Postoperative complications such as dry eye, ocular surface pain, and abnormal wound healing responses, including fibrosis or ectasia, remain a significant concern in corneal, refractive, and cataract surgeries as they occur even in those patients without the classical clinical risk factors. Persistent low-grade or subclinical ocular surface inflammation in these patients may have contributed to these suboptimal outcomes. Inflammatory factors such as IL-1β, IL-6, IL-17A, TNFα, IFNγ, and/or MMP-9 are reported to be higher on the ocular surface of patients with either overt or subclinical inflammation. These inflammatory factors disrupt tissue homeostasis and wound healing response as they (i) sensitize nociceptive (pain) pathways, (ii) destabilize cell-cell adhesion, (iii) increase TGFβ-dependent or independent extracellular matrix (ECM) deposition leading to scarring, and/or (iv) cause ectasia by decreasing ECM deposition and natural collagen cross-linking. These effects of molecular risk factors can be mitigated by preoperative BIOLOGICAL CLEANSING strategies designed to reduce the load of these inflammatory factors on the ocular surface. Depending on the clinical presentation and inflammatory load status, biological cleansing using (i) lubricants; (ii) eyelid hygiene; (iii) ocular surface washes; (iv) topical or oral nutraceuticals; (v) nonpharmacological treatments, such as thermal pulsation therapy and intense light therapy; (vi) topical immunomodulators, such as cyclosporine, tacrolimus, steroids, and Lifitegrast; and (vii) lifestyle modifications, such as diet and probiotics, can be followed. We and others have shown a reduction in these inflammatory factors on the ocular surface using one or more of these strategies. Incorporating biological cleansing protocols into presurgical preparation is a vital step toward modulating ocular surface biology to improve postoperative outcomes for patients.

Scopulariopsis brevicaulis is an uncommon cause of fungal keratitis, usually occurring after ocular trauma, and is associated with therapeutic difficulties because of its limited susceptibility to antifungal agents. We report the case of a 48-year-old man who presented with pain, redness, and watering of the left eye for one month following injury by iron foreign body particles during welding. Ocular examination revealed a corneal ulcer with hypopyon and markedly reduced visual acuity (2/60). Initial microscopic evaluation was negative for fungal elements; however, fungal culture after extended incubation yielded growth of S. brevicaulis, identified based on colony characteristics and microscopic morphology. Imaging further demonstrated left-sided dacryoadenitis. The patient was treated conservatively with intensive topical natamycin and voriconazole, along with systemic ketoconazole and supportive topical antibiotics. This approach led to clinical improvement, although some degree of visual impairment persisted. This case highlights the importance of maintaining a high index of suspicion, allowing prolonged incubation of fungal cultures, and initiating timely targeted antifungal therapy in rare mould keratitis to achieve favorable outcomes and potentially avoid surgical intervention.

Ocular fungal diseases are associated with severe infection and pain and, in advanced stages, can lead to vision loss. Current treatment options are limited to the topical application of conventional drugs, and the bioavailability of these drugs is quite limited due to ocular barriers. In this study, a dual-drug nanodelivery system was developed to improve intraocular drug delivery by combining antifungal and anti-inflammatory therapies. Posaconazole (PSC), a broad-spectrum triazole antifungal agent, and dexketoprofen trometamol (DKP), a rapidly acting nonsteroidal anti-inflammatory drug, were co-loaded onto polymeric micelles and then incorporated into electrospun poly(vinyl alcohol)/poly(vinylpyrrolidone) (PVA/PVP) nanofiber intraocular implants. DSC, XRD, FTIR, and FESEM analyses showed that both APIs were successfully converted into nanofiber form without disrupting the micelle structure. Comparative studies with DKP solution and PSC commercial oral suspension (Noxafil® 40 mg/mL) showed that the produced micelle-loaded nanofibers provided sustained release and significantly increased ex vivo ocular permeation and penetration. In vitro antifungal activity tests demonstrated efficacy against Candida albicans, and HET-CAM toxicity tests showed that the micelle-loaded nanofibers were non-irritating and suitable for ocular application. Overall, the micelle-loaded electrospun nanofiber ocular inserts developed in this study represent a promising platform for combined antifungal and anti-inflammatory ocular therapy.

Background/Objectives: Digital media play an important role in the lives of contemporary adolescents. While associated with many benefits, they also pose risks to physical health related to prolonged screen time and non-ergonomic body posture. This study analyzed the frequency of self-reported physical complaints among Polish adolescents in relation to time spent on different screen-based activities. Methods: The study included 9083 students aged 13-17 who completed an online survey in March and April 2024 in schools located in western Poland (approximately 30% of the region's student population). Physical symptoms selected from the HBSC-SCL instrument were analyzed and supplemented with neck or shoulder pain and eye strain. Results: Longer screen time was associated with more frequent occurrence of all analyzed complaints. A 5-item index ranging from 0 to 20 points was proposed, including headache, neck or shoulder pain, eye strain, dizziness, and problems falling asleep (mean 6.56 ± 5.15). The index showed reliability at the level of α = 0.744 and good model fit according to CFA (RMSEA = 0.025). In a multivariate linear regression model (R[2] = 0.153), after adjusting for age, gender, place of residence, and family affluence, the variability of this index was most strongly associated with time spent on social media (β = 0.40) and browsing websites (β = 0.30). Gender-specific models were also compared. Conclusions: The results confirm the co-occurrence of physical complaints during adolescence and a significant association between their severity and screen-based activities, particularly engagement in social media.

