Biomedical subjects

G Lesnoni

Publications and source records attributed to G Lesnoni.

10 recordsLinked to original sources

PubMed1997

Pars plana vitrectomy for retinal detachment due to internal posterior ophthalmomyiasis after cataract extraction.

BACKGROUND: The authors report a case of posterior internal ophthalmomyiasis causing vitreous haemorrhage and retinal detachment after uncomplicated cataract extraction. CASE REPORT: The patient suffered an abrupt vitreous haemorrhage 9 days after ECCE and posterior chamber IOL implantation. After 2 months the haemorrhage did not clear up and a retinal detachment arose. The patient underwent encircling scleral buckle, pars plana vitrectomy and fluid-gas exchange. In course of intervention the surgeon removed from the vitreous chamber a 14-mm-long round worm subsequently identified as a dipterous larva of the Sarcophagidae family. DISCUSSION: The patient showed no sign of subretinal tracking or retinal breaks or holes. The sclerocorneal surgical wound seems the most likely site of entrance of the parasite, and this would then be the first reported case of myiasis with no RPE tracking.

Aged↗

PubMed1997

The use of panoramic viewing system in relaxing retinotomy and retinectomy.

BACKGROUND: Retinotomies and retinectomies are surgical procedures mainly devoted to the peripheral retina that require optimal visibility and adequate magnification to make the surgeon's task easy, quick, and safe. The purpose of present study was to estimate to what extent the introduction of wide-angle viewing systems can help the surgeon perform safer and more effective retinotomy procedures. MATERIALS AND METHODS: The authors retrospectively analyzed the records of patients undergoing retinotomy procedures between 1993 and 1995 and divided them into two groups according to the viewing system used during the retinotomy procedures. Group 1 included 86 eyes that underwent surgery between July 1991 and June 1993 with Lander's plano-concave and prismatic lenses (Optikon, Rome, Italy), and group 2 included 96 eyes that underwent surgery between July 1993 and June 1995 with the Advanced Vitreoretinal Instruments system (New York, NY). Outcome measures were divided into preoperative (diagnosis at baseline, anterior proliferative vitreoretinopathy grade and extension, and visual acuity), intraoperative (size of retinotomy, number of laser spots, need for scleral depression, lensectomy, intraocular lens and capsule removal, and duration of treatment) and postoperative (anatomic success rates, visual acuity, postoperative intraocular pressure, and need for postoperative laser treatment and follow-up treatment). RESULTS: Among preoperative parameters, there were no significant differences between the two groups. For intraoperative parameters, eyes in group 2 underwent significantly shorter surgical procedures, had less of a need for scleral depression, and, as a group, had a higher average number of laser spots. For postoperative parameters, eyes in group 2 had a significantly lower need for laser treatment at the edge of retinotomy after surgery. CONCLUSION: Our results suggest that the use of a panoramic viewing system significantly decreases the time required for intervention, allowing more complete laser treatment along the edge of the retinotomy and lowering the need for scleral depression. The need for completion of laser treatment along the edge of the retinotomy after surgery also is reduced significantly, possibly increasing patient comfort because, especially in the early postoperative days, postoperative laser treatment can be extremely uncomfortable for the patient and difficult to perform for the surgeon. No prognostic benefit has been proven for any of the two groups because anatomic and visual results were overlapped.

Follow-Up Studies↗

PubMed1995

Analgesic effect of topical diclofenac versus betamethasone after posterior segment surgery.

