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Harry W. Flynn - One of the best experts on this subject based on the ideXlab platform.
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Multi-drug resistant Mycobacterium chelonae Scleral Buckle infection.
American journal of ophthalmology case reports, 2018Co-Authors: Daniel S. Churgin, Kimberly D. Tran, Ninel Z. Gregori, Ryan C. Young, Chrisfouad R. Alabiad, Harry W. FlynnAbstract:Abstract Purpose To describe a case of Multi-drug resistant Mycobacterium chelonae Scleral Buckle infection. Observations A 56 year-old male with history of retinal detachment repair with Scleral Buckle 20 years prior presented with 8 months of intermittent pain and redness in the left eye. The patient was diagnosed with Scleral Buckle infection, the Buckle was removed, and cultures revealed multi-drug resistant Mycobacterium chelonae. The postoperative course included orbital cellulitis treated with systemic linezolid, clarithromycin, and imipenem. All systemic antibiotics were discontinued on post-operative day 25, visual acuity improved to 20/25, the retina remained attached, and no recurrence occurred over 3 years of follow-up. Conclusions and importance NTM infections are typically chronic and often require lengthy treatment. SB infection is rare, but often associated with biofilm and antibiotic resistance. In spite of removing the SB, anchoring sutures, sheath surrounding the Buckle and associated biofilm, a prolonged course of systemic antibiotics may be necessary in some patients.
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Multi-drug resistant Mycobacterium chelonae Scleral Buckle infection
Elsevier, 2018Co-Authors: Daniel S. Churgin, Kimberly D. Tran, Ninel Z. Gregori, Ryan C. Young, Chrisfouad R. Alabiad, Harry W. FlynnAbstract:Purpose: To describe a case of Multi-drug resistant Mycobacterium chelonae Scleral Buckle infection. Observations: A 56 year-old male with history of retinal detachment repair with Scleral Buckle 20 years prior presented with 8 months of intermittent pain and redness in the left eye. The patient was diagnosed with Scleral Buckle infection, the Buckle was removed, and cultures revealed multi-drug resistant Mycobacterium chelonae. The postoperative course included orbital cellulitis treated with systemic linezolid, clarithromycin, and imipenem. All systemic antibiotics were discontinued on post-operative day 25, visual acuity improved to 20/25, the retina remained attached, and no recurrence occurred over 3 years of follow-up. Conclusions and importance: NTM infections are typically chronic and often require lengthy treatment. SB infection is rare, but often associated with biofilm and antibiotic resistance. In spite of removing the SB, anchoring sutures, sheath surrounding the Buckle and associated biofilm, a prolonged course of systemic antibiotics may be necessary in some patients. Keywords: Non-tuberculous mycobacterium, Scleral Buckle, Orbital celluliti
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pneumatic retinopexy for retinal detachment occurring after prior Scleral Buckle or pars plana vitrectomy
Ophthalmic Surgery and Lasers, 2014Co-Authors: Yasha S Modi, William E. Smiddy, Justin H Townsend, Aliza Epstein, Harry W. FlynnAbstract:BACKGROUND AND OBJECTIVE To report outcomes of pneumatic retinopexy (PR) for retinal detachment (RD) occurring after prior Scleral buckling surgery (SB) or pars plana vitrectomy (PPV). PATIENTS AND METHODS Single-center study evaluating all patients treated between January 2000 and March 2013. RESULTS Ten eyes underwent PR after prior SB. Nine of these 10 eyes had persistent subretinal fluid posterior to the Buckle in the setting of an open break on the Scleral Buckle. The mean time to PR in these cases was 8.5 days after SB. PR achieved anatomic reattachment in eight of 10 eyes, but two of 10 eyes required additional PPV to achieve retinal reattachment. Seven eyes underwent PR after prior PPV. The average time to RD after PPV was 67 days (range: 15-232 days). The location of the break was superior in four eyes, horizontal in two, and inferior in one. Anatomic reattachment with PR alone occurred in four of seven eyes (57%). CONCLUSION In the setting of recurrent RD after initial SB, pneumatic retinopexy was usually successful in the early postoperative course. In the setting of a new-onset RD after PPV, pneumatic retinopexy was a useful option, but recurrent RD was more common.
