Capsule Rupture Research Articles

SAT322 Case report: Impact Of Combined Treatment To Prolong Overall Survival In Advanced Adrenocortical Pediatric Cancer Associated With Li-Fraumeni Syndrome

Abstract Disclosure: I.P. de Magalhães: None. N.C. de Sousa: None. H.L. Charchar: None. A.W. Kuhn: None. M.Y. Nishi: None. F.L. Ledesma: None. R.I. Lopes: None. F.T. Dénes: None. P. Herman: None. M.R. Menezes: None. A. Latronico: None. B.B. Mendonca: None. M.Q. Almeida: None. M.B. Fragoso: None. Background: Adrenocortical cancer (ACC) in pediatric patients (<15 years of age) are even rarer compared to the general population it is a classic presentation of Li-Fraumeni syndrome (LFS). ACC incidence in this subgroup is limited to 0.3 cases per million per year with a high incidence in Sothwest of Brazil. Furthermore, the overall five-year survival of pediatric ACC cases is better than in adult with a rate of approximately 50%, considering a complete resection required for cure. However, prognosis of childhood ACC is highly variable and difficult to predict in clinical practice. Clinical Case: We present the case of a 3-year-old girl who was diagnosed with metastatic adrenocortical carcinoma with classical signs of virilization and Cushing's syndrome. The patient underwent transperitoneal right adrenalectomy in May 2011. During surgery, there was rupture of the tumor capsule and the inferior vena cava. She was referred to our service after 8 months due to the presence of locoregional recurrence and maintained hormonal secretion. Histological data confirmed ACC and the tumor was classified as Weiss score 5, Wieneke: 4, Ki67 40%. Genetic analysis identified germline confirmed p-R337H on TP53, XAF1-E134. Imaging exams documented suspected liver metastasis and peritoneal implants. She underwent palliative treatment with mitotane (M) and systemic chemotherapy EDP+M with partial response. A new surgical approach to the residual lesions was proposed. The patient underwent right partial hepatectomy and peritoneal implant removed in September 2012. After metastasectomy, the patient presented persistence of the disease. The patient was exposed to a new cycle of EDP+M, but the disease progressed. She underwent radiofrequency ablation of abdominal lesions in July 2013 without success. A new surgical approach was indicated in July 2013. The histological analysis confirmed metastases of ACC. She underwent a new chemotherapy regimen with gemcitabine, docetaxel and fluorouracil + M. She presented a complete response confirmed by radiological exams and hormonal data. Mitotane was discontinued in 2016 due to bladder bleeding. She presented an excellent response with combined treatment, without recurrence up to now with 10 years of recurrence free survival and 12 years of overall survival. She developed normal puberty and reached the target height and maintains primary adrenal insufficiency with glico and mineralocorticoid replacement. Although the tumor spillage, histological and molecular data predicted a dismal outcome this patient surprisingly is presenting an excellent evolution under continuous surveillance. Clinical Lesson: This report described a challenging pediatric advanced ACC which the combined treatment strategy provided successful outcome Presentation: Saturday, June 17, 2023

Safety and efficiency of lens cortex removal assisted by fluid jet

BackgroundThis retrospective study investigated the safety and efficiency of lens cortex removal assisted by a fluid-based capsular polishing technique called a fluid jet. MethodsThis was a retrospective case study. A total of 300 patients were included in this study. All patients underwent phacoemulsification using two different surgical sequences: a fluid jet before irrigation/aspiration (I/A) and an I/A before the fluid jet. They were divided into two groups: the fluid jet before I/A group (group 1, 150 eyes) and the I/A before the fluid jet group (group 2, 150 eyes). The frequencies of posterior capsule rupture (PCR) and posterior capsule being sucked into the I/A tip were recorded. The times of the fluid jet, I/A cortex, and entire procedure were noted. ResultsPCR occurred only in group 2. Compared with group 1, the posterior capsule being sucked into the I/A tip was more frequent in group 2 (P = 0.003). The fluid jet time was longer in group 1 than that in group 2 (P < 0.001). The I/A cortex time was shorter in group 1, and total time for fluid jet and I/A cortex together was shorter in group 2 (P = 0.014 and P = 0.007, respectively). However, the time of the entire procedure was shorter in group 1 (P < 0.001). ConclusionsFluid jet-assisted lens cortex removal is safe, time-saving, and simple to perform.

