RESUMO
Uncontrolled bleeding with associated trauma-induced coagulopathy (TIC) remains the leading cause of preventable death after severe trauma. Meanwhile, TIC is recognized as a separate clinical entity with substantial impact on downstream morbidity and mortality. In clinical practice severely injured and bleeding patients are often still being treated according to established damage control surgery (DCS) procedures with surgical bleeding control and empirical transfusion of classical blood products in predefined ratios in the sense of damage control resuscitation (DCR); however, algorithms are also available, which have been constructed from established viscoelasticity-based point of care (POC) diagnostic procedures and target value-oriented treatments. The latter enables a timely qualitative assessment of coagulation function from whole blood at bedside and provides rapid and clinically useful information on the presence, development and dynamics of the coagulation disorder. The early implementation of viscoelasticity-based POC procedures in the context of resuscitation room management of severely injured and bleeding patients was uniformly associated with reductions in potentially harmful blood products, especially overtransfusions, and an overall improvement in outcome including survival. The present article reviews the clinical questions around the use of viscoelasticity-based procedures as well as recommendations for the early and acute management of bleeding trauma patients taking the current literature into account.
Assuntos
Transtornos da Coagulação Sanguínea , Testes Imediatos , Centros de Traumatologia , Substâncias Viscoelásticas , Humanos , Transtornos da Coagulação Sanguínea/diagnóstico , Transtornos da Coagulação Sanguínea/terapia , Hemorragia/diagnóstico , Hemorragia/terapia , Testes Imediatos/organização & administração , Substâncias Viscoelásticas/uso terapêutico , AlgoritmosRESUMO
BACKGROUND: Pronolis®HD mono 2.5% is a novel, one-shot, high-density sterile viscoelastic solution, recently available in Spain, which contains a high amount of intermediate molecular weight hyaluronic acid (HA), highly concentrated (120 mg in 4.8 mL solution: 2.5%). The objective of the study was to analyze the efficacy and safety of this treatment in symptomatic primary knee osteoarthritis (OA). METHODS: This observational, prospective, multicenter, single-cohort study involved 166 patients with knee OA treated with a single-shot of Pronolis®HD mono 2.5% and followed up as many as 24 weeks. RESULTS: Compared with baseline, the score of the Western Ontario and McMaster Universities Arthritis Osteoarthritis Index (WOMAC) pain subscale reduced at the 12-week visit (primary endpoint, median: 9 interquartile range [IQR]: 7-11 versus median: 4; IQR: 2-6; p < 0.001). The percentage of patients achieving > 50% improvement in the pain subscale increased progressively from 37.9% (at 2 weeks) to 66.0% (at 24 weeks). Similarly, WOMAC scores for pain on walking, stiffness subscale, and functional capacity subscale showed significant reductions at the 12-week visit which were maintained up to the 24-week visit. The EuroQol visual analog scale score increased after 12 weeks (median: 60 versus 70). The need for rescue medication (analgesics/nonsteroidal anti-inflammatory drugs) also decreased in all post-injection visits. Three patients (1.6%) reported local adverse events (joint swelling) of mild intensity. CONCLUSIONS: In conclusion, a single intra-articular injection of the high-density viscoelastic gel of HA was associated with pain reduction and relief of other symptoms in patients with knee OA. TRIAL REGISTRATION: ClinicalTrial# NCT04196764.
Assuntos
Osteoartrite do Joelho , Estudos de Coortes , Método Duplo-Cego , Humanos , Ácido Hialurônico , Injeções Intra-Articulares , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/tratamento farmacológico , Dor/tratamento farmacológico , Dor/etiologia , Estudos Prospectivos , Resultado do Tratamento , Substâncias Viscoelásticas/uso terapêuticoRESUMO
Internal limiting membrane (ILM) grafting provides a useful option for repair of large and refractory macular holes that fail to close following prior ILM removal. However, current ILM graft techniques are associated with several challenges that may result in failure, most notably the difficulty in maintaining the graft in situ. In this video, the authors describe their modified technique for ILM grafting using a double layer of viscoelastic for stabilization in situ during the procedure. Four of five eyes managed with this technique demonstrated type 1 closure, and all eyes demonstrated improvement in visual acuity.
