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PubMed1975

Evaluation and optimum use of directed horizontal filtered air flow for surgeries.

Airborne micro-organisms, a suspected cause of surgical wound infection, are significantly reduced by the use of filtered unidirectional air flow (UAF) in operating rooms. A horizontal UAF system was installed at UCLA for evaluation and to determine procedures which would optimize its use. Major findings are listed: though the air flow was found to be somewhat turbulent and non-uniform in velocity downstream from the filter-bank entrance, the gross flow direction was maintained throughout the protected region; airborne particles were swept downstream with little vertical drop and no large scale recirculation; proper orientation and placement of objects in the clean air stream maximized its purging effect; correlation of non-viable with viable particle counts was not possible; better control of sources of contamination, particularly the operating team, would further reduce the potential for airborne infection; as yet there is no definitive proof that the addition of filtered UAF in a modern operating room reduces occurrences of deep wound sepsis.

Air Microbiology↗
PubMed1981

The effects of Arvin and surgery on red cell filterability.

Arovin (ancrod) treatment is generally recognized to lower fibrinogen levels and is sometimes used to decrease plasma and whole blood viscosity. The fall in fibrinogen is accompanied by a rise in fibrinogen degradation products (FDP), but none of the other clotting factors is affected. This study shows that patients undergoing surgery with subsequent Arvin treatment decrease their red cell filterability (RCF), and that this drop cannot be explained by either the surgical intervention, a direct effect of Arvin on the red cells, or the lowered fibrinogen levels. However the decrease of RCF does correlate with the rise in FDP.

Ancrod↗
PubMed2003

Morphologic classification of filtering blebs after glaucoma filtration surgery: the Indiana Bleb Appearance Grading Scale.

PURPOSE: To establish a new classification system for filtering blebs according to clinical morphologic parameters. The purpose of this classification system is to provide a uniform and objective assessment of bleb appearance and establish a framework system through which outcomes of filtration surgery may be better correlated to clinical morphology. MATERIALS AND METHODS: The Indiana Bleb Appearance Grading Scale contains a set of photographic standards illustrating a range of filtering bleb morphology selected from the slide library of the Glaucoma Service at the Indiana University Department of Ophthalmology. These standards consist of slit lamp images for grading bleb height, extent, vascularity, and leakage with the Seidel test. For grading, the morphologic appearance of the filtration bleb is assessed relative to the standard images for the 4 parameters and scored accordingly. Fifty-one clinical bleb photographs were evaluated and scored by 3 glaucoma subspecialists in a masked fashion according to the scale. RESULTS: For all of the grading scales, high interobserver agreement was found using the scale to classify the appearance of filtering blebs (height +0.76; extent +0.78; vascularity +0.90, interclass correlation coefficient for consistency using a 2-way mixed effect model). CONCLUSION: The Indiana Bleb Appearance Grading Scale is a simple, reproducible, yet comprehensive system for classifying the morphologic slit lamp appearance of filtration blebs.

Filtering Surgery↗
PubMed1996

Re-forming the flat anterior chamber with Healon.

A shallow or flat anterior chamber may occur after complicated cataract surgery, a filtering procedure for glaucoma, or combined surgery. We describe a technique for injecting sodium hyaluronate (Healon) into the anterior chamber through the previous paracentesis tract in the operating room or at the slitlamp microscope. Re-forming the anterior chamber with Healon may pre-empt the anatomical sequelae of prolonged anterior chamber shallowing and prevent the need for more invasive surgery.

Aged↗
PubMed2000

Particulate emboli capture by an intra-aortic filter device during cardiac surgery.

OBJECTIVE: Particulate embolization is associated with neurologic morbidity after cardiac surgery. Crossclamp manipulation has been identified as the single most significant cause of particulate emboli release during cardiac surgery. A new intra-aortic filtration method has been assessed with regard to its safety and its ability to capture particulate emboli before they enter the central circulation. METHODS: Patients undergoing cardiac surgery with cardiopulmonary bypass through standard median sternotomy were selected for emboli management by means of intra-aortic filtration. A novel intra-aortic filter device was inserted through a modified 24F arterial cannula immediately before releasing the crossclamp in 77 patients. Filters remained in the aorta until cardiopulmonary bypass was discontinued and the heart was fully ejecting. The procedure was assessed for facility, safety, and effect on routine cardiopulmonary bypass operation and function. RESULTS: The insertion and removal of the intra-aortic filter were safe, easy, and uneventful in most patients. Patient hemodynamics and bypass flow rates remained normal throughout the filter dwell period. No strokes or gross neurologic defects were noted. Electron microscopic analysis of 12 filters revealed an insignificant degree of platelet adhesion on filter surfaces. Histology samples (n = 44) were examined, and 66% (n = 29) showed evidence of atheromatous material, 36% (n = 16) with platelet-fibrin, 25% (n = 11) with true thrombus and/or blood clot, 7% (n = 3) with normal vessel wall, and 2% (n = 1) with aggregates of cholesterol or grumous portion of atheromatous plaque. CONCLUSION: The intra-aortic filter can be safely deployed and captures particulate emboli, the predominant origin of which is atheromatous. The beneficial effects of this device on neurologic outcomes have yet to be determined.

