Ophthopedia’s Post

ICYMI: Cornea Update: Alternative Approach for the Treatment of Conjunctivochalasis: Plasma-Based Conjunctivoplasty: Purpose: The aim of this study was to evaluate the efficacy of plasma-based conjunctivoplasty as a new surgical approach for conjunctivochalasis. Methods: This prospective, noncomparative, interventional study included research on 42 eyes of 33 patients who underwent plasma therapy because of conjunctivochalasis between February 2020 and December 2021. Maintaining a 2-mm distance from the limbus, at least 3 lines (approximately 2 mm deep) of plasma therapy were applied to the conjunctiva from the temporal quadrant to the nasal quadrant. Patient symptoms, the fluorescein clearance test, ocular surface integrity with fluorescein staining, the Ocular Surface Disease Index questionnaire, tear breakup time (TBUT), tear meniscus height, and complications were evaluated. Results: The mean patient age at the time of surgery was 67.3 ± 7.2 (range: 54–81) years. After surgery, the grades of conjunctivochalasis decreased in all patients. Although epiphora was present in 28 eyes (66.6%) preoperatively, none of the cases had epiphora during the follow-up period. The Ocular Surface Disease Index score improved significantly from 34.7 ± 10.3 preoperatively to 5.0 ± 4.2 3 months postoperatively (P http://dlvr.it/T9Q1QG #Cornea #MostPopularArticles #Ophthalmology

Ophthopedia Update:Intrastromal Corneal Ring Segments and Keratoconus Progression: A Case Series Study: Objective: To assess keratoconus (KC) progression following the implant of intrastromal corneal ring segments (ICRSs) in young patients. Materials and methods: Retrospective, longitudinal, observational, controlled nonrandomized case series study. Keratoconus patients aged 25 years or younger who underwent uneventful ICRS surgery and completed at least 3 years of follow-up were enrolled. Controls were of similar age and treatment-naive patients with KC. The following Pentacam imaging (Oculus, Wetzlar, Germany) data were analyzed: keratometric (maximum, in-flattest meridian, in-steepest meridian, and mean), aberrometric (higher-order aberrations and coma), pachymetric (thinnest corneal thickness), and elevation (maximum posterior elevation). The main outcome measure was KC progression. Results: The study sample comprised 20 eyes of 18 cases (age 20.20 ± 3.70 years, nine right eyes, 14 male patients) and 30 eyes of 24 controls (age 20.80 ± 3.20 years, 15 right eyes, 21 male patients). The mean follow-up duration was 4.90 ± 1.70 years (range 3–8 years) for cases and 4.50 ± 1.40 years (range 3–8 years) for controls. Four cases and two controls met criteria for KC progression. Conclusions: Intrastromal corneal ring segments did not have significant impact on KC progression in the cohort. #Ophthalmology #Eye #Ophthotwitter

It's another FIRST for Joseph J. Ricotta MD, MS, DFSVS, FACS, National Medical Director, Vascular Surgery and Endovascular Therapy, Tenet Healthcare and the vascular team at Delray! Dr. Ricotta and his team are the first in Palm Beach County to place @Abbott's Esprit BTK Everolimus Eluting Resorbable Scaffold! This is a breakthrough innovation for people with chronic limb-threatening ischemia (CLTI) below-the-knee (BTK). The Esprit BTK System is designed to keep arteries open and deliver a drug (Everolimus) to support vessel healing prior to completely dissolving. Previously, the standard of care has been balloon angioplasty, which relies on a small balloon delivered via a catheter to the blockage to compress it against the arterial wall, opening the vessel and restoring blood flow. However, blockages treated only with balloon angioplasty have poor short- and long-term results, and in many instances the vessels become blocked again, requiring additional treatment. The Esprit BTK System is a dissolvable stent and is comprised of material similar to dissolving sutures. The device is implanted during a catheter-based minimally invasive procedure via a small incision in the leg. Once the blockage is open, the Esprit BTK scaffold helps heal the vessel and provides support for approximately three years until the vessel is strong enough to remain open on its own. For more information on Dr. Ricotta and @Prime Vascular Institute visit https://lnkd.in/ernivBk9 We are #DelrayMedicalCenter. #strongertogetherforyou #PBHNProud #palmbeachhealthnetwork #palmbeachhealthnetworkphysiciangroup

