RESUMO
BACKGROUND AND OBJECTIVE: To compare outcomes of macular hole surgery using silicone oil with C3F8 gas tamponade. PATIENTS AND METHODS: A retrospective case-control study of patients who underwent macular hole surgery for stage 2, 3, or 4 macular holes. RESULTS: Forty-six eyes of 44 patients underwent macular hole surgery involving injection of silicone oil (23 cases) or gas tamponade (23 controls). Anatomic closure occurred in 19 (82.6%) cases and 20 (86.9%) controls. Visual acuity improved to 20/70 or better in 4 (17.3%) of the cases and in 17 (73%) of the controls. CONCLUSION: In the current study of macular hole surgery, outcomes were better among patients with gas tamponade.
Assuntos
Fluorocarbonos/administração & dosagem , Perfurações Retinianas/cirurgia , Óleos de Silicone/administração & dosagem , Vitrectomia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Perfurações Retinianas/classificação , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual/fisiologiaRESUMO
OBJECTIVE: To determine whether a single topical aqueous suppressant applied immediately after pars plana vitrectomy with long-acting gas tamponade prevents intraocular pressure (IOP) elevation. METHODS: Fifty patients who met the inclusion criteria and underwent pars plana vitrectomy with long-acting gas tamponade were randomized to receive a combination of timolol maleate and dorzolamide hydrochloride, long-acting timolol alone, dorzolamide alone, or placebo at the conclusion of surgery. The IOP was checked by a portable, handheld tonometer (Tono-Pen) at the conclusion of surgery and at 5 hours, 1 day, and 1 week after surgery. RESULTS: There were no significant differences in IOP among the groups at the conclusion of surgery. The IOP at 5 hours after surgery (27.0 vs 17.4 mm Hg; P<.001) and 1 day after surgery (26.1 vs 19.9 mm Hg; P =.01) showed a statistically significant difference between the placebo and timolol-dorzolamide groups. The timolol-dorzolamide group showed greater IOP control than either the timolol alone or the dorzolamide alone groups at 5 hours (P =.04 for both). CONCLUSION: The use of a single topical aqueous suppressant (timolol-dorzolamide) given after pars plana vitrectomy with long-acting gas tamponade effectively prevents significant postoperative IOP elevation at 5 hours and 1 day after surgery.
Assuntos
Anti-Hipertensivos/uso terapêutico , Fluorocarbonos , Pressão Intraocular/efeitos dos fármacos , Complicações Pós-Operatórias/prevenção & controle , Hexafluoreto de Enxofre , Vitrectomia , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Sulfonamidas/administração & dosagem , Sulfonamidas/uso terapêutico , Tiofenos/administração & dosagem , Tiofenos/uso terapêutico , Timolol/administração & dosagem , Timolol/uso terapêuticoRESUMO
PURPOSE: To investigate the incidence, causative organisms, and visual acuity outcomes associated with endophthalmitis after pars plana vitrectomy. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients who developed acute-onset postoperative endophthalmitis (within 6 weeks of surgery) after pars plana vitrectomy at Bascom Palmer Eye Institute between January 1, 1984 and December 31, 2003. RESULTS: During the 20-year study interval, the overall incidence rate of postvitrectomy endophthalmitis was 0.039% (6/15,326). Cultured organisms were Staphylococcus aureus (n = 3), Proteus mirabilus (n = 1), and Staphylococcus epidermidis/Pseudomonas aeruginosa (n = 1); one case was culture-negative. Visual acuity after treatment for endophthalmitis ranged from 2/200 to no light perception, with a final vision of light perception or no light perception in four of six (67%) eyes. CONCLUSION: The incidence of endophthalmitis after pars plana vitrectomy is low but the visual acuity outcomes after treatment are generally poor.
Assuntos
Endoftalmite/epidemiologia , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/epidemiologia , Infecções Oculares Bacterianas/microbiologia , Complicações Pós-Operatórias , Acuidade Visual/fisiologia , Vitrectomia/efeitos adversos , Doença Aguda , Adulto , Idoso , Câmara Anterior/microbiologia , Antibacterianos , Quimioterapia Combinada/uso terapêutico , Endoftalmite/tratamento farmacológico , Infecções Oculares Bacterianas/tratamento farmacológico , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Proteus mirabilis/isolamento & purificação , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação , Resultado do Tratamento , Corpo Vítreo/microbiologiaRESUMO
PURPOSE: To report infraorbital nerve dysfunction after laser in situ keratomileusis. DESIGN: Observational case report. METHODS: Neuro-ophthalmologic examination with brain and orbital magnetic resonance imaging (MRI) and orbital computed tomography (CT). RESULTS: During laser in situ keratomileusis, two healthy women, aged 42 and 46 years, experienced acute onset of sharp ipsilateral cheek pain. Both cases occurred during manipulation of the eyelid speculum. Postoperatively, ipsilateral numbness and tingling or pain of the upper cheek was reported, and examination showed decreased sensation in the distribution of the infraorbital nerve. In both cases, brain and orbit MRI and orbit CT were normal. Both patients were managed medically. In one patient, mild symptoms persisted 1 year postoperatively, and in the second patient, moderate discomfort persisted 8 months postoperatively. CONCLUSION: Infraorbital nerve palsy is a potential complication of laser in situ keratomileusis. Symptoms improve but may persist.
