scholarly journals A novel way of Subfoveal Perfluorocarbon liquid Removal using 26 gauge spinal anesthesia needle

2020 ◽  
Vol 12 (1) ◽  
pp. 119-124
Author(s):  
Abhishek Anand ◽  
Lalit Agarwal ◽  
Nisha Agrawal
Keyword(s):  
Spinal Anesthesia ◽  
Silicone Oil ◽  
Case Series ◽  
Cost Effective ◽  
Nerve Fibers ◽  
Complete Restoration ◽  
Pars Plana ◽  
Liquid Removal ◽  
Sd Oct

Introduction: Perfluorocarbon (PFCL) is an essential adjunct of retinal detachment surgery. Subfoveal migration of PFCL is a rare and vision threatening complication of its use. Various techniques have been described for its removal. However, no consensual technique of its removal has been established. We present a nova, relatively atraumatic and cost effective way of PFCL removal using a widely available 26G spinal anesthesia needle. Case: An 18 years old myopic patient who had undergone left eye pars plana vitrectomy (PPV) for myopic Rhegmatogenous Retinal Detatchment (RRD) in the past presented after 1 month with retained subfoveal PFCL. Its subretinal location was confirmed by Optical Coherence Tomography (OCT). He was taken up for early Silicone Oil Removal (SOR) along with removal of retained subfoveal PFCL under high magnification by using a surgical disposable contact macula lens. A 26G spinal anesthesia needle tip was used to dissect a small separation parallel to the nerve fibers at the temporal edge of tense cystic PFCL bleb. Silicone tipped flute cannula was used to passively aspirate the sub retinal PFCL under fluid with no additional intervention. No barrage LASER was done. Observation: Anatomical restoration of the retina was noted both intraoperatively and post-operatively. SD-OCT showed complete restoration of anatomical layers with no presence of intraretinal cystic cleft both at day 1 and 30 days postoperatively. Conclusion: Safe removal of subfoveal PFCL can be done with 26G spinal anesthesia needle which is atraumatic, inexpensive and readily available. However, long term validity of this process needs to be established in a case series.

Pars plana Ex-Press mini shunt for management of persistent glaucoma in vitrectomized eyes: A novel technique

2020 ◽  
Vol 30 (5) ◽  
pp. 1179-1184 ◽  
Author(s):  
Abdussalam Abdullatif ◽  
Heba El-Saied
Keyword(s):  
Intraocular Pressure ◽  
Silicone Oil ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Secondary Glaucoma ◽  
Antiglaucoma Medication ◽  
Novel Approach ◽  
Pars Plana ◽  
Secondary Refractory

Purpose: To evaluate the safety and efficacy of a novel approach to implant Ex-Press mini shunt via the pars plana under a scleral flap in pseudophakic or aphakic, vitrectomized patients with secondary refractory glaucoma. Methods: A prospective interventional case series of three patients with secondary glaucoma after pars plana vitrectomy. Intraocular pressure was not controlled by silicone oil removal, if the patient was siliconized, nor the maximum medical treatment. Ex-Press mini shunt via the pars plana was implanted. We evaluated the control of intraocular pressure and the development of intraoperative and postoperative complications. Results: During 1-year follow-up, control of intraocular pressure was achieved; 14, 15, and 15 mmHg at the 3 months, and 15, 15, and 16 mmHg at the 6 months in our three cases without antiglaucoma treatment and 16, 16, and 18 with single antiglaucoma medication at 1 year. Blebs were posterior and diffuse. No complications were encountered intraoperatively or postoperatively. Ultrasound biomicroscopy showed suprachoroidal posterior lake of fluid as an additional filtration route without any choroidal or retinal complication. Conclusion: Implantation of Ex-Press mini shunt via the pars plana in aphakic or pseudophakic, vitrectomized eyes is a promising, safe, and effective technique in patients with secondary glaucoma.

scholarly journals Selective Laser Trabeculoplasty for Glaucoma Secondary to Emulsified Silicone Oil after Pars Plana Vitrectomy: A Pilot Study

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Zeynep Alkin ◽  
Banu Satana ◽  
Abdullah Ozkaya ◽  
Berna Basarir ◽  
Cigdem Altan ◽  
...  
Keyword(s):  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Open Angle Glaucoma ◽  
Case Series ◽  
Open Angle ◽  
Selective Laser Trabeculoplasty ◽  
Consecutive Case ◽  
Laser Trabeculoplasty ◽  
Pars Plana ◽  
The Mean

