ABSTRACT
Antecedentes y objetivo Evaluar el impacto económico en España derivado de la introducción del implante XEN®63 como alternativa quirúrgica en el manejo del glaucoma primario de ángulo abierto (GPAA) con o sin cataratas en pacientes refractarios. Materiales y métodos Se diseñó un análisis de impacto presupuestario para estimar los costes del tratamiento quirúrgico del GPAA desde la perspectiva del Sistema Nacional de Salud (SNS) español, en un horizonte temporal de1 año. Los comparadores considerados (trabeculectomía, esclerectomía profunda no perforante, válvula de Ahmed, iStent inject®, Preserflo® microshunt y XEN®45) se corresponden a los empleados en la práctica clínica pública española. Para el cálculo de la población diana, cuotas de mercado y uso de recursos en términos de visitas de seguimiento, procedimientos adicionales y complicaciones poscirugía, se emplearon datos de la literatura y se validaron con un panel de cuatro expertos. Los costes unitarios (de2021) se obtuvieron de la base de datos ESALUD Resultados la inclusión de XEN®63 podría generar un ahorro de 2.569.737 tras un año desde su introducción, derivado del ahorro en el coste del implante y del procedimiento (−423.120; −0,7%), de las visitas de seguimiento (−777.407; −4,5%), de los procedimientos adicionales (−1.048.145, −20,6%) y de las complicaciones poscirugía (−321.065, −14,2%). Conclusiones La incorporación de XEN®63 en el arsenal quirúrgico para el tratamiento del GPAA refractario con y sin cataratas podría generar ahorros para el SNS (AU)
Background and objective To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. Materials and methods A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1year. The comparators considered (trabeculectomy, deep non-perforating sclerectomy, Ahmed valve, iStent inject®, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs (2021) were obtained from the ESALUD database. Result The inclusion of XEN®63 could generate savings of 2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (−423,120; −0.7%), follow-up visits (−777,407; −4.5%), additional procedures (−1,048,145; −20.6%) and post-surgery complications (−321,065; −14.2%). Conclusion The incorporation of XEN®63 in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS (AU)
Subject(s)
Humans , Glaucoma, Open-Angle/surgery , Health Care Costs , Trabeculectomy/methods , Glaucoma, Open-Angle/economics , Cataract Extraction , Trabeculectomy/economics , SpainABSTRACT
BACKGROUND AND OBJECTIVE: To evaluate the economic impact in Spain derived from the introduction of the XEN®63 implant as a surgical alternative in the management of primary open angle glaucoma (POAG) with or without cataract in refractory patients. MATERIALS AND METHODS: A budget impact analysis was designed to estimate the costs of surgical treatment of POAG from the perspective of the Spanish National Health System (NHS), over a time horizon of 1 year. The comparators considered (trabeculectomy, deep non-penetrating sclerectomy, Ahmed valve, iStent inject, Preserflo® microshunt and XEN®45) correspond to those used in Spanish public clinical practice. For the calculation of the target population, market shares and resource use in terms of follow-up visits, additional procedures and post-surgery complications, data from the literature were used and validated with a panel of 4 experts. Unit costs ( 2021) were obtained from the ESALUD database. RESULTS: The inclusion of XEN®63 could generate savings of 2,569,737 after one year since its introduction, derived from savings in the cost of the implant and procedure (-423,120; -0.7%), follow-up visits (-777,407; -4.5%), additional procedures (-1,048,145; -20.6%) and post-surgery complications (-321,065; -14.2%). CONCLUSIONS: The incorporation of XEN63®in the surgical arsenal for the treatment of refractory POAG with and without cataracts could generate savings for the NHS.
