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At least 1,117 records · Page 62Linked to original sources
PubMed1999

Surgical revision of glaucoma shunt implants.

BACKGROUND AND OBJECTIVE: To determine the efficacy of surgical revision of glaucoma shunt implants in patients with advanced glaucoma. PATIENTS AND METHODS: The records of 13 patients who underwent revision of their shunt implants were retrospectively reviewed. RESULTS: Surgical success was achieved in: 3 of 3 patients (100%) with drainage tube malposition or extrusion; 1 of 6 patients (17%) with occlusion of the intracameral portion of the drainage tube; and 1 of 4 patients (25%) with elevated intraocular pressure secondary to fibrous capsule formation over the implant. CONCLUSIONS: Surgical revision of glaucoma shunt implants is a useful procedure in patients who develop tube malposition or extrusion. Surgical revision is much less effective in patients with tube occlusion or fibrous capsule formation. Failure of the shunts due to recurrent fibrosis is commonly observed.

Adolescent↗
PubMed2001

[High pressure occlusion of leukocyte depletion arterial line filter in patients with cardio-pulmonary bypass surgery].

Cardio-pulmonary bypass (CPB) leads the activation of neutrophil, which may cause reperfusion organ dysfunction. Utility of using the leukocyte depletion arterial filter to pretend postoperative complications has been reported. The other side, the risk of the leukocyte depletion filter occlusion with high-pressures of CPB arterial line (high-pressure occlusion) has been noted. We used the leukocyte deletion filter (LG-6, Pall), and experienced two cases of high-pressure occlusion in 421 CPB surgery with LG-6 (0.48%). No high-pressure occlusion was occurred with 1,508 patients used the standard arterial line filter in it period (0%, p = 0.007). In the both cases of high-pressure occlusion, monitored arterial line pressure increased to over 340 mmHg within 10 minutes after CPB installation. The filters were changed to standard type, then no more filter trouble was occurred. In the second case, we inspected the occluded LG-6. Light microscopic survey showed eosin stained small spherical cells (HE) and negative for fibrin (PTAH). Electromicroscopy revealed that spherical cells (1-2 microns) adherated to structure of the filter. No fibrin was detected with Gel electrophoresis. Because of the pathologic analysis, the cells, which might cause the filter occlusion, were platelet. In addition, no fibrin exist suggests that the coagulation system did not relate to the high-pressure occlusion. In conclusion, we experienced two high-pressure occlusion cases of the leukocyte depletion arterial filter with CPB surgery (0.48%); the filter occlusion may be caused by the initial thrombus formation by platelet.

Aged↗
PubMed2000

[Intraocular pressure evolution after phacoemulsification in eyes with filtering blebs].

PURPOSE: To evaluate the effect of phacoemulsification in functioning filtered glaucoma eyes, on intraocular pressure (IOP) and the use of antiglaucomatous medication. To determine the influence of time lapsed between surgeries on the results. METHOD: 20 eyes of 20 patients treated by phacoemulsification in 1997, who had undergone previous glaucoma filtering surgery in which IOP was well controlled, were retrospectively evaluated. RESULTS: Mean preoperative IOP was 13.2+/-4.1 mmHg (range: 5-21). Mean IOP increased after phacoemulsification in every postoperative control (0.9-2.6 mm Hg), the differences were not significant. Mean score medication increased (0.2-1) after surgery, but the difference was not significant. Mean preoperative IOP was 5.7 mm Hg lower in patients whose phacoemulsification was performed before 18 months after trabeculectomy than those whose surgery was performed later (P<0.001). Moreover, the patients operated earlier showed an IOP increase after phacoemusification (3.2-3.9 mm Hg) during the first six postoperative months (P<0.05). However, the patients who underwent filtering surgery later, did not show any significant change in postoperative IOP. Visual acuity (VA) significantly improved after cataract surgery (P<0.05). VA was equal or better than 0.5 in 43.75% of the patients, six months postoperatively. CONCLUSIONS: We have found a slight increase in IOP after phacoemulsification in filtered glaucoma eyes. To reduce the time lapsed between trabeculectomy and phacoemulsification could be a risk factor predisposing to failure of previously functioning filtering blebs.

