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Background: Gonococcal ocular lesions develop most commonly due to poor hygiene habits, when the infection is transmitted by eye-hand contact; in addition, they may develop when the infection is transported to the eye as a result of hematogenous or lymphogenous spread. Purpose: To present a rare case of endophthalmitis secondary to gonococcal sepsis, and to highlight its clinical features. Material and Methods: Visual acuity assessment, comprehensive eye examination, and microbiological examination. Results: Patient’s history was significant for acute suppurative gonococcal prostatitis (with acute retention of urine, and severe sepsis with liver abscess, and suppurative tonsillitis), for which he had been treated as an in-patient at the Department of Urology of the city hospital. In addition, he had suppurative blepharitis of the left eye. A week after he was discharged from the Department of Urology, he was hospitalized to the Department of Ocular Trauma of the Filatov institute with the diagnosis of endophthalmitis in the left eye. The patient poorly responded to treatment, and clinical manifestations of endophthalmitis were becoming more and more severe. He underwent evisceration of the left eye. Conclusion: Consultations of allied health professionals and multiprofessional management of gonorrhea patients are required to prevent complications in various organs and systems, should gonococcal sepsis develop.

In the poultry slaughtering, accurate viscera positioning is essential to reduce the damage of internal organs. The introduction of machine vision technique can help to locate the viscera and can provide new direction for the poultry evisceration. After a midline abdominal incision of the poultry, the internal organs are taken out from the poultry that placed on the conveyor line by the parallel robot. Based on machine vision, the recognition accuracy of opened poultry viscera directly affects the level of visceral damage and residue caused by gripping manipulator. However, visceral positioning is often influenced by different noise in the abdominal cavity, such as mucous membranes and blood stains. Thus, the image segmentation of poultry viscera is a complex process, and it is challenging to remove the noise. In general, existing image segmentation methods can hardly segment visceral regions well. To strengthen the anti-noise ability, we proposed an improved region-based active contour method with the level-set formulation. This method combined with several operations of color space conversion and top-low-hat transformation, which could extract the viscera contour and precisely removed the noise. The results showed that recognition accuracy of the heart-liver area and fat area in the viscera are 98.98% and 99.75%, respectively, while the overall viscera for poultry was 98.96%. The results of this experiment suggested that the proposed image segmentation algorithm could achieve the required accuracy for poultry viscera detection. Thus, the proposed visceral contour recognition method could be applied in poultry processing, providing critical information to guide the robot for automated evisceration.

PurposeTo analyze the clinical characteristics of trauma-dominant orbital cellulitis (OC) and evaluate the risk factors associated with evisceration.MethodsThis retrospective study included inpatients diagnosed with orbital cellulitis at the Zhongshan Ophthalmic Center between January 2010 and December 2020. The demographic features, etiology, clinical characteristics, microbiological isolates, and risk factors associated with evisceration were analyzed.ResultsAmong 148 consecutive subjects (n = 148, 148 eyes), the mean age was 42.07 ± 20.35 years and 70.27% were male. Penetrating globe injuries were the most common (52.03%). No light perception (NLP) was recorded in 50% of patients on admission. Endophthalmitis was observed in 103 cases (69.59%), intraocular foreign bodies (IOFB) were detected in 43 cases (29.05%), and total corneal melting was observed in 31 cases (20.95%). Sixty patients (40.54%) underwent evisceration. Logistic regression analysis showed that total corneal dissolution [odds ratio (OR) = 83.019, P = 0.000], IOFB (OR = 3.402, P = 0.016), and NLP (OR = 0.185, P = 0.001) were risk factors for evisceration. Microorganism detection showed that Pseudomonas aeruginosa and Bacillus cereus were the leading pathogens.ConclusionAmong hospitalized trauma-dominant OC patients, middle-aged men were the major subjects and penetrating globe injury was the major cause. Significant complications such as complete visual loss and evisceration were unavoidable in many patients with OC in the current study. NLP, IOFB, and total corneal melting were the risk factors for evisceration.

To describe the presentation and clinical course of a case of endogenous endophthalmitis caused by Clostridium septicum, an anaerobic and gram positive bacteria. Observational report of a clinical case presented in Spain. A 61-year-old male patient was referred to our hospital with a diagnosis of endophthalmitis of his left eye since ten days prior to presentation, and a history of poor response to medical treatment. Evisceration was performed, and C. septicum was isolated from a sample of the vitreous humor. Fourteen days after surgery, the patient returned with orbital cellulitis, and exenteration was performed. Forty-two days after initial presentation, colonoscopy revealed an adenocarcinoma of the proximal colon. Surgical resection of the tumor was performed, and clinical recovery was achieved. iSystemic C. septicum infection without a traumatic cause has been associated with malignancy, although an initial presentation of endophthalmitis has rarely been reported. In cases of clostridial endogenous endophthalmitis, investigation for colorectal carcinoma is indicated. [ABSTRACT FROM AUTHOR]

Angela C Gauthier, Oluseye K Oduyale, Michael J Fliotsos, Sidra Zafar, Nicholas R Mahoney, Divya Srikumaran, Fasika A Woreta Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USACorrespondence: Fasika A WoretaWilmer Eye Institute, Johns Hopkins School of Medicine 600 North Wolfe Street, Baltimore, MD 21205, USATel +1 410-961-2868Fax +1 410-614-9632Email fworeta1@jhmi.eduPurpose: To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma.Patients and Methods: Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018.Results: There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2– 92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9– 91.2) versus 42.2 years (range 4.2– 91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0– 14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p< 0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group.Conclusion: Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.Keywords: evisceration, enucleation, open globe repair, traumatic eye injury

