Blurred Vision Research Articles

Cessation of ocular hypertensive attacks following iStent trabecular micro-bypass stent implantation in a patient with Posner-Schlossman syndrome: a case report

Background: Posner-Schlossman syndrome (PSS) is an ocular condition with self-limiting recurrent episodes of markedly elevated intraocular pressure (IOP) and non-granulomatous anterior chamber inflammation. Surgical treatment is indicated if medical therapy fails to control IOP.
 Case presentation: A 58-year-old male presented with intermittent attacks of blurred vision and pain in the right eye for 6 months. Examination revealed keratic precipitates with IOP of 56 mmHg in the right eye. Gonioscopy revealed open angles in both eyes. Erythrocyte sedimentation rate was within normal limits, while aqueous tapfor viral PCR, rapid plasma reagent test, and Mantoux test were negative. IOP was in the high-teens (inappropriate) on 2 topical antiglaucoma medications and the patient developed ocular surface problems. iStent was implanted. IOP remained stable within the mid-teens with no further episodes of raised IOP in the following 6 months.
 Conclusion: This case showed cessation of ocular hypertensive attacks in PSS after iStent implantation.

Quantitative analysis of choroidal morphology in preeclampsia during pregnancy according to retinal change

We sought to investigate changes in choroidal hemodynamics in preeclampsia according to presence of retinal change by quantitatively assessing choroidal vessels using optical coherence tomography (OCT). This retrospective study included 106 eyes (of 53 patients) with preeclampsia, including 70 eyes without retinal change in patients with preeclampsia (Group A), 22 eyes with retinal change in patients with preeclampsia (Group B), and 14 eyes of normal pregnant women (controls). Subfoveal choroidal thickness (SFCT) was measured on OCT B-scan images, and choroidal vessel densities (CVDs) were calculated using binarized OCT B-scan and en face images. Their values were then correlated with clinical parameters associated with preeclampsia. SFCT was greater in Group B compared to Group A or controls (354.32 ± 65.13 vs. 288 ± 55.68 or 277.21 ± 50.08, both P < 0.001). CVD on B-scan images was greater in Group B compared to Group A or controls (76.4 ± 4.9 vs. 73.7 ± 5.3 or 71.5 ± 5.1; both P ≤ 0.046). CVD on en face images was also greater in Group B compared to Group A or controls (64.7 ± 0.8 vs. 63.6 ± 1.5 or 63.3 ± 1.3; both P ≤ 0.001). SFCT and CVD positively correlated with each other (P ≤ 0.009) and were greater in patients with blurred vision and vaginal bleeding (P ≤ 0.020 for blurred vision and P ≤ 0.024 for vaginal bleeding). SFCT and CVDs were higher in preeclampsia patients with retinal change compared to those without retinal change or controls. Both SFCT and CVD showed association with blurred vision and vaginal bleeding.

SDG 17 and global partnership for sustainable development: unraveling the rhetoric of collaboration

As the 2030 SDG Agenda unfolds, a growing body of the literature from various disciplines is analyzing how sustainable development can be a process for change to achieve a dynamic equilibrium between the economic, social, and environmental dimensions. This article aims to critically examine the evolution and implementation of the UN 2030 agenda for sustainable development, with a particular focus on its collaborative approach. It discusses the SDG 17 called “Partnerships for the Goals. Strengthen the means of implementation and revitalize the global partnership for sustainable development”, devoting particular attention to how this SDG has been found in a blurred vision of collaboration. Actually, there has been much rhetoric about enhancing multi-stakeholder partnerships for sustainable development including the government, business sector, non-government organizations, academia, social partners, and civil society. However, reporting the difficulties and unmitigated success is not common. From the perspective of the theory of collaborative advantage, this paper examines the collaborative advantages and inertias of the process of collaborating and identifies important key elements to consider in SDG 17, such as power relations, trust, goal management, organizational cultures, and leadership.

Unilateral Roth spots as an initial presentation in Essential Thrombocythemia.

