Imaging vitreous cortex hyalocyte response to paracentral acute middle maculopathy (PAMM) using En Face OCT.

INTRODUCTION: Vitreous cortex hyalocytes (VCH) are resident macrophage cells that provide immunosurveillance, respond to tissue injury and inflammation, and help maintain the transparency of the media. In this case report we demonstrate the use of en face optical coherence tomography (OCT) to image VCH in vivo in a patient presenting with PAMM secondary to antiphospholipid syndrome. CASE DESCRIPTION: A 38-year-old female with no known medical history presented with complaints of visual disturbances in the right eye. OCT revealed hyperreflective bands in the IPL and INL nasal to the fovea. A diagnosis of PAMM was made. Work-up revealed elevated titers of antiphospholipid antibodies. En face OCT revealed a decline in the inflammatory activation over a seven-month period as evidenced by changes in VCH distribution and morphology. CONCLUSIONS: Our findings suggest that monitoring changes in the distribution and morphology of VCH could have a potential clinical utility for assessing disease severity, predicting recovery, and early recognition of treatment response in various inflammatory ocular pathologies such as PAMM.

Robotic Approach to Mitral Valve Surgery in Septo-Octogenarians.

Advanced age confers higher Society of Thoracic Surgeons (STS) predicted risks of mortality and longer hospital lengths of stay (LOS) in patients undergoing mitral valve surgery; some consider it a contraindication to robotic-assisted approaches. We analyzed the feasibility and safety of totally endoscopic robotic mitral valve surgery (TERMS) in patients ≥70 years. From 5/11 to 4/18, 570 consecutive patients underwent TERMS by the same 2-surgeon team utilizing the da Vinci Xi Surgical System. Differences in patient demographics, intraoperative variables, and outcomes were analyzed between septo-octogenarian (patients ≥70 years) and younger patients (<70 years). Patients requiring left ventricle patch reconstruction following mitral annular calcification resection were excluded. For those patients with STS predicted risk scores (n = 439), our outcomes were compared to those STS predictions. Patients ≥70 comprised 25% of our TERMS cohort. Patients ≥70 had higher rates of preoperative atrial fibrillation and congestive heart failure, and significantly higher STS predicted risks of mortality. Patients ≥70 had greater incidence of concomitant cryoablation, hybrid percutaneous coronary intervention, and tricuspid repair. Patients ≥70 did not have longer cardiopulmonary bypass or aortic occlusion times. Thirty-day mortality was similar between groups (P = 0.151). Median LOS was 1 day longer for patients ≥70, 4 vs 3 days (P < 0.001). Short LOS (<6 days) was achieved in 72% of patients ≥70, markedly outperforming the STS predicted rates (36%). Advanced age is not a limiting factor for robotic mitral valve surgery in most patients. TERMS in patients ≥70 years matched STS benchmark performance outcomes and provided excellent recovery as evidenced by the short LOS (<6 days) experienced by the majority of septo-octogenarian patients.