Transillumination Guided Cyclocryotherapy in the Treatment of Secondary Glaucoma

1992 ◽  
Vol 2 (4) ◽  
pp. 190-195 ◽  
Author(s):  
E. Vesti ◽  
W. Rong-Guang ◽  
C. Raitta
Keyword(s):  
Visual Acuity ◽  
Pain Relief ◽  
Clinical Signs ◽  
Neovascular Glaucoma ◽  
Secondary Glaucoma ◽  
Consecutive Series ◽  
Chronic Uveitis ◽  
Best Response ◽  
Iris Neovascularisation

A consecutive series of 38 eyes of 35 glaucoma patients treated with transillumination guided cyclocryotherapy (CCT) either to obtain pain relief or to achieve IOP control was studied at Helsinki University Eye Hospital. Transillumination was used to guide the applications to the correct site. The follow-up range was 1 - 43 months (mean 9 months). Pretreatment IOP was 39 ± 13 mm Hg and postoperative 26 ± 16 mm Hg (mean ± SD). Twenty-three eyes underwent one and 15 eyes 2 - 5 procedures. IOP control (IOP 9 - 23 mm Hg) was achieved in 50%. The response was more favorable in eyes without iris neovascularisation (59% achieved IOP control) than in eyes with neovascular glaucoma (38% achieved IOP control). The best response was achieved in eyes with chronic uveitis (5/7 eyes achieved IOP control). Repeated procedures improved the IOP control rate. Hypotony (IOP < 9 mm Hg) without clinical signs of phthisis occurred in three eyes (8%). Thirteen eyes needed primarily pain relief and 92% achieved it. Postoperatively vision was better in 8%, unchanged in 37% and worse in 55%. Visual acuity was 0.05 or better in nine eyes pretreatment and in eight eyes after treatment.

scholarly journals Presentation, etiology and treatment outcome of neovascular glaucoma in Ekiti state, South Western Nigeria

2021 ◽  
Vol 21 (3) ◽  
pp. 1266-1272
Author(s):  
Iyiade Ajayi ◽  
Olusola Omotoye ◽  
Kayode Ajite ◽  
Emmanuel Abah
Keyword(s):  
Social Sciences ◽  
Visual Acuity ◽  
Neovascular Glaucoma ◽  
Tertiary Hospital ◽  
Retinal Ischemia ◽  
Secondary Glaucoma ◽  
Vascular Endothelial ◽  
Health Promotion And Education ◽  
Endothelial Growth Factor

Background: Neovascular glaucoma (NVG), a form of secondary glaucoma has varying causes across geographical loca- tions. Objective: The objective of this study was to determine the presentation, aetiology, and outcome of treatment of patients with NVG in a Nigerian tertiary hospital. Method: A retrospective review of records of all cases of NVG seen over a 5year period was carried out. Demographic characteristics, presenting visual acuity and coexisting ocular and systemic conditions were noted. Data were analysed with Statistical Package for Social Sciences (SPSS) version 25. Results: 29 eyes of patients with NVG were analysed. Most of the patients (89.70%) presented with visual acuity less than 3/60 in the affected eye. All patients except one were treated with anti-glaucoma medications while only 9(31%) consented to and received anti-vascular endothelial growth factor. No patient had improvement in visual acuity despite resolution of other symptoms at 12week follow up. Conclusion: NVG though not as common as other forms of glaucoma accounted for a large proportion of monocular blindness in the affected eyes at presentation. There is need for health promotion and education among our people on the need for early preventive eye check practices. Keywords: Neovascular glaucoma; retinal ischemia; rubeosis iridis; secondary glaucoma.

