Management of optic disc pit-associated maculopathy: A case series from a tertiary referral center

2021 ◽  
pp. 112067212110237
Author(s):  
Ilkay Kilic Muftuoglu ◽  
Ecem Onder Tokuc ◽  
V Levent Karabas
Keyword(s):  
Optic Disc ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Maximum Height ◽  
Optic Disc Pit ◽  
Tertiary Referral Center ◽  
Number Of Patients ◽  
The Mean ◽  
Foveal Center

Purpose: To report outcomes of pars plana vitrectomy (PPV) combined with internal limiting membrane (ILM) stuffing technique in patients with optic disc pit associated maculopathy (ODP-M). Methods: Data including best-corrected visual acuity (BCVA), central macular thickness (CMT), foveal center point thickness (FCP), and maximum height of fluid (max_fluid) (intraretinal or subretinal) were collected from the medical records of the patients. Results: Six eyes of six patients with a mean age of 28.0 ± 17.68 years (range: 9–53 year) underwent PPV + ILM plug surgery. The mean follow-up duration was 25.62 ± 26.11 months (range: 11.80–78.00 month) duration. The mean BCVA increased from 1.25 ± 1.04 logMAR (20/355, Snellen equivalent) to 0.86 ± 1.09 logMAR (20/144, Snellen equivalent) at last follow-up ( p = 0.043). Compared to baseline, CMT, FCP, and max_fluid significantly decreased at all visits after the surgery ( p < 0.05 for all visits). At last follow-up, 66.6% of the eyes (four eyes) showed complete resolution of fluid at a mean of 5.25 ± 4.99 months (range: 1–12 months) after the surgery. Conclusion: PPV with ILM plug seemed to be an effective surgical technique in ODP-M. Studies with longer follow-up and higher number of patients are needed to confirm our results.

Optic Disc Pit Maculopathy after Prone Positioning Spine Surgery

2017 ◽  
Vol 27 (5) ◽  
pp. e144-e146
Author(s):  
Marcos Ruiz-Sánchez ◽  
Maria E. Rodríguez-González-Herrero ◽  
Jenifer Ruiz-Sará
Keyword(s):  
Optic Disc ◽  
Prone Position ◽  
Spine Surgery ◽  
Patient Positioning ◽  
Internal Limiting Membrane ◽  
Prone Positioning ◽  
Optic Disc Pit ◽  
Visual Acuity Loss ◽  
Optic Disc Pit Maculopathy

Purpose To report a case of optic disc pit maculopathy after spine surgery performed in the prone position. Methods Case report. Results A 32-year-old man underwent spine surgery for disc herniation repair. He complained of visual acuity loss immediately after the procedure. Optic disc maculopathy with internal limiting membrane detachment was found to be the cause. Vitrectomy was scheduled after a 12-month follow-up without resolution of the maculopathy. Conclusions Optic disc maculopathy has not previously been associated with nonocular surgery or patient positioning. Physiologic changes induced by the prone position likely altered the pressure gradient in the eye and led to the development of the maculopathy.

scholarly journals Inverted ILM flap technique in Optic Disc Pit Maculopathy: An Iranian experience with review of the literature

2021 ◽  
Author(s):  
Ali Tavallali ◽  
Yasaman Sadeghi ◽  
Seyed-Hossein Abtahi ◽  
Hosein Nouri ◽  
Mitra Rezaei ◽  
...  
Keyword(s):  
Optic Disc ◽  
Posterior Vitreous Detachment ◽  
Surgical Techniques ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Optic Disc Pit ◽  
Review Of The Literature ◽  
Pars Plana ◽  
Optic Disc Pit Maculopathy ◽  
Prospective Case Series