To describe a 25-year-old female patient with unilateral Roth spots as the initial presentation of Essential Thrombocythemia. Case report. A 25 -year-old female presented with visual complaints of seeing flashing lights and mild blurred vision in her left eye. Dilated fundus exam revealed intra-retinal hemorrhages with a pattern compatible with Roth spots. Further work up showed thrombocythemia with positive JAK2 (V617F) mutation, confirming the diagnosis of Essential Thrombocythemia (ET). The symptoms and fundus findings resolved in one month after initiation of the treatment with low dose oral aspirin.ET which is defined as repeated platelet count of ≥ 450,000 per microliter without a secondary cause, can present with highly variable symptoms from being asymptomatic to chest pain, cerebral venous sinus thrombosis, retinal vascular occlusion, and granuloma annulare.In the presented case Roth spots hastened the need for more complete workup to determine the systemic cause of this ocular finding, ultimately leading to the diagnosis. Finding of Roth spots may warrant a systemic work up to find out the underlying pathologic condition, which in the present case was Essential Thrombocythemia, a potentially life-threatening condition. Authors declare no conflict of interest.

Pterygium Classification Using Deep Patch Region-based Anterior Segment Photographed Images

Early pterygium screening is crucial to avoid blurred vision caused by cornea and pupil encroachment. However, medical assessment and conventional screening could be laborious and time-consuming to be implemented. This constraint seeks an advanced yet efficient automated pterygium screening to assist the current diagnostic method. Patch region-based anterior segment photographed images (ASPIs) focus the feature on a particular region of the pterygium growth. This work addresses the data limitation on deep neural network (DNN) processing with large-scale data requirements. It presents an automated pterygium classification of patch region-based ASPI using our previous re-establish network, “VggNet16wbn”, the VggNet16, with the addition of batch normalisation layer after each convolutional layer. During an image preprocessing step, the pterygium and nonpterygium tissue are extracted from ASPI, followed by the generation of a single and three-by-three image patch region-based on the size of the 85×85 dataset. Data preparation with 10-fold cross-validation has been conducted to ensure the data are well generalised to minimise the probability of underfitting and overfitting problems. The proposed experimental work has successfully classified the pterygium tissue with more than 99% accuracy, sensitivity, specificity, and precision using appropriate hyperparameters values. This work could be used as a baseline framework for pterygium classification using limited data processing.

Ayurvedic management of Keratoconus - A Case Report

This study reports a case of 37 years old female who had presented with the complaints of blurred vision in left eye for distant objects and also frequent headache and photophobia on exposure to bright light with heaviness in both of the eyes. The subject approached us with the reports of already performed corneal topography where corneal ectasia could be appreciated in both the eyes. The subject was already diagnosed as Keratoconus at previous hospital where she had consulted before. Ayurvedic treatment was initiated with Basti, Nasya, local ocular therapeutics which included Pindi, Bidalaka, Netra Prakshalana and Tarpana. The subject reported reduction in symptoms within 3 months of the treatment. It was observed that there was no progression of the disease from the findings of corneal topography which was repeated after the treatment within 3 months of initial visit.

Unobtrusive Refractive Power Monitoring: Using EOG to Detect Blurred Vision.

The rise in population and aging has led to a significant increase in the number of individuals affected by common causes of vision loss. Early diagnosis and treatment are crucial to avoid the consequences of visual impairment. However, in early stages, many visual problems are making it difficult to detect. Visual adaptation can compensate for several visual deficits with adaptive eye movements. These adaptive eye movements may serve as indicators of vision loss. In this work, we investigate the association between eye movement and blurred vision. By using Electrooculography (EOG) to record eye movements, we propose a new tracking model to identify the deterioration of refractive power. We verify the technical feasibility of this method by designing a blurred vision simulation experiment. Six sets of prescription lenses and a pair of flat lenses were used to create different levels of blurring effects. We analyzed binocular movements through EOG signals and performed a seven-class classification using the ResNet18 architecture. The results revealed an average classification accuracy of 94.7% in the subject-dependent model. However, the subject-independent model presented poor performance, with the highest accuracy reaching only 34.5%. Therefore, the potential of an EOG-based visual quality monitoring system is proven. Furthermore, our experimental design provides a novel approach to assessing blurred vision.