Abstract Conventional automated slaughter lines for pigs are organised as disassembly lines with many specialised machines. High costs and capacities make them relevant only for large scale meat production. The ambition with the novel Meat Factory Cell (MFC) concept is to provide the meat industry with a robust and flexible automation platform that is also relevant for smaller scale production. The MFC process deviates radically from conventional processing of pig carcasses after singeing. In MFC, the limbs are removed first. Then the dorsal muscles along the spinal axis from tail to head are removed with the column and rind in one meat cut, followed by removal of the viscera. Finally, the cut ribs and belly are removed. Such approaches to automation in pig abattoirs and cutting plants are highly needed in smaller scale production, and they should produce meat and offal as hygienically as conventional factories. This case study reports the evisceration of 37 pigs in 9 trials performed in 2019. Several approaches were tested with a prototype carcass holding unit. Evisceration could be undertaken without the need to cut through the gastrointestinal tract from tongue to rectum, reducing the probability of accidental faecal contamination of pork carcasses from the gut content. The Meat Factory Cell procedure is an advance towards automated evisceration of pig carcasses which is both simple and hygienic. The traditional separation of internal organs into a pluck set and a set of stomach and bowels was more prone to leakages.

AIM: To investigate the risk factors for eye removal following ocular trauma at a major ophthalmology department in China. METHODS: A retrospective study of patients who underwent eye removal surgery following ocular trauma was completed. Clinical outcomes were consulted in detail through the hospital’s computed medical data system. Patients’ information including age, gender, cause of ocular trauma, affected eye, and education level was collected and recorded in a standardized database. Chi-squared test, Student’s t-test, Fisher’s exact test, and bivariate correlation analysis were used for statistical comparisons. RESULTS: The present study included 1675 removal eyes from 1674 patients over the 20-year period. Patients included 80.5% males and 19.5% females, with mean age of 38y. The majority of the patients (70.7%) were blue-collar workers (physical laborers), and 1098 patients (65.6%) did not receive high school education. Work-related injuries were the most common reason for eye removal (n=739, 44.1%), of which 441 cases (59.7%) were related to metal/nail wounds. The most frequent injury type in males was work-related injuries (49.7%), whereas the most frequent injury type in females was home-related injuries (25.8%). CONCLUSION: Work-related injuries are a leading cause of severe ocular injury resulting in eye removal. In addition, men and undereducated patients are more likely to undergo eye removal surgery following ocular trauma. This study identified multiple high-risk factors leading to eye removal following ocular trauma, which is of great importance for preventing severe eye injuries.

The purpose is to develop a new method of evisceration of the eyeball in II–III degree subatrophies and assess its effectiveness. Material and methods. 172 patients with blind or incurable eyes who underwent one of the three operations: eye evisceration according to the newly developed technique involving an implantation of polytetrafluoroethylene grafts (main group), eyeball enucleation (comparison group I) and classical eye evisceration (comparison group II) were observed. Results. No complications were revealed either in the early or in the late period. A positive result was noted in all patients of the main group: average stump mobility was 140.1° ± 3.7° and average prosthesis mobility was 111.2° ± 4.0°. Prosthesis retraction after evisceration occurred 13.9 % less often than after enucleation (comparison group I), while the prosthesis retraction depth (mm) was 54.5 % lower than after enucleation. The retraction of the upper eyelid was also 26 % less common and its depth (mm) was 39.3 % lower.

Case Description- Umbilical hernia is occasionally seen with different levels of complexity in animals This emergency condition requires quick diagnosis and is corrected with various surgical approaches. The aim of this paper is to report the surgical correction of an eviscerated umbilical hernia with extensive adhesion in a bovine calf. Twenty days old indigenous male bovine calf was presented for surgical treatment of an umbilical hernia with extensive adhesion and evisceration.Clinical Findings- Physical examination through palpation revealed evisceration of umbilical content with extensive adhesion. Treatment and Outcome- The surgical procedure was carried out aseptically following standard procedure. The bovine calf recovered without any complication two weeks after surgery.Clinical Relevance- It can be concluded that surgical management along with administration of antibiotic, antihistaminic and anti-inflammatory drugs are effective for successful management of eviscerated umbilical hernia with extensive adhesion in the bovine calf

Orbital implant exposure may be the most common complication after evisceration surgery with orbital implantation. Management of implant exposure is a vital issue for oculoplastic surgeons. We present the case of a patient with nontraumatic eyeball rupture receiving dermis-fat graft after early implant exposure. The present case with multiple penetrating keratoplasty history underwent emergent evisceration and silicon sphere implantation due to nontraumatic eyeball rupture with severe uvea prolapse. The surrounding corneal tissue of the rupture aperture was almost unidentified before the operation. Deep superior sulcus syndrome and orbital implant exposure developed 2 months after the operation; hence, orbital reconstruction and dermis-fat graft transplantation were performed. Orbital reconstruction and orbital implant exposure management are discussed in the content.

