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1.
Medicina (Kaunas) ; 59(4)2023 Mar 23.
Artículo en Inglés | MEDLINE | ID: mdl-37109597

RESUMEN

Background: The aim of the study was to compare macular thickness behavior and clinical outcomes after femtosecond laser-assisted cataract surgery (FLACS) versus phacoemulsification conventional surgery (PCS). Methods: Macular Optical Coherence Tomography OCT was analyzed in 42 patients preoperatively, 1 day, 12 days, 4 weeks and 6 weeks postoperatively according to the 9-field Early Treatment Diabetic Retinopathy Study (ETDRS) grid. Clinical findings were collected in both the FLACS group and the PCS group. Results: There was no significant difference in macular thickness between the FLACS and PCS groups (p > 0.05). However, from postoperative day 12 onwards, there was a significant increase in macular thickness observed in both groups (p < 0.001). In the FLACS group, a significant increase in visual acuity was observed on the first postoperative day, as compared to the PCS group (p = 0.006). Conclusions: The use of a low-energy high-frequency femtosecond laser has potentially no effect on postoperative macular thickness. In the FLACS group, visual rehabilitation was significantly faster as compared to the PCS group. No complications occurred intraoperatively in either group.


Asunto(s)
Extracción de Catarata , Catarata , Terapia por Láser , Facoemulsificación , Humanos , Terapia por Láser/métodos , Facoemulsificación/métodos , Rayos Láser
2.
Graefes Arch Clin Exp Ophthalmol ; 259(6): 1487-1491, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33237392

RESUMEN

BACKGROUND: This study aimed to evaluate the long-term change of postoperative retinal shift after pars plana vitrectomy for macular off retinal detachment. METHODS: In this retrospective study, patients with retinal shift after pars plana vitrectomy for macula-off rhegmatogenous retinal detachment (RRD) were examined at 3 weeks and 12 months postoperatively. Fundus autofluorescence images were obtained to visualize retinal rotation. Best-corrected visual acuity was measured and metamorphopsia assessed using the Amsler grid. RESULTS: Nine patients with postoperative retinal shift were included in the study. Retinal shift decreased significantly in these patients, on average by 1.07° (range 0.52-1.62, p = 0.002) after 12 months. However, more patients complained of distorted vision after 12 months (odds ratio for change = 3.0, 95% CI: 0.24 to 157.49). The main reason was the new formation of an epiretinal membrane (odds ratio for change = infinity, 95% CI: 0.41 to infinity). There was no change in visual acuity observed (p = 0.16). CONCLUSION: Postoperative retinal shift after RRD repair decreases over a 1-year span. While retinal shift is the main cause for metamorphopsia in the early postoperative period, formation of an ERM is the main reason for distorted vision long term.


Asunto(s)
Membrana Epirretinal , Desprendimiento de Retina , Membrana Epirretinal/cirugía , Humanos , Complicaciones Posoperatorias , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/cirugía , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Vitrectomía
3.
Klin Monbl Augenheilkd ; 236(12): 1435-1438, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-30216944

RESUMEN

BACKGROUND: The aim of our study was to evaluate the clinical outcomes after Keraring implantation for keratoconus in patients with thin corneas. PATIENTS AND METHODS: Ten eyes from 10 patients with keratoconus, who underwent femtosecond laser-assisted Keraring implantation for keratoconus, were included in this retrospective study. Uncorrected visual acuity (UCVA), corrected visual acuity (CDVA), keratometric readings, central corneal thickness and thinnest corneal pachymetry have been evaluated preoperatively and 6 months after the Keraring implantation. RESULTS: UCVA, BCVA and keratometric readings improved at 6 months postoperatively. CONCLUSIONS: Our data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients with thin corneas at 6 months postoperatively.