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Scleral Buckle infections microbiological spectrum and antimicrobial susceptibility
Journal of Ophthalmic Inflammation and Infection, 2013Co-Authors: Jay Chhablani, Sameera Nayak, Animesh Jindal, Swapna R Motukupally, Annie Mathai, Subhadra Jalali, Rajiv Reddy Pappuru, Savitri Sharma, Taraprasad Das, Harry W. FlynnAbstract:The purpose of the present study was to evaluate the microbiological spectrum and antimicrobial susceptibility in patients with Scleral Buckle infection. Medical records of all the patients diagnosed as Buckle infection at L. V. Prasad Eye Institute between July 1992 and June 2012 were reviewed in this non-comparative, consecutive, retrospective case series. A total of 132 eyes of 132 patients underwent Buckle explantation for Buckle infection during the study period. The incidence of Buckle infection at our institute during the study period was 0.2% (31 out of 15,022). A total of 124 isolates were identified from 102 positive cultures. The most common etiological agent isolated was Staphylococcus epidermidis (27/124, 21.77%) followed by Mycobacterium sp. (20/124, 16.13%) and Corynebacterium sp. (13/124, 10.48%). The most common gram negative bacilli identified was Pseudomonas aeruginosa (9/124, 7.26%). The median interval between Scleral buckling surgery and onset of symptoms of local infection was 30 days. All eyes underwent Buckle explantation and median time interval between primary SB surgery and explantation was 13 months. Recurrent retinal detachment was observed in two cases at 7 and 48 months, respectively, after Buckle explantation. Gram positive, gram negative, and acid-fast organisms isolated from 2003 to 2012 were most commonly susceptible to vancomycin (100%), ciprofloxacin (100%), and amikacin (89%). Susceptibility to ciprofloxacin during the same time period was observed in 75% (15/20), 100% (13/13), and 87% (7/8) of gram positive, gram negative, and acid-fast isolates, respectively. Scleral Buckle infection is relatively rare and has a delayed clinical presentation. It is most commonly caused by gram positive cocci. Based on the current antimicrobial susceptibility, ciprofloxacin can be used as empirical therapy in the management of Scleral Buckle infections.
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baerveldt drainage implants in eyes with a preexisting Scleral Buckle
Archives of Ophthalmology, 2000Co-Authors: Ingrid U Scott, Harry W. Flynn, Steven J Gedde, Donald L Budenz, David S Greenfield, William J Feuer, Mozart O Mello, Rohit Krishna, David G GodfreyAbstract:Objective To describe the surgical insertion of a Baerveldt drainage implant and postoperative visual acuity and intraocular pressure (IOP) outcomes in patients with a preexisting Scleral Buckle. Methods Medical records of all patients with a preexisting Scleral Buckle who underwent insertion of a Baerveldt drainage implant at Bascom Palmer Eye Institute, Miami, Fla, from January 1, 1994, through December 31, 1998, were reviewed. Outcome measures included visual acuity and IOP at 1 year. Results At 1 year postoperatively, 14 (88%) of 16 patients had stable or improved visual acuity. Preoperatively, mean IOP was 30.9 mm Hg and the mean number of antiglaucoma medications was 3.4; at 1 year postoperatively, mean IOP was 12.0 mm Hg and the mean number of antiglaucoma medications was 0.8 ( P Conclusion Baerveldt drainage device insertion behind or over a preexisting encircling band is often successful in managing refractory glaucoma in patients who have undergone previous Scleral buckling procedures.
Adiel Barak - One of the best experts on this subject based on the ideXlab platform.