Subject(s)
Cataract , Glaucoma, Open-Angle , Trabeculectomy , Humans , Glaucoma, Open-Angle/surgery , Spain , Treatment Outcome , Cataract/complicationsABSTRACT
CASO CLÍNICO: Mujer de 27 años con proptosis del ojo derecho. Las pruebas de imagen mostraron una lesión extracónica en el tercio anterior medial de la órbita que afectaba al músculo recto interno. Se realizó exéresis del tumor con radioterapia adyuvante. El diagnóstico fue de sarcoma pleomorfo indiferenciado de alto grado. Tras 6 años de seguimiento no se ha observado recidiva. DISCUSIÓN: El sarcoma pleomorfo indiferenciado es una neoplasia maligna muy infrecuente en la región orbitaria. Tiene un rápido crecimiento local y es potencialmente metastatizante, por lo que debe hacerse estudio de extensión. El tratamiento de elección es la cirugía (AU)
CASE REPORT: A 27-year-old female presented to us with a complaint of proptosis of her right eye. Imaging tests showed an extraconal mass in the medial orbital wall, which affected the medial rectus. The tumor was removed and adjuvant radiotherapy was required. The histological examination showed an undifferentiated high-grade pleomorphic sarcoma of the orbit. There has not been recurrence after 6 years of follow-up. DISCUSSIÓN: Undifferentiated high-grade pleomorphic sarcoma is an uncommon cause of malignant orbital mass. It grows fast and can metastasize, so extension studies are required. Surgical excision is the treatment of choice (AU)
Subject(s)
Humans , Female , Exophthalmos/complications , Exophthalmos/diagnosis , Exophthalmos/surgery , Ophthalmology/instrumentation , Ophthalmology/methods , Sarcoma/diagnosisABSTRACT
CASE REPORT: A 27-year-old female presented to us with a complaint of proptosis of her right eye. Imaging tests showed an extraconal mass in the medial orbital wall, which affected the medial rectus. The tumor was removed and adjuvant radiotherapy was required. The histological examination showed an undifferentiated high-grade pleomorphic sarcoma of the orbit. There has not been recurrence after 6 years of follow-up. DISCUSSION: Undifferentiated high-grade pleomorphic sarcoma is an uncommon cause of malignant orbital mass. It grows fast and can metastasize, so extension studies are required. Surgical excision is the treatment of choice.
Subject(s)
Histiocytoma, Malignant Fibrous/pathology , Orbital Neoplasms/pathology , Adult , Female , Humans , Neoplasm GradingABSTRACT
CASE REPORT: A 15-year-old male, with no previous traumatic o surgical ocular injury, presented with a right eye proptosis and inferior displacement which began 4 months earlier. Ultrasound and CT showed a cystic lesion of 3.5 × 2 cm in the superior orbit. Surgical resection was performed by transconjunctival orbitotomy. The histopathology examination showed a cyst with nonkeratinized epithelium, and without goblet cells. After 10 years of follow-up, there have been no new lesions. DISCUSSION: Conjunctival primary orbital cysts are very uncommon. They are usually of small-moderate size; giant cysts are exceptional. Diagnosis by imaging is essential to establish the differential diagnosis and surgical treatment.
Subject(s)
Conjunctival Diseases , Cysts , Adolescent , Conjunctival Diseases/diagnosis , Conjunctival Diseases/surgery , Cysts/diagnosis , Cysts/surgery , Humans , Male , OrbitABSTRACT
Caso clínico: Varón de 15 años de edad, sin antecedente traumático o quirúrgico, que presenta proptosis con desplazamiento inferior del globo ocular derecho de cuatro meses de evolución. La ecografia y la TAC muestran una lesión quística de 3,5 × 2cm. Se reseca mediante orbitotomía transconjuntival. La histopatología muestra un quiste con un epitelio no queratinizado sin células caliciformes. Después de 10 años de evolución no ha recidivado . Discusión: Los quistes epiteliales conjuntivales primarios son muy infrecuentes. Suelen ser de pequeño-moderado tamaño; los gigantes son excepcionales. El diagnóstico por imagen es fundamental para el diagnóstico diferencial y el tratamiento quirúrgico(AU)
Case report: A 15-year-old male, with no previous traumatic o surgical ocular injury, presented with a right eye proptosis and inferior displacement which began 4 months earlier. Ultrasound and CT showed a cystic lesion of 3.5 × 2cm in the superior orbit. Surgical resection was performed by transconjunctival orbitotomy. The histopathology examination showed a cyst with nonkeratinized epithelium, and without goblet cells. After 10 years of follow-up, there have been no new lesions. Discussion: Conjunctival primary orbital cysts are very uncommon. They are usually of small-moderate size; giant cysts are exceptional. Diagnosis by imaging is essential to establish the differential diagnosis and surgical treatment(AU)
Subject(s)
Humans , Male , Adolescent , Eye Neoplasms/diagnosis , Eye Neoplasms/surgery , Exophthalmos/complications , Exophthalmos/diagnosis , Exophthalmos/surgery , Conjunctival Neoplasms/complications , Conjunctival Neoplasms/diagnosis , Orbital Neoplasms/complications , Orbital Neoplasms/diagnosis , Orbital Pseudotumor/complications , Exophthalmos/physiopathology , Exophthalmos , Conjunctival Neoplasms/physiopathology , Conjunctival Neoplasms , Orbital Neoplasms/physiopathology , Orbital NeoplasmsABSTRACT
OBJECTIVES: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. MATERIAL AND METHODS: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). RESULTS: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30 min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was "fairly or very satisfied" in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=.027) in trabeculectomy than in deep sclerectomy patients. CONCLUSIONS: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients.
