulsive Disorder.

INTRODUCTION: Ablative surgery is an intervention of last resort for treatment-resistant obsessive-compulsive disorder (TROCD). Our center has been using bilateral anterior capsulotomy (BAC) for the past 20 years for patients eligible for limbic surgery. This report details our experience with BAC for TROCD. METHOD: Five patients with OCD met eligibility criteria for BAC. Entry protocols were complex and took around 6 months to complete. Stereotactic radiofrequency was used to produce the capsulotomies. Lesion length varied between 5.7 and 16.9 mm in the coronal plane. Patients were followed between 4 and 20 years. RESULTS: All 5 patients (100%) were responders as defined by the widely accepted criteria of a reduction of ≥35% in Yale-Brown Obsessive Compulsive Scale (YBOCS) score at 18-month follow-up. Four patients remained responders at the 48 months. One patient was lost to follow-up. Responder status when viewed from the perspective of the YBOCS was sustained over the 4- to 20-year follow-up with one relapse 19 years postsurgery when medications were discontinued. Real-world psychiatric outcomes were different as other vulnerabilities surfaced illustrating the multifactorial determinants of mental health. No patient had any significant long-term neurocognitive or physical side effects. CONCLUSION: BAC should remain an option of last resort for patients with severe OCD who remain unresponsive to all other interventions.

The Efficacy of a Named Entity Recognition AI Model for Identifying Incidental Pulmonary Nodules in CT Reports.

Purpose: This study evaluates the efficacy of a commercial medical Named Entity Recognition (NER) model combined with a post-processing protocol in identifying incidental pulmonary nodules from CT reports. Methods: We analyzed 9165 anonymized CT reports and classified them into 3 categories: no nodules, nodules present, and nodules >6 mm. For each report, a generic medical NER model annotated entities and their relations, which were then filtered through inclusion/exclusion criteria selected to identify pulmonary nodules. Ground truth was established by manual review. To better understand the relationship between model performance and nodule prevalence, a subset of the data was programmatically balanced to equalize the number of reports in each class category. Results: In the unbalanced subset of the data, the model achieved a sensitivity of 97%, specificity of 99%, and accuracy of 99% in detecting pulmonary nodules mentioned in the reports. For nodules >6 mm, sensitivity was 95%, specificity was 100%, and accuracy was 100%. In the balanced subset of the data, sensitivity was 99%, specificity 96%, and accuracy 97% for nodule detection; for larger nodules, sensitivity was 94%, specificity 99%, and accuracy 98%. Conclusions: The NER model demonstrated high sensitivity and specificity in detecting pulmonary nodules reported in CT scans, including those >6 mm which are potentially clinically significant. The results were consistent across both unbalanced and balanced datasets indicating that the model performance is independent of nodule prevalence. Implementing this technology in hospital systems could automate the identification of at-risk patients, ensuring timely follow-up and potentially reducing missed or late-stage cancer diagnoses.

Local anaesthesia as a standard of care for penetrating keratoplasty?

BACKGROUND/OBJECTIVES: To determine preferences in the use of local anaesthesia (LA) versus general anaesthesia (GA) for penetrating keratoplasty (PK), and to examine the safety of LA for PK. SUBJECTS/METHODS: A retrospective analysis of PKs performed at an ophthalmology department in Canada from 01/01/2008 to 01/01/2020 was conducted to investigate rate of major complications. A questionnaire was also sent out to cornea specialists in the United Kingdom (UK) and Canada to determine trends in anaesthesia use for PK. Data on anaesthesia use in keratoplasty data was also obtained from the National Health Service Blood and Tissue (NHSBT) register. RESULTS: The retrospective study found that 2143 PKs were performed under LA by 4 surgeons. The following complications were revealed: 1 acute anxiety attack with tachycardia, 3 extraocular myotoxicity cases requiring squint surgery, 1 expulsive suprachoroidal haemorrhage and 1 retrobulbar haemorrhage. The survey revealed 92% of cornea specialists in Canada preferred LA to GA. In the UK, 4.5% of specialists preferred LA, with most preferring GA due to suprachoroidal haemorrhage risk. NHSBT data revealed that 86.6% of 6181 PKs performed in UK between 01/04/2015 and 31/03/2020 were done under GA. CONCLUSIONS: LA is preferred for PK in Canada, in contrast to the UK where GA is preferred. Our retrospective study suggests a low incidence of LA-related complications. We suggest that LA should be considered for most cornea transplant techniques, including optical penetrating keratoplasty. Rising worldwide keratoplasty numbers, ageing populations and risks of pandemics (e.g. COVID-19) give more reason for reduced reliance on GA.

