Surgical Treatment Moyamoya Disease

Moyamoya disease is a rare cerebrovascular disease most prevalent in East Asian Countries. Thanks to the new diagnostic capabilities, the number of cases discovered has been rising steadily in the latest years, including many asymptomatic patients. But asymptomatic from the clinical point of view does not necessarily mean that there are no subjacent problems and that there will be no disease progression. Indeed, many patients harbour cognitive decline long before they start with clinical or even radiological manifestations. The only effective treatment is surgical revascularization, with all its possibilities: direct, indirect, and combined. While direct techniques are more useful in adult moyamoya patients, children seem to benefit most from indirect techniques. Additionally, indirect or combined procedures can be used as salvage procedures in case of unsatisfactory outcomes. Thus, many surgeons posit that surgical treatment should be considered in moyamoya patients, even if asymptomatic, particularly in the paediatric age group.

Retinal Detachment and Laser Retinopexy Rates During the COVID-19 Pandemic

Purpose: At the start of March 2020, the COVID-19 pandemic placed an unprecedented burden on the healthcare system. Throughout much of the United States, shelter-in-place orders were imposed to reduce transmission. A consequence of this crisis, risk mitigation orders, and patient fear of exposure may have led to underutilization of emergency services. We aimed to quantify 2 emergent interventions in ophthalmology, specifically acute laser retinopexy procedures and retinal detachment repair, to determine whether these procedures decreased during the start of the pandemic. Methods: All retinal detachment surgeries and laser retinopexy procedures were identified using Current Procedural Terminology codes. Rate data during the study period (March 1 through May 31, 2020) was compared to historical data from the year prior (March 2019 through May 2019; epoch 1) as well as the immediate 3 months prior to the study period (December 2019 through February 2020; epoch 2). Results: Combined procedures fell by 38.5% ( P = .01) and 36.0% ( P = .02) when compared to epoch 1 and epoch 2, respectively. The rate of laser retinopexy procedures fell by 45.5% ( P = .02) and 33.0% ( P = .14) when compared to epoch 1 and epoch 2, respectively. The rate of retinal detachment repair fell by 29.4% ( P = .24) and 38.0% ( P = .07) when compared to epoch 1 and epoch 2, respectively. Conclusions: Procedures fell during the study period, suggesting underutilization of emergent ophthalmology care. It is necessary for ophthalmologists to emphasize the need to seek care for concerning symptoms.