182 research outputs found
Hyperhomocysteinemia in bilateral anterior ischemic optic neuropathy after conventional coronary artery bypass graft: A case report
No full textBackground: The incidence of anterior ischemic optic neuropathy after coronary artery bypass graft procedures ranges from 1.3 to 0.25%. The mechanisms of anterior ischemic optic neuropathy after cardiovascular procedures remain undefined but many systemic and related-to-surgery risk factors could underlie anterior ischemic optic neuropathy. In this case, we report a rare presentation of a bilateral anterior ischemic optic neuropathy after coronary artery bypass graft and speculate on the preoperative hyperhomocysteinemia as an independent risk factor for anterior ischemic optic neuropathy. Case presentation: A 56-year-old white man, a tobacco smoker with type 2 diabetes and coronary artery disease, underwent a conventional coronary artery bypass graft with extracorporeal circulation. In spite of ongoing anti-aggregation, antithrombotic, and vasodilator therapy, 10 days after the surgery he complained of severe bilateral visual loss. Funduscopy and fluorescein angiography revealed a bilateral anterior ischemic optic neuropathy. Analysis of preoperative laboratory tests revealed hyperhomocysteinemia. Conclusion: Hyperhomocysteinemia could increase the risk of ocular vascular damage and bilateral ocular involvement in patients who have undergone conventional coronary artery bypass graft
Analysis of morphologic and functional outcomes in macular edema due to central retinal vein occlusion treated with intravitreal dexamethasone implant
No full textPurpose. To analyze anatomic and functional retinal changes and their correlation after intravitreal dexamethasone implant (DEX implant) in patients with central retinal vein occlusion- (CRVO-) related macular edema (ME) using optical coherence tomography and microperimetry. Methods. Fifteen treatment-naïve patients with functional impairment due to CRVO-related ME were enrolled in this prospective interventional case series. Main outcomes were best-corrected visual acuity (BCVA), retinal sensitivity (RS), and central retinal thickness (CRT). Secondary outcomes were ellipsoid zone (EZ) status and fixation behaviour. All patients underwent DEX implant and were retreated according to predefined criteria. Data were prospectively recorded at baseline and at month 1, 3, 6, 9, and 12. Correlation between main outcomes was analyzed. Results. Fifteen eyes of 15 patients (9 men, 6 women; mean age 61.8 ± 10.9 years) were included. BCVA and CRT significantly improved at all follow-up visits, while RS significantly improved at 3, 6, 9, and 12 months. EZ status and fixation behaviour did not change significantly. Baseline CRT had a significant negative correlation with BCVA and RS at different follow-up visits (r=-0.52 to -0.63, p≤0.04; r=-0.52, p=0.04; resp.). At all time points, there was not a significant correlation between CRT and BCVA and RS, while RS and BCVA showed a significant correlation, increasing over time (r=-0.72 to -0.89; p<0.001). Conclusion. DEX implant led to a significant morphofunctional improvement. Baseline CRT is predictive of changes of functional outcomes whose correlation increases over time after treatment
Management of intra-operative complication during scleral buckling surgery - Francesco Boscia, Ermete Giancipoli, Giuseppe D'Amico Ricci, Giancarlo Sborgia
No full textManagement of intra-operative complication during scleral buckling surgery - Francesco Boscia, Ermete Giancipoli, Giuseppe D'Amico Ricci, Giancarlo Sborgia
No full text25-Gauge Vitrectomy in Open Eye Injury with Retained Foreign Body
No full textPurpose. Ocular trauma with retained foreign body is an important cause of visual impairment in working-age population. Clinical status impacts on the timing and planning of surgery. In the last year small gauge vitrectomy has become safer and more efficient, extending the range of pathologies successfully treated. Aims. To evaluate the safety and outcomes in patients with open eye injury with retained foreign body that underwent early 25-gauge vitrectomy. Methods. In this retrospective, noncomparative, interventional case series, we performed 25-gauge vitrectomy on 10 patients affected by open globe injuries with retained foreign body, over 3 years. We analyzed age, wound site, foreign body characteristics, ocular lesions correlated, relative afferent pupillary defect, visual acuity, and intraocular pressure. Follow-up evaluations were performed at 1, 3, and 6 months. According to the clinical status we performed other procedures to manage ocular correlated lesions. Results. The median age of patients was 37 years. The foreign body median size was 3.5 mm (size range, 1 to 10 mm). 