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1.
Ophthalmologe ; 117(3): 190-198, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32076840

RESUMO

A congenital cataract is a rare disorder, which is associated with a high risk of amblyopia. Ophthalmologists are faced with many diagnostic and surgical challenges in the management of this disease. Older children can undergo primary treatment with an intraocular lens, whereas children younger than 12 months of age usually initially remain aphakic. The most frequent long-term complication of aphakic eyes following congenital cataract surgery in connection with posterior capsulorrhexis and anterior vitrectomy is aphakic glaucoma, which in individual cases can lead to substantial impairment of vision. Many factors have been reported to increase the risk of postoperative glaucoma, including microphthalmos, fetal nuclear cataract, conspicuous family history and associated ocular malformations, such as persistent fetal vasculature (PFV). Cataract surgery during early infancy is well-established to be the most important factor for the formation of postoperative aphakic glaucoma. In individual treatment planning it has to be considered that although younger age at the time of cataract removal can provide better prerequisites for prophylaxis of amblyopia, it also confers a higher risk of development of aphakic glaucoma. Children undergoing congenital cataract surgery have to be regularly monitored given the lifelong risk for postoperative complications, such as aphakic glaucoma.


Assuntos
Ambliopia , Extração de Catarata , Catarata , Glaucoma , Vítreo Primário Hiperplásico Persistente , Ambliopia/cirurgia , Criança , Seguimentos , Glaucoma/cirurgia , Humanos , Lactente , Complicações Pós-Operatórias , Estudos Retrospectivos
2.
Medicine (Baltimore) ; 99(6): e18836, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32028394

RESUMO

RATIONALE: Malignant glaucoma is a refractory glaucoma which often relentlessly worsened despite conventional therapy. Ultrasonographic biomicroscopy always cannot show the ciliary-block of malignant glaucoma. We report a case of capsular tension ring induced ciliary-block and successfully treated by low dose laser cyclophotocoagulation, with 1-year follow-up. PATIENT CONCERNS: A 75-year-old woman was referred for glaucoma with a history of cataract and lens zonular laxity, and surgery with combined phacoemulsification and capsular tension ring implantation. She subsequently underwent trabeculectomy for uncontrolled intraocular pressure on maximal medical therapy. One day later, the patient presented as shallow anterior chamber of Shaffer grade 1 and an elevated intraocular pressure of 51.0 mmHg in the right eye. DIAGNOSIS: Ciliary block caused by capsular tension ring and malignant glaucoma was observed. INTERVENTIONS: Low dose laser cyclophotocoagulation was performed under retrobulbar anesthesia. OUTCOMES: One day later, the patient's intraocular pressure decreased to 14.3 mmHg on topical atropine 1% and 2 classes of intraocular pressure lowering medications. The patient discontinued topical atropine and intraocular pressure lowering medications 4 months postoperatively and her condition had remained stable for 1 year without any medications. The patient had a satisfactory recovery benefited from the low dose laser cyclophotocoagulation. LESSONS: Low dose laser cyclophotocoagulation in this challenging case of capsular tension ring-induced malignant glaucoma provided an effective and fast recovery of anterior chamber depth over a 1-year period.


Assuntos
Corpo Ciliar/cirurgia , Glaucoma/diagnóstico , Idoso , Diagnóstico Diferencial , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Fotocoagulação a Laser , Procedimentos Cirúrgicos Oftalmológicos
3.
Medicine (Baltimore) ; 99(7): e18637, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049779

RESUMO

RATIONALE: To report a case of diode laser transscleral cyclophotocoagulation (DLTSC) for uveitis-glaucoma-hyphema syndrome (UGH). PATIENT CONCERNS: The patient developed UGH on the right eye (OD) after vitrectomy and intraocular lens (IOL) implantation. DIAGNOSES: Best corrected visual acuity (BCVA) was HM/50 cm, intraocular pressure (IOP) was 51.3 mm Hg on the OD. He was found to have 3+ anterior chamber cells. A B-scan ultrasound showed vitreous opacity. Ultrasound biomicroscopy (UBM) showed the chafing between the IOL and the posterior surface of the iris. Thus, he was diagnosed as UGH on the OD. INTERVENTIONS: The patient was worried about the complications for removal of the IOL, a DLTSC approach was performed. OUTCOMES: BCVA was 20/40 on the OD, IOP was 12 mm Hg on the OD. There were no anterior chamber inflammation and no vitreous opacity. UBM showed there was no contact between IOL and the posterior surface of the iris, the fundus of the eye was clearly visible. LESSONS: UGH syndrome is a severe complication of cataract extraction. IOL extraction has been the traditional approach to treatment. DLTSC can be an option when the IOL is slightly tilted.