Анализ интраоперационных и ранних послеоперационных осложнений при факоэмульсификации катаракты

Relevance. Despite the high level of cataract surgery, in some cases complications arise that lead to a decrease in visual functions, an increase in the duration of inpatient treatment and additional economic costs. Analysis of the results of cataract phacoemulsification helps to increase the effectiveness of predicting complications and their prevention. Aim. Analysis of intraoperative and early postoperative complications in cataract surgery for 2021–2022, conducted on the basis of the 2nd ophthalmological department of the State Budgetary Institution “N.A. Semashko Regional Clinical Hospital” Ryazan, Russia. Material and methods. Retrospective analysis of 66 case histories of patients who had complications in the intra- and postoperative period of cataract surgery. Results. Intraoperative complications included: posterior capsule opening (22 cases), dislocation of lens masses into the vitreal cavity (10 cases), hemorrhagic ciliochoroidal detachment (4 cases), expulsive hemorrhage (2 cases), hyphema (2 cases). In the postoperative period, the following complications were detected: hyphema – 2, hemophthalmos-4, ciliochoroidal detachment – 5, dislocation of intraocular lens (IOL) – 5, retained lenticular material in the anterior chamber – 4, exudative reaction – 12, keratopathy – 6, pupillary block – 1, endophthalmitis – 1. Conclusion. The improvement of the phacoemulsification technique together with the preoperative preparation of patients with cataracts made it possible to achieve a low level of intra- and postoperative complications (1.16% in 2021 and 0.89% in 2022, respectively, of all operated patients with cataracts). However, after analyzing the nature of complications, we identified a number of patterns: among intraoperative complications, the most common is the opening of the posterior capsule of the lens (0,29%), among postoperative – an exudative reaction (0,16%). Keywords: сataract phacoemulsification, complications of cataract phacoemulsification, rupture of the posterior lens capsule, exudative inflammatory eye response, expulsive hemorrhage.

Low hemoglobin levels are associated with Bowman’s capsule rupture and peritubular capillaritis in ANCA-associated renal vasculitis: a link of vascular injury to anemia?

BackgroundAnemia in anti-neutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis is a severe complication that predicts renal survival. We here conducted correlative analyses to evaluate correlations of low hemoglobin levels and histopathological characteristics in ANCA-associated renal vasculitis.MethodsFifty-two patients with biopsy-proven ANCA-associated renal vasculitis observed between 2015 and 2020 were retrospectively evaluated. Spearman’s correlation was performed to assess correlations, and statistical evaluation was performed by simple and stepwise multivariable regression.ResultsRegarding laboratory anemia parameters, no significant association with serum hemoglobin levels was observed. Serum hemoglobin levels were associated with the estimated glomerular filtration rate in the total cohort (β = 0.539, p < 0.001), and in the MPO-ANCA subgroup (β = 0.679, p = 0.008). Among tubulointerstitial lesions, decreased serum hemoglobin levels correlated with peritubular capillaritis in the whole cohort (β = − 0.358, p = 0.013), and was suggested in the MPO-ANCA subgroup (p = 0.029, r = − 0.446). Regarding glomerular lesions, the prevalence of necrotic glomeruli significantly associated with low serum hemoglobin levels in PR3-ANCA (β = − 0.424, p = 0.028). In the total cohort, a significant correlation between decreased serum hemoglobin levels and the occurrence of diffuse Bowman’s capsule rupture was identified (β = − 0.374, p = 0.014), which was implied in the MPO-ANCA subgroup (p = 0.013, r = − 0.546; p = 0.0288, slope = − 16.65).ConclusionPeritubular capillaritis and Bowman’s capsule rupture correlate with low hemoglobin levels; this may indicate that histopathological lesions are linked with inflammatory vascular injury and relative erythropoietin deficiency in ANCA-associated renal vasculitis.Graphical abstract

Comparison of INTREPID® balanced and hybrid tips on anterior capsule rupture in ex vivo porcine eyes.

