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Interventional Case Series (interventional + case_series)
Selected AbstractsThe short-term effect of hyperoncotic albumin, given alone or with furosemide, on oxygenation in sepsis-induced Acute Respiratory Distress SyndromeANAESTHESIA, Issue 3 2007M. Kuper Summary Two prospective non-randomised interventional case series were conducted consecutively at a single university hospital mixed intensive care unit, in patients with severe sepsis and acute respiratory distress syndrome. The first series describes the administration of 200 ml of 20% human albumin solution over 120 s in 13 patients, examining the hypothesis that raising plasma albumin should improve oxygenation. The second series describes the effect of administering 30 mg of furosemide intravenously along with the albumin in 15 patients, exploring whether this would produce more sustained improvement in oxygenation than albumin only. Oxygenation and haemodynamic parameters were measured for 4 h, during the period of peak oncotic effect. Hyperoncotic albumin given alone or with furosemide produced only transient improvement in oxygenation and haemodynamics, which was statistically significant only in the patients given albumin alone. Although the plasma albumin remained significantly elevated at 4 h in both series, no sustained improvement in oxygenation was seen. [source] Reducing the incidence of early postoperative vitreous haemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachmentACTA OPHTHALMOLOGICA, Issue 6 2010Ling Yeung Acta Ophthalmol. 2010: 88: 635,640 Abstract. Purpose:, This study aimed to evaluate whether preoperative intravitreal injection of bevacizumab reduces early postoperative vitreous haemorrhage (VH) in vitrectomy for diabetic tractional retinal detachment. Methods:, We conducted a retrospective chart review of a consecutive, interventional case series. This included 29 eyes (27 patients) in the bevacizumab group and 40 eyes (37 patients) in the non-bevacizumab group. For statistical analysis, each patient was assigned to one of four groups according to the haemostatic modalities used (group 1, none; group 2, only long-acting gas; group 3, only preoperative intravitreal bevacizumab; group 4, both long-acting gas and preoperative intravitreal bevacizumab). The primary outcome measure was the incidence of early postoperative VH. The secondary outcome measure was visual acuity (VA) at 1 month. Results:, The incidence of early postoperative VH was highest in group 1 (63%), followed by group 2 (21%), group 3 (20%) and group 4 (5%). Group 3 showed the best visual recovery in the first month. All eyes in group 3 reached VA , 1/100 at 1 month after the operation, compared with 44%, 29% and 42% in groups 1, 2 and 4, respectively. Conclusions:, Preoperative intravitreal injection of bevacizumab may be useful for reducing early postoperative VH in vitrectomy for diabetic tractional retinal detachment. Eyes receiving preoperative intravitreal bevacizumab without the use of long-acting gas achieved the best visual recovery at 1 month after the operation. [source] Cryo-assisted anterior approach for surgery of retroocular orbital tumours avoids the need for lateral or transcranial orbitotomy in most casesACTA OPHTHALMOLOGICA, Issue 6 2010Nachum Rosen Acta Ophthalmol. 2010: 88: 675,680 Abstract. Purpose:, To describe and evaluate a cryo-assisted, minimally invasive, anterior approach for orbital tumour surgery. Methods:, Retrospective, non-comparative, consecutive, interventional case series of 103 patients who were operated on by the same surgeon for retroocular orbital tumours over the last 16 years. Results:, A cryo-assisted, minimally invasive, anterior approach was employed in 63 out of the 103 patients (61.2%). In 37 patients (35.9%), anterior orbitotomy without the use of cryoprobe was employed for biopsy or excision of small, anteriorly located lesions. Lateral orbitotomy was used in three patients (2.9%). In a subgroup of 61 patients with circumscribed lesions (mainly cavernous haemangiomas and schwannomas), cryoextraction was used in 51 (83.6%). None of the procedures required conversion to lateral orbitotomy and there were no intraoperative complications. Conclusion:, In contrast to other reports on the treatment of orbital lesions, in the current case series surgery of most solid tumours and many other cystic or infiltrative lesions was achieved here via an anterior, cryo-assisted approach, and thus with minimal trauma to the orbit. This approach warrants more favourable consideration because the combination of the anterior approach with the use of cryoprobe and surgical microscope can yield successful results, even in patients with large or deeply located tumours , obviating in most of them the need for lateral or transcranial orbitotomies with bone flaps. [source] Serious complications of cosmetic NewColorIris implantationACTA OPHTHALMOLOGICA, Issue 6 2010Justin E. Anderson Acta Ophthalmol. 