Clinical features of ankylosing spondylitis associated with acute anterior uveitis in Chinese patients

AIM: To characterize the clinical features, diagnosis, treatment and prognosis of uveitis associated with ankylosing spondylitis (AS) in Chinese patients. METHODS: Two hundred and three patients with uveitis associated with AS followed-up in the Third Military Medical University Daping Hospital between 2005 and 2010 were retrospectively evaluated in this study. Complete ophthalmological examinations were evaluated at baseline and during the follow-up period. The gender, age, follow-up time, mean frequency of uveitis onset, and accompanying eye examination findings, history, demographical parameters were reviewed. All the patients presented complete clinical and radiologic (sacroiliac, lumbar, dorsal and cervical spine, knee, ankle, shoulder, hip, elbow) evaluation. HLA-B27 typing was also searched. RESULTS: There were 203 patients diagnosed with AS associated welt's. All showed sacroiliac X-ray changes indicative of AS. There were 184 male and 19 female patients. The average age of patients was 35 +/- 12 (range 18-50). Mean follow-up period was 2.4 years (1-5 years). Acute anterior wets was the most common type of uveitis in both genders. 121 eyes presented unilateral involvement (55.2%), and 92 eyes presented bilateral involvement (45.3%) with onset alternately. 22 eyes occurred hypopyon, 16 eyes were found anterior vitreous cells, 7 eyes were noted reactive macular edema or exudation, 29 eyes presented posterior synechiae of iris, and 14 eyes presented cataract, 9 eyes presented secondary glaucoma, 2 eyes presented bend corneal degeneration and 1 eyes presented atrophy of eyeball. At the final visit, uveitis was well controlled in most patients. CONCLUSION: AS associated with uveitis in Chinese patients mainly manifests as acute anterior uveitis. A combination of corticosteroids with other mydriasis agents is effective for most AS associated with uveitis patients. In general, the prognosis is good in these cases.

Ten Years of Epidemiological and Diagnostic Aspects of Non-Traumatic Anterior Uveitis at Campus Teaching Hospital of Lome-Togo

Background: Uveitis is a serious disease which dangerous complications can jeopardize the visual prognosis. Anterior uveitis (AU) is the inflammation of the anterior uvea which is composed of the iris and the ciliary body. The objective of the study was to identify the epidemiological and etiological determinants of non-traumatic anterior uveitis at the Campus Teaching Hospital of Lomé. Materials and methods: Retrospective cross-sectional study of the records of patients diagnosed with anterior uveitis (AU) without a notion of trauma in the ophthalmology department of CHU Campus of Lomé from January 1, 2010 to December 31, 2019 (10 years). Results: 141 cases of uveitis, representing a prevalence of 0.18%. Female predominance, with a sex ratio of 0.76. Mean age was 34.74 ± 13.20 years. Decreased visual acuity was the primary complaint (34.40%), followed by ocular pain (28%). Non-traumatic anterior uveitis was unilateral in 87.2% of cases. Retro-corneal precipitates were present in all patients. 61.60% of patients had Tyndall in the anterior chamber. The etiology of non-traumatic AU was undetermined in 76.80% of cases. Toxoplasmosis, tuberculosis and syphilis were the main etiologies found. Conclusion: Non-traumatic anterior uveitis is relatively rare but serious, often affecting young subjects. It is a pathology that engages eye health professionals, not only because of the difficulties involved in diagnosing the etiology, but also because of its progression which sometimes leads to blindness.

Ten Years of Epidemiological and Diagnostic Aspects of Non-Traumatic Anterior Uveitis at Campus Teaching Hospital of Lome-Togo