BACKGROUND: In clinical use, topical diclofenac, a nonsteroidal antiinflammatory, was found to be remarkably effective as an analgesic. A trial was therefore conducted to quantify and compare this effect with that of other drugs commonly used after posterior segment surgery. METHODS: A single-blind, randomized study of 37 patients undergoing posterior segment surgery was conducted. On the day of surgery and for 30 days thereafter, one group received topical diclofenac 0.1% and one group received topical betamethasone 0.1%. Pain intensity was assessed by two standard psychologic tests, the McGill Pain Questionnaire (MPQ) and Scott's Visual Analogic Scale (VAS). RESULTS: The group receiving diclofenac had significantly lower pain scores on the MPQ at days 1 and 15 (P < 0.05 and P < 0.03, respectively). The VAS scores were also statistically lower for this group on day 15 (P < 0.03). CONCLUSION: Topical diclofenac 0.1% has greater analgesic action than topical betamethasone 0.1% without the side effects of steroids, and may be useful after posterior segment surgery.

Administration, Topical↗

PubMedDate not supplied

Post-traumatic macular break associated to congenital optic disc pit and pre-existing sensory macular detachment.

BACKGROUND: Optic disc pits represent a rare congenital abnormality frequently associated with macular detachment. Several theories on the pathogenesis of the detachment have been proposed, but the issue still remains unclear. Treatment remains speculative as well; advocated treatments include eye-patching, bed rest, steroids, laser photocoagulation, pars plana vitrectomy with fluid-air exchange and optic nerve sheath decompression. METHODS: The Authors report on the case of an optic pit with associated macular detachment which developed an inner layer macular hole and, after an apparently insignificant skull trauma, a large macular break. The patient underwent a standard three-port pars plana vitrectomy, fluid gas-exchange, posterior scleral buckling and laser treatment. RESULTS: Twelve months after surgery the retina was flat, posterior buckling was evident and laser treatment pigmented. Visual acuity was 20/600. CONCLUSIONS: The presence of strands of condensed vitreous strands crossing the posterior lacuna and exerting traction over the macula and optic disc, support the theory of a possible tractional role of anomalous vitreous adhesion in the pathogenesis of the detachment and macular break. Anomalous vitreous adhesion over the posterior retina could be related to the malformative genesis of the syndrome, and the anomalous persistence of the Cloquet's canal or primary vitreous could be responsible for the traction.

Adolescent↗

PubMedDate not supplied

Long-term prognosis after removal of silicone oil.

PURPOSE: To investigate surgical and functional results six or more months after silicone oil (SiO) removal in patients undergoing pars plana vitrectomy (PPV) and tamponade for various reasons. METHODS: Retrospective chart review. Inclusion criteria were recurrent retinal detachment with PVR grade C (R-RD), primary PVR grade C longer than 9 hours, recurrent vitreous hemorrhage in PDR (PDR-RVH) with traction RD, giant retinal tears (GRT) with PVR grade C and total RD with vitreous hemorrhage and hypotony in penetrating traumas (PT). Indications for removal of SiO included attached retina and intra-ocular pressure (IOP) more than 10 mmHg after 60 days or IOP more than 30 mmHg despite medication. RESULTS: Of the 212 patients undergoing PPV and SiO tamponade between 1994-1997, 91 met the inclusion criteria, 8 had incomplete charts so 83 eyes were included in the study. The mean interval between PPV and SiO removal was 163.1 +/- 111.0 days and follow-up was 351.5 +/- 148.6 days. At the time of SiO removal, 30.6% of phakic eyes had cataract, 14.4% keratopathy and 8.4% IOP more than 30 mmHg. At the last visit after SiO removal, 43.5% had cataract, 12.0 keratopathy, 6.0% IOP > 30 mmHg and 3.6% IOP < 5 mmHg. After SiO removal, 6.0% eyes developed R-RD. There was no significant difference in SiO duration for patients with and without R-RD. VA was more than 5/200 in 16.8% of eyes preoperatively, 79.5% at the time of SiO removal (p<0.05) and 78.3% at the last visit (n.s.) and better than 20/400 in respectively 2.4%, 51.8% (p<0.05) and 53% (n.s.). There was a tendency for VA to improve after SiO removal (p = 0.011). CONCLUSIONS: SiO is an effective tamponade for complex RD, although its possible benefits must always be weighted carefully against the complications and the need for further intervention. The present series compares favorably with the current literature in terms of complication rates. The optimal timing of SiO removal and precise screening and decision-making guidelines before removal are still the main issues and need careful consideration.

