Outcomes of scleral buckle technique performed by trainee doctors in retinal detachment

2021 ◽  
Vol 2 (3) ◽  
pp. 159-163
Author(s):  
Aalok Kumar ◽  
◽  
Sanjiv Kumar Gupta ◽  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Case Series ◽  
Complication Rates ◽  
Scleral Buckle ◽  
Retrospective Case ◽  
Anatomical Success

AIM: To evaluate the outcomes of patients operated for retinal detachment by scleral buckle technique done by trainee doctors pursuing postgraduate course in ophthalmology. METHODS: This study was a non-comparative retrospective case series to evaluate the demography, clinical features and outcomes of patients underwent rhegmatogenous retinal detachment (RRD) repaired by scleral buckle technique from July 2017 to February 2018 at a tertiary care center in India. Records of all these patients were screened. Statistical analyses were performed and using Fisher's exact test, Mann-Whitney test and Nominal Logistic regression. RESULTS: Totally of 41 patients were included out of which, 32 (78.04%) were males and 9 (21.95%) were females. In our study primary anatomical success rate was 95.12%, with significant visual gain. Postoperative complications were raised intraocular pressure (n=2), new breaks (n=2) and re-detachment in 2 patients which was successfully managed by pars plana vitrectomy (PPV) with internal tamponade and laser. CONCLUSION: The study showed that scleral buckle surgeries done by trainee doctors under supervision can achieve a high success rate in patients of RRD both in terms of postoperative anatomical success, visual acuity and complication rates. Thus, scleral buckle surgery can be an acceptable primary procedure for trainee doctors for management of RRD in selected cases despite the various treatment options now available.

Long-term outcomes of pediatric traumatic cataracts and retinal detachments due to self-inflicted injuries

2020 ◽  
pp. 112067212092645
Author(s):  
Tina Felfeli ◽  
Kamiar Mireskandari ◽  
Asim Ali
Keyword(s):  
Retinal Detachment ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Long Term Outcomes ◽  
Retrospective Case ◽  
Surgical Interventions ◽  
Severe Visual Loss

Purpose To report the characteristics and longitudinal visual outcomes of traumatic cataracts and retinal detachments in children with self-inflicted injury. Methods A retrospective case series of pediatric patients at a tertiary care center who sustained ocular trauma due to self-inflicted injury between 2000 and 2014. Results A total of 11 children, all with an intellectual disability and a mean age of 10 ± 4.8 years (range, 2.8–16.2), were identified with traumatic cataract secondary to ocular self-inflicted injury over the study period. Five eyes had a concurrent unilateral retinal detachment. Over the course of follow-up, one additional eye developed a cataract and five eyes developed a retinal detachment. Patients underwent an average of 2.5 ± 2.3 procedures and 17.1 ± 10.7 eye examinations over 11.7 ± 4.2 years of follow-up; 36% required general anesthesia for examination. Visual acuity was improved or preserved in 77% of the eyes that underwent surgical interventions, but was worse in the remaining cases due to development of traumatic retinal detachment. The use of protective helmets, eye shields, and immobilizing orthoses were essential in management of active self-inflicted injury. Conclusion Traumatic cataracts and retinal detachments due to self-inflicted injury may cause severe visual loss. Visual prognosis although poor in children with severe intellectual disabilities may be optimized with risk awareness for early detection and customized interventions.

Laryngeal Web in the Pediatric Population: Evaluation and Management

2019 ◽  
Vol 162 (2) ◽  
pp. 234-240 ◽  
Author(s):  
Claire M. Lawlor ◽  
Natasha D. Dombrowski ◽  
Roger C. Nuss ◽  
Reza Rahbar ◽  
Sukgi S. Choi
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
22Q11.2 Deletion Syndrome ◽  
Deletion Syndrome ◽  
Retrospective Case ◽  
Presenting Symptoms ◽  
Subglottic Extension ◽  
Type 3

Objective To discuss the presentation, evaluation, and management of pediatric laryngeal web. Study Design Retrospective case series. Setting Single tertiary care center. Subjects All patients with laryngeal web at Boston Children’s Hospital in the past 22 years. Methods No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. Results Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications. Conclusions Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child’s presentation.

