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P Kuthan

Publications and source records attributed to P Kuthan.

14 recordsLinked to original sources
PubMed2006

[Infliximab in the treatment of Wegener's granulomatosis: case report].

PURPOSE: to evaluate the efficacy of monoclonal anti-tumor necrosis factor alpha antibody infliximab in treatment of refractory Wegene's granulomatosis. Clinical manifestations of Wegener's granulomatosis at the time of infliximab initiation were: proptosis of both eyes due to progressive retrobulbar granulomas, visual impairment, optic disc edema, progressive diplopia, sinus and renal involvement. The disease was refractory to a treatment with various immunosuppressants, including intravenous cyclophosphamide or high doses of mycophenolate mofetil in combination with corticosteroids. METHODS: Observational case report. RESULTS: the patient received six infusions of infliximab (3 mg/kg) in addition to low doses of oral cyclophosphamide and corticosteroids. The interval between the first two infusions was 1 week. The interval between the second and third infusions was 4 weeks, thereafter 8, 12 and 34 weeks. Following the third infusion of infliximab the remission of Wegener's granulomatosis was seen. After the regression of retrobulbar granulomas visual acuity increased, ocular motility improved, diplopia and optic disc edema decreased. Remission has been maintained for 17 months. Infliximab was well tolerated during the short-term follow-up. CONCLUSION: Infliximab successfully induced remission in case of sight-threatening Wegener's granulomatosis in our patient. It seems that infliximab provides more effective therapeutic option in treatment of Wegener's granulomatosis refractory to standard immunosuppression and offers better perspectives for patients with previously poor prognosis. Furthermore, it enables reducing the exposure to immunosuppressive drugs.

Antibodies, Monoclonal↗
PubMed2004

[Treatment of uveal effusion syndrome after filtering surgery (2 case reports)].

The purpose of this article is to report the surgical treatment of two patients. After the filtering surgery a dehiscence of the conjunctiva emerged and was followed by an extreme hypotony of the eyeball and an extensive uveal effusion. The first patient, 82 years old lady, was treated with the diagnosis of chronic open angle glaucoma for 25 years. The right eye with an absolute glaucoma, the left eye had normal intraocular pressure (IOP) and was after a combined filtering surgical procedure with phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in 1998. In autumn 2000, the patient suffered conjunctivitis, and the prominent filtering bleb was damaged due to frequent rubbing of the eye because of itching. Severe hypotony of the eyeball with secondary uveal effusion followed. Considering the age of the patient and the only functional eye, an extreme surgery was indicated: PC IOL explantation (removal), pars plana vitrectomy (ppV) with silicone oil implantation. After the surgery the eyeball was anatomically stabilized and the VA (visual acuity) improved from initial uncertain light perception to 0.08 (1/12 or 3/36) and certain light perception. The second patient, 35 years old man suffered in 1995 a serious penetrating injury with an intraocular foreign body of the right globe. During the following five years the patient underwent in altogether six intraocular surgeries due to posttraumatic cataract and rhegmatogenous and tractional detachment of the retina. In the year 2000, trabeculectomy due to secondary glaucoma was indicated and 8 months later, on patients demand an anterior chamber intraocular lens (AC IOL) was implanted. During the first week after the surgery severe hypotonia of the globe and secondary uveal effusion caused by conjunctival dehiscence in the upper nasal quadrant of the eyeball developed. Because of complicated ocular history of the patient who underwent on the whole eight eye surgeries a relative minimal procedure was indicated: AC IOL removal and insufflation of 1 ml of 100% hexafluorosulfide (SF6) expansive gas into the anterior chamber and vitreous cavity. The globe was stabilized and the VA (visual acuity) improved from initial uncertain light perception to 0.25 (6/24 or 20/80) with certain light perception.

Adult↗
PubMed2001

[Initial experience with surgical decompression of the vein in branch retinal vein occlusion].

