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Lim ET, Stylianides N, Craciunas L, Tsampras N. Vaginal vault dehiscence with small bowel evisceration, bowel necrosis, and intra-abdominal haemorrhage: a case report. J Surg Case Rep 2024; 2024:rjae191. [PMID: 38572288 PMCID: PMC10987206 DOI: 10.1093/jscr/rjae191] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
Vaginal vault dehiscence with evisceration is a rare but a potentially life-threatening complication of total hysterectomy that requires prompt recognition, diagnosis, and management. The overall incidence of vaginal vault dehiscence is 0.53%. The mortality rate increases to 5.6% when bowel evisceration is present. We report a case of vaginal vault dehiscence with small bowel evisceration complicated by bowel necrosis and intra-abdominal haemorrhage in a 48-year-old woman following her first sexual intercourse 4 months after her total abdominal hysterectomy.
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Affiliation(s)
- Ee Thong Lim
- Department of Gynaecology, Manchester University NHS Foundation Trust, Oxford Rd, Manchester M13 9WL, United Kingdom
| | - Nicholas Stylianides
- Department of General Surgery, Manchester University NHS Foundation Trust, Oxford Rd, Manchester M13 9WL, United Kingdom
| | - Laurentiu Craciunas
- Centre for Life, Newcastle Fertility Centre, Biomedicine West Wing, International Centre for Life, Times Square, Newcastle upon Tyne NE1 4EP, United Kingdom
| | - Nikolaos Tsampras
- Developmental Biology and Medicine, School of Medical Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
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2
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Fuentes KJ, Arechavala Lopez SF, Fuentes I, Leal Hidalgo J, Martínez Zarate JJ. Atraumatic Spontaneous Transvaginal Small Bowel Evisceration: A Rare Surgical Emergency. Cureus 2024; 16:e56564. [PMID: 38646353 PMCID: PMC11029815 DOI: 10.7759/cureus.56564] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Abdominal pain ranks as the predominant cause for emergency department consultations. Although rare, transvaginal evisceration of the small intestine necessitates immediate surgical intervention due to its potential to induce intestinal ischemia and peritonitis. Key risk factors include postmenopausal status, a history of gynecologic surgery, and heightened abdominal pressure. Clinical presentation typically involves pain and protrusion of intestinal contents or even abdominal viscera. Diagnosis relies on thorough clinical assessment, and treatment strategies should be tailored to each patient. Here, we describe the case of a 65-year-old female patient with a non-traumatic evisceration of the ileum, who had undergone total abdominal hysterectomy following anterior colpocele a year ago, subsequently necessitating exploratory laparotomy and repair of the vaginal ampulla.
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Garrido-Hermosilla AM, Girón-Ortega M, Díaz-Ruiz MC. Evisceration of a globe with large scleromalacia and uveal prolapse after vegetal chemical burn. Orbit 2023; 42:659-660. [PMID: 34629035 DOI: 10.1080/01676830.2021.1982993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Antonio Manuel Garrido-Hermosilla
- Oculoplastics-Orbit & Ocular Oncology Units, Department of Ophthalmology, Virgen Macarena University Hospital, Seville, Spain
- RETICS OftaRed, Institute of Health Carlos III, Madrid, Spain
| | - Marina Girón-Ortega
- Department of Ophthalmology, Virgen Macarena University Hospital, Seville, Spain
| | - María Concepción Díaz-Ruiz
- Oculoplastics-Orbit & Ocular Oncology Units, Department of Ophthalmology, Virgen Macarena University Hospital, Seville, Spain
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4
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Abis P, Madeddu C, Magro Malosso G, Sole G, Mereu A, Locci G, Macciò A. Complicated enterocele: timely resolution with bowel resection via a vaginal approach: case report. Front Surg 2023; 10:1228981. [PMID: 37520150 PMCID: PMC10372482 DOI: 10.3389/fsurg.2023.1228981] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Enterocele is an uncommon, serious condition that requires accurate and early diagnosis to prevent complications such as intestinal obstruction, incarceration, and strangulation, with consequent intestinal ischemia, necrosis, and evisceration. We report a rare case of a patient with a voluminous enterocele and initial signs of intestinal ischemia who underwent urgent vaginal surgery. Case description An 80-year-old woman presented with a voluminous mass protruding from the vagina, associated abdominopelvic pain, a 10-day history of bowel sub-occlusion, and numerous episodes of profuse vaginal bleeding. She was diagnosed with an enterocele with early signs of complications. Owing to her advanced clinical condition and comorbidities, we opted for an urgent vaginal procedure. Intestinal loops with initial signs of ischemia were resected via a transvaginal approach, leading to good clinical outcomes. She was discharged on postoperative day 5. Conclusions This rare case highlights a surgical emergency that was managed with transvaginal resection of the intestine. Early identification of the initial signs of complications allowed for this less invasive approach, resulting in reduced morbidity and length of hospital stay.
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Affiliation(s)
- Paola Abis
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Gabriele Sole
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Alessia Mereu
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giorgia Locci
- Unit of Anatomic Pathology, ARNAS G. Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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5
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Thomas R, Grover A. Foam Sclerotherapy for Conjunctival Inclusion Cyst Post Evisceration. Cureus 2023; 15:e41570. [PMID: 37554591 PMCID: PMC10406155 DOI: 10.7759/cureus.41570] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2023] [Indexed: 08/10/2023] Open
Abstract
Orbital conjunctival epithelial cysts have traditionally been excised, with the risk of leaving behind remnants that may result in recurrences. We present an 18-year-old male who complained of a poorly retained prosthesis three years after a primary evisceration and polymethylmethacrylate (PMMA) ball implant. We performed cyst aspiration and injection foam sclerotherapy for the cyst, which resolved completely in six weeks, allowing the prosthesis to be retained comfortably. Aspiration and injection of sclerosing agents may result in the collapse of the cyst along with fibrosis of their walls with obliteration of the lumen, resulting in complete resolution.
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Affiliation(s)
| | - Ashok Grover
- Ophthalmology, Sir Ganga Ram Hospital, New Delhi, IND
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Jaime Moens B, Buonomo A, De Sutter P. Vaginal Cuff Dehiscence: Two Case Reports and a Review of the Literature. J Clin Med 2023; 12:4187. [PMID: 37445221 DOI: 10.3390/jcm12134187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
Vaginal cuff dehiscence (VCD) is a rare but serious condition associated with high morbidity, especially in the presence of an evisceration. It usually occurs as a complication of hysterectomy, but has also been reported after other pelvic surgeries. In this article, we will present two cases of vaginal cuff dehiscence with evisceration in post-menopausal patients. Both cases occurred post-operatively, the first after a laparoscopic radical hysterectomy and the other after a trachelectomy performed by robotic-assisted laparoscopy (with a prior history of subtotal hysterectomy). Both cases were treated surgically, the first by a combined laparoscopic and vaginal approach, and the second case only by laparoscopic approach. The main risk and protective factors are discussed in a narrative literature review which summarizes the available evidence on this rare condition, discussed by type of study designs and thus evidence level. A laparoscopic vaginal cuff closure is the most protective factor in preventing VCD, compared to a vaginal closure. Clinicians should be aware of this condition and of its risk factors and precipitating events in order to identify high-risk patients. Knowledge of these allows prompt recognition, which is crucial for adequate management, for which multiple approaches have been described.
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Affiliation(s)
- Babette Jaime Moens
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Antonino Buonomo
- Department of Gynaecology, Centre Hospitalier Universitaire Tivoli, Avenue Max Buset 34, 7100 La Louviere, Belgium
| | - Philippe De Sutter
- Department of Gynaecology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
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Chopra A, Rothstein A, Mohamed Ahmed A, Pannell S. Small Bowel Evisceration Through a Perforated Stercoral Ulcer. Am Surg 2023; 89:2885-2887. [PMID: 35128955 DOI: 10.1177/00031348221075733] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Stercoral ulcers are localized areas of loss of colonic mucosal integrity. They result from pressure necrosis of the colonic mucosa, secondary to chronic constipation and fecal inspissation. These ulcers are rare and, are associated with serious complications, including bleeding and perforation. We present the case of a 50-year-old woman who presented with small bowel evisceration through the anal canal secondary to extraperitoneal perforation of the rectum. The patient underwent emergent exploratory laparotomy with reduction of the bowel, followed by second look laparotomy in 24 hours. A full thickness defect in the rectum was identified and Hartmann's procedure was performed. The patient's postoperative course was uneventful. Extraperitoneal perforation and evisceration of bowel is a rare clinical entity. These cases are diagnosed early due to the obvious clinical presentation and however may be misdiagnosed as prolapse. They necessitate urgent and careful surgical planning, to ensure preservation of bowel and complete recovery.
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Affiliation(s)
- Asmita Chopra
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Anna Rothstein
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Amin Mohamed Ahmed
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
| | - Stephanie Pannell
- Department of Surgery, University of Toledo Medical Centre, Toledo, OH, USA
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8
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Parra-Tanoux D, Dussan-Vargas MP, Escandon MG. Painful-blind eye: A forgotten palliative care. Indian J Ophthalmol 2023; 71:2399-2408. [PMID: 37322649 PMCID: PMC10417970 DOI: 10.4103/ijo.ijo_3063_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 06/17/2023] Open
Abstract
Painful-blind eye (PBE) is a challenging and debilitating condition that greatly affects the quality of life of patients. Although PBE can result from a variety of etiologies, currently there is no guideline or consensus on how to approach therapeutically these patients, and most treatments are experience-based. We summarized the evidence from available studies to investigate the current state of PBE treatment strategies. This review revealed that the information available about therapeutic approaches in patients with PBE is insufficient and outdated, therefore, new experimental and larger studies are needed to reach an agreement about this condition.
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Affiliation(s)
- Daniela Parra-Tanoux
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Maria P Dussan-Vargas
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | - Martha Gonzalez Escandon
- Ophthalmology Department, Medicine School, Universidad de la Sabana, Chía, Cundinamarca, Colombia
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Xuan R, Hong SC, Trinh T, Coroneo MT, Petsoglou C. Case Series of Rare Fungal Keratitides: Experiences from a Quaternary Eye Hospital in Sydney, Australia. J Fungi (Basel) 2023; 9:jof9050589. [PMID: 37233300 DOI: 10.3390/jof9050589] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 05/27/2023] Open
Abstract
The present article reports on the management of six different and rare cases of fungal keratitides, two of which have never been documented in previous literature. This is a case series of six patients with rare fungal keratitides managed at a quaternary eye referral unit, Sydney Eye Hospital, Australia over a period of 7 months (May to December, 2022). The order of occurrence of fungi isolated was Scedosporium apiospermum, Lomenstospora prolificans, Cladosporium spp., Paecilomyces, Syncephalastrum racemosum and Quambalaria spp. A combination of medical and surgical interventions was employed, including topical and systemic anti-fungal therapy, with one requiring therapeutic penetrating keratoplasty and another eventuating in evisceration. Two patients were successfully treated with corneal debridement and two others required pars plana vitrectomy with anterior chamber washout. It is important to remain vigilant with monitoring patient symptoms and correlating with clinical signs to guide antifungal therapy even in the context of confirmed culture and sensitivity results.
