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Prevalence of Amblyogenic Risk Factors in Congenital Nasolacrimal Duct Obstruction in a Developing Country 发展中国家先天性鼻泪管梗阻中致畸危险因素的患病率
Pub Date : 2021-09-03 DOI: 10.11648/J.IJOVS.20210603.15
U. Raina, Shruti Bhattacharya, S. Gupta, Varun Saini, Banu Pavitra, Kumar Ravinesh, R. Cruz
PURPOSE: Conventionally, congenital nasolacrimal duct obstruction (NLDO) has been treated as an entity with no bearing on development of visual acuity and routine refraction is not done considering the volume of patients in a in a developing Asian country like India. This research was designed to study the prevalence of amblyogenic refractive error in patients with congenital NLDO, as compared to an age-matched control group, in a developing country. METHODS: In this study, 89 patients with congenital NLDO and 78 patients as age matched controls, less than 4 years of age were included at a tertiary care centre in India. All underwent a complete ocular examination and risk factors for amblyogenic refractive error were noted based on the AAPOS guidelines. RESULTS: There was no gender predisposition and no significant difference between the two groups in terms of mode of delivery, orthoptic check-up, keratometry, axial length, fundus or anterior segment examination. Amblyogenic refractive error, as defined by the AAPOS guidelines, was found in 18 (20.5%) patients in the case group compared to 3 (3.8%) in the control group, and this was as follows: astigmatism in 10, anisometropia in 5, hyperopia in 3 subjects, and myopia in 1. These risk factors were not greater in children with unilateral NLDO compared to bilateral NLDO, but both were greater than their control group. There was also no significant difference found between the two groups in terms of distribution of anisometropia. CONCLUSIONS: The prevalence of amblyogenic refractive error in congenital NLDO was significantly higher than in the control group. Hence, a thorough evaluation is warranted in cases of congenital NLDO for early detection amblyogenic refractive error.
目的:传统上,先天性鼻泪管阻塞(NLDO)一直被视为一个与视力发展无关的实体,考虑到印度等亚洲发展中国家的患者数量,常规屈光检查未进行。本研究旨在研究发展中国家先天性NLDO患者的弱视屈光不正患病率,并与年龄匹配的对照组进行比较。方法:在这项研究中,89例先天性NLDO患者和78例年龄匹配的对照组,年龄小于4岁,包括在印度的三级保健中心。所有患者都接受了完整的眼部检查,并根据AAPOS指南记录了弱视性屈光不正的危险因素。结果:两组在分娩方式、正视检查、角膜测量、眼轴长度、眼底及前段检查方面无性别易感性,差异无统计学意义。AAPOS指南定义的弱视性屈光不正,病例组有18例(20.5%),对照组有3例(3.8%),具体情况如下:散光10例,屈光参差5例,远视3例,近视1例。这些危险因素在单侧NLDO患儿中并不比双侧NLDO患儿更大,但两者均高于对照组。在屈光参差的分布方面,两组之间也没有显著差异。结论:先天性NLDO患者的屈光不正发生率明显高于对照组。因此,在先天性NLDO的病例中,为了早期发现弱视性屈光不正,需要进行彻底的评估。
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引用次数: 0
Macular Hole Following Retained Subfoveal PFCL 黄斑裂孔后保留中央凹下PFCL
Pub Date : 2021-08-24 DOI: 10.11648/J.IJOVS.20210603.14
Navneet S. Mehrotra, G. Mohan, M. Nagpal, S. Talati, Ak Sharma
Introduction: Perfluorocarbon liquids (PFCLs) were first developed in 1970s as possible substitutes to erythrocytes because of their capacity to dissolve relatively large amounts of oxygen. Based on their properties, PFCL are widely used in complex retinal detachments, but they can cause complications in cases of subretinal retention. Migration of peripherally located subretinal PFCL towards the fovea is well established, but spontaneous resolution of sub-foveal PFCL without surgical evacuation or displacement has rarely been described. Case report: We report a case of a 48 year old male on whom a vitrectomy was performed for a retinal detachment with scleral tear following trauma. PFCL was used for ten days as a temporary intraocular tamponade for retinal flattening. A second vitrectomy was done to replace the PFCL with silicone oil, following which retained sub-foveal PFCL was noted. Result: Fourteen months later, a macular hole developed and PFCL disappeared. Slight superior displacement of the macular area was observed due to contraction of fibrous proliferation superiorly. There was no decrease in visual acuity. Patient was advised to undergo silicon oil removal. CONCLUSION: In the future, improved understanding of the mechanisms of spontaneous resolution may enable the development of non-surgical methods to displace sub-foveal PFCL.
