Primary slow-coagulation transscleral cyclophotocoagulation laser treatment for medically recalcitrant neovascular glaucoma

2021 ◽  
pp. bjophthalmol-2021-319757
Author(s):  
Mohamed M Khodeiry ◽  
Alison J Lauter ◽  
Mohamed S Sayed ◽  
Ying Han ◽  
Richard K Lee
Keyword(s):  
Continuous Wave ◽  
Surgical Intervention ◽  
Neovascular Glaucoma ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Slow Coagulation ◽  
Minimum Angle ◽  
Transscleral Cyclophotocoagulation ◽  
Cumulative Probabilities

AimsTo report treatment outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (TSCPC) as an initial surgical intervention in patients with neovascular glaucoma (NVG).MethodsA retrospective study including 53 patients (mean age of 69.6±16.6 years and mean follow-up of 12.7±8.9 months) with a diagnosis of NVG and no previous incisional glaucoma or cyclophotocoagulation surgeries. All patients underwent slow-coagulation continuous-wave TSCPC (1250-milliwatt power and 4-second duration).Primary outcome measure was surgical success defined as an intraocular pressure (IOP) from 6 to 21 mm Hg with a reduction ≥20% from baseline, no reoperation for glaucoma and no loss of light perception vision. Secondary outcome measures include IOP, glaucoma medications, visual acuity (VA) and complications.ResultsIOP decreased from 40.7±8.6 mm Hg preoperatively to 18.4±12.2 mm Hg postoperatively (p<0.001). The preoperative number of glaucoma medications dropped from 3.3±1.1 at baseline to 2.0±1.5 at the last postoperative visit (p<0.001). The cumulative probabilities of success at 12 and 24 months were 71.7% and 64.2 %, respectively. Mean logarithm of the minimum angle of resolution VA was relatively unchanged from 2.27±0.63 to 2.25±0.66 at the last follow-up visit (p=0.618). The most common observed complications were decrease in baseline VA (13.2%) and anterior chamber inflammation (9.4%).ConclusionsSlow-coagulation TSCPC is an effective and relatively safe initial surgical intervention in medically uncontrolled NVG.

Intermediate-term outcomes of the Aurolab aqueous drainage implant in neovascular glaucoma

2021 ◽  
pp. bjophthalmol-2021-319999
Author(s):  
Subathra Gnanavelu ◽  
George Varghese Puthuran ◽  
Kousalya Pavani Chiranjeevi ◽  
Hiruni Kaushalya Wijesinghe ◽  
Vishnuvardhan Reddy ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
Neovascular Glaucoma ◽  
Primary Outcome Measure ◽  
Vein Occlusion ◽  
Minimum Angle ◽  
Cumulative Rate ◽  
Surgical Failure ◽  
The Mean ◽  
Rate Of Failure

PurposeTo assess the outcomes of the non-valved Aurolab aqueous drainage implant (AADI) in neovascular glaucoma (NVG).MethodsData of consecutive patients with NVG who underwent AADI and had a minimum follow-up of 2 years were included. The primary outcome measure was the cumulative rate of surgical failure defined as intraocular pressure (IOP) >21 mm Hg or reduced <20% below baseline, IOP ≤5 mm Hg, reoperation for glaucoma or a complication, or loss of light perception vision.ResultsWe included 85 eyes of 85 patients with NVG, with a mean age of 61.2±9.3 years. The most common aetiologies were proliferative diabetic retinopathy (n=43) and central retinal vein occlusion (n=24). The mean IOP decreased from 36.8±12.5 mm Hg at baseline to 15.8±7.5 mm Hg at 2-year follow-up (p<0.001) and the number of IOP-lowering medications reduced from 3.4±0.8 to 1.5±1.1 (p<0.001). The cumulative rate of failure increased from 3.1% (95% CI 1.1% to 11.8%) at 1 year to 33.8% (95% CI 20.4% to 52.5%) at 2 years. Multivariable analysis showed that eyes with open angles had a lower risk of failure (HR 0.17, 95% CI 0.10 to 1.03, p=0.09). The logarithm of minimum angle of resolution visual acuity declined from 0.98±0.7 to 1.8±1.0 at 2 years (p<0.001).ConclusionApproximately one-third of NVG eyes that received the AADI failed after 2 years of follow-up similar to other series. Early AADI implantation at the open angle stage of NVG may yield better results.

Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

2021 ◽  
pp. neurintsurg-2021-017341
Author(s):  
Devin V Bageac ◽  
Blake S Gershon ◽  
Jan Vargas ◽  
Maxim Mokin ◽  
Zeguang Ren ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Control Group ◽  
Anterior Circulation ◽  
Guide Catheter ◽  
Catheter Failure ◽  
Catheter Technology ◽  
Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

Early results of micropulse transscleral cyclophotocoagulation for the treatment of glaucoma

2019 ◽  
Vol 30 (4) ◽  
pp. 700-705 ◽  
Author(s):  
Alexander T Nguyen ◽  
Jessica Maslin ◽  
Robert J Noecker
Keyword(s):  
Intraocular Pressure ◽  
Continuous Wave ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Angle Closure ◽  
Secondary Outcome ◽  
Early Results ◽  
Pressure Lowering ◽  
Transscleral Cyclophotocoagulation ◽  
The Mean

Purpose: To describe our clinical experience with the efficacy and safety of micropulse transscleral cyclophotocoagulation as a treatment for glaucoma. Methods: In this retrospective case series, we reviewed the charts of 95 consecutive patients with various glaucoma subtypes who underwent micropulse transscleral cyclophotocoagulation. Patients were offered micropulse transscleral cyclophotocoagulation if they had perimetric glaucoma refractory to intraocular pressure–lowering topical medications and who were poor candidates for traditional filtering surgery. Eligible patients were treated with the Micropulse P3 device (IQ 810 Laser Systems; Iridex, Mountain View, CA, USA) at 2.0–2.5 W for a duration of 90 s per hemisphere at a 31.3% duty cycle. If a retreatment was needed, the power was increased to up to 3.0 W with other parameters remaining the same. Patients were considered successfully treated if their intraocular pressure was lowered by at least 20% compared to their baseline. The main outcome measure was post-operative intraocular pressure; secondary outcome measures included the number of adverse events and complications that occurred with treatment. Results: The glaucoma subtypes treated included primary open-angle glaucoma (n = 51), exfoliation glaucoma (n = 24), chronic angle-closure glaucoma (n = 15), and congenital/juvenile glaucoma (n = 5). The mean pre-operative intraocular pressure was 25.1 ± 5.3 mm Hg and the mean post-operative intraocular pressure at 12 months was 17.5 ± 5.1 mm Hg (p = 0.004). The mean number of intraocular pressure–lowering medications used preoperatively was 3.0 ± 1.1; the mean number of medications used at the 12-month post-operative visit was 1.4 ± 1.0 (p = 0.03). Success with one treatment was achieved in 73 (76.8%) of patients. With multiple treatments, all patients had significant intraocular pressure–lowering compared to baseline. The maximum number of treatments received by any single patient was 5. There were no instances of prolonged intraocular inflammation or long-term hypotony. Conclusion: Micropulse transscleral cyclophotocoagulation appears to be a safe and efficacious treatment for glaucoma. Given its improved safety profile compared to continuous-wave transscleral cyclophotocoagulation, it deserves consideration as a primary procedure.

Platelet-Rich Plasma versus Corticosteroid Injections in Rotator Cuff Related Shoulder Pain: A Comparative Study with Up to 18 Months of Follow-Up

2021 ◽  
Author(s):  
Juho Annaniemi ◽  
Jüri Pere ◽  
Salvatore Giordano
Keyword(s):  
Rotator Cuff ◽  
Shoulder Pain ◽  
Platelet Rich Plasma ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Subacromial Injection ◽  
Western Ontario Rotator Cuff ◽  
Feasible Alternative ◽  
Cuff Repair

