Ophthalmic surgery and lasers最新文献

Purpose: To assess patient comfort using combined anterior sub-Tenon's, topical, and intracameral ("Blitz") anesthesia versus retrobulbar anesthesia in glaucoma surgery.

Patients and methods: In this study, 139 consecutive patients who received retrobulbar anesthesia and 139 consecutive patients who received Blitz anesthesia during glaucoma surgery were evaluated in a prospective fashion. The retrobulbar group included 49 trabeculectomies, 36 aqueous shunts, and 54 phacotrabeculectomies. The Blitz group included 49 trabeculectomies, 30 aqueous shunts, and 60 phacotrabeculectomies. Patients were asked to assess their level of ocular pain operatively and postoperatively on a 10-point visual analog scale. The operative and postoperative pain scores and postoperative sedation of patients receiving retrobulbar anesthesia were compared with those of patients receiving Blitz anesthesia during trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery, separately.

Results: No statistically significant difference was found in the mean operative or postoperative pain scores between the two groups during trabeculectomy, phacotrabeculectomy, or aqueous shunt surgery.

Conclusions: Blitz anesthesia offers a reasonable alternative to retrobulbar anesthesia for trabeculectomy, phacotrabeculectomy, and aqueous shunt surgery.

Background and objective: To investigate the annual incidence rates of Neodymium:YAG laser procedures in the treatment of eye diseases.

Patients and methods: In this population-based retrospective study, we evaluated 6,040 patients treated with a Nd:YAG laser in the hospital district of southwestern Finland during the years 1987 to 1998. The corresponding annual incidence rates of different Nd:YAG laser procedures were calculated using the corrected population statistics of the hospital district.

Results: The annual incidence rates of all Nd:YAG laser procedures rose significantly (P < 0.0001) from 32.1 per 100,000 patients in 1987 to 169.0 per 100,000 people in 1998. A great majority of Nd:YAG patients were females with a higher median age than the males in the study (P < 0.0001).

Conclusion: The rise of the annual population-based incidence rates of cataract surgery with a 7% to 29% need of Nd:YAG laser capsulotomies explained the increase of all Nd:YAG laser procedures.

A 65-year-old male patient developed dissecting glaucoma filtration bleb following trabeculectomy with mitomycin-C (MMC). Surgical partial excision of the bleb was performed and the tissue was subjected to histopathological evaluation. The bleb area was covered by a conjunctival flap that was advanced with the help of a relaxing incision in the superior conjunctiva fornix. The dissecting bleb was successfully managed by controlling intraocular pressure, and the patient became asymptomatic without any medication. The light microscopic examination of the bleb showed irregularly arranged collagen bundles and hypocellularity of the subconjunctival tissue with places of nodular configuration of the fibroblast in the periphery. Surgical partial excision of the dissecting glaucoma filtering bleb is a reliable, simple, and precise method. Advancing the conjunctival flap by a superior conjunctival relaxing incision facilitates easy mobilization of the flap, ensures healthy resurfacing of the bleb, and prevents postoperative transconjunctival leakage. Histopathology of the bleb is compatible with the use of MMC during original filtering surgery.

This case report presents a patient who developed a large overhanging bleb following antimetabolite trabeculectomy surgery 6 years prior. Complaints included decreasing vision and foreign body sensation for several months. Successful excisional surgery with placement of compression sutures was performed. Visual acuity and intraocular pressure were maintained with the resolution of symptoms.

Two patients had undergone double-plate Molteno shunt implantation. Both patients required surgical revision, the first at 41 months and the second at 8 months postoperatively, because of a failure of previously functioning tube shunts caused by blockage of the external ostium and intraluminal invasion of the tube by fibrous tissue. At the time of surgical revision, fibrous tissue extended down the lumen of the tube, occluding its external ostium. After excision of this tissue, both shunts became fully functional. When functioning aqueous shunts fail and there is no evidence of a bleb over the shunt reservoir or blockage of the internal ostium, ingrowth of fibrous tissue into the external ostium should be considered as a potential cause, especially if a ripcord or Latina suture has been left in place.

Objective: To evaluate the use of combined mucous membrane and hard palate mucosal grafts in the reconstruction of contracted eye socket.

Patients and methods: Thirteen eyes of 13 patients with contracted sockets underwent socket reconstructive surgery with combined mucosal membrane and hard palate mucosal grafts.

Results: The average follow-up period was 33 months. Five of 13 patients required additional surgery after initial socket reconstruction. However, all patients who underwent socket reconstruction with hard palate mucosal grafts were able to wear a cosmetically acceptable ocular prosthesis postoperatively.

Conclusion: Combined mucosal membrane and hard palate mucosal grafts can be effectively used in the reconstruction of contracted sockets.