Abstract Purpose To present the outcome of optic disc pit maculopathy (ODPM) managed successfully with inverted internal limiting membrane (ILM) flap over the optic disc. Methods This prospective case series included three patients with ODPM who underwent pars plana vitrectomy with posterior vitreous detachment induction, followed by inverted ILM flap over the optic disc and gas tamponade. Patients were followed for 7-16 weeks as regards their functional and anatomical findings. A narrative review is also provided about Pathology, Pathogenesis, and surgical techniques in the treatment of ODPM Results Three adult patients (25–39 years old) were evaluated, with a mean duration of decreased visual acuity of 7.33 ± 2.40 months (4-12 months). Postoperatively, BCVA improved dramatically in one patient from 2/200 to 20/25. BCVA in the other two improved two and three lines, to 20/50 and 20/30, respectively. Significant anatomic improvement was achieved in all patients. Conclusion Vitrectomy with inverted ILM flap insertion over the optic disc can yield favorable anatomical improvement in patients with ODPM.

scholarly journals Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study

2020 ◽  
Vol 09 (03) ◽  
pp. 225-229
Author(s):  
Kevin Eng ◽  
Stephen Gill ◽  
Simon Hoy ◽  
Vivek Shridar ◽  
Natasha Van Zyl ◽  
...  
Keyword(s):  
Case Series ◽  
Visual Analogue Score ◽  
Rotational Stability ◽  
Volar Aspect ◽  
Number Of Patients ◽  
Case Series Study ◽  
Structural Graft ◽  
The Mean ◽  
Series Study

Abstract Background The volar scaphoid plate from Medartis (Medartis AG, Austrasse, Basel, Switzerland) is a variable angle titanium locking plate, preformed for the volar aspect of the scaphoid. It does not have compressive capability, and may act as a bridging device. It may provide an advantage over a compression screw where the pathoanatomy is less favorable to such a device with increased rotational stability. It may act as a buttress plate for correction of humpback deformity for example. It has been used in nonunions and with vascularized grafts. Questions Our study aims to assess the results of our patients with scaphoid nonunion treated with scaphoid volar plating over a larger number of patients. We aim to identify techniques to increase the success of plating. Methods Patients from our cohort were retrospectively reviewed. Operations were performed by three hand fellowship trained surgeons and in two centers. Inclusion involved a scaphoid plate procedure for a nonunion of the scaphoid with a minimum of 6 months of follow-up. Exclusions were those who had less than 6 months of follow-up. Data included demographics, patient-rated wrist evaluation (PRWE), a quick disabilities of the arm, shoulder, and hand (qDASH), visual analogue score, and range and grip. Radiology was reviewed. Results Thirty-two eligible patients were assessed. The mean age was 25 years (range 13–46), 2 were female and 15 were smokers. Mean follow-up postsurgery was 18 months. Twenty-nine of 32 patients united (90.6%) on computed tomography scan. Clinical assessment was performed in the 25 patients. The mean qDASH score was 12.5 (range 0–42) and mean PRWE was 11 (range 0–54). The mean arc of motion was 115 degrees. The mean grip strength was 39 kg compared with 41 kg on the nonoperated side. Conclusion We postulate that the plate acts like an internal bridging device, acting over a small distance, and inherent stability of the construct with structural graft and accurate reduction prior to plating is advantageous. Potential problems include plate impingement on the volar lip of the radius, particularly when trying to plate more proximal fractures. Ideally, it is utilized for mid to distal waist fractures.

scholarly journals Treatment outcomes of optic disc pit maculopathy over two decades

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Avadhesh Oli ◽  
Divya Balakrishnan
Keyword(s):  
Optic Disc ◽  
Subretinal Fluid ◽  
Optic Disc Pit ◽  
Long Term Outcomes ◽  
Ilm Peeling ◽  
Pars Plana ◽  
Optic Disc Pit Maculopathy ◽  
The Mean

