Suprachoroidal silicone oil as an intraoperative complication during Pars Plana Vitrectomy: A case report.

INTRODUCTION AND IMPORTANCE: Complications related to silicone oil tamponade are frequent. There are reports of events related to silicone oil (SO) injection during Pars Plana Vitrectomy (PPV). This case presents the unexpected injection of SO in the suprachoroidal space. The proper management of this complication along with the preventive measures are discussed. CASE PRESENTATION: A 38-year-old male presented with a one-week history of decreased vision in his right eye (OD). His visual acuity was hand motion (HM). A late-onset retinal detachment recurrence with proliferative vitreoretinopathy (PVR) in his OD was diagnosed. Cataract surgery and PPV were scheduled. During PPV, a choroidal detachment (CD) secondary to the suprachoroidal injection of silicone oil (SO) was noted. Suprachoroidal SO was identified timely and was managed with external drainage through a posterior sclerotomy. CLINICAL DISCUSSION: Suprachoroidal silicone oil injection is a potential complication during PPV. For the management of this complication, the drainage of the silicone oil from the suprachoroidal space through a posterior sclerotomy may be considered as an option. This complication may be avoided by periodically checking the correct position of the infusion cannula during the PPV, by injecting the SO into the vitreous cavity under direct visualization and by using automated injection systems. CONCLUSION: Suprachoroidal silicone oil injection is an intraoperative complication that might be avoided by cross-checking the correct position of the infusion cannula and by injecting SO under direct visualization.

How do we identify the crashing traumatic brain injury patient - the intensivist's view.

PURPOSE OF REVIEW: Over 40% of patients with severe traumatic brain injury (TBI) show clinically significant neurological worsening within the acute admission period. This review addresses the importance of identifying the crashing TBI patient, the difficulties appreciating clinical neurological deterioration in the comatose patient and how neuromonitoring may provide continuous real-time ancillary information to detect physiologic worsening. RECENT FINDINGS: The latest editions of the Brain Trauma Foundation's Guidelines omitted management algorithms for adult patients with severe TBI. Subsequently, three consensus-based management algorithms were published using a Delphi method approach to provide a bridge between the evidence-based guidelines and integration of the individual treatment modalities at the bedside. These consensus statements highlight the serious situation of critical deterioration requiring emergent evaluation and guidance on sedation holds to obtain a neurological examination while balancing the potential risks of inducing a stress response. SUMMARY: One of the central tenets of neurocritical care is to detect the brain in trouble. The first and most fundamental neurological monitoring tool is the clinical exam. Ancillary neuromonitoring data may provide early physiologic biomarkers to help anticipate, prevent or halt secondary brain injury processes. Future research should seek to understand how data integration and visualization technologies may reduce the cognitive workload to improve timely detection of neurological deterioration.

Crosslinking en la cirugía refractiva / Crosslinking in refractive surgery

La cirugía refractiva con la utilización del láser de excimero se ha convertido a nivel mundial en una cirugía muy demandada, por la posibilidad de mejorar no solamente la visión del paciente, sino también su calidad de vida. Estos procedimientos refractivos y los grandes avances tecnológicos de la cirugía refractiva hacen posible la búsqueda de técnicas para fortalecer la córnea y mejorar la estabilidad refractiva. El uso del crosslinking en la cirugía refractiva ha demostrado que podría modificar estos aspectos, y a su vez disminuir la regresión de las ametropías tratadas. Se realizó una búsqueda de diversos artículos publicados en los últimos diez años, con el objetivo de conocer los resultados de la aplicación del crosslinking en la cirugía refractiva corneal. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Excimer laser refractive surgery has become a very much demanded surgical alternative worldwide, due to the possibility of improving not only the patient's vision, but also their quality of life. These refractive procedures as well as the great technological advances in refractive surgery allow the search for techniques to strengthen the cornea and improve refractive stability. The use of crosslinking in refractive surgery has shown that it is possible to modify these aspects and at the same time reduce the regression of the ametropias treated. A search was conducted for papers published in the past ten years, to become acquainted with the results of the application of crosslinking in corneal refractive surgery. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Crosslinking en la cirugía refractiva / Crosslinking in refractive surgery

La cirugía refractiva con la utilización del láser de excimero se ha convertido a nivel mundial en una cirugía muy demandada, por la posibilidad de mejorar no solamente la visión del paciente, sino también su calidad de vida. Estos procedimientos refractivos y los grandes avances tecnológicos de la cirugía refractiva hacen posible la búsqueda de técnicas para fortalecer la córnea y mejorar la estabilidad refractiva. El uso del crosslinking en la cirugía refractiva ha demostrado que podría modificar estos aspectos, y a su vez disminuir la regresión de las ametropías tratadas. Se realizó una búsqueda de diversos artículos publicados en los últimos diez años, con el objetivo de conocer los resultados de la aplicación del crosslinking en la cirugía refractiva corneal. Se utilizó la plataforma Infomed, específicamente la Biblioteca Virtual de Salud(AU)

