Medium term results of penetrating keratoplasty

Purpose: This is a retrospective evaluation of penetrating keratoplasty for optical purpose in the Eye Clinic of the Clinical Emergency Hospital "St. Spiridon "Iasi. Methods: The study evaluated 51 eyes of 50 patients, mean age of patients was 50.8 years. Indications for penetrating keratoplasty were: stage IV keratoconus (31.3%), chronic corneal edema (29.4%), corneal dystrophies (17.6%), corneal leukoma (17.6%) and irreversible graft rejection (3.9%). Penetrating keratoplasties were performed by the same surgeon. Postoperatively, patients were evaluated regularly through a comprehensive eye exam. Mean follow-up was 22.7 months post-keratopsy (SD ± 20.8). Results: During follow-up Results: During follow-up 73% did not show any postoperative complication, while 17% of cases showed an increased intraocular pressure; 10% developed acute graft rejection. Survival without acute rejection of the transplant is 95% at one year and 93% at two years. Aphakic or pseudophakic cases have higher risk of developing high intraocular pressure compared to phakic eye (41% vs 3%). Among patients where the keratoplasty was performed on phakic eye (28), only one developed secondary cataract. Glaucoma before the intervention is a risk factor for increased intraocular pressure unlike patients without glaucoma. Also, performing penetrating keratoplasty combined with another procedure in the same operation increases the risk of ocular hypertension in 32% versus 18% for keratoplasty alone. Secondary astigmatism 3 months or more after keratoplasty recorded values between -3.5 and + 5 D. 30 patients(63.8%) had a final visual acuity between 0.3-0.9 Snellen line. 27.4% of patients had a better visual acuity compared to fellow eye. Conclusion: Penetrating keratoplasty results are influenced by preoperative status, type of surgery and also by rigorous long-term follow-up of patients to prevent and address complications as soon as possible

Multiple sclerosis and SARS-CoV-2 infection

Universitatea de Medicină și Farmacie „Grigore T. Popa” Iași, România, Clinica I Oftalmologie, Spitalul Clinic Județean de Urgență „Sf. Spiridon”, Iași, RomâniaSummary. We analyzed the case of a patient with multiple sclerosis associated with SARS-CoV-2 infection. The clinical appearance of the ophthalmologist does not justify the decrease in AV, which is why it is recommended to perform an MRI in an emergency. The patient accuses the decrease in visual acuity in the left eye. The appearance described is suggestive for multiple sclerosis. PCR testing was positive. After 14 days PCR test was negative but the ophthalmological evolution was unfavorable. Intravenous emergency treatment with Solumedrol was initiated for 5 days. The particularity of the case is due to the fulminant onset of multiple sclerosis in the context of SARS-CoV-2 infection and the unfavorable evolution in terms of AV, despite early treatment.Introducere. Pacientă, în vârstă de 16 ani, se prezintă în Clinica I Oftalmologie a Spitalului „Sf. Spiridon”, Iași, acuzând scăderea acuității vizuale la ochiul stâng cu debut acut. Pacienta nu prezintă alte antecedente personale patologice. AVOD=1 fc, AVOS= pmm., PIOAO=12mmHg. La examinarea polului anterior, nu se constată elemente patologice. La examinarea polului posterior, discul optic este normal colorat, are contur net, C/D=0,1, artere și vene cu calibru normal, maculă fără leziuni. Aspectul clinic oftalmologic nu justifică scăderea AV, motiv pentru care se recomandă efectuarea unui RMN în urgență. Se identifică leziuni în hipersemnal T2 și FLAIR cu restricție de difuzie localizată periventricular pe partea dreaptă, în contrast cu cornul posterior al ventriculului lateral drept cu diametru de 17/15 mm și două în centri senzoriali, una mai mare de 9,6mm parietal drept în substanța albă, periventricular, talamic drept, 9,6 mm în medulla oblongata de 13 mm. Aspectul descris este sugestiv pentru scleroză multiplă. Testarea PCR pentru SARS-CoV-2 a avut rezultat pozitiv, pacienta fiind asimptomatică. S-a format o echipă multidisciplinară alcătuită din oftalmologi, neurologi și medici infecționiști și s-a inițiat tratamentul în urgență intravenos cu Solumedrol timp de 5 zile, continuat cu Medrol per os. Evoluție. După 14 zile, testul PCR pentru SARSCoV- 2 s-a negativat, însă evoluția oftalmologică a fost nefavorabilă. Pacienta se prezintă după 3 luni, în urgență, acuzând percepția unui scotom central la OD. AVOD=0,6, iar AVOS a rămas pmm. La RMN leziunile au aspect staționar. După tratamentul intravenos cu Solumedrol 3 zile și per os cu Medrol, scotomul central de la OD se reduce în dimensiuni și AVOD se îmbunătățește la 0,8 fcnc. Discuții: Rămâne în discuție deschisă dacă infecția cu SARS-CoV-2 la persoane nevaccinate poate precipita debutul fulminant al unor patologii în stare latentă. Concluzii. Particularitatea cazului se datorează debutului fulminant al sclerozei multiple în contextul infecției cu SARS-CoV-2 și evoluției nefavorabile din punct de vedere al AV, în ciuda tratamentului instaurat precoce

