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PURPOSE: The purpose of this article is to discuss the early- and late-onset corneal complications that can occur following vitreoretinal surgery. METHODS: A systematic review of the literature was conducted using PubMed and Google Scholar databases. Articles detailing the clinical findings and the associations between surgical techniques, irrigating solutions, and microsurgical instruments used for vitreoretinal surgery and postoperative corneal complications were included in this review. RESULTS: Vitreoretinal surgery can be associated with corneal complications such as persistent corneal epithelial defects, neurotrophic keratopathy, band keratopathy, ocular surface disruption, and endothelial cell damage. Risk factors for the development of cornea complications after posterior segment surgery include history of uncontrolled diabetes mellitus, aphakia or pseudophakia, disrupted anterior lens capsule integrity, use of irrigating solutions without appropriate buffers, use of contact viewing lenses intraoperatively, intraocular gases or silicone oil after vitrectomy, and prolonged duration of surgery. CONCLUSIONS: Corneal complications secondary to vitreoretinal surgery are multifactorial, but more commonly arise in diabetic patients, those with preexisting ocular comorbidities, and under certain surgical-related conditions. Special pre-, peri-, and postoperative considerations, with a focus on early identification and management of risk factors, are required to help decrease the incidence of corneal complications.

PURPOSE The purpose of this study was to report the indications, ocular and systemic comorbidities, and surgical outcomes of corneal transplantation in patients older than 90 years. METHODS A retrospective review was conducted to identify individuals 90 years and older who underwent corneal transplantation surgery at the Bascom Palmer Eye Institute between January 2013 and October 2020. Outcomes included best-corrected visual acuity and graft survival over time. Paired t tests were used to compare visual acuity preoperatively versus postoperatively. Graft survival was evaluated with Kaplan-Meier curves. RESULTS Fifty-eight eyes of 52 consecutive individuals were included. The mean age of individuals was 92 ± 2 years; 26.9% were male; and 48.1% self-identified as non-Hispanic White and 38.5% as Hispanic. Postoperative follow-up was 14.7 ± 12.1 months. Of the 58 eyes, 44.8% (26/58) underwent penetrating keratoplasty, 46.6% (27/58) Descemet stripping automated endothelial keratoplasty, and 6.9% (4/58) keratoprosthesis. All surgeries were performed under monitored local anesthesia, without major complications. Surgical indications included pseudophakic bullous keratopathy (36.2%), glaucoma-associated corneal decompensation (27.6%), Fuchs endothelial dystrophy (25.9%), and perforated corneal ulceration (19.0%). The best-corrected visual acuity improved by 0.32 (95% confidence interval 0.14-0.50; P < 0.01) as early as 1 month postoperatively, and vision gains were sustained for at least 12 months. Graft survival probability at 12 months was 88%. CONCLUSIONS Corneal transplantation is a safe and successful procedure in restoring the visual acuity for patients older than 90 years after careful preoperative evaluation. Further research is needed to evaluate the impact of corneal transplantation on quality of life in patients in the 10th decade of life.

Preoperative LDH, CPK, alkaline phosphatase and liver scan results were compared with the presence or absence of hepatic metastases at operation in 124 laparotomies in 123 patients with colorectal carcinomas during a three-year period. The overall accuracy rates for the four tests ranged from 74 to 84 per cent. The false-negative rates were acceptably low (9–13 per cent) for all but the CPK determination. The false-positive rates were unacceptably high for all four tests (38 to 60 per cent). A “metastatic score” for reducing the high false-positive rate is described. In view of the high false-positive rates of preoperative screening tests, laparotomy is presently the most accurate method of diagnosing hepatic metastases.

Pulmonary dysfunction is a well-recognized sequela of sepsis, which has been quantitated by calculation of intrapulmonary shunt (Qs/Qt) and, more recently, by measurement of extravascular lung water (EVLW). We sought to demonstrate the relationship between Qs/Qt and EVLW in sepsis. Nine pigs were given live E. coli infusions and five control pigs received only crystalloid. Pulmonary artery pressure (PAP), pulmonary artery wedge pressure (PAWP), arterial blood gases (ABG), and mixed venous blood gas levels were measured serially and Qs/QT calculated. EVLW was measured simultaneously using the thermal-green dye technique. The septic group showed increases from baseline in PAP (2.4 X), EVLW (2x), and Qs/Qt (1.6x). Regression analysis of Qs/Qt or EVLW yielded a correlation coefficient of r = 0.48. We concluded that while sepsis can result in both increased EVLW and Qs/Qt, the correlation is not sufficiently strong to account for the increased Qs/Qt on the basis of elevated EVLW alone. The possible relationships of arterial hypoxemia and pulmonary edema, ventilation-perfusion mismatch, and alterations in the normal hypoxic vasoconstrictive response in sepsis are considered.

This study of 40 healthy adults undergoing elective gynecologic procedures was undertaken to evaluate the microdrip technic of administering ketamine or Innovar® slowly to induce anesthesia and to supplement N2O anesthesia. All patients were managed by the same anesthetist and surgeons and received 10 mg of diazepam and 0.4 mg of atropine IM for premedication. After injection of 10 mg of diazepam, anesthesia was induced by infusions containing either ketamine (2 mg/ml) or Innovar (0.1 ml/ml), at an average rate of 10 ml/min. The infusions were assigned to the patients randomly and their nature was disguised from the staff. After tracheal intubation, ventilation was mechanically supported and anesthesia maintained with N2O-O2 (2:1), by drip at a rate adjusted to the patient's vital signs, and by intermittent injections of 3 to 6 mg of d-tubocurarine. Special forms coded to suit computer use were used to collect data during induction, maintenance, and recovery, and standard mathematical tests were used for analysis. Results showed that (a) ketamine effects could not be differentiated clinically from those of Innovar; (b) ketamine dosage could be reduced to 0.3 to 0.5 the recommended bolus dosage; ( c ) pulse rates and incidence of mental aberrations during induction or recovery were equal in both groups; (d) blood pressure showed a modest but significant increase (10% from basal values) until 20 minutes of tracheal intubation only in the ketamine group; (e) mean Pao, determined 30 minutes after tracheal intubation was significantly higher in the ketamine group; (f) ketamine administration by the slow (20 mg/min) microdrip technic reduces the incidence of side effects.