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Cohen E, Ong Tone S, Mimouni M, Stein R, Chan CC, Chew HF, Rabinovitch T, Rootman DS, Slomovic AR, Hatch WV, Singal N. Comparison of long-term outcomes of simultaneous accelerated corneal crosslinking combined with intracorneal ring segment or topography-guided PRK. J Cataract Refract Surg 2024; 50:378-384. [PMID: 38015419 DOI: 10.1097/j.jcrs.0000000000001369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE To compare long-term outcomes of simultaneous accelerated corneal crosslinking (CXL) with intrastromal corneal ring segments (CXL-ICRS) with simultaneous accelerated CXL with topography-guided photorefractive keratectomy (CXL-TG-PRK) in progressive keratoconus (KC). SETTING Kensington Eye Institute and Bochner Eye Institute, Toronto, Canada. DESIGN Prospective nonrandomized interventional study. METHODS The change in visual and topographical outcomes of CXL-ICRS and CXL-TG-PRK 4 to 5 years postoperatively were compared using linear regression models adjusted for preoperative corrected distance visual acuity (CDVA) and maximum keratometry (Kmax). RESULTS 57 eyes of 43 patients with progressive KC who underwent simultaneous accelerated (9 mW/cm 2 , 10 minutes) CXL-ICRS (n = 32) and CXL-TG-PRK (n = 25) were included. Mean follow-up duration was 51.28 (9.58) and 54.57 (5.81) months for the CXL-ICRS and CXL-TG-PRK groups, respectively. Initial mean Kmax was higher in the CXL-ICRS group compared with the CXL-TG-PRK group (60.68 ± 6.81 diopters [D] vs 57.15 ± 4.19 D, P = .02). At the last follow-up, change (improvement) in logMAR uncorrected distance visual acuity (UDVA) compared with that preoperatively was significant with CXL-ICRS (-0.31 ± 0.27, P < .001, which is equivalent to approximately 3 lines) and not significant with CXL-TG-PRK (-0.06 ± 0.42, P = .43). The logMAR CDVA improved significantly with CXL-ICRS (-0.22 ± 0.20, P < .001), but not with CXL-TG-PRK (-0.05 ± 0.22, P = .25). Adjusting for baseline Kmax and CDVA, the improvement in UDVA was significantly greater with CXL-ICRS than with CXL-TG-PRK (-0.27, 95% CI, 0.06-0.47, P = .01). Improvement in CDVA was not significantly different. CONCLUSIONS In this cohort of progressive KC with long-term follow-up, UDVA showed more improvement with accelerated CXL-ICRS than with CXL-TG-PRK.
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Affiliation(s)
- Eyal Cohen
- From the Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada (Cohen, Tone, Mimouni, Stein, Chan, Chew, Rabinovitch, Rootman, Slomovic, Hatch, Singal); Division of Ophthalmology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel (Cohen); Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel (Mimouni)
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Farahvash A, Wang AM, Cardemil F, Chew HF, Gill HS, Antonyshyn OM. A Computed Tomography Scan Near Miss of an Intraorbital Wooden Foreign Body. Plast Surg (Oakv) 2024; 32:158-161. [PMID: 38433801 PMCID: PMC10902474 DOI: 10.1177/22925503221101954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
When intraorbital wooden foreign bodies are missed, the consequences can be devastating. While the gold standard diagnostic imaging is computed tomography (CT), it has low sensitivity. We present a 61-year-old man with a bamboo injury to his right eye. He underwent two CT scans that failed to raise the possibility of intraorbital foreign bodies. Upon additional review, a rectangular-shaped pocket of air was identified in the orbit which was most consistent with wooden foreign bodies based on the clinical history. A combined mid-lid approach followed by a transconjunctival and transcaruncular extension were employed to remove several wooden splinters. Postoperatively, due to recurrent orbital compartment syndrome, he required a second decompression with an inferior rim osteotomy. He had good recovery at 3 months follow-up. Overall, intraorbital wooden foreign bodies are challenging to diagnose due to imaging limitations. Providing a clear history and suspected diagnosis to radiology is critical for diagnosis.
