Avaliação da termoablação com endolaser da veia safena parva com anestesia local / Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia

Resumo Contexto Na insuficiência venosa crônica (IVC), a veia safena parva (VSP) é afetada em 15% dos casos. A cirurgia convencional é a técnica padrão para o tratamento da insuficiência da VSP, sendo a lesão no nervo sural uma complicação bastante temida. O tratamento de termoablação com endolaser tende a ser um método cirúrgico que diminui complicações da terapia cirúrgica da IVC. Objetivos Avaliar os pacientes com IVC submetidos à terapia por endolaser da VSP ao menos 30 dias após o procedimento. Métodos Foram analisados 54 membros inferiores de 46 pacientes submetidos à terapia por endolaser 1470 nm, sob anestesia local, para o tratamento da IVC em um hospital terciário. Os pacientes foram avaliados no período pré-operatório, intraoperatório e pós-operatório de 30 dias, através da clínica, exame físico e achados ecográficos. Resultados Nos 54 membros inferiores submetidos ao tratamento, comparando-se o período pré-operatório e o 30º dia pós-operatório, houve diferença significativa (p < 0,003) na redução do diâmetro da VSP tratada (6,37 mm pré-operatório e 5,15 mm no 30º dia pós-operatório) (IC95% 4,58-5,72) e na melhora do escore de gravidade clínica venosa (VCSS) (média de 8,02 pré-operatório e 6,11 no 30º dia pós-operatório) (IC95% 5,01-7,21) (p < 0,02). Complicações pós-operatórias, como parestesia e flebite, estiveram presentes e foram diagnosticadas em cinco e três pacientes, respectivamente, sem significar alteração na qualidade de vida e nas atividades de rotina. Conclusões A técnica de termoablação com laser da VSP mostrou-se segura e eficaz na redução dos sintomas clínicos e na melhora da qualidade de vida.

Abstract Background The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01—7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.

Comparison of endolaser or cryotherapy on capsule contraction syndrome after phaco - vitrectomy surgery for rhegmatogenous retinal detachment / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To compare the influence of endolaser or cryotherapy on capsule contraction syndrome (CCS) following phaco - vitrectomy and intraocular lens implantation in patients with rhegmatogenous retinal detachment. ·METHODS: A total of 244 eyes were enrolled in this retrospective analysis. The surgical approach was standard vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation simultaneously. There were 198 eyes underwent endolaser and 46 eyes underwent cryotherapy during the surgery. The main outcome measures were postoperative clinical outcomes including anatomical position of retina, the capsules and the position of IOLs and best corrected visual acuity (BCVA) at 1d,1wk,1,2,3,6mo and 1a. ·RESULTS: There were 6 eyes (3.0%) of CCS occurred in endolaser group and 5 eyes (10.9%) of CCS occurred in cryotherapy group. The different procedures during the surgery were significantly associated with the incidence of CCS (odds ratio:0.256,P=0.021,95% Cl:0.075-0.880). ·CONCLUSION: Different procedures during phaco -vitrectomy surgery are significantly associated with the incidence of CCS. Endolaser is more beneficial than cryotherapy in preventing CCS following phaco -vitrectomy and intraocular lens implantation.

Systemic Steroid Therapy for Serous Retinal Detachment Caused by Excessive Endolaser during Diabetic Retinopathy Surgery

PURPOSE: To report cases of macular serous retinal detachment caused by excessive intraoperative endolaser in patients with diabetic vitreous hemorrhage. Macular serous retinal detachment was improved by systemic steroid therapy. CASE SUMMARY: A 64-year-old male (case 1) and a 67-year-old female (case 2) treated with vitrectomy and endolaser (case 1, 3,184 shots; case 2, 1,734 shots) because of diabetic vitreous hemorrhage visited our out-patient clinic with blurred vision. Best corrected visual acuity (BCVA) in case 1 was hand motion and 0.03 in case 2. Fundus examination and optical coherence tomography (OCT) revealed extensive subretinal fluid accumulation of the posterior pole. With the diagnosis of macular serous retinal detachment caused by excessive intraoperative endoaser, oral steroid (40 mg/qd, 5 days) was administered and then later reduced in case 1. In case 2, we administered intravenous high-dose steroid (250 mg/qid, 3 days). After systemic steroid therapy, BCVA was improved to 20/30 in case 1 and 20/40 in case 2 and OCT showed the subretinal fluid was resolved. CONCLUSIONS: During diabetic retinopathy surgery, excessive endolaser induced macular serous retinal detachment and systemic steroid therapy was necessary in diabetic patients. Thus, physicians should be well acquainted with this complication.

The Prophylactic Effect of 360 Degree Endolaser Photocoagulation for Prevention of Retinal Detachment

PURPOSE: To evaluate the effectiveness of prophylactic effect of 360 degree endolaser photocoagulation for prevention of retinal detachment after pars plana vitrectomy. METHODS: In a retrospective study, 53 patients who underwent pars plana vitrectomy by one surgeon from Jan 2008 to Dec 2008 were examined. We compared the visual acuity improvement and postoperative retinal detachment and other postoperative complications in the 28 patients who received the 360 degree endolaser photocoagulation during the pars plana vitrectomy and the 26 patients who did not receive the 360 degree endolaser photocoagulation during the pars plana vitrectomy. RESULTS: Two patients who did not receive 360 degree endolaser photocoagulation during the surgery got the postoperative retinal detachment. One of them got the only fluid gas exchange, but the other had to receive the reoperation. There was no statistically significant difference of visual acuity between the two groups (p > 0.05), and no surgical complication associated with endolaser photocoagulation. CONCLUSIONS: 360 degree endolaser photocoagulation for prevention of retinal detachment during the pars plana vitrectomy would be considerable for preventing the retinal detachment development.

