scholarly journals A Comparison of Scleral Tunnel and Pericardial Graft Implantation Techniques in Patients undergoing Ahmed Glaucoma Valve Implantation

2020 ◽  
Vol 13 (2) ◽  
pp. 27
Author(s):  
Medhat A Bakr ◽  
Shaikha Al-Eid
Keyword(s):  
Single Case ◽  
Group Versus ◽  
Retrospective Chart Review ◽  
Neovascular Glaucoma ◽  
Care Hospital ◽  
Ahmed Glaucoma Valve ◽  
Refractory Glaucoma ◽  
Scleral Flap ◽  
Infection Level ◽  
Scleral Tunnel

The purpose of this study was to compare the two methods autologous scleral flap (scleral tunnel) and pericardial patch graft of tube covered in Ahmed glaucoma valve (AGV) in refractory glaucoma with respect to the tube exposure, infection, level of Intraocular Pressure (IOP), and any other complications due to applications of each technique. A retrospective chart review of 113 eyes in 102 patients with refractory glaucoma who underwent ahmed glaucoma valve (AGV) implantation (39 eyes in scleral tunnel and scleral flap group “first group” and 74 eyes in pericardium graft group” second group”) was performed. The procedures in these eyes were performed between January 2007 and October 2015 in a tertiary eye care hospital in KSA. The mean age was 56 ± 19 (8 months- 83 years) in the Scleral tunnel group and 50 ± 27 (1- 78 years) in the Pericardium group (p = 0.023). Fifty-six males and 57 females were included in the study. Medians of the follow-up were 48 ± 25.5 months (3 – 89) for the Scleral tunnel group and 29 ± 21.4 months (2 – 92) for the Pericardium group, and it is statistically significant (P < 0.001). According to the findings, preoperative diagnosis in the two groups included neovascular glaucoma (NVG) found in 21 eyes (53.8%) in the Scleral tunnel group versus 18 eyes (24.3%) in the Pericardium group (p = 0.009). Exposure of the valve was found in 15 eyes (20.27%) in Pericardium graft group versus 2 eyes (5.12%) only in scleral tunnel group (p = 0.002). These exposed valves lead to endophthalmitis in 5 cases in the second group and no single case in scleral tunnel group was detected (P < 0.001). The postoperative IOP values were statistically insignificant in all different time periods. Scleral tunnel method has less exposure rate than the pericardium graft. The purpose of this study was to compare the two methods autologous scleral flap (scleral tunnel) and pericardial patch graft of tube covered in Ahmed glaucoma valve (AGV) in refractory glaucoma with respect to the tube exposure, infection, level of Intraocular Pressure (IOP), and any other complications due to applications of each technique. A retrospective chart review of 113 eyes in 102 patients with refractory glaucoma who underwent ahmed glaucoma valve (AGV) implantation (39 eyes in scleral tunnel and scleral flap group “first group” and 74 eyes in pericardium graft group” second group”) was performed. The procedures in these eyes were performed between January 2007 and October 2015 in a tertiary eye care hospital in KSA. The mean age was 56 ± 19 (8 months- 83 years) in the Scleral tunnel group and 50 ± 27 (1- 78 years) in the Pericardium group (p = 0.023). Fifty-six males and 57 females were included in the study. Medians of the follow-up were 48 ± 25.5 months (3 – 89) for the Scleral tunnel group and 29 ± 21.4 months (2 – 92) for the Pericardium group, and it is statistically significant (P < 0.001). According to the findings, preoperative diagnosis in the two groups included neovascular glaucoma (NVG) found in 21 eyes (53.8%) in the Scleral tunnel group versus 18 eyes (24.3%) in the Pericardium group (p = 0.009). Exposure of the valve was found in 15 eyes (20.27%) in Pericardium graft group versus 2 eyes (5.12%) only in scleral tunnel group (p = 0.002). These exposed valves lead to endophthalmitis in 5 cases in the second group and no single case in scleral tunnel group was detected (P < 0.001). The postoperative IOP values were statistically insignificant in all different time periods. Scleral tunnel method has less exposure rate than the pericardium graft.