Assuntos
Glaucoma/cirurgia , Hifema/cirurgia , Fotocoagulação a Laser/métodos , Uveíte/cirurgia , Extração de Catarata/efeitos adversos , Glaucoma/etiologia , Humanos , Hifema/etiologia , Lasers Semicondutores , Implante de Lente Intraocular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Uveíte/etiologia , Vitrectomia/efeitos adversos
4.
Zhonghua Yan Ke Za Zhi ; 56(1): 13-16, 2020 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-31937058

RESUMO

Glaucoma surgery is one of the main methods of glaucoma treatment. In recent years, glaucoma surgery has been greatly developed. Minimally invasive surgical procedures for glaucoma have emerged. Patients and surgeons have also increased their expectations of surgery. However, due to the limitation of surgical controllability, the prediction of postoperative efficacy is still not satisfactory. By analyzing the principles and limitations of the existing surgical procedures, the authors put forward the premise of the controllability of glaucoma extrafiltration surgery as that the intraoperative filtration excess can be restricted, so as to effectively avoid the early postoperative complications such as shallow anterior chamber, hypotony and strong inflammation. And within 1 month after surgery, through the filtration of the bubble and the removal of the adjustable suture, the ideal filtration state is gradually achieved. With the controllable maintenance of intraocular pressure at 1 month after surgery, it is possible to effectively predict the intraocular pressure level of 2 years or longer. (Chin J Ophthalmol, 2020, 56: 13-16).


Assuntos
Cirurgia Filtrante/métodos , Glaucoma/cirurgia , Pressão Intraocular , Glaucoma/diagnóstico , Humanos , Implante de Lente Intraocular , Facoemulsificação , Complicações Pós-Operatórias , Suturas , Tonometria Ocular , Resultado do Tratamento
5.
Zhonghua Yan Ke Za Zhi ; 56(1): 66-70, 2020 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-31937066

RESUMO

In recent years, with the improvement of high-intensity focused ultrasound technology, ultrasound cycloplasty has once again gained clinical recognition, becoming one of the non-invasive procedures for glaucoma treatment. Although high-level evidence is still lacking so far, the existing literature has shown that ultrasound cycloplasty can effectively and safely decreases the intraocular pressure in glaucoma by reducing the formation of aqueous humor and increasing the drainage of aqueous humor through the uveoscleral pathway. This article focuses on the efficacy and safety of ultrasound cycloplasty in the treatment of glaucoma, reviews the existing literature, and summarizes the information on the development of equipment, treatment mechanisms, surgical procedures, effectiveness of intraocular pressure reduction, and post-operative complications, with the purpose to provide reference for clinical research and application. (Chin J Ophthalmol, 2020, 56: 66-70).


Assuntos
Corpo Ciliar/cirurgia , Glaucoma/cirurgia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Pressão Intraocular/fisiologia , Humor Aquoso , Glaucoma/diagnóstico , Humanos , Tonometria Ocular , Resultado do Tratamento , Terapia por Ultrassom , Acuidade Visual
6.
Medicine (Baltimore) ; 99(2): e18652, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914050

RESUMO

RATIONALE: Choroidal detachment is a major postoperative complication of trabeculectomy. Postoperative choroidal detachment occurs with low intraocular pressure (IOP), and is naturally resolved by elevation of IOP. We report a case of chronic chorioretinal detachment (CRD) in the eye with uveitic glaucoma after trabeculectomy which persisted with normal IOP resistant for medication and required surgery. PATIENT CONCERNS: A 63-year-old man was referred to our department with uncontrolled uveitic glaucoma in his right eye. At first presentation, IOP was 62 mm Hg in the right eye with opened angle, and active ocular inflammation was presented by moderate cell infiltration to the anterior chamber. DIAGNOSIS: Uveitic glaucoma. INTERVENTIONS: Trabeculectomy with mitomycin-C combined with phacoemulsification were performed without any surgical trouble. Postoperative inflammation in the anterior segment was mild, and IOP decreased to the middle-teen. OUTCOMES: At 19 days after surgery, the depth of the anterior chamber changed to shallow and CRD occurred in the inferior quadrant area. This complication could not be resolved by additional systemic corticosteroid medication and scleral fenestration. Although IOP was maintained in middle-teen range, suture fixation of the sclera flap and additional scleral fenestration were necessary to resolve CRD at 191 days after primary surgery. LESSONS: In uveitic eye with uncontrolled ocular hypertension, severe CRD after trabeculectomy is able to occur even with normal IOP, which requires surgical procedure in addition to the medical treatment.