Ophthopedia Update:CLINICOPATHOLOGIC CHANGES OF VITREOMACULAR INTERFACE IN IDIOPATHIC EPIRETINAL MEMBRANE WITH DISORGANIZATION OF RETINAL INNER LAYERS: Purpose: To compare the pathological characteristics of the vitreomacular interface of the idiopathic epiretinal membrane with and without disorganization of retinal inner layers (DRIL) and to correlate with clinical data. Methods: In this clinicopathologic study, the samples of epiretinal membrane and internal limiting membrane were extracted from DRIL(+) (19 eyes) and DRIL(−) (22 eyes) idiopathic epiretinal membrane eyes. Ultrathin series sectioning for transmission electron microscopy was observed and correlated with surgery status and prognosis. Results: All idiopathic epiretinal membrane eyes presented fibrocellular membranes accompanied by vitreous collagen, glial cells, and myofibroblasts, regardless of association with DRIL. A robust signal indicative of Collagen Type VI was observed in eyes DRIL(−), whereas Collagen Type I was discovered in DRIL eyes. Cell debris and microvascular basement membrane were seen on the retinal side of DRIL eyes and a larger cell count on the vitreous side. These have more intraoperative complications and less surgery benefit. Conclusion: Although internal limiting membrane peeling seems important, the histopathologic findings underscore the potential for retinal injury in DRIL(+) idiopathic epiretinal membrane eyes. This suggests that further research is needed to investigate individual preoperative assessment and to modify surgical procedures. #Ophthotwitter #Ophthalmology #Retina

Ophthopedia Update:POSTOPERATIVE PHOTORECEPTOR INTEGRITY AND ANATOMICAL OUTCOMES BASED ON PRESENTING MORPHOLOGIC STAGE OF RHEGMATOGENOUS RETINAL DETACHMENT: Purpose: To evaluate outer retinal recovery on postoperative optical coherence tomography (OCT) based on presenting morphologic stage of rhegmatogenous retinal detachment (RRD). Methods: Retrospective cohort of consecutive primary fovea-involving RRDs, referred from January 2012 to September 2022. Baseline OCTs were assessed for morphologic stage of RRD. Postoperative OCT scans were graded at 3, 6, and 12 months for external limiting membrane, ellipsoid zone and interdigitation zone discontinuity, epiretinal membrane formation and severity, and residual subfoveal fluid. Results: Three hundred and fifty-one patients were included. Increasing baseline morphologic stage of RRD was significantly associated with external limiting membrane, ellipsoid zone, and interdigitation zone discontinuity at all time points postoperatively (P < 0.001) and was shown to be an independent predictor of foveal photoreceptor integrity after adjusting for height of detachment, time to surgery, and duration of fovea involvement (P < 0.001). Earlier stages were associated with residual subfoveal fluid (P < 0.001). There was no association between the stages of RRD and epiretinal membrane severity. However, late stages presented with earlier development of epiretinal membrane (P = 0.012). Conclusion: Increasing morphologic stage of RRD is associated with delayed recovery of outer retinal bands in the first year and faster development of epiretinal membrane after RRD repair. The results of this study suggest that the stages may serve as a prognostic biomarker for postoperative photoreceptor recovery. #Ophthotwitter #Ophthalmology #Retina

Cornea Update: Alternative Approach for the Treatment of Conjunctivochalasis: Plasma-Based Conjunctivoplasty: Purpose: The aim of this study was to evaluate the efficacy of plasma-based conjunctivoplasty as a new surgical approach for conjunctivochalasis. Methods: This prospective, noncomparative, interventional study included research on 42 eyes of 33 patients who underwent plasma therapy because of conjunctivochalasis between February 2020 and December 2021. Maintaining a 2-mm distance from the limbus, at least 3 lines (approximately 2 mm deep) of plasma therapy were applied to the conjunctiva from the temporal quadrant to the nasal quadrant. Patient symptoms, the fluorescein clearance test, ocular surface integrity with fluorescein staining, the Ocular Surface Disease Index questionnaire, tear breakup time (TBUT), tear meniscus height, and complications were evaluated. Results: The mean patient age at the time of surgery was 67.3 ± 7.2 (range: 54–81) years. After surgery, the grades of conjunctivochalasis decreased in all patients. Although epiphora was present in 28 eyes (66.6%) preoperatively, none of the cases had epiphora during the follow-up period. The Ocular Surface Disease Index score improved significantly from 34.7 ± 10.3 preoperatively to 5.0 ± 4.2 3 months postoperatively (P http://dlvr.it/T8rcC0 #Cornea #MostPopularArticles #Ophthalmology

