Pneumatic Vitreolysis for the Treatment of Symptomatic Vitreomacular Traction: A Prospective Pilot Study

2018 ◽  
Vol 2 (5) ◽  
pp. 282-288
Author(s):  
Matthew F. Anderson ◽  
Itay Magal ◽  
Anna Ells ◽  
Michael Fielden ◽  
R. Geoff Williams ◽  
...  
Keyword(s):  
Gas Injection ◽  
Cost Savings ◽  
Vitreomacular Traction ◽  
Final Visit ◽  
Foveal Thickness ◽  
Presenting Symptoms ◽  
Retinal Breaks ◽  
Intravitreal Gas ◽  
The Mean

Purpose: The purpose of this study was to determine the efficacy of pneumatic vitreolysis in the treatment of symptomatic focal vitreomacular traction (VMT). Methods: Patients choosing intravitreal gas injection as their preferred treatment for symptomatic VMT were invited to participate in this prospective study; 0.3 mL of perfluoropropane gas was injected. Optical coherence tomography was performed pre-and postprocedure to determine the proportion of eyes showing release of VMT. Results: Nine eyes of nine participants were included in the study, with a mean follow-up of 5.0±1.8 months. Gas injection resulted in the release of VMT in 7 of 9 eyes (78%) during the course of the study. Both eyes in which the VMT failed to release also showed an improvement in central macular anatomy. Mean visual acuity improved from logarithm of the minimum angle of resolution (logMAR) 0.33±0.14 (Snellen equivalent, ∼20/42) to logMAR 0.24±0.21 (Snellen, ∼20/35) at final follow-up ( P = .03); 8 of 9 patients (89%) reported a subjective improvement in their presenting symptoms and/or vision during the study period. The mean maximum foveal thickness of 480 ± 22 μm at baseline reduced to 282 ± 94 μm by the time of the final visit ( P = .002). Two patients had retinopexy for retinal breaks/suspect breaks. Conclusions: Pneumatic vitreolysis is an effective treatment for symptomatic VMT and may offer cost savings for patients and/or health services.

Retroclival Epidural Hematomas

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 404-407 ◽  
Author(s):  
R. Shane Tubbs ◽  
Christoph J. Griessenauer ◽  
Todd Hankinson ◽  
Curtis Rozzelle ◽  
John C. Wellons ◽  
...  
Keyword(s):  
Glasgow Coma Scale ◽  
Scale Score ◽  
Glasgow Coma Scale Score ◽  
Pediatric Patients ◽  
Motor Vehicle ◽  
Coma Scale ◽  
Presenting Symptoms ◽  
Cord Injury ◽  
The Mean

Abstract BACKGROUND Retroclival epidural hematomas (REDHs) are infrequently reported. To our knowledge, only 19 case reports exist in the literature. OBJECTIVE This study was performed to better elucidate this pathology. METHODS We prospectively collected data for all pediatric patients diagnosed with REDH from July 2006 through June 2009. Data included mechanism of injury, Glasgow Coma Scale score, neurological examination, treatment modality, and outcome. Magnetic resonance imaging was used to measure REDH dimensions. RESULTS Eight children were diagnosed with REDH, and the hematomas were secondary to motor vehicle–related trauma in all cases. The mean age of patients was 12 years (range 4–17 years). The mean REDH height (craniocaudal) was 4.0 cm, and the mean thickness (dorsoventral) was 1.0 cm. At presentation, the mean Glasgow Coma Scale score was 8 (range 3–14), and there was no correlation between hematoma size and presenting symptoms. Two patients died soon after injury, and 2 additional patients had atlanto-occipital dislocation that required surgical intervention. No patient underwent surgical evacuation of the REDH. The mean follow-up was 14 months. At most recent follow-up, 4 patients are neurologically intact, 1 patient has a complete spinal cord injury, and 1 patient has mild bilateral abducens nerve palsy. CONCLUSION To our knowledge, this study of 8 pediatric patients is the largest series of patients with REDH thus far reported. Based on our study, we found that REDH is likely to be underdiagnosed, atlanto-occipital dislocation should be considered in all cases of REDH, and many patients with REDH will have minimal long-term neurological injury.

