Double versus single suture stenting to manage hypertensive spikes after glaucoma drainage device implantation

2021 ◽  
pp. 112067212110143
Author(s):  
Francesca Chemello ◽  
Anna Rodella ◽  
Guido Barosco ◽  
Piero Ceruti ◽  
Roberto Tosi ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Early Postoperative Period ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Device Implantation ◽  
Baerveldt Glaucoma Implant ◽  
The Mean ◽  
Group 2 ◽  
Single Suture ◽  
Group 1

Purpose: To evaluate the safety and efficacy of double compared to single intraluminal suture stenting in reducing early postoperative hypertensive spikes (HS) and hypotony after Baerveldt glaucoma implant surgery. Methods: For this retrospective study, we reviewed the medical charts of 60 patients (60 eyes) who underwent Baerveldt drainage device surgery between 2017 and 2019. Two groups were formed according to whether a single suture stent was placed within the tube (5-0 polypropylene, 30 eyes, group 1) or a double suture (5-0 and 6-0 polypropylene, 30 eyes, group 2). Intraocular pressure (IOP) was measured at baseline, at 6 h, and on postoperative days 1, 2, 5, 7, 14, 21, 30, 60, 90, 180. The occurrence of HS (IOP ⩾ 30 mmHg), anterior chamber reformation, decompressive paracentesis, anti-glaucoma medication, and adverse events were recorded. Results: There was a greater decrease in IOP from baseline at days 1, 2, and 21 ( p < 0.05) and number of HS at 6 h ( p = 0.006) and postoperative day 1 ( p < 0.001) in group 2. The mean number of decompressive paracentesis, anterior chamber reformation procedures, and topical anti-glaucoma medications was the same in both groups; the need for oral acetazolamide was significantly lower in group 2 at days 1, 21, and 30 ( p < 0.05). Conclusions: While both stenting methods provide a gradual, controlled decrease in IOP, the double stenting technique was associated with a sooner and greater postoperative reduction in IOP and a good safety profile thanks to fewer HS in the early postoperative period and less need for oral acetazolamide.

scholarly journals Outcome of a Low-Cost Glaucoma Implant versus the Baerveldt Glaucoma Implant for Paediatric Glaucoma in a Tertiary Hospital in Egypt

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Mahmoud F. Rateb ◽  
Hazem Abdel Motaal ◽  
Mohamed Shehata ◽  
Mohamed Anwar ◽  
Dalia Tohamy ◽  
...  
Keyword(s):  
Low Cost ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Glaucoma Drainage Device ◽  
Drainage Device ◽  
Group A ◽  
Baerveldt Glaucoma Implant ◽  
The Mean ◽  
Group B

Purpose. To compare safety and efficacy between a low-cost glaucoma drainage device (GDD), the Aurolab aqueous drainage implant (AADI), and the Baerveldt glaucoma implant (BGI) in refractory childhood glaucoma in Egypt. Methods. This is a retrospective study of patients who received either an AADI or BGI at a tertiary care postgraduate teaching institute. Children aged <16 years with uncontrolled intraocular pressure (IOP) with or without prior failed trabeculectomy who completed a minimum 6-month follow-up were included. The outcome measures were IOP reduction from preoperative values and postoperative complications. Results. Charts of 57 children (younger than 16 years old) diagnosed with refractory childhood glaucoma were included. Of these, 27 eyes received AADI implants (group A), while 30 received BGI implants (group B). The mean preoperative baseline IOP was 34 ± 5 mmHg in group A versus 29 ± 2 mmHg in group B (p=0.78) in patients on maximum allowed glaucoma medications. In group A versus group B, the mean IOP decreased to 13.25 ± 8.74 mmHg (p=0.6), 12.8 ± 5.4 mmHg (p=0.7), and 12.6 ± 5.6 mmHg (p=0.9) after 1 week, 3 months, and 6 months, respectively. However, in group A, an anterior chamber reaction appeared around the tube in 14 cases starting from the first month and resolved with treatment in only 4 cases. In the other 10 cases, the reaction became more severe and required surgical intervention. This complication was not observed in any eye in group B. Conclusion. AADI, a low-cost glaucoma implant, is effective in lowering IOP in patients with recalcitrant paediatric glaucoma. However, an intense inflammatory reaction with serious consequences developed in some of our patients; we believe these events are related to the valve material. We therefore strongly recommend against its use in children.