Subject(s)
Anesthesia, Local/methods , Glaucoma/surgery , Job Satisfaction , Patient Satisfaction , Adult , Aged , Aged, 80 and over , Cooperative Behavior , Female , Humans , Male , Middle Aged , Prospective Studies , Tenon CapsuleABSTRACT
Objetivos: Valorar el efecto analgésico así como la colaboración y satisfacción de los pacientes en la cirugía de glaucoma con anestesia subtenoniana. Material y métodos: Estudio prospectivo no controlado. Se estudiaron datos de 53 pacientes operados de glaucoma, asociado o no a cirugía de catarata, bajo anestesia subtenoniana, valorándose de manera cualitativa la satisfacción y colaboración, así como el grado de analgesia mediante una escala numérica de 1 (no dolor) a 10 (máximo). Resultados: La calificación media del dolor ha sido: 2,13 desviación estándar (DE): 1,47 al administrar la anestesia, 1,74 DE: 1,27 durante la intervención, 1,63 DE: 1,23 en el postoperatorio inmediato, 1,38 DE: 0,38 a los 30min y 1,38 DE: 0,63 al alta. El grado de satisfacción fue «bastante o muy satisfecho» en el 92,6% de los casos, tanto para pacientes como para cirujanos. En 24 casos el paciente refirió molestias, 15 de ellos durante la sutura conjuntival, requiriendo anestesia adicional y en cuatro casos, paracetamol sistémico. La puntuación del dolor fue significativamente mayor durante la cirugía (p=0,033) y en el postoperatorio inmediato (p=0,027) en los pacientes operados de trabeculectomía que en la esclerectomía profunda no penetrante (EPNP). Conclusiones: El buen nivel analgésico conseguido favoreció un alto grado de satisfacción por parte de cirujanos y pacientes, incluso en procedimientos de larga duración como esclerectomía profunda no penetrante combinada con facoemulsificación e implantes de dispositivos de drenaje. El dolor percibido por los pacientes durante la cirugía y postoperatorio inmediato fue mayor en la trabeculectomía que en la EPNP(AU)
Objectives: To evaluate the analgesic effect as well as patient cooperation and satisfaction with sub-tenon's anesthesia in glaucoma surgery. Material and methods: Prospective uncontrolled study. Fifty-three patients who underwent glaucoma surgery, with or without cataract extraction, with sub-Tenon's anesthesia have been studied. Satisfaction and cooperation were evaluated on a qualitative scale. The pain level was quantified using a numerical scale from 1 (no pain) to 10 (unsupportable pain). Results: The mean pain score at the different periods was: 2.13 (standard deviation [SD] 1.47) on administering anesthesia, 1.74 (SD 1.27) during the surgery, 1.63 SD (1.23) immediately after the procedure, 1.38 (SD 0.38) 30min later, and 1.38 (SD 0.63) when leaving the recovery unit. The postoperative satisfaction was fairly or very satisfied in 92.6% of the cases for both the surgeons and the patients. Twenty-four patients complained during the surgery, 15 of them at the conjunctival suture; in these cases additional anesthesia was administered, and, in 4 cases, intravenous paracetamol was