Asunto(s)
Queratocono , Implantación de Prótesis , Córnea , Sustancia Propia , Topografía de la Córnea , Humanos , Queratocono/cirugía , Prótesis e Implantes , Refracción Ocular , Estudios Retrospectivos
4.
Int Ophthalmol ; 39(10): 2149-2151, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-30656511

RESUMEN

BACKGROUND: To investigate response of dissolving collagen contact lenses as an alternative for bandage contact lenses, for the post-interventional care of epithelial defects after corneal cross-linking (CXL) treatment for keratoconus. PATIENTS AND METHODS: Follow-up visits were performed at day 1, 4 and 1 month after the intervention. We reviewed notes for re-epithelialization, comfort/pain and any untoward effects of Collagen SOFT SHIELD®. Assessment included visual acuity (VA), refraction (SE); corneal haze, epithelial erosion and pain status were assessed subjectively on a 4-point scale, from 0 (none) to 3 (severe). RESULTS: Thirty consecutive CXL patients with collagen shield application after CXL were included. Mean age was 28 years (range from 16 to 51 years old). Pre-CXL VA was 0.7 logMAR IQR 0.4-1.0; post-CXL VA at day 4 and month 1 was 0.6 logMAR IQR 0.4-0.9. Post-operative mean SE was 5.5D ± 4.1D. In all patients, the Collagen SOFT SHIELD® was completely dissolved at the 4-day follow-up visit. In most cases, epithelial defect was closed at day 4, on average 0.8 ± 0.5 days post-intervention; all epithelial defects were closed by month 1. Haze was minimal (mean haze score 1.4 ± 0.7 at day 4 and 1.0 ± 0.6 at 1 month). No adverse effects such as infection were observed. CONCLUSIONS: This study indicates that Oasis Collagen SOFT SHIELD® is valuable and safe alternative to standard bandage contact lens for the treatment of epithelial defects. This outcome may be of particular interest in patients where the contact lens removal is likely to be problematic.


Asunto(s)
Colágeno/uso terapéutico , Lentes de Contacto Hidrofílicos , Queratocono/terapia , Fotoquimioterapia/métodos , Adolescente , Adulto , Reactivos de Enlaces Cruzados/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Fármacos Fotosensibilizantes/uso terapéutico , Agudeza Visual , Adulto Joven
5.
Klin Monbl Augenheilkd ; 235(4): 404-408, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29669367

RESUMEN

PURPOSE: To report the visual outcomes and complications of automated anterior lamellar therapeutic keratoplasty (ALTK) in adults and children, and to examine these outcomes as a function of age and etiology. METHODS: A consecutive series of cases undergoing automated ALTK procedures performed at the Jules-Gonin Eye Hospital Lausanne, Switzerland, between June 2003 and January 2015. Only patients with at least 3 months of follow-up were included. RESULTS: There were 53 eyes (24 right) of 51 patients (17 female, 16 juvenile), with a mean age of 34.8 years (range from 3 months to 88 years), analyzed. The mean follow-up was 35 (± 26) months. Diagnosis in the adult (n = 37) vs. juvenile (n = 16) eyes was different: opacity following surgical complication 8 vs. 0, congenital 1 vs. 1, dystrophy 5 vs. 2, infection 12 vs. 5, keratectasia 3 vs. 0, trauma 7 vs. 0, tumor 1 vs. 3, and allergy 0 vs. 5. Visual impairment as a consequence of corneal scarring was the principle indication for surgery in both adult (70%; 26) and juvenile eyes (63%; 10); other indications were choristoma, dermoid, other tumors, astigmatism, and congenital opacity. In adult vs. juvenile eyes, the mean visual acuity (spectacle and contact lenses) was, at last visit, 0.55 vs. 0.45 LogMAR (p = 0.78), with a range of 100% to hand movements. Failure occurred in 6 (16%) vs. 2 (13%) cases and complications were observed in 14 (38%) vs. 9 (56%) cases, however, more surgical revision was required in juvenile eyes, 4 (11%) vs. 7 (43%) (p = 0.01, Fisher test). CONCLUSIONS: This study shows that anterior lamellar keratoplasty in children retains good visual function when combined with adequate amblyopic therapy. However, the rate of complications is higher in juveniles and requires more intensive interdisciplinary follow-up.


