RESUMEN
We report a case of varicella zoster virus (VZV)-associated anterior uveitis in a patient with weight loss, arthritis and signs of inflammatory bowel disease. Her clinical course included the development of a thalamic stroke secondary to VZV cerebral vasculopathy. Following antiviral therapy, the patient's neurologic symptoms recovered and her ophthalmic findings improved.
RESUMEN
PURPOSE: To compare sequential glaucoma drainage device (GDD) implantation with transscleral diode cyclophotocoagulation (CPC) following failure of a primary GDD. MATERIALS AND METHODS: A retrospective review of all patients who underwent GDD implantation at a single institution over 10 years. Patients who required an additional GDD and/or CPC were analyzed. Success was defined as absence of loss of light perception, reoperation for glaucoma, and intraocular pressure (IOP) >21 or <6 at 2 consecutive visits after an initial 3-month period. RESULTS: Thirty-two patients received sequential GDD. Twenty-one underwent CPC. Cohorts were statistically similar in regards to age, sex, race, and number of previous surgeries. Preoperatively, the GDD cohort had a lower IOP and better visual acuity. The mean length of follow-up was 37.9 months for the GDD group and 46.3 months for CPC. Both procedures significantly reduced IOP; however, CPC led to a greater reduction (P=0.0172). Survival analysis found the 5-year probability of surgical success to be 65.3% for sequential GDD and 58.0% for CPC (P=0.8678). No cases of phthisis occurred in either group. There were 2 cases of endophthalmitis (6.3%) in the GDD group, and none in the CPC group. In eyes without preexisting corneal edema, estimated corneal decompensation probability at 3 years was 31.6% for GDD and 6.7% for CPC (P=0.0828). CONCLUSIONS: Sequential GDD and CPC are both effective at reducing IOP following the failure of a primary GDD. CPC after GDD failure warrants further investigation as it led to a greater reduction in IOP with fewer serious adverse events.
Asunto(s)
Implantes de Drenaje de Glaucoma , Glaucoma/cirugía , Fotocoagulación , Implantación de Prótesis/métodos , Anciano , Cuerpo Ciliar/cirugía , Edema Corneal , Endoftalmitis , Femenino , Glaucoma/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Hipotensión Ocular/cirugía , Reoperación/métodos , Estudios Retrospectivos , Insuficiencia del Tratamiento , Agudeza Visual/fisiologíaRESUMEN
PURPOSE: To identify risk factors for device exposure and intraocular infection following implantation of a glaucoma drainage device. DESIGN: Retrospective case series. METHODS: The medical records of adult patients undergoing glaucoma drainage device implantation at an academic medical center between 2000 and 2010 were reviewed. Main outcome measures included device exposure and intraocular infection. RESULTS: Seven hundred and sixty-three cases were identified. These included 702 primary implants (ie, the first drainage device implanted into an eye) and 61 sequential implants. Among 702 primary implants, there were 41 cases of exposure (5.8%). None of the potential risk factors were statistically significant. Implant location was found to be a marginally significant risk factor. The exposure rates for inferior and superior implants were 12.8% (5 of 39) and 5.4% (36 of 663), respectively (P = .056). The highest rate of exposure for primary implants occurred in the inferior-nasal quadrant (17.2%, 5 of 29). The rate of exposure for sequential devices was 13.1% (8 of 61), with the highest rate also found in the inferior-nasal quadrant (20%, 5 of 25). Of 49 total exposures, 8 were associated with intraocular infection (16.3%). Exposures over inferior implants were more likely to be associated with infection than exposures over superior implants (41.7% vs 8.1%; P = .0151). CONCLUSION: Implant location approached, but did not reach, statistical significance as a risk factor for exposure. Exposures over inferior implants place patients at a higher risk of infection than superior exposures. More studies are needed to identify modifiable risk factors for device exposure.
Asunto(s)
Endoftalmitis/epidemiología , Infecciones Bacterianas del Ojo/epidemiología , Implantes de Drenaje de Glaucoma , Infecciones Neumocócicas/epidemiología , Falla de Prótesis/efectos adversos , Infecciones Estafilocócicas/epidemiología , Dehiscencia de la Herida Operatoria/epidemiología , Humor Acuoso/microbiología , Endoftalmitis/microbiología , Infecciones Bacterianas del Ojo/microbiología , Femenino , Glaucoma/cirugía , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Infecciones Neumocócicas/microbiología , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/microbiología , Staphylococcus/aislamiento & purificación , Streptococcus pneumoniae/aislamiento & purificación , Dehiscencia de la Herida Operatoria/microbiologíaRESUMEN
Elevated intraocular pressure is a common occurrence following vitreoretinal surgery. The use of silicone oil or intravitreal gas in conjunction with pars plana vitrectomy increases the likelihood of postoperative intraocular pressure elevation. Fortunately, the pressure elevation is usually transient and managed medically. In certain instances, surgical intervention is warranted. Therapeutic intervention should be tailored to the individual patient based on the mechanism of pressure elevation.