Causes of eye removal: Analysis of 586 eyes

Background/Aim. Eye enucleation is one of the oldest surgical procedures. The aim of the study was to determine the causes of enucleation as seen in a major reference eye center in Serbia. Methods. Retrospective case series involving a review of all enucleation procedures performed in the period between January 2000 and December 2008 at the Institute for Eye Diseases, Clinical Center of Serbia, Belgrade. The collected information included the basic demographic data and diagnosis of the affected eye. The diagnosis was made based on history, clinical and histological examinations. Clinical indications for enucleation were categorized as tumors, glaucoma, trauma, infections and other diseases. A statistical analysis was made using the Student's t-test. Results. There were 586 patients, 315 male and 271 female in our series. The mean age was 57.81, ranging from 3 months to 96 years. The most common cause of enucleations was tumor (76.11%), (p < 0.05). Choroid melanoma was the most common etiology leading to enucleation (81.18%), followed by retinoblastoma (12.34%). A total of 8.02% of enucleations were performed due to glaucoma that was primarily neovascular in 42.55% of cases or caused by trauma in 38.8% of cases. Trauma was the third common etiology of enucleation, and it was acute in 56.26% of cases or resulted in phthisis bulbi in 31.25% of cases. Enucleation caused by inflammation was performed in 2.90% of cases, out of which 52.94% of enucleations occurred after perforation of the cornea. In the group of other diseases the most common cause of enucleation was atrophy of the eye ball. Conclusion. Neoplasm, neovascular glaucoma, acute eye injury and atrophy of the eye ball are the most common causes of enucleation.

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Combined Scleral Flap with Donor Scleral Patch Graft for Anterior Tube Placement in Glaucoma Drainage Device Surgery

Case Reports in Ophthalmological Medicine ◽

10.1155/2016/2124581 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4

Author(s):

Jea H. Yu ◽

Chuck Nguyen ◽

Esmeralda Gallemore ◽

Ron P. Gallemore

Keyword(s):

Open Angle Glaucoma ◽

Effective Means ◽

Case Series ◽

Neovascular Glaucoma ◽

Tube Placement ◽

Glaucoma Drainage Device ◽

Scleral Flap ◽

Retrospective Case ◽

Glaucoma Drainage Devices ◽

Patch Graft

Purpose. To report a new technique for anterior placement of tubes for glaucoma drainage devices to reduce the risk of tube erosions.Methods. Retrospective review of select cases of Ahmed Valve surgery combined with the novel method of a limbal-based scleral flap covered by a scleral patch graft to cover the tube at the entrance through the limbus. Intraoperative and postoperative illustrations are shown to highlight the method of tube placement.Results. In this retrospective case series, 3 patients are presented illustrating the technique. Two had neovascular glaucoma and one had primary open-angle glaucoma (POAG). On average, intraocular pressure was reduced from39±14 mmHg to15±2 mmHg and the number of glaucoma medications was reduced from4±1to 0. Preoperative and most recent visual acuities were hand-motion (HM) and HM, 20/60 and 20/50, and 20/70 and 20/30, respectively.Conclusion. The combination of a limbal-based scleral flap with scleral patch graft to cover the tube with glaucoma drainage devices may be an effective means to reduce erosion and protect against endophthalmitis.

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Outcomes from a Multi-disciplinary Uveitis Referral Clinic in Tasmania, Australia and adaptation during the COVID-19 pandemic

10.21203/rs.3.rs-955163/v1 ◽

2021 ◽

Author(s):

Verlyn Yang

Keyword(s):

Case Series ◽

Developed Countries ◽

Posterior Uveitis ◽

Indigenous Populations ◽

Published Data ◽

Inflammatory Disorder ◽

Intermediate Uveitis ◽

Retrospective Case ◽

Common Causes

Abstract Background: Uveitis is one of the most common causes of visual impairment, accounting for up to 25% of visual loss in the developing world and 10% in developed countries. There are marked regional differences within Australia, particularly in rural and Indigenous populations. There is no published data on uveitis in Tasmania. Methods: A 5-year retrospective case series review of medical records of all patients reviewed to the clinic was performed. Results: A total of 95 patients were referred to the clinic. Seventy-six (76) patients (123 eyes) had uveitis and were analysed in detail (see table 1). Nineteen (19) patients had a diagnosis other than uveitis or were on immunosuppressive therapy for another ocular inflammatory disorder (detailed in Table 2). The most common anatomical diagnosis was posterior uveitis (29%), followed by pan-uveitis (20%) and intermediate uveitis (17%). Average follow-up was 36.7 months. Conclusion: The most common anatomical diagnosis was posterior uveitis (29%), followed by pan-uveitis (20%) and intermediate uveitis (17%). Telemedicine is a modality that could have application in management of Uveitis in regional areas.

