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Ioannis Mavrikakis

Publications and source records attributed to Ioannis Mavrikakis.

10 recordsLinked to original sources
PubMed2006

Cataract surgery by appointment--a pilot study.

BACKGROUND: "Cataract Surgery by Appointment" is a new method of delivery of cataract surgery that reduces the time a patient spends in hospital by their direct arrival at the operating theatre, having self-prepared for surgery, thus avoiding admission to the ward or time spent in the Day Case Unit. The patient can stay as little as 20 minutes from their arrival to going home. We describe the process in detail, and seek to evaluate the visual outcome, safety and patient satisfaction of same. METHODS: Visual outcome and safety data were obtained from patients' medical records, prospectively. Patients were also surveyed by a questionnaire to determine their satisfaction with the service and viability as a prospect for providing a more efficient cataract surgery service. RESULTS: In 2002, fifty-one eyes of 39 consecutive patients underwent "Cataract Surgery by Appointment". There were 16 male and 23 female. The pre-operative best-corrected visual acuity was 6/9 or better in 17 (33%) eyes. The post-operative best-corrected visual acuity was 6/9 or better in 44 (86%) eyes. There were no per-operative complications. Post-operative complications occurred in 3 (6%) eyes. The average number of days from surgery to final discharge was 14.5 days. Twenty-eight (72%) completed questionnaires were returned. The results show that the majority of patients were satisfied with their overall experience of this mode of delivery for cataract surgery. CONCLUSION: "Cataract Surgery by Appointment" performed under local anaesthesia by a skilled ophthalmic surgeon appears to be safe and effective for highly selected cases. This method of delivery gave a high level of patient satisfaction, and is the ultimate form of day case cataract surgery. The method may gain widespread use should per-operative intracameral pupil dilatation prove to be effective and acceptable. Attention should be paid to risk-stratification, so complex cases are allocated more time on the operating list.

Appointments and Schedules↗
PubMed2006

Linear basal cell carcinoma: a distinct clinical entity in the periocular region.

PURPOSE: To report periocular linear basal cell carcinoma (BCC) as a distinct clinical entity, and to highlight its existence in the ophthalmic literature. DESIGN: Retrospective, noncomparative, multicenter, interventional small case series. PARTICIPANTS: Four patients with linear BCC in the periocular region. INTERVENTION: All patients underwent margin-controlled excision, 3 utilizing Mohs' micrographic surgery and 1 using frozen section. MAIN OUTCOME MEASURES: Age, gender, location, preoperative tumor size, histological growth pattern, presence of perineural invasion, number of Mohs' levels used to obtain histologic clearance, postoperative defect size, and recurrence. RESULTS: In all 4 cases, the site of occurrence was in the lower eyelid and cheek. Histology revealed pigmented nodular BCC with an infiltrative component in 2 cases and nodular BCC in the remaining 2 cases. No perineural invasion was noted in any of the cases. Two Mohs' levels were required for complete excision in 3 patients. CONCLUSIONS: Linear BCC is a distinct clinical entity. Presence of the tumor along relaxing skin tension lines, increase in subclinical extension, and aggressive tumor behavior are reported observations. Because of these observations, it is suggested that margin-controlled excision should be considered for linear BCC.

Aged↗
PubMed2006

Surgical management of the severely contracted socket following reconstruction.

PURPOSE: To present a surgical technique for the early maintenance of the severely contracted socket following reconstruction. METHODS: Two patients with severely contracted sockets following multiple procedures and recurrent failure were identified over a 1 year period. Following fornix and eyelid reconstruction, silicone fixative was injected into the fornix through a standard conformer. The silicone fixed around a pre-placed K-wire passed from the lateral orbital rim to the posterior lacrimal crest. Both silicone and wire were removed at 3 months. RESULTS: Both patients were able to wear and maintain an acceptable prosthesis following the surgical procedure. CONCLUSION: This is a safe and effective method for the early maintenance of a severely contracted socket. This technique minimizes cheesewiring or extrusion and avoids damage to superior and inferior muscles and structures.

Adult↗
PubMed2006

Correction of involutional lower eyelid medial ectropion with transconjunctival approach retractor plication and lateral tarsal strip.

AIM: We describe the technique and our results in managing lower eyelid involutional medial ectropion using a combination of lateral tarsal strip to address horizontal eyelid laxity, and transconjunctival inferior retractor plication to address inferior retractor dehiscence. METHODS: Patients with symptoms of epiphora or signs of medial ectropion were offered this procedure. All had the following characteristics: medial lower eyelid eversion, punctal eversion >3 mm, medial canthal tendon laxity <4 mm, significant horizontal eyelid laxity and lacrimal systems that were patent to syringing. RESULTS: A total of 24 eyelids of 17 patients underwent this procedure over a 12-month period. The mean age of the patients was 79.7 years; 11 were male and six were female. The mean follow-up time was 18 months. Two eyes had undergone previous surgery. All patients had restoration of the eyelid margin to the globe and relief of symptoms. No complications were noted. DISCUSSION: These results suggest that excision of posterior lamellar tissue is not necessary for correction of involutional medial ectropion. Transconjunctival plication or reattachment of retractors is easy to perform and allows for the repair of more than the medial portion of the retractors if required.