Assuntos
Membrana Basal/transplante , Membrana Epirretiniana/cirurgia , Perfurações Retinianas/cirurgia , Substâncias Viscoelásticas/uso terapêutico , Vitrectomia/métodos , HumanosRESUMO
Severe corneal injuries often result in permanent vision loss and remain a clinical challenge. Human bone marrow-derived mesenchymal stem cells (MSCs) and their secreted factors (secretome) have been studied for their antiscarring, anti-inflammatory, and antiangiogeneic properties. We aimed to deliver lyophilized MSC secretome (MSC-S) within a viscoelastic gel composed of hyaluronic acid (HA) and chondroitin sulfate (CS) as a way to enhance corneal re-epithelialization and reduce complications after mechanical and chemical injuries of the cornea. We hypothesized that delivering MSC-S within HA/CS would have improved wound healing effects compared the with either MSC-S or HA/CS alone. The results showed that a once-daily application of MSC-S in HA/CS enhances epithelial cell proliferation and wound healing after injury to the cornea. It also reduced scar formation, neovascularization, and hemorrhage after alkaline corneal burns. We found that combining MSC-S and HA/CS increased the expression of CD44 receptors colocalized with HA, suggesting that the observed therapeutic effects between the MSC-S and HA/CS are in part mediated by CD44 receptor upregulation and activation by HA. The results from this study demonstrate a reproducible and efficient approach for delivering the MSC-S to the ocular surface for treatment of severe corneal injuries. Stem Cells Translational Medicine 2019;8:478-489.
Assuntos
Córnea/patologia , Lesões da Córnea/terapia , Células-Tronco Mesenquimais/metabolismo , Proteoma/metabolismo , Substâncias Viscoelásticas/uso terapêutico , Cicatrização/fisiologia , Animais , Feminino , Humanos , Ratos , Ratos Sprague-Dawley , Substâncias Viscoelásticas/farmacologiaRESUMO
Purpose: To investigate whether there is a difference between symptoms of floaters according to the type of ophthalmic viscosurgical devices(OVDs) used during phacoemulsification. Methods: A total of 112 eyes had undergone standard phacosurgery with the dispersive OVDs(Group1). Group2 comprised 117 eyes that underwent phacosurgery with the dispersive OVDs, but between continuous curvilinear capsulorhexis and hydrodissection, some OVDs had been removed. Group3 included 120 eyes that had undergone phacosurgery with the cohesive OVDs. Results: 14 eyes (12.5%) of Group1 had new-onset floater after surgery whereas 6 eyes (5.13%) in Group2, and 7 eyes (5.83%) in Group3 at the day after and a week after surgery. This was significantly higher in Group1 than Group2 and Group3, respectively (p=0.047,0.049). Conclusion: Cataract surgery with dispersive OVD can predispose the eye to an increased floater symptom. Therefore, surgeons should consider release some OVDs during hydrodissection with dispersive viscoelastics and keep trying to avoid IOP surge during surgery.