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Histological diagnosis of immune checkpoint inhibitor induced acute renal injury in patients with metastatic melanoma: a retrospective case series report

BMC Nephrology ◽

10.1186/s12882-020-02044-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Sebastian Hultin ◽

Kazi Nahar ◽

Alexander M. Menzies ◽

Georgina V. Long ◽

Suran L. Fernando ◽

...

Keyword(s):

Renal Dysfunction ◽

Metastatic Melanoma ◽

Immune Checkpoint ◽

Checkpoint Inhibitors ◽

Demographic Data ◽

Case Series ◽

Tubulointerstitial Injury ◽

Retrospective Case ◽

Pattern Of Injury ◽

Results Management

Abstract Background Immune checkpoint inhibitors (ICI) have become the standard of care in many oncological conditions but are associated with a spectrum of renal immune-related adverse events (IrAEs). We aimed to describe the spectrum, histology, management and outcomes of renal IrAE in patients with metastatic melanoma undergoing ICI therapy. Methods We conducted a retrospective review of 23 patients with a diagnosis of metastatic melanoma treated with ICI between January 2017 and April 2019 who developed a renal IrAE. Baseline demographic data, biochemical and histopathological results, management and outcomes were analyzed. Results The majority of patients who developed renal irAE were male and received combination immunotherapy. The median time of onset from initiation of ICI therapy to renal IrAE was 4 months. 52% of the treated renal IrAE had histopathologically confirmed renal IrAE. The most common histological pattern of injury was acute tubulo-interstitial nephritis (92%). One patient developed anti-GBM disease with non-dialysis dependent stage 5 CKD. In tubulointerstitial injury, there was no association between peak creatinine, renal recovery and histologically reported inflammation or fibrosis. Patients with renal IrAE demonstrated persisting renal dysfunction at 3, 6 and 12 months with a mean baseline, 3 and 12 month creatinine of 90.0 μmol/L, 127.0 μmol/L and 107.5 μmol/L respectively. Conclusion Renal IrAE is most commonly attributable to steroid responsive acute tubulointerstitial nephritis. The outcome of rarer pathologies such as anti-GBM disease may be adversely affected by a delayed diagnosis. There is persisting renal dysfunction following an episode of renal IrAE that may have impact on future renal and overall survival outcomes.

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Isolated Fibular Stress Fractures: Demographic and Radiographic Factors

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00372 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0037

Author(s):

Nana O. Sarpong ◽

Matthew Levitsky ◽

Michael Held ◽

Justin K. Greisberg ◽

J. Turner Vosseller

Keyword(s):

Risk Factors ◽

Stress Fracture ◽

Demographic Data ◽

Case Series ◽

Stress Fractures ◽

Prior History ◽

Retrospective Case ◽

Distal Fibula ◽

Retrospective Case Series ◽

Short Period

Category: Ankle, Trauma Introduction/Purpose: Fibular stress fractures are rare injuries that are incompletely understood in terms of pathogenesis and predisposing factors. While stress fractures all involve relative stress concentration in a finite area leading to local mechanical failure, the risk factors for this injury have not been assessed. Their relative rarity has made understanding of these risk factors difficult. In a retrospective case series, we sought to define demographic and radiographic risk factors for isolated fibular stress fractures. Methods: We retrospectively reviewed the records of 13 patients with isolated fibular stress fractures at our institution between January 2010 and November 2018. We collected and analyzed baseline demographic data and radiographic parameters including prior history of fracture, location of stress fracture, bone quality, and heel alignment. Results: The cohort consisted of 6 men and 7 women with a mean age of 41.8 years at the time of diagnosis of the fibular stress fracture. The average BMI in the cohort was 28.5 kg/m2. The location of the stress fracture was in the distal third of the fibula in 69.2% (9/13), proximal third in 23.1% (3/13), and middle third in 7.7% (1/13). There was no evidence of osteopenia on radiographic analysis in any patients, by assessment of the senior author and attending radiologist at our institution. Isolated stress fractures in the distal third of the fibula were observed more commonly in women. Distal fibula stress fractures were associated with physiologic hindfoot valgus, while proximal fractures were seen with a varus hindfoot. Conclusion: In this retrospective case series of a rare injury, isolated stress fractures in the distal third of the fibula were the most common fibular stress fracture. Proximal fibular stress fractures were associated with a varus hindfoot. All fractures in this case series healed with immobilization in a walking boot with or without a short period of nonweightbearing.

