scholarly journals Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Adonis El Salloukh ◽  
Abdus Samad Ansari ◽  
Alexander Chiu ◽  
Divya Mathews
Keyword(s):  
Surgical Intervention ◽  
Glaucoma Surgery ◽  
Lower Percentage ◽  
Visual Field Defects ◽  
Success Rates ◽  
Uveitic Glaucoma ◽  
Optic Nerve Damage ◽  
Primary Surgery

Abstract Background Uveitic glaucoma commonly leads to a more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). Methods Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow up was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopuncture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classified as a failure. Results A total of 16 patients with uveitic glaucoma were reviewed. Complete success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. Conclusion There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

scholarly journals Evaluating the long-term efficacy and effectiveness of Viscocanalostomy and combined phacoemulsification with Viscocanalostomy in the treatment of patients with uveitic glaucoma: 5-year follow up data

2020 ◽  
Author(s):  
Adonis El Salloukh ◽  
Abdus Samad Ansari ◽  
Alexander Chiu ◽  
Divya Mathews
Keyword(s):  
Surgical Intervention ◽  
Glaucoma Surgery ◽  
Lower Percentage ◽  
Visual Field Defects ◽  
Success Rates ◽  
Uveitic Glaucoma ◽  
Optic Nerve Damage ◽  
Primary Surgery

Abstract Background Uveitic glaucoma commonly leads to more intense optic nerve damage than other types of glaucoma, causing glaucomatous optic nerves and visual field defects. Anterior uveitis is the most commonly associated risk factor. Surgical intervention is usually indicated when all medical treatment has failed. We report five-year results for 16 eyes of uveitic glaucoma managed with viscocanalostomy (VC)/Phaco viscocanalostomy (PVC). Methods Retrospective analysis on all uveitic glaucoma cases meeting a five-year follow was completed. All patients were managed surgically with either viscocanalostomy (VC) or phacoviscocanalostomy (PVC). Outcomes evaluated included intraocular pressures measurement pre-listing, on day 1, year 1 to year 5. Complete success rate was defined as achieving an intraocular pressure (IOP) lower than 21 mmHg or reduced by 30% without medications, and qualified success was achieved when IOP was lower than 21 mmHg or a reduction in IOP of 30% with topical medical therapy ± Laser goniopinture (LGP). If further surgeries were required to reduce IOP due to glaucoma progression then they were classed as a failure. Results A total of 16 patients with uveitic glaucoma were reviewed. Complete Success was seen in 75% of patients at year 1, 50% of patients at year 3 and 19% of patients in year 5. Conversely qualified success was achieved in 94% of patients at year 1, 86% of patients at year 3 and 75% of patients at year 5. In the group of patients requiring further surgery, 50% of patients had previous surgeries, including cataract surgery, trabeculectomy and viscocanalostomy. There was a mean number of 4 pre-operative drops before their primary surgery and a mean drop in eye medications of 1.1 at 5 years follow-up. Success rates were prognostically linked to lower mean number of interventions and lower percentage of previous surgeries. Conclusion There remains a significant paucity of information in the utilization of PVC in uveitic glaucoma. The advantage of nonpenetrating glaucoma surgery (NPGS) includes the lack of entry into the anterior chamber and the avoidance of an iridectomy which may reduce intraocular inflammation and postoperative complications. Our study shows that non-penetrating surgery is successful in treating advanced uveitic glaucoma.

High rate of conversion from ocular hypertension to glaucoma in subjects with uveitis

2021 ◽  
pp. bjophthalmol-2021-318809
Author(s):  
Tiffany Ma ◽  
Joanne L Sims ◽  
Sonya Bennett ◽  
Shenton Chew ◽  
Rachael L Niederer
Keyword(s):  
Ocular Hypertension ◽  
Vision Loss ◽  
Glaucoma Surgery ◽  
High Rate ◽  
Rapid Progression ◽  
Central Vision ◽  
Uveitic Glaucoma ◽  
Central Vision Loss

