Optimizing outpatient neurosurgery: evaluating ambulatory surgery and same-day discharge following intracranial tumor surgery and endoscopic third ventriculostomy.

OBJECTIVE: Outpatient surgery and same-day discharge are developing fields that align with the evolving needs of modern healthcare, presenting a notable advantage by reducing patient susceptibility to nosocomial infections, thromboembolic complications, and medical errors. When paired with enhanced recovery after surgery protocols, they hold promise in safely transitioning certain patients undergoing cranial surgery to outpatient care. This study aimed to evaluate discharge on the same day of surgery after intracranial tumor resection and endoscopic third ventriculostomy (ETV) and to investigate potential associations with anesthesia methods, complications, and readmission rates. METHODS: A retrospective analysis of patients scheduled for planned discharge on the same day of surgery between August 2020 and October 2023 was conducted. Data included patient demographic characteristics, preoperative clinical deficits, diagnosis, findings on preoperative and postoperative MRI, lesion characteristics, complications, and readmission rates. RESULTS: A total of 202 patients were included in the study. The mean age was 56.8 years and 117 (57.9%) patients were female. Patients were admitted the evening before surgery to obtain preoperative clearance and undergo MRI. The most common diagnoses were metastasis (23.3%), meningioma (20.8%), glioblastoma (12.4%), and low-grade glioma (10.4%). Craniotomy (46.5%), stereotactic needle biopsy (35.1), and ETV (6.9%) were the most common procedures performed. Thirteen (6.4%) patients underwent awake craniotomy, and 189 (93.6%) surgical procedures were conducted under general anesthesia. Complications occurred in 1.5% of patients, with no permanent complications observed during a mean follow-up of 9.3 months. In total, 179 (88.6%) patients were successfully discharged on the same day of surgery. The median length of hospitalization was 26.8 hours, with the median length of postoperative stay being 7 hours. Twenty-three (11.4%) patients were deemed ineligible for discharge on postoperative day 0 and instead discharged on postoperative day 1. The reasons for these delays included further clinical monitoring (n = 12), social factors (n = 4), and patient preference (n = 7). Age was positively correlated with length of hospitalization (p = 0.006). In total, 6.4% of patients were readmitted within 1-30 days after discharge, with 2.5% readmitted to the department of neurosurgery. CONCLUSIONS: This study demonstrates the safety and feasibility of discharge on the same day of surgery, with a high success rate and low complication rates. Early discharge did not increase morbidity or readmission rates. Implementation of clear discharge protocols and thorough patient education are crucial for successful same-day discharge programs in neurosurgery.

Red-Light Transmittance Changes in Variegated Pelargonium zonale-Diurnal Variation in Chloroplast Movement and Photosystem II Efficiency.

Chloroplast movement rapidly ameliorates the effects of suboptimal light intensity by accumulating along the periclinal cell walls, as well as the effects of excess light by shifting to the anticlinal cell walls. These acclimation responses are triggered by phototropins located at the plasma membrane and chloroplast envelope. Here, we used a recently developed non-invasive system sensitive to very small changes in red light leaf transmittance to perform long-term continuous measurements of dark-light transitions. As a model system, we used variegated Pelargonium zonale leaves containing green sectors (GS) with fully developed chloroplasts and achlorophyllous, white sectors (WS) with undifferentiated plastids, and higher phototropin expression levels. We observed biphasic changes in the red-light transmittance and oscillations triggered by medium intensities of white light, described by a transient peak preceded by a constant decrease in transmittance level. A slight change in red-light transmittance was recorded even in WS. Furthermore, the chloroplast position at lower light intensities affected the rapid light curves, while high light intensity decreased saturated electron transport, maximum quantum efficiency of photosystem II, and increased non-photochemical quenching of chlorophyll fluorescence and epidermal flavonoids. Our results extend the knowledge of light-dependent chloroplast movements and thus contribute to a better understanding of their role in regulating photosynthesis under fluctuating light conditions.

Eye drops preservative as the cause of corneal band keratopathy in long-term pilocarpine hydrochloride treatment.