The Evolvement of OCT and OCT-A in Identifying Multiple Sclerosis Biomarkers

The prevalence of multiple sclerosis (MS) has been increasing among young people in developing countries over the last years. With the continuous development of new technology, the diagnosis and follow-up of these patients has received new parameters that physicians may use in their practice. This paper reviews the main biomarkers identified through Optical Coherence Tomography Angiography (OCT-A) involved in the development and progression of MS and investigates the role it may have in detecting changes to the central nervous system (CNS)

Stress and Burnout among Medical Specialists in Romania: A Comparative Study of Clinical and Surgical Physicians

This study, which focuses on 227 participants (196 females and 31 males) comprising 187 clinical specialists and 40 surgical physicians, examines the prevalence of burnout in medical specialists. We investigate the effects of the emotional exhaustion (EE), Depersonalization (D), and personal accomplishment (PA) dimensions on professional satisfaction and plans to change careers using the modified licensed Maslach Burnout Inventory—Human Services Survey (MBI-HSS (MP)). High emotional exhaustion is reported by 52.63% of men and 71.28% of women in the clinical medicine group (n = 188). In the surgical specialties (n = 39), scores are significantly higher, with 75% of men and 77.77% of women reporting EE. In our sample group, 71.36% express high levels of emotional exhaustion, with similar patterns across specialization and gender. Clinical medicine respondents report high degrees of depersonalization in 33.13% of females and 21.05% of males, while surgical specialty respondents report high levels in 33.33% of females and 50% of males. Across genders and specializations, 33.03% of all respondents show high levels of depersonalization. Clinical medicine participants report high levels of personal accomplishment (42.60% of females and 42.10% of males), whereas surgical specialties report 44.44% of females and 66.66% of male on the PA dimension. Of the total number of respondents, 44.05% report having a high level of personal accomplishment; differences exist depending on specialty and gender. In addition, questions regarding professional fulfilment and intention to change careers were presented to the participants. A total of 53.40% (16 male and 105 female) of the clinical medicine respondents said they intended to change careers, while 33 participants (9 male, 34 female) doubted if they would remain in the same specialization. Furthermore, 86 individuals (9 male and 77 female) in the surgical specialties said they would never choose to work in healthcare again. Regression analysis suggests that being male, higher in age, and working in surgical specialties with lower job satisfaction and a higher intention to change profession are associated with higher levels of EE. Age and work satisfaction are significant predictors of depersonalization, and higher career satisfaction is associated with increased levels of PA

Prognostic Significance of Multifactorial Analysis in Complex Cervical Aero-Digestive Trauma Cases

