We report the clinical course of a 31-year-old former intravenous drug user on methadone substitution therapy who injected methadone mixed with orange juice. She developed isolated metastatic Candida ...albicans anterior uveitis, which was treated with adequate systemic and local antifungal therapy. The uveitis regressed, but despite adequate local and systemic treatment, a lens abscess developed. Phacoemulsification and endocapsular intraocular lens implantation were performed, and the patient recovered 20/20 visual acuity in the affected eye. In patients with a history of injection drug use, persisting intravenous drug or substitution therapy abuse must be considered. Quick diagnosis and adequate treatment can prevent the development of widespread C albicans endophthalmitis, which has a poor visual prognosis. Early administration of antifungal and surgical therapy is crucial for achieving good functional results.
Zusammenfassung
Hintergrund
Die nicht-arteritische anteriore ischämische Optikusneuropathie (NAION) ist die häufigste akute optische Neuropathie bei älteren Menschen, mit einer Häufigkeit von 2 bis ...10 pro 100.000 Menschen im Alter von 50 Jahren und älter.
Ziel unserer Untersuchung war es, die Refraktionsfehler bei Patienten mit NAION zu überprüfen, vor allem hinsichtlich der Weitsichtigkeit als zusätzliches Risiko für NAION.
Methode und/oder Patienten
Retrospektiv wurden die medizinischen Unterlagen einer detaillierten Augenuntersuchung bei 109 Patienten (109 Augen) mit akuter NAION, die zwischen Januar 2002 und Dezember 2011 in unsere Abteilung aufgenommen wurden, überprüft. Die Refraktionsfehler wurden mit einem Autorefraktometer gemessen. Das sphärische Äquivalent wurde als Maß für Refraktionsfehler angewandt. Nur akute Episoden von diesen Patienten wurden in die Untersuchung eingeschlossen.
Ergebnisse
Das durchschnittliche Alter bei Ausbruch der ersten Episode war 68,53 Jahre. Die Mehrheit unserer NAION Patienten (76 von 109; 69,7 %) war zwischen 60 und 80 Jahre alt. Die meisten Augen (67 von 109) waren weitsichtig (61,5 %). Der durchschnittliche Grad der Weitsichtigkeit war + 2,38 D. Von den 109 Patienten mit NAION hatten 23 (21,1 %) bilaterale Episoden.
Schlussfolgerungen
Unsere Ergebnisse deuten darauf hin, daß Weitsichtigkeit ein prädisponierender Faktor für NAION sein könnte. Da es keine zuverlässige und wirksame Behandlung für NAION gibt, haben Maßnahmen zur Vermeidung ischämischer Optikusneuropathie Vorrang. Bei Patienten mit mäßiger Weitsichtigkeit sollte eine detaillierte Augenuntersuchung vorgenommen werden, mit nachdrücklicher Betonung der Erkennung und Behandlung anderer möglicher Risikofaktoren um das NAION-Risiko auf ein Minimum herabzusetzen.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The purpose of the present study was to assess the influence of preoperative activity of rheumatoid arthritis (RA) on early postoperative anterior chamber inflammation after phacoemulsification and ...intraocular lens implantation. Twenty-three eyes in 18 patients were included in our study. On the first postoperative day, anterior chamber inflammation was observed in 11 eyes (47.8%). Five days after surgery, we found postoperative inflammation only in 1 eye (4.3%). Keratic precipitates were observed in 1 eye (4.3%) on the second postoperative day. We found no correlation between the extent of anterior chamber inflammation and the preoperative activity of RA. Postoperative anterior chamber inflammation was also not associated with the medical management of RA.
14 patients (14 eyes) who sustained hyphema after blunt ocular trauma underwent visual field testing on a Humphrey field analyzer. The severity of field defects based on mean deviation (MD) and ...corrected-pattern standard deviation (CPSD) p values was correlated with age, presence of hyphema and the extent of angle recession. Over 60% of eyes with blunt ocular trauma suffer from a significant visual field loss (MD < 5%). There was no correlation between severity of field defects and the extent of hyphema or the angle recession. MD p values were found to be associated with older group, but not CPSD p values.
Background. Penetrating keratoplasty (PK) is rarely performed in mentally retarded patients, first of all because of numerous complications after surgery such as inflammation, self-inflicted injury, ...injury and because of difficult post-operative treatment. The aim of this study was to present the success of PK in this patients. In 16 years (from May 1984 to May 2000) 201 PK were performed, but only three in mentally retarded patients.Methods. We present three cases of PK in mentally retarded patients. All the patients were men. They were 14, 16 and 27 year old. The indication for PK were in two cases acute keratoconus and in one case acute keratoglobus. The mean followup was 24.6 months. Trepanation was made with rotor threpin and donor material was sutured using single continuous 10-0 nylon suture.Results. In two cases keratoplasties stayed clear. Visual acuities were 0,4 and 0,5. In one patient with very aggressive behaviour graft failure developed with significant corneal vascularisation. Re-keratoplasty was not performed.Conclusions. Adequate post-operative care following PK in mentally retarded patients is the most important factor for the success of transplantation. The indication for the surgery must be made very carefully especially in self-aggressive patients in residential care.
