Combined Pars Plana Vitrectomy and Ahmed Implantation for Refractory Glaucoma

Eyes with neovascular glaucoma often times present with vitreous hemorrhage which makes subsequent panretinal photocoagulation difficult to impossible. These eyes can benefit from pars plana vitrectomy combined with glaucoma shunt procedure. Other candidates are those refractory galucomatous eyes with severe vitreoretinal diseases that require surgical intervention. We performed standard pars plana vitrectomies in combination with Ahmed Glaucoma Valve implant and analyzed the surgical outcome in 11 eyes of 11 patiens with severe refractory galucoma. With the surgical success defined as an achievement of intraocular pressure(IOP) less or equal to 21 mmHg with anatomical reattatchment of retina, nine eyes(81.8%) became qualified in the success group. Complications included hyphema and/or severe fibrinous reaction (3 eyes), temporary IOP increase (3 eyes), recurrent vitreous hemorrhage (1 eye) and loss of light perception (1 eye). No eye showed postoperative hypotony, choroidal effusion or hemorrhage. In conclusion, in those eyes with refractory glaucoma accompanied with severe vitreoretinal disease that do not respond to the conventional IOP lowering procedures, combined pars plana vitrectomy with Ahmed Glaucoma Valve implantation may serve as a useful surgical alternative.

Surgical Treatment of Intracranial Arachnoid Cysts

Eighteen patients with symptomatic intracranial arachnoid cysts underwent 27 surgical procedures between January 1990 and December 1995. These were analysed with respect to their surgical procedures and results, complications and prognosis retrospectively, with an attempt assess the efficacy of each surgical procedure. Thirteen patients underwent excision of the inner and outer membranes with fenestration procedures to the basal cisterns(primary excision group), resulting in excellent or good outcomes in 12 cases, of which three patients were subjected to secondary shunt procedures due to symptom recurrence in two and persistence of the cyst in one during follow-up radiological study. There were no significant complications in this primary excision group. Four patients out of five in the primary shunt group had good or excellent results. But shunt revisions had to be performed in two patients;of these two patients, one died from subdural empyema and sepsis while the outcome of the other one was satisfactory. The results of this study suggested that excision and fenestration should be considered as the primary procedure in patients with symptomatic intracranial arachnoid cyst, especially in the pediatric age group.

Transjugular intrahepatic portosystemic stent-shunt procedure For refractory ascites / 介入放射学杂志

Objective To assess the clinical efficacy of TIPS in the treatment of patients with refractory ascites and investigate the clinical factors associated with TIPS. Methods 21 consecutive patients with refractory ascites, 16 men and 5 women with mean age of 45 years (range 22-69 years) were followed up for an average of 337 days (range 50-1323 days). Asites/ abdomen circumference, serum parameters, stents function, time of followed up and survival rate were analized. Results The ascites was significantly reduced as compared with basal values (P

A Case of Syringomyelia in Cervical and Thoracic Spinal Cord(C2~T10) Associated with Chiari Malformation

We have recently managed a case of syringomyelia associated with Chiari I Type malformation. The syrinx was found at C2 level to T10 level. And the patient complained left forearm pain and paresthesia in left shoulder, arm with segmental dissociated sensory loss. The cranio-vertebral decompression(suboccipital craniectomy, cervical laminectomy) and the shunting procedures were performed. Postoperative course was not uneven, the clinical and neurological improvement was observed. M.R.I. permitted rapid, exact diagnosis including localization of syrinx and information of associated anomaly.