Incidence of ocular surface squamous neoplasia in pterygium specimens

OBJECTIVE

Pterygium and ocular surface squamous neoplasia (OSSN) have been recognized as likely related conditions and share similar risk factors such as ultraviolet radiation and chronic inflammation. The purpose of this study is to review the incidence of OSSN in pathology specimens sent as pterygium at a single tertiary centre between 2010 and 2022.

METHODS

This is a retrospective chart review of patients operated on for pterygium between 2010 and 2022 at the University of Montreal Health Centre. Data collected include baseline demographics, results of pathology specimen, and clinical information for cases diagnosed as OSSN on pathology.

RESULTS

A total of 1559 patients were operated on for a clinical diagnosis of pterygium between 2010 and 2022, of which 854 patients (55%) were male. A total of 1142 specimens had available pathology reports, and most of the specimens were consistent with pterygium on pathology (1105 of 1142; 97%). There was an unexpected finding of 3 cases of OSSN (3 of 1142; 0.3%). Other diagnosis besides pterygium were seen in 3% of specimens (34 of 1142), including nevus (n = 12), spheroidal degeneration (n = 3), pyogenic granuloma (n = 3), and lymphangiectasia (n = 2). The 3 cases of OSSN included an 81-year-old male of French-Canadian background, a 52-year-old male of South Asian background, and a 59-year-old female of French-Canadian background. The pathology was diagnosed as conjunctival intraepithelial neoplasia (CIN) grade 3, CIN grade 2, and CIN grade 2, respectively.

CONCLUSION

The finding of OSSN in pterygium is rare in our population but can be clinically difficult to distinguish. It is important to send all pterygium specimens for pathology.

Gonioscopy-assisted Transluminal Trabeculotomy in Uveitis-related Ocular Hypertension and Glaucoma

PRCIS

Gonioscopy-assisted Transluminal Trabeculotomy may be an effective first line surgery for decreasing intraocular pressure and medication burden in patients with uveitis-related ocular hypertension or glaucoma.

PURPOSE

The purpose of the study is to determine the efficacy of Gonioscopy-assisted transluminal trabeculotomy (GATT) to lower the intraocular pressure (IOP) in uveitis-related ocular hypertension (OHT) or glaucoma.

METHODS

Retrospective case series that included patients with uveitis-related OHT or glaucoma that underwent GATT with or without concomitant cataract extraction and intraocular lens implantation at two Canadian academic centres from July 2018 to May 2022. Primary outcomes were : complete (no medications) and qualified success (with medication), and failure defined as (1) IOP > 21mmHg with maximal medical therapy, (2) the need of additional glaucoma procedure, (3) loss of light perception secondary to glaucoma, (4) IOP < 6 mmHg for 3 months.

RESULTS

Twenty-one eyes from 18 patients were included with a mean preoperative IOP of 26.2±7.3 mmHg on 4.3±0.7 classes of glaucoma drops. Average follow-up was 29.2±17.6 months and 76% of eyes (n=16) had reached at least 12 months of follow-up. At the 12 month follow-up visit, there was a significant decrease in average IOP by 9.9±7.9 mmHg (38%, P=0.005) and a decrease of 1.9 in glaucoma medication classes (P=0.002). Fourteen percent of eyes achieved complete success while 80% of eyes achieved qualified success. Six eyes failed (29%) and five patients (24%) required an additional glaucoma surgery. The most common postoperative complication was hyphema (n=9; 43%).

CONCLUSION

This small case series suggests that GATT may be an effective first line surgery for decreasing IOP and medication burden in patients with uveitis-related OHT or glaucoma. Further studies with longer follow-up should be conducted to assess its long-term outcomes.

Visual outcomes and rotational stability of a new non-diffractive extended-vision toric intraocular lens

OBJECTIVE

To evaluate visual outcomes and intraocular lens (IOL) rotational stability of patients undergoing immediate sequential bilateral cataract surgery with a non-diffractive extended-depth-of-focus toric IOL.

DESIGN

Non-comparative single-centre cohort study.

