Globe rupture with aphakia, aniridia, secondary glaucoma and late corneal decompensation: A multi-staged approach to management

Severe blunt ocular trauma may result in immediate and delayed complications requiring appropriate management algorithms. We hereby report a case of globe rupture, aphakia, traumatic aniridia, and secondary glaucoma in a 33-year-old male following road traffic accident. He was treated initially by primary repair followed by novel combined approach of aniridia IOL with Ahmed glaucoma valve implantation. Delayed corneal decompensation required deferred penetrating keratoplasty. After a follow-up of 3.5 years after last surgery, patient maintains good functional vision with stable IOL, clear corneal graft and controlled intraocular pressure. A meticulously planned and staged management approach appears better suited in complex ocular trauma in such scenarios giving a good structural and functional outcome

Clinical and surgical outcomes of glaucoma drainage device tube in ciliary sulcus versus anterior chamber in North Indian glaucoma patients

Purpose: To evaluate the outcome of glaucoma drainage device (GDD) insertion of tube through ciliary sulcus (CS) versus anterior chamber (AC) placement in the North Indian population Methods: This retrospective comparative case series included 43 patients in CS group and 24 in AC group, who underwent GDD implantation, from March 2014 to February 2020. The main outcome measures were intraocular pressure (IOP), number of anti?glaucoma medications, best corrected visual acuity (BCVA), and complications. Results: Sixty?seven eyes of 66 patients were included in study with mean follow?up of 25.04 months (range, 12–69 months) in the CS group and 17.4 months (range, 13–28 months) in the AC group. Preoperatively the two groups were similar except for postpenetrating keratoplasty glaucoma (PPKG) and pseudophakic patients, which were higher in the CS group (P < 0.05). Both groups showed statistically insignificant difference in postoperative IOP and BCVA at last follow?up (P = 0.173, P = 0.495, respectively). Postoperative complications were similar, except for corneal decompensation which was significantly higher in the AC group (P = 0.042). Conclusion: Our findings suggest that there was no statistically significant difference in mean IOP between the CS and AC groups at the last follow?up. CS placement of tube of GDD appears to be effective and safe technique. However, CS placement of tube resulted in lesser corneal decompensation and thus should be preferred in pseudophakic/aphakic patients, especially PPKG.

Vaccination strategies for people living with inborn errors of metabolism in Brazil

Abstract Objective: Through a literature review, make recommendations regarding immunizations in people living with Inborn Error of Metabolism (IEM) in Brazil, assess the possible impact on metabolic decompensations after immunization, and if this specific population may have an impaired immune response to vaccines. Source of data: The MeSH Terms vaccination OR vaccine OR immunization associated with the term inborn error of metabolism AND recommendation were used in combination with search databases. Only articles published after 1990, in the languages English, Spanish, French or Portuguese, human-related were included. Synthesis of data: A total of 44 articles were included to make the following recommendations. Individuals with IEMs need to be up to date with their immunizations. Regarding which vaccines should be offered, children and adults should follow the routine immunization schedules locally available, including the COVID-19 vaccines. The only exception is the rotavirus vaccine for hereditary fructose intolerance. The benefit of immunization outweighs the very low risk of metabolic decompensation. Since not all patients will have an adequate immune response, measuring antibody conversion and titers is recommended Conclusions: All patients should receive age-appropriate immunizations in their respective schedules without delays. The only situation when vaccination may be contraindicated is with oral rotavirus vaccine in hereditary fructose intolerance. Monitoring the levels of antibodies should be done to detect any immune dysfunction or the necessity for boosters. A personalized immunization schedule is ideal for patients with IEMs. The reference organizations could improve their recommendations to address all IEMs, not only some of them.

Functional recompensation during decompensated-stage cirrhosis / 中华肝脏病杂志

Recent studies suggest that recompensation of liver function appears in decompensated cirrhosis after effective treatment. However, liver function recompensation degree, recompensation evaluation diagnostic criteria, how to predict recompensation from the perspective of liver function, and others still need to be further explored. Therefore, functional recompensation is explored here from the perspective of decompensated-stage cirrhosis.