Gamma Knife surgery for pediatric arteriovenous malformations: a 25-year retrospective study

2012 ◽  
Vol 10 (5) ◽  
pp. 445-450 ◽  
Author(s):  
Eduard B. Dinca ◽  
Patricia de Lacy ◽  
John Yianni ◽  
Jeremy Rowe ◽  
Matthias W. R. Radatz ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Lesion Volume ◽  
Bleeding Rate ◽  
Patients Âgés ◽  
Obliteration Rate ◽  
Telephone Interviews ◽  
Presenting Symptoms ◽  
Martin Grade ◽  
The Mean

Object The authors present their 25-year experience in treating pediatric arteriovenous malformations (AVMs) to allow comparisons with other historic studies and data in adults. Methods Data were collected from a prospectively maintained departmental database selected for age and supplemented by case note review and telephone interviews as appropriate. Results Three hundred sixty-three patients, ages 1–16 years (mean ± SD, 12 ± 3.2 years), underwent 410 treatments; 4 had planned 2-stage treatments and 43 were retreated subsequent to an initial partial response. Fifty-eight percent received general anesthesia for the procedure. Sixteen percent had previously undergone embolization. The most common presenting symptoms were as follows: hemorrhage (80.2%), epilepsy (8.3%; overall seizure prevalence 19.9%), and migrainous headaches (6.3%). Only 0.28% of the AVMs were incidental findings. The mean lesion volume was 3.75 ± 5.3 cm3 (range 0.01–32.8 cm3), with a median Spetzler-Martin grade of III (range I–V). The mean peripheral (therapeutic) dose was 22.7 ± 2.3 Gy (range 15–25 Gy), corresponding to a mean maximum dose of 43.6 ± 6 Gy (range 25–51.4 Gy). The obliteration rate was 71.3% in patients who received one treatment and 62.5% for retreated patients, with a mean obliteration time of 32.4 and 79.6 months, respectively. The overall obliteration rate was 82.7%. No follow-up data are as yet available for the 4 patients who underwent the staged treatments. Only 4 patients received peripheral doses below 20 Gy, and the AVM was obliterated in 3 of these patients. The other patients received 20, 22.5, or 25 Gy and had obliteration rates of 82.6%, 77.7%, and 86.3%, respectively. The bleeding rate postradiosurgery was 2.2%, and the cumulative complication rate was 3.6%, with radionecrosis being the most common complication (1.1%). Conclusions Surprisingly, there was no correlation (p = 0.43) between outcome and radiosurgical dose when that dose was between 20 and 25 Gy, thus suggesting that the lower of these 2 doses may be effective. Radiosurgery for pediatric AVM is safe and effective.

Outcomes of conbercept therapy for choroidal neovascularization secondary to pathological myopia

2021 ◽  
Vol 2 (4) ◽  
pp. 210-213
Author(s):  
Zheng-Feng Liu ◽  
◽  
Da-Dong Guo ◽  
Mei-Hua Ding ◽  
Hong-Sheng Bi ◽  
...  
Keyword(s):  
Choroidal Neovascularization ◽  
Fundus Fluorescein Angiography ◽  
Pathological Myopia ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
The Mean ◽  
One Year

