ERM surgery resulted in similar anatomical and functional outcomes in both groups. Longer axial length does not seem to affect visual improvement and the complication rate.
Gaucher's disease is an autosomal recessive inherited disease characterized by oraganomegaly, cytopenia and bone destruction. Clotting disorders and platelet dysfunctions are described. We report the case of a 22-year-old man who presented subacute groin pain due to spontaneous iliopsoas hematoma. Laboratory investigations found moderate thrombocytopenia, normal coagulation factor activities and unspecific platelet function test disturbances. His spleen was moderately enlarged and no significant bone lesions were found. Iliopsoas hematoma is a rare complication in Gaucher's disease and should be included in the differential diagnosis of pain localized to the groin-hip area, which could rather evoke hip osteonecrosis in this context.
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SUMMARYOptic nerve disease has been reported in patients with renal failure. A toxic aetiology has been postulated. The incidence of this complication of renal failure has not been determined. We observed 60 patients with renal fail ure on dialysis for 24 months to determine the incidence of optic neuropathy. Four patients developed typical acute ischaemic optic neuropathy. Their case notes were reviewed in order to determine the pathogenesis. Each patient had long-standing renal failure and its sequelae of anaemia and hypertension. The immediate causes of ischaemia were hypotension in 1, severe anaemia in 1, and generalised atherosclerosis in 2 patients.Optic neuropathy is a well-known complication of renal failure/dialysis. A neurotoxic type of optic neuropathy in uraemic patients with a serum urea nitrogen level of more than 35.7 mmol/I was reported by Knox and associates, 1 who implicated hypertension and anaemia as well as a raised serum urea nitrogen. Medical management with haemodialysis was followed by improvement of vision in 4 of their patients. In 1 patient resumption of cortico steroid therapy was followed by improvement in vision, but the patient whose vision improved the most rapidly was managed by prompt use of both dialysis and oral corticosteroids.Hamad and associates described a similar type of optic neuropathy 2 in patients maintained on dialysis. In 1 case desferrioxamine toxicity was suspected. Other risk factors identified were again hypertension, anaemia and a raised serum urea nitrogen. Their third patient had profound loss of vision, and the likelihood of an atypical non-arteritic acute ischaemic optic neuropathy (AI ON) in a young patient in that particular clinical setting was noted.In contrast, all 4 of our patients had typical non-arteritic acute ischaemic optic neuropathy.
PATIENTS AND METHODSAll 60 patients attending the renal dialysis unit had oph
Purpose To study the incidence of tears and rhegmatogenous retinal detachments (RD) after macular surgery, according to the vacuum settings during vitrectomy.
Methods Comparative retrospective study of rhegmatogenous complications occurring during and after vitrectomy between 2 groups of consecutive patients. Group G400, included 1432 eyes vitrectomized with a maximum flow set at 4 ml / min and a maximum vacuum at 400 mm Hg. Group G230 included 434 eyes operated with the same flow rate with vacuum limited at 230 mm Hg. All patients were operated between November 2000 and June 2010, by two experienced surgeons.
Results The incidence of tears observed during surgery was 5.1 % for G400, versus 3 % for G230 (p = 0.01). The incidence of postoperative RD was 3.2 % for G400, versus 1.2 % for G230 (p = 0.02). The mean duration before the occurrence of RD was 73.3 + 98.5 days in G400, versus 21.6 + 16.3 days in G230 (p = 0.004).
Conclusion The incidence of tears observed during surgery was 5.1 % for G400, versus 3 % for G230 (p = 0.01). The incidence of postoperative RD was 3.2 % for G400, versus 1.2 % for G230 (p = 0.02). The mean duration before the occurrence of RD was 73.3 + 98.5 days in G400, versus 21.6 + 16.3 days in G230 (p = 0.004).
Purpose To report the incidence, the risk factors and the evolution after treatment of cystoid macular edema (CME) complicating epiretinal membrane (ERM) surgery.
Methods This study included 647 consecutive patients with ERM operated by 23‐gauge parsplana vitrectomy between January 2011 and July 2013. Combined phacoemulsification of the lens was performed in 71% of cases. Patients were considered as having a CME if they presented augmentation of central macular thickness with presence of cysts on OCT scans in the first year after surgery. Patients with history of retinal detachment, vein occlusion, uveitis, diabetic macular edema or neovascular AMD were excluded.
Results The incidence of CME was 2.6% (16/605) occurring within an average time of 129 ± 101 days. Predictive factors were the presence of preoperative CME on OCT scans (p=0.04) and preoperative prostaglandin use (p=0.02). Combined phacoemulsification was not identified as a risk factor. Treatment consisted in topical applications of non‐steroidal anti‐inflammatory drugs (NSAIDs) associated with dexamethasone and/or acetazolamide for a mean duration of 4 months. Intravitreal or subconjonctival corticoids injections were performed in 6 patients. A two‐line or more improvement in visual acuity was achieved respectively in 6 of 14 (43%) and 4 of 6 patients (67%). A dissipation of cysts on OCT scans was observed respectively in 4 of 14 (29%) and in 5 of 6 patients (83%).
Conclusion The incidence of CME after ERM surgery was 2.6%. Preoperative prostaglandin use and preoperative CME were associated with an increased risk of postoperative CME. Treatment with NSAIDs was effective in about one third of patients, corticoids injections in 5 of 6 patients.
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