Limb salvage surgery in chronic osteomyelitis : a case report

Osteomyelitis refers to an infection of the bone characterized by progressive inflammatory destruction caused by infecting microorganism. Open fracture carries the risk of developing osteomyelitis from 3 to 50% with a high amputation rate. Salvage of the limb is always a challenge and needs perseverance. We report the case of a 44-year-old male with chronic osteomyelitis with successful multiple limb salvage surgeries. The curative approach to chronic osteomyelitis has the following goals including arrest of infection, pain reduction and salvage of limb and function. With regard to survival and function, the result obtained in this case is more promising compared to above knee amputation

Unilateral ischemic central retinal vein occlusion in a young healthy adult: a case report

Central retinal vein occlusion (CRVO) is an obstruction of central retinal vein due to the impingement from the fellow central retinal artery. It is the second most common retinal vascular disease after diabetic retinopathy. Risk factor of CRVO includes diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, male gender and age above 50 years; with 90% of the cases occurred in individual aged 55 years and above. We report a rare case of left eye ischemic CRVO in a 24-year-old healthy gentleman who later on found out to have hypercholesterolemia. He presented with a sudden onset of reduced vision of his left eye. Examination revealed visual acuity (VA) of the left eye was 6/120. Fundus examination showed marked papilloedema with dilated and tortuous blood vessels and extensive flame-shaped hemorrhages with cotton wool spots in all four retinal quadrants. There was a presence of macular edema as well. The ancillary tests confirmed the diagnosis of left eye ischemic CRVO with significant macular edema. The blood investigation revealed elevated cholesterol levels. For treatment, 6 times of monthly intravitreal Ranibizumab injections were planned for the macular edema and oral Atorvastatin 40 milligrams daily was started. Following the intravitreal Ranibizumab injection, his VA has significantly improved with a reduction of macular edema. This report highlights the importance of prompt diagnosis and investigation of CRVO, especially in the younger age group. Early treatment of macular edema secondary to CRVO is able to reduce the edema thus leads to VA improvement

The outcome of Descemet membrane endothelial keratoplasty (DMEK) with different tamponade material.

OBJECTIVE: To compare the outcome of different tamponade material in Descemet membrane endothelial keratoplasty (DMEK). METHODS: Retrospective, interventional case series that includes 8 patients underwent DMEK performed by a single surgeon within Covid-19 pandemic period. All donor tissues were stripped by the operating surgeon with endothelial cell density of > 2400 cells/mm2. The tamponade material used were air in 2 patients, 20% sulfur hexafluoride (SF6) gas in 3 patients and 12% perfluoropropane (C3F8) gas in 3 patients. The main outcomes were graft detachment rate, rebubbling rate and graft survival rate. RESULTS: The overall graft detachment rate was 25% (2 patients). The graft detachment rate was 0% in 20% SF6 gas group compared to 50% (1 patient) from air tamponade group and 33.3% (1 patient) from 12% C3F8 gas group (p<0.05). The patient from air group underwent rebubbling twice while another patient from 12% C3F8 gas group underwent once. The overall survival rate was 75% (6 patients). All of them did not have graft detachment. CONCLUSION: 20% SF6 gas provides superior tamponade effect compared to both air and 12% C3F8 gas. The detachment rate influenced graft survival. Air tamponade showed higher rebubbling rate