Due to the development of the armamentarium and surgical techniques, the indications of pars plana vitrectomy (PPV) are expanding. It concerns also a relatively new indication, as is the branch retinal vein occlusion (BRVO) of the temporal part of the posterior pole of the retina with the secondary involvement of the macular region. The purpose of this prospective study is to demonstrate anatomical and functional results after the surgical decompression of the occlusion of the branch retinal vein draining the macular region. Since November 1999, 3 patients, one woman and 2 men (age 70, 47 and 76 years) with the quadrant BRVO of the temporal part of the retina involving the macular region were followed. The visual acuity before the surgery in all 3 patients was 6/36 (20/120 or 0.16) and the BRVO lasted for 3-5 months. The patients were examined by slitlamp biomicroscopy, and the course of the disease was documented by means of red-free fundus photographs as well as fluorescein angiograms. In all three patients, PPV and the adventitial sheathotomy of the arteriovenous crossing (AVC) were performed. Surgical decompression of BRVO and reperfusion of the ischemic part of the retina was achieved by separating the overlying arteriole from the venule at AVC. Neither per- nor postoperative complications were noted. In two patients, the visual acuity improved to 6/12 (20/40 or 0.5), and in the last one stabilized at 1/9 (20/180 or 0.11). The minimal follow-up period was 12 months. In conclusion, we recommend to performing this new type of delicate surgery procedure in individual cases on the basis of detailed biomicroscopial examination and fluorecein angiograms by an experienced vitreoretinal surgeon.

Aged↗
PubMed1999

[Vitrectomy and autologous thrombocyte concentrate in the treatment of idiopathic macular holes].

OBJECTIVE: To evaluate the results of surgery of idiopathic macular holes (IMH) using or not using autologous thrombocyte concentrates (ATC). METHOD: Fifty eyes with IMH, stage 2-4, were divided into two groups. Group 1 comprised 27 eyes with an average persistence of complaints of 12 months where pars plana vitrectomy (PPV) and tamponade with 16% C3F8 were combined with the use of ATC. Group 2 comprised 23 eyes with a mean duration of complaints of 14 months which were treated by PPV and 16% C3F8 without ATC. In all IMH stage 2 and 3 the posterior vitreous membrane was detached from the retina. The epimacular membrane was removed, if present. The mean follow-up period in group 1 was 17.2 months and in group 2 12.3 months. RESULTS: In group 1 anatomical success was achieved in 21 eyes (78%), visual acuity improved by two lines and more in 16 eyes (59%). In group 2 anatomical success was recorded in 15 eyes (69%) (p = 0.326) and visual acuity improved in 10 eyes (44%) (p = 0.265). Nine eyes were reoperated with ATC. Reoperations improved the anatomical success in the whole series to 90% and the functional success to 62%. The visual acuity improved in 70% operated eyes within 12 months from the onset of complaints and in 47% eyes with a longer case-history (p = 0.1182). Complications included retinal tears in 5 eyes (10%), detachment of the retina in one eye (2%), minor facete-like defects in the pigmented epithelium in 22 eyes (44%), disciform maculopathy in 5 eyes (10%) and atrophy of the optic disc in 3 eyes (6%). CONCLUSIONS: PPV is beneficial in IMH in the majority of patients. ATC can improve anatomical and functional results. Functional success is more likely after surgery in the early stage of the disease. The results of surgery are jeopardized by various complications. It is important to inform patients on the limitations and risk of surgery.

Adult↗
PubMed1999

[Vitrectomy in optic nerve disc pit with maculopathy].

There is described a rare case of a congenital optic disc pit of the 20-years old man that was accompanied by a cyst-like change in the macula with serous retinal detachment. Visual impairment in his right eye was treated with pars-plana-vitrectomy with surgical posterior vitreous detachment and gas tamponade. After temporary pneumatic displacement of the subretinal fluid inferiorly the corrected visual acuity improved to 6/9. Schisislike changes persisted in the macular area. Our findings could support the view on the two-layer structure of optic disk pit maculopathy and an important role of tangential vitreous traction in the pathogenesis of the central retinal detachment.

Adult↗
PubMed1999

[Retinal detachment with retinal tears--clinical characteristics and surgical results].

The authors evaluate a group of 53 eyes of 52 patients operated on account of retinal detachment with an oral dialysis. The mean follow-up period was 35 months. There were 37 (70%) traumatic dialyses. They were in the temporal lower quadrant in 58%, in the nasal upper quadrant in 16%, temporal upper quadrant in 13% and in the nasal lower quadrant in 13%. There were 16 (30%) idiopathic dialyses, all with one exception in the temporal upper quadrant, they were in the lower temporal quadrant. 52 eyes were operated primarily cryosurgically, one eye by pars plana vitrectomy. After primary surgery the retina adhered completely in 94% eyes. On account of relapses of detachment 9.4% eyes were reoperated. At the end of the follow up the retina adhered completely in 94% eyes. Functional improvement or stabilization of vision was achieved in 78% eyes with traumatic tears and in 87% eyes with idiopathic tears. The authors confirmed the existence of two different clinical entities--traumatic and idiopathic oral dialysis which differ as to site and to a certain extent also the prognosis of the disease.

