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Ocriplasmin for Vitreoretinal Diseases
Irena Tsui,Carolyn K. Pan,Ehsan Rahimy,Steven D. Schwartz
Journal of Biomedicine and Biotechnology , 2012, DOI: 10.1155/2012/354979
Abstract: Fibronectin and laminin are clinically relevant plasmin receptors in the eye. Located at the vitreoretinal interface, they are cleaved by ocriplasmin (Microplasmin, ThromboGenics, Iselin, NJ), a novel ophthalmic medication. A series of clinical trials to study ocriplasmin for the treatment of vitreoretinal diseases such as vitreomacular traction, macular hole, and exudative age-related macular degeneration are underway. The results are promising and may impact patient care.
Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement
Tariq M Aslam, Niall Patton
BMC Ophthalmology , 2004, DOI: 10.1186/1471-2415-4-13
Abstract: 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated.Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser.Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.Posterior capsular opacification (PCO) remains one of the most common post operative morbidities in modern day cataract surgery [1,2] and Nd:YAG posterior capsulotomy is one of the most commonly performed surgical procedures.However, the Nd: YAG capsulotomy procedure has been associated with complications such as damage to intraocular lenses [3], post operative intraocular pressure increases [4], cystoid macular oedema [4], disruption of the anterior vitreous face [5] and increased incidence of retinal detachment [6].Until recently Nd:YAG laser treatments have cost the U.S healthcare system up to $250 million annually [7]. Apart from exposing a patient to unnecessary risk, unqualified capsulotomies worsen this burden to the developed and developing world [8].PCO is an extremely common development in patients after cataract extraction and in many mild cases it may not be immediately obvious whether it is visually significant. Patients may have reduced vi
Basic training module for vitreoretinal surgery and the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment  [cached]
Yeh S,Chan-Kai BT,Lauer AK
Clinical Ophthalmology , 2011,
Abstract: Steven Yeh1, Brian T Chan-Kai2, Andreas K Lauer31Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA; 2Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; 3Casey Eye Institute, Oregon Health and Science University, Portland, OR, USABackground: The purpose of this study was to design and implement a vitreoretinal training module that would be useful for ophthalmology residents and fellows to learn the basic maneuvers required in vitreoretinal surgery.Methods: A prospective pilot study evaluating the training module was undertaken in 13 ophthalmology trainees (residents and vitreoretinal fellows) with varying levels of vitreoretinal training experience. A vitreoretinal training module was designed and consisted of a three-port vitrectomy setup (sclerotomy wound construction, infusion placement), intraocular tasks (core vitrectomy, driving the operating microscope, membrane peel, air–fluid exchange), and wound closure. Standard vitrectomy instrumentation, the VitRet eye (Phillips Studio, Bristol, UK) and vitreous-like fluid using dairy creamer and balanced saline were utilized. A five-point Likert scale, ie, the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment (CEIVITS), was devised to evaluate each component of the module. Vitreoretinal surgical maneuvers were digitally recorded and graded by an attending vitreoretinal surgeon. Linear regression and correlation were performed to evaluate the relationship between prior vitreoretinal experience and CEIVITS performance. The main outcome measures were correlation of vitreoretinal surgical experience and CEIVITS performance on simulated tasks using a basic vitreoretinal training module.Results: Thirteen participants from postgraduate year 2 to postgraduate year 6 levels were evaluated. Nine participants were male and four were female. The median age of participants was 32 (range 30–36) years and surgical experience was 0–410 prior vitreoretinal surgical procedures. A positive correlation (P < 0.05) was observed between vitreoretinal surgical experience and CEIVITS performance on the following tasks: total score (P = 0.021), sclerotomy wound construction (P = 0.047), infusion line placement (P = 0.012), air–fluid exchange (P = 0.004), and wound closure (P = 0.032). Post module surveys showed that the majority of trainees felt that the vitreoretinal training module improved their understanding of vitreoretinal surgery. The nonbiohazardous nature of the setup was advantageous from sanitation and cost perspectives.Conclusion: The implementation of our training m
Superficial extraconal blockade for vitreoretinal surgery  [cached]
Riad W,Abboud E,Al-Harthi E,Kahtani E
Saudi Journal of Anaesthesia , 2010,