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Invasive Fungal Rhinosinusitis with and without Orbital Complications: Clinical and Laboratory Differences

Journal of Fungi ◽

10.3390/jof7070573 ◽

2021 ◽

Vol 7 (7) ◽

pp. 573

Author(s):

Kuan-Hsiang Twu ◽

Ying-Ju Kuo ◽

Ching-Yin Ho ◽

Edward C. Kuan ◽

Wei-Hsin Wang ◽

...

Keyword(s):

Demographic Data ◽

Clinical Signs ◽

Case Series ◽

Ethmoid Sinus ◽

Retrospective Case ◽

Presenting Symptoms ◽

Fungal Rhinosinusitis ◽

Wbc Count ◽

Orbital Complications ◽

Invasive Fungal Rhinosinusitis

Background: Invasive fungal rhinosinusitis (IFS) is a rare but often fatal disease. There are limited studies regarding IFS with orbital complications (IFSwOC). The present study aimed to identify the clinical signs associated with IFSwOC and prognosticators of the disease. Methods: A retrospective case series was conducted of patients histopathologically confirmed IFS or fungal rhinosinusitis with clinically apparent neuro-orbital complications who underwent surgery between 2008 and 2018. Demographic data, presenting symptoms and signs, culture data, laboratory results, and patient outcomes were obtained from medical records. Results: A total of 38 patients were identified, including 9 patients with IFSwOC, and 29 patients with IFS without orbital complications (IFSsOC). The clinical signs associated with developing orbital complications include headache, fever, sphenoid sinus, or posterior ethmoid sinus involvement, CRP level ≥ 1.025 mg/dL, or ESR level ≥ 46.5 mm/h. In IFSwOC group, male, posterior ethmoid sinus involvement, WBC count ≥ 9000 μL, CRP level ≥ 6.91 mg/dL, or ESR level ≥ 69 mm/h were correlated with a significantly poorer prognosis. Conclusion: IFS patients with sphenoid or posterior ethmoid sinus involvement, headache or fever as presenting symptoms, elevated CRP, and ESR level were at risk of developing orbital complications. Timely surgical debridement followed by systemic antifungal treatment may improve treatment outcomes.

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Structural Fat Grafting to Improve Reconstructive Outcomes in Secondary Cleft Lip Deformity

The Cleft Palate-Craniofacial Journal ◽

10.1597/15-197 ◽

2017 ◽

Vol 54 (1) ◽

pp. 70-74 ◽

Cited By ~ 13

Author(s):

Christine M. Jones ◽

Brad T. Morrow ◽

William B. Albright ◽

Ross E. Long ◽

Thomas D. Samson ◽

...

Keyword(s):