Assuntos
Efusões Coroides/etiologia , Glaucoma/cirurgia , Trabeculectomia/efeitos adversos , Antibióticos Antineoplásicos/uso terapêutico , Doença Crônica , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Mitomicina/uso terapêutico , Hipotensão Ocular/etiologia , Facoemulsificação/métodos , Trabeculectomia/métodos
7.
Curr Opin Ophthalmol ; 31(2): 114-122, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31922978

RESUMO

PURPOSE OF REVIEW: Glaucoma management during pregnancy is a complex challenge, which requires balancing the clinical disease of the mother with the potential risks of therapy to the developing child. Because systematic studies are lacking in the pregnant population, this review aims to collect the array of available data from observational studies and case reports to provide the reader with guidance and context for the safety of glaucoma interventions during pregnancy. RECENT FINDINGS: Surgical glaucoma is a rapidly expanding field with many new technologies and procedures. We review the surgical options for the gravid patient with reference to traditional procedures like trabeculectomy and tube-shunts, and newer MIGS procedures. When indicated, orphan trabeculectomy, or with collagen matrix implant may be a viable solution for severe glaucoma during pregnancy. Newer MIGS procedures such as the gelatin stent may also provide minimally invasive options for pregnant patients. Two new medications, Vyzulta and Rhopressa, were recently released in 2018 and have limited data to support their safety for use during pregnancy. SUMMARY: The careful consideration of fetal health in the management of glaucoma during pregnancy is best done as a part of a multidisciplinary team including obstetrics and neonatology. When medication is necessary, steps to minimize systemic absorption should be employed. Surgical management should not be excluded for pregnant patients and may be considered before medical management in some cases to prevent fetal exposures and maternal harm.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Complicações na Gravidez , Stents , Trabeculectomia , Feminino , Humanos , Pressão Intraocular/fisiologia , Equipe de Assistência ao Paciente , Gravidez
8.
Curr Opin Ophthalmol ; 31(2): 132-138, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31922979

RESUMO

PURPOSE OF REVIEW: This review will provide an update on surgical techniques, outcomes, and complications for two new translimbal bleb-forming surgical glaucoma devices. RECENT FINDINGS: The XEN Gel Microstent and PreserFlo MicroShunt comprise a category of subconjunctival microinvasive glaucoma surgery developed with the aim of improving the predictability and safety profile of bleb-forming procedures. Both devices are made of noninflammatory material which limits postsurgical inflammation and scarring and have a valve-less intrinsic flow-limiting design, which decreases the risk of hypotony. There are various techniques of implantation for the XEN Gel Microstent each with their own advantages and disadvantages. SUMMARY: These devices have demonstrated promising outcomes in early experimental literature with similar intraocular pressure-lowering effects to traditional incisional surgery such as trabeculectomy or tube shunt surgery, but with fewer risks. Future randomized, prospective studies should be done to compare these gel stents and microshunts both to each other and to other traditional glaucoma surgeries.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Stents , Túnica Conjuntiva/cirurgia , Glaucoma/fisiopatologia , Humanos , Pressão Intraocular/fisiologia , Implantação de Prótese , Tonometria Ocular , Trabeculectomia
9.
Nat Genet ; 52(2): 160-166, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31959993

RESUMO

Glaucoma, a disease characterized by progressive optic nerve degeneration, can be prevented through timely diagnosis and treatment. We characterize optic nerve photographs of 67,040 UK Biobank participants and use a multitrait genetic model to identify risk loci for glaucoma. A glaucoma polygenic risk score (PRS) enables effective risk stratification in unselected glaucoma cases and modifies penetrance of the MYOC variant encoding p.Gln368Ter, the most common glaucoma-associated myocilin variant. In the unselected glaucoma population, individuals in the top PRS decile reach an absolute risk for glaucoma 10 years earlier than the bottom decile and are at 15-fold increased risk of developing advanced glaucoma (top 10% versus remaining 90%, odds ratio = 4.20). The PRS predicts glaucoma progression in prospectively monitored, early manifest glaucoma cases (P = 0.004) and surgical intervention in advanced disease (P = 3.6 × 10-6). This glaucoma PRS will facilitate the development of a personalized approach for earlier treatment of high-risk individuals, with less intensive monitoring and treatment being possible for lower-risk groups.


