Das Fasanella-Servat Verfahren zur operativen Behandlung der Ptosis

Die vorliegende Arbeit beschäftigt sich mit dem postoperativen Erfolg des Fasanella-Servat Verfahrens zur Ptosiskorrektur. Ausgewertet wurden 23 Operationen von 20 Patienten, die in den Jahren 1995 bis 2003 an der Universitätsaugenklinik nach dem Fasanella-Servat Verfahren durchgeführt wurden. Anhand der Aktendokumentation sowie der von niedergelassenen Augenärzten im Jahr 2004 eingeholten Angaben wurden die jeweiligen Operationsergebnisse dargestellt und bewertet. Es stellte sich heraus, dass die präoperative Bestimmung der Levatorfunktion und des Ptosisgrades essentiell für den erfolgreichen Einsatz des Fasanella-Servat Verfahrens sind. Hierdurch können Komplikationen und nachfolgende Reoperationen wirksam vorgebeugt werden. Kosmetisch befriedigende und gute postoperative Ergebnisse wurde in ingesamt 90% der Fälle erreicht. In keinem der dargestellten operierten Fälle trat eine postoperative Komplikation auf oder wurde eine Reoperation in dem Beobachtungszeitraum notwendig

“One of the baddies all along” : Moments that challenge a player’s perspective

Reflection has become a core interest for game designers. However, empirical research into the kinds and causes for reflection within games is scarce. We therefore conducted an online questionnaire where participants (n=101) openly reported perspective-challenging moments within games, their causes, experience, and impact. Where past work has emphasised transformative reflection that changes player’s views and behaviour outside the game, we found that players report predominantly moments of ‘endo’-transformative reflection, which is focused on players’ game-related behaviour and concepts. We further identify some causes of perspective-challenging moments relating to narrative, game systems, game-external sources, and player expectations. Narrative reveals emerge as a key cause of perspective challenge

Herpesviridae prevalence in aqueous humor using PCR

Narumon Keorochana, Wasamon Intaraprasong, Raveewan Choontanom Department of Ophthalmology, Phramongkutklao hospital, Phramongkutklao College of Medicine, Bangkok, Thailand Objective: The aim of this study was to determine the prevalence of Herpesviridae family in aqueous humor and the prevalence of antibodies against Herpesviridae family in serum.Methods: Participants undergoing cataract surgery were included in the study. Serum for viral serology including herpes simplex virus (HSV), varicella zoster virus (VZV), Epstein–Barr virus (EBV), and cytomegalovirus (CMV) was collected. Aqueous humor specimen was tapped for PCR analysis.Results: Ninety-two participants were included with a mean age of 67.67 years (SD ±12.51). The prevalence of positive serology tests was 83.3% for HSV, 94.0% for VZV, 98.8% for EBV, and 97.6% for CMV. A total of 66 aqueous humor specimens were negative for PCR of Herpesviridae family.Conclusion: This study showed previous HSV, VZV, EBV and CMV infections in >90% of the Thai population, while no viral presence was detected in aqueous humor. Thus, the serology test is unrelated to the presence of virus in the eye. We suggest that PCR is a valuable tool to diagnose intraocular viral infection and detect virus presenting active infection. Keywords: Herpesviridae, prevalence, aqueous humor, PCR, serology, uveiti

The efficacy of preoperative posterior subtenon injection of triamcinolone acetonide in noninfectious uveitic patients with secondary glaucoma undergoing trabeculectomy

Narumon Keorochana, Sutheera Kunasuntiwarakul, Isaraporn Treesit, Raveewan Choontanom Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand Objective: The aim of this study was to evaluate the efficacy and safety of preoperative posterior subtenon injection of triamcinolone acetonide (PSTA) in noninfectious uveitic patients with secondary glaucoma undergoing primary trabeculectomy with mitomycin C.Design: This was a retrospective study.Patients and methods: We reviewed the medical records of 10 noninfectious uveitic patients, who had received a single preoperative PSTA 40 mg/1 mL, with secondary glaucoma undergoing primary trabeculectomy with mitomycin C. We collected data before and after surgery on intraocular pressure (IOP), anterior chamber (AC) cells, best-corrected visual acuity (BCVA), morphologic characteristics of the filtering bleb and complications.Results: The mean time between injection and surgery was 7.8±3.88 days. Postoperative IOP level was significantly lower than preoperative level (31.3±11.44 mmHg) at all visits (P<0.02). Antiglaucoma medications were decreased from preoperative (4.9±0.88) to 12-month postoperative (0.8±1.31; P-value <0.001) and also discontinued in seven eyes (70%). About 12 months after surgery, eight eyes (80%) with qualified success and two eyes (20%) with failed treatment were recorded. AC cells and BCVA did not differ significantly from baseline; however, all inflammations were controlled successfully. Most desirable bleb morphology was shown at 12 months as well. Complications were blepharoptosis and hypotony maculopathy in two eyes (20%).Conclusion: A preoperative PSTA may be an effective and safe option in controlling intraocular inflammation and maintaining bleb function after trabeculectomy in noninfectious uveitic patients with secondary glaucoma during a 12-month period. Keywords: periocular injection, steroid, uveitis, triamcinolone acetonid

Combined central retinal vein, central retinal artery and cilioretinal artery occlusion with ischemic macular hole secondary to severe orbital cellulitis after black fly bite

Narumon Keorochana,1 Sritatath Vongkulsiri,2 Raveewan Choontanom31Ocular Inflammatory and Uveitis Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand; 2Retina Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, Thailand; 3Oculoplastic and Reconstruction Division, Department of Ophthalmology, Phramongkutklao Hospital, Phramongkutklao College of Medicine, Bangkok, ThailandBackground: Orbital cellulitis is an infection of the ocular adnexal and orbital tissues behind the orbital septum. The complications are poor prognosis. This paper is to describe some severe rare complications of orbital cellulitis.Case presentation: A case of 32-year-old female presented with acute severe progressive orbital cellulitis on the right eye after a black fly (Simuliidae spp.) bite. Orbital imaging with computed tomography and magnetic resonance imaging showed eyelid abscess with orbital abscess formation and superior ophthalmic vein thrombosis. She was promptly treated with intravenous vancomycin, piperacillin and had surgical procedures to release orbital pressure including lateral canthotomy, lateral cantholysis, and eyelid with orbital abscess drainage. Pus collection culture was positive for Staphylococcus aureus. Even though she responded well to antibiotics treatment, progression involved severe orbital inflammation with marked increased orbital pressure, and her visual acuity was such that she had no light perception. Combined central retinal vein, central retinal artery and cilioretinal artery occlusion were identified. Fundus examination showed retinal whitening at the posterior pole and a few scattered flame-shaped retinal hemorrhages. The cilioretinal artery presented with perivascular retinal whitening. A fundus fluorescein angiogram revealed cilioretinal and retinal artery filling delay and also delayed arteriovenous transit time. She also developed an ischemic macular hole after a week of treatment. We demonstrate an optical coherence tomography image showing the intact posterior hyaloid membrane that represents no traction on the macula to support the ischemic cause.Conclusion: Multiple retinal vascular occlusion and ischemic macular hole could be an early complication of severe orbital cellulitis from increased orbital pressure; therefore, close monitoring of visual acuity with IOP, and prompt treatment when indicated might reduce the risk of consequent blindness.Keywords: black fly, orbital cellulitis, central retinal vein occlusion, central retinal artery occlusion, cilioretinal artery occlusion, macular hol