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outcomes of Scleral Buckle removal experience from the last decade
Current Eye Research, 2017Co-Authors: Elad Moisseiev, Miri Fogel, Ido Didi Fabian, Adiel Barak, Joseph Moisseiev, Amir AlhalelAbstract:Purpose: To evaluate the indications, outcomes, and complications of Scleral Buckle removal over the past decade and compare to previously published data.Methods: Forty nine eyes of 49 patients who underwent Scleral Buckle removal and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, history of the retinal detachment, details of the Scleral buckling surgery, indication for Scleral Buckle removal, time from Scleral Buckle placement to removal, culture results, length of follow up, visual acuity (VA) throughout the follow up, and the occurrence of any complications or need for additional surgery after Scleral Buckle removal.Results: The overall rate of Scleral Buckle removal over the last decade was 5.7% (85/1493). Indications included Buckle extrusion (57.1%), infection (8.2%), both (26.5%) eyes, and strabismus and diplopia (8.2%). The median time from Scleral Buckle placement to removal was 35 months, but in 22.4% of...
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pseudophakic rhegmatogenous retinal detachment combined pars plana vitrectomy and Scleral Buckle versus pars plana vitrectomy alone
Graefes Archive for Clinical and Experimental Ophthalmology, 2016Co-Authors: Adiel Barak, Rivka KessnerAbstract:Purpose To compare the outcomes of combined vitrectomy + Scleral Buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD).
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comparison of pars plana vitrectomy with and without Scleral Buckle for the repair of primary rhegmatogenous retinal detachment
American Journal of Ophthalmology, 2011Co-Authors: Michael Kinori, Elad Moisseiev, Ido Didi Fabian, Adiel Barak, Joseph Moisseiev, Nadav Shoshany, Alon Skaat, Anat LoewensteinAbstract:Purpose To compare pars plana vitrectomy (PPV) with combined PPV and Scleral Buckle (SB) for the repair of noncomplex primary rhegmatogenous retinal detachment (RRD). Design Retrospective, nonrandomized, interventional case series. Methods We reviewed 181 consecutive cases of vitrectomy for primary RRD at 2 major medical centers in Israel. The follow-up was at least 3 months. There were 96 eyes in the PPV group and 85 eyes in the PPV plus SB group. Main outcome measures were single-surgery anatomic success (SSAS) and final visual acuity (VA). Results SSAS was achieved in 81.3% and 87.1% in the PPV and PPV plus SB groups, respectively ( P = .29). Final anatomic success rate was 98.9% and 98.8%, respectively ( P = .61). Final VA was 0.41 (20/51) in the PPV group and 0.53 (20/68) in the PPV plus SB group ( P = .13). The final VA was significantly better than the preoperative VA in both groups ( P P = .74). In phakic eyes, SSAS rates were 92% and 87.5%, respectively, and in pseudophakic eyes, SSAS rates were 77.5% and 86.7%, respectively, in the PPV and PPV plus SB groups ( P = .29). Conclusions The reattachment rate and the final VA were similar in both groups. The addition of SB did not improve the results and was associated with slightly lower VA than with PPV alone. Tear location or lens status had no significant effect on success rates. It is likely that in eyes undergoing PPV for primary RRD, addition of a SB is not warranted.
Rivka Kessner - One of the best experts on this subject based on the ideXlab platform.
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pseudophakic rhegmatogenous retinal detachment combined pars plana vitrectomy and Scleral Buckle versus pars plana vitrectomy alone
Graefes Archive for Clinical and Experimental Ophthalmology, 2016Co-Authors: Adiel Barak, Rivka KessnerAbstract:Purpose To compare the outcomes of combined vitrectomy + Scleral Buckle (SB) and vitrectomy alone for pseudophakic rhegmatogenous retinal detachment (RRD).
Joseph Moisseiev - One of the best experts on this subject based on the ideXlab platform.