Excimer laser refractive surgery has become a very much demanded surgical alternative worldwide, due to the possibility of improving not only the patient's vision, but also their quality of life. These refractive procedures as well as the great technological advances in refractive surgery allow the search for techniques to strengthen the cornea and improve refractive stability. The use of crosslinking in refractive surgery has shown that it is possible to modify these aspects and at the same time reduce the regression of the ametropias treated. A search was conducted for papers published in the past ten years, to become acquainted with the results of the application of crosslinking in corneal refractive surgery. Use was made of the platform Infomed, specifically the Virtual Health Library(AU)

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas / Morphology and morphometry of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas atendidos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a febrero del año 2016. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos atendidos en el Servicio de Cirugía Refractiva. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 90 ojos de 45 pacientes adultos sanos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular y paquimetría), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: según la cantidad de células endoteliales evaluadas no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad no existieron diferencias significativas entre la cantidad de células evaluadas en ambos ojos (p> 0,05). Los valores de hexagonalidad, coeficiente de variabilidad y tamaño celular promedio no mostraron diferencias significativas (p> 0,05) en ambos ojos según la cantidad de células evaluadas. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales sin existir variaciones según la cantidad de células evaluadas(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells, who had been seen at the refractive survey service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to February, 2016. Methods: descriptive, cross-sectional case-series research study of patients seen at the refractive surgery service. After applying the exclusion criteria, the sample was finally made up of 90 eyes from 45 healthy adult patients. SP-3000P non-contact endothelial microscopy was performed to determine the morphological (hexagonality and variability coefficient) and morphometric (cell density and pachymetry) values and the average of the average cellular corneal size according to the number of evaluated cells. Results: according to the number of evaluated endothelial cells, there were no differences as for the pachymetry in both eyes (p> 0.05). Regarding the cell density, there were no significant differences among the number of evaluated cells in both eyes (p> 0.05). The hexagonality, variability coefficient and average cell size did not show significant differences (p> 0.05) in both eyes according to the number of evaluated cells. Conclusions: the study of the corneal endothelium using the specular microscope is an effective method that allows to know the characteristics of the endothelial cells without no previous variations, according to the number of evaluated cells(AU)

Morfología y morfometría del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas / Morphology and morphometry of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells

Objetivo: describir las características morfológicas y morfométricas del endotelio corneal en adultos sin alteraciones corneales según cantidad de células evaluadas atendidos en el Servicio de Cirugía Refractiva del Instituto Cubano de Oftalmología Ramón Pando Ferrer en el período comprendido de enero a febrero del año 2016. Métodos: se realizó una investigación descriptiva de corte transversal de serie de casos atendidos en el Servicio de Cirugía Refractiva. Después de aplicar los criterios de exclusión, la muestra quedó conformada por 90 ojos de 45 pacientes adultos sanos. Se realizó microscopia endotelial de no contacto SP-3000P, para identificar los valores morfológicos (hexagonalidad y coeficiente de variabilidad) y morfométricos (densidad celular y paquimetría), así como el promedio del tamaño celular corneal según cantidad de células evaluadas. Resultados: según la cantidad de células endoteliales evaluadas no hubo diferencias en cuanto a la paquimetría en ambos ojos (p> 0,05). En relación con la densidad no existieron diferencias significativas entre la cantidad de células evaluadas en ambos ojos (p> 0,05). Los valores de hexagonalidad, coeficiente de variabilidad y tamaño celular promedio no mostraron diferencias significativas (p> 0,05) en ambos ojos según la cantidad de células evaluadas. Conclusiones: el estudio del endotelio corneal mediante la utilización del microscopio especular constituye un método efectivo que permite conocer las características de las células endoteliales sin existir variaciones según la cantidad de células evaluadas(AU)

Objective: to describe the morphological and morphometric characteristics of the corneal endothelium in adults without corneal alterations according to the number of evaluated cells, who had been seen at the refractive survey service of Ramón Pando Ferrer Cuban Institute of Ophthalmology from January to February, 2016. Methods: descriptive, cross-sectional case-series research study of patients seen at the refractive surgery service. After applying the exclusion criteria, the sample was finally made up of 90 eyes from 45 healthy adult patients. SP-3000P non-contact endothelial microscopy was performed to determine the morphological (hexagonality and variability coefficient) and morphometric (cell density and pachymetry) values and the average of the average cellular corneal size according to the number of evaluated cells. Results: according to the number of evaluated endothelial cells, there were no differences as for the pachymetry in both eyes (p> 0.05). Regarding the cell density, there were no significant differences among the number of evaluated cells in both eyes (p> 0.05). The hexagonality, variability coefficient and average cell size did not show significant differences (p> 0.05) in both eyes according to the number of evaluated cells. Conclusions: the study of the corneal endothelium using the specular microscope is an effective method that allows to know the characteristics of the endothelial cells without no previous variations, according to the number of evaluated cells(AU)