Surgical time and efficacy of illuminated chopper-assisted cataract surgery involving miosis after femtosecond laser pretreatment.

PURPOSE: To evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time in eyes with miosis after femtosecond laser pretreatment. METHODS: As retrospective study, three hundred thirty-six eyes of 336 consecutive patients who underwent the femtosecond laser and illuminated chopper-assisted cataract surgery were included. Cases with pupil less than 6 mm after femtosecond laser pretreatment were included in the miosis group. Pupil diameter, surgical time, and improved efficacy (100/surgical time×pupil size) were compared between eyes with and without miosis. RESULTS: Of 336 eyes, 20 were included in the miosis group (6.0%). Pupil diameter was smaller in eyes with miosis than in those without miosis (5.23 ± 0.38 mm vs 7.35 ± 0.64 mm, p < 0.001); however, surgical time was not different (6.86 ± 0.73 min vs 6.60 ± 1.27 min, p = 0.071) between the two groups. Mechanical pupil dilations were not needed in any cases. As a result, improved efficacy was calculated to be higher in patients with miosis (2.83 vs 2.14, p < 0.001). CONCLUSION: In terms of surgical time and improved efficacy, using the illuminated chopper simplified cataract surgery involving miosis after femtosecond laser pretreatment. The use of an illuminated chopper is expected to be a good solution for femtosecond laser-assisted cataract surgeries.

Changes in Aqueous Concentrations of Various Cytokines after Intravitreal Bevacizumab Injection for Chronic Central Serous Chorioretinopathy.

PURPOSE: This study aimed to investigate changes in cytokine levels after intravitreal bevacizumab injection in patients with chronic central serous chorioretinopathy (CSC). METHODS: In a prospective interventional trial, 12 eyes from 12 patients with chronic CSC and six eyes from six patients who underwent cataract surgery were included as controls. Patients diagnosed as with CSC received a single intravitreal injection of bevacizumab (1.25 mg/0.05 mL). Aqueous humor samples were collected from the patients and controls. Best-corrected visual acuity and foveal thickness were evaluated, and aqueous samples were obtained before and 4 weeks after injection. The aqueous concentrations of interleukin (IL)-6, IL-8, interferon-induced protein (IP)-10, monocyte chemotactic protein (MCP)-1, platelet-derived growth factor (PDGF)-AA, and vascular endothelial growth factor (VEGF) were measured using a multiplex bead assay. RESULTS: After injection, the foveal thickness decreased significantly from 328.08 µm (range, 210-477 µm) to 283.91 µm (range, 168-356 µm; p = 0.048), but the best-corrected visual acuity was not significantly different (p = 0.066). The aqueous levels of IL-8 increased significantly from 3.3 pg/mL (range, 1.5-8.3 pg/mL) to 4.7 pg/mL (range, 2.2-11.6 pg/mL) at 4 weeks after the injection (p = 0.046). The aqueous levels of VEGF decreased significantly from 31.4 pg/mL (range, 17.0-53.3 pg/mL) to 15.2 pg/mL (range, 7.7-21.5 pg/mL; p < 0.01). No significant changes in levels of IL-6 (p = 0.455), IP-10 (p = 0.055), MCP-1 (p = 0.076), and PDGF-AA (p = 0.339) were noted 4 weeks after injection. CONCLUSIONS: In this study we found intravitreal bevacizumab injection decreased VEGF and increased IL-8 in the eyes of patients with chronic CSC. This study suggests the possibility that the pathogenesis of CSC may be related to abnormal circulation of the choroidal blood vessels through VEGF and IL-8 cytokine level changes.

Intraoperative challenges and complications of cataract surgery between cataract surgery alone and phacovitrectomy in eyes with diabetic retinopathy: efficacy of illuminated chopper-assisted cataract surgery.