Phacoemulsification has emerged as the global standard for cataract surgery, and various novel methods, tools, and agents have promoted surgical efficiency and reduced complications. Conventionally, the phaco tip, which cleaves and aspirates the cataractous lens, has been mainly constructed of metal. In this study, the risk of anterior capsule rupture was evaluated under conditions of different power modes, longitudinal (Mode-L), torsional (Mode-T), or both (Mode-LT), and different aspiration powers (0 or 200 mmHg), using a traditional metal phaco tip (Group-M) or a new phaco tip with a high-strength polymer overmold on the needle edge (Group-P), which was developed to reduce the risk of capsule rupture. One hundred twenty porcine eyes were used for experiments within a setting of typical human physiological intraocular pressure. We found that Group-M showed capsule rupture with a smaller ultrasound power than did Group-P, regardless of power mode or aspiration power. In Group-M, there was no significant difference in risk of capsule rupture among power modes, however in Group-P, capsule rupture was least likely to occur with Mode-T. These results provide useful information for inexperienced ophthalmologists to improve surgical safety.

Crescentic glomerulonephritis in children: short-term follow-up predicts long-term outcome.

Crescentic glomerulonephritis (CrGN) is a relatively rare but severe condition in childhood with the clinical feature of rapidly progressive glomerulonephritis (RPGN). The aim of this study is to investigate the clinicopathological features and prognosis of CrGN in children. We retrospectively analyzed the clinical and laboratory data, renal pathological results, treatment, and outcome of 147 CrGN in two Chinese pediatric nephrology centers. Among the 147 children, there were 22 cases of type I (15.0%), 69 cases of type II (46.9%), and 56 cases of type III (38.1%). The mean percentages of crescents in CrGN I, II, and III were 85.3%, 68.7%, and 73.6%, respectively. The children with type I CrGN presented with more severe clinical manifestations and pathological lesions. The 3-month cumulative renal survival rates of types I, II, and III CrGN were 66.3%, 93.6%, and 75.6%, respectively. The 1-year cumulative renal survival rates of types I, II, and III CrGN were 56.9%, 85.3%, and 73.1%, respectively, and the 5-year cumulative renal survival rates of types I, II, and III CrGN were 33.8%, 73.5%, and 47.1%, respectively. The Kappa Consistency Test between the 3-month and 1-year total renal survival (82.1% vs. 74.7%) of the children was 0.683 (P < 0.001), and between the 1-year and 5-year total renal-free survival (78.3% vs. 69.1%) of the children was 0.476 (P < 0.001). The Bowman's Capsule Rupture (BCR), crescent, interstitial inflammation, and interstitial fibrosis/tubular atrophy (IF/TA) score were predictors of end-stage kidney disease (ESKD) risk but BCR showed better predictive value for ESKD than interstitial inflammation score (P = 0.027) and IF/TA score (P = 0.047). Patients with type I tended to have the worst renal survival rates. The three-month renal prognosis could partially reflect the 1-year renal prognosis, and the 1-year mortality rate could partially reflect the 5-year mortality rate of children with CrGN.

Vascular occlusion in a patient with posteriorly dislocated double IOL

Age and uncontrolled hypertension are well established risk factors for retinal vascular occlusion. IOL (intraocular lens) implantation following intraoperative posterior capsule rupture has an increased risk of IOL dislocation in the posterior segment. We came across a case of infero-temporal branched retinal vein occlusion followed by a direct injury by a mobile IOL which was posteriorly dislocated. The patient also had one another posteriorly dislocated IOL which was stuck in the anterior vitreous. This case highlights the need for the urgent removal of a posteriorly dislocated mobile IOL, which should precede the placement of a secondary IOL to avoid ocular complications.

