Retinopexia neumática para el tratamiento de desprendimientos regmatógenos de retina seleccionados / Pneumatic Retinopexy for Treating Selected Rhegmatogenous Retinal Detachments

Objetivo: Determinar los resultados anatómicos y funcionales en pacientes operados de desprendimiento de retina regmatógeno con técnica de retinopexia neumática. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo con pacientes operados con técnica de retinopexia neumática en el Centro Oftalmológico de Villa Clara entre junio del 2019 y abril del 2023. Resultados: La edad media de los pacientes estudiados fue de 62,1años. Los hombres fueron más afectados que las mujeres (60,6 por ciento). El 57,6 por ciento de los ojos tuvo agudeza visual mejor corregida de movimiento de manos al diagnóstico y el 93,9 por ciento mácula desprendida. En el 66,7 por ciento de las operaciones se utilizó el hexafloruro de azufre como tamponador. Se logró el éxito anatómico con una intervención en el 81,8 por ciento (IC 95 por ciento: 80-83,6 por ciento) de los casos. En estos, se alcanzó el éxito funcional en el 85,2 por ciento (IC 95 por ciento: 83,4 -87 por ciento). Los ojos con éxito anatómico alcanzaron como media una agudeza visual mejor corregida de 0,5 décimas (IC 95 por ciento: 0,2-0,7) y se logró una ganancia media de 0,4 décimas (IC 95 por ciento: 0,3-0,5). La complicación más frecuente fue la persistencia de líquido subretinal residual, el cual se presentó con más frecuencia en pacientes mayores de 60 años y desapareció como promedio a los 55,9 días sin necesidad de tratamiento. Conclusiones: La retinopexia neumática es una muy buena opción para tratar desprendimientos de retina seleccionados. En pacientes con ninguna o mínima vitreorretinopatía proliferativa, se logran buenos resultados anatómicos y funcionales(AU)

Objective: To determine the anatomical and functional results in patients operated on for rhegmatogenous retinal detachment using the pneumatic retinopexy technique. Methods: A descriptive, longitudinal and prospective study was conducted with patients operated on using the pneumatic retinopexy technique at Centro Oftalmológico, of Villa Clara Province, Cuba, between June 2019 and April 2023. Results: The mean age of the studied patients was 62.1 years. Men were more affected than women (60.6 percent). 57.6 percent of the eyes had best-corrected visual acuity of hand movement at diagnosis and 93.9 percent had detached macula. Sulfur hexafluoride was used as a buffer solution in 66.7 percent of the operations. Anatomical success was achieved with one operation in 81.8 percent (95 percent CI: 80-83.6 percent) of cases. In these, functional success was achieved in 85.2 percent (95 percent CI: 83.4-87 percent). The anatomically successful eyes achieved a mean best-corrected visual acuity of 0.5 tenths (95 percent CI: 0.2-0.7), apart from a mean gain of 0.4 tenths (95 percent CI: 0.3-0.5). The most frequent complication was the persistence of residual subretinal fluid, which occurred more frequently in patients older than 60 years and disappeared, on average, at 55.9 days without the need for treatment. Conclusions: Pneumatic retinopexy is a very good option to treat selected retinal detachments. In patients with no or minimal proliferative vitreoretinopathy, good anatomical and functional results are achieved(AU)

Estimation du succès fonctionnel et esthétique des implants dentaires / Estimation of the functional and aesthetic success of dental implants

