scholarly journals Wick technique in subscleral and subconjunctival Ologen™ implantation with trabeculectomy in patients with high risk of failure

2021 ◽  
Vol 17 (4) ◽  
pp. 366-374
Author(s):  
Muralidhar Rajamani ◽  
Chitra Ramamurthy
Keyword(s):  
Intraocular Pressure ◽  
High Risk ◽  
Retrospective Review ◽  
Ultrasound Biomicroscopy ◽  
Scleral Flap ◽  
Modified Technique ◽  
Topical Medication ◽  
Number Of Patients ◽  
The Mean ◽  
Wick Technique

Introduction: Ologen™ is traditionally placed subconjunctivally during trabeculectomy, which limits its area of action. Subscleral implantation of Ologen has been described involving fashioning a gutter beneath the scleral flap. This, however, would not prevent fibrosis at the margins of the scleral flap. We describe a modified technique of Ologen® placement that has the potential to prevent scarring at the margins of the flap withoutthe need to fashion a gutter. Materials and methods: The study involved a retrospective review of patients who had undergone trabeculectomy with Ologen implantation by the wick technique between January 2015 and August 2016. Patients judged to be at high risk of trabeculectomy failure were operated with this technique. Results: A total of six patients with median age of 38.5 years were included in the study. The mean preoperative intraocular pressure (IOP) was 30.8 ± 7.3 mmHg, which reduced to 10.6 ± 2.2 mmHg 18 months after surgery. By 18 months postoperative, all patients had IOP in the low teens (two patients required additional topical medication). One patient had two episodes of hypotony that responded to steroids and cycloplegics. Another patient required two needlings to bring IOP under control. No other complications were noted. Ultrasound biomicroscopy done 3 months after surgery showed two pieces of Ologen in one patient. Conclusions: The results of our study show that this technique may be used effectively in patients at high risk of trabeculectomy failure. Further studies in a larger number of patients with diverse high-risk conditions are required before this technique is recommended for general use.

scholarly journals The Results of Trabeculectomy with Antimetabolites in Elderly Patients: A Retrospective Study

Acta Medica ◽  
2021 ◽  
pp. 1-5
Author(s):  
Özlem Dikmetaş ◽  
Sepideh Lotfisadigh, ◽  
Merve Kaşıkçı ◽  
Ali Bülent Çankaya ◽  
Sibel Kocabeyoğlu
Keyword(s):  
Intraocular Pressure ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Mitomycin C ◽  
Open Angle Glaucoma ◽  
Success Rates ◽  
Topical Medication ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Objective: To examine the effectiveness and results of primary trabeculectomy with 5-fluorouracil (group 1) or mitomycin-C (group 2) in elderly patients. Materials and Methods: This was a retrospective study including 67 eyes with primary open-angle glaucoma that underwent primary trabeculectomy with group 1 or group 2. Patients who were followed up for less than 1 year or were under 55 years of age were excluded from the study. Surgical success was evaluated according to a decrease in cup/disk ratio and reduction of intraocular pressure without any topical medication. Results: The mean ages of participants were 65.7 years (range 59–88) and 65.9 years (range 59–74) in groups 1 and 2, respectively. The mean preoperative and postoperative intraocular pressure values were 31.3 ± 5.7 mmHg (range 17–46) and 14.8 ± 0.4 mmHg (range 10–21) in group 1 (p < 0.001) and 31.5 ± 7.4 mmHg (range 18–52) and 14.8 ± 2.9 mmHg (range 10–21) in group 2 (p < 0.001). Conclusion: The use of 5-fluorouracil or mitomycin-C during primary trabeculectomy is associated with high postoperative success rates. There were no significant differences between 5-fluorouracil and mitomycin-C in terms of intraocular pressure reduction.

scholarly journals Modular dual-mobility cups using ceramic liners: an original solution for selected indications?

