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Lupardi E, Laffi GL, Ciardella A, Barboni P, Fontana L. Ab-externo intraluminal stent for prolonged hypotony and choroidal detachment after Preserflo implantation. Eur J Ophthalmol 2023; 33:NP63-NP66. [PMID: 36348628 DOI: 10.1177/11206721221137166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE To describe a case of prolonged hypotony and choroidal detachment following insertion of a Preserflo™ MicroShunt in a patient with primary open-angle glaucoma (POAG). CASE REPORT An 84-year-old Caucasian man with medically uncontrolled POAG developed refractory hypotony and choroidal detachment following a mitomycin C augmented Preserflo MicroShunt (PMS) insertion. Initial medical treatment with Dexamethasone 2 mg/mL and Atropine 1% for the hypotony (4 mmHg) and choroidal detachment was unsuccessful, BCVA decreased from the preoperative 20/28 to 20/60. After 90 days, surgery revision was carried out by inserting a 10-0 nylon monofilament suture through the distal end of the PMS reaching the opposite end of the tube. The free end of the nylon suture was exposed from the conjunctiva in the inferotemporal quadrant close to the fornix to ensure access to the occlusive stent. After one month intraocular pressure (IOP) was 7 mmHg, the choroidal detachment was completely regressed, and best corrected visual acuity (BCVA) increased to 20/28, at that time the exposed part of the stent was trimmed. 6 months after the revision surgery IOP was 14 mmHg, BCVA was 20/25, and the nylon stent was retained side to side inside the PMS lumen. CONCLUSION The management of hypotony and choroidal detachment after a glaucoma drainage device (GDD) implantation is still unstandardized. The ab externo insertion of a nylon suture grants multiple advantages over the other techniques when performed on a PMS tube.
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Affiliation(s)
- Enrico Lupardi
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gian Luca Laffi
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Studio Oculistico d'Azeglio, Bologna, Italy
| | - Antonio Ciardella
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Luigi Fontana
- Ophthalmology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Fea A, Sacchi M, Franco F, Laffi GL, Oddone F, Costa G, Serino F, Giansanti F. Effectiveness and Safety of XEN45 in Eyes With High Myopia and Open Angle Glaucoma. J Glaucoma 2023; 32:178-185. [PMID: 36730214 DOI: 10.1097/ijg.0000000000002151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/14/2022] [Indexed: 02/03/2023]
Abstract
PRCIS XEN45 implant was an effective and safe procedure in primary open angle glaucoma (OAG) eyes with high myopia. Although the hypotony incidence rate was relatively high, it resolved with medical therapy and was of short duration. PURPOSE The purpose of this study is to evaluate the effectiveness and safety of the XEN45 stent in eyes with OAG and high myopia. DESIGN Retrospective and multicenter study. METHODS Consecutive OAG patients who underwent a XEN45, either alone or in combination with cataract surgery, and had a refractive error higher than -6 D and an axial length ≥26 mm. The primary endpoint was the mean intraocular pressure (IOP) lowering at the last follow-up visit. RESULTS Thirty-one eyes were included (96.8% with a primary OAG diagnosis). The mean refraction was -13.2±5.6 (range: -6.75 to-23.0) D. In the overall study sample, preoperative mean IOP (95% CI) was significantly lowered from 23.5 (20.5-26.4) mm Hg to 13.0 (12.2-13.8) mm Hg at the last follow-up visit, P <0.0001. At the last follow-up visit, 16 (57.1%) eyes achieved an IOP ≤14 mm Hg, 11 (68.9%) of them without treatment. The number of ocular hypotensive medications was significantly reduced from 3.0±1.1 drugs at preoperatively to 0.6±1.0 drugs at the last follow-up visit, P <0.0001. Median (95% CI) follow-up was 24.0 (12.0-24.0) months. Linear regression analysis showed a significant correlation between the preoperative refraction and the IOP lowering ( r =0.43, P =0.0155). Needling procedure was performed in 11 eyes (39.3%) and hypotony (defined as an IOP <6 mm Hg) was observed in 8 eyes (28.6%) during the first postoperative day and remained for a week. CONCLUSION Although the Xen implant effectively lowered IOP in highly myopic eyes with glaucoma, the incidence of hypotony was high, and in most cases, resolved within the first month with medical management and monitoring.