Assuntos
Extração de Catarata/métodos , Catarata/terapia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Substâncias Viscoelásticas/uso terapêutico , Idoso , Catarata/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Facoemulsificação/métodosRESUMO
PURPOSE: The aim of this study is to report surgical outcomes in patients undergoing phacoemulsification surgery (PE) with versus without ophthalmic viscosurgical devices (OVDs). METHODS: This is a comparative case series study. In total, 145 patients who performed PE with OVDs in 68 eyes (Group 1) and without OVD in 77 eyes (Group 2) were enrolled. A comprehensive ophthalmological examination was performed including slit-lamp, fundus examination. Best-corrected visual acuity (BCVA), intraocular pressure (IOP) specular endothelial microscopy (SM), and ultrasound pachymetry (UP) were also measured before surgery and at four-time points postoperatively. The differences in baseline characteristics as well as in outcomes were compared between the two groups. RESULTS: The mean BCVA was 0.41 ± 0.26 logMAR in Group 1 and 0.54 ± 0.34 in Group 2 at postoperative first day, with a significant difference (p < 0.01). The mean BCVA, IOP, and UP at 6 months did not differ between the groups. The mean baseline and postoperative SMs were 2063 and 1910 cells/mm2, respectively, and the endothelial cell loss (ECL) was 153.89 ± 189 in Group 1. The mean baseline and postoperative SMs were 2153 and 1948 cells/mm2, respectively, and the ECL was 205 ± 200 in Group 2. The difference between the groups was not statistically significant (p = 0.105). CONCLUSIONS: The ECL seemed to be higher in the Group 2, but the difference was not significant. The final clinical outcomes were similar between the groups. In selected cases, PE without OVD may be preferable to reduce the cost of surgery in places with low economic status and to prevent side-effects of these devices.
Assuntos
Facoemulsificação/métodos , Substâncias Viscoelásticas/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Perda de Células Endoteliais da Córnea , Feminino , Humanos , Pressão Intraocular , Implante de Lente Intraocular/métodos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Acuidade VisualRESUMO
PURPOSE: The purpose of this study was to compare a viscoelastic foam overlay (VEFO) to a standard hospital mattress for pressure injury (PI) prevention. We also compared interface pressures (IPs) of the VEFO to our facility's standard hospital mattress. DESIGN: Prospective, randomized controlled trial. SUBJECTS AND SETTING: Data analysis was based on 110 participants (55 in each group) who were 19 years or older, had a Braden Scale for Pressure Sore Risk score of 16 or less, and were cared for on a neurology, oncology, or pulmonology inpatient care unit. The research setting was the Samsung Medical Center in Seoul, South Korea. METHODS: Participants were divided into 2 groups: the experimental group were based on a VEFO on top of the standard hospital mattress used in our facility. Participants in the control group were placed on a standard hospital mattress with/without air overlay. All patients were given standard nursing care for prevention of PI. Skin assessments were completed daily over a period of 2 weeks. In addition, we compared IPs of the standard hospital mattress and the VEFO in participants randomly allocated to the intervention group. Interface pressure was measured over the sacral/coccygeal area with subjects in the supine position. Pressures were measured immediately before and immediately following placement of the VEFO and just before data collection began. Data were collected between October 2013 and November 2014. Pressure injury incidence was compared between groups using the χ test, and IPs were compared using the paired t test. INSTRUMENTS: Pressure injury development was determined using the staging system described in guidelines from the National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance in 2014. Interface pressure was measured using a device manufactured for this purpose. RESULTS: The incidence of PI development was significantly lower in subjects assigned to the experimental group as compared to those in the control group (3.6%-27.3% over the 2-week data collection period; P = .001). The maximum IP was significantly lower on the VEFO with standard hospital mattress than on the standard hospital mattress (paired t = 8.87, P < .001). CONCLUSIONS: Patients managed with a VEFO had a significantly lower incidence of PI than those managed with a standard hospital mattress. Additional research is needed to further characterize the efficacy of the VEFO, its effect on PI healing, and its effect of PI prevention in high-risk populations such as critically ill patients.