Abstract: Context: Needle length plays an important role for the success of ophthalmic block. The standard practice is to use 25 mm needles length; however, unnecessarily long needles may increase the risk of complications especially in the presence of staphyloma or previous scleral buckle. Aims: This work was designed to compare the efficacy of using 15 and 25 mm needle in performing extraconal block for patients undergoing vitreoretinal surgery. Settings and Design: Prospective randomized double blinded study. Materials and Methods: A total of 120 patients were enrolled in this study and were divided in two groups. In group (1) extraconal block was performed using 25 mm needle, while in group (2) 15 mm needle was used. After primary injection, assessment of the block was done by an anesthesiologist who was unaware of the needle used. If satisfactory akinesia was not achieved a supplementation was provided. At the end of the procedures, patients and surgeons were asked to assess their pain and satisfaction with the anesthetic technique. Statistical Analysis Used : The sample size calculation using N-Quary version 4. Numerical and categorical data were analyzed using an independent sample, a two-tailed t-test, and chi-square test, respectively. Results: The volume of primary injectable was significantly higher in group 2. The two groups were comparable as regards total volume of local anesthetic, supplementation rate, akinesia, pain score, and surgeon satisfaction. Conclusions: Using 15 mm needle length to perform extraconal blockade for posterior segment procedures is equally effective to 25 mm needle.
Basic training module for vitreoretinal surgery and the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment
Yeh S, Chan-Kai BT, Lauer AK
Clinical Ophthalmology , 2011, DOI: http://dx.doi.org/10.2147/OPTH.S23772
Abstract: asic training module for vitreoretinal surgery and the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment Original Research (2727) Total Article Views Authors: Yeh S, Chan-Kai BT, Lauer AK Published Date September 2011 Volume 2011:5 Pages 1249 - 1256 DOI: http://dx.doi.org/10.2147/OPTH.S23772 Steven Yeh1, Brian T Chan-Kai2, Andreas K Lauer3 1Emory Eye Center, Emory University School of Medicine, Atlanta, GA, USA; 2Cullen Eye Institute, Baylor College of Medicine, Houston, TX, USA; 3Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA Background: The purpose of this study was to design and implement a vitreoretinal training module that would be useful for ophthalmology residents and fellows to learn the basic maneuvers required in vitreoretinal surgery. Methods: A prospective pilot study evaluating the training module was undertaken in 13 ophthalmology trainees (residents and vitreoretinal fellows) with varying levels of vitreoretinal training experience. A vitreoretinal training module was designed and consisted of a three-port vitrectomy setup (sclerotomy wound construction, infusion placement), intraocular tasks (core vitrectomy, driving the operating microscope, membrane peel, air–fluid exchange), and wound closure. Standard vitrectomy instrumentation, the VitRet eye (Phillips Studio, Bristol, UK) and vitreous-like fluid using dairy creamer and balanced saline were utilized. A five-point Likert scale, ie, the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment (CEIVITS), was devised to evaluate each component of the module. Vitreoretinal surgical maneuvers were digitally recorded and graded by an attending vitreoretinal surgeon. Linear regression and correlation were performed to evaluate the relationship between prior vitreoretinal experience and CEIVITS performance. The main outcome measures were correlation of vitreoretinal surgical experience and CEIVITS performance on simulated tasks using a basic vitreoretinal training module. Results: Thirteen participants from postgraduate year 2 to postgraduate year 6 levels were evaluated. Nine participants were male and four were female. The median age of participants was 32 (range 30–36) years and surgical experience was 0–410 prior vitreoretinal surgical procedures. A positive correlation (P < 0.05) was observed between vitreoretinal surgical experience and CEIVITS performance on the following tasks: total score (P = 0.021), sclerotomy wound construction (P = 0.047), infusion line placement (P = 0.012), air–fluid exchange (P = 0.004), and wound closure (P = 0.032). Post module surveys showed that the majority of trainees felt that the vitreoretinal training module improved their understanding of vitreoretinal surgery. The nonbiohazardous nature of the setup was advantageous from sanitation and cost perspectives. Conclusion: The implementation of our training module for residency and vitreoretinal fellowship was feasible and the CEIVITS adequatel
Scleral ulceration after vitreoretinal surgery  [cached]
Gokhale Nikhil
Indian Journal of Ophthalmology , 2009,
Abstract: Scleral ulceration after ocular surgery is a rare but serious complication. Determination of the underlying systemic and local causes is critical for treatment. An unusual case of ischemic scleral ulceration after vitreoretinal surgery in a diabetic patient is reported. Patient was successfully treated with a pedicle conjunctival graft.