Unilateral blurred vision in pediatric patient associated with cavum velum interpositum cyst.

Unilateral blurred vision in pediatric patient associated with cavum velum interpositum cyst.

Fundus autofluorescence, optical coherence tomography and electroretinography abnormalities in a patient with digoxin retinopathy that resemble those in KCNV2-associated retinopathy.

Digoxin related retinal toxicity causes blurred vision, photophobia, central scotoma, color vision abnormality, and electroretinography (ERG) abnormalities. Here, we report a case with transient abnormalities in vison, in which fundus autofluorescence (FAF), optical coherence tomography (OCT), and ERG findings resembled those in KCNV2 (potassium voltage-gated channel modifier subfamily V member 2)-associated retinopathy. An 89-year-old woman presented with complaints of acute blurred vision, nyctalopia, photophobia, and color vision abnormality. She received digoxin for tachycardia induced by atrial fibrillation for a month. The fundi showed a faint white ring at the fovea, which showed hyperfluorescence in FAF. OCT showed a thickened EZ in the macula. A dark-adapted (DA)-30 ERG showed a reduced and "squaring (trough-flattened)" a-wave, and a delayed, supernormal b-wave, resulting in a high b/a-wave amplitude ratio. The digoxin dose was reduced following an elevation in serum levels. Five weeks later, her visual acuities improved, and abnormal hyperfluorescence on FAF disappeared. After 6months, no visual symptoms were reported. The ellipsoid-zone thickening in OCT improved; however, the b/a-wave amplitude ratio on DA-30 ERG remained high. The b-wave in LA-long-flash ERG was initially reduced, which improved after correction of serum level of digoxin. The patient's clinical findings resembled those of patients with KCNV2-associated retinopathy or temporal hyperkalemia. These disorders appear to have a common pathogenesis, which may be related to abnormal extracellular potassium levels in the retina. The on-bipolar cells seemed to be more affected than the off-bipolar cells in digoxin related retinal toxicity.

Prevalence of Convergence Insufficiency in Patients Suffering from Headache.

Objective: To find out the prevalence of convergence insufficiency (CI) in patients suffering from headache. Study Design: Cross Sectional, Observational study. Setting: Departments of Eye, The Children’s Hospitals and The Institute of Child Health, Multan and Govt. Shahbaz Sharif Hospital, Multan. Period: August 2020 to January 2021. Material &amp; Methods: A total of 95 patients between the ages of 08-62 years with a complaint of headache were examined. Both male and female patients having complaint of headache, patients more than 07 years of age and patients with complaint of discomfort and blur vision at near after focusing for few minutes were included. While uncooperative patients, patients less than 07 year of age and patients having systemic and neurological diseases that can cause headache were excluded. Patient's visual acuity (VA) was recorded with Snellen’s chart and refraction was done with retinoscopy/ auto refractometer. Fundoscopy was carried out to find out any pathology i.e., papilledema. Convergence was checked by pencil push-up test and amplitude of accommodation was measured using RAF rule. Descriptive statistics including frequencies and percentages were extracted for categorical variables and mean ± standard deviation (SD) for quantitative variables. Results: In this study, we recruited 95 patients with a complaint of headache between the ages of 08-62 years and mean age was 27.80 years. 68 (71.60 %) were female and 27 (28.40 %) were male. These patients were examined to determine the prevalence of convergence inefficiency in patients suffering from a headache. Out of these 95 patients having headache 27 (28.4%) had poor convergence, 42 (44.2%) had weak convergence and 26 (27.4%) had normal convergence. This study suggested that 69 (72.6%) patients with headache had varying degree of CI. Conclusion: Our study suggested that headache is more common in females than males and CI is the most common cause of headache among these patients. These patients should be assessed and treated to relieve their symptoms and enable them to spend a better quality of life. We recommend ophthalmologists and optometrists to measure CI as a part of their routine ophthalmic examination.