简介:全氟化碳液体(PFCLs)最早是在20世纪70年代开发的,作为红细胞的可能替代品,因为它们具有溶解相对大量氧气的能力。基于其特性,PFCL被广泛应用于复杂的视网膜脱离,但在视网膜下保留的情况下会引起并发症。周围定位的视网膜下PFCL向中央凹的迁移是很好的,但没有手术清除或移位的中央凹下PFCL自发解决很少被描述。病例报告:我们报告一个48岁的男性的情况下,玻璃体切除术进行视网膜脱离巩膜撕裂创伤后。PFCL作为暂时性眼内填塞使视网膜变平,使用10天。第二次玻璃体切除术用硅油代替PFCL,随后注意到保留了中央凹下PFCL。结果:14个月后出现黄斑孔,PFCL消失。由于纤维增生的收缩,可见黄斑区域有轻微的上移位。视力没有下降。建议患者进行硅油去除术。结论:在未来,对自发消退机制的进一步了解可能会促进非手术方法的发展,以取代中央凹下PFCL。
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引用次数: 0
Treatment Burden and Quality of Life of Patients with Neovascular Age-Related Macular Degeneration (nAMD) and Their Caregivers—A Review 新生血管性年龄相关性黄斑变性(nAMD)患者及其照护者的治疗负担和生活质量综述
Pub Date : 2021-08-05 DOI: 10.11648/J.IJOVS.20210603.13
R. Biswas, R. Roy, Nitin Maksane, Maulik Bhavsar, Ajitabha Sanyal
The growing incidence of neovascular age-related macular degeneration (nAMD) in India and its debilitating consequences, such as physical, psychological, and emotional stress, are a cause of significant concern. Failing eyesight due to nAMD hinders the ability of patients to perform daily tasks, leading to dependency on others – often resulting in anxiety and depression. Although treatment options such as anti-vascular endothelial growth factors (anti-VEGFs) are readily available, long-term treatment compliance is often compromised. Thus, it is important for health care providers to be aware of the burden associated with nAMD for both patients and caregivers. India, with its large urban and rural population base, faces varied challenges in health care accessibility and affordability. Further, there is a paucity of India-specific studies to ascertain patient and caregiver burden related to nAMD. A deeper understanding of disease awareness and treatment expectations from an Indian perspective may further help clinicians to provide optimum management to patients. The current review provides insights into the quality of life (QoL) and treatment-related burden for patients with nAMD and their caregivers. Further, it emphasizes the need of PAN-India studies to ascertain the patient and caregiver burden related to nAMD, which may assist in devising treatment algorithms and pricing policies suited to the Indian population and enable patients to receive quality eye care.