AIM: To evaluate the one-year outcome of intravitreal conbercept injections for the treatment of choroidal neovascularization secondary to pathological myopia (pm-CNV) by optical coherence tomography angiography (OCTA). METHODS: The medical records of 26 consecutive eyes of 23 patients who received intravitreal injections of conbercept for pm-CNV with a follow-up of one year were retrospectively reviewed. All the patients were diagnosed by fundus fluorescein angiography (FFA) and OCTA at the first visit. All approaches were performed as “1+PRN” treatment. Outcomes included best-corrected visual acuity (BCVA), central foveal thickness (CFT) and the mean CNV area by OCTA. RESULTS: Mean Logarithm BCVA improved from (0.66±0.51) at baseline to (0.39±0.38) at one year (t=3.528, P=0.004). The CFT before treatment and after one year after were 275.08±48.74) μm and (205.15±43.74) μm respectively (t=4.630, P=0.001). The mean pm-CNV areas before treatment and after one year treatment were (0.48±0.24) mm2 and (0.15±0.11) mm2 respectively, with a significant difference among them (t=5.329, P=0.000). Twenty-one eyes had no needs after the first treatment. Four eyes received 2 injections and only one eye received 3 injections. No severe adverse events were noted relevant to the therapy. CONCLUSION: Intravitreal conbercept can improve the vision and relieve CFT and CNV area for the treatment of pm-CNV with “1+PRN” by OCTA for one year, however, long-term follow-up still need to be performed.

Long-Term Efficacy of Dexamethasone Intravitreal Implant in the Treatment of Vogt-Koyanagi-Harada (VKH) Disease Relapsing Posterior Uveitis

2021 ◽  
Author(s):  
Tarek Roshdy Elhamaky
Keyword(s):  
Visual Acuity ◽  
Posterior Uveitis ◽  
Systemic Steroid ◽  
Foveal Thickness ◽  
Dexamethasone Intravitreal Implant ◽  
Central Foveal Thickness ◽  
Intravitreal Implant ◽  
The Mean ◽  
Vkh Disease

Abstract Purpose: To investigate the efficacy and safety of dexamethasone intravitreal implant in the treatment of relapsing posterior uveitis in patients with chronic recurrent VKH disease.Methods: This is a prospective study of 29 eyes of 16 patients with posterior uveitis in chronic recurrent VKH disease. All patients received previous systemic steroid and immunosuppressive regimens. All patients underwent a comprehensive ophthalmic examination, including BCVA (log MAR), IOP, FFA, and SD-OCT. All patients underwent intravitreal injection with sustained-release dexamethasone 0.7 mg implant (Ozurdex®). Primary outcome measures included mean change in best corrected visual acuity (BCVA) and central foveal thickness (CFT) at 24 months follow-up compared to baseline. Results: At 24 months follow-up, the mean BCVA improved from 0.82 ± 0.13 to 0.38 ± 0.06logMAR (P <0.0001). The mean CFT reduced from 505 ± 29 to 244 ± 23 um (P <0.0001). The mean IOP changed from 15.1±2.2 to16.9±3.1 mmHg with no significant value. Twenty-one eyes (72.4%) received one injection, while eight eyes (27.6%) required two injections. The mean number of injections was 1.2± 0.60. The mean follow-up time was 24.75± 0.9months. No serious ocular or systemic adverse events were noted during the follow-up period. Ocular hypertension was recorded in there (10.3%) eyes and controlled by IOP lowering medications. Cataract progression occurred in 11 (37.9%) eyes.Conclusions: Our cohort highlights the beneficial effects of the Dexamethasone implant 0.7 mg in the treatment of VKH disease relapsing posterior uveitis improving visual acuity, reducing macular edema, and minimizing the burden of systemic steroid in this sample study.

scholarly journals Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Josef Guber ◽  
Celine Rusch ◽  
Ivo Guber ◽  
Hendrik P. N. Scholl ◽  
Christophe Valmaggia
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Adverse Events ◽  
Gas Injection ◽  
Posterior Vitreous Detachment ◽  
Vitreomacular Traction ◽  
Final Visit ◽  
Viable Option ◽  
Vitreous Detachment ◽  
Lower Success Rate

AbstractTo evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

Endocrinopathy, Vision, Headache, and Recurrence After Transsphenoidal Surgery for Rathke Cleft Cysts

