Gonioscopy-assisted transluminal trabeculotomy is an effective surgical treatment for uveitic glaucoma

2021 ◽  
pp. bjophthalmol-2021-320270
Author(s):  
Avner Belkin ◽  
Yuri Valere Chaban ◽  
Derek Waldner ◽  
Saba Samet ◽  
Iqbal Ike K Ahmed ◽  
...  
Keyword(s):  
Outcome Measure ◽  
Case Series ◽  
Cataract Extraction ◽  
Secondary Outcome ◽  
Efficacy And Safety ◽  
Medication Usage ◽  
Uveitic Glaucoma ◽  
Surgical Success ◽  
Lens Implantation

BackgroundTo assess the efficacy and safety of gonioscopy-assisted transluminal trabeculotomy (GATT) in uveitic glaucoma (UG).MethodsA retrospective interventional case series in which 33 eyes of 32 patients with UG underwent GATT with or without concomitant cataract extraction and intraocular lens implantation (CE/IOL) at three Canadian treatment centres from October 2015 to 2020. The main outcome measure was surgical success defined as an intraocular pressure (IOP) ≤18 mm Hg and at least one of the following: IOP within one mm Hg of baseline on fewer glaucoma medications as compared with baseline or a 30% IOP reduction from baseline on the same or fewer medications. Secondary outcome measures were IOP, medication usage and surgical complications.ResultsMean patient age (mean±SD) was 49±16 years (range: 18–79) and 44% were female. GATT was performed as a standalone procedure in 52% of cases and the remainder were combined with CE/IOL. Surgical success was achieved in 71.8% (SE: 8.7%) of cases. Mean preoperative IOP (±SD) was 31.4±10.8 mm Hg on a median of 4 medications. 59% of patients were on oral carbonic anhydrase inhibitors (CAIs) prior to surgery. After 1 year, average IOP was 13.8 mm Hg on a median 1 medication, with 6% of patients being on oral CAIs. No sight threatening complications occurred during surgery or follow-up.ConclusionGATT is an effective surgical strategy in the management of UG. This microinvasive conjunctival-sparing procedure should be considered early in these patients.

scholarly journals Efficacy and Safety of Infliximab in HLA-B27-associated Ocular Inflammation Refractory or Intolerant to Conventional Immunomodulatory Therapy

2020 ◽  
Author(s):  
Asima Bajwa ◽  
Arash Maleki ◽  
Abhishek R Payal ◽  
Adriana Fandiño ◽  
María Inés Menéndez Padrón ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Case Series ◽  
Ocular Inflammation ◽  
Infliximab Therapy ◽  
Immunomodulatory Therapy ◽  
Secondary Outcome ◽  
Hla B27 ◽  
Efficacy And Safety ◽  
Active Patients

Purpose: To determine the efficacy and safety of infliximab therapy in patients with HLA B-27-associated ocular inflammation resistant or intolerant to conventional immunomodulatory therapy. Methods: This was a retrospective observational case series. All cases were uveitic patients with positive HLA-B27, confirmed through HLA testing, resistant or intolerant to conventional immunomodulatory therapy. The primary outcome of the study was to identify the efficacy of infliximab determined by the control of inflammation, duration of remission, and the ability to reduce conventional immunomodulatory therapy. The secondary outcome was an improvement of two or more lines of best-corrected visual acuity (BCVA) on the Snellen visual acuity chart. Results: Twenty-four patients (38 eyes) were included in the study. All patients were followed for 24 months. Twenty-one (87.5%) patients completed 24 months of follow-up. Sixteen (66.7%) patients had active uveitis at the beginning of therapy. One patient out of these active patients had active inflammation at the end of follow-up period. Thirteen (87.5%) out of sixteen active patients were in steroid-free remission. The mean duration of treatment to induce remission was 16.5 months (range 6–24 months). Corticosteroid was stopped in 19 (90.5%) patients by the end of the study. At the end of the study, in patients who achieved remission, 14 (58.3%) patients were in remission on infliximab therapy and 6 (25%) patients were in remission off infliximab therapy. Of the 38 eyes, 8 (21.05%) showed improvement in BCVA (three eyes had successful cataract extraction with intraocular lens implantation during infliximab therapy with no subsequent inflammation), while 26 eyes (68.4%) had stable BCVA over the 24-month study period. The side effects included allergic reaction, fatigue, cellulitis, headache, restlessness, elevation of liver enzymes, and anemia. Two patients (n = 24, 8.3%) experienced severe adverse effects and the treatment was stopped prematurely in these two patients. Conclusion: Infliximab might induce and maintain the steroid-free remission in HLAB27- associated ocular inflammation in patients resistant or intolerant to conventional immunomodulatory therapy.