Background and Objectives: In the context of complex aerodigestive cervical traumas, the prognosis and outcome heavily depend on risk factors, particularly injuries to the larynx, trachea, major digestive tissues, cervical vertebrae, and vascular structures. With the increasing prevalence of trauma as a public health concern, there is a pressing need for epidemiological research and the implementation of preventative measures. The purpose of this research is to establish the profile of the predictable impact factors that determine the prognosis of patients with complex cervical trauma. Methods and Methods: The study group consisted of 106 patients with complex cervical trauma pathology developed by various mechanisms such as car accidents, home-related accidents, aggression, gunshot wounds, and self-inflicted attempts, resulting in hospitalization in the E.N.T. Clinic at “St. Spiridon” Iași Hospital, from 2012 to 2016; medical records were the source of the collected data. Results: Hemodynamic instability upon admission associated with age, muscle and laryngeal injuries, and anemia were identified as negative prognostic factors. Additionally, the utilization of imaging-based paraclinical investigations for diagnosing traumatic lesions emerged as a positive prognostic factor in managing this pathology. The management of penetrating cervical trauma remains a subject of debate, with some advocating for surgical exploration beyond the platysma layer in all cases, while others argue for a more selective conservative approach due to a high rate of negative explorations. Conclusions: The statistical evaluation of epidemiological, clinical, lesion, paraclinical, and therapeutic parameters is needed to establish predictable risk factors in the prognosis of complex aerodigestive cervical trauma

Clinical Study on the Ocular Manifestations in Patients with Obstructive Sleep Apnea Syndrome—Preliminary Results

Obstructive sleep apnea syndrome is a multisystemic disorder associated with a series of side effects. Obstructive sleep apnea syndrome (OSAS) includes hypoxemia and is correlated with an increased incidence for various neuronal conditions, including glaucoma, strokes, reduced mental ability, depressive disorders, peripheral neuropathy, and non-arteritic ischemic optic neuropathy. This study’s aims are the evaluation of the degree of ocular surface damage in obstructive sleep apnea patients (in the absence of the continuous positive airway pressure treatment) and the structural changes in the optic nerve, and to establish correlation between the degree of damage to the ocular surface (eye dryness by Schirmer test) and corneal biomechanics by ocular response analyzer. The subjects included in the study will be grouped as follows: a group of patients with glaucoma and obstructive sleep apnea syndrome that will be compared to patients with glaucoma only as well as identifying the evolution of structural changes in patients with glaucoma and sleep apnea syndrome. A prospective study included 65 eyes from 65 subjects diagnosed with obstructive sleep apnea (45 eyes of 45 subjects with glaucoma and OSAS as well as 20 subjects, 20 eyes with dry-eye syndrome and OSAS) who did not follow the continuous positive airway pressure treatment. The control group consisted of 45 subjects (45 eyes) with (mild or moderate) primary open-angle treated glaucoma without obstructive sleep apnea. All patients had ophthalmologic evaluations according to a standardized protocol. Moreover, respiratory functional parameters (apnea–hypopnea index—AHI) and the body mass index were recorded. Within the studied group, patients with mild or moderate primary open-angle glaucoma, with moderate or severe dry-eye syndrome, patients with floppy-eyelid syndrome, with optical non-arteritis ischemic neuropathy, and a patient with retinal central vein occlusion were identified. The increased rate of the apnea syndrome during sleep produces a severe disorder of the ocular surface and a retinal neuro-degenerative disorder. The eyes of patients with sleep apnea syndrome (SAS) and glaucoma have lower mean intraocular pressure than eyes with glaucoma without SAS. However, the mean C/D ratio in eyes with glaucoma correlates with the severity of SAS. There is a positive correlation between the severity of the apnea and the ocular disorder’s degree similar to the studies in the literature review. The joint cooperation between the sleep specialists and ophthalmologists can lead to the improvement of the vascular and ocular status for the obstructive sleep apnea patients