Primary Pars Plana Vitrectomy With 360-Degree Endolaser Photocoagulation for Pseudophakic Rhegmatogenous Retinal Detachment

PURPOSE: To report the results of primary pars plana vitrectomy with 360-degree endolaser photocoagulation for pseudophakic rhegmatogenous retinal detachment. METHODS: We retrospectively reviewed the medical records of 35 eyes of 35 patients who hadundergone vitrectomy without scleral bucking as a primary operation for pseudophakic rhegmatogenous retinal detachment with a follow-up period of more than 12 months. We also analyzed the anatomical success rate and the patients' final visual acuities. In all patients, endolaser photocoagulation was applied to the retinal tears, as well as to 360-degrees of the peripheral retina, using a curved illuminating endolaser probe intraoperatively. RESULTS: The mean patient age was 61 years, and the mean follow-up period was 20 months. The mean preoperative visual acuity (logMAR) was 1.06, while the mean postoperative visual acuity (logMAR) was 0.23. Twenty-four (69%) of the 35 patients showed macular detachment, and 34 (97%) of the 35 eyes experienced retinal reattachment and visual improvement after a single operation. Complications included epiretinal membrane (6%) and cystoid macular edema (3%). CONCLUSIONS: Primary pars plana vitrectomy with 360-degree endolaser photocoagulation, instead of sclera buckling, seemsto be an effective method in managing pseudophakic rhegmatogenous retinal detachment.

The effect of vitrectomy,endolaser photocoagulation and silicone oil injection for acute retinal necrosis syndrome / 医学研究生学报

Objective:Acute retinal necrosis syndrome(ARNS) is a rare disease with high blinding rate.The surgery of vitrectomy,endolaser photocoagulation and silicone oil injection is considered an effective treatment of ARNS.The study investigated the effect of vitrectomy,endolaser photocoagulation and silicone oil injection treating ARNS.Methods:A consecutive 16 eyes of 16 patients with ARNS were treated with vitrectomy,endolaser photocoagulation and silicone oil injection.The 5 eyes without retinal detachment were photocoagulated from the posterior border of necrosis to the ora serrata.The 11 eyes with retinal detachment were treated with subtotal retinal photocoagulation,air/fluid exchange and silicone oil injection.The follow-up time were 6 months at least,16 months in average.Results:The final best-correcting visual acuity was counting fingers in 3 eyes(18.8%),0.02-0.3 in 7 eyes(43.8%),0.4-0.6 in 5 eyes(31.3%),0.7 in 1 eye(6.3%).The silicone oil was uneventfully removed in 14 patients(87.5%) from 3 to 12 months.No one had a recurrent retinal detachment.Conclusion:There is a favorable effect in ARNS with the treatment of vitrectomy,endolaser photocoagulation and silicone oil injection.

A long-term follow-up for diabetic retinopathy with diffuse retinal edema and massive subretinal hard exudates / 解放军医学杂志

Objective To evaluate the clinical effects of surgical treatment for diabetic retinopathy(DR)with diffuse diabetic retinal edema(DDRE)and massive subretinal hard exudates(MSHE)by vitrectomy,endolaser retinal photocoagulation and long acting gas tamponade via analyzing the long term results.Methods Thirty eyes of twenty five patients with DR with DDRE and MSHE were recruited from October 2001 to December 2006.Among them,17 eyes belonged to 14 male patients and 13 eyes of 11 females.The patients' age was from 36 to 68 years(mean 54.6).The best corrected visual acuity(BCVA),color fundus photography,fundus fluorescein angiography(FFA)and optic coherence tomography(OCT)were performed preoperatively.Pars plana vitrectomy,posterior hyaloid removal,endolaser photocoagulation and long acting gas tamponade were used to treat the affected eyes.Results Preoperative BCVA was finger counting to 0.05 in all the 30 eyes.During 12-23 months of follow up period,2 eyes showed no change in BCVA,vision improvement was observed in 28 eyes(93.3%)with BCVA rising to 0.03-0.04 in 3 eyes,≥0.09 in 25 eyes,and among them the BCVA rose from 0.04 to 1.0 in one eye.The macular retina thickness thinned from preoperative ≥450?m to postoperative 160 220?m,intra-retinal and pre-retinal hemorrhage as well as MSHE was absorbed markedly or completely.Visual acuity decreased in 7 eyes(23.3%)during 24-42 months of follow up,anterior ischemic opticneuropathy occurred in 3 eyes(10%),macular edema recurred in 4 eyes(sub-macular hard exudates appeared in 2 eyes),and macular thickness measured 310-410?m.Scars in sub-fovea and peri-fovea sub-retina were noted in 5 eyes,in which the visual acuity was improved from finger counting to 0.04.Conclusion Vitrectomy,including posterior hyaloid removal,endolaser retinal photocoagulation and long acting gas tamponade may offer satisfactory effects in the treatment for DR complicated with DDME and MSHE.