Decision taking in corneal refractive surgery.

A 27-year-old woman who wants to get rid of contact lenses and spectacles was seen at our clinic. She had strabismus surgery as a child and was patched for the right eye but now shows mild nondisturbing exophoria. Infrequently, she likes to box in the sports school. Her corrected distance visual acuity at presentation in the right eye was 20/16 with -3.75 -0.75 × 50 and in the left eye 20/16 with -3.75 -1.25 × 142. Her cycloplegic refraction in the right eye was -3.75 -0.75 × 44 and in the left eye was -3.25 -1.25 × 147. The left eye is the dominant eye. The tear break-up time was 8 seconds in both eyes, and the Schirmer tear test was 7 to 10 mm in right and left eyes, respectively. Pupil sizes under mesopic conditions were 6.62 mm and 6.68 mm. The anterior chamber depth (ACD) (measured from the epithelium) in the right eye was 3.89 mm and in the left eye was 3.87 mm. The corneal thickness was 503 µm and 493 µm of the right and left eye, respectively. Corneal endothelial cell density was on average 2700 cells/mm2 for both eyes. Slitlamp biomicroscopy showed clear corneas and a normal flat iris configuration. Supplemental Figures 1 to 4 (available at http://links.lww.com/JRS/A818, http://links.lww.com/JRS/A819, http://links.lww.com/JRS/A820, and http://links.lww.com/JRS/A821) show the corneal topography and Belin-Ambrósio deviation (BAD) maps at presentation of the right eye and left eye, respectively. Would you consider this patient a candidate for corneal refractive surgery (eg, laser-assisted subepithelial keratectomy, laser in situ keratomileusis [LASIK], or small-incision lenticule extraction [SMILE] procedure)? Has your opinion changed given the recent opinion of the U.S. Food and Drug Administration (FDA) regarding LASIK?1 The patient herself is slightly favoring an implantation of a phakic intraocular lens (pIOL), as she prefers something reversible. Would you implant a pIOL, and which type of IOL, for this level of myopia? What is your diagnosis or are additional diagnostic methodologies needed to establish a diagnosis? What is your treatment advice for this patient? REFERENCES 1. U.S. Food and Drug Administration, HHS. Laser-assisted in situ keratomileusis (LASIK) lasers-patient labeling recommendations; draft guidance for industry and food and drug administration staff; availability. July 28, 2022, Federal Register; 87 FR 45334. Available at: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/laser-assisted-situ-keratomileusis-lasik-lasers-patient-labeling-recommendations Accessed January 25, 2023.

Femtosecond Laser Assisted Cataract Surgery: A Review.

Femtosecond laser assisted cataract surgery (FLACS) offers a level of precision, accuracy and customization that is not possible with manual phacoemulsification (MP). With the increase of patient expectations and premium intraocular lens utilization in the era of refractive cataract surgery, predictability and accuracy has become of utmost importance. FLACS has four main functions: creation of a consistently sized round capsulotomy, treatment of keratometric astigmatism with arcuate incisions, construction of clear corneal incisions, and fragmentation and/or softening of the lens. However, FLACS may have limitations due to suction loss, incomplete capsulotomy or poor pupillary dilation. Patient selection and surgeon experience is critical. This review article will focus on the various platforms available for FLACS, the steps in cataract surgery it can perform, and overall advantages and limitations of the technology.

A newly isolated strain of Serratia sp. from an oil spillage site of Assam shows excellent bioremediation potential.

A hydrocarbon-degrading strain was isolated from a petroleum oil-contaminated site which was identified on the basis of 16S rDNA gene sequencing as a member of the genus Serratia. The isolate reduced surface tension of petroleum oil supplemented medium by 48.35% with respect to control after 7 days of treatment. Fluorescence microscopy revealed that its chemotaxis was towards hydrocarbon. The isolate degraded 87.54 and 85.48% of diesel and kerosene in liquid culture, respectively, after 28 day incubation at 37 ± 2 °C. The ex situ pilot scale bioremediation experiment in which artificially contaminated soil (10 and 20% v/w kerosene) was treated for 7 days showed a germination rate of Vigna radiate seeds of 52% and 72%, respectively. Interestingly, a germination rate of 31% was obtained with the heavily contaminated soil samples collected from the oil spillage site after 20 days of bioremediation treatment. The presence of υCH3 (asymmetric stretching), υC=C (stretch), and υC-C (stretch) in the crude biosurfactant produced by the isolate was revealed by FTIR analysis, and emulsification index (E 24) was found 60 and 56.6%, respectively, against diesel and kerosene oil. The non-cytotoxicity nature of the biosurfactant also supports its potential application in field trial.

Impact of lean six sigma process improvement methodology on cardiac catheterization laboratory efficiency.

