Functional outcomes in high risk ICU patients in Central Australia: a prospective case series

PurposeTo describe the anatomical and functional outcomes of the novel LVP keratoprosthesis (Kpro), developed as an alternative to the modified osteo-odonto keratoprosthesis (MOOKP), in eyes with end-stage corneal blindness where conventional corneal surgeries are contraindicated.MethodsThis prospective case series included 58 eyes of 56 patients (12 children and 44 adults) with severe bilateral keratopathy and completely dry, dermalised ocular surfaces who underwent unilateral LVP Kpro implantation from 2012 to 2016. In this two-stage procedure, an ocular surface labial mucous membrane grafting was performed, followed for 3 months by the implantation of the device under the engrafted mucosal flap. The primary outcome measures were anatomical retention rate and improvement in best corrected visual acuity (BCVA). The secondary outcome measure was rate of occurrence of complications.ResultsMean postoperative follow-up was 2.5±1.1 years. Kaplan-Meier survival analysis showed an anatomical retention rate of 90.8%±3.9% at 1 year, 80%±5.7% at 2 years and 76.6%±6.5% at 3–5 years. The survival rates were comparable in children and adults (91% vs 72% at 5 years, p=0.258). About 61.5% of eyes maintained 20/400 or better vision and median BCVA improved from perception of light to 20/70 at 1 year postoperatively (p<0.0001). Complications like retroprosthetic membrane formation, glaucoma, vitritis, endophthalmitis and panophthalmitis occurred in 43%, 26%, 22%, 12% and 3% of the eyes, respectively.ConclusionThe LVP Kpro is an effective procedure for the treatment of end-stage corneal blindness in completely dry eyes. The LVP Kpro can be particularly useful in situations where the MOOKP is contraindicated or difficult to perform.

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The FICI grading for a dacryocystorhinostomy ostium

European Journal of Ophthalmology ◽

10.1177/1120672121994747 ◽

2021 ◽

pp. 112067212199474

Author(s):

Mohammad Javed Ali ◽

Adit Gupta ◽

Chittabhathina Sri Lakshmi ◽

Mohammad Hasnat Ali

Keyword(s):

Functional Outcomes ◽

Statistical Tests ◽

Recursive Partitioning ◽

Case Series ◽

Conditional Inference ◽

Statistical Software ◽

Fluorescein Dye ◽

Prospective Case Series ◽

Larger Sample ◽

Significant Factors

Purpose: The objective of this study is to propose a simple grading to assess the health of a dacryocystorhinostomy (DCR) ostium. Methods: Prospective case series of 237 Ostia evaluated following dacryocystorhinostomy were included in the study. All the ostia were assessed for 10 parameters in detail using the earlier published DCR ostium scoring (DOS scoring). Each of the 10 parameters were scored individually, and final DOS scores were obtained. The anatomical and functional outcomes of each of the surgery were noted. The most significant parameters that influenced the success were determined using the binary recursive partitioning in a conditional inference framework. Data management and statistical tests were performed using the statistical “Software R” and the library “partykit” toolkits. Results: The most significant DCR ostium parameters that influenced the outcomes were anatomical and functional fluorescein dye transit ( p < 0.001), dynamicity of internal common opening (ICO) on the blink ( p < 0.001), end-on threats to ICO from granuloma, membrane or a synechia, and cicatricial closure of the Ostia. Each of these significant factors (FICI – Fluorescein endoscopy dye test, ICO dynamicity, Cicatricial ostium closure and ICO threats) were assigned simple scoring and the final scores were graded from 0 (poor DCR ostium) to +5 (excellent DCR ostium). FICI grading can guide the physician on the health status of the DCR ostium and the possible need for intervention. Conclusion: FICI DCR ostium grading is a simple, easy to perform, and physician-friendly system. More studies with larger sample size would help in further validating the FICI grading.

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Anatomical and functional outcomes after hysterectomy and bilateral sacrospinous ligament fixation for stage IV uterovaginal prolapse: a prospective case series

BMC Urology ◽

10.1186/s12894-020-00694-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Tilemachos Kavvadias ◽

Birgitt Schoenfisch ◽

Sara Yvonne Brucker ◽

Christl Reisenauer

Keyword(s):

Functional Outcomes ◽

Case Series ◽

Stage Iv ◽

Uterovaginal Prolapse ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

Prospective Case Series

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Closure or medical therapy of patent foramen ovale in cryptogenic stroke: prospective case series

Neurological Research and Practice ◽

10.1186/s42466-021-00114-3 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Sven Poli ◽

Elisabeth Siebert ◽

Joshua Mbroh ◽

Khouloud Poli ◽

Markus Krumbholz ◽

...

Keyword(s):

High Risk ◽

Medical Therapy ◽

Intracranial Hemorrhage ◽

Patent Foramen Ovale ◽

Case Series ◽

Low Risk ◽

Foramen Ovale ◽

Prospective Case Series ◽

Pfo Closure

Abstract Background Results of randomized controlled trials (RCT) do not provide definite guidance for secondary prevention after ischemic stroke (IS)/transient ischemic attack (TIA) attributed to patent foramen ovale (PFO). No recommendations can be made for patients > 60 years. We aimed to compare interventional and medical PFO-management in cryptogenic IS/TIA patients, including patients > 60 years. Methods Prospective case series including consecutive cryptogenic IS/TIA patients with PFO at Tuebingen university stroke unit, Germany. ‘PFO-closure’ was recommended in patients ≤70 years when featuring high-risk PFO (i.e., with atrial septal aneurysm, spontaneous, or high-grade right-to-left shunt during Valsalva). Primary (recurrent IS/intracranial hemorrhage) and secondary endpoints (e.g., disability) were assessed during ≥1-year follow-up; planned subgroup analyses of patients ≤60/> 60 years. Results Among 236 patients with median age of 58 (range 18–88) years, 38.6% were females and median presenting National Institutes of Health Stroke Scale score was 1 (IQR 0–4). Mean follow-up was 2.8 ± 1.3 years. No intracranial hemorrhage was observed. Recurrent IS rate after ‘PFO-closure’ was 2.9% (95%CI 0–6.8%) and 7% (4–16.4) in high-risk PFO patients ≤60 (n = 103) and > 60 years (n = 43), respectively, versus 4% (0–11.5) during ‘medical therapy alone’ MTA (n = 28). 42 low-risk PFO patients treated with MTA experienced no recurrent IS/TIA. Conclusions In our real-world study, IS recurrence rate in ‘PFO-closure’ high-risk PFO patients ≤60 years was comparable to that observed in recent RCT. High-risk PFO patients > 60 years who underwent PFO-closure had similar IS recurrence rates than those who received MTA. MTA seems the appropriate treatment for low-risk PFO. Trial registration ClinicalTrials.gov, registration number: NCT04352790, registered on: April 20, 2020 – retrospectively registered.

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