Background. To investigate the efficacy of selective laser trabeculoplasty (SLT) for lowering intraocular pressure (IOP) in patients with open angle glaucoma (OAG) secondary to emulsified silicone oil (SO).Methodology/Principal Findings. Prospective, interventional, consecutive case series of 11 eyes with sustained elevation of IOP after SO removal. The mean IOP at baseline, week 1, month 1, month 3, and month 6 was evaluated. The mean baseline IOP was significantly decreased from 25 ± 2.7 mmHg to 18.4 ± 5.5 mmHg at week 1(P=0.01), 17.9 ± 3.1 mmHg at month 1(P=0.008), 15.8 ± 3.9 mmHg at month 3(P=0.003), and 16.2 ± 4.7 mmHg at month 6(P=0.004). IOP < 21 mmHg was achieved in 91% of the eyes without a significant complication at month 6.Conclusion/Significance. SLT may be successful for lowering IOP in patients with OAG secondary to emulsified SO which was not controlled with maximum antiglaucomatous medical treatment.

scholarly journals RESECTION AND REGENERATION- A HOPE FOR THE HOPELESS

2020 ◽  
pp. 1-5
Author(s):  
Apeksha Annigeri B. ◽  
Rajiv Nidasale Puttaswamaiah ◽  
Avinash Janaki Lingaraju
Keyword(s):  
Alveolar Bone ◽  
Treatment Plan ◽  
Treatment Options ◽  
Case Series ◽  
Cost Effective ◽  
Ridge Preservation ◽  
Tooth Structure ◽  
Implant Placement ◽  
Long Term Prognosis

Preservation of tooth structure has always been the prime aim of dental practice. Teeth with advanced periodontal disease in multirooted teeth often pose a significant challenge to the clinician, complicating the treatment plan and compromising long term prognosis. The outcome of the treatment is determined by proper case selection and surgical, endodontic and prosthetic parameters. Resective and regenerative osseous procedures are often employed to help preserve the tooth structure, alveolar bone involving the retained root of multirooted teeth and are cost effective over the other treatment options like ridge preservation/augmentation followed by implant placement. This case series describes application of resective and regenerative techniques for molars with extensive combined periodontal-endodontic disease.

scholarly journals Long-term outcome of scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients

2019 ◽  
Author(s):  
Han Zhao ◽  
Wanpeng Wang ◽  
Zhengping Hu ◽  
Baihua Chen
Keyword(s):  
Intraocular Lens ◽  
Pars Plana Vitrectomy ◽  
Ocular Trauma ◽  
Silicone Oil ◽  
Trauma Patients ◽  
Oil Removal ◽  
Silicone Oil Removal ◽  
Pars Plana ◽  
Scleral Fixated Intraocular Lens

Abstract Background To investigate the long-term outcomes and complications of scleral-fixated intraocular lens (SFIOL) implantation without conjunctival peritomies and sclerotomy in patients with a history of ocular trauma with inadequate capsular support during primary pars plana vitrectomy or silicone oil removal. Methods Records of ocular trauma patients who underwent implantation of SFIOL without conjunctival peritomies and sclerotomy during primary pars plana vitrectomy or silicone oil removal. Results Sixty-nine eyes of 69 patients were included in this study. The median follow-up period was 34 months (range, 6-99 months). The average patient age at the time of surgery was 44 years old (range, 4-80 years). At the end of follow-up, the preoperative mean of best corrected visual acuity (BCVA) was 0.79 ± 0.86 log of the minimum angle of resolution (logMAR), which improved 0.20 ± 0.26 logMAR postoperatively (P = 0.01). BCVA improved or remained unchanged in 64 eyes (92.8%), VA decreased two lines in five eyes (7.2%). Early postoperative complications included transient corneal edema in seven eyes (10.1%), minor vitreous hemorrhage in four eyes (5.8%), transient elevated intraocular pressure (IOP) in one eye (1.4%), and hypotony in three eyes (4.3%). Late postoperative complications included persistent elevated IOP in five eyes (7.2%), epiretinal membrane formation in three eyes (4.3%), and cystoid macular edema noted in one eye (1.4%). Conclusion Use of a scleral-fixated intraocular lens implantation without conjunctival peritomies and sclerotomy in ocular trauma patients during either primary pars plana vitrectomy or second silicone oil removal is a valuable approach for the management of traumatic aphakia in the absence of capsular support.

