Bilateral Thermal Keratopathy Due to Plasma Skin Regeneration.

A 40-year-old woman underwent periocular plasma skin regeneration, a cosmetic treatment for periorbital rejuvenation. She subsequently developed bilateral thermal keratitis, manifesting as blurred vision, irritation, and redness, with a vision decrease to 20/60 and 20/50 in her OD and OS, respectively. Examination demonstrated bilateral large, irregular corneal epithelial defects and edema, necessitating treatment with amniotic membrane grafts, bandage contact lenses, and hypertonic saline. One year posttreatment, her visual acuity improved to 20/20 and 20/25, albeit with ongoing symptomatic dryness and bilateral anterior stromal haze. This case, as only the second reported instance of ocular damage from periocular plasma skin regeneration, underscores the need for heightened awareness of potential ocular complications following plasma skin regeneration and reinforces the importance of protective measures during periocular procedures.

The "Pocket" Technique: A Novel Surgical Technique for Repair of Glaucoma Drainage Device Tube Exposure.

Exposure of glaucoma tube shunts is an uncommon post-operative complication which poses a significant risk to the patient and may be difficult to repair. In this case series, the authors present two cases utilizing a novel surgical technique, the "pocket" technique, to place a scleral patch graft to address tube exposure. Patient 1 remained free of tube exposure at most recent follow up visit after 21 months, and patient 2 remained free of tube exposure at most recent follow up visit after 4 months. This technique offers an elegant surgical option that has multiple benefits; It allows for stability of the scleral patch graft even in cases of scarred down, thinned conjunctiva with minimal Tenons, allows for repair along the entire length of the tube shunt including perilimbal exposures, and allows for secondary healing when there is not enough conjunctiva to cover both the opening and the patch. These advantages make the "pocket" technique a quick to perform, minimally invasive surgical approach that is useful for addressing both difficult and straightforward tube exposure cases.

Difficulties of nasocutaneous fistula repair, following lacrimal outflow system malignancy resection.

PURPOSE: To evaluate the incidence of nasocutaneous fistula (NCF) development, following en bloc resection of lacrimal outflow system malignancies (LOSM), and describe the methods of surgical repair. METHODS: Retrospective review of all patients who underwent resection of LOSM with reconstruction and post-treatment protocol at the University of Miami between 1997 and 2021. RESULTS: Of the 23 included patients, 10 (43%) developed postoperative NCF. All NCFs developed within one year of surgical resection or completion of radiation therapy. NCF was seen more frequently in patients who underwent adjuvant radiation therapy and those who had reconstruction of the orbital wall with titanium implants. All patients underwent at least one revisional surgery to close the NCF, including local flap transposition (9/10), paramedian forehead flap (5/10), pericranial flap (1/10), nasoseptal flap (2/10), and microvascular free flap (1/10). Local tissue transfer, pericranial, paramedian, and nasoseptal forehead flaps failed in most cases. Two patients had long-term closure; one patient who underwent a paramedian flap and a second who underwent a radial forearm free flap, suggesting that well-vascularized flaps may be the most viable option for repair. CONCLUSIONS: NCF is a known complication, following en bloc resection of lacrimal outflow system malignancies. Risk factors for formation may include adjuvant radiation therapy and use of titanium implants for reconstruction. Surgeons should consider utilizing robust vascular-pedicled flaps or microvascular free flaps for repair of NCF in this clinical scenario.

Outcomes of resident physician-performed cataract surgery in a diverse veterans affairs health system population.

Purpose: To evaluate visual acuity (VA) outcomes and complications from resident physician-performed cataract surgery in a diverse Veterans Affairs Hospital population. Methods: A retrospective chart review was conducted for patients who underwent cataract surgery performed by resident physicians from 01/01/2013 to 12/31/2015 at the Veterans Affairs Medical Center. Intraoperative and postoperative clinical information, best-corrected VA (BCVA) (1 day, months 1, 2-3, and 6), and surgery complications were extracted. Univariable and multivariable linear regression models were performed for risk factors of BCVA change. Results: This study included 1183 patients, with mean (SD) age of 70.8 (9.3) years. 1154 (97.5%) were males, 493 (41.7%) African-American, and 681 (57.6%) Caucasian. The mean (SD) VA in logMAR was 0.69 (0.74) at baseline, improved to 0.19 (0.36) at 1 month, 0.16 (0.34) at 2-3 months, and 0.14 (0.36) at 6 months. 1080 (91.3%) patients experienced VA improvement from baseline and 1023 (86.5%) patients achieved at least 20/40 BCVA at 1 month. There were 86 (7.3%) complications, most commonly including 47 (4.0%) posterior capsular tears and 64 (5.4%) vitreous loss. In multivariable analysis, younger age (P < 0.0001), worse baseline VA (P < 0.0001), and absence of iris prolapse (P < 0.001) were significantly associated with greater improvement in VA at 1 month. Conclusion: In a diverse VAMC, resident-performed cataract surgeries achieved significant improvement in VA with a cumulative complication rate lower than previously reported. Resident physician education may benefit from specific focus on prevention of iris prolapse and better incision construction during surgery as these intraoperative events often led to delayed stabilization of visual outcome beyond 1 month.