Asunto(s)
Opacidad de la Córnea/cirugía , Sustancia Propia/cirugía , Trasplante de Córnea/instrumentación , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Astigmatismo/etiología , Niño , Preescolar , Trasplante de Córnea/métodos , Femenino , Estudios de Seguimiento , Humanos , Lactante , Masculino , Persona de Mediana Edad , Refracción Ocular , Estudios Retrospectivos , Agudeza Visual , Adulto Joven
7.
Graefes Arch Clin Exp Ophthalmol ; 251(3): 803-7, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22892583

RESUMEN

PURPOSE: To evaluate visual recovery and intraocular straylight in keratoconus patients 3 months and 1 year after corneal crosslinking (CXL) PATIENTS AND METHODS: Thirty-three eyes of 28 consecutive patients with mild to moderate keratoconus were included. The following were assessed at baseline, 3 months and 1 year after CXL: corrected distance visual acuity (CDVA), intraocular straylight, spherical equivalent (SE), keratometry (Kmax and K min (Diopters D and axis), the regularity index and pachymetry. Changes from baseline were calculated using mixed linear regression models. RESULTS: The CDVA remained unchanged 3 months after CXL (-0.003 (95 % CI: -0.038 to 0.044); p = 0.880) and improved after 1 year (-0.042 (95 % CI: -0.078 to -0.007; p = 0.021)). The mean straylight value increased significantly by 0.27 (95 % CI: 0.18 to 0.35; p < 0.001) 3 months after CX and normalized to preoperative values after 1 year (0.06 (95 % CI: -0.03 to 0.14; p = 0.215)). SE improved from the mean preoperative value of -2.61 D (95 % CI: -3.83 to -1.39) by 1.95 (95 % CI: 1.03 to 2.86; p < 0.001) at 3 months and remained stable at the 1-year follow-up visit (2.17 (95 % CI: 1.21 to 3.12; p < 0.001)). Parameters of of keratometry changed only minimally. The regularity index remained almost unchanged at 3 months (2.45 (95 % CI: -4.97 to 9.88; p = 0.503)) and decreased by 6.97 (95 % CI: -14.08 to 0.14; p = 0.054). Pachymetry decreased by 44.0 µm (95 % CI: 56.1 to 31.9; p < 0.001) at 3 months and almost returned to preoperative values at 12 months (-11.3 µm (95 % CI: -27.9 to 5.3; p = 0.175)). CONCLUSIONS: In accordance with the decrease in CDVA and patients' complaints of disability due to glare, intraocular straylight increased 3 months after surgery. One year after CXL, there was an increase in CDVA due to an improved SE and regularity index, and intraocular straylight had normalized.


Asunto(s)
Córnea/fisiología , Reactivos de Enlaces Cruzados/uso terapéutico , Queratocono/tratamiento farmacológico , Agudeza Visual/fisiología , Adolescente , Adulto , Colágeno/metabolismo , Sustancia Propia/metabolismo , Femenino , Deslumbramiento , Humanos , Queratocono/metabolismo , Queratocono/fisiopatología , Luz , Masculino , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Recuperación de la Función/fisiología , Riboflavina/uso terapéutico , Dispersión de Radiación , Rayos Ultravioleta , Adulto Joven
8.
J Clin Med ; 12(13)2023 Jul 04.
Artículo en Inglés | MEDLINE | ID: mdl-37445506

RESUMEN

BACKGROUND AND OBJECTIVES: The aim of the research was to investigate the differences in the concentrations of IL-12, IL-4, IL-10, and IFN-γ in tears after LASIK and PRK procedures. MATERIALS AND METHODS: The study included 68 myopic eyes up to -3.0 D refractive spherical equivalent, divided into two groups: Group 1 LASIK (n = 31) and Group 2 PRK (n = 37). Three tear samples were taken from each eye: immediately before the procedure (t0), 1 h after the procedure (t1), and 24 h after the procedure (t2). The concentrations of IL-12p70, IL-4, IL-10, and IFN-γ in the tear samples were determined by flow cytometry. Participants were not taking anti-inflammatory therapy 24 h after the procedure. RESULTS: IL-4 levels 1 h after treatment did not differ between LASIK and PRK (p = 0.990), while 24 h after PRK there was a significant decrease in IL-4 levels (p < 0.05), but not after LASIK (p = 0.476). In both the LASIK (p < 0.05) and PRK (p < 0.05) groups, there is an increase in IL-10 concentrations 1 h after treatment, which persists 24 h after LASIK (p < 0.05) but not after PRK (p = 0.081). There is an increase in IL-12p70 concentration 1 h after treatment in both the LASIK (p < 0.001) and PRK groups (p < 0.001). There is also an increase in IL-12p70 concentration 24 h after PRK (p < 0.005), but not after LASIK (p = 0.775). CONCLUSIONS: IL-4 concentration shows a significantly higher value in the LASIK group than in the PRK group after 24 h. IL-10 and IL-12p70 levels increase one hour after surgery in both groups. After 24 h, the IL-10 levels remain elevated in the LASIK group, and the IL-12p70 levels remain elevated in the PRK group. Thus, LASIK and PRK procedures show different inflammatory dynamics.