Background: Uveitis is a serious disease which dangerous complications can jeopardize the visual prognosis. Anterior uveitis (AU) is the inflammation of the anterior uvea which is composed of the iris and the ciliary body. The objective of the study was to identify the epidemiological and etiological determinants of non-traumatic anterior uveitis at the Campus Teaching Hospital of Lomé. Materials and methods: Retrospective cross-sectional study of the records of patients diagnosed with anterior uveitis (AU) without a notion of trauma in the ophthalmology department of CHU Campus of Lomé from January 1, 2010 to December 31, 2019 (10 years). Results: 141 cases of uveitis, representing a prevalence of 0.18%. Female predominance, with a sex ratio of 0.76. Mean age was 34.74 ± 13.20 years. Decreased visual acuity was the primary complaint (34.40%), followed by ocular pain (28%). Non-traumatic anterior uveitis was unilateral in 87.2% of cases. Retro-corneal precipitates were present in all patients. 61.60% of patients had Tyndall in the anterior chamber. The etiology of non-traumatic AU was undetermined in 76.80% of cases. Toxoplasmosis, tuberculosis and syphilis were the main etiologies found. Conclusion: Non-traumatic anterior uveitis is relatively rare but serious, often affecting young subjects. It is a pathology that engages eye health professionals, not only because of the difficulties involved in diagnosing the etiology, but also because of its progression which sometimes leads to blindness.

Novel biomarkers for patients with idiopathic acute anterior uveitis:neutrophil to lymphocyte ratio and platelet to lymphocyte ratio

AIM： To assess the levels of the neutrophil to lymphocyte ratio（N/L） and the platelet to lymphocyte ratio（P/L） in patients with idiopathic acute anterior uveitis（AAU） and to compare with healthy controls.METHODS： Thirty-six male patients with idiopathic AAU and 36 male healthy subjects were enrolled in this retrospective study.Complete ophthalmological examination and complete blood count measurements results of all subjects were evaluated.RESULTS： There was a significant difference in N/L and P/L between idiopathic AAU and control groups（P=0.006,P=0.022）.Also,correlation analysis revealed a significant correlation between C-reactive protein（CRP） and N/L（P= 0.002;r=0.461）.CONCLUSION： Our study for the first time provides evidence of N/L and P/L may be useful biomarkers in patients with idiopathic AAU.N/L is correlated with CRP,so it can be a useful biomarker to predict the prognosis in idiopathic AAU.

Severe Cytomegalovirus anterior uveitis and corneal endotheliitis after use of topical tacrolimus

Dear Editor,Cytomegalovirus(CMV) uveitis is typically characterized by anterior segment inflammation with coin-shaped or linear keratic precipitates(KPs), mild cells and aqueous flare in the aqueous humor, corneal endothelial cell loss。

Novel diagnostic imaging techniques and applications in anterior uveitis,intermediate uveitis,and scleritis

Uveitis can cause significant visual morbidity and often affects younger adults of working age.Anterior uveitis,or inflammation limited to the anterior chamber(AC),iris,and/or ciliary body comprises the majority of uveitis cases.Current clinical biomarkers and conventional grading scales for intraocular inflammation are mostly subjective and have only a moderate degree of interobserver reliability,and as such they have significant limitations when used in either clinical practice or research related to uveitis.In recent years,novel imaging techniques and applications have emerged that can supplement exam findings to detect subclinical disease,monitor quantitative biomarkers of disease progression or treatment effect,and provide overall a more nuanced understanding of disease entities.The first part of this review discusses automated algorithms for optical coherence tomography(OCT)image processing and analysis as a means to assess and describe intraocular inflammation with higher resolution than that afforded by conventional AC and vitreous cell ordinal grading scales.The second half of the review focuses on anterior segment OCT and OCT angiography(OCTA)in scleritis and iritis,especially with regards to their ability to directly image and characterize the pathologic structures and vasculature underlying these diseases.Finally,we briefly review experimental animal research with promising but more distant human clinical applications,including in vivo molecular microscopy of inflammatory markers and investigation of gold nanoparticles as a potential contrast agent in OCT imaging.Imaging modalities are discussed in the broader context of trends within the field of uveitis towards greater objectivity and quantifiable outcome measures and biomarkers.

