1,721,032 research outputs found
Adult respiratory distress syndrome. A histopathologic study
No full textThe results of an anatomohistopathologic study carried out on subjects who died from various causes in resuscitation centers are reported with specific reference to the evolutive phases of the adult respiratory distress syndrome (ARDS). While a precise anatomohistopathologic diagnosis of non-clinically diagnosed ARDS in its initial phase is considered possible, the importance of recognizing this pathology in cadavers and living patients is emphasized because of the medico-legal implications involved
The pneumothorax as complication of continuous artificial ventilation [DER PNEUMOTHORAX ALS KOMPLIKATION LANGANHALTENDER ATMUNGS REANIMATION]
No full textThe authors briefly discuss the main lesions produced during intensive treatment in 500 patients who died in an Intensive Care Unit during the period Dec. 13, 1971 to Sept. 9, 1974. Special attention is given, both from a clinical and from a pathologic point of view, to 36 cases of pneumothorax induced by automatic respiration
Inverted ILM Flap for the Treatment of Myopic Macular Holes: Healing Processes and Morphological Changes in Comparison with Complete ILM Removal
No full textPurpose. To investigate the microstructural changes after successful myopic macular hole (MMH) surgery, comparing inverted ILM flap and complete ILM removal techniques, and their association with visual function. Methods. Spectral-domain optical coherence tomography (SD-OCT) was used to evaluate both external limiting membrane (ELM) and ellipsoid zone (EZ) recovery in 40 eyes of 39 patients who underwent pars plana vitrectomy with either inverted internal limiting membrane flap technique (n = 27) or complete ILM removal (n = 13) to achieve MH closure. The association between ELM and EZ recovery and visual acuity was also investigated. The patients were followed up at 1 year. Results. ELM and EZ was recovered in 72% and 62% of cases, respectively, regardless of the surgical techniques 1 year after surgery. A strong positive association between the ELM and EZ recovery and the mean BCVA was found: regardless of the surgical technique, this was statistically significant at each time point (p < 0.05). None of the baseline variables were found to act as predictive factors for either ELM or EZ. Conclusion. The inverted ILM flap technique did not affect the MMH healing processes compared to complete ILM removal. Thus, the presence of the ILM plug did not interfere with the restoration of both ELM and EZ, which correlated with functional recovery
Retrobulbar triamcinolone for inflammatory choroidal neovascularization in pregnancy
No full textBackground: Choroidal neovascularization (CNV) in pregnancy has rarely been described. A differential diagnosis between inflammatory, idiopathic, and myopic CNV may be challenging. Moreover, there is no consensus on management, and therapeutic options may be further limited by patient and physician concerns about potential risk to the fetus. Herein, we report a case of inflammatory CNV during pregnancy and describe a previously unreported management approach with retrobulbar triamcinolone injections.
Case presentation: A 36-year-old woman presented with vision loss and metamorphopsia in her right eye while 21 weeks pregnant. She was diagnosed with an inflammatory CNV based on the following multimodal imaging findings: a type 2 lesion with the "pitchfork sign" on OCT, along with the absence of tomographic signs of myopic CNV, and the presence on autofluorescence of multiple hyper-autofluorescent spots, interpreted as focal areas of inflammation at the level of the outer retina and inner choroid. The patient refused oral corticosteroids and any intravitreal injection therapies. Therefore, she was treated with two trans-Tenon's retrobulbar injections of triamcinolone acetonide after explaining the procedure and acquiring consent. The treatment resulted in a regression of inflammatory signs and a reduction of neovascular activity. No adverse events occurred for the mother or the baby, neither during the pregnancy nor after delivery.
Conclusion: Inflammatory CNV may be rarely associated with pregnancy. The correct diagnosis is crucial to allow the consideration of all possible management options. To the best of our knowledge, this is the first reported case of treatment with retrobulbar triamcinolone injections. This may represent a suitable therapeutic option in the absence of any other therapeutic approaches
1000 cSt silicone oil vs heavy silicone oil as intraocular tamponade in retinal detachment associated to myopic macular hole
No full textBackground: Several surgical techniques have been described for the treatment of retinal detachment (RD) associated to myopic macular hole (MMH). In this retrospective study, the anatomical and functional outcomes of pars plana vitrectomy (PPV) with long-term tamponade, using either 1000 cSt silicone oil (SO) or heavy silicone oil (HSO), are compared.
