Long-term follow-up for bimanual microincision cataract surgery: Comparison of results obtained by surgeons in training and experienced surgeons

Purpose: To determine the efficacy of bimanual microincision cataract surgery (B-MICS) performed by surgeons in training, evaluating clinical results, posterior capsule opacification (PCO) incidence, and clear corneal incision (CCI) architecture in a long-term follow-up and comparing results with those obtained by experienced surgeons. Patients and methods: Eighty eyes of 62 patients operated on by three surgeons in training who used B-MICS technique for the first time were included in the study (Group A). Eighty eyes of 59 patients who underwent B-MICS by three experienced surgeons were included as a control group (Group B). Best corrected visual acuity, astigmatism, corneal pachymetry, and endothelial cell count were evaluated before surgery and at 1 month and 18 months after surgery. Anterior segment optical coherence tomography images were obtained to study the morphology of CCIs. PCO incidence was evaluated using EPCO2000 software. Results: Out of 160 surgeries included in the study, mean best-corrected visual acuity improvement at 18 months was 0.343\ub10.246 logMAR for Group A, and 0.388\ub10.175 logMAR for Group B, respectively. We found no statistically significant induced astigmatism nor corneal pachymetry changes in either group, while we noticed a statistically significant endothelial cell loss postoperatively in both groups (P < 0.05). In Group A, mean PCO score was 0.163\ub10.196, while for Group B, it was 0.057\ub10.132 (P=0.0025). Mean length and inclination of the CCIs for Group A and Group B were, respectively, 1,358\ub1175 \ub5m and 1,437\ub1256 \ub5m and 141.8\ub0\ub16.4\ub0 and 148.7\ub0\ub15.1\ub0. As regards corneal architecture in the 320 CCIs considered, we found posterior wound retractions and endothelial gaps, respectively, 9.8% and 11.6% for Group A and 7.8% and 10.8% for Group B. Conclusion: B-MICS performed by surgeons in training is an effective surgical technique even when assessed after a long-term follow-up. PCO incidence resulted in being higher for less experienced surgeons. Corneal incisions were shorter and less angled in surgeons in training in comparison with results obtained by expert surgeons

Chemical injury treated with autologous limbal epithelial stem cell transplantation and subconjunctival bevacizumab

Limbal stem cell (LSC) deficiency leads to corneal opacity due to a conjunctivalization of the corneal surface. LSC transplantation, which can be followed by corneal keratoplasty, is an effective procedure to restore corneal transparency; however, a common cause of failure of this procedure is neovascularization (NV)

Results and complications of surgeons-in-training learning bimanual microincision cataract surgery

PURPOSE: To evaluate visual outcomes and complications of bimanual microincision cataract surgery performed by surgeons in training. SETTING: Institute of Ophthalmology, University of Modena and Reggio Emilia, Modena, Italy. DESIGN: Prospective case series. METHODS: The corrected distance visual acuity (CDVA), astigmatism, corneal pachymetry, and endothelial cell count were evaluated before and 7 and 30 days after bimanual MICS performed by surgeons in training. Intraoperative and postoperative complications were also recorded. RESULTS: Three surgeons in training performed bimanual MICS in 150 eyes of 131 patients. There were 18 intraoperative complications (12.0%) (10 iris traumas [6.6%]; 4 capsule ruptures without vitreous loss [2.7%]; 3 capsule ruptures with vitreous loss [2.0%]; 1 intraocular lens [IOL] implantation in the sulcus due to zonular laxity [0.7%]). There were 5 postoperative complications (3.3%) (2 iris prolapses [1.3%]; 1 IOL loop malposition [0.7%]; 1 narrowing of anterior chamber [0.7%]; 1 capsulorhexis phimosis [0.7%]). Thirty days postoperatively, the mean CDVA improvement was 0.53 ± 0.20 (Snellen decimal) (P &lt; .05), the mean decrease in astigmatism was 0.09 ± 0.54 diopter (P = .29), and the mean increase in corneal pachymetry was 7.42 ± 22.01 μm (P = .12). There was statistically significant endothelial cell loss (mean 496.50 ± 469.66 cells/mm(2)) (P &lt; .05). CONCLUSIONS: Bimanual MICS performed by surgeons in training was safe and effective. Visual outcomes and complication rates were similar to those reported for coaxial cataract surgery performed by surgeons in training

Successful treatment of Fusarium keratitis after photo refractive keratectomy.

A 39-year-old woman presented to our hospital with a history of photorefractive keratectomy (PRK), performed two weeks prior; slit-lamp examination revealed diffuse conjunctival congestion, corneal ulcer and stromal infiltration. After 5 days of antifungal and antibacteric treatment, the infiltrate progressively increased so that a therapeutic penetrating keratoplasty was necessary. The microbiological analyses revealed the presence of fungal filaments. Twenty days after surgery the patient had recurrent fungal infiltrate in the donor cornea with wound dehiscence. We performed a second penetrating keratoplasty. With the matrix-assisted-laser-desorption-ionization-time-of-flight analysis (MALDI-TOF) we identified a Fusarium solani. Intravenous amphothericine B, a combination of intracameral and intrastromal voriconazole and intracameral amphotericine B were administered. After 6 months from the last surgery the infection was eradicated. The management of fungal keratitis after PRK depends on many factors: In our experience, a prompt keratoplasty and the use of intracameral antifungal medication proved to be very effective

Bilateral posterior scleritis as a presenting manifestation of giant cell arteritis: A case report