Background: Anterior staphyloma is defined as a localized defect in the anterior eye wall with protrusion of the uveal tissue due to alterations in scleral thickness and structure. The causes could be congenital, trauma, or following infection. Surgical options include staphylectomy with graft (corneal/corneoscleral), biosynthetic graft, enucleation or evisceration in a painful blind eye). Purpose: To demonstrate staphylectomy with careful preservation of ocular structures followed by optical keratoplasty in a single setting. Synopsis: A 39-year-old Asian Indian lady presented with complaints of blurring of vision and whitish opacity in both eyes since childhood, associated with progressive enlargement and protrusion of the black part of the left eye with severe pain at the time of presentation. Her clinical examination revealed leucomatous corneal opacity in both the eyes and anterior staphyloma and keratinization in the left eye. Visual acuity was counting fingers close to face in the right eye and hand movements close to face in the left eye with projection of rays being accurate in both eyes. Ultrasound B scan showed posterior staphyloma in the right eye with sub-Tenon's fluid and increased retinochoroidal thickness. The left eye posterior segment with B scan was normal. The available surgical options were evisceration with secondary orbital implant and ocular prosthesis or staphylectomy with corneal transplantation. To provide the best option for the patient in her eye with better visual potential, staphylectomy with corneal transplantation was done. Highlights: Painful blind eye is usually dealt with evisceration. This video demonstrates the technique of staphylectomy with corneal graft and restoration of structural integrity. Evisceration is a destructive procedure that involves removal of the intraocular contents. The patient will have to deal with the hassles of prosthesis maintenance and stigma of the artificial eye. Video link: https://youtu.be/VoS8Irsh1yY

Background: Eye removal surgeries, also called anophthalmic surgeries, are usually performed for a painful blinded eye due to various underlying causes. In this case review, we intended to study the indications, the types of anophthalmic surgeries, and post-operative complications related to eye removal surgeries., Method:  Five years of retrospective case review of surgical eye removals was conducted from 1st June 2018 to 31st May 2023 at Hospital Canselor Tuanku Muhriz (HCTM), University of Kebangsaan Malaysia (UKM). Medical record files were used to analyse the age, gender, affected eye, types of surgeries, and indications of the eye removal surgery., Results:  Fourteen eyes underwent anophthalmic surgeries inclusive of evisceration (78.57%, n = 11), enucleation (14.29%, n = 2), and exenteration (7.14%, n = 1). Among the evisceration group, 63.64% (n = 7) were due to endophthalmitis, 27.27% (n = 3) were due to ocular trauma, and 9.09% (n = 1) were done for a painful blind due to neovascular glaucoma. Two enucleation surgeries were performed for retinoblastoma and one exenteration for orbital metastatic malignancy., Conclusion:  The preferred choice of anophthalmic surgery was in favour of evisceration, especially when the underlying causes were due to benign conditions. The most common indications of anophthalmic surgeries were endophthalmitis, trauma, and malignancies. Enucleation and exenteration were performed mainly for the blinded eye due to the intraocular malignancies and malignancy with an extraocular spread. A fairly lesser number of anophthalmic surgeries over the five years could imply an improvement in the conservative management approach of a painful blinded eye., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Wangdi et al.)

Background: Painful blind eye conditions in Africa constitute a compelling area of concern within public health, presenting substantial complexities for healthcare systems and the individuals afflicted. This comprehensive review delves into recent research and advancements concerning the management of these conditions across the African region. Drawing upon contemporary studies and data, we scrutinise the multifaceted aspects, including prevalence rates, causative factors, and regional variations., Objective: To review existing articles on the current state of the management of blind painful eye conditions in Africa., Materials and Methods: Articles regarding the subject were obtained from Google Scholar, AJOL, and PubMed using the keywords, painful, blind eye (PBE), Africa., Results: Forty-four relevant articles were reviewed. They were further categorized into epidemiology, management approaches and challenges to management., Conclusion: The management of the PBE poses a huge challenge and can either be medical or surgical. Collaborative efforts should be targeted at preventing the causes of a PBE. As the burden of painful blind eye conditions continues to exert a profound impact across Africa, this article underscores the pressing need for collaborative efforts involving governments, non-governmental organisations, and international entities. By prioritising awareness and enhancing healthcare accessibility, we collectively strive towards the alleviation of suffering and the prevention of avoidable visual impairment in this region., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of the west African college of surgeons.)

Abstract Apostichopus japonicus is a useful model for studying organ regeneration, and the gut microbiota is important for host organ regeneration. However, the reconstruction process and the mechanisms of gut microbiota assembly during gut regeneration in sea cucumbers have not been well studied. In the present study, gut regeneration was induced (via evisceration) in A. japonicus, and gut immune responses and bacterial diversity were investigated to reveal gut microbiota assembly and its possible mechanisms during gut regeneration. The results revealed that bacterial community reconstruction involved two stages with distinct assembly mechanisms, where the reconstructed community was initiated from the bacterial consortium in the residual digestive tract and tended to form a novel microbiota in the later stage of reconstruction. Together, the results of immunoenzyme assays, community phylogenetic analysis, and source tracking suggested that the host deterministic process was stronger in the initial stage than in the later stage. The bacterial interactions that occurred were significantly different between the two stages. Positive interactions dominated in the initial stage, while more complex and competitive interactions developed in the later stage. Such a dynamic bacterial community could provide the host with energetic and immune benefits that promote gut regeneration and functional recovery. The results of the present study provide insights into the processes and mechanisms of gut microbiota assembly during intestinal regeneration that are valuable for understanding gut regeneration mechanisms mediated by the microbiota.