Les implants dentaires ont révolutionné la réhabilitation orale partielle et totale. Des taux de succès allant de 80% à 100% à travers le monde (Buser, 2019) Le succès du traitement implantaire doit répondre à deux objectifs pour être validé. Le premier est le concept d'ostéointégration et le second sur l'aspect esthétique des tissus autour de l'implant. notre objectif était d'estimer le taux de succès fonctionnel, en se basant sur les critères de succès d'Albrektsson et coll (Albrektsson,1986 ) ainsi qu'une évaluation esthétique par le PES (Belser, 2009) sur un échantillon de 50 patients dont 107 implants posés au secteur antérieur où le profil esthétique joue un rôle important. Le taux de succès fonctionnel était estimé à 94% voire 03 échecs sur 50 patients, avec une différence significative entre le succès implantaire et le degré d'hygiène bucco dentaire (p=0.00001) ; ainsi que le degré d'inflammation (p=0.0000) et la maladie parodontale p=0.04. On a eu 100% de succès chez les patients à qui on a procédé à un enfouissement total de l'implant. Enfin le succès esthétique était bon chez 42(84%) patients pour un score de 8 à10, et favorable chez les 5(10 %) restants pour un score de 5 à 7

Dental implants have revolutionized partial and total oral rehabilitation. Success rates ranging from 80% to 100% worldwide (Buser, 2019) The success of the implant treatment must meet two objectives to be validated. The first is the concept of osseointegration and the second on the aesthetic appearance of the tissues around the implant. Our objective was to estimate the functional success rate, based on the success criteria of Albrektsson et al (Albrektsson, 1986) as well as an aesthetic evaluation by the PES (Belser, 2009) on a sample of 50 patients including 107 implants placed in the anterior sector where the aesthetic profile plays an important role. The functional success rate was estimated at 94% or even 03 failures out of 50 patients, with a significant difference between the implant success and the degree of oral hygiene (p=0.00001); as well as the degree of inflammation (p=0.00001) and finally the periodontal disease (p=0.04). We have had 100% success in patients who have undergone total burying of the implant Finally, aesthetic success was good in 42 (84%) patients for a score of 8 to 10, and favorable in the remaining 5 (10%) for a score of 5 to 7.

Pre-operative optical coherence tomography predictors: Do they hold any relevance in the era of inverted internal limiting membrane flap in large macular holes?

Purpose: To study the relevance of preoperative OCT predictors in large macular holes (MH) treated using the inverted ILM peel technique. Methods: Prospective study of 95 patients undergoing vitrectomy for large MH between January 2019 and December 2020 was performed by dividing the patients into groups depending on various quantitative parameters and indices of MH such as base diameter (BD), hole form factor (HFF), macular hole index (MHI), diameter hole index (DHI), and tractional hole index (THI) by using parameters such as minimal hole diameter, hole height, nasal and temporal arm lengths. Depending upon the duration of symptoms, patients were divided into three groups: <3 months, 3–6 months, and >6 months. Anatomical success rate, type of closure, and postoperative vision gain were analyzed in relation to the abovementioned diameters, indices, and duration to see if any significance existed. Results: The mean age of patients included in the study was 60.48 ± 13.88 years, with female preponderance (males: females = 37:58). Change in logMAR was statistically significant individually with all studied parameters (P < 0.0001) without influence of size of hole and other indices. BD and DHI levels showed significant association with type of closure as indicated by P values of 0.017 and 0.048, respectively. Duration of symptoms showed no significance in terms of anatomical and functional success. Conclusion: OCT predictors of MH success seem to have lost relevance with inverted flap surgeries as 100% anatomical success is achieved with this technique, with 95.78% (91/95) achieving type 1 closure with statistically significant equivalent functional gain across the indices with no effect of duration of symptoms.

The role of the rhinostomy ostium size on functional success in dacryocystorhinostomy / O papel do tamanho do óstio da rinostomia no sucesso funcional em dacriocistorrinostomia

