ABSTRACT
PURPOSE: To analyze clinical outcomes and intraocular pressure control following scleral-glued intraocular lens (IOL) fixation in eyes with pseudoexfoliation (PXF). METHODS: A retrospective chart review and outcome analysis was performed on a series of eyes undergoing glue-assisted, scleral-fixated (scleral-glued) IOL insertion in the setting of PXF and poor or absent capsular support. RESULTS: In total, 28 eyes were included in the study. The indications for scleral-glued IOL fixation included late endocapsular IOL dislocation (21/28, 75%), exchange for iris-fixated IOL due to complication (4/28, 14%), subluxed crystalline lens (2/28, 7%), and aphakia after complicated cataract surgery (1/28, 4%). In total, 15/28 (54%) eyes had diagnosed preexisting glaucoma at the time of scleral-glued surgery. The most common postoperative complication was ocular hypertension requiring escalation of medical management, which occurred in 8/28 (29%) eyes. At final follow-up, corrected distance visual acuity was equivalent to or improved from preoperative measurements in 25/28 (89%) eyes. CONCLUSIONS: The scleral-glued surgery is a good option for fixating an IOL in eyes with PXF and poor zonular integrity or absent capsular support. Special attention should be placed on intraocular pressure control following surgery, which can be less predictable in PXF eyes with or without preexisting glaucoma.
Subject(s)
Exfoliation Syndrome/complications , Intraocular Pressure/physiology , Lens Implantation, Intraocular/methods , Lenses, Intraocular , Sclera/drug effects , Tissue Adhesives/therapeutic use , Aged , Aged, 80 and over , Exfoliation Syndrome/physiopathology , Female , Humans , Male , Middle Aged , Postoperative Complications , Retrospective Studies , Tonometry, Ocular , Treatment Outcome , Visual Acuity/physiologyABSTRACT
PURPOSE: The purpose of this study was to report the successful treatment of persistent placoid maculopathy with intravitreal ranibizumab. METHODS: A 60-year-old man with an 8-year history of blurry vision was diagnosed with bilateral persistent placoid maculopathy complicated by a choroidal neovascular membrane. The left eye received two laser photocoagulation treatments. The right eye was injected twice with intravitreal bevacizumab and then 3 times with intravitreal ranibizumab over the course of 1 year. RESULTS: Visual acuity in the left eye dropped from 20/30 to 20/100 despite gradual resolution of fluid. However, visual acuity in the right eye improved from 20/50 to 20/25 where it remained for 24 months after the last injection. CONCLUSION: Ranibizumab seems to be efficacious in the treatment of choroidal neo-vascularization in persistent placoid maculopathy.
ABSTRACT
BACKGROUND: Concomitant mitral regurgitation (MR) is frequently seen in patients undergoing aortic valve replacement (AVR) for aortic stenosis. This study was undertaken to characterize the magnitude of MR in these patients and identify factors associated with significant postoperative change. METHODS: Between 2002 and 2006, 391 patients with stenotic AV disease but no structural mitral valve disease underwent AVR without coronary artery bypass grafting. Excluded were 164 patients with combined aortic and mitral intervention, right heart surgery, or moderate to severe aortic insufficiency, to yield a final study group of 227 patients. Follow-up echographic evaluation of MR was obtained in 87 of 219 patients (40%) discharged alive without mitral valve intervention. RESULTS: Overall mortality was 3.5%. After AVR, intraoperative MR severity improved in 66% of patients. Independent predictors of lower postoperative MR were small left atrial size (p = 0.03), the presence of aortic insufficiency (p < 0.01), and preoperative congestive heart failure (p = 0.04). Prosthetic valve type or size was not an independent predictor of postoperative MR. After adjustment for intraoperative underestimation of MR grade, there was no difference between the postprocedural MR grade and the early or late follow-up MR grade (p = 0.6 and p = 0.8, respectively). CONCLUSIONS: The results of this study support a conservative, tailored approach to concomitant mitral surgery in patients presenting for correction of aortic stenosis who demonstrate functional mitral regurgitation. Characteristics associated with resolution may allow for identification of patients most likely to benefit from mitral valve repair or replacement.