Liver cirrhosis: Decompensation and "recompensation" / 临床肝胆病杂志

The evolution concept of decompensated cirrhosis rebuilds the clinical staging system for decompensated cirrhosis, which changes the focus from the pattern of disease progression to refining the status of acute decompensation onset and proposing "recompensation" of decompensated cirrhosis. During the process, factors such as portal hypertension and systemic inflammatory changes can affect the clinical outcome of decompensated cirrhotic patients. Significantly, more evidence is warranted to elucidate the clinical characteristics and potential mechanisms of achieving "recompensation" after etiology control, such as in viral hepatitis patients.

Rol de los péptidos natriuréticos en insuficiencia cardíaca: El fino equilibrio entre la medicina de precisión y la optimización de los recursos

La insuficiencia cardíaca constituye la fase final de la mayoría de las patologías cardiovasculares. Si bien el interrogatorio, el conocimiento de los antecedentes personales y familiares del paciente, sumados al examen físico detallado, contribuyen en sobremanera al diagnóstico; muchas veces el diagnóstico diferencial del síndrome de insuficiencia cardíaca no nos permite diferenciar entre los cuadros compensados de aquellos portadores de insuficiencia cardíaca en las primeras fases de la descompensación o nos llevan a la duda entre diagnósticos diferenciales. La falta de disponibilidad de camas de hospitalización, problemas de cobertura médica o incluso problemas sociales o psicológicos, obligan muchas veces a la determinación de altas precoces con el riesgo presente de descompensaciones e internaciones reiteradas. Evitar descompensaciones frecuentes es el trabajo silencioso que debe realizar el médico para tratar de detectar precozmente con la finalidad de enlentecer o detener el progreso de la enfermedad cardiovascular, evitando estudios e internaciones costosas. Entre el armamento necesario para cumplir con esta finalidad se encuentra el dosaje de péptidos natriuréticos. La presente revisión trata de resumir los datos disponibles que valoran el control de los niveles de péptidos natriuréticos en nuestra asistencia de los pacientes con insuficiencia cardíaca.

Heart failure constitutes the final stage of most cardiovascular diseases. Although the questioning, the knowledge of the patient s personal and family history, added to the detailed physical examination, greatly contribute to the diagnosis; Many times the differential diagnosis of heart failure syndrome does not allow us to differentiate between the compensated conditions of those with heart failure in the early stages of decompensation or leads us to doubt between differential diagnoses. The lack of availability of hospital beds, problems of medical coverage or even social or psychological problems, often force the determination of early discharges with the present risk of decompensation and repeated hospitalizations. Avoiding frequent decompensations is the silent work that the physician must do to try to detect it early in order to slow down or stop the progress of cardiovascular disease, avoiding expensive studies and hospitalizations. Among the weapons necessary to fulfill this purpose is the dosage of natriuretic peptides. This review attempts to summarize the available data that assess the control of natriuretic peptide levels in our care of patients with heart failure.

A insuficiência cardíaca constitui o estágio final da maioria das doenças cardiovasculares. Apesar do questionamento, o conhecimento da história pessoal e familiar do paciente, somado ao exame físico detalhado, contribuem muito para o diagnóstico; Muitas vezes, o diagnóstico diferencial da síndrome da insuficiência cardíaca não nos permite diferenciar as condições compensadas dos portadores de insuficiência cardíaca nos estágios iniciais de descompensação ou nos leva à dúvida entre os diagnósticos diferenciais. A falta de disponibilidade de leitos hospitalares, problemas de cobertura médica ou mesmo problemas sociais ou psicológicos, muitas vezes obrigam à determinação de altas precoces com o risco atual de descompensação e hospitalizações repetidas. Evitar descompensações frequentes é o trabalho silencioso que o médico deve fazer para tentar detectá-la precocemente, a fim de retardar ou interromper o progresso das doenças cardiovasculares, evitando estudos e internações dispendiosas. Entre as armas necessárias para cumprir esse propósito está a dosagem de peptídeos natriuréticos. Esta revisão tenta resumir os dados disponíveis que avaliam o controle dos níveis de peptídeo natriurético em nosso tratamento de pacientes com insuficiência cardíaca.

Cardiovascular damage due to COVID-19: what do we need to know?

