Management of massive suprachoroidal hemorrhage.
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Biomedical subjects
Publications and source records attributed to A Dellaporta.
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Combined trepanotrabeculectomy (TTE) and intracapsular cataract extraction for advanced cataract and severe open angle glaucoma proved to be successful in 84% of the operated eyes which were followed for one to 11 years. Complications were infrequent as compared to other combined procedures. The frequency of postoperative flat anterior chamber in particular was much lower. In 77% of the eyes the surgical scars were covered by normal conjunctiva without evidence of extraocular filtration. No avascular cystic blebs formed. The same operation performed as a secondary procedure seems to be equally successful. Eight eyes, which previously had successful trepanotrabeculectomy, developed cataract, which was removed without impinging on the function of the trabeculectomy scars. If the two operations are to be performed in separate sittings, it is advisable to perform the TTE first, followed by cataract extraction.
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Posterior scleral trephination at the pars plana ciliaris in a dependent site, with normal conjunctiva covering the opening, proved a reliable method for evacuating subchoroidal effusion in cases of flat anterior chamber. The method was also successful in cases occurring after retinal detachment surgery and after retinal detachment surgery and after expulsive hemorrhage. Unlike linear sclerotomy, drainage of the subchoroidal effusion continues for several days after the trephination.
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Trabeculectomy has proved to be superior to the classic filtering glaucoma operations. The final postoperative surgical scars should determine the most desirable technique. In this article, the scars observed in 73 eyes after primary trepanotrabeculectomy were followed up for two to eight years. Fifty-six of 73 eyes (80%) showed flat scars covered by normal conjunctiva without avascular cystic areas, no evidence of external filtration, and normalized intraocular tension. These scars did not impair the anatomic integrity of the eye and remained unchanged during the years.
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Fifteen eyes of 11 patients with rubeosis iridis and angle neovascularization associated with retinal vascular disorders were treated with pan-retinal photocoagulation. In seven of the 15 eyes, the new vessels on the surface of the iris and in the angle regressed after pan-retinal photocoagulation therapy for disk neovascularization; five of the remaining eight eyes that were treated prospectively demonstrated similar involution of the rubeosis iridis. In three of the five preexisting peripheral anterior synechiae regressed and angle structures previously obscured became visible. Three to 36 months after therapy, three eyes developed a few new abnormal iris and angle vessels.
Two patients with orbital involvement of plasma cell myeloma are presented. The first patient presented an isolated plasmacytoma in the orbit; the second patient had generalized plasma cell myeloma. In both cases X-rays and computed tomographic scanning gave valuable information and biopsy confirmed the diagnosis.
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