AimsTo examine presentation, management and long-term sequelae of ocular hypertension and uveitic glaucoma.MethodsRetrospective observational study of all subjects with uveitic glaucoma or ocular hypertension seen in Auckland uveitis clinics over the last 10 years.ResultsA total of 188 eyes of 139 subjects with uveitic glaucoma or ocular hypertension were included for analysis. Total follow-up was 1854.5 eye years (mean 9.9 years). The mean age at uveitis diagnosis was 49.3 years. 52.5% of subjects were male. The most common diagnoses were idiopathic uveitis (29.3%), sarcoidosis (13.3%), herpes zoster (6.9%), HLA-B27 uveitis (6.9%), tuberculosis (5.9%) and Posner-Schlossmann or cytomegalovirus (CMV) uveitis (5.3%). Median intraocular pressure (IOP) at diagnosis was 35 mm Hg (IQR 29–45). 144 eyes (77.0%) developed glaucoma during the follow-up period, of whom 41 lost some central vision due to glaucoma. Oral acetazolamide was required for IOP control in 64.5%, 50 eyes underwent trabeculectomy, 18 eyes required a tube and 6 underwent minimally invasive glaucoma surgery.ConclusionRapid progression was observed from ocular hypertension to uveitic glaucoma. Uveitic glaucoma is aggressive, with high likelihood of requiring surgical management and high risk of central vision loss. Close collaboration between uveitis and glaucoma specialists is required to maximise outcomes for these patients.

The role of Ahmed glaucoma valve in the management of refractory glaucoma: Long-term outcomes and complications

2020 ◽  
pp. 112067212096873
Author(s):  
Jade Luzu ◽  
Christophe Baudouin ◽  
Pascale Hamard
Keyword(s):  
Medical Treatment ◽  
Glaucoma Surgery ◽  
Ahmed Glaucoma Valve ◽  
Success Rates ◽  
Refractory Glaucoma ◽  
Filtration Surgery ◽  
Corneal Decompensation

Purpose: To retrospectively evaluate the efficacy and long-term complications of the Ahmed glaucoma valve (AGV) in refractory glaucoma. Materials and methods: Seventy-eight eyes with glaucoma refractory to conventional surgical procedures (filtration surgery and diode laser cyclophotocoagulation) underwent AGV implantation between May 2006 and August 2018. The criteria for success were defined as an intraocular pressure (IOP) less than 18 mmHg and a decrease of at least 20% from the preoperative IOP. The criteria for failure were an IOP greater than 18 mmHg or less than 5 mmHg, an increase in medical treatment, a decrease of less than 20% of the initial IOP, the need for another glaucoma surgery, or a decrease in visual acuity attributable to the valve. Results: IOP decreased from 31.0 ± 9.0 mmHg to 17.2 ± 7.2 mmHg (mean follow-up 32.5 months), for a mean IOP lowering of 44.5% ( p < 0.001). Medical treatment was significantly reduced from 5.3 ± 1.5 to 2.8 ± 1.9 ( p < 0.0001). The cumulative success rates were 59.4% at 3 years and 45.1% at 5 years. Encapsulation of the filtration bleb was the most common short-term complication (32.1%). Relevant long-term complications were bleb fibrosis with elevated IOP (12.8%) and corneal decompensation (10.2%). Conclusion: The AGV is an effective procedure in the long-term for controlling IOP in refractory glaucoma, with limited incidence of complications. These results suggest that the AGV might be considered earlier in the surgical strategy for glaucoma not controlled after one well-performed conventional filtration surgery.

Needle revision outcomes after glaucoma filtering surgery: survival analysis and predictive factors

2019 ◽  
Vol 30 (2) ◽  
pp. 350-359 ◽  
Author(s):  
Alessandro Rabiolo ◽  
Alessandro Marchese ◽  
Paolo Bettin ◽  
Davide Monteduro ◽  
Mario Galasso ◽  
...  
Keyword(s):  
Intraocular Pressure ◽  
Glaucoma Surgery ◽  
Safe Procedure ◽  
Success Rates ◽  
Criterion A ◽  
Hypotony Maculopathy ◽  
Primary Surgery ◽  
Complete Failure ◽  
Needle Revision