Clinical Analysis of 240 Patients with HLA-B27 Associated Acute Anterior Uveitis

Purpose: To analyze the prevalence of HLA-B27 associated acute anterior uveitis and to identify its clinical features. Methods: A total of 240 patients with HLA-B27 associated acute anterior uveitis,who were admitted to Zhejiang Ophthalmologic Hospital between December 2006 and October 2012, were retrospectively analyzed.The age of onset,sex,affected eyes,HLA-B27 antigen detection,recurrence,joint involvement, and surgical complications were investigated. Results:The average age of onset was 37.0 ±12.0 years and the ratio of male to female patients was 2.4:1. Most cases had alternate unilateral or bilateral involvement. Among all participants, 234 cases (97.5%) were HLA-B27 positive, and 124 cases (51.7%) had spondyloarthropathies (SpA), dominated by 108 cases with ankylosing spondylitis. (AS,45.0%),and mostly seen in male subjects(P<0.05).Six patients were HLA-B27 negative(2.5%)and on statistical significance was noted between male and female patients (P >0.05).A total of 193 cases (80.4%) presented with complications, mainly fibrinous exudation, posterior synechia, and vitreous opacity. Conclusion: HLA-B27 that is associated acute anterior uveitis with a relatively high incidence and recurrence presents with more severe clinical features than does idiopathic acute anterior uveitis,and it often accompanies systemic arthritic diseases. HLA-B27 antibody detection is associated with the diagnosis and treatment of acute anterior uveitis.

Presumed Acquired Retinal Astrocytoma in Association with Anterior Uveitis

Purpose:To report a case of presumed acquired retinal astrocytoma in association with anterior uveitis. Methods:A 29-year-old man presented with mutton fat keratic precipitates in the inferiorlower cornea,with complicated cataract and a circumscribed,solitary,yellowish-white retinal lesion in the right eye.Phacoemulsification with intraocular lens implantation was performed, with election to observeand the lesion was observed periodically. The lesion was followed for over two years without any change in size, shape or, and appearance. The anterior uveitis has not recurred at the time of writing. Results:Systemic medical and laboratory evaluations, including chest computed tomography,cranial magnetic resonance imaging,and serum angiotensin converting enzyme level, were normal. The characteristic fundus, FA,OCT scan, ultrasound scan,and lack of other contributory laboratory findings strongly supported the diagnosis of acquired retinal astrocytoma in this patient. Conclusion:We hypothesized that anterior uveitis may contribute to the growth and maintenance of retinal lesions. (Eye Science 2013; 28:51-54)

Complication rates after direct anterior vs posterior approach for hip hemiarthroplasty in elderly individuals with femoral neck fractures

BACKGROUND Dislocation rates after hemiarthroplasty reportedly vary from 1%to 17%.This serious complication is associated with increased morbidity and mortality rates.Approaches to this surgery are still debated,with no consensus regarding the superiority of any single approach.AIM To compare early postoperative complications after implementing the direct anterior and posterior approaches(PL)for hip hemiarthroplasty after femoral neck fractures.METHODS This is a comparative,retrospective,single-center cohort study conducted at a university hospital.Between March 2008 and December 2018,273 patients(a total of 280 hips)underwent bipolar hemiarthroplasties(n=280)for displaced femoral neck fractures using either the PL(n=171)or the minimally invasive direct anterior approach(DAA)(n=109).The choice of approach was related to the surgeons’practices;the implant types were similar and unrelated to the approach.Dislocation rates and other complications were reviewed after a minimum followup of 6 mo.RESULTS Both treatment groups had similarly aged patients(mean age:82 years),sex ratios,patient body mass indexes,and patient comorbidities.Surgical data(surgery delay time,operative time,and blood loss volume)did not differ significantly between the groups.The 30 d mortality rate was higher in the PL group(9.9%)than in the DAA group(3.7%),but the difference was not statistically significant(P=0.052).Among the one-month survivors,a significantly higher rate of dislocation was observed in the PL group(14/154;9.1%)than in the DAA group(0/105;0%)(P=0.002).Of the 14 patients with dislocation,8 underwent revision surgery for recurrent instability(posterior group),and one of them had 2 additional procedures due to a deep infection.The rate of other complications(e.g.,perioperative and early postoperative periprosthetic fractures and infection-related complications)did not differ significantly between the groups.CONCLUSION These findings suggest that the DAA to bipolar hemiarthroplasty for patients with femoral neck fractures is associated with a lower dislocation rate(<1%)than the PL.