Small bowel evisceration from dehiscent vaginal cuff is unusual subsequent to laparoscopic hysterectomy. This complication is seldom cited in studies and reviews. We present an uncommon case of evisceration of small bowel from vaginal cuff dehiscence (VCD). The event occurred approximately 2 hours subsequent to the first act of coitus performed 3 months after the laparoscopic hysterectomy. Patient was brought to the emergency department for primary treatment. Urgent surgical intervention was planned. Small intestine was reposed after saline wash. Repairing of the vault was done with continuous suture by polyglactin-910 braided synthetic absorbable suture no.1. Patient was sent to home after 5 days of surgery. The strength of vaginal vault in laparoscopic hysterectomy depends on technique of vaginal cuff closure and types of suture materials used during surgery. Postoperative counseling of patients for recommencing physical activity and sexual intercourse is also of utmost significance.

Drain site eviscerations have been reported as a rare complication following abdominal surgery. An 82-year-old women was diagnosed with carcinoma stomach and underwent laparoscopic subtotal gastrectomy. A few hours following removal of the duodenal stump drain, she developed small bowel evisceration through the drain site. It was successfully managed with immediate bedside release of fascial constriction followed by definitive repair later. Although herniations and eviscerations via larger drain sites have been reported, eviscerations from small laparoscopic port sites used for drains are rare. Here, we report the first case of small bowel evisceration with strangulation through a 5-mm port site.

Infection of the sclera poses a therapeutic challenge due to its poor vascularity. Herein, we describe a case of fungal scleritis following evisceration in an immunocompetent man. Aggressive multidrug medical treatment was combined with enucleation to eliminate the infection. Thus, a multipronged approach is to be adopted for successful outcome and the prevention of complications.

BACKGROUND: Two patients received ocular injuries from rusted metallic projectiles at their industrial workplaces. Said injuries resulted in the loss of their eyes by evisceration surgeries to prevent fatal infections. CASE DESCRIPTION: The first case, a man in his twenties, received a stock conformer immediately after surgery and started prosthetic therapy within 2 months. The second case, a man in his forties, started prosthetic therapy after 10 years. Definitive custom ocular prostheses were fabricated and relined according to conventional protocol. RESULTS: On issue of the prosthesis, there was adequate retention, aesthetics and stability to extra-ocular movements and treatment was considered successful for both cases. However, follow-ups showed noticeable prosthetic eye movements for case 1 which, to some extent mimicked the physiologic movement of its fellow natural eye. Case 1 adjusted to his prosthesis better while case 2 was still adjusting with little to no physiologic movement. CONCLUSION: Prosthetic rehabilitation should be started as early as possible to obtain optimum rehabilitative results. [ABSTRACT FROM AUTHOR]

To assess which signs and eye prosthesis care habits are related to subjective discomfort in patients with dry anophthalmic socket syndrome (DASS), using standardized tools from daily practice. 62 anophthalmic sockets were compared with their healthy fellow eye using the Standard Patient Evaluation of Eye Dryness (SPEED) score. The correlations between SPEED questionnaire and the prosthesis care, discharge characteristics score, conjunctival inflammation score, meibomian gland dysfunction (MGD) scores and Schirmer I test were studied. The anophthalmic sockets group achieved a higher SPEED test score (p < 0.01), discharge score (p < 0.01), conjunctival inflammation score (p < 0.01), MGD scores (p < 0.01) and lower Schirmer I test (p < 0.01) compared with their fellow, healthy eye. Patients with a prosthesis replacement of one year or less, those with a current fit time of one year or less and those with a cleaning frequency above one month reported better SPEED, (p < 0.01), conjunctiva inflammation (p < 0.01) and MGD scores (p < 0.01). Most anophthalmic patients suffer mild to severe DASS, which seems related to discharge, conjunctival inflammation and MGD. Moreover, certain practices related to the care of the prosthesis such as replacing with a frequency lower than yearly, current fitting time inferior to one year and a removing and cleaning regime above one month, were related to a lower discomfort sensation, conjunctival inflammation and MGD. Clinicians should consider the DASS when facing patients with anophthalmic socket and discomfort symptoms. [ABSTRACT FROM AUTHOR]

Drainage tubes are commonly used to remove unwanted fluid after surgery. However, they are not indicated in all situations, and there is no evidence to support their common utilization. A 31-year-old woman at 38 weeks of gestation with a history of five cesarean sections presented with lower abdominal pain following a tonic-clonic epileptic seizure. Emergency surgery was performed due to fetal distress, and the uterus was found to be ruptured. After delivering the baby and closing the uterus, a drainage tube was inserted into the pouch of Douglas. Two days after surgery, the right ampulla and infundibulum were eviscerated from the drain site during the drainage tube removal. A second surgery was performed to reduce the herniated uterine tube. Drainage tubes are typically easily removed without complications. Some reported complications related to drainage tube removal include herniation, anchoring and suctioning of the uterine tube to the drainage tube, knotting with the colonic epiploica, and fracturing and retraction of the drainage tube due to adhesions. To the best of our knowledge, this is the first reported case of uterine tube evisceration during drainage tube removal. Evisceration after drainage tube removal is very rare. We believe that this is the first report of immediate evisceration after the removal process. Such complications can be avoided with more restricted instructions for the use of drainage tubes and more researches on the reasons for these complications. • Uterine tube evisceration after drainage tube removal is very rare. • This is the first report of immediate evisceration after the removal process. • Tube evisceration can be avoided with more restricted instructions for the use of drainage tubes. • More researches are needed to detect the reasons for these complications. [ABSTRACT FROM AUTHOR]