This contemporary review examines health care disparities that pediatric patients may experience throughout the perioperative period, focusing on the ambulatory surgery setting. Existing literature focused on outcomes during inpatient procedures; however, disparities may manifest preoperatively, intraoperatively and postoperatively in the outpatient setting. Inequities related to race/ethnicity, geographic location, language barriers, insurance status, and utilization of perioperative services are highlighted. Strategies to mitigate these disparities in the ambulatory setting include selecting patients carefully, encouraging accreditation of facilities, and increasing the number of fellowship-trained pediatric anesthesiologists. Future opportunities include system-level changes to promote more equitable perioperative care in the ambulatory setting.

This review synthesizes best practices for ambulatory pediatric tonsillectomy with or without adenoidectomy in ambulatory surgery centers. It emphasizes rigorous patient selection-particularly for severe obstructive sleep apnea, age, obesity, and complex comorbidities-along with individualized anesthetic plans (induction and airway choice), multimodal opioid-sparing analgesia, and robust post-operative nausea and vomiting prophylaxis. Standardized post-anesthesia care unit monitoring, discharge criteria, caregiver education, and escalation pathways address common complications (airway events, hemorrhage, pain, dehydration). Preparedness-pediatric advanced life support-certified staff, emergency equipment, and transfer agreements-underpins safety. Quality-improvement initiatives and emerging tools offer avenues to further reduce morbidity and unplanned admissions.

Ambulatory surgical centers (ASCs) are projected to increase in numbers for a myriad of reasons. They provide a cost effective, efficient way to render medical care in a setting that is often also more convenient for patients and families. As a result of this growth, several questions arise for the ideal pediatric patient candidate for this setting. This review highlights selection criteria such as patient age, cardiopulmonary status, and preoperative comorbidities to further elucidate appropriate selection criteria for pediatric patients in ASCs.

The number of patients taking glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose co-transporter 2 (SGLT 2) inhibitors presenting for elective surgery is increasing. Patients taking GLP-1 RAs with the highest risk of aspiration are non-fasters who have recently initiated the drug, have had a recent dose escalation, and/or have active gastrointestinal symptoms. Asymptomatic patients on stable doses of GLP-1 RAs can continue the medication throughout the peri-operative period. SGLT 2 inhibitor use carries a risk of euglycemic diabetic ketoacidosis, particularly in patients on insulin with prolonged fasting and should be held prior to elective procedures.

Tail docking with rubber rings is a routine husbandry procedure in lambs that induces pain and stress, and these effects may be modulated by social context. In lambs, the effects of sibling presence have been confounded by factors such as maternal contact or environmental enrichment. The aim of this study was to compare behavioral and physiological responses to tail docking with rubber rings in weaned twin lambs housed with either their docked or undocked sibling, or with familiar docked or undocked lambs. Forty-two 4-month-old lambs were tail docked with rubber rings and pair-housed with: (1) undocked sibling (UND-SI, n=10); (2) docked sibling (DOC-SI, n=10); (3) undocked familiar lamb (UND-FL, n=11); or (4) docked familiar lamb (DOC-FL, n=11). Behaviors were continuously recorded for 27 min surrounding the procedure (10 min before and 17 min after). Heart rate, rectal temperature, and eye surface temperature were measured immediately before and 40 min after the procedure. The percentage of change of each physiological variable was calculated relative to its baseline value. Lambs housed with undocked siblings reduced both tail-wagging events (UND-FL vs UND-SI: P=0.004) and agonistic behaviors (UND-FL vs UND-SI: P=0.003). In contrast, those housed with docked siblings increased both tail-wagging events (DOC-FL vs DOC-SI: P=0.0001) and the percentage of change in eye surface temperature (DOC-FL vs DOC-SI: P=0.002). In conclusion, housing tail-docked lambs with UND-SI attenuated behavioral indicators of pain, including tail-wagging and agonistic behaviors, whereas co-housing with DOC-SI intensified both tail-wagging and the change in eye surface temperature.

We report a case of fungal endophthalmitis caused by the rare fungus Fusicolla species in a 32-year-old female presenting with redness and pain in the right eye. The case illustrates the challenges in diagnosing infectious uveitis and highlights the importance of molecular diagnostics in identifying rare fungal pathogens. This is the first documented case of ocular involvement associated with this species.