1/28. Intraocular injection of crystalline cortisone as adjunctive treatment of diabetic macular edema.PURPOSE: To report the clinical outcome of a diabetic patient with macular edema treated with an intravitreal injection of crystalline cortisone. methods: Interventional case report. A 73-year-old patient with diabetes mellitus presented with clinically significant diffuse macular edema caused by nonproliferative diabetic retinopathy. Despite grid laser coagulation in the macular region, cystoid macular edema progressed, and within 6 months before the cortisone injection, visual acuity declined from 0.25 to 0.16 and, finally, to 0.10. The patient received a single intravitreal injection of triamcinolone acetonide with topical anesthesia. RESULTS: After the intravitreal injection of triamcinolone acetonide, visual acuity improved from 0.10 to 0.40 during the follow-up period spanning 5 months. intraocular pressure increased to values up to 30 mm Hg before antiglaucomatous treatment. CONCLUSION: Intravitreal injection of triamcinolone acetonide may be useful for treatment of diabetic macular edema resistant to conventional therapy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/28. Silicone oil-induced secondary glaucoma: a case study.Silicone oil intraocular tamponade is a widely accepted procedure in the management of complex retinal detachments caused by proliferative diabetic vitreoretinopathy. Silicone oil has a high surface tension that mechanically limits fibrovascular reproliferation resulting in successful retinal reattachments. However, postoperative secondary glaucoma is a relatively frequent complication that may require intensive nursing management focused at intraocular pressure monitoring, positioning compliance, pain management, fluid and electrolyte balance, and glucose control. This article presents the postoperative clinical course of a 51-year-old man with diabetes and recurrent proliferative diabetic vitreoretinopathy who developed secondary glaucoma after silicone oil injection with a dramatic rise in intraocular pressure on the first postoperative day. nursing management concurrent with medical and surgical management is discussed and the necessary nursing plan of care is identified.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/28. Development of diabetes mellitus several years after manifestation of diabetic nephropathy: case report and review of literature.OBJECTIVE: To describe an unusual case of development of diabetes mellitus (DM) several years after manifestation of diabetic nephropathy and to review the related literature. methods: We present a case report, including detailed laboratory and pathologic findings in a 51-year-old man who was diagnosed as having DM several years after presenting with diabetic nephropathy. The pertinent literature is also reviewed. RESULTS: A 51-year-old African American man presented with proteinuria of 4 g/24 h. Past medical history was significant for impaired glucose tolerance diagnosed 2 years previously. Subsequent follow-up demonstrated fasting blood glucose levels ranging from 108 to 123 mg/dL and glycated hemoglobin levels ranging from 5.3 to 5.8%. The patient also had chronic hepatitis c, hypertension, a history of intravenous drug abuse, and a family history of DM and hypertension. On examination of the patient, his blood pressure was 180/90 mm Hg. Funduscopy revealed mild diabetic retinopathy. work-up was negative for glomerulonephritis, connective tissue disease, vasculitis, or multiple myeloma. kidney biopsy revealed thickened glomerular basement membranes and diffuse glomeru-losclerosis, consistent with diabetic nephropathy. During follow-up, 9 years after presenting with proteinuria and 4 years after diagnosis of biopsy-proven diabetic nephropathy, the patient had a blood glucose level of 890 mg/dL and diabetic ketoacidosis. CONCLUSION: This case provides one explanation for the natural course of patients who present with "diabetic complications" but have no diabetes. Some of those patients may have "prediabetes" and may manifest with DM during follow-up. We also conclude that hyperglycemia is not the only important factor in the pathogenesis of diabetic nephropathy.