scholarly journals Corynebacterium ocular infection after Baerveldt glaucoma implant surgery: treatment involving immediate tube withdrawal and temporary subconjunctival tube placement: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naruka Mitsui ◽  
Kae Sugihara ◽  
Jiro Seguchi ◽  
Etsuo Chihara ◽  
Yuki Morizane ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Vitreous Body ◽  
Tube Placement ◽  
Glaucoma Drainage Device ◽  
Ocular Infection ◽  
Implant Surgery ◽  
Drainage Device ◽  
Old Japanese ◽  
Patch Graft ◽  
Baerveldt Glaucoma Implant

Abstract Background We report a case of Corynebacterium endophthalmitis secondary to tube exposure following Baerveldt glaucoma implant surgery that was successfully treated with prompt tube withdrawal and temporary subconjunctival tube placement without removing the glaucoma drainage device. Case presentation A 65-year-old Japanese man with secondary glaucoma underwent glaucoma drainage device surgery with a donor scleral patch graft in the inferonasal quadrant of his right eye. Ten months after surgery, he presented with tube exposure due to dehiscence of the overlying conjunctiva and erosion of the scleral patch graft. Eleven days later, mild inflammation was found in the anterior chamber and anterior vitreous body, with the root of the tube surrounded by a plaque at the site of insertion in the anterior chamber. He was diagnosed with infectious endophthalmitis secondary to tube exposure. Two days later, since medical therapy was ineffective, the tube was withdrawn from the anterior chamber and irrigated with a polyvinyl alcohol-iodine solution, and the tube was tucked into the subconjunctival space. Complete resolution of the infection was achieved 1.5 months later. The tube was reinserted nasally into the anterior chamber and covered with a scleral patch graft and a free limbal conjunctival autograft. Thereafter, there has been no recurrence of infection or tube exposure. Twenty eight months after tube reinsertion, his right best-corrected visual acuity was 20/50 and intraocular pressure was 12 mmHg. Conclusion Prompt tube withdrawal and temporary subconjunctival tube placement followed by tube reinsertion may be effective for endophthalmitis associated with tube exposure after glaucoma drainage device surgery.

Topical N-acetylcysteine Reduces Interleukin-1-alpha in Tear Fluid after Laser Subepithelial Keratectomy

2009 ◽  
Vol 19 (4) ◽  
pp. 554-559 ◽  
Author(s):  
Berrak Urgancioglu ◽  
Kamil Bilgihan ◽  
Doruk Engin ◽  
Meltem Yalinay Cirak ◽  
Ahmet Hondur ◽  
...  
Keyword(s):  
Wound Healing ◽  
Interleukin 1 ◽  
Early Postoperative Period ◽  
Tear Fluid ◽  
Control Group ◽  
Corneal Wound Healing ◽  
Corneal Wound ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Purpose To evaluate the effect of topical N-acetylcysteine (NAC) on interleukin 1-alpha (IL-1α) levels in tear fluid after myopic laser subepithelial keratectomy (LASEK) and its possible role in modulating corneal wound healing. Methods Twenty-six eyes of 13 patients who underwent myopic LASEK were divided into 2 groups. Group 1 (n=10 eyes) was used as a control group. All patients received topical lomefloxacin and dexamethasone postoperatively. Additionally, patients in Group 2 received topical NAC for 1 month postoperatively. Tear fluid samples were collected with microcapillary tubes preoperatively, on the first and on the fifth postoperative day, and the release of IL-1α in tear fluid was calculated. Haze grading and confocal microscopic examination were performed at 1 and 3 months postoperatively. Results The mean IL-1-α release values were 0.285±0.159 pg/min in Group 1 and 0.235±0.142 pg/min in Group 2 preoperatively. In Group 1, the values were 0.243±0.155 pg/min on day 1 and 0.164±0.125 pg/min on day 5. In Group 2, the mean IL-1α release values were 0.220±0.200 pg/min on day 1 and 0.080±0.079 pg/min on day 5. The difference between the groups was significant only for day 5 (p<0.05). Mean corneal haze score and grey scale value in confocal microscopy were significantly higher (p<0.05) in Group 1 at 1 month. However, at 3 months there was no difference between groups (p>0.05). Conclusions NAC seems to have an additive effect to steroids in suppressing IL-1α levels in tear fluid and may be clinically advantageous in modulating corneal wound healing during the early postoperative period after LASEK.

