Diode Laser Transscleral Cyclophotocoagulation With a Novel Low-Cost Torchlight Method of Trans-Corneal Transillumination in Refractory Pediatric Glaucoma.

PRCIS: Trans-corneal transillumination (TI) aided transscleral cyclophotocoagulation (TSCPC) for intraocular pressure control of refractory pediatric glaucoma was found to be effective at 1 year. PURPOSE: To study 1-year outcomes of diode laser TSCPC with trans-corneal TI using a novel low-cost torchlight method in refractory pediatric glaucoma. METHODS: This prospective interventional study included children with refractory glaucoma who underwent TSCPC with the Oculight laser system (IRIS Medical Instruments) with trans-corneal TI (TSCPC-TI) using a novel low-cost torchlight method. Children completing a minimum 1-year follow-up were analyzed. They were compared with a historical control group of children who underwent TSCPC without TI (TSCPC-No-TI) at the 1-year follow-up period. We analyzed the mean laser energy delivered, post-laser intraocular pressure reduction, number of antiglaucoma medications (AGM), the requirement of retreatment and complications of the procedure in both groups. RESULTS: Forty-two eyes of 35 patients comprised the TSCPC-TI group and were compared with 31 eyes of 21 patients in the TSCPC-No-TI group. The TSCPC-TI group required lower energy than the TSCPC-No-TI group (24.7±7.8 J vs. 47.2±10.9 J, P <0.0001). Mean topical antiglaucoma drug requirement decreased from 2.9±0.08 before treatment to 0.66±0.8 at the end of 1 year in TSCPC-TI and from 2.6±1.0 before treatment to 0.6±0.77 in the TSCPC-No-TI groups, respectively ( P =0.15). There was a significantly reduced dependence of oral acetazolamide in the TSCPC-TI group at 1-year follow-up [5.7% vs. 61.9%, respectively ( P <0.001%)]. No adverse event of hypotony or choroidal detachment was noted in any group. CONCLUSIONS: TSCPC aided by TI with a low-cost torchlight for pediatric refractory glaucoma was found to be effective at 1 year in reducing intraocular pressure and the burden of medication.

Bilateral Acute Iris Transillumination and Elevated Intraocular Pressure After COVID-19 Infection.

Bilateral acute iris transillumination (BAIT) is characterized by abundant pigment discharge into the anterior chamber. Atonic pupil and severe intraocular pressure (IOP) elevations may be observed. Generally, there is a viral upper respiratory tract infection or systemic fluoroquinolone usage before BAIT. Two cases with a recent history of coronavirus disease 2019 (COVID-19) presented with a complaint of decreased vision. Elevated IOP and iris transillumination defects were observed in both patients. Both patients were diagnosed with BAIT. Although elevated IOP was controlled with medical treatment in 1 patient, glaucoma surgery was performed in the other patient because it could not be controlled with medical treatment. As both patients received no systemic treatment for COVID-19, the pressure rise seems to be directly related to the viral infection alone through the inflammatory process. Atypical ocular presentations of COVID-19 should be kept in mind as it can have serious consequences.

Bilateral acute Iris transillumination after COVID-19 pneumonia.

PURPOSE: To report the diagnosis, treatment and follow-up of a case of bilateral acute iris transillumination (BAIT) developed after COVID-19 pneumonia. METHOD: Case report. CASE: A 66-year-old male patient with COVID-19 pneumonia received systemic treatments of favipiravir, prednisolone, moxifloxacin and piperacillin-tazobactam during hospitalization. The patient applied to our clinic with the complaint of blurred vision 20 days after the diagnosis of COVID-19. The best corrected visual acuity (BCVA) was 0.3 in the right eye and 0.5 in the left eye. In the anterior segment examination; ciliary injection, intense pigment dispersion in the anterior chamber, pigment deposits on the lens and iris, 2-3 + cells in the anterior chamber, posterior synechia, and 360 degrees diffuse iris transillumination were observed in both eyes. The pupillary response to light was weak. Bilateral fundus examination were normal. In the anterior chamber sample; HSV, VZV, CMV and Toxoplasma PCR were negative. Bilateral acute iris transillumination (BAIT) diagnosed in the patient and topical 0.1% dexamethasone and topical 1% cyclopentolate were started. In the follow-up, visual acuity increased 1.0 in both eyes, there were no cells in the anterior chamber, and the pigment dispersion was still continuing despite a decrease. CONCLUSION: BAIT, which can usually be seen after upper respiratory tract infections, can also be seen after covid 19 pneumonia and be kept in mind as a possible eye involvement in patients with COVID-19 infection.

