Crosbykey6320

BACKGROUND The burden of enterocutaneous fistula (ECF) after emergency general surgery (EGS) has not been rigorously characterized. We hypothesized that ECF would be associated with higher rates of post-discharge mortality and readmissions. METHODS Using the 2016 National Readmission Database, we conducted a retrospective study of adults presenting for gastrointestinal (GI) surgery. Cases were defined as emergent if they were non-elective admissions with an operation occurring on hospital day 0 or 1. We used ICD-10 code K63.2 (fistula of intestine) to identify postoperative fistula. We measured mortality rates and 30- and 90- day readmission rates censuring discharges occurring in December or from October-December, respectively. RESULTS 135,595 patients underwent emergency surgery; 1,470 (1.1%) developed ECF. Mortality was higher in EGS patients with ECF than in those without (10.1% vs. 5.4%; OR 1.99, 95% CI 1.67-2.36) among patients who survived the index admission. Readmission rates were higher for EGS patients with ECF than without at 30 days (31.0% vs. 12.6%; OR 3.12, 95% CI 2.76-3.54) and at 90 days (51.1% vs. 20.1%; OR 4.15, 95% CI 3.67-4.70). Similar increases were shown in elective GI surgery. CONCLUSIONS ECF after gastrointestinal EGS is associated with significantly increased odds of mortality and readmission, with rates continuing to climb out to at least 90 days. Processes of care designed to mitigate risk in this high-risk cohort should be developed.Level II, prognostic.PURPOSE To investigate the effectiveness and safety of a custom-made iris prosthetic device used to reduce photic symptoms in patients with congenital aniridia. SETTING Cincinnati Eye Institute, Cincinnati, Ohio, USA. DESIGN Retrospective single-surgeon case series. METHODS The charts of all eyes of patients diagnosed with congenital aniridia syndrome who underwent implantation of the custom-made iris prosthesis at the setting institution between 2008 and 2018 were reviewed. Eyes with more than 6 months of follow-up were included in evaluation. Charts were carefully reviewed for comorbid conditions, interventions, and outcomes. RESULTS Ninety-six eyes of 50 patients were included in the study. Subjective reduction in photophobia and glare was reported in 95.7% and 95.2% of cases, respectively. The incidence of Aniridia Fibrosis Syndrome (AFS) in our study (3.1%, 95% CI 0.6 to 8.9%) was similar to previous studies in the literature. CONCLUSION The custom-made iris prosthesis was an effective and safe option to reduce photic symptoms in patients with congenital aniridia. The custom, flexible iris implant dis not appear to alter the risk for AFS. These highly complex eyes with significant comorbid pathologies demand an individualized approach and careful long-term follow-up.PURPOSE To compare the outcomes of an intraoperative aberrometer (ORA) to the Barrett Universal II (Barrett II) and Hill-RBF 2.0 (Hill-RBF) intraocular lens (IOL) power calculation formulas. SETTING Duke University Eye Center, Durham, North Carolina, USA. DESIGN Retrospective study. METHODS Patients without history of refractive corneal surgery who had uncomplicated cataract surgery from April 2016 to June 2018 were enrolled. Refractive prediction error was calculated with the Barrett II formula, the Hill-RBF formula, and the ORA intraoperative aberrometer (OIA) and was stratified by axial length, IOL type, and the percentage of eyes within a diopteric range of target refraction. RESULTS Nine-hundred and forty-nine eyes were included. The mean and median absolute predictive errors were 0.29 diopters (D) and 0.23 D (Barrett II), 0.31 D and 0.24 D (Hill-RBF), and 0.31 D and 0.25 D (IA), respectively (P > 0.05). Axial length stratification did not influence statistical difference in the IOL prediction methods. Barrett II outperformed the OIA in the short-eye (P = 0.026) and toric multifocal (P = 0.011) groups. Postoperative refraction was within 0.50 D of target in 84% (Barrett II), 83% (Hill-RBF), and 82% (OIA) of eyes (P > 0.05). CONCLUSIONS Comparing the OIA to the Barrett II and Hill-RBF calculators, there was minimal clinical difference in the short axial length and toric multifocal group. Regarding postoperative predicted spherical equivalent, for patients without a history of refractive surgery and good potential visual acuity, refractive outcome was not improved by utilizing the OIA.PURPOSE To assess the preliminary safety and efficacy of custom silicone artificial iris implantation. SETTING Stein Eye Institute. DESIGN Prospective consecutive case series. METHODS Review of medical records of patients implanted with the artificial iris and followed for 1 year. Safety measures included corrected distance visual acuity (CDVA), intraocular pressure (IOP), endothelial cell count (ECC), surgical complications, secondary interventions, and adverse events (AEs). Efficacy measures included CDVA with glare, subjective daytime and nighttime glare graded from 0 to 10 (very significant), and subjective cosmetic appearance graded from 0 to 10 (very satisfied). RESULTS Twenty eyes (19 patients) were implanted. Safety data were mixed. CDVA improved in 13 eyes and worsened in 6. ECC decreased from 1918 ± 870 to 1405 ± 705 cells/mm (P = 0.02). Eight eyes experienced postoperative complications. There were 4 IOP elevations, 2 corneal decompensations, 1 case of cystoid macular edema, and 1 device dislocation. Four eyes underwent secondary surgical interventions including 2 AEs (1 glaucoma surgery, 1 device dislocation). Efficacy outcomes were excellent. CDVA with glare improved from 1.5 ± 0.6 to 0.7 ± 0.8 logMAR (P less then 0.01). Mean subjective daytime glare decreased from 8.9 ± 1.8 to 2.7 ± 2.6 (P less then 0.01) and nighttime glare decreased from 7.9 ± 1.8 to 2.5 ± 2.7 (P less then 0.01). Mean cosmesis improved from 2.2 ± 1.6 to 8.8 ± 2.1 (P less then 0.01). CONCLUSION Custom artificial iris implantation was moderately risky but very effective at reducing light and glare sensitivity and improving ocular cosmesis.(250 words max) PURPOSE To compare short-term refractive and visual acuity outcomes after topography-guided laser in situ keratomileusis (LASIK) planned with a new topography analysis system to those based on the manifest refraction. SETTING Retrospective data from 4 clinical sites in the USA. DESIGN Double-arm, non-masked, non-randomized retrospective chart review. METHODS This was a retrospective study of postoperative refraction and visual acuity at least 2 months after uncomplicated LASIK using the Contoura Vision algorithm on the WaveLight Topolyzer VARIO laser. One arm comprised eyes treated using the manifest refraction (Manifest), while the other included eyes treated with an ablation profile determined by the Phorcides Analytic Engine (Analytic). RESULTS Clinical results from a matched group of 317 Manifest eyes and 323 Analytic eyes were available for analysis. Residual refractive results, both sphere and cylinder, were similar between groups. GSK046 However, significantly more eyes had 20/16 or better (-0.