Follow-up of Methanol-related Visual Defects in a Cohort Study: Initial Severity Predicts Long-term Outcome.

Methanol poisoning can occur either intentionally through the consumption of methanol-containing products or accidentally through ingestion, resulting in visual impairment. We assessed the long-term visual sequelae in patients with methanol poisoning. This prospective cohort study was conducted at referral centers, Khorshid and Alzahra University Hospitals, affiliated with Isfahan University of Medical Sciences, Isfahan, Iran. The study included patients hospitalized for methanol poisoning from June 22, 2018, to June 21, 2020, with follow-up extended until June 2021. Toxico-clinical and ophthalmologic examination data were collected from patients upon hospital admission, discharge, and during follow-up. Thirty-nine patients were assessed in this study. The majority of them (94.9%) were male, with an average age of 34 years. Patients who presented with reduced visual acuity (VA) upon admission subsequently showed abnormalities (in acuity and visual fields) during follow-up (n = 13). Among the patients who displayed visual field defects on admission, bilateral optic disc atrophy was observed in follow-up (n = 13). Conversely, patients who reported blurred vision, with or without photophobia upon admission, had normal results in their follow-up eye examinations. Among the 36 patients who underwent dialysis, 14 (38.9%) exhibited visual impairment during follow-up examinations. Additionally, 38 patients received sodium bicarbonate, and 14 of them (36.85%) also presented ocular abnormalities. Patients who demonstrated VA deficits upon admission are more likely to experience long-term VA and visual field defects, as well as optic disc atrophy. Patients who solely complained of blurred vision, with or without photophobia, during admission were less likely to develop long-term visual defects.

High-Resolution Iterative Feedback Network for Camouflaged Object Detection

Spotting camouflaged objects that are visually assimilated into the background is tricky for both object detection algorithms and humans who are usually confused or cheated by the perfectly intrinsic similarities between the foreground objects and the background surroundings. To tackle this challenge, we aim to extract the high-resolution texture details to avoid the detail degradation that causes blurred vision in edges and boundaries. We introduce a novel HitNet to refine the low-resolution representations by high-resolution features in an iterative feedback manner, essentially a global loop-based connection among the multi-scale resolutions. To design better feedback feature flow and avoid the feature corruption caused by recurrent path, an iterative feedback strategy is proposed to impose more constraints on each feedback connection. Extensive experiments on four challenging datasets demonstrate that our HitNet breaks the performance bottleneck and achieves significant improvements compared with 29 state-of-the-art methods. In addition, to address the data scarcity in camouflaged scenarios, we provide an application example to convert the salient objects to camouflaged objects, thereby generating more camouflaged training samples from the diverse salient object datasets. Code will be made publicly available.

