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What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
Ninety-nine percent of my patients have one or both of the conditions that are my subspecialties. One is cataract, which is cured by surgery; the other is glaucoma, which is managed but rarely cured. The procedures done by ophthalmologists are, by and large, scheduled at a convenient time, at the discretion of the patient, and usually are brief. Cataract surgery takes 10–15 minutes and glaucoma surgery can take 30–45 minutes, and they’re scheduled at elective hours, e.g., 9:00 a.m. on Tuesday. Since they’re of limited duration, the surgeon’s leg does not go numb while sitting in the operating room chair. Cataract surgery accounts for most of the surgeries I do. Patients elect to have cataract surgery when their vision is inadequate for their needs due to clouding of the natural lens of the eye. Surgery involves exchanging the cloudy lens for a clear artificial lens. Nearly all cataract patients do well and are happy and grateful.
Suprachoroidal hemorrhage
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Uday R Desai, Alexander Rubowitz
In eyes that are aphakic or have an AC-IOL, infusion (whether through the limbus or the pars plana) may still drain out through the filter, and maintaining IOP may be impossible. In these cases, sacrificing the filter may be the only alternative. The conjunctiva over the filter is removed and the flap is secured with interrupted 10-0 nylon sutures. The drainage and reformation proceed as has already been described. The potentially high postoperative IOP is managed medically, and additional glaucoma surgery is performed as warranted as the eye stabilizes.
Laser Surgery in the Treatment of Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Since then, electrolysis, beta-irradiation, cryotherapy, xenon arc, ultrasound, surgical excision, and various visible and infrared lasers have been tried in an attempt to improve on this type of glaucoma surgery. In current practice, laser-based cyclodestructive procedures are useful in the treatment of glaucomas with poor surgical prognosis in which trabeculectomy with antimetabolites or aqueous drainage devices have failed. In addition, these procedures may also be used to decrease pain and to lower pressure in cases with limited visual potential. The most frequently used techniques are laser-based contact and noncontact cyclophotocoagulation using Nd:YAG or diode-based laser systems. The use of these techniques causes considerable pain, inflammation, and visual loss; they should therefore be treatments of last recourse (Figure 15.28). Initial reports of sympathetic ophthalmia were in eyes with previous ocular surgery, creating controversy. Subsequently, there have been reports of sympathetic ophthalmia occurring in eyes after cyclophotocoagulation that were not previously operated upon. Laser–tissue interactions vary somewhat depending on the wavelength and the peak power delivered. High-power, pulsed lasers (20 μs), such as the Microrupter series, cause more tissue disruption. Continuous-wave lasers require a longer exposure time to deliver sufficient energy to cause cyclophotocoagulation; the effects are more coagulative in nature. Distinctive pops that are heard are steam bubbles disrupting uveal tissue. The reported rates of phthisis are in excess of the occurrence of choroidal hemorrhage or loss of fixation in eyes with advanced glaucoma undergoing trabeculectomy. This argument in favor of cyclophotocoagulation should perhaps be revisited by surgeons. Although laser-based treatments produce less pain than cyclocryotherapy, they should be performed under retrobulbar anesthesia and the patients given a 3- to 4-day supply of moderate strength analgesic, such as Vicodin.
Bilateral Acute Depigmentation of Iris (BADI) and Bilateral Acute Iris Transillumination (BAIT)Following Acute COVID-19 Infection
Published in Ocular Immunology and Inflammation, 2023
Cigdem Altan, Berna Basarir, Serife Bayraktar, Ilknur Tugal-Tutkun
In patients who had resolution of pigment dispersion during follow-up, resolution time was recorded. Retinal nerve fiber layer (RNFL) thickness via spectral-domain optical coherence tomography (Spectralis; Heidelberg Engineering, Dossenheim, Heidelberg, Germany) and visual field static automated perimetry, using the 30–2 Swedish Interactive Threshold Algorithm (SITA) standard program (Humphrey Visual Field Analyzer; Carl Zeiss-Meditec Inc., Dublin, CA) findings were recorded. Patients were treated with topical prednisolone acetate 1% when they had acute symptoms or ongoing high-grade pigment dispersion in the anterior chamber and the dose was reduced according to the severity of the signs. In patients with an IOP equal or higher than 24 mmHg, topical antiglaucomatous medications (Dorzolamide/timolol fixed combination or brinzolamide/timolol fixed combination and/or topical brimonidine twice a day and prostaglandin analogs as a last option) and oral asetazolamid were used if needed. The highest IOP during follow-up and total follow-up time were recorded. Glaucoma surgery was carried out in patients with high IOP under maximum antiglaucomatous medication and/or progressive optic nerve head cupping. Topical tobramycin was used in the postoperative one-week period. Clinical findings after glaucoma surgery were also recorded.
The treatment of glaucoma using topical preservative-free agents: an evaluation of safety and tolerability
Published in Expert Opinion on Drug Safety, 2021
Anastasios G. Konstas, Antoine Labbé, Andreas Katsanos, Frances Meier-Gibbons, Murat Irkec, Konstadinos G. Boboridis, Gábor Holló, Julián García-Feijoo, Gordon N. Dutton, Christophe Baudouin
A recent study [124] evaluated the association between preservative exposure and the rate of further filtering surgery in all patients in a French medical-administrative database (EGB) who were commenced on glaucoma eyedrops between 2008 and 2015. Three treated groups were created according to the level of preservative exposure during follow-up: ‘0% preservatives, i.e. PF, ‘mixed’ and ‘100% preservatives’. The rate of glaucoma surgery was estimated according to preservative exposure indicators in Cox multivariate models adjusted on age, sex, number of glaucoma eye drops simultaneously used and duration of therapy. The sample consisted of 12.454 French patients with a median follow-up of 4.1 years. A total of 231 (1.9%) patients underwent glaucoma surgery during follow-up. Importantly, multivariable analysis revealed that the risk of glaucoma surgery was significantly greater in both the ‘mixed’ therapy group (hazard ratio = 3.94 [95% CI, 1.54–10.05]) and the ‘100% preservative’ group (hazard ratio = 7.97 [95% CI, 3.07–20.67]) when compared with the PF treatment group [124].
Intravitreal Ziv-Aflibercept : Safety Analysis in Eyes Receiving More Than Ten Intravitreal Injections
Published in Seminars in Ophthalmology, 2020
Sumit Randhir Singh, Goura Chattannavar, Apoorva Ayachit, Miguel Cruz Pimentel, Alex Alfaro, Sarvesh Tiwari, Abhishek Heranjal, Anand Subramanyam, Imoro Zeba Braimah, Abhinav Dhami, Parineeta Sachdev, Ahmad Mansour, Jay Chhablani
Main aetiologies were AMD (50 eyes including 2 eyes with retinal angiomatous proliferation, RAP), DME (16), RVO (BRVO, 8; CRVO, 7 eyes), polypoidal choroidal vasculopathy (PCV, 4 eyes), CNVM due to causes such as chronic central serous chorioretinopathy (CSCR, 3 eyes), idiopathic (2), inflammatory (2), or degenerative causes (angioid streaks, 1 eye) and a case of peripapillary retinal capillary haemangioma (1 eye). Among the 94 eyes, 16 patients had a previous history of glaucoma or steroid response. Among these, two had undergone glaucoma surgery (one trabeculectomy and Ahmad glaucoma valve each) prior to inclusion in the study. Six eyes developed IOP elevation during the follow up period among which four eyes had prior history of glaucoma or steroid response. All but one eye were medically managed with anti-glaucoma medications alone. The details of patient requiring glaucoma surgery are explained below.