Assuntos
Doenças dos Nervos Cranianos/etiologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Nervo Maxilar/patologia , Paralisia/etiologia , Adulto , Encéfalo/patologia , Doenças dos Nervos Cranianos/diagnóstico , Neuralgia Facial/diagnóstico , Neuralgia Facial/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Órbita/patologia , Paralisia/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND AND OBJECTIVE: To determine the incidence rate of acute-onset postoperative endophthalmitis and to assess visual acuity outcomes after treatment from the most recent 7 years (1995-2001) compared with the previous 11 years (1984-1994) among patients undergoing intraocular surgery at the same institution. PATIENTS AND METHODS: The medical records were reviewed of all patients undergoing intraocular surgery at the Bascom Palmer Eye Institute between January 1, 1995 and December 31, 2001. RESULTS: The 7-year incidence rate of acute-onset postoperative endophthalmitis was 0.05% (17 of 35,916 intraocular surgeries). The number of patients with endophthalmitis (incidence) and their median final visual acuity for each surgical category are as follows: cataract extraction: 8/21,972 (0.04%) - 20/100; glaucoma surgery: 4/1,970 (0.2%) - 20/70; penetrating keratoplasty: 2/2,362 (0.08%) - light perception; pars plana vitrectomy: 2/7,429 (0.03%) - hand movements; secondary intraocular lens placement: 1/485 (0.2%) - 20/40. Of the 8 cases of endophthalmitis after cataract surgery, 6 cases occurred after phacoemulsification and 2 of these cases had a dear corneal sutureless incision. CONCLUSION: The most recent 7-year incidence rate of acute-onset postoperative endophthalmitis is significantly lower than that of the previous 11 years (0.05% versus 0.09%; = 0.031) at the same institution. Visual acuity outcomes after treatment were generally better in cataract surgery, glaucoma surgery, and secondary intraocular lens categories compared to pars plana vitrectomy and penetrating keratoplasty categories.
Assuntos
Endoftalmite/epidemiologia , Infecções Oculares Bacterianas/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Acuidade Visual , Doença Aguda , Endoftalmite/microbiologia , Endoftalmite/terapia , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/terapia , Florida/epidemiologia , Humanos , Incidência , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/terapia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Corioide/irrigação sanguínea , Neovascularização de Coroide/patologia , Artérias Ciliares/patologia , Epitélio Pigmentado Ocular/patologia , Descolamento Retiniano/patologia , Hemorragia Retiniana/patologia , Neovascularização de Coroide/etiologia , Complicações do Diabetes , Enucleação Ocular , Feminino , Angiofluoresceinografia , Humanos , Hipertensão/complicações , Verde de Indocianina , Pessoa de Meia-Idade , Recidiva , Descolamento Retiniano/etiologia , Hemorragia Retiniana/etiologia , Acuidade VisualAssuntos
Endoftalmite/microbiologia , Infecções Oculares Bacterianas , Glucocorticoides/efeitos adversos , Infecções por Mycobacterium não Tuberculosas , Mycobacterium chelonae/isolamento & purificação , Triancinolona Acetonida/efeitos adversos , Corpo Vítreo/microbiologia , Antibacterianos , Diabetes Mellitus Tipo 2/complicações , Quimioterapia Combinada/uso terapêutico , Endoftalmite/terapia , Enucleação Ocular , Infecções Oculares Bacterianas/etiologia , Infecções Oculares Bacterianas/terapia , Humanos , Injeções , Edema Macular/tratamento farmacológico , Edema Macular/etiologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/etiologia , Infecções por Mycobacterium não Tuberculosas/terapia , Corpo Vítreo/efeitos dos fármacosRESUMO
OBJECTIVE: To investigate the clinical settings and treatment outcomes for endophthalmitis caused by Pseudomonas aeruginosa. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: The medical records were reviewed of all patients treated for P. aeruginosa endophthalmitis at a single institution between January 1, 1987, and December 31, 2001. MAIN OUTCOME MEASURES: Final visual acuity and rate of enucleation or evisceration. RESULTS: The study included 28 eyes of 28 patients with a median age of 75 years (range, 5-93 years). The clinical setting of endophthalmitis included: cataract surgery (n = 9), corneal ulcer (n = 7), penetrating keratoplasty (n = 5), bleb associated (n = 2), glaucoma drainage implant (n = 2), pars plana vitrectomy (n = 1), iris cyst removal (n = 1), and trauma (n = 1). In acute-onset postoperative cases (n = 10), the median interval between surgery and presentation with endophthalmitis was 4 days (range, 1-26 days). The median duration of symptoms was 1 day, and all patients were treated on the day of diagnosis. Eleven patients (39%) had hand motions or better vision in the infected eye at the time of initial diagnosis. Because of no light perception visual acuity, necrosis of cornea and sclera, and intractable pain, 7 eyes (25%) underwent evisceration or enucleation as initial treatment; of the remaining 21 eyes, intravitreal antibiotics were administered in all cases and intravitreal dexamethasone was administered in 15 cases (71%). Pars plana vitrectomy was performed in 12 patients (43%). The organism was sensitive to the initial antibiotics administered in all but 2 cases. Final visual acuity was 5/200 or better in 2 of 28 eyes (7%). Nineteen patients (68%) had a final visual acuity outcome of no light perception, and no patient achieved a final visual acuity of better than 20/400. Overall, 18 of the 28 eyes (64%) were either eviscerated or enucleated. CONCLUSIONS: Endophthalmitis caused by P. aeruginosa is associated with poor visual outcomes despite prompt treatment with intravitreal antibiotics to which the organisms were sensitive.