Biomedical subjects
Publications and source records attributed to H Sajjadi.
Patients who have never had otologic surgery or whose previous surgery has preserved the bridge or canal wall can undergo an intact-bridge mastoidectomy. The intact-bridge mastoidectomy can achieve the advantages of improved hearing (as in intact-wall techniques) and eradicated cholesteatoma (as in open-cavity techniques). This article reviews the surgical techniques of intact-bridge mastoidectomy.
Postoperative care is as important as the actual surgical procedure, if not more important. Thiersch skin grafting remains an excellent technique to ensure proper healing in the mastoid cavity and ear canal. Successful surgical outcomes depend on a well-coordinated effort by the surgical team and the patient. Preoperative planning, intraoperative surgical technique, and postoperative care and follow-up are discussed in this article.
PURPOSE: To compare the results of a limbal versus a pars plana approach for primary posterior capsulectomy and anterior vitrectomy in the management of childhood cataract. SETTING: Department of Ophthalmology, Labbafinejad Medical Center, Tehran, Iran. METHODS: A randomized, controlled, double-masked clinical trial of 45 eyes was conducted. After being matched, 38 eyes were included in the study and were divided into 2 equal groups for data analysis. All eyes had lensectomy and posterior chamber intraocular lens (PC IOL) implantation. Primary posterior capsulectomy and anterior vitrectomy were performed through the limbus in half of the eyes and the pars plana in the other half. Main outcome measures included visual acuity, estimated red reflex, postsurgical inflammatory reaction, corneal clarity, posterior synechias, iris capture, IOL position, capsulectomy size, glaucoma, cystoid macular edema, retinal tear, and postoperative refraction. RESULTS: No statistically significant differences were found between the 2 approaches in the outcome measures. CONCLUSION: The anatomic and visual results were encouraging when posterior capsulectomy and anterior vitrectomy, using a limbal or pars plana approach, were combined with lensectomy and PC IOL implantation in children. The application of these techniques depends on surgeon experience and skill.
Ménière's disease is a pathologic condition of the inner ear that is characterized by vertigo, tinnitus and a progressive loss of hearing. When Ménière's disease is unresponsive to medical treatment and when destructive surgery is not advisable, patients, particularly the elderly, often benefit from endolymphatic sac enhancement, a conservative, nondestructive surgical procedure. We evaluated the outcomes of 62 such patients, aged 65 years and older, who underwent a total of 78 endolymphatic sac enhancements. We assessed their response to surgery by means of a questionnaire, which classified pre- and post-surgical data according to criteria established by the American Academy of Otolaryngology-Head and Neck Surgery. Of the 27 patients who returned questionnaires, 23 reported significant alleviation of vertigo symptoms and 19 said their hearing ability had either improved or was maintained at presurgical levels. Endolymphatic sac enhancement resulted in no mortality, and morbidity was documented in only one patient. We conclude that endolymphatic sac enhancement is a safe and viable treatment for elderly patients with Ménière's disease that is refractory to medical therapy.
BACKGROUND: To determine the inflammatory course and level of visual rehabilitation after cataract extraction and posterior chamber lens implantation in patients with Fuchs' heterochromic iridocyclitis complicated by cataract. METHODS: In a clinical trial, 32 eyes (visual acuity of 20/160 or worse) of 30 patients underwent extracapsular cataract extraction (19 eyes) or lensectomy (13 eyes) accompanied by posterior chamber intraocular lens implantation. Indirect ophthalmoscopy was performed intraoperatively prior to intraocular lens implantation and the extent of vitreous haze was assessed. If vitreous haziness was 3+ or more, core vitrectomy (two eyes) or three-port pars plana deep vitrectomy (four eyes) was performed. RESULTS: After an average follow up of 14.4 months (6 to 24 months), there was no statistically significant increase in cell and flare in the anterior chamber and vitreous or in keratic precipitates compared with the preoperative status of the eyes. However, 12% of the eyes developed synechiae (anterior and/or posterior) in comparison to preoperative condition (p < 0.05). Eight-seven percent of the eyes gained visual acuity of 20/40 or better (P < 0.005). Using the logistic regression model, a higher level of preoperative inflammation was associated with reduced likelihood of gaining visual acuity of 20/25 or more (OR = 0.25, 95% CI 0.049, 1.255). The complications of surgery were synechiae, 12%; opaque posterior capsule, 12%; vitreous loss, 3%; chronic glaucoma, 3%; and retinal detachment, 3%. CONCLUSIONS: Implantation of a posterior chamber intraocular lens can be well tolerated in patients with Fuchs' heterochromic iridocyclitis. Vitrectomy, whenever indicated in addition to cataract extraction, improves visual rehabilitation.