BACKGROUND: To compare the intraoperative challenges, complications, and operation time of illuminated chopper-assisted cataract surgery between cataract surgery only and phacovitrectomy in eyes with diabetic retinopathy. METHODS: One university hospital, retrospective case series. Two hundred ninety-five eyes of 295 consecutive patients with diabetic retinopathy who underwent cataract surgery only or phacovitrectomy were retrospectively reviewed. Intraoperative challenges and complications of cataract surgery were thoroughly analyzed by 3D viewing of digitally recorded videos. The pupil diameter, operation time, and improved efficacy (100/operation time × pupil diameter) were compared between the cataract surgery only and phacovitrectomy groups. RESULTS: Of the 295 eyes, 211 underwent cataract surgery only, and 84 underwent phacovitrectomy. Intraoperative challenges such as small pupil, miosis, or poor red reflex occurred more frequently (46 [21.8%] vs. 28 [33.3%], p = 0.029); pupil diameter was smaller (7.34 ± 0.94 vs. 6.89 ± 0.88 mm, p < 0.001) in the phacovitrectomy group than in the cataract surgery only group; however, rates of posterior capsule rupture and operation time were not different between the two groups (0 [0%] vs. 1 [1.2%], p = 0.285; 16.54 ± 2.65 vs. 16.31 ± 4.30 min, p = 0.434). Improved efficacy was higher in the phacovitrectomy group (0.85 ± 0.18 vs. 0.97 ± 0.28, p = 0.002). CONCLUSIONS: The use of an illuminated chopper is a potential solution for diabetic cataract surgery, particularly in phacovitrectomy, by decreasing the use of supplemental devices, operation time, and posterior capsule rupture. TRIAL REGISTRATION: Retrospectively registered.

Improved visibility of illuminated chopper-assisted cataract surgery involving iris challenges.

Purpose: The aim of this study was to evaluate the efficacy of the illuminated chopper-assisted cataract surgery in terms of shortening the surgical time and reducing the use of pupil expansion devices in eyes with iris challenges. Methods: This was a retrospective case series of a university hospital. Four hundred forty-three eyes of 433 consecutive patients who underwent illuminated chopper-assisted cataract surgery were included in this study. Cases with preoperative or intraoperative miosis, iris prolapse, and intraoperative floppy iris syndrome were included in the iris challenge group. Use of tamsulosin, iris hooks, pupil size, surgical time, and improved visibility (100/surgical time × pupil size) were compared between eyes with and without iris challenges. Mann-Whitney U test, Pearson's Chi-square test, and Fisher's exact test were used for statistical analysis. Results: Of 443 eyes, 66 were included in the iris challenge group (14.9%). Tamsulosin use was more common in patients with iris challenges and iris hooks were used more frequently (9.1% vs. 0%, P < 0.001) in patients with iris challenges than in those without iris challenges. Pupil size was smaller in patients with iris challenges (6.01 vs. 7.64 mm, P < 0.001). However, surgical time was not different (16.9 vs. 16.5 min, P = 0.064) between the two groups. As a result, improved visibility was calculated to be higher in patients with iris challenges (1.05 vs. 0.81, P < 0.001). Conclusion: In terms of surgical time and improved visibility, using the illuminated chopper simplified cataract surgery involving iris challenges. The use of an illuminated chopper is expected to be a good solution for challenging cataract surgeries.

Vitreous Cortex Remnants Removal With Beveled Vitrectomy Probe During Vitrectomy For Primary Rhegmatogenous Retinal Detachment.

PURPOSE: To introduce a new surgical technique with a beveled vitrectomy probe for the removal of peripheral vitreous cortex remnants (VCR) in primary rhegmatogenous retinal detachment (RRD). METHODS: This study was a retrospective case series. From September 2019 to June 2022, 54 patients with complete or partial posterior vitreous detachment who underwent vitrectomy for primary RRD by a single surgeon were enrolled. RESULTS: After staining the vitreous with triamcinolone acetonide, the presence of VCR was assessed in detail. If VCR were present, the macular VCR were removed using surgical forceps, and then, a free flap of peripheral VCR was used as a handle for removing peripheral VCR using the beveled vitrectomy probe. Of the total patients, the presence of VCR was confirmed in 16 patients (29.6%). There were no intraoperative or postoperative complications, except for retinal redetachment caused by proliferative vitreoretinopathy, that occurred in only one eye (1.9%). CONCLUSION: Using a beveled vitrectomy probe was a practical solution for removing VCR during RRD vitrectomy because additional instruments were not needed and risk of iatrogenic retinal damage was low.

Assessment of Clinical Outcome of Lumbar Transforaminal Foraminoplasty in Patients with Lumbar Spinal Stenosis.