2010: 88: 700,704 Abstract. Purpose:, This case report describes serious postoperative complications and markedly elevated intraocular pressure (IOP) associated with the NewColorIris cosmetic implant. Methods:, We report an interventional case series of two patients who suffered multiple complications after NewColorIris implantation carried out in Panama. Assessment included visual acuity, photography, endothelial cell count and anterior segment optical coherence tomography (OCT) when possible. Results:, Both patients presented with endothelial cell loss, uveitis, pigment dispersion and elevated IOP. Anterior segment OCT demonstrated irregularities in the position and configuration of the implants within the anterior chamber with resultant areas of implant,iris and implant,endothelial contact. One patient had acute postoperative hyphaema that resolved with anterior chamber tissue plasminogen activator injection. Both patients required explantation OU, one eye has required trabeculectomy, and one eye with bullous keratopathy is being evaluated for Descemet's stripping endothelial keratoplasty. Conclusions:, Implantation of the NewColorIris cosmetic implant can lead to serious complications including hyphaema, uncontrolled IOP, severe endothelial cell loss, bullous keratopathy and anterior uveitis. Explantation may lead to improvement, but permanent damage to the trabecular meshwork and corneal endothelium persists. [source] Photodynamic therapy for chronic central serous chorioretinopathyACTA OPHTHALMOLOGICA, Issue 3 2010José M. Ruiz-Moreno Abstract. Purpose:, This study aimed to evaluate the efficacy of photodynamic therapy (PDT) in treating chronic central serous chorioretinopathy (CSC). Methods:, We describe a non-randomized, multicentre, interventional case series. A total of 82 eyes of 72 patients with chronic CSC were treated by conventional PDT. LogMAR best corrected visual acuity (BCVA) (ETDRS charts) and central foveal thickness (CFT) measured by optical coherence tomography before and after PDT, number of PDT treatments and complications were used as outcome indicators. Results:, Mean follow-up was 12 ± 10 months and mean age was 46 ± 10 years. Mean logMAR BCVA changed from 0.53 (standard deviation [SD] 0.43) before PDT to 0.38 (SD 0.41) at 3 months and 0.48 (SD 0.50) at 6 months (p < 0.0001 and p = 0.007, respectively, Student's t- test for paired data). Mean BCVA at the end of follow-up was 0.37 (SD 0.45; p < 0.0001 from baseline). Macular detachment was resolved and subretinal fluid (SRF) disappeared in all cases. Central foveal thickness decreased from 325 ,m (SD 95), to 229 ,m (SD 70) at 1 month after PDT, 206 ,m (SD 68) at 3 months, and 202 ,m (SD 76) at 6 months (all p < 0.0001, Student's t- test for paired data). No cases developed severe visual loss or complications derived from PDT. Reactive retinal pigment epithelium hypertrophy appeared in nine cases after PDT. Conclusions:, Photodynamic therapy with verteporfin may be useful in chronic CSC for improving BCVA and reducing SRF and CFT. Randomized studies with longer follow-up are needed to assess the real role of this treatment in chronic CSC. [source] Long-term study of vascular perfusion effects following arteriovenous sheathotomy for branch retinal vein occlusionACTA OPHTHALMOLOGICA, Issue 3 2010Mahiul M. K. Muqit Abstract. Purpose:, To evaluate the perfusion effects and long-term visual outcome of pars plana vitrectomy (PPV) combined with arteriovenous sheathotomy (AVS) with or without triamcinolone for nonischaemic branch retinal vein occlusion (NI-BRVO). Methods:, Prospective, interventional case series of eight patients with NI-BRVO and haemorrhagic macular oedema. Patients underwent PPV and AVS (n = 5), or PPV, AVS and intravitreal triamcinolone (IVT, n = 3). A masked grading technique assessed fundus photographs and fluorescein angiography (FFA) following surgery. Scanning laser ophthalmoscopy/optical coherence tomography (SLO/OCT) evaluated macular oedema and outer retinal architecture. Main outcomes examined included visual acuity (VA), retinal reperfusion, collateral vessel regression, vascular dilatation, cystoid macular oedema (CMO), and ocular neovascularization. Results:, Seven of eight patients underwent uncomplicated surgery, with increased intraretinal perfusion and reduced engorgement of distal retinal veins. The mean pre-logMAR VA was 0.8 (SD 0.17) and did not improve significantly after surgery (post-logMAR 0.6, SD 0.38; p = 0.11, paired t -test). SLO/OCT showed persistent CMO in four patients, and subfoveal thinning of the photoreceptor layer. Collateral vessels disappeared at the blockage site post-AVS in 7/8 eyes, and this was associated with improved retinal perfusion. Six of eight patients developed epiretinal membrane. No patients developed ocular neovascularization. The average follow-up was 34.5 months. Conclusions:, PPV with AVS is a safe procedure, and adjunctive IVT had no additional effects on vascular perfusion. Successful decompressive surgery was followed by disappearance of collateral vessels at the BRVO blockage site and was a clinical marker for intravascular reperfusion. Long-term epiretinal gliosis and subfoveal photoreceptor atrophy limited functional and visual recovery. [source] Subconjunctival injection of bevacizumab (Avastin®) for corneal neovascularizationACTA OPHTHALMOLOGICA, Issue 2009MF DE LA PAZ Purpose to study the effects of subconjunctival injection of Bevacizumab on corneal neovascularization. Methods Prospective interventional case series on 7 eyes of 7 patients who underwent subconjunctival injection with Bevacizumab. The following parameters were studied pre-op, at 1 week, 30, 60 and 90 days post-op: UCVA, BCVA, pachymetry with OCT, slit lamp examination and photographic imaging. Conjunctival impression cytology pre-op at 1 week and 9o days was done and complications were also noted. Results Pre-op diagnoses were: herpetic leucoma (4 eyes), chemical burn (2 eyes), neurotrofic keratopathy (1 eye). An informed off-label consent form prior to procedure was signed. 1.25 mg of subconjunctival Bevacizumab was injected nearest the area affected. Mean preoperative UCVA and BCVA were 0.86 and 0.44 LogMar units, improved to 0.61 and 0.26 LogMar units at 90 days post-op, respectively. Central and peripheral pachymetry improved from 532 and 623 microns pre-op, to 529 and 619 microns at 90 days post-op, respectively. All slit lamp findings and photographic imaging showed a clear regression of superficial and deep stromal corneal vascularization, with clearing of lipid deposits around the affected areas. No toxic effects were noted on conjunctival impression cytology. Conclusion Subconjunctival injection of Bevacizumab is a safe and effective procedure for the regression of superficial and deep corneal neovascularization. It may be a good alternative for patients prior to performing an optical keratoplasty or for those who are poor candidates for the same. [source] Phacoemulsification in vitrectomized eyes: results using a ,phaco chop' techniqueACTA OPHTHALMOLOGICA, Issue 4 2009Nishant Sachdev Abstract. Purpose:, To evaluate the intraoperative and early postoperative complications of phacoemulsification using a ,phaco chop' technique in previously vitrectomized eyes. Methods:, A prospective interventional case series. Seventy-five previously vitrectomized eyes of 73 consecutive patients underwent phacoemulsification using a ,phaco chop' technique via clear corneal incision. Patients were observed for any intraoperative or early postoperative complications. Results:, Fifty-four eyes (72%) had predominant nuclear sclerosis or posterior subcapsular cataract. The intraoperative findings included intraoperative miosis [seen in 21 eyes (28%)] and posterior capsule plaques [in 15 eyes (20%)]. No other significant intraoperative complication (posterior capsule rupture, zonular lysis or dropped nuclei) was observed. In the early postoperative period, one patient had massive serous choroidal detachment, which resolved with conservative treatment. Mean preoperative visual acuity (LogMar scale) was 0.74, which improved to 0.36 postoperatively (p < 0.001). Conclusion:, Phacoemulsification using a ,phaco chop' technique is a safe procedure in vitrectomized eyes. [source] Temporal changes in retinal thickness after removal of the epiretinal membraneACTA OPHTHALMOLOGICA, Issue 4 2009Hitoshi Aso Abstract. Purpose:, We aimed to study the temporal aspects of the postoperative reduction of retinal thickness in eyes with epiretinal membrane after vitrectomy with peeling of the epiretinal membrane and internal limiting membrane. Methods:, In a retrospective study performed as a non-comparative, interventional case series, 16 eyes from 15 patients with idiopathic epiretinal membrane who underwent vitrectomy and removal of the epiretinal membrane were followed up using optical coherence tomography measurements. Retinal thickness in the macular area was assessed by the foveal thickness and macular volume in a circle 6 mm in diameter. Results:, Scattergrams of the foveal thickness and macular volume were best fitted with exponential curves. The average time constants of the exponential curve for foveal thickness and macular volume changes were 31 days (range 4,109 days) and 36 days (range 5,100 days), respectively. The average expected final values for foveal thickness and macular volume were 334 ,m (range 206,408 ,m) and 7.53 mm3 (range 6.57,8.66 mm3), respectively, which were significantly greater than those in normal controls (p < 0.0001, t -test). Conclusions:, Retinal thickness decreases rapidly immediately after surgical removal of the epiretinal membrane and the reduction rate gradually slows thereafter. Approximation of the exponential curve provides an estimation of final retinal thickness after surgical removal of the epiretinal membrane; final thickness is expected to be greater than in normal eyes. [source] Boston KPro experience in BarcelonaACTA OPHTHALMOLOGICA, Issue 2008M DE LA PAZ Purpose To describe the indications, intraoperative complications, post-operative complications and anatomical and functional results of Type I Boston keratoprosthesis at our eye center in Barcelona. Methods Retrospective interventional case series on 24 eyes of 22 patients who underwent Boston keratoprosthesis implant from May 2006 to May 2008. Results The main indication for Boston keratoprosthesis implantation was a repeated failed graft (mean = 2.33 previous grafts). The most common principal pathologies were: bullous keratopathy, herpetic keratitis, aniridic keratopathy, corneal ectasia, calcific band keratopathy. No major intraoperative complications