Patient Satisfaction ◽

Cleft Lip ◽

Rating Scale ◽

Average Length ◽

Care Center ◽

Case Series ◽

Fat Grafting ◽

Retrospective Case ◽

Student’S T

Objective To describe the technique and results of structural fat grafting in cleft lip revision, including patient satisfaction and aesthetic outcome. Design Retrospective case series Setting Multidisciplinary cleft care center. Patients All patients who underwent structural fat grafting between June 2006 and September 2012 for cleft lip revision, with appropriate photographic follow-up included. Twenty-two cases were reviewed; 18 had sufficient data to be included. Interventions Patients underwent structural fat grafting for cleft lip revision, most commonly injecting fat under deficient philtral columns, the nostril base, and upper lip. Main Outcome Measures Blinded observers rated outcomes using the Asher-McDade nasolabial appearance rating scale. Patients completed questionnaires assessing their satisfaction. A paired Student's t-test was used to test outcomes for significance (alpha = 0.05). Results Patients were an average of 16 years old (range 6-43); average length of follow up was 11.7 months. Overall symmetry and aesthetics were improved based on the nasal form ( P = 0.006) and vermillion border (P - 0.04) when rated using the Asher-McDade scale. No complications were recorded. Patients were significantly happier with their appearance after fat grafting (P < 0.001) and were uniformly positive when questioned about the ease of the surgery and rate of recovery. Conclusions Structural fat grafting is a safe and effective way to improve symmetry and enhance facial proportions in patients with cleft lip. Given the high degree of patient satisfaction, few complications, and durable results, fat grafting offers many advantages in cleft lip revision.

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Modified Manouguian Technique for Aortic Root Enlargement: A Case Series

10.22541/au.163592360.09879068/v1 ◽

2021 ◽

Author(s):

Madison Malfitano ◽

Julia A. Brickey ◽

Aurélie Merlo ◽

Thomas Caranasos

Keyword(s):

Aortic Root ◽

Case Reports ◽

Case Series ◽

Mechanical Valve ◽

Surgical Aortic Valve Replacement ◽

Retrospective Case ◽

Valve Size ◽

Single Operator ◽

Common Etiology ◽

Aortic Root Enlargement

Background: Manouguian aortic root enlargement (ARE) has been a standard root enlargement procedure to assist in patients with a small annular size. We describe a modification to the Manouguian ARE similar to Yang et al. This approach could serve as an alternate technique for performing ARE; to date only case reports have defined this approach and no studies have evaluated its efficacy or safety. Methods: A retrospective case series was performed on patients who underwent ARE for surgical aortic valve replacement via the modified Manouguian procedure at a single institution. Thirteen patients were identified between 2015-2021, and all surgeries were performed by a single operator. Data were collected via the Society of Thoracic Surgeons database and chart review. The primary outcome was difference in valve size after the procedure. Results: The most common indication for surgery was aortic stenosis (12, 92%), with the most common etiology being degenerative calcification (7, 54%). Congenital bicuspid or uni-cuspid valves were identified in 5 (38%) patients. The majority (10, 77%) of patients received a mechanical valve. This procedure was successfully performed in all 13 of the patients. Additionally, 13 of the 13 patients (100%) were upsized to a satisfactory valve size based on pre-operative echocardiography sizing. Conclusions: The modified Manouguian aortic enlargement technique can be safely and effectively used as an aortic enlargement procedure in a broad sample of patients.

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Unraveling the Etiology of Pediatric Vertigo and Dizziness: A Tertiary Pediatric Center Experience

Medicina ◽

10.3390/medicina57050475 ◽

2021 ◽

Vol 57 (5) ◽

pp. 475

Author(s):

Nina Božanić Urbančič ◽

Domen Vozel ◽

Jure Urbančič ◽

Saba Battelino

Keyword(s):

Multidisciplinary Approach ◽

Clinical Presentation ◽

Case Series ◽

Vestibular Migraine ◽

The Self ◽

Retrospective Case ◽

Common Cause ◽

Migrainous Vertigo ◽

Retrospective Case Series ◽

Pediatric Center

Background and Objectives: Numerous authors have reported that the commonest type of vertigo in children is migraine-associated vertigo (vestibular migraine and benign paroxysmal vertigo of childhood—BPV). We aimed to provide the possible etiological background of vertigo and dizziness in Slovenian children. Materials and Methods: A retrospective case series of pediatric vertigo and dizziness children referred to the tertiary pediatric otorhinolaryngology center from 2015 to 2020. Children received a complete audiological and vestibular workup and were referred to pediatric specialists depending on the clinical presentation. Results: Of 257 children (42% male, 58% female) aged 1–17 years (M = 10.9, SD = 4.3 years) in 19.1% vertigo and dizziness were classified as central, in 12.4% as a peripheral vestibular, in 10.9% as a hemodynamic, in 5.8% as a psychological and none as visual by pediatric neurologists, otorhinolaryngologists, cardiologists, psychologists or ophthalmologists, respectively. 40.8% (20) children with central vertigo had BPV (7.8% of all children) and 8.2% (4) migrainous vertigo. In 43.6% (112 children), the etiology remained unclassified. Conclusions: After a thorough multidisciplinary workup, the etiology of vertigo and dizziness was unraveled in the majority of children referred to our tertiary otorhinolaryngology center. The most common cause was central; however, in a considerable number, the etiology remained unclassified. The latter could be attributed to the self-limiting nature of vertigo spells. Hence, a child presenting with dizziness and vertigo requires a multidisciplinary approach, in which referral to a neurologist is, in most cases, essential.

