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Fahmeeda Murtaza,1 Dana Toameh,2 Saed Al-Habib,3 Raj Maini,2 Hannah H Chiu,2,4,5 Eric S Tam,2,4,5 Sohel Somani2,4,5 1Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; 2Uptown Eye Specialists, Brampton, Ontario, Canada; 3U Sculpt Plastic Surgery, Vaughan, Ontario, Canada; 4Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Ontario, Canada; 5William Osler Health System, Brampton, Ontario, CanadaCorrespondence: Sohel SomaniUptown Eye Specialists, 401-7900 Hurontario Street, Brampton, Ontario, L6Y 0P6, CanadaTel +1 416 292-0330Fax +1 416 292-0331Email s.somani@utoronto.caBackground: BroadBand light intense pulsed light (BBL-IPL) therapy has shown to reduce hordeolum and blepharitis frequency. This study aims to evaluate the efficacy and safety of BBL-IPL therapy in patients with dry eye disease (DED) from meibomian gland dysfunction (MGD).Methods: This is a retrospective, consecutive case series of 48 patients with DED from MGD who underwent BBL-IPL therapy from October 2016 to January 2019 at a single, outpatient clinic in Ontario, Canada. Clinical outcomes included first and average non-invasive keratograph tear break-up times (NIKBUT), bulbar redness (BR) scores, tear meniscus heights (TMH), visual acuity (VA) and meibograph grades. Patient-reported outcomes included the Canadian dry eye assessment (CDEA) questionnaire and patient subjective assessment (PSA) scores. Outcomes were measured at baseline and after completion of 4 monthly BBL-IPL sessions.Results: The mean severity of dry eye symptoms as measured by the CDEA and PSA decreased significantly from 19.78 ± 9.62 to 12.08 ± 7.40 (p< 0.001) and from 7.65 ± 1.74 to 4.77 ± 2.03 (p< 0.001), respectively. Twenty-five percent of patients reported no dry eye symptoms after treatment. The meibograph grade improved significantly in both eyes (p< 0.001). Approximately 71.0% and 80.1% of patients had an improved meibograph grade in the right and left eye, respectively. Near-significant improvements were observed for BR scores and VA. There was also a trend towards improved first/average NIKBUT and TMH scores. No adverse events were noted.Conclusion: BBL-IPL appears to be an effective and safe treatment modality in improving dry eye symptoms and meibomian gland function in patients with DED from MGD.Keywords: BroadBand light, intense pulsed light, meibomian gland dysfunction, dry eye disease

Carter W Lim,1– 3 Sohel Somani,3– 5 Hannah H Chiu,3– 5 Raj Maini,3– 5 Eric S Tam3– 5 1Faculty of Medicine, University of Ottawa, Ottawa K1H 8M5, Canada; 2Eye Foundation of Canada, Toronto M3N 2V6, Canada; 3William Osler Health System, Brampton L6R 3J7, Canada; 4Uptown Eye Specialists, Brampton L6Y 0P6, Canada; 5Faculty of Medicine, University of Toronto, Toronto M5S 1A8, CanadaCorrespondence: Eric S TamUptown Eye Specialists, 401-7900 Hurontario Street, Brampton L6Y 0P6, ON, CanadaTel +1416-292-0330Email ericstam@gmail.comPurpose: To determine astigmatic changes of intrastromal limbal-relaxing incisions (LRIs) performed during femtosecond laser-assisted cataract surgery (FLACS).Design: Retrospective case series.PatientsandMethods: Patients undergoing FLACS with adjunctive astigmatism management with intrastromal LRIs were included. All eyes had preoperative corneal cylinder (Kcyl) ≥ 0.20D on ocular biometry. An intrastromal LRI nomogram of single, non-paired LRIs placed at the 9 mm optical zone was used. Keratometry was measured preoperatively,and postoperatively at 1week, 1month, and 3months (POM3). Alpins astigmatism analysis was used to calculate target-inducedastigmatism (TIA, equivalent to preoperative Kcyl), surgicallyinducedastigmatism (SIA), difference vectors (DV), and correction indices (CI). Secondary analysis included multivariable binary logistic regression to determine clinical factors associated with corrections> 125% (CI> 1.25).Results: A totalof 154 eyes (125 patients) were studied. Mean preoperative Kcyl was 0.87± 0.42D(SD), which did not significantly differ from POM3 Kcyl (0.87± 0.51D, p=0.470). Only the against-the-rule(ATR) subgroup demonstrated a small but significant reduction in Kcyl from preoperative (0.96± 0.51D) to POM3 (0.89± 0.55D, p=0.032). Sixteen eyes (10.4%) had Kcyl≤ 0.5D preoperatively, compared to 46 eyes (29.9%) at POM3 (p< 0.0001). Mean SIA was 0.80± 0.52D. Mean DV was 0.85± 0.47. Mean CI was 0.79. Fifty-one eyes (33%) had astigmatism correction> 125%. On multivariable regression analysis, ATR astigmatism class (p=0.026) and lower arc lengths (30º) (p=0.005) were associated with correction> 125%. Lower preoperative corneal astigmatism was inversely correlated with CI (p< 0.001).Conclusion: Although intrastromal LRIs can be conveniently performed during FLACS and appear safe, only patients with ATR astigmatism demonstrated a significant reduction in corneal astigmatism 3-months postoperatively under the current nomogram. Areas for future refinements to the nomogram were identified.Keywords: astigmatism, astigmatic keratotomy, refractive laser-assisted cataract surgery

