Corneal Epithelial Thickness Measured by Manual Electronic Caliper Spectral Domain Optical Coherence Tomography: Distributions and Demographic Correlations in Preoperative Refractive Surgery Patients.

PURPOSE: The aim of this study was to report the distributions and demographic correlations of corneal epithelial thickness measured by manual electronic caliper spectral domain optical coherence tomography in preoperative refractive surgery patients. DESIGN: This was a retrospective review. METHODS: The charts of 218 consecutive patients (413 eyes) who presented for refractive surgery evaluation from April 2013 through September 2013 were retrospectively reviewed. RESULTS: The mean corneal epithelial thickness was 51.0 µm with a range of 43 to 61 µm. Corneal epithelial thickness was significantly correlated with sex (P < 0.0001), corneal keratometry (P = 0.01), and underlying corneal thickness excluding the epithelium (P = 0.0268). No significant associations were identified in which corneal epithelial thickness correlated with either age (P = 0.0760) or existing refractive status of the eye (P = 0.5135). CONCLUSIONS: Corneal epithelial thickness measured by manual electronic caliper optical coherence tomography in preoperative refractive surgery patients is comparable with the findings for the general population using other measurement techniques, the awareness of which may be useful in the preoperative assessment of these patients.

Long-term outcomes of optical coherence tomography-guided transepithelial phototherapeutic keratectomy for the treatment of anterior corneal scarring.

AIM: To report the long-term outcomes of optical coherence tomography (OCT)-guided transepithelial phototherapeutic keratectomy (PTK) for the management of anterior corneal scarring. METHODS: The charts of 60 patients (64 eyes) who underwent OCT-guided transepithelial PTK for anterior corneal scarring were retrospectively reviewed. The procedure involved a preoperative OCT-measured depth of treatment calculation to reduce or eliminate corneal scarring, followed by a combined myopic and hyperopic transepithelial excimer laser treatment profile established to attain the desired refractive result. The main outcome measures consisted of change in best spectacle-corrected visual acuity (BSCVA), change in OCT-measured parameters, and change in corneal topography indices. RESULTS: The mean follow-up was 41.0 weeks (range: 12-117 weeks). BSCVA improved from a mean of 0.77 logMAR (0.65-0.89) preoperatively to a mean of 0.34 logMAR (0.21-0.46) postoperatively (p<0.0001). Comparison of preoperative and postoperative corneal topographic indices showed significant improvement in all parameters analysed: corneal cylinder (p=0.0008), surface asymmetry index (p=0.0054), surface regularity index (p=0.0047) and projected visual acuity (p=0.0045). Postoperative spherical equivalent averaged 0.91 (±0.71) dioptres of error from the intended target refractive outcome. Two patients required penetrating keratoplasty and one patient underwent repeat PTK during the study interval. CONCLUSIONS: The OCT-guided transepithelial PTK technique described in this study can deliver positive long-term results and predictable refractive outcomes in the treatment of anterior corneal scarring.

A case of carcinoid likely causing jejunal intussusception.

A 34-year-old female was admitted to Emergency Department with an abrupt onset of diffuse abdominal pain. A CT scan done prior to her transfer revealed significant dilated loops of bowel as well as multiple target signs with likely torsed bowel. The patient consented to an exploratory laparotomy. During surgery, the proximal jejunum was found to be intussuscepted, a rare finding in an adult. There was evidence of mesenteric foreshortening throughout the small bowel and multiple whitish lesions within the mesentery, both consistent with the desmoplastic response that is characteristic of carcinoid. The interest for this case report comes from the patient's surgical findings of jejunal intussusception as well as her extensive history, which includes a bowel resection with an ileocolic anastomosis for presumed ischemia and a carcinoid tumor in the stomach which had been removed endoscopically.

Is magnetic resonance imaging in addition to a computed tomographic scan necessary to identify clinically significant cervical spine injuries in obtunded blunt trauma patients?

BACKGROUND: Guidelines are in place directing the clearance of the cervical spine in patients who are awake, alert, and oriented, but a gold standard has not been recognized for patients who are obtunded. Our study is designed to determine if magnetic resonance imaging (MRI) detects clinically significant injuries not seen on computed tomographic (CT) scans. METHODS: The trauma registry was used to identify and retrospectively review medical records of blunt trauma patients from January 1, 2005, to March 30, 2012. Only obtunded patients with a CT scan and MRI of the cervical spine were included. RESULTS: The study cohort consisted of 277 patients. In 13 (5%) patients, MRI detected clinically significant cervical spine injuries that were missed by CT scans, and in 7 (3%) these injuries required intervention. The number needed to screen with MRI to prevent 1 missed injury was 21. CONCLUSIONS: The findings suggest that the routine use of MRI in clearing the cervical spine in the obtunded blunt trauma patient.