Aim: To study the long-term outcomes of optic disc pit maculopathy. Methods: Electronic medical records of 154 patients with optic disc pit were reviewed and 50 patients with optic disc pit maculopathy who met the study criteria were included in the study. Demographic profile of patients, along with clinical characteristics, optical coherence tomography (OCT) features and change in best-corrected visual acuity (BCVA) was recorded. Patients were treated either by observation, barrage laser alone or pars plana vitrectomy (PPV) with optional additional surgical procedures. The primary outcome measures were the change in BCVA and resolution of fluid on OCT. Results: The mean age of patients was 29.96 years (3–62 years) with a follow-up of 27.16 months. The mean baseline BCVA in observation, laser and vitrectomy group was log MAR 0.94, 0.76 and 0.87 and final BCVA was log MAR 0.9, 0.67 and 0.46, respectively. There was a statistically significant improvement in the final BCVA and reduction in subretinal fluid with resolution of the schisis cavity in vitrectomy group than in other groups. On regression analysis significant association was found between final BCVA with baseline BCVA ( R2 = 0.815, p = 0.002), use of C3 F8 endotempanode ( p = 0.004) ILM peeling ( p = 0.012) and use of triamcinolone (TA; p = 0.003). No significant association was found with juxtapapillary endolaser ( p = 0.062). Conclusions: In patients with disc pit maculopathy, PPV lead to better functional and anatomical outcomes as compared to laser or observation alone. Use of surgical adjuvants like ILM peeling, TA and C3F8 tamponade improved the outcomes, unlike juxtapapillary endolaser treatment.

scholarly journals Re-evaluating diabetic papillopathy using optical coherence tomography and inner retinal sublayer analysis

Eye ◽  
2021 ◽  
Author(s):  
Josef Huemer ◽  
Hagar Khalid ◽  
Daniel Ferraz ◽  
Livia Faes ◽  
Edward Korot ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Visual Acuity ◽  
Optic Disc ◽  
Case Series ◽  
Retinal Nerve Fibre Layer ◽  
Optical Coherence ◽  
Patients With Diabetes ◽  
Optic Disc Swelling ◽  
The Mean

Abstract Background/Objectives To re-evaluate diabetic papillopathy using optical coherence tomography (OCT) for quantitative analysis of the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell layer (mGCL) and inner nuclear layer (mINL) thickness. Subjects/Methods In this retrospective observational case series between June 2008 and July 2019 at Moorfields Eye hospital, 24 eyes of 22 patients with diabetes and optic disc swelling with confirmed diagnosis of NAION or diabetic papillopathy by neuro-ophthalmological assessment were included for evaluation of the pRNFL, mGCL and mINL thicknesses after resolution of optic disc swelling. Results The mean age of included patients was 56.5 (standard deviation (SD) ± 14.85) years with a mean follow-up duration of 216 days. Thinning of pRNFL (mean: 66.26, SD ± 31.80 µm) and mGCL (mean volume: 0.27 mm3, SD ± 0.09) were observed in either group during follow-up, the mINL volume showed no thinning with 0.39 ± 0.05 mm3. The mean decrease in visual acuity was 4.13 (SD ± 14.27) ETDRS letters with a strong correlation between mGCL thickness and visual acuity (rho 0.74, p < 0.001). Conclusion After resolution of acute optic disc swelling, atrophy of pRNFL and mGCL became apparent in all cases of diabetic papillopathy and diabetic NAION, with preservation of mINL volumes. Analysis of OCT did not provide a clear diagnostic distinction between both entities. We suggest a diagnostic overlay with the degree of pRNFL and mGCL atrophy of prognostic relevance for poor visual acuity independent of the semantics of terminology.

Incudostapedial Rebridging Ossiculoplasty with Bone Cement

2009 ◽  
Vol 141 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Tekin Baglam ◽  
Erkan Karatas ◽  
Cengiz Durucu ◽  
Ali Kilic ◽  
Enver Ozer ◽  
...  
Keyword(s):  
Bone Cement ◽  
Chart Review ◽  
Case Series ◽  
Cost Effective ◽  
Hearing Results ◽  
Tertiary Referral Center ◽  
Different Types ◽  
The Mean ◽  
One Year

