Experience in managing glaucoma filtration surgery complications with oral doxycycline: A case series

2021 ◽  
pp. 112067212199295
Author(s):  
Geng-Yi Yong ◽  
Jelinar Mohamed-Noor ◽  
Poh-Yan Ong ◽  
Nurull Bahya Suliman ◽  
Ching-Wei Lim ◽  
...  

Purpose: To report the clinical profile and effectiveness of oral doxycycline as a non-invasive treatment for glaucoma filtering surgery complications. Method: Prospective case series. Results: Doxycycline is widely used in treating corneal melts, ocular surface diseases, meibomian gland disease, recurrent epithelial cell erosion, rosacea, and keratitis sicca. This prospective case series highlights the successful treatment of five patients with leaking blebs and conjunctiva erosion from glaucoma filtration surgery with the use of oral doxycycline. There was no adverse event reported in our cases. Conclusions: This study suggests that oral doxycycline may be a feasible non-surgical treatment modality due to its ability to inhibit collagenolysis, restore the Meibomian gland function, thereby stopping breakdown and promote conjunctival tissue healing.

2020 ◽  
pp. 112067212092434
Author(s):  
Michael O’Rourke ◽  
Sarah Moran ◽  
Niamh Collins ◽  
Aoife Doyle

Purpose Bleb dysfunction may occur as a late complication following glaucoma filtration surgery. Over-filtering, thinning and cystic blebs can lead to hypotony, leak and corneal dellen. We report our surgical management and outcomes of this specific entity using donor scleral patch grafts. Methods This is a 10-year non-comparative, retrospective interventional case series. Bleb reconstruction involved excision of encysted conjunctiva and sclera to identify the original fistula. A functioning donor scleral patch graft was sited over this with fixed and releasable sutures and the conjunctiva advanced. Intraocular pressure, visual acuity and post-operative issues were assessed. Results A total of 18 eyes of 17 patients with mean age 65 years (standard deviation 13.5) were included. Trabeculectomy was the primary procedure in 72% ( n = 13) and deep sclerectomy in 28% ( n = 5). Bleb leak accounted for 61% ( n = 11), hypotony 33% ( n = 6) and corneal dellen 6% ( n = 1). Mean pre-operative intraocular pressure was 7 mm Hg (standard deviation 4.6) which increased to 18.5 mm Hg (standard deviation 12) at day 1 ( p < 0.001), 11.8 mm Hg (standard deviation 4.6) at 3 months ( p < 0.05), 12.1 mm Hg (standard deviation 4.2) at 1 year ( p < 0.01) which was maintained at 12.1 mm Hg (standard deviation 5.3) at last follow-up ( p < 0.001). Post-operative interventions included bleb needling, re-suturing, suture removal, further glaucoma management, bleb leak and cataract surgery. Visual acuity also improved post-operatively and was maintained. Conclusion Reconstruction of the filtering bleb architecture with donor sclera results in improved intraocular pressure while maintaining visual acuity. Post-operative care is required to support the restored bleb function. Our findings support the use of scleral patch graft as an effective and safe method for the long-term management of hypotony and bleb leak as a late complication of glaucoma filtration surgery.


2020 ◽  
Vol 9 (7) ◽  
pp. 2120
Author(s):  
Luc Van Doorne ◽  
Pedram Gholami ◽  
Jan D’haese ◽  
Geert Hommez ◽  
Gert Meijer ◽  
...  

