1/15. Surgically induced necrotizing scleritis in a patient with ankylosing spondylitis.We present the case of a 75-year-old man with ankylosing spondylitis who developed surgically induced necrotizing scleritis (SINS) more than 3 years after uneventful extracapsular cataract extraction and posterior chamber intraocular lens implantation. The patient presented with a painful eye and increasing vertical diplopia. To our knowledge, neither the association of SINS and ankylosing spondylitis nor vertical diplopia as its presenting complaint has been described.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/15. Rectus muscle trauma complicating sub-Tenon's local anaesthesia.PURPOSE: To describe three cases of rectus muscle trauma in patients undergoing phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia via the inferonasal quadrant. methods: Retrospective review was carried out of 3 cases from 1080 patients who underwent phacoemulsification cataract extraction and intraocular lens implantation under sub-Tenon's local anaesthesia in our unit over a 3 year period up to April 2000. RESULTS: Two patients complained postoperatively of vertical diplopia and were shown to have restriction of elevation of the eye, which was found at surgical exploration to be due to inferior rectus muscle restriction. One patient had post-operative horizontal diplopia due restriction of abduction and exploration of the medial rectus muscle was planned. CONCLUSION: Rectus muscle trauma is proposed as a complication of sub-Tenon's local anaesthesia and caution is advised to operators to clearly identify the sub-Tenon's space for injection of local anaesthetic.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
3/15. Combined strabismus and phacoemulsification cataract surgery: a useful option in selected patients.PURPOSE: To evaluate the role of combined strabismus and phacoemulsification cataract extraction in patients with symptomatic cataract and strabismus. methods: Four procedures of combined strabismus and cataract surgery are described in 3 elderly patients with strabismus of differing aetiologies. Two patients underwent one procedure; the other patient underwent two combined procedures, one to each eye. RESULTS: The visual acuity improved in all 3 patients. Post-operative alignment of the visual axis was achieved which allowed resolution of symptomatic diplopia in patient 1, functional binocular single vision in patient 2 and a noticeably reduced compensatory head posture in patient 3. CONCLUSIONS: Combined strabismus and cataract surgery is a safe procedure that can optimise visual alignment and improve visual acuity with a minimum number of operations.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/15. Inferior oblique overaction/contracture following retrobulbar anesthesia for cataract extraction with a positive Bielschowsky head Tilt test to the contralateral shoulder. A report of one case.BACKGROUND AND PURPOSE: This is a report of a patient with diplopia, hypertropia, extorsion and a positive Bielschowsky head Tilt Test following retrobulbar anesthesia, due to an inferior oblique muscle overaction-contracture. CASE REPORT: Oculomotor and sensorimotor examinations and ocular motility recordings and Bielschowsky head Tilt Test demonstrated overaction characteristics overpowering the contracture characteristics of the involved inferior oblique muscle. RESULTS: Weakening of the overacting inferior oblique eliminated the vertical and torsional deviations and the forced head tilt difference upon tilting the head to either shoulder. It also normalized ocular motility and resulted in a symptom-free patient. CONCLUSION: Oblique muscle dysfunction with vertical and torsional deviations and a positive Bielschowsky head Tilt Test can result from retrobulbar anesthesia.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
5/15. diplopia after cataract surgery.A 69-year-old man developed binocular, vertical diplopia after undergoing cataract extraction in both eyes. He had normal extraocular motility and a 2 prism diopter right hypertropia that was comitant but could not be relieved with overlying prisms. Funduscopy revealed an epiretinal membrane within the macula on the left more than the right. After his metamorphopsia worsened, and his visual acuity decreased to 20/40 in the left eye, he underwent pars plana vitrectomy with removal of the epiretinal membrane and his diplopia resolved. Macular pathology including epiretinal membranes and choroidal neovascular membranes may rarely cause binocular diplopia because of foveal displacement and rivalry between central and peripheral fusional mechanisms.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