Open Globe Injury with Corneal Laceration Full-Thickness, Anterior Lens Capsule Rupture, and Traumatic Cataract

Introduction: Ocular trauma is a common, preventable cause of visual impairment. Mechanical eye injuries affect the eye in many ways ranging from mild to severe morbidity. In this case, we inform the sequence of what we found in this ocular trauma and how we treat this case. Case Presentation: A 26-year-old male patient presented with pain and stiffness in the right eye. The patient was involved in an accident 16 hours before being admitted to the emergency room. Previously, the patient had been taken to a secondary hospital. No medications were given. The patient was referred directly to a tertiary hospital for further management. The visual acuity of the right eye and left eye were 1/300 and 6/6. Soft palpation indicated decreased intraocular pressure (IOP) on the right eye. Slit lamp examination found conjunctival hyperemia, full-thickness corneal laceration, irregular iris, posterior synechiae, declining pupil reflex, and hazy lens. Fundus reflex declined. The right eyeball exploration showed a membrane at the camera oculi anterior and a suspected hazy lens with mass and capsule of the lens. Doubtful prognosis on the right eyeball. Conclusions: The outcome of ocular trauma might be debatable and vary in any condition. Proper management can avoid unprecedented complications and improve patient visual results. A good perspective will also make satisfied both the patient and the physician.

Two point four million cataract surgeries: 30-years with the Swedish National Cataract Register 1992-2021.

The present review summarizes data collected by the Swedish National Cataract Register (NCR), which by the end of 2021 contained data for more than 2.4 million cataract surgeries between 1992-2021. During these 30 years, the cataract surgery rate (CSR) rose from 3700 to 12800. The coverage of NCR is very high including 93% of all cataract procedures in Sweden between 2010-2021. Independently of demographic changes, the proportion of operations of patients age 60-79 has increased while the proportion of 80-90+ has decreased. The median visual acuity of the first eye planned for surgery was 0.1 decimal in 1992 and has increased to 0.5 decimal in 2021. Patient Reported Outcome Measures (PROM:s) have been registered with the Catquest-9SF questionnaire since 2008, demonstrating intervention at an earlier stage, but consistently favorable outcomes. Surgical complications have decreased; endophthalmitis has decreased from 0.10% to below 0.02%, and posterior capsule rupture from 2.8% to 0.6%.

Assessing the validity of flap motility sign in predicting the extent of anterior capsular tears in phacoemulsification.

Capsulorhexis is an integral step of cataract surgery, and continuous curvilinear capsulorhexis is crucial during phacoemulsification to prevent intraoperative complications. However, sometimes during phacoemulsification in complicated and hard cataract cases, rhexis extension may occur, resulting in posterior capsular rent, nucleus drop, cortex drop, and aphakia. It may not always be possible to continue with phacoemulsification in all cases. In this perspective, the authors describe a novel flap motility sign (FMS) to predict the extent of anterior capsular tear during phacoemulsification. A total of 21,678 patients underwent phacoemulsification for three years, from July 2016 to June 2019. One hundred and twenty-one patients had an anterior capsular tear. There were 102 cases (84.3%) with pre-equatorial tears and 19 cases (15.70%) with postequatorial tears. All pre-equatorial flaps were everted and fluttering, and all postequatorial flaps were inverted and nonfluttering. Posterior capsule rupture (PCR) was observed in all 19 cases of postequatorial flaps (100%). No PCR was observed in patients with fluttering and everted flaps (0%). In-the-bag and scleral-fixated intraocular lens implantations succeeded in pre-equatorial and postequatorial tears, respectively. There was no case of a nucleus drop. This study validates FMS as a predictor for identifying the extent of anterior capsular tears, thereby determining the endpoint of safe phacoemulsification and the site for intraocular lens implantation. Pre-equatorial tears allow for the continuation of safe phacoemulsification and in-the-bag intraocular implantation. Postequatorial tears necessitate timely conversion to small-incision cataract surgery or extracapsular cataract extraction.