Assuntos
Glaucoma/genética , Polimorfismo de Nucleotídeo Único , Austrália , Estudos de Casos e Controles , Proteínas do Citoesqueleto/genética , Progressão da Doença , Proteínas do Olho/genética , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Glaucoma/etiologia , Glaucoma/cirurgia , Glicoproteínas/genética , Humanos , Pressão Intraocular/genética , Herança Multifatorial , Razão de Chances , Nervo Óptico/fisiologia , Penetrância , Trabeculectomia/efeitos adversos , Reino Unido , Estados Unidos
10.
Eur J Ophthalmol ; 30(1): 168-174, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30563364

RESUMO

PURPOSE: To report on the clinical presentation and surgical treatment (procedure and outcome(s)) of glaucoma in children with facial port wine stain. MATERIALS AND METHODS: This is a retrospective chart review of children with facial port wine stain referred to Alexandria University paediatric ophthalmology practice from 2005 to 2016. The charts of 22 children (44 eyes) with facial port wine stain were reviewed. The data extracted included demographics, results of ophthalmic examination findings and treatment(s). The main outcome measures were the number of eyes stratified as glaucoma, glaucoma suspects and no glaucoma at the initial and final presentations. RESULTS: The average age of presentation was 18.2 (±33.9) months. After a follow-up of over 16.1 (±24.8) months, there were 34%, 30% and 36% of the study eyes diagnosed as glaucoma, glaucoma suspects and no glaucoma, respectively with mean ± standard deviation of intraocular pressure of 20.6 ± 5.1, 13.6 ± 5.4 and 7.5 ± 1.7 mmHg. The majority (91%) of eyes presenting with glaucoma had clear corneas. In total, 11 eyes were operated upon for glaucoma. The recorded success rate was 91%. Two eyes developed a postoperative exudative choroidal detachment, of which one resolved spontaneously and the other was successfully managed by intravitreal gas injection. CONCLUSION: Glaucoma is a significant ocular hazard in children with facial port wine stain that may not be evident on the initial presentation. The presentation is usually with a clear cornea and surgical intervention is associated with a high success rate and a low rate of complications.


Assuntos
Glaucoma/complicações , Mancha Vinho do Porto/complicações , Síndrome de Sturge-Weber/complicações , Criança , Pré-Escolar , Feminino , Glaucoma/diagnóstico , Glaucoma/cirurgia , Humanos , Lactente , Pressão Intraocular/fisiologia , Injeções Intravítreas , Masculino , Hipertensão Ocular/complicações , Hipertensão Ocular/diagnóstico , Hipertensão Ocular/cirurgia , Período Pós-Operatório , Estudos Retrospectivos , Tonometria Ocular , Trabeculectomia/métodos
11.
Eur J Ophthalmol ; 30(1): 217-220, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30862191

RESUMO

PURPOSE: Over-filtration and subsequent hypotony are recognised complications of penetrating glaucoma procedures, especially when augmented with antimetabolites. Patients with uveitis are especially at risk of hypotony and this can reduce the final acuity achieved, compromise surgical outcomes and adversely affect the inflammatory status. The incidence of hypotony following XEN45 implant insertion is higher for uveitic patients and we present a method of surgically addressing this hypotony with transconjunctival compression sutures that are placed over the overdraining XEN45 implant. METHODS: We present a retrospective case series of consecutive uveitic glaucoma patients who had conjunctival compression sutures between 2015 and 2018 following XEN45 insertion, at the Manchester Royal Eye Hospital, UK. Two 9/0 nylon sutures were placed in a horizontal figure-of-eight conformation transconjunctivally across the overdraining bleb: one directly over the XEN45 implant and one at the posterior limit of the implant in order to restrict flow. RESULTS: Three patients underwent conjunctival compression sutures following XEN45 implant-related hypotony and all three had successful resolution of their hypotony and visual symptoms. No patients required long-term topical agents to control their intraocular pressure. CONCLUSION: Conjunctival compression sutures are an effective option for addressing persistent hypotony following XEN45 implant insertion in patients with uveitic glaucoma.


Assuntos
Túnica Conjuntiva/cirurgia , Implantes para Drenagem de Glaucoma/efeitos adversos , Glaucoma/cirurgia , Hipotensão Ocular/cirurgia , Técnicas de Sutura , Uveíte/cirurgia , Adulto , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Hipotensão Ocular/etiologia , Hipotensão Ocular/fisiopatologia , Complicações Pós-Operatórias , Estudos Retrospectivos , Suturas , Tonometria Ocular , Trabeculectomia/métodos
12.
Eur J Ophthalmol ; 30(1): 212-216, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30832506

RESUMO

A new technique of correcting tube-corneal touch is described in a case of Ahmed glaucoma valve implantation. This technique repositions the intracameral tube without externalization unlike the standard procedures which aim to correct tube-corneal touch. The technique makes use of a transscleral supracapsular anchor suture to facilitate repositioning of the tube within the ciliary sulcus. Feasible only in pseudophakic and aphakic patients, either a preexisting iridectomy or intraoperative iridectomy is an essential prerequisite to perform this procedure. The final positioning of the tube within the sulcus potentially prevents chronic rubbing of the iris by polypropylene suture as opposed to a transcameral suture.


