Corneal epithelial defects following vitreoretinal surgery: incidence and outcomes from the DISCOVER study

AIM: To investigate the incidence, risk factors, clinical course, and outcomes of corneal epithelial defects (CED) following vitreoretinal surgery in a prospective study setting. METHODS: This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study. Subjects with CED 1d after surgery without intraoperative corneal debridement was defined as the postoperative CED group. Subjects who underwent intraoperative debridement were defined as intraoperative debridement group. Eyes were matched 2:1 with controls (eyes without postoperative CED) for comparative assessment. The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement. Secondary outcomes included time to defect closure, delayed healing (>2wk), visual acuity (VA) and presence of scarring at one year and cornea consult. RESULTS: This study included 856 eyes that underwent vitreoretinal surgery. Intraoperative corneal debridement was performed to 61 (7.1%) subjects and postoperative CED developed spontaneously in 94 (11.0%) subjects. Significant factors associated with postoperative CED included prolonged surgical duration (P=0.003), diabetes mellitus (P=0.04), postoperative ocular hypotension (P<0.001). Prolonged surgical duration was associated with intraoperative debridement. Delayed defect closure time (>2wk) was associated with corneal scar formation at the end of the 1y in all epithelial defect subjects (P<0.001). The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%. CONCLUSION: Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED. Delayed defect closure is associated with a greater risk of corneal scarring at one year. The overall rate of corneal scarring following vitrectomy is low at <2%.

Wellens’ Syndrome: Incidence, Characteristics, and Long-Term Clinical Outcomes

Background: Sparse study of large sample size are available on patients with Wellens’ syndrome. We sought to assess the current incidence, risk factors, clinical presentation and long-term outcomes of this population. Methods: Among a total of 3528 patients with ACS underwent angioplasty from 2017 to 2019 in our center, 2127 NSTE-ACS patients with culprit vessel of LAD were enrolled in this study. According to electrocardiographic criteria, they were divided into Wellens’ group (n = 200) and non-Wellens’ group (n =1927). The primary endpoint was cardiac death; the secondary endpoint was MACCE, a composite of all-cause death, cardiac death, recurrent myocardial infarction, target lesion revascularization, heart failure and stroke. Results: The incidence of Wellens’ syndrome was 5.7% (200 of 3528) in all the ACS patients. Wellens’ syndrome was more often manifested as NSTEMI (69% vs 17.5%, P＜0.001). Percent of preexisting coronary heart disease (39.6% vs 23%) and previous PCI (19.5% vs 9%) were significantly higher in the non-Wellens’ group than in Wellens’ group (all P<0.001). More importantly, the proportion of early PCI was higher in Wellens’ group (68% vs 59.3%, P=0.017). At a median follow-up of 24 months, Wellens’ syndrome was not a factor that affects the prognosis of MACCE (P=0.05) and cardiac death (P=0.188). Conclusions: In patients with NSTE-ACS, Wellens’ syndrome does not affect the prognosis. The presence of age≥65years, diabetes, NSTEMI, eGFR< 60ml/min and left main disease were associated with an incidence of cardiac death. Early recognition and aggressive intervention are critical as they may help to attenuate adverse outcomes.

Myasthenia Gravis in pregnancy: Systematic review and case series

Background Myasthenia gravis is an autoimmune disease which can impact pregnancy. Methods Six databases were systematically searched for studies with at least five subjects reporting pregnancy outcomes for women with myasthenia gravis in pregnancy. Assessment of bias was performed for all included studies. Forty-eight cases from our own centre were also included in the analysis. Results In total, 32 publications met inclusion criteria for systematic review, for a total of 33 unique data sets including 48 cases from our institution. Outcome data was available for 824 pregnancies. Spontaneous vaginal delivery occurred in 56.3% of pregnancies. Overall risk of myasthenia gravis exacerbation was 33.8% with a 6.4% risk of myasthenic crisis in pregnancy and 8.2% postpartum. The incidence risk of transient neonatal myasthenia gravis was 13.0%. Conclusions The current systematic review provides the best estimates of risk currently available to aid in counselling women with myasthenia gravis in pregnancy.