Comparative Analysis of the Hot Isostatic Pressing Densification Behavior of Uniform and Non-Uniform Distributed Powder

Hot isostatic pressing (HIP) technology can directly produce nearly clean shaped workpieces that meet the requirements while ensuring machining accuracy and surface quality. Usually, people use numerical simulation methods to reduce experimental costs. Generally, a uniform powder relative density distribution of about 65% is used in the simulation. However, in practical engineering, we found that even with additional tools such as vibration tables, the powder filling is not uniform. The non-uniform distribution causes uneven shrinkage of the powder and capsule after HIP. In this paper, a numerical model for HIPing of Ti-6Al-4V powder is developed to improve the prediction by comparing the uniform and non-uniform initial powder distribution. The results show that different initial relative density distributions affect the powder densification process and further affect the deformation of the capsule. It also leads to non-uniform stress distribution after HIP, which increases the risk of capsule rupture. The analysis of the numerical simulation results and the comparison with the experimental results highlights that taking into account the non-uniform powder distribution inside the capsule is vital to improve numerical results and produce near-net shape components. The maximum error of the simulation with the usual initial relative density setting of 65% is 4.2%. However, considering the uneven distribution of initial powder, the maximum error is reduced to 3.16%, and the average error is also less than 2%.

Ultrasound-guided hydrodilatation for adhesive capsulitis: capsule-preserving versus capsule-rupturing technique

ObjectiveTo compare the clinical efficacy of capsule-rupturing versus capsule-preserving ultrasound-guided hydrodilatation in patients with shoulder adhesive capsulitis (AC). To determine potential factors affecting the outcome over a 6-month follow-up.Materials and methodsWithin a 2-year period, 149 consecutive patients with AC were prospectively enrolled and allocated into (i) group-CR, including 39 patients receiving hydrodilatation of the glenohumeral joint (GHJ) with capsular rupture and (ii) group-CP, including 110 patients treated with GHJ hydrodilatation with capsular preservation. Demographics, affected shoulder, and AC grade were recorded. Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and visual analog scale (VAS) were used for clinical assessment at baseline/1/3/6 months. Comparisons were performed with Mann-Whitney U test and Kolmogorov-Smirnov test. Linear regression was used to identify predictors of outcome. P value < 0.05 defined significance.ResultsDASH and VAS scores in both groups improved significantly compared to baseline (P < 0.001) and were significantly lower in the CP compared to CR group at all time-points following intervention (P < 0.001). Capsule rupture was a significant predictor of DASH score at all time-points (P < 0.001). DASH scores correlated to initial DASH score at all time-points (P < 0.001). DASH/VAS scores at 1 month were correlated to the AC grade (P = 0.025/0.02).ConclusionGHJ hydrodilatation results in pain elimination and functional improvement till the mid-term in patients with AC, with improved outcome when adopting the capsule-preserving compared to the capsule-rupturing technique. Higher initial DASH score is predictive of impaired functionality in the mid-term.

Ruptured Subcapsular Liver Hematoma: A Rare Complication of HELLP Syndrome

This case report highlights the rare and life-threatening complication of ruptured subscapular liver hematoma in the setting of hemolysis, elevated liver enzymes, and low platelets syndrome, a complication associated with pre-eclampsia. A 30-year-old pregnant woman at 38 weeks of gestation presented with high blood pressure, exaggerated neurological reflexes, and high levels of albumin in her urine. Her condition deteriorated over time, and liver function tests revealed elevated readings. An emergency cesarean section was performed, during which a large liver tear with active bleeding and rupture of the liver capsule in the right lobe were discovered. An exploratory laparotomy revealed a massive hemoperitoneum with active bleeding, and hepatic packing was performed using three gauzes. Despite this, the patient's liver parameters continued to worsen, and she was transferred to the intensive care unit for further resuscitation. After 72 hours, she underwent a second operation to remove the gauze packing, and hemostasis was successfully achieved without any active bleeding. Early detection of ruptured subcapsular liver hematoma and a coordinated approach involving medical, obstetrical, radiology, and surgical teams can lead to successful treatment of this rare and dangerous complication.

