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Euglycemic diabetic ketoacidosis is a metabolic condition characterized by relative euglycemia, ketonemia, and metabolic acidosis that occurs through mechanisms resembling starvation. Pancreaticoduodenectomy is a complex abdominal operation that subjects patients to a prolonged fasting and an inflammatory state. This study examined the incidence of euglycemic diabetic ketoacidosis and potential opportunities for early diagnosis and management in patients undergoing pancreaticoduodenectomy.A single-institution retrospective review of 350 patients who underwent pancreaticoduodenectomy between 2017 and 2020 was performed. Primary endpoints were peak beta-hydroxybutyrate levels, peak lactate levels, lowest pH, peak base deficits, and urinary output within the first 24 hours, postoperatively. Additional endpoints included incidence of postoperative pancreatic fistula, delayed gastric emptying, total complications, postoperative hospital length of stay, readmission rates, and changes in insulin regimen at discharge.Of the 350 cases reviewed, 39 (11.1%) patients developed euglycemic diabetic ketoacidosis. Male sex and pancreatic cancer were associated with a risk for euglycemic diabetic ketoacidosis (P.05). Patients with euglycemic diabetic ketoacidosis had significantly higher peak beta-hydroxybutyrate levels than patients without euglycemic diabetic ketoacidosis (mean difference = 19.8 mg/dL, 95% confidence interval = 14.7-24.9, P.001), and were nearly four times more likely to require insulin at discharge (odds ratio 3.8, 95% confidence interval = 1.1-13.0, P.05).This is the first large descriptive study that investigates euglycemic diabetic ketoacidosis after pancreaticoduodenectomy. Euglycemic diabetic ketoacidosis after pancreaticoduodenectomy is associated with significantly higher beta-hydroxybutyrate levels and new or increased insulin requirement at discharge. Our study demonstrates potential markers for euglycemic diabetic ketoacidosis after pancreaticoduodenectomy, offering an opportunity to identify and successfully treat this disease in a timely manner.

Background and Objective: To utilize quantitative ultra widefield retinal imaging to investigate the risk factors associated with the incidence and severity of postoperative epiretinal membrane (ERM) in patients who underwent primary rhegmatogenous retinal detachment (RRD) repair. Patients and Methods: This retrospective study included patients who underwent pars plana vitrectomy (PPV) with scleral buckle (SB) for RRD, without a prior history of ERM, and who underwent ultra widefield imaging postoperatively between June 2020 and February 2022. The size and location (distance from the macula) of the drainage retinotomy and the area of peripheral pathology, including retinal breaks and laser scars, were quantitatively measured with cloud-based software. The severity of postoperative ERM formation at 6 months was graded from grade 1 to 4. We investigated the risk factors that were significantly associated with the incidence and severity of postoperative ERM at 6 months. Results: We included 80 eyes (80 patients) in this study. Postoperative ERM developed in 37 eyes (46%) at 6 months. The severity of ERM was grade 1 in 24 eyes (65%), grade 2 in 6 eyes (16%), grade 3 in 4 eyes (11%), and grade 4 in 3 eyes (8%). Postoperative ERM was not associated with the presence or the location of drainage retinotomy ( P = 0.836 and 0.820, respectively). However, it was significantly associated with larger surface area of drainage retinotomy ( P = 0.039). In addition, postoperative ERM was significantly associated with a larger area of peripheral pathology ( P = 0.012), a larger extent of RRD ( P = 0.013), vitreous hemorrhage ( P = 0.026), redetachment within 6 months ( P = 0.022), use of silicone oil as a tamponade ( P = 0.047), and number of surgeries within 6 months ( P = 0.027). These factors, in addition to 360° endolaser, were also significantly associated with the severity of postoperative ERM. In multivariable linear regression analysis, the only variable that remained statistically significant was the size of the drainage retinotomy ( P = 0.023). Conclusion: The pathogenesis of postoperative ERM is multifactorial. Large drainage retinotomies may increase the risk of ERM formation. [ Ophthalmic Surg Lasers Imaging Retina 2023;54:206–216.]

To identify baseline ocular and systemic factors associated with central subfield thickness (CST) fluctuations in patients with diabetic macular edema (DME) using data from Diabetic Retinopathy Clinical Research Protocols T and V.Post hoc analysis of clinical trial databases.Patients in Protocols T and V.The standard deviation (SD) of all recorded CSTs for each patient during each Protocol's study period was calculated. The CST SD (corresponding to CST fluctuations) for each patient was analyzed against baseline ocular and systemic factors using linear regression analyses. Each Protocol was analyzed separately.Factors associated with CST fluctuations.A total of 1197 eyes of 1197 subjects were included. In Protocol T (559 eyes, mean CST SD was 56.4 ± 35.1 microns), using multivariate linear regression analysis, baseline urine albumin/creatine ratio (for every 1000 mg/g, CST point estimate 3.50, 95% confidence interval [CI] 0.58 to 6.43,Worse visual acuity at baseline, baseline renal disease, hypertension, female gender, type 1 diabetes, and delayed anti-VEGF treatment may be associated with increased CST fluctuations in patients with DME. Addressing these parameters may limit CST fluctuations and help identify patients requiring more frequent monitoring or treatment.