Assuntos
Bandagens/normas , Estado Terminal/terapia , Úlcera por Pressão/prevenção & controle , Substâncias Viscoelásticas/farmacologia , Idoso , Idoso de 80 Anos ou mais , Roupas de Cama, Mesa e Banho/normas , Feminino , Humanos , Doença Iatrogênica/prevenção & controle , Incidência , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , República da Coreia , Fatores de Risco , Substâncias Viscoelásticas/uso terapêuticoRESUMO
BACKGROUND: We have previously described the hemostatic efficacy of a self-expanding polyurethane foam in lethal venous and arterial hemorrhage models. A number of critical translational questions remain, including prehospital diagnosis of hemorrhage, use with diaphragmatic injury, effects on spontaneous respiration, the role of omentum, and presence of a laparotomy on foam properties. METHODS: In Experiment 1, diagnostic blood aspiration was attempted through a Veress needle before foam deployment during exsanguination (n = 53). In Experiment 2: a lethal hepatoportal injury/diaphragmatic laceration was created followed by foam (n = 6) or resuscitation (n = 10). In Experiment 3, the foam was deployed in naïve, spontaneously breathing animals (n = 7), and respiration was monitored. In Experiments 4 and 5, the foam was deployed above (n = 6) and below the omentum (n = 6) and in naïve animals (n = 6). Intra-abdominal pressure and organ contact were assessed. RESULTS: In Experiment 1, blood was successfully aspirated from a Veress needle in 70% of lethal iliac artery injuries and 100% of lethal hepatoportal injuries. In Experiment 2, in the presence of a diaphragm injury, between 0 cc and 110 cc of foam was found within the pleural space. Foam treatment resulted in a survival benefit relative to the control group at 1 hour (p = 0.03). In Experiment 3, hypercarbia was observed: mean (SD) Pco2 was 48 (9.4) mm Hg at baseline and 65 (14) mm Hg at 60 minutes. In Experiment 4, abdominal omentum seemed to influence organ contact and transport in two foam deployments. In Experiment 5, there was no difference in intra-abdominal pressure following foam deployment in the absence of a midline laparotomy. CONCLUSION: In a series of large animal studies, we addressed key translational issues surrounding safe use of foam treatment. These additional data, from diagnosis to deployment, will guide human experiences with foam treatment for massive abdominal exsanguination where no other treatments are available.
Assuntos
Traumatismos Abdominais/terapia , Hemorragia/terapia , Poliuretanos/uso terapêutico , Substâncias Viscoelásticas/uso terapêutico , Animais , Modelos Animais de Doenças , Técnicas Hemostáticas , Humanos , Suínos , Pesquisa Translacional BiomédicaRESUMO
BACKGROUND: Noncompressible abdominal bleeding is a significant cause of preventable death on the battlefield and in the civilian trauma environment, with no effective therapies available at point of injury. We previously described the development of a percutaneously administered, self-expanding, poly(urea)urethane foam that improved survival in a lethal Grade V hepatic and portal vein injury model in swine. In this study, we hypothesized that survival with foam treatment is dose dependent. METHODS: A high-grade hepatoportal injury was created in a closed abdominal cavity, resulting in massive noncompressible hemorrhage. After injury, the animals were divided into five groups. The control group (n = 12) was treated only with fluid resuscitation, and four polymer groups received different dose volumes (Group 1, n = 6, 64 mL; Group 2, n = 6, 85 mL; Group 3, n = 18, 100 mL; and Group 4, n = 10, 120 mL) in addition to fluids. Ten minutes after injury, the foam was percutaneously administered, and animals were monitored for 3 hours. RESULTS: Survival with hepatoportal injury was highest in Group 4 (90%) and decreased in a dose-dependent fashion (Group 3, 72%; Group 2, 33%; Group 1, 17%). All polymer groups survived significantly longer than the controls (8.3%). Hemorrhage rate was reduced in all groups but lowest in Group 4 versus the control group (0.34 [0.052] vs. 3.0 [1.3] mL/kg/min, p < 0.001). Increasing foam dose volume was associated with increased peak intra-abdominal pressure (88.2 [38.9] in Group 4 vs. 9.5 [3.2] in the controls, p < 0.0001) and increased incidence of focal bowel injuries. CONCLUSION: The self-expanding foam significantly improves survival in a dose-dependent fashion in an otherwise lethal injury. Higher doses are associated with better survival but resulted in the need for bowel resection.
