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PURPOSE.To quantify the changes in retinal straylight that occur after laser-assisted subepithelial keratectomy (LASEK). METHODS. This prospective study included 86 eyes of 49 patients who were scheduled for LASEK surgery. Patients were divided into groups based on their preoperative contact lens wear habits: rigid lenses (RCL), soft lenses (SCL), spectacles after a period of contact lenses (SaC), and spectacles only (Specs). Retinal straylight was tested before surgery and 6 months after surgery with the compensation comparison method. Straylight was also compared to a normal reference database. The difference with the average straylight increase with age, called base-and age-corrected (BAC) straylight, was also studied. RESULTS. Before surgery, BAC straylight was found to be strongly elevated, with a value of 0.15 Ϯ 0.14 log units. After LASEK, this decreased to 0.00 Ϯ 0.14 log units. The reduction was significant (paired t-test, P Ͻ Ͻ 0.01) and correlated with preoperative BAC straylight levels (r 2 ϭ 0.332; P Ͻ Ͻ 0.01). There was no correlation between the straylight change and the spherical equivalent of the laser refractive correction (r 2 ϭ 0.042; P ϭ 0.059). Preoperative wear of soft contact lenses increased the BAC straylight by approximately 0.06 log units, with respect to the spectacles groups (P Ͻ 0.05, unpaired t-test), but after surgery, this difference was no longer found (P Ͼ 0.05). CONCLUSIONS. Higher than normal preoperative BAC straylight was found to normalize after LASEK refractive surgery. Wearing soft contact lenses causes an additional increase in preoperative BAC straylight that is eliminated after LASEK. (Invest Ophthalmol Vis Sci.

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Background: Multivisceral transplantation entails the en-bloc transplantation of stomach, duodenum, pancreas, liver and bowel following resection of the native organs. Diffuse portomesenteric thrombosis, defined as the complete occlusion of the portal system, can lead to life-threatening gastrointestinal bleeding, malnutrition and can be associated with liver and intestinal failure. Multivisceral transplantation is the only procedure that offers a definitive solution by completely replacing the portal system. However, this procedure is technically challenging in this setting. The aim of this study is to describe our experience, highlight the challenges and propose technical solutions.Materials and Methods: We performed a retrospective analysis of our cohort undergoing multivisceral transplantation for diffuse portomesenteric thrombosis at our institution from 2000 to 2020. Donor and recipient demographics and surgical strategies were reviewed in detail and posttransplant complications and survival were analyzed.Results: Five patients underwent MVTx. Median age was 47 years (23–62). All had diffuse portomesenteric thrombosis with life-threatening variceal bleeding. Major blood loss during exenteration was avoided by combining two techniques: embolization of the native organs followed by a novel, staged extraction. This prevented major perioperative blood loss [median intra-operative transfusion of 3 packed red blood cell units (0–5)]. Median CIT was 330 min (316–416). There was no perioperative death. One patient died due to invasive aspergillosis. Four others are alive and well with a median follow-up of 4.1 years (0.3–5.9).Conclusions: Multivisceral transplantation should be considered in patients with diffuse portomesenteric thrombosis that cannot be treated by any other means. We propose a standardized surgical approach to limit the operative risk and improve the outcome.

Introduction: The current guidelines advocate the implementation of stroke networks to organize endovascular treatment (ET) for patients with acute ischemic stroke due to large vessel occlusion (LVO) after transfer from a Primary Stroke Centre (PSC) to a Comprehensive Stroke Centre (CSC). In France and in many other countries around the world, these transfers are carried out by a physician-led mobile medical team. However, with the recent broadening of ET indications, their availability is becoming more and more critical. Here, we retrospectively analysed data of patients transferred from a PSC to a CSC for potential ET to identify predictive factors of major complications (MC) at departure and during transport that absolutely require the presence of a physician during interhospital transfer. Methods: This observational, single-centre study included patients with evidence of intracranial LVO transferred for ET from Perpignan to a 156 km-distant CSC between January 1, 2015 and ­December 31, 2018. We compared 2 groups: MC group (patients who required emergency intervention by the medical team due to life-threatening complications, including need of mechanical ventilation at departure) and non-MC group (all other patients who experienced no or only minor complications that could be managed by the emergency paramedics alone). Results: Among the 253 patients who were transferred to the CSC, 185 (73.1%) had no complication, 57 (22.6%) minor complications, and 11 (4.3%) had MC. In multivariate analysis, MC was associated with basilar artery (BA) occlusion (p < 0.0001), initial National Institute of Health Stroke Scale (NIHSS) score >22 (p < 0.005), and history of atrial fibrillation (p < 0.04). Among the 168 patients treated with intravenous thrombolysis (IVT), only 1 patient (0.6%) had MC due to an IVT-related adverse event during transfer. Conclusions: Physician-led inter-hospital transports are warranted for patients with BA occlusion, initial NIHSS score >22, or history of atrial fibrillation. For the other patients, transfer without a physician may be considered, even if treated with IVT.