Effect of age on outcome and revision in total ankle arthroplasty

2020 ◽  
Vol 102-B (7) ◽  
pp. 925-932 ◽  
Author(s):  
Mario Gaugler ◽  
Nicola Krähenbühl ◽  
Alexej Barg ◽  
Roxa Ruiz ◽  
Tamara Horn-Lang ◽  
...  
Keyword(s):  
Pain Relief ◽  
Clinical Outcome ◽  
Revision Surgery ◽  
Preoperative Assessment ◽  
Total Ankle Arthroplasty ◽  
Consecutive Series ◽  
Ankle Arthroplasty ◽  
Major Revision ◽  
Effect Of Age

Aims To assess the effect of age on clinical outcome and revision rates in patients who underwent total ankle arthroplasty (TAA) for end-stage ankle osteoarthritis (OA). Methods A consecutive series of 811 ankles (789 patients) that underwent TAA between May 2003 and December 2013 were enrolled. The influence of age on clinical outcome, including the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and pain according to the visual analogue scale (VAS) was assessed. In addition, the risk for revision surgery that includes soft tissue procedures, periarticular arthrodeses/osteotomies, ankle joint debridement, and/or inlay exchange (defined as minor revision), as well as the risk for revision surgery necessitating the exchange of any of the metallic components or removal of implant followed by ankle/hindfoot fusion (defined as major revision) was calculated. Results A significant improvement in the AOFAS hindfoot score and pain relief between the preoperative assessment and the last follow-up was evident. Age had a positive effect on pain relief. The risk for a minor or major revision was 28.7 % at the mean follow-up of 5.4 years and 11.0 % at a mean follow-up of 6.9 years respectively. The hazard of revision was not affected by age. Conclusion The clinical outcome, as well as the probability for revision surgery following TAA, is comparable between younger and older patients. The overall revision rate of the Hintegra total ankle is comparable with other three component designs. TAA should no longer be reserved for low demand elderly patients, but should also be recognized as a viable option for active patients of younger age. Cite this article: Bone Joint J 2020;102-B(7):925–932.

Visual Loss

2013 ◽  
Author(s):  
Jess T. Whitson
Keyword(s):  
Visual Acuity ◽  
Visual Loss ◽  
Vision Loss ◽  
Neovascular Glaucoma ◽  
Shunt Surgery ◽  
Shunt Implantation ◽  
Shunt Group ◽  
Long Term Follow Up ◽  
Tube Shunt

Tube shunt surgery use has increased significantly in recent years. Once reserved as a treatment option for more refractory types of disease, such as uveitic or neovascular glaucoma, or for eyes that had failed one or more trabeculectomies, tube shunts are now being used by some surgeons in place of trabeculectomy as a first-line surgical alternative in eyes with other less aggressive or less difficult to control forms of glaucoma. Visual loss can occur following tube shunt implantation as a result of complications during the postoperative period or from the progression of underlying disease (see Table 40.1). Although tube shunt implantation is associated with similar postoperative complications as trabeculectomy surgery, such as hypotony, hemorrhage, and failure to control IOP, there are several unique complications that may develop with the use of tube shunts, many of which may result in vision loss. Visual loss following tube shunt surgery is not uncommon. A large, systematic literature review of tube shunts by Hong and coworkers reported rates of vision loss following tube shunt surgery (defined as loss of 2 or more lines of visual acuity at last follow-up) ranging from (mean [SD]) 24 (7)% with the Ahmed™ Glaucoma Valve (New World Medical, Inc., Rancho Cucamonga, California) to 33 (18)% with the Molteno® implant (Molteno Ophthalmic Ltd., Dunedin, New Zealand). In the Tube Versus Trabeculectomy (TVT) Study, an ongoing, prospective, randomized clinical trial that is comparing the Baerveldt® 350 mm tube shunt (Abbott Medical Optics, Inc., Santa Ana, California) to trabeculectomy with mitomycin-C (MMC) in eyes with previous trabeculectomy and/or cataract surgery, vision loss (defined as loss of 2 or more lines of Snellen visual acuity) occurred in 31 of the 107 patients (29%) in the tube shunt group. The occurrence of any postoperative complication significantly increased the risk of vision loss (p < 0.001), and this risk correlated to the number of complications. Corneal decompensation has been reported to occur in up to 30% of patients during long-term follow-up after tube shunt surgery.