Retrospective analysis of ophthalmology referrals during the COVID-19 pandemic compared to prepandemic.

OBJECTIVE: This study was conducted to analyse emergency ophthalmology referrals to a Canadian tertiary academic centre during the current coronavirus disease 2019 (COVID-19) pandemic in comparison to prepandemic referrals. DESIGN: This was a retrospective chart review looking at emergency referrals seen by the ophthalmology service between March 18 to April 17, 2020 (representing the COVID-19 period), and March 18 to April 17, 2019 (representing the pre-COVID-19 period). METHODS: Data gathered from referral records included patient demographics, timing and site of referral, and ophthalmic diagnosis. Referrals were categorized as urgent or nonurgent, with urgent indicating the need for ophthalmic assessment within 24 hours. RESULTS: The total number of referrals decreased by 54.2% in the COVID-19 period versus the pre-COVID-19 period. There was a similar bimodal age distribution in both periods, with fewer patients over 65 years of age presenting during the pandemic. Tertiary hospital referrals decreased by 62% in the pandemic period, while nontertiary emergency department referral trends varied and outpatient clinic referrals increased by 16%. Overall, there was a significant shift in the distribution of referral sites (p = 0.04). The proportion of urgent referrals increased by 14% during the pandemic; this was not statistically significant. There was no significant change in the timing of referrals or in the distribution of diagnostic segments. CONCLUSIONS: This study offers insight into the impact of the COVID-19 pandemic on ophthalmology referral patterns in a Canadian context. Moving forward, it helps to guide resource allocation and public education on the importance of seeking necessary eye care.

Transforming Disruption Into Innovation: A Partnership Between the COVID-19 Medical Student Response Team and the University of British Columbia.

The COVID-19 pandemic caused substantial disruptions in medical education. The University of British Columbia (UBC) MD Undergraduate Program (MDUP) is the sixth-largest medical school in North America. MDUP students and faculty developed a joint response to these disruptions to address the curriculum and public health challenges that the pandemic posed. After clinical activities were suspended in March 2020, third- and fourth-year MDUP students formed a COVID-19 Medical Student Response Team (MSRT) to support frontline physicians, public health agencies, and community members affected by the pandemic. A nimble organizational structure was developed across 4 UBC campuses to ensure a rapid response to meet physician and community needs. Support from the faculty ensured the activities were safe for the public, patients, and students and facilitated the provision of curricular credit for volunteer activities meeting academic criteria. As of June 19, 2020, more than 700 medical students had signed up to participate in 68 projects. The majority of students participated in projects supporting the health care system, including performing contact tracing, staffing public COVID-19 call centers, distributing personal protective equipment, and creating educational multimedia products. Many initiatives have been integrated into the MDUP curriculum as scholarly activities or paraclinical electives for which academic credit is awarded. This was made possible by the inherent flexibility of the MDUP curriculum and a strong existing partnership between students and faculty. Through this process, medical students were able to develop fundamental leadership, advocacy, communication, and collaboration skills, essential competencies for graduating physicians. In developing a transparent, accountable, and inclusive organization, students were able to effectively meet community needs during a crisis and create a sustainable and democratic structure capable of responding to future emergencies. Open dialogue between the MSRT and the faculty allowed for collaborative problem solving and the opportunity to transform disruption into academic innovation.