given. Pain scores were significatively higher during the surgery (P=.033), and immediately after the procedure (P=0.027) in trabeculectomy than in deep sclerectomy patients. Conclusions: The good analgesic level reached led to a high level of patient and surgeon satisfaction, even in longer procedures such as deep sclerectomy combined with cataract extraction, or implantation of drainage devices. Pain scores were significatively higher in trabeculectomy than in deep sclerectomy patients(AU)
Subject(s)
Humans , Glaucoma/surgery , Anesthesia/methods , Pain, Postoperative/epidemiology , Prospective Studies , Tenon Capsule , Patient Satisfaction , Cataract Extraction/methods , Phacoemulsification/methodsABSTRACT
PURPOSE: To evaluate the results and long-term complications of glaucoma drainage devices (GDD) in paediatric patients (0-15 years). METHODS: Retrospective cohort study was conducted on 17 implanted glaucoma drainage devices from July 1994 to April 2007 in 14 patients (17 eyes). In two patients (3 eyes) a Molteno GDD (MGDD) was implanted, and in 12 patients (14 eyes) an Ahmed GDD (AGDD) was used. We studied the demographic and glaucoma related patient data, as well as the probability of surgical success. The time which intraocular pressure (IOP) was controlled and the postoperative complications were also studied. RESULTS: Of the fourteen patients, 9 (64.28%) showed congenital glaucoma, and 5 (35.71%) aphakic glaucoma. The pre-aqueous drainage device median IOP was 29.82 mmHg (SD: 6.98), and 14.05 mmHg (SD: 7.57) postoperative. The median follow-up was 3.14 years (3 months-8.3 years). Success of aqueous drainage device was defined as an IOP less than 21 mmHg with or without medication on the last two follow-up visits, and without severe complications or further glaucoma surgery. Using a Kaplan Meier analysis there was success in 76%, 63% and 55% at the six months, 1-3 years and 4-8 years respectively. The GDD was a failure in 41.17%. CONCLUSIONS: GDDs are a good surgery option for refractory paediatric glaucoma when other surgery procedures have failed or have bad prognosti.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Glaucoma Drainage Implants/adverse effects , Humans , Infant , Infant, Newborn , Male , Molteno Implants/adverse effects , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
CASE REPORT: A 62-year-old man with previous renal transplant and immunosuppressive treatment presented with decreased visual acuity (20/100) in his left eye, corneal oedema and intraocular pressure of 46 mmHg. One month later an inferior marginal dendritic keratitis appeared. Corneal scraping and real-time polymerase chain reaction showed herpes simplex virus (HSV). DISCUSSION: The autoimmune corneal endotheliopathy or acute idiopathic corneal endotheliitis is characterised by corneal stromal oedema and keratic precipitates. HSV might be secreted from the trabeculum, innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal oedema usually starts from the periphery.