Incidence of brain metastases and overall survival in patients with primary cardiac sarcoma: A retrospective case series.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10584-10584
Author(s):  
Maryann Shango ◽  
Lili Zhao ◽  
Monika Leja ◽  
Jonathan B. McHugh ◽  
Scott Schuetze ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Cancer Center ◽  
R0 Resection ◽  
Left Heart ◽  
Retrospective Case ◽  
Imaging Evaluation ◽  
Presenting Symptoms ◽  
Primary Cardiac Sarcoma

10584 Background: Primary cardiac sarcoma (PCS) is the most common primary cardiac malignancy, but is a rare primary site of sarcoma. We present 21 cases from a tertiary care center to better understand this uncommon malignancy. Methods: A cancer center-based registry and pathology database were searched to identify pts diagnosed with PCS from 1992-2013 at University of Michigan. Kaplan-meier method was used to estimate survival. Cox proportional hazard model was used to associate variables to occurrence of metastases (mets) or death. Results: Atotal of 21 pts (F12, 9M) with PCS were identified, median age 36 (range 11-74). The most common presenting symptoms included dyspnea (16) and chest pain (6; 5 with associated pericardial effusion). Histologies included: angiosarcoma (9), leiomyosarcoma (4), undifferentiated pleomorphic (3), spindle cell (2), fibrosarcoma (1), rhabdomyosarcoma (1) and synovial (1). Sites of origin were R atrium (7), R ventricle (2), L atrium (10) and pericardium (2). Ten pts presented with mets; most common sites were lung (8), liver (2), brain (2), pancreas (2) and bone (2). Surgery was attempted in 12 pts, achieving 1 R0 resection. Pts received a median of 1 (0-7) systemic therapies. Median overall (OS) was 12.6 mos (range 3-79) from diagnosis. Pts without prior surgery were more likely to have mets or death (p=0.038). Brain mets were common, occurring in 7 of 21 pts after a median of 7 mos (range 1-75) from diagnosis. Median OS after diagnosis of brain mets was 8 mos. Of the 7 pts who developed brain metastasis, 5 had PCS originating in the left heart. Of the 2 pts with PCS in the right heart, one was evaluated for and had a right to left shunt. The likelihood of developing brain mets did not correlate with age, chemotherapy, or surgery. Conclusions: PCS portends an extremely poor prognosis, marked by inability to achieve complete resection and a high incidence of disseminated disease at diagnosis. Metastatic disease to the brain was much more common in PCS (33%) as compared to STS of any origin (approximately 1-8%), particularly in pts with PCS originating in the left heart. Clinicians should have a low threshold for brain imaging evaluation of PCS pts.

scholarly journals 25-gauge vitrectomy with gas tamponade for rhegmatogenous retinal detachment: experienced vs. inexperienced surgeons

2020 ◽  
Author(s):  
Martin Pencak ◽  
Miroslav Veith ◽  
Zbynek Stranak ◽  
Jakub Dite ◽  
Jana Vranova ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Rhegmatogenous Retinal Detachment ◽  
Case Series ◽  
Functional Results ◽  
Complication Rates ◽  
Gas Tamponade ◽  
Single Operation ◽  
Case Series Study ◽  
The Mean

Abstract Introduction: To compare the results and complication rates of a 25-gauge pars plana vitrectomy (25g PPV) with gas tamponade for rhegmatogenous retinal detachment (RRD) between experienced and inexperienced surgeons.Materials and Methods: This is a retrospective comparative consecutive case series study of patients with uncomplicated RRD treated with 25g PPV with gas tamponade. Patients were divided into 2 groups: In Group 1 (ESG) the procedure was performed by an experienced vitreoretinal surgeon and in Group 2 (ISG) the procedure was performed by 2 inexperienced surgeons. Anatomical and functional results and complication rates were compared between the two groups.Results: 216 eyes were included in the study. In the ESG (106 eyes), the single operation success rate was 94.3%, and the final success rate was 100%. The mean best-corrected visual acuity (BCVA) improved from 0.38 decimal to 0.73 decimal. In the ISG (110 eyes), the single operation success rate was 93.6%, and the final success rate was 100.0%. The mean BCVA improved from 0.33 decimal to 0.74 decimal. The differences between groups were not statistically significant. There was no difference in complication rates between groups.Conclusions: A 25g PPV with gas tamponade for treatment of RRD yields excellent anatomical results and improvement in BCVA. With good technique and use of modern vitrectomy machines and instruments, even inexperienced surgeons can achieve high single operation success rate, suggesting a short learning curve. The complication rate is comparable between experienced and inexperienced surgeons.

scholarly journals Neurocysticercosis – A Window to Intraocular Involvement

2016 ◽  
Vol 7 (2) ◽  
pp. 135-141
Author(s):  
BN Kalpana ◽  
HR Samhitha ◽  
Kailash P Chhabria ◽  
Sonali Muralidhar ◽  
Kirti Raj
Keyword(s):  
Retinal Detachment ◽  
South India ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Case Series ◽  
Positive Association ◽  
Care Hospital ◽  
Retrospective Case ◽  
Tractional Retinal Detachment ◽  
Number Of Patients