BACKGROUND: Lumbar spinal stenosis (LSS), a common spinal disorder that negatively affects quality of life, is a disabling condition accompanied by back pain, leg pain, and claudication. Lumbar foraminal stenosis (LFS) is often accompanied by lumbar central stenosis (LCS) and conservative treatment is often ineffective. A surgical approach, including a minimally invasive technique, is usually recommended for the conservative treatment of refractory conditions. To achieve effective decompression of LSS, a specially designed new instrument for lumbar transforaminal foraminoplasty (TFFP) can be considered before opting for surgical treatment. OBJECTIVE: To evaluate the clinical outcomes and safety of TFFP with a specially designed instrument. STUDY DESIGN: Retrospective design. SETTING: This research was conducted in a hospital outpatient surgical center. METHODS: The medical records of 112 patients who underwent TFFP from December 1, 2018 to January 1, 2020, were reviewed. Outcome measures were obtained using the numeric rating scale for pain (NRS pain), Oswestry Disability Index (ODI), and walking distance without pain for functional ability at preprocedure and 1, 3, and 6 months postprocedure. The clinical data and radiologic findings were analyzed to evaluate correlations between predictive factors and efficacy of TFFP. RESULTS: Among 112 patients who underwent TFFP, 110 were accessed and analyzed. The percentage of successful responders was 59.1%, 73.6%, and 74.5 % of 110 patients at one, 3, and 6 months, respectively. The NRS pain score, ODI, and duration of walking without radicular pain were improved significantly at the one-, 3-, and 6-month follow-up periods (all P < 0.001). No serious adverse events occurred during this study. LIMITATIONS: The limitations of this study include the possibility of bias due to nonrandomized patient selection. CONCLUSION: TFFP using the Foramoon® device (Mcarekorea, Seongnam-si, Gyeonggi-do, Republic of Korea) appeared to be effective for managing patients with LFS and LCS, who were refractory to conservative care.

The effect of social distancing on the reach of an epidemic in social networks.

How does social distancing affect the reach of an epidemic in social networks? We present Monte Carlo simulation results of a susceptible-infected-removed with social distancing model. The key feature of the model is that individuals are limited in the number of acquaintances that they can interact with, thereby constraining disease transmission to an infectious subnetwork of the original social network. While increased social distancing typically reduces the spread of an infectious disease, the magnitude varies greatly depending on the topology of the network, indicating the need for policies that are network dependent. Our results also reveal the importance of coordinating policies at the 'global' level. In particular, the public health benefits from social distancing to a group (e.g. a country) may be completely undone if that group maintains connections with outside groups that are not following suit.

Comparison of vasodilatory properties between desflurane and sevoflurane using perfusion index: a randomised controlled trial.

BACKGROUND: The perfusion index (PI), calculated from the photoplethysmographic waveform, reflects peripheral vasomotor tone. As such, the PI serves as a surrogate for quantitative measures of drug-induced vasoconstriction or vasodilation. This study aimed to compare the effect on the PI of desflurane and sevoflurane at equi-anaesthetic concentrations in patients undergoing single-agent inhalation anaesthesia, where equi-anaesthetic dose was based on the known minimum alveolar concentration of these agents. METHODS: We randomly allocated patients scheduled for arthroscopic knee surgery to receive either desflurane or sevoflurane general anaesthesia after target-controlled induction of anaesthesia with propofol. Anaesthesia was maintained at age-corrected minimum alveolar concentration 1.0, under neuromuscular block (rocuronium). The PI and haemodynamic data were recorded every minute for 35 min after induction of anaesthesia and after standardised nociceptive stimulation. The primary outcome was PI, compared between the groups over time (repeated-measures analysis of variance). Secondary outcomes included MAP and HR. RESULTS: Sixty-nine participants (mean [range] age: 42 yr [19-65 yr]; 49% females) were assigned to either desflurane (n=34) or sevoflurane (n=35). The PI remained higher under desflurane compared with sevoflurane, both before (mean difference [MD]: 3.3; 95% confidence intervals [CIs]: 2.0-4.7; P<0.001) and after tetanic stimulation (MD: 2.8; 95% CI: 2.0-3.7; P<0.001). Higher PI paralleled lower MAP in participants assigned to desflurane anaesthesia (P<0.001), both before (MD: 8 mm Hg; 95% CI: 4-12) and after nociceptive stimulation (MD: 14 mm Hg; 95% CI: 7-22). HR was similar throughout. CONCLUSIONS: These findings suggest that at equipotent doses, desflurane exerts more potent vasodilatory properties and lowers blood pressure by a magnitude potentially associated with harm. CLINICAL TRIAL REGISTRATION: NCT03570164.

Does glycopyrrolate premedication facilitate tracheal intubation with a rigid video-stylet?: A randomized controlled trial.

