Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

Zusammenfassung OP-Ablauf Die posteriore lamelläre Keratoplastik stellt ein verlässliches Verfahren zur schnellen visuellen Rehabilitation von Patienten mit Erkrankungen des Hornhautendothels dar. Unsere Autoren von der Augenklinik des Luzerner Kantonsspitals stellen die Technik der posterioren lamellären Keratoplastik mittels Descemetstripping und Mikrokeratom (DSAEK: Descemet Stripping Automated Endothelial Keratoplasty) vor.

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Robotic-assisted interaortocaval dissection of an extra-adrenal paraganglioma in supine position via a trans-peritoneal approach

Endocrine Abstracts ◽

10.1530/endoabs.63.p812 ◽

2019 ◽

Author(s):

Thierry Quackels ◽

Simone Albisinni ◽

Valerio Lucidi ◽

Barbara Dessars ◽

Natacha Driessens

Keyword(s):

Supine Position ◽

Robotic Assisted ◽

Extra Adrenal Paraganglioma

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Key concepts and instrumentation for endothelial keratoplasty and deep anterior lamellar keratoplasty

Minerva Oftalmologica ◽

10.23736/s0026-4903.18.01813-5 ◽

2019 ◽

Vol 60 (4) ◽

Author(s):

Silvana Madi ◽

Ahmed Hussein

Keyword(s):

Lamellar Keratoplasty ◽

Deep Anterior Lamellar Keratoplasty ◽

Endothelial Keratoplasty ◽

Anterior Lamellar Keratoplasty ◽

Key Concepts

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Сomparative analysis of clinical and functional results after different modifications of endothelial keratoplasty

POINT OF VIEW EAST – WEST ◽

10.25276/2410-1257-2020-3-28-31 ◽

2020 ◽

pp. 28-31

Author(s):

S.V. Trufanov ◽

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E.P. Salovarova ◽

E.V. Sukhanova ◽

◽

...

Keyword(s):

Functional Results ◽

Endothelial Keratoplasty

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DMEK, DSAEK in the treatment of endothelial-epithelial corneal dystrophy

Modern technologies in ophtalmology ◽

10.25276/2312-4911-2020-3-114-115 ◽

2020 ◽

pp. 114-115

Author(s):

D.A. Krivolapova ◽

◽

G.A. Yessenzhan ◽

B.I. Issergepova ◽

A.K. Kanatbekova ◽

...

Keyword(s):

Corneal Dystrophy ◽

Endothelial Keratoplasty

Актуальность. DMEK (descemet membraneendothelial keratoplasty) и DSAEK (Descemet’sstripping automated endothelial keratoplasty) в лечении эндотелиально-эпителиальных дистрофий(ЭЭД) – наиболее высокотехнологичный, малоинвазивный, патогенетически ориентированный метод трансплантации роговицы. Учитывая отсутствие тенденции к снижению частоты ЭЭД во всем мире, представляется актуальным изучение эффективности современных методов эндотелиальной кератопластики. Цель. Оценка клинической эффективностиDMEK, DSAEK у больных с эндотелиально-эпителиальной дистрофией роговицы. Материал и методы. В исследование включены7 пациентов (4 женщины и 3 мужчин), прооперированные в КазНИИ ГБ в период с 2018 по 2019 г. Средний срок наблюдения – 12,6 месяцев. Средний возраст пациентов на момент операции – 69,57лет и варьировал от 52 до 79 лет. Для объективной оценки структуры роговицы, пахиметрии использовался метод оптической когерентной томографии Spectralis роговичный модуль. Результаты. Показанием к проведению эндотелиальной кератопластики в 1 случае (1 глаз)явилась первичная дистрофия Фукса, во всех остальных случаях – вторичная ЭЭД в исходе предшествующей хирургии катаракты. Проведено 4DSAEK (у 1 пациента повторно) и 4 DMEK; операции во всех случаях произведены без осложнений.В одном случае DSAEK на 3-и сутки наблюдалось частичное отслоение лоскута в пределах 1 квадранта, пациенту в условиях операционной введен воздух, достигнуто полное прилегание лоскута. Восстановление прозрачности роговицы достигнуто во всех случаях. Острота зрения до операции составила в среднем, 0,08; на 10 сутки после операции наблюдалось повышение остроты зрения в среднем до 0,2 (от 0,1 до 0,3). Снижение отека роговицы отмечалось, в среднем, через 1–2 мес. после операции. Пахиметрия до операции составила от 570 до 800 мкн в оптической зоне, через 3 мес. эти данные составили от 550 до 680 мкн. Выводы. DMEK и DSAEK – эффективный, безопасный, малоинвазивный метод трансплантации роговицы, с минимальным реабилитационным периодом – предпочтительный в случаях декомпенсации эндотелия.