Aged↗
PubMed1997

[Anesthetic management of cesarean section in a patient with pulmonary embolism due to deep venous thrombosis].

A 28-year-old primipara with pulmonary embolism due to deep venous thrombosis was scheduled for cesarean section under general anesthesia. Her Swan-Ganz catheter and blood gas data revealed pulmonary hypertension and hypoxemia, respectively. Heparin was discontinued 6 hours before operation. A transesophageal echocardiogram (TEE) probe and an inferior vena cava filter were inserted before surgery. Anesthesia was maintained with nitrous oxide and isoflurane in oxygen before delivery, and after delivery with nitrous oxide in oxygen, fentanyl and midazolam. Nitroglycerin and prostaglandin E1 were administered before and after delivery, respectively, to control pulmonary artery pressure, although they were not effective. The anesthetic course was uneventful and her baby's Apgar scores were satisfactory. Mean pulmonary artery pressure (MPAP) gradually decreased after surgery. The inferior vena cava filter may be effective in preventing new pulmonary embolism, and MPAP and TEE monitoring are useful for early detection of pulmonary emboli.

Adult↗
PubMed1998

The protective effect of a leucocyte removal filter on the lung in open-heart surgery for ventricular septal defect.

We elucidated the protective effect of a leucocyte removal filter on cardiopulmonary bypass (CPB)-induced lung dysfunction during open-heart surgery for ventricular septal defect (VSD). Forty-six VSD patients were divided into two groups: (a) a control group of 22 patients in whom the banked blood was used to prime the CPB circuit, and (b) a leucocyte removal group of 24 patients in whom a leucocyte removal filter was used for priming and every supplement of banked blood during and after the operation. The respiratory index immediately after the CPB was significantly lower in the leucocyte removal group than in the control group (2.23 +/- 0.22 vs 3.90 +/- 0.68; p < 0.05). The duration of stay in the intensive care unit was significantly shorter in the leucocyte removal group (3.0 +/- 0.4 vs 4.1 +/- 0.4 days; p < 0.05). These data suggest that the use of a leucocyte removal filter for blood added to the CPB prime or administered after CPB may have protective effects on lung function after open heart surgery for VSD patients.

Child↗
PubMed1998

Clinical evaluation of a leucocyte-depleting blood cardioplegia filter (BC1B) for elective open-heart surgery.

Activation of leucocytes during extracorporeal circulation has attracted attention in recent years as a cause of reperfusion injury in open-heart surgery patients. In the present study, 40 adult patients undergoing elective open-heart surgery were randomized into two groups: 20 using the Pall BC1B leucocyte-depleting filter for blood cardioplegia (group 1) and the other 20 without the filter (group 2). In order to determine if the filter was effective in protecting the myocardium, CPK-MB and troponin-T (TnT) were measured. In addition, efforts were also made to determine appropriate sites at which the BC1B blood cardioplegia filter should be positioned. There were no significant differences between the two groups in terms of conditions of perfusion. No adverse effects were seen in either group. The total leucocyte reduction rate through the filter was 98.1% with the passage of 2 liters of blood through the filter. A pressure drop of 4.4 +/- 3.2 mmHg was observed through the filter during use. Statistically significant differences were noted between the two groups in CPK-MB (p = 0.031) and TnT (p = 0.004). Findings obtained in previous studies demonstrate that the various advantages of leucocyte reduction, shown in experimental studies, can be translated into clinical advantages. In conclusion, based on the results in this clinical study showing significant difference in CPK-MB and TnT which are known effective indicators for myocardial injury, between leucoreduced and non-leucoreduced group, the Pall BC1B leucocyte-depleting filter for blood cardioplegia has been shown to be effective in alleviating reperfusion injury in open-heart surgery patients.