2020 ◽  
Vol 30 (2_suppl) ◽  
pp. 59-65
Author(s):  
Rocco D’Apolito ◽  
Guido Bandettini ◽  
Filippo Maria Piana Jacquot ◽  
Luigi Zagra
Keyword(s):  
High Risk ◽  
Consecutive Series ◽  
Cobalt Chromium ◽  
Original Solution ◽  
Dual Mobility ◽  
Number Of Patients ◽  
Revision Tha ◽  
Ceramic Liner ◽  
Dual Mobility Cups ◽  
The Mean

Background: Dual mobility (DM) has been shown to improve stability both in primary and revision total hip arthroplasty (THA) and is increasingly used in patients at high risk of dislocation and in the treatment of THA instability. The introduction of modular liners has helped to overcome some of the limitations of monoblock DM cups. In this context, the use of a ceramic liner would avoid the conventional cobalt-chromium liner in the titanium shell, which can be problematic in some situations. The aim of this paper is to report the outcomes of a consecutive series of patients undergoing revision THA using a modular DM cup with a ceramic liner instead of the conventional metal one, and to clarify the rationale for this currently “off-label” use. Patients and methods: This is a retrospective series of patients who received this new DM bearing in a single institution. Patients were followed up clinically and radiologically at 1 month, 3 months, 6 months and yearly thereafter. Results: 5 patients received the ceramic liner in the study period (2014–2019). The indications were instability or high risk of dislocation in ceramic liner fracture and ARMD with soft tissue damage after MoM THA. The mean age at surgery was 74 (63–82) years, the mean follow-up was 36 (12–72) months. No dislocation occurred, and no adverse events related to the implant were recorded. Conclusions: The use of a ceramic liner in a modular DM cup offers several advantages in selected patients, and the results of our cohort are encouraging. However, caution is needed in introducing this new bearing because knowledge is currently limited. Further studies on a larger number of patients and with longer follow-ups are needed to confirm these findings and before widespread use of the device.

scholarly journals Asymptomatic chronic hypotony due to subclinical choroidal effusion after blunt trauma

2020 ◽  
Vol 17 (2) ◽  
pp. 203-208
Author(s):  
John Mark Sim De Leon ◽  
Ronald Steven Medalle
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Case Report ◽  
Blunt Trauma ◽  
Ultrasound Biomicroscopy ◽  
Scleral Flap ◽  
Hypotony Maculopathy ◽  
Post Traumatic ◽  
Choroidal Effusion ◽  
Cyclodialysis Cleft

Objective: To present a case report of asymptomatic post-traumatic chronic hypotony in which the cause was undetected until phacoemulsification. Methodology: Case report. Results: A 55-year-old female’s left eye suffered blunt trauma causing hyphema and iritis, which were successfully managed; however, up to a year after, the intraocular pressure (IOP) ranged from 3 to 5 mmHg and the anterior chamber remained very shallow (Van Herick grade 4) with the lens–iris diaphragm pushed anteriorly with difficulty assessing the angles for recession or clefts . Visual acuity was initially 20/20 upon resolution of the hyphema but worsened to 20/40 a year after, presumably due to a developing cataract. Periodic dilated fundus examinations revealed no hypotony maculopathy or choroidal effusions. Prior to phacoemulsification, ultrasound biomicroscopy (UBM) revealed 360 degrees of mild peripheral choroidal effusions. During phacoemulsification, after intraocular lens insertion, direct gonioscopy revealed a supero-nasal cyclodialysis cleft (2 clock hours) and this was repaired intraoperatively with direct cyclopexy through a partial thickness scleral flap. Postoperatively, the vision improved to 20/20 without correction and the IOP normalized to 16 to 18 mmHg. Conclusion: Chronic hypotony post-trauma may be asymptomatic and the cause may not be clinically evident and may be detected by UBM (choroidal effusion). In our case, the proximate aetiology (cyclodialysis cleft) of the effusion was only observed intraoperatively after phacoemulsification for which cyclopexy was performed which increased the IOP to physiologic levels.

scholarly journals Hydroxychloroquine and azithromycin: As a double edge sword for COVID-19?

2021 ◽  
Author(s):  
Seyed Parsa Eftekhar ◽  
Sohrab Kazemi ◽  
Mohammad Barary ◽  
Mostafa Javanian ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
High Risk ◽  
Qt Interval ◽  
Torsade De Pointes ◽  
Post Treatment ◽  
Cardiac Monitoring ◽  
Qtc Interval ◽  
Qt Interval Prolongation ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean

AbstractBackgroundHydroxychloroquine with or without azithromycin was one of the common therapies at the beginning of the COVID-19 pandemic. They can prolong QT interval, cause Torsade de pointes, and lead to sudden cardiac death. We aimed to assess QT interval prolongation and its risk factors in patients who received hydroxychloroquine with or without azithromycin.MethodsThis was a retrospective cohort study. 172 patients with COVID-19 included, hospitalized at hospitals of Babol University of Medical Sciences between March 5, 2020, and April 3, 2020. Patients were divided into two groups: hydroxychloroquine alone and hydroxychloroquine with azithromycin. Electrocardiograms were used for outcome assessment.Results83.1% of patients received hydroxychloroquine plus azithromycin vs 16.9% of patients who received only hydroxychloroquine. The mean age of patients was 59.2 ± 15.4. The mean of post-treatment QTc interval in the monotherapy group was shorter than the mean of post-treatment QTc interval in the combination therapy group but it had no significant statistical difference (462.5 ± 43.1 milliseconds vs 464.3 ± 59.1 milliseconds; P = 0.488). Generally, 22.1% of patients had a prolonged QTc interval after treatment. Male gender, or baseline QTc ≥ 450 milliseconds, or high-risk Tisdale score increased the likelihood of prolonged QTc interval. Due to QTc prolongation, 14 patients did not continue therapy after 4 days.ConclusionHospitalized patients treated with hydroxychloroquine with or without azithromycin, had no significant difference in prolongation of QT interval and outcome. But the number of patients with prolonged QT intervals in this study emphasizes careful cardiac monitoring during therapy; especially in high-risk patients.

scholarly journals Overweight or Obese Individuals at Eighteen Years of Age Develop Pancreatic Adenocarcinoma at a Significantly Earlier Age

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
David T. Chao ◽  
Nilesh H. Shah ◽  
Herbert J. Zeh ◽  
Aatur D. Singhi ◽  
Nathan Bahary ◽  
...  
Keyword(s):  
Body Mass Index ◽  
High Risk ◽  
Pancreatic Adenocarcinoma ◽  
Body Mass ◽  
Retrospective Review ◽  
Covariate Data ◽  
Maximum Lifetime ◽  
Significant Difference ◽  
Increase Risk ◽  
The Mean

Background. Adolescent obesity is a national epidemic that recently has been shown to increase risk for pancreatic adenocarcinoma (PC) and is associated with an earlier age of PC onset. We hypothesized that PC patients who are overweight or obese at age 18 would have an earlier age of PC onset. Methods. Retrospective review of 531 patients in our PC registry was completed. Self-reported weight at age 18 and maximum lifetime weight were used to calculate body mass index (BMI) at age 18 (BMI-18) and maximum lifetime BMI. Results. Complete BMI and baseline covariate data was available in 319 PC patients. Mean age (in years) of PC diagnosis for patients whose BMI-18 was overweight (64.0) or obese (59.9) was significantly different when compared to patients with a normal BMI-18 (66.7). No significant difference was observed in the mean age of PC diagnosis in those patients who maintained a normal BMI-18 when compared to those patients who subsequently became overweight or obese (67.0 versus 66.6; p=0.65). Conclusions. An elevated BMI at age 18 is associated with an earlier age of PC onset and should be factored into determining the optimal age of beginning screening for patients at high risk for PC.

scholarly journals Compare Brimonidine 0.2% versus Latanoprost 0.005% (Xalatan) in preventing intraocular pressure after YAG laser posterior capsulotomy in patients visiting ophthalmology clinic in Ardabil city

2016 ◽  
Vol 6 (1) ◽  
pp. 189
Author(s):  
Habib Ojaghi ◽  
Rahim Masoumi ◽  
Solmaz Eskandar-Sani
Keyword(s):  
Intraocular Pressure ◽  
Double Blind ◽  
Yag Laser ◽  
Posterior Capsulotomy ◽  
Double Blind Clinical Trial ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Mean ◽  
Iop Elevation ◽  
Neodymium Yag Laser

Background: The transient increase of intraocular pressure (IOP) following neodymium YAG laser capsulotomy can occur in a significant number of patients, which requires prophylactic treatment with IOP reducing drugs, and in some patients, postoperative IOP monitoring. This study was performed to compare the efficacy of brimonidine 0.2% versus latanoprost0.005% (Xalatan) in preventing the IOP elevation after YAG laser posterior capsulotomy in patients visiting ophthalmology clinic in Alavi Hospital.Methods: This study was a randomized, double-blind clinical trial that included 100 patients who had developed posterior capsule opacification (PCO) as a result of previous cataract surgery and were candidate for undergoing YAG laser posterior capsulotomy. The patients were randomly divided into two groups of 50 patients. One group received brimonidine 0.2% one hour before surgery, and the other group received Xalatan 0.005% in the night before laser surgery. In both groups the patients' IOP was measured in baseline, 1, 2, 3, 24 hours, 3 days and one week after surgery. The gathered data were analyzed using statistical methods in SPSS.16.Results: The mean IOP, 1, 2, 3, and 24 hours, 3 days, and one week after surgery didn't show any significant difference between two groups. IOP one hour before surgery changed significantly compared to one hour after surgery and a statistically significant relationship was found between the two groups, though at other times of measurement, the differences were not significant.Conclusions: Results showed that using Brimonidine 0.2% or Latanoprost 0.005% as prophylactic before YAG laser posterior capsulotomy could be effective in preventing IOP after treatment.

scholarly journals Chronic Diseases in the Geriatric Population: Morbidity and use of Primary Care Services According to Risk Level.