Adolescent↗
PubMed1998

Results of penetrating keratoplasty in bullous silicone oil keratopathy.

BACKGROUND: To evaluate the results of penetrating keratoplasty (PK) in bullous silicone oil keratopathy (BSK). MATERIAL AND METHODS: PK for BSK was performed in 13 patients, aged from 31 to 82 years. In all patients, pars plana vitrectomy (PPV) with silicone oil implantation (SOI) had been previously performed as the definitive surgery: for complicated retinal detachment with advanced proliferative vitreoretinopathy in 12 eyes and for diabetic traction detachment in one eye. Seven patients were monocular. All 13 eyes were aphakic and there was a long-lasting contact of silicone oil with the corneal endothelium. Before keratoplasty, each eye underwent between two and five operations, on average three, for retinal detachment or late complications of SOI. The interval between SOI and PK was from 11 to 79 months. The patients were followed up for 12-52 months. RESULTS: At the last follow-up examination, a clear graft was found in 6 out of 13 eyes (46%). The six clear grafts were found in the ten eyes where silicone oil had been removed before keratoplasty. The graft became opaque in all three eyes in which silicone oil had not been removed. Six out of seven eyes with failed grafts atrophied. Visual acuity improved in all six eyes with the clear graft from had movement preoperatively to 0.05-0.25. The decreased visual acuity was caused by irreparable damage to the macula, which resulted from high myopia, proliferative vitreoretinopathy or long-lasting detachment of the macula. CONCLUSIONS: PK in BSK was successful only in those eyes in which the attached retina enabled the removal of the silicone oil before the PK. The reattached retina and useful visual acuity before the development of BSK were the preconditions for functional success of the PK.

Adult↗
PubMed1997

[Long-term results of pars plana vitrectomy and silicone oil in large retinal tears in children].

Pars plana vitrectomy (PPV) with implantation of silicone oil (ISO) was performed giant tears (GT) in 24 eyes of 22 children aged 6-15 years. In 15 eyes of 13 children idiopathic GT were involved (71%), in 9 eyes (29%) the GT was preceded by an injury-contusion in 5 eyes and a perforating injury in 4 eyes. The patients were followed up for 24-132 months after operation, on average for 55 months. The final anatomical success with an attached macula and functional success with a visual acuity of 0.02 or better were achieved in 18 eyes (75%). The results did not depend on the size of the GT and were better in post-traumatic than in idiopathic GT. The success of the operation declined from 82% after two years and 79% after 3 years to 45% after 5 and more years. The silicone oil was removed in 13 years (46%). Of those in 4 eyes (31%) the detachment relapsed and in two eyes (15%) the relapse was the cause of the final failure. PPV with ISO was a very effective operation in GT. Proliferative vitreoretinopathy was the main cause of surgical failures and a frequent obstacle for removal of silicone oil from the eye. Dispensarization, prophylactic cryopexy and early diagnosis of GT are the main prerequisites of a better prognosis and results in GT in children.

Adolescent↗
PubMed1996

[Heparin-associated type II thrombocytopenia as a cause of multiple thromboembolism complications].

13 days after hysterectomy and subcutaneous treatment with unfractionated heparin (10000 IU daily) a 68 year old women developed a pulmonary embolism and deep vein thrombosis of the right leg. She thereupon received intravenous heparin (1000 IU/h). Eight days later she developed acute ischaemia of both legs, and Doppler examination revealed acute Leriche's Syndrome with thrombosis of both iliac arteries. Platelet count fell from, initially 152 x 10(9)/I, to 44 x 10(9)/I. Although heparin-associated thrombocytopenia type II was suspected a confirmation by demonstrating a heparin dependent antibody with the heparin-induced platelet activation (HIPA)-test failed and therefore crossreactivity of low molecular heparins or heparinoids could not be assessed. After discontinuation of heparin and iliacal artery thrombectomy a combination therapy with aspirin plus ticlopidine (500 mg/d respectively) was started and continued until phenprocoumon could exert its full effect. No recurrent thromboembolic events occurred, the platelet counts normalized and the patient fully recovered.

Aged↗