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Affiliation(s)
- Antonio Fea
- Complex Ophthalmology Structure, City of Health and Science of Turin, Department of Surgical Sciences - University of Turin, Turin
| | - Matteo Sacchi
- Eye Clinic, San Giuseppe Hospital, IRCCS Multimedica, Milan
| | - Fabrizio Franco
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | | | | | - Giacomo Costa
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Federica Serino
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
| | - Fabrizio Giansanti
- Ophthalmology Department, SOD Ophthalmology, AOU Careggi Florence, Florence, Italy
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Abstract
PURPOSE To assess the advantages and adverse effects of intraoperative low-dose Mitomycin C in filtering glaucoma surgery. METHODS Sixty eyes of 48 patients undergoing surgery for uncontrolled glaucoma were randomized to two groups: one underwent standard trabeculectomy, the other had trabeculectomy with intraoperative application of 0.1 mg/ml mitomycin C. Follow-up was at least one year. RESULTS The success rate (IOP < 18 mmHg) was 96.6% in the mitomycin C group and 73.3% in the control group. Mean IOP at one year of successful cases was 11.1 +/- 3.1 mmHg in the mitomycin C group and 16.4 +/- 6.1 mmHg in controls (p < 0.0001). Two patients in the mitomycin C group (6.6%) and six (20%) in the control group needed antiglaucomatous drugs to keep IOP below 18 mmHg. CONCLUSIONS Mitomycin C is a useful adjunct to glaucoma surgery. Adverse effects at the dosage used are mainly due to hypotony and are preventable with two-layer suture. Low-dose mitomycin C may be useful in standard primary trabeculectomy.
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Affiliation(s)
- E Martini
- Department of Physiopathologic Optics, University of Bologna, Italy
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Cavazza S, Laffi GL, Lodi L, Collina G. Primary cutaneous adenoid cystic carcinoma of the upper lid: a case report and literature review. Int Ophthalmol 2012; 32:31-5. [DOI: 10.1007/s10792-011-9503-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Accepted: 12/20/2011] [Indexed: 10/14/2022]
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Cavazza S, Laffi GL, Lodi L, Gasparrini E, Tassinari G. Orbital dermoid cyst of childhood: clinical pathologic findings, classification and management. Int Ophthalmol 2011; 31:93-7. [DOI: 10.1007/s10792-011-9419-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 01/01/2011] [Indexed: 11/29/2022]
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Laffi GL, Guidi SG, Meduri R, Scorolli L, Golfieri R, Eusebi V, Safran AB. Cholesteatoma of the sphenoid sinus presenting as painful optic neuropathy. Neuroophthalmology 2009. [DOI: 10.3109/01658109409024058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cavazza S, Laffi GL, Lodi L, Tassinari G, Dall'Olio D. Congenital dacryocystocele: diagnosis and treatment. Acta Otorhinolaryngol Ital 2008; 28:298-301. [PMID: 19205594 PMCID: PMC2689544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/30/2007] [Accepted: 03/01/2008] [Indexed: 05/27/2023]
Abstract
Five children were diagnosed with congenital dacryocystocele; in all cases, the cystic lesion was unilateral; age ranged from 7 to 60 days (mean 29 days). The mean ultrasonography diameter of the cyst, at the time of the diagnosis, was 11.51 mm. Topical and systemic antibiotics and massage were prescribed. One patient had no recurrence of the dacryocystocele but 4 showed no improvement with medical treatment; they were submitted to successful probing in the first months of life under general anaesthesia. Nasal endoscopy revealed a nasolacrimal cyst in one patient. True dacryocystocele is relatively rare: ultrasound is a simple, non-invasive method that can reliably distinguish dacryocystocele from other pathological conditions. Several reports have described a variable natural course of these lesions but there are controversial opinions regarding their management. Initially, we treated this congenital anomaly with digital massage, and topical and systemic antibiotics. Probing under general anaesthesia was performed in the event of dacryocystitis or lack of resolution after a short trial period with digital massage. Particular attention was paid to nasal bilateral endoscopy to exclude a nasal obstruction caused by cystic swelling of the nasolacrimal duct. When performed, the probing procedure was successful in all patients.
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Affiliation(s)
- S Cavazza
- Department of Ophthalmology, "Maggiore" Hospital, Bologna, Italy.
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Abstract
PURPOSE To assess the efficacy, predictability, stability, and safety of a two-step LASIK procedure using topography-guided ablation to correct astigmatism after penetrating keratoplasty. METHODS Fifteen eyes of 15 patients underwent a two-step LASIK procedure at the Maggiore Hospital of Bologna, Italy. In the first step, a flap was created using the Hansatome microkeratome. In the second step, topography-guided ablation using the LaserSight LSX was planned with interactive software (CIPTA) once topographical and refractive stabilization had been obtained. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), cylindrical correction, gain of lines of BSCVA, spherical equivalent refraction, and complications were analyzed. RESULTS Minimum follow-up was 12 months (range: 12 to 30 months). Uncorrected visual acuity improved in all 15 (100%) eyes. At the last postoperative examination, 11 (73%) eyes had UCVA > or = 20/40. Nine (60%) eyes were within 1.0 diopter (D) of the attempted correction. Mean postoperative astigmatism was -1.67 (range: -3.5 to 0; standard deviation: 1.26). Index of success of astigmatic correction was 0.26. No patient lost Snellen lines of BSCVA. Intraoperative complications included two buttonhole flaps, and postoperative complications included one flap retraction. No further laser treatment was needed. CONCLUSIONS The two-step LASIK procedure using topography-guided ablation reduces spherical and cylindrical refractive error due to penetrating keratoplasty. Topography-guided ablation also proved to be effective in correcting irregular astigmatism.