Assuntos
Epitélio Posterior/patologia , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Falha de Prótese/etiologia , Implantação de Prótese/métodos , Tato , Afacia Pós-Catarata/etiologia , Afacia Pós-Catarata/cirurgia , Pré-Escolar , Glaucoma/etiologia , Humanos , Pressão Intraocular , Masculino , Reoperação , Retalhos Cirúrgicos , Técnicas de Sutura
13.
Eur J Ophthalmol ; 30(1): 162-167, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30301386

RESUMO

PURPOSE: To analyze the risk factors associated with early and late failure after goniotomy for primary pediatric glaucoma. METHODS: A retrospective study was done on infants who underwent goniotomy as the initial surgical procedure for primary pediatric glaucoma, and had a follow-up period ⩾48 months after surgery. Early and late failures were defined as intraocular pressure ⩾18 mmHg or signs of glaucoma progression before and after the end of first year, respectively. RESULTS: A total of 81 eyes of 47 children were included. The mean age at the time of surgery was 6.1 ± 6.7 months, 34 children (72.3%) were bilateral. The mean follow-up was 5.9 ± 2.8 years. Of the included eyes, 41 eyes (50.6%) showed success, 25 eyes (30.9%) showed an early failure, and 15 eyes (18.5%) showed a late failure. The mean survival time was 43 months. However, only surgery before the end of the first month and positive consanguinity of the parents (P < 0.01 for both) were independent risk factors for early and late failure of goniotomy for primary pediatric glaucoma. Patients with late failure showed a statistically significant lower preoperative intraocular pressure (P = 0.02). A larger preoperative corneal diameter and a male gender were associated with higher but statistically insignificant failure rates. There were no differences in the early or late failure rates between unilateral and bilateral cases. CONCLUSION: A positive consanguinity of the parents and surgery before the end of the first month are the major predictors of failure of goniotomy.


Assuntos
Previsões , Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Complicações Pós-Operatórias/diagnóstico , Trabeculectomia/efeitos adversos , Pré-Escolar , Feminino , Seguimentos , Glaucoma/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Tonometria Ocular , Resultado do Tratamento
14.
Int J Med Inform ; 133: 104007, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31706228

RESUMO

OBJECTIVE: Comprehensive analysis of ophthalmic surgical outcomes is often restricted by limited methodologies for efficiently and accurately extracting clinical information from electronic health record (EHR) systems because much is in free-text form. This study aims to utilize advanced methods to automate extraction of clinical concepts from the EHR free text to study visual acuity (VA), intraocular pressure (IOP), and medication outcomes of cataract and glaucoma surgeries. METHODS: Patients who underwent cataract or glaucoma surgery at an academic medical center between 2009 and 2018 were identified by Current Procedural Terminology codes. Rule-based algorithms were developed and used on EHR clinical narrative text to extract intraocular lens (IOL) power and implant type, as well as to create a surgery laterality classifier. MedEx (version 1.3.7) was used on free-text clinical notes to extract information on eye medications and compared to information from medication orders. Random samples of free-text notes were reviewed by two independent masked annotators to assess inter-annotator agreement on outcome variable classification and accuracy of classifiers. VA and IOP were available from semi-structured fields. RESULTS: This study cohort included 6347 unique patients, with 8550 stand-alone cataract surgeries, 451 combined cataract/glaucoma surgeries, and 961 glaucoma surgeries without concurrent cataract surgery. The rule-based laterality classifier achieved 100% accuracy compared to manual review of a sample of operative notes by independent masked annotators. For cataract surgery alone, glaucoma surgery alone, or combined cataract/glaucoma surgeries, our automated extraction algorithm achieved 99-100% accuracy compared to manual annotation of samples of notes from each group, including IOL model and IOL power for cataract surgeries, and glaucoma implant for glaucoma surgeries. For glaucoma medications, there was 90.7% inter-annotator agreement. After adjudication, 85.0% of medications identified by MedEx determined to be correct. Determination of surgical laterality enabled evaluation of pre- and postoperative VA and IOP for operative eyes. CONCLUSION: This text-processing pipeline can accurately capture surgical laterality and implant model usage from free-text operative notes of cataract and glaucoma surgeries, enabling extraction of clinical outcomes including visual acuities, intraocular pressure, and medications from the EHR system. Use of this approach with EHRs to assess ophthalmic surgical outcomes can benefit research groups interested in studying the safety and clinical efficacies of different surgical approaches.


