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Bilateral Infusion Pump Implants as Therapy for Refractory Corneal Ulcers in a Patient With CREST Syndrome An Interdisciplinary Approach

José De Andrés, PhD, MD; Salvador García-Delpech, MD; Vicente Luis Villanueva Pérez, MD; Manuel Díaz-Llopis, PhD, MD; Patricia Udaondo, MD; María Teresa Serrano Sánchez, MD; David Salom, PhD, MD
Arch Ophthalmol. 2008;126(7):964-967. doi:10.1001/archopht.126.7.964.
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Internal infusion pumps are implantable and programmable systems that have been widely used for years in the management of chronic pain. During the past few years, these devices have had an increasingly prominent role given the possibility of insulin infusions in patients with diabetes mellitus because they provide patients with higher autonomy in the management of their disease, despite the fact that they are expensive systems and require surgery for implantation. These features make internal infusion pumps a suitable therapeutic option for those patients who need to use artificial tears continuously because of severe dry eyes. We report a case of severe eye pain due to xerophthalmia in a patient with CREST (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) syndrome who was treated with an implanted pump reservoir.

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Figure 1.

Location of the reservoir pumps in the abdomen next to the umbilicus and trajectory of the catheter on the anterior wall to the inferior side of the clavicle (A), creation of the abdominal pocket (B), and placement of the reservoir (C).

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Figure 2.

Incision under the clavicle and craniocaudal tunneling (A), introduction of catheters and disposition in the abdomen (B), and tunneling on the lateral wall of the neck and introduction of the catheter (C).

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Figure 3.

Tunneling in the retroauricular area and the temporal region (A-D). The catheter is fixed to the temporal muscle fascia using an anchor sleeve (E). The end of the catheter is located next to the physiologic site of tear outflow (F).

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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