Assuntos
Traumatismos Abdominais/terapia , Hemorragia/terapia , Técnicas Hemostáticas , Poliuretanos/uso terapêutico , Substâncias Viscoelásticas/uso terapêutico , Animais , Relação Dose-Resposta a Droga , Serviços Médicos de Emergência/métodos , Feminino , Poliuretanos/administração & dosagem , Ressuscitação , Suínos , Substâncias Viscoelásticas/administração & dosagemRESUMO
OBJETIVO: Estudar por biomicroscopia ultrassônica (UBM) de alta frequência as características anatômicas da viscocanalostomia, e a relação dessas características com a redução da pressão intraocular. MÉTODOS: Estudo transversal, que incluiu nove olhos (sete pacientes) submetidos à viscocanalostomia, e posteriormente examinados por UBM de alta frequência (80 MHz). Os parâmetros da UBM avaliados após um follow-up mínimo de seis meses foram: presença de espaço intraescleral, comprimento e altura máximos do espaço intraescleral, e a espessura mínima da membrana trabéculo-descemética (MTD) residual. O sucesso cirúrgico definiu-se como pressão intraocular (PIO) <22mmHg ou redução de 20% da PIO sem medicação tópica. Possíveis associações entre as variáveis da UBM e o resultado cirúrgico foram avaliados. RESULTADOS: O tempo médio entre a cirurgia e a realização da UBM foi de 15,5 ± 8,8 meses (6 - 29 meses). Verificou-se uma redução da PIO de 23,5 ± 6,9 mmHg (13,7-32,0) pré-operatória para 14,5 ± 2,4 mmHg (10,7-17,3) pós-operatória (p<0,05). Identificou-se a presença de espaço intraescleral em todos os olhos. A média do comprimento máximo do espaço intraescleral era 1,83 ± 0,51mm; a média da altura máxima do espaço intraescleral era 0,36 ± 0,17mm; e a média da espessura mínima da MTD era 0,14 ± 0,07mm. Não foram encontradas correlações significativas entre o valor da PIO pós-operatória e o comprimento do espaço intraescleral (r²=0,359), a altura do espaço intraescleral (r²=0,017) e a espessura da MTD (r²=0,003). CONCLUSÃO: Em pacientes submetidos à viscocanalostomia, a UBM após um follow-up mínimo de seis meses identificou o espaço intraescleral em todos os olhos. Não se encontrou qualquer correlação estatisticamente significativa entre os valores de PIO pós-operatória e as características anatômicas do espaço intraescleral.
PURPOSE: To evaluate by high frequency ultrasound biomicroscopy (UBM) the anatomical characteristics of viscocanalostomy and their relationship with the intraocular pressure (IOP) lowering. METHODS: A transversal study which included 9 eyes (7 patients) undergoing viscocanalostomy and examined by high frequency UBM (80 MHz). Several UBM variables were evaluated, including the presence of the intrascleral space, the maximum length and height of the intrascleral space and the minimum thickness of residual trabeculo-Descemet membrane (TDM). Surgical success was considered to be achieved when IOP was <22mmHg or the IOP was lowered 20% or more without the use of any medication. The possible association between UBM variables and the surgical outcome was determined. RESULTS: The mean time between surgery and the UBM examination was 15.5 ± 8.8 months (range 6-29). The mean IOP decreased from a preoperative value of 23.5 ± 6.9 mmHg (range 13.7-32.0) to 14.5 ± 2.4 mmHg (range 10.7-17.3) postoperative (p<0.05). The presence of an intrascleral space was a constant finding. The mean length of the intrascleral space was 1.83 ± 0.51mm, the mean height was 0,36 ± 0,17mm; and the mean TDM thickness was 0.14 ± 0.07mm. There were a poor correlation between the level of IOP at the time of UBM and the lenght of the intrascleral space (r²=0.359), the height of the intrascleral space (r²=0.017) or the thickness of the remaining TDM (r²=0.003). CONCLUSION: In patients undergoing viscocanalostomy, UBM examination after a minimum of 6-month follow-up period showed the presence of an intrascleral space in all patients. There was no statiscally significant relationship between the level of IOP and the anatomical characteristics of the intrascleral space.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Cirurgia Filtrante/métodos , Esclera , Glaucoma de Ângulo Aberto/cirurgia , Hipertensão Ocular/cirurgia , Pressão Intraocular , Lâmina Limitante Anterior , Substâncias Viscoelásticas/uso terapêutico , Estudos Transversais , Resultado do TratamentoRESUMO