Assuntos
Registros Eletrônicos de Saúde , Procedimentos Cirúrgicos Oftalmológicos , Idoso , Idoso de 80 Anos ou mais , Catarata , Extração de Catarata , Feminino , Glaucoma/cirurgia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Acuidade Visual
15.
J Vet Emerg Crit Care (San Antonio) ; 30(1): 74-80, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31883205

RESUMO

OBJECTIVE: To describe the treatment and clinical course of a dog accidentally prescribed 10 times the recommended dose of colchicine (0.3 mg/kg/d instead of 0.03 mg/kg/d). CASE SUMMARY: After glaucoma surgery, a 1-year-old male neutered Pomeranian weighing 6.8 kg was prescribed 1,000 µg colchicine twice a day per os. The dog presented to the emergency department after the first dose with vomiting and was treated as an outpatient. Two colchicine doses later, the dog represented with vomiting, ocular pain, and increased intraocular pressure. The dog's vital signs were normal, and the dog was admitted for rehydration, analgesia, and revision glaucoma surgery the next day. Two hours after revision surgery, the dog developed vomiting and diarrhea. Postoperatively, the dog was hypothermic (36.3°C), persistently hypertensive (227 mm Hg), and bradycardic (60/min). Biochemistry revealed metabolic acidosis and increased hepatic enzyme activities. Mannitol was administered for presumed cerebral edema. Later, the dog developed bradycardia due to second-degree atrioventricular heart block, which responded to atropine. Total hospitalization was 9 days. Treatment included IV fluids, IV lipid emulsion, N-acetylcysteine, activated charcoal, gastroprotectants, antiemetics, opioids, antimicrobials, and barrier nursing due to transient neutropenia. NEW OR UNIQUE INFORMATION PROVIDED: This is the first report to describe the successful treatment of a dog with colchicine overdose. The systemic effects were presumed to be secondary to colchicine toxicosis rather than diet, infection, or other drug reaction, and may have been compounded by a second anesthetic episode. Gastrointestinal signs, symptoms of cerebral edema, cardiac arrhythmias, and neutropenia were documented. One other report of colchicine overdose in a dog exists, and that patient was euthanized. This report demonstrates that complete recovery with intensive care is possible; however, the prognosis remains guarded.


Assuntos
Colchicina/envenenamento , Doenças do Cão/diagnóstico , Animais , Bradicardia/etiologia , Bradicardia/veterinária , Carvão Vegetal/uso terapêutico , Cuidados Críticos , Diarreia/etiologia , Diarreia/veterinária , Doenças do Cão/sangue , Doenças do Cão/terapia , Cães , Overdose de Drogas/complicações , Overdose de Drogas/veterinária , Hidratação/veterinária , Glaucoma/cirurgia , Glaucoma/veterinária , Masculino , Complicações Pós-Operatórias/veterinária , Vômito/etiologia , Vômito/veterinária
16.
Int J Mol Sci ; 21(1)2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31861830

RESUMO

Regorafenib eye drops were developed for treating age-related macular degeneration. This study aimed to investigate the effects of this multi-kinase inhibitor on intraocular pressure (IOP), bleb formation, and conjunctival changes in a canine filtration surgery model. Glaucoma filtration surgery models were created in 24 eyes of 24 beagles. In experiment 1 (Ex 1), regorafenib eye drops (regorafenib group: n = 6) or a vehicle (control group, n = 6) were instilled twice daily for 4 weeks postoperatively. In experiment 2 (Ex 2), regorafenib eye drops were instilled as in Ex 1 (regorafenib group: n = 6) for 12 weeks while conventional intraoperative mitomycin-C (MMC) was utilized (MMC group: n = 6), In Ex 1, only the regorafenib group showed significant IOP reduction with a significantly higher bleb score. Subconjunctival area, collagen density, vessels, and cells showing proliferation and differentiation were lower in subconjunctival tissue in the regorafenib group. In Ex 2, no significant difference was found in IOP reduction and bleb formation between the regorafenib and MMC groups; bleb walls were significantly thicker and collagen density and vessels were higher in the regorafenib group; and no differences were observed in the above-mentioned cells. Thus, regorafenib might be a better alternative to MMC for creating thicker and less ischemic blebs in glaucoma filtration surgery.