Neurosurgery ◽  
2010 ◽  
Vol 67 (3) ◽  
pp. 837-843 ◽  
Author(s):  
Scott D. Wait ◽  
Mark P. Garrett ◽  
Andrew S. Little ◽  
Brendan D. Killory ◽  
William L. White
Keyword(s):  
Rational Choice ◽  
Surgical Management ◽  
Transsphenoidal Surgery ◽  
Squamous Metaplasia ◽  
Senior Author ◽  
Visual Symptoms ◽  
Presenting Symptoms ◽  
Rathke Cleft Cyst ◽  
The Mean

Abstract BACKGROUND Rathke cleft cyst can enlarge and become symptomatic. OBJECTIVE To review the clinical data and results of all patients treated by the senior author for a Rathke cleft cyst. METHODS A prospectively maintained surgical database, supplemented with updates from telephone conversations, of all patients presenting to the Barrow Neurological Institute from 1992 to the present was reviewed. RESULTS Seventy-three patients (17 males, 56 females; mean age, 40 years; range, 5–80 years) underwent 77 resections. The mean length of follow-up was 27 months (range, 0–129 months). Presenting symptoms included headache (75%), followed by endocrinopathy (49%), and visual symptoms (39%). Preoperative chiasmopathy resolved in 75% and improved in 21% of the patients. Patients' preoperative endocrinopathy resolved at various rates, depending on the specific axis (29%–100%). Endocrinopathies were more likely to resolve in females than males. New postoperative endocrinopathies also occurred (0–8%). Headache resolved (68%) or improved (21%) in most patients. No patient had worsened headaches. Eight patients had a recurrence, 4 of whom underwent reoperation. The presence of squamous metaplasia was the only predictor of recurrence. CONCLUSION Surgical fenestration and/or resection of Rathke cleft cyst via the transsphenoidal approach are a rational choice for surgical management of these lesions when symptomatic. In most cases, visual symptoms and headache can be expected to improve. New persistent endocrine deficits can be expected in a small percentage of patients, but preexisting endocrinopathies resolve in many patients.

Identification of Underlying Causes of Spontaneous Submacular Hemorrhage by Indocyanine Green Angiography

2015 ◽  
Vol 233 (3-4) ◽  
pp. 146-154 ◽  
Author(s):  
Hyesun Kim ◽  
Sung Chul Lee ◽  
Sang Myung Kim ◽  
Ji Hwan Lee ◽  
Hyoung Jun Koh ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Indocyanine Green ◽  
Indocyanine Green Angiography ◽  
Age Related Macular Degeneration ◽  
Fundus Photography ◽  
Submacular Hemorrhage ◽  
Foveal Thickness ◽  
Central Foveal Thickness ◽  
The Mean

Purpose: To investigate the causes of acute spontaneous submacular hemorrhage with indocyanine green angiography (ICGA). Methods: Retrospective observation case series. A total of 51 eyes from 51 patients with newly developed spontaneous submacular hemorrhage were enrolled. Best-corrected visual acuity (BCVA), fundus photography, fluorescein angiography, spectral domain optical coherence tomography (OCT), and ICGA at baseline were analyzed. The extent of hemorrhage using fundus photography, height of hemorrhage, and central foveal thickness measured by OCT was analyzed to compare the diagnostic and nondiagnostic groups. Results: The mean logarithm of the minimum angle of resolution (logMAR) BCVA at presentation was 1.21 ± 0.74 (Snellen equivalent, 20/324); the mean follow-up period was 23.9 ± 23.9 months. The cause of submacular hemorrhage was diagnosed in 43 of 51 eyes (84.3%) based on ICGA at presentation. The initial diagnoses were correct in 93% of eyes. In 3 cases, the initial diagnosis of age-related macular degeneration (AMD) was changed to polypoidal choroidal vasculopathy (PCV) based on follow-up ICGA. The central foveal thickness was significantly greater in the nondiagnostic group (1,102.4 vs. 666.7 μm, respectively; p = 0.008). The most common cause of submacular hemorrhage was neovascular AMD (52.9%), followed by PCV (37.3%), macroaneurysm (5.9%), and lacquer crack (3.9%). The mean final visual acuity was generally worse in patients with submacular hemorrhage with typical AMD (visual acuity 20/618) or PCV (visual acuity 20/240) compared to that in patients with retinal macroaneurysm (visual acuity 20/100) or lacquer crack (visual acuity 20/72). Conclusions: ICGA at initial presentation helps identify causes of submacular hemorrhage, allowing differential treatment approaches that may improve outcomes and safety.