scholarly journals Sympathetic Ophthalmia Two Weeks After 23-Gauge Vitrectomy

2020 ◽  
Author(s):  
Bahaeddin El Khatib ◽  
Alexander Hacopian ◽  
Menka S. Patel ◽  
Monica Dalal ◽  
H. Nida Sen ◽  
...  
Keyword(s):  
Rare Disease ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Case Series ◽  
Sympathetic Ophthalmia ◽  
Ocular Injury ◽  
History Of ◽  
Pars Plana ◽  
23 Gauge ◽  
The Uk

Abstract Sympathetic Ophthalmia (SO) is a rare disease that presents as a bilateral, diffuse, granulomatous panuveitis. Sympathetic Ophthalmia is a clinical diagnosis with history of penetrating ocular injury in the inciting eye and presence of panuveitis in the sympathizing eye. Though early enucleation is believed to minimize the risk, there have been reports of SO even after enucleation of inciting eyes. The possible association between vitrectomy and SO has been initially proposed by Gass [9] and later studied extensively in a large cohort in the UK with an estimated SO risk of 1 in 799 vitrectomies [11]. There have been several case series and reports of SO following vitrectomy, however only three documented cases of SO following vitrectomy without use of silicone oil. These cases demonstrated an onset of SO ranging between 4 weeks to 2 months. We present a patient with SO in the sympathizing eye presenting 16 days after an uncomplicated 23-gauge (23G) sutureless pars plana vitrectomy (PPV) without the use of silicone oil.

Long-term Results of Pars Plana Vitrectomy and Silicone Oil for Complications of Diabetic Retinopathy

1994 ◽  
Vol 4 (1) ◽  
pp. 52-58 ◽  
Author(s):  
I. Karel ◽  
B. Kalvodová
Keyword(s):  
Diabetic Retinopathy ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Posterior Pole ◽  
Vitreous Haemorrhage ◽  
Long Term Results ◽  
Diabetic Patients ◽  
Pars Plana

Pars plana vitrectomy (PPV) with silicone oil implantation (SOI) was performed for advanced proliferative diabetic retinopathy (PDR) in 110 eyes of 98 diabetic patients. In, 77 eyes (70%) it was a primary SOI as part of the initial operation; in 33 eyes (30%) it was a secondary SOI in reoperations. Indications for SOI were traction retinal detachment of the posterior pole, combined traction and rhegmatogenous detachment, vitreous haemorrhage with florid vascularised fibrous proliferations, and recurrent vitreous haemorrhage after PPV. The patients were followed up for 24 to 72 months, with a mean of 53 months. At the end of follow-up, anatomical success was achieved in 63 eyes (57%), and functional success with visual acuity 0.01 and better in 35 eyes (32%). Functional failures were caused by retinal redetachment in 47 eyes (43%), by secondary glaucoma in 10 eyes (9%), retinal ischemia in 15 eyes (13%) and keratopathy in three eyes (3%). The functional success rate decreased with follow-up from 67% after six months to 50% by 60 months after SOI. Silicone oil bubble in the anterior chamber, rubeosis iridis, cataract, and glaucoma were the most frequent postoperative complications. PPV with SOI was highly effective in many serious complications of advanced PDR. Functional success was mostly lasting and markedly improved the quality of life of these patients.

scholarly journals Retinal detachment in the eye with the choroidal coloboma

2014 ◽  
Vol 142 (11-12) ◽  
pp. 717-720 ◽  
Author(s):  
Dragan Vukovic ◽  
Sanja Petrovic-Pajic ◽  
Predrag Paovic
Keyword(s):  
Retinal Detachment ◽  
Silicone Oil ◽  
Surgical Techniques ◽  
Case Series ◽  
Scleral Buckling ◽  
Posterior Segment ◽  
Scleral Buckle ◽  
Silicon Oil ◽  
Encircling Band ◽  
Pars Plana

Introduction. Choroidal coloboma is a congenital defect caused by an inadequate closure of embryonic fissure. About 40% of the eyes with the choroidal coloboma (CHC) develop the retinal detachment (RD). It is extremely difficult to manage these cases due to the lack of pigmentation at the site of choroidal coloboma. Outline of Cases. This is a case series of five patients with CHC and RD who were successfully operated using one of two different surgical techniques: pars plana vitrectomy (PPV) + silicone oil internal tamponade and/or scleral buckle with encircling band with laser photocoagulation (SB+EB+LPC) around the coloboma. The purpose of this paper is to present how to successfully handle patients with CHC, who have concurrent retinal detachment in the same eye and to compare two different techniques and indications for the predominant use of one of them in a specific case. Conclusion. Both surgical techniques can be applied with equal success in the operation of retinal detachment in eyes with the chorioidal coloboma. Which one will be used depends only of the posterior segment of eye findings. We use scleral buckling in cases with RD accompanied by CHC when the peripheral break is evident and there are no breaks in the coloboma itself. We also perform, 2-3 days after surgery, laser burns around the coloboma, which is our modification of this technique. In all other cases it is indicated to perform PPV+silicon oil internal tamponade.