Assuntos
Antimetabólitos/uso terapêutico , Glaucoma/cirurgia , Mitomicina/uso terapêutico , Compostos de Fenilureia/uso terapêutico , Inibidores de Proteínas Quinases/uso terapêutico , Piridinas/uso terapêutico , Animais , Túnica Conjuntiva/efeitos dos fármacos , Túnica Conjuntiva/patologia , Modelos Animais de Doenças , Cães , Cirurgia Filtrante/métodos , Glaucoma/tratamento farmacológico , Glaucoma/patologia , Pressão Intraocular/efeitos dos fármacos
17.
Medicine (Baltimore) ; 98(48): e18123, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770242

RESUMO

This retrospective observational study aims to report the clinical characteristics and surgical results in eyes with Posner-Schlossman syndrome (PSS), and compare these outcomes between cytomegalovirus (CMV)-positive and -negative eyes.We reviewed the medical records of 21 consecutive immunocompetent patients clinically diagnosed with PSS between the years 2010 and 2018. Aqueous humor was collected from all the affected eyes to detect if CMV was present, and polymerase chain reaction (PCR) was performed using the herpesvirus family primers.The average period between the initial PSS attack and aqueous humor sampling at our institute was 9.3 years. Out of the 21 patients, 62% were CMV-positive. Regardless of CMV status, the mean intraocular pressure (IOP), mean deviation (MD), and central corneal endothelium cell (CEC) density, at the initial examination at our institute were already significantly worse in the affected eyes than in the unaffected eyes (all P values < .05). The average visual acuity (VA) was only significantly worse in the CMV-positive group (P = .02). Out of all the patients, those that were CMV-positive had undergone more glaucoma surgeries (P = .056). Fourteen patients underwent either a trabeculectomy (TRAB) or a trabeculotomy (LOT), and their IOP significantly reduced following surgery (P < .001). In 85.7% of those that had surgery, their IOP was successfully lowered to less than 20 mm Hg.Long-lasting PSS causes a decrease in VA, MD, and the CEC density. A prompt diagnosis is required, and an appropriate treatment plan should be formulated. In those patients with PSS that develop uncontrolled glaucoma, both TRAB and LOT may be effective in controlling IOP.


Assuntos
Infecções por Citomegalovirus/cirurgia , Citomegalovirus , Infecções Oculares Virais/cirurgia , Hipertensão Ocular/cirurgia , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Uveíte Anterior/cirurgia , Infecções por Citomegalovirus/virologia , Epitélio Anterior/cirurgia , Epitélio Anterior/virologia , Infecções Oculares Virais/virologia , Feminino , Glaucoma/cirurgia , Glaucoma/virologia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/virologia , Procedimentos Cirúrgicos Oftalmológicos/métodos , Estudos Retrospectivos , Síndrome , Trabeculectomia , Resultado do Tratamento , Uveíte Anterior/virologia
18.
Rom J Ophthalmol ; 63(3): 268-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687630

RESUMO

Purpose. To report a case of malignant glaucoma in a pseudophakic female patient, with no history of glaucoma, resolved through pars plana anterior vitrectomy. Case presentation. An 80-year-old female patient presented in our Emergency Department after a five-day history of pain in her left eye (LE). In the last day, the patient noticed marked visual loss and ocular pain. Visual acuity was light perception and Goldman tonometry was 80 mmHg in her LE. The biomicroscopy revealed absent peripheral and central anterior chamber (AC) and posterior chamber (PC) pseudophakia. Posterior segment ecography showed no vitreous or choroidal abnormalities. A peripheral laser YAG iridotomy was made and the patient was treated with intravenous 20% mannitol, topical timolol, topical brimonidine, and topical cycloplegics. 12 hours later, despite a patent iridotomy in the LE eye, intraocular pressure (IOP) was 55 mmHg, absent AC with severe corneal edema. The diagnosis of pseudophakic malignant glaucoma was made and laser YAG capsulotomy was performed with no resolution of symptoms and signs. 24 hours later, we performed pars plana anterior vitrectomy. Postoperatively, the AC depth increased and the IOP decreased to 20mmHg. After a week, the patient was discharged with hand movement perception visual acuity in her LE, 20 mmHg IOP, reduced corneal edema, normal depth AC. After a month, the corneal edema resolved, the visual acuity was 2/50, IOP was 20mmHg, and the AC had a normal depth. Conclusion. Malignant glaucoma is a sight threatening condition, reported in pseudophakic eyes. Although, literature describes cases solved by cycloplegics and laser YAG capsulotomy, our patient needed pars plana anterior vitrectomy for the resolution of symptoms and signs.


