Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report

Motoko Kawashima1, Shinichi Kawashima2, Murat Dogru1,3, Makoto Inoue4, Jun Shimazaki1,51Department of Ophthalmology, Tokyo Dental College, Chiba, Japan; 2Department of Ophthalmology, International University of Health and Welfare, Tokyo, Japan; 3Department of Ocular Surface and Visual Optics, Keio University School of Medicine, Tokyo, Japan; 4Kyorin Eye Center, Tokyo, Japan; 5Department of Ophthalmology, Keio University School of Medicine, Tokyo, JapanIntroduction: Severe ocular trauma requires emergency surgery, and a fresh corneal graft may not always be available. We describe a case of perforating eye injury with corneal ­opacity, suspected endophthalmitis, and an intraocular foreign body. The patient was successfully treated with a two-step procedure comprising endoscopy-guided vitrectomy followed by corneal transplantation. This surgical technique offers a good option to vitrectomy with simultaneous keratoplasty in emergency cases where no graft is immediately available and there is the ­possibility of infection due to the presence of a foreign body.Case presentation: A 55-year-old Japanese woman was referred to our hospital with a ­perforating corneal and lens injury sustained with a muddy ferrous rod. Primary corneal sutures and lensectomy were performed immediately. Vitreoretinal surgery was required due to ­suspected endophthalmitis, vitreous hemorrhage, retinal detachment, dialysis and necrosis of the peripheral retina. Instead of conventional vitrectomy, endoscopy-guided vitreous surgery was performed with the Solid Fiber Catheter AS-611 (FiberTech, Tokyo, Japan) due to the presence of corneal opacity and the unavailability of a donor cornea. The retina was successfully attached with the aid of a silicon oil tamponade. Following removal of the silicon oil at 3 months after surgery, penetrating keratoplasty and intraocular lens implantation with ciliary sulcus suture fixation were performed. At 6 months after penetrating keratoplasty, the graft remained clear and visual acuity was 20/40.Conclusion: Primary endoscopic surgery for vitreoretinal complications in eyes with perforating injury performed prior to penetrating keratoplasty appears to be advantageous in terms of avoiding damage to the corneal endothelium.Keywords: vitreoretinal surgery, emergency, foreign bod

Is it essential to perform preoperative diagnostic curettage in patients scheduled for uterine myoma surgery?

Objective: Uterine myoma, which arises from the myometrium of uterus, is among the most common benign tumors of women. Generally, it has an asymptomatic character, however, in symptomatic cases, it presents with abnormal uterine bleeding. The objective of this study is to determine whether preoperative diagnostic curettage is essential or not by comparing the preoperative and postoperative endometriums of patients that underwent surgery with uterine myoma diagnosis. Material and Method: In this study,260 patients that received surgery with uterine myoma diagnosis in the Gynecology and Obstetrics Department of Taksim Education and Research Hospital in Istanbul between January 2007 and January 2010, were included. The histopathologic analysis of specimens obtained by preoperative curettage and hysterectomy, was carried out in a retrospective fashion. Results: The mean age of patients was 48.3 ± 7.5 years. The distribution of preoperative curettage specimens with regard to endometrial status was as follows: phase compatible endometrium in 156 (60%), endometrial polyp in 74 (28.5%), atrophic endometrium in 20 (7.7%), and endometrial hyperplasia in 10 patients (3.8%). Among the phase compatible endometriums, 85 patients (54.5%) had proliferative endometrium, 39 patients (25%) had late secretory phase endometrium, and 32 patients (20.5%) had early secretory phase endometrium. The distribution of postoperative hysterectomy specimens with regard to endometrial status was as follows: Phase compatible endometrium in 160 patients (61.5%), endometrial polyp in 61 patients (22.5%), endometrial hyperplasia in 14 patients (5.4%), and atrophic endometrium in 25 patients (9.6%). Among the phase compatible endometriums; 96 patients (60%) had proliferative endometrium, 44 patients (27.5%) had late secretory endometrium, and 20 patients (12.5%) had early secretory endometrium. Conclusion: No difference was observed between the histopathologic results of diagnostic curettage and hysterectomy relative to malignancy or a pathology that would change the surgery plan. The result is very important because it shows that performing curettage before myoma surgery is not an essential procedure. In this study, since endometrial cancer may not have been detected due to limited number of patients, further studies including higher number of patients are required to confirm our results

A Bimodal Extension of the Generalized Gamma Distribution

A bimodal extension of the generalized gamma distribution is proposed by using a mixing approach. Some distributional properties of the new distribution are investigated. The maximum likelihood (ML) estimators for the parameters of the new distribution are obtained. Real data examples are given to show the strength of the new distribution for modeling data.Una extensión bimodal de la distribución gamma generalizada es propuesta a través de un enfoque de mixturas. Algunas propiedades de la nueva distribución son investigadas. Los estimadores máximo verosímiles (ML por sus siglas en inglés) de los parámetros de la nueva distribución son obtenidos. Algunos ejemplos con datos reales son utilizados con el fin de mostrar las fortalezas de la nueva distribución en la modelación de datos

Amniotic membrane transplantation for wound dehiscence after deep lamellar keratoplasty: a case report

<p>Abstract</p> <p>Purpose</p> <p>To report amniotic membrane (AM) transplantation in a patient with wound dehiscence 5 months after deep lamellar keratoplasty (DLKP)</p> <p>Methods</p> <p>The patient was an 84-year-old Japanese man who had undergone right DLKP 5 months earlier for central corneal scarring due to recurrent stromal herpetic keratitis. He developed wound dehiscence with corneal stromal melting due to recurrence of stromal herpes in both the donor and recipient sites. "AM roll-in filling technique" and AM patching were performed.</p> <p>Results</p> <p>Following AM transplantation, stromal inflammation subsided and complete epithelization occurred within 10 days of surgery.</p> <p>At 8 months postoperatively, biomicroscopy revealed stable wound apposition or stromal gain. Following AM transplantation, stromal inflammation subsided and complete epithelialization was achieved within 10 days after surgery.</p> <p>Conclusion</p> <p>AM transplantation may offer an effective treatment modality for herpetic corneal wound dehiscence after DLKP.</p