scholarly journals Corneal endothelial cell loss after Baerveldt glaucoma drainage device implantation in the anterior chamber

2016 ◽  
Vol 95 (1) ◽  
pp. 91-96 ◽  
Author(s):  
Annelie N. Tan ◽  
Carroll A. B. Webers ◽  
Tos T. J. M. Berendschot ◽  
John de Brabander ◽  
Pauline M. de Witte ◽  
...  
Keyword(s):  
Endothelial Cell ◽  
Anterior Chamber ◽  
Cell Loss ◽  
Corneal Endothelial Cell ◽  
Glaucoma Drainage Device ◽  
Endothelial Cell Loss ◽  
Drainage Device ◽  
Device Implantation

scholarly journals Nitinol clips sternal osteosynthesis after heart/great arteries surgery as a method for prevention of postoperative complications

2015 ◽  
Vol 18 (3) ◽  
pp. 32
Author(s):  
E. R. Charchyan ◽  
A. B. Stepanenko ◽  
N. A. Galeev ◽  
A. A. Skvortsov ◽  
A. P. Gens
Keyword(s):  
Postoperative Complications ◽  
Blood Loss ◽  
Postoperative Period ◽  
Classical Method ◽  
Median Sternotomy ◽  
Early Postoperative Period ◽  
High Incidence ◽  
The Mean ◽  
Group 2 ◽  
Group 1

The problem of sternal osteosynthesis after cardiac surgery is relevant because of a relatively high incidence of postoperative complications associated with inadequate sternal consolidation. The use of nitinol clips is one of the reliable and versatile methods of sternal osteosynthesis. Our research included 208 postoperative patients with different cardiac surgical pathologies. All interventions were carried out with cardiopulmonary bypass using median sternotomy. Patients were divided into 2 groups according to sternal fixation methods: group 1 (105 patients) - wire suture osteosynthesis, group 2 (103 patients) - nitinol clips closure. The short-term postoperative results were analyzed by using the major criteria for comparison. Radiographically confirmed varying degrees of sternal defects in the immediate postoperative period were observed in 15.2% of patients in group 1 and 3.8% of patients in group 2. In group 1 significant sternal defects requiring sternal refixation were observed in 4.8% of patients; in group 2 no such cases were identified. The mean blood loss in the drainages for 24 hours after surgery in group 1 was 351 65 ml; in group 2 - 192 43 ml. The total number of resternotomies for bleeding in group 1 was 6.7% of cases, with half of them being the patients with the source from the sternum in the site of wire sutures, while in group 2 4.9% patients underwent resternotomy, with no bleeding from the sites of clip fixation. Thus, the use of nitinol clips after longitudinal median sternotomy is a more reliable method of sternal osteosynthesis (as compared with the classical method), which enables us to minimize the risk of damage to the retrosternal structures, preserve sternal consolidation and reduce blood loss in the drainages in the early postoperative period.