BACKGROUND AND OBJECTIVE: Questions remain regarding wound stability, in particular astigmatism and leakage, in large, sutureless, clear corneal incisions. A polymethylmethacrylate (PMMA) implant, which may be more desirable than a silicone foldable in a very young patient, can be implanted through this incision. PATIENTS AND METHODS: Twenty eyes of 19 patients underwent a 5.2-mm, temporal approach, clear corneal, sutureless phacoemulsification with intraocular lens implantation. The Langerman single hinge technique with a curvilinear groove and a triplanar, sutureless incision was used in all cases. RESULTS: The average axis-corrected induced cylinder was 1.05 D of with-the-rule change. Stromal hydration was not done and only one eye required a single suture. CONCLUSION: A 5.2-mm, clear corneal incision was self-sealing, with an acceptable induced with-the-rule astigmatism.
Congenital hereditary endothelial dystrophy is characterized by a diffuse bilateral corneal opacity (edema). Its inheritance has been reported to be both autosomal recessive and dominant. All our cases seemed to be autosomal recessive. There seems to be a prevalence of the recessive gene in the Iranian population. The dystrophy might be misdiagnosed as congenital glaucoma, as in several of our cases. We have operated on 37 eyes of 21 patients during the past 10 years. Our visual and anatomical success rate has been very good, with 92% clear grafts and only an 8% rejection rate, in contrast to poor prognosis that has been previously reported. In children, suture removal should be started 3 months postoperatively. Partial amblyopia was preexistent in all cases, but deep amblyopia was not common.
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The effect of systemic low dose cyclosporin-A (5 mg/kg/day as initial dose) combined with 0.2 to 0.6 mg/kg/day prednisolone (when necessary) in clinical course of 22 patients suffering from severe forms of Behçet's disease are reviewed. All the patients had received other drugs previously and had either no response to them or developed intolerable side effects, therefore, pre treatment visual acuity (VA) was compared to post treatment VA as "self control". The average age of our patients was 30.6 years (range 19-51 years). The average duration of our therapy was 19.5 months (range 4-32 months). Improvement or stabilization of vision was achieved in 21 patients (95%). The intraocular inflammation was controlled in all of the eyes and most of the non-ocular signs and symptoms were also improved. Serious side effects included rise in creatinine in 10 (45%) of the patients, rise in bilirubin in 6 (27%) and hypertension in 1 (4.5%). These side effects disappeared as the dose of cyclosporin-A was tapered. We believe this form of therapy is of great value in the management of severe forms of Behçet's disease.
An 8-month-old caucasian girl with monosomy 21 and sclerocornea underwent bilateral penetrating keratoplasties. Both light and electron microscopic studies were performed on the corneal buttons. Light microscopy revealed variable and abnormal corneal thickness with the peripheral cornea being thinner than the center, lack of Bowman's layer, irregular stromal lamellae, stromal vascularization, markedly underdeveloped or absent Descemet's membrane, and marked attenuation of the endothelium. Electron microscopy demonstrated basal epithelial cells with a thin epithelial basement membrane residing directly on stromal lamellae without intervening Bowman's layer. Stromal collagen fibrils were irregular in size measuring 38-69 nm in diameter. We believe this to be the first report of corneal transplantation and the second reported case of sclerocornea in a patient with monosomy 21.
PURPOSE: To identify the clinical features in eyes with intraretinal foreign bodies (IRFBs) and evaluate the results of surgical management in these cases. METHODS: The records of 75 patients (76 eyes) with IRFBs were retrospectively reviewed. All eyes underwent vitrectomy. The IRFBs were removed with intraocular forceps in 45 eyes (59.2%) and by magnetic extraction in 31 eyes (40.8%), either through pars plana sclerotomy or through the sclera over the IRFB after precise localization. Laser photocoagulation or cryotherapy was performed around the IRFB before surgery in 38 eyes. RESULTS: The average follow-up period was 34 months. Of the 75 patients, 46 (61.3%) were injured at war. The IRFBs were metallic in 71 (93.4%) eyes. Of these, 59 (83%) were ferromagnetic. In these 76 eyes, final visual acuity was 20/15-20/40 in 37 (48.6%), and 20/50-20/200 in another 10 (13%). In 19 eyes (25%), partial or total retinal detachment was present at the final follow-up examination. CONCLUSION: Surgical management of IRFBs is a complicated procedure. The appropriate route of removal may be determined by the type and site of the embedded IRFB. Performance of a meticulous vitrectomy is mandatory, and an attempt should be made to minimize the rate of iatrogenic peripleral retinal breaks. Preoperative retinopexy around the site of the embedded foreign body is recommended, if possible, to reduce the risk of retinal detachment. The prognosis in eyes with IRFBs and rhegmatogenous retinal detachment is guarded.
We used a Landers-Foulks temporary keratoprosthesis lens to combine penetrating keratoplasty with vitreoretinal surgery in 21 eyes of 21 patients. Ten of these patients were victims of combat injuries; 11 had traumatic injuries unrelated to war. After a mean follow up of 11 months, satisfactory overall results, ie, an attached retina and a clear cornea, were obtained in nine eyes (42.8%). In two, the retina was attached but the corneal graft was rejected. Eight eyes achieved a visual acuity of 5/200 or better. The visual prognosis as well as the rate of retinal reattachment for the combat-injured eyes were poorer than those for the traumatic noncombat-injured eyes. At the last follow-up examination, 60% of the combat-injured eyes were considered visually lost, as compared with 36.3% of the noncombat-injured eyes.