Treatment of uveitis and scleritis patients in Malaysia

●AIM:To determine the common causes and visual outcome after treatment among uveitis and scleritis patients.●METHODS:This is a retrospective cohort observational study.All consecutive clinical records of patients with newly diagnosed uveitis and scleritis over a 4-year period,from Jan.1,2017 to Dec.31,2020,were analysed.Data was collected at the presentation and included a follow-up period of one year.●RESULTS:A total of 288 patients were recruited during the study period.Anterior uveitis was the most common anatomical diagnosis(50.0%)followed by panuveitis(25.0%),scleritis(13.5%),posterior uveitis(6.9%),and intermediate uveitis(4.5%).Viral Herpes was the most common cause of infectious cases,while Vogt-Koyanagi-Harada(VKH)disease and human leucocyte antigen(HLA)B27 spondyloarthropathy were the leading causes of identifiable non-infectious cases.Majority of patients presented with unilateral,non-granulomatous uveitis with an absence of hypopyon.Anatomical locations like posterior uveitis and panuveitis,and visual acuity worse than 3/60 at presentation were the factors associated with poor visual outcomes(P<0.05).About 60%of patients had an identifiable cause for the uveitis and scleritis,with nearly equal distribution of infectious(n=85,29.5%)and noninfectious causes(n=84,29.2%).About 14.5%of patients were clinically blind at 1y of follow-up.The most common complication in our uveitis patients was glaucoma(47.5%),followed by cystoid macula oedema(18.9%)and cataract(13.9%).●CONCLUSION:Uveitis and scleritis are important causes of ocular morbidity.They are potentially blinding diseases which can have a good outcome if diagnosed and treated early.

Frequency of Uveitis among Juvenile Idiopathic Arthritis Patients in a Tertiary Care Hospital of Bangladesh: A Retrospective Study

Background: Juvenile idiopathic arthritis (JIA) is the most frequently encountered pediatric rheumatologic disorder with an unknown etiology. At present there is no published data regarding the frequency of uveitis in patients with JIA in Bangladesh. This study aimed to observe the frequency of JIA-associated uveitis (JIAU) and distribution of uveitis among different sub-categories of JIA at the Pediatric Rheumatology division, both outdoor and indoor patients, Department of Pediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) in Bangladesh. Methods: This was a retrospective study of 1784 JIA patients at the Pediatric Rheumatology division, BSMMU from July 2010 to March 2023. Results: Among the 1784 enrolled JIA patients, we observed that 0.73% of cases had uveitis. Here, 61.5% of JIAU cases were male. Most of the cases (92.3%) had bilateral uveitis and only 7.7% cases had unilateral uveitis. Among JIAU patients, the majority were Oligo JIA (53.8%), followed by ERA 30.8%, Poly JIA RF(−) 7.7% and Systemic JIA 7.7% cases respectively. This study also revealed that 15.4% of JIAU patients had ANA positivity and 23% had HLA B-27 positivity. Here we also found ocular complications associated with uveitis such as band keratopathy (23.1%), posterior synechiae (15.4%) and cataract (15.4%). Conclusions: In this study, we observed only 0.73% of patients of JIA had developed uveitis which is lower than the frequency observed in other European studies. This study also showed various ocular complications amongst JIA-associated uveitis patients which signifies the importance of adherence to periodic ophthalmological follow-up to prevent these ocular complications.

Progress in the Use of Glucocorticoids and Biological Agents in Non-Infectious Uveitis

One of the main immune-mediated diseases that lead to avoidable blindness is non-infectious uveitis. Glucocorticoids are the first-line therapy choice for noninfectious uveitis;however, biologics are also showing promise in the management of this condition. The description of glucocorticoid and biologic usage in non-infectious uveitis is the main topic of this paper.

Late corneal ectasia after penetrating and deep anterior lamellar keratoplasty for keratoconus