Visual Function after Implantation of Aniridia Intraocular Lens for Traumatic Aniridia in Vitrectomized Eye

2007 ◽  
Vol 17 (4) ◽  
pp. 660-665 ◽  
Author(s):  
S. Moghimi ◽  
M. Riazi Esfahani ◽  
M. Maghsoudipour
Keyword(s):  
Visual Acuity ◽  
Contrast Sensitivity ◽  
Intraocular Lens ◽  
Visual Function ◽  
Secondary Glaucoma ◽  
Posterior Chamber ◽  
Antiglaucoma Medication ◽  
Posterior Chamber Intraocular Lens ◽  
Previous Trauma

Purpose To evaluate the efficacy and safety of aniridia posterior chamber intraocular lens (PCIOL) in traumatic aniridia and aphakia in vitrectomized eyes. Methods Four aphakic patients with traumatic aniridia and previous pars plana vitrectomy (PPV) due to posterior segment trauma enrolled in the study, and had secondary implantation of an aniridia PCIOL. Two patients were men and two women with mean age of 39.25 years. Complete ophthalmic examinations, including preoperative and postoperative visual acuity in dark and light, glare disability, visual function (using VF-9 questions modified from VF-14), stereopsis, and contrast sensitivity in 3, 6, 12, and 18 cycle per degree frequencies, were done for all patients. Postoperative intraocular pressure (IOP), IOL centration, and intraocular inflammation were monitored. Mean follow-up was 12.25 months (range 7 to 15 months). Results Visual acuity improved in all four patients, especially in the light. Glare was subjectively reduced in all of them. Stereopsis was measurable in three of them postoperatively. Contrast sensitivity improved in all patients, especially in brightness and lower frequencies. All four eyes had improved VF-9. All eyes achieved the desired anatomic results. Two cases developed elevated IOP early after surgery. In one eye, IOP elevation was transient and controlled with antiglaucoma medication, but the other eye, which had secondary glaucoma from previous trauma, required cyclophotocoagulation for the IOP to be controlled. No patient developed chronic uveitis or redetachment. Conclusions The aniridia PCIOL can overcome aphakia, reduce glare, and increase visual function, contrast sensitivity, and stereopsis in vitrectomized eyes with traumatic aniridia. Although this kind of IOL appears safe, some disadvantages are secondary glaucoma and reduced visibility of peripheral fundus, and caution should be used in its implantation until more patients with longer follow-up are studied.

scholarly journals Management of Dislocated Intraocular Lenses with Iris Suture

2016 ◽  
Vol 27 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Mun Y. Faria ◽  
Nuno P. Ferreira ◽  
Mario Canastro
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Macular Edema ◽  
Clinical Signs ◽  
Intraocular Lenses ◽  
Posterior Chamber ◽  
Pigment Dispersion ◽  
Corneal Incision ◽  
The Mean

Purpose Subluxated or malpositioned intraocular lenses (IOLs) and inadequate capsular support is a challenge for every ophthalmic surgeon. Iris suture of an IOL seems to be an easy technique for the management of dislocated 3-piece IOL, allowing the IOL to be placed behind the iris, far from the trabecular meshwork and corneal endothelium. The purpose of this study is to assess the results of pars plana vitrectomy (PPV) and iris suture of dislocated 3-piece acrylic IOLs. Methods In this retrospective, nonrandomized, interventional case consecutive study, of a total of 103 dislocated IOLs, 36 eyes were considered for analysis. All 36 eyes had subluxated or totally luxated 3-piece IOL and underwent iris suture at the Ophthalmology Department of Santa Maria Hospital-North Lisbon Hospital Center, Portugal, from January 2011 until November 2015. All patients underwent 3-port 23-G PPV. The optic zone of the dislocated IOL was placed anterior to the iris with the haptics behind, in the posterior chamber. Haptics were sutured to iris followed by placement of the optics behind iris plane. Postoperative measures included best-corrected visual acuity (BCVA), IOL position, intraocular pressure, pigment dispersion, clinical signs of endothelial cell loss, and development of macular edema. Results A total of 36 eyes of 36 patients were included. All underwent successful iris fixation of dislocated 3-piece IOL. Mean overall follow-up was 15.9 months (range 3-58 months). At presentation, 16 eyes (44.4%) had a luxated IOL and 20 eyes (55.6%) a subluxated IOL. As underlying cause, 17 eyes (47.2%) had a history of complicated cataract surgery, 5 eyes (13.9%) had a traumatic dislocation of the IOL, and 6 eyes (16.7%) had a previous vitreoretinal surgery. A total of 8 eyes (22.2%) had late spontaneous IOL dislocation after uneventful cataract surgery. The mean preoperative BCVA was 1.09 ± 0.70 logarithm of the minimal angle of resolution (logMAR) units and mean postoperative BCVA was 0.48 ± 0.58 of logMAR units. The mean visual acuity improvement was 4.08 ± 5.33 lines on the logMAR scale. In this study, every IOL was stable at the last follow-up. As late complications, macular edema occurred in 1 patient and retinal detachment occurred in 2 patients. There were no cases of endophthalmitis. Conclusions Iris suture fixation of subluxated IOL is a good treatment option for eyes with dislocated IOLs, leading to long-term stability of the IOL. The advantage of this procedure is using the same IOL in a closed eye surgery. No astigmatic difference is expected as no large corneal incision is needed.