Adult↗
PubMed1990

[Prevention of scarring of filtering bleb by 5-fluorouracil].

Scarring of the filtering bleb is the most common cause of failure of surgery for glaucoma. It is much more common when the surgery is for certain types of glaucoma, such as aphakic glaucoma, cases of previously failed filtering surgery and neovascular and uveitic glaucoma. In 31 such high-risk cases we injected 5-fluorouracil subconjunctivally for 7-16 days after operation to prevent scarring of the filtering bleb. The success rate was 83%. After a follow-up of 3-12 months, there was statistically significant improvement in each group as compared to cases in which the drug was not administered. Further indications should be considered for the use of 5-fluorouracil in glaucoma.

Conjunctiva↗
PubMed1999

Combined cataract and glaucoma surgery: trabeculectomy versus endoscopic laser cycloablation.

PURPOSE: To determine whether combined cataract surgery with endoscopic laser cycloablation produces less inflammation than cataract surgery combined with a filtering procedure. SETTING: Taylor Regional Hospital (surgeries) and EyeSight Associates (examinations), Warner Robins, Georgia, USA. METHODS: A randomized prospective study was conducted of 58 eyes of 58 patients comparing endoscopic laser cycloablation performed through a cataract incision at the time of cataract surgery with combined trabeculectomy and cataract surgery. RESULTS: Mean follow-up was 2 years. At the final available visit, 30% of endoscopic laser patients achieved intraocular pressure control (below 19 mm Hg) without medication and 65% with medication. Forty percent of trabeculectomy patients achieved control without medication and 52% with medication. Four endoscopic laser patients (14%) and 3 trabeculectomy patients (10%) were considered treatment failures (required additional surgical intervention). CONCLUSION: Endoscopic laser cycloablation performed through a cataract incision was a reasonably safe and effective alternative to combined cataract and trabeculectomy surgery, providing an option for cataract patients who have glaucoma requiring surgical intervention.

Cataract↗
PubMed1996

Late bleb leakage after trabeculectomy with 5-fluorouracil or mitomycin C.

OBJECTIVE: To determine the prevalence of late filtering bleb leakage after trabeculectomy performed with intraoperative adjunctive use of 5-fluorouracil (5-FU) or mitomycin C. DESIGN: Case series. SETTING: Private clinic in São Paulo. PATIENTS: Forty-seven consecutive patients (47 eyes) who had previously undergone trabeculectomy with intraoperative application of either 5-FU (25 mg/mL) or mitomycin C (0.2 mg/mL) and who had functioning filtering blebs. The patients who received 5-FU had advanced primary open-angle glaucoma without previous surgery; those who received mitomycin C had either previous failed filtering surgery or refractory glaucoma. All patients had been followed for at least 6 months. OUTCOME MEASURES: Slit-lamp appearance of bleb, bleb leakage, as determined with the Seidel test. RESULTS: None of the eyes had spontaneous bleb leakage. Ten (32.2%) of the 31 eyes that received 5-FU and 5 (31.2%) of the 16 eyes that received mitomycin C had induced bleb leakage. Thirty filtering blebs were classified as transparent, 10 as vascularized and 7 as ischemic. The rates of bleb leakage for the three groups were 46.7%, 0% and 14.3% respectively (p = 0.012). CONCLUSIONS: The importance of late bleb leakage in patients who receive intraoperative 5-FU or mitomycin C in predisposing these eyes to late complications, such as endophthalmitis and hypotony, needs to be evaluated.

Adult↗
PubMed2005

The incidence of emboli during cardiac surgery: a histopathologic analysis of 2297 patients.