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Mularoni A, Torreggiani A, di Biase A, Laffi GL, Tassinari G. Conservative Treatment of Early and Moderate Pellucid Marginal DegenerationA new refractive approach with intracorneal rings. Ophthalmology 2005; 112:660-6. [PMID: 15808259 DOI: 10.1016/j.ophtha.2004.10.050] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 10/20/2004] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the use of the intracorneal ring (ICR; Intacs, Addition Technology, Inc., Fremont, CA) for the treatment of pellucid marginal degeneration (PMD). DESIGN Case series. PARTICIPANTS Eight patients with PMD who were intolerant to contact lenses received ICR segments in the superior cornea (0.25 mm thickness) and in the inferior cornea (0.45 mm thickness). The diagnosis was supported by Orbscan II tomography (Bausch & Lomb). MAIN OUTCOME MEASURES Preoperative and postoperative uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, and spherical equivalent were assessed. Changes in corneal shape were evaluated by corneal tomographic maps. RESULTS The minimum follow-up was 12 months (range, 12-42 months; standard deviation [SD], 14.14). Uncorrected visual acuity improved in all 8 eyes (100%). At the last postoperative examination, 6 eyes (75%) had a BCVA > or =20/25; mean postoperative refractive astigmatism was -2.53 (range, -4.50 to -1.25; SD, 1.03). Mean postoperative spherical equivalent was -1.52 (range, -7.25 to +1.87; SD, 3.01). At the third postoperative month, refractive stability was obtained. No patients lost any Snellen lines of BCVA. No intraoperative and postoperative complications occurred. CONCLUSIONS Intracorneal ring implantation is a promising new treatment for patients with early to moderate PMD and who are intolerant of contact lenses.
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Safran AB, Laffi GL, Bullinger A, Viviani P, de Weisse C, Désangles D, Tschopp C, Mermoud C. Feasibility of automated visual field examination in children between 5 and 8 years of age. Br J Ophthalmol 1996; 80:515-8. [PMID: 8759261 PMCID: PMC505522 DOI: 10.1136/bjo.80.6.515] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIMS To investigate how young children develop the ability to undergo a visual field evaluation using regular automated perimetry. METHODS The study included 42 normal girls aged 5, 6, 7, and 8 years. Twelve locations in the 15 degrees eccentricity were tested in one eye, using an Octopus 2000R perimeter with a two level strategy. False positive and false negative catch trials were presented. The examination was performed three times in succession. Before the examination procedure, a specially designed programme was conducted for progressive familiarisation. RESULTS During the familiarisation procedure, it was found that all of the 5-year-old children, seven of the 6-year-old children, and three of the 7-year-old children were unable to perform immediately, and correctly, the instructions given during the familiarisation phase; these children took from 30 seconds to 3 minutes to comply with the examiner's requests. With the exception of one 5-year-old child, all tested subjects completed the planned procedure. The mean proportion of false negative answers in catch trials was 1.6%. The mean proportion of false positive answers was 12.2%. The quadratic dependency on age suggested by the averages was not significant (F(3,116) = 0.88; p = 0.45). Detection stimulus improved with age, as shown by the fact that probability of perceiving dim stimulus increases significantly (F(3,116) = 12.68; p < 0.0001). CONCLUSION Children did remarkably well regarding both the duration of the examination and the reliability of the answers. A preliminary familiarisation phase with a specially designed adaptation programme was found to be mandatory with children aged 7 or under. To our knowledge, this is the first time that such an investigation has been performed.
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Affiliation(s)
- A B Safran
- Neuro-ophthalmology Unit, Geneva University Hospital, Switzerland
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Safran AB, Laffi GL, Demierre B. An unusual form of blink reflex induced by pressing on a frontal burr hole. Br J Ophthalmol 1994; 78:503-4. [PMID: 8060946 PMCID: PMC504840 DOI: 10.1136/bjo.78.6.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- A B Safran
- Department of Ophthalmology, Geneva University Hospital, Switzerland
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Affiliation(s)
- G L Laffi
- Department of Ophthalmology, Geneva University Hospital, Switzerland
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