Chronic myeloid leukaemia accelerates proliferative retinopathy in patients with co-existent diabetes: A risk factor not to be ignored

2019 ◽  
pp. 112067211987534
Author(s):  
Rohan Chawla ◽  
Suneel Kumar ◽  
Devesh Kumawat ◽  
Shorya Vardhan Azad ◽  
Shreyas Temkar ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Chronic Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Management Strategies ◽  
Neovascular Glaucoma ◽  
Proliferative Retinopathy ◽  
Screening Guidelines ◽  
Imaging Characteristics ◽  
Patients With Diabetes

Objective: To describe the retinal imaging characteristics, retinopathy management strategies and visual outcomes in cases of diabetes with chronic myeloid leukaemia. Design: Retrospective observational study. Participants: Patients with diabetes and chronic myeloid leukaemia managed at our tertiary eye care centre from January 2015 to December 2017. Methods: Detailed ophthalmic and systemic evaluation, treatment and follow-up records were reviewed. The main measures studied were visual acuity, intra-ocular pressure, retinopathy severity, and surgical indications and techniques. Results: Of the six patients studied, three had diabetes and chronic myeloid leukaemia at presentation, while in three cases chronic myeloid leukaemia was diagnosed following evaluation for proliferative retinopathy. The visual acuity ranged from 20/20 to perception of light. All eyes had marked proliferative retinopathy out of proportion to the exudation. None of the eyes had significant macular oedema. Pan-retinal photocoagulation (10/12, 83.33%), intravitreal anti-vascular endothelial growth factor injection (8/12, 66.67%), vitrectomy (2/12, 16.67%), cataract surgery (2/12, 16.67%) and trabeculectomy followed by cryoablation (2/12, 16.67%) was performed for management of the ocular disease as indicated. Median follow-up was 16.5 months (range: 6–24 months). Final visual acuity ranged from PL to 20/20 with acuity ⩾ 20/100 in eight eyes. Four eyes had advanced optic neuropathy from neovascular glaucoma. Conclusion: Accelerated proliferative retinopathy can be seen in cases of diabetes with chronic myeloid leukaemia at the very initial ophthalmic evaluation. Thus, there is a need to alter screening guidelines for retinopathy in cases of diabetes with chronic myeloid leukaemia. Early detection and aggressive management may help preserve visual acuity in such cases.

RECURRENT DORSAL WRIST GANGLION: AETIOLOGY AND TREATMENT

Hand Surgery ◽  
1996 ◽  
Vol 01 (01) ◽  
pp. 7-9 ◽  
Author(s):  
Susan L. Filan ◽  
Timothy J. Herbert
Keyword(s):  
Pain Relief ◽  
Clinical Signs ◽  
Wrist Pain ◽  
Scapholunate Ligament ◽  
Successful Method ◽  
Wrist Function ◽  
Dorsal Wrist Ganglion ◽  
Radial Wrist Pain