9.
J Clin Med ; 12(6)2023 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-36983402

RESUMEN

(1) Background: Mid-stromal isolated Bowman layer transplantation aims to reduce and stabilize corneal ectasia in patients with advanced, progressive keratoconus. The purpose of this review is to evaluate the effectiveness and safety of this new surgical technique. (2) Methods: Following the PRISMA statement and checklist, we searched Medline, the Cochrane Controlled Trials Register, and Embase and used a broad systematic search strategy according to the Cochrane Collaboration. (3) Results: Eight studies with a total number of 120 eyes of 106 patients met our inclusion criteria. One month after Bowman layer transplantation, patients with keratoconus showed a significant decrease in the measured simulated keratometry (-4.74 D [95% CI -6.79 to -2.69]) and the maximum keratometry (-7.41 D [95% CI -9.64 to -5.19]), which remained significant one year postoperatively (-2.91 D [95% CI -5.29 to -0.53] and -5.80 D [-8.49 to -3.12]). Intra- and postoperative complications were observed in 3% and 9% of the patients, respectively. An estimated success rate of 75% to 85% was achieved by experienced surgeons at 5 to 8 years postoperatively. (4) Conclusions: Bowman layer transplantation may be an effective and safe treatment option in patients with advanced, progressive keratoconus. Additional multicenter prospective interventional studies are needed to confirm these preliminary findings.

10.
Graefes Arch Clin Exp Ophthalmol ; 249(9): 1367-71, 2011 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-21567210

RESUMEN

BACKGROUND: Straylight gives the appearance of a veil of light thrown over a person's retinal image when there is a strong light source present. We examined the reproducibility of the measurements by C-Quant, and assessed its correlation to characteristics of the eye and subjects' age. PARTICIPANTS AND METHODS: Five repeated straylight measurements were taken using the dominant eye of 45 healthy subjects (age 21-59) with a BCVA of 20/20: 14 emmetropic, 16 myopic, eight hyperopic and seven with astigmatism. We assessed the extent of reproducibility of straylight measures using the intraclass correlation coefficient. RESULTS: The mean straylight value of all measurements was 1.01 (SD 0.23, median 0.97, interquartile range 0.85-1.1). Per 10 years of age, straylight increased in average by 0.10 (95%CI 0.04 to 0.16, p < 0.01]. We found no independent association of refraction (range -5.25 dpt to +2 dpt) on straylight values (0.001; 95%CI -0.022 to 0.024, p = 0.92). Compared to emmetropic subjects, myopia reduced straylight (-.011; -0.024 to 0.02, p = 0.11), whereas higher straylight values (0.09; -0.01 to 0.20, p = 0.09) were observed in subjects with blue irises as compared to dark-colored irises when correcting for age. The intraclass correlation coefficient (ICC) of repeated measurements was 0.83 (95%CI 0.76 to 0.90). CONCLUSIONS: Our study showed that straylight measurements with the C-Quant had a high reproducibility, i.e. a lack of large intra-observer variability, making it appropriate to be applied in long-term follow-up studies assessing the long-term effect of surgical procedures on the quality of vision.


Asunto(s)
Emetropía/fisiología , Oftalmoscopía/normas , Estimulación Luminosa/métodos , Errores de Refracción/fisiopatología , Retina/fisiología , Adulto , Astigmatismo/fisiopatología , Femenino , Deslumbramiento/efectos adversos , Humanos , Hiperopía/fisiopatología , Luz , Masculino , Persona de Mediana Edad , Miopía/fisiopatología , Oftalmoscopía/métodos , Reproducibilidad de los Resultados , Dispersión de Radiación , Agudeza Visual/fisiología , Adulto Joven
11.
BMC Urol ; 11: 24, 2011 Dec 07.
Artículo en Inglés | MEDLINE | ID: mdl-22151977

