Prognostic Factors Associated with Visual Outcome after Pars Plana Vitrectomy with Internal Limiting Membrane Peeling for Idiopathic Epiretinal Membrane

PURPOSE: Pars plana vitrectomy with internal limiting membrane peeling for idiopathic epiretinal membrane has shown varying results. More data are needed on the factors associated with visual outcome. METHODS: We extracted baseline clinical characteristics, optical coherence tomography (OCT) characteristics and 3-month postoperative best-corrected visual acuity (BCVA). Linear regression analysis was used to evaluate whether baseline and OCT characteristics are associated with BCVA at 3 months as well as BCVA difference. RESULTS: Out of 82 operated eyes, 66 (80%) had a 3-month follow-up, and 47 (71%) showed a 3-month postoperative improvement. Preoperative BCVA was an independent determinant of postoperative BCVA (r = 0.31; p < 0.01) and BCVA difference (r = 0.68; p < 0.01). Other baseline and OCT characteristics showed no independent associations with postoperative outcome. CONCLUSION: Better preoperative BCVA predicts better postoperative BCVA. Other baseline and OCT characteristics are not associated with visual outcome 3 months after surgery

Nosocomial infections after aneurysmal subarachnoid hemorrhage : time course and causative pathogens

BackgroundNosocomial infections after aneurysmal subarachnoid hemorrhage (aSAH) are associated with prolonged length of stay and poor functional outcome. It remains unclear if infections result in prolonged length of stay or, vice versa, if prolonged length of stay results in more infections. Before strategies can be designed to reduce infections after aneurysmal subarachnoid hemorrhage, more data are needed on time course and causative pathogens of infections. AimTo investigate the time course of infection onset and bacterial microorganisms that cause nosocomial infections after aSAH. MethodsIn consecutive patients with aneurysmal subarachnoid hemorrhage admitted to the University Medical Center Utrecht between 2009 and 2011, we analyzed the proportion of patients with infections, day of infection onset, and culture results. ResultsOf the 291 included patients, 107 (37%) patients developed 115 nosocomial infections. Fifty-six patients (19%) developed an infection within the first week. Median day of infection onset was for pneumonia (n=49; 17%) day 4 (interquartile range 3-9), respiratory tract infection (n=16; 6%) day 4 (interquartile range 1-7), urinary tract infection (n=27; 9%) day 11 (interquartile range 7-14), and meningitis/ventriculitis (n=10; 3%) day 19 (interquartile range 9-33). Cultures of infections mostly yielded Staphylococcus aureus (20%), Haemophilus influenzae (15%), and Escherichia coli (14%), ConclusionNosocomial infections after subarachnoid hemorrhage are common and mostly occur in the first week after ictus. Future studies should investigate if general hygienic measures, infection awareness, minimizing the duration of mechanical ventilation and use of catheters/drains, or prophylactic antibiotics reduce infections and improve functional outcome

Patient- and Aneurysm-Specific Risk Factors for Intracranial Aneurysm Growth : A Systematic Review and Meta-Analysis

