ABSTRACT
RESUMEN: La incidencia de complicaciones en los tejidos periimplantarios, como recesiones y dehiscencias, ha ido en aumento en los últimos años, principalmente asociados a un incorrecto posicionamiento espacial de los implantes. El objetivo de este reporte de caso es presentar el manejo quirúrgico de una complicación estética debida a la mal posición de un implante en la zona anterior. Caso. Paciente se presenta con recesión mucosa y dehiscencia por vestibular del implante 1.2, causados por su mal posicionamiento. Se realiza explantación mediante llave de alto torque e inserción de un nuevo implante en combinación con regeneración ósea (sticky bone) e injerto de tejido conectivo, lo que recupera la armonía gingival. Conclusión. La explantación conservadora acompañada de regeneración tisular ofrecen una interesante alternativa para el tratamiento de defectos estéticos severos asociados a la mal posición de implantes. La sistematización de este tipo de protocolos es fundamental para mejorar su predictibilidad.
ABSTRACT: An increase in the incidence of peri-implant soft tissue complications, such as facial recession and dehiscence, has been observed in the last years, mainly associated with an incorrect spatial placement of the implants. This case report focuses on the surgical management of an esthetic complication due to an incorrect implant position in the anterior region. Case report. Patient presented with recession and dehiscence in the facial area of implant 1.2, due to its incorrect placement. Explantation was performed with a high torque wrench, followed by the immediate placement of a new implant in combination with bone regeneration (sticky bone) and soft tissue augmentation. Conclusion. The use of atraumatic explantation techniques followed by guided tissue regeneration offers an interesting alternative for the treatment of severe defects in the esthetic region due to incorrectly placed implants. An adequate systematization of these protocols is key to improve their predictability.
Subject(s)
Humans , Female , Prostheses and ImplantsABSTRACT
A 48-year-old lady presented with bilateral symptomatic uveitis. She had bilateral cosmetic iris implantation 4 years ago. She underwent bilateral cosmetic iris explantation and goniosynechialysis to open up areas of angle compromise. This patient presented before significant angle compromise. This case report also serves to highlight the serious potential risks associated with cosmetic iris implantation. Patients with cosmetic iris implants should be warned of the potential complications and advised explantation at the earliest.
ABSTRACT
Intraocular lenses (IOLs) used in cataract surgery sometimes have to be explanted because of eventual complications like incorrect power, dysphotopsia, opacification, or rupture during implantation. However, current explantation procedures present several shortcomings related to the need for incision enlargement and/or potential damage to ocular structures. We present a new device which increases safety while cutting the lens, allowing the explantation through the original incision, and applicable to any type of IOL.
ABSTRACT
Purpose: To describe clinical presentations and comparative outcomes of primary versus deferred intraocular lens (IOL) explantation in delayed-onset endophthalmitis. Methods: In this retrospective study, a total of 77 eyes of 77 patients that were diagnosed clinically as delayed-onset endophthalmitis and underwent IOL explantation from January 1990 to January 2018 were included undiluted vitreous biopsy and IOL were subjected to microbiologic evaluation. Duration of symptoms, presenting visual acuity, organisms isolated, time to IOL explantation, time to endophthalmitis, resolution after explantation, number of repeat intravitreal injections, and final visual acuity were compared in the primary and the deferred IOL explantation groups. Results: There were primary and deferred IOL explantations. Interval between inciting event and endophthalmitis, between onset of symptoms to presentation, total follow-up, complication rate, and final visual acuity was comparable between the two groups. Median time to IOL explantation in the deferred group was 70 days. Between the primary and deferred IOL explantation groups the number of repeat intravitreal injections was 0.58 ± 0.86 and 2.62 ± 1.78 respectively, (P < 0.0001, 95% confidence interval, CI 2.00–2.22); the number of days to resolution after IOL explantation was 35.16 ± 14.26 and 55.5 ± 8.24 respectively, (P < 0.0001, 95% CI 15.22–25.45). Conclusion: Early IOL explantation in delayed-onset endophthalmitis causes faster clinical resolution and reduces the number of repeat intravitreal injections. Final visual improvement, however, may be unaffected.
ABSTRACT
Asteroid Hyalosis (AH) is a common clinical disease,which has been considered a benign disorder as it rarely impairs visual acuity.It was often discovered when the patient was treated for other eye diseases.The mechanism was unclear.Its characteristic B-ultrasound property makes the B-ultrasound a very helpful diagnostic technique.In the case of the patients with other fundus diseases associated with AH,optical coherence tomography (OCT) and fluorescein angiography (FA) may be used to reduce the interference from asteroid bodies,therefore improve the fundus visibility.Recent studies have shown that AH can incorporate with many other eye diseases.For example,in patients with cataracts,asteroid hyalosis can cause surface calcification of silicone plate intraocular lenses,which in most cases may lead to the need for explantation of the calcified intraocular lenses.The efficacy of pars plana vitrectomy (PPV),the removal of some,or all,of the eye`s vitreous humor for AH remains controversial.In this paper,we provide a review of the recent literature on AH disease: the etiology,diagnosis and treatment.We hope to thus improve the awareness and outcomes of AH disease.
