Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

ABSTRACT.Purpose: To evaluate the risk factors for the development of pterygium in a Middle Eastern country (Jordan) and to compare our findings with those from other countries. Methods: This study was conducted in Irbid District, in northern Jordan, a region located 31 degrees north of the equator, with a stable, subtropical climate. In this case control study, 96 adult subjects presenting with pterygium were interviewed and compared to 192 control subjects who were group-matched for age and sex. A standard questionnaire and eye examination were completed for both groups.Results: There was a strong positive association between pterygium and environmental factors. The most striking increase in the risk of pterygium occurred in subjects who worked outdoors compared to those who worked indoors, with an odds ratio of 5.47. Current and previous sunlight exposures were associated with a higher risk of developing pterygium, with odds ratios of 3.54 and 4.52, respectively. Previous use of sunglasses represented a protective element, but the protective role of recent use of sunglasses was not statistically significant. Conclusion: There is a statistically significant association between outdoor work, sunlight exposure and pterygium formation. Efforts should be made to educate outdoor workers to wear sunglasses and brimmed hats. Public education should focus on avoidance of unnecessary sunlight exposure.

No abstract

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Optical coherence tomography (OCT) is a noninvasive imaging modality that uses low-coherent interferometry to visualize an optical cross-section of biological tissues. Over the past two decades, the ability to perform OCT imaging of the neural retina has afforded clinicians and researchers a highly reproducible method of diagnosing and following diabetic macular edema (DME) that compares favorably to other methods of DME assessment such as clinical examination and fundus photography. Although central subfield mean thickness has been the OCT parameter most commonly used to evaluate DME in clinical research trials, OCT also allows evaluation of morphologic changes that occur in DME, including compact retinal thickening, intraretinal cystic changes, subretinal fluid, and vitreomacular traction. OCT parameters have been shown to be only moderately correlated with visual acuity. However, improvements in technology leading to higher resolution, faster acquisition speed, image registration, and three-dimensional imaging that are available with newer spectral domain OCT models may allow future identification of valid OCT-derived surrogate markers for visual function in patients with diabetes.

Optical Coherence Tomography (OCT) is a high-resolution, cross-sectional imaging technique that allows detailed assessment of retinal thickness and morphologic evaluation of the neurosensory retinal layers. OCT imaging has rapidly been integrated into diagnosis and management of diabetic macular edema (DME) in routine clinical practice and clinical trials. OCT findings correlate well with other evaluation techniques for DME. Although there is a moderate correlation between OCT measured retinal thickness and visual acuity, OCT cannot replace visual acuity because there is a high degree of variability. Recent improvements in OCT technology have led to widespread interest in the use of spectral domain OCT, which is faster and has higher resolution than time domain OCT. Future research in OCT imaging will likely result in improvements in image quality. The ability to combine OCT with other various diagnostic modalities will further improve the evaluation of DME in both clinical practice and trials.

Background Though Limbal Relaxing Incisions (LRI) were used widely to correct pre-existing corneal astigmatism during cataract surgery, they have been replaced recently with the more expensive methods like the use of toric Intra Ocular Lenses (IOL) and femtosecond during cataract surgery. We conducted our study to re-evaluate the role of (LRI) in correcting pre-existing moderate corneal astigmatism during cataract surgery in settings where other options are neither available nor affordable. Methods Retrospective analysis of all consecutive cases of LRI performed by a single surgeon at the time of cataract surgery to correct moderate corneal astigmatism (1.5-3D) in a community hospital over a period of 6 months. Corneal astigmatism, uncorrected distance visual acuity (UDVA) and best corrected distance visual acuity (CDVA) were recorded pre-operatively, 4 weeks and 3 months post-operatively. Data on age, intraocular lens (IOL) power, predictive refraction and post-operative spherical equivalent was also collected and analyzed. The number and position of LRI was determined based on the pre-existing corneal astigmatism using online calculator. Results 29 eyes of 25 patients with the mean age of 73.6 years (range: 46 to 90 years) and corneal astigmatism between 1.5 to 3D were included. Statistically significant reduction in the mean corneal astigmatism was recorded from 2.05 ± 0.45D preoperatively to 0.85 ± 0.56D postoperatively (P < 0.0001). All eyes showed reduction in astigmatism; 83% of eyes had < 1.0D post-operatively and 66% of eyes had < 0.75D. UDVA of 6/9 or better was recorded in 80% of eyes post-operatively (CDVA of 6/9 or better in 100%). The spherical equivalent was within 1.0D of the predictive refraction postoperatively in nearly all eyes (97%) and within 0.5D in 86% of the eyes. There were no peri-operative or post-operative complications were recorded in any case. Conclusion Combining LRI and cataract surgery to address moderate degrees of corneal astigmatism is a safe, reliable and predictable option especially in areas where more expensive methods such as toric IOL or excimer laser are not available or affordable. LRI has no significant effect on the spherical equivalent and is an excellent tool in reducing patient’s spectacle dependence.

Purpose To analyze the real-life clinical outcome of a single dexamethasone implant (DEX) injection in the treatment of persistent diabetic macular edema (DME) after anti-vascular endothelial growth factor (anti-VEGF) agents in a sample of the Jordanian population. Methods An observational case study design that involved a retrospective chart review analysis in a tertiary hospital in Amman, Jordan. Patients who showed persistent DME after receiving at least six doses of anti-VEGF agents for DME treatment were included. Results The study population consisted of 72 participants (29 females, 43 males) having an average age of 66 years. All patients had best-corrected visual acuity (BCVA) less than 0.7 (6/9) and SD-OCT documented center-involved DME. The study results showed that the average baseline BCVA improved from 0.205±0.1 before DEX injection to 0.358±0.1 at 3 months post-injection (p<0.0001). The central mean thickness (CMT) showed significant improvement also (539.347±132.402 to 379.041±99.430, p<0.0001). There was a mean of 3 mmHg increase in intraocular pressure at 3 months post-injection (p<0.0001), however, only 4% of patients required medical treatment. Other inflammatory biomarkers in OCT, such as intraretinal hyper-reflective dots (HRD), showed significant improvement also (23.67±16 to 14.83±13, p<0.0001). No other significant safety concerns were noticed. Conclusion A single DEX injection showed significant clinical and anatomical improvement in DME cases that are persistent after anti-VEGF treatment in our sample, with an excellent safety profile. In case of supply shortage of intravitreal injections, which occurs frequently at our center, a single DEX injection may be utilized as an effective DME therapy. Further research is mandated to identify clinical response in a larger sample and more frequent injections.