The relationship between diabetes mellitus and ocular complications has been extensively studied by many authors. Diabetic keratopathy has already been well characterized and defined as a clinical entity. This review focuses on exploring corneal epithelial changes in diabetic patients, aiming to provide a pragmatic overview of the existing knowledge on this topic. The paper systematically examines alterations in corneal epithelial structure and their impact on diabetic patients. Advanced imaging techniques are also discussed for their role in precise characterization and improved diagnostics. Additionally, the paper explores the mechanisms behind corneal epithelial changes in diabetes, looking at factors such as hyperglycemia, oxidative stress, and Advanced Glycation End-Products. The impact of altered corneal epithelial integrity on barrier function and susceptibility to external issues is considered, addressing potential links to heightened proteolytic enzyme activities and delayed wound healing observed in diabetic individuals. The review also covers the practical implications of corneal epithelial changes, including the association with corneal erosions, persistent epithelial defects, and an increased risk of dry eye syndrome in diabetic patients.

Background and Objectives: Lower extremity amputations (LEAs) represent a significant health problem. The aim of our study was to analyse the type and trends of diabetes-related LEAs in patients hospitalized in one surgical centre in Bucharest between 2018 and 2021. The second aim was to assess the impact of the COVID-19 pandemic on the trends of LEAs. Materials and Methods: We performed a retrospective analysis of all lower limb amputations performed between 01 January 2018 and 31 December 2021 in the Department of Surgery, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania. We evaluated demographic parameters, type of LEA, the level, the laterality and trends of the amputations, the main aetiologies leading to amputation, and the length of hospitalization. Results: During the study period, 1711 patients underwent an LEA. The mean age was 64.53 ± 9.93 years, 71.6% (n = 1481) being over 60. Men outnumbered women by a ratio of 3.62:1. The most frequent interventions were ray amputations in 41.2% (n = 705) of patients; then, there were amputations of the toe (20.4%, n = 349), transtibial amputations (18.9%, n = 323), transfemoral amputations (10.6%, n = 181), and midfoot amputations (9%, n = 154). Wet gangrene was the most frequent aetiology (40.9%, n = 699). The total number of LEAs decreased constantly throughout the analysed period, such that 616 LEAs were performed in 2018 and 323 LEAs in 2021 (p < 0.001). There was a statistically significant increase in the rate of major LEAs in the pandemic vs. pre-pandemic period (37% vs. 24.4%, p < 0.001). Conclusions: In our study, the total number of LEAs decreased throughout the analysed period, but there was an increase in the rate of major LEAs in the pandemic vs. pre-pandemic period. Being over 65 years of age, leucocytosis, sepsis at presentation, and diabetic polyneuropathy were important risk factors for the necessity of LEA in complicated diabetes-related foot disease.

Background: Diabetic neuropathy affects almost half of diabetic patients, yet the relative contributions of metabolic, vascular and clinical factors remain controversial. We aimed to investigate which risk factors are more associated with reduced corneal nerve fiber length (CNFL). Methods: This is a cross-sectional study of 30 patients with type 2 diabetes. We assessed metabolic parameters (HbA1c, lipids), vascular measurements (Doppler ultrasonography of carotid and ophthalmic arteries, central vessel density measured by optical coherence tomography angiography), and corneal epithelial thickness. We explored the data using network analysis, then applied penalized mixed-effect regression (in which $\beta$ represents the standardized coefficients with mean 0 and unit standard deviation), followed by generalized additive models and polynomial transformations. Results: Penalized regression identified vascular parameters as dominant predictors: carotid plaques ($\beta$ = −0.609) and intima-media thickness ($\beta$ = −0.574) showed the strongest associations with CNFL. Traditional metabolic markers including HbA1c failed to meet selection thresholds. Bifurcation velocity ($\beta$ = −0.313) and corneal sensitivity measures ($\beta$ = 0.278–0.135) were also significant. The non-linear modeling showed complex vascular–structural interactions. Conclusions: Vascular compromise, particularly carotid disease, had the highest association with CNFL in our cohort. Thus, our study reports a higher effect of vascular parameters than HbA1c in patients with a longer history of diabetes. This may reflect the progression of diabetic complications, where initial metabolic insults are followed by vascular pathology as the primary driver of end-organ damage. Our findings highlight the need for carotid artery screening in diabetic patients for a better estimation of the neuropathy risk.