25-gauge vitrectomy was performed within 12 hours of trauma. Foreign body removal occurred via a clear corneal or scleral tunnel incision or linear pars plana scleral access. Visual acuity improved in all patients. Endophthalmitis was never reported. Only two cases reported postoperative ocular hypertension resolved within the follow-up. Retinal detachment recurred in one case only. Conclusions. 25-gauge vitrectomy could be considered as early approach to manage open globe injuries with a retained posterior segment foreign body in selected cases with good outcomes and low complication rate
One-year outcomes of 27-gauge versus 25-gauge pars plana vitrectomy for uncomplicated rhegmatogenous retinal detachment repair
No full textBackground: 27-gauge (27G) and 25-gauge (25G) transconjunctival sutureless vitrectomy (TSV) were considered equal about safety, effectiveness and vitrectomy time for the treatment of rhegmatogenous retinal detachment (RRD), although larger and long-term comparative studies are needed to confirm previous knowledge. Furthermore, a combined comparison of time duration of surgery and vitreous removal was never performed. Our purpose was to compare the safety and efficacy of 27G versus 25G TSV for the treatment of uncomplicated RRD over a 1-year follow-up. Methods: A 12-months single-center prospective, randomized, interventional study of 92 consecutive patients was performed. 46 patients underwent 27G TSV (Group 1) and 46 underwent 25G TSV (Group 2). Primary outcomes were primary and final reattachment rate, and final functional success (visual acuity ≥ 20/200, 1 LogMar). Secondary outcomes were the surgical and vitrectomy time. Complications were recorded. Results: All functional and morphologic data at baseline and at all follow-up time points up to 12 months after surgery were available for only 88 patients. Four patients in Group 1 dropped out of the study after surgery. There was no significant difference in baseline characteristics between the two groups. Primary and final reattachment rates were 90.5% and 100% in Group 1, and 95.6% and 100% in Group 2, respectively (p> .05, p> .05, respectively). Visual acuity improved from 1.5 ± 1.09 LogMar to 0.38 ± 0.55 LogMar in Group 1 (p< .001) and 1.2 ± 0.9 LogMar to 0.49 ± 0.53 LogMar in Group 2 (p< .001), without significant difference between the groups (p> .05). The surgical time was 73.2 ± 11.3 min with 27G TSV and 64.4 ± 9.5 min with 25G TSV (p = .0001). The vitrectomy time was 19.9 ± 3.8 min with 27G TSV and 20.8 ± 3.8 min with 25G TSV (p> .05). One single case of choroidal detachment occurred. Conclusions: Reattachment rates, functional success and vitrectomy time were comparable between 27G and 25G TSV for RRD. Surgical time was significantly longer using 27G vitrectomy
Oxane HD vs silicone oil and scleral buckle in retinal detachment with proliferative vitreoretinopathy and inferior retinal breaks.
No full textBACKGROUND: To compare pars plana vitrectomy (PPV) with 1300 cs silicone oil and scleral buckle (SB) vs PPV with Oxane HD tamponade for rhegmatogenous retinal detachment (RRD) with inferior retinal breaks (IRB).
METHODS: Twenty eyes of 20 consecutive patients with primary inferior RRD and PVR >or=CP2 were alternatively assigned to PPV and 1300 cs silicone oil and segmental SB in the inferior periphery (group 1, n = 10) or PPV with Oxane HD (group 2, n = 10) in order of presentation. Silicone oil/Oxane HD removal was performed 12 weeks after surgery. Subjects were followed up for 6 months from oil removal.
RESULTS: Operative time was lower in Oxane HD group (P = 0.012). In both groups, the retina was primary reattached at the third month after oil removal in nine eyes (90%). At the end of follow-up, retina was reattached in nine eyes (90%) in group 1 (including one eye with oil in situ), and in eight eyes (80%) in group 2 (P > 0.05).
