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Necrotizing scleritis is the most destructive and vision-threatening form of scleritis. Necrotizing scleritis can occur in systemic autoimmune disorders and systemic vasculitis, as well as following microbial infection. Rheumatoid arthritis and granulomatosis with polyangiitis remain the commonest identifiable systemic diseases associated with necrotising scleritis. Pseudomonas species is the most common organism causing infectious necrotizing scleritis, with surgery the most common risk factor. Necrotizing scleritis has the highest rates of complications and is more prone to secondary glaucoma and cataract than other phenotypes of scleritis. The differentiation between non-infectious and infectious necrotizing scleritis is not always easy but is critical in the management of necrotizing scleritis. Non-infectious necrotizing scleritis requires aggressive treatment with combination immunosuppressive therapy. Infectious scleritis is often recalcitrant and difficult to control, requiring long-term antimicrobial therapy and surgical debridement with drainage and patch grafting due to deep-seated infection and the avascularity of the sclera. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the impact of scleral lenses (SLs) on higher‑order aberrations (HOAs), corrected distance visual acuity (CDVA), and contrast sensitivity (CS) in pellucid marginal degeneration (PMD) eyes. Methods: SLs were fitted in 24 eyes diagnosed with PMD. CDVA, CS, and HOAs were measured at baseline and with the lens on the eye. The HOAs were measured using an i‑Trace aberrometer. Results: A statistically significant improvement was noted in CDVA (P < 0.001) with BSS lenses (0.05 ± 0.04) compared to baseline (0.42 ± 0.06). Front surface eccentricity 1 (FSE1) lens provided the best CDVA in most of the eyes. The baseline CS of 1.24 ± 0.74 improved to 1.58 ± 0.48 with SL and reported a statistically significant improvement (P < 0.001) and a gain of 6 letters. The baseline higher order‑root mean square (HO‑RMS) was 0.89 ± 0.53 µm, which reduced to 0.38 ± 0.24 µm (P < 0.001), and RMS coma of 0.45 ± 0.29 µm improved to 0.20 ± 0.12 µm (P < 0.001). Though there was a marginal reduction from 0.04 ± 0.14 to 0.03 ± 0.07, RMS spherical aberration did not show any statistically significant difference (P = 0.37). RMS secondary astigmatism reduced from 0.17 ± 0.15 µm to 0.08 ± 0.12 µm (P = 0.007), and RMS trefoil reduced to 0.13 ± 0.09 µm from 0.64 ± 0.36 µm (P < 0.001) with SLs and showed statistically significant improvement. Conclusion: SLs can be considered an effective option that corrects a significant amount of HOAs and enhances visual performances in PMD eyes. [ABSTRACT FROM AUTHOR]

Background: Emergence agitation is a complex syndrome of altered consciousness after emergence from anesthesia. It can result in injury to patients and staff and is associated with other postoperative complications. Sevoflurane has been associated with emergence agitation, potentially due to low tissue solubility and therefore speed of emergence. Prior meta‐analyses comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics did not demonstrate a statistically significant difference. Given the publication of additional relevant studies not included in prior meta‐analyses as well as improved diagnosis of emergence agitation, we aim to perform an updated, comprehensive meta‐analysis comparing emergence agitation incidence between sevoflurane and isoflurane anesthetics in children. Methods: We conducted an updated systematic review and meta‐analysis of clinical trials comparing sevoflurane to isoflurane in children <18 years of age, reporting emergence agitation as an outcome, published before July 2023 using databases and registers. Our primary outcome was the incidence of emergence agitation. Secondary outcomes were time to extubation, awakening time, and length of stay in the postanesthetic care unit. We assessed the risk of bias using the Cochrane Risk of Bias tool version 2. We pooled the effect size for the outcomes using the fixed effects model if we had low heterogeneity, otherwise, we used a random‐effects model. Results: Eight randomized controlled trials (523 children) were included in the final analysis. The incidence of emergence agitation after isoflurane was significantly lower compared to sevoflurane (risk ratio: 0.62 (95% CI: [0.46–0.83]; I2 = 40.01%, p <.001)). Time to extubation, awakening times, and postanesthetic care unit duration were not significantly different. The protective effect of isoflurane compared to sevoflurane remained significant in subgroups of patients who received premedication or intraoperative systemic analgesics (risk ratios: (0.48 [0.28–0.82]; I2 = 60.78%, p =.01), (0.52 [0.37–0.75]; I2 = 0.00%, p <.001), respectively). Conclusion: The risk of emergence agitation in children after maintenance anesthesia with sevoflurane is significantly greater than with isoflurane; we did not find evidence of prolonged emergence or postanesthetic length of stay. When possible, isoflurane should be considered for maintenance anesthesia over sevoflurane in patients at high risk of emergence agitation. [ABSTRACT FROM AUTHOR]