Surgical Treatment of Childhood Inflammatory Myofibroblastic Tumors

2016 ◽  
Vol 27 (04) ◽  
pp. 319-323 ◽  
Author(s):  
Beril Talim ◽  
İbrahim Karnak ◽  
Saniye Ekinci ◽  
Fatih Andiran ◽  
Arbay Çiftçi ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Lower Lobe ◽  
Diagnostic Methods ◽  
Incomplete Resection ◽  
Total Resection ◽  
Presenting Symptoms ◽  
Inflammatory Myofibroblastic Tumors ◽  
The Mean

Aim A retrospective study was performed to evaluate the clinical features, diagnostic methods, and treatment alternatives of childhood inflammatory myofibroblastic tumors (IMTs). Patients and Methods Patients who underwent surgical treatment for IMT between 2000 and 2015 were evaluated for age, sex, presenting symptoms, physical examination findings, diagnostic methods, treatment modalities, histopathologic findings, and results of surgical treatment during long-term follow-up. Results Eleven patients who underwent surgical treatment were included in the study. Male:female ratio was 7:4 and the mean age of the patients was 6.09 years (1–10 years). Presenting symptoms were respiratory difficulty, cough (n = 7, 63.3%), abdominal pain, vomiting (n = 2, 18.8%), loss of body weight (n = 1, 9.09%), palpable mass (n = 1, 9.09%), and rectal bleeding (n = 1, 9.09%). Ultrasonography (n = 4, 36.3%) and computed tomography (n = 9, 81.1%) were used for diagnosis. Localizations of tumors were lungs (n = 5, 45.4%), mediastinum (n = 2, 18.1%), spleen (n = 1, 9.09%), neck (n = 1, 9.09%), colon (n = 1, 9.09%), and rectum (n = 1, 9.09%). The mean size of mass was 6.6 cm (2–12 cm) and six patients were diagnosed with preoperative biopsy. Lung lobectomy (right lower lobe; n = 3, right middle and lower lobe; n = 2), total resection of mass with adjacent bowel (n = 2), partial splenectomy (n = 1), total resection of neck mass (n = 1), and incomplete resection (n = 2) were the choice of surgical treatment. Incomplete resection was performed in masses closely adjacent to atrium and mediastinal structures. In histopathologic evaluation, surgical margins were free of tumor in four cases, positive in six cases, and were not reported in one case. Anaplastic lymphoma kinase (ALK) positivity was detected in six cases, negative in two cases, and was not evaluated in three cases. Two cases who had residual mass with positive ALK received chemotherapy. Mean follow-up time was 68.2 months (5 months to 12 years). During follow-up, there was no recurrence or distant metastasis. Ten patients survived and one patient was lost to follow-up. Conclusion IMT is a rare tumor of childhood with a spectrum of clinical findings because of variable localization. Surgical treatment is the first choice of treatment. Patients with residual mass and ALK positivity may require medical treatment. In our series, long-term survival of patients was favorable in patients with total resection.

scholarly journals Long-term Clinical Course of Korean Patients Diagnosed with Macular Telangiectasia Type 2