PARTICIPANTS

Twenty patients (40 eyes) with significant cataracts and corneal astigmatism who underwent immediate sequential bilateral cataract surgery with the AcrySof IQ Vivity Extended Vision Lens (Alcon Laboratories Inc, Fort Worth, Tex.).

METHODS

Binocular uncorrected visual acuities (UCVA) and monocular best-corrected visual acuities (BCVA) were assessed at distance (6 m), intermediate (66 cm), and near (40 cm) postoperatively at 1 week and 3 months. The rotational stability of each IOL was assessed at 1 day, 1 week, and 3 months postoperatively. A validated questionnaire (Questionnaire for Visual Disturbances [QUVID]) was used for patient-reported subjective visual disturbances preoperatively at a 3-month follow-up.

RESULTS

Binocular distance, intermediate, and near UCVAs (mean ± SD) were 0.00 ± 0.16, 0.09 ± 0.08, and 0.14 ± 0.11 logMAR at 1 week and 0.01 ± 0.06, 0.08 ± 0.08, and 0.14 ± 0.07 logMAR at 3 months postoperatively, respectively. Distance monocular BCVA improved from 0.22 ± 0.23 logMAR preoperatively to 0.02 ± 0.06 logMAR at 3 months. Monocular BCVAs at 3 months were 0.08 ± 0.08 logMAR at intermediate distance and 0.05 ± 0.08 logMAR at near distance. IOL rotation from the intended placement axis was 2.5 ± 1.7 degrees at 1 week and 1.7 ± 1.7 degrees at 3 months postoperatively.

CONCLUSIONS

The AcrySof IQ Vivity Extended Vision IOL achieved good UCVAs and BCVAs for distance, intermediate, and near vision. This IOL also provided excellent rotational stability for astigmatism correction.

Adults with tuberous sclerosis complex: A distinct patient population

OBJECTIVES

There are few data on adults living with tuberous sclerosis complex (TSC), with most studies focusing on pediatric populations. The objective of our study was to examine a large national cohort of adults with TSC, and to describe the clinical characteristics of these adults and the nature of the multidisciplinary care that they receive.

METHODS

Six Canadian medical centers collaborated in this study. Data were collected using a standardized form, and descriptive statistics were used for the analyses.

RESULTS

Our study included 181 adults with definite TSC (mean age = 33.6 years [SD = 13.7]). More than 40% (n = 75) had family members affected by TSC. Forty-six percent (n = 83) of individuals had intellectual disability. Nearly 30% (n = 52) of individuals reported living alone or with a partner/spouse. Seventy-six percent (n = 138) of people had epilepsy, 43% (n = 59) of whom had drug-resistant epilepsy, and 21% (n = 29) had undergone epilepsy surgery. Neuropsychiatric disease (n = 128) and renal angiomyolipomas (n = 130) were both present in approximately 70% of people. Renal imaging was performed in 75.7% (n = 137) of participants within the past 3 years. Renal and pulmonary function tests, as well as electrocardiograms, were recently performed in a minority of individuals.

SIGNIFICANCE

Our cohort of adults with TSC showed that an important proportion have a milder phenotype, and are more frequently familial, as compared to children with TSC (and differing from prior reports in adult cohorts). Drug-resistant epilepsy, neuropsychiatric comorbidities, and renal angiomyolipoma are challenging factors in adults with TSC. Our participating medical centers generally followed recommended screening strategies, but there remain important gaps in care. Multidisciplinary and structured TSC care centers offering service to adults may help to improve the health of this important patient population.

Neurosyphilis masquerading as oculomotor nerve palsy in a healthy middle-aged man: Case report and review of the literature

Acquired isolated oculomotor nerve palsy (ONP) is a commonly encountered clinical entity in ophthalmology. While most cases are due to microvascular ischemia, the diagnosis of ONP requires careful evaluation for alternate life-threatening etiologies. We present a case of isolated complete pupil-involving ONP in a healthy 47-year-old man in whom aneurysmal compression was initially suspected. Investigations later revealed a diagnosis of neurosyphilis. Neurosyphilis is an extremely rare cause of isolated ONP and seldom reported in the literature. Timely recognition of this disease by ophthalmologists can help orient patients to the appropriate neurology and infectious disease services they need.

