ABSTRACT
PURPOSE: To report the 2-year outcomes of a novel surgical technique allowing reduction of the intraluminal diameter of the tube without total tube occlusion in order to allow enough increase in outflow resistance to permit resolution of hypotony whilst also achieving adequate IOP control. METHODS: This was a single-surgeon retrospective case note review of all non-valved GDD cases over an 8-year period (2008-2015) that underwent ab interno ligation of the drainage tube in order to manage post-operative hypotony (Baerveldt or Molteno). Twelve eyes of 12 patients (4.4%) developing refractory hypotony that did not respond to multiple intracameral ophthalmic viscoelastic device (OVD) injections were included in this retrospective case series and were treated with our ab interno tube ligation technique. The post-ligation management algorithm consisted of re-instating topical anti-glaucoma agents, laser suture lysis (LSL), or further ab interno ligation. RESULTS: Mean IOP increased from 2.8 mmHg at baseline to 7.8 mmHg, 7.1 mmHg, 9.0 mmHg, 13.6 mmHg, 10.9 mmHg, 13.9 mmHg and 13.6 mmHg at day 1, week 1, month 1, month 3, month 6, year 1 and year 2 respectively, with or without additional topical anti-glaucoma medications. Although hypotony resolution following our technique was achieved in all eyes at 2 years, 8.3% of cases required reinstatement of topical medications to maintain IOP control within the target range. CONCLUSIONS: We propose ab interno partial tube tying as an effective surgical option to achieve an immediate, predictable and sustained IOP elevation either as a primary procedure or when traditional methods have failed to resolve hypotony in eyes with non-valved GDDs.
Subject(s)
Glaucoma Drainage Implants/adverse effects , Glaucoma/surgery , Intraocular Pressure/physiology , Ocular Hypotension/surgery , Ophthalmologic Surgical Procedures/methods , Postoperative Complications/surgery , Adolescent , Adult , Aged , Child , Female , Follow-Up Studies , Glaucoma/physiopathology , Humans , Ligation/methods , Male , Middle Aged , Ocular Hypotension/etiology , Ocular Hypotension/physiopathology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Reoperation , Retrospective Studies , Time Factors , Treatment Outcome , Visual Acuity , Young AdultABSTRACT
A prospective, cohort, clinical study was conducted at Dr. D. Y. Patil Hospital, Kolhapur from August 2010 to August 2013. The aim was to evaluate the results of type 1 interlay tympanoplasty with respect to graft uptake, hearing improvement and complications. Total of 100 cases with a mucosal type of chronic suppurative otitis media and a large central perforation (involving more than 50 % of tympanic membrane) were operated for type 1 tympanoplasty where the graft was placed by interlay method (below the fibro-squamous layer and above the mucosal or endothelial layer). Patients were followed up with ear microscopy at each follow up visit and an audiometry at the end of 3rd month. Statistical analysis was done by statcal software using paired t test and two sample t test for proportion. 96 (96 %) cases had a successful graft uptake. The mean pre-operative air-bone gap was 36.42 ± 12.0 dB; whereas the mean post-operative air-bone gap was 9.7 ± 6.71 dB. Except for residual perforation in four patients and partial tympanomeatal flap necrosis in two patients no other complications were encountered. Thus, we conclude that, the interlay tympanoplasty is a safe and effective method of graft placement for large central perforation.
ABSTRACT
According to WHO, there will be epidemic of diabetes world over and India is going to be 'A diabetes capital of the world' by 2025. With the increasing incidence of diabetes, the associated complications are also bound to increase. Rhinocerebral mucormycosis is one of them.Rhinocerebral Mucormycosis is an opportunistic, fulminating fungal infection, caused by Rhizopus species of order of mucorales, frequently seen in diabetic and immunocompromised patients. Mucormycosis has a very high mortality rate.Early diagnosis and treatment with Amphotericin-B is the key to combat this disease successfully. We have seen 13 cases in last 3 years (2002-2005) in our area. This incidence is significant, as this type of cases were rarely seen before 2002, in this geographical area. We present an account of these cases; treatment strategies adopted, review of literature, and highlight 'the role of ENT surgeon in diagnosis and management of this dreadful disease'.