Subject(s)
Endophthalmitis/virology , Endothelium, Corneal , Herpesviridae Infections , Keratitis/virology , Trabecular Meshwork , Endophthalmitis/diagnosis , Endophthalmitis/drug therapy , Herpesviridae Infections/diagnosis , Herpesviridae Infections/drug therapy , Humans , Keratitis/diagnosis , Keratitis/drug therapy , Male , Middle AgedABSTRACT
Propósito: Evaluar los resultados y complicaciones a largo plazo de los dispositivos de drenaje para glaucoma (DDG) en pacientes pediátricos (0-15 años). Material y métodos: Estudio retrospectivo de cohortes de 17 DDG implantadas desde julio de 1994 hasta abril del año 2007 en 14 pacientes (17 ojos). En dos pacientes (3 ojos) se implantó un DDG de Molteno (DDGM) y en 12 pacientes (14 ojos) un DDG de Ahmed (DDGA). Se han recogido datos demográficos y relacionados con la afección glaucomatosa de cada paciente. Se ha estudiado el porcentaje de éxito de la cirugía, así como el tiempo durante el cual se ha mantenido controlada la tensión desde el implante del dispositivo y las complicaciones derivadas de este. Resultados: De los 14 pacientes, nueve (64,28%) presentaban glaucoma congénito, y cinco (35,71%) glaucoma afáquico secundario a cirugía de catarata. La media de la presión intraocular (PIO) preoperatoria fue de 29,82mmHg (DS: 6,98). La media de la PIO posquirúrgica fue de 14,05 mmHg (DS: 7,57). La media del seguimiento ha sido de 3,14 años (3 meses-8,3 años). Se ha considerado como éxito mantener, en las dos últimas revisiones, la PIO igual o por debajo de 21mmHg sin signos de progresión de glaucoma con o sin uso de fármacos hipotensores tópicos, sin necesidad de cirugías de glaucoma adicionales y sin la aparición de complicaciones devastadoras para la visión. La probabilidad acumulada de éxito según el análisis de Kaplan Meier ha sido de 76, 63 y 55% a los 6 meses, 1-3 años y 4-8 años respectivamente. El 41,17% de los DDG fracasaron (7/17). Conclusiones: Los DDG son una buena opción quirúrgica para los glaucomas refractarios pediátricos cuando otros procedimientos quirúrgicos han fracasado o tienen un mal pronóstico(AU)
Purpose: To evaluate the results and long-term complications of glaucoma drainage devices (GDD) in paediatric patients (0-15 years). Methods: Retrospective cohort study was conducted on 17 implanted glaucoma drainage devices from July 1994 to April 2007 in 14 patients (17 eyes). In two patients (3 eyes) a Molteno GDD (MGDD) was implanted, and in 12 patients (14 eyes) an Ahmed GDD (AGDD) was used. We studied the demographic and glaucoma related patient data, as well as the probability of surgical success. The time which intraocular pressure (IOP) was controlled and the postoperative complications were also studied. Results: Of the fourteen patients, 9 (64.28%) showed congenital glaucoma, and 5 (35.71%) aphakic glaucoma. The pre-aqueous drainage device median IOP was 29.82mmHg (SD: 6.98), and 14.05mmHg (SD: 7.57) postoperative. The median follow-up was 3.14 years (3 months-8.3 years). Success of aqueous drainage device was defined as an IOP less than 21mmHg with or without medication on the last two follow-up visits, and without severe complications or further glaucoma surgery. Using a Kaplan Meier analysis there was success in 76%, 63% and 55% at the six months, 1-3 years and 4-8 years respectively. The GDD was a failure in 41.17%. Conclusions: GDDs are a good surgery option for refractory paediatric glaucoma when other surgery procedures have failed or have bad prognosti(AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Glaucoma/surgery , Drainage/methods , Retrospective Studies , Cohort Studies , Cataract Extraction/adverse effects , Aphakia, Postcataract , Glaucoma/congenitalABSTRACT
