RESUMO
The present report describes a case of semi-autologous corneal transplantation with bilateral surgery using two operating microscopes simultaneously. An 86-year-old man with history of six prior failed penetrating keratoplasties in his right eye presented with decreased vision. His other eye was deeply amblyopic but had a clear 30-year-old Castroviejo-square graft with an endothelial cell count of 803 cells/mm2. A semi-autologous graft was performed from the left eye to the right. Surgery was performed simultaneously on both eyes by two different surgeons using a standard ophthalmic operating microscope as well as a second ENT microscope. Upon trephination of the right failed corneal graft, vitreous opacities were noted and sent for culture. The semi-autologous tissue was directly transferred from the left eye to the right without any storage in preservation media to avoid endothelial cell loss. The semi-autologous graft remained clear in the immediate postoperative period. However, the vitreous cultures grew coagulase-negative Staphylococcus. Despite all efforts, the patient eventually developed a retinal detachment and vision in the right eye decreased to light perception. Autologous penetrating keratoplasty is an option for patients with loss of corneal function in a potentially seeing eye and a clear cornea in a contralateral eye with poor visual potential due to non-corneal disease. This case is unique in that part of the autologous penetrating keratoplasty had an old square graft in the center and corneal transplant surgery was done simultaneously in both eyes. It also highlights chronic indolent endophthalmitis as a potential cause of multiple graft failures.
RESUMO
Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon's mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon's MMC after trabeculectomy.
RESUMO
OBJECTIVE: To assess the impact of a 5 min interactive online survey on raising awareness about cornea donation and willingness to become a donor. METHODS: An interactive online questionnaire was used to collect information regarding awareness, perceptions and attitudes towards cornea donation and to educate the participants about the process and value of cornea donation. Willingness to become a cornea donor was assessed at the beginning and the end of the survey. RESULTS: The survey was completed by 1769 Greek residents. Willingness to become a cornea donor increased from 40.5% (n=717) at the beginning of the survey to 55.2% (n=977) by the end of it (p<0.00001). Younger participants, those whose work or studies were unrelated to the medical field, and those with the least knowledge about cornea donation and transplantation were more likely to change their views towards donation by the end of the survey (42.3%, 44.8% and 82.1% increase in willingness to donate, respectively). Major deterrents to donation were lack of information, concerns about the use of the donated corneas and corruption within the medical field. CONCLUSION: Our 5 min online survey had a significant impact on changing the mentality towards cornea donation in Greece. We live in an online era and incorporation of online tools and applications in awareness campaigns towards cornea and organ donation has become a necessity.
RESUMO
BACKROUND: The electronic diagnostic tools of acute appendicitis present serious disadvantages, thus some clinical scores have been formed in order to reach the diagnosis easily and safely. Alvarado and RIPASA scores are the most commonly used and the purpose of this meta-analysis is to compare the diagnostic accuracy of these two scoring systems. METHOD: We searched MEDLINE (1966-2017), Scopus (2004-2017), ClinicalTrials.gov (2008-2017), Google Scholar (2004-2017) and Cochrane Central Register of Controlled Trials CENTRAL (1999-2017) databases. We selected all observational cohort studies that reported diagnostic parameters of Alvarado and RIPASA diagnostic scores on patients with clinical status of acute appendicitis. Statistical meta-analysis was performed with Meta Disc 1.4 software. RESULTS: Twelve studies were included in our meta-analysis which enrolled 2161 patients. The sensitivity of RIPASA score was 94% (95% CI, 92%-95%) and the specificity was 55% (95% CI, 51%-55%). In addition, the area under the Roc Curve (AUC) was 0.9431 and the diagnostic Odds Ratio was 24.66 (95% CI, 8.06 to 75.43). The sensitivity of Alvarado score was 69% (95% CI, 67%-71%) and the specificity was 77% (95% CI, 74%-80%). Moreover, the AUC was 0.7944 and the diagnostic Odds Ratio was 7.99 (95% CI, 4.75 to 13.43). CONCLUSION: RIPASA scoring system is more sensitive than Alvarado one, but the low specificity forms the need of a supplementary mean to provide the accurate diagnosis. Nevertheless, the wide and safe use of both tests is recommended in health systems that lack electronic diagnostic tests, such us developing countries or rural hospitals.