2021 ◽  
Vol 62 (8) ◽  
pp. 1098-1104
Author(s):  
Kyung Hae Kang ◽  
Ji Hyun Yoon ◽  
Jong Woo Kim ◽  
Chul Gu Kim ◽  
Jae Hui Kim
Keyword(s):  
Visual Acuity ◽  
Final Visit ◽  
Ellipsoid Zone ◽  
Visual Deterioration ◽  
Macular Telangiectasia ◽  
Macular Telangiectasia Type 2 ◽  
The Mean

Purpose: To evaluate long-term visual prognosis and changes in the retinal microstructure in patients with macular telangiectasia type 2.Methods: Retrospective analysis of medical records were performed for 61 eyes (32 patients) diagnosed with macular telangiectasia type 2. The visual acuity at diagnosis was compared with that at the final visit. In addition, cases were classified into three grades based on optical coherence tomography (OCT) findings: grade 1, inner retinal cavities only; grade 2, outer retinal cavities with ellipsoid zone disruption; and grade 3, ellipsoid zone disruption with proliferation of retinal pigment epithelium. Change in the grade during the follow-up was verified. In addition, visual acuities were compared between eyes with and without a change in grade.Results: The mean follow-up period was 41.5 ± 33.2 months. Visual acuity had deteriorated significantly from the mean logarithm of the minimal angle of resolution 0.23 ± 0.26 at diagnosis to a mean of 0.31 ± 0.31 at the final visit (p < 0.001). When classified using OCT, 65.6%, 22.9%, and 11.5% were grades 1, 2, and 3, respectively, at diagnosis and 47.5%, 36.1%, and 16.4% at the final visit. Progression of grade was noted in 22.9%. A higher degree of visual deterioration was noted in eyes showing progression than in eyes without (p = 0.002).Conclusions: During the long-term follow-up period, visual deterioration was noted in patients with macular telangiectasia type 2. However, the degree of deterioration was not high. Progression in the disruption of the retinal microstructure was the likely cause of visual deterioration.

scholarly journals Intraocular pressure change with face-down positioning after macular hole surgery

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242567
Author(s):  
Sung Won Choi ◽  
Chong Eun Lee ◽  
Yu Cheol Kim
Keyword(s):  
Intraocular Pressure ◽  
Macular Hole ◽  
Axial Length ◽  
Pressure Change ◽  
Idiopathic Macular Hole ◽  
Pars Plana ◽  
Intravitreal Gas ◽  
The Mean ◽  
Iop Elevation

This study evaluated changes in intraocular pressure (IOP) with face-down positioning (FDP) following surgical treatment of idiopathic macular hole. We retrospectively reviewed the records of 130 patients diagnosed with idiopathic macular hole who underwent pars plana vitrectomy (PPV) with intravitreal gas injection after fluid-gas exchange. We analyzed IOP changes in both eyes following FDP over the course of 7 days. The mean IOP of the operated eyes was 14.98±2.95 mmHg preoperatively and 16.82±3.12 and 15.57±6.10 mmHg on postoperative days 2 and 7, respectively. In contralateral eyes, the mean IOP changed from 14.78±3.15 mmHg preoperatively to 16.27±1.87 and 14.40±4.14 mmHg on postoperative days 2 and 7, respectively. On postoperative day 2, the IOP increased in both eyes compared to the preoperative values, but the increase was significant only in operated eyes (p = 0.039). In contralateral eyes, the IOP on postoperative day 7 was significantly decreased compared with that on postoperative day 2 (p = 0.021) and in eyes with an axial length ≥ 23.0 mm, compared with the preoperative values (p = 0.042). The IOP of the operated eyes on postoperative day 7 was higher than that of the contralateral eyes (p = 0.039). Based on a short-term follow-up, FDP after PPV with intravitreal gas tamponade for the treatment of idiopathic macular hole may cause IOP elevation not only in the operated, but also in the contralateral eyes; the IOP increase in contralateral eyes was not as significant as that in operated eyes and was not maintained over 7 days after surgery; the IOP change seems to be affected by axial length and lens status.

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