Efficacy of Three Different Prophylactic Treatments for Postoperative Nausea and Vomiting after Vitrectomy: A Randomized Clinical Trial

Postoperative nausea and vomiting (PONV) after vitreoretinal surgery may potentially be associated with severe complications, such as suprachoroidal hemorrhage. The purpose of the present multicenter clinical trial (NCT02386059) was to assess the efficacy of three different prophylactic treatments for PONV after vitrectomy under local anesthesia. Patients undergoing primary vitrectomy were randomized to the control arm or to one of the treatment arms (4 mg ondansetron, 4 mg dexamethasone, combination of the two drugs). The primary outcome measure was the proportion of complete response (no nausea, no vomiting, no retching, and no use of antiemetic rescue medication) during 24 h after vitrectomy. Secondary outcomes included the severity standardized score of PONV, postoperative pain standardized score, and rate of ocular and non-ocular adverse events. Baseline demographics of the 1287 patients were comparable between the four arms. The combined therapy group showed a statistically significant lower incidence of PONV compared to the placebo and monotherapy (p < 0.001). PONV severity was also reduced in the combination group compared to the others (p < 0.001). Postoperative pain scores and adverse events were comparable among the four groups. Combined therapy with dexamethasone and ondansetron was the most effective treatment for reducing the incidence and severity of PONV in patients undergoing vitrectomy under local anesthesia

Comparison of perioperative parameters in one-handed rotational phacoemulsification versus conventional phacoemulsification and femtosecond laser-assisted cataract surgery

AIM: To compare perioperative parameters of one-handed rotational phacoemulsification technique (one-handed phaco-roll) with each of other two techniques, “Divide et Conquer” and femtosecond laser-assisted cataract surgery (FLACS) METHODS: In this retrospective and comparative cohort study, eyes with uncomplicated cataract (nuclear density grade 2 to 3) treated routinely with one-handed phaco-roll (n=23; Group 1) or “Divide et Conquer” (n=23; Group 2) or FLACS (n=23; Group 3) were enrolled. Intraoperative parameters including effective phaco-time (EPt), ultrasound time (USt), aspiration time, surgical time, phacoemulsification (phaco)-power, balanced salt solution (BSS) use, cumulative dissipated energy (CDE) were recorded and compared. Clinical outcomes including best corrected visual acuity (BCVA), corneal endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT) and central macular thickness (CMT), were assessed and compared pre-operatively and at 1mo after surgery. RESULTS: Aspiration and surgical time, and BSS used were lower in Group 1 (P<0.01) than other groups. EPt, phaco-power and CDE were lower in Group 1 (P<0.05) than Group 2 but not significantly different from Group 3. In Group 1, USt was lower (P<0.05) than Group 2 but higher (P<0.05) than Group 3. BCVA improved in all groups without significant difference between Group 1 and the other ones. No significant differences regarding all post-operative morphologic outcomes (ECD, ECL, CCT, CMT) were reported. No clinical complications occurred. CONCLUSION: One-handed phaco-roll seems to be less time-consuming than “Divide et Conquer” and FLACS and less energy-consuming than “Divide et Conquer”. Furthermore, one-handed phaco-roll seems to have an equal safety profile compared to the other two techniques

Difference between arterial pressure in clino- and orthostatism. A method for evaluating preparation for pheochromocytoma intervention

Four patients with pheochromocytoma underwent pre-surgical treatment with phenoxybenzamine and volemic expansion. The postural hypotension was evaluated by daily monitoring of the arterial pressure and heart rate in clino orthostatism. The patients underwent surgery and hemodynamic monitoring by Swan-Ganz catheter when postural hypotension was at the lowest level. Hemodynamic data were: elevated cardiac output, normal systemic vascular resistance and filling pressure. These results confirm that the orthostatic hypotension reduction is a valid indication to evaluate the effectiveness of the treatment period with phenoxybenzamine and volemic expansion

Transanal microscopic surgery in the treatment of recurrent rectal cancer in the elderly

http://www.sciencedirect.com/science/article/pii/S0748798312009377# ------ Background: Transanal microscopic surgery is an important application of minimally invasive surgery of the rectum, allowing complex intervention by transanal excision of full-thickness resection with anastomotic reconstruction. Transanal endoscopic microsurgery (TEM) can have a diagnostic and therapeutic value in the treatment of relapse in the elderly. Methods: Between January 2002 and December 2010, 7 patients (5 men and 2 women; mean age, 66 years) with early rectal cancer recurrence were selected for this palliative surgical procedure for recurrent tumor from adenocarcinoma of the rectum. Four men and 1 woman had undergone ultra-low anterior resection, followed by chemo- or radiotherapy (T3N1M0); one woman had received TEM (T1NxM0) and one man underwent local excision after neoadiuvant chemo/radio therapy (T2NxM0). The patients were selected according to rigid sigmoidoscope, echo transrectal colonoscopy and abdominal echo ultrasound to rule out liver metastases, computed tomography (CT) and magnetic resonance imaging (MRI) of the abdomen and pelvis, with and without contrast material, and positron- emission tromography-CT. The lesions were superficial (<2 cm) and localized to the posterior wall of the rectum. Results: Follow-up was approximately 12-28 months; histopathologic staging confirmed the complete excision of recurrences. The patients were then referred for complementary therapies. Only 1 patient presented with retrorectal abscess, which was treated with conservative techniques. Conclusion: The significance of local recurrence for conservative treatment of adenocarcinoma of the rectum is still controversial because the recurrence is an expression of tumor spread uncontrolled by surgical and radio- or chemotherapy. The alternative to conservative surgery is an abdominoperineal resection according to Miles, but this highly invasive procedure can be considered palliative in the majority of recurrences. Based on equal cancer treatment, the reduction of surgical trauma and preservation of anatomical integrity are an important result

Anterior capsule staining using micronized triamcinolone in the absence of red reflex

We describe a technique to stain the anterior lens capsule with micronized triamcinolone to perform a continuous curvilinear capsulorhexis (CCC) during phacoemulsification in the absence of a red reflex due to vitreous hemorrhage. After a self-sealing clear corneal tunnel incision is performed using a 2.75 mm blade, a dispersive ophthalmic viscosurgical device (OVD) is injected to protect the iridocorneal angle. An air bubble as large as possible is injected into the center of the anterior chamber, and a small amount of micronized triamcinolone is then injected as needed to stain the anterior lens capsule. The OVD injection permits the removal of excessive triamcinolone and protects the corneal endothelium from damage during phacoemulsification. A capsulorhexis forceps is used to perform the CCC. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned

Variable outcome of photodynamic therapy for choroidal neovascularization associated with choroidal nevus.

PURPOSE: To report five cases of classic choroidal neovascularization (CNV) associated with choroidal nevus treated with photodynamic therapy (PDT) with verteporfin. METHODS: The patients underwent an ophthalmologic evaluation, including fluorescein angiography and indocyanine green angiography. Clinical and angiographic data were retrospectively analyzed to evaluate visual acuity outcomes and both clinical evolution and angiographic evolution. RESULTS: Two patients presented with subfoveal CNV, and three had juxtafoveal CNV. The mean follow-up was 25.8 months. Visual outcomes were extremely variable. Indeed, best-corrected visual acuity decreased in three eyes, stabilized in one case, and improved in the other case. The number of PDT sessions necessary to obtain CNV stabilization with cessation of fluorescein leakage varied from one to six. CONCLUSION: Bearing in mind that both the natural history and the post-PDT outcome may be extremely variable, further studies are needed to assess the real benefit of PDT for classic CNV secondary to choroidal nevus