Acoustic neuroma surgery and delayed facial palsy

Delayed onset of facial palsy is possibly an underestimated but distressing complication of acoustic neuroma surgery. The incidence of this complication reported in the literature has varied from 11.7 to 41%. This study reviewed retrospectively 60 primary acoustic neuroma surgeries performed by a single neurotologist. The dee-layed onset of facial dysfunction was defined according to the guidelines described by of Lalwani Butt, Jackler, Pitts and Jingling in 1995. They considered either a deterioration of facial function from normal to abnormal or an increased severity of the degree of facial paralysis, which was grouped using the House-Brackmann scale system. Fifteen of the 60 patients (25%) were found to have a deterioration of facial function. The incidence of delayed facial palsy was not influenced by age, sex or tumor size. The majority of the patients had a favorable prognosis. Only three patients had a grade III-IV facial function at 1 year. It is possible that these latter cases might have benefited from intraoperative meatal facial nerve decompression, as advocated by Sargent, Kartush and Graham

Acanthamoeba keratitis: perspectives for patients

Purpose: To unveil the long-term prognosis of Acanthamoeba keratitis based on clinical presentation and timing of diagnosis to better inform patients since the first visit regarding their length of treatment, quality of life, and visual function.Methods: Retrospective observational study enrolling patients with Acanthamoeba keratitis from 1994 to 2019. Patients with a complete eye examination and medical records were analyzed. The severity of the disease, the time from onset of symptoms to the appropriate therapeutic regimen, the time until clinical resolution, visual function, and long term follow-up was evaluated. Quality of life was assessed at the last follow-up visit by means of the VFQ-25 questionnaire.Results: Thirty-five patients (40 eyes) were assessed. The overall healing time of patients with Acanthamoeba keratitis was 12.5 ± 3.5 months, while patients with a severe corneal ulcer (stage III) had a significant longer healing time (16.2 ± 3.7 months) compared to patients with stage II (7.04 ± 0.7 months) or I (7.7 ± 1.5 months; p < .05). Patients who received a prompt therapy (<30 days form symptoms onset) had a reduced healing time compared to patients with a delayed diagnosis (p < .01). Quality of life was assessed after a mean of 11.7 ± 4.7 years and it was mildly reduced (86.6 ± 17). Patients that were diagnosed early (<30 days from onset) showed a lower reduction in quality of life than in patients that were diagnosed >30 days from onset. After resolution, 59% of the patients considered unnecessary any further proposed surgical intervention.Conclusions: Delayed diagnosis of Acanthamoeba keratitis and disease severity significantly increases healing time and duration of treatment. The time to diagnosis and disease stage at diagnosis predicts the duration of treatment, the final outcome, quality of life, and the requirement of surgery. These data would allow us to promptly inform patients about long-term disease timeline, future outcomes, improving disease acceptance, and quality of life

Lamellar macular holes: monitoring and management strategies

Lamellar macular holes are a vitreoretinal condition characterized by abnormalities in foveal contour with splitting of the neuroepithelium and often an intact photoreceptor layer. Recent developments in high-resolution imaging have increased our ability to study the details of the vitreoretinal interface and to distinguish between different forms of lamellar holes. A new classification is needed to help clinicians in the management of lamellar macular holes. Some clinicians prefer to observe these clinical entities, especially when visual acuity is maintained or alterations of the photoreceptor layer are present. Nevertheless, lamellar holes may sometimes progress, and visual acuity can deteriorate. On the other hand, surgical treatment may lead to positive anatomical and functional outcomes, but not without risks. This review provides a critical overview of the available data on lamellar macular holes, focusing on diagnosis and managing options

Inflammaging at ocular surface: clinical and biomolecular analyses in healthy volunteers

PURPOSE. To assess the ocular surface in volunteers who consider themselves as healthy, in order to evaluate how para-inflammatory mechanisms fail with age, and thus investigate the phenomenon of "InflammAging.''METHODS. In this observational prospective cohort study, volunteers were categorized into three groups according to age: young (19-40 years), middle-aged (41-60 years), and older adults (61-93 years). Clinical assessments included tear breakup time (T-BUT) and Schirmer test type I. Dry eye symptoms were evaluated by the Ocular Surface Disease Index (OSDI) questionnaire. Conjunctival mRNA and protein expression of intercellular adhesion molecule-1 (ICAM-1), MUC5AC, and IL-8 were measured by real-time PCR and immunofluorescence.RESULTS. A total of 82 volunteers (38 males and 44 females) were enrolled. T-BUT decreased significantly with increasing age (young: 11.13 +/- 0.18 seconds; middle-aged: 10.83 +/- 0.56 seconds; older: 9.00 +/- 1.00 seconds, P < 0.05). Schirmer test values decreased significantly with age (young: 20.6 +/- 1.0 mm; middle-aged: 19.2 +/- 1.2 mm; older: 16.0 +/- 1.1 mm, P < 0.05). OSDI scores increased with age in both groups, but they were substantially higher in women. Conjunctival expression of inflammatory markers ICAM-1, IL-8, and MUC5AC increased with age.CONCLUSIONS. Clinical signs, symptoms, and biomarkers of chronic inflammation increased with age in a cohort of volunteers who considered themselves healthy, indicating an age-related progressive impairment of ocular surface system function