Quality of vision after myopic refractive surgeries: SMILE, FS-LASIK, and ICL

BackgroundTo characterize the quality of vision after SMILE, FS-LASIK, and ICL implantation and evaluate the related factors.Methods131 eyes of 131 myopic patients (90 female, 41 male) who underwent refractive surgeries including SMILE (35 patients), FS-LASIK (73 patients), and ICL implantation (23 patients) were analyzed. The Quality of Vision questionnaires were completed 3 months after surgery, and the results were characterized and analyzed with baseline characteristics, treatment parameters, and postoperative refractive outcomes using logistic regression analysis to find out predicted factors.ResultsMean age was 26.5 ± 4.6 years (range: 18 to 39 years) and mean preoperative spherical equivalent was − 4.95 ± 2.04 diopters (D) (range: -1.5 to -13.5). Safety and efficacy index was comparable between different techniques: the safety index was 1.21 ± 0.18, 1.22 ± 0.18, and 1.22 ± 0.16 and the efficacy index were 1.18 ± 0.20, 1.15 ± 0.17, 1.17 ± 0.15 for SMILE, FS-LASIK and ICL respectively. The mean overall QoV score was 13.40 ± 9.11, with mean frequency, severity, and bothersome score of 5.40 ± 3.29, 4.53 ± 3.04, and 3.48 ± 3.18 respectively, and there was no significant difference between different techniques. Overall, the symptom with the highest scores was glare, following fluctuation in vision and halos. Only the scores of halos were significantly different among different techniques (P < 0.000). Using ordinal regression analysis, mesopic pupil size was identified as a risk factor (OR = 1.63, P = 0.037), while postoperative UDVA was a protective factor (OR = 0.036, P = 0.037) for overall QoV scores. Using binary logistic regression analysis, we found that patients with larger mesopic pupil size had an increased risk to experience glare postoperatively; compared to ICL, patients who underwent SMILE or FS-LASIK tended to report fewer halos; patients with better postoperative UDVA were less likely to report blurred vision and focusing difficulty; with larger residual myopic sphere postoperatively, patients experienced focusing difficulties and difficulty judging distance or depth perception more frequently.ConclusionsSMILE, FS-LASIK, and ICL had comparable visual outcomes. Overall, glare, fluctuation in vision, and halos were the most frequently experienced visual symptoms 3 months postoperatively. Patients with ICL implanted tended to report halos more frequently compared with SMILE and FS-LASIK. Mesopic pupil size, postoperative UDVA, and postoperative residual myopic sphere were predicted factors for reported visual symptoms.

Association between outdoor play and myopia among children in Cross River State, Nigeria. A case control study

Purpose: Myopia is a refractive error of the eyes that causes blurred distance vision. Near work, genetics and environmental factors have been implicated as risk factors in Child myopia. This study seeks to determine the association between time spent on outdoor play and myopia among children in Calabar, Nigeria.&#x0D; Methods: It was a hospital-based case-control study conducted among 120 children (5-17 years old) selected and matched by age and sex from out-patients of the Cross River Eye Care Program. After obtaining parental consents, assent was obtained from the children before conducting comprehensive eye examinations. Myopia was defined as a spherical equivalent of ≥-0.50D. Cases were children diagnosed with myopia and controls were those without myopia. Independent samples t-test and Spearman’s correlation were conducted and P-value &lt; 0.05 was considered to be statistically significant at 95% confidence interval.&#x0D; Results: Cases spent lesser time playing outdoors than controls (M = 1.95 vs 2.40 hours daily, p = 0.01). Spearman’s correlation found a statistically significant, weak, negative correlation between time spent on outdoor play and myopia [rs(118) = -0.217, p = 0.017]. Spending above 2 hours on outdoor play had an OR of 0.37 (95% CI = 0.170 - 0.816).&#x0D; Conclusion: In this association found between time spent on outdoor play and myopia, as time spent on outdoor play increases, myopia decreases. Increased time spent on outdoor play was a protective factor against myopia. Hence it is recommended that more awareness be created on the protective effect of outdoor play.

An unusual cause of diplopia and blurred vision in a patient with renal insufficiency.

We report the interesting case of a 75-year-old patient who presented with sudden onset of diplopia and a blurred vision of the right eye. Recurrent headaches in the temporal region were reported as further symptoms. Clinical examination revealed abduction restriction on the right side and bilateral vascular congestion in the anterior segment of the eye, and marked chemosis. As relevant pre-existing conditions, the patient had severe hypertension, long-standing nicotine abuse (>50py), 3-vessel coronary artery disease, myocardial infarction 33 years ago, and cardiac bypass surgery five years ago. Furthermore, the patient suffered from chronic renal failure stage G5D, according to Kidney Disease Outcomes Quality Initiative (K/DOQI), with the need for dialysis. For this reason, a polytetrafluoroethylene loop shunt was created on the right cubital region five years ago, which underwent thrombectomies one year ago and three months ago. During the last revision, the shunt was extended to the internal jugular vein to improve patency, which was not reported by the patient with a language barrier, and no documentation from the external hospital was available.

