Use of Indocyanine Green-SPY Angiography for Tracking Lymphatic Recovery After Lymphaticovenous Anastomosis.
INTRODUCTION: Lymphaticovenous anastomosis (LVA) is a surgical treatment option for patients with early stage lymphedema. Prospective Randomized Study to Compare Lymphocele and Lymphorrhea Control Following Inguinal and Axillary Therapeutic Lymph Node Dissection With or Without the Use of an Ultrasonic Scalpel.
BACKGROUND: Many attempts to prevent lymphatic complications following therapeutic lymph node dissection (TLND) have included modifications in surgical techniques through the use of ultrasonic scalpels (USS) or lymphostatic agents. Joyce S1, Gordon K2, Brice G1, Ostergaard P3, Nagaraja R4, Short J1, Moore S1, Mortimer P3, Mansour S1,3. Congenital lymphedema is swelling that results from abnormalities in the lymphatic system that are present from birth. Congenital lymphoedema is a primary lymphoedema (see this term), occurring before the age of 2 years.
The Dog Health Handbook is not intended to replace the advice of a Veterinarian, Groomer or Pet Health Professional. Diffuse interstitial lung disease refers to a group of lung disorders in which the deep lung tissues become inflamed. Causes The lungs contain tiny air sacs (alveoli), which is where oxygen is absorbed.
Ectopia lentis is a displacement or malposition of the eye's crystalline lens from its normal location.
With anterior lens luxation, the lens pushes into the iris or actually enters the anterior chamber of the eye.
With posterior lens luxation, the lens falls back into the vitreous humour and lays on the floor of the eye. Lens subluxation is also seen in dogs and is characterized by a partial displacement of the lens. Terrier breeds are predisposed to lens luxation, and it is probably inherited in the Sealyham Terrier, Jack Russell Terrier, Wirehaired Fox Terrier, Tibetan Terrier,[7] Miniature Bull Terrier, Shar Pei, and Border Collie.[8] The mode of inheritance in the Tibetan Terrier[5] and Shar Pei[9] is likely autosomal recessive.
Helpful sites for tools to help you to easily create and save instruction sheets for your patients and purchase kits (cataract & refractive) to help with your patients' post-operative care. Check out the latest Stellaris, Stellaris PC, Victus, Crystalens, Trulign and enVista surgical videos from Bausch + Lomb. Soothe XP-Xtra Protection eye drops go further than ordinary lubricant eye drops which simply provide moisture that can evaporate quickly from the eye's surface. Soothe Hydration Lubricant Eye Drops provides dry eye therapy that moisturizes, comforts, and protects against further irritation.
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Soothe Night Time Lubricant Eye Ointment (Preservative free) for overnight relief of dry eyes. Alaway (ketotifen fumarate ophthalmic solution) Antihistamine Eye Drops are indicated for temporary relief for itchy eyes due to ragweed, pollen, grass, animal hair and dander.
Temporarily relieves minor eye symptoms of itching and redness caused by ragweed, pollen, grass, animal hair, and dander. This paper aims to explain the relevance of anterior segment imaging in diagnosis and surgical management of glaucoma. Ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT) were selected because they provide the most detailed information. Anterior chamber angle (ACA) structures’ morphology and topography features of eyes with angle closure glaucoma or angle occludability are conveyed and considered in their diagnosis and management; the role of biometric descriptors working as glaucoma screening tools, assessing surgical outcomes and light, accommodative and age effects is discussed. Optical biomicroscopy and gonioscopy have been classically used to assess anterior segment and ACA structures, and how they relate1.
The innovative development of anterior segment imaging has allowed visualizing anterior segment structures and aspects relevant to diagnosis and management of glaucoma, which could not be conveyed by conventional techniques. Ultrasound biomicroscopy or UBM is based on the emission of a high-frequency ultrasound beam (35, 50 and 80 MHz) with low tissue penetration, and which reflection at tissue interfaces provides high-resolution cross sectional images. Primary angle closure glaucoma is a heterogeneous group of eye diseases caused by a variety of mechanisms.
This invariably leads to iris apposition to the trabecular meshwork and subsequent increase in intraocular pressure. Aqueous humour flow resistance at the irido-lenticular contact increases the pressure in the posterior chamber, widens its area and produces an anterior iris bowing leading to angle closure6 (Fig.1). UBM and AS-OCT confirm diagnosis and document pressure balance restoration between both anterior and posterior chambers after laser peripheral iridotomy (LPI).