scholarly journals Outcome of Ahmed Glaucoma Valve in Refractory Glaucoma – Our Population Analysis

2021 ◽  
Vol 37 (3) ◽  
Author(s):  
Momina Faisal ◽  
Saadia Farooq ◽  
Hajra Farooq
Keyword(s):  
Population Analysis ◽  
Tertiary Care ◽  
Case Series ◽  
Cyst Formation ◽  
Safe Procedure ◽  
Care Hospital ◽  
Ahmed Glaucoma Valve ◽  
Refractory Glaucoma ◽  
Retrospective Case ◽  
Retrospective Case Series

Purpose:  To find out the outcomes of Ahmed Glaucoma Valve (AGV) implantation in a tertiary care hospital. Study Design:  Retrospective case series. Place and Duration of Study:  Shifa International Hospital Islamabad from January 2018 to July 2020. Methods:  This retrospective case series of 19 eyes of 17 patients with refractory glaucoma included patients who underwent AGV implantation with a follow-up period of 6 months to 01 year. AGV was done as a primary procedure in 3 patients and secondary procedure in 17 patients after a previously failed trabeculectomy. All patients underwent complete eye examination, before surgery and then at 1 month, 2months, 6 months and 1 year. Goldman tonometer was used to check IOP. Complications, interventions and the number of anti-glaucoma medications (in post-operative period) needed to achieve the target pressure were noted. Success was defined as an IOP of less than 18 mm Hg, with or without a single anti-glaucoma medication. Results:  Complete success was achieved in 57.9% and conditional success in 42.2%. The most common complication was encapsulated cyst formation in 31.6% and post-operative interventions were bleb deroofing in 10.5%, tube readjustment and tube wash in 10.5% and YAG vitreolysis in 5.3%. Conclusion:  AGV is an effective and relatively safe procedure in refractory glaucoma irrespective of initial diagnosis and age of the patient. Encapsulated bleb was the commonest complication. Key Words:  Ahmad Glaucoma valve, Glaucoma, Intra Ocular Pressure.

scholarly journals Efficacy and safety of intravitreal bevacizumab in eyes with neovascular glaucoma undergoing ahmed glaucoma valve implantation: 2-year follow-up

2014 ◽  
Vol 93 (1) ◽  
pp. e1-e6 ◽  
Author(s):  
Enyr S. Arcieri ◽  
Jayter S. Paula ◽  
Rodrigo Jorge ◽  
Kleyton A. Barella ◽  
Rafael S. Arcieri ◽  
...  
Keyword(s):  
Intravitreal Bevacizumab ◽  
Neovascular Glaucoma ◽  
Efficacy And Safety ◽  
Ahmed Glaucoma Valve ◽  
Valve Implantation ◽  
Ahmed Glaucoma Valve Implantation

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

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.

scholarly journals Retrospective evaluation of intravenous fosfomycin in multi-drug resistant infections at a tertiary care hospital in Lebanon

2021 ◽  
Vol 15 (09) ◽  
pp. 1308-1313
Author(s):  
Tala Ballouz ◽  
Rony M Zeenny ◽  
Nisrine Haddad ◽  
Nesrine Rizk ◽  
Souha S Kanj
Keyword(s):  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Clinical Effectiveness ◽  
Initial Step ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Care Hospital ◽  
Drug Resistant ◽  
Effective Option ◽  
Favorable Clinical Outcome