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Affiliation(s)
- Armin Farahvash
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Annie M.Q. Wang
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Felipe Cardemil
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Hall F. Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Harmeet S. Gill
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Oleh M. Antonyshyn
- Division of Plastic, Reconstructive & Aesthetic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Sorkin N, Hatch W, Mimouni M, Chew HF, Rootman DS, Slomovic AR, Bujak MC, Chan CC, Thorpe KE, Perez M, Stiuso V, Singal N. A randomized controlled trial comparing femtosecond-enabled deep anterior lamellar keratoplasty and standard deep anterior lamellar keratoplasty (FEDS Study). Eye (Lond) 2023; 37:2693-2699. [PMID: 36693916 PMCID: PMC10482827 DOI: 10.1038/s41433-023-02387-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 12/06/2022] [Accepted: 01/11/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES To compare outcomes of femtosecond-enabled deep anterior lamellar keratoplasty (FE-DALK) and standard deep anterior lamellar keratoplasty (S-DALK). METHODS An open label, randomized controlled trial (Kensington Eye Institute, Toronto, ON, Canada) including 100 eyes of 97 participants with either keratoconus or corneal scarring, randomized to either FE-DALK (n = 48) or S-DALK (n = 49). PRIMARY OUTCOMES postoperative astigmatism and surgically induced corneal astigmatism (SIA) - both at 15 months. SECONDARY OUTCOMES 6-, 12- and 15-month postoperative uncorrected- and best spectacle-corrected visual acuity, steep and flat keratometry, manifest sphere and astigmatism, rate of conversion to penetrating keratoplasty (PK), big-bubble success, central corneal thickness, endothelial cell count and complications. RESULTS In intention-to-treat analysis, mean postoperative astigmatism in the FE-DALK (n = 30) and S-DALK (n = 30) groups at 15 months was 7.8 ± 4.4 D and 6.3 ± 5.0 D, respectively (p = 0.282) with an adjusted mean difference of 1.3 D (95% CI -1.08, +3.65). Mean SIA (arithmetic) was 9.2 ± 7.8 and 8.8 ± 5.4 D, respectively (p = 0.838) with a mean difference of 0.4 D (95% CI -3.13, +3.85). In an analysis of successful DALK cases only, mean postoperative astigmatism in the FE-DALK (n = 24) and S-DALK (n = 20) groups at 15 months (after excluding 4 eyes with AEs) was 7.3 ± 4.4 and 6.2 ± 4.9 D, respectively (p = 0.531) with an adjusted mean difference of 0.9 D (95% CI -1.94, +3.71). Mean SIA (arithmetic) was 9.1 ± 7.8 and 7.9 ± 4.6 D, respectively (p = 0.547) with a mean difference of 1.2 D (95% CI -2.70,+5.02). Comparison of secondary outcomes showed only weak statistical evidence. CONCLUSIONS In this randomized controlled trial, FE-DALK and S-DALK showed comparable functional and anatomical outcomes.
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Affiliation(s)
- Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Matthew C Bujak
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre (AHRC), Toronto, ON, Canada
| | - Mauricio Perez
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Vera Stiuso
- Kensington Eye Institute, Toronto, ON, Canada
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
- Kensington Eye Institute, Toronto, ON, Canada
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Billig AB, Dengler J, Hardisty M, Chew HF, Kiss A, Fialkov JA. Are We Overoperating on Isolated Orbital Floor Fractures? Plast Reconstr Surg 2023; 152:629-637. [PMID: 36780363 DOI: 10.1097/prs.0000000000010284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Orbital floor fracture defect size and inferior rectus (IR) rounding index are currently accepted indications for surgery to prevent late enophthalmos. The authors analyzed the positive predictive value (PPV) of these indications. METHODS Twenty-eight patients with orbital floor fractures presenting without enophthalmos underwent Hertel exophthalmometry at presentation and at weeks 1, 2, 3, 6, 13, 26, and 52 or more after injury. Orbital defect size and IR rounding index were measured from computed tomographic scans, and PPVs of defects of 1.5 to 2 cm 2 or larger and IR rounding index of 1 or higher for enophthalmos (≥2 mm) were calculated. RESULTS Nineteen patients had isolated orbital floor fractures (group A), three had noncontinuous orbital floor and medial wall fractures (group B), and six had continuous orbital floor with medial wall fractures (group C). Mean follow-up time was 440 days. Of all patients, 20 had a defect size of 1.5 cm 2 or larger, 12 had a defect of 2.0 cm 2 or larger, and 13 had an IR rounding index of 1 or higher. Of the 28 patients, only one from group A and two from group C developed enophthalmos of 2 mm only. The PPVs of orbital floor defect size of 1.5 cm 2 or larger and 2 cm 2 or larger (groups A and B only) for late enophthalmos were 6.7% and 0%, respectively. The PPV of IR rounding index of 1 or higher for late enophthalmos (all groups) was 0%. CONCLUSIONS For patients with orbital floor fractures presenting without enophthalmos, defects of 1.5 cm 2 or larger and 2 cm 2 or larger, and IR rounding index of 1 or higher, are weakly predictive of late enophthalmos. Furthermore, patients who do not develop enophthalmos within 3 weeks of injury are unlikely to develop significant (>2 mm) late enophthalmos. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Allan B Billig
