Extracranial meningiomas are rare with a reported incidence of 1-2 %. Diagnosis is a challenge due to the unusual site of occurrence. The treatment of choice is surgical excision. A case that presented with primary lesion in the cheek with no detected intracranial extension is being reported.
The objective of this 5-year retrospective study of PCV eyes was to assess the clinical presentation and long-term real world visual and anatomical outcomes following therapy. Data included the baseline clinical and demographic profile, visual acuity and treatment details. Main outcome measured were anatomical and visual outcomes with treatment, treatment compliance and complications. Out the 45 PCV eyes (51 patients), 76.4% lesions occurred predominantly at the macula. Clinical presentations were variable though visible polyps (16.6%) and massive subretinal hemorrhage (17.7%) were less frequent. DLS with diffuse PEDs or thumb shaped PEDs were the most common finding in SD-OCT. OCTA was sensitive in identifying BVNs compared to ICGA but were poor in identifying polyps. Vision improvement was achieved in 42% eyes, while loss occurred in 26.6% eyes, with deterioration more in type 1 PCV. Baseline good vision, thicker CCT, smaller lesions and minimum recurrences at year 1 were risk factors associated with good outcomes. Mean number of injections was 18.7. 22% received primary PDT while 11% eyes received rescue PDT. Low fluence PDT was found to be as effective as standard fluence. Though not significant, PDT eyes required lesser injections than monotherapy. As an agent Aflibercept seemed to be better than Ranibizumab and was the most preferred switching agent (55% needed switch). Loading dose followed by PRN was the only feasible regimen with relatively reasonable compliance. Complications included RIP (11%) and 2 eyes requiring Vitrectomy for breakthrough vitreous hemorrhage. The superiority of aflibercept and the feasibility of a PRN approach is underlined in this study. In spite of suboptimal compliance this study reveals that nearly half the eyes demonstrated visual gains and anatomic stability.
To evaluate and compare the efficacy of reduced-fluence photodynamic therapy (PDT) with standard-fluence photodynamic therapy in treating polypoidal choroidal vasculopathy. Twenty-eight eyes (27 patients) with polypoidal choroidal vasculopathy were retrospectively analysed; 14 eyes received Indocyanine green angiography-guided standard-fluence (SF) PDT (50 J/cm) and 14 eyes received Indocyanine green angiography-guided reduced-fluence (RF) PDT (25 J/cm). Primary outcome measured after 6 months of treatment were the changes in mean BCVA, polyp regression, polyp PED height, central choroidal thickness (CCT), post PDT intravitreal anti VEGF injection need and complications. Results of both the groups were comparable at 6 months follow up. Mean change in log mar visual acuity at 6 months for the SF PDT group was 0.12 compared to 0.13 for the RF PDT group (p = 0.919). Mean change in PED height at 6 months for the SF PDT group was 159 μm compared to 172 μm for the RF PDT group (p = 0.06). Mean change in CCT at 6 months for the SF PDT group was 45μm compared to 10μm for the RF PDT group (p = 0.96). While the SF PDT group needed a mean of 2 injections post PDT, the RF PDT group required a mean of 3 injections during the course of 6 months follow up. Neither of the group reported any adverse effects following the procedure. Our study demonstrated that reduced-fluence PDT is at least on par with standard-fluence PDT in management of PCV.
A 42 years old female referred in our tertiary care centre with history of road side accident (2014-11-08), with degloving injury of left lower limb and left upper limb injury for K-wiring and debridement.After checking base line investigation and fasting condition (all investigation including chest-X ray, ECG and CBC were within normal limit except low HB of 9 mg/dl) anaesthetic plan was prepared. Spinal anaesthesia started for lower limb surgery by using free flow of CSF technique with 27 G quincke's needle and 2 ml of 0.5% bupivacaine heavy. Case started and completed smoothly with stable haemodynamics.Near closure of lower limb procedure, supraclavicular brachial plexus block tried by blind technique by paraesthesia eliciting. Three attempts were taken, but could not achieve adequate level of surgical anaesthesia because patient became irritable and coughing. Mean while patient developed hypotension and little tachycardia, at that time managed with intravenous fluid and shifted the patient to recovery ward with instructions of chest-X ray and blood transfusion.After few hours patient developed severe hypotension and respiratory distress. Same time she developed diffuse swelling that was confined over neck and chest region initially. Physician made differential diagnosis of angioneurotic oedema; blood transfusion related side effects and advised for supportive management.After quick assessment of patient; kept on oxygen and advised for shifting of patient to ICU for further management. Dopamine infusion started and NIV bipap was started in ICU with low PEEP by junior resident for temporary purpose but within 30 minutes patient became more restless and haemodynamic parameters became quite unstable. Diffuse swelling became more significant and extends up to face and periorbital area above and reached up to whole abdomen area.In arterial blood gas analysis we found significant hypoxia (pao 2 < 40 mm Hg). We decided to detache the BiPAP and intubate the patient and kept on T-piece with high flow oxygen.By palpating subcutaneous swelling we found characteristic egg shell crackling feel of subcutaneous crepitations; in chest-X ray we found minimal pneumothorax with massive emphysema. Than we made multiple skin nick and started milking, but saturation was not improving. Finally we inserted the chest tube connected with water seal drain bag in same side of pneumothorax under all aseptic precautions.There was not clear cut indication of chest tube insertion because there was minimal pneumothorax component but there was need for effective ventilation for treating hypoxia and respiratory distress. After putting chest tube, we started ventilation with very low PEEP of 3-5 mm of Hg. Manual milking of subcutaneous tissue was started. Patient kept on minimal sedation with fentanyl and midazolam infusion. It was beneficial in view of its analgesic property which was needed for pain that was occurring because of bilateral intercostal drain tubes. Intravenous dexamethasone and broad spectrum antibiotics were administered empir...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.