Background. To compare the efficacy of selective laser trabeculoplasty (SLT) as treatment of pseudoexfoliation glaucoma (PG) and primary open-angle glaucoma (POAG) in a prospective clinical ...study.Methods. Ten eyes of 10 patients suffering from uncontrolled PG (PG group) and 10 eyes of 10 patients with uncontrolled POAG (POAG group) were treated with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The baseline characteristics were similar in both groups. The intraocular pressure (IOP) was measured before the treatment and 1day, 1 week, 1 month and 3, 6, 9, 12, 15, 18, 24, 30, and 36 months after the treatment. Success was defined as an IOP lowering, exceeding 20% of pretreatment IOP. Any modification of hypotensive medication led to exclude the eye from the study. Statistical analysis comparing the two groups was carried out using the independent-sample t test for continuous variables and the Log-Rank test for survival analysis. All tests were conducted considering p< 0.05 as significant.Results. The mean follow-up time was 22.8 months (SD 12.5) for the PG group and 24.3 months (SD 10.8) for the POAG group (n. s.). No significant difference was found between the two groups for mean pretreatment IOP (23.6 mm Hg SD 5.7 in the PG group vs. 22.8 mm Hg SD 2.4 in the POAG group) and for mean IOPs during the whole follow-up period. At all follow-up visits, the mean IOP reductions were smaller in the PG group than in the POAG group (7.0 mm Hg SD 3.3 vs. 7.7 mm Hg SD 2.0 at 24 months). However such difference was statistically signifficant only at 36 months (4.7 mm Hg SD 1.1 vs. 8.3 mm Hg SD 1.5). At all follow-up visits, the mean percent IOP reduction was smaller in the PG group than in the POAG group (27.6% SD 7.1 vs. 32.1% SD 7.1 at 24 months). Furthermore, such a difference was statistically significant at 9, 12, and 36 months (21.8% SD 1.6 vs. 34.1% SD 4.7). According to the Kaplan-Meier survival analysis, the 36-month success rate was 47% in the PG group and 59% in the POAG group, but the differences between the two groups were nonsignificant (p> 0.05).Conclusions. SLT is an effective procedure for lowering IOP, although within 3 years there has been a substantial failure rate in both PG and POAG eyes, and the success seems to decline faster in PG eyes.
TYPES, CAUSES AND TREATMENT OF EYELID TRAUMA Mateja Naji; Tomaž Gračner; Bojan Gračner ...
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
05/2004, Volume:
73, Issue:
5
Journal Article
Peer reviewed
Open access
Background. Eyelid trauma is a common cause of visit to the ophthalmologist, but there are just a few recent epidemiological studies. Purpose of our study was to analyse eyelid injuries according to ...the mechanism of injury, causes of eyelid injuries and different types of treatment.Methods. A retrospective review of data from patients who received surgical treatment for eyelid injuries at the Ophthalmology Department, Maribor General Hospital in 2000 and 2001 was carried out. Eyelid injuries were divided into a minor trauma with patients treated as outpatients and major trauma patients who needed hospital treatment. According to the mechanism of injury eyelid injuries were divided into a blunt trauma, sharp trauma and combination of both. They according to the localisation injuries were divided into injuries of upper lid, lower lid and both lids at the same time. We looked for causes of eyelid injuries, accompanying injuries and different types of treatment of eyelid injuries.Results. Out of 295 patients 239 were men (81%) and 56 were women (19%). 27 patients (9%) suffered major trauma and needed hospitalisation while 268 suffered minor trauma and they were treated as outpatients (91%). Blunt trauma was present in 195 cases (66%), sharp trauma was present in 40 cases (14%) and in 60 cases (20%) the injury was combination of sharp and blunt trauma. The most common causes were sudden falls in 89 cases (30%), followed by violence in 85 cases (29%). 215 patients (73%) clinically showed injury of upper lid, 46 patients (16%) showed injury of the lower lid and in 34 cases (11%) both lids were injured. Accompanying injury of the eyeball was present in 138 patients (47%) and face injuries in 17 patients (6%).251 patients (85%) needed skin sutures, 6 patients (2%) needed skin and subcutaneous tissue suturing, lid margin was treated in 33 cases (11%) and canaliculus was treated in 5 cases (2%).Conclusions. Results of our study showed that eyelid injuries were more frequent in man and blunt trauma was the most frequent type of injury. The most common cause of injury was sudden fall. Injuries were mostly minor, and patients were treated as outpatients. Only 9% of patients suffered major trauma and needed a hospitalisation. In almost half of patients additional injury to the eye was present. According to the results of our study of eyelid trauma, which showed big diversity of injuries and high frequency of additional injuries to the eye, ophthalmologic examination and treatment should be performed in all of these cases.
Our aim was to investigate the efficacy of selective laser trabeculoplasty (SLT) for the treatment of primary open-angle glaucoma (POAG) in a prospective clinical study.
In 36 eyes of 36 patients ...suffering from uncontrolled POAG, treatment was carried out with a frequency-doubled, Q-switched Nd:YAG laser (532 nm). The intraocular pressure (IOP) was measured before the treatment and one day, one week, one month and 3, 6, 12, 18, 24, 30, 36, 42 and 48 months after. A failure was defined as an IOP reduction of less than 20% from pretreatment IOP, or a progression of visual field or optic disc damage requiring filtering surgery. The hypotensive medication during the study period remained unchanged.
The mean follow-up time was 34 months (SD 12.9). The mean pretreatment IOP was 22.9 mm Hg (SD 2.1). At one month of follow-up, the mean IOP reduction was 5.3 mm Hg (SD 2.1) or 23.1% and at 6 months 5.6 mm Hg (SD 2.6) or 24.5%. At 12 months of follow-up, the mean IOP reduction was 5.6 mm Hg (SD 2.3) or 24.5% and at 24 months 6.2 mm Hg (SD 2.5) or 27%. At 36 months of follow-up, the mean IOP reduction was 6.4 mm Hg (SD 2.1) or 27.4% and at the end of 48 months of follow-up, the mean IOP reduction was 5.9 mm Hg (SD 2.0) or 25.4%. The success rate after 12 months determined from the Kaplan-Meier survival analysis was 97%, after 24 months 88%, after 36 months 76% and after 48 months 71%.
SLT is an effective procedure for the treatment of POAG.