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Affiliation(s)
- Rachel Xuan
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
- Save Sight Institute, University of Sydney, Sydney, NSW 2000, Australia
| | - Sheng Chiong Hong
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Tanya Trinh
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
| | - Minas T Coroneo
- Department of Ophthalmology, Prince of Wales Hospital, Randwick, Sydney, NSW 2031, Australia
- School of Medicine, University of New South Wales, Kensington, Sydney, NSW 2033, Australia
| | - Constantinos Petsoglou
- Department of Ophthalmology, Sydney and Sydney Eye Hospital, Sydney, NSW 2000, Australia
- Save Sight Institute, University of Sydney, Sydney, NSW 2000, Australia
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10
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Uyanik I, Topcu H, Cabuk KS, Efe AC, Ulas MG. Treatment of tissue necrosis with hyperbaric oxygen therapy in a patient with pseudomonas endophthalmitis and orbital cellulitis: a case report. Rom J Ophthalmol 2023; 67:191-194. [PMID: 37522028 PMCID: PMC10385712 DOI: 10.22336/rjo.2023.33] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2023] [Indexed: 08/01/2023] Open
Abstract
Purpose: This report presents the treatment of tissue necrosis after evisceration with hyperbaric oxygen therapy (HBOT) in a patient with pseudomonas endophthalmitis and orbital cellulitis. Methods: A 49-year-old woman was admitted to our clinic with severe pain and vision loss after cataract surgery 3 days before, and pars plana vitrectomy 2 days before for endophthalmitis, in another hospital. Examination findings included limbal perforation, orbital cellulitis findings, and loss of light perception in the right eye. The patient, who received evisceration surgery and antibiotic treatment, showed loosening of the conjunctival sutures and necrosis in the conjunctiva, tenon, and sclera on the 9th postoperative day. The necrotic tissues were surgically debrided and the patient was referred to HBOT. Results: With HBOT and antibiotherapy, signs of inflammation regressed, healing on the conjunctival surface was accelerated, and prosthesis was suitable for use. Conclusions: Hyperbaric oxygen therapy is a treatment method that plays an active role in the healing of necrotic tissues by increasing the oxygenation and vascularization of the tissue.
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Affiliation(s)
- Ismail Uyanik
- University of Health Sciences, Istanbul, Turkey; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Husna Topcu
- University of Health Sciences, Istanbul, Turkey; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Kubra Serefoglu Cabuk
- University of Health Sciences, Istanbul, Turkey; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ayse Cetin Efe
- University of Health Sciences, Istanbul, Turkey; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Goksel Ulas
- University of Health Sciences, Istanbul, Turkey; Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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11
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Svedberg K. Outcome of eviscerations and enucleations at a Swedish tertiary referral centre between 2008 and 2019: improved surgical management leading to reduced complication rate. Orbit 2023; 42:174-180. [PMID: 35611572 DOI: 10.1080/01676830.2022.2078844] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim of this study was to investigate the results of all eviscerations and enucleations performed at the Department of Ophthalmology, Sahlgrenska University Hospital, during 2008-2019 and to compare them with previously collected data from 1999 to 2007. METHODS This was a retrospective investigation using the medical records for all patients having had an evisceration or an enucleation at the Department of Ophthalmology, Sahlgrenska University Hospital, during the two defined periods of time. Main outcome measure was postoperative complications. RESULTS During 1999-2007, 181 surgeries were performed, 100 with implants, and 28/100 exposed implants and 9/100 removed implants were recorded during follow-up. During 2008-2019, 250 operations were performed with 158 implants, and there were 3/158 exposed implants and 2/158 extruded implants. Two ruptures of the surgical wound without implant exposure were noted, and one implant was exchanged. The reduction of exposed implants between the two periods was statistically significant (p < .001, Chi-square test). In enucleations, the use of one kind of porous polyethylene implant in the recent study period replaced a multitude of implants in the earlier study period. In eviscerations, the major change between the two study periods was the introduction of the split sclera technique and smaller implant size. CONCLUSION The change in surgical technique between the two periods led to a significant reduction in implant-related complications.
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Affiliation(s)
- Karin Svedberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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12
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Mickevicius T, Holtmann C, Draganov J, Prues-Hoelscher J, Geerling G, Borrelli M. Lagophthalmos-induced corneal perforation in a patient with congenital erythropoietic porphyria. Orbit 2023:1-7. [PMID: 36734461 DOI: 10.1080/01676830.2023.2169718] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 01/12/2023] [Indexed: 06/18/2023]
Abstract
Congenital erythropoietic porphyria (CEP) is a rare autosomal recessive disorder in which the activity of uroporphyrinogen III synthase (UROS) is decreased. This results in the accumulation of photoreactive porphyrinogens, primarily in the skin and bone marrow. We describe a case of a patient with CEP who initially presented with scarring and shortening of the anterior and posterior lid lamella, which led to the development of lagophthalmos. Vascularized hyperkeratotic plaques in both corneas were also present. Despite treatment with topical ocular surface lubricants, corneal perforation with iris and uvea prolapse developed and evisceration of the right eye under local anesthesia was performed. The presented case suggests that despite topical therapy, ocular complications may exacerbate requiring surgical intervention, especially in the presence of lagophthalmos.
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Affiliation(s)
- Tomas Mickevicius
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Christoph Holtmann
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Jutta Draganov
- Department of Anesthesiology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | | | - Gerd Geerling
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
| | - Maria Borrelli
- Department of Ophthalmology, University Hospital of Düsseldorf, Düsseldorf, Germany
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Shivanna Y, Gorimanipalli B, Sanjay S. Every eye needs a best chance to see: Just give it. Indian J Ophthalmol 2023; 71:673. [PMID: 36727390 DOI: 10.4103/ijo.ijo_2053_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background Anterior staphyloma is defined as a localized defect in the anterior eye wall with protrusion of the uveal tissue due to alterations in scleral thickness and structure. The causes could be congenital, trauma, or following infection. Surgical options include staphylectomy with graft (corneal/corneoscleral), biosynthetic graft, enucleation or evisceration in a painful blind eye). Purpose To demonstrate staphylectomy with careful preservation of ocular structures followed by optical keratoplasty in a single setting. Synopsis A 39-year-old Asian Indian lady presented with complaints of blurring of vision and whitish opacity in both eyes since childhood, associated with progressive enlargement and protrusion of the black part of the left eye with severe pain at the time of presentation. Her clinical examination revealed leucomatous corneal opacity in both the eyes and anterior staphyloma and keratinization in the left eye. Visual acuity was counting fingers close to face in the right eye and hand movements close to face in the left eye with projection of rays being accurate in both eyes. Ultrasound B scan showed posterior staphyloma in the right eye with sub-Tenon's fluid and increased retinochoroidal thickness. The left eye posterior segment with B scan was normal. The available surgical options were evisceration with secondary orbital implant and ocular prosthesis or staphylectomy with corneal transplantation. To provide the best option for the patient in her eye with better visual potential, staphylectomy with corneal transplantation was done. Highlights Painful blind eye is usually dealt with evisceration. This video demonstrates the technique of staphylectomy with corneal graft and restoration of structural integrity. Evisceration is a destructive procedure that involves removal of the intraocular contents. The patient will have to deal with the hassles of prosthesis maintenance and stigma of the artificial eye. Video link https://youtu.be/VoS8Irsh1yY.
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Affiliation(s)
- Yathish Shivanna
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Bhavya Gorimanipalli
- Department of Cornea and Refractive Services, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Srinivasan Sanjay
- Uveitis and Ocular Immunology, Narayana Nethralaya, Bangalore, Karnataka, India
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14
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Filatova IA, Mokhammad IM, Shemetov SA, Kondratyeva UP, Balatskaya NV, Denisyuk VO. [Immunomorphological aspects of post-traumatic subatrophy of the eyeball]. Vestn Oftalmol 2023; 139:26-34. [PMID: 37638569 DOI: 10.17116/oftalma202313904126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
PURPOSE The study attempts to characterize immunomorphological disorders at different degrees of post-traumatic subatrophy of the eyeball. MATERIAL AND METHODS The study included 123 patients with blind and unpromising eyes, eyeball subatrophy of various degrees, who were divided into three groups (1, 2 and 3) depending on the degree of eyeball subatrophy. RESULTS The greatest risk of autoimmune inflammation was observed in patients with degree I subatrophy. Contusion injury of the eye was proven to not exclude the course of post-traumatic autoimmune uveitis. The development of post-traumatic subatrophic process is associated with activation of systemic organ-specific immunity, shift of balance in main regulatory subpopulations. CONCLUSION The study showed that the most severe clinical course of chronic post-traumatic uveitis is observed in patients as a result of penetrating trauma to the eyeball. The contusion nature of such ocular injury does not exclude the development of autoimmune inflammation.
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Affiliation(s)
- I A Filatova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - I M Mokhammad
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - S A Shemetov
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - U P Kondratyeva
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - N V Balatskaya
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - V O Denisyuk
- AO Meditsina (Clinic of Academician Roitberg), Moscow, Russia
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Abstract
PURPOSE Describe presumed microbial keratitis cases resulting in evisceration/enucleation from 2012 to 2016 in Sydney, Australia. METHODS A retrospective case review included 33 patients. Cases were identified from pathology and hospital coding data. Sociodemographic and clinical details were collated. RESULTS Mean age was 79 years (range: 38-100 years), and 64% female. There were 30 eviscerations and 3 enucleations, at a median time of 8 days (range: 1-270 days) due to endophthalmitis (n = 15, 45%). Major ocular associated factors included topical corticosteroid use in 12 patients (36%), exposure keratopathy in 4 (12%), ectropion in 3 (9%), degenerative corneal disease in 3 (9%), and corneal graft in 2 (6%). Pseudomonas aeruginosa was the most common isolate with no reports of antimicrobial resistance. CONCLUSIONS Educating elderly patients with a history of topical corticosteroid use, corneal or ocular surface disease about prompt hospital presentation and treatment of microbial keratitis may decrease the probability of losing the eye.