Abstract Introduction Endonasal and external dacryocystorhinostomy procedures have both been used for the treatment of post-saccular obstruction of the lacrimal system. Functional success of these surgeries depends on several factors. Objective To evaluate the status of the rhinostomy ostium with endonasal and external approaches in dacryocystorhinostomy operations and to determine the effect of ostium size on postoperative functional success. Methods The charts of the patients operated in our hospital between May 2017 and January 2019 were analyzed retrospectively (ethical approval number: 2018-12.04). The patients that were operated in the ophthalmology and otolaryngology departments were included in the study. Endoscopic rhinostomy ostium measurements, punctum lavage findings and complications were recorded at 8 weeks postoperative at the earliest. Results When the 64 patient charts were reviewed (76 operations), the mean ostium width was 1.85 ± 1.11 mm in the endonasal approach group and 3.60 ± 2.24 mm in the external approach group. The mean ostium areas in endonasal and external group were 14.61 ± 16.66 mm2 and 56.05 ± 60.41 mm2, respectively. The ostium was anatomically patent and punctum lavages were negative in 11 patients (6 patients in the endonasal approach group and 5 patients in the external approach group) and these cases were considered as functional failures. The rhinostomy ostium was significantly wider in the external approach group, but this was considered ineffective on functional outcomes. Conclusion Lacrimal duct stenosis can be successfully treated with endonasal and external methods. Tear drainage may be insufficient even in the presence of a patent ostium. Therefore, functional success should also be considered when evaluating the overall success of dacryocystorhinostomy. An anatomically patent ostium is definitely required, while it is believed that ostium size does not affect functional surgical success.

Resumo Introdução Dacriocistorrinostomia endonasal e externa têm sido usados para o tratamento de obstrução pós‐sacular do sistema lacrimal. O sucesso funcional dessas cirurgias depende de vários fatores. Objetivo Avaliar o status do óstio da rinostomia nas abordagens endonasal e externa em dacriocistorrinostomias e a importância do tamanho do óstio no sucesso funcional pós‐operatório. Método Os prontuários de pacientes operados em nosso hospital entre maio de 2017 e janeiro de 2019 foram analisados retrospectivamente (número de aprovação ética: 2018-12,04). Foram incluídos no estudo os pacientes operados nos setores de oftalmologia e otorrinolaringologia. Medidas do óstio da rinostomia endoscópica, achados à irrigação do ponto lacrimal e complicações foram registrados a partir da 8ª semana de pós‐operatório. Resultados Foram avaliados prontuários de 64 pacientes (76 operações); a largura média do óstio era de 1,85 ± 1,11 mm no grupo endonasal e de 3,60 ± 2,24 mm no grupo externa. As áreas médias do óstio no grupo endonasal e externa foram 14,61 ± 16,66 mm2 e 56,05 ± 60,41 mm2, respectivamente. O óstio estava anatomicamente pérvio e as irrigações do ponto lacrimal foram negativas em 11 pacientes (6 pacientes no grupo endonasal e 5 pacientes no grupo externa) e esses casos foram considerados como falhas funcionais. O óstio da rinostomia foi significativamente maior no grupo externo, mas sem relação com a eficácia nos resultados funcionais. Conclusão A estenose do ducto lacrimal pode ser tratada com sucesso com métodos endonasais e externos. A drenagem lacrimal pode ser insuficiente mesmo na presença de óstio pérvio. Portanto, o sucesso funcional também deve ser considerado ao avaliar o sucesso do procedimento. Embora um óstio anatomicamente patente seja necessário, o tamanho do óstio não afeta o sucesso cirúrgico funcional.

Long-Term Results of Intermittent Exotropia Surgery: Comparison between Motor and Functional Success

PURPOSE: To evaluate the long-term surgical success rate (>3 years) and contributing success factors considering motor and sensory criteria for patients with intermittent exotropia. METHODS: Fifty-four patients who received surgery for intermittent exotropia and were followed-up for a minimum of 3 years, including reoperation, were retrospectively evaluated. The first procedure was unilateral recession and resection in 50 patients and bilateral lateral rectus recession in 4 patients. Patients were classified as achieving a good, fair or poor outcome based on motor and sensory criteria. Success rate and associated factors such as postoperative alignment, exotropia type, first surgical procedure, and proportion of patients receiving reoperations were analyzed. RESULTS: The mean follow-up period after the first surgery was 4.81 +/- 1.30 years. The good outcome was achieved in 32 patients (59.3%), fair in 14 patients (25.9%), and poor in 8 patients (14.8%) considering motor criteria only. The good outcome was achieved in 29 patients (51.9%), fair in 12 patients (22.2%), and poor in 14 patients (25.9%) when considering combined motor/sensory (functional) criteria. No patient who received bilateral lateral rectus recession as the first procedure belonged to the good outcome group (p = 0.03 by motor criteria and p = 0.044 by functional criteria). Patients who received reoperation were significantly more likely to be in the good and fair groups (p = 0.009 by motor criteria and p = 0.02 by functional criteria). CONCLUSIONS: Long-term surgical results of intermittent exotropia in this Korean population revealed 85.2% motor success rate and 74.1% functional success rate. Early postoperative overcorrection was not associated with long-term success. Recession and resection procedure and reoperations were significantly associated with better outcome based on motor and functional criteria. Diligent reoperations after the first surgery could possibly contribute to good long-term functional outcome in intermittent exotropia patients.