Introduction: Low and ultralow colorectal anastomoses, used in the surgical treatment of lower rectal cancer, are associated with an increased risk of anastomotic fistula and local complications, especially in the context of sphincter-sparing procedures. Near-infrared/ICG fluorescence technology enables objective assessment of tissue viability and can influence intraoperative decisions by modifying the transection level or adjusting the anastomotic configuration. Clinical data and the literature suggest a more pronounced potential benefit in anastomoses located at 4–8 cm from the anal margin, where vascular reserve is limited.Methods and Results: We conducted a prospective study at our service during 2021–2025, including patients in whom the ICG/NIR intraoperative technique was used, with a predilection for colorectal tumor pathology. In 2021–2025, our department surgically treated 420 patients with colorectal cancer, of whom 70 had rectal cancer, with 27 undergoing sphincter-sparing resections and the rest undergoing abdominoperineal amputation. Indocyanine green (ICG) was used in 22 cases to evaluate the viability of colonic segments and the perfusion of anastomoses, aiming to optimize reconstructive safety. Our department’s experience indicates an upward trend in restorative procedures, but this is accompanied by an increase in morbidity due to local complications, which necessitates integrating modern perfusion assessment methods, such as ICG, into treatment algorithms.Conclusions: Preservation of the anal sphincter remains an important goal for patients and a technical and oncologic challenge for the surgeon, requiring careful selection, rigorous counseling, and standardized intraoperative evaluation of perfusion. ICG/NIR technology can be a truly helpful instrument in the surgical decision-making process, influencing the surgical strategy and the postoperative evolution of patients.

(1) Background: Diabetic retinopathy and peripheral arterial disease co-occur through shared endothelial pathophysiology. Ankle-brachial index (ABI), the standard peripheral screening tool, demonstrates poor sensitivity (35%) in diabetic cohorts due to medial arterial calcification. We comparatively assessed the association of peak-systolic velocity of posterior/anterior tibial artery ratio (PT:AT) versus that of traditional pressure-based (ABI) with foveal avascular zone (FAZ), a marker of retinal ischemia, and thus hypothesized that PT:AT would demonstrate stronger association with FAZ compared to ABI in our cohort. (2) Methods: Cross-sectional pilot study of 30 type 2 diabetes mellitus patients. We aimed to enhance the robustness of our results using five convergent statistical methods. (3) Results: PT:AT showed strong association with FAZ (r = 0.471, p = 0.0086, 95% CI [0.13, 0.71]), with convergent evidence across all five analytical methods. ABI showed no effect (r = −0.024, p = 0.901, 95% CI [−0.38, 0.34]). We showed that velocity-based metrics identify microvascular dysfunction, whereas the pressure-based ABI does not. The mediation analysis showed that the relation of PT:AT to FAZ is not significantly mediated by the resistivity index of ophthalmic artery. (4) Conclusions: In this pilot study, velocity-based tibial hemodynamics showed a stronger cross-sectional relationship with retinal microvascular damage compared to pressure-based ABI. These preliminary findings suggest PT:AT assessment may complement ABI screening in diabetic foot clinics to identify patients requiring intensive retinal surveillance. Multicenter validation is required before clinical implementation.

Background. High-grade serous ovarian carcinoma is often diagnosed at an advanced stage, in which optimal cytoreduction, defined as no gross residual disease following surgery, is critical for survival. In patients with high tumor burden, neoadjuvant chemotherapy followed by interval debulking surgery is a valid alternative. Objectives. To describe a rare case of complete pathological response after neoadjuvant chemotherapy and its prognostic implications. Case report. A 75-year-old woman was diagnosed with FIGO stage IIIC high-grade serous ovarian carcinoma. Due to poor performance status and extensive disease, she received four cycles of platinum–taxane-based neoadjuvant chemotherapy, resulting in a complete radiologic response according to RECIST 1.1 criteria. Interval debulking surgery achieved complete cytoreduction, and histopathology confirmed a complete pathological response. Adjuvant and maintenance therapy were not administered, as the patient declined further treatment. After approximately six years of follow-up, the patient remains disease-free. Conclusions. Complete pathological response after neoadjuvant chemotherapy is rare and may predict prolonged disease-free survival, warranting further investigation into predictors of treatment response.