Endolymphatic sac enhancement surgery has proved, over the last several decades, to be a conservative and relatively safe procedure for patients in whom extensive empirical medical therapy has failed. The operation can usually be done as an outpatient procedure or with a one-night postoperative stay, and it has relatively low morbidity. Up to 90% of patients exhibit significant improvement of their episodic vertigo after the operation. Destructive procedures such as labyrinthectomy and vestibular neurectomy are reserved for rare cases of failure of the endolymphatic sac enhancement and are not offered to patients as a primary surgical alternative. Wide decompression of the mastoid and sigmoid sinus is of paramount importance in achieving an adequate endolymphatic sac enhancement. At the end of the operation, meticulous attention should be given to cleaning bone dust and debris from the wound and to stopping all bleeding and bony oozing. Wide opening of the posterior aditus and facial recess is usually necessary to prevent postoperative aditus block. In the postoperative period, scrupulous attention should be given to wound healing; if infection develops in the wound, aggressive antibiotic therapy should be administered to prevent labyrinthitis that could result in deafness.
The results of vitrectomy in 240 consecutive cases of ocular trauma were reviewed. Of these cases, 71.2% were war injuries. Intraocular foreign bodies were present in 155 eyes, of which 74.8% were metallic and 61.9% ferromagnetic. Multivariate analysis identified the prognostic factors predictive of poor visual outcome, which included: (1) presence of an afferent pupillary defect; (2) double perforating injuries; and (3) presence of intraocular foreign bodies. Association of vitreous hemorrhage with intraocular foreign bodies was predictive of a poor prognosis. Eyes with foreign bodies retained in the anterior segment and vitreous had a better prognosis than those with foreign bodies embedded in the retina. Timing of vitrectomy and type of trauma had no significant effect on the final visual results. Prophylactic scleral buckling reduced the incidence of retinal detachment after surgery. Injuries confined to the cornea had a better prognosis than scleral injuries.
A subset of patients with intractable Menière's disease had a good result for months or years following endolymphatic sac enhancement (ESE), only to develop recurrent symptoms of Menière's disease, including vertigo and deafness. Revision procedures (ESR) revealed extrasaccular fibrosis or granulation tissue, osteoneogenesis, and aditus block syndrome resulting in saccular obstruction and a tight contiguous dura in 26 patients (4% of total ESE patients to date). Following ESR, symptoms and pathologic findings in the main were diminished; in one patient, useful hearing was restored from complete deafness. ESR provides another option for managing these recurrent problems, and most of our patients have continued to do well. This option of therapy, plus a unique opportunity to assess the pathogenesis of Menière's disease in humans will be discussed.
The round window niche and membrane can be involved in clinical problems including perilymphatic fistulas, sensorineural hearing loss in otitis media, and a variety of others. The background of these problems is documented by a review of the literature and recent experimental evidence on round window grafting and tracer studies. Clinical pathological correlates including recent clinical experience are discussed for perilymphatic fistulas (sudden deafness, chronic progressive fluctuating sensorineural hearing loss, and association with Meniere's disease), sensorineural hearing loss in acute and chronic otitis media, and findings in round window membrane including absent round window reflex in cases of exploratory tympanotomy and otosclerosis. In addition, a new syndrome termed perilymphatic hypertension is described as seen in a subset of patients with sudden sensorineural hearing loss.
Principles of diagnosing and treating Meniere's disease using endolymphatic sac enhancement are described. Based on a current understanding of the natural history and pathogenesis of this disease, the terminology, diagnosis, and thereby are discussed. Techniques (methods) and surgical objectives of endolymphatic sac enhancement are designed to counteract the pathogenesis (endolymph malabsorption). Current surgical methods and results are presented for 100 patients selected at random from a larger group. Discussion of this method of treatment and reporting criteria follow.
PURPOSE: To identify the factors influencing anatomical and visual results in cases of rhegmatogenous retinal detachment undergoing primary scleral buckling. METHODS: A retrospective study of 233 eyes of 226 patients was done. The data were evaluated by univariate analysis and stepwise logistic regression analysis. RESULTS: Retinal reattachment was achieved with primary scleral buckling in 197 eyes (84.5%). The extent of retinal detachment, preoperative proliferative vitreoretinopathy (PVR), preoperative visual acuity and relative afferent pupillary defects were identified as influencing anatomical results, by univariate analysis. The predictive roles of extent of retinal detachment (P<0.0001) and preoperative PVR (P=0.0085) were shown to be significant by step-wise logistic regression. As well as the above factors, the patient's age, the duration of symptoms and the status of the macula were predictors of visual results, by univariate analysis. Stepwise logistic regression analysis confirmed the predictive roles of preoperative visual acuity (P<0.0001) and the extent of retinal detachment (P=0.0089). CONCLUSIONS: Cases with a larger extent of retinal detachment, more advanced preoperative PVR and poorer preoperative visual acuity have less favorable anatomical and functional results.