CONTEXT: Pediatric cataract surgery is traditionally done with the aid of high-molecular-weight viscoelastics which are expensive. It needs to be determined if low-cost substitutes are just as successful. AIMS: The study aims to determine the success rates for anterior and posterior capsulorrhexis and intraocular lens (IOL) implantation in the bag for pediatric cataract surgery performed with the aid of a low-molecular-weight viscoelastic. SETTINGS AND DESIGN: Nonrandomized observational study. MATERIALS AND METHODS: Children less than 6 years of age who underwent cataract surgery with IOL implantation in the period May 2008-May 2009 were included. The surgeries were done by pediatric ophthalmology fellows. A standard procedure of anterior capsulorrhexis, lens aspiration with primary posterior capsulorrhexis, anterior vitrectomy, and IOL implantation was followed. Three parameters were studied: successful completion of anterior and posterior capsulorrhexis and IOL implantation in the bag. RESULTS: 33 eyes of 28 children were studied. The success rate for completion was 66.7% and 88.2 % for anterior and posterior capsulorrhexis, respectively. IOL implantation in the bag was successful in 87.9%. CONCLUSIONS: 2% hydroxypropylmethylcellulose is a viable low-cost alternative to more expensive options similar to high-molecular-weight viscoelastics. This is of great relevance to hospitals in developing countries.
Assuntos
Capsulorrexe , Catarata , Implante de Lente Intraocular , Metilcelulose/análogos & derivados , Oftalmologia/estatística & dados numéricos , Substâncias Viscoelásticas/uso terapêutico , Capsulorrexe/economia , Capsulorrexe/instrumentação , Capsulorrexe/métodos , Criança , Pré-Escolar , Redução de Custos , Bolsas de Estudo/estatística & dados numéricos , Humanos , Derivados da Hipromelose , Lactente , Metilcelulose/economia , Metilcelulose/uso terapêutico , Oftalmologia/educação , Substâncias Viscoelásticas/economiaRESUMO
PURPOSE: To analyze and compare the postoperative outcomes of eyes with accidental intraoperative inversion of implantable collamer lens (ICL) and viscocannula-assisted reinversion in high myopia. DESIGN: Retrospective observational case comparison. SETTING: Institutional practice. PATIENTS: Consecutive eyes with accidental intraoperative inversion of ICL and viscocannula-assisted reinversion from January 2007 to September 2010 were analyzed retrospectively. They were compared with the fellow eyes with normal ICL implantation at 1 month, 6 months, and 2 years. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), corneal pachymetry, endothelial cell loss, intraocular pressure, lens transparency, anterior chamber depth, and postoperative uveitis. RESULTS: A total of 206 myopic eyes had ICL implantation. Eight eyes (3.8%) of 8 patients had accidental intraoperative reinversion. Their fellow eyes had normal ICL implantation. There was no significant change (P = .611) in UCVA (reinverted and fellow eyes) at 2 years. There was no significant difference in postoperative UCVA (P = .611) and BCVA (P = .854) between the reinverted and the fellow eyes. The mean endothelial loss at 1 month, 6 months, and 2 years was 0.96% ± 0.5%, 0.92% ± 0.63%, and 0.89% ± 0.52% respectively in the reinverted eyes. There was no significant difference in the endothelial loss between the 2 groups at 1 month (P = .753), 6 months (P = .834), and 2 years (P = .916). One out of 8 eyes with reinversion had postoperative corneal edema, which resolved at 48 hours. None of the eyes reported uveitis or glaucoma. There was no loss of lens transparency. CONCLUSION: Intraoperative inversion can occur during insertion of ICL and viscocannula-assisted reinversion can be performed without significant complications.