The Role of Telemedicine to Alleviate an Increasingly Burdened Healthcare System: Retinopathy of Prematurity

Telemedicine-based remote digital fundus imaging (RDFI-TM) offers a promising platform for the screening of retinopathy of prematurity. RDFI-TM addresses some of the challenges faced by ophthalmologists in examining this vulnerable population in both low- and high-income countries. In this review, we studied the evidence on the use of RDFI-TM and analyzed the practical framework for RDFI-TM systems. We assessed the novel technological advances that can be deployed within RDFI-TM systems including noncontact imaging systems, smartphone-based imaging tools, and deep learning algorithms.

[Severe obstetric complications nescessitating hospitalization and intensive care: a ten year retrospective study]

OBJECTIVES

To assess the serious maternal morbidity during pregnancy, delivery and post partum, which led to an hospitalization in a medical or surgical intensive care unit.

STUDY DESIGN

A Retrospective study was carried out on a period of ten years, from July 1986 to July 1996, in the University Teaching Hospital of Besançon.

PATIENTS

The criterions of inclusion come from the definition of the serious maternal morbidity decided by the Inserm: any admission of a pregnant woman in a medical or surgical intensive care unit in the 42 days of the post-partum, whatever the term of the pregnancy and the type of the post-partum, extra uterine pregnancy, spontaneous miscarriage and medical or voluntary abortion.

METHODS

Forty-six patient's medical file hospitalized in a medical or surgical intensive care unit between July, 1st 1986 and July, 31st 1996, have been studied.

RESULTS

The analysis of the cause underline the gravity of the pathologies handled with young patients and initially healthy, the short length of controlled ventilation and hospitalization, the avoidability of great number of transfer in an intensive care unit, and the lack of hospitalization due to anaesthesia. The frequency of hospitalisation in an intensive care unit during and after the pregnancy was estimated at 0.17% of lives births.

CONCLUSION

The serious maternal morbidity could be an indicator of the quality of the obstetrics cares which would complete the study of the maternal mortality. The potential gravity of the complication of the pregnancy and the delivery require better care of this patients.

Effect of cytidine diphosphate choline on anoxia tolerance of cultured myocardial cells

Three series of cultured Wistar rat heart cells (10 treated and 10 controls x 3) were examined with a laser contraction-meter in a special chamber for anoxia to determine whether cytidine diphosphate choline (CDPC), a membrane phospholipid precursor, can protect against total oxygen deprivation. Heart rate and force of contraction (inotropism) were monitored during a 40-minute period of hypoxia. CDPC in a concentration of 142 micrograms/ml-1 was added to the culture medium only during the anoxia period in series I, during the 3 days of culture in series II, and during the 3 days of culture and the 40-minute hypoxia period in series III. In series I, inotropism decreased by 21% versus 55% in control group (P less than 0.05). In series II, inotropism decreased by 25% versus 43% in control group (P less than 0.05). In series III, inotropism decreased by 22% versus 44% in control group (P less than 0.05). Compared with control cells, cells treated with CDPC during anoxia maintained a significantly greater inotropic state. The effect is greatest if the cells are weak, as in series I. CDPC may be a useful component of the cardioplegic mixture during cardiopulmonary bypass and in the treatment of myocardial ischemia.

[Flumazenil and volatile anesthetics. Study of possible interferences in rats]

Many works suggest contradictory experimental or clinical results of flumazenil effects during inhalation anaesthesia. In ten rats anaesthesia was induced with 5% isoflurane or halothane during one minute and maintained during 5 minutes with 1% the same halogene anaesthetic in 50% N2O and O2. Then 0.2 mg of flumazenil or a same volume of placebo were administered intraperitoneally and during the last 5 minutes, the rats were exposed in 1% volatile anesthetic gas flow. Sleep times were measured in terms of reestablishment of the righting reflex. Each rat was anesthetized four time: halothane and isoflurane, with flumazenil or placebo. In those conditions, there were no significant changes in sleep times either the anaesthesia were associated, with flumazenil or with placebo.

