1/6. Expulsive hemorrhage before phacoemulsification.A 65-year-old white man who was scheduled for cataract extraction experienced a sudden increase in intraocular pressure (IOP) with flattening of the anterior chamber immediately after the anterior capsule incision. The eye was sutured, and because no decrease in pressure was noted, surgery was postponed. The presence of the cataract prevented ophthalmoscopic examination. Echographic examination revealed a hemorrhagic choroidal detachment with involvement of the ciliary body. The patient was examined regularly until the choroidal detachment disappeared 4 weeks later. He then had uneventful phacoemulsification and intraocular lens implantation.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/6. Expulsive choroidal effusion: case report of a rare complication of intraocular surgery.A case of expulsive choroidal effusion occurring during extracapsular cataract extraction in a 75 year old woman is presented. The episode occurred at the time of insertion of the pseudophake into the ciliary sulcus. The woman had pre-existent filtering bleb and was hypertensive, factors which may have contributed to the episode. Although this is dramatic occurrence, it needs to be distinguished from expulsive choroidal hemorrhage which carries a much worse porgnosis. In this instant, management was expectant and patient attained 6/12 with over-refraction. It is recommended that patients who may be at risk for expulsive choroidal effusion should have in the bag pseudophake fixation rather than sulcus fixation to obviate pressure on the circular vascular arcade.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/6. Management of traumatic rupture of the globe in aphakic patients.We report the successful treatment of three cases of traumatic ruptures of the globe complicated by massive choroidal hemorrhage, uveal prolapse and retinal detachment. All three of the eyes were aphakic prior to injury and all patients were age 64 or older. The presenting visual acuity in all patients was light perception. The blunt injury in each case caused a wound dehiscence at the site of previous cataract extraction. All injuries were associated with uveal prolapse. Secondary surgical intervention was performed when the hemorrhagic choroidal detachments had decreased as demonstrated by echography in the suprachoroidal space, occurring at an average of 14 days after injury. The management consisted of surgical drainage of the choroidal hemorrhage combined with vitrectomy and silicone oil injection. Successful reattachment of the retina was achieved in all cases. Postoperative epiretinal membranes formed in two cases but all were anatomically successful at six months. Final visual acuities varied from 20/70 to 1/200, visual acuity being a function of secondary contusive damage to the retina and choroid. We believe that in eyes sustaining severe blunt injuries resulting in rupture of the globe complicated by massive choroidal hemorrhage and retinal detachment, properly timed external drainage of the choroidal hemorrhage combined with pars plana vitrectomy and silicone oil injection is a useful approach.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/6. Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery.The incidence of acute intraoperative suprachoroidal hemorrhage (AISH) was studied in 2,839 consecutive extracapsular cataract extraction cases operated by nucleus expression and phacoemulsification. Twenty-five eyes (0.9%) were identified with this complication. Acute intraoperative suprachoroidal hemorrhage was defined as the acute accumulation of fluid in the suprachoroidal space which resulted from a presumed suprachoroidal hemorrhage at the time of surgery. Preoperative risk factors for the development of this complication included advanced age and the presence of glaucoma. sex, controlled hypertension, long axial length, and method of cataract removal could not be identified as significant risk factors. Recognition of the early signs of AISH and initiation of rapid wound closure followed by the completion of secondary operations performed the next day helped to meet the surgical objective and to provide excellent visual results, with 21 eyes (84%) having a visual acuity of 20/30 or better.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/6. vitrectomy and fluid infusion in the treatment of delayed suprachoroidal hemorrhage after combined cataract and glaucoma filtration surgery.I report the successful treatment of one case of massive, delayed suprachoroidal hemorrhage that occurred after combined intracapsular cataract extraction and trabeculectomy. Significant vitreous incarceration in the filtration site and consequent vitreoretinal traction were present so that a limbal approach anterior vitrectomy was necessary before choroidal drainage could be accomplished safely. An infusion of balanced salt solution through a limbal infusion cannula was employed during vitrectomy and also during drainage of suprachoroidal blood. The simultaneous intravitreal infusion helped to create an efficient, controlled choroidal drainage procedure. In addition to relieving vitreoretinal traction, this technique helps prevent the periods of extreme hypotony experienced when choroidal drainage and anterior chamber reformation are accomplished serially in step-wise fashion. This use of this method also obviates the compromised view of the peripheral retina which occurs when air is introduced into the vitreous cavity.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/6. Hemorrhagic ocular complications associated with the use of systemic thrombolytic agents.OBJECTIVE: This study aimed to report three patients with hemorrhagic ocular and orbital complications associated with the use of systemic thrombolytic agents. DESIGN: The study design was a retrospective small case series. PARTICIPANTS: Three eyes of three patients were studied. INTERVENTION: Surgical procedures to reduce intraocular pressure or relieve optic nerve compression were performed. MAIN OUTCOME MEASURES: visual acuity and intraocular pressure were measured. RESULTS: Three patients received an intravenous thrombolytic agent on diagnosis of an acute myocardial infarction. One patient had a spontaneous suprachoroidal hemorrhage develop with secondary acute angle closure glaucoma shortly after receiving tissue plasminogen activator. Another patient had an orbital hemorrhage develop on receiving tissue plasminogen activator 4 days after an uncomplicated cataract extraction. The third patient experienced an orbital hemorrhage while receiving streptokinase 1 day after undergoing an external levator resection. Two patients suffered significant visual loss due to glaucoma or compressive optic neuropathy. CONCLUSIONS: The onset of eye pain or visual loss after the administration of a systemic thrombolytic agent should alert the physician to the possibility of an ocular or adnexal hemorrhage. Prompt diagnosis and treatment can improve the likelihood of a favorable visual outcome.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |