Surgical revision of filtration blebs: a follow-up study.

PURPOSE: To assess the clinical outcome of one technique for surgical revision of filtration blebs in terms of bleb function and intraocular pressure control. METHODS: Retrospective analysis of 36 consecutive cases of leaking, overfiltrating, or oversized blebs treated with bleb excision and conjunctiva and Tenon advancement in a glaucoma referral center between January 1991 and December 1999. Surgical success was defined as a final intraocular pressure between 6 and 22 mm Hg with or without topical antiglaucoma medication, resolution of the bleb leak, hypotony maculopathy and symptoms, and no need for repeat glaucoma surgery. RESULTS: With a minimum of 12 months and an average of 29.5 months of follow-up, the overall success rate was 86.1%, with 51.6% of patients not requiring medication. In the success group, mean (SD) intraocular pressure was 23.7 (5.9) mm Hg before the original trabeculectomy, 4.3 (3.7) mm Hg prior to revision surgery, and 13.5 (SD 3.8) mm Hg at the last follow-up visit after the revision surgery. Mean number of antiglaucoma medications was 2.1 (range, 1-4) before the original trabeculectomy, none before the revision surgery, and 0.8 (range, 0-3) at the last follow-up visit. CONCLUSIONS: The surgical revision technique offers a definitive solution for most of these bleb complications and a satisfactory intraocular pressure control in the majority of patients.

Bilateral optic neuritis with branch retinal artery occlusion associated with vaccination.

A case of a 40-year old marine with bilateral optic neuritis and a branch retinal artery occlusion after vaccination is presented. Blood investigations showed no abnormalities. Cerebrospinal fluid studies revealed a lymphocytic pleocytosis and IgG antibodies against hepatitis A and rabies. Computerized tomography and magnetic resonance imaging of the brain were negative. A diagnosis of vaccine-induced auto-immune demyelinative optic neuritis was made. The clinical picture improved after systemic corticosteroid treatment.

Hydatidiform mole with coexisting twin pregnancy after gamete intra-fallopian transfer.

The pregnancy of a 31-year-old infertility patient is described. After gamete intra-Fallopian transfer, her pregnancy evolved uneventfully until the 18th week of gestation, when vaginal bleeding occurred. Ultrasonographic findings suggested a molar pregnancy with two live fetuses. At 24 weeks gestation, two male infants were spontaneously delivered. Fetal (46 XY) and molar (46 XX) karyotypes and post-mortem findings were consistent with a bizygotic twin pregnancy associated with a complete hydatidiform mole. The pathogenesis and obstetrical management are discussed.

[Echographic diagnosis and perinatal management in fetal abdominal wall defects]. / Echoscopische diagnostiek en perinataal beleid bij foetale buikwanddefecten.

Twenty-seven cases of foetal abdominal wall defects are described, diagnosed prenatally by means of real-time ultrasonography in the period 1 January 1980-31 December 1989, in the hospital of the Free University of Amsterdam. In 17 out of 20 (85%) cases with omphalocele there were additional abnormalities, mainly chromosomal defects (41%), cardiac (25%) and genitourinary (25%) malformations. In gastroschisis, associated structural anomalies occurred in 57% (4/7). No chromosomal defects were found in the group with gastroschisis. Intrauterine foetal death occurred in 10 cases. Seven pregnancies were electively aborted because of association with an anomaly incompatible with postnatal life. One child died at two months. Six children (4 with omphalocele, 2 with gastroschisis) were successfully treated surgically. When ultrasonography demonstrates a foetal abdominal wall defect detailed sonographic examination is recommended to exclude additional malformations. In case of omphalocele prenatal chromosome analysis is indicated. Delivery in a tertiary care center is recommended. Elective caesarean section does not appear justified.

Ultrasonographic diagnosis and perinatal management of fetal abdominal wall defects.

Thirty-four fetuses with ultrasonographically diagnosed abdominal wall defects are described. In 20 out of the 25 (80%) cases with omphalocele, there were associated abnormalities, mainly chromosomal defects (48%), cardiac (28%), genitourinary (20%), craniofacial (20%) and diaphragmatic anomalies (12%). In gastroschisis, associated structural anomalies occurred in 2 out of 5. The 4 cases of abdominal wall defects as a part of amniotic band syndrome were associated with multiple severe defects. No chromosomal defects were found in the group with gastroschisis and amniotic band syndrome. Intrauterine fetal death occurred in 8 cases. Sixteen pregnancies were electively aborted because of an association with an anomaly incompatible with postnatal life; 3 pregnancies were electively terminated on their parents' own request. Two infants died shortly after birth. Seven infants were successfully treated. When level I ultrasound examination demonstrates a fetal abdominal wall defect, a detailed level II ultrasound examination is recommended to exclude associated malformations. In case of omphalocele, prenatal chromosome analysis is indicated. Delivery in a tertiary care center is recommended. A randomized prospective trial is needed to see whether cesarean section or vaginal delivery is the preferred mode of delivery for these infants.