Background: Free-handed, flaplessly placed mini dental implants (MDIs) are a valuable, more affordable and minimally invasive treatment to support overdentures in fully edentulous jaws, especially for medically compromised patients. However, critical 3D radiographic evaluation is lacking. This multicenter prospective case series assessed clinical outcome and carried out 3D- cone-beam computerized tomography (CBCT) analysis of free-handed flaplessly placed one-piece maxillary MDIs by an experienced maxillofacial surgeon. Methods: Thirty-one patients suffering from an ill-fitting maxillary denture relating to compromised bone volume (as confirmed on CBCT), with a dentate mandible, were selected. They received 5–6 MDIs free-hand flaplessly placed and mentally guided with preoperative CBCT. Final connection and attachment activation took place six months later. After two years each implant was individually assessed with CBCT for perforations on eight sites. Implant survival, prosthetic failure, clinical stability and sinus/nasal complaints were registered after three years. Results: 32/185 (17.3%) MDIs failed during the provisional loading with non-activated attachments; 17 replacements in 10 patients were performed. Of the 170 actively loaded 170 MDIs, 82.3% survived and 27/31 prostheses (87%) were fully functional. In total 98/170 MDIs showed no perforation. Based on 1360 CBCT observations, 231 perforations (16.9%) were registered. Of most perforations 37 (25%) were observed at the apical tip and 37 were positioned (21%) into the sinus/nasal cavity, although without clinical complaints. Conclusions: Given the compromised population, the minimally invasive procedure and the low treatment cost involved, a failure rate of 17% is substantial, however clinically acceptable given the critical bone condition. However, even in experienced surgical hands, freehanded and flapless placement yield a high risk for implant perforation, although this did not necessarily lead to complications.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kang Yoon Kim ◽  
Byunghoon Chung ◽  
Eung Kweon Kim ◽  
Kyoung Yul Seo ◽  
Ikhyun Jun ◽  
...  

Abstract Background To acquire desirable outcomes of penetrating keratoplasty (PKP), various factors affecting graft survival, visual function, and subjective symptom should be considered. As ocular surface and meibomian gland function are associated with these factors, this study aims to investigate changes of ocular surface and meibomian gland parameters after PKP. Methods This retrospective case series study included 24 eyes of 24 patients who underwent penetrating keratoplasty. Examinations on lipid layer thickness (LLT), meiboscore, tear meniscus area (TMA), tear breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer I test (SIT), Ocular Surface Disease Index (OSDI), and meibomian gland functions were performed before and at 1 week, 1 month, 6 months, and 12 months after surgery. Results Compared to baseline (2.9 ± 0.6 s), TBUTs were longer at 1 week (4.4 ± 0.5 s, P = 0.027) and 6 months (4.4 ± 0.5, P = 0.048) after surgery. CFS values improved from baseline (6.5 ± 1.1) to 6 months (3.5 ± 0.6, P = 0.023) and 12 months (3.3 ± 0.7, P = 0.001) after surgery. Meibum quality value worsened at 1 week and 12 months after surgery and meibomian gland expressibility value worsened at 1 week and 6 months after surgery compared to baseline. OSDI scores improved at 6 and 12 months after surgery. Meiboscore showed no change throughout the follow up period. The patients with high preoperative meiboscore had worse meibomian gland expressibility at 6 and 12 months and meibum quality at 6 months postoperatively compared to their baseline and to those of patients with low preoperative meiboscore. Conclusions After penetrating keratoplasty, ocular surface parameters including corneal staining, TBUT, and OSDI significantly improved whereas meibomian gland parameters showed deteriorations, which was marked in patients with high preoperative meiboscore. Thus, perioperative management of MGD is recommended for patients who undergo penetrating keratoplasty, especially in patients with advanced MGD.


2016 ◽  
Vol 3 (3) ◽  
pp. 114-118 ◽  
Author(s):  
Dan-Xu Ma ◽  
Yun Wang ◽  
Meng-Meng Bao ◽  
Chen Zhang ◽  
Xue-Yang Li ◽  
...  

2019 ◽  
Vol 3 ◽  
pp. 4
Author(s):  
Andrew C. Clark ◽  
Devang Butani

Sacral insufficiency fractures (SIFs) are a cause of debilitating low back pain that is often difficult to diagnosis and manage. The diagnosis of SIF is often delayed due to inaccurately attributing symptoms to spondylosis, which is a commonly present in the elderly population where SIFs are most prevalent. Historically, treatment consisted of medical management and open reduction internal fixation reserved for severe cases. However, percutaneous sacroplasty has emerged as a minimally invasive treatment option which provides early pain relief without significant complications. The objective of this article is to raise awareness of SIFs and percutaneous sacroplasty as an effective and safe treatment method.


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