AIM:To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty(PK)and deep anterior lamellar keratoplasty(DALK)in terms of incidence,time of onset and risk factors of corneal ectasia.METHODS:Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed.Final Pentacam scans were evaluated together with vision and previous topographies.Main outcome measures were vision,K values,apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements.Anterior segment optic coherence tomography was performed for further evaluation.RESULTS:Mean follow-up was 127.2mo(24–282mo)in PK,and 64.3mo(24–144mo)in DALK.K max was higher in DALK(60.6 vs 56.7 D,P=0.012).Inferior recipient was thinner(595.9μm)in PK than DALK(662.2μm,P=0.021),due to longer follow-up.Overall corneal ectasia rate was 20.0%within 24y.Ectasia rate was the same(6.7%)in DALK 2/30 and in PK 4/60 in 10y and 13.3%in 12y(4/30 and 8/60,respectively).It increased to 23.3%(14/60)in PK over 24y.While ectasia was not seen before 7y in PK,it could be seen in DALK starting from the 5^(th) year.The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK.Inferior recipient was significantly thinner in 18 eyes with ectasia(502.7μm)compared to 76 non-ectasia(649.1μm,P=0.000).Inferior graft was thinner(561.0 vs 620.4μm,P=0.006),K max(63.3 vs 56.5 D,P=0.000),and anterior elevation was higher in ectasia(89.1 vs 48.6μm,P=0.002).Accelerated crosslinking was performed on 5 eyes.CONCLUSION:Inferior-superior recipient and inferior graft thinning on tomography,with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia.The incidence of corneal ectasia increases with the time.

Uveitis glaucoma hyphema syndrome as a result of glaucoma implant: A case report

BACKGROUND Glaucoma is caused by increased intraocular pressure(IOP)that damages the optic nerve,leading to blindness.The Ahmed glaucoma valve(AGV)is a glau-coma drainage implant device that is used in glaucoma patients with uncontrolled IOP.A possible complication after any ocular surgery however is hyphema,which can itself progress to uveitis glaucoma hyphema(UGH)syndrome on rare occasions.UGH syndrome has not yet been reported as a complication of AGV implantation.CASE SUMMARY Here,we have reported a case of a 55-year-old female who developed both hyphema and pigmentation as a result of AGV implantation.We confirmed UGH syndrome secondary to AGV implantation after the patient underwent another surgery to shorten and reposition the AGV tube.After the second surgery,the patient’s IOP was reduced,and she had a clear cornea and no signs of hyphema.CONCLUSION This first report of UGH syndrome as a complication of AGV implantation reminds clinicians that frequent follow-up is paramount.

Ultrasound-guided serratus anterior plane block enhances postoperative analgesia and recovery in thoracoscopic surgery

BACKGROUND The serratus anterior muscle,located in the lateral aspect of the thorax,plays a crucial role in shoulder movement and stability.Thoracoscopic surgery,while minimally invasive,often results in significant postoperative pain,complicating patient recovery and potentially extending hospital stays.Traditional anesthesia methods may not adequately address this pain,leading to increased complications such as agitation due to inadequate pain management.AIM To evaluate the application value of ultrasound-guided serratus anterior plane block(SAPB)in patients undergoing thoracoscopic surgery,focusing on its effects on postoperative analgesia and rehabilitation.METHODS Eighty patients undergoing thoracoscopic surgery between August 2021 and December 2022 were randomly divided into two groups:An observation group receiving ultrasound-guided SAPB and a control group receiving standard care without SAPB.Both groups underwent general anesthesia and were monitored for blood pressure,heart rate(HR),oxygen saturation,and pulse.The primary outcomes measured included mean arterial pressure(MAP),HR,postoperative visual analogue scale(VAS)scores for pain,supplemental analgesic use,and incidence of agitation.RESULTS The observation group showed significantly lower cortisol and glucose concentrations at various time points post-operation compared to the control group,indicating reduced stress responses.Moreover,MAP and HR levels were lower in the observation group during and after surgery.VAS scores were significantly lower in the observation group at 1 h,4 h,6 h,and 12 h post-surgery,and the rates of analgesic supplementation and agitation were significantly reduced compared to the control group.CONCLUSION Ultrasound-guided SAPB significantly improves postoperative analgesia and reduces agitation in patients undergoing thoracoscopic surgery.This technique stabilizes perioperative vital signs,decreases the need for supplemental analgesics,and minimizes postoperative pain and stress responses,underscoring its high application value in enhancing patient recovery and rehabilitation post-thoracoscopy.