Introduction: Fosfomycin has re-emerged as a possible therapeutic alternative for the treatment of resistant bacterial pathogens. Its main mechanism of action is the inhibition of the initial step of cell wall synthesis and is active against both Gram-positive and Gram-negative bacteria. However, its clinical effectiveness against multidrug resistant bacteria remains largely unknown. Therefore, we aim to evaluate the clinical and microbiological effectiveness of intravenous fosfomycin as well as its safety in a tertiary care teaching hospital in Lebanon. Methodology: This is a retrospective chart review of adult patients who had presented to the hospital and were treated with intravenous fosfomycin for at least 24 hours for any type of infection between 2014 and 2019. Results: Among 31 episodes treated with intravenous fosfomycin, 68% had an overall favorable clinical response. In 84% of the episodes, fosfomycin was administered in combination with other antibiotics, commonly tigecycline. Of those with available cultures at end of therapy, 73% achieved microbiological success. No relapse was documented within 30 days of completion of therapy. In the episodes secondary to resistant pathogens, the rates of favorable clinical outcome and microbiological success at the end of therapy were 71% and 73%, respectively. Fosfomycin resistance developed in two cases and mild adverse events occurred in 65% of the episodes during the course of treatment. Conclusions: Fosfomycin is a safe and effective option in the treatment of multi-drug resistant infections. Nevertheless, careful stewardship is important to maintain its efficacy and to reduce the risk of selection of antimicrobial resistance.

scholarly journals Spinal cord hemangioblastomas with a focus on clinical presentation, diagnosis, and treatment at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review

2021 ◽  
Vol 12 ◽  
pp. 24
Author(s):  
Syed Sarmad Bukhari ◽  
Muhammad Ehsan Bari ◽  
Nasir Ud Din ◽  
Zubair Ahmad
Keyword(s):  
Spinal Cord ◽  
Stromal Cells ◽  
Tertiary Care ◽  
Neuron Specific Enolase ◽  
Retrospective Chart Review ◽  
Vascular Tumors ◽  
Care Hospital ◽  
Mitotic Figures ◽  
Cluster Of Differentiation

Background: Hemangioblastomas are benign neoplasms that consist of stromal cells and small blood vessels. They are highly vascular tumors and can arise throughout the central nervous system. This study aims to provide an overview of our experience with this rare tumor’s presentation, radiology, histopathology, and outcomes as literature regarding this pathology is sparse from our country. Methods: The study is a retrospective review of cases that were histopathology proven cases of spinal cord hemangioblastomas. The clinical characteristics of these patients were examined, and their presentation was recorded. The radiology was also reviewed to describe classic appearance on magnetic resonance imaging. A detailed review of immunohistochemistry was also performed and outcome was described. Results: A total of 25 cases of spinal hemangioblastomas were found in our records in the period of 2001–2019. There were 20 males (80%) and only 5 female patients (20%). Gross tumor fragments ranged in size from 0.24 cm2 to 10.5 cm2 (mean 3.28 ± 2.65). Histologically, tumor was composed of nests of large stromal cells with clear to vacuolated cytoplasm separated by thin-walled capillaries. Focal intratumoral hemorrhage was noted. No significant cytological atypia or mitotic figures were noted. Immunohistochemical stains were performed to confirm the diagnosis and exclude other tumors. Inhibin was tested in 20 cases and it was positive in 16 cases (80%). Neuron-specific enolase was positive in 6/8 cases. Cluster of differentiation (CD) CD68 was positive in 6/6 cases and vimentin in 4/4 cases. Glial fibrillary acidic protein (GFAP) and epithelial membrane antigen were performed in 14 and 8 cases, respectively, and all were negative. Cytokeratin AE1/AE3 was negative in 13/13 cases. CD34 highlighted vasculature in the 8 cases in which it was performed and was negative in tumor cells. Follow-up was available in 17 out of 25 cases and ranged from 12 months to 216 months (mean 61.8 ± 60.6 months). Recurrence occurred in 2 out of 17 (11.7%) patients for whom follow-up information was available. Conclusion: Our experience shows that spinal cord hemangioblastomas can be surgically removed in most cases with a low risk of recurrence. Most patients in our study were male and unlike other studies, none of our cases showed GFAP positivity.

