Ultrasound-guided pacemaker implantation at the bedside: A lifesaving technique for cardiac emergencies.

OBJECTIVE: To investigate the safety and effectiveness of implanting temporary pacemakers using ultrasound-guidance at the bedside for rescuing patients in case of cardiac emergencies. METHODS: We enrolled 194 patients with cardiac emergencies requiring temporary pacemakers in this study, and randomly assigned them to either a bedside ultrasound-guided installation group or an electrocardiogram-guided installation group. There were 105 cases in the bedside ultrasound-guided installation group, aged approximately 66.3 ± 10.2 years, and 89 cases in the electrocardiogram-guided installation group, aged approximately 65.8 ± 9.5 years old, and disease composition was similar between the two groups. We then compared the duration of the procedure, success rates, and occurrence of adverse events between the two groups. RESULTS: The two groups showed similar clinical characteristics. The success rates of venipuncture and temporary pacemaker electrode placement were both 100% in the bedside ultrasound-guided installation group, compared to 87.8% and 96.7% respectively, in the electrocardiogram-guided installation group, with a statistically significant difference between the two groups. The duration of puncture was significantly shorter in the bedside ultrasound-guided installation group than in the electrocardiogram-guided installation group, with statistically significant differences. Moreover, no adverse events such as hematoma, pneumothorax and electrode dislodgement occurred in the bedside ultrasound-guided installation group, while 13 cases in the electrocardiogram-guided installation group experienced adverse events, and the difference was statistically significant. CONCLUSIONS: The bedside installation of temporary pacemakers using ultrasound guidance is a simple, safe, effective, and cost-efficient procedure that boasts a high success rate, does not involve radiation, and enables accurate placement of the electrode catheter.

Long-term Efficacy of Trabeculectomy on Chinese Patients with Pigmentary Glaucoma: A Prospective Case Series Observational Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Though trabeculectomy is often performed on patients with medically refractive pigmentary glaucoma (PG), the clinical outcomes of surgical treatment on PG remain unknown. The aim of this study was to summarize the long-term efficacy and safety of trabeculectomy on PG.</p><p><b>METHODS</b>This was a prospective case series observational study. Eighteen consecutive PG patients were followed up for 8 years after trabeculectomy from May 2006 to April 2007. Visual acuity (VA), best-corrected visual acuity (BCVA), slit lamp biomicroscopy, intraocular pressure (IOP) measurement, Humphrey visual field analysis (VFA), and stereoscopic funduscopy were performed on admission and every 6 months after the surgery. Postoperative IOP, VA, BCVA, VFA, adjunctive anti-glaucoma medication, treatment-related side-effects, changes in blebs, and main clinical findings in the anterior segment of PG were recorded and compared with the baseline.</p><p><b>RESULTS</b>Eighteen PG eyes from 18 patients, with average preoperative IOP of 34.5 ± 4.7 mmHg (range: 21-47 mmHg, 1 mmHg=0.133 kPa) were enrolled in this study. All enrolled patients completed the follow-up visits and required examinations. Eight years after trabeculectomy, all surgical eyes (18/18) had satisfactory IOP control with an average of 13.7 ± 2.5 mmHg (range: 9-19 mmHg), which was significantly lower than baseline (P = 0.001). Majority (15/18) of the PG eyes had stable VA, BCVA, VFA, and optic disc cupping parameters. Functional blebs still existed in 12/18 of the PG eyes at the last follow-up visit. Unanimously, pigmentation in the anterior segment attenuated with time after surgical treatment. No severe side-effects were recorded in any of the surgical eyes.</p><p><b>CONCLUSIONS</b>All surgical PG eyes in this study had satisfactory IOP control 8 years after the surgery with well-preserved visual function. The long-term efficacy and safety of trabeculectomy are promising in PG patients.</p>