[Repetitive inhalation anesthesia in rats]

Inhalational anesthesia in the rat seems a good process, by a rapid induction and awakening if a steady state ventilation-perfusion ratio and no pollution are obtained. Animals are cooped up in an "induction-box" which is joined to a scavenger system. Anesthesia maintenance is assumed with a Bain circuit and allows short and frequent anesthesia. Isoflurane does not markedly decrease circulatory and respiratory factors at low concentration (2%). So any anaesthetist can do himself such a practical system.

[Value of the radionetwork of the transportation company in Besançon for alarm forwarding]

The C.B. users offered for a few years a way for putting-out the distress on the highway. There were 2,000 in Besançon and surroundings in 1982. Today they are becoming no existent. Since then a new system of alarm run is born with 150 buses, 178 kilometers of net-travel and a sweep frequency of 10 min from 6h30 a.m., to 8h p.m, and of 30 min until 12h p.m. The 250 "C.T.B." drivers assume a regular surveillance of the urban and suburban highways. A standard message in used between the C.T.B. (Besançon Company of Buses.) regulation and Samu 25, regulation which allows to fix circumstances, place of road accident and inventory of casualties: 27 emergency calls are received in 1987, 50 in 1988. It might be possible to use other private or public radiotelephonic network.

[Two-years' experience of ambulatory anesthesia in otorhinolaryngology in children]

Three hundred children were anaesthetized for E.N.T. operations. The anaesthetic consultation took place one week prior to operation. The anaesthetic comprises premedication, inhalation of halothane for infants, or propofol drip for the others with tracheal tubing for 10% of them. Recovery in every case is supervised in the recovery room. There are few setbacks with this method. Eleven children were not accepted for operation for sociological or medical reasons (Willebrand diseases) and only 3 had to remain in hospital until the following day due to slow recovery from anaesthetic.

[The indirect calorimeter, "do it yourself"]

An original metabolic calculator is realized with common and fiable transducers: a "microgaz Roche Kontron 7640" gives the PiO2-PeO2 and PeCO2 (Clark and Stow Severinghaus electrods), a pneumotachograph Gould 17212 (or the reliable integrated flow meter of the respirator) gives the expiratory minute volume. These values are inserted in an micro computer (Sharp PC 1261). The soft is wrote so that results are not altered when high FiO2 are used. Consumption of lipids and glucids is displayed in percentage when diuresis and urea values are entered. This device is compared with a well known expenditure monitor: Deltatrac (Datex): simultaneous measures are carried out in patients with miscellaneous diseases (15 series of 10 measures). Regression curves appear to be very reliable, as well for VO2(r = 0.98), VCO2 (r = 0.94) energy expenditure (0.97) as for R.Q (r = 0.77).

[Monitoring of gases and vapors in the anesthesia system]

By now inhalation anesthesia makes anesthetic gaz and vapours analysis compulsory. This paper give an account of numerous gaz analyzers which are available today. Different kinds of oximeters (galvanic, polarographic, paramagnetic) carbon dioxide analysers, halothane, enflurane or isoflurane-meters are reviewed. Advantage/cost ratio of mass spectrometer is discussed too. Practical advices on use and site of slow and fast analysers are recalled.

[Use of propofol in ophthalmological anesthesia in elderly patients]

Forty patients more than 65 years old were anaesthetized with propofol for cataract surgery. Patients were divided into two groups: those intubated after topical oropharyngeal anaesthesia and those intubated after muscle relaxation obtained with suxamethonium. Induction and maintenance of anaesthesia were carried out with 2.5 mg . kg-1 and 4 mg . kg-1 . h-1 respectively. Concurrent use of muscle relaxants had no effect on the action and characteristics of the general anaesthesia or recovery. Relative bradycardia (7%) and arterial hypotension (25%) occurred rapidly following induction and continued during the entire period of anaesthesia despite the systematic infusion of 500 ml of electrolyte solutions. Recovery was extremely rapid. The original Glasgow score was obtained within 20 min. The only negative side-effects were generally late occurring (4-6 h): postanaesthetic nausea or vomiting. Otherwise, tolerance was excellent. Use of propofol was ideal for this type of surgery due to its strong and durable ocular hypotensive effect.