Rare Presentation of Bilateral Carotid Cavernous Fistula as Suprachoroidal Hemorrhage during Cataract Surgery.

To report a rare case of suprachoroidal haemorrhage (SCH) duringphacoemulsification in a patient with bilateral carotid-cavernous fistula (CCF). Case report. A 76-year-old female with underlying hypertension presented left eye poor vision due to an underlying dense cataract. Her initial preoperative assessment was uneventful, and she underwent phacoemulsification. During epinucleus removal, there was sudden, unexpected anterior chamber shallowing, resulting in posterior capsule rupture. While the surgeon extended the wound to facilitate epinucleus removal, there was a further decrease of red reflex, followed by hardening of the globe, indicating an SCH. The corneal wound was opposed swiftly without an intraocular lens. Further evaluation after that revealed patient had a chronic headache for several years, and ocular examination showed bilateral esophoria. A computed tomography (CT) demonstrated features suggestive of bilateral CCF, which was confirmed with CT angiography later. Patients with CCF have elevated episcleral venous pressure and vortex venous pressure. Sudden decompression of the globe in these patients predisposes them to higher SCH risk, although this condition is generally rare in phacoemulsification.

ОСОБЕННОСТИ КЛИНИЧЕСКИХ ПРОЯВЛЕНИЙ ЗРЕЛОЙ ТЕРАТОМЫ ЯИЧНИКА

The study of the described clinical case is of undoubted interest, taking into account the peculiarities of the clinical picture. In this clinical case, there was an asymptomatic course of the disease, which did not manifest itself as the occurrence of clinical symptoms during the patient's pregnancies, despite the change in the architectonics of the pelvis. In addition, there were no complications associated with the presence of a mature ovarian teratoma. The patient was not regularly monitored by an obstetrician – gynecologist, despite the presence of fibroids and adenomyosis. A detailed ultrasound examination of the pelvic organs carried out earlier would have made it possible to diagnose this pathology and carry out treatment. Despite the low frequency of malignancy of this histological type of true ovarian tumors, such a probability is not completely excluded with their long-term existence. In addition, in the presence of a mature teratoma, complications such as infection, torsion or rupture of the formation capsule are often found. Such complications may occur suddenly and lead to vital complications, require emergency surgical intervention. At the same time, there may be no possibility of intraoperative histological examination of the removed drug, which in case of ovarian tumors may lead to an inadequate amount of surgical intervention. In addition, without surgical treatment and subsequent histological examination of the removed ovarian formation, it is impossible to carry out differential diagnosis of mature and immature teratomas as well as other true ovarian tumors, including malignant ones. Therefore, after conducting a study of this clinical case, the following conclusions can be drawn. It is necessary to carry out preventive examinations of patients without gynecological pathology and careful dispensary observation of patients with gynecological diseases carefully, with ultrasound of the pelvic organs, which will allow timely diagnosis and treatment, to avoid possible complications.

"Capsule drape wrap"-a new technology for iridoschisis management during phacoemulsification.

To introduce a new technique for iridoschisis management during phacoemulsification: "capsule drape wrap". "Capsule drape wrap" technique was used for an 80-year-old man with idiopathic iridoschisis in the right eye during phacoemulsification. The inserted flexible nylon iris hooks to hold anterior capsule in place, the margin of the anterior capsule could act as drape wrap, tracking the fibrillary iris strands firmly from free floating and stabilizing the capsular bags simultaneously. The eye with iridoschisis was successfully treated. Iris fibrils remained immobile during the procedure, and despite the severity of iridoschisis, there were no intraoperative complications such as tear of the iris, hyphema, iris prolapse, loss of mydriasis, or rupture of the posterior lens capsule during phacoemulsification. The best-corrected visual acuity was increased by 0.1 (logMAR) 6mo after the surgery. "Capsule drape wrap" for iridoschisis is easily manageable, prevents further disruption to the loose iris fibers and ensures the stability of capsule-iris complex simultaneously, consequently minimizing the risk of surgical complications in phacoemulsification.