Abstract Purpose: Given the complications involved in corticosteroid (CS) injections, subacromial platelet-rich plasma (PRP) injections may provide a valid alternative to CS in the treatment of rotator cuff related shoulder pain (RCRSP).Methods: We retrospectively reviewed a total of 98 patients affected by RCRSP who were treated with either subacromial injection of PRP or CS. The PRP group received three injections of autologous PRP at two weeks interval, and the CS group received one injection of CS. Western Ontario Rotator Cuff Index (WORC) was the primary outcome measure, while secondary outcome measures were the Visual Analogue Scale (VAS), Range of Motion (ROM) and need for cuff repair surgery, which were analyzed at interval of 6, 12, and 18 months.Results: A total of 75 patients were included in the analysis (PRP n = 35, CS n = 40). Mean follow-up was (PRP 21.1 ± 8.7 months vs CS 33.6 ± 16.3 months, p <0.001). Both groups showed improvement in WORC, VAS and ROM. No significant differences were detected between the two groups in any of the primary (WORC) or secondary outcomes during 6, 12 and 18 months (all p > 0.05). No adverse events were detected.Conclusion: Both treatments improve RCRSP patient’s symptoms, but none of them seems to result in a significant better outcome in this series of patients. PRP can be a safe and feasible alternative to CS in treatment of RCRSP even at long follow-up, to reduce local and systemic effects involved with CS injections.

scholarly journals Incidence and immediate consequences of electrical shocks among Danish electricians: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046584
Author(s):  
Karin Biering ◽  
Anette Kærgaard ◽  
Ole Carstensen ◽  
Kent Jacob Nielsen
Keyword(s):  
Cohort Study ◽  
Participation Rate ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Exit Point ◽  
Physical Damage ◽  
Electrical Shock ◽  
Health Related ◽  
Electrical Shocks

ObjectivesThe health-related consequences of electrical shocks are mostly studied in patients from selected cohorts in hospital burn units, by making internal comparisons of subgroups, but without comparing them to unexposed individuals, or considering information regarding the preinjury health of the injured persons. Often, little is known about the details of the electrical shocks. Our purpose was to do a longitudinal study of Danish electrical workers, to monitor exposure to electrical shocks weekly over a 6-month period and to determine whether these shocks have short-term, health-related consequences.DesignProspective cohort study with weekly measurements.SettingMembers of the Danish Union of Electricians.ParticipantsOf the 22 284 invited, 6960 electricians (31%) participated in the baseline data collection, and the participation rate in the weekly follow-up ranged from 61% to 81% during the 6 month follow-up.Primary and secondary outcome measuresThe primary outcome measure was an electrical shock and secondary outcomes were the immediate health-related consequences of the shocks.ResultsA total of 2356 electrical shocks were reported by 1612 (23%) of the participants during the 26-week follow-up. Alternating current and voltage below 1000 V were the most common forms of electricity. In most cases, the fingers/hands were the entry and exit points, but many were unable to specify the exit point. The participants categorised 73% of the electrical shocks as ‘not at all severe’, and most of the shocks did not cause any immediate physical damage. However, flashbacks were more common than physical consequences. Only a few of the participants contacted health services following an electrical shock, and even fewer were absent from work.ConclusionNearly one-fourth of Danish electricians experienced one or more electrical shocks during a 26-week period, but most of the shocks are not perceived as severe, and have only limited immediate consequences.

scholarly journals Hybrid Polyetheretherketone (PEEK)–Acrylic Resin Prostheses and the All-on-4 Concept: A Full-Arch Implant-Supported Fixed Solution with 3 Years of Follow-Up

2020 ◽  
Vol 9 (7) ◽  
pp. 2187 ◽  
Author(s):  
Miguel de Araújo Nobre ◽  
Carlos Moura Guedes ◽  
Ricardo Almeida ◽  
António Silva ◽  
Nuno Sereno
Keyword(s):  
Bone Loss ◽  
Subjective Evaluation ◽  
Acrylic Resin ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Marginal Bone Loss ◽  
Mechanical Complications ◽  
Hybrid Prosthesis ◽  
Technical Complication