CONCLUSIONS: Silicone oil+SB and Oxane HD appear equal for primary RRD with IRB, but a large multi-centre study is required. Oxane HD permitted a reduced operative time
Morphologic and functional outcomes of different optical coherence tomography patterns of myopic foveoschisis after vitrectomy and inner limiting membrane peeling
No full textObjective: To evaluate the morphologic and functional outcomes of different optical coherence tomography (OCT) patterns of myopic foveoschisis after vitrectomy with Inner Limiting Membrane (ILM) peeling. Methods: In this prospective non-randomised study, 62 consecutive eyes with Myopic Foveoschisis were categorised into three groups according to OCT pattern: retinoschisis type (Rt) Group (23/62), foveal detachment type (FDt) Group (20/62) and macular hole type (MHt) Group (19/62). All patients underwent 25-Gauge vitrectomy and ILM peeling. Air or gas tamponade was used. All patients were observed at month 1, 2, 4 and 6 after surgery. Main outcomes measures: surgical success as resolution of myopic foveoschisis, central retinal thickness (CRT), IS/OS junction recovery and best-corrected visual acuity (BCVA) measurement. Any complication was reported. Results: In all eyes OCT showed a resolution of the retinoschisis, foveal detachment and macular hole pattern, respectively. CRT significantly decreased in all Groups (p <.001), mainly in MHt. IS/OS junction recovery was mainly observed in MHt. BCVA significantly increased in all Groups (p <.01). A functional gain ≥2 Snellen lines occurred in 70, 85 and 68% in the Rt, FDt and MHt Group, respectively. Final BCVA was correlated with preoperative BCVA (R 0.74, p < 0.0001), postoperative CRT (R −0.49, p < 0.0001), and the recovery of IS/OS junction at 6 months (R 0.76, p < 0.0001). Few postoperative complications occurred. Conclusions: Vitrectomy with ILM peeling results in favourable anatomic and functional outcomes for different patterns of myopic foveoschisis
Low-fluence-rate photodynamic therapy to treat subfoveal choroidal neovascularization in pathological myopia. A study of efficacy and safety.
No full textBACKGROUND: To evaluate the efficacy and safety of low-fluence-rate photodynamic therapy (LFPDT) to treat choroidal neovascularisation (CNV) secondary to pathological myopia (PM).
METHODS: Twenty-five eyes with CNV in PM underwent LFPDT, with a standard dose of verteporfin and timing but adopting fluence and irradiance rates reduced to 25 mJ/cm2 and 300 mW/cm2, respectively. Best corrected visual acuity (BCVA) was measured and biomicroscopy and fluorescein angiography (FA) were evaluated. Particular attention was paid to choroidal hypoperfusion, and to changes (depigmentation/atrophy) at the RPE level in areas exposed to laser light.
RESULTS: After a mean follow-up of 13.4+/-2.46 months (range: 12-21), and 1.37+/-0.66 treatments (range: 1-3), BCVA was stable in 29 (91%) eyes. Two (6%) patients gained more than three lines and one (3%) eye lost more than three lines. Mean greatest linear dimension did not change significantly (p=0.08) at the end of follow-up. RPE depigmentation was present in six eyes (18%) and no patient showed RPE atrophy.
CONCLUSIONS: LFPDT is effective and safe for CNV secondary to PM treatment, stabilizing visual acuity and lesion size and determining only mild RPE changes. Further controlled studies are needed to demonstrate the long-term efficacy and safety of this treatment option
THREE-PORT LENS-SPARING VITRECTOMY FOR AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY: EARLY SURGERY BEFORE TRACTIONAL RETINAL DETACHMENT APPEARANCE
No full textPURPOSE. Aggressive posterior retinopathy of prematurity (APROP) may suddenly develop into tractional retinal detachment (TRD), often resulting in poor vision if untreated. The aim of the current study is to examine the anatomic results and complications of lens-sparing vitrectomy (LSV) for stage 3 APROP, before TRD appearance. METHODS. A retrospective, noncomparative, consecutive case series of 13 eyes of 9 patients (mean gestational age 24.1±0.9 weeks [range: 23-25 weeks], mean birthweight of 725.8±107.9 grams [range: 598-897 grams]) with stage 3 APROP was carried out. The eyes did not respond to at least one session of retinal laser photocoagulation, showing signs of disease progression. All eyes underwent 20-gauge LSV before retinal detachment appearance. RESULTS. All eyes underwent 20-gauge three-port LSV and intraoperative additional laser photocoagulation. At the end of the surgery, five eyes were tamponaded with air; in eight eyes, a balanced salt solution was left in the vitreous cavity. After 13.5±5.3 months of follow-up (range: 4-22), the retina was completely attached in all eyes, without any signs of progression. The authors did not observe any intraoperative or postoperative complications. CONCLUSIONS. Surgical approach to stage 3 APROP refractory to laser photocoagulation could be effective and safe in order to avoid the progression of the disease
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