SUMMARY Severe Acute Respiratory Syndrome Coronavirus 2 is part of the Cononaviridae family and is the causative agent of the 2019 (Covid-19) Coronavirus pandemic declared by the World Health Organization in March, 2020. This virus has a high rate of transmission, affecting several individuals, and has caused thousands of deaths. The clinical manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 infection are not restricted only to the respiratory tract, and there is an express involvement of the cardiovascular system with a higher risk of death in this group. In such patients there is an overactivation of renin-angiotensin-aldosterone system, which promotes an increase in the expression of angiotensin-converting enzyme - 2 that acts as a receptor for the SPIKE protein expressed by the virus and enables the interaction between the host cell and Severe Acute Respiratory Syndrome Coronavirus 2. This process of infection causes a hyperinflammatory state that increases the inflammatory markers of cardiac injury. Hence, an adequate understanding and clinical guidance regarding the monitoring, and controlling the damage in these patients is essential to avoid worsening of their clinical condition and to prevent death.

Lower incisor changes following non-extraction orthodontic decompensation in Class III surgical cases

@#The amount of incisor decompensation during pre-surgical orthodontics may affect the outcome of Class III orthognathic cases. The purpose of this study was to assess the lower incisor changes post-orthodontic decompensation in Class III surgical cases and to investigate the amount of crowding as a predictive factor. This was a retrospective study reporting on 22 Class III orthognathic cases. The lower incisor angulation (LIA) and distance of the lower incisor edge to the A-Pogonion line (Li-APo) were measured on pre-treatment and presurgical lateral cephalograms whereas crowding was measured on digitised pre-treatment study models. Pearson’s correlation (p <0.05) was used to assess the correlation of crowding with LIA and Li-APo changes, and prediction of the lower incisor decompensation was conducted using linear regression analysis. Results showed lower incisors were retroclined at 79.84° ± 7.08° and positioned ahead of APo line by 6.52 mm ± 2.97 mm at the start of treatment. Pre-surgical LIA and Li-APo were found to increase following orthodontic decompensation to 90.43° ± 5.96° and 10.34 mm ± 3.25 mm, respectively. There was a moderate positive correlation (r = 0.592) between crowding and Li-APo changes which was statistically significant, p value = 0.004, and had a strong predictor with 31.8% predictability. However, LIA showed a weak correlation (r = 0.329) with crowding and was not statistically significant (p = 0.135). Li-APo changes during orthodontic decompensation can be predicted with 31.8% predictability using the formula; Li-APo change = 2.064 + 0.503 (crowding).

A Rehabilitation of Missing Maxillary Anterior Teeth in a Severe Skeletal Class III Malocclusion Patient Requiring Implants

@#Management of traumatic dental injuries (TDI) in a young patient may range from simple to complex. In a situation where teeth are lost, a reliable and conservative treatment option is an implant-supported fixed dental prosthesis (i-FDP), as this treatment option negates the need to prepare sound abutment teeth as in the case of conventional fixed bridges. However, the placement of implants is usually prosthetically driven to allow for a 3D functional and aesthetic restoration. In the presence of severe skeletal Class III malocclusion, treatment may incorporate pre-surgical orthodontic treatment, followed by jaw surgery to correct the skeletal discrepancies and finally post-surgical orthodontic treatment before the rehabilitation with implants. A multidisciplinary treatment approach in a stepwise manner is required to address the patient’s overall treatment needs. This case report presents a joint prosthodontics, orthodontics and oral maxillofacial surgical management of a young adult male patient with a Skeletal Class III malocclusion who required rehabilitation of avulsed missing anterior teeth sustained from childhood TDI. The severity of the skeletal relationship required a Le Fort I maxillary advancement and a bilateral sagittal split osteotomy for the setback of the mandible in combination with orthodontics for correction of malocclusion and arch relationship prior to implant placement. Correction of the malocclusion and jaw deformity allowed the functional and aesthetic rehabilitation of the missing teeth using an i-FDP.

