Percutaneous Unilateral Biliary Metallic Stent Placement in Patients with Malignant Obstruction of the Biliary Hila and Contralateral Portal Vein Steno-Occlusion

OBJECTIVE: To investigate the outcomes of percutaneous unilateral metallic stent placement in patients with a malignant obstruction of the biliary hila and a contralateral portal vein steno-occlusion. MATERIALS AND METHODS: Sixty patients with a malignant hilar obstruction and unilobar portal vein steno-occlusion caused by tumor invasion or preoperative portal vein embolization were enrolled in this retrospective study from October 2010 to October 2013. All patients were treated with percutaneous placement of a biliary metallic stent, including expanded polytetrafluoroethylene (ePTFE)-covered stents in 27 patients and uncovered stents in 33 patients. RESULTS: A total of 70 stents were successfully placed in 60 patients. Procedural-related minor complications, including self-limiting hemobilia (n = 2) and cholangitis (n = 4) occurred in six (10%) patients. Acute cholecystitis occurred in two patients. Successful internal drainage was achieved in 54 (90%) of the 60 patients. According to a Kaplan-Meier analysis, median survival time was 210 days (95% confidence interval [CI], 135-284 days), and median stent patency time was 133 days (95% CI, 94-171 days). No significant difference in stent patency was observed between covered and uncovered stents (p = 0.646). Stent dysfunction occurred in 16 (29.6%) of 54 patients after a mean of 159 days (range, 65-321 days). CONCLUSION: Unilateral placement of ePTFE-covered and uncovered stents in the hepatic lobe with a patent portal vein is a safe and effective method for palliative treatment of patients with a contralateral portal vein steno-occlusion caused by an advanced hilar malignancy or portal vein embolization. No significant difference in stent patency was detected between covered and uncovered metallic stents.

Radial optic neurotomy for central retinal vein occlusion

When several and very different treatment modalities exist for one ailment, it usually means that none of them is generally effective or superior to others. Central retinal vein occlusion [CRVO] is a condition for which various types of management have been proposed. However, the only standard care suggested by the Central Vein Occlusion Study Group [CVOSG] is panretinal photocoagulation when the condition is complicated by iris neovascularization. In 2001, radial optic neurotomy [RON] was suggested by Opremcak for treatment of CRVO. This therapeutic modality has raised much debate among authorities. Herein, we present the opposing views of two vitreoretinal specialists regarding this issue

Oclusão de ramo da veia central da retina / Retinal vein branch occlusion

As oclusões venosas retinianas são a segunda causa mais comum de doenças vasculares da retina, atrás apenas da retinopatia diabética. A obstrução venosa de ramo é definida como a oclusão focal de uma veia retiniana em nível de um cruzamento arteriovenoso, no qual a artéria passa anteriormente à veia. Serão revisto o estudo multicêntrico sobre o tratamento com fotocoagulação a "laser" para esta doença, bem como abordadas as novas terapêuticas cirúrgicas propostas.

Neurotomía óptica radial en trombosis de vena central de retina: experiencia y seguimiento anual de 20 casos de la Fundación Oftalmológica Los Andes / Radial optic neurothomy in retinal central vein thrombosis: experience and annual follow up of 20 cases of the Fundación Oftalmológica Los Andes

Objetivo: Evaluar resultados quirúrgicos de pacientes sometidos a vitrectomía y neurotomía óptica radial (RON) en trombosis de vena central de la retina (TVCR). Métodos: 20 pacientes con TVCR intervenidos de RON, seguimiento a 3 y 12 meses, visión estandarizada ETDRS, OCT, angiofluoresceinografía. Resultados: Agudeza visual mejor o igual en 75 por ciento (45 por ciento superior a 0,1), mejora angiográfica y reducción del grosor foveal OCT (650u preop. vs 293u postop.) Se observó edema macular persistente 20 por ciento hemorragia vítrea y catarata en un 15 por ciento. Seguimiento promedio 12 meses. Conclusión: La Neurotomía Óptica radial mostró utilidad acelerando la resolución del cuadro. Los resultados visuales fueron levemente superiores a la evolución natural de la enfermedad, después de 12 meses de seguimiento.

Complicações após tentativa de anastomose retinocoroideana a laser na obstrução da veia central da retina / Complications after attempts to create a laser-indiced chorioretinal venous anastomosis in central retinal vein occlusion

Objetivos: Descrever e analisar as complicações encontradas nos pacientes com obstrução da veia central da retina (OVCR), tratados pela técnica da anastomose retinocoroideana a laser. Local: Instituto da Visão - Belo Horizonte - MG. Pacientes e Métodos: A anastomose retinocoroideana a laser foi realizada em dez pacientes portadores de OVCR, sendo cinco casos do tipo isquêmica e cinco do tipo não isquêmica. Resultados: As complicações imediatas e tardias, após a implementação do laser com a técnica descrita, ocorreram respectivamente em dois e seis casos e incluíram três pacientes que apresentaram hemorragia vítrea de grande magnitude e deslocamento tracional da retina. Conclusões: Embora a técnica de fotocoagulação descrita possa criar uma anastomose retinocoroideana, esse tratamento pode levar a complicações graves. Estudos adicionais envolvendo maior número de pacientes são necessários para se estabelecer eventuais benefícios desse tratamento.