Eye Injuries, Penetrating↗

PubMedDate not supplied

Copper intraocular foreign body: diagnosis and treatment.

Copper intraocular foreign bodies (IOFB) are relatively common after penetrating eye injuries. Ocular signs and symptoms vary greatly in relation to the copper content, ranging from chronic uveitis and severe visual loss for IOFB containing more than 85% copper, to local copper deposits with no severe ocular damage for less toxic alloys. Reported here is the case of a ten-year-old boy who suffered from recurrent chronic uveitis five months after a perforating eye injury due to copper wire. Diagnostic ultrasound and computerized tomography revealed an IOFB within the lens and X-ray spectrometry (DXS) indicated the nature of the IOFB as copper, and accurately measured the dissolution of the metal. The patient underwent cataract extraction and standard three-port pars plana vitrectomy with gas-fluid exchange. Twelve months after surgery the retina was flat and visual acuity had risen to 20/60. Undiluted vitreous samples obtained in the course of the intervention, studied by immunohistochemical techniques, showed an inflammatory reaction with a prevalence of PMN-N and CD3 T-lymphocytes. DXS thus appears to be a new and reliable diagnostic tool for the early detection and management of copper and other toxic metal IOFB.

Child↗

PubMedDate not supplied

Automatic speech recognition in vitreo-retinal surgery. A project for a prototypal computer-based voice-controlled vitrectomy machine.

In the past half decade automatic speech recognition techniques, software and hardware technology have matured enough to support sophisticated medical applications. The project described aimed at introducing a computer-based, voice-controlled prototype system in a simulated vitreo-retinal surgery scenario. The aim was to provide the surgeon with a tool that could significantly improve the quality and ease of work and shorten the duration of intervention. The speech recognition system allows voice entry of simple commands to simulate surgical instrument control, including the infusion pump, vitreous cutter and diathermy. The project relies on a Markov-based, speaker-dependent, commercial isolated-word recognizer, and consists of a specific recognition vocabulary and application software, created and developed by the authors. Results have been encouraging. The system performed well under the test conditions, proving robust, simple to use and accurate (over 97% average word recognition rate). On the basis of their experience, the authors believe that automatic speech recognition technology, though suffering from some limitations such as the need for training, speaker dependence and a relatively small vocabulary, and requiring extensive testing under operating conditions, merits further development and opens new perspectives for a possible new generation of surgical instruments.

Artificial Intelligence↗

PubMedDate not supplied

Repair of scleral rupture and total retinal detachment in a self-injuring psychotic patient under local anesthesia: a case report.

PURPOSE: Ocular self-injury by psychotic patients is an uncommon cause of ocular morbidity that poses peculiar problems. This report describes a schizophrenic self-injuring patient with scleral rupture and retinal detachment (RD), treated under loco-regional anesthesia. CASE REPORT: A 65-year-old man presented with scleral rupture, hyphema, traumatic lens luxation, vitreous prolapse, vitreous hemorrhage and total RD after deliberately hitting his head. The fellow eye had been successfully operated with scleral buckle surgery for the same reason two years earlier. The patient underwent a two-step surgical procedure under local anesthesia, with repositioning and resection of the uveal prolapse and scleral rupture repair and, separately, lens removal pars plana vitrectomy (PPV), membrane peeling, retinotomy, laser treatment and SiO tamponade. RESULTS: Twelve months after PPV, the cornea was clear, IOP was 16 mmHg, the retina was attached and VA was 20/200. The fellow eye maintained 20/30 VA. CONCLUSIONS: In psychotic patients the intrinsic difficulty of a traumatic RD is combined with systemic illness, no compliance and the risk of recurrence. Although ocular traumas usually require general anesthesia, this patient underwent both interventions under local anesthesia with sedation, because of his psychotic condition and chronic liver failure. Local anesthesia and sedation proved effective in controlling pain and intra-operative compliance even in such a difficult patient. Although it is reasonable to question operating on such patients, we nonetheless believe that every attempt should always be made at gaining useful vision in both eyes since these patients are at a high risk of recurrent ocular trauma.