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/28. Management of post-vitrectomy persistent vitreous hemorrhage in pseudophakic eyes.PURPOSE: To prospectively assess the effect of neodymium:yttrium-aluminum-garnet peripheral capsulotomy on postvitrectomy hemorrhage in diabetic patients with a posterior chamber intraocular lens (IOL) implant and an intact posterior capsule. DESIGN: Interventional case series. methods: This is a prospective case series, clinical practice. patients: Five vitrectomized, diabetic, pseudophakic patients with persistent vitreous cavity hemorrhage remaining after vitrectomy were selected. They all had a posterior chamber IOL implant with an intact posterior capsule. Additionally, they had all undergone laser panretinal photocoagulation in the involved eye in the past for diabetic retinopathy. neodymium:yttrium-aluminum-garnet laser capsulotomy outside the optic of the IOL was performed in victrectomized diabetic patients to treat the remaining vitreous cavity hemorrhage. visual acuity, intraocular pressure (IOP), and fundus examination were measured and done immediately after the laser procedure, in 7 days and in approximately 3 months. RESULTS: The visual acuity was improved at the time of the first follow-up. However, a mild elevation of IOP was noticed in some patients, which was treated with topical dorzolamide. The final visual acuity was dramatically improved, to 20/30 or better, and the IOP was normalized without medication within a few weeks in all five cases. No neovascularization of the iris or elsewhere was noticed in any case. CONCLUSIONS: neodymium:yttrium-aluminum-garnet laser peripheral capsulotomy appears to be a safe and effective management procedure in treating postvitrectomy hemorrhage in diabetic patients who have previously undergone cataract surgery with posterior chamber lens implant, intact posterior capsule, and extensive panretinal photocoagulation. The vitreous hemorrhage cleared completely in all five cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/28. Sandostatin LAR for cystoid diabetic macular edema: a 1-year experience.We report the clinical outcome of a 46-year-old diabetic patient with cystoid macular edema treated with Sandostatin long-acting release (LAR). Because cystoid changes in both eyes were refractive to conventional treatment (i.e., vitrectomy and periocular steroids), the patient was treated with Sandostatin LAR 20 mg every four weeks. One year later the patient maintained corrected visual acuity of 20/40 in the right eye and 20/100 in the left eye, the cystoid changes had disappeared in the right eye and had greatly decreased in the left eye. In addition, the intraocular pressure had declined and no other complications were found. Thus, Sandostatin LAR may be considered for the treatment of diabetic patients with cystoid macular edema.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/28. Migration of intravitreal silicone oil through a Baerveldt tube into the subconjunctival space.A 28-year-old patient developed proliferative diabetic retinopathy with florid rubeosis iridis and ultimately required the placement of a Baerveldt tube to control his secondary glaucoma. Eighteen months later, he underwent a pars plana vitrectomy, scleral buckle, lensectomy, and membrane peeling to reattach a severe diabetic retinal detachment. Ultimately, some of the 5000 cs silicone oil migrated through the tube to the episcleral region under the plate of the Baerveldt device. The oil intermittently blocked the shunt, causing elevated intraocular pressure. Despite ultimate surgical removal of the oil from around the tube and plate, a substantial amount remained encapsulated in the subconjunctival space. Prevention of this complication includes placement of a short tube well anterior to the iris in the inferior portion of the anterior chamber.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/28. Unilateral macular oedema secondary to retinal venous congestion without occlusion in patients with diabetes mellitus.OBJECTIVE: To identify fundus characteristics associated with intraocular and intra-individual variations in the distribution of macular oedema in patients with diabetes. methods: A review was carried out of fundus photographs and fluorescein angiograms from 226 diabetes patients who received photocoagulation treatment for macular oedema. Cases with strictly unilateral clinically significant macular oedema were identified. RESULTS: Strictly unilateral macular oedema was identified in five patients with non-proliferative diabetic retinopathy, three of whom demonstrated angiographic leakage confined to a single venous drainage unit, and two of whom demonstrated leakage confined to two adjacent venous drainage units opposing one another on either side of the temporal circulatory watershed. Involved drainage units were delimited by arteriovenous crossings displaying signs of venous compression. Affected eyes had more frequent and more severe crossing signs involving macular drainage than fellow eyes. Although all patients had been examined regularly, no patient had had branch retinal vein occlusion and no patient developed such occlusion during 5 years of follow-up. CONCLUSION: In the present study, unilateral macular oedema in patients with diabetes was associated with angiographic leakage from venous drainage units where compression signs indicated a higher than normal likelihood of upstream congestion being present. Presumably, a modest increase in venous pressure induced macular oedema because of an underlying abnormal vascular vulnerability induced by diabetes.