Purpose: To evaluate the efficacy and safety of needle revision and examine factors predictive of failure. Methods: In total, 157 eyes of 131 patients that underwent needle revision augmented with either 5-fluorouracil or betamethasone for trabeculectomy failure were included in this retrospective study. Complete failure was defined as additional glaucoma surgery, ciliodestructive procedures, loss of light perception, sight-threatening complications, hypotony maculopathy, and surgical bleb revision. Success was defined as intraocular pressure ⩽ 18 (criterion A), ⩽15 (criterion B), and ⩽12 mmHg (criterion C) reached with (qualified) or without (complete) medications, and absence of any criteria of complete failure. Results: The median (interquartile range) follow-up was 25.0 (41.0) months. Complete failure rates were 19%, 26%, and 31% at 1, 2, and 3 years, respectively. For criterion A, qualified and complete success rates were, respectively, 77% and 69% at 1 year, 66% and 51% at 2 years, and 60% and 47% at 3 years. For criterion B, qualified and complete success rates were, respectively, 67% and 61% at 1 year, 48% and 42% at 2 years, and 44% and 39% at 3 years. For criterion C, qualified and complete success rates were, respectively, 43% and 41% at 1 year, 27% and 25% at 2 years, and 24% and 23% at 3 years. High baseline intraocular pressure and primary surgery were associated with higher and lower risks of complete failure, respectively. Conclusion: Needle revision is an effective and safe procedure to rescue failing trabeculectomy postponing or avoiding further glaucoma surgery. Eyes with low target intraocular pressure may have poor long-term outcomes.

scholarly journals The Role of Hydraulic Silicate Cements on Long-Term Properties and Biocompatibility of Partial Pulpotomy in Permanent Teeth

Materials ◽  
2021 ◽  
Vol 14 (2) ◽  
pp. 305
Author(s):  
Chung-Min Kang ◽  
Saemi Seong ◽  
Je Seon Song ◽  
Yooseok Shin
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Antimicrobial Properties ◽  
Permanent Teeth ◽  
Success Rates ◽  
Pulp Tissue ◽  
Cox Regression Analysis ◽  
Clinical Variables

The use of hydraulic silicate cements (HSCs) for vital pulp therapy has been found to release calcium and hydroxyl ions promoting pulp tissue healing and mineralized tissue formation. The present study investigated whether HSCs such as mineral trioxide aggregate (MTA) affect their biological and antimicrobial properties when used as long-term pulp protection materials. The effect of variables on treatment outcomes of three HSCs (ProRoot MTA, OrthoMTA, and RetroMTA) was evaluated clinically and radiographically over a 48–78 month follow-up period. Survival analysis was performed using Kaplan–Meier survival curves. Fisher’s exact test and Cox regression analysis were used to determine hazard ratios of clinical variables. The overall success rate of MTA partial pulpotomy was 89.3%; Cumulative success rates of the three HSCs were not statistically different when analyzed by Cox proportional hazard regression analysis. None of the investigated clinical variables affected success rates significantly. These HSCs showed favorable biocompatibility and antimicrobial properties in partial pulpotomy of permanent teeth in long-term follow-up, with no statistical differences between clinical factors.

scholarly journals The Long-Term Follow-Up of Patients with Cystine Stones: A Single-Center Experience for 13 Years

2021 ◽  
Vol 10 (7) ◽  
pp. 1336
Author(s):  
Toshifumi Takahashi ◽  
Shinya Somiya ◽  
Katsuhiro Ito ◽  
Toru Kanno ◽  
Yoshihito Higashi ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Median Number ◽  
Small Sample ◽  
Age At Diagnosis ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Cystine Stones

