Publications by authors named "Dagmar R Lemus"

2 Publications

  • Page 1 of 1

Clinical features and outcomes of pars plana vitrectomy in patients with retained lens fragments.

Ophthalmology 2003 Aug;110(8):1567-72

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami School of Medicine, Miami, Florida 33101, USA.

Purpose: To investigate the clinical features, visual acuity outcomes, and adverse events in patients with retained lens fragments managed by pars plana vitrectomy (PPV).

Design: Retrospective, noncomparative, consecutive case series.

Methods: Medical records of all patients who underwent PPV for retained lens fragments at Bascom Palmer Eye Institute during the 12-year interval between January 1, 1990, and December 31, 2001, were reviewed.

Results: The study included 343 eyes of 343 patients, with a median age of 76 years and a median follow-up after PPV of 8 months. The median interval between cataract surgery and PPV was 12 days. Visual acuity was >or=20/40 in 29 (9%) patients preoperatively and 190 (56%) at last follow-up (P < 0.001). Visual acuity was or=30 mmHg was present in 87 (25%) eyes preoperatively and 7 (2%) at last follow-up (P < 0.001); the number of patients on antiglaucoma medications at these two time points was 135 (40%) and 96 (29%), respectively (P = 0.001). Among the 148 (44%) patients with final vision <20/40, the primary cause of visual impairment was cystoid macular edema (CME) in 41 (29%), preexisting ocular disease in 34 (24%), corneal edema in 22 (15%), history of retinal detachment (RD) in 19 (13%), epiretinal membrane in 6 (4%), and other causes in 21 (15%). Significant predictors of better final visual acuity include better presenting visual acuity (P < 0.001), presence of an intraocular lens (i.e., no aphakia) before PPV (P = 0.026), no suprachoroidal hemorrhage (P = 0.010), no serous choroidal detachment (P = 0.037), no RD (P = 0.005), no CME (P = 0.038), and no additional surgery after the PPV (P < 0.001). Timing of PPV (i.e., 1 to 4 to 12 weeks between cataract surgery and PPV) was not significantly associated with final visual acuity or IOP outcome; there was also no significant difference in acuity or IOP outcome between patients who underwent PPV on the same day as cataract surgery compared with all other patients.

Conclusions: The most important predictor of final visual acuity after PPV for retained lens fragments is a less complicated clinical course (e.g., no suprachoroidal hemorrhage, no RD, no CME, and no additional surgery after PPV). The most common cause of decreased final vision was CME.
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http://dx.doi.org/10.1016/S0161-6420(03)00488-3DOI Listing
August 2003

Local anesthesia with intravenous sedation for surgical repair of selected open globe injuries.

Am J Ophthalmol 2002 Nov;134(5):707-11

Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, School of Medicine, Miami, Florida 33101, USA.

Purpose: To report factors associated with the use of local anesthesia with intravenous sedation (local anesthesia/sedation) rather than general anesthesia for surgery for open globe injuries in adult reparable eyes.

Design: Retrospective, nonrandomized, comparative case series.

Methods: Medical records were reviewed of all patients with open globe injuries repaired at Bascom Palmer Eye Institute between 1995 and 1999. "Adult reparable eyes" (eyes in patients >/=18 years of age, not treated with primary enucleation or evisceration, followed up >/=2 months) were included.

Results: In all, 220 eyes of 218 patients met inclusion criteria. General anesthesia was employed in 80 of 200 (36%) and local anesthesia/sedation in 140 of 220 (64%). Patients who had local anesthesia/sedation were significantly more likely to have an intraocular foreign body (31% vs 14%; P =.010, chi-square test), better presenting visual acuity (1.8 logMAR [logarithm of the minimum angle of resolution] units vs 2.5 logMAR units; P <.001, t test), more anterior wound location (75% corneal/limbal vs 65%; P =.003, chi-square), shorter wound length (6.3mm vs 10.8mm; P <.001, t test), and dehiscence of previous surgical wound (26% vs 12%; P =.021, chi-square) and were significantly less likely to have an afferent pupillary defect (22% vs 51%; P <.001, chi-square). There was no anesthesia-related complication in either group. The local anesthesia/sedation group had a shorter mean operating time than did the general anesthesia group (78 minutes vs 117 minutes; P <.001, t test). The general anesthesia group had a longer mean follow-up than the local anesthesia/sedation group (20.2 months vs 13.9 months, respectively; P =.002, t test). Change in visual acuity between the presenting and final examinations was similar for open globe injuries repaired with general anesthesia compared with local anesthesia/sedation (0.94 vs 0.72 logMAR units of visual acuity, respectively; P =.16, t test).

Conclusions: Local anesthesia/sedation is a reasonable alternative to general anesthesia for selected patients with open globe injuries.
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http://dx.doi.org/10.1016/s0002-9394(02)01692-6DOI Listing
November 2002