Adult↗
PubMed2001

Antiinflammatory effect of heparin-coated circuits with leukocyte-depleting filters in coronary bypass surgery.

Cardiac surgery with cardiopulmonary bypass is associated with a systemic inflammatory response. We examined combined use of heparin coating of the cardiopulmonary bypass circuit and a leukocyte-depleting arterial line filter to reduce this response. Thirty patients were allocated randomly to equal groups with a conventional circuit and arterial line filter (C group), a heparin-coated circuit with a conventional filter (H group), or a heparin-coated circuit with a leukocyte-depleting arterial line filter (HF group). Cytokines and respiratory function were repeatedly measured perioperatively. Plasma interleukin (IL)-6 concentrations in the HF group were lower than in the C group immediately following bypass and operation, at 4 h, and 12 h (p < 0.05). Plasma IL-8 was lower in the HF group than in the C group at 4 h (p < 0.05). The respiratory index was lower immediately after bypass in the HF group than the C group (0.61 +/- 0.2 versus 1.05 +/- 0.4, p < 0.05). Heparin-coated circuits with leukocyte-depleting filters decrease inflammatory responses and improve pulmonary function during operation.

Adult↗
PubMed1986

Triple procedure of extracapsular cataract surgery, posterior chamber lens implantation, and glaucoma filter.

A triple procedure consisting of extracapsular cataract surgery, posterior chamber intraocular lens implantation, and glaucoma filtering operation was performed in 30 eyes of 28 patients. The follow-up time was six to 24 months, with a median of 11 months. Group I consisted of 21 eyes with advanced glaucoma and poor to marginal pressure control. After surgery, the pressure was less than or equal to 21 mm Hg in 62% but 86% still required medication. This intraocular pressure control is worse than that reported by others. Group II consisted of nine eyes with a functioning filtering bleb before surgery. The incision was made through the filtering bleb in order to facilitate the cataract surgery. A new filtering procedure was performed adjacent to the original one. There was loss of control in a significant number of eyes but, with rare exception, no better or worse than that reported with other approaches. In pseudophakia there is a poor correlation between pressure control and a visible bleb. The visual results for both groups were good, with 73% obtaining 20/40 or better visual acuity.

Aged↗
PubMed2002

[Massive choroidal hemorrhage as a late trabeculectomy complication ].

The purpose of this paper was to present the case of an unusual late complication of filtering glaucoma surgery. A massive choroidal hemorrhage occurred 5 years after trabeculectomy and extracapsular cataract extraction. The diagnosis was confirmed by MRI examination. Improvement in choroidal status and in visual acuity (from hand motions to 6/12 with aphakic correction of 12 diopters) was observed during three weeks of medication. The retina and the choroid remained attached during two years of observation.

Aged↗
PubMed2006

[Covered sclerotomy for fistulating glaucoma surgery].

BACKGROUND: Covered sclerotomy was developed as a minimally invasive modification of filtering glaucoma surgery. In this prospective study the clinical results are compared after one year. PATIENTS AND METHODS: 58 eyes with advanced glaucoma were studied. 32 eyes had a covered sclerotomy (ST) and 26 had an ST with viscoelastic filling of the anterior chamber in order to reduce the postoperative hypotony rate (ST+H). The ST procedure consisted in the preparation of a 4-mm corneoscleral tunnel incision with a T-shaped 1.75-mm wide perforation and radial transection of the tunnel floor. RESULTS: The preoperative intraocular pressure (IOP) was on average 30 +/- 8.5 mmHg (ST) and 26 +/- 8.3 mmHg (ST+H). After 1 year the IOP decreased significantly (P < 0.05) to 17 +/- 3.7 mmHg (ST) and 17 +/- 2.9 mmHg (ST+H). The mean IOP reduction was 37 % (ST) and 30 % (ST+H). Revisions were required in 37 % (ST) and 15 % (ST+H) of the cases. The postoperative hypotony rate was 34 % in both groups. The number of morphologically functional filtering blebs was 60 % (ST) and 70 % (ST+H) after one year. CONCLUSIONS: The covered sclerotomy required minimal surgical manipulations of the conjunctiva and sclera. After 1 year a significant reduction of the IOP was achieved. However, the occurrence of bleb scarring could not be lowered compared to trabeculectomy. Therefore further modifications with the primary application of antimetabolites are planned.

Adult↗