PURPOSE: To compare the surgical results according to the IOL implantation time in patients who were performed simultaneous lens extraction, vitrectomy and silicone oil endotamponade. METHODS: We reviewed the medical records of 60 eyes in 57 patients with vitreoretinal diseseases. The group I included 32 eyes those were performed simultaneous lens extraction, vitrectomy and silicone oil endotamponade as the first surgery, and sequential IOL implantation at the time of silicone oil removal as the second surgery. The group II included 28 eyes those were performed simultaneous lens extraction, vitrectomy, silicone oil endotamponade and IOL implantation as the first surgery, and sequential oil removal as the second surgery. The cases were evaluated 6 months after silicone oil removal. Anatomical and functional success rate, difference of postoperative predictive refraction, postoperative complication occurrence rate were compared between two groups. RESULTS: The anatomical successes were achieved in 93.8% (30/32 eyes) and 92.9% (26/28 eyes) in the group I and II respectively. The functional successes were achieved in 71.9% (23/32 eyes) and 78.6% (22/28 eyes) in the group I and II respectively. The differences between preoperative predicted target refraction and postoperative final refraction were 0.68D and 0.92D in the group I and II respectively. The incidence of postoperative anterior chamber reaction and secondary glaucoma were significantly high after second surgery in the group I. CONCLUSIONS: We recommend a simultaneous implantation of IOL at the combined surgery of lens extraction and vitrectomy with silicone oil endotamponade to reduce postoperative complications.
Anterior Chamber ; Endotamponade ; Glaucoma ; Humans ; Incidence ; Lenses, Intraocular ; Medical Records ; Postoperative Complications ; Silicone Oils ; Vitrectomy*

PURPOSE: Combined with vitreoretinal surgery, silicone oil endotamponade has become a standard technique and improved the prognosis of complex retinal diseases. To improve success rate of silicone oil endotamponade, the authors analysed complications and associated with other variables. METHODS: The authors analysed 90 cases of silicone oil endotamponade (102 eyes), all operated by one surgeon from 1995 to 2000 and followed-up over 6 months. The series consisted of proliferative diabetic retinopathy (48 eyes), complex retinal detachment (33 eyes), proliferative vitreoretinpathy (11 eyes) and ocular trauma (10 eyes). Analysed variables were preoperative visual acuity, rubeosis iridis, nuber of operations, duration of tamponade, emulsification of silicone oil, lentile status, anterior proliferative vitreoretinpathy, keratopathy, change of ocular tension, redetachment, macular degeneration and electroretinogram. RESULTS: Anatomic success was achieved in 95 of 102 eyes (93.1%) and functional success was achieved in 66 eyes (64.7%). Change of ocular tension over 10mmHg, anterior proliferative vitreoretinpathy and anatomical failure were statistically significant prognostic factors. CONCLUSIONS: Silicone oil endotamponade is an effective measure for complex retinal diseases, but its complication has always been an issue. If these complications can well be kept under the control, silicone oil endotamponade will become more widely used surgical modality.
Diabetic Retinopathy ; Endotamponade* ; Intraocular Pressure ; Lens Plant ; Macular Degeneration ; Prognosis ; Retinal Detachment ; Retinal Diseases ; Silicone Oils* ; Visual Acuity ; Vitrectomy ; Vitreoretinal Surgery

PURPOSE: To analyze trends in rhegmatogenous retinal detachment (RRD) surgery among the members of the Korean Retina Society from 2001 to 2013. METHODS: In 2013, surveys were conducted by email and post to investigate the current practice patterns regarding RRD treatment. Questions included how surgeons would manage six cases of hypothetical RRD. Results were compared to those reported in 2001. RESULTS: A total of 133 members (60.7%) in 2013 and 46 members(79.3%) in 2001 responded to the survey. Preference for pneumatic retinopexy has decreased in uncomplicated primary RRD (p = 0.004). More respondents in 2013 selected vitrectomy as the primary procedure when mild vitreous hemorrhage (p = 0.001), myopia (p = 0.044) and history of successful scleral buckling on the fellow eye (p = 0.044) were added to the primary scenario. Vitrectomy was over twice as popular in cases of pseudophakic, macula-off RRD with posterior capsular opacity (p = 0.001). CONCLUSIONS: For RRD with myopia, pseudophakia and media opacity, surgical interventions over the last decade have drastically shifted from scleral buckling and pneumatic retinopexy to vitrectomy.
Endotamponade/trends ; Female ; Health Care Surveys ; Humans ; Male ; Middle Aged ; Ophthalmologic Surgical Procedures/*trends ; Ophthalmology/organization & administration ; Practice Patterns, Physicians'/*trends ; Republic of Korea ; Retinal Detachment/*surgery ; Scleral Buckling/trends ; Societies, Medical ; Surveys and Questionnaires ; Vitrectomy/trends

Female ; Humans ; Hysterectomy ; Postpartum Hemorrhage/therapy* ; Postpartum Period ; Risk Assessment ; Treatment Outcome ; Uterine Balloon Tamponade