Iris-trabecular apposition disclosed by gonioscopy, UBM or AS-OCT do not necessarily imply an intraocular pressure increase9. UBM and AS-OCT show a generally thick, flat, slightly anterior bowing iris which abruptly ascends after its insertion on the ciliary body’s anterior surface assuming a "square root" appearance.  Indentation gonioscopy or UBM may reveal the double-hump sign.

UBM and AS-OCT document argon laser peripheral iridoplasty effect on ACA opening and enable objective anterior segment measurements (Fig. UBM and AS-OCT can confirm the presence of an intumescent lens pushing forward the iris and ciliary body to cause iris- trabecular meshwork apposition. Some eyes from which nanophthalmos is an extreme example, are prone to angle closure due to their dimensions, unsuccessful regulation mechanisms and vitreous resistance to fluid flow.
Figure 7 - Corneal edema, highly shallow anterior chamber, anterior positioning of the iris-lens diaphragm, iris thinning, uveal effusion (red arrows). Iris or ciliary body primary or secondary cystic or solid lesions, goniosynechia, cyclitic membrane, vitreous hernia or retinal surgery tamponade material may determine partial or intermittent angle closure that can be documented by UBM and AS-OCT (Fig.
Imaging is particularly important if optical media are not transparent (hyphema or hypopyon) and can reveal angle recession or cyclodialysis, potentially explaining intraocular pressure increase after trauma (Fig. Lighting conditions may cause relevant topography variation of anterior segment structures (Fig.
The diagnostic triad of pigmentary glaucoma: Krukenberg spindle, radial transillumination defects and trabecular meshwork pigment are caused by pigment dispersion due to mechanical friction between posterior iris surface and zonule . Pavlin’s first biometric descriptors have increased objectivity, accuracy and reproducibility of anterior segment measurements. Research is under way to find one or a set of effective biometric descriptors to accurately diagnose angle occludability and predict angle closure glaucoma probability15,16.
UBM and AS-OCT substantially complement optical biomicroscopy in assessing filtering blebs’ features. Yamamoto has proposed a classification system correlating filtering bleb ultrasound characteristics and bleb function. Figure 15 -  a and a’ DIFFUSE filtering bleb: patent internal ostium, large intrascleral lake, hyporeflectivity and heterogeneous structure of suprascleral tissues. Correlation between in vivo confocal microscopy findings and filtering bleb reflectivity (AS-OCT) with filtering glaucoma surgery outcomes has suggested that lower reflective and heterogeneous suprascleral tissues match with loose connective tissue, where gaps and high fluid content abound thus documenting a functional bleb20. Very high frequency probes (80 MHz) enable the identification of Schlemm's canal, confirming its opening after viscocanaloplasty (Fig. High intensity focused ultrasound (HIFU) is already being used to treat refractory glaucoma .
UBM or AS-OCT enable ACW measurements to select the best ring diameter for direct use on the ciliary body (Fig.
AS-OCT and UBM share overlapping features: both are useful in glaucoma diagnosis and surgical management assessment. Anterior segment imaging facilitates the understanding of the underlying mechanism of the heterogenous group of angle closure glaucomas, highlights the relevance of quantitative anterior segment imaging concept and shows high applicability in glaucoma filtering surgery outcomes assessment18,23. To all colleagues and friends who have entrusted their patients to the author and whose corresponding images illustrate this paper. A todos os colegas em cujas maos da autora confiaram os seus doentes e aqui veem as imagens correspondentes. Swelling may be present in a single affected limb, several limbs, genitalia, or the face. These air sacs open up or expand with each breath. The tissue around these air sacs is called the interstitium. A partial dislocation of a lens is termed lens subluxation or subluxated lens; a complete dislocation of a lens is termed lens luxation or luxated lens. Based on work by Prashanth Saddala, Alara Eren, Jacki Buros (bot) and Alexandra Almonacid, wikidoc user LBiller and wikidoc anonymous user CultureDrone. Soothe XP eye drops contain Restoryl the advanced lipid restorative to protect against tear loss. Soothe Long Lasting Hydration Lubricant eye drops relieve dry eyes and help prevent further irritation.
It is based on the emission of an infrared light beam by a superluminescent diode, which is then split in two: one subeam is directed towards the biological sample and the other one to a reference mirror.
The ultrasound transducer requires immersion in a saline water bath usually filling an eyecup applied to the eye so that ultrasound beam reachs anterior segment structures, where echoes are produced to create bidimensional images.