- From the Plastic Surgery Department, Hadassah University Medical Center
| | - Jana Dengler
- Division of Plastic Surgery, Sunnybrook Health Sciences Center
| | - Michael Hardisty
- Orthopaedic Biomechanics Laboratory
- Institute of Biomaterials and Biomedical Engineering
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto
| | - Alex Kiss
- Department of Research Design and Biostatistics, Sunnybrook Research Institute
| | - Jeffrey A Fialkov
- Division of Plastic Surgery, Sunnybrook Health Sciences Center
- Institute of Biomaterials and Biomedical Engineering
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Alsarhani W, Lam PW, Kus JV, Rowsell C, Tsui GK, Tadros M, Fattouh R, Yucel Y, Kertes PJ, Chew HF. Post-traumatic Fungal Keratitis and Endophthalmitis Caused by Coniochaeta Hoffmannii with Late Recurrence following Therapeutic Full-thickness Penetrating Keratoplasty. Ocul Immunol Inflamm 2022; 31:826-829. [PMID: 35404731 DOI: 10.1080/09273948.2022.2048028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND To report a rare case of fungal keratitis and endophthalmitis due to Coniochaeta hoffmannii. METHODS Case report. RESULTS A 71-year-old immunocompetent male sustained a corneal laceration, traumatic cataract, and retinal detachment due to penetrating injury from a nail pulled from a wooden deck. The patient's postoperative course was complicated by infectious keratitis. Fungal cultures, DNA sequencing and analysis of the internal transcribed spacer sequence confirmed Coniochaeta hoffmannii. Topical and oral voriconazole treatments were initiated; however, due to impending perforation, a therapeutic corneal transplant was required. One year later, the patient developed a new corneal infiltrate at the graft-host junction: Corneal scrapings were culture positive for Coniochaeta hoffmannii. This was treated with topical and intrastromal voriconazole along with oral itraconazole 200 mg once daily for 8 months. CONCLUSIONS Coniochaeta hoffmannii may cause recalcitrant keratitis and endophthalmitis, which required longstanding antifungal treatment.
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Affiliation(s)
- Waleed Alsarhani
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Philip W. Lam
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Julianne V. Kus
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Corwyn Rowsell
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | | | - Manal Tadros
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Ramzi Fattouh
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Yeni Yucel
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health, Toronto, ON, Canada
| | - Peter J. Kertes
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Hall F. Chew
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, ON, Canada
- Department of Ophthalmology & Vision Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Din N, Mimouni M, Slomovic J, Aldrees S, Trinh T, Cohen E, Gouvea L, Alshaker S, Chan CC, Chew HF, Singal N, Rootman DS, Slomovic AR. Comparative evaluation of four Descemet membrane endothelial keratoplasty graft preparation techniques. Canadian Journal of Ophthalmology 2022; 58:191-197. [PMID: 35151620 DOI: 10.1016/j.jcjo.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/03/2021] [Accepted: 01/13/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To compare subjective and objective outcomes of 4 different Descemet membrane endothelial keratoplasty (DMEK) peeling techniques performed by novice surgeons at different stages in their surgical career. DESIGN An ex vivo prospective study. METHODS In the first round, 2 DMEK peeling techniques were pitched against each other: the peripheral scoring and Sinskey dissection technique with the peripheral scoring and microhoe dissection and the peripheral blunt microhoe dissection against the scleral spurectomy and microhoe dissection. Three surgeons with different operative experience performed the peeling. Outcome measures included graft peeling time, surgeon's peeling difficulty grading (on a scale of 1-10, 1 being the easiest and 10 the hardest), number of radial and circumferential tears before and after trephination, and tissue loss. The 2 techniques that performed the best from the first round proceeded to the final round to identify the best overall technique. RESULTS In total, 90 tissues (45 pairs) were peeled by 3 surgeons. Following the first-round results, the peripheral scoring and Sinskey dissection and peripheral blunt microhoe dissection proceeded to the final round. There were no significant differences between the groups in terms of peeling times, subjective feeling of difficulty, post-trephination tears, and peeling success rates (P > 0.05 for all). However, the peripheral scoring and Sinskey dissection technique had significantly fewer pretrephination radial tears (1.3 ± 1.3 vs 6.1 ± 5.2, P = 0.007) and circumferential tears (0.6 ± 0.9 vs 1.8 ± 2.1, P = 0.02). CONCLUSIONS This study demonstrates that the learning curve can be overcome quickly with appropriate DMEK peeling techniques. The peripheral scoring and Sinskey dissection peeling technique allows efficient peeling with fewer related tears.
