Primary Orbital Respiratory Epithelial Cyst: A Systematic Review and Two Case Reports.

A primary orbital respiratory cyst is a congenital choristoma that presents in the orbit and with different signs and symptoms depending on the location, which might also change the surgical approach. The aim of this report is to describe 2 new cases of primary respiratory epithelial cysts and to review the literature on presentation, management, and risk factors with different surgical approaches and complications. Two cases presenting with gradually increased proptosis had a confirmed diagnosis of a respiratory epithelial cyst. CT and MRI imaging revealed a thin-walled intraconal cystic lesion. Complete surgical removal was not possible and an incisional biopsy of the wall was performed. Rarely, orbital respiratory epithelium cysts are primary lesions. The high risk of breaking the capsule during surgery and the presence of residual epithelial cells within the orbit may cause cyst's recurrence. Indeed, we recommend careful attention during dissection maneuvers and a long-term follow-up.

Outcomes of Medical and Surgical Management in Aqueous Misdirection Syndrome.

Purpose: To report the outcomes of medical and surgical management in patients diagnosed with aqueous misdirection syndrome (AMS). Patients and Methods: A retrospective chart review of all cases diagnosed with AMS at a single tertiary care eye center during the period from 2014 to 2021. Outcome measures were anatomical success (deepening of the anterior chamber (AC)), functional success (improvement in visual acuity), and treatment success (control of intraocular pressure (IOP)). Results: A total of 26 eyes with AMS from 24 patients were included. The patients were followed for a mean duration of 24 ± 18 months. Although some patients initially responded to medical and laser therapy, all but one (3.8%) eventually required surgery during the first 3 months after presentation. The mean duration from presentation until surgery was 45.9 ± 45.8 days (range: 2-119 days). The majority of cases (69.2%) were managed by pars plana vitrectomy. At the last follow-up visit, anatomical success was achieved in 20 (76%) eyes, 15 (57%) eyes had a final visual acuity that was either similar to or better than baseline, and successful control of IOP was achieved in 17 (65%) eyes. Univariate analysis revealed that a history of trabeculectomy as a cause of AMS was a risk factor for treatment failure (OR, 7.8; 95% CI, 1.16-52.35; P, 0.02). Conclusion: Our findings indicate that medical and laser management of AMS provide temporary control, and almost all patients eventually require surgery within the first 3 months. A history of trabeculectomy was found to be a risk factor for treatment failure.

Comparing the accuracy of point-of-care with laboratory (capillary, venous, and arterial) blood glucose levels in critically ill patients with and without shock.

OBJECTIVES: To compare the accuracy of point-of-care capillary and venous/arterial samples to laboratory testing of venous/arterial samples in critically sick shocked and non-shocked patients. This is a prospective case-control study including capillary, venous, and arterial blood samples from 268 critically ill patients. The King Fahd Military Medical Complex in Dhahran, Saudi Arabia, was the site of this investigation. RESULTS: We were able to obtain data on 268 patients for this investigation. POCT and lab findings of venous and central blood did not differ significantly (P = 0.389 and 0.208), while POCT indicated somewhat higher results with venous glucose concentrations of 10.18 and 10.05 (POCT and lab tests respectively) and 9.18 and 9.54 (POCT and lab tests respectively). In addition, the mean differences between POC and laboratory analyses of venous, arterial, and central glucose were 0.13, - 1.75, and - 0.36 mmol/L for venous, arterial, and central glucose, respectively. Except for arterial blood glucose, we did not observe a significant difference between POCT and routine laboratory analysis of glucose concentrations in critically ill patients. Compared to laboratory blood analysis, the use of POCT is marginally accurate, with no difference between shocked and non-shocked patients.

Accelerated versus conventional corneal collagen crosslinking: Short-term clinical outcomes in stabilizing keratoconus.

PURPOSE: The purpose of the study is to compare the short-term outcomes of corneal collagen crosslinking (CXL) using the conventional (Dresden) protocol and an accelerated CXL (ACXL) protocol to stop keratoconus (KC) progression. METHODS: A chart review was performed for all the patients with KC who underwent CXL in the last 7 years. Data were compared at baseline and at all follow-up examinations for uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BCVA), keratometry (K), central corneal thickness, and complications of CXL. Pre- and post-intervention values were compared for each group. P < 0.05 was statistically significant. RESULTS: After the treatment, there was a statistically greater improvement in UCVA in the conventional CXL (CCXL) group (49%) compared to the ACXL group (34%) (P = 0.028). The improvement in BCVA was similar between the groups (P = 0.060). Gain of two lines of UCVA and stability were comparable between groups (P = 0.078 and P = 0.060, respectively). The average flat K and steep K values fluctuated remarkably across different follow-up assessments in both the groups. At 3 months of follow-up, there was a statistically significantly faster return to baseline levels of flat and steep Ks in the CCXL group (P = 0.028 and P = 0.002, respectively). CONCLUSION: The findings of the current study confirm the efficacy and safety of accelerated high-fluence CXL compared to CCXL. Both protocols were effective in stabilizing KC at 9th-month and the last follow-up visit. Larger prospective randomized controlled trials and longer follow-up are required to confirm our findings.