• Zone 3 injuries were the most common location of injury among all mechanisms of sports related OGIs. • Final visual outcomes did not differ significantly between penetrating-object and blunt trauma associated mechanisms of OGIs. • Most of the study cohort were adolescent males, implying the need for increased use of eye protection among this demographic. To describe the mechanisms and visual outcomes of recreational and sports-related open globe injuries (OGIs). A retrospective case series of eyes experiencing OGI secondary to recreational and sports-related activities at Memorial Hermann Hospital – Texas Medical Center (MHH-TMC) from January 1st, 2010 through March 31st, 2015 was conducted. Exclusionary criteria included no documented ophthalmologic examination upon presentation and repairs performed by services other than ophthalmology. A two-tailed t -test and Fisher's exact test were utilized to assess for statistical significance (p < 0.05). A total of 20 eyes from 20 patients experiencing OGIs secondary to recreational and sports-related activities were included. Thirteen eyes (65 %) presented with OGIs from penetrating objects while seven eyes (35 %) had injuries from blunt injuries. Males comprised most of the total study group (17 of 20 patients), and zone 3 injuries were the most common location of OGI. While eyes with OGIs from blunt trauma underwent evisceration/enucleation procedures more frequently than OGIs from penetrating mechanisms (71% vs 23 %) (p = 0.10), the final visual outcomes were similarly poor between groups. Only three eyes in this series experienced an improvement from baseline VA; all three eyes had lacked initial findings consistent with severe injury. Recreational and sports related OGIs most commonly occur in zone 3 and in young males, regardless of injury type. OGIs due to both penetrating and blunt trauma mechanisms implicate poor functional outcomes, but the absence of certain presenting injury features may indicate possibility of eventual visual recovery. [ABSTRACT FROM AUTHOR]

We describe a case of right eye tubercular (TB) panuveitis with corneal involvement where repeated intraocular sampling was unsuccessful. Finally, evisceration and histopathology of ocular tissue confirmed the diagnosis of ocular tuberculosis. A chest X-ray showed signs of pulmonary TB. The patient was lost to follow-up but reported 2 months later with the right eyelid margin nodules with surface ulceration. Both eyelid and pulmonary lesions were resolved with anti-TB therapy.

Abstract Sea cucumbers (a class of echinoderms) exhibit a high capacity for regeneration, such that, following ejection of inner organs in a process called evisceration, the lost organs regenerate. There are two ways by which evisceration occurs in sea cucmber species: from the mouth (anterior) or the anus (posterior). Intriguingly, regenerating tissues are formed at both the anterior and posterior regions and extend toward the opposite ends, and merge to form a complete digestive tract. From the posterior side, the digestive tube regenerates extending a continuous tube from the cloaca, which remains at evisceration. In posteriorly-eviscerating species, the esophagus remains in the body, and a new tube regenerates continuously from it. However, in anterior-eviscerating species, no tubular tissue remains in the anterior region, raising the question of how the new digestive tube forms in the anterior regenerate. We addressed this question by detailed histological observations of the regenerating anterior digestive tract in a small sea cucumber, Eupentacta quinquesemita (“ishiko” in Japanese) after induced-evisceration. We found that an initial rudiment consisting of mesenchymal cells is formed along the edge of the anterior mesentery from the anterior end, and then, among the mesenchymal cells, multiple clusters of epithelial-like cells appears simultaneously and repeatedly in the extending region by mesenchymal–epithelial transition (MET) as visulalized using toluidine blue staining. Subsequently, multiple cavities were formed surrounded with these epithelial cells, and appeared to coalesce with each other to form into multiple lumens, and to eventually become a single tube. This anterior tube then fused to the tube regenerated from the posterior rudiment. Thus, we elucidated the process of regeneration of the anterior portion of the gut in an anteriorly eviscerating species, and suggest the involvement of MET and fusion of cavities/lumens in regeneration of the digestive tube.