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outcomes of Scleral Buckle removal experience from the last decade
Current Eye Research, 2017Co-Authors: Elad Moisseiev, Miri Fogel, Ido Didi Fabian, Adiel Barak, Joseph Moisseiev, Amir AlhalelAbstract:Purpose: To evaluate the indications, outcomes, and complications of Scleral Buckle removal over the past decade and compare to previously published data.Methods: Forty nine eyes of 49 patients who underwent Scleral Buckle removal and had at least 6 months of follow-up were included in this retrospective study. Recorded parameters included demographic information, history of the retinal detachment, details of the Scleral buckling surgery, indication for Scleral Buckle removal, time from Scleral Buckle placement to removal, culture results, length of follow up, visual acuity (VA) throughout the follow up, and the occurrence of any complications or need for additional surgery after Scleral Buckle removal.Results: The overall rate of Scleral Buckle removal over the last decade was 5.7% (85/1493). Indications included Buckle extrusion (57.1%), infection (8.2%), both (26.5%) eyes, and strabismus and diplopia (8.2%). The median time from Scleral Buckle placement to removal was 35 months, but in 22.4% of...
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comparison of pars plana vitrectomy with and without Scleral Buckle for the repair of primary rhegmatogenous retinal detachment
American Journal of Ophthalmology, 2011Co-Authors: Michael Kinori, Elad Moisseiev, Ido Didi Fabian, Adiel Barak, Joseph Moisseiev, Nadav Shoshany, Alon Skaat, Anat LoewensteinAbstract:Purpose To compare pars plana vitrectomy (PPV) with combined PPV and Scleral Buckle (SB) for the repair of noncomplex primary rhegmatogenous retinal detachment (RRD). Design Retrospective, nonrandomized, interventional case series. Methods We reviewed 181 consecutive cases of vitrectomy for primary RRD at 2 major medical centers in Israel. The follow-up was at least 3 months. There were 96 eyes in the PPV group and 85 eyes in the PPV plus SB group. Main outcome measures were single-surgery anatomic success (SSAS) and final visual acuity (VA). Results SSAS was achieved in 81.3% and 87.1% in the PPV and PPV plus SB groups, respectively ( P = .29). Final anatomic success rate was 98.9% and 98.8%, respectively ( P = .61). Final VA was 0.41 (20/51) in the PPV group and 0.53 (20/68) in the PPV plus SB group ( P = .13). The final VA was significantly better than the preoperative VA in both groups ( P P = .74). In phakic eyes, SSAS rates were 92% and 87.5%, respectively, and in pseudophakic eyes, SSAS rates were 77.5% and 86.7%, respectively, in the PPV and PPV plus SB groups ( P = .29). Conclusions The reattachment rate and the final VA were similar in both groups. The addition of SB did not improve the results and was associated with slightly lower VA than with PPV alone. Tear location or lens status had no significant effect on success rates. It is likely that in eyes undergoing PPV for primary RRD, addition of a SB is not warranted.
Edwin H Ryan - One of the best experts on this subject based on the ideXlab platform.
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cost analysis of Scleral Buckle pars plana vitrectomy and pars plana vitrectomy with Scleral Buckle for retinal detachment repair
Retina-the Journal of Retinal and Vitreous Diseases, 2021Co-Authors: Peter J Belin, William E. Smiddy, Nicholas A Yannuzzi, Sushant Wagley, Edwin H RyanAbstract:PURPOSE To compare the cost and utility of Scleral Buckle (SB), pars plana vitrectomy (PPV) and PPV with SB (PPV/SB) for moderately complex rhegmatogenous retinal detachment (RRD) repair. METHODS Cost-utility analysis utilizing data from the Primary Retinal Detachment Outcomes Study (PRO Study). The model estimated costs, lifetime utility, and lifetime cost per quality-adjusted life year (QALY) for treatment of moderately complex RRD with SB, PPV or PPV/SB. Data from the Centers for Medicare and Medicaid Services were used to calculate costs in hospital and ASC settings. RESULTS Total costs (2020 United States dollars) for repair of a moderately complex RRD in hospital (ASC) settings were $5975 ($3774) for the SB group, $8125 ($5082) for the PPV group, and $7551 ($4713) for the PPV/SB group. The estimated lifetime QALYs gained were 5.4, 4.7, and 4.7 in the SB, PPV and PPV/SB groups, respectively. The cost per QALY for hospital and ASC settings was $1106 a ($699) for the SB group, $1729 ($1081) for the PPV group, and $1607 ($1003) for the PPV/SB group. CONCLUSIONS SB, PPV and PPV/SB yielded very favorable cost-utility results for the repair of moderately complex RRD, with slightly better results for SB, compared to current willingness to pay standards.