Background: The aim of this three-year prospective study was to examine the outcome of a solution for full-arch rehabilitation through a fixed implant-supported hybrid prosthesis (polyetheretherketone (PEEK)-acrylic resin) used in conjunction with the All-on-4 concept. Methods: Thirty-seven patients (29 females, 8 males), with an age range of 38 to 78 years (average: 59.8 years) were rehabilitated with 49 full-arch implant-supported prostheses (12 maxillary rehabilitations, 13 mandibular rehabilitations and 12 bimaxillary rehabilitations). The primary outcome measure was prosthetic survival. Secondary outcome measures were marginal bone loss, plaque and bleeding scores, veneer adhesion issues, biological complications, mechanical complications, and the patients’ subjective evaluation. Results: There were two patients (maxillary rehabilitations) lost to follow-up, while one patient withdrew (maxillary rehabilitation). One patient with bimaxillary rehabilitation fractured the mandibular PEEK framework, rendering a 98% prosthetic survival rate. Implant survival was 100%. Average (standard deviation) marginal bone loss at 3-years was 0.40 mm (0.73 mm). Veneer adhesion was the only technical complication (n = 8 patients), resolved for all patients. Nine patients (n = 11 prostheses) experienced mechanical complications (all resolved): fracture of acrylic resin crowns (n = 3 patients), prosthetic and abutment screw loosening (n = 4 patients and 3 patients, respectively), abutment wearing (n = 1 patient). One patient experienced a biological complication (peri-implant pathology), resolved through non-surgical therapy. A 90% satisfaction rate was registered for the patients’ subjective evaluation. Conclusions: Based on the results, the three-year outcome suggests the proposed rehabilitation solution as a legitimate treatment option, providing a potential shock-absorbing alternative that could benefit the implant biological outcome.

A CAMBRA Model For High Caries Risk Indian Children: A Pragmatic Comprehensive Tailored Intervention

2016 ◽  
Vol 40 (1) ◽  
pp. 36-43 ◽  
Author(s):  
Krishan Gauba ◽  
Ashima Goyal ◽  
Neeti Mittal
Keyword(s):  
Pediatric Dentistry ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Healthy Children ◽  
Caries Risk ◽  
Indian Children ◽  
Carious Lesions ◽  
High Caries Risk ◽  
Set Up

Objective: To evaluate a CAMBRA based therapeutic and preventive model for high caries risk children in a pediatric dentistry clinic set-up. Study design: A total of 100 systemically healthy children aged 4–8 years with dmft/DMFT ≥5 and/or ≤20% magnitude of cariogram sector ‘chance to avoid new cavities’ were enrolled. The program comprised of following components i.e. caries risk assessment, customized preventive interventions (Motivational interviewing and counseling, oral prophylaxis, fluoride varnish, fissure sealants) and restorative procedures. The recall intervals were scheduled on the basis of caries risk i.e. every 1 month (≤40% chance to avoid new cavities) and 3 months (≥41% chance to avoid new cavities). The primary outcome measure was ‘new carious lesions' at 12 months following achievement of ‘termination levels' i.e. ≥41% magnitude of ‘chance to avoid new cavities.' The secondary outcome measures were changes in cariogram parameters at termination and duration needed to achieve termination levels. Results: The program showed 97% success rate as 3/100 subjects developed new carious lesions at 12 months follow up. Highly significant (p&lt;0.001) favorable shift was achieved in cariogram parameters at termination. Termination levels were achieved in 2.71±4.854 months. Conclusions: The present CAMBRA based program with customized intervention and recall schedules showed favorable results.

scholarly journals Prognostic value of reduction in left atrial size during a follow-up of heart failure: an observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044409
Author(s):  
Masayuki Shiba ◽  
Takao Kato ◽  
Takeshi Morimoto ◽  
Hidenori Yaku ◽  
Yasutaka Inuzuka ◽  
...  
Keyword(s):  
Heart Failure ◽  
Lower Risk ◽  
Left Atrial ◽  
Primary Outcome ◽  
Outcome Measure ◽  
No Reduction ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Group Change

ObjectiveThe association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF.DesignA multicentre prospective cohort study.SettingThis study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan.ParticipantsThe current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275).Primary and secondary outcomesThe primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF.ResultsThe cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04).ConclusionPatients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.

