Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

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Introduction:To the authors’ knowledge, this is the first report of Descemet tear postcataract surgery that was successfully treated with ripasudil hydrochloride hydrate.Patient and Clinical Findings:An 85-year-old pseudophakic man presented with blurry vision and mild photophobia in the left eye. Slitlamp biomicroscopy showed moderate corneal edema and a central Descemet tear from cataract surgery 7 years earlier.Diagnosis, Intervention, and Outcomes:The patient was treated for 1 month with prednisolone acetate 1% and sodium chloride 5% hyperosmotic ophthalmic solution with no clinical improvement. He declined surgical intervention and opted for medical management with ripasudil 0.4% ophthalmic solution, a rho kinase inhibitor. He applied it topically 4 times daily for 3 months, with improvement of corneal edema and corrected distance visual acuity. After discontinuation of ripasudil, his edema and vision worsened and then improved again after retreatment, showing a strong clinical response. 2 years after starting ripasudil therapy, the patient had continued to use ripasudil 3 times daily and reported worsened vision at lower doses.Conclusions:The use of topical ripasudil may be a viable medical intervention for corneal edema due to Descemet tear instead of surgery, although chronic use may be required.