Assuntos
Complicações Intraoperatórias , Implante de Lente Intraocular , Erros Médicos , Metilcelulose/análogos & derivados , Miopia/cirurgia , Lentes Intraoculares Fácicas , Substâncias Viscoelásticas/uso terapêutico , Câmara Anterior/cirurgia , Contagem de Células , Perda de Células Endoteliais da Córnea/diagnóstico , Topografia da Córnea , Endotélio Corneano/patologia , Humanos , Derivados da Hipromelose , Doença Iatrogênica , Pressão Intraocular/fisiologia , Metilcelulose/uso terapêutico , Miopia/fisiopatologia , Refração Ocular/fisiologia , Reoperação , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
PURPOSE OF REVIEW: Corneal endothelial cell loss remains a well known, undesirable side-effect of cataract surgery that may, in severe cases, negatively impact patients' postoperative visual outcomes. This article reviews the current literature and describes in detail how the degree of corneal endothelial cell loss is influenced by specific patient risk factors, as well as the arrival of newer surgical techniques and technologies. RECENT FINDINGS: Recent studies have demonstrated a reduction in corneal endothelial cell loss after phacoemulsification with the use of viscoelastic materials and modifications in phacoemulsification technology. Some patient characteristics may predispose patients to increased endothelial cell loss during cataract surgery. SUMMARY: Advances in surgical technique, the implementation of newer surgical technologies such as torsional ultrasound and viscoelastic devices, and aspects of patients' preexisting medical history may lead to varying degrees of endothelial cell loss after cataract surgery. Appropriately addressing these issues during the perioperative period may improve the rate of endothelial cell loss, and thus further enhance the visual outcome of patients undergoing cataract surgery.
Assuntos
Perda de Células Endoteliais da Córnea/etiologia , Facoemulsificação , Complicações Pós-Operatórias , Perda de Células Endoteliais da Córnea/prevenção & controle , Humanos , Seleção de Pacientes , Fatores de Risco , Substâncias Viscoelásticas/uso terapêuticoRESUMO
PURPOSE: Severe alveolar bony resorption in the edentulous posterior maxilla and pneumatization of the maxillary sinus wall make traditional implant placement impossible in the posterior maxilla. To reconstruct the severely resorbed maxilla for dental implant placement, 1 successful technique is to elevate the maxillary sinus floor using demineralized bone matrix (DBM) grafts. The purpose of this study was to evaluate a histologic and histomorphometric evaluation of DBM grafts in the human maxilla. PATIENTS AND METHODS: Nine months after grafting, at the time of dental implantation, biopsy samples were taken from the grafted areas of 8 patients and were analyzed histologically. RESULTS: All the sinus lifts were successful in the clinical study conducted after implantation. Resorption of the graft materials and new bone formation were observed, and there was direct deposition of bone on the surface of the graft particles. CONCLUSION: The results of this study indicate that limited maxillary sinus lift with DBM graft material is a clinically reliable preimplant procedure.