Abstract Purpose To describe the spectrum of bacterial and fungal pathogens in cases of endophthalmitis requiring evisceration and report their antimicrobial susceptibilities. Methods Retrospective, consecutive, and descriptive case series of endophthalmitis that underwent evisceration from January 2004 to December 2017. Vitreous samples from all patients had been investigated for bacteria and fungus using institutional protocol. Bacterial isolates were identified using analytical profile index (API) system until 2010 and Vitek-2 compact system (bioMérieux, France), thereafter. The susceptibility of bacterial isolates to a variety of antibiotics was determined by the Kirby-Bauer disk-diffusion method. Results Of 791 cases reviewed, culture positivity was reported in 388 cases (48.92%). Commonest clinical setting of endophthalmitis necessitating evisceration was post-microbial keratitis (58%), followed by post-trauma and post-cataract surgery (14–15%). The commonest isolate was Streptococcus pneumoniae, seen in 68 samples overall (17.52%). One hundred and eighty-three isolates (47.16%) were gram-positive, 86 (22.16%) were gram-negative, and fungi constituted 137 (35.3%) isolates. Streptococcus pneumoniae was the commonest gram-positive bacterial isolate seen in 68/183 samples (37.15%). Among gram-negative organisms, the commonest was Pseudomonas aeruginosa seen in 47/86 (54.65%). Aspergillus spp. formed the commonest fungal isolate, 58/137 (42.33%). The susceptibility of the gram-positive bacteria was highest with vancomycin, 136/147 (92.51%) and for gram-negative bacteria was seen best with imipenem 24/29 (82.75%). Susceptibility to ceftazidime was 31/61 (50.81%) in 31/61. Conclusion Endophthalmitis due to Pneumococci, Aspergillus, and Pseudomonas can be very fulminant and progress to require evisceration in spite of prompt and appropriate treatment.

The purpose of the work is to evaluate the characteristics of primary posttraumatic eyeball removal in the adult population of the Krasnoyarsk Territory. Material and methods. The analysis of 87 patients’ medical documents from the Krasnoyarsk Regional Ophthalmologic Clinical Hospital has been carried out since 2003 till 2016; the primary posttraumatic eyeball removal was performed. Gender, age, place of residence, social and labor status of patients, the type and nature of the injuries that caused the eyeball removal as a primary surgical intervention have been taken into account. Results and discussion. Between 2003-2016 the proportion of primary posttraumatic removal of the eyeball was ranged from 9 % to 42.9 % of all eye removal procedures due to trauma., Their were 73 (83.9 %) men and 14 (16.1 %) women among 87 patients aged 18-88 years. Distribution by social status came up to unemployed citizens (48.3 %), officially employed - 28.8 % and pensioners - 22.9 %. Home accident trauma was more common (68.9 % of cases), criminal (24.1 %) and industrial (6.9 %) injuries were less often. The period from the eye injury moment till its removal was 0-90 days. The main causes of primary posttraumatic eye removal were eyeball destruction in 65.5 % of cases, panophthalmia was in 19.6 %, eye painful subatrophy - in 14.9 % of cases. Conclusion. Primary posttraumatic eyeball removal can be considered as a model of the entire population of post-traumatic enucleations. Specific gravity (23.9 %), increase in the frequency of primary post-traumatic eyeball removal can influence on the waiting time for traumatic enucleation in general. In the overwhelming number of injured patients, the primary removal of the eyeball is the consequence of the injury severity, in 34.5 % of cases it is due to the imperfection of medical care at various stages of its delivery.

Vivek Pravin Dave,1 Rajeev R Pappuru,1 Mudit Tyagi,1 Avinash Pathengay,2 Taraprasad Das1 1Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India; 2Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Hanumanthawaka Chowk, Visakhapatnam 530040, Andhra Pradesh, India Purpose: To report the presentation and management outcomes of endophthalmitis with endoscopic vitrectomy. Methods: This is a retrospective interventional case series conducted at a tertiary eye care center in south India. Thirty three eyes of 33 patients were included. The medical records of the patients who underwent endoscopic vitrectomy for endophthalmitis from April 2014 to March 2018 were reviewed. Data with regard to age, gender, etiology of endophthalmitis, corneal and retinal examination, type of intervention, final anatomic and visual outcome, and the total follow-up were collected. The main outcome measures were the final visual acuity and evisceration rates. Results: The mean age at presentation was 46.84±19.89 years, with a median age of 50 years. Based on etiology, 13 eyes (39.4%) were post-trauma endophthalmitis, eleven eyes (33.33%) were post-cataract surgery, three eyes (9.09%) were endogenous, three eyes (9.09%) were post-perforated corneal ulcer, two eyes (6.06%) were post-retinal surgery, and one eye (3.03%) was post-combined cataract and corneal surgery. Twenty-four eyes (72.72%) had a favorable anatomic outcome at the last visit, and five eyes (15.15%) had a favorable visual outcome. Of those with unfavorable visual outcome, ten eyes had further visual potential. Sixteen eyes (48.48%) showed a positive culture on microbiologic evaluation. The predominant organism isolated was Pseudomonas aeruginosa. Evisceration was required only in one eye (3.03%). Conclusion: Endoscopic vitrectomy allows early management of endophthalmitis in spite of hazy media. This ensures a reasonable visual outcome, controls the infection, and reduces the incidence of evisceration in these eyes. Keywords: evisceration, trauma, vitrectomy