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Affiliation(s)
- Nizar Din
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON..
| | - Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Jacqueline Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Sultan Aldrees
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Eyal Cohen
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Larissa Gouvea
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Sara Alshaker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Clara C Chan
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - David S Rootman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
| | - Allan R Slomovic
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON
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Din N, Chew HF. Blossoming vision: unusual donor tissue configuration in a jaundiced cornea tissue. Can J Ophthalmol 2020; 56:147. [PMID: 33039323 DOI: 10.1016/j.jcjo.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Nizar Din
- Division of Ophthalmology and Visual Sciences, University of Toronto Toronto Western Hospital 399 Bathurst St, Toronto, ON M5T 2S8
| | - Hall F Chew
- Division of Ophthalmology and Visual Sciences, University of Toronto Toronto Western Hospital 399 Bathurst St, Toronto, ON M5T 2S8
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Vrouwe SQ, Zuo KJ, Grotski CH, Tredget EE, Chew HF, Cartotto R. Orbital Compartment Syndrome Following Major Burn Resuscitation: A Case Series and Survey of Practice Patterns. J Burn Care Res 2020; 42:193-199. [PMID: 32818243 DOI: 10.1093/jbcr/iraa126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Orbital compartment syndrome (OCS) is a rare but devastating complication of over-resuscitation in burn patients that may lead to permanent visual loss. The purpose of this study was to 1) present a series of burn patients with OCS and 2) survey practice patterns of monitoring intra-ocular pressure (IOP) during burn resuscitation. Cases of OCS at two American Burn Association (ABA)-verified burn centers were retrospectively reviewed. Patients were included if they 1) required lateral canthotomy/cantholysis for elevated IOPs or 2) developed blindness on admission unrelated to any other ocular pathology. Data were collected on demographics, burn characteristics, fluid administration, ophthalmologic findings, and complications. An eight-item electronic survey was distributed by email through the ABA to all physician members. Twelve patients with OCS were identified, with a mean age of 47.8 ± 12.4 years and TBSA of 63.7 ± 18.6%. Mean fluid resuscitation at 24 hours was 4.9 ± 1.6 ml/kg/%TBSA or 0.29 ± 0.06 liter/kg. Eight patients underwent canthotomy/cantholysis for OCS, whereas four were later found to have visual loss. A total of 83 (14%) ABA physicians responded to the survey. IOP was routinely measured by 23% of respondents during acute burn resuscitation. OCS appears to have developed despite a relatively low 24-hour ml/kg/% burn resuscitation volume, but with a relatively higher cumulative (liter/kg) fluid volume. Their survey found that monitoring of IOP during burn resuscitation is not routinely performed by the majority of providers. Taken together, the present study suggests clinical guidelines to recognize this complication of over-resuscitation.
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Affiliation(s)
- Sebastian Q Vrouwe
- Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada
| | - Kevin J Zuo
- Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada
| | | | - Edward E Tredget
- Division of Plastic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, Ontario, Canada
| | - Robert Cartotto
- Division of Plastic and Reconstructive Surgery, University of Toronto, Ontario, Canada.,Ross Tilley Burn Centre, University of Toronto, Ontario, Canada
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Affiliation(s)
- Jason M Kwok
- Department of Ophthalmology & Vision Sciences (Kwok, Chew), University of Toronto; Sunnybrook Health Sciences Centre (Chew), Toronto, Ont
| | - Hall F Chew
- Department of Ophthalmology & Vision Sciences (Kwok, Chew), University of Toronto; Sunnybrook Health Sciences Centre (Chew), Toronto, Ont.
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Hatch W, El-Defrawy S, Ong Tone S, Stein R, Slomovic AR, Rootman DS, Rabinovitch T, Kranemann C, Chew HF, Chan CC, Bujak MC, Cohen A, Lebovic G, Jin Y, Singal N. Accelerated Corneal Cross-Linking: Efficacy, Risk of Progression, and Characteristics Affecting Outcomes. A Large, Single-Center Prospective Study. Am J Ophthalmol 2020; 213:76-87. [PMID: 31945333 DOI: 10.1016/j.ajo.2020.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/02/2020] [Accepted: 01/03/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE We examined the efficacy and preoperative characteristics that affect outcomes of accelerated (9 mW/cm2 for 10 minutes) corneal cross-linking (CXL). DESIGN Prospective single-center observational cohort study. METHODS We enrolled 612 eyes of 391 subjects with progressive keratoconus (n = 589), pellucid marginal degeneration (n = 11), and laser in situ keratomileusis-induced ectasia (n = 12). We evaluated best spectacle-corrected visual acuity (BSCVA), topography, refraction, endothelial cell density, corneal thickness, haze, intraocular pressure, and visual function before and 12 months after the CXL procedure. We tabulated the proportion of those with progression of maximum keratometry (Kmax). We included participant's race, age, sex, and the presence of preoperative apical scarring and environmental allergies in a multivariable linear regression model to determine the effect of these characteristics on outcomes. RESULTS At 1 year there was no significant change in mean Kmax (n = 569). Progression of Kmax was higher in subgroups with a baseline Kmax >58 diopters (n = 191) and those 14-18 years of age (n = 53). Preoperative BSCVA, Kmax, refraction, corneal cylinder, coma, central corneal thickness, and vision function were statistically and clinically significant predictors of outcomes (P < .001). Preoperative apical scarring led to worsening haze (P = .0001), more astigmatism (P = .002), more central corneal thinning (P = .002), and was protective to the endothelium (P = .008). Race, age, and sex affected some outcomes. CONCLUSION Mean Kmax was stable at 1 year after accelerated CXL. Younger patients and those with a higher preoperative Kmax need to be monitored closely for progression. Preoperative BSCVA, topography, refraction, CCT, and apical scarring were significant predictors of outcomes.