Síndrome de misdirección del humor acuoso tras cirugía filtrante de glaucoma en paciente con síndrome de transiluminación aguda iridiana bilateral (BAIT) / Aqueous humor misdirection syndrome after glaucoma filtering surgery in patient with bilateral acute iris transillumination (BAIT) syndrome

CASO CLÍNICO: El síndrome BAIT (Bilateral Acute Iris Transillumination (transiluminación iridiana aguda bilateral) es una enfermedad caracterizada por dispersión pigmentaria severa aguda bilateral del iris y parálisis del esfínter pupilar. Mujer de 51 años diagnosticada de síndrome BAIT con hipertensión ocular refractaria en ojo izquierdo (OI) que precisa realización de cirugía filtrante. Durante la primera semana del postoperatorio desarrolla un cuadro de misdirección del humor acuoso, por lo que se procede a vitrectomía posterior vía pars plana, con resolución del mismo. CONCLUSIÓN: Presentamos el primer caso descrito en la bibliografía de síndrome de misdirección acuosa secundaria a cirugía filtrante de glaucoma en una paciente con síndrome BAIT, patología de reciente definición y con pocos casos descritos actualmente

CASE REPORT: Bilateral Acute Iris Transillumination (BAIT) is a disease characterised by bilateral acute, severe pigment dispersion of the iris, and pupil sphincter paralysis. The case is reported of a 51-year-old female who was diagnosed with BAIT syndrome, with refractory ocular hypertension in the left eye, and who needed filtering surgery. Aqueous misdirection was developed a week after surgery, then pars plana vitrectomy was performed and the complication was solved. CONCLUSION: This is the first case described in literature of aqueous humor misdirection syndrome secondary to glaucoma filtering surgery in a patient diagnosed of BAIT syndrome. This is a recently defined disease with a few cases currently described

An unexpected complication in bilateral acute iris transillumination: Cystoid macular edema.

A 47-year-old male presented with bilateral 4 + circulating pigment in the anterior chamber, diffuse iris transillumination, dilated pupils unresponsive to light, and high intraocular pressure (IOP) levels in both eyes. Visual acuity and IOP improved bilaterally with topical steroid and antiglaucomatous therapy. In the 10th month, bilateral cystoid macular edema (CME) was developed and resolved after subtenon triamcinolone injections. CME recurred after cataract surgery in the right eye which was treated with intravitreal dexamethasone implant injection. CME was recurred in the left eye and treated with intravitreal dexamethasone implant at the same setting with cataract surgery. CME can be seen in the course of bilateral acute iris transillumination (BAIT). This is the first BAIT case presenting with bilateral CME.

[Combined approach for parotid lithiases: A 9 cases retrospective study]. / Abord combiné des lithiases parotidiennes : étude rétrospective de 9 cas.

INTRODUCTION: Minimally invasive techniques (MIT), including sialendoscopy, extracorporeal lithotripsy and intraoral approach, have to be preferred in parotid stones removal. In case of MIT failure, a combined intra- and extra-oral approach can be achieved. The aim of our study was to evaluate the efficacy and the complications of these combined approaches. MATERIALS AND METHODS: A retrospective study has been conducted on patients treated between 2006 and 2015. All adult patients presenting with one or more parotid stones and in whom TMI failed have been included. Age and sex of the patients, number, size and location of the stones, result of the procedure, occurrence of pain, swelling, or infection have been recorded. RESULTS: Nine patients were included (mean age: 56). Mean follow-up was 48 months. Eighty-eight percent of patients had an unique stone. Nine stones were extracted by combined approach. Mean diameter of the stones was 8.5mm and 33% of them were located at the junction between middle and posterior third of parotid duct. All the patients suffered preoperatively from daily retention symptoms, such as pain (55%) and swelling (100%). Two patients had an infectious complication (duct and/or gland infection). Seventy-five percent (9/12) of stones were removed. Complications consisted of 1 fistula, 1 facial paresis, 3 recurrences. Seven of 9 patients (77%) had a total relieve after surgery. DISCUSSION: Surgical combined approaches for parotid stones removals are indicated after failure of MIT when symptoms affect quality of life.