Assuntos
Glaucoma/cirurgia , Pressão Intraocular/fisiologia , Terapia a Laser/métodos , Pseudofacia/cirurgia , Acuidade Visual , Vitrectomia/métodos , Idoso de 80 Anos ou mais , Feminino , Glaucoma/complicações , Glaucoma/diagnóstico , Humanos , Pseudofacia/complicações , Pseudofacia/diagnóstico , Lâmpada de Fenda
19.
Niger J Clin Pract ; 22(11): 1606-1610, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31719284

RESUMO

Aims: To review the trends in glaucoma procedural treatments from January 2009 to December 2017. Methodology: A retrospective search was carried out from the operating theater and laser room records of the Eye Foundation Hospitals in Lagos, Abuja, and Ijebu-Imushin. Consecutive glaucoma procedures for each year from January 2009 to December 2017 were recorded in the data sheet prepared for the study. Data were analyzed using SPSS version 25. Results: From 2009 to 2017, trabeculectomy had been decreasing in frequency from 117 to 65 (44%), except for 2015. The frequency of use of glaucoma drainage device (GDD) has been steadily increasing from 1 in 2013 to 26 in 2017, but this is not statistically significant. The frequency of cataract extraction with trabeculectomy reduced drastically from 20 in 2009 to 3 (566%) in 2014. Bleb review (BR) increased from 2 in 2009 to 18 (800%) in 2015, however, it dropped to 6 in 2017 (66%). Among the laser procedures, transscleral cyclophotocoagulation (g-probe) is commonly done. It increased from 40 procedures in 2009 to 98 in 2014 (145%). There has been an increase in laser trabeculoplasty from 15 in 2009 to 44 in 2013 (193%). Laser iridotomy increased from 12 in 2009 to 26 in 2015 (116%). From 2009 to 2015, there was an increase in glaucoma procedures and surgeries - 206 to 325 (58%) but this declined by 27% from 2015 to 2017. Conclusion: Trabeculectomy is the most performed procedure at our centers. This is followed by g-probe and laser trabeculoplasty. The rate of trabeculectomy is on the decrease, while the rate of GDD is increasing. The laser procedures are also on the increase.


Assuntos
Extração de Catarata/estatística & dados numéricos , Implantes para Drenagem de Glaucoma/tendências , Glaucoma/cirurgia , Terapia a Laser/estatística & dados numéricos , Trabeculectomia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Extração de Catarata/tendências , Corpo Ciliar , Glaucoma/epidemiologia , Humanos , Pressão Intraocular , Terapia a Laser/métodos , Terapia a Laser/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Retrospectivos , Esclera , Trabeculectomia/métodos , Resultado do Tratamento , Adulto Jovem
20.
Turk J Ophthalmol ; 49(4): 183-187, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31486604

RESUMO

Objectives: To report the results obtained from glaucoma drainage device (GDD) implantation in patients with aniridia-related glaucoma and to review the literature. Materials and Methods: We retrospectively reviewed 6 patients who underwent GDD implantation for glaucoma secondary to congenital aniridia between April 2001 and February 2015. Data on age at surgery, gender, laterality, surgeries before GDD implantation, GDD model, concomitant ocular disorders, visual acuity, and intraocular pressure (IOP) values before and at 1 and 12 months after GDD implantation, medications, follow-up period, findings during last visit, complications, and course of disease were collected. Results: Mean age at surgery was 16.00±12.31 years (range 5-37 years). Mean IOP was 33.00±12.11 (range 22-50) mmHg just before the GDD implantation with a mean of 3.5±1.2 medications. Mean IOP 1 month after implantation was 16.33±4.22 (range 12-24) mmHg with a mean of 1.5±0.8 medications; at 12 months, mean IOP was 19.50±4.76 (range 15-26) mmHg with 3.0±0.8 medications. At the last follow-up visit, IOP was 21.16±4.07 (range 16-26) mmHg with a mean of 3.33±0.51 medications. Mean follow-up was 19.16±8.8 (range 12-36) months. Surgical success rates were 83.3%, 66.6%, and 50.0% at 1 month, 12 months, and the last visit, respectively. Conclusion: GDD implantation was effective in controlling aniridic glaucoma with a success rate of 83.3% at 1-month follow-up and 66.6% at 1-year follow-up. Therefore, it should be considered as an initial surgical treatment for aniridic glaucoma; the clinician should be alert for concomitant ocular disorders.


Assuntos
Aniridia/complicações , Implantes para Drenagem de Glaucoma , Glaucoma/cirurgia , Adolescente , Adulto , Anti-Hipertensivos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Pressão Intraocular , Masculino , Complicações Pós-Operatórias , Implantação de Prótese/métodos , Estudos Retrospectivos , Acuidade Visual , Adulto Jovem
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