OBJECTIVE: Manipulation of the atherosclerotic aorta during cardiac surgery is assumed to cause embolization, which can contribute to adverse outcomes. Recently, as a result of worldwide trials deploying the Embol-X intraaortic filter during cardiac surgery, such emboli were captured and processed for histopathologic analysis. METHODS: Filters with a pore size of 120 microns were placed in 2297 patients who underwent the following operations: coronary artery bypass grafting (CABG) (70%), valve (17%), combination CABG/valve (11%), and other (2%). RESULTS: The filters captured at least one embolus in 98% of the patients. An average of 8.3 particles was captured per filter (range of 0-74). The surface area of the emboli was on an average 5.8 mm2 (range of 0-188 mm2). Histologic analysis of the captured particles indicated that in 79% of the filters fibrous atheromata were noted, in 44% there were platelets and fibrin, 8% had red blood cell thrombus, 3% had fibro-fatty/adventitial tissue, 2% had other material including cartilage, myocardium, lung, suture, and a teflon pledget. Of the patients enrolled, 1569 were high-risk. The average number of particles captured in the high-risk patients was 8.5 versus 5.8 for the low- to moderate-risk patients (P < .0001). Concomitantly,there was an increase in the embolic burden between the higher- and lower-risk patients (surface area 6.6 vs. 4.0 mm2, P < .0001). CONCLUSION: These data show the ubiquitous incidence of emboli during cardiac procedures. Intraaortic filtration should reduce adverse outcomes as was demonstrated for the high-risk patients in this study. Aortic manipulation during cardiac surgery can cause embolization and increase morbidity. The use of an intraaortic filter can decrease the embolic burden. We now report the histopathologic analysis of these emboli.

Aorta↗
PubMedDate not supplied

Dysfunctional filtering blebs.

Guarded filtration surgery, is commonly used to control the intraocular pressure (IOP) in glaucomatous patients. Filtration surgery lowers the IOP by creating a fistula between the inner compartments of the eye and the subconjunctival space (i.e., filtering bleb). There are several options to improve the function of filtering blebs and to prevent their failure. However, improvement of IOP control after guarded filtration procedures is associated with a higher frequency of bleb-related complications. Early (e.g., bleb leak, excessive filtration, flat anterior chamber, filtration failure) and late (e.g., bleb leak, excessive filtration and hypotony, symptomatic blebs, bleb encapsulation, filtration failure, bleb infection) complications associated with filtering procedures should be managed adequately to prevent further problems. Techniques to improve the function of filtering blebs and to treat postoperative complications have progressed over the past decade.

Glaucoma↗
PubMed2006

Filtering bleb evaluation with slit-lamp-adapted 1310-nm optical coherence tomography.

PURPOSE: Investigation of slit-lamp-adapted 1310-nm optical coherence tomography (OCT) as an in vivo imaging device in the postoperative course of glaucoma surgery. METHODS: Postoperative images of filtering blebs and deep sclerectomies and their healing processes were qualitatively evaluated with a slit-lamp-adapted anterior segment OCT (AS-OCT; Heidelberg Engineering, Heidelberg, Germany) in 28 patients. Ophthalmologic examinations included slit-lamp examination, applanation tonometry, and slit-lamp photography. The OCT scans were qualitatively correlated with the morphologic and functional outcome of the filtering bleb. RESULTS: 1310-nm OCT was able to demonstrate the internal structure and the dimensions of filtering blebs, as well as the scleral flap and the deep sclerectomy location including Descemet membrane. Functioning filtering blebs showed a low OCT signal, small fluid-filled cysts, superficial microcystic layer, and a slack internal texture. High internal reflectivity indicated an earlier scarring of the filtering bleb. Nonfunctioning filtering blebs delivered a high OCT signal, no or few cysts, and a dense internal texture. These different OCT patterns correlated with the clinical outcome. CONCLUSIONS: Slit-lamp-adapted 1310-nm OCT allowed the noncontact observation and documentation of the postoperative healing course of filtering blebs after glaucoma surgery. Internal structures of the filtering bleb and deep sclerectomies could be visualized. Functioning and dysfunctioning filtering blebs delivered different OCT pattern and correlated with the clinical outcome. This could be a new way to assess the postoperative healing process with the possibility of earlier intervention in cases of impending scarring.