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Avdagic E, Chew HF, Veldman P, Tu EY, Jafri M, Doshi R, Boggild AK, Reidy JJ, Farooq AV. Resolution of Acanthamoeba Keratitis with Adjunctive Use of Oral Miltefosine. Ocul Immunol Inflamm 2019; 29:278-281. [PMID: 31829774 DOI: 10.1080/09273948.2019.1695853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To report a series of cases demonstrating the resolution of Acanthamoeba keratitis (AK) with adjunctive use of oral miltefosine.Methods: Retrospective case series.Results: The first case was a 27-year-old female who presented with severe pain and photophobia. The diagnosis of AK was made with confocal microscopy, which revealed a significant burden of stromal cysts. After approximately 2 weeks of adjunctive oral miltefosine therapy, there was a severe inflammatory response within the cornea followed by quick resolution of the AK. The second case was a 31-year-old male in whom the diagnosis of AK was confirmed by culture and polymerase chain reaction. Adjunctive oral miltefosine was started 3 months after presentation, leading to a quick resolution.Conclusions: Oral miltefosine may have cysticidal properties and should be considered as adjunctive therapy for the treatment of AK, particularly in cases with a significant burden of cysts or in cases recalcitrant to other treatments.
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Affiliation(s)
- Ema Avdagic
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Hall F Chew
- Department of Ophthalmology and Vision Science, University of Toronto, Toronto, Canada
| | - Peter Veldman
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Elmer Y Tu
- Department of Ophthalmology and Visual Sciences, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mansab Jafri
- Kansas City University of Medicine and Biosciences, Kansas City, Missouri, USA
| | - Rutvi Doshi
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Andrea K Boggild
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada.,Tropical Disease Unit, Toronto General Hospital, Toronto, Canada.,Public Health Ontario Laboratory, Public Health Ontario, Toronto, Canada
| | - James J Reidy
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
| | - Asim V Farooq
- Department of Ophthalmology and Visual Science, University of Chicago, Chicago, Illinois, USA
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Olteanu C, Shear NH, Chew HF, Hashimoto R, Alhusayen R, Whyte-Croasdaile S, Finkelstein Y, Burnett M, Ziv M, Sade S, Jeschke MG, Dodiuk-Gad RP. Severe Physical Complications among Survivors of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Drug Saf 2018; 41:277-284. [PMID: 29052094 DOI: 10.1007/s40264-017-0608-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Few studies have reported the physical complications among Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) survivors. OBJECTIVE The aim of this study was to comprehensively characterize the physical complications among SJS/TEN survivors and to learn about patients' perspectives of surviving SJS/TEN. METHODS SJS/TEN survivors older than 18 years of age were assessed by different methods: a medical interview; a questionnaire assessing patients' perspectives; thorough skin, oral mucous membrane, and ophthalmic examinations; and a retrospective assessment of medical records. RESULTS Our cohort consisted of 17 patients with a mean time of 51.6 ± 74.7 months (median 9, range 1-228) following SJS/TEN. The most common physical complications identified in the medical examination were post-inflammatory skin changes (77%), cutaneous scars (46%), dry eyes (44%), symblepharon, and chronic ocular surface inflammation (33% each). Novel physical sequelae included chronic fatigue (76%) and pruritus (53%). We also found a novel association between the number of mucous membranes affected in the acute phase of SJS/TEN and hair loss during the 6 months following hospital discharge; hair loss was reported in 88% of the group of patients who had three or more mucous membranes affected versus 29% of patients who had less than three mucous membranes involved (p = 0.0406). Following hospital discharge due to SJS/TEN, 59% of patients were followed by a dermatologist, although 88% had dermatological complications; 6% were followed by an ophthalmologist, even though 67% had ophthalmological complications; and 6% of female survivors were followed by a gynecologist, even though 27% had gynecological complications. CONCLUSION Survivors of SJS/TEN suffer from severe physical complications impacting their health and lives that are mostly under recognized and not sufficiently treated by medical professionals.
