RESUMO
PURPOSE: Suboptimal visual acuity after endothelial keratoplasty has been attributed to increased anterior corneal high-order aberrations (HOAs). In this study, we determined anterior and posterior corneal HOAs over a range of severity of Fuchs' endothelial corneal dystrophy (FECD). DESIGN: Cross-sectional study. PARTICIPANTS: A total of 108 eyes (62 subjects) with a range of severity of FECD and 71 normal eyes (38 subjects). METHODS: All corneas were examined by using slit-lamp biomicroscopy to determine the severity of FECD versus normality. Fuchs' endothelial corneal dystrophy corneas were categorized as mild, moderate, or advanced according to the area and confluence of guttae and the presence of clinically visible edema. Normal corneas were devoid of any guttae. Wavefront errors from the anterior and posterior corneal surfaces were derived from Scheimpflug images and expressed as Zernike polynomials through the sixth order over a 6-mm diameter optical zone. Backscatter from the anterior 120 µm and posterior 60 µm of the cornea also was measured from Scheimpflug images and was standardized to a fixed scatter source. Variables were compared between FECD and control eyes by using generalized estimating equation models to adjust for age and correlation between fellow eyes. MAIN OUTCOME MEASURES: High-order aberrations, expressed as root mean square of wavefront errors, and backscatter of the anterior and posterior cornea. RESULTS: Total anterior corneal HOAs were increased in moderate (0.61±0.27 µm, mean ± standard deviation; P = 0.01) and advanced (0.66±0.28 µm; P = 0.01) FECD compared with controls (0.47±0.16 µm). Total posterior corneal HOAs were increased in mild (0.22±0.09 µm; P = 0.017), moderate (0.22±0.08 µm; P < 0.001), and advanced (0.23±0.09 µm; P < 0.001) FECD compared with controls (0.16±0.03 µm). Anterior and posterior corneal backscatter were higher for all severities of FECD compared with controls (P ≤ 0.02, anterior; P ≤ 0.001, posterior). CONCLUSIONS: Anterior and posterior corneal HOAs and backscatter are higher than normal even in early stages of FECD. The early onset of HOAs in FECD might contribute to the persistence of HOAs and incomplete visual rehabilitation after endothelial keratoplasty.
Assuntos
Aberrações de Frente de Onda da Córnea/fisiopatologia , Distrofia Endotelial de Fuchs/fisiopatologia , Espalhamento de Radiação , Aberrometria , Adulto , Idoso , Idoso de 80 Anos ou mais , Contagem de Células , Córnea/fisiopatologia , Córnea/efeitos da radiação , Paquimetria Corneana , Estudos Transversais , Endotélio Corneano/patologia , Feminino , Humanos , Luz , Masculino , Pessoa de Meia-Idade , Lâmpada de Fenda , Acuidade Visual/fisiologiaRESUMO
PURPOSE: To assess cleaning effectiveness of room surfaces in an office-based intravitreal injection practice by using adenosine triphosphate (ATP) luminometry. DESIGN: Prospective, comparative case series. PARTICIPANTS: A total of 792 intravitreal injection room surfaces were sampled (396 before cleaning, 396 after cleaning) using 3 cleaning methods. METHODS: Three cleaning methods were evaluated: baseline terminal cleaning, directed terminal cleaning, and enhanced terminal cleaning. For each method, residual ATP bioburden (relative light units [RLUs]/sample) was sampled from 9 high-touch injection room surfaces before and after terminal cleaning using the 3M Clean-Trace ATP System (3M Inc, St. Paul, MN). Surface ATP RLUs were used to compare cleaning methods and against an ATP benchmark of fewer than 250 RLU. Differences between cleaning methods were compared by using paired t tests with Bonferroni correction for 3 comparisons. MAIN OUTCOME MEASURES: Surface ATP RLU levels. RESULTS: In baseline terminal cleaning and directed terminal cleaning, the median ATP level of all surfaces exceeded threshold when sampled after terminal cleaning (391 RLU and 264 RLU, respectively), and levels were increased significantly at the completion of the injection clinic and before terminal cleaning (780 RLU and 626 RLU, respectively; P < 0.003). In enhanced terminal cleaning, the median ATP level was below threshold after terminal cleaning (71 RLU), was unchanged at the completion of injection clinic and before terminal cleaning (63 RLU; P = 0.27), and was significantly lower than after the baseline terminal and directed terminal cleaning methods (P < 0.003). CONCLUSIONS: An easily adopted enhanced terminal cleaning program reduced surface ATP bioburden in intravitreal injection rooms to less than clean benchmarks used in nonophthalmologic healthcare settings.