Blister↗
PubMed1987

Light filtering lenses as an alternative to cataract surgery.

A patient complaining of extreme light sensitivity and "smokey" vision was diagnosed as having developing cataracts. He would not consent to surgery until alternative treatments were attempted. Tinted prescription sunglasses were too dark indoors, interfered with his work and didn't relieve the symptoms. Special light filtering lenses from Corning, ones that block blue light thought to scatter as it enters the eye and cause the glare experienced by cataract sufferers, increased functional vision and offered this patient a comfortable alternative while awaiting surgery.

Aged↗
PubMed1995

Clinical performance of a high-efficiency rapid flow leucocyte removal filter for leucocyte depletion of heparinized cardiopulmonary bypass perfusate.

The method of leucocyte depletion has been recently introduced to the field of cardiopulmonary bypass to reduce leucocyte-mediated organ dysfunction. In this study, we evaluated the efficacy and biocompatibility of the Pall RC400 filters for leucocyte depletion of heparinized cardiopulmonary bypass (CPB) perfusate taken from the heart-lung machine during routine cardiac surgery. For each filter, 700 ml blood were used as filtrate. Filtration was divided into the following groups to study the effect of loading pressure on the efficacy of the filters: under gravity pressure as a control (n = 8), under 100 mmHg (n = 8), 200 mmHg (n = 8), and 300 mmHg loading pressure (n = 8) driven by a roller pump. In addition, heparinized predonation blood taken at the beginning of CPB (n = 8) was filtered under gravity in comparison with the perfusate taken at the end of CPB. The results showed that the average leucocyte removal rate by an RC400 filter for 700 ml of blood was 96.8%. There was no significant difference of leucocyte removal rate between filtration under gravity and under loading pressure up to 300 mmHg. This allows clinical filtration at a speed up to 500 ml/min. The platelet removal rate was significantly higher in blood taken at the beginning of CPB than in blood taken at the end of CPB. Complment split product, C5a, increased only slightly during filtration indicating that this filter, made from polyester, has a good blood compatible characteristic. We conclude that the Pall RC400 leucocyte removal filter is suitable and safe to be used for leucocyte filtration of heparinized CPB perfusate during cardiac surgery.

Blood Component Removal↗
PubMed2005

Effects of a leukocyte depleting arterial line filter on perioperative morbidity in patients undergoing cardiac surgery: a controlled randomized trial.

BACKGROUND: Activated leukocytes may increase morbidity in cardiac surgery. The objective of this study is to investigate the influence on morbidity of leukocyte-depleting blood filters placed into the arterial line of cardiopulmonary bypass circuits. METHODS: Simple, blind, prospective, randomized and controlled clinical trial carried out in a cardiac surgery ICU at a university center. We included 159 consecutive low-risk patients (ie, Parsonnet score < 10) undergoing cardiac surgery who were initially stratified in three risk levels according to the Parsonnet score at admission into the hospital (ie, low, < 4; middle, 4 to 7; and high, 8 to 10). Once stratified, all patients were randomized to undergo cardiopulmonary bypass either with a conventional blood filter or with a leukocyte filter (randomization ratio, 2:1). The outcome variable was morbidity. Patients were considered to have a high morbidity if any of the following clinical situations were present (ie, pulmonary dysfunction, cardiac dysfunction, perioperative infections, postoperative hyperthermia, and hyperdynamic states). RESULTS: The leukocyte filter was used in 52 patients and the conventional filter in 107 patients. The morbidity rate was similar in both groups, but patients with leukocyte filter had a lower incidence of perioperative infections, fever, and hyperdynamic states as compared with patients with the conventional filter. CONCLUSIONS: Leukocyte filtration in patients undergoing cardiac surgery with extracorporeal perfusion showed no measurable effects on postoperative morbidity. However, although not statistically significant, a decrease was observed in the rates of perioperative infection, fever, and hyperdynamic states.

Blood Transfusion↗