Objective : To analyse the clinical characteristics of intraocular cysticercosis and the association of neurocysticercosis with intraocular involvement in these patientsMaterials and methods: Retrospective case series of records of patients managed at a Tertiary Care Hospital in South India. Case records of patients managed at a Tertiary Care Hospital in South India over two years (October 2012 – October 2014) were reviewed and cases reported with intraocular cysticercosis were included in the study and results analyzed.Results: Five (5) patients of intraocular cysticercosis were diagnosed in a two year period at our centre, 60% being bilateral. Eight (8) eyes of five (5) patients had intraocular cysts documented by clinical examination and B mode ultrasonography (75% eyes with active cysts, 25% eyes inactive) .Visual acuity at presentation of eyes with active cysts ranged from perception of light to counting finger 4m. The 75% eyes had tractional retinal detachment at presentation. Neurocysticercosis was documented in 80% of the cases oncomputed tomography / magnetic resonance imaging . Six (6) eyes with active cysts underwent parsplanavitrectomy with cyst removal using vitreous cutter with concurrent management of tractional retinal detachment in five (5) eyes. Postoperative visual recovery was poor in eyes with associated tractional retinal detachment while good anatomical outcome was achieved in all six (6) cases.Conclusion: Intraocular cysticercosis can be associated with cysts in other areas. High number of patients with neurocysticercosis (80%) in those with intraocular cysticercosis in our study may indicate positive association between the two which needs further investigation.

scholarly journals RECENT INCREASE IN COLISTIN-RESISTANT EXTENSIVELY DRUG RESISTANT ACINETOBACTER INFECTIONS AT A TERTIARY CARE CENTER IN PAKISTAN

2019 ◽  
Author(s):  
Nosheen Nasir ◽  
Fatima Sharif ◽  
Rubab Mansoor ◽  
Shehryar Ahmed ◽  
Bushra Jamil ◽  
...  
Keyword(s):  
Care Center ◽  
Treatment Options ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Antimicrobial Treatment ◽  
Common Diagnosis ◽  
Resistant Strains ◽  
Treat All

Abstract Background Acinetobacter is an important nosocomial pathogen and a major cause of morbidity and mortality in hospitalized patients. Recently, colistin resistant strains of Acinetobacter were reported from different parts of the world. We are describing a case series of 18 patients with colistin resistant Acinetobacter over a span of 4 years. Methods Patients with any clinical specimen positive for colistin resistant Acinetobacter from 2014 to 2017 were identified from the hospital records. Three cases were isolated between 2014 and 2015, six cases in 2016 and 9 cases in 2017. Data on patients’ demographics as well as clinical data was collected retrospectively on a structured proforma from the hospital medical records. Results Mean age of the patients was 50 ± 18 years. Fifteen (83.3%) out of the 18 patients were male. Acinetobacter Pneumonia was the most common diagnosis in n=13(72.2% of the patients). Nine (50%) of the patients developed sepsis. In addition to Colistin resistance, carbapenem and amikacin resistance was documented to be 94% and 61% respectively. Colistin and carbapenem based combinations were used to treat all patients with a mean antibiotic duration of 20 ± 10 days. Median length of hospital stay was 25 days (range 8 - 61), with 14 patients (77.8%) requiring ICU admission. Eight (44.4%) of the patients expired and only 6 (33.3%) achieved microbiological eradication. Conclusion Infections due to Colistin resistant strains of Acinetobacter are rapidly increasing, have limited antimicrobial treatment options and are associated with poor outcomes.

Two hundred and forty-eight cases of visual snow: A review of potential inciting events and contributing comorbidities

Cephalalgia ◽  
2021 ◽  
pp. 033310242199635
Author(s):  
Dev G Mehta ◽  
Ivan Garza ◽  
Carrie E Robertson
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Cortical Atrophy ◽  
Posterior Cortical Atrophy ◽  
Retrospective Case ◽  
Triggering Events ◽  
Perception Disorder ◽  
Visual Disturbances

Objective To review characteristics and outcomes of all cases of visual snow seen at our institution, with attention to possible triggering events or comorbidities. Methods This is a retrospective case series of patients seen at our tertiary care center from January 1994 to January 2020. Charts were reviewed if they contained the term “visual snow”. Results Of the 449 charts reviewed, 248 patients described seeing visual snow in part or all of their vision. Thirty-eight reported transient visual snow as their typical migraine aura. Of the remaining 210 patients, 89 were reported to have either an inciting event or contributing comorbidity for their visual snow symptoms, including: Post-concussion (n = 15), dramatic change in migraine or aura (n = 14), post-infection (n = 13), hallucinogen persisting perception disorder (n = 10), ocular abnormalities (n = 7), idiopathic intracranial hypertension (n = 4), neoplastic (n = 1), and posterior cortical atrophy (n = 1). Some patients had partial improvement with benzodiazepines (n = 6), lamotrigine (n = 5), topiramate (n = 3) and acetazolamide (n = 3). Presenting characteristics were similar, but patients with visual snow attributed to an inciting event or contributing comorbidity were more likely to have some improvement in their symptoms by last follow-up compared to spontaneous visual snow ( p < .001). Conclusions Though most cases of visual snow are spontaneous, potential secondary causes should be recognized by clinicians. Patients who develop visual snow after an inciting event or related to an underlying comorbidity may have a better prognosis than those in whom it develops spontaneously. In select cases, treatment of the suspected underlying cause may significantly alleviate the otherwise typical intractable visual disturbances associated with visual snow.