Introduction: Cystine stone development is relatively uncommon among patients with urolithiasis, and most studies have reported only on small sample sizes and short follow-up periods. We evaluated clinical courses and treatment outcomes of patients with cystine stones with long-term follow-up at our center. Methods: We retrospectively analyzed 22 patients diagnosed with cystine stones between January 1989 and May 2019. Results: The median follow-up was 160 (range 6–340) months, and the median patient age at diagnosis was 46 (range 12–82) years. All patients underwent surgical interventions at the first visit (4 extracorporeal shockwave lithotripsy, 5 ureteroscopy, and 13 percutaneous nephrolithotripsy). The median number of stone events and surgical interventions per year was 0.45 (range 0–2.6) and 0.19 (range 0–1.3) after initial surgical intervention. The median time to stone events and surgical intervention was 2 years and 3.25 years, respectively. There was a significant difference in time to stone events and second surgical intervention when patients were divided at 50 years of age at diagnosis (p = 0.02, 0.04, respectively). Conclusions: Only age at a diagnosis under 50 was significantly associated with recurrent stone events and intervention. Adequate follow-up and treatment are needed to manage patients with cystine stones safely.

scholarly journals One-year outcomes of microhook trabeculotomy versus suture trabeculotomy ab interno

2021 ◽  
Author(s):  
Hiroshi Yokoyama ◽  
Masashi Takata ◽  
Fumi Gomi
Keyword(s):  
Survival Analysis ◽  
Clinical Success ◽  
Treatment Success ◽  
Medication Use ◽  
Glaucoma Surgery ◽  
Success Rates ◽  
Kaplan Meier ◽  
One Year ◽  
Ab Interno

Abstract Purpose To compare clinical success rates and reductions in intraocular pressure (IOP) and IOP-lowering medication use following suture trabeculotomy ab interno (S group) or microhook trabeculotomy (μ group). Methods This retrospective review collected data from S (n = 104, 122 eyes) and μ (n = 42, 47 eyes) groups who underwent treatment between June 1, 2016, and October 31, 2019, and had 12-month follow-up data including IOP, glaucoma medications, complications, and additional IOP-lowering procedures. The Kaplan–Meier survival analysis was used to evaluate treatment success rates defined as normal IOP (> 5 to ≤ 18 mm Hg), ≥ 20% reduction of IOP from baseline at two consecutive visits, and no further glaucoma surgery. Results Schlemm’s canal opening was longer in the S group than in the μ group (P < 0.0001). The Kaplan–Meier survival analysis of all eyes showed cumulative clinical success rates in S and µ groups were 71.1% and 61.7% (P = 0.230). The Kaplan–Meier survival analysis of eyes with preoperative IOP ≥ 21 mmHg showed cumulative clinical success rates in S and μ groups were 80.4% and 60.0% (P = 0.0192). There were no significant differences in postoperative IOP at 1, 3, and 6 months (S group, 14.9 ± 5.6, 14.6 ± 4.5, 14.6 ± 3.9 mmHg; μ group, 15.8 ± 5.9, 15.2 ± 4.4, 14.7 ± 3.7 mmHg; P = 0.364, 0.443, 0.823), but postoperative IOP was significantly lower in the S group at 12 months (S group, 14.1 ± 3.1 mmHg; μ group, 15.6 ± 4.1 mmHg; P = 0.0361). There were no significant differences in postoperative numbers of glaucoma medications at 1, 3, 6, and 12 months (S group, 1.8 ± 1.6, 1.8 ± 1.5, 2.0 ± 1.6, 1.8 ± 1.5; μ group, 2.0 ± 1.6, 2.0 ± 1.6, 2.1 ± 1.6, 2.2 ± 1.7; P = 0.699, 0.420, 0.737, 0.198). Conclusion S and µ group eyes achieved IOP reduction, but μ group eyes had lower clinical success rates among patients with high preoperative IOP at 12 months.