The aim is to present a patient with severe bilateral corneal complications after long-term antiglaucoma treatment with 1% pilocarpine hydrochloride (Pilokarpin, Pliva, Zagreb, Croatia) and its management. A patient with narrow-angle glaucoma treated with 1% topical pilocarpine hydrochloride eye drops for the last twenty years complained of impaired vision, intermittent visual haloes and eye redness. Ophthalmologic examination showed bilateral band keratopathy, peripheral laser iridotomy, medicamentous myosis, brown nuclear cataract, and synchysis scintillans of his right eye. Band keratopathy was thought to have resulted from the presence of the preservative phenylmercuric nitrate in the pilocarpine hydrochloride eye drops. Treatment of the patient consisted of two separate procedures for both eyes, i.e. phaco trabeculectomy and six months later corneal procedure including abrasion of corneal epithelium followed by removal of the superficial stromal calcium deposits by means of a 3.75% ethylenediaminetetraacetic (EDTA) solution. After phaco trabeculectomy, visual acuity was 0.8 on both eyes. Bilateral visual improvement with visual acuity 1.0 was recorded after corneal treatment with EDTA. In conclusion, one must be aware of preservative complications in long-term topical use, such as band keratopathy that can be visually incapacitating. Surgical treatment using EDTA is safe and effective treatment for band keratopathy.

Intralesional triamcinolone acetonide injection for chalazion.

The aim of the study was to evaluate the efficacy of intralesional triamcinolone acetonide injection in primary and recurrent chalazion. The study included 30 patients with primary and recurrent chalazion (37 cases) and 24 patients as a control group. Patients with primary and recurrent chalazion received intralesional injection of 0.1 to 0.2 mL triamcinolone acetonide (40 mg/mL). Control group received intralesional injection of 0.1 to 0.2 mL 0.9% NaCl. Data on the lesion size, including digital color photography, lesion regression or recurrence, and complete ophthalmic examination were recorded at the time of injection and after a week or two until resolution or surgical excision. Success was defined as at least 80% decrease in size with no recurrence. Resolution of the lesion was found in 35 cases after one or two injections, with a mean time to resolution of 15.27 +/- 6.12 days. Subcutaneous injection of the steroid triamcinolone acetonide in primary and recurrent chalazion appears to be a simple and efficacious therapeutic option for chalazion.

Safety and efficacy of monotherapy change to fixed combination (travoprost 0.004%/timolol 0.5%) in 6 months follow up period.

PURPOSE: To assess the safety and efficacy of changing antiglaucoma therapy to the travoprost 0.004%/timolol 0.5% (TTFC) fixed combination from previous monotherapies. METHODS: Prospective, open-label, observational, multicenter cohort. A change was done from prior monotherapy at day 0 to TTFC dosed once a day, regardless in the evening or in the morning, without washout period. Active evaluation of systemic and local tolerability (adverse events), and efficacy. i.e., intraocular pressure (IOP) lowering was done at control 1 (day 30), control 2 (day 90) and control 3 (day 120). RESULTS: 40/155/170 patients (79/309/339 eyes) completed the study (120 days/ 90 days/baseline, respectfully). At control 1 excluded were patients with low tolerability (severe hyperemia (6 patients), discomfort (4), chest pain (1)) and non responders (IOP lowering less than 15% from baseline IOP or target IOP >18 mmHg (4 patients)). Mean IOP at control 1 was 15.92 +/- 1.85 mm Hg (21.66% reduction) for 155 patients (non responders excluded), at control 2 was for 155 patients 15.67 +/- 2.17 mm Hg (21.14% reduction), and at control 3 for 40 patients 16.28 +/- 1.59 mm Hg (19.86% reduction). At control 2 analysis of IOP reduction by 4 groups of previous monotherapy (timolol 0,5% (N = 33/66), latanoprost 0.005% (N = 49/98), betaxolol 0.5% (N = 30/60), and travoprost 0.004% (N = 43/85) was performed. 40 patients/79 eyes endured to control 3 (after day 90 free samples were not available for all patients). Analysis of IOP reduction by 4 groups of previous monotherapy medications was performed (timolol 0.5% (N = 7/14), latanoprost 0.005% (N = 14/28), betaxolol 0.5% (N = 7/14), travoprost 0.004% (N = 12/23)). CONCLUSIONS: Changing patients from prior monotherapy to TTFC can provide on average a further reduction in IOP, while demonstrating a favorable safety profile.