Posterior scleritis is a rare and frequently misdiagnosed form of ocular inflammation that may be either idiopathic or associated with various systemic diseases. The systemic associations1 are similar to those observed in anterior scleritis and include rheumatoid arthritis, Wegener granulomatosis, systemic lupus erythematosus, systemic vasculitis, relapsing polychondritis, sarcoidosis, and other autoimmune diseases. Moreover, it may occur in isolation or associated with either anterior scleritis or anterior uveitis. Giant cell arteritis (GCA) is a systemic immune-mediated vasculitis that affects medium-sized and large arteries. GCA has a wide spectrum of clinical features related to both systemic inflammation and ischemia. The most common symptoms are headache, scalp tenderness, jaw claudication, and systemic manifestations (fever, weight loss, anorexia, and malaise). Ophthalmologic symptoms are common manifestations of GCA and may occur alone, without other symptoms of GCA. Arteritic anterior ischemic optic neuropathy (AAION) is the most common ophthalmologic manifestation. Other ocular manifestations are central or branch retinal artery occlusion and diplopia that results from ischemia of extraocular muscles or ocular motor nerves.2 A few other reports about the association of GCA with scleritis have appeared in the literature.3, 4 and 5 We report a case of bilateral posterior scleritis that was diagnosed in association with GCA

Postoperative diffuse opacification of a hydrophilic acrylic intraocular lens: analysis of an explant

Purpose: We describe the clinicopathological and ultrastructural features of an opaque single-piece hydrophilic acrylic intraocular lens (IOL) explanted from a patient. Method: The main outcome of this report is the documentation of calcium deposits confirmed by surface analysis. The decrease in visual acuity was due to the opacification of the IOL. The opacification involved both the optic plate and the haptics. Results: The analysis at the scansion electron microscope revealed that the opacity was caused by the deposition of calcium and phosphate within the lens optic and haptics. Conclusion: This is the first case about the opacification of an Oculentis L-313. The opacification was characterized by calcium and phosphate deposition probably due to a morphological alteration of the posterior surface of the IOL

Manual de Indicadores para Monitoreo de Planes Prediales para el Manejo de Bosques con Ganadería Integrada (MBGI) Región Parque Chaqueño

Un sistema de monitoreo en un proceso sistemático de recolección, evaluación y análisis de la información necesaria para el seguimiento del impacto de la aplicación del Plan de Manejo sobre el sistema predial. Por lo tanto, la evaluación de los ambientes físico, biótico, social y económico durante la aplicación de los tratamientos y las inversiones propuestas, debe permitir la detección temprana de los posibles desvíos en el cumplimiento del plan y las reformulaciones necesarias para corregir las decisiones tomadas. El presente documento presenta los indicadores para planes MBGI a escala predial y propone una metodología de toma de la información y análisis de los indicadores.EEA Santa CruzFil: Alaggia, Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi. Campo Anexo Villa Dolores; Argentina.Fil: Alaggia Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Cabello, María Julia. Ministerio de Agricultura Ganadería y Pesca (MAGyP); Argentina.Fil: Carranza, Carlos. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi. Campo Anexo Villa Dolores; Argentina.Fil: Cavallero, Laura. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi. Campo Anexo Villa Dolores; Argentina.Fil: Daniele, Gonzalo. Ministerio de Ambiente y Desarrollo Sustentable. Dirección Bosques; Argentina.Fil: Erro Velazquez, Melisa. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Ledesma, Marcela. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi. Campo Anexo Villa Dolores; Argentina.Fil: Lopez, Dardo Ruben. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Manfredi. Campo Anexo Villa Dolores; Argentina.Fil: Lopez, Dardo Ruben. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Mussat, Eloisa. Consultora independiente; Argentina.Fil: Navall, Jorge Marcelo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santiago del Estero; Argentina.Fil: Peri, Pablo Luis. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Peri, Pablo Luis. Universidad Nacional de la Patagonia Austral; Argentina.Fil: Peri, Pablo Luis. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina.Fil: Rusch, Veronica Elena. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche. Área Recursos Forestales. Grupo Ecología Forestal; Argentina.Fil: Sabatini, Ángel. Secretaría de Ambiente y Desarrollo Sustentable de Nación. Dirección de bosques. Área socioeconómica; Argentina.Fil: Saravia Sanchez, Juan José. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santiago del Estero; Argentina.Fil: Uribe Echevarría, Josefina. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Quimilí; Argentina.Fil: Volante, José Norberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Salta; Argentina

Increased neuroendocrine cells in resected metastases compared to primary colorectal adenocarcinomas.

Neuroendocrine differentiation has been described in rectal adenocarcinomas receiving neoadjuvant therapy prior to radical surgery, but its clinical relevance is controversial and no data are currently available in colorectal carcinoma metastases as compared to primary tumors. The presence of chromogranin A positive tumor cells was investigated by means of immunohistochemistry on surgical specimens from 54 primary colorectal carcinomas and their corresponding metastases, resected at diagnosis or during tumor progression. In 47 patients, tumor metastases were resected 1 month to 12 years after chemotherapy and/or radiotherapy, while in the remaining seven patients no additional therapy after primary surgery was performed. In primary tumors, neuroendocrine differentiation was found in 12/54 cases (22.2%) as compared to 25/54 metastatic lesions (46.3%; p?=?0.01). The presence of neuroendocrine phenotype was not correlated with any clinical pathological parameter nor with a different proliferation index. However, patients having neuroendocrine cells in the primary tumor had a significantly shorter survival from the time of metastatic spread than those having not (33.3 vs. 55.5 months; p?=?0.04). In summary, our data show that colorectal carcinoma metastases contain a higher percentage of neuroendocrine differentiated cells as compared to their corresponding primaries, a finding possibly related to the influence of chemotherapy in neuroendocrine differentiation during colorectal carcinoma progression