Changes in anterior chamber depth following vitrectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Anterior segment morphometry is crucial for ophthalmologists to understand the visual outcomes of cataract surgery, keratorefractive surgery, as well as some other anterior segment disorders. Previous reports in literature have shown that anterior chamber depth (ACD) may shift slightly after vitrectomy. This study aimed to characterize the shortterm changes in ACD in eyes after vitrectomy by means of A-scan ultrasound.</p><p><b>METHODS</b>A prospective case series study was carried out on 29 eyes of 29 patients who underwent vitrectomy as the sole procedure. ACD was measured using A-scan ultrasound biometry shortly before vitrectomy and 1 week, 1 month, and 3 months after the surgery. Postoperative ACDs were compared with baseline.</p><p><b>RESULTS</b>Twenty-nine patients (16 males and 13 females) were enrolled in the study, with mean age of (50 ± 11) (25-65) years. Twenty-three eyes of 23 patients were vitrectomized for vitreous hemorrhage (VH) and the other six were operated for idiopathic epiretinal membrane (ERM). The mean preoperative ACD of the VH eyes was (2.98 ± 0.38) mm. No significant difference was found between the ACD of the VH eyes and their fellow eyes (P = 0.058). The average preoperative ACD in the ERM eyes was (2.94 ± 0.31) mm, which was statistically deeper than that of their fellow eyes ((2.85 ± 0.28) mm, P = 0.008). No statistical difference was found in the postoperative average ACD of the VH eyes compared with baseline. In the ERM group, the postoperative ACD in the surgical eyes was still statistically deeper than the fellow eyes 1 week after surgery (P = 0.034). However, such statistical difference disappeared at 1 or 3 months postoperative (P = 0.186 and 0.682).</p><p><b>CONCLUSIONS</b>ERM may induce deepening of the ACD, which can be recovered by uneventful vitrectomy. VH does not cause shift of ACD, neither does vitrectomy.</p>

Efficacy of laser peripheral iridoplasty and iridotomy on medically refractory patients with acute primary angle closure: a three year outcome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Argon laser peripheral iridoplasty (ALPI) is proved to be effective in lowering intraocular pressure (IOP) of patients with mild acute primary angle closure (APAC). It is unclear whether this laser treatment is equally efficient in managing patients with severe APAC. This study aimed to evaluate the IOP-lowering efficacy of ALPI and laser peripheral iridotomy (LPI) on patients with refractory APAC, who have previously responded poorly to intensive medical therapy.</p><p><b>METHODS</b>Thirty-six patients (8 men and 28 women) were identified as medically refractory APAC, who still had ocular pain, red eye, hazy cornea, closed anterior chamber (AC) angle, and IOP of not less than 21 mmHg after two days or more of anti-glaucoma medication. All enrolled patients underwent ophthalmologic examinations including measurement of visual acuity (VA), best corrected VA (BCVA), IOP, biomicroscopy, and gonioscopy followed by ALPI immediately in the APAC eye and LPI in both eyes.</p><p><b>RESULTS</b>All patients were affected unilaterally, with average age of (54.6 ± 11.7) (range, 37.0 - 75.0) years old. The mean IOP value of the affected eyes dropped from (31.6 ± 7.7) (range, 21.0 - 39.0) mmHg at enrollment to (18.4 ± 8.7) (range, 10.0 - 27.0) mmHg 2 hours after ALPI. At follow-up day 7, the mean IOP value maintained at (14.8 ± 4.2) (range, 9.0 - 21.0) mmHg, which was significantly different (P = 0.000) compared with baseline. The average decrease of IOP in the APAC eyes was (16.8 ± 7.4) (range, 12.0 - 21.0) mmHg. At follow-up three years later, the mean IOP of the APAC eyes stabilized at (16.3 ± 3.2) (range, 9.0 - 20.0) mmHg with at least 180° of AC angle opened.</p><p><b>CONCLUSION</b>ALPI and LPI lower the IOP of medically refractory cases of APAC though they have responded poorly to anti-glaucoma medication.</p>