Seven patients with symptomatic recurrent dorsal wrist ganglia were treated by excision of the origin of the ganglion from the scapholunate ligament combined with dorsal capsulorrhaphy. All patients presented with radial wrist pain associated with recurrent dorsal wrist ganglia. Examination revealed localised tenderness over the scapholunate joint with clinical signs of scaphoid instability in every case. Postoperatively, all patients reported pain relief and improved wrist function. There have been no recurrences, with an average follow-up of 14 months (range 12–22 months). Dorsal capsulorrhaphy appears to be a successful method of relieving symptoms, improving wrist function and preventing ganglion recurrence.

scholarly journals A Comparative Study between Ultrasound Cycloplasty and Cyclocryotherapy for the Treatment of Neovascular Glaucoma

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Wang Ruixue ◽  
Wang Tao ◽  
Li Ning
Keyword(s):  
Pain Relief ◽  
Ciliary Body ◽  
Primary Outcome ◽  
Histological Study ◽  
Neovascular Glaucoma ◽  
Secondary Outcome ◽  
Matrix Metalloproteinase 1 ◽  
The Mean ◽  
Histological Effect

Purpose. To compare the clinical efficacy, safety, and histological effect between ultrasound cycloplasty (UCP) and cyclocryotherapy in the treatment of neovascular glaucoma. Methods. Two groups of neovascular glaucoma patients who underwent two types of treatment, respectively, namely, 26 patients treated by UCP and 23 by cyclocryotherapy, were treated and observed during the clinical study for six months. The primary outcome was evaluated by the surgical success, which was defined as the intraocular pressure (IOP) reduction of greater than or equal to 20% from the baseline and the IOP value of greater than 5 mmHg at the last follow-up. The secondary outcome referred to pain relief, complications, and the mean of the IOP at each follow-up. In the animal experiment, 18 New Zealand rabbits were divided into two groups and treated by UCP and cyclocryotherapy, respectively. The changes in the tissues and in the expression of matrix metalloproteinase-1 (MMP-1) were observed immediately. Results. The mean IOP baseline for the UCP and cyclocryotherapy groups was 54.6 ± 9.7 mmHg and 53.3 ± 11.7 mmHg, respectively. After six months of follow-up, the IOP value decreased to 30.3 ± 9.4 mmHg for the patients treated by UCP and to 30.4 ± 9.1 mmHg for those treated by cyclocryotherapy. The two groups achieved a satisfying success rate in the treatment of neovascular glaucoma of up to 70% at least. Vision impairment was observed in some patients treated with cyclocryotherapy, and these patients suffered from more complications and less pain relief than the patients who were treated with UCP. The histological study showed that the ciliary body was completely destroyed after cyclocryotherapy and that MMP-1 was found only in the ciliary muscle. After the UCP treatment, MMP-1 could still be found in the ciliary body, and only the double-layer epithelial cells presented with coagulative necrosis. Conclusion. The UCP treatment and cyclocryotherapy both showed good efficacy in significantly reducing the IOP. However, the UCP treatment was safer with less postoperative complications and adverse effects. Thus, the overall treatment effect of the UCP was more efficient than that of cyclocryotherapy.

scholarly journals Diagnostics of infrapatellar saphenous neuralgia—a reversible cause of chronic anteromedial pain following knee surgery

2021 ◽  
Author(s):  
Schu-Ren Yang ◽  
Michael T. Hirschmann ◽  
Alain Schiffmann ◽  
Balazs K. Kovacs ◽  
Julian Gehweiler ◽  
...  
Keyword(s):  
Pain Relief ◽  
Knee Joint ◽  
Knee Pain ◽  
Nerve Block ◽  
Joint Instability ◽  
Clinical Signs ◽  
Knee Surgery ◽  
Concomitant Surgery ◽  
The Impact