Assessment of Idiopathic Macular Hole Surgery by Heidelberg Retina Tomograph

For the evaluation of preoperative and postoperative factors effecting the results of vitrectomy as a treatment of full thickness macular hole, we estimated the three dimensional morphology of macular hole using the HRT [Heidelberg retina tomography]and investigated every patient's history and operation method. Pars plana vitrectomy, epiretinal and internal limiting membrane removal, and C3F8 injection were performed in 19 patients[19 eyes]with full thickness macular holes. Anatomic success was seen in 12 eyes[63.2%]and was statistically related with preoperative hole area, volume and depth. Functional success was seen in 6 eyes[31.6%]and was significantly related with preoperative hole volume and depth, marginal detachment area and volume, hole diameter and hole area. In addition, anatomic success was statistically related with internal limiting membrane removal[p<0.01], stage and preoperative visual acuity [p<0.05]. Functional success was significantly related with preoperative visual acuity, internal limiting membrane removal[p<0.01], stage and duration of the disease[p<0.05]. We conclude that preoperative HRT is a useful method in deciding the operative indications and also in predicting the outcomes.

Prognostic Factors in Idiopathic Macular Hole Surgery

We evaluated the relationship between the surgical success of idiopathic macular hole and sex, age, duration, epiretinal membrane, preoperative visual acuity, size of the hole, and surgical method. Of all 25 eyes in 23 patients, 14 eyes(56%)showed anatomical success(disappearance of the hole), and 17 eyes(68%)functional success(the final visual acuity of 0.15 or more with more than one line improvement). There were statistically significant differences of anatomical(p=0.001)and functional success(p=0.020)between the Group I where its macular hole was less than one-fourth of the optic disc in size and the other group, and anatomical success(p=0.039)between the group with the age of less than 70 years(Group A)and the other group. In Group I, anatomical and functional success were both 92%(11 eyes/12 eyes). In Group A, anatomical and functional success were 72%(13 eyes/18 eyes)and 77%(14 eyes/18 eyes), respectively, and there was statistically significant relationship between size of the hole and anatomical success(p=0.024), and difference of anatomical success between the group with duration of less than 6 months and the other group(p=0.023). Good surgical result may be expected in the idiopathic macular hole of the age of less than 70 years with about 350 micrometer or less in size and duration of less than 6 months.

Clinical Study for Anatomical Reattachment and Visual Outcome in Rhegmatogenous Retinal Detachment Treated with Scleral Buckling

We analyzed a total of 41 eyes with rhegmatogenous retinal detachment treated with scleral buckling to evaluate factors elated to anatomical and functional success rate. 22 patients (55 %) were wemen. The most common age group was third decade(27.5%). Among the associated ocular findings, the most common finding was high-degree myopia (14 eyes, 34.1%) and the next was lattice degeneration. The most common postoperative complication was temporary elevation of intraocular pressure (14 eyes, 34.1 %). The overall anatomical success rate was 87.8 % and functional success rate was 68.3%. Important factors related to anatomical and functional success were duration of retinal detachment(less than 1 month), location of tears(at or anterior to the equator) and the difference of intraocular pressure between affected and unaffected eyes(less than 10 mmHg). The macular status was highly related to the functional success. The sex, age , preoperative visual acutiy, preoperative refractive error and surgical method had no statistically significant relationship with success rate.