Caso clínico: Varón de 62 años de edad con trasplante renal y tratamiento inmunosupresor que acude por disminución de la visión (20/100) en ojo izquierdo, edema corneal y presión intraocular de 46mmHg. Un mes después aparece queratitis dendrítica marginal inferior. El raspado corneal y la proteína C reactiva demuestran la presencia de un virus del herpes simple (HVS). Discusión: La epiteliopatía corneal autoinmunitaria o endotelitis idiopática corneal se caracteriza por edema corneal y precipitados queráticos. Se cree que el HVS podría ser secretado desde el trabeculum, inervado por el nervio trigémino, apoyado clínicamente por la progresión del edema estromal desde la periferia(AU)
Case report: A 62-year-old man with previous renal transplant and immunosuppressive treatment presented with decreased visual acuity (20/100) in his left eye, corneal oedema and intraocular pressure of 46mmHg. One month later an inferior marginal dendritic keratitis appeared. Corneal scraping and real-time polymerase chain reaction showed herpes simplex virus (HSV). Discussion: The autoimmune corneal endotheliopathy or acute idiopathic corneal endotheliitis is characterised by corneal stromal oedema and keratic precipitates. HSV might be secreted from the trabeculum, innervated by the trigeminal nerve. This hypothesis is supported by the clinical observation that the corneal stromal oedema usually starts from the periphery(AU)
Subject(s)
Humans , Male , Middle Aged , Herpes Simplex/complications , Eye Infections/diagnosis , Endothelium, Corneal/microbiology , Trabecular Meshwork/microbiologyABSTRACT
PURPOSE: To evaluate intraocular pressure (IOP) and visual acuity (VA) results after glaucoma drainage device (GDD) implantation combined with simultaneous pars plana vitrectomy (PPV). MATERIAL AND METHODS: Retrospective review of 8 eyes (7 patients). The diagnosis was neovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy in 4 eyes, in a which a double plate Molteno implant was placed, and glaucoma secondary (GS) to complicated cataract surgery in 3 eyes and penetrating trauma in one eye, in which a glaucoma Ahmed valve was implanted. RESULTS: Mean preoperative IOP was 35.77 mmHg (20-50) and 11.5 mmHg (2-20) postoperatively, and mean number hypotensive drugs was decreased from 2.33 (0-3) before surgery to 0.62 (0-3) after it. Preoperative VA in NVG was light perception or counting fingers, and it was lost in three eyes. In GS, VA before surgery was below 0.1 in all eyes, and three months after surgery mean VA was 0.42 (0.1-0.8). Mean follow-up was 10.12 months (5-27). The complications were tube obstruction in two cases, one of these presenting also a suprachoroidal hemorrage and ptisis bulbi, plate exposure in one case, and bullous keratopathy as a late complication in another eye. CONCLUSIONS: The VA and IOP were well controlled with this procedure in GS. In NVG, IOP was controlled, but visual results were poor due to complications and the underlying pathology.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Vitrectomy , Aged , Aged, 80 and over , Cataract Extraction , Choroid Hemorrhage/etiology , Corneal Diseases/etiology , Diabetic Retinopathy/complications , Equipment Failure , Eye Injuries, Penetrating/complications , Female , Glaucoma/etiology , Glaucoma, Neovascular/etiology , Glaucoma, Neovascular/surgery , Humans , Intraocular Pressure , Male , Middle Aged , Molteno Implants , Postoperative Complications/etiology , Postoperative Complications/surgery , Retrospective Studies , Treatment OutcomeABSTRACT
Objetivo: Evaluar los resultados en cuanto a control de presión intraocular (PIO) y agudezavisual (AV) tras cirugía de implante de drenaje para glaucoma (DDG) combinada con vitrectomíapars plana (VPP) simultánea.Material y métodos: Revisión retrospectiva de 8 ojos (7 pacientes). El diagnóstico era glaucomaneovascular (GNV) secundario a retinopatía diabética proliferativa en 4 ojos, en los quese colocó un implante de Molteno de doble plato, y glaucoma secundario (GS) a cirugía decatarata complicada en 3 ojos y a traumatismo penetrante en otro, en los que se usó unaválvula de Ahmed.Resultados: La PIO media pasó de 35,77 mmHg (20-50) preoperatoria a 11,5 mmHg (2-20)postoperatoria, y