Methods: Forty-two eyes affected by RD associated with MMH were included. The surgical technique involved standard 3-port 20-gauge PPV with long-term tamponade. The patients were divided into two groups, according to the intraocular tamponade: SO in group 1 (n = 17), and HSO in group 2 (n = 25). Internal limiting membrane (ILM) removal was performed in 15 cases of group 1 and 20 cases of group 2. Tamponade removal was performed 2 to 5 months after primary surgery. The patients were assessed 1 week and 1 month after primary surgery, and then 1 week and 1 month after tamponade removal or after further surgery if macular redetachment had occurred. The patients were also visited every 2 months for at least 1 year after final tamponade removal. Follow-up was considered closed at 1 year after final tamponade removal.
Results: Preoperative best-corrected visual acuity (BCVA), expressed as LogMar, was 2.8 ± 0.77 for group 1 and 2.1 ± 0.94 for group 2. At the last visit, the BCVA was 1.41 ± 0.96 and 1.48 ± 0.77 for groups 1 and 2 respectively. Retinal reattachment was achieved with one operation in 13 eyes of group 1 (76.5%) and 18 of group 2 (81.8%) (P = 0.69). The average number of surgery needed to achieve retinal attachment by patients of group 1 and 2 was respectively 1.36 ± 0.63 and 1.46 ± 0.59 (P = 0.77). Five patients of group 1 and four of group 2 developed a chronic glaucoma (P = 0.238).
Conclusions: PPV with ILM peeling and long-term tamponade was demonstrated to be a good surgical option to treat RD due to MMH; SO and HSO seemed to be equally effective, although the success rates remained far from an ideal 100%
Letter to the editor relating to Graefe's Arch Clin Exp Ophthalmol. 2018 May; 256(5): 863-877. "Macular buckle technique in myopic traction maculopathy: a 16-year review of the literature and a comparison with vitreous surgery"
No full textN/
Intravitreal Brolucizumab for Neovascular Age-Related Macular Degeneration in a Vitrectomized Eye
No full textThe efficacy of intravitreal anti-VEGF may be reduced in vitrectomized eyes due to acceler- ated drug clearance. Given its longer durability, brolucizumab may represent a suitable ther- apeutic option. However, its efficacy in vitrectomized eyes remains to be explored. Herein, we describe the management of a macular neovascularization (MNV) in a vitrectomized eye with brolucizumab after unsuccessful treatment with other anti-VEGF. A 68-year-old male was treated with pars plana vitrectomy for epiretinal membrane in his left eye (LE) in 2018. After surgery, best corrected visual acuity (BCVA) improved to 20/20 with a remarkable reduction of metamorphopsia. After 3 years, the patient returned, presenting visual loss in the LE due to MNV. He was treated with intravitreal bevacizumab injections. However, after the loading phase, an increased lesion size and exudation with worsening BCVA were detected. Therefore, the treatment was switched to aflibercept. However, after three monthly intravitreal injections, further worsening was recorded. Treatment was then switched to brolucizumab. Anatomical and functional improvement was noticed 1 month after the first brolucizumab injection. Two additional injections were performed, and further improvement was recorded with BCVA recovery to 20/20. At the last follow-up visit 2 months after the third injection, no recurrence was detected. In conclusion, determining whether anti-VEGF injections are efficacious for vit- rectomized eyes would be helpful for ophthalmologists managing such patients, as well as when considering pars plana vitrectomy in eyes at risk of MNV. In our case, brolucizumab was found to be effective after unsuccessful treatment with other anti-VEGF. Additional studies are required to evaluate the safety and efficacy of brolucizumab for MNV in vitrectomized eyes
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