Assuntos
Transplante Ósseo/métodos , Levantamento do Assoalho do Seio Maxilar/métodos , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/cirurgia , Biópsia , Medula Óssea/patologia , Matriz Óssea/transplante , Transplante Ósseo/patologia , Implantação Dentária Endóssea/métodos , Prótese Dentária Fixada por Implante , Seguimentos , Humanos , Ácido Hialurônico/uso terapêutico , Maxila/diagnóstico por imagem , Maxila/cirurgia , Pessoa de Meia-Idade , Osseointegração/fisiologia , Osteoclastos/patologia , Osteócitos/patologia , Osteogênese/fisiologia , Osteotomia/métodos , Piezocirurgia/métodos , Radiografia Panorâmica , Transplante Homólogo , Substâncias Viscoelásticas/uso terapêuticoRESUMO
The purpose of this study was to evaluate the effectiveness of phacoemulsification and viscogoniosynechialysis in the management of patients with chronic angle-closure glaucoma (CACG). Fifty-six eyes of 45 recruited patients were classified into two groups: group 1 had medically controlled CACG (IOP Assuntos
Glaucoma de Ângulo Fechado/cirurgia
, Gonioscopia
, Procedimentos Cirúrgicos Oftalmológicos
, Facoemulsificação
, Substâncias Viscoelásticas/uso terapêutico
, Idoso
, Inibidores da Angiogênese/uso terapêutico
, Anticorpos Monoclonais/uso terapêutico
, Anticorpos Monoclonais Humanizados
, Bevacizumab
, Doença Crônica
, Feminino
, Fibrina/biossíntese
, Seguimentos
, Glaucoma de Ângulo Fechado/diagnóstico
, Humanos
, Iris/metabolismo
, Edema Macular/diagnóstico
, Edema Macular/tratamento farmacológico
, Edema Macular/etiologia
, Masculino
, Pessoa de Meia-Idade
, Complicações Pós-Operatórias
, Estudos Prospectivos
, Tomografia de Coerência Óptica
, Resultado do Tratamento
RESUMO
BACKGROUND: Nonanimal stabilized hyaluronic acid (NASHA) offers longer-lasting correction than many other injectable products and is associated with low risk of immunogenic and hypersensitivity reactions. A new large-particle stabilized hyaluronic acid-based gel has been developed to restore facial volume and define facial contours. OBJECTIVE: This study was conducted to assess the long-term efficacy and safety of a large-particle stabilized hyaluronic acid-based gel in patients seeking facial contouring. METHODS: Fifty-seven adult patients seeking esthetic cheek or chin augmentation or both received subcutaneous or supraperiosteal injections or both of large-particle stabilized hyaluronic acid-based gel (20 mg/mL). Efficacy was assessed subjectively using the Global Aesthetic Improvement Scale at intervals up to 12 months after treatment. RESULTS: After treatment, patients and investigators independently considered treatment sites to be at least somewhat improved in 91% and 96% (6 months), 68% and 77% (9 months), and 58% and 52% (12 months) of cases, respectively. Patient- and investigator-assessed treatment response rates (the proportion of patients showing at least moderate improvement) were 72% and 81% (6 months), 42% and 40% (9 months), and 21% and 15% (12 months), respectively. Most commonly reported adverse events were local injection-site reactions, skin induration, and implant mobility. CONCLUSION: This large-particle stabilized hyaluronic acid-based gel is well tolerated and provides relatively long-lasting esthetic correction of the cheeks and chin after subcutaneous or supraperiosteal injection.
Assuntos
Face/cirurgia , Ácido Hialurônico/análogos & derivados , Adulto , Idoso , Materiais Biocompatíveis , Bochecha/cirurgia , Queixo/cirurgia , Feminino , Géis , Humanos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/química , Ácido Hialurônico/uso terapêutico , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Tamanho da Partícula , Estudos Prospectivos , Próteses e Implantes , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Substâncias Viscoelásticas/administração & dosagem , Substâncias Viscoelásticas/química , Substâncias Viscoelásticas/uso terapêutico , Adulto JovemRESUMO
Viscoexpression method of nucleus delivery in manual small incision cataract surgery is described in this article. The practical modifications to the conventional technique in special situations are presented. Intraoperative and postoperative problems likely to be encountered and the steps to avoid them and tackle them effectively are discussed.