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Affiliation(s)
- Maria Cabrera-Aguas
- Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Save Sight Institute, Sydney, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, Australia
| | - Pauline Khoo
- Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Save Sight Institute, Sydney, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, Australia
| | - Stephanie L Watson
- Discipline of Ophthalmology, Faculty of Medicine and Health, The University of Sydney, Save Sight Institute, Sydney, Australia.,Corneal Unit, Sydney Eye Hospital, Sydney, Australia
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Zhou H, Zhu C, Chen K, Zheng X. The effects of hydroxyapatite implantation with the autogenous sclera cap: A cohort study. Medicine (Baltimore) 2022; 101:e29519. [PMID: 35905211 PMCID: PMC9333501 DOI: 10.1097/md.0000000000029519] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We performed a novel hydroxyapatite (HA) prosthesis implantation method in which an HA implant was implanted into the scleral shell with an autogenous scleral cap. Twenty-six patients who had undergone the novel HA prosthesis implantation method and 32 patients who had undergone traditional HA prosthesis implantation were retrospectively reviewed. The postoperative activity of the artificial eye was measured by the Hirschberg test combined with arc perimetry. The visual analog score (VAS) was used to evaluate 2-month postoperative pain and 2-month postoperative discomfort. HA implant vascularization was measured with enhanced magnetic resonance imaging (MRI) 2 and 6 months after the operation. The enhancement volume (VE) and the volume of the HA implant (VHA) were measured. All cases were followed up for 2 years. Measurement data were processed using SAS 6.12. There was a statistically significant difference (P = .016) between the percentages of excellent grade in the two groups. Two months after implantation, the median pain scores of the study and control groups were 2 and 2.5, respectively, and there was a statistically significant difference (W = 585.0, P = .004); there was a statistically significant difference (W = 535.5, P = .000) between the median discomfort scores of the study group (score = 1) and control group (score = 2); the mean VE/VHA values of the study and control groups were 0.3075 and 0.1535, respectively, and there was a statistically significant difference (t = -8.196, P = .000). Six months after implantation, the VE/VHA values of the study and control groups were 0.9686 and 0.5934, respectively, and there was a statistically significant difference (W = 549.0, P = .000). Within 2 years of postoperative follow-up, there were no serious complications in the study group. In the study group, in which the hydroxyapatite implant was implanted into a preserved scleral shell with unaltered muscles and covered with an autogenous scleral cap, postoperative activity and the fibrovascularization of the HA implant were significantly increased, and postoperative pain and discomfort were significantly reduced.
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Affiliation(s)
- Hongwei Zhou
- Department of Ophthalmology, Lianshui County People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Chongyan Zhu
- Department of Ophthalmology, Lianshui County People’s Hospital, Nanjing Medical University, Huai’an, China
- *Correspondence: Chongyan Zhu, Department of Ophthalmology, Lianshui County People’s Hospital, 6# Hongri Road, Lianshui, Huai’an, Jiangsu 223400, China (e-mail: )
| | - Kai Chen
- Department of Ophthalmology, Lianshui County People’s Hospital, Nanjing Medical University, Huai’an, China
| | - Xiang Zheng
- Department of Ophthalmology, Lianshui County People’s Hospital, Nanjing Medical University, Huai’an, China
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Tianthong W, Aryasit O. Outcomes of evisceration or enucleation by resident trainees in patients with recalcitrant endophthalmitis or panophthalmitis. Medicine (Baltimore) 2022; 101:e29932. [PMID: 35905216 PMCID: PMC9333489 DOI: 10.1097/md.0000000000029932] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
To evaluate the surgical outcomes and complications of evisceration or enucleation with primary implantation, performed by ophthalmology resident trainees, in regards to patients with recalcitrant endophthalmitis or panophthalmitis. We also compared the surgical outcomes and complications between resident trainees and experienced staff. In this retrospective analysis, the clinical records of all patients diagnosed with endophthalmitis or panophthalmitis who underwent enucleation or evisceration with primary implantation over a 13-year period were reviewed. The factors predicting implant exposure or extrusion in regards to patients who underwent eye removal by trainees were identified using multivariate analysis. The percentages of successful prosthesis fittings and complications were also reported. Sixty-six patient records, median age of 46.8 years, who underwent eye removal by resident trainees were reviewed. Thirty-six (55%) out of 66 patients were diagnosed with panophthalmitis. Four patients (6%) had implant exposure, and 4 patients (6%) had implant extrusion. Multivariate analysis demonstrated that Pseudomonas aeruginosa infection (P = .02, adjusted odd ratio [aOR] = 33.75) and not receiving intravitreal antimicrobial drugs before the eye removal procedure (P = .02, aOR = 30.11) were associated with implant exposure or extrusion. Patients with panophthalmitis who underwent evisceration had a higher rate of implant exposure or extrusion than those who underwent enucleation (P = .03, aOR 38.38). At the last visit, 65 patients had a successful prosthesis fitting. Furthermore, there were similar rates of complications and successful prosthesis fittings between experienced staff and resident trainees. This study suggests that evisceration or enucleation with primary implant placement in patients with recalcitrant endophthalmitis or panophthalmitis can be performed by resident trainees with acceptable surgical outcomes and a low rate of serious complications.
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Affiliation(s)
- Wannaporn Tianthong
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Orapan Aryasit
- Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- *Correspondence: Orapan Aryasit, Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand (e-mail: )
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18
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Ahmad M, Parikh R, Akhlaq A, Pradeep T, Breazzano MP, Fu R. Risk factors for enucleation or evisceration in endophthalmitis. Orbit 2022; 42:279-289. [PMID: 35855625 DOI: 10.1080/01676830.2022.2097699] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To identify clinical risk factors for enucleation or evisceration in patients with endophthalmitis at an academic institution. METHODS A retrospective review of patients diagnosed with endophthalmitis at Wilmer Eye Institute from 2010 to 2019 was conducted. Clinical characteristics, including demographics, cause for endophthalmitis, microbial culture results, salvaging procedures and surgical intervention were recorded. In patients who underwent enucleation or evisceration, type of surgery and placement of a primary implant were recorded. Chi-squared, Student's t-tests and multivariate analysis were used to identify clinical factors that predicted enucleation or evisceration. RESULTS Two hundred and fifty three patients treated for endophthalmitis over the study period were identified, of which 25 (9.88%) underwent enucleation or evisceration. Risk factors for enucleation or evisceration included poor presenting visual acuity (OR 7.86, CI: 2.26, 27.3), high presenting intraocular pressure (OR 1.07, CI: 1.03, 1.12), presence of relative afferent pupillary defect (OR 3.69, CI: 1.20, 11.37) and positive vitreous culture for methicillin-resistant staphylococcus aureus (MRSA) (OR 18.3, CI: 1.54, 219.2) on multivariate analysis. Patients undergoing enucleation or evisceration were also more likely to have trauma, corneal ulcer or combined causes for endophthalmitis and underwent fewer salvaging surgical and procedural interventions. There were no significant differences in characteristics of those receiving enucleation versus evisceration in our cohort. CONCLUSION Patients with endophthalmitis who underwent enucleation or evisceration had more severe disease on presentation compared to those treated with eye sparing therapy. Presenting clinical characteristics may have a role in triage and management decisions for patients presenting with severe endophthalmitis.
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Affiliation(s)
- Meleha Ahmad
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA.,Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma USA
| | - Rupin Parikh
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA.,Dean McGee Eye Institute, University of Oklahoma, Oklahoma City, Oklahoma USA
| | - Anam Akhlaq
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA
| | - Tejus Pradeep
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA
| | - Mark P Breazzano
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA.,Retina-Vitreous Surgeons of Central New York, Liverpool, New York, USA.,Department of Ophthalmology and Visual Sciences, State University of New York Upstate Medical University, Syracuse, New York, USA
| | - Roxana Fu
- Department of Ophthalmology, University of California at San Francisco, San Francisco, California, USA.,Department of Ophthalmology, The University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Azad F, Schiff J, Macias R, O'Toole T, Cheung VWF. Live Donation of Corneal Tissue in the Setting of Orbital Exenteration for Malignancy. Eplasty 2022; 22:e17. [PMID: 35873070 PMCID: PMC9275411] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background. The availability of corneal tissue is a major limiting factor in utilizing keratoplasty for correction of corneal blindness. Viable corneal tissue is typically difficult to obtain as posthumous donation is required to avoid significant morbidity and loss of vision in live patients. As a result, the possibility of obtaining viable corneal tissue from a living donor is rarely discussed. This report describes a case in which corneal donation was completed in a living patient undergoing exenteration for invasive squamous cell carcinoma of the maxillary sinus. Performing corneal donation in similar patients in the future should be considered by head and neck surgeons as an opportunity to increase the availability of corneal tissue.
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Affiliation(s)
- Fereshteh Azad
- Kresge Eye Institute, MI
- Spectrum Health, Grand Rapids, MI
| | - Jonathan Schiff
- Michigan State University College of Human Medicine, Grand Rapids, MI
| | - Rachel Macias
- Spectrum Health Plastic Surgery Residency, Grand Rapids, MI
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20
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Lugo Merly AN, Montalvo Toledo LA, Requejo GA, Meléndez A, Álvarez S, López A, Ríos R, Villegas VM, Oliver AL. Risk Factors Leading to Enucleation or Evisceration in Infectious Endophthalmitis. J Clin Med 2022; 11:3145. [PMID: 35683532 DOI: 10.3390/jcm11113145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
Endophthalmitis treatment consists of intravitreal antibiotics injections and, in selected circumstances, pars plana vitrectomy. However, severe or refractory cases may require an enucleation or evisceration (ENEV). Our study seeks to identify risk factors leading to enucleation or evisceration in patients with infectious endophthalmitis. A retrospective chart review of subjects with a clinical diagnosis of infectious endophthalmitis was undertaken. The affected eyes were stratified into groups: those that underwent ENEV and those in which the eyeball was preserved (EP). The groups were compared using statistical analyses. In total, 69 eyes diagnosed with infectious endophthalmitis were included in the study. There was a higher frequency of exogenous infectious endophthalmitis in the ENEV group versus the EP group. Postsurgical infectious endophthalmitis was lower in the ENEV than in the EP group. A visual acuity of no light perception was more common in the ENEV compared to the EP group. Panophthalmitis was more frequent in the ENEV versus the EP group. Our findings suggest that eyes with endophthalmitis presenting with a visual acuity of no light perception, panophthalmitis, or exogenous etiology have a higher risk of requiring ENEV. In addition, eyes with a postsurgical etiology may be at a lower risk of requiring ENEV.