Intraoperative Perfluorophenanthrene Use in Complicated Retinal Detachment

23 eyes of 23 patients who underwent conventional vitreoretinal surgery with high specific gravity perfluorocarbon liquid, perfluorophenanthrene, for complicated retinal detachment were evaluated retrospectively. Preoperative vitreoretinal findings showed grade C2 PVR in 4 eyes and C3 in 1 eye and C4 in 10 eyes and C5 in 8 eyes. As a result, 17 eyes(74%) showed anatomical success, completely reattached in 15 eyes, partially reattached in 2 eyes, and 12 eyes(52%) showed functional success (corrected visual acuity 5/200 or better). Follow-up period was over 6 months in all cases. Postoperative complications includes keratopathy in 6 eyes, hypotony in 5 eyes, cataract in 2 eyes, transient vitreous hemorrhage in 1 eye, acute increased IOP in 1 eye, posterior synechiae in 1 eye, cystoid macular edema in 1 eye, and pupillary membrane in 1 eye. Consequently, perfluorophenanthrene can be used beneficially in yield of surgical field and mechanical stabilization of retina in complicated retinal detachment surgery.

A Clinical Study on Rhegmatogenous Retinal Detachment

We reviewed charts of patients on the clinical characteristics and factors which affect the prognosis of surgical results in the 77 patients(77 eyes) who were diagnosed with rhegmatogenous retinal detachment and operated on and followed for at least 3 months postoperatively at Korea University Guro hospital. We evaluated the characteristics of rhegmatogenous retinal detachment in Korea by comparing with other reports on retinal detachment as well. The factors associated with anatomic success were the duration of retinal detachment and the prescence of proliferative vitreoretinopathy. High success rate was achieved when the duration was less than 1 month and there was no proliferative vitreoretinopathy. The factors associated with functional success included the duration of retinal detachment, proliferative vitreoretinopathy, preoperative refractive error and the degree of retinal detachment(P<0.05).

Surgical Result of Vitrectomy in Ocular Trauma

We reviewed 49 patients(50 eyes) who had undergone pars plana vitrectomy for the traumatized eyes during the last 4 years. We divided patients into 4 groups according to the characteristics of ocular injuries-anterior segment Injury, posterior penetrating injury, intraocular foreign body and blunt injury. We analyzed surgical results and compared surgical outcomes according to timing of vitrectomy performed(within 2 weeks VS more than 2 weeks after trauma). Anatomical success was achieved in 36 eyes(72.0%) and functional success was achieved in 23 eyes(46.0%). The main causes of functional and anatomical failure were macular pucker and phthisis bulbi respectively. The anatomical and functional success rates were higher when vitrectomy was performed within 2 weeks after trauma. In posterior penetrating injury group, however, anatomical success rate was lower when vitrectomy was performed more than 2 weeks after trauma. The frequency of retinal detachment was higher when vitrectomy was performed more than 2 weeks after trauma. In cases of intraocular foreign body, retinal detachments were developed in all patients after vitrectomy performed more than 2 weeks after trauma. If vitrectomy is required for patients with ocular injury, we suggest vitrectomy within 2 weeks after frauma for better chance to perserve the globe and for salvaging vision.

Effect of Encircling Silicone Sponge for Retinal Detachment

120 eyes of 119 patients with retinal detachment were treated with an encircling silicone sponge scleral buckling in the department of Ophthalmolgy, Severance Hospital, Yonsei University Medical Center from September 1, 1988, to January 31, 1991. Results were as follow 107 eyes among 120 eyes (89.2%) showed anatomical success, and 54 eyes of them (45%) showed functional success. As the preoperative factors, the case of over 20/70 vision (100%, p>0.05, 100%, p0.05, 57%, p0.05,61%, p0.05, 54%, p<0.05) showed favorable anatomical and functional success rate. The presence and degree of the proliferative vitreoretinaopathy affected the anatomical and functional success rate, but the age of patients did not affect the success of surgery.