Aged↗

PubMedDate not supplied

Nanophthalmic uveal effusion syndrome after prophylactic laser treatment.

PURPOSE: We report a case of nanophthalmic uveal effusion syndrome (NUES) with total exudative retinal detachment (RD) after prophylactic argon laser (AL) treatment. The RD subsided and eventually resolved with i.v. steroid therapy. METHODS: A 45-year-old woman was referred to us with NUES and total exudative RD after prophylactic AL treatment for retinoschisis performed elsewhere. The patient had been scheduled for surgical intervention and was given i.v. prednisolone. RESULTS: Two days after starting i.v. prednisolone, the subretinal fluid partially resolved. Intervention had therefore been postponed. After 15 days the RD almost disappeared and vision improved to 20/400. Ten days later the macula was flat and vision was 20/200. At the six-month follow-up visit vision was 20/40. CONCLUSIONS: To our knowledge this is the first report of NUES and total exudative RD following AL treatment that resolved with i.v. steroid therapy alone. Since the AL treatment clearly seemed to play a role in the pathogenesis of the NUES and associated RD we strongly advise careful assessment of the risk/benefit ratio of prophylactic laser treatment in nanophthalmic patients. Although sclerectomy and vortex vein decompression are well-established techniques, we believe steroid therapy might be tried before proceeding to surgery.

Female↗

PubMedDate not supplied

Patient satisfaction and vision improvement after multiple surgery for recurrent retinal detachment.

PURPOSE: To assess patient satisfaction and functional status improvement after multiple surgery for recurrent retinal detachment (RRD) with proliferative vitreoretinopathy (PVR) grade C. Main outcome measures included visual acuity (VA), anatomic outcome, and patients' answers to a standardized multiple-choice questionnaire. METHODS: The authors retrospectively reviewed records of patients undergoing pars plana vitrectomy (PPV) for RRD with PVR grade C operated between 1997 and 1999. All included patients underwent a standardized telephone interview aimed at assessing the patients' visual performance and satisfaction. Statistical analysis used Wilcoxon signed-rank test, Mann-Whitney rank sum test, and Spearman rank correlation coefficient. p Values less than 0.05 were considered statistically significant. RESULTS: The population study included 62 patients with an average 19+/-4.1 months follow-up. The average number of operations was 2.9+/-0.7 with 1.45+/-0.50 recurrences. At the end of the study, 40/62 eyes had better than 5/400 vision and 14/62 better than 20/200; 2 patients had no light perception and 5 eyes still had RRD. Questionnaire answers yielded the following results: 61% believed their VA was better than before surgery, 13% the same, and 26% worse. Fifty-two percent noticed an improvement in binocular vision versus 35% stable and 13% worse: 84% thought their result had been worth the operation, 15% did not, and 2% did not know. Ninety percent believed the information they received before surgery was accurate. Results exceeded expectations in 35% of cases and matched them in 26%. Increase in binocular visual performance after intervention was significant for clothing, bathing, and home deambulation, climbing steps, watching TV, and reading, but not for car driving. The difference in VA improvement in satisfied and unsatisfied patients was significant. There was no significant correlation between patients' satisfaction and fellow-eye vision. CONCLUSIONS: The sample population showed a high rate of satisfaction and significant subjective improvement on four out of five tested activities, despite multiple surgeries and overall poor outcome, even in patients with a good VA in fellow eye. Many other factors such as visual field and contrast sensitivity improvement, not investigated by the authors, can play an important role in the visual functional status. Correct and extensive patient information remains critical in such settings.

Female↗