The Efficacy and Safety of Combined Trabeculectomy Cataract Extraction, and Intraocular Lens Implantation

Ophthalmology ◽  
1988 ◽  
Vol 95 (6) ◽  
pp. 754-763 ◽  
Author(s):  
David L. McCartney ◽  
James E. Memmen ◽  
Walter J. Stark ◽  
Harry A. Quigley ◽  
A. Edward Maumenee ◽  
...  
Keyword(s):  
Intraocular Lens ◽  
Cataract Extraction ◽  
Intraocular Lens Implantation ◽  
Efficacy And Safety ◽  
Lens Implantation

scholarly journals Posterior-Chamber Phakic Intraocular Lens Implantation in Patients over 40 Years of Age

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Pedro Tañá-Rivero ◽  
Francisco Pastor-Pascual ◽  
Marceliano Crespo ◽  
José L. Rodríguez-Prats ◽  
José J. Muñoz-Tomás ◽  
...  
Keyword(s):  
Crystalline Lens ◽  
Posterior Chamber ◽  
Spherical Equivalent ◽  
Efficacy And Safety ◽  
Phakic Intraocular Lens ◽  
Implantable Collamer Lens ◽  
Lens Implantation ◽  
Over 40 Years ◽  
Myopic Astigmatism

Purpose. To assess the efficacy, safety, and predictability of the Visian Implantable Collamer Lens (ICL) model having a central port in patients over 40 years of age. Methods. This study included 33 eyes from 21 patients who underwent V4c ICL implantation for the correction of myopia and myopic astigmatism. We assessed uncorrected (UDVA) and corrected (CDVA) distance visual acuity, refraction, intraocular pressure (IOP), endothelial cell density (ECD), vault, and adverse events occurring over a 1-year period. Results. Mean age of the patients at the time of implantation was 43.52 ± 4.49 years (range: 40 to 56 years). Efficacy and safety indexes were 1 and 1.09, respectively. Surgical outcomes for CDVA were as follows: no eye lost any lines, 19 eyes (57.58%) showed no CDVA changes, 7 eyes (21.21%) gained 1 line, 4 eyes (12.12%) gained 2 lines, and 3 eyes (9.09%) gained ≥3 lines. Mean postoperative spherical equivalent (SE) was −0.09 ± 0.47 D. A total of 29 eyes (87.8%) were within ±0.50 D and 31 eyes (93.9%) were within ±1.00 D of the desired SE. At 1-year, mean IOP was 15.27 ± 3.03 mmHg (range: 9 to 20 mmHg, p=0.12 pre vs. post) and mean ECD was 2516 ± 234 cells/mm2 (p=0.29 pre vs. post). Mean postoperative vault was 320 ± 136 μm, with 201–300 μm being the most prevalent vault range for 9 eyes (31.03%). None of the eyes showed a vault >701 μm. There were neither intraoperative nor postoperative complications; in fact, all ICL implantation procedures were uneventful. Conclusions. Our study’s findings support the use of this lens in patients over 40 years of age. A long follow-up period is advisable to monitor ICL position relative to the crystalline lens.

Non-Freeze Epikeratophakia in Children

1998 ◽  
Vol 8 (1) ◽  
pp. 8-11
Author(s):  
M.T. Aznabayev ◽  
M.M. Bikbov ◽  
R.A. Aznabayev
Keyword(s):  
Cataract Extraction ◽  
Spherical Equivalent ◽  
Efficacy And Safety ◽  
Donor Cornea ◽  
Traumatic Cataract ◽  
Original Design ◽  
Epithelial Growth

We describe the use of unfrozen tissue lenses in 42 cases of epikeratophakia in children aged 2-14 years. Fourteen operations were performed in an aphakic eye, 28 in combination with congenital or traumatic cataract extraction. The tissue lenses, made from unfrozen donor cornea according to an original design, healed in 91.5% of cases. The tissue lens was removed when epithelial growth was inadequate on its surface. A five-year follow-up showed that correction within 3.0 D of emmetropia was achieved in 73.7% of the eyes. Preoperatively, mean keratometry readings were 43.5±0.2 D, increasing postoperatively to 53.6±0.8 D. Mean spherical equivalent at the spectacle plane increased by 9.6±0.9 D. Our investigations show the efficacy and safety of non-freeze epikeratophakia in the correction of pediatric aphakia.