The risk of development of perioperative myocardial lesions and acute left ventricular insufficiency in the patients presenting with pheochromocytoma

2013 ◽  
Vol 59 (3) ◽  
pp. 45-50
Author(s):  
A B Kuznetsov ◽  
D G Bel'tsevich ◽  
M A Lysenko ◽  
L E Kats ◽  
I S Gomzhin ◽  
...  
Keyword(s):  
Pulmonary Oedema ◽  
Contractile Activity ◽  
Tumour Size ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Differential Diagnostics ◽  
Duration Of Surgery ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Differential diagnostics of coronary heart disease (CHD) and catecholamine-induced cardiomyopathy was undertaken in 19 of the 106 patients presenting with pheochromocytoma. Group 1 included 13 patients having the history of acute myocardial infarction. Diagnostics of CHD was performed following the adequate preoperative alpha-blockade (supplemented by Β-blockade whenever indicated). Group 2 was comprised of 6 patients suffering pulmonary oedema (normotensive, 10-70 min after removal of the tumour) and showing the elevated levels of biomarkers of myocardial necrosis and/or ischemic-type changes of ECG in the early postoperative period. The clinically significant myocardial ischemia requiring correction was documented only in one of the 19 patients. The two groups were not significantly different in terms of the mean tumour size and duration of surgery, the quality of preoperative compensation, and intraoperative fluctuations of arterial pressure. The mean age of the patients in group 1 (47 years) was much higher than that in group 2 (29 years). All patients in group 2 exhibited the predominantly adrenalin-type secretion whereas 10 patients of group 1 had the noradrenalin-type secretion and two others mixed-type secretion with the predominance of noradrenalin release. It was shown that the patients with the predominantly adrenaline-type secretion by the tumour were at higher risk of pulmonary oedema. The possibility of application of alpha-methylparatyrosine having beneficial effect on contractile activity of myocardium as the main agent for preoperative preparation is discussed.

scholarly journals Effect of Uncomplicated Cataract Surgery on Central Macular Thickness in Diabetic and Non-diabetic Subjects

2019 ◽  
Author(s):  
Brahm Prakash Guliani ◽  
Isha Agarwal ◽  
Mayuresh P. Naik
Keyword(s):  
Diabetic Retinopathy ◽  
Cataract Surgery ◽  
Normal Subjects ◽  
Early Postoperative Period ◽  
Macular Thickness ◽  
Central Macular Thickness ◽  
Significant Difference ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Purpose: To assess the quantitative changes of macula in diabetic and non-diabetic eyes after uncomplicated cataract surgery. Methods: In this prospective interventional study being performed in a tertiary healthcare hospital, a total of 660 eyes were divided into two groups. Group 1 included 330 eyes from healthy subjects and group 2 included 330 eyes from well-controlled diabetic subjects with no diabetic retinopathy planned for phacoemulsification with foldable IOL implantation by the same surgeon under similar settings. Optical Coherence Tomography (Heidelberg Spectralis SD-OCT) was used to assess preoperative and postoperative central macular thickness (CMT) at weeks 1 and 6. Results: The mean CMT in group 1 preoperatively, at postoperative week 1, and at post-operative week 6 was 257.03 ± 20.904, 262.82 ± 17.010, and 265.15 ± 20.078 μm, respectively. The corresponding values in group 2 were 255.36 ± 17.852, 259.15 ± 16.644, and 266.09 ± 18.844 μm, respectively. There was no significant difference in the mean CMT values between the two groups on any of the three occasions when the CMT was measured (P = 0.374 and P = 0.313 at weeks 1 and 6, respectively). Conclusion: There was no statistically significant difference in CMT between normal subjects and diabetic subjects without diabetic retinopathy preoperatively and in early postoperative period after uncomplicated phacoemulsification surgery.

Creation of physiologic rhythm by closed loop stimulation in heart failure patients with severe chronotropic incompetence: worldwide first results of a pilot study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  
Keyword(s):  
Heart Rate ◽  
Closed Loop ◽  
Funding Source ◽  
Chronotropic Incompetence ◽  
First Results ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG

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