Aged↗
PubMed2003

The incidence of irreversible retinal toxicity in patients treated with hydroxychloroquine: a reappraisal.

PURPOSE: To define the risk of hydroxychloroquine (HCQ)-related retinal toxicity in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who are receiving recommended dosages of the drug (< or =6.5 mg/kg/day). DESIGN: Prospective cohort study, from 1985 to 2000. PARTICIPANTS: Greek patients with RA (n = 335) and SLE (n = 191) treated with HCQ, 400 of whom had completed at least 6 years of treatment. METHODS: Ophthalmologic evaluation was performed every 6 months from 1985 to 1995, and yearly thereafter. This consisted of best-corrected visual acuity, color vision testing, static central visual field testing, fundoscopy, electroretinography, and fluorescein angiography, when indicated. MAIN OUTCOME MEASURES: Fundus lesions attributed to HCQ. RESULTS: No HCQ retinal toxicity was noted in any of the 526 patients during the first 6 years of treatment. Two (3.4%) of the first 58 long-term (>6 years) treated patients developed HCQ-related maculopathy at 8 and 6.5 years of treatment, despite regular ophthalmologic evaluation. On follow-up 7 and 9 years after cessation of HCQ treatment, both patients had stable eye disease. No HCQ retinal toxicity was observed in the subsequent 342 patients who were treated for >6 years. Overall, the incidence of HCQ-related retinopathy in 400 patients who were treated with recommended dosages of the drug for a mean of 8.7 years was reduced to 0.5%. CONCLUSIONS: After a baseline ophthalmic examination to confirm the absence of preexisting fundus pathology, patients with normal renal function may receive HCQ at a maximal daily dosage of 6.5 mg/kg and continue safely for 6 years. However, annual screening is recommended in patients who have taken the drug, even in recommended doses, for >6 years.

Adolescent↗
PubMedDate not supplied

The osteo-odonto-keratoprosthesis (OOKP).

The osteo-odonto-keratoprosthesis (OOKP), although described over 40 years ago, remains the keratoprosthesis of choice for end-stage corneal blindness not amenable to penetrating keratoplasty. It is particularly resilient to a hostile environment such as the dry keratinized eye resulting from severe Stevens-Johnson syndrome, ocular cicatricial pemphigoid, trachoma, and chemical injury. Its rigid optical cylinder gives excellent image resolution and quality. The desirable properties of the theoretical ideal keratoprosthesis is described. The indications, contraindications, and patient assessment (eye, tooth, buccal mucosa, psychology) for OOKP surgery are described. The surgical and anaesthetic techniques are described. Follow-up is life-long in order to detect and treat complications, which include oral, oculoplastic, glaucoma, vitreo-retinal complications and extrusion of the device. Resorption of the osteo-odonto-lamina is responsible for extrusion, and this is more pronounced in tooth allografts. Regular imaging with spiral-CT or electron beam tomography can help detect bone and dentine loss. The optical cylinder design is discussed. Preliminary work towards the development of a synthetic OOKP analogue is described. Finally, we describe how to set up an OOKP national referral center.

Alveolar Process↗
PubMedDate not supplied

Changes in corneal topography with upper eyelid gold weight implants.

PURPOSE: To determine the effect of upper eyelid gold weight implantation on corneal astigmatism. METHODS: This is a prospective, cohort study. Eighteen eyes of 18 patients underwent upper eyelid gold weight implantation for facial nerve palsy. Nine of these patients recovered facial nerve function and underwent elective removal of the gold weight. Corneal topography was performed before and after gold weight implantation. Corneal topography was also performed after gold weight removal in patients who recovered from facial nerve paralysis. RESULTS: With-the-rule corneal astigmatism increased significantly by 1.4 diopters (D) +/-2.0, from a mean of 0.3 to 1.7 D after gold weight implantation (p = 0.034). With-the-rule corneal astigmatism in patients who had gold weight removal decreased by 1.2 +/- 2.1 D, from 2.2 to 1.0 D after gold weight removal (p = 0.136). CONCLUSIONS: Upper eyelid gold weight implantation causes an increase in corneal astigmatism, predominantly in the vertical axis, which appears to be reversible on removal of the gold weight.

Adult↗
PubMedDate not supplied

MR findings in a patient with isolated intrinsic optic nerve lymphoma.

We present a case of unilateral isolated intrinsic optic nerve small B-cell lymphoma confirmed by optic nerve biopsy in a patient with lymphoplasmacytoid lymphoma. Brain and orbital MRI with gadolinium revealed fusiform enlargement of the optic nerve from the level of the optic nerve head to the prechiasmatic region, with associated homogeneous enhancement of the nerve itself.

Diagnosis, Differential↗