1.Clinical Presentation and Management of Eyes with Globe Perforation during Peribulbar and Retrobulbar Anesthesia: A Retrospective Case Series
Naresh BABU ; Jayant KUMAR ; Piyush KOHLI ; Ashish AHUJA ; Prerana SHAH ; Kim RAMASAMY
Korean Journal of Ophthalmology 2022;36(1):16-25
Purpose:
To evaluate the clinical presentation, management, and outcome of eyes with an inadvertent globe perforation during peribulbar or retrobulbar block.
Methods:
This retrospective study evaluated the eyes which had an accidental globe perforation during local ocular anesthesia from 2012 to 2020. The patients were divided into three groups: group 1, Clear media with no rhegmatogenous retinal detachment (RRD); group 2, significant vitreous hemorrhage (VH) precluding the retinal view without RRD; and group 3, RRD with/without VH.
Results:
Twenty-five patients were included in the study. The mean axial length (AL) was 24.7 ± 2.7 mm (range, 20.9–31.2 mm). The most common presenting feature was VH (n = 14). The treatment included retinal laser barrage (n = 7) and vitrectomy (n = 17). Retinal breaks were identified in all the eyes (total breaks = 37). The mean presenting best-corrected visual acuity in groups 1, 2, and 3 were logarithm of the minimum angle of resolution 0.79 ± 0.73, 1.82 ± 0.78, and 2.13 ± 0.59 respectively. All the treated patients had an attached retina at the last follow-up. The mean final best-corrected visual acuity for each group was logarithm of the minimum angle of resolution 0.59 ± 0.79, 0.48 ± 0.26, and 1.25 ± 0.64, respectively (p = 0.006). The development of RRD was associated with a larger AL (p = 0.015); while the development of significant VH associated with the superior location of the perforation (p = 0.015), late recognition of the perforation (p = 0.004), and multiple perforations (p = 0.015).
Conclusions
Early recognition and intervention in eyes with an inadvertent perforation can lead to a good outcome. Eyes with a longer AL, superior, and multiple perforations are at higher risk of developing complications like RRD and VH. Complications like RRD, macular injury, and vascular occlusion are risk factors for poor prognosis.
2.A Novel Technique for Retrieval of a Drug-Eluting Stent After Catheter Break and Stent Loss.
Sunil P WANI ; Seung Woon RHA ; Ji Young PARK ; Kanhaiya L PODDAR ; Lin WANG ; Sureshkumar RAMASAMY ; Ji Mi MOON ; Ji Bak KIM ; Sang Ryol RYU ; Seung Yong SHIN ; Un Jung CHOI ; Cheol Ung CHOI ; Hong Euy LIM ; Jin Won KIM ; Eung Ju KIM ; Chang Gyu PARK ; Hong Seog SEO ; Dong Joo OH
Korean Circulation Journal 2010;40(8):405-409
Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.
Angioplasty
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Cardiac Catheterization
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Cardiac Catheters
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Catheters
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Dimaprit
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Drug-Eluting Stents
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Emergencies
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Humans
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Stents
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Thoracic Surgery
3.Impact of Heterogeneous Overlapping Drug-Eluting Stents on the Arterial Responses of Rabbit Iliac Arteries: A Comparison With Overlapping Bare Metal Stents.
Seung Woon RHA ; Kang Yin CHEN ; Dong Joo OH ; Yong Jian LI ; Zhe JIN ; Kanhaiya Lal PODDAR ; Sureshkumar RAMASAMY ; Yoshiyasu MINAMI ; Amro ELNAGAR ; Byoung Geol CHOI ; Sang Pyo HONG ; Byoung Won CHEON ; Sang Ki MOON ; Sung Il IM ; Sun Won KIM ; Jin Oh NA ; Cheol Ung CHOI ; Hong Euy LIM ; Jin Won KIM ; Eung Ju KIM ; Seong Woo HAN ; Chang Gyu PARK ; Hong Seog SEO ; Jung Ha KIM ; Young Joon HONG ; Myung Ho JEONG
Korean Circulation Journal 2012;42(6):397-405
BACKGROUND AND OBJECTIVES: Although the use of heterogeneous overlapping drug-eluting stents (DES) is not uncommon in clinical practice, whether the implantation sequences of heterogeneous DES will influence the endothelialization or arterial responses differently remains unclear. MATERIALS AND METHODS: Twenty-one rabbits were randomized to receive overlapping stents in the iliac artery for 3 months {distal sirolimus-eluting stent (SES, Cypher(TM))+proximal paclitaxel-eluting stent (PES, Taxus(TM)) (C+T, n=7), distal Taxus+proximal Cypher (T+C, n=7) and bare metal stent (BMS)+BMS (B+B, n=7)}. Endothelial function was evaluated by the acetylcholine provocation test during follow-up angiography. Histopathological changes in proximal, overlapped, and distal stented segments were evaluated. RESULTS: Although the overall angiographic outcomes were comparable, late loss (mm) in the distal stented segment was higher in the B+B (0.39+/-0.07) and C+T (0.40+/-0.20) than that in the T+C (0.06+/-0.02) group (p<0.001). The incidence of acetylcholine-induced spasm was higher in the DES groups compared with BMS, regardless of the implantation sequences (85.7% in C+T vs. 14.3% in B+B vs. 71.4% in T+C, p=0.017). Notably, only the distal Cypher implantation group (C+T) had three cases of stent fracture. A histopathological analysis showed that despite similar arterial injury scores, Taxus and Cypher stents had higher inflammatory reactions at the overlapped and distal segments compared with those of BMS. CONCLUSION: Despite similar arterial injury, higher inflammatory reactions were observed in overlapping DES segments regardless of the implantation sequence compared with that of BMS. Moreover, DES was associated with impaired endothelial function on the adjacent non-stented segments.
Acetylcholine
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Angiography
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Drug-Eluting Stents
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Endothelium
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Follow-Up Studies
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Iliac Artery
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Incidence
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Rabbits
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Spasm
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Stents
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Taxus
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Vasoconstriction