It can be categorized according to the mainly involved anterior segment structure showing abnormalities related to size or position or as a result of abnormal forces in the posterior segment6,7 (Table 1). High resolution images provided by AS-OCT and especially UBM can unveil the structure preferably involved in the underlying mechanism and guide to the most effective management approach6,8. Anterior segment imaging can also explain the reasons whereby this procedure is unsuccessful in some angle closure situations such as incomplete LPI, goniosynechiae and plateau iris syndrome. The most peripheral hump drapes over the rigid, anteriorly positioned ciliary body, and the central rests over a long extension on the anterior lens surface.  A modified dynamic gonioscopy procedure using AS-OCT allowed to conclude that ACA amplitude was significantly higher after indentation and that indirect signs were reliable to suggest a plateau iris11.
An increased lens vault or crystalline lens rise (CLR) elevates the probability of developing angle-closure glaucoma, regardless of lens thickness and location12  (Figs.

This determines the expansion of choroidal volume and explains why posterior lenticular pressure promotes extreme forward positioning of anterior segment structures. Supraciliary effusion pushing forward the lens equator, irido-ciliary sulcus and posterior chamber deletion.
UBM and AS-OCT reveal a back bowing iris touching zonular bundles, a "reverse pupillary block" and document iris flattening after LPI, confirming a pressure gradient rebalance between anterior and posterior chambers14 (Fig. The internal echostructure of the filtering bleb and the presence of an intrascleral route have shown good correlation with intraocular pressure control (type L bleb)17 (Table 2).
Internal ostium patency (blue X), wide iridectomy (red X), suprascleral hyper-reflective tissues, scleral lake and route absent (yellow X), but suprascleral hypo-reflective line (yellow arrow). Iris (red arrow) and ciliary body (white arrow) hernia into the intrascleral lake, closing the angle and the trabeculo-Descemet’s window. Gap in corneal tissue thickness suggesting anterior drainage device embedded in corneal tissue.
Ultrasound waves are transmitted through a circular microdevice with six piezoelectric transducers that focus ultrasound emission on the ciliary body, promoting precise cyclocoagulation. Particular technology and technical features of each will guide our preference according to the answers we are specifically looking for22 (Table 4). In people with interstitial lung disease, this tissue becomes stiff or scarred, and the air sacs are not able to expand as much.
Ultrasound waves cross well the iris and ciliary body pigmented epithelia, thus offering high-resolution images of structures behind the iris, as the ciliary body. Anterior rotation of the ciliary body, associated with anterior positioning of the iris dilator’s anchorage point, determines: irido-ciliary sulcus narrowing, iris apposition to the trabecular meshwork and angle closure.
Visualizing ciliary body and how it relates with ACA structures is more difficult in AS-OCT images. The mechanism afore explained leads to maximal resistance to aqueous humour flow and consequently to an intraocular pressure rise9. Good intraocular pressure control was shown for diffuse and microcystic filtering blebs18,19  (Table 3, Fig.
Evidence shows efficacy associated with intraocular pressure control and higher tolerance when compared to other cyclodestructive techniques.
The former is used by Visante OCT (Carl Zeiss Meditec, Dublin, CA, USA), whereas the latter is used by SD-OCT (Heidelberg Engineering, Heidelberg, Germany). The same does not apply to light beams, which are highly absorbed by the pigment posterior layer of the iris.1,3,4,5. In eyes prone to angle-closure glaucoma, this phenomenon can be compromised and even be a precipitating factor6. The farther away the iris dilator "joint" from the scleral spur, the lower the probability of angle closure8. UBM and AS-OCT document lens, iris and vitreous anteriorly positioned, absence of posterior chamber, markedly reduced anterior chamber depth until athalamia, and uveal effusion (Figs. After its manual localization and applicating a semi-automated software system, the ACA can be quantitatively characterized in a fast and reproducible manner6. Wide subscleral lake (red X) and posterior scleral route marked by suprachoroidal linear shadow (red arrows).
Morphology alterations produced by circular ultrasound cyclocoagulation can be evaluated using UBM21. Swept-source OCT or SS-OCT was developed from SD-OCT and allows for a full 360? assessment of the ACA1,2,3,5. From the latter two aspects may be inferred: the relevance of assessing iris thickness and standardizing test lighting conditions when using UBM or AS-OCT for quantitative assessments10. Identifying the scleral spur in angle closure cases may be difficult, especially in the upper and lower quadrants5,12 (Fig.
Relation with neighboring structures – proximity to the iris and distancing of corneal endothelium.
Radial section– polyedric scleral lake showing the non-reflective drainage implant, intact trabeculo-Descemet’s window, subscleral route and heterogeneous reflective suprascleral tissues, suggesting a functioning bleb. A respiratory therapist will help you set up oxygen for use in the home or outside of the home.

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