Epidemiological survey of patients with decompensated hepatitis C cirrhosis in hospital in 2012-2019 / 公共卫生与预防医学

Objective To analyze the epidemiological characteristics of patients with decompensated hepatitis C cirrhosis in hospital from 2012 to 2019. Methods Data of 496 patients with decompensated liver cirrhosis who were treated in the inpatient department of the hospital from 2012 to 2019 were collected. The age and gender distribution, basic information, the first complications during follow-up and the cause of death were analyzed. Results Patients with decompensated liver cirrhosis were mainly male and ≥ 60 years old. The proportion of males was significantly higher than that of females (P<0.05). There were significant differences in gender, age, region, years of hepatitis C infection, family history of liver disease, diabetes mellitus, hypertension, antiviral treatment and child Pugh classification of liver function (P<0.05). The first complication of patients with decompensated liver cirrhosis from highest to lowest rate were ascites, spontaneous peritonitis, upper gastrointestinal bleeding, esophagogastric varices and hepatic encephalopathy. During the follow-up period, 97 patients died, with an annual mortality rate of 4.89%. The causes of death ranked from high to low were primary liver cancer, hemorrhagic shock, hepatic encephalopathy, hepatorenal syndrome, multiple organ function failure, and septic shock. Conclusion Age, gender, region, years of hepatitis C infection, family history of liver disease, diabetes, hypertension, antiviral treatment and liver function were important influencing factors for the occurrence of decompensated liver cirrhosis in the hospital from 2012 to 2019. Health education should be strengthened and corresponding intervention measures should be formulated to reduce the incidence of decompensated liver cirrhosis.

Utility of Neutrophil to Lymphocyte Ratio as a Predictor of Complications in Patients with Liver Cirrhosis.

Neutrophil to Lymphocyte Ratio (NLR) has been considered an inexpensive biomarker to reflect inflammation in patients with cirrhosis. Raised NLR has been associated with poor clinical outcome and mortality in these patients. We conducted this study to correlate the association of Neutrophil to Lymphocyte Ratio with complications of cirrhosis and assess the short-term outcome during hospital admission. MethodsWe conducted a prospective observational study in 120 patients with cirrhosis from January 2017 to June 2018. All patients were diagnosed based on clinical history, examination and ultrasound. Complications were diagnosed by clinical and laboratory evaluation. Total white blood cell count, lymphocyte count, and neutrophil count were recorded, and neutrophil to lymphocyte ratio was calculated. Statistical analysis by means of test of association and binary logistic regression analysis was carried out. ResultsOut of the 120 patients enrolled in our study, majority were male (90%), and in the age group 51 - 60 years (38.3%). Majority (39.2%) of the patients had portal hypertension with oesophageal variceal bleeding as complication. Mean NLR for the patients was 5.824. A total of 91% patients with NLR>12 were admitted with decompensated liver disease and 66.7% of those patients presented with more than 2 complications that is hepatic encephalopathy and spontaneous bacterial peritonitis. 41.7% patients with NLR >12 had mortality as the outcome. Chi square test of association of NLR with complications (p=0.003) and mortality (p=0.03) were significant. However, NLR could not predict complications in our study population. ConclusionsRaised Neutrophil to Lymphocyte Ratio is associated with complication and mortality in patients with cirrhosis. However, it could not effectively predict the complications in patients with cirrhosis.

Enhanced recovery after surgery improves clinical outcomes of liver transplant recipients / 器官移植

Objective To investigate the rationality and efficacy of enhanced recovery after surgery (ERAS) in liver transplant recipients. Methods Clinical data of 465 liver transplant recipients were retrospectively analyzed. All recipients were divided into the ERAS group (n=163) and control group (n=302) according to whether they received ERAS. The severity of disease in the ERAS group was worse than that in the control group. Operation situations including the operation time, anhepatic phase and intraoperative blood transfusion volume of the liver transplant recipients were observed and recorded. Postoperative recovery conditions including the length of intensive care unit (ICU) stay, total length of hospital stay, total ventilator removal time at postoperative 28 d and postoperative re-intubation rate were recorded. The survival rates at 90 d, 180 d and 1 year after liver transplantation were calculated. The influencing factors of survival rate of liver transplant recipients were analyzed. Results The anhepatic phase in the ERAS group was 45 (39, 53) min, significantly longer than 40 (32, 48) min in the control group (P < 0.05). The volume of erythrocyte infusion in the ERAS group was 10 (7, 13) U, significantly less than 18 (10, 28) U in the control group (P < 0.05). The length of postoperative ICU stay and total length of hospital stay in the ERAS group were 135 (84, 212) h and 24 (18, 33) d, significantly shorter than 154 (103, 253) h and 34 (20, 50) d in the control group (both P < 0.05). Total ventilator removal time at postoperative 28 d was 26 (25, 27) d, significantly longer than 26 (23, 27) d in the control group (P < 0.05). The postoperative re-intubation rate in the ERAS group was 11.0%, significantly lower than 20.8% in the control group (P < 0.05). The 90 d, 180 d and 1-year survival rates in the ERAS group were 92.8%, which were significantly higher than 81.1%, 78.1% and 75.7% in the control group (all P < 0.05). ERAS and operation time were the independent influencing factors of survival rate of liver transplant recipients (both P < 0.05). Conclusions ERAS after liver transplantation can improve the survival rate of recipient, shorten the length of hospital stay, reduce the re-intubation rate and accelerate the rehabilitation after liver transplantation.