Micropulse transscleral cyclophotocoagulation in glaucoma treatment. Preliminary results

2021 ◽  
pp. 48-51
Author(s):  
O.Y. Kukleva ◽  
◽  
K.P. Zhukov ◽  
A.K. Drakon ◽  
D.D. Dement'ev ◽  
...  
Keyword(s):  
Primary Open Angle Glaucoma ◽  
Open Angle Glaucoma ◽  
Neovascular Glaucoma ◽  
Open Angle ◽  
Refractory Glaucoma ◽  
Preliminary Results ◽  
Average Decrease ◽  
Micropulse Laser ◽  
Transscleral Cyclophotocoagulation

Objective. To evaluate the preliminary results after micropulse cyclophotocoagulation in patients with primary open-angle refractory glaucoma (POAG) and neovascular glaucoma. Methods. Retrospective study of adult patients with glaucoma, with at least 6 months follow-up after the only one session of micropulse laser therapy. The study included 16 patients, 17 eyes with refractory primary open-angle glaucoma (POAG) and neovascular glaucoma. Follow up period was 6 months. The same surgical technique was used in all cases. The wavelength of the laser beam was 810 nm, the total exposure was 160 s, the energy was 2000 mJ, 31,3% of active cycle, the pulse duration was 0.5 ms, the period was 1.1 ms. Results. The average decrease in IOP was 26.6%. No complications identified Conclusions: micropulse transscleral cyclophotocoagulation has been shown to be safe and effective in lowering IOP in patients with refractory glaucoma. However, further study of this method is required. Key words: micrоpulse transscleral cyclophotocoagulation, glaucoma, intraocular pressure.

A meta-analysis of taxanes in adjuvant chemotherapy (ACT) of early breast cancer (EBC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 545-545 ◽  
Author(s):  
A. K. Nowak ◽  
T. Ferguson ◽  
N. R. Wilcken ◽  
D. Ghersi
Keyword(s):  
Breast Cancer ◽  
Outcome Measures ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Quality Criteria ◽  
Fixed Effect Model ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Significant Heterogeneity

545 Background: Taxanes (docetaxel and paclitaxel) are highly active against breast cancer. Recent trials have examined taxanes as ACT for EBC. The objective of this meta-analysis is to compare taxane containing ACT regimens with ACT not containing a taxane in women with operable EBC. Methods: Eligible studies were properly randomized controlled trials in women with operable EBC receiving ACT (neoadjuvant CT was excluded) that compared taxane containing ACT regimens to ACT without a taxane. Studies were identified by a specifically designed search performed of the Cochrane Breast Cancer Group specialized register (to January 2007), Medline (to November 2006), and relevant conference proceedings (to November 2006). The primary outcome measure was overall survival (OS); secondary outcome measures included disease free survival (DFS) and toxicity. Two reviewers independently assessed eligibility, quality, and time-to-event (TTE) outcomes. Hazard ratios were derived for TTE outcomes where possible, and a fixed effect model was used for meta-analysis. Results: 20 studies were identified, 11 (4 abstracts; 7 full publications) with sufficient data published for inclusion (10 for OS, 11 for DFS). The average median follow-up was 54.6 months. All studies fulfilled quality criteria (allocation concealment, outcome measures, balance between arms, follow-up and intention to treat analysis) adequately or well. Amongst 17056 women with 2397 deaths, the HR for OS was 0.81, (95%CI=0.75–0.88, p<0.00001) favoring taxane-containing ACT. 19943 women were included in analysis of DFS with a HR=0.81 (95%CI=0.75- 0.86, p<0.00001) favoring taxane-containing ACT. There was no statistically significant heterogeneity for either OS or DFS. The effects were consistent in studies of node positive or node negative/positive patients, and with the same or longer duration of ACT in the taxane arm. Further analyses of taxane type (docetaxel or paclitaxel), sequential or concurrent taxane-anthracycline, and toxicity will be presented. Conclusions: This is the first meta-analysis quantifying the statistically significant OS and DFS benefit for the use of taxanes as ACT in operable EBC. Additional relevant studies remain unreported. Ongoing studies will define the optimal use of taxanes in EBC. No significant financial relationships to disclose.

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