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21
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Eisapour M, Salamat N, Salari MA, Bahabadi MN, Salati AP. Post-autotomy regeneration of respiratory tree in sea cucumber Holothuria parva. J Exp Zool B Mol Dev Evol 2022; 338:155-169. [PMID: 34813182 DOI: 10.1002/jez.b.23109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 10/24/2021] [Accepted: 11/10/2021] [Indexed: 11/07/2022]
Abstract
The respiratory trees present only in the class Holothuroidea and the rest of the echinoderms lack it. Only some holothurian species have the ability to regenerate their respiratory trees after autotomy. Therefore, respiratory trees could be considered as a suitable model to assess the regeneration mechanisms in animals. In the present study, the respiratory tree regeneration after posterior evisceration were examined in Holothuria parva during 75 days. Since autotomy reduces antioxidant defense in the organisms, in the present study alterations of antioxidant enzymes were also evaluated during the experiment. H. parva is the dominant intertidal species distributed in the north of the Persian Gulf. In the present study, H. parva ejected the left respiratory tree, the digestive tract and supportive mesenteries from the anus, about 1-2 min after potassium chloride injection. The closure of the opening at the posterior ends of the body was the first reaction to the injury. Seven days after evisceration, the small bud formed on the dorsal side of the cloaca which was covered with the coelomic epithelium of cloaca. The coelomic epithelium started to proliferate to undifferentiated cells on the apex of the buds. The primary respiratory tree consisted of the luminal cuboidal epithelium and thin connective tissue surrounded by the slender coelomic epithelium. This preliminary organ was observed at the apex of the buds, 13 days after evisceration. Gradually, myoepithelial cells arranged around a longitudinal axis and formed a circular muscle. The primitive branches of primary respiratory tree started to form 18 days after evisceration. Forty days after evisceration, the luminal epithelium of the respiratory tree had the same appearance as the intact luminal epithelium. The regenerated respiratory tree was histomorphologically very similar to an intact respiratory tree 56 days postevisceration, but unlike that, it was not yet wrapped around the intestine and was completely separate from it. Despite the development of the regenerating respiratory tree, no wrapping around the intestine was observed until the end of the experiment. According to the results, the activity of the catalase (CAT) and superoxide dismutase (SOD) in the muscle homogenate was significantly higher than the control 5 days after evisceration. The CAT and SOD levels gradually decreased in eviscerated animals. The lipid peroxidation level followed a decreasing trend in the eviscerated animals during the experiment. However, its value reduced to the control level at the end of the experiment.
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Affiliation(s)
- Mina Eisapour
- Department of Marine Biology, Faculty of Marine Sciences, Khorramshahr University of Marine Science and Technology, Khorramshahr, Iran
| | - Negin Salamat
- Department of Marine Biology, Faculty of Marine Sciences, Khorramshahr University of Marine Science and Technology, Khorramshahr, Iran
| | - Mohammad Ali Salari
- Department of Marine Biology, Faculty of Marine Sciences, Khorramshahr University of Marine Science and Technology, Khorramshahr, Iran
| | - Mahmoud Nafisi Bahabadi
- Department of Fisheries and Biology, Persian Gulf Research Institute, Persian Gulf University, Bushehr, Iran
| | - Amir Parviz Salati
- Department of Fisheries, Faculty of Marine Natural Resources, Khorramshahr University of Marine Science and Technology, Khorramshahr, Iran
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22
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Trenkić M, Babić GS, Randelović M, Krstić M, Radenković M, Tasić-Otašević S. A case of mycotic keratitis due to Fusarium sp. with an undesirable outcome. J Infect Dev Ctries 2022; 16:729-732. [PMID: 35544638 DOI: 10.3855/jidc.15824] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/30/2021] [Indexed: 10/31/2022] Open
Abstract
Fungal keratitis, an infective disease of the cornea, represents a serious diagnostic and therapeutic problem that, if not recognized on time, could lead to irreversible eye damage. Herein we report a case of fungal keratitis due to Fusarium spp. infection. The 60-year-old man was admitted to our clinic due to an atraumatic acute onset of the disease, with a decrease in the visual acuity, photophobia, redness, and severe pain in the right eye. Clinical observation revealed an ulcer that affected 1/3 of the cornea and a hypopion in the anterior chamber. After the first results of microbiological analyzes, local and systemic antifungal therapy was applied. Due to the fact that the patient voluntarily left the treatment, there was a drastic worsening of the local findings as a full thickness total corneal infiltrate with more intense anterior chamber reaction. Finally, evisceration was performed. Given the fact that fungal keratitis is more prevalent in developing countries, official protocols and available effective antifungals are crucial for adequate treatment and a favorable outcome of this infection.
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Affiliation(s)
- Marija Trenkić
- Department of Ophthalmology, Faculty of Medicine, University of Niš, Serbia
| | | | - Marina Randelović
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia
| | - Miljan Krstić
- Department of Pathology, Faculty of Medicine, University of Niš, Serbia
| | | | - Suzana Tasić-Otašević
- Department of Microbiology and Immunology, Faculty of Medicine, University of Niš, Serbia.
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23
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Byard RW. Major organ loss from post-mortem animal predation: Issues arising from emptied body cavities. Med Sci Law 2022; 62:60-63. [PMID: 34098787 DOI: 10.1177/00258024211020280] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The feeding of animals on bodies after death - so-called post-mortem animal predation - may complicate autopsy interpretations when there has been removal of significant amounts of skin and tissues. An extreme situation which sometimes arises is the complete evisceration and/or consumption of all major cavity organs. Search of autopsy files at Forensic Science South Australia was undertaken for examples of this phenomenon. Although such a finding at autopsy may suggest the actions of larger animals such as dogs or sharks, it may also occur when groups of smaller animals, such as cats, act in concert. Complete loss of organs may also occur if significant insect activity accompanies decomposition. Empty body cavities may therefore result from of a wide variety of animal activities involving a range of species in quite different environments. A significant problem once organs have been removed or consumed is in identifying or excluding natural diseases or injuries that may have played a role in the lethal episode.
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Affiliation(s)
- Roger W Byard
- Adelaide Medical School, The University of Adelaide and Forensic Science SA, Australia
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24
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Chai HX, Samsudin A, Jayaraman K, Chong MF. The Noxious Intruder of the Eye: Endogenous Klebsiella Panophthalmitis. Cureus 2021; 13:e18725. [PMID: 34790480 PMCID: PMC8585515 DOI: 10.7759/cureus.18725] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/05/2022] Open
Abstract
Endogenous Klebsiella pneumoniae panophthalmitis commonly affects those with compromised immunity. The occurrence of this infection in healthy individuals is rare. We describe the case of a healthy adult who presented with endogenous Klebsiella pneumoniae panophthalmitis from an asymptomatic liver abscess. A 64-year-old, previously healthy gentleman presented with rapidly progressive left eye periorbital swelling and blurring of vision. He had a low-grade fever three days prior to the development of ocular symptoms, but otherwise no other systemic complaints. Visual acuity was light perception in the left eye, and ocular motility was restricted in all directions of gaze. Ocular examination revealed proptosis, severe conjunctival chemosis, hazy cornea, and fibrin deposition in the anterior chamber. The posterior segment could not be visualized. Ultrasound of the hepatobiliary system revealed an abscess in the right lobe of his liver. His blood cultures grew Klebsiella pneumoniae. Despite being treated with high-dose intravenous antibiotics, his eye condition deteriorated. Evisceration was performed when he developed scleral melting and globe perforation. We highlight the importance of a high index of suspicion of endogenous Klebsiella panophthalmitis as it can be easily missed in healthy adults. Early diagnosis and prompt management are needed to prevent morbidity and mortality from this devastating infection.
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Affiliation(s)
- Huei Xian Chai
- Ophthalmology, University of Malaya Medical Centre, Selangor, MYS
| | - Amir Samsudin
- Ophthalmology, University of Malaya Medical Centre, Selangor, MYS
| | | | - Mei Fong Chong
- Ophthalmology, Hospital Raja Permaisuri Bainun, Ipoh, MYS
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25
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Dave TV, Das AV, Mohapatra S, Bansal O, Ganguly A. Outcomes and complications of evisceration with primary implant: an electronic medical record driven analytics of 1800 cases. Orbit 2021; 41:717-725. [PMID: 34783616 DOI: 10.1080/01676830.2021.1998915] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the surgical outcomes and implant complications in 1,800 patients undergoing evisceration with primary implant. METHODS An Electronic Medical Record-driven analysis of 1,800 patients undergoing evisceration with primary implant between 2013 and 2019. Implant sizing was performed intra-operatively to place the largest implant without tension on the wound closure. Outcome measures included implant complications, prosthesis measurements, and incidence of a good aesthetic outcome. Good outcome was defined as <2 mm enophthalmos and grade 1 or less superior sulcus deformity with a custom ocular prosthesis. RESULTS Eighteen hundred eyes of 1800 patients were included. The mean age at surgery was 36 ± 21 years (median 32 years). Implants used were poly(methyl methacrylate) (PMMA) in 1737 (97%) and porous polyethylene in 63 (3%) patients. Two-petal sclerotomy was performed in 1512 (88%) and four-petal sclerotomy in 165 (10%) patients. The mean diameter of the implant used was 19.35 ± 1.18 mm (median 20, range 10-22 mm). The implant extrusion rate was 3% (56) and implant displacement was seen in none. The mean prosthesis volume and thickness were 2.22 ± 0.67 ml (median 2, range 1-6.5 ml) and 6 ± 1 mm (median 6, range 2-9 mm). The mean difference in prosthesis projection on Hertel's exophthalmometer was 0.28 ± 1 mm (median 0, range 0-1 mm). Good outcome was observed in 93%. The mean follow-up period was 351 ± 386 days (median 194). CONCLUSION Evisceration with empirically selected primary orbital implant placement is associated with minimal implant complications and gives a good aesthetic outcome in 93% of the patients.
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Affiliation(s)
- Tarjani Vivek Dave
- Ophthalmic Plastic Surgery Service, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
| | - Sameer Mohapatra
- Ophthalmic Plastics, Orbit and Ocular Oncology, Mithu Tulsi Chanrai Campus, LV Prasad Eye Institute, Bhubaneswar, India
| | - Oshin Bansal
- Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology, GMR Varalakshmi Campus, LV Prasad Eye Institute, Visakhapatnam, India
| | - Anasua Ganguly
- Ophthalmic Plastic and Facial Aesthetic, Orbit and Ocular Oncology, Kode Venkatadri Chowdary Campus, LV Prasad Eye Institute, Vijayawada, India
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26
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Tze-Suen C, Chew-Ean T, Md Din N. Fungal Keratitis in a Tertiary Hospital in Malaysia. Cureus 2021; 13:e18389. [PMID: 34729270 PMCID: PMC8556526 DOI: 10.7759/cureus.18389] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2021] [Indexed: 11/29/2022] Open
Abstract
Background Fungal keratitis is one of the commonest causes of corneal blindness in developing countries including Malaysia. We aim to evaluate the sociodemographic background, clinical features, predisposing factors, laboratory findings, management, complications, and visual outcome of patients with fungal keratitis in a tertiary hospital in Malaysia. Methods A retrospective review of medical and microbiology records of all patients treated for corneal ulcer from 2015 to 2019 at Hospital Sultanah Bahiyah was performed. Sociodemography, predisposing risk factors, clinical characteristics, causative organisms, and final visual outcome were analyzed. Results We identified 103 patients with a diagnosis of fungal keratitis. The majority of the patients were of Malay ethnicity (85.4%) and male gender (81.6%), with an age range of 21 to 60 years (94.1%). Ocular trauma was the main predisposing factor in 82 (79.6%) patients. Poor visual improvement was observed in groups with ulcer more than 4mm (67.5%), presence of hypopyon (50.9%), and high intraocular pressure (75.0%) upon presentation. Fusarium spp. (19.4%) was the commonest fungus isolated followed by Aspergillus spp. (5.8%). All patients were prescribed either topical, oral, intracameral, or combined therapy, whereas 20 (19.4%) patients required surgical intervention, of which 16 (15.5%) underwent penetrating keratoplasty and three (2.9%) required evisceration. Conclusion The epidemiological, socioeconomic, and predisposing factors may facilitate timely diagnosis and prompt treatment to achieve a better visual outcome and minimize complications including corneal blindness.
