1/21. ciliary body melanocytoma with anterior segment pigment dispersion and elevated intraocular pressure.PURPOSE: To discuss a case in which melanocytoma of the ciliary body presented with widespread pigment dispersion and elevated intraocular pressure (IOP). methods: A 64-year old woman presented with increased IOP and persistent anterior segment inflammation in her right eye. She had undergone a trabeculectomy for uncontrolled IOP before presentation. Slit-lamp examination, gonioscopy, and ultrasound biomicroscopy revealed a ciliary body mass with extension into the subconjunctiva in addition to widespread pigmentary dispersion in the anterior segment. Enucleation of the right eye was performed for histopathologic evaluation, as a diagnosis of ciliary body melanoma was made on clinical examination. RESULTS: Histopathologic findings were diagnostic of a melanocytoma of the ciliary body with necrosis and focal malignant transformation with extension of melanocytoma cells and melanophages into the subconjunctival space, trabecular meshwork, and anterior chamber angle. CONCLUSION: Melanocytoma of the ciliary body is a rare intraocular tumor that may present with pigment dispersion and secondary elevated IOP. Careful examination of the anterior segment is imperative in such cases.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/21. Unilateral capsular glaucoma after long-standing bilateral pigmentary glaucoma.In 1964 we treated a 42-year-old woman diagnosed to have classical bilateral pigment dispersion syndrome combined with an intraocular pressure (IOP) of up to 28 mmHg in both eyes. The patient now has a daughter, also with pigment dispersion syndrome. Miotic treatment brought the IOPs to normal, and 8 years later when the disease was in the inactive phase all treatment could be discontinued. At the age of 67 years, exfoliation deposits became visible in the right eye only, but the IOPs were still below 21 mmHg. Four years later, the pressure of the right eye rose to 31 mmHg. During the next few years all available IOP-lowering medications and laser trabeculoplasty failed, and finally trabeculectomy had to be performed to keep the pressure of the right eye under control and to halt visual field changes, which had already appeared. This case illustrates that development of exfoliation syndrome may take place irrespective of pigment dispersion, and that their simultaneous occurrence may lead to an IOP rise that is resistant to medical therapy and laser trabeculoplasty. It additionally provides further clues to the pathogenesis of capsular glaucoma.- - - - - - - - - - ranking = 0.6keywords = pressure (Clic here for more details about this article) |
3/21. Markedly increased unilateral intraocular pressure during hemodialysis in a patient with ipsilateral exfoliative glaucoma.PURPOSE: To report a man with markedly increased intraocular pressure in a unilateral exfoliated eye during hemodialysis. METHOD: Case report. RESULTS: A 75-year-old man with unilateral exfoliative glaucoma complained of blurred vision in his right eye during hemodialysis. The blurred vision always occurred during hemodialysis, and the intraocular pressure was increased during hemodialysis. The average increase in intraocular pressure during hemodialysis in the right eye was 22.5 mm Hg, and the intraocular pressure in the left eye remained in the normal range during hemodialysis. argon laser trabeculoplasty was performed on the right eye, and a decrease in intraocular pressure was attained. CONCLUSION: physicians must be alert to intraocular pressure increases in these eyes during hemodialysis.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
4/21. Pigmentary dispersion syndrome induced by a posterior chamber phakic refractive lens.PURPOSE: To report a case of bilateral pigmentary dispersion syndrome (PDS) induced by the implantation of posterior chamber phakic refractive lenses (PRLs). METHOD: Case report. RESULTS: Following bilateral implantation of posterior chamber phakic refractive lenses in 38-year-old woman, unilateral elevated intraocular pressure (IOP) developed within months that was attributable to pigment dispersion within the anterior chamber. Findings consistent with PDS included bilateral transillumination defects of the iris in areas contacting the anterior surface of the PRLs, pigment deposits on the anterior surface of the PRLs, Krukenberg spindles, and bilateral dense pigmentation of the trabecular meshwork. The patient's IOP is presently under control and she has not developed glaucomatous damage. CONCLUSIONS: The development of PDS in this case demonstrates that posterior chamber phakic refractive lenses can make contact with the posterior iris and induce pigment dispersion syndrome in susceptible patients.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
5/21. Pigment dispersion with elevated intraocular pressure after AcrySof intraocular lens implantation in the ciliary sulcus.A 45-year-old white woman had phacoemulsification with intraocular lens (IOL) implantation. The surgery was routine except for a linear tear in the posterior capsule; there was no disruption of the anterior vitreous face. After residual soft lens matter was removed, an AcrySof IOL was placed in the ciliary sulcus. One month postoperatively, the patient presented with an intraocular pressure (IOP) of 30 mm Hg and signs of pigment dispersion with 360 degrees of heavy pigmentation of the trabecular meshwork and iris transillumination defects. intraocular pressure was controlled with a topical beta-blocker. The optic disc appearance and visual field remained normal, but the uniocular hyperpigmentation of the trabecular meshwork was still present. We hypothesize that the sharp square edge of the AcrySof IOL increases the risk of a chafing effect on the posterior iris pigment and advocate that this IOL be placed in the capsular bag and ideally have 360 degrees of protective overlapping of the anterior capsule over the edge of the optic.- - - - - - - - - - ranking = 1.2keywords = pressure (Clic here for more details about this article) |
