ABSTRACT
Toxic epidermal necrolysis and mucopolysaccharidosis are both rare diseases that pose significant airway maintenance challenges to anesthesiologists. In this report, we describe the anesthesia management in a 4-year-old male with mucopolysaccharidosis type II who developed toxic epidermal necrolysis and presented for ophthalmic surgical procedures. Combined use of propofol and ketamine with the support of high-flow nasal oxygen enabled adequate analgesia and sedation while maintaining spontaneous ventilation and airway patency. The strategy presented in this report may contribute to enhancing the safety of sedation in spontaneously breathing children with abnormal airways.
Subject(s)
Anesthesia , Ketamine , Mucopolysaccharidosis II , Propofol , Stevens-Johnson Syndrome , Male , Humans , Child , Child, Preschool , Stevens-Johnson Syndrome/complications , Stevens-Johnson Syndrome/therapy , Anesthesia/methods , Mucopolysaccharidosis II/complicationsABSTRACT
Trabeculectomy still achieves the strongest intraocular pressure (IOP) reduction of all glaucoma surgical techniques, but with the drawback of a significant risk profile. Against this background, canaloplasty has established itself as a much gentler alternative which achieves sufficient IOP reduction and enables a significant reduction in postoperative glaucoma medication. However, approximately half of patients are not completely medication free. In response, a number of modifications have been developed with the goal of further enhancing the IOP-lowering effect of canaloplasty, but without the risk of serious complications. By combining canaloplasty with the newly developed suprachoroidal drainage, a uveoscleral drainage is created in addition to the trabecular outflow improvement, which seems to have an additive effect. Thus, for the first time, an IOP-lowering effect comparable to successful trabeculectomy can be achieved. Numerous other modifications with implants also enhance the potential of canaloplasty or offer other additional benefits such as the possibility of telemetric IOP self-measurement by the patient. The additional creation of a subconjunctival drainage with or without use of cytostatic drugs also seems promising. Ab interno procedures, on the other hand, have limited pressure-lowering potential but may provide some additional benefit in mild glaucoma and in the setting of cataract surgery.
Subject(s)
Cytostatic Agents , Glaucoma, Open-Angle , Glaucoma , Trabeculectomy , Glaucoma/surgery , Glaucoma, Open-Angle/surgery , Humans , Intraocular Pressure , Trabeculectomy/methodsABSTRACT
PURPOSE: To evaluate the feasibility and effects of the intrastromal implantation of chemically modified corneal stroma obtained from chicken into the corneas of rabbits for corneal thickening. METHODS: Chicken corneas were cut, debrided, treated with cross-linking and implanted in an intrastromal pouch created in the cornea of 10 white New Zealand rabbits with femtosecond laser. Slit-lamp biomicroscopy and optical coherence tomography were performed immediately, 7, 30 and 90 days postoperatively. Corneas were removed at 90 days and cut in two halves. One half was sent to histological analysis for the presence of necrosis, polymorphonuclear inflammatory cells, blood vessels and fibrosis, while the other half was evaluated with transmission electron microscopy to verify tissue organization and the presence of keratocytes and inflammatory cells. Corneal thicknesses were comparatively analyzed over time with Wilcoxon test (p ≤ 0.05). RESULTS: The chicken grafts were incorporated into the cornea of all animals over time. Mean rabbit cornea thickness increased from 338 µm preoperatively to 538 µm (p < 0.0077) at 90 days, while mean chicken graft thickness decreased from 350 to 215 µm (p < 0.0077). No clear signs of rejection attributable to the xenograft were observed in any of the implanted eyes. However, some macroscopic and histological events were observed in some of the eyes, probably due to procedural issues during implantation. CONCLUSION: The intrastromal implantation of chicken grafts was shown to be feasible and predictable to thicken the recipient rabbit cornea without apparent rejection. However, before being considered in humans, further meticulous clinical trials are required to establish the clinical utility, safety and efficacy of xenografts for the treatment of patients with advanced keratoconus.
Subject(s)
Corneal Transplantation , Keratoconus , Animals , Chickens , Cornea/surgery , Corneal Stroma/surgery , Humans , RabbitsABSTRACT
Presbyopia is an age-related eye condition,and its most prominent sign is the reduction in the amplitude of accommodation,resulting in the disability to modify the focus from far to near of the eyes.Surgical therapy of presbyopia still remain great challenge for refractive surgeons.Surgical strategies of presbyopia include extraocular (corneal or scleral) and intraocular procedures,such as excimer laser surgery,conductive keratoplasty,INTRACOR,corneal inlays,multiple types of muhi-focal or accommodating intraocular lens,laser-assisted presbyopia reversal,scleral expansion bands,etc.Each procedure owns its unique advantages and disadvantages.This review attempted to address the surgical options available and likely to be available in the near future and discuss the key problems in presbyopia procedures.
ABSTRACT
Retinoschisis is an abnormal separation of the retinal layers and is asymptomatic in most cases. Enlargement of the area of retinoschisis and retinal tear and detachment are possible complications of the disease, and the treatment of retinoschisis is controversial. In this case report, we present a case of retinal detachment associated with senile retinoschisis in which pneumatic retinopexy was chosen as the treatment of choice and was performed successfully in one of the eyes. After a literature review on retinoschisis and pneumatic retinopexy for the treatment of associated retinal detachment, we found only one case that was successfully treated without drainage of subretinal fluid, using air as the filler. However, no previous reports have been found in the literature on the effectiveness of pneumatic retinopexy using C3F8 as the sole treatment for progressive retinal detachment in senile retinoschisis.
Retinosquise significa uma separação anormal das camadas da retina e, na maioria dos casos, é assintomática. Aumento da área de retinosquise, roturas e descolamento de retina são possíveis complicações da doença, sendo seus tratamentos controversos. Nesse relato, apresentamos um caso de descolamento de retina associado à retinosquise senil em que foi optado pela retinopexia pneumática como primeiro tratamento, com sucesso em um dos olhos tratados. Revisada literatura sobre retinosquises e retinopexia pneumática para tratamento de descolamento de retina associado, foi encontrado apenas um caso tratado com sucesso, sem drenagem de líquido sub-retiniano, utilizando-se ar como agente tamponante. Não existem relatos na literatura de retinopexia pneumática efetiva utilizando C3F8 como tratamento único para descolamento de retina progressivo na retinosquise senil.
Subject(s)
Humans , Male , Middle Aged , Fluorocarbons/therapeutic use , Retinal Detachment/therapy , Retinoschisis/therapy , Disease Progression , Follow-Up Studies , Light Coagulation , Ophthalmologic Surgical Procedures , Retinal Detachment/pathology , Retinoschisis/pathology , Subretinal Fluid , Tomography, Optical Coherence , Treatment FailureABSTRACT
Os fibro-histiocitomas representam 1 por cento das massas orbitárias e podem ser histologicamente classificados em benignos, localmente agressivos e malignos - os últimos representando aproximadamente 11 por cento do total. Nesse estudo, os autores descrevem um caso raro de fibro-histiocitoma maligno de pálpebra, ressaltando as características clínicas e histopatológicas desta neoplasia.
Fibrous histiocytomas represent 1 percent of all orbital masses and may be classified into benign, locally aggressive and malignant - these representing nearly 11 percent of the total. In this study, the authors describe an unusual case of malignant fibrous histiocytoma of the eyelid, discussing clinical and histological features of this neoplasm.
