1/60. Long-term outcome of aqueous shunt surgery in ten patients with iridocorneal endothelial syndrome.PURPOSE: To report the long-term outcome of ten patients with iridocorneal endothelial (ice) syndrome who underwent aqueous shunt surgery for uncontrolled glaucoma. DESIGN: Noncomparative, retrospective case series. PARTICIPANTS: The authors reviewed charts of ten patients with ice syndrome-related glaucoma who underwent aqueous shunt surgery at one institution between 1987 and 1996. MAIN OUTCOME MEASURES: intraocular pressure (IOP), number of glaucoma medications, and further surgical interventions were measured. RESULTS: With a median follow-up of 55 months, four eyes had adequate IOP control (IOP <21 mm Hg) with one or two medications after the initial aqueous shunt surgery. An additional three eyes achieved adequate IOP control after one or more tube repositionings or revisions of the initial aqueous shunt. In this series, the aqueous shunt surgery most often failed because of blocking of the tube ostium by iris, ice membrane, or membrane-induced tube migration. CONCLUSION: Aqueous shunt surgery appears to be an effective method for IOP lowering in some eyes with ice syndrome-related glaucoma when medical treatment or conventional filtration surgeries fail, but additional glaucoma procedures and/or aqueous shunt revisions and tube repositionings are not uncommon.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/60. Combined phacoemulsification and penetrating keratoplasty.To highlight indications, technique, and advantages of closed-chamber phacoemulsification and intraocular lens (IOL) implantation during penetrating keratoplasty for corneal opacities. case reports of 2 patients who underwent combined phacoemulsification, IOL implantation and penetrating keratoplasty. The technique described allowed controlled capsulorrhexis, cataract removal and in-the-bag IOL implantation. Complications due to increased posterior pressure during open-sky extracapsular cataract were not encountered. The surgical technique described in this report can only be used in selected patients undergoing combined corneal transplant and cataract surgery. In this group of patients, however, the technique offers many intra- and postoperative advantages.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/60. Surgical management of coexisting pseudophakic bullous keratopathy and glaucoma.This technique is a 1-step surgical management approach for patients with pseudophakic bullous keratopathy, glaucoma, and an unsatisfactory intraocular lens (IOL). The outcome of 4 consecutive patients who had penetrating keratoplasty, IOL removal, vitrectomy, transscleral sutured IOL implantation, and trabeculectomy by the same surgeon were reviewed. All patients had had intracapsular cataract extraction with anterior chamber IOL implantation and were on antiglaucoma therapy. Main outcome measures were Snellen visual acuity and intraocular pressure. A 1-stage quintuple procedure can achieve relatively rapid visual rehabilitation in these high-risk eyes. The role of filtration surgery is controversial, but it was partially successful in controlling postoperative intraocular pressure.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/60. Corneoscleroplasty with maintenance of the angle in two cases of extensive corneoscleral disease.PURPOSE: We report a 2 year follow-up in two patients after corneoscleroplasty. METHOD: Using lamellar corneoscleral dissection to maintain the drainage angle and its function, we performed a 14 mm allograft corneoscleroplasty in 2 eyes. For surgical treatment in both cases a 9.5 mm corneal button was excised from the recipient after peritomy and scleral lamellar preparation up to 14 mm. A 14 mm donor button was inserted and held in place with multiple Prolene sutures. One eye presented with a large perforating corneal ulcer after herpetic keratitis in a patient with recurrent rheumatoid uveitis associated with rubeosis iridis. The second eye had had a penetrating keratoplasty for keratoconus 30 years previously and presented with decompensating keratoglobus. Immune suppression was performed with systemic cyclosporin A and additional steroids when required. RESULTS: Both patients had a clear graft at the last follow-up visit and visual acuity was improved to a best corrected visual acuity of 0.6. intraocular pressure in the keratoglobus eye was maintained at 6 mmHg without treatment, whereas the second case required continuing treatment with systemic acetazolamide because of neovascular glaucoma. The anterior chamber angles remained open in both patients. contact lenses were helpful in the prevention of epithelial irregularities and defects. Both patients had an episode of immunological graft reaction which was reversed by immunosuppressive treatment. phacoemulsification with intraocular lens implantation, which was performed 2 years after transplantation in the keratoglobus eye, did not affect the graft clarity or cause rejection episodes. CONCLUSION: Our results using corneoscleroplasty have been encouraging in severe destructive corneal disease.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/60. Development of a newly designed double-fixed Seoul-type keratoprosthesis.OBJECTIVE: To develop a newly designed double-fixed keratoprosthesis (Seoul-type keratoprosthesis [S-KPro]) and to assess its mechanical stability and biocompatibility. methods: Twenty-five rabbits were divided into 4 groups by fixation technique, amniotic membrane (AM) implantation, and skirt material. The eyes were studied with the use of slitlamp, light, and electron microscopy. Stress testing was performed. In addition, 2 human subjects underwent S-KPro implantation. Best-corrected visual acuity was checked, and ophthalmic examination was performed. RESULTS: The average retention period of the group receiving double-fixated polyurethane-S-KPro with AM was longer (>24 weeks) than that of the others. Fibroblast invasions were found in polyurethane pores but not in polytetrafluoroethylene (Gore-Tex) pores on light microscopy. The minimal pressure that induced aqueous leakage was greater than 250 mm Hg in all of the tested eyes. Two human subjects have maintained a good postoperative condition for 18 and 8 months. CONCLUSIONS: The double-fixation technique of applied S-KPro and AM appears to be helpful in improving the stability of the keratoprosthesis. Polyurethane with relatively large pore size (40 microm) may be used successfully as a material for the keratoprosthesis skirt. CLINICAL RELEVANCE: Our results may be important for improving the clinical outcome of keratoprosthesis.