Multidrug-Resistant Pseudomonas aeruginosa Keratitis Associated With Artificial Tear Use.

This case report describes severe multidrug-resistant Pseudomonas aeruginosa keratitis in a 72-year-old man after EzriCare artificial tear use.

Idiopathic Intracranial Hypertension in Female-to-Male Transgender Patients on Exogenous Testosterone Therapy.

PURPOSE: To present four female-to-male (FTM) transgender patients on testosterone therapy diagnosed with idiopathic intracranial hypertension (IIH). METHODS: The authors report 4 consecutive FTM transgender patients on exogenous testosterone diagnosed with IIH at a single institution. RESULTS: Patient 1 presented with progressive blurred vision and a central scotoma 10 weeks after starting testosterone cypionate injections for hormonal gender transition. Bilateral grade 5 papilledema was present; the patient underwent bilateral optic nerve sheath fenestration with improved vision and resolution of edema. Patient 2 presented with transient vision loss, pulsatile tinnitus, and blurred vision 13 months after starting testosterone cypionate injections. The patient had grade 4 and 3 disc edema of the right and left eyes, respectively. Patient 3 presented with headaches and pulsatile tinnitus and was on testosterone injections at an unknown dose. The examination revealed grade 1 and 2 disc edema of the right and left eyes, respectively. Patient 4 presented with decreased vision, transient visual obscurations, and daily migraines while using topical testosterone gel every other day. Color vision was reduced, and lumbar puncture revealed elevated intracranial pressure. All patients had neuroimaging findings consistent with increased intracranial pressure. CONCLUSIONS: Testosterone therapy plays an essential role in FTM hormonal transitioning and may play a role in IIH. Patients undergoing testosterone therapy for gender transition should be informed of the possibility of developing IIH while on treatment, with obesity possibly increasing this risk. Comprehensive eye examinations should be considered in these patients before initiating hormone therapy.

Perioperative adverse events in women over age 65 undergoing robot-assisted sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: Pelvic floor disorders are common among and disproportionately affect older women. There are limited data regarding perioperative adverse events in older women undergoing robot-assisted sacrocolpopexy (RASC) specifically. The aim of this study was to compare the rate of perioperative adverse events in younger (age <65 years) versus older (age >65 years) women who underwent RASC. METHODS: We conducted a retrospective cohort study of women who underwent RASC between 2013 and 2018. Postoperative adverse events were categorized according to the Clavien-Dindo classification. Our primary outcome was the rate of intraoperative adverse events and postoperative adverse events with Clavien-Dindo grade II or greater. Outcomes were compared using univariate and multivariate analysis. RESULTS: Of the 327 patients included in the study, 227 were <65 years of age and 100 were ≥65 years of age. Women ≥65 years of age had higher rates of hypertension, higher American Society of Anesthesiologist (ASA) class, and higher Charlson Comorbidity Index (CCI) scores compared with women <65 years of age; these were not associated with increased likelihood of adverse events. The overall rate of any perioperative adverse event was 18.3%. There was no statistically significant difference in the overall rate of perioperative adverse events between younger and older women (18.5% vs 18.0%, p = 0.91). CONCLUSIONS: There is no difference in rate of adverse events between women ≥65 years of age undergoing RASC and their younger counterparts.

Author Correction: Combined inhibition of MEK and nuclear ERK translocation has synergistic antitumor activity in melanoma cells.

A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.

Combined inhibition of MEK and nuclear ERK translocation has synergistic antitumor activity in melanoma cells.

Genetic alterations in BRAF, NRAS and NF1 that activate the ERK cascade, account for over 80% of metastatic melanomas. However, ERK cascade inhibitors have been proven beneficial almost exclusively for BRAF mutant melanomas. One of the hallmarks of the ERK cascade is the nuclear translocation of ERK1/2, which is important mainly for the induction of proliferation. This translocation can be inhibited by the NTS-derived peptide (EPE) that blocks the ERK1/2-importin7 interaction, inhibits the nuclear translocation of ERK1/2, and arrests active ERK1/2 in the cytoplasm. In this study, we found that the EPE peptide significantly reduced the viability of not only BRAF, but also several NRAS and NF1 mutant melanomas. Importantly, combination of the EPE peptide and trametinib showed synergy in reducing the viability of some NRAS mutant melanomas, an effect driven by the partial preservation of negative feedback loops. The same combination significantly reduced the viability of other melanoma cells, including those resistant to mono-treatment with EPE peptide and ERK cascade inhibitors. Our study indicates that targeting the nuclear translocation of ERK1/2, in combination with MEK inhibitors can be used for the treatment of different mutant melanomas.