Challenges in acanthamoeba keratitis: a review

To review challenges in the diagnosis and management of Acanthamoeba keratitis (AK), along with prognostic factors, in order to help ophthalmologists avoid misdiagnosis, protracted treatment periods, and long-term negative sequelae, with an overarching goal of improving patient outcomes and quality of life, we examined AK studies published between January 1998 and December 2019. All manuscripts describing clinical manifestations, diagnosis, treatment, prognosis, and challenges in short- and long-term management were included. The diagnosis of AK is often challenging. An increased time between symptom onset and the initiation of appropriate therapy is associated with poorer visual outcomes. The timely initiation of standardized antiamoebic therapies improves visual outcomes, decreases the duration of treatment, and reduces the chances of needing surgical intervention. In clinical practice, AK diagnosis is often missed or delayed, leading to poorer final visual outcomes and a negative impact on patient morbidity and quality of life

[Day surgery and otologic diseases].

The aim of the present work was to check the results obtained in a group of patients suffering from otological pathologies who had undergone day surgery. In addition, to determine the reliability and validity of this form of out-patient surgery in otology, complications were compared with a similar group of patients who had undergone surgery under normal hospital in-patient conditions. The study only viewed patients hospitalized for otological pathologies from January 1995 to April 1998. During this period of time 90 patients with varying degrees of otological pathologies underwent out-patient day surgery. This surgical activity was then compared to the same type of surgery performed under normal in-patient hospitalization. During the post-operative phase of day surgery, only 7 patients (7.7%) had to be fully hospitalized: 5 complaining of dizziness, the other 2 with fever that ruled out discharge in the evening. In all cases, after hospitalization for the night the patient could be safely discharged. In the normally hospitalized in-patients, complications arose in 14 cases (8.6%) with fever being the most common complication (8 patients). On the basis of the results, it appears that nearly all otological pathologies can be treated in day surgery. This solution limits complications and ensures good economic management; it results in savings and improved organization, reduces the waiting lists and rationalizes use of the operating rooms. Moreover, it must be pointed out that the program was highly appreciated by the patients who could better schedule their own activities, both work and social-family obligations. This aspect is quite important in view of a broader outlook on the economics of the national health system as it shows a savings, not only in the health costs, but also in the overall labor costs

Multiple paragangliomas of the head and neck.

Multiple paragangliomas of the head and neck are rare conditions. The incidence of multiple paragangliomas is reported to the approximately 10% of the total patients, but in familial cases it increases up to 35-50%. In the head and neck region, the most common association is represented by bilateral carotid body tumors or by carotid body tumor associated with tympanic-jugular glomus. The presence of three synchronous glomus tumors is really rare, as well as association with vagal glomus and carotid body. In this paper the authors present a patient affected ipsilaterally by a carotid body tumor and vagal paraganglioma, focusing on the diagnostic options offered by imaging techniques (CT and MRI)

Cerebrospinal fluid leak management following cerebellopontine angle surgery

Objective: Postoperative cerebrospinal fluid leak (CSF) is a serious complication of the cerebellopontine angle surgery. In the current literature, CSF leak rates vary from 8.1 to 20%. The various options in managing this troublesome complication include conservative treatment or invasive surgical repair. The focus of this report is to retrospectively analyze our experience on this specific topic reviewing the incidence of CSF leak and the outcomes of its treatment in a group of patients who underwent surgery for different pathology of the cerebellopontine angle. Method: Eighty-five patients who underwent primary surgical procedures performed by a single neurologist were selected for this study. There were 70 surgical removals of acoustic neuromas, and 15 other cerebellopontine lesions. Results: The overall incidence of CSF leak in the total group analyzed was 17.6%. There were five CSF rhinorrheas and 10 wound CSF leaks. Ten acoustic neuromas and five other cerebellopontine angle lesions exhibited this complication. The leak was cured in 53.3% of the cases using a continuous lumbar cerebrospinal fluid drainage (CLCFD). In two patients, the leak was treated with an extradural repair. Conclusions: Although CLCFD is not routinely used in the treatment of the CSF leak, it proved to be an efficacious and safe option, confirmed by no meningitis observed in our patients treated with this method