Pneumatic tools for vitreoretinal surgery
Romano MR, Vallejo-Garcia JL, Randazzo A, Vinciguerra P.
Clinical Ophthalmology , 2012, DOI: http://dx.doi.org/10.2147/OPTH.S28496
Abstract: eumatic tools for vitreoretinal surgery Short Report (2376) Total Article Views Authors: Romano MR, Vallejo-Garcia JL, Randazzo A, Vinciguerra P. Published Date March 2012 Volume 2012:6 Pages 385 - 387 DOI: http://dx.doi.org/10.2147/OPTH.S28496 Received: 22 November 2011 Accepted: 28 December 2011 Published: 13 March 2012 Mario R Romano, Jose Luis Vallejo-Garcia, Alessandro Randazzo, Paolo Vinciguerra Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano, Milan, Italy Abstract: One of the difficulties of microsurgery is learning how to control physiological tremors. The pneumatic tool eliminates the physiological tremor, but no tactile feedback is provided. The manual tremor when closing the forceps is completely eliminated and the exact target can be more easily grabbed. Forceps closure pressure can rise up to 50 psi, whereas the scissors can be used in two modes: multicut and proportional. When performing bimanual surgery the pedal range is divided into two steps: in the first step, the forceps are controlled, and in the second step, the forceps remain closed. At the same time the scissors start to work in the preselected mode. No adverse events occurred and no iatrogenic retinal breaks were produced. Precision and control sensation were a grateful surprise.
Effect of Anterior Capsule Polishing on the Need for Laser Capsulotomy  [PDF]
Hamad Elzarrug, Kevin M. Miller, Yu Fei, Shahriar Farzad, Yaroslav O. Grusha
Open Journal of Ophthalmology (OJOph) , 2017, DOI: 10.4236/ojoph.2017.74041
Abstract:
Purpose: To determine the effect of anterior capsule polishing (APC) on the rate of posterior capsule opacification (PCO) as assessed by the need for laser posterior capsulotomy. Setting: University-based clinical practice, Jules Stein Eye Institute, Los Angles, California, USA. Methods: This study involved a retrospective review of eyes that underwent phacoemulsification and intraocular lens implantation between September 1991 and June 1999. Lens epithelial cells in the 763 study eyes were mechanically debrided or polished from the inside surface of the anterior capsules using a pair of Shepherd-Rentsch (Morning STAAR Inc.) capsule polishers. The 484 control eyes that had surgery earlier in the series were not polished. The rate of laser capsulotomy in the ACP and the non-ACP groups was compared using a Kaplan-Meier survival analysis. Multivariate regression was performed to determine if variables other than ACP influenced the need for laser posterior capsulotomy. Results: We identified 763 eyes that had ACP and 484 that did not. At the 24-month follow-up interval, 26.6% of the eyes in the ACP group had received a capsulotomy versus 19.50% in the non-APC. Next, a separate study was done using only one eye per patient, taking the patient as the unit of analysis. Again the capsulotomy rate was higher in the ACP group compared to the non-ACP (1.02 per 100 person-months of follow-up vs. 0.74 per 100 person-months of follow-up). Finally, a third Kaplan-Meier analysis was done on 52 patients that had one eye treated with the ACP procedure and the other eye with the non-ACP procedure. Although the log-rank test showed the statistical significant of this analysis to be borderline, the results again favored the non-ACP group with a lower capsulotomy rate. Multivariate analysis showed very similar results to the above univariate studies. The mean time to capsulotomy was 46 months for the polished group and 70 months for the unpolished group. The severity of cataract (p = 0.46) and the type of haptics (p = 0.86) did not influence the rate of capsulotomy. Plate haptic IOLS had a higher rate of capsulotomy than loop haptic IOLS (p = 0.001). Conclusions: Polishing of the anterior capsule with Shepherd-Rentsch polishers may unexpectedly increase the rate of posterior capsule opacification in eyes with round-edge silicone lenses.