Purpose: The study aims to analyze risk factors for exposure of orbital implants after evisceration by comparison of patients with and without exposure of implants. Methods: This is a case control study in retrospective interventional case series; Group A- implant exposures after evisceration, Group B - Patients on follow up after evisceration with implant, without exposure, with matched duration of follow up. The sample size is calculated for a power of 80. Results: Group A comprised 32 sockets with implant exposure, presenting at median 18 months after surgery; Group B included 61 eviscerated sockets, without implant exposure, with follow up median 36 months. Odds Ratio (OR) was calculated; infected eyes -OR 1.3, P = 0.6; phthisical eye - OR 1.4, P = 0.43; multiple prior surgeries- OR 1.55, P = 0.33. Group A had 59.3% porous implants, Group B 55.7%, - OR 1.3, P = 0.5. Mean implant size in Group A 19.06 mm, Group B 18.78 mm- showed no statistical difference. Multiple logistic regression analysis showed no significant risk factor for exposure. Surgeon factor was not analyzed since there were multiple surgeons. Conclusion: This is the first study with calculated sample size, comparing implant exposure patients to a control group. Porous implant material, presence of infection, phthisical scleral shell, and prior surgery showed higher trend of exposure (Odds ratio >1), but none was conclusive. Larger size of implant was not a risk factor for exposure. Eliminating the role of several factors in implant exposure allows the surgeon to make better surgical choices: such as place an implant of appropriate size, of a material of surgeon's choice, and do primary placement of implant in a patient with evisceration post-corneal ulcer or endophthalmitis. A hypothesis and a recommendation is that meticulous attention be paid to surgical technique.

Most species of the class Holothuroidea are able to regenerate most of their internal organs following a typical evisceration process, which is a unique mechanism that allows sea cucumbers to survive in adverse environments. In this review, we compare autotomy among different type of sea cucumber and summarize the histocytological events that occur during the five stages of intestinal regeneration. Multiple cytological activities, such as apoptosis and dedifferentiation, take place during wound healing and anlage formation. Many studies have focused on the molecular regulation mechanisms that underlie regeneration, and herein we describe the techniques that have been used as well as the development-related signaling pathways and key genes that are significantly expressed during intestinal regeneration. Future analyses of the underlying mechanisms responsible for intestinal regeneration should include mapping at the single-cell level. Studies of visceral regeneration in echinoderms provide a unique perspective for understanding whole-body regeneration or appendage regeneration.

Purpose: To present two cases of neonatal endophthalmitis with poor prognosis that were managed with primary evisceration. Observations: Case 1 is a 27-weeks’ gestation neonate who developed Pseudomonas aeruginosa endophthalmitis complicated by globe rupture. Case 2 describes a 34-weeks’ gestation neonate with Serratia marcescens endophthalmitis. Both patients had poor prognosis and thus underwent primary evisceration with good long-term cosmetic outcomes at 15 years and 17 months, respectively. Conclusions and Importance: Primary evisceration should be considered in neonates with endophthalmitis with a poor prognosis and can result in good long-term cosmesis.

A 29-years-old Turkish man who had undergone evisceration with primary orbital implantation 20 months prior complained of difficulty wearing his artificial eye. Slit-lamp examination revealed a conjunctival cyst in the center of the anophthalmic socket, with no evidence of scleral or orbital implant exposure. The cyst was completely excised under general anesthesia and did not require use of any sclerosing substance or dye. At 6 months postoperatively, there was no recurrence of the cyst or exposure of the sclera or orbital implant. As the upper and lower fornices were sufficiently deep, the patient could wear his artificial eye. [ABSTRACT FROM AUTHOR]

The disapproval of broiler carcasses in slaughterhouses leads, directly, to losing quality and quantity of produced meat, to compromising the production line efficiency and causing processing additional costs. The carcasses can be partially or completely condemned, due to numerous causes. The identification of carcasses condemnation causes and the analyses of its factors enables to minimize losses and the improvement of the slaughter process. Thus, this research aimed to: identify the causes of total broiler carcasses condemnation, by utilization of quality tools, and elaborate an action plan that would reduce the total condemnation of broiler carcasses. The study was carried out in a slaughterhouse located in the western region of the state of Paraná. It was noted that the main cause of broiler carcasses condemnation was contamination (57.0%). The factors related with the contamination of broiler carcasses were the lack of uniformity in the weight of the broilers, the inappropriate pre slaughter fasting time, flaw in the regulation of cloaca's extracting machine, abdomen cutter and viscera extracting machine and the poor staff training. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the safety and effectiveness of 2% subconjunctival injection of Fluconazole as an adjunctive treatment in severe recalcitrant fungal keratitis. Study Design: Interventional case series. Place and Duration of Study: Ophthalmology department of Holy family hospital, Rawalpindi medical university, from January 2019 to August 2019. Methods: The study included 18 eyes of 18 patients with severe resistant fungal corneal ulcer. We excluded those cases who had known hypersensitivities to Fluconazole. These ulcers were refractory to primary conventional antifungal therapy with topical Natamycin, topical and systemic Fluconazole. Sample for culture was taken with sterile cotton bud and scraping was taken with kimura spatula. All resistant cases were given1.0 ml of 2% subconjunctival Fluconazole injection once a day for at least one week. After that depending upon the condition, the injections were given on alternate days for 2 weeks. Results: Average age of the patients was 35.22 years (SD ± 10.42). Among total 18 patients, six (33.33%) were females and 12 (66.67%) were males. Thirteen (72.22%) cases showed absolute response after one week and 5 (27.77%) cases needed more injections. Four (22.22%) of these 5 cases partially improved and one case failed to show improvement. Final vision varied in different cases according to the position of the residual scar. Five cases ended up in keratoplasty. Local or systemic toxicity was not seen in any case. Conclusion: Subconjunctival injection of 2% Fluconazole can be used as an adjunctive therapy for severe fungal keratitis without any toxic complications. [ABSTRACT FROM AUTHOR]

