Dataset Information

Three techniques for guidewire-assisted sulcus glaucoma tube shunt placement.

ABSTRACT:

Purpose

Tube shunts can be inserted into the anterior chamber, ciliary sulcus, or pars plana. Sulcus tube placement can be challenging. This report demonstrates three techniques for guidewire-assisted sulcus tube insertion.

Observations

The first technique uses a needle inserted through a paracentesis 180-degrees across from the tube entry site and creates an ab-interno sclerotomy through which the guidewire is inserted by docking it into the needle bevel. The second technique involves inserting the guidewire into the eye via a paracentesis and using microforceps to retrieve it through a sclerotomy. The third technique uses forceps to insert the guidewire into a paracentesis 180° across from the planned tube entry site and dock it into a needle bevel that has been inserted into the sulcus. Each of these techniques provides a reliable and reproducible way to insert a tube into the sulcus.

Conclusions and importance

Guidewire-assisted tube entry offers a promising solution in cases of difficult sulcus tube placement without substantial additional cost.

SUBMITTER: Shah A

PROVIDER: S-EPMC10945046 | biostudies-literature | 2024 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Three techniques for guidewire-assisted sulcus glaucoma tube shunt placement.

Shah Arjav A Kanter Jacob A JA Eisengart Jonathan J Blieden Lauren S LS Qiu Mary M

American journal of ophthalmology case reports 20240228

<h4>Purpose</h4>Tube shunts can be inserted into the anterior chamber, ciliary sulcus, or pars plana. Sulcus tube placement can be challenging. This report demonstrates three techniques for guidewire-assisted sulcus tube insertion.<h4>Observations</h4>The first technique uses a needle inserted through a paracentesis 180-degrees across from the tube entry site and creates an ab-interno sclerotomy through which the guidewire is inserted by docking it into the needle bevel. The second technique inv ...[more]

PMID: 38501095

Similar Datasets

Project description:BackgroundThe success rate of correct endotracheal tube (ETT) placement for junior medical staff is less than 50% and accidental oesophageal intubation is common. Rapid confirmation of correct tube placement is important because tube malposition is associated with serious adverse outcomes including hypoxaemia, death, pneumothorax and right upper lobe collapse.ETT position can be confirmed using chest radiography, but this is often delayed; hence, a number of rapid point-of-care methods to confirm correct tube placement have been developed. Current neonatal resuscitation guidelines advise that correct ETT placement should be confirmed by the observation of clinical signs and the detection of exhaled carbon dioxide (CO2). Even though these devices are frequently used in the delivery room to assess tube placement, they can display false-negative results. Recently, newer techniques to assess correct tube placement have emerged (e.g. respiratory function monitor), which have been claimed to be superior in the assessment of tube placement.ObjectivesTo assess various techniques for the identification of correct ETT placement after oral or nasal intubation in newborn infants in either the delivery room or neonatal intensive care unit compared with chest radiography.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL,The Cochrane Library 2012, Issue 4), MEDLINE (January 1996 to June 2014), EMBASE (January 1980 to Juen 2014) and CINAHL (January 1982 to June 2014). We searched clinical trials registers and the abstracts of the Society for Pediatric Research and the European Society for Pediatric Research from 2004 to 2014. We did not apply any language restrictions.Selection criteriaWe planned to include randomised and quasi-randomised controlled trials and cluster trials that compared chest radiography with clinical signs, respiratory function monitors, exhaled CO2 detectors or ultrasound for the assessment of correct ETT placement either in the delivery room or the neonatal intensive care unit.Data collection and analysisTwo review authors independently evaluated the search results against the selection criteria. We did not perform data extraction and 'Risk of bias' assessments because we identified no studies that met our inclusion criteria.Main resultsWe did not identify any studies meeting the criteria for inclusion in this review.Authors' conclusionsThere is insufficient evidence to determine the most effective technique for the assessment of correct ETT placement either in the delivery room or the neonatal intensive care unit. Randomised clinical trials comparing either of these techniques with chest radiography are warranted.