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Affiliation(s)
- Chow Tze-Suen
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, MYS
| | - Tan Chew-Ean
- Department of Ophthalmology, Hospital Sultanah Bahiyah, Alor Setar, MYS
| | - Norshamsiah Md Din
- Department of Ophthalmology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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Yu Z, Xue Z, Liu C, Zhang A, Fu Q, Yang K, Zhang F, Ran L. Distinct microbiota assembly mechanisms revealed in different reconstruction stages during gut regeneration in the sea cucumber Apostichopus japonicus. Microbiologyopen 2021; 10:e1250. [PMID: 34964292 PMCID: PMC8608568 DOI: 10.1002/mbo3.1250] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022] Open
Abstract
Apostichopus japonicus is a useful model for studying organ regeneration, and the gut microbiota is important for host organ regeneration. However, the reconstruction process and the mechanisms of gut microbiota assembly during gut regeneration in sea cucumbers have not been well studied. In the present study, gut regeneration was induced (via evisceration) in A. japonicus, and gut immune responses and bacterial diversity were investigated to reveal gut microbiota assembly and its possible mechanisms during gut regeneration. The results revealed that bacterial community reconstruction involved two stages with distinct assembly mechanisms, where the reconstructed community was initiated from the bacterial consortium in the residual digestive tract and tended to form a novel microbiota in the later stage of reconstruction. Together, the results of immunoenzyme assays, community phylogenetic analysis, and source tracking suggested that the host deterministic process was stronger in the initial stage than in the later stage. The bacterial interactions that occurred were significantly different between the two stages. Positive interactions dominated in the initial stage, while more complex and competitive interactions developed in the later stage. Such a dynamic bacterial community could provide the host with energetic and immune benefits that promote gut regeneration and functional recovery. The results of the present study provide insights into the processes and mechanisms of gut microbiota assembly during intestinal regeneration that are valuable for understanding gut regeneration mechanisms mediated by the microbiota.
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Affiliation(s)
- Zichao Yu
- School of Laboratory Animal & Shandong Laboratory Animal CenterShandong First Medical University & Shandong Academy of Medical SciencesJinanChina
| | - Zhuang Xue
- Liaoning Key Laboratory of Marine Animal ImmunologyDalian Ocean UniversityDalianChina
| | - Chao Liu
- Liaoning Key Laboratory of Marine Animal ImmunologyDalian Ocean UniversityDalianChina
| | - Anguo Zhang
- National Marine Environmental Monitoring Center, Ministry of Ecology and EnvironmentDalianChina
| | - Qiang Fu
- Liaoning Key Laboratory of Marine Animal ImmunologyDalian Ocean UniversityDalianChina
| | - Kun Yang
- School of Laboratory Animal & Shandong Laboratory Animal CenterShandong First Medical University & Shandong Academy of Medical SciencesJinanChina
| | - Fang Zhang
- School of Laboratory Animal & Shandong Laboratory Animal CenterShandong First Medical University & Shandong Academy of Medical SciencesJinanChina
| | - Liyuan Ran
- School of Laboratory Animal & Shandong Laboratory Animal CenterShandong First Medical University & Shandong Academy of Medical SciencesJinanChina
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Almarzouki N, Alessa S, Raffa L. Clinical profile of patients with endophthalmitis: A 16- year retrospective, cross-sectional study at tertiary care hospital in Western Saudi Arabia. Niger J Clin Pract 2021; 24:1527-1530. [PMID: 34657020 DOI: 10.4103/njcp.njcp_514_20] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aim This study aimed to profile the clinical features and demographics of patients with endophthalmitis in a tertiary care center, Western region, Saudi Arabia. We used a retrospective cross-sectional case series at King Abdulaziz University Hospital. Materials and Methods Endophthalmitis was diagnosed in a total of 14 eyes of 14 patients treated in our hospital between 2002 and 2018. The patients' medical records were reviewed to gather demographic and clinical data. Results The mean age of patients was 52.8 ± 19.2 years, and 50% of patients were male. The majority of endophthalmitis cases were post-ophthalmic surgery (50%), 35.7% were of endogenous origin, 7.2% were associated with corneal ulcer with perforation, and 7.2% were post open globe injury. Patients' admission to the hospital ranged from 2 to 10 days from symptoms occurrence with a median of 5 days. Half of the patients presented with no light perception vision, counting fingers in 14.2%, hand motion in 14.2%, light perception in 7.2%, and 20/300 in 7.2%. The final visual outcome improved in four cases (28.5%) with best corrected visual acuity of 20/40 reached in one patient. Conclusion Post- ophthalmic surgery and endogenous endophthalmitis were the most common causes of endophthalmitis among our patients, with late presentation to the hospital and poor vision at presentation also being common findings. These findings highlight the necessity of proper patient education, after care and adherence to sterile techniques in ensuring that patients recover successfully from ophthalmic surgery.
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Affiliation(s)
- N Almarzouki
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - S Alessa
- King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
| | - L Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Abstract
Drain site eviscerations have been reported as a rare complication following abdominal surgery. An 82-year-old women was diagnosed with carcinoma stomach and underwent laparoscopic subtotal gastrectomy. A few hours following removal of the duodenal stump drain, she developed small bowel evisceration through the drain site. It was successfully managed with immediate bedside release of fascial constriction followed by definitive repair later. Although herniations and eviscerations via larger drain sites have been reported, eviscerations from small laparoscopic port sites used for drains are rare. Here, we report the first case of small bowel evisceration with strangulation through a 5-mm port site.
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Affiliation(s)
- Mathews James
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - G Senthil
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - R Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Stabile G, Mordeglia D, Romano F, Carlucci S, Mangino FP, Nappi L, Sorrentino F, De Manzini N, Ricci G. Postcoital Vaginal Perforation and Evisceration in Women with No Prior Pelvic Surgery: Laparoscopic Management and Systematic Review of the Literature. Int J Environ Res Public Health 2021; 18:9746. [PMID: 34574671 DOI: 10.3390/ijerph18189746] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/23/2022]
Abstract
Objective: to evaluate risk factors, causes, management and surgical therapy of postcoital vaginal perforation and evisceration in women with no prior pelvic surgery. Data sources: We used MEDLINE (PubMed), Scopus, Embase and Web of Science for our research. Our review includes all reports from 1980 to November 2020. The research strategy adopted included different combinations of the following terms: (intercourse) AND (coitus) AND (vaginal perforation). Methods of study selection: we report a case of vaginal evisceration after consensual intercourse in a young and healthy woman. In addition, we performed a systematic review of vaginal perforations with or without evisceration in women without prior surgery or any other predisposing disease. All studies identified were listed by citation, title, authors and abstract. Duplicates were identified by an independent manual screening, performed by one researcher and then removed. For the eligibility process, two authors independently screened the title and abstracts of all non-duplicated papers and excluded those not pertinent to the topic. Tabulation, integration and results: We have followed the PRISMA guidelines. Five manuscripts were detected through the references of the works that had been identified with the research on MEDLINE (PubMed), Scopus, Embase and Web of Science. We found 16 cases between 1980 and 2020. The young age and the virginal status represent the principal risk factors and all the lacerations occurred in the posterior vaginal fornix. The most common surgical technique was the laparotomic approach and, in the remaining cases, the laparoscopic and vaginal route was performed. Conclusions: Post-coital vaginal perforation and evisceration in women with no prior pelvic surgery is a rare condition in the clinical practice and, when it is associated with evisceration it is a surgical emergency. Usually, these injuries are not life-threatening conditions but, a delay in diagnosis, can lead to severe complications. In consideration of the high heterogeneity of the data in the literature, it is essential to define a diagnostic–therapeutic management for the patients with vaginal perforation. With our review, we try to identify the associated risk factors, the best and fastest diagnosis, and the best surgical approach. We believe that a combined vaginal and laparoscopic approach can be the best surgical treatment, useful to diagnose injuries of the abdominal organs and to improve postoperative outcome.
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Hann MJ, Mair TS, Gardner A, Mudge M, Southwood LL, Dechant JE, Barton MH, Garcia-Macias J, Parker RA, Hassel D, Archer DC. Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study. Equine Vet J 2021; 54:719-725. [PMID: 34418125 DOI: 10.1111/evj.13498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/09/2021] [Accepted: 08/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Incisional complications are a common cause of morbidity following laparotomy. Although uncommon, acute abdominal dehiscence (AAD) is a potentially fatal post-operative complication. However, few AAD cases are described in the literature. OBJECTIVES To describe common features of cases of AAD following ventral midline laparotomy, management and outcomes. STUDY DESIGN Retrospective case series. METHODS Hospital records of horses that underwent a ventral midline laparotomy at nine hospitals in the UK, Ireland and USA over a 10-year period (2009-2019) were reviewed. Data were collected for pre-, intra- and post-operative factors that were considered relevant. Descriptive statistical analysis was performed. RESULTS A total of 63 cases of AAD were identified. AAD occurred due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line in 46 horses (73%). AAD occurred at a median of 5 days (0.5-70 days) post-operatively and broodmares accounted for 25% of the cases (n = 16). Surgical site infection developed prior to AAD in 28 horses (44%); leakage of peritoneal fluid occurred in 5% of horses prior to AAD being identified. Surgical repair was performed in 27 horses (43%), 10 (16%) were treated conservatively and 26 (41%) were euthanised immediately. Repair was most frequently performed using suture (n = 14), wire (n = 5) or a combination (n = 5). Overall survival to hospital discharge was 39% (24/63). Where surgical repair was performed, 15 horses (56%) survived to hospital discharge; 9 horses (90%) managed conservatively survived to hospital discharge. MAIN LIMITATIONS Follow-up was not performed for all cases following hospital discharge and some data were incompletely recorded in hospital files. CONCLUSIONS Previously stated causative factors for AAD were not consistent features in the present study. Surgical site infection following laparotomy and pregnant or early post-partum mares may be important risk factors for AAD and warrant further investigation.