Phacoemulsification in eyes with white cataract.

Phacoemulsification of white cataracts is associated with some difficulties and a higher rate of intraoperative complications. The aim of this report is to describe one of these cases and the possible ways to manage them. We report on cataract surgery in a 79-year-old patient with white mature cataract and insufficient mydriasis because of the pseudoexfoliation syndrome. The use of vital dyes for staining the anterior capsule enhances visualization and helps perform continuous curvilinear capsulorrhexis, which is a key point for performing successful phacoemulsification. In case of small pupils because of insufficient pharmacological mydriasis, we can either enlarge the pupil or work through it. Meticulous preoperative biomicroscopic and A-scan examination (the type of cataract according to intralental A-scan findings) can help select appropriate phaco technique. Despite a higher rate ofintraoperative complications, white cataracts can be safely operated on with phacoemulsification technique.

Phacoemulsification in pseudoexfoliation (PEX) syndrome.

The aim is to present the phacoemulsification phaco-chop technique in a patient with pseudoexfoliation (PEX) syndrome without the use of additional pupil dilatation methods. Phacoemulsification surgery and posterior chamber intraocular lens implantation in patients with PEX syndrome is associated with a higher rate of intraoperative complications such as zonular dehiscence, capsular rupture, vitreous loss and dropped nucleus. Many options are available for pupils that cannot be dilated sufficiently with pharmacologic agents, such as viscodilatation (Healon 5), bimanual stretching, iris retractor-hooks, and many others. We present cataract surgery in a patient with sufficient mydriasis despite PEX syndrome. The operation was done successfully without intraoperative and postoperative complications. It is concluded that cataract surgery in patients with PEX syndrome is more complicated because of zonular weakness and poor pupillary dilatation. Therefore, these patients should be managed with utmost care and operated on in time by an experienced surgeon.

[The prevalence of pseudoexfoliation syndrome in patients admitited for cataract surgery to the department of ophthalmology, Sibenik General Hospital]. / Prevalencija pseudoeksfolijativnog sindroma u bolesnika zaprimljenih radi operacije katarakte na ocni Odjel Opce bolnice Sibenik.

AIM: To evaluate the prevalence of pseudoexfoliation syndrome (PEX) in patients admitted for cataract surgery to the Department of Ophthalmology, Sibenik General Hospital, Croatia. METHODS: A total of 150 patients (299 eyes) were examined in this prospective study. All patients underwent complete ophthalmologic evaluation: history, visual acuity, refraction, slit lamp examination of the lens and fundus with respect to age, sex, presence of PEX (unilateral or bilateral), intraocular pressure (IOP), maturity of the cataract (immature, mature, hypermature), color of the iris, and diameter of the dilated pupil. RESULTS: The prevalence of PEX was 26% (39 of 150 patients). PEX was unilateral in 9% (14/150) and bilateral in 17% (25/150) of patients. The study included 74 (49%) females and 76 (51%) males. There was no significant sex difference in the prevalence of PEX (p=0.264). The mean age of those with bilateral PEX (74.3 +/- 6.3 years) was significantly higher than that of those with unilateral PEX (71 +/- 6 years) or without PEX (63.9 +/- 9.4 years) (ANOVA p = 0.036). The mean IOP in the eyes with PEX (18.1 +/- 3.9 mm Hg) was significantly higher than in those without PEX (15.4 +/- 2.5 mm Hg) (p < 0.0001). The mean diameter of dilated pupil in the eyes without PEX (8.2 +/- 0.56 mm) was significantly higher than that in those with PEX (6.5 +/- 0.9 mm) (p < 0.0001). There was no significant relationship between the color of the iris and frequency of PEX (p = 0.472). CONCLUSIONS: PEX was found to be a relatively common condition in our patients (26%) undergoing cataract surgery. The mean age of patients with PEX was significantly higher than the mean age of patients without PEX. Cataract surgery is associated with more complications in the eyes with PEX because of insufficient mydriasis, weakened zonular attachment, and instability of lens, and higher IOP. It is important to perform applanation tonometry and to follow up every patient with PEX to enable early detection of increased IOP.