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PDT4CNV

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After reading this forum off and on over the last year, I was hoping more residents would become involved. A lot of topics are on continuous repeat. I thought it might be interesting to have discussion or at least mention of interesting patients or surgeries and to possibly discuss recent developments in the literature or news that affects ophthalmology.

A recent interesting case.
1. Teenage patient with M3 AML. Inpatient receiving chemo. Has developed chronic headache and then horizontal double vision. Medication list significant for ALTRA. MRI head read as nl by radiologist. After examining, patient had signs of a left 6th, had papilledema, and the MRI in fact had subtle signs of increased ICP including posterior scleral flattening vertical tortuosity of the nerve. OP after LP was >50. LP had a noted therapeutic effect as well. We diagnosed this patient with PTC secondary to the ALTRA. This responded to diamox and the symptoms and 6th have improved since ALTRA was discontinued.

A recent interesting surgery:
Patient with near total 3rd. As you all know, outcomes are often not very good. We usually try recess/resect procedures or swinging the superior oblique around. We have tried a newer technique where we brought up a periosteal flap from the medial orbital wall and fixed this to the medial rectus insertion. The last patient we disinserted the muscle before attaching the flap and this patient has single vision in primary gaze. I know this technique is being done elsewhere, but I am curious what other resident's experience is with this technique or with surgical treatment of 3rd nerve palsy.

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Thanks for sharing these cases! We can also use the new cases posted on EyeRounds and the Podcasts from Josh Young as a means for discussions too.


Such as:

http://www.eyeorbit.org/eyeorbitgal...48&sessionid=4e0403dc2d0dad694fb8b118286cb329

Post-Operative Endophthalmitis: a population-based study
Paper Discussed: Ng JQ, Morlet N, Pearman JW, et al.
Management and outcomes of postoperative endophthalmitis since the endophthalmitis vitrectomy study: the Endophthalmitis Population Study of Western Australia (EPSWA)'s fifth report.
Ophthalmology, July 2005, 112(7) p1199-206

Abstract:
PURPOSE: To examine if changes in the diagnosis and management of postoperative endophthalmitis have occurred since 1995, and to identify factors that might predict final visual outcome. DESIGN: Retrospective, population-based, noncomparative, consecutive case series. PARTICIPANTS: Patients with clinically diagnosed endophthalmitis after cataract surgery and lens-related surgery in Western Australia from 1980 to 2000. METHODS: Endophthalmitis cases were identified using record linkage and cross-referencing with the surgical logbooks of vitreoretinal surgeons before validation by medical record review. MAIN OUTCOME MEASURES: Microbiological data (microorganisms isolated and antibiotic susceptibilities), diagnostic interventions, surgical procedures, therapeutic interventions, and visual acuity (VA). RESULTS: During the 21-year period, 213 episodes of endophthalmitis occurred after cataract surgery. Since 1995, both anterior chamber sampling and vitreous sampling have increased significantly. The overall use of vitrectomy has also increased, but we did not observe a difference according to presenting VA. Intravitreal antibiotic use increased significantly, whereas the use of both subconjunctival and IV antibiotics decreased. In one third of patients, the VA at least 6 months after admission for endophthalmitis was worse than 6/18. This was associated with treatment that did not include the use of oral antibiotics (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.21-12.39; P = 0.02), growth from intraocular samples of organisms other than coagulase-negative staphylococci (OR, 9.84; 95% CI, 2.84-34.09; P<0.001), and a discharge VA worse than 6/18 (OR, 6.10; 95% CI, 1.63-22.89; P = 0.01). CONCLUSIONS: Although we observed noticeable changes in the diagnosis and management of endophthalmitis since 1995, visual outcomes have not improved and remain poor. Our finding that treatment with oral antibiotics may be associated with a better visual outcome warrants further investigation.
 
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