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Affiliation(s)
- Michelle J Hann
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, UK
| | - Tim S Mair
- Bell Equine Veterinary Clinic, Maidstone, UK
| | - Alison Gardner
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, Ohio, USA
| | - Margaret Mudge
- Department of Veterinary Clinical Sciences, Ohio State University, Columbus, Ohio, USA
| | - Louise L Southwood
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, Pennsylvania, USA
| | - Julie E Dechant
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Michelle H Barton
- University of Georgia College of Veterinary Medicine, Athens, Georgia, USA
| | | | | | - Diana Hassel
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Debbie C Archer
- Department of Equine Clinical Science, Institute of Veterinary Science, University of Liverpool, Leahurst Campus, Neston, UK
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Kim JM, Sung JY, Lim HB, Choi EJ, Lee SB. Risk Factors for Orbital Implant Extrusion after Evisceration. J Clin Med 2021; 10:3329. [PMID: 34362115 DOI: 10.3390/jcm10153329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/01/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
This study analyzed risk factors for extrusion of orbital implants after evisceration by comparing patients with and without implant extrusion. METHODS We retrospectively reviewed the medical records of patients who underwent evisceration with primary implant placement by a single surgeon from January 2005 to December 2019 at the Chungnam National University Hospital. Age, sex, underlying systemic diseases, axial length of the fellow eye, the cause of evisceration, endophthalmitis type, implant type and size, and preoperative computed tomography findings were evaluated. Logistic regression analysis was used to identify the risk factors for implant extrusion. RESULTS Of the 140 eyes of 140 patients, extrusion occurred in five eyes (3.6%). Endophthalmitis (odds ratio (OR), 15.49; 95% confidence interval (CI), 1.70 to 2038.56; p = 0.010), endogenous endophthalmitis (OR, 18.73; 95% CI, 3.22 to 125.21, p = 0.002), orbital cellulitis (OR, 320.54; 95% CI, 29.67 to 44801.64; p < 0.001), implant size (OR, 0.50; 95% CI, 0.30 to 0.79; p = 0.004), and hydroxyapatite for the implant (OR, 0.07; 95% CI, 0.00 to 0.66; p = 0.016) were risk factors for implant extrusion in univariate logistic regression analysis. Multiple logistic regression analysis identified orbital cellulitis as the only risk factor for extrusion (OR, 52.98; 95% CI, 2.18 to 15367.34; p = 0.009). CONCLUSIONS Evisceration with primary orbital implantation is a feasible option in endophthalmitis, but the risk of extrusion should be taken into consideration. When performing evisceration in a patient with orbital cellulitis, secondary implantation should be carried out only after any infection is controlled.
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Hassanin FF, Elkhamary S, Al Thaqib R, Strianese D. A Case of Escherichia coli Endogenous Panophthalmitis and Orbital Cellulitis With Normal Workup for Primary Focus. Cureus 2021; 13:e15103. [PMID: 34159011 PMCID: PMC8212906 DOI: 10.7759/cureus.15103] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We describe a case of a poorly controlled diabetic patient with left endogenous panophthalmitis with orbital cellulitis and positive ocular culture of Escherichia coli with negative systemic workup and rare clinical presentation. Was misdiagnosed and mismanaged as acute angle-closure glaucoma. Despite medical treatment with intravenous antibiotics, the patient required evisceration of the left eye as a result of the delay in diagnosis and treatment. A high index of suspicion for endogenous endophthalmitis and awareness of the proper workup and different clinical presentations is needed to avoid vision and life-threatening consequences.
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Affiliation(s)
- Fadi F Hassanin
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU.,College of Medicine, Jeddah University, Jeddah, SAU
| | | | - Rawan Al Thaqib
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | - Diego Strianese
- Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, SAU
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Tirakunwichcha S, Pongsachareonnont P. Factors Associated with Visual Outcome after Primary Repair of Open-Globe Injury by Ophthalmology Residents in Training in a Tertiary Eye Center. Clin Ophthalmol 2021; 15:1173-1181. [PMID: 33790529 PMCID: PMC8005269 DOI: 10.2147/opth.s300753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess factors associated with visual outcome after open-globe injury (OGI) repair by trainees. Methods In this observational study, charts of OGIs repaired by trainees at King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok were retrospectively reviewed. Preoperative, intraoperative, and postoperative outcomes (day 1, month 1, and month 6 postoperation) were analyzed. Results A total of 78 OGIs presented in a 10-year period. A biphasic pattern was found among the young and the elderly. Approximately 73.6% of the cases had had surgical repair outside office hours. A majority of cases had been caused by machinery and hammers, and had visual acuity (VA) <20/200. Three cases were reported as having been unsuccessful intraoperatively for globe repair. A fifth of the cases required evisceration/enucleation within 2 weeks of presentation. Presenting VA worse than hand motion was associated with the risk of evisceration/enucleation (OR 14.5, P=0.013). VA improved at 6 months postoperation to the range of counting fingers and 20/200 (OR 15.6, P<0.01). High ocular trauma scores (OTSs) was associated with lower risk of evisceration/enucleation, and 12% retinal detachment (RD) was discovered, of which 90% occurred within 1 month after OGI repair. Conclusion Most OGIs were efficiently managed by the trainees, seldomly requiring assistance from subspecialists. Poor initial VA was associated with high risk of visual loss, whereas higher OTSs were inversely related to lower risk of evisceration or enucleation. There was a higher percentage of participants with final VA of 20/100-20/20 than the preoperative period. Precaution and careful evaluation of RD in the early postoperative period is recommended.
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Affiliation(s)
- Suppapong Tirakunwichcha
- Ophthalmic Plastic and Reconstructive Surgery Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Pear Pongsachareonnont
- Vitreoretinal Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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Zeng H, Rasschaert G, De Zutter L, Mattheus W, De Reu K. Identification of the Source for Salmonella Contamination of Carcasses in a Large Pig Slaughterhouse. Pathogens 2021; 10:pathogens10010077. [PMID: 33477347 PMCID: PMC7831019 DOI: 10.3390/pathogens10010077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/16/2022] Open
Abstract
To identify the major source of Salmonella contamination in a pig slaughterhouse, samples were collected from the clean and unclean area and Salmonella isolates were further typed. Carcasses entering the clean area showed a Salmonella contamination rate of 96.7% in the oral cavity and 55.0% in the rectum content samples. Evisceration seemed not to be critical as the contamination rate of the carcasses was similar before (16.7%) and after (18.3%) this slaughter step. In the unclean area, a limited number of oral cavity samples were positive after bleeding, while a dramatic increase of positives was observed after dehairing. Salmonella was detected in up to 0.01 mL of the recycled water collected from the dehairing machine. Genotyping of Salmonella isolates showed that similar pulsotypes were present in the oral cavity and recycled water. Based on these observations it can be concluded that the recycled water used in the dehairing machine was the major source for the carcass contamination in this slaughterhouse.
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Affiliation(s)
- Hang Zeng
- Flanders Research Institute for Agriculture, Fisheries and Food (ILVO), Brusselsesteenweg 370, B-9090 Melle, Belgium; (H.Z.); (G.R.)
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium;
| | - Geertrui Rasschaert
- Flanders Research Institute for Agriculture, Fisheries and Food (ILVO), Brusselsesteenweg 370, B-9090 Melle, Belgium; (H.Z.); (G.R.)
| | - Lieven De Zutter
- Department of Veterinary Public Health and Food Safety, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133, B-9820 Merelbeke, Belgium;
| | - Wesley Mattheus
- Infectious Diseases in Humans, Bacterial Diseases, Sciensano, B-1180 Brussels, Belgium;
| | - Koen De Reu
- Flanders Research Institute for Agriculture, Fisheries and Food (ILVO), Brusselsesteenweg 370, B-9090 Melle, Belgium; (H.Z.); (G.R.)
- Correspondence: ; Tel.: +32-9-272-3043
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Mishra P, Yadav VK, Hasan M. Evisceration of umbilical content with extensive adhesion: A surgical approach. Clin Case Rep 2020; 8:3569-3570. [PMID: 33363982 PMCID: PMC7752345 DOI: 10.1002/ccr3.3217] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/20/2020] [Accepted: 07/11/2020] [Indexed: 11/08/2022] Open
Abstract
With timely recognition and surgical intervention along with administration of an antibiotic, antihistaminic, and anti-inflammatory drugs, evisceration of umbilical content with extensive adhesion can be treated, and the outcome is also good.
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Affiliation(s)
- Pravin Mishra
- Faculty of Veterinary ScienceBangladesh Agricultural UniversityMymensinghBangladesh
| | - Vivek Kumar Yadav
- Faculty of Veterinary ScienceBangladesh Agricultural UniversityMymensinghBangladesh
| | - Moinul Hasan
- Department of Surgery and ObstetricsBangladesh Agricultural UniversityMymensingh, MymensinghBangladesh
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Gauthier AC, Oduyale OK, Fliotsos MJ, Zafar S, Mahoney NR, Srikumaran D, Woreta FA. Clinical Characteristics and Outcomes in Patients Undergoing Primary or Secondary Enucleation or Evisceration After Ocular Trauma. Clin Ophthalmol 2020; 14:3499-3506. [PMID: 33149543 PMCID: PMC7602916 DOI: 10.2147/opth.s273760] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the frequency of primary versus secondary eye removal, frequency of enucleation versus evisceration, and characteristics and outcomes of patients undergoing these procedures after presenting with severe ocular trauma. Patients and Methods Retrospective chart review of patients presenting to the emergency department (ED) with severe eye trauma necessitating enucleation or evisceration between 2010 and 2018. Results There were 92 eyes from 90 patients included in our study. Twenty-seven percent of eyes underwent primary removal (n=25, 14 enucleation, 11 evisceration), while 73% of eyes underwent secondary removal (n=67, 50 enucleation, 17 evisceration). The mean patient age was 45.2 years (range 4.2–92.6); primary enucleation/evisceration patients were older on average than secondary eye removal patients [53.8 years (range 15.9–91.2) versus 42.2 years (range 4.2–91.6 years), p=0.04]. A median of 34 days passed between ED presentation and secondary enucleation/evisceration. Before undergoing secondary enucleation/evisceration, patients underwent a median of one ocular procedure (range 0–14) for various complications of trauma including orbital infection, choroidal or retinal tear or detachment, and wound dehiscence. Open globe injury repairs comprised 43 of the 92 total procedures (47%) performed prior to secondary enucleation/evisceration. Secondary enucleations/eviscerations required a median of seven clinic visits compared to two clinic visits required after primary surgeries (p<0.01). 10.7% of all patients (n=10) had at least one implant-related complication following enucleation/evisceration, with all but one of these patients being in the secondary enucleation/evisceration group. Conclusion Primary enucleation or evisceration was performed in 27% of all eye removals, and enucleation was performed in 69.6% of all eye removals. Future research is warranted to determine if primary eye removal may be appropriate and when to consider enucleation versus evisceration.