were noted and average time of surgery was 47 minutes. The mean follow-up time was 7.42 months. The major post-operative complications encountered were retroprosthetic membrane in 2 eyes, endophthalmitis in 2 eyes and corneal graft melting in 1 eye. The mean best corrected visual acuity improved from 0.015 pre-operatively to 0.1 post-operatively. Only one case of extrusion due to melting was encountered which was resolved by a reimplantation of the keratoprosthesis. Conclusion Our short-term experience with the type I Boston Keratoprosthesis is a good alternative for patients with repeated graft failures. Improvement in visual acuity is immediate and only minor complications were encountered. [source] Retinal pigment epithelium changes after photodynamic therapy for choroidal neovascularization in pathological myopiaACTA OPHTHALMOLOGICA, Issue 1 2007Maurizio Battaglia Parodi Abstract. Purpose:, To describe changes in the retinal pigment epithelium (RPE) induced by photodynamic therapy (PDT) in eyes with subfoveal choroidal neovascularization (CNV) associated with pathological myopia (PM). Methods:, We carried out an open-label, prospective, interventional case series including 26 patients affected by subfoveal CNV in PM who underwent PDT with a 12-month follow-up. Particular attention was paid to the detection of changes at the RPE level in the areas exposed to the laser compared with baseline conditions. Results:, The median age of the patients was 58.5 years and the median duration of symptoms was 2 weeks. A pigmentary zone was present before PDT in 20 eyes (77%), incompletely encircling the CNV in all but two of the 20 eyes. At the end of the follow-up, the CNV in all eyes was seen to be completely or incompletely encircled by a band of hyperpigmentation, which was surrounded by RPE alterations, including depigmentation in all cases and atrophic changes in 14 eyes. Conclusions:, After PDT, alterations in the RPE develop in myopic eyes. These include accentuation of the pigmentary zone surrounding the CNV and progressive atrophic changes. Further studies are needed to correlate post-PDT RPE damage with longterm visual outcome. [source] Intravitreal bevacizumab (Avastin) as a treatment of the neovascular complications of laser-induced chorioretinal anastomosis for nonischaemic central retinal vein occlusionCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 5 2009Kenneth C S Fong FRCOphth Abstract Purpose:, To describe the use of intravitreal bevacizumab followed by sectorial retinal photocoagulation to treat the neovascular complications of laser-induced chorioretinal anastomosis (L-CRA) for nonischaemic central retinal vein occlusion (CRVO). Methods:, Prospective interventional case series of three patients with nonischaemic CRVO who were treated with L-CRA. Patients were followed up every 2 weeks after the laser treatment. If neovascularization occurred at the site of the anastomosis, intravitreal bevacizumab (1.25 mg) was injected followed by laser photocoagulation to areas of retinal ischaemia and the area of retina anterior to the L-CRA 1 week later. Fluorescein angiography was performed to confirm the presence of neovascularization. Best-corrected visual acuity measurements were performed at every visit. Results:, Three patients (one woman, two men) with a mean age of 76.3 years developed neovascularization at the L-CRA site and underwent treatment as described with a mean follow-up time of 7 months. The neovascularization developed within 1 month after the laser anastomosis in all three cases. All patients only required one intravitreal bevacizumab injection to control the neovascularization. No complications of the intravitreal injections were noted. Conclusions:, Intravitreal bevacizumab appears to be an effective tool in the immediate control of neovascularization following L-CRA for nonischaemic CRVO. This appears to cause immediate regression of the neovascular frond and allows time for the laser, which is applied subsequently to have its effect. [source] Traumatic intralenticular abscess: a case seriesCLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 3 2007Amjad Salman MS Abstract Purpose:, To report the clinical presentation, management and outcome of eyes with traumatic intralenticular abscess. Methods:, In this interventional case series, records of eight patients (eight eyes) with intralenticular abscess developing following trauma were reviewed. All patients underwent extracapsular cataract extraction with intracameral antibiotics with or without pars plana vitrectomy. Main outcome measures studied were resolution of infection and final visual outcome. Results:, Lens abscess developed in six eyes following penetrating injury and in two eyes following intraocular penetration of caterpillar hair. Gram positive cocci were cultured from the lens aspirate in five eyes and Staphylococcus epidermidis was the most common organism isolated. Cataract extraction resulted in control of the infection in all eyes and seven eyes (87.5%) had a favourable visual outcome. Conclusion:, Early lens extraction with intracameral antibiotics in eyes with intralenticular abscess allows control of infection with good visual outcome. [source] | ||||||||||