Incidence and Outcomes of Cystoid Macular Edema after Descemet Membrane Endothelial Keratoplasty (DMEK) and DMEK Combined with Cataract Surgery.

PURPOSE: To investigate the incidence and outcomes of cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) alone and DMEK combined with cataract surgery (DMEK triple). MATERIALS AND METHODS: A retrospective chart review was performed for patients who underwent DMEK and DMEK triple between January 2014 and March 2018 at two tertiary hospitals. Patients with minimum of 6 months of follow-up were included. Logistic regression analysis was used to identify potential risk factors for CME including gender, age, glaucoma, uveitis, epiretinal membrane, diabetes mellitus, iridotomy, and rebubbling. RESULTS: 09 eyes of 193 patients who underwent DMEK (124 eyes) and DMEK triple (85 eyes) were included. The 6-month incidence of CME was 3.8% (8/209) for all cases, 2.4% (2/85) for DMEK triple, and 4.8% (6/124) for DMEK alone. CME was treated with topical prednisolone acetate 1% and nepafenac four times daily, and/or periocular triamcinolone acetonide, with resolution in all cases. On average, CME was detected 8.9 ± 2.1 weeks postoperatively, with a mean time to resolution of 4.1 ± 1.7 months. The 6-month best-corrected distance visual acuity of eyes that developed CME was not significantly different compared to eyes that did not develop CME (0.17 ± 0.15 logMAR vs. 0.23 ± 0.27 logMAR; p = .76). On logistic regression analysis, no risk factors for developing CME were identified. CONCLUSIONS: The incidence of CME after DMEK was low and not associated with decreased long-term visual acuity. Most cases of CME occurred between 1 and 3 months postoperatively. Predictive factors for CME after DMEK require further study.

Refractive Outcomes of Descemet Membrane Endothelial Keratoplasty Combined With Cataract Surgery in Fuchs Endothelial Dystrophy.

PURPOSE: To evaluate the refractive outcomes of Descemet membrane endothelial keratoplasty combined with cataract surgery (DMEK triple) in patients with Fuchs endothelial dystrophy. METHODS: A retrospective analysis of 68 eyes of 68 patients with Fuchs endothelial dystrophy who underwent DMEK triple between 2014 and 2018. RESULTS: The mean age of patients was 66.5 ± 8.6 years, and 65% (44 of 68) were female. Mean target refraction was -0.69 diopters (D) (interquartile range: -0.80 to -0.50 D). At 6 months, 47% (32 of 68) and 63% (43 of 68) of eyes were within ±0.50 and ±1.00 D of target refraction, respectively. Among eyes greater than 0.50 D from target, 78% (28 of 36) were hyperopic surprises. Mean spherical equivalent at 6 months was -0.14 ± 1.26 D, representing a mean hyperopic shift of 0.55 D from target. Preoperative pachymetry was higher in eyes with greater than 0.50 D of hyperopic surprise (648 ± 60 vs 613 ± 49 µm, P = .04). Refractive shift was greater in eyes with a preoperative central corneal thickness of 640 µm or greater versus eyes with a central corneal thickness of less than 640 µm (+1.20 ± 0.92 vs +0.40 ± 0.99 D, P = .02). None of the eyes with a preoperative central corneal thickness of 640 µm or greater shifted myopically compared to target (range: -0.09 to +2.89 D). CONCLUSIONS: A mean hyperopic shift of 0.55 D from target refraction occurred after DMEK triple, and 47% of eyes were within 0.50 D of target refraction at 6 months postoperatively. Thicker corneas preoperatively had greater hyperopic shift. A greater myopic target refraction may be warranted in eyes with a preoperative central corneal thickness of 640 µm or greater. [J Refract Surg. 2020;36(10):661-666.].