Keratic precipitates morphology in vitreoretinal lymphoma evaluated with in-vivo confocal microscopy

A 51-year-old female patient presented to our department with a one-year history of bilateral blurred vision with floaters. Ocular examination showed bilateral vitritis with a moderate haze which was more accentuated and prominent at the periphery in the right eye (OD) (figure 1 A, asterisks). Spectral-domain optical coherence tomography (SD-OCT) showed numerous pigment epithelial detachment (figure B, white arrows), with a lumpy-bumpy choroid. The diagnosis of vitreoretinal lymphoma (VRL) was suspected and confirmed histologically by the presence of atypical lymphocytes in the vitreous samples and an elevated Interleukin (IL)-10 to IL-6 ratio. In addition to those posterior segment manifestations, slit-lamp examination of the OD showed central stellate granulomatous keratic precipitates (KPs) (figure C). On in-vivo confocal microscopy (IVCM), those infiltrating KPs appeared as a hyperreflective deposit at the level of the corneal endothelium with a dendritic shape, and were interconnected by multiple thin and fibrillar pseudopodia in a comet-like appearance (figure D, yellow arrows), which is a highly suggestive pattern of KPs of VRL associated anterior uveitis when the latter is unusually granulomatous.

Effects of various hyperopia intervention levels on male college students' gait kinematics.

Background: Hyperopia is a common blurred vision phenomenon that affects postural control in gait; however, current research has focused on the alteration and correction of hyperopia's physiological characteristics, ignoring the effect of hyperopia on gait kinematic characteristics. The effect of hyperopia on the basic form of movement walking is a worthy concern. Objective: To investigate the gait kinematic characteristics of male college students with varying degrees of visual acuity (normal vision, hyperopia 150°, and hyperopia 450°), as well as to provide a theoretical foundation for the effect of visual acuity on gait and fall risk reduction. Methods: Twenty-two male college students with normal visual acuity were chosen. Their vision was tested using a standard visual acuity logarithm table at normal and with 150° and 450° concave lenses. Gait kinematic data were collected under normal vision and hyperopic conditions using the PN3 Pro advanced inertial motion capture system and Axis Studio application program. Results and conclusion: 1. The change of center of gravity in Pre-double support was smaller than normal vision; Late-single support and Late-swing was larger than normal vision; 2. The percentage of the double-leg support decreased; the percentage of the single-leg support and the Late-swing increased; 3. For the joints' range of motion, Trunk flexion and extension range of motion in Pre-single support, Late-double support and Pre-swing smaller than normal visual acuity, and Late-swing larger than normal; hip internal abduction and adduction and internal and external rotation are larger than normal vision in Late-single support; knee and ankle in abduction and adduction direction are larger than normal vision in the swing stage; hip flexion and extension, internal external rotation are larger than normal vision in the swing stage. Hyperopic interventions have an impact on the kinematic characteristics of gait in male college students, mainly in terms of altered balance, increased instability, increased difficulty in maintaining trunk stability, and increased risk of injury.