BACKGROUND AND PURPOSE—: Follow-up imaging is often performed in intracranial aneurysms that are not treated. We performed a systematic review and meta-analysis on patient- and aneurysm-specific risk factors for aneurysm growth. METHODS—: We searched EMBASE and MEDLINE for cohort studies describing risk factors for aneurysm growth. Two authors independently assessed study eligibility and rated quality with the Newcastle Ottawa Scale. With univariable Poisson regression analysis, we calculated risk ratios (RRs) with corresponding 95% confidence intervals (95% CI) of risk factors for aneurysm growth. Heterogeneity was assessed with I. RESULTS—: Eighteen studies on 15 patient-populations described 3990 patients with 4972 unruptured aneurysms. A total of 437 aneurysms (9%) enlarged during 13 987 aneurysm-years of follow-up. Compared with aneurysms ≤4 mm, RRs were 2.56 (95% CI, 1.93–3.39; I=98%) for ≥5 mm, 2.80 (95% CI, 2.01–3.90; I=96%) for ≥7 mm, and 5.38 (95% CI, 3.76–7.70; I=97%) for ≥10 mm. Compared with aneurysms on the middle cerebral artery, the RR for basilar artery was 1.94 (95% CI, 1.32–2.83; I=57%). RRs were 2.03 (95% CI, 1.52–2.71; I=59%) for smoking at baseline, 2.04 (95% CI, 1.56–2.66; I=90%) for multiple unruptured aneurysms, 1.26 (95% CI, 0.97–1.62; I=59%) for women, 1.24 (95% CI, 0.98–1.58; I=40%) for hypertension, and 2.32 (95% CI, 1.46–3.68; I=91%) for irregular aneurysm shape. Compared with other regions, RR was 0.75 (95% CI, 0.58–0.96) for Japan and 0.64 (95% CI, 0.45–0.90) for Finland. CONCLUSIONS—: Most risk factors for aneurysm growth are consistent with risk factors for rupture. In contrast with rupture, the risk of growth was smaller in Japanese and Finnish cohorts compared with other regions. Pooling of individual patient data from low- and high-risk geographical regions is needed to assess independent predictors of aneurysm growth

Perimesencephalic Hemorrhage : A Review of Epidemiology, Risk Factors, Presumed Cause, Clinical Course, and Outcome

BACKGROUND AND PURPOSE: We systematically reviewed the literature on epidemiology, risk factors, presumed cause, clinical course, and outcome of perimesencephalic hemorrhage. METHODS: PubMed, Embase, and the Cochrane Library were searched until March 2016. Quality assessment was done by 2 authors independently. Pooled prevalence ratios and pooled odds ratios with 95% confidence intervals were calculated for data extracted from case-control studies. RESULTS: We included 208 papers. The incidence of perimesencephalic hemorrhage is ≈0.5 per 100.000 person-years, men are more often affected, and no risk factors were confirmed. Two decision analyses both found that a single, high-quality computed tomography angiography is the preferred diagnostic approach. Short-term complications, such as hydrocephalus or cranial nerve palsies, are rare, and usually transient, with the exception of acute symptomatic hydrocephalus necessitating treatment in 3% of patients. Lacunar infarcts in the brain stem were convincingly described in 4 patients only. Fatal rebleeding after installment of anticoagulation in the initial days after the hemorrhage was described in 1 patient. At long-term follow-up, death related to the hemorrhage has not been reported, disability is found in 0% to 6%, and neuropsychological sequelae are suggested. CONCLUSIONS: A single, high-quality computed tomography angiography is the preferred diagnostic strategy. Short-term complications are rare and often transient. Long-term outcome is excellent with respect to disability and death, but high-quality studies focused at neuropsychological sequelae are needed

Effect of endothelin receptor antagonists on clinically relevant outcomes after experimental subarachnoid hemorrhage : a systematic review and meta-analysis

In clinical trials, endothelin receptor antagonists (ETRAs) reduced vasospasm but did not improve functional outcome after subarachnoid hemorrhage (SAH). We assessed the effects of treatment with ETRAs on clinically relevant outcomes in animal studies modelling SAH by performing a systematic review of the literature for controlled animal studies of ETRAs for the treatment of SAH. Primary outcomes were neurobehavioral outcomes and case fatality. Secondary outcomes were cerebral vasospasm and cerebral blood flow. Summary estimates were calculated using normalized mean difference random effects meta-analysis. We included 27 studies (55 experiments, 639 animals). Neurobehavioral scores were reported in none of the experiments, and case fatality in 8 (15%). Treatment with ETRAs was associated with a pooled odds ratio for case fatality of 0.61 (95% confidence interval (CI), 0.27 to 1.39); a 54% increase (95% CI, 39 to 69) in cerebral arterial diameter; and a 93% increase (95% CI, 58 to 129) in cerebral blood flow. We conclude that there is no evidence from animal studies that treatment with an ETRA improves clinically relevant outcomes after SAH. The reduction in cerebral vasospasm observed in animal studies is consistent with that observed in clinical trials, an effect that is not associated with better functional outcome in patients