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Affiliation(s)
- Angela C Gauthier
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluseye K Oduyale
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Michael J Fliotsos
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sidra Zafar
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas R Mahoney
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Byrne J, Kehoe JD, Kayyal MY. Special type trocar-site hernia with evisceration of the appendix following laparoscopic repair of a perforated duodenal ulcer. J Surg Case Rep 2020; 2020:rjaa376. [PMID: 33024537 PMCID: PMC7526464 DOI: 10.1093/jscr/rjaa376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/17/2020] [Indexed: 12/16/2022] Open
Abstract
Trocar-site hernia is an uncommon complication of laparoscopic surgery and can be classified as early-onset, late-onset or special type. Special type hernias usually occur in the early postoperative period and result in evisceration of intra-abdominal contents through all layers of the abdominal wall without an overlying hernia sac. We present a case of special type herniation of the appendix through a 5-mm trocar site in the right iliac fossa following laparoscopic repair of a perforated duodenal ulcer. In this case, herniation occurred after removal of a drain inserted through the trocar site intraoperatively and was treated with emergent open appendicectomy. A number of patient and technical factors may be associated with an increased risk of trocar-site herniation including increasing age, elevated body mass index, increasing trocar size, longer procedure duration and absence of fascial closure. These factors must be borne in mind when planning trocar placement and number to reduce the risk of herniation.
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Affiliation(s)
- Jim Byrne
- Department of General Surgery, Cork University Hospital, Cork, Ireland
| | - John D Kehoe
- Department of General Surgery, Cork University Hospital, Cork, Ireland
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Sanchez-Vicente JL, Contreras-Díaz M, López-Herrero F, Martínez-Borrego A, Galván-Ledesma A, Lozano-Bernal O, García-Vazquez M, De Las Morenas-Iglesias J, Caro-Magdaleno M. Clostridium Septicum Endogenous Endophthalmitis as the Initial Manifestation of Colorectal Carcinoma: Clinical Case Report and Literature Review. Ocul Immunol Inflamm 2020; 30:348-354. [PMID: 32966149 DOI: 10.1080/09273948.2020.1799039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To describe the presentation and clinical course of a case of endogenous endophthalmitis caused by Clostridium septicum, an anaerobic and gram positive bacteria. METHODS Observational report of a clinical case presented in Spain. CLINICAL CASE A 61-year-old male patient was referred to our hospital with a diagnosis of endophthalmitis of his left eye since ten days prior to presentation, and a history of poor response to medical treatment. Evisceration was performed, and C. septicum was isolated from a sample of the vitreous humor. Fourteen days after surgery, the patient returned with orbital cellulitis, and exenteration was performed. Forty-two days after initial presentation, colonoscopy revealed an adenocarcinoma of the proximal colon. Surgical resection of the tumor was performed, and clinical recovery was achieved. CONCLUSIONS iSystemic C. septicum infection without a traumatic cause has been associated with malignancy, although an initial presentation of endophthalmitis has rarely been reported. In cases of clostridial endogenous endophthalmitis, investigation for colorectal carcinoma is indicated.
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Affiliation(s)
| | | | | | - Ana Martínez-Borrego
- Department of Ophthalmology , Virgen Del Rocío University Hospital, Seville, Spain
| | | | - Oscar Lozano-Bernal
- Department of Ophthalmology , Virgen Del Rocío University Hospital, Seville, Spain
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Wu H, Wang JY, Zhong XC, Shi X, Wu YH, Ye J. Ocular injury resulting in eye removal at a large tertiary care center in China. Int J Ophthalmol 2020; 13:1312-1317. [PMID: 32821687 DOI: 10.18240/ijo.2020.08.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/08/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the risk factors for eye removal following ocular trauma at a major ophthalmology department in China. METHODS A retrospective study of patients who underwent eye removal surgery following ocular trauma was completed. Clinical outcomes were consulted in detail through the hospital's computed medical data system. Patients' information including age, gender, cause of ocular trauma, affected eye, and education level was collected and recorded in a standardized database. Chi-squared test, Student's t-test, Fisher's exact test, and bivariate correlation analysis were used for statistical comparisons. RESULTS The present study included 1675 removal eyes from 1674 patients over the 20-year period. Patients included 80.5% males and 19.5% females, with mean age of 38y. The majority of the patients (70.7%) were blue-collar workers (physical laborers), and 1098 patients (65.6%) did not receive high school education. Work-related injuries were the most common reason for eye removal (n=739, 44.1%), of which 441 cases (59.7%) were related to metal/nail wounds. The most frequent injury type in males was work-related injuries (49.7%), whereas the most frequent injury type in females was home-related injuries (25.8%). CONCLUSION Work-related injuries are a leading cause of severe ocular injury resulting in eye removal. In addition, men and undereducated patients are more likely to undergo eye removal surgery following ocular trauma. This study identified multiple high-risk factors leading to eye removal following ocular trauma, which is of great importance for preventing severe eye injuries.
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Affiliation(s)
- Han Wu
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Jing-Yi Wang
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xin-Cao Zhong
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Xin Shi
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
| | - Yi-Hua Wu
- Department of Toxicology of School of Public Health, Zhejiang University School of Medicine, Hangzhou 310029, Zhejiang Province, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang Province, China
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Abstract
INTRODUCTION Insufficient orbital volume in an anophthalmic socket is a major problem for the placement of an ocular prosthesis. This study reports the outcomes of the use of autologous pericranium graft in association with a large primary or secondary orbital implant in patients with a contracted socket and large orbital volume deficit. METHODS This was a retrospective single-institution study. Participants were 13 patients with contracted socket, volume deficit, and insufficient conjunctiva to cover the new implant divided into two groups, A (n = 3) and B (n = 10), according to the baseline condition of the socket. Surgery was primary evisceration (group A only) and placement of a large orbital implant followed by an autologous pericranium graft over the implant (groups A and B). RESULTS Mean follow-up duration for the patient series was 9.5 months (range 9-24). Complete epithelialization of the pericranium graft was recorded at 47.3 days of follow-up (range 33-67). No cases of implant exposure or shrinkage were noted during follow-up. Main postoperative complications were conjunctival granuloma (five patients, 38.5%), conjunctival seroma (one patient, 7.7%). All patients were satisfied with the aesthetic outcome. CONCLUSION Autologous pericranial graft was effective in reconstructing the contracted socket so that the anophthalmic socket could accommodate a larger or secondary orbital implant. The efficacy of this procedure needs to be confirmed in a larger patient series.
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Jamayet NB, Kirangi JK, Husein A, Alam MK. A comparative assessment of prosthetic outcome on enucleation and evisceration in three different etiological eye defects: A case series. Eur J Dent 2020; 11:130-134. [PMID: 28435380 PMCID: PMC5379827 DOI: 10.4103/1305-7456.202636] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Enucleation and evisceration are the most common surgical procedures that are performed to manage tumor, trauma, and infection. Given the consequences of surgical intervention, the conditions of the remaining eye socket may affect future prosthetic rehabilitation. A custom-made ocular prosthesis can be used to help restore the esthetics and functional defects and to improve the quality of life of patients with such conditions. An assessment must be performed on the prosthetic outcome before rehabilitation. The etiology of defect, type of surgery, condition of the remaining socket, and patient's age should all be considered. This report discusses three different etiological eye defects that have undergone enucleation and evisceration and describes the factors that have a significant role in the esthetic and functional outcome of the prosthesis. This report should serve as a helpful aid for maxillofacial prosthodontists to understand the primary objective of rehabilitating each eye defect and to meet patient expectations.
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Affiliation(s)
- Nafij Bin Jamayet
- Maxillofacial Prosthetics Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - John Kariuki Kirangi
- Maxillofacial Prosthetics Unit, School of Dental Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Adam Husein
- Prosthodontic Unit, School of Dental Science, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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West CT, Robinson P, Winehouse J. Single hem to reduce evisceration following Bogotá bag for damage control surgery: 'sail technique'. BMJ Mil Health 2020; 166:279-280. [PMID: 32111680 DOI: 10.1136/jramc-2019-001292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 08/06/2019] [Accepted: 08/07/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Charles Timothy West
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - P Robinson
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
| | - J Winehouse
- Department of General Surgery, Dorset County Hospital NHS Foundation Trust, Dorchester, UK
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44
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Kong VY, Weale RD, Blodgett JM, Madsen A, Laing GL, Clarke DL. Selective Nonoperative Management of Abdominal Stab Wounds with Isolated Omental Evisceration is Safe: A South African Experience. Scand J Surg 2020; 110:214-221. [PMID: 32090686 DOI: 10.1177/1457496920903982] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Selective nonoperative management of abdominal stab wound is well established, but its application in the setting of isolated omental evisceration remains controversial. The aim of the study is to establish the role of selective nonoperative management in the setting of isolated omental evisceration. MATERIALS AND METHODS A retrospective study was conducted over an 8-year period from January 2010 to December 2017 at a major trauma center in South Africa to determine the outcome of selective nonoperative management. RESULTS A total of 405 consecutive cases were reviewed (91% male, mean age: 27 years), of which 224 (55%) cases required immediate laparotomy. The remaining 181 cases were observed clinically, of which 20 (11%) cases eventually required a delayed laparotomy. The mean time from injury to decision for laparotomy was <3 h in 92% (224/244), 3-6 h in 6% (14/244), 6-12 h 2% (4/244), and 12-18 h in 1% (2/244). There was no significant difference between the immediate laparotomy and the delayed laparotomy group in terms of length of stay, morbidity, or mortality. Ninety-eight percent (238/244) of laparotomies were positive and 96% of the positive laparotomies (229/238) were considered therapeutic. CONCLUSION Selective nonoperative management for abdominal stab wound in the setting of isolated omental evisceration is safe and does not result in increased morbidity or mortality. Clinical assessment remains valid and accurate in determining the need for laparotomy but must be performed by experienced surgeons in a controlled environment.