Role of serotonin in development of esophageal and gastric fundal varices  [cached]
Jelena S Rudi?, ?or?e M ?ulafi?, Du?ko S Mirkovi?, Rada S Je?i?, Miodrag N Krsti?
World Journal of Gastroenterology , 2010,
Abstract: AIM: To determine the effect of free serotonin concentrations in plasma on development of esophageal and gastric fundal varices.METHODS: This prospective study included 33 patients with liver cirrhosis and 24 healthy controls. Ultrasonography and measurement of serotonin concentration in plasma were carried out in both groups of subjects. The upper fiber panendoscopy was performed only in patients with liver cirrhosis.RESULTS: The mean plasma free serotonin levels were much higher in liver cirrhosis patients than in healthy controls (219.0 ± 24.2 nmol/L vs 65.4 ± 18.7 nmol/L, P < 0.0001). There was no significant correlation between serotonin concentration in plasma and the size of the esophageal varices according to Spearman coefficient of correlation (rs = -0.217, P > 0.05). However, the correlation of plasma serotonin concentration and gastric fundal varices was highly significant (rs = -0.601, P < 0.01).CONCLUSION: Free serotonin is significant in pathogenesis of portal hypertension especially in development of fundal varices, indicating the clinical value of serotonergic receptor blockers in these patients.
Fundal Height Growth Curve for Thai Women  [PDF]
Jirawan Deeluea,Supatra Sirichotiyakul,Sawaek Weerakiet,Renu Buntha,Chamaiporn Tawichasri,Jayanton Patumanond
ISRN Obstetrics and Gynecology , 2013, DOI: 10.1155/2013/463598
Abstract: Objectives. To develop fundal height (FH) growth curve from normal singleton pregnancy based on last menstrual period (LMP) and/or ultrasound dating for women in the northern part of Thailand. Methods. A retrospective time-series study was conducted at four hospitals in the upper northern part of Thailand between January 2009 and March 2011. FH from 20 to 40 weeks was measured in centimeters. The FH growth curve was presented as smoothed function of the 10th, 50th, and 90th percentiles, which were derived from a regression model fitted by a multilevel model for continuous data. Results. FH growth curve was derived from 7,523 measurements of 1,038 women. Gestational age was calculated from LMP in 648 women and ultrasound in 390 women. The FH increased from 19.1?cm at 20 weeks to 35.4?cm at 40 weeks. The maximum increase of 1.0?cm/wk was observed between 20 and 32 weeks, declining to 0.7?cm/wk between 33 and 36 weeks and 0.3?cm/wk between 37 and 40 weeks. A quadratic regression equation was FH GA2 (wk) (R-squared?=?0.85). Conclusions. A demographically specific FH growth curve may be an appropriate tool for monitoring and screening abnormal intrauterine growth. 1. Introduction Routine symphysis-fundal height (or “fundal height” in short) measurement during pregnancy has been used in antenatal care with a long history, to estimate size of uterus and gestational age. It is simple, convenient, safe, and cheap [1–4]. Abnormal fundal height (smaller or larger than gestational age) may indicate abnormal uterus, fetal growth, and amniotic fluid development. Fundus smaller than gestational age may indicate intrauterine growth restriction (IUGR), small for gestational age (SGA), or oligohydramnios, while fundus larger than gestational age may reflect large fetus for gestational age (LGA), polyhydramnios, twins, or uterine tumor [5]. Although ultrasound is replacing fundal height measurement in detecting the above conditions [6, 7], in developing countries, it is not fully available in all antenatal care levels, due to high cost and lack of experienced personnel [1, 3]. Therefore WHO Reproductive Health Library still recommends using fundal height measurement as a tool to estimate gestational age and detect SGA and multiple pregnancies [1]. National Institute for Health and Clinical Excellence Guideline for Antenatal Care (clinical guideline 62) also recommends routine measurement and monitoring fundal height for every antenatal visit [8]. According to Cochrane review, there is not enough evidence to evaluate the use of fundal height measurement during antenatal
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