Tzu-Lin Yeh,1,2 Hsin-Hao Chen,1 Hsiao-Hui Chiu,3 Yu-Hua Chiu,4 Lee-Ching Hwang,5,6 Shang-Liang Wu7 1Department of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu City, Taiwan; 2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; 3Department of Nursing, Taipei Veterans General Hospital, Taipei City, Taiwan; 4Occupational Safety and Health Office, Taipei Veterans General Hospital, Taipei City, Taiwan; 5Department of Family Medicine, MacKay Memorial Hospital, Taipei, Taiwan; 6Department of Medicine, MacKay Medical College, New Taipei City, Taiwan; 7School of Medicine, Griffith University, Gold Coast Campus, QLD, Australia Purpose: To investigate morbidity associated with overweight and obesity in health personnel and compare the differences among work roles.Materials and methods: This retrospective cohort study examined measurements obtained during employee medical checkups between 2007 and 2016 in a Taiwan medical center. BMI was used to define overweight (≥24 and

The prophylactic efficacy of pre-operative antacid administration was shown by comparing the pH and volumes of gastric contents in 50 female patients treated with 10 ml of Mist. Magnesium Trisilicate B.P.C. with that of 50 controls. Routine antacid prophylaxis was advocated for all patients undergoing pelvic laparoscopy as intra-operative conditions increase the risk of pulmonary acid aspiration.

A randomized double-blind trial compared 1·0% etidocaine and 1·5% lignocaine (both with 1/200,000 adrenaline), for caudal anaesthesia for pelvic floor repair. Etidocaine was highly effective for the surgical procedure, with rapid onset of action, adequate muscle relaxation and longer duration of action. Its use for post-operative analgesia may be hindered by the concomitant immobilization of the legs. The problem of tachyphylaxis with etidocaine needs further investigation.

Two cases are presented in which injury to the stomach occurred in association with laparoscopy under general anaesthesia. The common aetiological factor was gastric inflation resulting from I.P.P.V. via mask. Precautionary measures in the anaesthetic induction technique are described.

Fifty fit, female patients were given four consecutive intravenous doses of etomidate 10 mg, so as to maintain sleep, after establishment of epidural block for postpartum sterilization. A matched group was given four doses of thiopentone 125 mg. Cumulative hypnotic effect, as judged by increasing sleep duration with second and subsequent doses, was much less with etomidate than with thiopentone. Etomidate did not depress blood pressure, whereas it fell progressively with successive doses of thiopentone. Injection pain was reported in 68% of patients receiving etomidate, and this tended to increase with successive doses; 12 % also showed local inflammation at the injection site. Tremor, due to etomidate, was common, but did not increase with successive doses. Feelings of sleepiness, lasting several hours after waking, were more common after thiopentone than after etomidate.

A comparative study between Etomidate and Thiopentone was carried out on 100 healthy female patients scheduled for post-partum abdominal sterilization under epidural analgesia. Our results show Etomidate to be a safe and effective induction agent, comparable to Thiopentone in having a rapid onset of action and rapid recovery time. The pulse rates and blood pressures remained relatively stable during the use of Etomidate. However, there was a high incidence of transient respiratory upsets while causing less respiratory depression than Thiopentone. The objectionable features of Etomidate are high incidence of pain on injection and involuntary muscular activity, which account for the low anaesthetist acceptance rate.