Abstract Objectives To evaluate the impact of diagnostic nerve block and ultrasound findings on therapeutic choices and predict the outcome after concomitant surgery in patients with suspected neuropathy of the infrapatellar branch of the saphenous nerve (IPBSN). Methods Fifty-five patients following knee surgery with suspicion of IPBSN neuralgia were retrospectively included. Ultrasound reports were assessed for neuroma and postsurgical scarring (yes/no). Responders and non-responders were assigned following anesthetic injection of the IPBSN. The type of procedure (neurectomy/interventional pain procedure/other than nerve-associated therapy) and pain score at initial follow-up were recorded and patients were assigned as positive (full pain relief) or negative (partial/no pain relief) to therapeutic nerve treatment. Factors associated with a relevant visual analog scale (VAS) reduction were assessed using uni- and multivariate logistic regression models and chi-square for quantitative and qualitative variables (p ≤ 0.05). Results Responders (37/55) more often had an entrapment or an evident neuroma of the IPBSN (97% vs. 6%). A positive Hoffmann-Tinel sign (p = 0.002) and the absence of knee joint instability (p = 0.029) predicted a positive response of the diagnostic nerve block (90%; 26/29). In the follow-up after therapeutic nerve treatment, all patients with full pain relief showed neuromas or entrapment of the IPBSN. Patients negatively responding to therapeutic nerve treatment more frequently showed an additional knee joint instability (25% vs. 4%). Conclusion Selective denervation for neuropathic knee pain is beneficial in selected patients with significant VAS reduction after diagnostic nerve block. Non-responders following diagnostic nerve block but sonographic evidence of IPBSN pathologies need to be evaluated for other causes such as knee joint instability. Key Points • Sonographic diagnosis of neuroma or entrapment of the IPBSN is frequently seen in patients with anteromedial knee pain and leads to a good response to diagnostic nerve block following knee surgery. • The vast majority of patients with clinical signs of IPBSN neuropathy and response to a diagnostic nerve block sustained full pain relief following therapeutic nerve treatment. • Patients not responding to therapeutic IPBSN treatment have to be evaluated for other causes of anteromedial knee pain such as knee joint instability.

scholarly journals Clinical Efficacy and Safety of the EX-PRESS Filtration Device in Patients with Advanced Neovascular Glaucoma and Proliferative Diabetic Retinopathy

2018 ◽  
Vol 9 (1) ◽  
pp. 67-75 ◽  
Author(s):  
Rana Hanna ◽  
Beatrice Tiosano ◽  
Shmuel Graffi ◽  
Dan Gaton
Keyword(s):  
Visual Acuity ◽  
Diabetic Retinopathy ◽  
Proliferative Diabetic Retinopathy ◽  
Case Series ◽  
Neovascular Glaucoma ◽  
Light Perception ◽  
Filtration Surgery ◽  
The Mean ◽  
Filtration Device

Background: The prognosis of conventional filtration surgery in eyes with neovascular glaucoma (NVG) is limited due to increased fibrovascular proliferation or bleeding. This study aims to evaluate the safety and efficacy of the EX-PRESS filtration device in the management of NVG associated with proliferative diabetic retinopathy (PDR). Methods: In this retrospective case series, we reviewed the medical records of patients diagnosed as having NVG associated with PDR who underwent EX-PRESS filtration surgery. The main outcome measures were: postoperative intraocular pressure (IOP), the percent of IOP drop, the number of glaucoma medications, visual acuity, and complications of surgery. Successful surgery was defined as an IOP <22 mm Hg and >5 mm Hg with or without additional glaucoma surgery, and no loss of light perception or less than a 2-line decrease on the Snellen chart of the best corrected visual acuity (BCVA). Results: Five patients (5 eyes) were included in this study. The mean preoperative IOP was 33.4 ± 5.9 mm Hg compared to an IOP of 17.0 ± 3.0 mm Hg at the last follow-up (p = 0.003). The mean number of preoperative anti-glaucoma medications was 3.8 ± 0.4 compared to 2.2 ± 1.5 (p = 0.06) at the last follow-up visit. Final visual acuity improved or stabilized within 1 Snellen line in all 5 patients. Three patients had a “hypertensive phase” (defined as an IOP >21 mm Hg during the first 6 postoperative months) which resolved within 2 months. Two patients developed a hyphema that resolved spontaneously. None of the patients experienced any serious complications. Conclusion: EX-PRESS filtration device has a good IOP-lowering effect and a low rate of complications in patients with advanced NVG associated with PDR. In addition, there was no loss of light perception or no line decrease of the BCVA.

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