在印度,新生血管性年龄相关性黄斑变性(nAMD)的发病率越来越高,其衰弱后果,如身体、心理和情绪压力,是一个值得关注的问题。由于nAMD导致的视力下降阻碍了患者执行日常任务的能力,导致依赖他人-通常导致焦虑和抑郁。虽然抗血管内皮生长因子(anti- vegf)等治疗方案很容易获得,但长期治疗的依从性往往受到损害。因此,对于卫生保健提供者来说,重要的是要意识到与nAMD相关的负担对患者和护理人员都是如此。印度拥有庞大的城市和农村人口基础,在保健可及性和可负担性方面面临各种挑战。此外,缺乏印度特有的研究来确定与nAMD相关的患者和护理人员负担。从印度人的角度更深入地了解疾病意识和治疗期望可能会进一步帮助临床医生为患者提供最佳管理。目前的综述提供了对nAMD患者及其护理者的生活质量(QoL)和治疗相关负担的见解。此外,它强调需要进行泛印度研究,以确定与nAMD相关的患者和护理人员负担,这可能有助于制定适合印度人口的治疗算法和定价政策,并使患者能够获得高质量的眼科护理。
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引用次数: 1
Internal Audit as a Quality Assurance Tool to Ensure Staff and Patient Safety During COVID-19 Pandemic 内部审计是确保COVID-19大流行期间工作人员和患者安全的质量保证工具
Pub Date : 2021-07-28 DOI: 10.11648/J.IJOVS.20210603.12
S. Dubey, Shalinder Sabherwal, J. Farooqui, P. Garg, U. Mathur, Ashutosh Kumar Singh
We present the process of development and implementation of an internal audit for prevention of spread of COVID-19 at a tertiary eye hospital, which can be used for further improvement of the system and be utilized by similar organizations to enhance patient and staff safety and quality of service. It is a Single center prospective audit. Based on the guidelines put forth by various international (Centers for Disease Control and Prevention, World Health Organization) and Indian (Ministry of Health and Family Welfare, All India Ophthalmological Society) authorities, preventive protocols were formulated. To ensure compliance of these protocols, audit sheets in the form of checklists and questionnaires were prepared. Facility and process audits were undertaken for registration, outpatient department and pre-surgical counseling. Pilot audits were carried out to develop more detailed audits, and implemented for one week. There was 100% compliance from the staff in personal protective equipment usage and hand hygiene. However, 21 incidents of physical distancing not being maintained by them were noted. Though there was 100% compliance in use of facemask by the staff and patients, 34.5% of patients were noticed wearing the mask improperly. It was also noted that, at the entry, thermal screening was not performed at 6/53 (11.3%) observations with no thermal screener at 3/23 instances. This study describes the process of formulating and conducting audits as a monitoring and evaluation tool, which is most relevant in ongoing COVID-19 pandemic to ensure safety of patients and health care workers.
我们介绍了一家三级眼科医院预防COVID-19传播的内部审计的制定和实施过程,可用于进一步改进系统,并可供类似组织使用,以提高患者和员工的安全和服务质量。这是一个单中心前瞻性审核。根据各种国际(疾病控制和预防中心、世界卫生组织)和印度(卫生和家庭福利部、全印度眼科学会)当局提出的指导方针,制定了预防方案。为了确保这些规程得到遵守,编制了核对表和调查表形式的审计单。对登记、门诊和术前咨询进行了设施和过程审核。进行试点审计,以制定更详细的审计,并实施了一周。员工在个人防护用品使用和手部卫生方面100%符合要求。但是,注意到21起他们没有保持身体距离的事件。医护人员和患者对口罩使用的符合性为100%,但发现有34.5%的患者口罩佩戴不当。还注意到,在进入时,6/53(11.3%)的观察没有进行热筛选,3/23的观察没有进行热筛选。本研究描述了作为监测和评估工具制定和实施审计的过程,这与正在进行的COVID-19大流行最相关,以确保患者和医护人员的安全。
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引用次数: 0
A Case History of Internal Ophthalmomyiasis, a Rare and Devastating Disease 一种罕见的毁灭性疾病——眼内眼病1例
Pub Date : 2021-07-15 DOI: 10.11648/J.IJOVS.20210603.11
S. Noman, Murtuza Nuruddin
To report a rare case of unilateral internal ophthalmomyiasis with complete visual loss. Method: An otherwise healthy 12 years old boy presented with redness and painful rapid loss of vision in his right eye for the past 12 days. There was no history of associated trauma. On examination, there was no perception of light in his right eye and normal vision in left eye. There was severe anterior and posterior segment inflammation which prevented the view of fundus. B-scan of the right eye showed diffuse choroidal and optic nerve thickening. Routine blood count and X-ray chest did not reveal any significant findings. In the midst of uncertainity regarding diagnosis and to relieve the patient from severe pain, enucleation of right eye was performed and histopathological examination of the specimen was done to confirm the diagnosis. Result: Histopathology report showed gross irregular inflammatory thickening of the choroid with severe granulomatous inflammation. There was an infective agent in the choroid having an outer cuticle and an irregular hyaline branching innner tube. These features were suggestive of ophthalmomyiasis of the choroid. Conclusion: Although rare, ophthalmomyiasis should be considered in the differential diagnosis of panuveitis. Early recognition of this condition, when tumour and other conditions are suspected, would avoid invasive surgical procedures, such as enucleation.