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Prediction of Post spinal anesthesia hypotension in patients undergoing cesarean section using Perfusion index

Birat Journal of Health Sciences ◽

10.3126/bjhs.v5i3.33708 ◽

2020 ◽

Vol 5 (3) ◽

pp. 1241-1245

Author(s):

Kumud Pyakurel ◽

Lalit Kumar Rajbanshi ◽

Ramesh Bhattarai ◽

Sonia Dahal

Keyword(s):

Spinal Anesthesia ◽

Cesarean Delivery ◽

Supine Position ◽

Roc Curve ◽

Anesthetic Management ◽

College Teaching ◽

Perfusion Index ◽

Sensory Level ◽

Roc Curve Analysis ◽

Group I

Introduction: Spinal anesthesia induced hypotension frequently complicates Cesarean delivery. This is usually due to sudden sympatholysis causing decreased venous return which can be aggravated by physiological changes of pregnancy leading to change in baseline peripheral vascular tone. Strategies to prevent hypotensive episodes should be the primary aim of anesthetic management. A simple noninvasive measurement of perfusion index derived from pulse oximeter predicting hypotension during the routine intraoperative course could provide a new dynamism to the management and improving the safe execution of anesthesia. Objectives: The primary objective of this study was to compare incidence of hypotension following SAB for LSCS in patients with baseline PI ≤ 3.5 to those with PI > 3.5. The secondary objectives were to compare PI, HR, SBP, MAP at various time intervals and also to study the side effects between the two groups. Methodology: This prospective observational study was conducted at Nobel Medical College Teaching Hospital from to July 2019 to October 2019. 73 Term parturients presenting for elective cesarean delivery were included for the study. Upon arrival in the operation room, standard monitors were attached and baseline HR, SBP, DBP, MAP, PI and SPO2 were recorded in supine position. The patients with baseline PI ≤ 3.5 were enrolled into Group I and those with a PI > 3.5 were enrolled into Group II. Spinal Anesthesia with 10mg of 0.5% heavy Bupivacaine and 20mcg Fentanyl ( total 2.4ml) was given at L3-L4 interspace in sitting position using midline approach. Patient was then returned to supine position with left lateral tilt of 15 degrees to facilitate left uterine displacement. Upper sensory level was checked at 5 minutes using alcohol swab. Once T-6 level was reached, surgery was started. Maternal SBP, DBP, MAP, HR and PI were recorded at 1 minute intervals between spinal injection and delivery and then 3 minutes until end of surgery. Clinically relevant hypotension was defined as the decrease in MAP by 20% or more from baseline value. Results: The incidence of hypotension in Group I was 18.8% (6/30) compared to 81.3% (26/38). This was clinically and statistically highly significant (P = 0.000, odds ratio 0.11). On Spearman’s rank correlation we found highly significant correlation between baseline PI >3.5 and number of episodes of hypotension (rs 0.482, P = 0.000). The sensitivity and specificity of baseline PI with cut-off 3.5 for predicting hypotension were 81.3% and 66.7% respectively. The ROC curve analysis showed 3.53 as appropriate cut‑off for our findings. The area under the ROC curve (AUC) was 0.734 [Figure 6](Lower bound 0.608 and upper bound 0.861, P=0.001). Conclusion : This study demonstrates that baseline PI of > 3.5 correlates with incidence of hypotension after spinal anesthesia for cesarean delivery in healthy parturients compared to a baseline PI of < 3.5.

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