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At least 739 records · Page 41Linked to original sources
PubMed2005

The prophylactic use of inferior vena cava filters in patients undergoing high-risk spinal surgery.

Prophylactic inferior vena cava filter (IVCF) placement is advocated in some high-risk groups. We sought data regarding safety and efficacy for prophylactic IVCF placement in patients at high risk for venous thromboembolism (VTE) following major spinal reconstruction. Seventy-four spine surgery patients with contraindication to anticoagulation (44 females, 30 males; mean age 56.2) received prophylactic IVCFs. Criteria were (1) history of thromboembolism, (2) diagnosed thrombophilia, (3) malignancy, (4) bedridden >2 weeks prior to surgery, (5) staged procedures or multiple levels, (6) combined anterior/posterior approaches, (7) expected need for significant iliocaval manipulation during exposure, and (8) single-stage anesthetic time >8 hr. Seventy patients had at least two risk factors. All received IVCFs prior to the first stage of spine reconstruction. Patients were evaluated for filter complications, deep vein thrombosis (DVT), and pulmonary embolism (PE). Patients' lower extremity veins from groin to ankle were imaged weekly until discharge using duplex ultrasound (DUS). One-third also underwent thoracic and pelvic computed tomography scans, and the pelvic veins, IVC, and pulmonary vasculature were evaluated for VTE. Multiple DUS (n = 198, mean 2.6 studies per patient) were performed in 68 patients. At a mean follow-up of 11 months, one of the patients developed PE. Twenty-seven limbs in 23 patients developed DVT. Five limbs had isolated calf DVT, and 22 had proximal vein involvement. Insertion site DVT accounted for nearly one-third of the DVTs. Six patients died from unrelated complications. There was one technical error with an IVCF deployed in the iliac vein. Despite a high incidence of DVT following high-risk spinal surgery, prophylactic IVCF placement appears to protect patients from PE.

Adolescent↗
PubMed2006

Anesthesia for glaucoma surgery.

Injections of local anesthetic behind the globe could potentially damage the optic nerve, resulting in visual field defects or even blindness. Glaucoma patients may be at increased risk of this occurring, because of increased susceptibility to pressure/ischemic damage. In extreme cases, this may manifest as visual field "wipe-out." Because of these concerns, "newer" techniques of anterior placement of anesthetic have been promoted, including subconjunctival, anterior sub-Tenon's, topical, and intracameral anesthesia. There remains some controversy regarding the effect of different anesthesia techniques on complication and failure rates for glaucoma surgery.

Anesthesia↗
PubMed2000

Schlemm's canal becomes smaller after successful filtration surgery.

OBJECTIVE: To determine whether filtration surgery causes secondary changes in the trabecular meshwork and Schlemm's canal. Successful filtration surgery allows most aqueous outflow to enter the filtration bleb, bypassing the meshwork and canal, and may result in underperfusion of these structures. METHODS: Eyes with primary open-angle glaucoma (POAG) that had undergone filtration surgery were studied and compared with eyes with POAG that had not undergone surgery. In addition, normal eyes and eyes with pseudoexfoliative glaucoma were studied for comparison. The trabecular meshwork and Schlemm's canal were examined by light and electron microscopy. RESULTS: Schlemm's canal was significantly smaller in eyes with POAG after filtration surgery than in normal eyes (canal width, 178 +/- 71 microm vs 276 +/- 52 microm; P<.001) or in eyes with medically treated POAG of similar clinical severity (261 +/- 60 microm, P =. 03). The decrease in canal size seemed to be related to the success of the filtration procedure, since eyes with blebs and low pressures had the smallest canals. Eyes with medically treated POAG at earlier clinical stages of glaucoma did not have a significant decrease in canal size when compared with normal eyes. Eyes with advanced pseudoexfoliative glaucoma had canal widths 20% smaller than those in normal eyes (P =.08). CONCLUSIONS: Filtration surgery was associated with a decrease in the size of Schlemm's canal, most likely due to underperfusion of the meshwork. A significant decrease in canal size is otherwise not a finding in POAG. In contrast, the canal tended to become smaller in advanced cases of pseudoexfoliative glaucoma. CLINICAL RELEVANCE: The decrease in size of Schlemm's canal after successful filtration surgery could make glaucoma more difficult to control if the filter ultimately fails. Arch Ophthalmol. 2000;118:1251-1256

Aged↗
PubMed1995

[An experimental study on homoharringtonine and glaucoma surgery].

PURPOSE: To test the inhibiting effect of a Chinese herbal drug. Homoharringtonine (HH) on the wound healing process at the filtering site in an experimental model. METHODS: Posterior sclerectomies were performed in 20 rabbits. Postoperatively one eye of each rabbit received subconjunctival injections of HH and fellow eye received saline injections in a randomized masked fashion. RESULTS: 14 days after operation, intraocular pressure decreased significantly compared with that of control (P < 0.05). The number of filtration blebs was greater than that of control (14/6). On pathological examination, the number of fibroblasts per square measure of cross section of tissue cut from filtration region that was diminished significantly compared with that of control (P < 0.01). There were no serious and permanent ocular toxic and side effects. CONCLUSIONS: The study suggests that the HH can inhibit cicatrization at the glaucoma filtering site, promote the formation of filtering blebs and provide a sufficient evidence for the further clinical use of HH.

Animals↗
PubMed2001

How does nonpenetrating glaucoma surgery work? Aqueous outflow resistance and glaucoma surgery.

Histologic, experimental, and theoretical studies of the aqueous outflow pathways point toward the juxtacanalicular region and inner wall of Schlemm's canal as the likely site of aqueous outflow resistance in the normal eye. At least 50% of the aqueous outflow resistance in the normal eye and the bulk of the pathologically increased resistance in the glaucomatous eye resides in the trabecular meshwork and the inner wall of Schlemm's canal. The uveoscleral, or uveovortex, pathway, which accounts for perhaps 10% of the aqueous drainage in the healthy aged human eye, can become a major accessory route for aqueous drainage after pharmacologic treatment. Surgeries designed to incise or remove the abnormal trabecular meshwork of glaucoma address the pathologic problem of the disease. Surgeries that unroof Schlemm's canal or expand the canal, such as viscocanalostomy, probably cause inadvertent ruptures of the inner wall and juxtacanalicular tissue, thus relieving the abnormal outflow resistance of glaucoma. This review is a summary of current thought on the pathophysiology of aqueous outflow resistance in glaucoma and, in light of this, provides an interpretation of the mechanism of pressure reduction created by these new surgeries.

Anterior Eye Segment↗