Dataset Information

Surgical Management of Complications after Dexamethasone Implant.

ABSTRACT: Purpose:To report surgical management of ocular complications occurred after dexamethasone (DEX) implant (Ozurdex®) injection. Methods:Retrospective interventional case series. Results:Different surgical procedures including viscoexpression to manage the migration of the implant into the anterior chamber, "phaco-rolling" technique for the intralenticular injection, and vitrectomy with implant removal for an acute endophthalmitis were performed. Successful management of different complications after DEX implant by using individualized surgical approaches was observed. Conclusions:Early and targeted surgical management is required in selected cases of ocular complications after DEX implant. The implant removal was needed to preserve ocular anatomy and function.

SUBMITTER: Sborgia G

PROVIDER: S-EPMC7035535 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Surgical Management of Complications after Dexamethasone Implant.

Sborgia Giancarlo G Niro Alfredo A D'Oria Francesco F Galeone Alessandra A Sborgia Luigi L Boscia Francesco F Sborgia Alessandra A Alessio Giovanni G

Case reports in ophthalmological medicine 20200210

<h4>Purpose</h4>To report surgical management of ocular complications occurred after dexamethasone (DEX) implant (Ozurdex®) injection.<h4>Methods</h4>Retrospective interventional case series.<h4>Results</h4>Different surgical procedures including viscoexpression to manage the migration of the implant into the anterior chamber, "phaco-rolling" technique for the intralenticular injection, and vitrectomy with implant removal for an acute endophthalmitis were performed. Successful management of diff ...[more]

PMID: 32095301

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Project description:Background and objectiveComplications associated with implant-based reconstruction have a spectrum of severity with sequelae ranging from mild aesthetic deformities to additional surgery, reconstructive failure and systemic illness. The purpose of this narrative review of the literature is to provide updated evidence-based information on the management of complications in implant-based reconstruction.MethodsA systematic search of PubMed, OVID MEDLINE and the Cochrane Library databases was performed to identify common complications associated with implant-based breast reconstruction, incidences of occurrence as well as preventative and management strategies.Key content and findingsPertinent short and long-term complications of implant-based breast reconstruction include hematoma, implant infection, seroma, skin envelope necrosis, capsular contracture, rupture, malposition, animation and contour deformities, implant-associated anaplastic large cell lymphoma, and breast implant illness. Important preventative measures for short term complications include meticulous sterile technique and antibiotic irrigation, adequate drainage and critical evaluation of mastectomy flaps. Management of short-term complications requires early recognition and aggressive treatment to prevent reconstructive failure as well as long-term complications such as capsular contracture. Important technological advances include dual-port expanders for seroma drainage, indocyanine green angiography for mastectomy flap perfusion evaluation, cohesive form-stable implants for treatment of rippling, and various biologic and synthetic mesh products for pocket control and correction.ConclusionsImportant principles in management of short-term complications in implant-based reconstruction include aggressive and early intervention to maximize the chance of reconstructive salvage. Contemporary technological advances have played an important role in both prevention and treatment of complications. Over-arching principles in management of implant-based reconstruction complications focus on preventative techniques and preoperative patient counseling on potential risks, their likelihood, and necessary treatments to allow for informed and shared decision-making.

Project description:Study designRetrospective analysis on a national longitudinal database (2007-2014).ObjectiveTo determine the association between arthrodesis and complication rates, costs, surgical revision, and postoperative opioid prescription.Summary of background dataArthrodesis in patients receiving laminectomy for lumbar spondylolisthesis remains controversial. However, population-level evidence to support the use of arthrodesis remains limited.MethodsWe identified 73,176 patient records and used coarsened exact matching to create comparable populations of patients who received laminectomy or laminectomy with arthrodesis. We use linear and logistic regression models to analyze the relationship between arthrodesis and postoperative complications, length of stay, costs, readmissions, surgical revisions, and postoperative opioid prescribing.ResultsPatients who underwent arthrodesis spent 1 more day in the hospital on average (P < 0.01), and had higher costs of care at their index visit ($24,126, P < 0.01), which were partially offset by lower costs of care over the 2 years following their procedure ($14,667 less in arthrodesis patients, P = 0.01). Patients with arthrodesis were less likely to have a surgical revision (odds ratio = 0.66, P < 0.01). Patients with arthrodesis used more opioids in the first 2 months following their procedure, but had comparable opioid use to patients undergoing laminectomy without arthrodesis in all other postoperative months over the next 2 years, and were not more or less likely to convert to chronic opioid use. Postoperative opioid prescription varied dramatically across states (P < 0.01); geographic variation in opioid use is substantially greater than differences in opioid use based on procedure performed.ConclusionArthrodesis is associated with reduced likelihood of surgical revision and increased use of opioids in the first 2 months following surgery, but not associated with greater or lesser opioid use beyond the initial 2 postoperative months. Geographic variation in opioid use is substantial even after accounting for patient characteristics and for whether patients underwent arthrodesis.Level of evidence3.

Dataset Information

Surgical Management of Complications after Dexamethasone Implant.

Publications

Surgical Management of Complications after Dexamethasone Implant.

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