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retinal detachment with inferior retinal breaks primary vitrectomy versus vitrectomy with Scleral Buckle pro study report no 9
Retina-the Journal of Retinal and Vitreous Diseases, 2021Co-Authors: Matthew R Starr, Geoffrey G Emerson, Edwin H Ryan, Claire Ryan, Nora J Forbes, Antonio Capone, Anthony Obeid, Michael Ammar, Luv G Patel, Daniel P JosephAbstract:Introduction Rhegmatogenous retinal detachments with inferior retinal breaks are believed to have a higher risk of recurrent rhegmatogenous retinal detachment. This study compared anatomic and visual outcomes between primary pars plana vitrectomy (PPV) and combination PPV with Scleral Buckle (PPV/SB) for rhegmatogenous retinal detachments with inferior retinal breaks. Methods This is an analysis of the Primary Retinal Detachment Outcomes study, a multi-institutional cohort study of consecutive primary rhegmatogenous retinal detachment surgeries from January 1, 2015, through December 31, 2015. The primary outcome was single-surgery success rate. Only eyes with inferior retinal breaks (one break in the detached retina between five and seven o'clock) were included. Results There were 238 eyes that met the inclusion criteria, 95 (40%) of which underwent primary PPV and 163 (60%) that underwent combined PPV/SB. The single-surgery success rate was 76.8% for PPV and 87.4% for PPV/SB (P = 0.0355). This remained significant on multivariate analysis (P = 0.01). Subgroup analysis showed that a superior single-surgery success rate of PPV/SB was especially noted in phakic eyes (85.2% vs. 68.6%; P = 0.0464). Conclusion Retinal detachment with inferior retinal breaks had a higher single-surgery success rate if treated with PPV/SB compared with PPV alone, particularly in phakic eyes.
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factors associated with the use of 360 degree laser retinopexy during primary vitrectomy with or without Scleral Buckle for rhegmatogenous retinal detachment and impact on surgical outcomes pro study report number 4
Retina-the Journal of Retinal and Vitreous Diseases, 2020Co-Authors: Jay C Wang, Edwin H Ryan, Claire Ryan, Srividya Kakulavarapu, Patrick J Mardis, Marianeli Rodriguez, James A Stefater, Nora J Forbes, Omesh P Gupta, Antonio CaponeAbstract:PURPOSE To determine factors associated with 360-degree laser retinopexy (360LR) during primary pars plana vitrectomy ± Scleral Buckle for rhegmatogenous retinal detachment (RRD) and its impact on surgical outcomes. METHODS This is a multicenter, retrospective, interventional study. Patients undergoing primary pars plana vitrectomy or primary pars plana vitrectomy + Scleral Buckle for noncomplex primary RRD in 2015 were evaluated. Primary outcomes were single surgery anatomical success (SSAS) and final anatomical success. Secondary outcomes included final logarithm of the minimum angle of resolution visual acuity, epiretinal membrane formation, cystoid macular edema development, and number of subsequent vitrectomies. Multivariate regressions were performed. RESULTS Two thousand two hundred and forty-eight surgeries by 61 surgeons were included; of which, 516 underwent 360LR. Younger age (P = 0.01), more retinal breaks (P = 0.01), more extensive RRD (P < 0.001), and surgeon ID (P < 0.001) were significantly associated with 360LR. No significant associations between 360LR and single surgery anatomical success (P = 0.44), epiretinal membrane formation (P = 0.14), cystoid macular edema development (P = 0.28), or number of subsequent vitrectomies (P = 0.41) were found. Controlling for case complexity, 360LR was significantly associated with lower final anatomical success (P < 0.001) and worse final logarithm of the minimum angle of resolution visual acuity (P < 0.001). CONCLUSION Multiple factors influenced whether 360LR was performed during primary pars plana vitrectomy ± Scleral Buckle for RRD. However, 360LR was not associated with improved surgical outcomes, and in fact, it may be associated with poorer outcomes.