RESUMEN

BACKGROUND: Choriocarcinoma is a very rare cause of ocular metastasis. Only 18 male patients have been reported on, 4 of whom survived, but with significant loss of vision. CASE PRESENTATION: A 26-year-old Caucasian man, suffering from testicular choriocarcinoma with pulmonary, cerebral, renal, hepatic and osseous metastases, underwent left radical orchiectomy. While being treated with chemotherapy, he presented with loss of vision in the left eye. Ophthalmoscopy revealed bilateral non-pigmented, hemorrhagic choroidal tumours, compatible with secondary lesions. Continued chemotherapy and stereotactic radiotherapy of the skull and spine lead to full remission with excellent vision, after more than 4 years of follow up. CONCLUSION: Testicular choriocarcinoma is an exceptional cause of choroidal metastasis, potentially asymptomatic and with specific clinical features. Radiotherapy can complement radical orchiectomy and chemotherapy, to achieve full remission and maintain good vision.


Asunto(s)
Quimioradioterapia/métodos , Coriocarcinoma/terapia , Neoplasias de la Coroides/terapia , Neoplasias Testiculares/terapia , Adulto , Coriocarcinoma/diagnóstico , Neoplasias de la Coroides/diagnóstico , Humanos , Masculino , Resultado del Tratamiento
12.
BMC Ophthalmol ; 11: 1, 2011 Jan 17.
Artículo en Inglés | MEDLINE | ID: mdl-21241468

RESUMEN

BACKGROUND: Excessive wound healing, with scarring of the episcleral tissue or encapsulation of the filtering bleb is the main reason for failure in trabeculectomy. Ranibizumab, an inhibitor of the Vascular Endothelial Growth Factor (VEGF), is seen as a promising candidate to prevent or treat extensive wound healing. We describe the design of a two phased study, i) assessing the local tolerability and safety of topical ranibizumab and ii) assessing the efficacy of topical ranibizumab against placebo in patients who underwent trabeculectomy with mitomycin C combined with phacoemulsification and intra ocular lens (IOL) implantation. METHODS/DESIGN: In the first phase five patients that had trabeculectomy with mitomycin C combined with phacoemulsification and IOL implantation will be treated with topical ranibizumab (Lucentis®) eye drops (2 mg/ml) four times daily for one month. The treatment will be started at the first postoperative day. Patients will be assessed for local and systemic side effects using a standardised schedule. In the second phase, after successful completion of phase 1, consenting eligible patients who underwent trabeculectomy with mitomycin C combined with phacoemulsification and IOL implantation will be randomised to either receive topical ranibizumab eye drops (2 mg/ml) four times daily for 1 month or placebo (BSS 4x/d for 1 month). Patients will be reviewed weekly for 4 weeks until conjunctival sutures are removed. Further follow up examinations are planned after 3 and six months. Assessment of differences in the intraocular eye pressure will be considered primary, and bleb appearance/vascularisation using a standardized photography and the Moorfields bleb grading system, postoperative intraocular pressure and conjunctival wound healing problems will be considered secondary outcome parameters. DISCUSSION: Anti-VEGF-antibodies might be more effective in preventing scaring and might have fewer toxic side effects than the currently used anti-metabolites and may replace them in the long term.


Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Glaucoma/cirugía , Proyectos de Investigación , Trabeculectomía , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Anticuerpos Monoclonales/efectos adversos , Anticuerpos Monoclonales Humanizados , Conjuntiva/cirugía , Esquema de Medicación , Estudios de Seguimiento , Glaucoma/fisiopatología , Humanos , Presión Intraocular , Implantación de Lentes Intraoculares , Mitomicina/uso terapéutico , Soluciones Oftálmicas , Facoemulsificación , Periodo Posoperatorio , Ranibizumab , Suturas , Resultado del Tratamiento , Cicatrización de Heridas
13.
Sci Rep ; 11(1): 18089, 2021 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-34508148

RESUMEN

To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.