FUNCTIONAL OUTCOME OF PIRIFORMIS MUSCLE SPARING POSTEROLATERAL APPROACH IN BIPOLAR HEMIARTHROPLASTY: A RETROSPECTIVE STUDY.

2021 ◽  
pp. 30-32
Author(s):  
Nadeem A. Lil ◽  
Vipul R. Makwana ◽  
Arjav R. Patel ◽  
Aakrut S. Modi ◽  
Tirth D. Patel ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Single Case ◽  
Tertiary Care ◽  
Hip Dislocation ◽  
Posterolateral Approach ◽  
Harris Hip Score ◽  
Bipolar Hemiarthroplasty ◽  
Care Hospital ◽  
Piriformis Muscle

INTRODUCTION: Hemiarthroplasty for hip fracture is a common surgical procedure and is the treatment of choice for displaced intracapsular neck of femur fracture. Numerous approaches are used to access the hip joint. The standard posterior approach is used by many surgeons to preserve the abductor complex but is associated with higher dislocation rate. In this study we assess functional outcomes of piriformis sparing posterolateral approach for hemiarthroplasty of hip. MATERIAL AND METHODOLOGY: We retrospectively reviewed 96 patients who underwent bipolar hemiarthroplasty of hip performed by chief surgeon between May 2018 to September 2020. All the database was retrieved from institutional database of tertiary care hospital. Functional outcome was measured by modied HARRIS HIP SCORE. RESULTS: Till minimum 1 year follow up we noticed that there was no single case of hip dislocation. Joint proprioception was preserved. In the nal follow up average Harris hip score was 92.2. No infection, nerve injury, implant migration occurred in our study. DISCUSSION: The main aim of the arthroplasty procedure is to decrease pain, to achieve mobility and restore anatomy. The piriformis sparing approach not only preserves abductor complex but also piriformis muscle. The muscle works like cradle, at the posterosuperior part of the joint, an area with a high risk of dislocation. The only disadvantage was noted in this approach was increased exposure difculty in obese patients CONCLUSION: From this study we conclude that Piriformis sparing posterolateral approach is safe, demands some technical aspects and should be used by surgeons using posterolateral approach.

scholarly journals 1081. Use of Antimicrobials at the End of Life (EOL): A Retrospective Cohort Study Analyzing Providers’ Reasons for Prescribing Antimicrobials at the EOL, Their Benefits and Adverse Effects

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S383-S384
Author(s):  
Pooja Vyas ◽  
Prashant Malhotra ◽  
Santiago Lopez ◽  
Bruce Hirsch ◽  
Kayla D Finuf
Keyword(s):  
End Of Life ◽  
Symptom Relief ◽  
Symptom Control ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Chi Square ◽  
Potential Benefits ◽  
Tract Infections

Abstract Background Infections are common in terminally ill patients, and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) increase the risk of antimicrobial resistance and Clostridium difficile infection. Very few studies have described the risks and benefits of antimicrobials in patients at EOL. Here, we describe a retrospective chart review of antimicrobial use at EOL. Methods We reviewed electronic medical records of patients admitted in a palliative care unit of a tertiary care hospital between 2017 and 2018 and assessed antimicrobial use in the last 14 days of life. The analysis excluded neutropenic patients. Differences in demographics and symptom control between patients who did or did not receive antibiotics (AB+ or AB−) were analyzed using chi-square analyses; P-values were computed using Mann–Whitney tests. Results Of a total of 133 patients included, 89 (67%) received antimicrobials (AB+); however, the role of antibiotics was documented in only 12% of patients. The AB− and AB+ groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (table). Documented infections were similar between AB− and AB+ groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay (LOS). Conclusion Our study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. These results indicate that the risks of antimicrobial use may outweigh potential benefits and their use should be a part of goals of care discussions at EOL. Disclosures All authors: No reported disclosures.

Sign in / Sign up

Export Citation Format

Share Document