Sutureless Tectonic Mini-Descemet's Stripping Automated Endothelial Keratoplasty (“mini-DSAEK”) for the management of corneal perforations

Purpose To report the outcomes of a new technique, pull-through sutureless ‘mini-DSAEK’, to manage corneal perforations secondary to different aetiologies including trauma, neurotrophic ulcer following penetrating keratoplasty (PK), herpes simplex keratitis and microbial keratitis. Methods In this retrospective case series, we report the clinical outcomes of five cases of sutureless tectonic mini-DSAEK performed in patients presenting with large corneal perforations to Southend University Hospital between November 2019 and October 2020. One corneal perforation was sufficiently peripheral for the tectonic mini-DSAEK graft to be successfully positioned outside of the central visual axis. Four corneal perforations were central or paracentral for which the tectonic grafts involved the visual axis. Results Anterior chambers remained deep and formed with no evidence of leak in all subsequent follow ups in all patients representing 100% tectonic success. All tectonic grafts remained attached except one partially detached graft. One patient underwent uneventful phacoemulsification with intraocular lens implant 8 months after the primary intervention with excellent visual outcome. Two patients underwent two-piece mushroom PK and one patient underwent triple procedure (cataract extraction + intraocular lens + PK) for visual rehabilitation 2–6 months after the primary intervention with good visual outcome. Conclusion Sutureless tectonic pull-through mini-DSAEK is a useful technique in the management of corneal perforations, with a number of advantages compared with conventional techniques.

Evaluation of educational interventions on eye health for dietetic and pharmacy professions: a pre-post study

Background We piloted an educational intervention that aimed to enhance awareness about nutrition-age-related macular degeneration (AMD) links among practising and student dietitians then expanded the scope of this intervention to include general eye health, which was delivered to pharmacy students. Methods A pilot intervention was conducted in 2019 at the Dietitians Australia Conference (Gold Coast, Australia) where practising and student dietitians underwent a 2-hour small group educational workshop on nutrition and AMD links. Pre-post questionnaires were administered to participants, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcome was a change in AMD-related nutrition knowledge pre-post intervention. A larger intervention was then conducted at the University of Sydney (Sydney, Australia) where pharmacy students underwent a 4-hour educational module to improve general eye health knowledge, as well as student perceptions and attitudes towards a pharmacists’ role in low vision care. Similarly, pre-post questionnaires were administered, with voluntary completion of both questionnaires an indicator of consent to participate in the intervention. The primary intervention outcomes were changes in total knowledge, total perception and total attitude scores pre-post intervention. Results (1) Among 10 accredited and 5 student dietitians, there was significant overall knowledge improvement (mean pre-post score: 7.07 ± 1.94 vs. 10.8 ± 1.01, p = 0.001) specifically around appropriate dietary advice, food sources of key AMD-related nutrients, and awareness of supplements. (2) Among 179 second-year pharmacy students enrolled in the ‘Pharmacy Practice’ Unit of Study (Bachelor of Pharmacy, University of Sydney), total eye health knowledge (6.25 ± 1.93 vs. 6.64 ± 2.0; p = 0.011) significantly improved, along with total perception scores (41.54 ± 5.26 vs. 42.45 ± 4.95; p = 0.004). Total attitude scores were not significantly different. Conclusions The pilot intervention improved relevant nutrition-AMD knowledge among practising/student dietitians. The modified intervention for pharmacy students also significantly improved general eye health knowledge as well as students’ perception of a pharmacists’ role in low vision care.

Essential Infantile Esotropia: A Course of Treatment From Our Experience

Background: Essential infantile esotropia (EIE) is the most common type of childhood esotropia. Although its classical approach is surgical, less invasive techniques have been proposed as an adjunct or alternative to traditional surgery. Among them, chemodenervation with botulinum toxin (BT) has been investigated, showing variable and sometimes conflicting results.Objectives: To compare the outcomes of bilateral BT injection and traditional surgery in a pediatric population with EIE in order to optimize and standardize the therapeutic approach. Other purposes are to evaluate whether early intervention may prevent the onset of vertical ocular deviation (which is part of the clinical picture of EIE) and/or influence the development of fine stereopsis, and also to assess changes in refractive status over time among the enrolled population.Methods: A retrospective consecutive cohort study was conducted in 86 children aged 0–48 months who underwent correction of EIE. The primary intervention in naïve subjects was either bilateral BT injection (36 subjects, “BT group”) or strabismus surgery (50 subjects, “surgery group”).Results: Overall, BT chemodenervation (one or two injections) was effective in 13 (36.1%) subjects. With regard to residual deviation angle, the outcomes at least 5 years after the last intervention were overlapping in children receiving initial treatment with either injection or surgery; however, the success rate of primary intervention in the surgery group was higher, and the average number of interventions necessary to achieve orthotropia was smaller. Both early treatment with chemodenervation and surgery at a later age were not found to prevent the onset of vertical ocular deviation, whereas, surprisingly, the percentage of subjects developing fine stereopsis was higher in the surgery group. Finally, with regard to the change in refractive status over time, most of the subjects increased their initial hyperopia, whereas 10% became myopic.Conclusions: Our data suggest that a single bilateral BT injection by age 2 years should be considered as the first-line treatment of EIE without vertical component; whereas, traditional surgery should be considered as the first-line treatment for all other cases and in subjects unresponsive to primary single BT injection.

Results of the valve-preserving operations in the patients, suffering aortal dissection Type A

Objective. To investigate resuspension of aortal valve in the patients, suffering aortal dissection of Type A. Materials and methods. In 1994 - 2018 yrs period in Amosov National Institute of Cardio-Vascular Surgery 385 patients, suffering an acute aortal dissection Type A, were treated. In 169 patients aortal dissection have led to occurrence of an acute aortal insufficiency. Among these patients resuspension of the aortal valve was performed in 43, who have got aortal insufficiency from moderate one to severe. Results. In 43 patients with initial aortal insufficiency, from moderate one to severe, to whom resuspension of aortal valve was performed, postoperatively, in accordance to data of echocardiography, its function have appeared competent. During the year after primary intervention in 2 patients the aortal valve prosthesis was performed for severe aortal insufficiency developed. Conclusion. Resuspension of aortal valve constitutes an effective method of its function restoration in patients, suffering aortal dissection Type A and aortal insufficiency from moderate to severe. Preservation of own aortal valve improves patient’s quality of life, lowers the risks of thromboembolic and hemorrhagic complications and prevents delay for thrombing of a false channel due to long-lasting anticoagulant therapy.

Translating Exercise Benefits Over Telehealth

Background: Gerofit-Geriatric walking clinic is a home-based program that helps older veterans engage in regular walking via different platforms to improve access. The objective was to compare the outcomes of face-to-face visits to telehealth visits. Methods: Older Veterans (N=646) and walking-buddies (N=154) were seen either face-to-face or via telehealth at baseline, 2-, and 6-months. The primary intervention, pedometer feedback and motivational phone calls were delivered remotely. Results: Demographic data were similar in both Veteran groups and 47% were seen via telehealth. Compared to face-to-face, a higher proportion in the telehealth group had walking buddies (10% vs. 27%; p<0.001), received exercise counseling (75% vs. 95%; p=0.001), and reported perceived barriers (40% vs. 67%; p=0.004). There were statistically significant improvements in step-counts at 2- and 6-months compared to baseline (57% and 99% improvement; p<0.01) with no significant between-group differences. Conclusion: Tailored activity promotion programs via telehealth are effective in reaching older veterans.