Asunto(s)
Fluorocarburos/administración & dosificación , Cuerpo Vítreo/efectos de los fármacos , Cuerpo Vítreo/fisiopatología , Desprendimiento del Vítreo/tratamiento farmacológico , Anciano , Anciano de 80 o más Años , Toma de Decisiones Clínicas , Manejo de la Enfermedad , Femenino , Humanos , Inyecciones Intravítreas , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Retrospectivos , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Agudeza Visual , Desprendimiento del Vítreo/diagnóstico , Desprendimiento del Vítreo/cirugía
14.
J Ophthalmol ; 2021: 1877516, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34777856

RESUMEN

AIM: To assess the impact of posterior corneal asphericity on postoperative astigmatism. METHODS: We included retrospectively 70 eyes of 70 patients that underwent cataract surgery. We included data of the Q value, K max, K1, K2, astigmatism AL, and ACD. We performed a vectorial analysis to calculate the astigmatic vectors. RESULTS: Seventy eyes were evaluated. 40 eyes were of females (58%) and 30 of males (42%). The average cohort age was 73 ± 8.9 years. Axial length (AL) was 23.5 ± 0.9, anterior chamber depth (ACD) was 3.13 ± 0.3, and the average posterior Q value was -0.35 ± 0.2. The only significant predictive variable for the correction index (CI) was the posterior Q value (r = 0.24, p < 0.05) and for the surgically induced astigmatism (SIA) (ß = 0.34, r = 0.58, p < 0.05). CONCLUSION: Posterior corneal surface asphericity significantly influences the surgically induced astigmatism and the overcorrection for cataract patients after Lucidis EDOF IOL implantation.

16.
J Clin Med ; 9(12)2020 Dec 14.
Artículo en Inglés | MEDLINE | ID: mdl-33327511

RESUMEN

PURPOSE: To investigate clinical and surgical factors influencing the outcome after primary rhegmatogenous retinal detachment surgery. METHODS: A retrospective, single-centre, case-control study of 1017 eyes of 1017 consecutive patients with primary rhegmatogenous retinal detachment (RRD) who underwent pars plana vitrectomy (PPV), were included in the study. Analysed surgical factors were: combined procedure with phacoemulsification, type of retinopexy (cryocoagulation, endolaser, combined), type of tamponade (gas, silicone oil), and anatomical factors: primary proliferative vitreoretinopathy (PVR) and macular detachment at the time of surgery. RESULTS: Overall retinal re-detachment rate was 10.1%. The main reason for re-detachment was an insufficient retinopexy in 53.6%, followed by PVR (37.3%), and retinal detachment occurred at a different location caused by another break in 9.1%. No significant difference in the rate of re-detachment was found if a phacoemulsification with simultaneous IOL implantation was performed (p = 0.641). No significant difference between the various retinopexy techniques was found (p = 0.309). Risk factors re-detachment were primary PVR (p = 0.0003), silicone oil as initial tamponade (p = 0.0001) as well as macula off detachments (p = 0.034). CONCLUSIONS: The present study showed no significant difference between the types of retinopexy and if additional phacoemulsification was performed or not. Factors associated with a higher risk for re-detachment were detached macula at surgery, primary PVR and primary oil-filling.

17.
Clin Ophthalmol ; 14: 1413-1416, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32546949

RESUMEN

PURPOSE: To evaluate the effect of extrascleral cryocoagulation for the treatment of proliferative vitreoretinopathy (PVR) during retinal detachment repair. METHODS: Patients with a rhegmatogenous retinal detachment associated with peripheral PVR Grade C star-folds were included in this study and analysed retrospectively. In all patients, PVR star-folds were treated by extrascleral cryocoagulation. RESULTS: A total of six patients with a rhegmatogenous retinal detachment associated with at least one peripheral PVR star-fold were included in this study. Reattachment of the retina was successfully achieved in all patients. CONCLUSION: This novel and simple technique for the treatment of localized PVR using extrascleral cryocoagulation appears to be a safe and effective approach with favourable surgical success rates.