#5132 POST-COVID-19 ANTI-GLOMERULAR BASEMENT MEMBRANE DISEASE: TWO CLINICAL CASES

Abstract Background and Aims Acute kidney injury is a common complication in patients hospitalized with COVID-19, has multiple aetiologies, and is usually multifactorial. We present two cases of anti-glomerular basement membrane (anti-GBM) disease diagnosed after SARS-CoV-2 infection, suggesting a causal correlation. Case Reports A 76-year-old female, with chronic kidney disease (serum creatinine 1.5mg/dL), hypertension, weight loss (16 Kg/6 months) and a pancreatic nodule under surveillance, presented to the emergency department with 1 week of nausea, vomits, diarrhoea and oliguria, as well as a history of mild SARS-CoV-2 infection 2 weeks before presentation. Lab work revealed severe anaemia (7.4 g/dL), inflammatory markers elevation, nephrotic proteinuria (proteinuria/creatininuria ratio 30 g/g), leucoerythrocyturia, serum creatinine of 19.3 mg/dL, hyperkalaemia and metabolic acidosis requiring dialysis induction. Renal ultrasound showed signs of chronicity and several cysts. Aetiological study disclosed positive anti-GBM antibody (1800 U/L) and negative ANCA. Complementary study failed to identify pulmonary involvement or neoplasms. Given the severity of the renal dysfunction along with the absence of alveolar haemorrhage, immunosuppression and plasmapheresis were not initiated. Patient was discharged and remains dialysis dependent. A 65-year-old male smoker with type 2 diabetes and combined pulmonary fibrosis and emphysema, presented in the emergency department with 2 months of asthenia, weight loss and anaemia, in addition to dyspnoea and haemoptysis in the past 3 days. Lab work exposed moderate anaemia (9.7 g/dL), elevated inflammatory markers, serum creatinine of 1.18 mg/dL (previously 0.8 mg/dL), leucoerythrocyturia and positive SARS-CoV-2 test. Angio-Computed Tomography exhibited known pulmonary fibrosis and possible bacterial superinfection. Despite antibiotic therapy (10 days of levofloxacin), haemoptysis remained and kidney function continuously worsened (serum creatinine 2.1 mg/dL). Complementary study showed positive ANCA-MPO (1125.4 U/L) and anti-GBM antibody (460.8U/L). Renal ultrasound was innocent. Kidney biopsy revealed: 6 glomeruli with cellular crescents with segmental necrosis, 3 with focal Bowman's capsule rupture; erythrocyte casts; intimal arterial fibrosis; moderate tubular atrophy; diffuse linear deposits of IgG. Immunosuppression was initiated with prednisolone (1 mg/Kg/day), cyclophosphamide (3x 12.5mg/Kg-750 mg, 2x 500 mg), rituximab (2x 1g), immunoglobulin (1x 2 g/Kg) and plasmapheresis (15 sessions). Kidney function continued to deteriorate (maximum serum urea 306 mg/dL, maximum serum creatinine 6.92 mg/dL) requiring dialysis induction 3 weeks after the beginning of immunosuppression. Even though haemoptysis ceased, the patient remains dialysis dependent 8 months after. Conclusion Literature reports an increase of Anti-GBM disease since the beginning of the pandemic. The presented cases support the apparent correlation, suggesting SARS-CoV-2 as a precipitant of this disease by endothelial injury with basal membrane exposure and autoantibody development. In the second case, the authors assume a subacute ANCA-MPO vasculitis with superimposed anti-GBM (eventually precipitated by COVID-19). Even though the causal association is not established, we highlight the importance of clinical suspicion of this rare aetiology in cases of acute kidney injury after SARS-CoV-2 infection.