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Autologous Scleral Pocket Technique for Ahmed Glaucoma Valve Implantation with Pars Plana Tube Insertion for Neovascular Glaucoma

Journal of Clinical Medicine ◽

10.3390/jcm10081606 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1606

Author(s):

Hitomi Maki ◽

Sotaro Mori ◽

Hisanori Imai ◽

Hiroko Yamada ◽

Keiko Otsuka ◽

...

Keyword(s):

Case Series ◽

Neovascular Glaucoma ◽

Ahmed Glaucoma Valve ◽

Retrospective Case ◽

Corneal Endothelial Cell Density ◽

Drug Score ◽

Pars Plana ◽

The Mean ◽

Valve Implantation ◽

Ahmed Glaucoma Valve Implantation

Specific postoperative complications, such as tube exposure and conjunctival erosion, have occurred despite the favorable surgical outcomes of tube shunt surgeries for refractory glaucoma. The new autologous scleral pocket technique is performed by inserting the tube into the vitreous cavity without using a donor scleral patch. The purpose of this study was to evaluate the surgical results of Ahmed glaucoma valve (AGV) implantation using this technique for neovascular glaucoma (NVG), which is one of the representative refractory types of glaucoma. This observational retrospective case series included 15 consecutive eyes of 15 patients with NVG who had undergone AGV implantation at Kobe University between January 2018 and December 2019. The mean preoperative intraocular pressure (IOP) was 37.2 ± 13.8 mmHg and the glaucoma drug score was 4.2 ± 2.2. The mean IOP and glaucoma drug score at 1 year postoperatively decreased to 15.0 ± 4.6 mmHg and 1.3 ± 2.0, respectively (p < 0.001). No significant change in the corneal endothelial cell density following surgery was observed (p = 0.09); however, one patient required an additional trabeculectomy at 7 months postoperatively. No cases of tube exposure or conjunctival erosion were observed at 1 year postoperatively. These results indicated the effectiveness and safety of this technique in patients with NVG.

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Midfoot Ulcers Treated with Gastrocnemius-Soleus Recession

Foot & Ankle International ◽

10.3113/fai.2009.0842 ◽

2009 ◽

Vol 30 (9) ◽

pp. 842-846 ◽

Cited By ~ 35

Author(s):

James M. Laborde

Keyword(s):

Case Series ◽

Primary Treatment ◽

Foot Ulcers ◽

Transfemoral Amputation ◽

Retrospective Case ◽

Medical Problems ◽

Level Of Evidence ◽

Common Cause ◽

Tendon Lengthening ◽

Resolution Level

Background: Foot ulcers in patients with neuropathy are a common cause of hospital admission for infection sometimes resulting in amputation in patients with neuropathy. Tendon lengthening alone has been reported to be successful in treating neuropathic forefoot ulcers. Tendon lengthening has also been recommended as an adjunct to bony procedures (exostectomy or fusion) for treating midfoot ulcers. The author reports the results of gastrocnemius-soleus recession as the sole treatment of diabetic midfoot ulcers. Materials and Methods: This study evaluated the results of 11 patients with 11 neuropathic plantar midfoot ulcers who were treated primarily with gastrocnemius-soleus recession with an average followup of 39 months. Potentially risky bony procedures were done after tendon lengthening if ulcers did not heal or recurred. Results: Ten of the ulcers healed but one patient was lost to followup after his ulcer healed. One ulcer did not heal and one ulcer recurred but healed again after midfoot fusion. One patient later had a transfemoral amputation due to gangrene. Two patients later died from medical problems unrelated to their surgery. There were no incision problems, or transfer ulcers. Conclusion: The author believes gastrocnemius-soleus recession as a primary treatment of diabetic midfoot ulcers is a low risk method of promoting ulcer resolution. Level of Evidence: IV, Retrospective Case Series

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