19.
J Vasc Surg ; 50(6): 1280-4, 2009 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-19958984

RESUMEN

BACKGROUND: To evaluate the effectiveness of the Viabahn Open Revascularization Technique (VORTEC) in the treatment of thoracoabdominal aortic aneurysms (TAAAs) and pararenal aortic aneurysms (PAAAs) by hybrid procedures. METHODS: Between December 2004 and March 2009, 58 patients (45 male, mean age, 74 years) were diagnosed with TAAA (n = 30) and PAAA (n = 28) and treated electively by combined hybrid techniques. Hybrid procedure includes bypass surgery of the visceral and renal arteries (debranching or rerouting), followed by endovascular exclusion of the aortic aneurysm. One hundred thirteen renovisceral vessels were revascularized in a retrograde fashion (ie, 98 renal and 15 visceral arteries), using VORTEC. The novel technique consists of the placement of self-expanding stent-grafts (Viabahn graft, Gore and Associates, Flagstaff, Ariz) in Seldinger technique into the renal and visceral arteries after surgical identification of the origin of the arteries. The end of the stent outside of the renal artery was sutured end to side directly with the main feeding graft, bypassing the aneurysm, or was fixed into an interposition branch graft on the main bypass. All cases were treated by two-staged approach (endovascular aneurysm repair [EVAR] performed after recovery from the debranching procedure). Computed tomography angiography and clinical follow-up were obtained before discharge, at six weeks, and three, six, and 12 months after the procedure and then annually. RESULTS: Primary technical success of VORTEC was achieved in all patients. Overall primary patency rate of the novel technique was 97% during a mean follow-up of 22.1 +/- 12.9 months (range, 1-52 months); the primary patency of the subgroups PAAAs and TAAAs was 97.7% and 96.4%, respectively; the assisted primary patency rate was 98%, as two occluded Viabahn grafts were reopened by thrombolysis and thrombus aspiration. No patient required long-term hemodialysis. Thirty-day mortality rate was 8.6% (5/58) and 25.8% (15/58) for the entire follow up. Permanent neurologic deficit occurred in two cases (3.4%; paraplegia, n = 1; paraparesis, n = 1). The overall endoleak rate was 17.1% as three patients presented early (30-day) type I endoleak, treated by cuff-implantation, and six patients presented type II endoleak, three of them treated by coil embolization of the patent vessel and the others treated conservatively with radiological surveillance. CONCLUSION: VORTEC allows performance of easy, safe, and minimally invasive revascularization of renal and visceral arteries and may represent a significant technical advance in the hybrid repair of TAAAs and PAAAs. However, the questions of reproducibility by other centers and long-term results are mandatory to establish this alternative revascularization option.


Asunto(s)
Aneurisma de la Aorta Torácica/cirugía , Implantación de Prótesis Vascular/instrumentación , Prótesis Vascular , Stents , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/mortalidad , Aneurisma de la Aorta Torácica/fisiopatología , Aortografía/métodos , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Femenino , Oclusión de Injerto Vascular/etiología , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Paraparesia/etiología , Paraplejía/etiología , Diseño de Prótesis , Falla de Prótesis , Reoperación , Estudios Retrospectivos , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Grado de Desobstrucción Vascular
20.
Ophthalmol Ther ; 8(2): 297-303, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31004281

RESUMEN

INTRODUCTION: The aim of this study was to assess the incidence of persistent postoperative cystoid macular edema (pCME) in patients undergoing pars plana vitrectomy with epiretinal membrane peel (ERM) only versus those with ERM peel combined with internal limiting membrane peel (ILM). Secondary endpoints of the study were to review both the central macular thickness (CMT) and visual acuity. METHODS: The patients were divided in two groups, one group in which only the ERM was peeled (n = 36 patients) and another group in which both the ERM and the ILM were removed (n = 62 patients). The results were analyzed retrospectively. Each patient received a complete ophthalmological examination, including best-corrected visual acuity (BCVA) using an ETDRS chart and spectral domain optical coherence tomography, at three time points: prior to surgery and 3 weeks and 3 months after surgery. RESULTS: A total 98 eyes of 98 patients were included in this study. The mean follow-up time was 7.7 months. CMT decreased significantly after surgery in all patients, and none of these changes differed significantly between the two groups. The BCVA increased significantly after surgery across all patients, and there were no significant changes between the two treatment groups. Postoperative pCME occurred in eight patients in each group, representing 22.2% of the 36 patients in the ERM only group and 12.9% of the 62 patients in the ERM/ILM peel group. However, this difference was not statistically significant. CONCLUSIONS: No difference was found between the two groups in terms of incidence of pCME. Both groups experienced had similar decrease in the CMT and improvement in the BCVA postoperatively.

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