Treatment Outcomes and Lessons Learned From Transilluminated Powered Phlebectomy for Varicose Veins in 1034 Patients.

INTRODUCTION: Transilluminated powered phlebectomy (TIPP) is a minimally invasive technique of varicose vein removal, which combines irrigated illumination with tumescent anesthesia for ablation of superficial varicosities and endoscopic-powered venous resection. The objective of this study was to analyze treatment outcomes of this treatment modality. METHODS: A retrospective evaluation of prospectively collected data from all patients undergoing TIPP procedure for symptomatic varicose veins during a recent 12-year period was performed. Pertinent patient demographics, disease classification, perioperative complications, quality of life, and treatment outcomes were collected and analyzed. RESULTS: A total of 1167 limbs in 1034 patients (mean age, 52.4 years) were treated during the study period. The mean procedure time was 18.4 ± 8.9 minutes (range, 6.0-82.0 minutes). The mean number of incisions for TIPP procedure was 6.3 ± 3.6. All TIPP procedures were technically successful, and no patient required conversion to hook stab phlebectomy. Fifteen (1.5%) patients developed residual or recurrent varicosities, which were treated with sclerotherapy during the follow-up period. Postoperative complications included hematoma at 2 weeks (5.8%), ecchymosis at 2 weeks (32.9%), saphenous neuropathy (0.3%), cellulitis (1.0%), and skin pigmentation (1.9%). There was no postoperative deep vein thrombosis or mortality. CONCLUSIONS: Transilluminated powered phlebectomy is an effective method for varicose vein removal and is associated with high clinical success and excellent cosmetic results. Meticulous technical steps are critical in achieving successful outcomes while minimizing complications. Technical considerations and lessons learned from our experiences are discussed in this report.

Transilluminator burns in the neonatal intensive care unit: a mimicker of more serious disease.

We report an outbreak of erythematous to purpuric papules and vesicles in four neonates whose lesions arose within a 72-hour period in a neonatal intensive care unit. As isolated lesions, the clinical presentation mimicked cutaneous aspergillosis. Ultimately, because of the number of patients with similar lesions, an exogenous source was suspected and determined to be a faulty transillumination device.

Ultraviolet light hazards from transilluminators.

Ultraviolet (UV) light boxes ("transilluminators") are commonly used in molecular biology laboratories for visualizing ethidium bromide-intercalated nucleic acids separated under electric current in electrophoretic gels. These devices typically have peak outputs at 254 or 312 nm, well within the UV-C and -B regions that are biologically active and capable of damaging skin. Field evaluations of laboratory transilluminators under actual conditions of use indicate that the UV light emitted from transilluminators is an identifiable and potentially significant occupational hazard for many laboratory workers, as is the high frequency of workstation surface contamination with ethidium bromide, a known mutagen. Fortunately, these hazards can be relatively easily controlled through worker training and the regular use of basic personal protective equipment.

Transillumination blisters in a neonate.

Transillumination with a high-intensity fiberoptic light source is an effective means of diagnosing pneumothoraces and localizing arteries and veins for blood sampling. It has been used for these purposes in neonatal intensive care units since the 1970s. Thermal burns were reported in association with the technique initially, but this complication now occurs infrequently because of numerous safety precautions. We present a case of thermal blisters induced by transillumination in a neonate. This entity is an important addition to the differential diagnosis of vesicobullous eruptions in the neonate.