Bowman Layer Transplantation With Stromal Inclusion Using Femtosecond Laser: 3-year Results.

PURPOSE: The aim of this study was to evaluate the 3-year clinical results of Bowman layer with stromal inclusion (Bowman layer) transplantation using femtosecond laser for patients with advanced keratoconus. METHODS: This single-center retrospective study included 7 eyes of 7 patients diagnosed with progressive keratoconus who underwent Bowman layer transplantation with stromal inclusion between 2018 and 2020. Follow-up was carried out from the date of surgery until 36 months later. Bowman layer grafts were positioned into a mid-stromal pocket performed by a femtosecond laser and patients were evaluated up to 3 years after surgery. RESULTS: Corneal flattening of 5.49 D (P = 0.0020) in Kmax was observed, increased in corneal pachymetry, and an improvement best-corrected visual acuity measured in logarithm of minimum angle of resolution (LogMAR) from 0.89 to 0.60 and tolerance to contact lens from 42% of the patients to 100% of them. Stabilization of the cornea was achieved in 100% with no further progression of the keratoconus; all surgical procedures were uneventful, and no complications were observed during the 3 years of follow-up. CONCLUSIONS: Bowman layer transplantation with stromal inclusion flattened the cornea improving best-corrected visual acuity and contact lens tolerance and stabilized keratoconus in 100% of the patients during 3 years of follow-up and may be a feasible option in patients with advanced and progressive KC to delay or avoid the need for PK or DALK.

Correlation Between Corneal Nerve Density and Symptoms of Small Fiber Neuropathy in Patients With Fibromyalgia: The Confounding Role of Severe Anxiety or Depression.

OBJECTIVE: A consistent line of investigation proposes fibromyalgia as a dysautonomia-associated neuropathic pain syndrome. Comorbid anxiety or depression amplifies fibromyalgia symptoms. The recent recognition of small fiber neuropathy in fibromyalgia patients supports the neuropathic nature of the illness. Corneal confocal microscopy accurately identifies small nerve fiber pathology. The newly developed Small-Fiber Symptom Survey captures the spectrum of small fiber neuropathy symptoms. We aimed to correlate corneal nerve density with different fibromyalgia disease severity questionnaires including the Small-Fiber Symptom Survey. We defined the possible confounding role of comorbid anxiety or depression severity in the clinical-pathological association. METHODS: This is a case series of 28 women with fibromyalgia. A single ophthalmologist quantified corneal subbasal plexus nerve density. Corneal innervation was correlated (Spearman ρ) with the following clinical questionnaires scores: Small-Fiber Symptom Survey, Revised Fibromyalgia Impact Questionnaire, and COMPASS-31 (Composite Autonomic Symptom Survey 31-Item Score). Validated inquiry forms assessed the comorbid anxiety and/or depression severity. RESULTS: There were no clinical-pathological correlations in the group as a whole. In the subgroup of fibromyalgia women without severe anxiety or depression (n = 13), there was a strong negative correlation between corneal nerve density with the Small-Fiber Symptom Survey score (ρ = -0.771, p = 0.002) and COMPASS-31 score (ρ = -0.648, p = 0.017). Patients with profound anxiety or depression (n = 15) had more intense symptoms but had not clinical-pathological correlations. CONCLUSIONS: Small fiber neuropathy and dysautonomia symptoms correlate with corneal denervation in women with fibromyalgia without severe anxiety or depression. This clinical-pathological association reinforces fibromyalgia as a dysautonomia-related neuropathic pain syndrome. Severe anxiety or depression distorts fibromyalgia symptoms. PRACTICAL POINT: Corneal confocal microscopy may become a useful procedure to study fibromyalgia patients.

Updates in Mirizzi syndrome.

Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction of the common hepatic duct, triggering liver dysfunction. Our aim is to identify and describe the current epidemiology, diagnostic methods, and treatment of Mirizzi syndrome. A literature search was performed using different databases, including Medline, Cochrane, Embase, Medscape, PubMed, using keywords: Mirizzi syndrome, epidemiology, markers, pathophysiology, clinical presentation, diagnosis, and treatment. Selected original articles, review articles or case reports from 1997 to 2015 were collected, written in English or Spanish. The endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate diagnostic method. The traditional treatment has been surgery and involves an incision at the bottom of the gallbladder and calculus removal. If fistulas are observed, it is performed a partial cholecystectomy; otherwise, a cholecystocholedochoduodenostomy is an alternative. Endoscopic treatment includes biliary drainage and stone extraction. Many surgeons claim that laparoscopic cholecystectomy is contraindicated in Mirizzi syndrome because of the presence of inflammatory tissue and adhesions in the Calot's triangle. If dissection is attempt, it can cause unnecessary injury to the bile duct. However, other surgeons consider the laparoscopic approach is feasible, although technically challenging. Currently, laparoscopic cholecystectomy for this condition is considered controversial and technically challenging; however, it has shown that with the right skills and equipment, it is a safe and feasible way to treat some cases of Mirizzi syndrome type I and II.