el número de fármacos hipotensores medio de 2,33 (0-3) preoperatorio a0,62 (0-3) postoperatorio. En los GNV, la AV preoperatoria era percepción de luz o contardedos, y se perdió en 3 ojos. En los GS era inferior a 0,1, aumentando hasta una AV mediade 0,42 (0,1-0,8) a los 3 meses. El seguimiento medio fue de 10,12 meses (5-27). Las complicacionesfueron obstrucción del tubo por fibrina en 2 casos, uno de los cuales (GNV) presentóuna hemorragia supracoroidea tras la desobstrucción y evolución a ptisis bulbi, extrusióndel reservorio en un caso, y descompensación corneal tardía en un caso.Conclusiones: En los GS los resultados han sido buenos, con mejoría de la AV y PIO controlada.En los GNV se consiguió controlar la PIO y evitar dolor, pero los resultados visualesfueron malos por la enfermedad de base(AU)
Purpose: To evaluate intraocular pressure (IOP) and visual acuity (VA) results after glaucomadrainage device (GDD) implantation combined with simultaneous pars plana vitrectomy(PPV).Material and methods: Retrospective review of 8 eyes (7 patients). The diagnosis wasneovascular glaucoma (NVG) secondary to proliferative diabetic retinopathy in 4 eyes, in awhich a double plate Molteno implant was placed, and glaucoma secondary (GS) tocomplicated cataract surgery in 3 eyes and penetrating trauma in one eye, in which aglaucoma Ahmed valve was implanted.Results: Mean preoperative IOP was 35.77 mmHg (20-50) and 11.5 mmHg (2-20) postoperatively,and mean number hypotensive drugs was decreased from 2.33 (0-3) before surgery to 0.62(0-3) after it. Preoperative VA in NVG was light perception or counting fingers, and it waslost in three eyes. In GS, VA before surgery was below 0.1 in all eyes, and three months aftersurgery mean VA was 0.42 (0.1-0.8). Mean follow-up was 10.12 months (5-27). Thecomplications were tube obstruction in two cases, one of these presenting also asuprachoroidal hemorrage and ptisis bulbi, plate exposure in one case, and bullouskeratopathy as a late complication in another eye.Conclusions: The VA and IOP were well controlled with this procedure in GS. In NVG, IOP wascontrolled, but visual results were poor due to complications and the underlyingpathology(AU)
Subject(s)
Humans , Male , Female , Aged , Glaucoma Drainage Implants , Vitrectomy , Glaucoma, Neovascular/diagnosis , Intraocular Pressure , Visual Acuity , Microscopy , Carbonic Anhydrase Inhibitors/therapeutic useABSTRACT
OBJECTIVE: To study the intermediate-term results of glaucoma drainage devices (DDG) with respect to control of intraocular pressure (IOP), control of glaucoma, and maintenance of pre-operative visual acuity. METHODS: This was a retrospective cohort study of 86 eyes in 77 patients in whom a DDG was implanted, using descriptive statistics and survival analysis. RESULTS: Success was achieved in 53 eyes (61.6%), complete (without treatment) in 34 eyes (39.5%) and qualified (needing treatment) in 19 eyes (22.1%). In the 33 eyes where the DDG treatment was unsuccessful, poor IOP control occurred in 13 eyes - (15.1%), and complications occurred in 20 eyes (23.2%) resulting in a severe reduction or loss of visual acuity (plate exposure, suprachoroidal hemorrhage, retinal detachment). IOP control was obtained in 66 eyes (76.7%), 47 of them without treatment (54.6%), although on 13 occasions the overall treatment failed due to complications occurring. Despite IOP control, glaucoma progression occurred in 7 eyes (8.1%). Preoperative vision was maintained in 46 eyes (53.5%), but decreased by 3 or more lines in 20 eyes (46.5%); bullous kerathopathy was the most frequent cause of the worsening. Loss of light perception occurred in 21 eyes (24.4%) and 4 eyes (4.6%) were eviscerated. CONCLUSIONS: DDG are an effective surgical option for control of IOP when conventional surgery has a poor prognosis, but they are associated with an increased risk of serious complications and loss of visual acuity in a significant proportion of cases.