摘要报告一例罕见的单侧内眼病伴完全视力丧失的病例。方法:一名健康的12岁男孩,在过去的12天里,他的右眼出现了红肿和痛苦的快速视力丧失。没有相关的创伤史。经检查,右眼无光感,左眼视力正常。严重的前、后段炎症妨碍了眼底的观察。右眼b超显示弥漫性脉络膜及视神经增厚。常规血球计数和胸部x光检查未发现任何重大发现。在诊断不确定的情况下,为了减轻患者的剧烈疼痛,我们对右眼进行了剜出,并对标本进行了组织病理学检查以确认诊断。结果:组织病理学报告显示脉络膜明显不规则炎性增厚伴严重肉芽肿性炎症。脉络膜内有感染因子,有外角质层和不规则的透明分枝内管。这些特征提示脉络膜眼肿病。结论:眼肿病虽少见,但在鉴别诊断全葡萄膜炎时应予以重视。当怀疑有肿瘤或其他疾病时,及早发现这种情况,可以避免侵入性的手术,如去核。
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引用次数: 0
A Case of Bilateral Peripheral Ulcerative Keratitis 双侧周围性溃疡性角膜炎1例
Pub Date : 2021-06-30 DOI: 10.11648/J.IJOVS.20210602.23
Belghmaidi Sarah, Darfaoui Zineb, Hajji Ibtissam, Moutaouakil Abdeljalil
Peripheral ulcerative keratitis (PUK) is an aggressive, potentially sight-threatening cause for peripheral corneal thinning. It may precede the diagnosis of the systemic condition and therefore these cases require urgent investigation. A 43-year-old woman presented with bilateral tearing and ocular pain persisting for 7 months. Visual acuity was 6/6 in both eyes. On biomicroscopic examination, presence of crescent shaped corneal ulcer with perilesional haziness. A tear film study demonstrated decreased Schirmer test results (5mm in both eyes) and tear film break-up time (5 sec in both eyes). The interrogation and the patient revealed he had recurrent skin lesions in both legs with chronic itching, and recurrent oral and genital ulcers healing spontaneously. The diagnosis of Behcet disease was proposed. Pathergy test was negative, HLA B51 was positif. Systemic therapy was started with colchicine at a dose of 2mg/day. Eye drops and systemic prednisolone at 1mg/kg/day was continued with progressive decrease. The follow up at 3 months and 6 months showed no signs of recurrence of ulceration in both eyes. Corneal manifestation has rarely been reported in Behcet’s disease. Combined intraocular anterior and posterior segment inflammation are most common features of ocular Behcet disease. Collaborative management of ophthalmic patients having systemic illness along with internists improves overall outcomes and prevents morbidity in such patients.
