Sonography Evaluation associated with Adnexal Pathology Standard Strategies and Different Degrees of Experience

Purpose To compare laser in situ keratomileusis flaps created at the programmed target thickness of 120 μm using the LenSx multifunctional and the FS200 single-functional femtosecond lasers as evaluated by anterior segment optical coherence tomography (AS-OCT). Methods This was a prospective, comparative, consecutive, blinded, nonrandomized study. Patients with stable refraction for over a year were consecutively allocated to the LenSx group or the FS200 group (n = 66; 33 patients in each group). All the patients underwent refractive surgery in both eyes. Previous eye surgery, ocular pathology associated with refractive errors, pregnancy, breastfeeding, and use of medication that causes ocular adverse effects constituted the exclusion criteria. Corneal topography, corneal tomography, dilated fundoscopy, applanation tonometry, ultrasonic pachymetry, dynamic and static refraction, visual acuity, and AS-OCT were evaluated before and after surgery. AS-OCT flap thickness was measured at 20 points on each cornea. Results In the LenSx group, AS-OCT flap thickness differed significantly from the target thickness at 2 of 20 points (mean differences of 2.106 and 1.803 μm). In the FS200 group, 6 of 20 measurements differed significantly (mean differences ranging from 1.121 to 2.121 μm). The 2 lasers were similarly successful in creating regular and uniform flaps. The agreement between the 2 blinded examiners regarding the AS-OCT flap thickness measurements was excellent (intraclass correlation coefficient >0.75) in both groups. Conclusions Both femtosecond lasers were safe and capable of creating highly reproducible, uniform, and regular flaps at the target preoperative thickness of 120 μm. The LenSx multifunctional femtosecond laser offers the advantage of allowing both cataract and corneal surgeries.Purpose To evaluate clinical and ultrasonographic findings associated with advanced microbial keratitis with concurrent endophthalmitis. Methods We performed a retrospective analytical study of patients with severe microbial keratitis who underwent ocular ultrasonography for possible endophthalmitis at our institution over a 5-year period. Ocular and medical history, ocular examination findings, microbiology results, and ultrasonographic features were collected. Results Of the 81 included eyes, 15 were diagnosed with endophthalmitis based on clinical findings and evidence of vitritis on ultrasound. Historical factors and physical examination findings more common in the endophthalmitis group than the keratitis-only group include presenting vision of light perception or no light perception (73.3% vs. Selleck GLPG1690 31.8%, P = 0.003), history of cataract surgery (80.0% vs. 45.5%, P = 0.02), and full thickness ulcer or perforation (33.3% vs. 9.1%, P = 0.03). Gram-positive organisms were more common in the endophthalmitis group (60.0% vs. 30.3%, P = 0.04). Ultrasound findings of choroidal thickening and retinal detachment were more common in the endophthalmitis group (26.7% vs. 3.4%, P = 0.01 and 13.3% vs. 8.4%, P = 0.04) in addition to the expected preponderance of membranous and dispersed vitreous opacities in that group. Final visual acuity was worse in the endophthalmitis group (2.3 vs. 3.5 LogMAR, P = 0.02). Conclusions Diagnosing endophthalmitis can be difficult in eyes with advanced microbial keratitis, and the visual outcomes are often extremely poor. Clinicians should have a particularly high index of suspicion in eyes presenting with light perception or no light perception vision, history of cataract extraction, full thickness ulcer or perforation, or choroidal thickening or retinal detachment on ultrasound.Purpose To evaluate dry eye and quantitative and qualitative changes of meibomian glands with meibography in patients with pemphigus. Methods Twenty left eyes of 20 patients with pemphigus (group 1) and 20 left eyes of 20 age- and sex-matched healthy volunteers (group 2) were enrolled. Dry eye was evaluated with Oxford scale scoring, tear film breakup time, Schirmer 1 tests, and Ocular Surface Disease Index score assessments. Morphological changes and dropout ratio of meibomian glands were evaluated by upper and lower eyelid meibography (SL-D701; Topcon, IJssel, The Netherlands). Meibomian gland dropout ratio was scored for each eyelid from grade 0 (no loss) through grade 3 (lost area >2/3 of the total meibomian gland area). Results The mean ages of group 1 and group 2 were 51.8 ± 11.1 (range 32-73) and 50.4 ± 9.6 years (range 32-70), respectively (P = 0.672). Schirmer 1 and tear film breakup time values were lower and Oxford and Ocular Surface Disease Index scores were higher in group 1 when compared with group 2, and the differences were statistically significant (P = 0.01, P less then 0.001, P = 0.001, and P less then 0.001, respectively). Upper eyelid, lower eyelid, and total eyelid meiboscore values were significantly higher in group 1 (P = 0.005, P = 0.018, and P = 0.002, respectively). Morphological changes in meibomian glands were detected in 16 eyes (80%) among group 1. Conclusions Between patients with pemphigus and those who were healthy, there were significant differences in the results of dry eye tests and meibomian gland morphology. Patients with pemphigus should be monitored for dry eye and meibomian gland dysfunction and be promptly treated to prevent the serious consequences of dry eye.Background It is a challenge to characterize the consciousness level of patients with severe disturbance of consciousness and predict their prognosis effectively for Chinese doctors. We aimed to investigate the psychometric property and the diagnostic practicality of severe disturbance of consciousness by Chinese Nanjing persistent vegetative state scale (CNPVSS) which was first set up in 1996 and modified in 2001 and 2011. Methods The concurrent validity, inter-rater consistency and diagnostic accuracy of CNPVSS and Chinese version of coma recovery scale-revised (CRS-R) were investigated by assessment of 380 patients with severe disorders of consciousness. Results Total scores of the CNPVSS were correlated significantly with that of the CRS-R, indicating acceptable concurrent validity. Sub-scale analysis showed moderate to high inter-rater reliability and test-retest reliability. CNPVSS was superior to CRS-R on the diagnosis sensitivity. The CNPVSS was able to distinguish 65 patients in emergence from minimal consciousness state who were misclassified as in minimal consciousness state (MCS) by the CRS-R, and it could also distinguish two patients in MCS who were misclassified as in vegetative state by the CRS-R.