2021 ◽  
Author(s):  
Jaime Barrio Cortes ◽  
Almudena Castaño Reguillo ◽  
María Teresa Beca Martínez ◽  
Mariana Bandeira de Oliveira ◽  
María Carmen López Rodríguez ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Chronic Diseases ◽  
Chronically Ill ◽  
Risk Level ◽  
Geriatric Population ◽  
Factors Associated ◽  
Number Of Patients ◽  
Use Of Services ◽  
The Mean

Abstract Background: Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services.Methods: This was a cross-sectional descriptive observational study. Patients older than 65 years from a basic health area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done.Results: A total of 3,292 chronic patients older than 65 years were identified, of whom 1,628 (49.5%) were low risk, 1,293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD=8.1) years and 2,167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD=2), 89.4% had multimorbidity and 1,550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD=18.2) [men: 19.4 (SD=19.8); women: 19.5 (SD=17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD=19.6); in people 76-85 years old, it was 22.1 (SD= 20.3); and in people 66-75 years old, it was 14.5 (SD=13.9). The factors associated with greater use of services were age (B coefficient [BC]= 0.3; 95%CI= 0.2 – 0.4), high risk level (BC=1.9; 95%CI =0.4 – 3.2), weight of complexity (BC=0.7; 95%CI=0.5 – 0.8), and ≥ 4 chronic diseases (BC=0.7; 95%CI=0.3 – 1.1).Conclusions: In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

scholarly journals Identification of Patients with a High Risk of Developing Precancerous Colon Diseases at the Outpatient Stage

2019 ◽  
Vol 26 (6) ◽  
pp. 28-36
Author(s):  
Anastasiia F. Gayazova ◽  
Tatyana V. Bolotnova
Keyword(s):  
Physical Activity ◽  
Colorectal Cancer ◽  
High Risk ◽  
Colon Polyps ◽  
Erosive Gastritis ◽  
Number Of Patients ◽  
History Of ◽  
The Mean ◽  
Colon Diseases ◽  
Poor Nutrition

Aim. To identify patients with a high risk of precancerous diseases of the colorectal region for colonoscopy assignment in the practice of a district physician.Materials and methods. 122 patients were surveyed who underwent colonoscopy by the appointment of a district physician at the Municipal Polyclinic No. 3 in Tyumen. All examined patients were divided into two groups according to colonoscopy: with colon polyps — 64 (52.5 %) and without colon polyps — 58 patients (47.5 %).Results. The mean age of patients in the group with colon polyps was 59.8 ± 4.7 years, in the second group — 58.2 ± 4.8 years. In the group with colon polyps, more patients exhibited a low physical activity and poor nutrition compared to the group without colon polyps. Erosive gastritis and obesity prevailed in patients of the group with colon polyps as compared to the second group. The number of patients who smoked and drank alcohol prevailed in the group with colon polyps, in comparison with the second group. Patients with colon polyps were twice as likely to have a burdened hereditary history of colorectal cancer as those without colon polyps. Conclusion. Thus, the group of high risk of colon polyps included patients with risk factors: smoking, low physical activity and burdened hereditary history of colon cancer, as well as erosive gastritis in the history.

scholarly journals Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jaime Barrio-Cortes ◽  
Almudena Castaño-Reguillo ◽  
María Teresa Beca-Martínez ◽  
Mariana Bandeira-de Oliveira ◽  
Carmen López-Rodríguez ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Chronic Diseases ◽  
Chronically Ill ◽  
Risk Level ◽  
Geriatric Population ◽  
Factors Associated ◽  
Number Of Patients ◽  
Use Of Services ◽  
The Mean

Abstract Background Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services. Methods This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done. Results A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76–85 years old, it was 22.1 (SD = 20.3); and in people 66–75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2–0.4), high risk level (BC = 1.9; 95%CI =0.4–3.2), weight of complexity (BC = 0.7; 95%CI = 0.5–0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3–1.1). Conclusions In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.

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