Project description:ObjectiveTo compare the efficacy and safety of tube shunt implantation with trabeculectomy in the treatment of patients with glaucoma.MethodsA systematic literature search was performed for studies comparing tube with trabeculectomy in patients with glaucoma (final search date: 27 February 2022). Comparisons between tube and trabeculectomy were grouped by the type of tube (Ahmed, Baerveldt, Ex-PRESS and XEN). The primary endpoints included intraocular pressure (IOP), IOP reduction (IOPR), IOPR percentage (IOPR%), complete success rate (CSR), qualified success rate (QSR) and adverse events (AEs).ResultsForty-nine studies were included in this meta-analysis and presented data for 3795 eyes (Ahmed: 670, Baerveldt: 561, Ex-PRESS: 473, XEN: 199, trabeculectomy: 1892). Ahmed and Ex-PRESS were similar to trabeculectomy in terms of IOP outcomes and success rate (Ahmed vs trabeculectomy: IOPR%: mean difference (MD)=1.34 (-5.35, 8.02), p=0.69; Ex-PRESS vs trabeculectomy: IOPR%: MD=0.12 (-3.07, 3.31), p=0.94). The IOP outcomes for Baerveldt were worse than those for trabeculectomy (IOPR%: MD=-7.51 (-10.68, -4.35), p<0.00001), but the QSR was higher. No significant difference was shown for the CSR. XEN was worse than trabeculectomy in terms of IOP outcomes (IOPR%: MD=-7.87 (-13.55, -2.18), p=0.007), while the success rate was similar. Ahmed and Ex-PRESS had a lower incidence of AEs than trabeculectomy. Baerveldt had a lower incidence of bleb leakage/wound leakage, hyphaema and hypotonic maculopathy than trabeculectomy but a higher incidence of concurrent cataracts, diplopia/strabismus and tube erosion. The incidence of AEs was similar for the XEN and trabeculectomy procedures.ConclusionCompared with trabeculectomy, both Ahmed and Ex-PRESS appear to be associated with similar ocular hypotensive effects and lower incidences of AEs. However, Baerveldt and XEN cannot achieve sufficient reductions in IOP outcomes similar to those of trabeculectomy.Prospero registration numberCRD42021257852.

Project description:BackgroundPlacement of a syringo-subarachnoid shunt as a surgical management for syringomyelia has been well described in the literature. Good results in terms of clinical and radiological improvement have been documented especially for posttraumatic syringomyelia. Traditionally, this has been performed using open approaches which are fraught with risks of cerebrospinal fluid leak, delayed wound healing, and increased postoperative pain. With the help of minimally invasive techniques that are currently being used to treat various degenerative spinal disorders, most of these complications may be minimized. However, few reports in literature describe similar approaches for accessing intradural intramedullary spinal cord lesions and especially for syringomyelia.MethodsRetrospective case review: using a 22-mm tubular retractor, a laminotomy was performed, durotomy done, and spinal cord identified. Myelotomy was performed at the dorsal root entry zone, syrinx visualized and entered, followed by placement of syringo-subarachnoid shunt.ResultsThree male patients aged 44, 57, and 37 underwent placement of syringo-subarachnoid shunts using minimally invasive fixed tubular retractors. Indications included posttraumatic or postsurgical spinal cord syrinx. Follow-up period was 1 year in all cases. There were no neurological or technique-related complications. All patients showed clinical improvement upon subsequent follow up.ConclusionsOur clinical experience on the treatment of syringomyelia via a minimally invasive fixed tubular retractor is presented. We find that this is an ideal approach for placement of syringo-subarachnoid shunts, as it provides direct access to the lesion with minimal collateral damage and wound-related complications.Level of evidence4.Clinical relevanceRelevant - in demonstrating the effectiveness of an already established procedure through a novel, minimally invasive approach which has the potential to significantly reduce the overall morbidity, in view of the inherent approach-related benefits as compared to conventional open approaches.

Dataset Information

Three techniques for guidewire-assisted sulcus glaucoma tube shunt placement.

Purpose

Observations

Conclusions and importance

Publications

Three techniques for guidewire-assisted sulcus glaucoma tube shunt placement.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets