Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Central corneal thickness in eyes with pseudoexfoliation syndrome in Kashmir Valley - a hospital based study

Introduction: Pseudoexfoliation syndrome (PEX) is characterized by the production and accumulation of extracellular granular fibrillar material in many ocular tissues. Pseudoexfoliation has been closely associated with glaucoma and raised intraocular pressure (IOP) is the most important known risk factor for glaucoma. Central corneal thickness (CCT) may affect the accuracy of IOP measurements. Thus, it is possible to underestimate/overestimate the IOP reading in the PEX syndrome and overlook an early glaucomatous damage. The aim of our study was to determine the central corneal thickness (CCT) in eyes with pseudoexfoliation (PEX). Methods: Total 2076 eyes (of 1224 patients) with pseudoexfoliation on clinical examination were enrolled in this prospective clinical study and CCT was measured in each eye using specular microscopy. Results: Mean CCT (????m) in eyes with Pseudoexfoliation was 525.43 ± 34.27. CCT in eyes with Hypertensive PEX (513.2 ± 27.8) and PEX Glaucoma (509.22 ± 29.76) was significantly thinner than in eyes with Normotensive PEX (528.17± 30.33) (P = 0.001, P = 0.0001, respectively). There was no significant difference in CCT between the fellow eyes in cases of unilateral pseudoexfoliation (P = 0.54). Conclusion: Mean central corneal thickness (CCT) in eyes with pseudoexfoliation is 525.4 µm and CCT is significantly thinner in Hypertensive PEX as well as Glaucomatous PEX eyes than Normotensive PEX eyes

Factors affecting visual outcome in traumatic cataract and its associated ocular injuries - A hospital based study

Background: Ocular trauma is a major cause of visual impairment throughout the world, although little is known about the factors that affect the visual outcome in traumatic cataract in developing countries. Aims and Objectives: To find out the associated ocular injuries and the factors affecting final visual outcome of patients with traumatic cataract. Material Methods: This prospective hospital based study was conducted on 40 patients of traumatic cataract. Patients were managed with lens extraction and intraocular lens implantation. Regular follow up of patients was done and best corrected visual acuity and post operative complications were assessed at the end of six months. Results: Our study showed that majority (50%) of patients were in the age group of < 20 years with male preponderance. visual outcome was significantly better in younger age group (< 20 yrs) than the older group (> 20 yrs) ( p = 0 .03). There was no significant difference in final visual outcome of traumatic cataracts caused by penetrating or blunt trauma ( p = 0.73). Corneal tear was most common associated ocular damage followed by uveitis, lens matter in anterior chamber. Conclusions: Age of the patient affects final visual outcome after surgical treatment of traumatic cataract but type of trauma (blunt / penetrating) had no significant effect on final visual outcome. Corneal tear was most common associated ocular damage