A novel side effect of mitogen-activated protein kinase inhibitor cobimetinib: Acute corneal decompensation

A 38-year-old man with a diagnosis of BRAF-mutated metastatic melanoma was referred to our clinic. He had been under treatment with 60-mg oral cobimetinib daily for 21 days/7 day off in combination with 960 mg vemurafenib twice daily. The patient had symptoms of blurred vision and photophobia in his right eye. A slit-lamp examination revealed bilateral central corneal stromal opacity and epithelial microcystic edema Involvement was more severe in the right eye compared with the left eye. Fourteen days after the first visit, the patient's symptoms and slit-lamp findings were largely resolved. We suggest that endothelium pump failure was involved in this acute corneal decompensation case similar to the mechanism in retinal pigment epithelium.

Indicaciones y técnicas de trasplante de córnea en una clínica oftalmológica privada en Colombia / Indications and techniques of corneal transplantation in a private ophthalmologic clinic in Colombia

Introducción: el trasplante de córnea es el injerto mas frecuente en el campo de la medicina; las técnicas para realizarlo han evolucionado permitiendo hacer procedimientos menos invasivos, con menor riesgo de rechazo del injerto y con una recuperación más rápida. La escasez de donantes para realizar trasplantes de córnea, genera una limitación terapéutica muy importante en el campo de la patología corneal. Objetivo: Reportar las Indicaciones y Técnicas empleadas en los Trasplantes de Córnea, en una institución privada con atención terciaria en Oftalmología en Bogotá, Colombia. Diseño del Estudio: Estudio transversal de fuentes secundarias. Método: Se hizo un estudio transversal, con las historias clínicas electrónicas de los pacientes operados con algún tipo de trasplante de córnea, en la Clínica Barraquer de América en el periodo comprendido desde Enero del 2010 a Diciembre del 2018 Resultados: Las cuatro primeras Indicaciones para Trasplantes de córnea fueron: 1) Ectasias Corneales 38.27% 2) Descompensación corneal 20.88% 3) Reposición de Injerto 17.72% 4) Leucomas Cicatriciales 16.22%. Las técnicas empleadas fueron Injerto Penetrante el 54.11% - Injertos Laminares (43.52%) con un 17.25% de Injertos Endoteliales. Conclusión: Existen diferencias en la frecuencia de las Indicaciones para trasplante de córnea según la región del país y también respecto a las publicaciones internacionales. El Queratocono fue la indicación mas frecuente. La Queratoplastia Penetrante la técnica más frecuente como procedimiento primario, pero también como técnica alternativa debido a la falta de oportunidad para realizar el trasplante.

Background: corneal transplant is the most frequent graft in the fi eld of medicine; the techniques to carry it out have evolved allowing to make less invasive procedures, with less risk of rejection of the graft and with a faster recovery. The shortage of donors to perform corneal transplants generates a very important therapeutic limitation in the field of corneal pathology.. Objective: To report the Indications and surgical techniques in Corneal Transplants in a tertiary referral center and private Ophthalmological clinic in Bogotá-ColombiaStudy Design: Cross sectional study using secondary data. Method: A cross sectional study was performed with the electronic clinical records of the patients that had a corneal graft of any kind during the period between January 2010 and December 2018 at the Barraquer Clinic in América. Results: The top four indications for corneal transplantation were: 1) Corneal Ectasias 38.27% - 2) Bullous Keratopathy 20.88% ­ 3) Re-Graft 17.72% and 4) Leucomas 16.22%. Penetrating Keratoplasty was the most common indication (54.11%) followed by Lamellar Techniques 43.52% of which Endothelial keratoplasty was performed in 17.25%. Conclusion: Corneal transplant indications and its frequency, are different between country regions in Colombia and towards international reviews. For us, Keratoconus was the most frequent indication. and Penetrating Keratoplasty, the most frequent technique as a primary procedure, but also as an alternative technique due to the lack of opportunity to perform the transplant.

Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors

Background: Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver disease and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria, and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. Aim of the study: The present study was aimed at estimating the prevalence of acute on chronic liver failure in our institute, etiology of underlying chronic liver disease, precipitating acute event and mortality rate. Materials and methods: 150 patients admitted and treated with the diagnosis of ACLF in the Institute of Hepatobiliary Sciences, Rajiv Gandhi Government General Hospital during the period from December 2016 to November 2018 were included in the study. Their data regarding etiology of chronic liver disease, precipitating acute events and mortality were collected and analyzed. Results: Out of 386 patients, 150 patients were admitted with acute on chronic liver failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%). No precipitating cause could be identified in Premkumar K, Krishnasamy Narayanasamy. Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors. IAIM, 2019; 6(4): 49-54. Page 50 12.7% of patients. Mortality rate was high in ACLF grade 3 (95%), followed by ACLF grade 2 (62%) and ACLF grade 1 (15%). Conclusion: ACLF is a dynamic syndrome presenting with single, two or more organ failure in a patient with chronic liver disease following a triggering event and associated with high short term mortality. In our hospital, the prevalence of ACLF was 39% and the overall mortality rate was 83%. Infection and alcohol were found to be important precipitating factors. A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome

Progress of antiviral therapy for hepatitis C virus-related decompensated cirrhosis / 中华肝脏病杂志

Direct-acting antiviral agents (DAAs) are the main antiviral therapeutics for hepatitis C virus-related decompensated stage cirrhosis. DAAs of NS3/4A protease inhibitors use is not recommended for patients with decompensated cirrhosis due to characteristics of DAAs metabolism in liver. The recent guidelines have recommended sofosbuvir (SOF)-based plan including pan-genotype plan of sofosbuvir(SOF)/velpatasvir (VEL), sofosbuvir combined with daclatasvir (DCV), genotype 1,4,5,6 specific plan of sofosbuvir (SOF) / ledipasvir (LDV) for 24 weeks or above in combination with ribavirin for 12 weeks because NS5B and NS5A inhibitors has no obvious effect on CYP450 enzyme system and achievement of sustained virological response (SVR) rates at 12/24 weeks is achievable in 88% ~ 100%, and liver reserve function improves in 42% ~ 53% of patients. Furthermore, approximately 15.5% ~ 49% of patients waiting for liver transplantation after treatment with DAAs do not require liver transplantation for short-term and 10.3% ~19.2% of patients receiving SOF/LDV, and SOF combined with DCV not needed liver transplantation. Thus, the clinical application of DAAs provides a safe and reliable antiviral treatment plan for hepatitis C virus-related decompensated stage cirrhosis.

Progress in diagnosis and treatment of medium chain acyl coenzyme A dehydrogenase deficiency / 中国实用儿科杂志

Medium chain acyl CoA dehydrogenase deficiency is a mitochondrial fatty acid oxidative deficiency disease. It has various clinical manifestations,such as hypoglycemia,lethargy,myasthenia,etc. Different clinical manifestations and atypical biochemical examination can increase the difficulty of diagnosis,which is more likely to result in misdiagnosis. If it is not treated in time,mortality and the rate of sequelae are high,but if confirmed by neonatal screening and treated in time,satisfactory results can be obtained.

Non-Descemet stripping automated endothelial keratoplasty for post radial keratotomy corneal edema

An elderly male with monocular status presented with complaints of gradual loss of vision in his left eye. Slit-lamp evaluation revealed postradial keratotomy (RK) corneal decompensation. He underwent non-Descemet stripping automated endothelial keratoplasty (nDSAEK) in his left eye. Postoperatively, his visual acuity improved from counting finger at 1 m to 20/200, J5. Graft adherence was good. A preexisting epiretinal membrane with macular edema was noted, but our patient refused any further surgical intervention for the same. In conclusion, nDSAEK may be considered as an effective treatment modality for the management of post-RK corneal decompensation.

Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.