Clinical Outcomes and Complications of Midfoot Charcot Reconstruction With Intramedullary Beaming

2018 ◽  
Vol 40 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Samuel E. Ford ◽  
Bruce E. Cohen ◽  
W. Hodges Davis ◽  
Carroll P. Jones
Keyword(s):  
Clinical Outcomes ◽  
Corrective Osteotomy ◽  
Tertiary Care ◽  
Case Series ◽  
Deep Infection ◽  
Complication Rates ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported

Background: The purpose of this study was to examine the clinical outcomes and complications of patients with midfoot Charcot managed with midfoot osteotomy, realignment arthrodesis, and stabilization using intramedullary beams. Methods: Consecutive patients with midfoot Charcot treated at a tertiary-care foot and ankle center from January 2013 to July 2016 who underwent corrective osteotomy with internal beam fixation were identified; 25 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, weightbearing radiographs, and patient-reported outcome measures. The primary outcome measure was defined as restoration of a stable, plantigrade, ulcer-free foot. Median age was 58 years, median BMI was 32, and 80% were diabetic (75% insulin-dependent). Results: An ulcer-free, stable, plantigrade foot was obtained in 84% of patients. The radiographic lateral and anteroposterior Meary angle medians improved 9° and 15°, respectively, from preoperative to final postoperative weightbearing measurements ( P < .001 and P = .02). Overall, 46% of midfoot osteotomies were united on final radiographs at a median 18-month radiographic follow-up. Deep infection developed in 6 (24%) patients. The presence of a preoperative ulcer was found to be predictive of postoperative infection (P = .04); all 6 deep infections occurred in patients with preoperative ulceration. Four (16%) patients progressed to amputation at a mean 15 postoperative months, all for deep infection. Conclusion: Midfoot Charcot reconstruction with intramedullary beaming allowed for restoration of an ulcer-free, plantigrade foot in most patients, but the complication rates were high, especially in patients with preoperative ulceration. Level of Evidence: Level IV, retrospective case series.

Anatomic and Visual Outcomes Following Surgical Repair of Retinoschisis-Related Retinal Detachments

2018 ◽  
Vol 3 (1) ◽  
pp. 6-9 ◽  
Author(s):  
Maxwell S. Stem ◽  
Bruce R. Garretson ◽  
Bozho Todorich ◽  
Jade Price ◽  
Adam J. Weiner ◽  
...  
Keyword(s):  
Retinal Detachment ◽  
Success Rate ◽  
Proliferative Vitreoretinopathy ◽  
Surgical Repair ◽  
Case Series ◽  
Scleral Buckle ◽  
Entire Cohort ◽  
Initial Surgery ◽  
The Mean ◽  
Anatomic Success

Purpose: The purpose of this article is to report the characteristics of patients with retinoschisis-related retinal detachments and to summarize their clinical outcomes after surgical repair. Methods: A single-center interventional case series of 37 eyes from 35 patients who underwent surgery to repair a retinoschisis-related retinal detachment between January 1, 2009 and January 1, 2017 was conducted. Results: The mean ± SD age at the time of the first retinal detachment repair was 63 ± 13 years. As the initial surgery, scleral buckle was performed in 14 eyes, scleral buckle + vitrectomy in 14 eyes, and vitrectomy in 9 eyes. The single-operation success rate for the entire cohort was 65% (24/37), and the final anatomic success rate was 97% (36/37). Among eyes requiring more than 1 surgery, 46% (6/13) developed proliferative vitreoretinopathy. Best-corrected visual acuity improved or remained stable after 1 year of follow-up in the majority (n = 27, 73%) of eyes. The mean (SD) number of surgeries required to achieve the final anatomic and visual result was 1.8 (1.2) for all eyes (range, 1-5 surgeries). Conclusion: The single-surgery success rate for retinoschisis-related retinal detachments was lower than that reported for typical rhegmatogenous retinal detachments, and the incidence of proliferative vitreoretinopathy was higher. When counseling patients with retinoschisis-related retinal detachments, it is important to caution them that they may require more than 1 surgery to achieve anatomic success.

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