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/28. Migration of intraocular silicone into the cerebral ventricles.PURPOSE: To report a case in which silicone oil in the eye migrated into the cerebral ventricles and the subarachnoid space. DESIGN: Observational case report. methods: A 62-year-old woman presented with proliferative diabetic retinopathy and tractive retinal detachment in her left eye. Par plana vitrectomy and injection of 5,000-centistoke-viscosity silicone oil were performed. intraocular pressure was elevated after the operation and poorly controlled for 4 months. Eight months after the first operation, the patient felt dizzy. Computed tomography (CT), magnetic resonance imaging (MRI), and optical coherence tomography (OCT) scanning were performed. RESULTS: The CT imaging, MRI, and OCT showed silicone oils migrated into the sella cistena superioris and the cerebral ventricles. Follow-up examination was continued. CONCLUSION: Although silicone oil migrating into the ventricles is unusual, we suggest that every patient undergoing silicone oil tamponade with poorly controlled high intraocular pressure and optic disk atrophy should be carefully evaluated.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
9/28. Clinicopathological features of severe corneal blood staining associated with proliferative diabetic retinopathy.A 54-year-old man with a history of severe proliferative diabetic retinopathy in both eyes and profound visual impairment presented with severe corneal blood staining in the left eye secondary to a "spontaneous" total hyphaema and raised intraocular pressure in an eye with iris neovascularization. Despite anterior chamber washout, the cornea remained virtually opaque and thickened. The subject subsequently underwent pars plana vitrectomy with endolaser using a temporary keratoprosthesis, insertion of a Morcher iris-surround intraocular lens and penetrating keratoplasty. Histopathology of the excised corneal button revealed fine eosinophilic granules composed of aggregations of haemoglobin and its breakdown products dispersed throughout the stroma, with occasional foci of weakly positive Perl staining for intracellular haemosiderin. fluorescence confocal microscopy revealed a marked increase in fluorescence throughout the corneal stroma and the basal epithelial layer. This case highlights the microstructural features and aspects of the surgical management of severe corneal blood staining.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
10/28. Selective laser trabeculoplasty for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.PURPOSE: Intravitreal injection of triamcinolone acetonide has increasingly become a therapeutic option for neovascular, inflammatory, and edematous intraocular diseases. A common side effect of this treatment is a steroid-induced elevation of intraocular pressure. In most of these patients, the rise in intraocular pressure can be treated topically. Those cases that cannot be treated medically have been treated with filtering surgery. This report presents a case of intraocular pressure elevation after intravitreal triamcinolone acetonide injection that was successfully treated with selective laser trabeculoplasty. CASE REPORT: A 63-year-old white man presented with brow ache on the right side approximately 3 months after undergoing intravitreal injection of triamcinolone acetonide for diabetic macular edema in the right eye. Applanation tonometry revealed an intraocular pressure of 45 mm Hg in the involved eye. After initial treatment with topical medications, the patient underwent selective laser trabeculoplasty. Now, 6 months postlaser treatment, the intraocular pressure in the involved eye is stable at 15 mm Hg without topical medications. CONCLUSIONS: A steroid-induced elevation of intraocular pressure is a common and widely reported side effect of treatment with intravitreal triamcinolone acetonide. This case report suggests that selective laser trabeculoplasty has potential as first- or second-line therapy for intraocular pressure elevation after intravitreal triamcinolone acetonide injection.- - - - - - - - - - ranking = 11keywords = pressure (Clic here for more details about this article) |
| | Next -> |