Subject(s)
Glaucoma Drainage Implants , Glaucoma/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cohort Studies , Female , Humans , Infant , Male , Middle Aged , Retrospective Studies , Time Factors , Treatment OutcomeABSTRACT
Objetivos: Analizar los resultados a medio plazo de los dispositivos de drenaje para glaucoma (DDG) en cuanto a control de la presión intraocular (PIO), del glaucoma y del mantenimiento de la visión preoperatoria. Métodos: Estudio de cohortes retrospectivo de 86 ojos de 77 pacientes en los que se ha implantado un DDG. Se ha empleado estadística descriptiva y análisis de supervivencia. Resultados: Se han considerado como éxito 53 ojos (61,6%), completo (sin tratamiento) en 34 ojos (39,5%); y relativo (con tratamiento) en 19 ojos (22,1%). Las causas de fracaso han sido: mal control de la PIO en 13 ojos - (15,1%), y complicaciones en 20 ojos (23,2%) con reducción severa o pérdida de visión (extrusión del reservorio, hemorragia supracoroidea, desprendimiento de retina). Se ha obtenido control de la PIO en 66 ojos (76,7%), en 47 de ellos sin tratamiento (54,6%), aunque 13 de estos han sido fracasos por complicaciones. A pesar del control de la PIO, en siete ojos (8,1%) se ha observado progresión del glaucoma. En cuanto a la visión, en 46 ojos (53,5%) se ha mantenido estable y en 40 ha disminuido 3 o más líneas (46,5%), siendo la causa más frecuente la descompensación correvisioneal. En 21 ojos (24,4%) se ha perdido la percepción de la luz, y cuatro ojos (4,6%) han sido eviscerados. Discusión: Los DDG son una opción quirúrgica eficaz para el control de la PIO en ojos con mal pronóstico para la cirugía convencional de glaucoma, pero presentan complicaciones graves y deterioro visual en un porcentaje elevado de casos
Objective: To study the intermediate-term results of glaucoma drainage devices (DDG) with respect to control of intraocular pressure (IOP), control of glaucoma, and maintenance of pre-operative visual acuity. Methods: This was a retrospective cohort study of 86 eyes in 77 patients in whom a DDG was implanted, using descriptive statistics and survival analysis. Results: Success was achieved in 53 eyes (61.6%), complete (without treatment) in 34 eyes (39.5%) and qualified (needing treatment) in 19 eyes (22.1%). In the 33 eyes where the DDG treatment was unsuccessful, poor IOP control occurred in 13 eyes - (15.1%), and complications occurred in 20 eyes (23.2%) resulting in a severe reduction or loss of visual acuity (plate exposure, suprachoroidal hemorrhage, retinal detachment). IOP control was obtained in 66 eyes (76.7%), 47 of them without treatment (54.6%), although on 13 occasions the overall treatment failed due to complications occurring. Despite IOP control, glaucoma progression occurred in 7 eyes (8.1%). Preoperative vision was maintained in 46 eyes (53.5%), but decreased by 3 or more lines in 20 eyes (46.5%); bullous kerathopathy was the most frequent cause of the worsening. Loss of light perception occurred in 21 eyes (24.4%) and 4 eyes (4.6%) were eviscerated. Conclusions: DDG are an effective surgical option for control of IOP when conventional surgery has a poor prognosis, but they are associated with an increased risk of serious complications and loss of visual acuity in a significant proportion of cases
Subject(s)
Humans , Glaucoma/surgery , Glaucoma Drainage Implants , Retrospective Studies , Treatment Outcome , Intraocular PressureABSTRACT
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Subject(s)
Humans , Filtering Surgery , Fluorouracil/therapeutic use , Glaucoma/surgery , Mitomycin/therapeutic use , Fluorouracil/administration & dosage , Fluorouracil/adverse effects , Mitomycin/administration & dosage , Punctures , Treatment FailureABSTRACT
Caso clínico: Presentamos un paciente varón de 56 años de edad con un exoftalmos maligno en el contexto de una enfermedad de Graves, que sufrió un claro empeoramiento coincidiendo con su entrada en crisis hipotiroidea, con una evolución tórpida, que requirió de distintas medidas terapéuticas para la reducción de la proptosis. Discusión: En el manejo de este tipo de pacientes hay que tener en cuenta si cumplen o no criterios de gravedad y/o actividad para aplicar las distintas opciones terapéuticas en el momento preciso
Case report: We present the case of a 56-year-old male with a malignant exophthalmos in the context of Graves disease. He suffered a significant worsening coincident with a hypothyroid crisis, and various therapeutic approaches were required for reduction of the proptosis. Discussion: When managing this condition, both the severity of the exophthalmos and the activity of the thyroid must be considered when choosing which of the different therapeutic approaches should be employed