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Affiliation(s)
- V Y Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa
| | - R D Weale
- Department of Surgery, North West Deanery, Manchester, United Kingdom
| | - J M Blodgett
- Department of Epidemiology, University College London, London, United Kingdom
| | - A Madsen
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - G L Laing
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
| | - D L Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.,Department of Surgery, University of KwaZulu-Natal, Durban, South Africa
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45
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Abstract
Intestinal stomas have been performed for hundreds of years for both benign and malignant disorders of the large and small bowel. Complications of stomas like stomal prolapse, parastomal hernia, and retraction are well-known. The evisceration of intra-abdominal contents is a very rare occurrence, carrying a high burden of morbidity. The etiology, timing, and treatment of this complication are not adequately described in the literature. We report two patients who were operated and in whom ostomy was fashioned; parastomal evisceration occurred in the early postoperative period in both cases. Both of these patients were operated emergently, and reduction of eviscerated contents followed by stoma refashioning was performed. One patient survived; whereas, the other patient who presented with septic shock expired due to multiorgan dysfunction syndrome. This report describes a rare and possibly fatal complication of ostomy and highlights the importance of meticulous operative technique in ensuring safety in this procedure.
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Affiliation(s)
- Aditya A Kulkarni
- Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Vivek Chauhan
- Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Vishal Sharma
- Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
| | - Harjeet Singh
- Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, IND
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46
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Lu YL, Chen ZTY, Tsai IL. Dermis-fat graft as treatment of early implant exposure in a postpenetrating keratoplasty patient with nontraumatic eyeball rupture. Taiwan J Ophthalmol 2019; 10:134-137. [PMID: 32874844 PMCID: PMC7442098 DOI: 10.4103/tjo.tjo_143_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 05/22/2019] [Indexed: 11/04/2022] Open
Abstract
Orbital implant exposure may be the most common complication after evisceration surgery with orbital implantation. Management of implant exposure is a vital issue for oculoplastic surgeons. We present the case of a patient with nontraumatic eyeball rupture receiving dermis-fat graft after early implant exposure. The present case with multiple penetrating keratoplasty history underwent emergent evisceration and silicon sphere implantation due to nontraumatic eyeball rupture with severe uvea prolapse. The surrounding corneal tissue of the rupture aperture was almost unidentified before the operation. Deep superior sulcus syndrome and orbital implant exposure developed 2 months after the operation; hence, orbital reconstruction and dermis-fat graft transplantation were performed. Orbital reconstruction and orbital implant exposure management are discussed in the content.
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Affiliation(s)
- Yi-Ling Lu
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - Zoe Tzu-Yi Chen
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
| | - I-Lun Tsai
- Department of Ophthalmology, Taipei City Hospital, Taipei, Taiwan
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47
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Abstract
The purpose of this article is to describe a surgical technique to repair an exposed orbital implant by posterior auricular muscle autograft. A retrospective review was conducted of four patients with an exposed orbital implant that were treated with a posterior auricular muscle graft. Four patients received posterior auricular muscle patch graft to the exposed orbital implant. The donor site healed with minimal scarring and remained well hidden. The graft incorporated fully into surrounding orbital tissue with no recurrent exposure at average of 13 month follow-up. The posterior auricular muscle autograft is a viable technique for repairing an exposed orbital implant.
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Affiliation(s)
- Catherine Y Liu
- a Department of Ophthalmology , University of Illinois at Chicago , Chicago , IL , USA
| | - Michael G Sun
- a Department of Ophthalmology , University of Illinois at Chicago , Chicago , IL , USA
| | - Scott Jones
- b Colorado Eye Institute , Colorado Springs , CO , USA
| | - Pete Setabutr
- a Department of Ophthalmology , University of Illinois at Chicago , Chicago , IL , USA
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48
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Dave VP, Pappuru RR, Tyagi M, Pathengay A, Das T. Endoscopic vitrectomy in endophthalmitis: initial experience of 33 cases at a tertiary eye care center. Clin Ophthalmol 2019; 13:243-251. [PMID: 30787589 PMCID: PMC6368127 DOI: 10.2147/opth.s185716] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To report the presentation and management outcomes of endophthalmitis with endoscopic vitrectomy. Methods This is a retrospective interventional case series conducted at a tertiary eye care center in south India. Thirty three eyes of 33 patients were included. The medical records of the patients who underwent endoscopic vitrectomy for endophthalmitis from April 2014 to March 2018 were reviewed. Data with regard to age, gender, etiology of endophthalmitis, corneal and retinal examination, type of intervention, final anatomic and visual outcome, and the total follow-up were collected. The main outcome measures were the final visual acuity and evisceration rates. Results The mean age at presentation was 46.84±19.89 years, with a median age of 50 years. Based on etiology, 13 eyes (39.4%) were post-trauma endophthalmitis, eleven eyes (33.33%) were post-cataract surgery, three eyes (9.09%) were endogenous, three eyes (9.09%) were post-perforated corneal ulcer, two eyes (6.06%) were post-retinal surgery, and one eye (3.03%) was post-combined cataract and corneal surgery. Twenty-four eyes (72.72%) had a favorable anatomic outcome at the last visit, and five eyes (15.15%) had a favorable visual outcome. Of those with unfavorable visual outcome, ten eyes had further visual potential. Sixteen eyes (48.48%) showed a positive culture on microbiologic evaluation. The predominant organism isolated was Pseudomonas aeruginosa. Evisceration was required only in one eye (3.03%). Conclusion Endoscopic vitrectomy allows early management of endophthalmitis in spite of hazy media. This ensures a reasonable visual outcome, controls the infection, and reduces the incidence of evisceration in these eyes.
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Affiliation(s)
- Vivek Pravin Dave
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Rajeev R Pappuru
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Mudit Tyagi
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
| | - Avinash Pathengay
- Retina and Uveitis Department, GMR Varalaxmi Campus, LV Prasad Eye Institute, Hanumanthawaka Chowk, Visakhapatnam 530040, Andhra Pradesh, India
| | - Taraprasad Das
- Smt Kanuri Santhamma Center for Vitreoretinal Diseases, Kallam Anji Reddy Campus, LV Prasad Eye Institute, Hyderabad 500034, Telangana, India,
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Nadal J, Daien V, Jacques J, Hoa D, Mura F, Villain M. Evisceration with autogenous scleral graft and bioceramic implantation within the modified scleral shell: 133 cases over 17 years. Orbit 2019; 38:19-23. [PMID: 29672208 DOI: 10.1080/01676830.2018.1464584] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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] [Received: 08/09/2017] [Accepted: 04/04/2018] [Indexed: 06/08/2023]
Abstract
INTRODUCTION To present long-term follow-up data on evisceration performed with autogenous scleral grafting and ceramic implantation in a modified scleral shell. METHODS This was a retrospective analysis of all consecutive eviscerations performed in the Department of Ophthalmology, Montpellier University Hospital, France, between February 1998 and October 2015. For all patients, the technique used was a conventional anterior evisceration after total keratectomy, disinsertion of the medial rectus muscle, sectioning of the optic nerve and excision of sclera centered on the papilla. The scleral graft was then sutured just behind the sutured keratectomy, and the bioceramic implant was inserted by posterior way in the scleral shell. Demographic characteristics, implant size and type, cosmetic results from pictures of all patients and complications were recorded. This study was performed with Ethics Review Committee Approval, and in compliance with the Declaration of Helsinki. RESULTS In total, 133 patients (36.6% women) were identified during the study period. The mean (SD) implant size was 17.32 (1.84) mm. The median follow-up after evisceration was 57.43 (24.7, 68.3) months. Two cases of implant exposure (1.5%) were recorded. For 24 patients (17.9%), additional surgeries were performed for ptosis (2.2%), conjunctival cyst (1.5%), or post-evisceration socket syndrome (6.7%). Cosmetics results were excellent for 50.1% of cases, good for 33.3% and fair for 16.6%; using a grading scale based on the superior sulcus deformity. CONCLUSION Evisceration with autogenous scleral grafting and ceramic implantation can result in a high volume of restoration, good cosmetic results, and low risk of exposure of the implant.
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Affiliation(s)
- Jeremy Nadal
- a Department of Ophthalmology , Nîmes University Hospital , Nîmes Cedex , France
| | - Vincent Daien
- b Department of Ophthalmology , Gui De Chauliac Hospital , Montpellier , France
- c INSERM , Univ Montpellier, Neuropsychiatry: Epidemiological and Clinical Research , Montpellier , France
| | - Jérôme Jacques
- b Department of Ophthalmology , Gui De Chauliac Hospital , Montpellier , France
| | - Didier Hoa
- a Department of Ophthalmology , Nîmes University Hospital , Nîmes Cedex , France
- b Department of Ophthalmology , Gui De Chauliac Hospital , Montpellier , France
| | - Frederic Mura
- b Department of Ophthalmology , Gui De Chauliac Hospital , Montpellier , France
| | - Max Villain
- b Department of Ophthalmology , Gui De Chauliac Hospital , Montpellier , France
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50
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Filatova IA, Kharlampidi MP. [Change of priorities when selecting the method of eye removal: enucleation versus evisceration]. Vestn Oftalmol 2019; 135:16-21. [PMID: 31215530 DOI: 10.17116/oftalma201913502116] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
UNLABELLED The development and evolution of conservative and surgical methods of treating patients with various ocular pathologies influence the priorities when selecting the method of eye removal. PURPOSE To perform comparative analysis of eye removal methods based on the results of own studies over a long period. MATERIAL AND METHODS The study analyses eye removal surgeries performed in Helmholtz Moscow Research Institute of Eye Diseases over the period of 1991 to 2016 and investigates the reasons of selecting enucleation and evisceration methods. RESULTS Over the period of 1991 to 2001, there were 968 eye removal surgeries performed in the department of traumatology, with reasons listed as trauma aftermath - 884 (91.3%) cases, outcomes of various diseases - 85 (8.7%) cases. From 2002 to 2016, a total of 2529 eye removal surgeries have been performed due to non-oncological reasons, of which 1337 (52.9%) were enucleation surgeries and 1190 (47.1%) - evisceration surgeries. However, over the last 15 years, there has been a clear tendency for changing priorities when selecting the method of eye removal: from 2002 to 2016, the number of eviscerations has increased by 4.2 times (from 16 to 66.6%), while the percentage of enucleations has decreased from 84 to 33.4%. The rise in frequency of eviscerations was noted in post-traumatic pathologies, including post-traumatic uveitis and preatrophy, and buphthalmos. CONCLUSION Analysis of clinical and statistical data accumulated over more than 10 years showed positive dynamics in the decrease of eye removal cases and changes in priority when selecting the method towards evisceration, which causes fewer complications, has better functional and esthetic results - especially considering the ongoing development of new evisceration techniques.
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Affiliation(s)
- I A Filatova
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
| | - M P Kharlampidi
- Helmholtz Moscow Research Institute of Eye Diseases, 14/19 Sadovaya-Chernogryazskaya St., Moscow, Russian Federation, 105062
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