外周性溃疡性角膜炎(PUK)是一种侵袭性的,潜在的视力威胁的外周角膜变薄的原因。它可能先于全身性疾病的诊断,因此这些病例需要紧急调查。43岁女性,双侧流泪,眼部疼痛持续7个月。双眼视力均为6/6。生物显微镜检查发现月牙形角膜溃疡伴病灶周围模糊。泪膜研究显示Schirmer试验结果(双眼5mm)和泪膜破裂时间(双眼5秒)减少。询问和病人透露,他有反复出现的皮肤病变,在双腿慢性瘙痒,和反复出现的口腔和生殖器溃疡自愈。提出了白塞病的诊断方法。病理检查阴性,HLA B51阳性。全身治疗以秋水仙碱开始,剂量为2mg/天。继续滴眼液和全身强的松龙剂量为1mg/kg/天,并逐渐减少。随访3个月和6个月均未见双眼溃疡复发。白塞氏病很少有角膜表现的报道。眼内前后段合并炎症是眼部白塞病最常见的特征。眼科全身性疾病患者与内科医生的协作管理可改善整体预后,并预防此类患者的发病率。
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引用次数: 0
Shorten Myopic Axial Length with Repeated Low-lever Laser Light Therapy 重复低水平激光治疗近视眼轴长缩短
Pub Date : 2021-06-26 DOI: 10.11648/J.IJOVS.20210602.22
Z. Lei, Qiu Kaikai, W. Bruce
Purpose: This study was to confirm that repeated low-lever laser light therapy (LLLT) could control myopic axial length (AL) elongation. Methods: Twenty myopia, 5 to 13 years old, were included in this study. All subjects kept daily repeated therapy with LLLT for mean 3 months; According to the baseline AL (> 24.40 mm or not), and ages (> 10 years old or not), we built two age groups and two AL groups. The AL between baseline and follow-up as well as different groups were all tested by SPSS 26.0, respectively. Results: 85% and 75% of AL were shortened for the right and left compared with those of baseline, respectively. The follow-up right and left AL were both significantly shortened (P=.002, P=.003, respectively) from baseline mean right AL 24.52 ± 1.01 mm, left AL 24.51 ± 0.96 mm, to 24.41 ± 0.98 mm (-0.11 mm right AL shortened amount) and 24.42 ± 0.93 (-0.09 mm left AL shortened amount), respectively. Long baseline AL group was significantly (P=.02, P=.03) shortened more AL than those of small baseline AL group for both right and left AL (-0.17 mm versus -0.05 mm, P <.001, respectively). From age group aspect, although it was also significant difference changed (shortened) for right AL (P=.008), but not for left AL (P=.051). Conclusions: LLLT could control myopia axial length progression.
目的:研究反复低强度激光治疗(LLLT)对近视眼轴长(AL)伸长的控制作用。方法:选取20例5 ~ 13岁近视儿童作为研究对象。所有受试者每天使用LLLT重复治疗,平均3个月;根据基线AL (bb0≥24.40 mm)和年龄(bb1≥10岁)分为2个年龄组和2个AL组。基线与随访、组间AL均采用SPSS 26.0软件进行统计分析。结果:与基线相比,右侧AL缩短85%,左侧AL缩短75%。随访左、右AL均明显缩短(P=。002, P =。003),从基线平均右侧AL为24.52±1.01 mm,左侧AL为24.51±0.96 mm,分别降至24.41±0.98 mm(右侧AL缩短-0.11 mm)和24.42±0.93 mm(左侧AL缩短-0.09 mm)。长基线AL组显著(P=。02, P=.03)左、右AL均比基线AL小组缩短(-0.17 mm比-0.05 mm, P <。001年,分别)。从年龄组来看,虽然右侧AL也有显著差异(缩短)(P= 0.008),但左侧AL无显著差异(P= 0.051)。结论:LLLT可控制近视眼轴长进展。
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引用次数: 0
To Study Presentation of Ocular Cysticercosis and Evaluate Its Demographic Data, Diagnosis, Treatment and Outcome in a Hill Population of Northern India 研究印度北部山区人群眼囊虫病的表现并评估其人口学资料、诊断、治疗和结果
Pub Date : 2021-06-22 DOI: 10.11648/J.IJOVS.20210602.21
D. Arora, Anuj Sharma, R. Raman, Ankit Parasher, Chinky Sharma, D. Sharma, Bhawna Tiwari, Himanshu Arora, Abhishek Kumar, K. Gupta, Niyaaz Ahmad, S. Nautiyal, S. Verma, Deepak Anthwal, D. Sharma