Robotic-assisted low anterior resection for rectal cancer shows similar clinical efficacy to laparoscopic surgery: A propensity score matched study

BACKGROUND Rectal cancer ranks as the second leading cause of cancer-related mortality worldwide,necessitating surgical resection as the sole treatment option.Over the years,there has been a growing adoption of minimally invasive surgical techni-ques such as robotic and laparoscopic approaches.Robotic surgery represents an innovative modality that effectively addresses the limitations associated with traditional laparoscopic techniques.While previous studies have reported favo-rable perioperative outcomes for robot-assisted radical resection in rectal cancer patients,further evidence regarding its oncological safety is still warranted.AIM To conduct a comparative analysis of perioperative and oncological outcomes between robot-assisted and laparoscopic-assisted low anterior resection(LALAR)procedures.METHODS The clinical data of 125 patients who underwent robot-assisted low anterior resection(RALAR)and 279 patients who underwent LALAR resection at Shandong Provincial Hospital Affiliated to Shandong First Medical University from December 2019 to November 2022 were retrospectively analyzed.After performing a 1:1 propensity score matching,the patients were divided into two groups:The RALAR group and the LALAR group(111 cases in each group).Subsequently,a comparison was made between the short-term outcomes within 30 d after surgery and the 3-year survival outcomes of these two groups.RESULTS Compared to the LALAR group,the RALAR group exhibited a significantly earlier time to first flatus[2(2-2)d vs 3(3-3)d,P=0.000],as well as a shorter time to first fluid diet[4(3-4)d vs 5(4-6)d,P=0.001].Additionally,the RALAR group demonstrated reduced postoperative indwelling catheter time[2(1-3)d vs 4(3-5)d,P=0.000]and decreased length of hospital stay after surgery[5(5-7)d vs 7(6-8)d,P=0.009].Moreover,there was an observed increase in total cost of hospitalization for the RALAR group compared to the LALAR group[10777(10780-11850)dollars vs 10550(8766-11715)dollars,P=0.012].No significant differences were found in terms of conversion rate to laparotomy or incidence of postoperative complications between both groups.Furthermore,no significant disparities were noted regarding the 3-year overall survival rate and 3-year disease-free survival rate between both groups.CONCLUSION Robotic surgery offers potential advantages in terms of accelerated recovery of gastrointestinal and urologic function compared to LALAR resection,while maintaining similar perioperative and 3-year oncological outcomes.

Direct anterior compared to posterior approach for hip hemiarthroplasty following femoral neck fractures

The differences in complication rates between the direct anterior and posterior approaches for hemiarthroplasty in elderly patients with femoral neck fractures are not yet fully understood.Dislocation,a severe complication associated with increased mortality and often requiring additional surgery,may occur less frequently with the direct anterior approach compared to the posterior approach.Careful consideration of patient demographics is essential when planning the surgical approach.Future research in this area should focus on robust randomized controlled trials involving elderly patients recovering from femoral neck fractures.

Risk factors of non-arteritic anterior ischaemic optic neuropathy and central retinal artery occlusion

AIM:To investigate the difference in risk factors between non-arteritic anterior ischaemic optic neuropathy(NAION)and central retinal artery occlusion(CRAO)and develop a predictive diagnostic nomogram.METHODS:The study included 37 patients with monocular NAION,20 with monocular CRAO,and 24 with hypertension.Gender,age,and systemic diseases were recorded.Blood routine,lipids,hemorheology,carotid and brachial artery doppler ultrasound,and echocardiography were collected.The optic disc area,cup area,and cup-to-disc ratio(C/D)of the unaffected eye in the NAION and CRAO group and the right eye in the hypertension group were measured.RESULTS:The carotid artery intimal medial thickness(C-IMT)of the affected side of the CRAO group was thicker(P=0.039)and its flow-mediated dilation(FMD)was lower(P=0.049)than the NAION group.Compared with hypertension patients,NAION patients had higher whole blood reduced viscosity low-shear(WBRV-L)and erythrocyte aggregation index(EAI;P=0.045,0.037),and CRAO patients had higher index of rigidity of erythrocyte(IR)and erythrocyte deformation index(EDI;P=0.004,0.001).The optic cup and the C/D of the NAION group were smaller than the other two groups(P<0.0001).The diagnostic prediction model showed high diagnostic specificity(83.7%)and sensitivity(85.6%),which was highly related to hypertension,the C-IMT of the affected side,FMD,platelet(PLT),EAI,and C/D.CONCLUSION:CRAO patients show thicker C-IMT and worse endothelial function than NAION.NAION and CRAO may be related to abnormal hemorheology.A small cup and small C/D may be involved in NAION.The diagnostic nomogram can be used to preliminarily identify NAION and CRAO.