BACKGROUND: A rigid video-stylet intubation device provides safe and accurate access to the trachea by enabling visualization of the airway structures during tracheal intubation. The primary purpose of this study was to examine the effects of glycopyrrolate premedication on tracheal intubation with a rigid video-stylet. METHODS: In this prospective, randomized, double-blinded study, 78 patients were randomly assigned to the control group (n = 39; no glycopyrrolate administration) or the glycopyrrolate group (n = 39; 0.005 mg/kg glycopyrrolate, intramuscular injection). A rigid video-stylet was used for tracheal intubation. The degree of oral secretion observed through the video-stylet monitor was assessed using the OptiScope laryngeal view and graded on a 4-point scale (1, excellent; 2, good; 3, poor; and 4, unacceptable). The time to intubation and hemodynamic variables at baseline and 1, 3, and 5 minutes after intubation were recorded. RESULTS: The OptiScope laryngeal view grades of the glycopyrrolate group (grade 1 = 16 [41.0%], 2 = 17 [43.6%], 3 = 6 [15.4%], and 4 = 0 [0%]) were significantly higher than those of the control group (grade 1 = 9 [23.1%], 2 = 11 [28.2%], 3 = 18 [46.2%], and 4 = 1 [2.6%]; P = .02). The intubation time was shorter in the glycopyrrolate group (18.5 seconds [15.0-22.0]) than the control group (22.0 seconds [17.9-26.4], P = .02). There was no significant difference in the hemodynamic variables between groups. CONCLUSION: Glycopyrrolate facilitated tracheal intubation with a rigid video-stylet by decreasing oral secretions and providing better visualization and faster intubation with hemodynamic stability. TRIAL REGISTRY: www.clinicaltrials.gov; Identifier: NCT03050242.

Intracameral air injection during Ahmed glaucoma valve implantation in neovascular glaucoma for the prevention of tube obstruction with blood clot: Case Report.

RATIONALE: Glaucoma drainage implant surgery is a treatment option for the management of neovascular glaucoma. However, tube obstruction by blood clot after Ahmed glaucoma valve (AGV) implantation is an unpredictable clinically challenging situation. PATIENT CONCERNS-DIAGNOSES-INTERVENTIONS: We report 4 cases using intracameral air injection for the prevention of the tube obstruction of AGV by blood clot. OUTCOMES: The first case was a 57-year-old female suffering from ocular pain because of a tube obstruction with blood clot after AGV implantation in neovascular glaucoma. Surgical blood clot removal was performed. However, intractable bleeding was noted during the removal of the blood clot, and so intracameral air injection was performed to prevent a recurrent tube obstruction. After the procedure, although blood clots formed around the tube, the tube opening where air could touch remained patent. In 3 cases of neovascular glaucoma with preoperative severe intraocular hemorrhages, intracameral air injection and AGV implantation were performed simultaneously. In all 3 cases, tube openings were patent. It appears that air impeded the blood clots formation in front of the tube opening. LESSONS: Intracameral air injection could be a feasible option to prevent tube obstruction of AGV implant with a blood clot in neovascular glaucoma with high risk of tube obstruction.

Outdoor Air Pollution and Pterygium in Korea.

We investigated relationships between outdoor air pollution and pterygium in Korean adults. This study includes 23,276 adults in population-based cross-sectional data using the Korea National Health and Nutrition Examination Survey 2008-2011. Pterygium was assessed using slit lamp biomicroscopy. Air pollution data (humidity, particulate matter with aerodynamic diameter less than 10 µm [PM10], ozone [O3], nitrogen dioxide [NO2], and sulfur dioxide levels [SO2]) for 2 years preceding the ocular examinations were acquired. Associations of multiple air pollutants with pterygium or pterygium recurrence after surgery were examined using multivariate logistic models, after adjusting for several covariates. Distributed lag models were additionally used for estimating cumulative effects of air pollution on pterygium. None of air pollution factors was significantly associated with pterygium or pterygium recurrence (each P > 0.05). Distributed lag models also showed that air pollution factors were not associated with pterygium or pterygium recurrence in 0-to-2 year lags (each P > 0.05). However, primary pterygium showed a weak association with PM10 after adjusting for covariates (odds ratio [OR] 1.23; [per 5 µg/m³ PM10 increase]; P = 0.023). Aging, male sex, and greater sun exposure were associated with pterygium, while higher education level and myopia were negatively associated with pterygium (each P ≤ 0.001). Male sex and myopia were negatively associated with pterygium recurrence (each P < 0.05). In conclusion, exposure to higher PM10 levels was associated with primary pterygium, although this study observed no significant association between air pollution and overall pterygium or pterygium recurrence in Korean adults.