Aim: To study presentation of ocular cysticercosis and to evaluate its demographic data, diagnosis, treatment and outcome in hill population of Northern India. Materials and methods: This is a retrospective study carried out in Dehradun, Uttarakhand in a tertiary eye care hospital over 4 years from 2016-2020. The study involved 38 patients who presented with unilateral eye disease and were diagnosed to have ocular or adenexal cysticercosis. We analysed retrospectively their geographical data, clinical presentation, serology, imaging, response to treatment and clinical outcome. Results: Age of patients ranged from 16-54 years. Male to female ratio was 1:3.75. Total no. of eyes affected were 38. All were unilateral presentation. 30 eyes (78.94%) presented with extraocular cysticercosis and 8 eyes (21.05%) with intraocular cysticercosis. 27 of the patients (71.05%) were from lower socioeconomic status with poor hygiene and sanitation conditions. 32 (89.21%) patients gave history of association with non-vegetarian diet. Extraocular cysticercosis group had restriction of ocular motility as most prevalent presentation seen in 16 eyes (53.33%) and proptosis as the most prevalent sign seen in 17 eyes (56.66%). Cyst prevalence was most frequently detected in superior rectus muscle seen in 14 eyes (53.84%). Intraocular cysticercosis group had blurring of vision as the most prevalent presenting symptom in 8 eyes (100.0%). Panuveitis in 6 eyes (75%) and presence of subretinal cyst in 4 eyes (50%) was the most prevalent sign seen in intraocular cysticercosis group. Enzyme linked immunosorbent assay test confirmed serology in 35 cases (92.10%). The USG B-scan detected presence of scolex in 36 eyes (94.73%). Magnetic resonance imaging (MRI) confirmed deep seated extraocular cysticercosis lesions and neurocysticercosis (NCC) undetected by computerized tomography (CT). CT was diagnostic for NCC in 5 cases (13.15%). Oral Albendazole and prednisolone were successful in management of extraocular cysticercosis. Intraocular cysticercosis was treated well with pars plana vitrectomy surgery with good visual recovery. Conclusion: Extraocular cysticercosis was more prevalent than intraocular cysticercosis. Early diagnosis and treatment made a difference in final outcome of the two groups. Imaging studies of orbital B-scan ultrasonography (USG B scan), CT and MRI with immune serological test of enzyme linked immunosorbet assay (ELISA) and Western blot for anticysticercus antibodies helped in confirming the diagnosis. Extraocular cysticercosis can be managed well medically with good clinical outcome. Intraocular cysticercosisis is best treated surgically. Safer and modern vitreoretinal surgical techniques promise good surgical outcome and visual recovery. Timely intervention and frequent postoperative follow up would help in keeping a watch on development of complications and maintenance of good vision.
目的:研究印度北部山区眼囊虫病的临床表现,评价其人口学资料、诊断、治疗和转归。材料和方法:这是一项回顾性研究,于2016-2020年在北阿坎德邦德拉敦的一家三级眼科医院进行,为期4年。该研究涉及38例单侧眼部疾病并被诊断为眼部或腺囊尾蚴病的患者。我们回顾性分析了他们的地理资料、临床表现、血清学、影像学、治疗反应和临床结果。结果:患者年龄16 ~ 54岁。男女比例为1:3.75。总没有。38只眼睛受到影响。均为单侧呈现。眼外囊虫病30眼(78.94%),眼内囊虫病8眼(21.05%)。27例(71.05%)患者社会经济地位较低,卫生条件差。32例(89.21%)患者有非素食史。眼外囊虫组以眼球运动受限为主要表现16眼(53.33%),眼球突出为主要表现17眼(56.66%)。囊肿最常见于上直肌,14眼(53.84%)。眼内囊虫组以视力模糊为主要表现,8只眼(100.0%)。全葡萄膜炎6眼(75%),视网膜下囊肿4眼(50%)是眼内囊虫病组最常见的征象。酶联免疫吸附试验血清学证实35例(92.10%)。USG - b扫描发现36只眼(94.73%)存在头节。磁共振成像(MRI)证实深部眼外囊虫病病变和计算机断层扫描(CT)未发现的神经囊虫病(NCC)。CT诊断NCC 5例(13.15%)。口服阿苯达唑和强的松龙治疗眼外囊虫病是成功的。眼内囊虫病行玻璃体切除手术治疗效果良好,视力恢复良好。结论:眼外囊虫病发生率高于眼内囊虫病。早期诊断和治疗对两组患者的最终预后有显著影响。眼眶B超扫描(USG B scan)、CT和MRI影像学检查、免疫血清学酶联免疫沙冰试验(ELISA)和抗囊虫抗体免疫印迹检测有助于确诊。眼外囊虫病的医学治疗效果好,临床效果好。眼内囊虫病最好手术治疗。更安全和现代的玻璃体视网膜手术技术保证了良好的手术效果和视力恢复。及时的干预和术后频繁的随访有助于观察并发症的发展和维持良好的视力。