6/15. Accommodative intraocular lens tilting.PURPOSE: To report an unusual complication of accommodative intraocular lens (IOL) implantation after clear lens extraction for hyperopia correction. DESIGN: Observational case report. METHOD: A 48-year-old woman underwent clear lens exchange for the correction of moderate hyperopia. A Crystalens Model AT-45 Accommodating Posterior Chamber IOL (AT-45 IOL) was implanted to allow optimal distance and near vision. At the 3-week follow-up appointment, she complained of monocular diplopia. Ocular examination showed an increased astigmatism, causing decreased visual acuity. Scheimpflug Pentacam Image and Wave Front Analysis supported the diagnosis of IOL tilting. RESULTS: IOL repositioning was unsuccessful because of fibrosis of the haptics. It was necessary to replace AT 45 IOL with a monofocal acrylic sulcus-fixated IOL. CONCLUSION: Control of capsular fibrosis should be a major concern, especially in this type of IOL. Accommodating IOL exchange appears to be a safe alternative to manage this complication.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/15. Persistent strabismus after cataract extraction.BACKGROUND: Transient ocular misalignment as a complication of parabulbar and peribulbar anesthesia has already been reported in the literature. The aim of our study was to present a case of irreversible iatrogenic vertical strabismus after cataract surgery, which had to be operated on. methods: Clinical and orthoptic evaluation of a female patient with vertical diplopia after phacoemulsification cataract surgery. RESULTS: One week after the uneventful surgery, a 68-year-old patient complained of a sudden vertical deviation in the operated eye. The patient had not had a history of previous motility disorders. On examination, the patient showed hypertropia in the left eye of 15-20 degrees in primary position. Three and 6 months postoperatively, there was no a spontaneous improvement, while the persistent vertical deviation was 40 prism dioptres. strabismus surgery was required 1 year after the cataract surgery. CONCLUSION: diplopia is a complication of peribulbar anesthesia which could be persistent. The superior and inferior rectus muscle are especially vulnerable. Its occurrence may be technique--related and the incidence increases when hyaluronidase is not available.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
8/15. Thyroid eye disease presenting after cataract surgery.strabismus presenting after cataract surgery has been attributed to a variety of disorders, some of which are unrelated to the surgery. When thorough ophthalmologic and neurologic examinations fail to elucidate a definitive etiology, the motility disturbance is often ascribed to operative trauma to the orbital soft tissues. In a series of 58 patients with strabismus presenting after cataract surgery, eight (14%) were found to have previously unsuspected thyroid eye disease. Three of the eight patients had past histories of systemic dysthyroidism, but none reported diplopia prior to cataract extraction. Three of the remaining five patients showed normal thyroid function tests. Absence of diplopia prior to cataract extraction in these patients may be due to: 1) poor vision precluding diplopia until surgical restoration of sight; 2) intraoperative aggravation of the inflammatory process in otherwise subclinical thyroid eye disease; or 3) onset of clinical thyroid eye disease that was temporally associated with cataract surgery by chance. Thyroid eye disease should be included in the differential diagnosis of all patients presenting with binocular diplopia following cataract surgery. Suitable neuroimaging studies may be needed to confirm the diagnosis.- - - - - - - - - - ranking = 2keywords = extraction (Clic here for more details about this article) |
9/15. Inferior rectus muscle restriction after retrobulbar anesthesia for cataract extraction.Among the recognized complications of retrobulbar anesthesia, postoperative permanent diplopia has rarely been reported. We describe two patients with inferior rectus muscle restriction after retrobulbar anesthesia for cataract extraction and intraocular lens implantation. Both did well after inferior rectus recession with placement of an adjustable suture.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
10/15. Anisophoria after implantation of an intraocular lens.After extracapsular cataract extraction, a Simcoe-style posterior chamber intraocular lens was implanted in the left eye of a 69-year-old patient. The visual acuity of the right eye was 20/25 with 3.0 diopter correction. Probably as a result of a biometric error, the left eye was rendered myopic (-1.75 -3.00 X 25 degrees). This anisometropia caused a disturbing diplopia, which could be explained by anisophoria rather than by aniseikonia. The problem of anisophoria is discussed, along with suggestions for correcting the problem.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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