To assess the effect of an internal limiting membrane (ILM) flap (IF) in MH surgery on best-corrected visual acuity (BCVA) and integrity of the ellipsoid zone (EZ) and external limiting membrane (ELM). Patients were included who had successful surgery for MH <400µm with or without an IF. Main outcome measures were BCVA and restoration of the ELM and EZ at 12 months. 60 patients were included, 36 with conventional peeling and 24 with an IF. BCVA improved from 0.74 (±0.30) logMAR (20/110 Snellen) to 0.26 (±0.20) (20/36 Snellen) in patients without and from 0.77 (±0.32) logMAR (20/118 Snellen) to 0.18 (±0.12) (20/30 Snellen) in patients with an IF, respectively. There was no difference in the integrity of the EZ and ELM in patients with or without an IF at either 3 (p=0.58, p=0.20), 6 (p=0.81, p=0.10) or 12 months (p=0.60, p=0.20) or in BCVA at 3 (p=0.24), 6 (p=0.18) and 12 months (p=0.11). In the multivariable model, only pre-operative BCVA (p<0.01), EZ integrity (p=0.001) and age (p<0.01) were associated with post-operative BCVA. In patients undergoing surgery for MH <400µm the use of an IF did not affect BCVA or the integrity of the EZ and ELM. In patients undergoing surgery for MH less then 400µm the use of an IF did not affect BCVA or the integrity of the EZ and ELM. To reduce the total clinic visit duration among retina providers in an academic ophthalmology department. All patient encounters across all providers in the department were analyzed to determine baseline clinic visit duration time, defined as the elapsed time between appointment time and checkout. To increase photography capacity, a major bottleneck identified through root cause analysis, four interventions were implemented training ophthalmic technicians to perform fundus photography in addition to OCTs, relocating photography equipment to be adjacent to exam rooms, procuring three additional Optos widefield retinal photography units, and shifting staff schedules to better align with that of the providers. These interventions were implemented in the clinics of two retina providers. The average baseline visit duration for all patients across all providers was 87 minutes (19550 patient visits). The prior the average visit duration was 80 minutes for provider 1 (557 patient visits) and 81 minutes for provider 2 (1246 patient visits). In the four weeks after interventions were implemented, the average visit duration decreased to 60 minutes for provider 1 and 57 minutes for provider 2. A systematic approach and a multi-disciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations. A systematic approach and a multi-disciplinary team resulted in targeted, cost-effective interventions that reduced total visit durations. To determine whether optical coherence tomography angiography is of diagnostic utility for Susac syndrome (SuS) by quantifying microvascular retinal changes. We enrolled 18 eyes of 9 healthy controls and 18 eyes of 9 patients with chronic SuS (12 had previous branch retinal artery occlusions and 6 were clinically unaffected). Images of the fovea were taken using an optical coherence tomography angiography system. Analysis included vessel density, fractal dimension, vessel diameter and measurements of the foveal avascular zone (area, eccentricity, acircularity index, axis ratio) in deep and superficial retinal layers. Skeleton density and inner ring vessel density was significantly lower in patients with SuS (SD Susac 0.11±0.01 vs. controls 0.12±0.01, p=0.027. VD SuS 0.39±0.04 vs. controls 0.42±0.02, p=0.041). https://www.selleckchem.com/products/Irinotecan-Hcl-Trihydrate-Campto.html Eccentricity and axis ratio were significantly higher in patients with SuS (EC Susac 0.61±0.11, controls 0.51±0.10, p=0.003; AR Susac 1.57±0.28, controls 1.39±0.11, p=0.005). SuS eyes (affected and unaffected) had poorer outcomes of the remaining vascular parameters compared to controls (p>0.05). OCTA identified chronic microvascular changes in the eyes of patients with chronic SuS. Even clinically unaffected SuS eyes showed poorer vascular parameters. Although further research is needed, this non-invasive imaging modality appears to have potential to serve as a valuable additive diagnostic tool. OCTA identified chronic microvascular changes in the eyes of patients with chronic SuS. Even clinically unaffected SuS eyes showed poorer vascular parameters. Although further research is needed, this non-invasive imaging modality appears to have potential to serve as a valuable additive diagnostic tool. The addition of a small dose of opioids during epidural labor analgesia can enhance the local analgesic effect, reduce the dose of local anaesthetic required, and minimize motor blockade. For the treatment of visceral pain, studies have shown that κ-opioid receptor agonist are more effective than μ-receptor agonists. This study compared the effectiveness of epidural nalbuphine and sufentanil in combination with ropivacaine for labor analgesia, respectively. We conducted a prospective, randomized, double-blind, multicentre clinical trial. Parturients who requested labor pain relief were randomly assigned to either the nalbuphine group or sufentanil group. After 5 minutes of initial dose, parturients in nalbuphine group received 10 mL 0.1% ropivacaine plus 0.3 mg/mL nalbuphine solution. The sufentanil group received the same ropivacaine dose plus 0.3 μg/mL sufentanil. The primary outcome was the duration of analgesia (the time to the first requirement for additional medication). Secondary outcomes included the ropivacaine dose per hour, and adverse reactions. Between November 2018 and February 2019, 180 parturients were recruited for the study. The study showed that the duration of analgesia was shorter in the nalbuphine group as compared with the sufentanil group (P=0.040). The ropivacaine dose per hour in nalbuphine group 9.3 (2.4) mg was significantly greater versus sufentanil group 8.4 (2.5) mg (P=0.024). No serious adverse events directly associated with the analgesics were observed. The analgesia effects of 0.3 mg/mL nalbuphine with ropivacaine are inferior to 0.3 μg/mL sufentanil with ropivacaine in labor analgesia. No serious side effects, either in the mother or in the fetus, were observed. The analgesia effects of 0.3 mg/mL nalbuphine with ropivacaine are inferior to 0.3 μg/mL sufentanil with ropivacaine in labor analgesia. No serious side effects, either in the mother or in the fetus, were observed.