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引用次数: 0
How to Avoid Giant Retinal Tear Slippage: New Surgical Approach 如何避免巨大的视网膜撕裂滑移:新的手术途径
Pub Date : 2021-06-16 DOI: 10.11648/J.IJOVS.20210602.20
M. Zidi
Introduction: The retinal detachment (RD) by giant tear is a rare but serious clinical form. Apart from its therapeutic difficulty, during the fluid-air exchange, it poses a problem of retinal slippage which may be responsible for therapeutic failure or at best for retinal folds with serious anatomical and functional consequences. The purpose of this study is to shed light on the keys to the success of this technique. Material and methods: Retrospective study over 5 years from January 2014-December 2019 concerning 56 cases of retinal detachment by giant tear. All the patients were operated on by vitrectomy and laser endophotocoagulation of the tear edge and on 360°. The technique involved a first transient exchange of PFCL-air followed by a second exchange of silicone-air or gas-air depending on the case. Results: Intraoperatively, no cases of slipping, even in the cases of gas tamponade, have been observed. A primary retinal re-application of the RD was noticed in 87.5% of cases. The rate of retinal detachment recurrence was 12.5% (all had an advanced vitreoretinal proliferation). After recurrence surgery, the final reapplication rate was 100%. Conclusion: Mastering the PFCL-Air exchange during vitrectomy retinal detachments by giant tearing according to the technique described helps to prevent the slippage of the retina. The gas tamponade can be an alternative to silicone tamponade in some cases of giant tears selected with lower horns above the 4 – 8 meridians.
摘要视网膜脱离(RD)是一种罕见但严重的临床形式。除了治疗困难外,在液气交换过程中,它还会造成视网膜滑脱的问题,这可能导致治疗失败,或者充其量造成视网膜褶皱,造成严重的解剖和功能后果。这项研究的目的是阐明这种技术成功的关键。材料与方法:回顾性研究2014年1月至2019年12月5年间56例巨大撕裂性视网膜脱离病例。所有患者均行玻璃体切除和激光撕边内凝术,并360°切除。该技术包括第一次pfcl -空气的短暂交换,然后根据情况进行第二次硅空气或气体-空气交换。结果:术中无滑倒病例,即使在气体填塞的情况下,也未观察到。在87.5%的病例中发现了RD的原发性视网膜再应用。视网膜脱离复发率为12.5%(均为晚期玻璃体视网膜增生)。复发手术后,最终复涂率为100%。结论:掌握大撕裂法玻璃体切除视网膜脱离术中PFCL-Air交换有助于防止视网膜滑脱。气体填塞可以替代硅胶填塞,在某些情况下,巨大的撕裂选择较低的角以上的4 - 8个经络。
{"title":"How to Avoid Giant Retinal Tear Slippage: New Surgical Approach","authors":"M. Zidi","doi":"10.11648/J.IJOVS.20210602.20","DOIUrl":"https://doi.org/10.11648/J.IJOVS.20210602.20","url":null,"abstract":"Introduction: The retinal detachment (RD) by giant tear is a rare but serious clinical form. Apart from its therapeutic difficulty, during the fluid-air exchange, it poses a problem of retinal slippage which may be responsible for therapeutic failure or at best for retinal folds with serious anatomical and functional consequences. The purpose of this study is to shed light on the keys to the success of this technique. Material and methods: Retrospective study over 5 years from January 2014-December 2019 concerning 56 cases of retinal detachment by giant tear. All the patients were operated on by vitrectomy and laser endophotocoagulation of the tear edge and on 360°. The technique involved a first transient exchange of PFCL-air followed by a second exchange of silicone-air or gas-air depending on the case. Results: Intraoperatively, no cases of slipping, even in the cases of gas tamponade, have been observed. A primary retinal re-application of the RD was noticed in 87.5% of cases. The rate of retinal detachment recurrence was 