6/21. Late onset lens particle glaucoma as a consequence of spontaneous dislocation of an intraocular lens in pseudoexfoliation syndrome.PURPOSE: To report acute onset lens particle glaucoma associated with pseudoexfoliation-related dislocation of an intraocular lens implant 12 years after cataract surgery. methods: Case report. RESULTS: An 80-year-old woman presented with acute onset of left eye pain that was associated with white fleck-like particles circulating in the anterior chamber and an intraocular pressure of 48 mm Hg. The posterior chamber intraocular lens within the capsular bag was positioned more posteriorly to the iris plane than usual, and pseudoexfoliative material was present on the lens capsule and the zonules. anterior chamber aspirate confirmed the presence of lens cortical fibers. CONCLUSION: Spontaneous dislocation of the posterior chamber intraocular lens in patients with pseudoexfoliation syndrome several years after cataract surgery may liberate lens cortical material, causing lens particle glaucoma.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
7/21. Endogenous serratia marcescens endophthalmitis with dark hypopyon: case report and review.A case of endogenous serratia marcescens endophthalmitis in a patient with diabetes, end-stage renal disease, and an indwelling venous catheter is reported. The patient presented with a tan hypopyon and elevated intraocular pressure. diagnosis was established by positive blood, vitreous, conjunctival, and catheter tip cultures. After a deteriorating course the eye was enucleated. Gross and histopathologic examination revealed the presence of a dark hypopyon with iris necrosis and pigment dispersion and possible spontaneous globe perforation. This is the eleventh reported case of endogenous Serratia endophthalmitis. Previous association of a pink hypopyon and of pigmented vitreous fluid and Serratia endophthalmitis has been reported. This is the first case of dark hypopyon in endogenous serratia marcescens endophthalmitis reported in the medical literature. Previous entities associated with dark hypopyon have been limited to intraocular melanoma and listeria monocytogenes endophthalmitis. Dark hypopyon in the appropriate clinical setting may be useful in aiding diagnostic and therapeutic decisions.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
8/21. Unilateral symptomatic elevation of intraocular pressure and prevention using a hyperosmotic agent during hemodialysis.BACKGROUND: We report on a patient with unilateral elevation of intraocular pressure during hemodialysis. CASE: A 60-year-old man with unilateral exfoliative material complained of severe pain in the right eye during hemodialysis. OBSERVATIONS: The intraocular pressure (IOP) in the patient's right eye was 56 mm Hg, and increased repeatedly during hemodialysis. The IOP in his left eye remained within a normal range. trabeculectomy failed to reduce the elevation of IOP in the right eye. Changes in plasma osmotic pressure during hemodialysis were marked when the IOP was elevated. The administration of a hyperosmotic agent prevented the elevation of IOP during hemodialysis. CONCLUSIONS: physicians should be aware that elevation of IOP in patients with eyes with exfoliative material may occur during hemodialysis even after trabeculectomy. This can be prevented by administering a hyperosmotic agent during hemodialysis.- - - - - - - - - - ranking = 1.4keywords = pressure (Clic here for more details about this article) |
9/21. iris prolapse at the surgical site: a late complication of nonpenetrating deep sclerectomy.To investigate the occurrence and management of late-onset iris prolapse through the surgical wound after nonpenetrating deep sclerectomy. Two cases of iris prolapse that presented 8 and 10 months, respectively, after surgery for glaucoma were reviewed. One of the cases was associated with mild trauma. The postoperative follow-up was 5 and 24 months, respectively. The iris tissue bulge did not progress and there were no other complications. The visual acuity was not affected and the intraocular pressure was controlled with medical therapy. These cases demonstrate that the eye is weaker than normal at the surgical site after nonpenetrating deep sclerectomy, allowing iris protrusion. iris prolapse should be added to the list of late postoperative complications of nonpenetrating deep sclerectomy.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
10/21. Hemorrhagic Descemet's membrane detachment after viscocanalostomy.We report a case of hemorrhagic detachment of Descemet's membrane after viscocanalostomy. A 60-year-old man with pseudoexfoliative glaucoma had an uneventful viscocanalostomy in the right eye. On the first postoperative day, a 5.0 mm x 5.0 mm Descemet's membrane detachment was present in the superior nasal quadrant. The space between Descemet's membrane and the stroma was filled with a hemorrhage. The hemorrhage resorbed by 6 months postoperatively, and Descemet's membrane completely reattached without surgical manipulation. The final visual acuity dropped from 20/40 to 20/100, final intraocular pressure was 20 mm Hg with 1 medication, and a paracentral fibrinoid scar persisted 18 months after surgery. Hemorrhagic detachment of Descemet's membrane can cause visual acuity deterioration and should be recognized as a rare complication of viscocanalostomy.- - - - - - - - - - ranking = 0.2keywords = pressure (Clic here for more details about this article) |
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