scholarly journals A Conscious Sedation Protocol for Videolaryngostroboscopy in Pediatric Patients

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Samantha Anne ◽  
Lawrence M. Borland ◽  
Laura Haibeck ◽  
Joseph E. Dohar
Keyword(s):  
Outcome Measures ◽  
Pediatric Patients ◽  
Conscious Sedation ◽  
Treatment Plan ◽  
Tertiary Care ◽  
Case Series ◽  
Diagnostic Information ◽  
Secondary Outcome ◽  
Sedation Protocol

Objective. To determine best sedation protocol for videolaryngostroboscopy in children unable to tolerate non-sedated evaluation.Materials and Methods.Consecutive case series of 10 children with voice disturbances, unable to tolerate nonsedated videolaryngostroboscopy at an academic tertiary care children’s hospital. Flexible fiberoptic videolaryngostroboscopy was performed and interpreted by pediatric otolaryngologist and speech and language pathologist. Sedation was administered with newly described protocol that allowed functional portion of evaluation.Main Outcome Measures: ability to follow commands and tolerate flexible fiberoptic videolaryngostroboscopy.Secondary Outcome Measures: total phonation time, complications, need for subsequent videolaryngostroboscopic attempts, clinical outcomes, and follow-up.Results. 10 children underwent procedure under conscious sedation. 9/10 children were able to perform simple tasks and maintain adequate phonation time to complete stroboscopic exam. 1/10 patients failed to complete exam because of crying during entire exam. Mean exam time was 2 minutes 52 seconds (SD 86 seconds), phonation time is 1 minute 44 seconds (SD 60 seconds), and number of tasks completed was 10.5 (SD 8.6).Conclusions. Conscious sedation for videolaryngostroboscopy can be safely and effectively performed in children unable to comply with nonsedated examination. Such studies provide valuable diagnostic information to make a diagnosis and to devise a treatment plan.

scholarly journals Effect of monocular surgery for large-angle horizontal deviation in adults

1970 ◽  
Vol 3 (1) ◽  
pp. 27-30 ◽  
Author(s):  
S Ganguly ◽  
R Pradhan
Keyword(s):  
Visual Acuity ◽  
Large Angle ◽  
Anterior Segment ◽  
Case Series ◽  
Strabismus Surgery ◽  
Slit Lamp ◽  
Surgical Success ◽  
Squint Surgery ◽  
Indirect Ophthalmoscope

Background: Surgical success rate of strabismus is variable. Objective: To evaluate the outcome of monocular strabismus surgery for adults with largeangle deviation. Subjects and methods: This study was that of a retrospective interventional case series. A total of 48 consecutive adult patients with large-angle socially-noticeable strabismus underwent clinical evaluation for squint surgery. They were divided into 2 groups of which 28 had exotropia while 20 had esotropia with deviation ranging from 40 to 80 prism diopters (PD). Visual acuity measurement (V/A), cycloplegic refraction and orthoptic evaluation were done in all cases along with detailed anterior segment evaluation. Fundus examination was carried out with indirect ophthalmoscope and slit-lamp bio-microscopy with + 90 D lens. For each case, a repeat evaluation was done after a six-week interval. The surgical procedure was monocular recession and resection carried out under peri-bulbar anesthesia by the same surgeon. Post-operative visual acuity, fusion, stereopsis and ocular alignment were noted in all cases during follow up visits. Results: Successful ocular alignment (< 10 PD) was achieved in 40 patients while binocularity was noted in 3. Forty patients were happy with the cosmetic outcome and psychosocial rehabilitation. No statistically significant improvement was noted in visual acuity and binocular function. Successful alignment was related to pre-operative deviation of less than 30 degrees. Conclusion: Monocular surgery under peri-bulbar anesthesia is a useful procedure for large-angle horizontal strabismus. Key words: strabismus; exotropia; esotropia; fusion; binocularity DOI: 10.3126/nepjoph.v3i1.4275Nepal J Ophthalmol 2011;3(5):27-30

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