Scleromalacia, plant sap, chemical burn, four petals technique, evisceration Keywords: Scleromalacia; chemical burn; plant sap; evisceration; four petals technique EN Scleromalacia chemical burn plant sap evisceration four petals technique 659 660 2 10/25/23 20231201 NES 231201 A 37-year-old-man from Nicaragua was referred to our Oculoplastics and Orbit Unit due to a large dark vascularized lesion in his left eye (Figure 1A). [Extracted from the article]

Sea cucumbers have been emerged as important models to study organ regeneration and development owing to the capacity to regenerate its organs quickly after evisceration. Evisceration is a special defense mechanism for sea cucumber to eject all of internal organs when they encounter predators or adverse environmental conditions. However, little was known about the dynamics of bacterial community in coelomic fluid after evisceration. In the present study, evisceration was induced by intracelomic injection of 0.35 M KCl, and the significantly alternation of bacterial community in coelomic fluid of sea cucumber Apostichopus japonicus was observed with lower diversity and total bacterial load at 7 dpe (days post evisceration) and 14 dpe. The bacterial community was tended to restore at 28 dpe. In particular, relative abundances of Bacteroidetes and Rubritaleaceae, which involved in degradation of polysaccharides and lipid, increased significantly at 7 dpe (p < 0.05), and returned to the original level at 28 dpe. In addition, the predicted functions of bacterial community indicated that the bacteria associated with metabolism pathways of amino acid, lipid and carbohydrate also increased significantly at 7 dpe. These results suggested that the bacterial community in coelomic fluid of A. japonicus was highly dynamic and could rebuild a stable community structure after evisceration. It was suggested that the enriched metabolic related beneficial bacteria at early stage played a role after evisceration in terms of decomposing polysaccharides and lipid to provide energy.

Surgeons performing laparoscopy in pregnancy are developing specific practices to improve care of gravid women. In this case, a pregnant 26-year-old patient underwent laparoscopic ovarian cystectomy in the second trimester, with cyst wall removal through an 8 mm umbilical port site incision. She returned four days later with pain and drainage from the umbilicus, and examination under anesthesia revealed omental evisceration through the umbilical incision. The patient healed well following excision of affected omentum, reapproximation of fascia in a simple, interrupted fashion, and closure of skin in a subcuticular fashion. Due to increased intra-abdominal pressure associated with a gravid uterus and other factors, port site closure for incisions smaller than 10 mm may improve healing and prevent complications of laparoscopic surgery in pregnancy.

In the present study, the regeneration process following posterior evisceration along with changes in antioxidant enzymes during regeneration in Holothuria parva was investigated for the first time. In the present study, evisceration was induced after molecular and morphological identification of the species. Most of the digestive tract and the left respiratory tree were removed from the body through the anus. The tissue regeneration of the digestive tract and changes in the activity of antioxidant enzymes [superoxide dismutase (SOD), catalase (CAT), and lipid peroxidation (LPO)] were examined during 75 days. According to the results, evisceration in this species was from the anus and the regeneration process could be divided into four steps based on the histomorphological alterations. The digestive tract grew in the form of a straight cord from the anterior end to the cloaca. During the regeneration process, several cavities were created inside the cord, which gradually joined to form a continuous lumen. For the first time on the 24th day after evisceration, food was found in the digestive tract. Fifty days after evisceration, the tissue structure of different parts derived from regenerated digest tract was found to be similar to that in the intact digestive tract. According to the results, 5 days after evisceration the activity of CAT and SOD in the regenerated digestive tract was significantly higher than in the control. The CAT and SOD levels gradually decreased in the regenerated digestive tract, although by the end of the experiment it was significantly higher than in the control group. The LPO level in eviscerated animals showed a decreasing trend during the experiment and its value decreased to the control level at the end of the experiment. [ABSTRACT FROM AUTHOR]

Background/aim: To investigate the risk factors for evisceration in a gynecological oncology population. The secondary aim was to evaluate the impact of evisceration on survival. Materials and methods: Inclusion criteria consisted of having had an elective surgery performed through a xiphoidopubic incision in our institution and having a gynecological malignancy based on pathology. A total of 198 patients were evaluated, 54 with evisceration and 144 without evisceration. Due to the widely varied prognosis of female genital cancers, the survival was analyzed on a homogenized group, including only 62 patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer. Results: The preoperative factors associated with evisceration in the univariate analysis were old age, high body mass index (BMI), hypertension, smoking, comorbidities, high American Society of Anesthesiologist (ASA) score (3 and 4), and low preoperative albumin level. The associated intraoperative factors were bleeding volume, receiving more than two units of erythrocyte suspension or fresh frozen plasma, and having had a major operation. The associated postoperative factors were the albumin transfusion and the antibiotic use in the early postoperative period. In the multivariate analysis, smoking, low levels of preoperative albumin, high BMIs, and high ASA scores (3 and 4) were independent prognostic factors for evisceration. Evisceration was not associated with recurrence and survival in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer. Conclusion: Smoking, preoperative hypoalbuminemia, obesity, and high ASA scores (3 and 4) were the prognostic factors for evisceration. Short-term modifiable factors such as smoking cessation and improved nutritional status should be considered in elective gynecological oncology surgeries. Evisceration had no impact on survival and recurrence in the patients with primary advanced stage epithelial ovarian-tubal-peritoneal cancer. [ABSTRACT FROM AUTHOR]

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