Posttraumatic endophthalmitis due to tobacco drying wire treated with vitrectomy, temporary keratoprosthesis, and keratoplasty

AIM. To report a case of posttraumatic endophthalmitis with corneal opacity that was treated by combined penetrating keratoplasty using temporary keratoprosthesis and pars plana vitrectomy (PPV) with silicon oil tamponade. CASE PRESENTATION. A 35-year-old woman was admitted to our clinic after open globe injury due to wire used for tobacco drying. At the time of her first visit, her best-corrected visual acuity was light perception. On the day of admission a 20-G PPV with phacoemulsification and vancomycin administration in tapping was performed. The operation was aborted due to visualisation constraints. Four days later 20-G PPV in combination with penetrating keratoplasty with use of temporary keratoprosthesis and silicon oil tamponade was performed. General and topical antibiotics and topical antifungal drugs were administered. Five months after hospitalisation visual acuity was light perception, and the corneal graft remained clear, but proliferative vitreoretinopathy was observed. CONCLUSIONS. Combined penetrating keratoplasty using temporary keratoprosthesis and PPV could be advantageous in managing visualisation constraints due to posttraumatic endophthalmitis; however, functional results are not satisfactory

Wide-Field Landers Temporary Keratoprosthesis in Severe Ocular Trauma: Functional and Anatomical Results after One Year

Purpose. To evaluate longitudinal functional and anatomical results after combined pars plana vitrectomy (PPV) and penetrating keratoplasty (PKP) using a wide-field Landers intraoperative temporary keratoprosthesis (TKP) in patients with vitreoretinal pathology and corneal opacity due to severe ocular trauma. Material and Methods. Medical records of 12 patients who had undergone PPV/PKP/KP due to severe eye trauma were analyzed. Functional (best-corrected visual acuity) and anatomic outcomes (clarity of the corneal graft, retinal attachment, and intraocular pressure) were assessed during the follow-up (mean 16 months). Results. Final visual acuities varied from NLP to CF to 2 m. Visual acuity improved in 7 cases, was unchanged in 4 eyes, and worsened in 1 eye. The corneal graft was transparent during the follow-up in 3 cases and graft failure was observed in 9 eyes. Silicone oil was used as a tamponade in all cases and retina was reattached in 92% of cases. Conclusions. Combined PPV and PKP with the use of wide-field Landers TKP allowed for surgical intervention in patients with vitreoretinal pathology coexisting with corneal wound. Although retina was attached in most of the cases, corneal graft survived only in one-fourth of patients and final visual acuities were poor

Long-term follow-up of retropupillary iris-claw intraocular lens implantation: A retrospective analysis Cataract and refractive surgery

Background: The ideal intraocular lens in cases of aphakia without capsular support is debated. Choices include anterior chamber lenses, iris- or scleral-sutured lenses, and iris-claw lenses. Our aim was to report our long-term evaluation of the use of retropupillary implantation of the Artisan iris-claw intraocular lens (RPICIOL) in several aphakic conditions without capsular support. Methods: A retrospective analysis of consecutive 320 eyes of 320 patients (222 males and 98 females) without capsular support in which we performed RPICIOL implantation in post-traumatic aphakia (141 eyes, group 1), post-cataract surgery aphakia (122 eyes, group 2), and in cases in which penetrating keratoplasty was associated with vitrectomy (57 eyes, group 3). Either anterior or posterior vitrectomy procedures were performed with 20-, 23-, or 25-gauge techniques for different associated anterior or posterior segment indications. We reviewed the refractive outcome, anatomical outcome, long-term stability of the implants, and possible long-term complications. Results: The mean patient age was 59.7 years (range, 16-84 years) in group 1; 60.1 years (range, 14-76 years) in group 2; and 65.8 years (range, 25-71.5 years) in group 3. The mean follow-up time was 5.3 years (range, 1 month to 8 years). At the end of the follow-up period, the mean post-operative best-corrected LogMAR visual acuity was 0.6 (range, perception of light to 0.3) in group 1; 0.3 (range, 0.5-0.1) in group 2; and 0.6 (range, hand movement to 0.2) in group 3. Disenclavation of RPICIOLs occurred in three cases because of slippage of one of the iris-claw haptics and spontaneous complete posterior dislocation occurred in one case. One case presented with retinal detachment, and no cases of uveitis were observed. Eight cases complained of chronic dull pain, and severe iridodonesis was seen in five cases. One case of post-operative macular edema was observed without post-operative increase in the mean intraocular pressure. There was no statistically different change in the endothelial cell density (cells/mm2) at the end of the follow-up period. Conclusions: RPICIOL for secondary implantations is a valid alternative strategy to scleral-fixated or angle-supported IOL implantation

MODIFICATION of ADJUSTABLE MACULAR BUCKLING with 29-G CHANDELIER LIGHT for OPTIMAL POSITIONING in HIGHLY MYOPIC EYES with MACULAR HOLE

Purpose: To evaluate the efficacy of the modification of Adjustable Macular Buckling device in the treatment of myopic macular hole retinal detachment with posterior staphyloma. Methods: Four consecutive patients suffering from myopic macular detachment with macular hole were treated using the macular buckling procedure. An Adjustable Macular Buckling device was used in all four cases and was modified using a 29-gauge optical fiber to illuminate its macular plate. Results: Optical coherence tomography showed successful retinal reattachment and closure of the macular hole after the buckling procedure. The macular plate of the buckling device was properly positioned in all four patients. No complications were observed. Conclusion: The modification of the macular buckling device improves the accuracy of its positioning by illuminating its macular plate

Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation

Abstract BACKGROUND: Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia. METHODS: Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel. RESULTS: Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque. CONCLUSION: Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0-5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result

New Paradigms in Telemedicine: Ambient Intelligence, Wearable, Pervasive and Personalized

After decades of development of information systems dedicated to health professionals, there is an increasing demand for personalized and non-hospital based care. An especially critical domain is cardiology: almost two third of cardiac deaths occur out of hospital, and victims do not survive long enough to benefit from in-hospital treatments. We need to reduce the time before treatment. But symptoms are often interpreted wrongly. The only immediate diagnostic tool to assess the possibility of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision making but require setting up new infrastructures. The European EPI-MEDICS project has developed an intelligent Personal ECG Monitor (PEM) for the early detection of cardiac events. The PEM embeds advanced decision making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care provider only if necessary and requiring no specific infrastructure. This solution is a typical example of pervasive computing and ambient intelligence that demonstrates how personalized, wearable, ubiquitous devices could improve healthcare

New paradigms in Telemedicine: Ambient Intelligence, Wearable, Pervasive and Personalized.

After decades of development of information systems dedicated to health professionals, there is an increasing demand for personalized and non-hospital based care. An especially critical domain is cardiology: almost two third of cardiac deaths occur out of hospital, and victims do not survive long enough to benefit from in-hospital treatments. We need to reduce the time before treatment. But symptoms are often interpreted wrongly. The only immediate diagnostic tool to assess the possibility of a cardiac event is the electrocardiogram (ECG). Event and transtelephonic ECG recorders are used to improve decision making but require setting up new infrastructures. The European EPI-MEDICS project has developed an intelligent Personal ECG Monitor (PEM) for the early detection of cardiac events. The PEM embeds advanced decision making techniques, generates different alarm levels and forwards alarm messages to the relevant care providers by means of new generation wireless communication. It is cost saving, involving care provider only if necessary and requiring no specific infrastructure. This solution is a typical example of pervasive computing and ambient intelligence that demonstrates how personalized, wearable, ubiquitous devices could improve healthcare