12.5% (all had an advanced vitreoretinal proliferation). After recurrence surgery, the final reapplication rate was 100%. Conclusion: Mastering the PFCL-Air exchange during vitrectomy retinal detachments by giant tearing according to the technique described helps to prevent the slippage of the retina. The gas tamponade can be an alternative to silicone tamponade in some cases of giant tears selected with lower horns above the 4 – 8 meridians.","PeriodicalId":14184,"journal":{"name":"International Journal of Ophthalmology & Visual Science","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86463598","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Optic Neuropathy and Scleritis as the Presenting Feature of Lepra Reaction 视神经病变和巩膜炎是Lepra反应的表现特征
Pub Date : 2021-06-15 DOI: 10.11648/J.IJOVS.20210602.18
Nishikant Borse, V. Borse, T. Borse, Shiamak Cooper
A major problem in the management of leprosy patients is the occurrence of "reactions". These reactions are the consequences of the dynamic nature of the immune response to Mycobacterium leprae (M. leprae) that may occur before, during, or following the completion of multi-drug therapy (MDT). They can be of two types- Type 1 lepra reaction and Type 2 lepra reaction also known as Erythema Nodosum Leprosum (ENL). We report an unusual case of a 35 year old male patient who initially presented with complaints of a central scotoma. He neither had visible skin lesion suggestive of leprosy nor a history of either completion or concurrent anti leprosy drug treatment. He was diagnosed to be a case of anterior ischemic optic neuropathy for which he was treated with intravenous injections of methylprednisolone to which he significantly responded. Two months later, he complained of diminution of vision, redness and pain in the left eye which was diagnosed as scleritis. He was managed with topical prednisolone acetate eye drops. Within a week, the patient developed skin lesions over the cheekbones, ear lobules and the back of his hands. He was referred to a rheumatologist and a dermatologist for the same. The dermatologist suspected the lesions to be a manifestation of a Lepra Reaction. The presence of lepra bacilli was confirmed after taking a biopsy from the raised lesions and he turned out to be a case of undiagnosed lepromatous leprosy. He was subsequently treated with anti-leprosy drugs according to the WHO-MDT-MB along with a cover of steroids. After three months of initiation of this treatment, his ocular and dermatological lesions completely resolved. This is a unique case in which anterior ischemic optic neuropathy and scleritis preceded the symptom of leprosy, manifested as skin lesions.
麻风病患者管理中的一个主要问题是“反应”的发生。这些反应是对麻风分枝杆菌(M. leprae)的动态免疫反应的结果,可能发生在多药治疗(MDT)之前、期间或之后。它们可分为两种类型- 1型麻风反应和2型麻风反应,也称为麻风结节性红斑(ENL)。我们报告一个不寻常的情况下,一个35岁的男性患者谁最初提出投诉中央暗斑。他既没有可见的麻风皮肤病变,也没有完成或同时进行抗麻风药物治疗的历史。他被诊断为前路缺血性视神经病变,他接受静脉注射甲基强的松龙治疗,他有明显的反应。两个月后,他主诉视力减退,左眼发红、疼痛,诊断为巩膜炎。患者局部使用醋酸泼尼松龙滴眼液。一周之内,病人的颧骨、耳部和手背都出现了皮肤损伤。他被介绍给一位风湿病学家和一位皮肤科医生。皮肤科医生怀疑这些病变是Lepra反应的表现。在对凸起的病变进行活检后证实存在麻风杆菌,结果证明他是一例未确诊的麻风性麻风。随后,根据世卫组织mdt - mb,他接受了抗麻风病药物治疗,并服用了类固醇。开始这种治疗三个月后,他的眼部和皮肤病变完全消失。这是一个独特的病例,其中前缺血性视神经病变和巩膜炎先于麻风病的症状,表现为皮肤病变。
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International Journal of Ophthalmology & Visual Science
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