Acute Uveitis in Neovascular Glaucoma Patient after a Single Dose of Travoprost

A 38-year-old man with no history of uveitis developed neovascular glaucoma (NVG) due to proliferative diabetic retinopathy (PDR). He had a history of ocular surgery with placement of glaucoma drainage implants (GDI), ultrasonic phacoemulsification, and intraocular lens implantation in both eyes. The patient had undergone a recent pars plana vitrectomy with complete panretinal photocoagulation (PRP) to clear vitreous hemorrhage in his right eye. To prevent progressive optic nerve damage, travoprost was tentatively administered because of inadequate intraocular pressure (IOP) control following surgery, laser treatment, and topical administration of many other IOP-lowering drugs. The patient experienced severe vision loss associated with acute anterior and intermediate uveitis. We consider it a rare complication due to the NVG patient’s vulnerability following ocular surgery. Given that acute uveitis developed rapidly and required time to resolve, systemic corticosteroid treatment could be considered to accelerate the resolution of inflammation.

Efficacy of laparoscopic low anterior resection for colorectal cancer patients with 3D-vascular reconstruction for left coronary artery preservation

BACKGROUND Laparoscopic low anterior resection(LLAR)has become a mainstream surgical method for the treatment of colorectal cancer,which has shown many advantages in the aspects of surgical trauma and postoperative rehabilitation.However,the effect of surgery on patients'left coronary artery and its vascular reconstruction have not been deeply discussed.With the development of medical imaging technology,3D vascular reconstruction has become an effective means to evaluate the curative effect of surgery.AIM To investigate the clinical value of preoperative 3D vascular reconstruction in LLAR of rectal cancer with the left colic artery(LCA)preserved.METHODS A retrospective cohort study was performed to analyze the clinical data of 146 patients who underwent LLAR for rectal cancer with LCA preservation from January to December 2023 in our hospital.All patients underwent LLAR of rectal cancer with the LCA preserved,and the intraoperative and postoperative data were complete.The patients were divided into a reconstruction group(72 patients)and a nonreconstruction group(74 patients)according to whether 3D vascular reconstruction was performed before surgery.The clinical features,operation conditions,complications,pathological results and postoperative recovery of the two groups were collected and compared.RESULTS A total of 146 patients with rectal cancer were included in the study,including 72 patients in the reconstruction group and 74 patients in the nonreconstruction group.There were 47 males and 25 females in the reconstruction group,aged(59.75±6.2)years,with a body mass index(BMI)(24.1±2.2)kg/m^(2),and 51 males and 23 females in the nonreconstruction group,aged(58.77±6.1)years,with a BMI(23.6±2.7)kg/m^(2).There was no significant difference in the baseline data between the two groups(P>0.05).In the submesenteric artery reconstruction group,35 patients were type Ⅰ,25 patients were type Ⅱ,11 patients were type Ⅲ,and 1 patient was type Ⅳ.There were 37 type Ⅰ patients,24 type Ⅱ patients,12 type Ⅲ patients,and 1 type Ⅳ patient in the nonreconstruction group.There was no significant difference in arterial typing between the two groups(P>0.05).The operation time of the reconstruction group was 162.2±10.8 min,and that of the nonreconstruction group was 197.9±19.1 min.Compared with that of the reconstruction group,the operation time of the two groups was shorter,and the difference was statistically significant(t=13.840,P<0.05).The amount of intraoperative blood loss was 30.4±20.0 mL in the reconstruction group and 61.2±26.4 mL in the nonreconstruction group.The amount of blood loss in the reconstruction group was less than that in the control group,and the difference was statistically significant(t=-7.930,P<0.05).The rates of anastomotic leakage(1.4%vs 1.4%,P=0.984),anastomotic hemorrhage(2.8%vs 4.1%,P=0.672),and postoperative hospital stay(6.8±0.7 d vs 7.0±0.7 d,P=0.141)were not significantly different between the two groups.CONCLUSION Preoperative 3D vascular reconstruction technology can shorten the operation time and reduce the amount of intraoperative blood loss.Preoperative 3D vascular reconstruction is recommended to provide an intraoperative reference for laparoscopic low anterior resection with LCA preservation.