Low-Dose Lithium for Long-Term Treatment of Clozapine- Induced Neutropenia: A Case Series

2019 ◽  
Vol 8 (2) ◽  
pp. 155-158 ◽  
Author(s):  
Muhammad R. Baig
Keyword(s):  
Mental Health ◽  
Effective Treatment ◽  
Low Dose ◽  
Lithium Treatment ◽  
Case Series ◽  
Cost Effective ◽  
Term Treatment ◽  
Treatment Resistant ◽  
Long Term Treatment

Background: Treatment-resistant psychosis makes schizophrenia a disabling and costly illness. Clozapine is an effective treatment for treatment-resistant psychosis, though it is underutilized mainly due to prescribing providers’ fear of a serious yet uncommon complication, clozapine-induced neutropenia. Clozapine-induced neutropenia predisposes patients to potentially life-threatening infections leading prescribers to stop use when blood counts start to drop even well above the recommended cut-off point. Colonystimulating factors are effective options for reducing risk and duration of neutropeniarelated events though they add a significant cost burden to the patient and healthcare system. There is a great need for feasible and cost-effective pharmacotherapies in the mental health care setting for the management of clozapine-induced neutropenia. Objective: We evaluated adjunctive use of lithium when prescribed at a low-dose to stabilize dropping blood count in patients receiving clozapine for treatment-resistant psychosis. Methods & Results: A case series analysis of three patients who were followed in a mental health outpatient clinic for the management of schizophrenia. Blood counts of all the patients were stabilized by low-dose lithium treatment and continued to receive long term treatment of clozapine. Conclusion: Results suggest low-dose lithium as a feasible and cost-effective pharmacotherapeutic option enabling the continuation of clozapine, an effective treatment for treatment-resistant psychosis.

Management of Suture Penetration in Combined Vitrectomy and Scleral Buckle Surgery

2020 ◽  
Vol 4 (3) ◽  
pp. 202-209
Author(s):  
Mehdi Najafi ◽  
Danny A. Mammo ◽  
Geoffrey G. Emerson
Keyword(s):  
Surgical Outcome ◽  
Silicone Oil ◽  
Intraoperative Complications ◽  
Late Complications ◽  
Subretinal Space ◽  
Subretinal Hemorrhage ◽  
Full Thickness ◽  
Scleral Buckle ◽  
Pars Plana

Purpose: To evaluate the surgical outcome of deep or full-thickness suture penetration during combined pars plana vitrectomy and scleral buckle (PPV/SB) surgery. Methods: Clinical data of patients who underwent PPV/SB for retinal detachment in our practice between June 2017 and April 2019 were reviewed. Cases with full-thickness scleral penetration were identified. Data including initial presentation, intraoperative complications, and management were collected. Long-term surgical outcome, complications, and recurrent detachment were determined. Results: Twenty-three cases with evidence of suture penetration were identified. In none of the cases the penetrated suture was visible in the subretinal space. The suture was replaced in cases with persistent leakage through the penetration site or when the surgical plan involved silicone oil insertion. Subretinal hemorrhage was noted during vitrectomy in 7 (30%) patients. The subretinal hemorrhage migrated to the macula in 2 (9%) cases and was drained through a posterior retinotomy. Retinal incarceration was noted in 4 (17%) cases and was released using a focal retinotomy in 2 (9%)cases to reattach the retina. Late complications included epiretinal membrane in 6 (26%) and recurrent detachment occurred in 2 (9%) patients. Final anatomical success was achieved in all patients. Conclusions: We propose new principles in the management of suture penetration during combined PPV/SB surgery. In the absence of a visible penetrated suture, suture replacement is required when there is profuse leakage through the penetration site or if silicone oil is used as tamponade. We recommend removal of submacular hemorrhage through a posterior retinotomy. The incarcerated retina can be flattened using release retinotomies.

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