Combined Femtosecond Laser-Assisted Cataract Surgery and Small-Gauge Pars Plana Vitrectomy Using Different Devices: A New Trend for Vitreoretinal Surgery?

BACKGROUND AND OBJECTIVE: To report the efficacy, safety, and benefits of femtosecond laser-assisted cataract surgery (FLACS) combined with sutureless 23-gauge pars plana vitrectomy (PPV). PATIENTS AND METHODS: This multicenter, retrospective study evaluated patient records and videos of 43 cases with retinal pathologies and cataract who underwent the combined procedure. RESULTS: In 44.2% and 55.8% of cases, respectively, the LenSx Laser (femtosecond machine; Alcon, Fort Worth, TX) and the Constellation (vitreous cutter; Alcon, Fort Worth, TX), and the Victus (femtosecond machine; Bausch + Lomb, Rochester, NY) and Stellaris PC (vitreous cutter; Bausch + Lomb, Rochester, NY) were used. No complications developed during capsulorrhexis, even without a red fundus reflex, retrobulbar block, or scleral indentation. Foldable intraocular lenses remained stable in the capsular bag during the vitreoretinal surgeries and postoperative visits. The mean times of femtosecond phacoemulsification, vitreoretinal surgery, and total surgery were 22.9 minutes +/- 4.7 minutes, 43.1 minutes +/- 9.8 minutes, and 65.3 minutes +/- 8.6 minutes, respectively. CONCLUSION: This emerging technology is safe and offers several potential benefits for the success of the combined procedure.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo. Sao Paulo, BrazilConselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brasilia, BrazilJose Berrocal Award (Panamerican Vitreoretinal Society, Puerto Rico)Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilUniv Buenos Aires, Inst Oftalmol Alta Complejidad, Buenos Aires, DF, ArgentinaBrazilian Inst Fight Blindness INBRACE, Assis & Presidente Prudente, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilWeb of Scienc

Combined Femtosecond Laser-Assisted Cataract Surgery and Small-Gauge Pars Plana Vitrectomy Using Different Devices: A New Trend for Vitreoretinal Surgery?

BACKGROUND AND OBJECTIVE: To report the efficacy, safety, and benefits of femtosecond laser-assisted cataract surgery (FLACS) combined with sutureless 23-gauge pars plana vitrectomy (PPV). PATIENTS AND METHODS: This multicenter, retrospective study evaluated patient records and videos of 43 cases with retinal pathologies and cataract who underwent the combined procedure. RESULTS: In 44.2% and 55.8% of cases, respectively, the LenSx Laser (femtosecond machine; Alcon, Fort Worth, TX) and the Constellation (vitreous cutter; Alcon, Fort Worth, TX), and the Victus (femtosecond machine; Bausch + Lomb, Rochester, NY) and Stellaris PC (vitreous cutter; Bausch + Lomb, Rochester, NY) were used. No complications developed during capsulorrhexis, even without a red fundus reflex, retrobulbar block, or scleral indentation. Foldable intraocular lenses remained stable in the capsular bag during the vitreoretinal surgeries and postoperative visits. The mean times of femtosecond phacoemulsification, vitreoretinal surgery, and total surgery were 22.9 minutes +/- 4.7 minutes, 43.1 minutes +/- 9.8 minutes, and 65.3 minutes +/- 8.6 minutes, respectively. CONCLUSION: This emerging technology is safe and offers several potential benefits for the success of the combined procedure.Fundacao de Amparo a Pesquisa do Estado de Sao Paulo. Sao Paulo, BrazilConselho Nacional de Desenvolvimento Cientifico e Tecnologico, Brasilia, BrazilJose Berrocal Award (Panamerican Vitreoretinal Society, Puerto Rico)Univ Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilUniv Buenos Aires, Inst Oftalmol Alta Complejidad, Buenos Aires, DF, ArgentinaBrazilian Inst Fight Blindness INBRACE, Assis & Presidente Prudente, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Ophthalmol, Sao Paulo, BrazilWeb of Scienc

Highly active antiretroviral therapy for critically ill HIV patients: A systematic review and meta-analysis

<div><p>Introduction</p><p>It is unclear whether the treatment of an HIV infection with highly active antiretroviral therapy (HAART) affects intensive care unit (ICU) outcomes. In this paper, we report the results of a systematic review and meta-analysis performed to summarize the effects of HAART on the prognosis of critically ill HIV positive patients.</p><p>Materials and methods</p><p>A bibliographic search was performed in 3 databases (PubMed, Web of Science and Scopus) to identify articles that investigated the use of HAART during ICU admissions for short- and long-term mortality or survival. Eligible articles were selected in a staged process and were independently assessed by two investigators. The methodological quality of the selected articles was evaluated using the <i>Methodological Index for Non-Randomized Studies</i> (MINORS) tool.</p><p>Results</p><p>Twelve articles met the systematic review inclusion criteria and examined short-term mortality. Six of them also examined long-term mortality (≥90 days) after ICU discharge. The short-term mortality meta-analysis showed a significant beneficial effect of initiating or maintaining HAART during the ICU stay (random effects odds ratio 0.53, p = 0.02). The data analysis of long-term outcomes also suggested a reduced mortality when HAART was used, but the effect of HAART on long-term mortality of HIV positive critically ill patients remains uncertain.</p><p>Conclusions</p><p>This meta-analysis suggests improved survival rates for HIV positive patients who were treated with HAART during their ICU admission.</p></div

Funnel plot of the effects of highly active antiretroviral therapy (HAART) on <i>short-term</i> mortality–random effects odds ratio.

<p>Funnel plot of the effects of highly active antiretroviral therapy (HAART) on <i>short-term</i> mortality–random effects odds ratio.</p

General characteristics of the studies.

<p>General characteristics of the studies.</p

Highly active antiretroviral therapy systematic review and meta-analysis flowchart.

<p>HAART systematic review flowchart, which shows the procedure used for the selection of the articles for the qualitative and quantitative synthesis. <i>HAART</i> highly active antiretroviral therapy; <i>ICU</i> intensive care unit. PRISMA Model Flow Diagram [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0186968#pone.0186968.ref024" target="_blank">24</a>].</p

Forest plot of the effects of highly active antiretroviral therapy (HAART) on <i>short-term</i> mortality–random effects odds ratio.

<p>Forest plot of the effects of highly active antiretroviral therapy (HAART) on <i>short-term</i> mortality–random effects odds ratio.</p