Pregnancy Induced Hypertension and Retinopathy

AIM AND OBJECTIVES: The aim of this study is to determine the prevalence of retinal changes in pregnancy induced hypertension and to find out its association with severity of hypertension and proteinuria. MATERIAL AND METHODS: A total of 94 pregnant females presented with pregnancy induced hypertension were included in this study. Patients with pre-existing hypertension, coexisting diabetes mellitus, severe anemia, connective tissue disorders were excluded from the study. Detailed fundus examination done and results were interpreted. OBSERVATION: Out of 94 patients with pregnancy induced hypertension, 41.5% belongs to 26-28 years of age.59.65 were primigravida. Headache was common complaint with 27.6% followed by blurred vision. Among the participants, 52.1% having systolic blood pressure of 150 to 159mmHg presented with fundus changes and 45.8% having diastolic pressure of more than 110mmHg presented fundus finding. In fundus finding, 51.0% presented with hypertensive retinopathy. Among hypertensive retinopathy, 43.8% cases were Grade I, 39.6% cases were Grade II, 12.5%cases were Grade III,4.1% cases were Grade IV.Grade I and Grade II found to be common. Our study shows statistically significant relationship with severity of hypertension and retinal changes (p&lt;0.05) CONCLUSION: The study concluded that there is a positive correlation of fundus changes with severity of hypertension and grades of proteinuria. There is positive association with severity of hypertension, blood urea levels, serum uric acid level. So regular ophthalmic examination is mandatory in assessing the vascular changes in retina and helps in follow up the patients postpartum to prevent the complications. Keywords: Pregnancy induced hypertension, Hypertensive retinopathy, proteinuria..

A pregnant lady with compound bowel obstruction managed with thoracic epidural as sole anesthesia in a resource-restricted setting: a case report

BackgroundPreserving the mother’s safety, sustaining the pregnancy state, and achieving the optimal fetal outcome are the major priorities when managing obstetric patients for non-obstetric surgery. Only necessary and urgent surgeries are carried out during pregnancy due to the effects of anesthesia and surgery on the fetus. Compound bowel obstruction (small and large bowel obstruction) is rare, especially during the third trimester of pregnancy. Besides this, the procedure (laparotomy) was done with awake opioid-based thoracic epidural anesthesia as the sole anesthesia. This case report of awake laparotomy for major abdominal surgery is the first of its kind with an excellent feto-maternal outcome.Case presentationA 30-year-old African pregnant lady presented to the emergency department with a chief complaint of abdominal pain and vomiting for an 8-hour duration; associated with this, she had a history of blurred vision, lightheadedness, loss of appetite, low-grade fever, and constipation. Later, she was diagnosed with large bowel obstruction and underwent an emergency laparotomy, managed with a thoracic epidural sole anesthesia.ConclusionA multidisciplinary team approach is greatly recommended to safeguard a sufficient standard of care for both the mother and fetus. The provision of regional anesthesia for patients with high risks in perioperative periods is crucial for a better postoperative outcome. We have confidence that thoracic epidural anesthesia can be used as another anesthetic option for major abdominal surgery in a resource-restricted setting for patients who are expected to have a significant risk of perioperative adverse events under general anesthesia.

Transperitoneal Laparoscopic Right Adrenalectomy for Cortical Adenoma

Primary hyperaldosteronism, or Conn's syndrome, is a disease in which one or both adrenal glands produce excess amounts of aldosterone, leading to hypertension and hypokalemia. Common conditions resulting in this disorder include adenoma of the adrenal gland or hyperplasia of both adrenal glands. In rare cases, it is caused by malignant growth in the adrenal cortex or familial hyperaldosteronism. High blood pressure may cause headaches or blurred vision. Low potassium may cause fatigue, muscle cramps, muscle weakness, numbness, or temporary paralysis. Primary hyperaldosteronism is diagnosed by measuring serum levels of aldosterone, renin, and potassium. Patients classically have high aldosterone levels, suppressed renin levels, and low potassium levels. Once the diagnosis is established, localization of the source is performed using imaging studies. Adrenal vein sampling is also performed to determine more precisely and directly the side that is producing excess aldosterone. Primary hyperaldosteronism caused by an adrenal gland tumor is treated with adrenalectomy. Approximately 95% of patients will notice significant improvement in their hypertension after successful surgery. Here, we present the case of a 58-year-old woman with hypokalemia and long-standing hypertension refractory to medical treatment. Her blood tests showed high aldosterone levels and low renin levels, confirming the diagnosis of hyperaldosteronism. On CT scan, an adrenal nodule was noted on both sides. Adrenal vein sampling identified the right adrenal nodule as the cause. Laparoscopic access was gained, the adrenal gland was dissected and exposed, the adrenal vein ligated, and the adrenal gland was removed.