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Affiliation(s)
- Cristina Olteanu
- Division of Dermatology, Department of Medicine, University of Alberta, 8-112 Clinical Sciences Building, Edmonton, AB, T6G 2G3, Canada
| | - Neil H Shear
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada. .,Division of Clinical Pharmacology and Toxicology, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Rena Hashimoto
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada
| | - Raed Alhusayen
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada
| | | | - Yaron Finkelstein
- Paediatric Emergency Medicine, Clinical Pharmacology and Toxicology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Marjorie Burnett
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Michael Ziv
- Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
| | - Shachar Sade
- Department of Pathology, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Marc G Jeschke
- Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Roni P Dodiuk-Gad
- Division of Dermatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Suite MI-700, Toronto, ON, M4N 3M5, Canada.,Dermatology Department, Emek Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Institute of Technology, Haifa, Israel
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Shah BR, Alobthani M, Chew HF. Calcium crystals in the anterior chamber as a harbinger of hyperparathyroidism. Can J Ophthalmol 2018; 53:e130-e132. [DOI: 10.1016/j.jcjo.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 10/31/2017] [Indexed: 10/18/2022]
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Showail MJ, Kus JV, Tsui GK, Chew HF. Fungal keratitis caused by Metarhizium anisopliae complex. Med Mycol Case Rep 2017; 17:28-30. [PMID: 28702317 PMCID: PMC5491454 DOI: 10.1016/j.mmcr.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 06/11/2017] [Accepted: 06/18/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report a case of fungal keratitis caused by Metarhizium anisopliae complex Methods Case report Results Our patient presented with a central corneal infiltrate. Fungal culture yielded a Metarhizium species. She was started on antifungal agents with no significant improvement. A therapeutic corneal transplant was performed after perforation. At two years follow up, she was free of infection. Conclusion Metarhizium anisopliae is a very rare cause of keratitis. Although previous reported cases showed clinical improvement with antifungal agents, this case required surgical treatment to control the infection.
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Affiliation(s)
- Mahmood J. Showail
- The Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, Canada M5T 3A9
- The Department of Ophthalmology, King Abdulaziz University, Jeddah, Saudi Arabia
- Corresponding author at: Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, Canada M5T 3A9.
| | - Julianne V. Kus
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada
- The Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - George Kar Tsui
- Public Health Ontario Laboratories, Public Health Ontario, Toronto, ON, Canada
| | - Hall F. Chew
- The Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Suite 400, Toronto, ON, Canada M5T 3A9
- The John and Liz Tory Eye Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Chiu HH, Sade S, Chew HF. Corneal melt following collagen crosslinking and topography-guided customized ablation treatment for keratoconus. Can J Ophthalmol 2017; 52:e88-e91. [PMID: 28576226 DOI: 10.1016/j.jcjo.2016.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 11/01/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Shachar Sade
- Department of Laboratory Medicine & Pathobiology, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ont.
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Leung VC, Pechlivanoglou P, Chew HF, Hatch W. Corneal Collagen Cross-Linking in the Management of Keratoconus in Canada: A Cost-Effectiveness Analysis. Ophthalmology 2017; 124:1108-1119. [PMID: 28457614 DOI: 10.1016/j.ophtha.2017.03.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/09/2017] [Accepted: 03/09/2017] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To use patient-level microsimulation models to evaluate the comparative cost-effectiveness of early corneal cross-linking (CXL) and conventional management with penetrating keratoplasty (PKP) when indicated in managing keratoconus in Canada. DESIGN Cost-utility analysis using individual-based, state-transition microsimulation models. PARTICIPANTS Simulated cohorts of 100 000 individuals with keratoconus who entered each treatment arm at 25 years of age. Fellow eyes were modeled separately. Simulated individuals lived up to a maximum of 110 years. METHODS We developed 2 state-transition microsimulation models to reflect the natural history of keratoconus progression and the impact of conventional management with PKP versus CXL. We collected data from the published literature to inform model parameters. We used realistic parameters that maximized the potential costs and complications of CXL, while minimizing those associated with PKP. In each treatment arm, we allowed simulated individuals to move through health states in monthly cycles from diagnosis until death. MAIN OUTCOME MEASURES For each treatment strategy, we calculated the total cost and number of quality-adjusted life years (QALYs) gained. Costs were measured in Canadian dollars. Costs and QALYs were discounted at 5%, converting future costs and QALYs into present values. We used an incremental cost-effectiveness ratio (ICER = difference in lifetime costs/difference in lifetime health outcomes) to compare the cost-effectiveness of CXL versus conventional management with PKP. RESULTS Lifetime costs and QALYs for CXL were estimated to be Can$5530 (Can$4512, discounted) and 50.12 QALYs (16.42 QALYs, discounted). Lifetime costs and QALYs for conventional management with PKP were Can$2675 (Can$1508, discounted) and 48.93 QALYs (16.09 QALYs, discounted). The discounted ICER comparing CXL to conventional management was Can$9090/QALY gained. Sensitivity analyses revealed that in general, parameter variations did not influence the cost-effectiveness of CXL. CONCLUSIONS CXL is cost-effective compared with conventional management with PKP in the treatment of keratoconus. Our ICER of Can$9090/QALY falls well below the range of Can$20 000 to Can$100 000/QALY and below US$50 000/QALY, thresholds generally used to evaluate the cost-effectiveness of health interventions in Canada and the United States. This study provides strong economic evidence for the cost-effectiveness of early CXL in keratoconus.