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Context: We report a 59 year old Chinese woman in pheochromocytoma multisystem crisis and was initially stabilised with ECMO; subsequently she manifested rapid cyclical fluctuation of blood pressure precipitated by explantation of ECMO. Case Description: Madam L presented with chest pain and giddiness. She developed cardiogenic shock refractory to double inotropes and intra-aortic balloon pump (IABP); but responded to Extra-Corporal Membrane Oxygenation (ECMO). Subsequently rapid cyclical blood pressure fluctuations from 230 mmHg to 50mmHg systolic occurred after explantation of ECMO. Biochemically urine metanephrines and normetanephrines were more than seven times above upper limit of normal. Imaging confirmed the presence of right adrenal mass likely pheochromocytoma. She was started on alpha blockade and underwent an uneventful laparotomy with removal of a 10 cm adrenal mass. Histology confirmed a large cystic pheochromocytoma with haemorrhagic components. Conclusions: Pheochromocytoma crisis should be suspected in cases of unexplained shock or Takutsubo cardiomyopathy; early recognition and ECMO support can be life-saving. In addition, ECMO explantation can trigger rapid cyclical blood pressure fluctuations and should be closely monitored for.
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Aim: To report the management of recurrent postoperative fungal endophthalmitis (POFE) after failed pars plana vitrectomy (PPV) and antifungal therapy. Settings and Design: Tertiary Care Referral Centre in North India. Retrospective, single institution, interventional case‑series. Materials and Methods: Six patients with microbiologically proven recurrent post‑operative fungal endophthalmitis refractory to conventional management were included. The final recurrence was managed with intraocular lens (IOL) explantation and re‑PPV. Main outcome measures included preserved globe anatomy, visual acuity and retinal status. ‘Anatomical success’ was defined as preserved anatomy of the globe, and absence of signs of inflammation. 'Functional success' was defined as an attached retina and a best corrected visual acuity of better than 20/400. Results: Of the six cases of POFE, five were culture positive [Aspergillus flavus (1), Aspergillus fumigatus (2), Candida albicans (1) and Candida glabrata (1)] and one was smear positive for yeast. All recurred (mean recurrences, 4) despite a mean of 2.17 PPVs and intravitreal amphotericin B. No recurrences were observed after IOL explantation with re – PPV (median follow‑up, 37 months). Pre‑study defined criteria for successful ‘anatomical’ and ‘functional’ outcomes were achieved in 83.3% and 50% respectively. Conclusion: This report highlights the effective role of combined IOL explantation with PPV in managing recurrent POFE.
ABSTRACT
We are seeing more implantation of cardiac device such as pacemakers and defibrillators and also cardiac implantable electronic device infection. The infection may affect just the pocket site or progress to deeper infection and bacteraemia. Inadequately treated infection may lead to right sided endocarditis, cardiotomy for pacemaker explantation and increased cost and length of stay in the hospital. We report a Staphylococcal infection of a pacemaker system, its successful medical and surgical management.
ABSTRACT
Thirty turtles (15 Clemys mutica and 15 Geoclemys reevesii) which were inoculated with human sera those were positive for hepatitis B surface antigen (HBsAg) and hepatitis B "e" antigen (HBeAg) were found to be infected with hepatitis B virus (HBV). The levels of HBV infection markers, such as HBsAg and antibody to HBsAg (anti-HBsAg), were retinely monitored in the turtles' serum for 46 weeks. Within two weeks of the inoculation, 42% of the turtles tested were positive for HBsAg, and their reciprocal titers as measured by reverse passive hemagglutination (RPHA) and enzyme linked immunoabsorbance assay (ELISA) ranged from 16 to 96. Within 20 weeks, the remaining turtles tested HBsAg positive, as confirmed by ELISA. At 20 weeks, all but one of the turtles exhibited changes in HBV blood marker from HBsAg to anti-HBs; the one exception was positive for both HBsAg and anti-HBs. At the 47th week, 7 animals were killed and their organs were examined for HBV infected cells utilizing an immunofluorescent technique. Numerous fluorescent cells which reacted with human anti-HBs nad anti-HBc were observed in the following organs: pancreas, liver, kidney, and brain. Histopathologically, edematous changes in hepatocytes and minor cellular infiltration attributed to an inflammatory response were noted. Liver and kidney cells from the infected animals were cultured, and HBV antigen positive cells for HBsAg and HBcAg were detected in the cultures. Throughout the experiment, HBsAg was detected in the supernatant by ELISA. Virus particles which were indistinguishable from Dane particles were seen in the cytoplasmic vacuoles of the cultured cells by electron microscopy. Finally, the presence of HBV DNA was established by molecular hybridization techniques in the culture supernatants of kidney cells from the infected turtles.