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/60. descemet membrane detachment after viscocanalostomy.PURPOSE: To report a case that developed a large descemet membrane detachment after viscocanalostomy. methods: Case report. A 60-year-old man with primary open-angle glaucoma underwent viscocanalostomy RE. One day after surgery, a small, localized detachment of descemet membrane was present at the operation site. Six months after surgery, he had a large superior descemet membrane detachment involving his visual axis. RESULTS: The descemet membrane remained attached after descemetopexy with sodium hyaluronate and air. Final visual acuity was 20/80, and intraocular pressure was 17 mm Hg without medication. CONCLUSION: Detachment of the descemet membrane should be recognized as a potential complication of viscocanalostomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/60. Successful goniosynechialysis for angle-closure glaucoma after vitreoretinal surgery.PURPOSE: To describe 2 cases of long-term successful clinical outcome after goniosynechialysis for secondary angle-closure glaucoma after vitreoretinal surgery. methods: case reports. Goniosynechialysis was performed bilaterally in 1 patient and unilaterally in another for uncontrolled angle-closure glaucoma after vitreoretinal surgery. RESULTS: Angle reopening was performed 2 to 4 months after initial closure. After follow-up of between 3 and 5 years, intraocular pressure has remained below 21 mm Hg without medication in all three eyes. CONCLUSION: Goniosynechialysis should be considered a viable therapeutic alternative to filtration surgery in selected patients with a recent history of angle-closure glaucoma after vitreoretinal surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/60. herpes simplex virus bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma: an unusual presentation.PURPOSE: To report an unusual case of herpetic bullous keratitis misdiagnosed as a case of pseudophakic bullous keratopathy with secondary glaucoma. RESULTS: A retrospective analysis of the case record of a 60-year-old man who had earlier undergone bilateral cataract surgery, was done. He presented with a complaint of decrease in vision in the right eye of 20 days duration. On examination, cornea showed epithelial bullae all over the surface with stromal and epithelial edema. intraocular pressure was 30 mm of Hg in RE. He was treated with anti-glaucoma medications. Two dendritic lesions were seen in the cornea during a subsequent visit four days later. Virological investigations confirmed a diagnosis of herpes simplex keratitis. He was treated with topical acyclovir. CONCLUSIONS: This case highlights the fact that herpes simplex keratitis can present initially as a more diffuse corneal stromal and epithelial edema with epithelial bullae mimicking bullous keratopathy. Herpetic bullous keratitis, although unusual, should be considered in the differential diagnosis under such circumstances.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/60. Initial treatment of descemetocele with hydrophilic contact lenses.A hydrophilic contact lens was used as the initial mode of therapy in 5 cases of descemetocele. The lens was left in place over the descemetocele continuously for periods ranging from 2 to 15 months. corneal perforation did not occur, and the anterior chamber remained formed in all cases. The device seemingly provides sufficient structural reinforcement to Descemet's membrane to prevent its distension by the intraocular pressure. It also maintains Descemet's membrane in a moist state and protects the descemetocele from the trauma of the lid margins during blinking. This series of cases indicates that a hydrophilic contact lens can be a very effective temporizing measure for the treatment of descemetocele, enabling the surgeon initially to cope with an ocular emergency in a very simple manner, and to convert the ultimate surgical repair to a scheduled, carefully planned procedure with a much greater potential for success.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/60. Hemorrhagic Descemet's membrane detachment as a complication of deep sclerectomy: a case report.PURPOSE: To report a case that developed hemorrhagic Descemet's membrane detachment after deep sclerectomy. PATIENT AND methods: Case report. A 63-year-old diabetic patient suffering from uncontrolled chronic open-angle glaucoma with full medication, underwent an uneventful deep sclerectomy operation combined with intraoperative mitomycin-C. RESULTS: On the second postoperative day, a hemorrhagic Descemet's membrane detachment (HDDM) was observed. The hemorrhage showed rapid absorption rate during the first two weeks along with reduction of the HDDM. After this period of time the rate of blood absorption was decreased. The Descemet's membrane reattached completely six months after surgery without any intervention but a paracentral corneal scar was present. The bleb was not functionally impaired during the whole postoperative period, and intraocular pressure remained stable at the level between 12 and 15 mmHg without medication. CONCLUSION: Hemorrhagic Descemet's membrane detachment should be considered as a potential complication of deep sclerectomy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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