Potential Importance of Ozone in the Association Between Outdoor Air Pollution and Dry Eye Disease in South Korea.

IMPORTANCE: Air pollution is an important public health concern and the ocular surface is continuously exposed to pollutants in outdoor air. Ocular surface abnormalities related to air pollution are thought to be a subtype of dry eye disease (DED). However, to date, there is no large-scale study evaluating an association between air pollution and DED that includes multiple air pollutants. OBJECTIVE: To investigate associations between outdoor air pollution and DED in a Korean population. DESIGN, SETTING, AND PARTICIPANTS: A population-based cross-sectional study using data on 16 824 participants in the fifth Korea National Health and Nutrition Examination Survey was conducted from January 1, 2010, to December 31, 2012. Data analysis was conducted from September 1 to 30, 2015. Dry eye disease was defined as previously diagnosed by an ophthalmologist or the presence of frequent ocular pain and discomfort. Outdoor air pollution measurements (mean annual humidity, particulate matter with aerodynamic diameter <10 µm [PM10], ozone, and nitrogen dioxide levels) were collected from 283 national monitoring stations in South Korea. MAIN OUTCOMES AND MEASURES: Associations of multiple air pollutants with DED were assessed from multivariable logistic regression analyses. Sociodemographic factors and previously known factors associated with DED were applied as covariates (model 1 controlled for sociodemographic factors and model 2 controlled for sociodemographic, behavioral, and clinical factors). RESULTS: Among 16 824 participants (7104 men and 9720 women), higher ozone levels and lower humidity levels were significantly associated with symptoms and diagnosis of DED. In model 1, an increase in ozone levels of 0.003 ppm was significantly associated with symptoms and diagnosis of DED (symptoms: odds ratio [OR], 1.16; 95% CI, 1.02-1.30; P = .04; diagnosis: OR, 1.21; 95% CI, 1.05-1.40; P = .008), while a 5% increase in humidity levels was significantly associated with decreased symptoms and diagnoses of DED (symptoms: OR, 0.87; 95% CI, 0.77-0.98; P = .03; diagnosis: OR, 0.86; 95% CI, 0.76-0.97; P = .01). In model 2, an increase in ozone levels of 0.003 ppm was significantly associated with symptoms and diagnosis of DED (symptoms: OR, 1.17; 95% CI, 1.02-1.34; P = .03; diagnosis: OR, 1.27; 95 CI, 1.09-1.48; P = .002), while a 5% increase in humidity levels was significantly associated with decreased symptoms and diagnoses of DED (symptoms: OR, 0.88; 95% CI, 0.78-0.98; P = .045; diagnosis: OR, 0.86; 95% CI, 0.76-0.97; P = .02). In model 2, an increase in nitrogen dioxide of 0.003 ppm (OR, 1.12; 95% CI, 1.02-1.23 P = .02) was also associated with diagnosis of DED. Levels of sulfur dioxide and PM10 were not associated with symptoms or diagnosis of DED in model 1 or model 2 (P > .05 for each). CONCLUSIONS AND RELEVANCE: Higher ozone levels and lower humidity levels were associated with DED in the Korean population, while PM10 level was not associated with DED.

Development of estimation methods of skin oxidation and evaluation of anti-oxidative effects of genistein in topical formulations.

The objective of the present study was to establish the method of measurement of hydrogen peroxide and to estimate the anti-oxidative effect of genistein in the skin. UVB induced skin oxidation and anti-oxidative effect of genistein formulations were evaluated by determining levels of hydrogen peroxide. The mechanism involved in the determination of hydrogen peroxide is based on a color reaction between ferric ion (Fe(3+)) and xylenol orange, often called FOX assay and subsequent monitoring of absorbance values of the reactant at 540 nm. The reaction was to some extent pH-dependent and detection sensitivity was greatest at pH 1.75. Genistein liposomal gel demonstrated better anti-oxidative effect with regard to lowering hydrogen peroxide levels elevated by UVB irradiation compared to genistein-suspended gel. A linear relationship has been observed between anti-oxidative effect of genistein and drug deposition in the skin tissue. Genistein liposomal gel resulting in the localization of the drug in the deeper skin led to improved anti-oxidative effect compared to genistein gel. The suggested method for evaluation of oxidation of the skin can be used as a tool to screen effective anti-oxidative agents and their delivery systems acting on the skin.