Scleral Suture Fixation of Dislocated Posterior Chamber Intraocular Lens: Modification for Tapered Haptics.

To present a surgical modification to a previously published technique that allows repositioning and scleral fixation of one-piece acrylic intraocular lenses with tapered haptics. A retrospective review of three consecutive cases. Our technique modification enables repositioning using scleral suture fixation of one-piece intraocular lenses with tapered haptics by looping the haptic at its proximal, notched junction to the optic with the polypropylene suture. The suture knot is internalized which effectively suspends the intraocular lens and allows for better adjustment of the intraocular lens centration. Two cases were endocapsular dislocations; the third case was dislocated extracapsularly due through a posterior capsule rupture. All showed adequate lens centration at 3 months of follow-up. One case had suffered a vitreous hemorrhage a month postoperatively that is clearing. Repositioning using scleral fixation of one-piece intraocular lenses with tapered haptics is possible with a minor technique modification. This offers an alternative to intraocular lens exchange.

Bowman’s capsule rupture and the Oxford MEST-C score in adult patients with Immunoglobulin a vasculitis nephritis: a single center experience

Objective Bowman’s capsule rupture (BCR) is a glomerular pathological change, but it is still not well recognized in immunoglobulin A vasculitis nephritis (IgAV-N). The Oxford MEST-C score is a classification for IgA nephropathy; however, its clinical correlation and prognostic value in adult patients with IgAV-N are unclear. Methods A retrospective study of 145 adult patients with IgAV-N diagnosed by renal biopsy was conducted. Clinical manifestations, pathological changes and the prognosis of IgAV-N patients were compared depending on the presence or absence of BCR, International Study of Kidney Disease in Children (ISKDC) classification and MEST-C score. The primary endpoint events were end-stage renal disease, renal replacement therapy and all-cause death. Results In total, 51 of 145 (35.17%) patients with IgAV-N presented with BCR. Patients with BCR had more proteinuria, lower serum albumin, and more crescents. Compared with IgAV-N patients with crescents only, 51/100 patients with crescents combined with BCR had a higher proportion of crescents in all glomeruli (15.79% vs. 9.09%; p = 0.003). Patients with higher ISKDC grades had more severe clinical presentation, but it did not reflect the prognosis. However, the MEST-C score not only reflected clinical manifestations but also predicted prognosis (p < 0.05). BCR contributed to the effectiveness of the MEST-C score in predicting the prognosis of IgAV-N (C-index: 0.845 to 0.855). Conclusions BCR is associated with clinical manifestations and pathological changes in patients with IgAV-N. The ISKDC classification and MEST-C score are related to the patient’s condition, but only the MEST-C score is correlated with the prognosis of patients with IgAV-N, while BCR can improve its predictive ability.

Имплантация интраокулярной линзы при травматической катаракте: сроки и перспективы

A prospective randomized clinical trial included 30 patients (60 eyes) with traumatic cataract after open eye injury. Patients were divided into 2 groups depending on the time of the operation. The first (n = 15, 30 eyes) was an early operation (1–3 days after the injury). The second (n = 15, 30 eyes) is a late operation (6 or more days after the injury). Research methods – measurement of visual acuity, intraocular pressure (IOP), assessment of inflammation of the anterior chamber, position of the intraocular lens (IOL), etc. The study period was 1, 3, and 6 weeks after surgical treatment. It was revealed that visual acuity with the best correction was noted 6 weeks after the early operation. Also in the group of early cataract surgery, the frequency of postoperative complications (rupture of the posterior capsule, increased IOP, inflammation of the anterior chamber, IOL opacity, posterior synechia, IOL subluxation and pigment deposition on the IOL) was significantly lower than in the late surgery group (p &lt; 0.05). It is recommended to perform cataract surgery and IOL implantation after open eye injuries at an early stage. Keywords: surgery, traumatic cataract, vision, intraocular lens implantation