OBJECTIVE: The purpose of this study is to evaluate hearing results of our experience with ionomeric bone cement repair of ossicular discontinuity between incus and stapes. STUDY DESIGN: Case series with chart review. SETTING: Tertiary referral center. SUBJECTS AND METHODS: One hundred thirty-six patients who underwent incudostapedial rebridging ossiculoplasty with ionomeric bone cement were included in the study. Preoperative and postoperative audiologic results of incudostapedial rebridging ossiculoplasty with bone cement were evaluated. One year of follow-up is provided. RESULTS: The postoperative air-bone gap was less than 20 dB in 81.6 percent after one year. The mean preoperative and postoperative pure-tone avarages of the patients were 52.82 ± 5.59 and 32.81 ± 7.18 dB, respectively ( P < 0.01). The mean preoperative and postoperative air-bone gaps were 35.83 ± 4.73 and 16.54 ± 5.01, respectively ( P < 0.01). There were no statistically significant differences among the hearing results of different types of surgeries ( P >0.05). No complications in the middle ear related to bone cements were encountered. CONCLUSIONS: Incudostapedial rebridging ossiculoplasty with ionomeric bone cement is a reliable method for ossicular reconstruction that is cost effective and offers satisfactory hearing results in selected patients.

scholarly journals Extensive Internal Limiting Membrane Peeling for Proliferative Vitreoretinopathy

2021 ◽  
Author(s):  
Anibal Francone ◽  
Martin Charles
Keyword(s):  
Retinal Detachment ◽  
Proliferative Vitreoretinopathy ◽  
Silicone Oil ◽  
3D Visualization ◽  
Case Series ◽  
Internal Limiting Membrane ◽  
Internal Limiting Membrane Peeling ◽  
Membrane Peeling ◽  
The Mean

Abstract Purpose: The aim of this study was to describe the anatomical outcomes of Brilliant Blue G (BBG)–assisted extensive internal limiting membrane peeling (eILMp) for proliferative vitreoretinopathy (PVR) under three-dimensional (3D) visualization. Methods: This study constitutes a retrospective case series conducted in a private retina practice, of 14 consecutive patients (14 eyes) with rhegmatogenous retinal detachment (RRD) complicated by PVR who underwent pars plana vitrectomy between January 2019 and January 2020. The internal limiting membrane (ILM) was selectively stained with BBG, and perspectives were enhanced with a 3D visualization system. We peeled off the ILM beyond the vascular arcades up to the periphery. The main outcome was anatomical success, defined as persistent retinal reattachment after removal of the silicone oil tamponade.Results: Anatomic success was achieved with a single surgery in 11 of 14 (78.6%) eyes, and eventual success was achieved in all eyes. The mean patient follow-up time was 12.3 months (range, 7–16 months). The mean preoperative logMAR BCVA was 2.09 (range, 2.8–1.3), which decreased to 1.54 (range, 2.8–0.6) at the last follow-up. Conclusion: This technique allowed the creation of a cleavage plane underlying the PVR membranes that facilitated its complete ILM removal, thereby reducing the risk of recurrence of retinal detachment.

scholarly journals Management of Recurrent Optic Disc Pit-Associated Maculopathy with Human Amniotic Membrane Graft in a Pediatric Case: A Case Report

2021 ◽  
pp. 734-739
Author(s):  
Aditya Kelkar ◽  
Jai Aditya Kelkar ◽  
Mounika Bolisetty ◽  
Ashwani Kanoriya
Keyword(s):  
Optic Disc ◽  
Amniotic Membrane ◽  
Subretinal Fluid ◽  
Internal Limiting Membrane ◽  
Human Amniotic Membrane ◽  
Optic Disc Pit ◽  
Primary Surgery ◽  
Ocular Coherence Tomography ◽  
Pars Plana

A 13 years old previously operated with 25-G pars plana vitrectomy with double internal limiting membrane peel and juxtapapillary endolaser with SF 6 gas tamponade for optic disc pit-associated maculopathy (ODP-M), presented with recurrence after 9 months of successful primary surgery. Three 25-G sclerotomies were made and Human Amniotic Membrane Graft was tucked into the optic disc pit (ODP), the position of the graft was confirmed with intraoperative ocular coherence tomography. Subretinal fluid rapidly resolved within 48 h and best-corrected visual acuity improved to 0.5 LogMAR after 1 week. During the follow-up period of 12 months, no episodes of recurrence or reduction vision or adverse reactions were noted.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

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