Intravitreal ranibizumab is highly effective in improving or stabilizing vision and lesion morphology in patients with macular choroidal neovascularization secondary to angioid streaks.
The aim of the study was to determine whether certain factors are related to an increased risk of developing open-angle glaucoma. A total of 345 untreated glaucoma suspects with intraocular pressure (IOP) > or = 21 mmHg, cup to disc ratio 0.4 or less and no visual field defects, were followed up for 6 to 8 years (mean 7.3). During the follow-up 71 patients developed established glaucoma and were compared to the remaining 274 patients. The following factors were analysed: age, family history of glaucoma, IOP, Humphrey 30-2 visual fields, optic disc appearance, myopia, exfoliation, arterial hypertension and diabetes. Analysis yielded statistically significant results regarding a number of these factors in the patients who subsequently developed open-angle glaucoma. A significant association with the subsequent development of field loss in ocular hypertension (OHT) included: heredity (p < 0.001), age > or = 60 years (p = 0.013), axial myopia (0.001 < p < 0.01) and arterial hypertension (p = 0.05). About 20% of patients with ocular hypertension developed glaucoma over a period of seven years. Risk factors such as heredity, age, myopia and arterial hypertension, among others, must be considered in the follow-up of glaucoma suspects.
Background
Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice.
Methods
COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement.
Results
Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001).
Conclusion
Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
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