HOW TO AVOID ANASTOMOTIC COLON FISTULAS? A simple way, with the PHOTOPLETHYSMOGRAPHY (pulse) function of the operating room oximeter. The pulse curve displayed on the screen shows heart rate, but ESPECIALLY the systo-diastolic variation pressure of the skin and mucosas. Because it's PRESSURE THAT ENSURES VASCULARIZATION. Good pulse amplitude on the upstream and downstream stumps of the resected segment enables safe anastomosis. If the pulse is absent or weak, resection can be extended to well-vascularized levels. Indocyanine green-enhanced fluorescence shows vascularization but cannot differentiate vascularization at good pressure from that at too low pressure. See article: Infrared parietal colorectal flowmetry: a new application of the pulse oximeter. Is this method useful for general surgeons in preventing anastomotic leakage after colorectal resections? https://lnkd.in/eFKc_u5f

HOW TO AVOID ANASTOMOTIC COLON FISTULAS? A simple way, with the PHOTOPLETHYSMOGRAPHY (pulse) function of the operating room oximeter. The pulse curve displayed on the screen shows heart rate, but ESPECIALLY the systo-diastolic variation pressure of the skin and mucosas. Because it's PRESSURE THAT ENSURES VASCULARIZATION. Good pulse amplitude on the upstream and downstream stumps of the resected segment enables safe anastomosis. If the pulse is absent or weak, resection can be extended to well-vascularized levels. Indocyanine green-enhanced fluorescence shows vascularization but cannot differentiate vascularization at good pressure from that at too low pressure. See article: Infrared parietal colorectal flowmetry: a new application of the pulse oximeter. Is this method useful for general surgeons in preventing anastomotic leakage after colorectal resections? https://lnkd.in/eqH-4nd9

Bilateral Ectopic Submandibular Glands in the Carotid Triangles: A Case Report with Review of Literature ABSTRACT This case report presents a rare and unusual bilateral ectopic location of the submandibular glands in the carotid triangles of the infrahyoid region of the neck. Both submandibular glands were found anteromedial to the carotid sheath suspended from the floor of the mouth by their ducts and from the lingual nerves by branches to the glands. Such rare variations are crucial in diagnostic imaging, aesthetic surgery, radiation therapy, and surgical treatment of diseases comprising those of the glands. The consideration of such unusual location is of relevance in the differential diagnosis of neck mass and the decision-making process regarding approaches to the submandibular glands during various surgical procedures (trans-cervical, trans-oral, endoscopic, etc.) and in avoiding the risk of injury to adjacent neurovascular structures such as facial vessels, cervical and mandibular branches of the facial, hypoglossal, and lingual nerves. https://lnkd.in/d-v7cM4d

The Steerable sheath revolution! Do you all use steerable sheaths and transfemoral access in FB-EVAR? This study compared outcomes of FB-EVAR using upper extremity (UE) or Transfemoral (TF) access for target artery (TA) incorporation. The study analyzed data from patients undergoing FB-EVAR between November 2013 and December 2022 (n=541). Patients were categorized based on the type of access used. Procedural details, outcomes, and complications were compared between UE and TF access groups. Key findings include: 🐅 TF access increased over time, with significant improvements in procedural metrics and decreased adverse events compared to UE access. 🐴 TF access was associated with shorter procedure times, lower blood loss, and fewer adverse events, particularly cerebrovascular events. 🐂 Technical success rates were high and comparable between UE and TF access groups. 🐗 TF access was effective even for devices with directional branches, contradicting the belief that it poses greater technical challenges. 🐃 There were no significant differences in radiation exposure between UE and TF access groups. In conclusion: a total TF approach for FB-EVAR is increasingly favored and has demonstrated favorable outcomes compared to UE access, even for devices with directional branches. This study suggests that UE access may carry a higher risk of adverse events, particularly cerebrovascular events, and supports the routine use of TF access for FB-EVAR. Link to article: https://lnkd.in/e_SQ2bXW Congratulations to the authors: Thomas Mesnard Andrea Vacirca, Aidin Baghbani Oskouei, Titia Sulzer, Safa Savadi, Lucas Ruiter Kanamori, Emanuel R. Tenorio, Aleem Mirza, Naveed Saqib, Alexandre Bernardo C Mendes, Ying Huang, Gustavo Oderich MD Please also read this interesing take and 'how I use it' piece on this topic by Stéphan Haulon, Ming Guo and dominique fabre: https://lnkd.in/emvWJggH Both published in the Journal of Vascular Surgery. #FEVAR #BEVAR #aneurysm #endovascular