ABSTRACT
Peripartum cardiomyopathy is a rare form of heart failure with significant perioperative implications. In this case report, we describe a 34-year-old gravida 5, parity 3, patient who was admitted for an elective cesarean delivery. During the delivery, the patient developed sudden cardiac arrest and was emergently intubated in the operating room. An emergent transesophageal echocardiogram revealed a left ventricular ejection fraction of 10% with global biventricular hypokinesis. Urgent multidisciplinary consultations led to the rapid implementation of the Impella™ 2.5 for ventricular support. The patient recovered ventricular function within 4 days and recovered to baseline function.
Subject(s)
Cardiomyopathies/etiology , Cardiomyopathies/surgery , Cesarean Section/adverse effects , Heart-Assist Devices , Peripartum Period , Acute Disease , Adult , Cardiomyopathies/diagnostic imaging , Female , Heart Ventricles , HumansSubject(s)
Eye Infections, Viral/diagnosis , Retinal Necrosis Syndrome, Acute/diagnosis , Subacute Sclerosing Panencephalitis/diagnosis , Adolescent , Diagnosis, Differential , Eye Infections, Viral/virology , Fluorescein Angiography , Humans , Male , Retinal Necrosis Syndrome, Acute/virology , Subacute Sclerosing Panencephalitis/virology , Tomography, Optical Coherence , Vision, Low/diagnosisABSTRACT
OBJECTIVE: To describe the outcome of patients with occult choroidal neovascularization in age-related macular degeneration treated with transpupillary thermotherapy. DESIGN: Prospective, nonrandomized, nonmasked case series. METHODS: All patients with age-related macular degeneration with a predominantly occult choroidal neovascular membrane and an initial visual acuity of 20/400 or better were offered treatment using transpupillary thermotherapy. The treatment consisted of using a diode laser, a spot size of about 3000 to 6000 micro m delivered over 60 seconds, and a power of 600 to 1000 mW. MAIN OUTCOME MEASURES: A stable, improved, or worsened visual acuity and the need for additional treatment. RESULTS: Sixty-nine patients were treated. All patients have been followed up for at least 6 months. At the 6-, 9-, and 12-month follow-up visits, 71% of patients have stable or improved visual acuity and 29% have lost 2 or more lines of visual acuity on the Snellen letter chart. CONCLUSION: Large-spot size transpupillary thermotherapy is effective in stabilizing the visual acuity in those patients who have occult choroidal neovascularization due to age-related macular degeneration.
Subject(s)
Choroidal Neovascularization/therapy , Hyperthermia, Induced/methods , Macular Degeneration/complications , Aged , Aged, 80 and over , Choroidal Neovascularization/etiology , Female , Follow-Up Studies , Humans , Lasers , Male , Prospective Studies , Pupil , Treatment Outcome , Visual AcuityABSTRACT
OBJECTIVE: To investigate results of macular pucker surgery with and without internal limiting membrane (ILM) peeling. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Forty-four consecutive patients underwent pars plana vitrectomy to remove an idiopathic macular pucker by two surgeons from June 1999 to July 2000. INTERVENTION: During the vitrectomy, one surgeon removed only the macular epiretinal membrane (24 patients), whereas the other surgeon removed the macular epiretinal membrane and then performed an additional ILM peeling (20 patients). MAIN OUTCOME MEASURES: Visual acuity and recurrence of macular pucker. RESULTS: Twenty-four (55%) patients underwent pars plana vitrectomy without ILM peeling, and 20 patients (45%) underwent pars plana vitrectomy with ILM peeling. Visual acuity improved or was unchanged in 79% of operated eyes without ILM peeling and 100% of operated eyes with ILM peeling (P = 0.01). Visual acuity improved 5 or more lines in 25% of operated eyes without ILM peeling and 30% of operated eyes with ILM peeling. At the final visit, 21% of eyes without ILM peeling at the initial surgery showed postoperative recurrent macular pucker or persistent contraction to the ILM, whereas none of the eyes with ILM peeling had evidence of this. CONCLUSIONS: This pilot study provides evidence that peeling of the ILM during macular pucker surgery may not have deleterious effects.
