A new technique for fixating the capsular bag in patients with ectopia lentis is presented. In this technique, the capsulorhexis is performed using a femtosecond laser, followed by the insertion of a standard capsular tension ring to redistribute capsular forces. The nucleus is hydroprolapsed into the anterior chamber and nuclear disassembly is performed above the iris plane to reduce zonular stress. Finally, a 5-0 polypropylene monofilament is used to fixate a capsular tension segment and subluxated capsular bag. This novel double-flanged method, achieved with cautery, does not require direct suturing of the monofilament on the sclera. This article describes the use of this new technique in 3 eyes, 2 in patients with Marfan syndrome and 1 in a patient with microspherophakia.
Deep venous thrombosis (DVT) management includes prediction rule evaluation to define standard pretest DVT probabilities in symptomatic patients. The aim of this study was to evaluate the incremental usefulness of hormonal therapy to the Wells prediction rules for DVT in women. We studied women undertaking compressive ultrasound scanning for suspected DVT. We adjusted the Wells score for DVT, taking into account the β-coefficients of the logistic regression model. Data discrimination was evaluated by the receiver operating characteristic (ROC) curve. The adjusted score calibration was assessed graphically and by the Hosmer-Lemeshow test. Reclassification tables and the net reclassification index were used for the adjusted score comparison with the Wells score for DVT. We observed 461 women including 103 DVT events. The mean age was 56 years (±21 years). The adjusted logistic regression model included hormonal therapy and six Wells prediction rules for DVT. The adjusted score weights ranged from -4 to 4. Hosmer-Lemeshow test showed a nonsignificant P value (0.69) and the calibration graph showed no differences between the expected and the observed values. The area under the ROC curve was 0.92 [95% confidence interval (CI) 0.90-0.95] for the adjusted model and 0.87 (95% CI 0.84-0.91) for the Wells score for DVT (Delong test, P value < 0.01). Net reclassification index for the adjusted score was 0.22 (95% CI 0.11-0.33, P value < 0.01). Our results suggest an incremental usefulness of hormonal therapy as an independent DVT prediction rule in women compared with the Wells score for DVT. The adjusted score must be evaluated in different populations before clinical use.
Purpose
To report a successful ab-interno trabeculotomy with Kahook Dual Blade (KDB) in secondary traumatic angle recession glaucoma in a child and discuss the possible mechanisms of action.
Observations
A 7 years-old boy presented, after a blunt trauma in the left eye, with angular recess surroundings 110° and concomitant intra-ocular pressure (IOP) elevation around 35 mmHg, despite the maximum topical and systemic ocular hypotensive therapy. As there was no glaucomatous neuropathy yet, a KDB ab-interno trabeculotomy was performed. After KDB's surgery, oral and topical hypotensive medications were gradually withdrawn until complete suspension with IOP levels around 11 mmHg, which has remained the same in the last 2 years. Both functional and structural assessment of glaucoma have maintained stable throughout the follow-up until the present moment.
Conclusion and Importance
The KDB has demonstrating a favorable safety profile and a useful surgical technique that should be considered mainly in trabecular glaucomas, as well as those secondary to trauma. Studies are still needed to define which patient and glaucoma profile are the most suitable for the procedure and for how long it is effective.
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