Assuntos
Trifosfato de Adenosina/análise , Procedimentos Cirúrgicos Ambulatórios/normas , Inibidores da Angiogênese/administração & dosagem , Bactérias/isolamento & purificação , Desinfecção/métodos , Controle de Infecções/normas , Injeções Intravítreas , Contagem de Colônia Microbiana , Microbiologia Ambiental , Humanos , Medições Luminescentes , Estudos Prospectivos , Garantia da Qualidade dos Cuidados de SaúdeRESUMO
PURPOSE: Corneas with advanced Fuchs' endothelial dystrophy that require endothelial keratoplasty manifest anterior corneal structural and cellular abnormalities that have been associated with visual deficits before and after endothelial keratoplasty. In this study, we determined the onset of these abnormalities in the course of the disease. DESIGN: Cross-sectional study. PARTICIPANTS: Sixty-three eyes (39 subjects) with a range of severity of Fuchs' dystrophy and 25 eyes (13 subjects) with normal corneas. METHODS: All corneas were examined using slit-lamp biomicroscopy, ultrasonic pachymetry, and confocal microscopy. The clinical grade of Fuchs' dystrophy was assessed according to the presence and extent of guttae and clinically evident edema and was categorized as mild (grades 1 and 2), moderate (grades 3 and 4), or advanced (grades 5 and 6). Normal corneas were devoid of any central guttae (grade 0). Corneal backscatter (haze) was measured from the confocal image light intensity profile. Stromal cell density and number and the presence of abnormal subepithelial cells were determined from confocal images. Comparisons between groups were made by using generalized estimating equation models. MAIN OUTCOME MEASURES: Anterior corneal backscatter, stromal cell density and number, presence of subepithelial cells, and central corneal thickness. RESULTS: Anterior corneal backscatter was 18% to 67% higher in eyes with moderate and advanced Fuchs' dystrophy compared with normal eyes (P ≤ 0.003); a similar trend was noted in mild Fuchs' dystrophy eyes compared with normal eyes (P = 0.08). Stromal cell density and the absolute number of stromal cells in the anterior 10% of the stroma were approximately 20% and 27% lower, respectively, in Fuchs' dystrophy (regardless of severity) compared with normal (P < 0.001). Abnormal subepithelial cells were visible in 9%, 19%, and 30% of corneas with mild, moderate, and advanced Fuchs' dystrophy, respectively. Only corneas with advanced Fuchs' dystrophy were thicker than normal (P < 0.001). CONCLUSIONS: Anterior corneal cellular and structural abnormalities begin early in the course of Fuchs' dystrophy, before the onset of clinically evident edema. The chronicity of these changes can explain their incomplete resolution after endothelial keratoplasty, and understanding the onset of these may help to determine the optimal time to intervene to achieve best outcomes.
Assuntos
Córnea/patologia , Distrofia Endotelial de Fuchs/patologia , Idoso , Idoso de 80 Anos ou mais , Substância Própria/patologia , Estudos Transversais , Endotélio Corneano/patologia , Células Epiteliais/patologia , Feminino , Humanos , Masculino , Microscopia Confocal , Pessoa de Meia-Idade , Células Estromais/patologiaRESUMO
BACKGROUND: Single-incision pediatric endosurgical (SIPES) appendectomy has been reported in few pediatric surgical centers. We have adopted the technique recently and have offered it to all patients in whom appendectomy was indicated. The purpose of this study was to report our experience with SIPES appendectomy for acute appendicitis, perforated appendicitis, and interval appendectomy, and to compare the results with those from patients who underwent conventional laparoscopic appendectomy 1 year previously. METHODS: After IRB approval, data on all SIPES appendectomies performed in our hospital were prospectively collected, including operative time, intra- and postoperative complications, conversion rate, blood loss, and hospital length of stay. Cases were stratified into three categories: acute appendicitis, perforated appendicitis, and interval appendectomy. They were compared to patients operated on in 2007 using conventional laparoscopic (three-trocar) appendectomy. RESULTS: During the study period, 75 SIPES appendectomies were undertaken. Mean age was 11 years (range = 2-19 years) and mean weight was 45 kg (range = 12-132 kg). All SIPES appendectomies were completed laparoscopically, and additional trocars were placed in 20% of cases. SIPES interval appendectomies took the longest and had the highest conversion rate (33%). Follow-up data was available in 63 patients (82%) at a median of 3 weeks. There were three wound infections in the SIPES group (4%) and one in the 151 control patients. Compared to historic controls, operative time was shorter with SIPES compared to conventional laparoscopy for acute appendicitis (37 ± 12.3 vs. 44.1 ± 20.3 min, p = 0.01, 95% CI = 32-42 min). CONCLUSION: SIPES appendectomy is a very good alternative to the conventional laparoscopic approach, especially for acute appendicitis. It is technically more challenging for perforated appendicitis and interval appendectomy. Yet, with appropriate consideration and skill, scarless appendectomy is achievable.
Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Adulto JovemRESUMO
PURPOSE: To describe IOL haptic with iris or ciliary body touch on ultrasound biomicroscopy (UBM) in pseudophakic patients with unexplained recurrent hyphema or vitreous hemorrhage. METHODS: Retrospective chart review of 10 patients who presented with unexplained recurrent hyphema and or vitreous hemorrhage. RESULTS: There were eight posterior chamber intraocular lenses (PCIOL) and two sulcus lenses. Four cases had a history of glaucoma; two cases which had a history of trabeculectomy were found to have some bridging vessels along the sclerostomy requiring argon laser gonioplasty. No preceding trauma or retinal pathology was found. UBM revealed haptic-ciliary body or haptic-iris touch in cases with a PCIOL and haptic-iris touch in both sulcus lens cases. One case with a PCIOL did not reveal any haptic-iris or ciliary body touch and instead displacement of the optic temporally, though haptics remained intracapsular. CONCLUSIONS: UBM is a useful tool to evaluate haptic position in pseudophakic patients with unexplained recurrent hyphema and/or vitreous hemorrhage. This is the largest existing series of patients with this clinical entity reported from a single institution.
Assuntos
Migração de Corpo Estranho/complicações , Hifema/diagnóstico , Iris/cirurgia , Lentes Intraoculares/efeitos adversos , Microscopia Acústica/métodos , Pseudofacia/complicações , Hemorragia Vítrea/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Corpo Ciliar , Feminino , Migração de Corpo Estranho/diagnóstico , Humanos , Hifema/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Desenho de Prótese , Pseudofacia/diagnóstico , Recidiva , Estudos Retrospectivos , Hemorragia Vítrea/etiologiaRESUMO
BACKGROUND: To determine the occurrence of macular edema (ME) in vitreoretinal lymphoma (VRL). METHODS: Retrospective analysis of 17 patients (31 eyes) with VRL. A review of the literature was done as well. RESULTS: Nine patients (15 eyes) had fluorescein angiography and/or optical coherence tomography at presentation. In the ME group (six eyes of four patients), three patients (five eyes) had prior chemotherapy and radiation. Excluding eyes with radiation retinopathy (three eyes), rate of ME was 25% (3/12). When two unirradiated fellow eyes of eyes with radiation retinopathy were also excluded, ME rate was 10% (1/10). Excluding the eyes with intraocular surgery, the rate of ME was 0%. In the group without ME (nine eyes of six patients), one patient (one eye) was treated with chemotherapy and radiation and three patients (five eyes) with chemotherapy. Review of the literature showed that the ME was found between 2 and 60% of cases, but most of the cases with ME had prior interventions. CONCLUSIONS: Macular edema in VRL is not uncommon but usually related to prior interventions. Macular edema as an initial presentation of VRL is rare.
RESUMO
An 85-year-old man with remote thermal sclerostomy and Descemet's stripping automated endothelial keratoplasty (DSAEK) in the right eye presented urgently for pain and blurred vision in that eye. Examination revealed bleb purulence and vitreous cellular aggregates concerning for endophthalmitis. Microscopy of a vitreous sample revealed yeast and pseudohyphae. He developed corneal infiltrates consistent with fungal infection. Therapy included topical, intravitreal, and systemic antifungals voriconazole and amphotericin. Fungal pathogens have very rarely been reported to cause bleb-associated endophthalmitis and should be considered in addition to bacterial pathogens. Vitreous aspiration should be performed in all cases of bleb-related endophthalmitis and include fungal studies. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:691-693.].
Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/efeitos adversos , Endoftalmite/etiologia , Infecções Oculares Fúngicas/etiologia , Esclerostomia/efeitos adversos , Infecção da Ferida Cirúrgica/etiologia , Idoso de 80 Anos ou mais , Doenças da Córnea/cirurgia , Endoftalmite/diagnóstico , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/microbiologia , Humanos , Glaucoma de Baixa Tensão/cirurgia , Masculino , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologiaRESUMO
PURPOSE: The increased use of computed tomography (CT) to diagnose appendicitis in children has led to a concern for the possibility of increased CT-related cancer morbidity. We designed a clinical protocol for the diagnosis and treatment of appendicitis in children in an attempt to decrease the use of CT scans at our institution. METHODS: Patients who had surgical consultation for suspected appendicitis were placed on the clinical protocol. Data concerning diagnosis and treatment were collected prospectively. Retrospective data from patients admitted to our institution with acute appendicitis before the clinical protocol were collected as historical controls. RESULTS: One hundred twelve patients were diagnosed and treated by our protocol between June and November 2009. Of these, 100 patients underwent an appendectomy for acute appendicitis. They were compared with 146 patients from 2007. In-house CT use decreased from 71.2% to 51.7% (P = .01). Preoperative ultrasound use increased from 2.7% to 21% (P < .001). The negative appendectomy rate increased (6.8% vs 11%, P = .25). CONCLUSIONS: Our findings suggest that the implementation of an evidence-based clinical protocol for the diagnosis and treatment of acute appendicitis in children may safely decrease the use of CT scans and increase the use of ultrasound.
Assuntos
Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Protocolos Clínicos , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Apendicectomia/métodos , Apendicectomia/estatística & dados numéricos , Criança , Pré-Escolar , Medicina Baseada em Evidências , Feminino , Humanos , Lactente , Masculino , Neoplasias Induzidas por Radiação/prevenção & controle , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Tomografia Computadorizada por Raios X/efeitos adversos , UltrassonografiaRESUMO
Reaction of sulfur ylide with a series of aryl substituted chiral non-racemic sulfinyl imines afforded the corresponding aziridines in high yield and good stereoselection. The sulfur ylides were generated by the thermally induced decarboxylation of carboxymethylsulfonium betaines. A drop in the diastereomeric ratio was observed when going from electron deficient to electron releasing aryl substituted imines. Sulfonium methylidene aziridinations involving the decarboxylation of carboxymethylsulfonium betaine functionality compliments existing technologies with the advantages of the reaction protocol, levels of conversion and scope.
Assuntos
Aneurisma/diagnóstico , Doenças dos Nervos Cranianos/diagnóstico , Artéria Retiniana/patologia , Neovascularização Retiniana/diagnóstico , Vasculite Retiniana/diagnóstico , Sinovite/diagnóstico , Uveíte/diagnóstico , Aneurisma/genética , Aneurisma/terapia , Artrite , Criança , Terapia Combinada , Doenças dos Nervos Cranianos/genética , Doenças dos Nervos Cranianos/terapia , Análise Mutacional de DNA , Angiofluoresceinografia , Glucocorticoides/uso terapêutico , Humanos , Fotocoagulação a Laser , Edema Macular , Masculino , Proteína Adaptadora de Sinalização NOD2/genética , Peptidil Dipeptidase A/sangue , Neovascularização Retiniana/genética , Neovascularização Retiniana/terapia , Vasculite Retiniana/genética , Vasculite Retiniana/terapia , Retinite/diagnóstico , Retinite/genética , Retinite/terapia , Sarcoidose , Sinovite/genética , Sinovite/terapia , Tomografia de Coerência Óptica , Triancinolona Acetonida/uso terapêutico , Uveíte/genética , Uveíte/terapia , Acuidade VisualRESUMO
Thermally induced decarboxylation of carboxymethylsulfonium betaines results in formation of the corresponding sulfur ylides in situ. Decarboxylation rates for a range of arylcarboxymethylsulfonium betaine salts have been determined using NMR spectroscopy, and the efficiency of ylide generation and trapping has been evaluated via methylidene transfer to a range of aldehydes to form epoxides.