Chronic Plantar Heel Pain: Treatment with a Short Leg Walking Cast

1996 ◽  
Vol 17 (1) ◽  
pp. 41-42 ◽  
Author(s):  
Christopher L. Tisdel ◽  
Marion C. Harper
Keyword(s):  
Complete Resolution ◽  
Surgical Intervention ◽  
Pain Treatment ◽  
Heel Pain ◽  
Treatment Modalities ◽  
Plantar Heel Pain ◽  
Long Term Follow Up

The efficacy of a short leg walking cast in the treatment of chronic plantar heel pain was assessed for 32 patients with 37 involved extremities treated over a 2-year period. All patients had failed numerous other treatment modalities and had been symptomatic for an average of 1 year. Long-term follow-up for 24 patients with 28 involved extremities revealed complete resolution of pain for 7 extremities (25%), improvement for 17 (61%), and no improvement for 4 (14%). Ten (42%) patients were completely satisfied with cast treatment, 3 (12%) were satisfied with reservations, and 11 (46%) were dissatisfied. Casting appears to be a reasonable option for patients with recalcitrant heel pain and should be offered before surgical intervention.

SHORT TO MEDIUM RESULTS USING THE REMOTION TOTAL WRIST REPLACEMENT FOR RHEUMATOID ARTHRITIS

Hand Surgery ◽  
2013 ◽  
Vol 18 (02) ◽  
pp. 175-178 ◽  
Author(s):  
A. S. C. Bidwai ◽  
F. Cashin ◽  
A. Richards ◽  
D. J. Brown
Keyword(s):  
Rheumatoid Arthritis ◽  
Pain Relief ◽  
Surgical Intervention ◽  
Case Series ◽  
High Rate ◽  
Wound Breakdown ◽  
Radial Forearm ◽  
Skin Coverage

We present the clinical outcome of patients who underwent RE-MOTION Total Wrist Replacement (TWR) for the treatment of Rheumatoid arthritis involving the wrist. Ten patients were available for follow-up, ranging from one to five years after index surgery. Two patients required surgical intervention for wound breakdown, including one patient who required a radial forearm flap for skin coverage. No patients required revision surgery or conversion to fusion. Patients who did not have complications gained statistically significant pain relief and improvement in mean overall flexion. In this small case series with short to medium results patients reported an improvement in terms of flexion and pain. Despite this, the question of efficacy of TWR compared to fusion in the long term remains unanswered due to the high rate of complications.

Long-Term Outcomes of Patients with Acromegaly - A Report from the Swedish Pituitary Register

2022 ◽  
Author(s):  
Steinunn Arnardóttir ◽  
Jacob Järås ◽  
Pia Burman ◽  
Katarina Berinder ◽  
Per Dahlqvist ◽  
...  
Keyword(s):  
High Rate ◽  
Hormone Deficiency ◽  
Visual Field Defects ◽  
Mortality Data ◽  
Pituitary Hormone ◽  
Biochemical Control ◽  
Long Term Outcomes ◽  
Over Time

Objective: To describe treatment and long-term outcomes of patients with acromegaly from all health-care regions in Sweden. Design and Methods: Analysis of prospectively reported data from the Swedish Pituitary Register of 698 patients (51% females) with acromegaly diagnosed from 1991-2011. The latest clinical follow-up date was December, 2012, while mortality data were collected for 28.5 years until June, 2019. Results: The annual incidence was 3.7/million; 71% of patients had a macroadenoma, 18% had visual field defects, and 25% had at least one pituitary hormone deficiency. Eighty-two percent had pituitary surgery, 10% radiotherapy and 39% medical treatment. At the 5- and 10-year follow-ups, IGF-I levels were within the reference range in 69% and 78% of patients, respectively. In linear regression the proportion of patients with biochemical control including adjuvant therapy at 10 year follow-up increased over time with 1.23 % per year. The SMR (95% CI) for all patients was 1.29 (1.11-1.49). For patients with biochemical control at the latest follow-up, SMR was not increased, neither among patients diagnosed 1991-2000, SMR 1.06 (0.85-1.33) or 2001-2011, SMR 0.87 (0.61-1.24). In contrast, non- controlled patients at the latest follow up from both decades had elevated SMR, 1.90 (1.33-2.72) and 1.98 (1.24-3.14), respectively. Conclusions: The proportion of patients with biochemical control increased over time. Patients with biochemically controlled acromegaly have normal life expectancy while non-controlled patients still have increased mortality. The high rate of macroadenomas and unchanged age at diagnosis illustrates the need for improvements in the management of patients with acromegaly.

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