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Affiliation(s)
- Victoria C Leung
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada; Toronto Health Economics and Technology Assessment Collaborative, Toronto, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Kensington Eye Institute, Toronto, Canada
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Abstract
Anterior segment stem cell technology, due to its already well-defined corneal limbal stem cells with greater ease of evaluation, has been at the forefront of ophthalmic stem cell treatment and technology since 1997. This paper provides an overview of the current standard of care for treatment of limbal stem-cell deficient conditions and reviews recent treatment technologies using ex vivo expansion of cultivated limbal stem cells of the cornea.
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Affiliation(s)
- Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ontario, Canada M4N 3M5
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Abstract
BACKGROUND To determine whether there is a clinically significant reduction in visual acuity (VA) or contrast sensitivity (CS), with and without glare, following examination with pupil dilation in patients currently driving. METHODS From November 1, 2004, to February 28, 2005, 105 consecutive patients were assessed in our institution. The better eye was assessed pre- and post-dilation with and without glare administered through the Brightness Acuity Tester. VA was assessed using the Early Treatment in Diabetic Retinopathy Study (ETDRS) and Snellen charts. CS was measured using the Vistech VCTS 6500 Chart. RESULTS With no glare, there was a mean reduction of 4.8 letters read from the ETDRS chart following dilation (p < 0.001). With glare, there was a mean reduction of 7.1 letters (p < 0.001). Compared with patients with initial VA of 20/20, patients presenting with a Snellen VA of 20/25 to 20/40 had a 9.75 relative risk of postdilation VA worse than 20/40, whereas patients with initial VA of 20/40 had a 19.8 relative risk of postdilation VA worse than 20/40. With the addition of glare, these relative risks increased to 13.9 and 28.8, respectively. Without glare, there was a significant reduction in CS after dilation at spatial frequencies of 2.0, 4.0, and 6.0 cycles/degree (p = 0.014, p < 0.001, and p < 0.001, respectively). With glare, there was a greater reduction in CS at these 3 spatial frequencies (p < 0.001 for all). INTERPRETATION There is a significant reduction in VA and CS after dilation that is further confounded by the effect of glare. This reduction may limit some patients from driving after dilation.
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Affiliation(s)
- Hall F Chew
- Department of Ophthalmology and Vision Sciences, University of Toronto, Ont
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Forooghian F, Chew HF, Muni RH, Adamus G, Drake JM, Buncic JR. Paraneoplastic optic disc oedema and retinal periphlebitis associated with pineal germinoma. Br J Ophthalmol 2007; 91:985-6. [PMID: 17576721 PMCID: PMC1955653 DOI: 10.1136/bjo.2006.112193] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Paul RA, Chew HF, Singal N, Rootman DS, Slomovic AR. Piggyback intraocular lens implantation to correct myopic pseudophakic refractive error after penetrating keratoplasty. J Cataract Refract Surg 2004; 30:821-5. [PMID: 15093644 DOI: 10.1016/j.jcrs.2003.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine the safety and efficacy of implanting a second intraocular lens (IOL) to correct myopic pseudophakic refractive error after penetrating keratoplasty (PKP). SETTING Department of Ophthalmology, Toronto Western Hospital, Toronto, Ontario, Canada. METHODS In this retrospective case series, 6 eyes of 6 post-PKP pseudophakic patients had a second piggyback IOL implantation to correct a residual myopic refractive error. The uncorrected visual acuity (UCVA) and the best corrected visual acuity (BCVA) were measured at regular intervals during a 7-month follow-up. Efficacy was determined by the achieved refractive correction and Snellen UCVA measurements. Safety was measured by loss of BCVA and complications (intraoperative and postoperative). RESULTS The UCVA improved in all cases. Five patients achieved a BCVA of 20/40 or better postoperatively. Before surgery, the mean spherical equivalent (SE) was -8.08 diopters (D) (range -6.13 to -12.00 D). After surgery, the mean SE was -0.94 D (range -2.38 to +0.25 D). Four patients were within +/-1.50 D of emmetropia. There were no intraoperative or postoperative complications. CONCLUSION Implanting a piggyback IOL was a safe and effective means of correcting myopic pseudophakic refractive error post PKP.