Placenta accreta syndrome results from the abnormal adherence of the placenta to the myometrium due to the absence of the decidua basalis and imperfect development of the Nitabuch layer. It causes serious obstetric morbidity due to the risk of massive hemorrhage. Balloon occlusion of internal iliac arteries has been used prophylactically to decrease hemorrhage in cesarean hysterectomy for placenta accreta. In this paper, two cases of placenta accreta syndromes wherein bilateral internal iliac artery balloon occlusion was done prior to cesarean hysterectomy are presented. Case 1 is a 50-year-old G4P0 (0030) pregnancy uterine who came in at 33 3/7 weeks age of gestation for fetal surveillance. Case 2 is a 38-year-old G4P2 (2012) pregnancy uterine who came in at 33 4/7 weeks age of gestation for decreased fetal movement. Both cases were successfully delivered via cesarean hysterectomy with prophylactic balloon occlusion under a multidisciplinary team in a tertiary care center.
Balloon Occlusion ; Placenta Accreta

In the management of carotid cavernous fistula, detachable balloon has become the treatment of choice.However, technical difficulties are not uncommon, and transarterial balloon embolization fail in 5% to 10% ofcases. Failure occurs because in some patients, the fistula orifice may be too small to allow entry. Using atracker catheter system with Guglielmi detachable coils, we achieved successful transarterial occlusion of acarotid cavernous fistula with a small fistula.
Balloon Occlusion ; Catheters ; Fistula* ; Humans

Carotid-cavernous fistula is a serious complication of head trauma. We have experienced 5 cases of carotid-cavernous fistula(four cases were traumatic and one was spontaneous) recently and have successfully managed them by detachable balloon occlusion. We have found that while some cases had typical manifestations, the others had atypical features. We therefore concluded that clinical suspicion and early imaging studies are essential steps in the management of carotid-cavernous fistula. Careful monitoring and prompt treatment are important because of its dismal progression and poor outcome. Detachable balloon occlusion is a method of choice in management of carotid-cavernous fistula, because it can be used under local anesthesia. It provides a chance of early detection of neurological deterioration during the procedure and it can be, if necessary performed during diagnostic procedures.
Anesthesia, Local ; Balloon Occlusion* ; Craniocerebral Trauma ; Fistula*

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.
Blood Transfusion ; Carboprost ; Delayed Diagnosis ; Diagnosis* ; Erythrocytes ; Hematocrit ; Hemorrhage ; Hemostasis ; Hypovolemia ; Iliac Artery ; Maternal Mortality ; Methylergonovine ; Oxytocin ; Platelet Count ; Postpartum Hemorrhage* ; Postpartum Period* ; Resuscitation ; Sutures ; Tranexamic Acid ; Uterine Balloon Tamponade ; Uterus ; Vital Signs

Postpartum hemorrhage (PPH) is an important cause of maternal mortality. There is currently no single, satisfactory definition of PPH. The various definitions of PPH may result in delayed diagnosis. Underestimated blood loss concerning PPH is considered one of the biggest problems. The diagnosis of PPH should include proper estimation of blood loss before vital signs and clinical symptoms change. Management of PPH involves early recognition, assessment and resuscitation. Careful monitoring of vital signs, laboratory tests, coagulation testing in particular, and timely diagnosis of the cause of PPH are important. The first priority in the management of PPH is the rapid correction of hypovolemia with fluid infusion and packed red blood cells transfusion, followed by blood component therapy as indicated by the hematocrit, coagulation tests, platelet count and clinical features. Pharmacological management of PPH is to contract uterus (e.g., oxytocin, methylergonovine, 15-methylprostaglandin F2alpha, misoprostol) and to aid hemostasis (e.g., tranexamic acid, recombinant factor VIIa). Surgical management (e.g., balloon tamponade, uterine compression suture, iliac artery ligation) should be considered if hemorrhage persists or vital signs is unstable.
Blood Transfusion ; Carboprost ; Delayed Diagnosis ; Diagnosis* ; Erythrocytes ; Hematocrit ; Hemorrhage ; Hemostasis ; Hypovolemia ; Iliac Artery ; Maternal Mortality ; Methylergonovine ; Oxytocin ; Platelet Count ; Postpartum Hemorrhage* ; Postpartum Period* ; Resuscitation ; Sutures ; Tranexamic Acid ; Uterine Balloon Tamponade ; Uterus ; Vital Signs

We analyzed 20 cases of traumatic carotid cavernous fistula(CCF) during the recent 10 years The results are summarized as follows: 1) In 18 cases(90%), the clinical symptoms & signs of CCF occurred within 2 months after trauma. 2) The sites of fistulae were common in horizontal segment(40%) and at the junction(30%) between horizontal segment and posterior ascending segment of cavernous portion of internal carotid artery. 3) The main draining veins of CCF were the superior ophthalmic vein(90%) and the inferior petrosal sinus(70%). 4) The methods of treatment were occlusion of fistula with balloon(9 cases), occlusion of cavernous ICA with balloon(2 cases), ligation of cervical ICA with Poppen's clamp(4 cases) and trapping(2 cases). Two patients were not treated and another patient was healed spontaneously. 5) The frequency and severity of complication was significantly decreased in cases treated by detachable balloon occlusion than by direct cervical ICA ligation or trapping procedures. 6) The procedure using the self-sealed goldvalve balloon was simple, but had a risk of premature separation and premature deflation.
Balloon Occlusion ; Carotid Artery, Internal ; Fistula* ; Humans ; Ligation ; Veins