BACKGROUND: Operational inefficiencies are ubiquitous in several healthcare processes. To improve the operational efficiency of our catheterization laboratory (Cath Lab), we implemented a lean six sigma process improvement initiative, starting in June 2010. We aimed to study the impact of lean six sigma implementation on improving the efficiency and the patient throughput in our Cath Lab. METHODS: All elective and urgent cardiac catheterization procedures including diagnostic coronary angiography, percutaneous coronary interventions, structural interventions and peripheral interventions performed between June 2009 and December 2012 were included in the study. Performance metrics utilized for analysis included turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start and manual sheath-pulls inside the Cath Lab. RESULTS: After implementation of lean six sigma in the Cath Lab, we observed a significant improvement in turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab. The percentage of cases with optimal turn-time increased from 43.6% in 2009 to 56.6% in 2012 (p-trend<0.001). Similarly, the percentage of cases with an aggregate on-time start increased from 41.7% in 2009 to 62.8% in 2012 (p-trend<0.001). In addition, the percentage of manual sheath-pulls performed in the Cath Lab decreased from 60.7% in 2009 to 22.7% in 2012 (p-trend<0.001). CONCLUSIONS: The current longitudinal study illustrates the impact of successful implementation of a well-known process improvement initiative, lean six sigma, on improving and sustaining efficiency of our Cath Lab operation. After the successful implementation of this continuous quality improvement initiative, there was a significant improvement in the selected performance metrics namely turn-time, physician downtime, on-time patient arrival, on-time physician arrival, on-time start as well as sheath-pulls inside the Cath Lab.

Adenoviral keratoconjunctivitis.

Viral conjunctivitis caused by adenovirus is the most common infectious conjunctivitis. Adenoviruses are highly contagious pathogens. The modes of transmission are mainly through hand to eye contact, ocular secretions, respiratory droplets, and contact with ophthalmic care providers and their medical instruments. The most frequent manifestation of ocular adenoviral infection is epidemic keratoconjunctivitis, followed by pharyngoconjunctival fever. Epidemic keratoconjunctivitis is also the most severe form and presents with watery discharge, hyperemia, cheosis, and ipsilateral lymphadenopathy. Pharyngoconjunctival fever is characterized by abrupt onset of high fever, pharyngitis, bilateral conjunctivitis, and periauricular lymph node enlargement. Isolated follicular conjunctivitis without corneal or systemic involvement also occurs. The rate of clinical accuracy in diagnosing viral conjunctivitis is less than 50%. Rapid diagnostic tests now being used decrease unnecessary antibiotic use. Treatment for viral conjunctivitis is mostly supportive. The majority of cases are self-limited, and no treatment is necessary in uncomplicated cases.

A Complicated Case of Acute Promyelocytic Leukemia in the Second Trimester of Pregnancy Successfully Treated with All-trans-Retinoic Acid.

A 40-year-old female at 26-week gestation was diagnosed with acute promyelocytic leukemia (APL) after an abnormal prenatal lab workup showed pancytopenia. She was treated with all-trans-retinoic acid (ATRA), idarubicin, and dexamethasone. After day one of treatment, she developed differentiation syndrome, which was treated with dexamethasone. At 30-week gestation, she had preterm premature rupture of membranes and delivered by cesarean section because of the fetus' breech presentation. Despite ATRA's potential for teratogenicity, a viable infant was born without apparent anomalies. Postpartum, she underwent consolidation treatment with ATRA and arsenic trioxide (ATO). The patient continued ATRA therapy after delivery and is currently in remission.

Deep anterior lamellar keratoplasty for keratoconus: a review.

Deep anterior lamellar keratoplasty (DALK) is a surgical technique that involves the removal of pathological corneal stroma down to Descemet membrane and replacing it with a donor cornea. Over the last decade, there has been a paradigm shift in the surgical techniques of DALK, which has made it safer with visual outcomes comparable with penetrating keratoplasty. This review aims to discuss the existing popular techniques of DALK, their advantages and limitations. We will also describe techniques of DALK that are useful in special situations.

Lateral sliding bridge flap technique along with platelet rich fibrin and guided tissue regeneration for root coverage.

Gingival recession is defined as the apical migration of the gingival margin with exposure of root surfaces. The etiology of the condition is multifactorial. Given the high rate of gingival recession defects among the general population, it is imperative that dental practitioners have an understanding of the etiology, complications and management of the condition. A recent innovation in dentistry is the preparation and use of platelet-rich fibrin (PRF) for recession defects. The article presents a case report, which highlights the use of lateral sliding bridge flap along with PRF in a collagen membrane carrier (guided tissue regeneration) for the treatment of multiple recession defects.