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Affiliation(s)
- Robert A Paul
- University of Toronto, Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
PURPOSE The goal of the study was to determine the safety and analgesic efficacy of a patient-controlled infusion pump that dispenses bupivacaine extra-articularly to the infrapatellar fat pad after anterior cruciate ligament (ACL) reconstruction with ipsilateral bone-patellar tendon-bone autogenous graft. TYPE OF STUDY Prospective clinical study. METHODS Twenty-one consecutive patients were enrolled in the study. After surgery, the catheter of a bupivacaine infusion pump was implanted extra-articularly onto the infrapatellar fat pad. Ten patients were given infusion pumps with 50 mL of 0.5% bupivacaine to be self-administered for analgesia. Eleven patients were given infusion pumps with 50 mL of 0.25% bupivacaine. Opioid analgesics were available if patients were unable to control the pain solely with the bupivacaine pump. Historic controls consisted of 62 consecutive patients who underwent ACL reconstruction before study initiation. Patients recorded volumes of self-administered bupivacaine; also recorded were postoperative pain levels using a visual analog scale (VAS). Opioid analgesic usage was measured and compared with historic controls. RESULTS Amount of bupivacaine infused and VAS recorded pain levels were not significantly different between the 0.5% and the 0.25% bupivacaine groups. Opioid analgesic usage was significantly reduced when the 0.5% bupivacaine group was compared with historic controls (mean morphine equivalents via intramuscular route: 0.5% group, 17.6 mg; historic controls, 66.4 mg; P =.015). This was also significant when normalized by patient weight (0.5% group, 0.227 mg/kg; historic controls, 0.880 mg/kg; P =.023). Opioid usage in the 0.25% group (35.7 mg and 0.540 mg/kg) was also less than historic controls; however, this was not statistically significant. CONCLUSIONS Infrapatellar fat pad infusion with 0.5% bupivacaine may provide enhanced analgesia after ACL reconstruction with ipsilateral bone-patellar tendon-bone autogenous graft. A double-blinded, randomized control trial with a greater number of patients is required to confirm these findings.
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Affiliation(s)
- Hall F Chew
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Chew HF, You CK, Brown MG, Heisler BE, Andreou P. Mortality, morbidity, and costs of ruptured and elective abdominal aortic aneurysm repairs in Nova Scotia, Canada. Ann Vasc Surg 2003; 17:171-9. [PMID: 12616362 DOI: 10.1007/s10016-001-0242-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Ruptured abdominal aortic aneurysms (RAAA) have a 78-94% mortality rate. If cost-effectiveness of screening programs for abdominal aortic aneurysms (AAA) are to be assessed, direct costs for RAAA repairs and elective AAA (EAAA) repairs are required. This study reports mortality, morbidity, and direct costs for RAAA and EAAA repairs in Nova Scotia in 1997-1998 and also compares Nova Scotia and U.S. costs. We performed a retrospective study of 41 consecutive RAAA and 48 randomly selected EAAA patients. Average total costs for RAAA repair were significantly greater than those for EAAA repair (direct costs: $15,854 vs. $9673; direct plus overhead costs: $18,899 vs. $12,324 [pricing in 1998 Canadian dollars]). Intensive care unit length of stay and blood product usage were the most substantial direct cost differentials ($3593 and $2106). Direct cost for preoperative testing and surveillance was greater in the EAAA group ($839 vs. $33). Estimates of U.S. in-hospital RAAA and EAAA repair costs are more than 1.5 times Nova Scotia costs. Direct in-hospital RAAA repair costs are $6181 more than EAAA repair costs. These in-hospital cost data are key cost elements required to assess the cost-effectiveness of various screening strategies for earlier detection and monitoring of AAA within high-risk populations in Canada. Further studies are required to estimate cost per quality-adjusted-life-year gained for various AAA screening and monitoring strategies in Canada.
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Affiliation(s)
- Hall F Chew
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Abstract
The fate of the injured anterior cruciate ligament (ACL) is variable. The spectrum of injury ranges from partial sprain (grade 1 or 2) to a complete disruption (grade 3), which may occur in isolation or in combination with injury to other structures in the knee. Postinjury symptoms of knee instability usually depend on the degree of joint laxity and the athletic demands of the individual. If an ACL injury is left untreated, repeated episodes of subluxation can inflict further intraarticular damage, with an increased risk of developing osteoarthritis. Predicting the outcome after ACL injury is difficult, and treatment should be individualized.
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Affiliation(s)
- N A Evans
- Orthopaedic and Sport Medicine Clinic of Nova Scotia, Halifax, Nova Scotia, B3H 4M2, CAN
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