BackgroundAnastomotic leakage (AL) remains the most important complication following colorectal surgery, and is associated with high morbidity and mortality rates. Previous research has focused on identifying risk factors and potential biomarkers for AL, but the sensitivity of these tests remains poor.ObjectiveThis prospective multicenter observational study aims at combining multiple parameters to establish a diagnostic algorithm for colorectal AL.MethodsThis study aims to include 588 patients undergoing surgery for colorectal carcinoma. Patients will be eligible for inclusion when surgery includes the construction of a colorectal anastomosis. Patient characteristics will be collected upon consented inclusion, and buccal swabs, breath, stool, and blood samples will be obtained prior to surgery. These samples will allow for the collection of information regarding patients’ inflammatory status, genetic predisposition, and intestinal microbiota. Additionally, breath and blood samples will be taken postoperatively and patients will be strictly observed during their in-hospital stay, and the period shortly thereafter.ResultsThis study has been open for inclusion since August 2015.ConclusionsAn estimated 8-10% of patients will develop AL following surgery, and they will be compared to non-leakage patients. The objectives of this study are twofold. The primary aim is to establish and validate a diagnostic algorithm for the pre-operative prediction of the risk of AL development using a combination of inflammatory, immune-related, and genetic parameters. Previously established risk factors and novel parameters will be incorporated into this algorithm, which will aid in the recognition of patients who are at risk for AL. Based on these results, recommendations can be made regarding the construction of an anastomosis or deviating stoma, and possible preventive strategies. Furthermore, we aim to develop a new algorithm for the post-operative diagnosis of AL at an earlier stage, which will positively reflect on short-term survival rates.Trial RegistrationClinicaltrials.gov: NCT02347735; https://clinicaltrials.gov/ct2/show/NCT02347735 (archived by WebCite at http://www.webcitation.org/6hm6rxCsA)
A 62-year-old woman presented to our clinic in April 2021 with a painful right eye and increased light sensitivity for 1 week, 30 years after laser in situ keratomileusis (LASIK) in both eyes for myopia of −2.5 diopters. There were no complaints of the left eye. There were no abnormalities in her medical history. The uncorrected distance visual acuity (UDVA) of the right eye at presentation was 20/20.Slitlamp biomicroscopy revealed epithelial ingrowth on the right eye with stromal edema and inflammation and fine keratic precipitates on the endothelium (Figures 1 and 2Figure 1.Slitlamp biomicroscopy of epithelial ingrowth inferiorly in the right eye.Figure 2.Slitlamp biomicroscopy of epithelial ingrowth with stromal cellular inflammation). The cornea of the left eye was unremarkable. The anterior chamber of the right eye showed 1 + cells (SUN grading). There were no abnormalities in the posterior segment. Figure 3Figure 3.OCT of the cornea of the right eye in the 101- to 281-degree meridian. shows the corneal epithelial ingrowth with a swept-source optical coherence tomography (OCT) and Figure 4Figure 4.Axial corneal Scheimpflug tomography map of the right eye. an axial corneal Scheimpflug tomography map.What is your treatment advice for this patient from a short- and long-term perspective?
A 25-year-old woman was seen at our clinic with contact lens (CL) intolerance and a request for spectacle independence. Her medical history included asthma and allergic rhinitis. Because of the allergies, the patient used to extensively rub her eyes. Her hobby is boxing. The corrected distance visual acuity at presentation was 20/20 with −4.75 −2.50 × 52 and 20/20 with −5.75 −2.00 × 121 in the right and left eyes, respectively. The subjective refraction 6 months later was −5.00 −1.50 × 60 and −4.75 −1.50 × 121 in the right and left eyes, respectively. Her tear breakup time was 3 and 5 seconds and the Schirmer tear test values were 11.0 and 12.0 mm in the right and left eyes, respectively. The anterior chamber depth (ACD) (measured from the endothelium) was 2.87 mm and 2.89 mm in the right and left eyes, respectively. The corneal thickness was 566 μm and 551 μm of the right and left eyes, respectively. Corneal endothelial cell density was on average 2100 cells/mm2 for both eyes. Slitlamp biomicroscopy showed some slight punctate keratopathy inferiorly of both corneas. Figures 1 to 4 JOURNAL/jcrs/04.03/02158034-202009000-00020/figure1/v/2023-08-19T002553Z/r/image-tiff JOURNAL/jcrs/04.03/02158034-202009000-00020/figure2/v/2023-08-19T002553Z/r/image-tiff JOURNAL/jcrs/04.03/02158034-202009000-00020/figure3/v/2023-08-19T002553Z/r/image-tiff JOURNAL/jcrs/04.03/02158034-202009000-00020/figure4/v/2023-08-19T002553Z/r/image-tiff show the corneal topography and Belin-Ambrósio maps at presentation and 6 months later of the right and left eyes, respectively.
A 31-year-old woman was seen at our clinic with dissatisfying hyperopic error after a myopic laser treatment of her left eye in April 2018. The surgery took place 1 year previously. There were no abnormalities in her medical history. The preoperative corrected distance visual acuity (CDVA) in the left eye was 20/16 with −7.50 −0.50 × 75. The refraction in the right eye was −3.50 −1.25 × 90. The cycloplegic correction of the left eye preoperatively was −6.50 −0.50 × 68. A femtosecond-assisted laser in situ keratomileusis procedure was performed with an optical zone of 6.3 mm, an ablation zone of 7.97 mm, and a maximum ablation depth of 121 μm. The laser was set at a correction of −7.50 −0.5 × 75. The temperature and humidity during the laser treatment were 20 degrees and 47%, respectively. Figure 1 shows the excimer laser treatment data (AMARIS 750, SCHWIND eye-tech-solutions). At 1 week postoperatively the uncorrected distance visual acuity (UDVA) was 20/25, and at 1 month postoperatively the CDVA was 20/16 with +2.50. Slitlamp examination showed a clear cornea. No corneal topography was made at that timepoint. At referral 7 months later, the patient's UDVA was 20/100 and CDVA was 20/16 with +2.50 −1.25 × 140 in the left eye. The patient reports decreased vision since the treatment in 2018 and wants to see better without spectacles. Figure 2 shows the postoperative Scheimpflug topography of the left eye, flat keratometry (K1) 36.1 @ 178.4 and steep keratometry (K2) 36.6 @ 88.4. What do you believe could be the cause of this overcorrection? What is your advice in terms of correction of the refractive error for this patient?
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