A modified approach to actively remove high viscosity silicone oil through 23-gauge cannula

AIM: To report a simple approach to actively remove high viscosity silicone oil through a 23-gauge cannula via pars plana. METHODS: Forty-eight eyes of 48 patients underwent silicone oil (5700 centistokes) removal (SOR) were enrolled. A section of blood transfusion set was prepared to connect a standard 23-gauge cannula and vitrectomy machine. Silicone oil was removed with suction of 500-mm Hg vacuum through the cannula. Main outcome measures were SOR duration, number of sutured sites, intraocular pressure (IOP), best-corrected visual acuity (BCVA), and complications. RESULTS: Silicone oil was successfully removed in all cases. The mean SOR time was 5.70±0.85min. Nine eyes (18.75%) needed suture partial sclerotomies. No intraoperative complications were noted. Transient hypotony (≤8 mm Hg) was seen in 3 eyes (6.25%) on postoperative day 1, but all resolved within 1wk. Retinal reattachment was achieved in all cases and no other postoperative complications were noted during 3-month following-up. BCVA at the final visit improved or stabilized in all patients comparing to the preoperative level. CONCLUSION: Active removal of high viscosity silicone oil through a 23-gauge instrument cannula jointed with blood transfusion set is a practical and reliable technique when considering two sides of efficacy and safety.     

Outcomes of 25-gauge pars plana vitrectomy for cytomegalovirus retinitis-related retinal detachment

Purpose:The purpose of this study is to evaluate the anatomical and functional outcomes of 25-gauge (G) pars plana vitrectomy (PPV) in patients with cytomegalovirus retinitis (CMVR)-related rhegmatogenous retinal detachment (RRD).Methods:Single-center retrospective consecutive case series of patients who underwent 25-G PPV for CMVR-related RRD repair with a minimum follow-up of 3 months. Complete anatomic success was defined as the complete attachment of retina including the periphery. Best-corrected visual acuity (BCVA) of ≥20/400 was defined as functional success.Results:Sixteen eyes of 15 patients were included in the study. Eleven patients were human immunodeficiency virus positive, three patients had hematological malignancies, and one patient suffered from dyskeratosis congenita. The mean follow-up was 20.5 ± 17.4 months (range 3–60 months). Complete anatomical success was seen in 15 eyes (93.75%). One eye had a residual inferior detachment with attached macula. Silicone oil was used as tamponade in 15 eyes and C₃F₈ gas in one eye. The mean change in BCVA was statistically significant, preoperative LogMAR BCVA was 2.05 ± 0.94 while the final follow-up postoperative LogMAR BCVA was 1.03 ± 0.61 (P < 0.001). Thirteen eyes (81.25%) had final BCVA ≥20/400.Conclusion:Microincision vitrectomy surgery can achieve excellent retinal reattachment rates in post-CMVR RRDs without significant intraoperative and postoperative complications. The visual outcome varies depending on the status of the optic disc and macula. Majority of the patients maintained functional vision.     

Postoperative Complications of Pars Plana Vitrectomy for Diabetic Retinal Disease

ABSTRACT

Despite recent advances in the medical management of diabetic retinal disease, there remain established indications for vitreoretinal surgery in the treatment of severe proliferative diabetic retinopathy. These include non-clearing vitreous hemorrhage and tractional retinal detachment. Advances in surgical instrumentation, technique, and experience have led to improved visual outcomes, as well as a corresponding decrease in the incidence of postoperative complications. However, the presence of systemic and ocular factors in diabetic patients increases the risk of adverse events compared to non-diabetic individuals. This review will focus on the most important postoperative complications following pars plana vitrectomy, with specific considerations for the diabetic patient.     

Surgical Management and Outcome of Open Globe Injuries with Posterior Segment Complications: A 10-Year Review

Purpose: To describe the characteristics, management, and outcomes of open globe injured (OGI) eyes that underwent pars plana vitrectomy (PPV) for posterior segment complications. Methods: Retrospective chart review of cases that underwent PPV for posterior segment complications associated with OGI between 2003-2012 at University Hospital, Newark, NJ. Results: 120 eyes were identified and classified as follows: “early retinal detachment (RD)” (within 30 days of OGI), 64 (53%) eyes; “delayed RD” (≥30 days after OGI), 30 (25%) eyes; and “no RD,” 26 (22%) eyes. Injuries included penetrating (39 (33%) eyes), rupture (60 (50%) eyes), and penetrating wounds with retained intraocular foreign body (21 (17%) eyes). Injuries in Zones I, II, and III were seen in 40 (35%) eyes), 38 (34%) eyes, and 35 (31%) eyes, respectively, with statistically different ocular trauma scores (p<0.01) associated with each zone of injury. Mean presenting and final logMAR VA were 2.20± 0.63 and 1.87 ±0.60, respectively (p<0.01), with a mean follow-up of 3.2 years. Final overall anatomic success after surgeries was 98% for early RD and 95% for delayed RD. Conclusion: Despite a high anatomic success rate, the overall functional success rate for eyes with posterior segment trauma that undergo PPV is poor and comparable to other studies.     

Verruca plana as a complication of CO2 laser treatment: A case report

Carbon dioxide (CO₂) laser treatment is a common therapeutic modality for many dermatologic conditions. It uses a high energy, infrared beam of light, which selectively targets water-containing tissue resulting in controlled ablative resurfacing. This modality, however, can manifest significant cosmetic side effects. Here we report a case of verruca plana manifesting as a response to CO₂ laser treatment. A 74-year-old female with recent Mohs surgery for a basal cell carcinoma, presented for full-face-fractionated CO₂ treatment to address her surgical scars in addition to treating her mild diffuse actinic damage. Six weeks post treatment, the patient developed erythematous thin plaques over the areas that had been treated. Histology was consistent with verruca plana. Lesions showed mild improvement with topical tretinoin. Verruca plana are benign and typically self-limited; however, they can present a significant cosmetic burden to patients and are an important complication to consider when performing elective cosmetic procedures.     

针灸临证拾遗

针灸疗法具有适应证广、简便经济、疗效显著等特点,且具有较好的安全性,无毒副作用,为其他药物疗法所不及,值得临床广泛应用。     

艾拉光动力治疗尖锐湿疣及多发性跖疣临床疗效观察

目的:观察艾拉光动力疗法(5-盐酸氨酮戊酸光动力疗法,5-aminolevulinie acid photodynamic therapy,ALA-PDT)治疗尖锐湿疣(Condyloma acuminatum,CA)及多发性跖疣(Verruca phmtaris,PS)的安全性与疗效.方法:以ALA-PDT治疗151例CA及PS患者,末次治疗后第1周进行疗效评价,第4、8周和12周观察复发率和不良反应.结果:疗程结束后CA及PS的疣体清除率分别为96.5%和75.4%,治疗后复发率分别为12.1%和16.3%.未发生系统不良反应,局部不良反应发生率分别为10.47%和3.08%,主要为烧灼感,局部红肿.结论:ALA-PDT治疗CA及PS治愈率均较高,但治疗CA疗效更好.复发率低,安全性好.