Intra-Operative Discomfort in Photorefractive Keratectomy.

PURPOSE: Photorefractive keratectomy (PRK) remains a viable, safe, and efficacious option for patients wishing to correct refractive errors. One of its most significant drawbacks is pain. While post-operative pain has been well studied with different management options, intra-operative pain has been less well defined. The purpose of this study was to characterize intra-operative pain during PRK in regard to eye operated on, gender, excimer platform used, surgeon, and age. PATIENTS AND METHODS: A total of 134 patients (264 eyes) were prospectively randomized to undergo bilateral PRK of either the right eye first or the left eye first followed immediately by the fellow eye. In the immediate post-operative period they were surveyed using an 11-point Numeric Rating Scale regarding intra-operative pain or discomfort experienced in each eye. Resultant pain scores were then analyzed via two sample z-test and analysis of variance (ANOVA) to characterize pain overall as well as comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, inter-surgeon variability, and age. RESULTS: Of 264 eyes surveyed the mean pain experienced on a 0-10 pain scale was 1.13 (minimal discomfort). There was no statistically significant difference in pain or discomfort when comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, operating surgeon, or age. CONCLUSION: Intra-operative pain or discomfort experienced by patients is minimal. The absence of statistically significant differences in pain scores studied implies that standard of care procedures achieve adequate analgesia in PRK.

Definitive Treatment of Neurological Decompression Sickness in a Resource Limited Location.

BACKGROUND: While Fairbanks, AK, USA, is a remote location with significant constraints on medical resources and specialty care, a small U.S. Air Force clinic was able to provide a pilot with definitive care for neurological decompression sickness.CASE REPORT: A 31-yr-old female patient presented to her flight surgeon in Anchorage, AK, USA, with migrating polyarthropathy and headaches 48 h after a flight which included planned aircraft decompression for high altitude low opening (HALO) jump operations. In order to get definitive treatment in a hyperbaric chamber, the patient typically would have to be flown to Seattle, WA, USA. This transfer of care would cost the Air Force approximately 150,000 and may have led to more complicated disease. Fortunately, Eielson Air Force Base (AFB) in Fairbanks had previously procured a Hyperlite hyperbaric chamber specifically for this situation. After consultation with a hyperbaric specialist, the team decided that the most appropriate course of action was to transfer her by car 6 h north from Anchorage to Fairbanks. On initiation of the Hart treatment table, she experienced immediate reduction in joint pain with a reversal of neurological symptoms.DISCUSSION: This patients care could not have been done without the procurement of a hyperbaric chamber. This case demonstrates the utility and necessity for these capabilities at more facilities that manage significant flying operations. Military bases should ensure that hyperbaric treatment capabilities are available within a close proximity.Petruso MJ, Philbrick SM. Definitive treatment of neurological decompression sickness in a resource limited location. Aerosp Med Hum Perform. 2021; 92(1):4749.

Recording and viewing stereoscopic ophthalmic surgical videos with smartphones.

OBJECTIVE: To determine whether stereoscopic footage of cataract surgery could be captured with smartphones and to develop a procedure for editing and viewing the footage. The authors sought to measure whether subjectively convincing stereo footage could be captured with smartphones, whether it would be possible to sync this footage for stereoscopic viewing, and whether these tasks could easily be performed at lower cost than commercially available options. DESIGN: Brief research report. PARTICIPANTS: The entities studied were phones and programs. METHODS: Surgeries were recorded at Fort Belvoir Community Hospital. Two smartphones were attached to the eyepieces of a surgical microscope's assistant scope. Surgical footage was recorded. Videos from the left and right eyepieces were edited and combined into videos that facilitated stereoscopic viewing. RESULTS: Stereo footage was captured with 2 smartphones and edited to enable 3D viewing with both anaglyph glasses and head-mounted displays. Viewing experience was superior when using head-mounted displays compared to using anaglyph glasses. CONCLUSIONS: Stereoscopic footage of operations performed under the surgical microscope may be captured and viewed using inexpensive equipment and simple procedures requiring minimal prior expertise. The techniques described in this paper may enable more training programs to capture and distribute 3D footage of their operations, enhancing the educational value of ophthalmic surgical videos.

A Unique Case of Muscle-Invasive Metastatic Breast Cancer Mimicking Myositis.

Breast cancer rarely metastasizes to the muscles, and it is even more unusual for this phenomenon to result in airway compromise. We present a unique case of an 84-year-old female who presented with neck swelling and upper airway obstruction due to metastatic breast cancer invading the sternocleidomastoid muscles. After establishing the diagnosis and discussing possible treatment options, the patient elected for antiestrogen therapy, palliative tracheostomy, radiation therapy, and hospice services.