THE EFFECT OF INTERNAL LIMITING MEMBRANE PEELING ON THE INNER RETINAL LAYERS IN PATIENTS WITHOUT MACULAR PATHOLOGIC CONDITION.

BACKGROUND: To examine the effect of internal limiting membrane peeling on the inner retinal layers in patients without macular pathological condition. METHODS: A prospective nonrandomized trial of patients undergoing pars plana vitrectomy with internal limiting membrane peeling for pathologic condition outside the macula was performed. Optical coherence tomography including macular ganglion cell layer, inner plexiform layer, and peripapillary retinal nerve fiber layer imaging was performed before surgery, 1, 3, and 6 months postoperatively, and at the end of follow-up (ranges between 4 and 17 months). Patients with any macular pathological condition on optical coherence tomography before surgery were excluded. The main outcome measure was change in thickness of the ganglion cell layer and inner plexiform layer. RESULTS: Ten patients who underwent pars plana vitrectomy with internal limiting membrane peeling for macula-on retinal detachment were included in the analysis. The mean age was 55 years, and the mean follow up was 10.8 months. All patients completed at least two postoperative follow-up visits that included an optical coherence tomography as per the protocol (range 2-6 months). There was an immediate reduction in the global (G), inferotemporal, superotemporal, and superior (S) ganglion cell layer thickness at the first follow up as compared with the preoperative state ( P = 0.028, P = 0.027, P = 0.026, and P = 0.027 respectively). From the first follow-up visit onward until the final follow-up, the thinning persisted, although there was no further statistically significant thinning. CONCLUSION: Peeling of the internal limiting membrane causes significant ganglion cell layer thinning in maculae without pathologic condition before surgery. At up to 17 months of follow-up, this effect seems to be immediate and nonprogressive.

SYRINGE DESIGN AND FILLING TECHNIQUE AFFECT ACCURACY OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR INTRAVITREAL INJECTIONS.

PURPOSE: To evaluate the effect of syringe design and filling technique on the accuracy of anti-vascular endothelial growth factor delivery. METHODS: Volume output was measured with three syringe designs: a 1.0-mL slip-tip syringe, a 1.0-mL Luer-lock syringe, and a ranibizumab prefilled syringe-using two filling techniques ("upward" and "downward") and two fluids (water and bevacizumab). A total of 300 simulated injections were performed. Accuracy was determined by difference from the intended volume of 50 µ L and by mean absolute percentage error. RESULTS: Volume outputs were significantly different between syringe designs, with mean values of 61.99 ± 4.18 µ L with the 1-mL slip-tip syringe, 57.43 ± 4.95 µ L with the Luer-lock 1-mL syringe, and 51.06 ± 4.74 µ L with the ranibizumab syringe, making the latter the most accurate syringe. There were 37 cases (12.3%) of underdosing below 50 µ L, the majority of which occurred with the ranibizumab syringe. The "downward" technique reduced the occurrence of air bubbles. CONCLUSION: Intravitreal injections using 1.0-mL syringes are less accurate than using the ranibizumab prefilled syringe, which has a low-volume and low dead-space plunger design. The variability in volume output may result in less predictable treatment response, especially in cases of underdosing, which were more common with the ranibizumab syringe.

Frequency and prediction of deep uterine involvement in advanced high-grade epithelial ovarian cancer: is uterine preservation an option?

INTRODUCTION: Hysterectomy is traditionally part of the surgical treatment for advanced high-grade epithelial ovarian carcinomas, although the incidence of uterine involvement has not been fully investigated. Some young patients with advanced high-grade epithelial ovarian carcinomas want uterine preservation. We aimed to determine the frequency of non-serosal (deep) uterine involvement in patients with high-grade epithelial ovarian carcinomas and to establish predictive factors for such involvement. METHODS: A retrospective cohort study was performed of 366 consecutive patients with advanced high-grade epithelial ovarian carcinomas who had surgery between January 2012 and December 2019. Data collected included demographic and clinical details, and surgical and pathological reports to determine macroscopic and microscopic deep uterine involvement. The characteristics of the patients with and without deep uterine involvement were compared and univariate and multivariate Cox proportional hazard models were used to assess correlations and determine risk factors. RESULTS: A total of 311 patients were included in the final analysis. The mean age was 62±11.6 years, with 32 (10.3%) being younger than 45. Most (92.3%) had serous carcinoma. Uterine involvement, excluding superficial (serosa-only), was present microscopically in 194 patients (62.4%) but was detected macroscopically at surgery in only 166 patients. Deep involvement was missed at surgery in 28 patients (14.4%), including parametrial involvement (n=18), parametria plus cervix (n=2), cervical involvement (n=3), endometrium (n=3), and myometrium (n=2). Multivariate analysis identified factors associated with deep uterine involvement including residual disease at surgery (HR 2.43, 95% CI 1.13 to 4.48; p=0.004) and CA125 >1000 U (HR 1.8, 95% CI 1.09 to 2.94; p=0.02). CONCLUSIONS: The incidence of deep uterine involvement in high-grade epithelial ovarian carcinomas is high. It can be diagnosed in most but not all cases on gross examination at surgery and is associated with residual disease and CA125 >1000 U. Patients who desire uterine preservation should be advised on an individual basis, given these factors and the operative findings.

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.

Toric Intraocular Lens Calculations With the Barrett Calculator: A Comparison of the Calculator With and Without the Integrated K Method.

PURPOSE: To compare the accuracy of the Barrett Integrated K (IK) toric calculator with the standard Barrett toric calculator. METHODS: Consecutive patients who underwent cataract extraction with implantation of a toric intraocular lens at the Rabin Medical Center, Israel, were reviewed. Errors in predicted postoperative refractive astigmatism were calculated for the Barrett toric calculator using biometry measurements only and with the IK tool using biometry and tomography. Both methods were assessed with predicted and measured posterior corneal astigmatism (PPCA and MPCA, respectively). RESULTS: The study included 73 eyes of 59 patients. The mean centroid prediction error using PPCA (0.08 ± 0.80 D @ 78°) was significantly different compared with MPCA (0.07 ± 0.80 D @ 48°, P = .016). In addition, a significant difference between IK-PPCA (0.06 ± 0.80 D @ 80°) and IK-MPCA (0.05 ± 0.80 D @ 38°) was found (P = .023). The median absolute prediction error ranged from 0.55 D using IK-PPCA to 0.60 D using PPCA, with no significant differences between the four calculation versions. No significant differences were found between the calculators in the predictability rates within ±0.50, ±0.75, and ±1.00 D. Analysis of one eye of each patient showed similar results. CONCLUSIONS: The IK calculator yielded comparable outcomes to the standard Barrett calculator. Although differences in the mean centroid errors were found, they were clinically insignificant and predominantly seen in the axis of the predicted astigmatism error. These minor differences were mainly attributed to the incorporation of the MPCA in the calculation. [J Refract Surg. 2022;38(9):565-571.].