1/38. Late removal of dense posthemorrhagic vitreous membranes following cataract extraction.Severe, seemingly permanent intraocular hemorrhages caused by ocular trauma, Eales' disease and retinal vein thrombosis, lead to late formation of a dense retrolental membrane, vitreous liquefaction and intumescent cataract with faulty light perception. In the absence of ultrasound, the diagnosis was made possible only after removal of the cataract. Lens extraction and excision of the vitreal membrane led to surprisingly good recovery of vision. Three cases are presented and the pathological study of a posthemorrhagic membrane.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/38. Uveitic angle closure glaucoma in a patient with inactive cytomegalovirus retinitis and immune recovery uveitis.We report a case of uveitic acute angle closure glaucoma in a patient with acquired immunodeficiency syndrome (AIDS) associated with inactive cytomegalovirus retinitis and immune recovery vitritis. We conducted a long-term, follow-up examination of a 47-year-old male with AIDS and inactive cytomegalovirus retinitis caused by immune recovery on highly active antiretroviral therapy (HAART). We found vitritis and ultimate development of uveitic glaucoma in the postoperative periods following repair of retinal detachment and extracapsular cataract extraction with intraocular lens implant. An episode of acute angle closure secondary to posterior synechiae and iris bombe subsequently developed, requiring peripheral laser iridotomy. Immune recovery in the setting of inactive cytomegalovirus retinitis can result in intraocular inflammation severe enough to cause angle closure glaucoma and profound ocular morbidity.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
3/38. The management of glaucoma in nanophthalmos.patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
4/38. Neuro-ophthalmologic complications of cataract surgery.Neuro-ophthalmologic complications from cataract surgery are uncommon and include central nervous system toxicity, binocular diplopia, traumatic optic neuropathy and ischemic optic neuropathy. Retrobulbar blocks may be accidentally injected into the subarachnoid space with diffusion to the brainstem. This leads to cardiovascular, respiratory, and mental status compromise. Most patients have complete recovery with adequate support. Post-operative, binocular diplopia may occur secondary to anisometropia or previously unrecognized misalignment. Periocular injection may cause paresis or fibrosis of extraocular muscles. Anterior or posterior ischemic optic neuropathy can occur in the first 6 weeks after cataract surgery with or without periocular injection. The risk to the other eye is high with subsequent contralateral cataract extraction. Post-operative vision loss associated with direct traumatic needle injury is recognized immediately. Therefore, an orbital MRI may be warranted for a patient with an optic neuropathy in the first 24 hours after cataract surgery using periocular anesthesia. If evidence of needle injury is present on neuroimaging, a trial of steroids should be considered.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
5/38. Severe Graves' ophthalmopathy after retrobulbar anesthesia for cataract extraction in a patient with mild stable thyroid eye disease.It has been hypothesized that the distinct anatomic localization of the Graves' triad may be partially explained by pressure and trauma. While there are reports of local trauma clearly contributing to the pathogenesis of pretibial myxedema, direct evidence for a similar mechanism in Graves' ophthalmopathy (GO) has been lacking. We describe a 65-year-old male patient with stable mild Graves' ophthalmopathy of 24 years' duration in whom a retrobulbar block was administered prior to cataract removal. Three weeks after the procedure, he complained of rapidly progressive bilateral diplopia. In 6 months, there was moderate exophthalmos, exposure keratitis, almost complete ophthalmoplegia, and decreasing visual acuity requiring surgical decompression. Postdecompression, inflammatory signs and vision improved but there was complete ophthalmoplegia. The eye signs remained unchanged for the next 4 months but there was exacerbation of the disease within a week of receiving radioiodine despite concomitant steroid administration. Orbital irradiation was finally administered with rapid improvement in extraocular eye muscle function. We hypothesize that local inflammatory and immune responses stimulated by trauma and/or pressure in the retrobulbar compartment, triggered the development of severe ophthalmopathy in this patient. Thyroid-stimulating immunoglobulin (TSI) levels remained markedly elevated despite the clinical improvement suggesting that the beneficial effects of radiotherapy in this case were not mediated by suppressing TSI production.- - - - - - - - - - ranking = 0.8keywords = extraction (Clic here for more details about this article) |
6/38. exfoliation syndrome after cataract extraction.The authors describe three cases in which exfoliative material was noted on the posterior surface of intraocular lenses, years after extracapsular cataract extraction and lens implantation in eyes where no exfoliative material was seen before the operation. All three cases had an open posterior capsule before the exfoliative material was first seen. This phenomenon has not been previously presented in the literature.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/38. vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes.OBJECTIVE: To describe vitrectomy-phacoemulsification-vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56-78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery. INTERVENTION: The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to "debulk" the vitreous and soften the eye. Step 2: phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments. MAIN OUTCOME MEASURES: intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications. RESULTS: The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage. CONCLUSIONS: The vitrectomy-phacoemulsification-vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
8/38. Production of human lens capsule illustrated by a case of chronic lenticular chalcosis.The osmiophilic capsular inclusion bodies in a case of accidental lenticular chalcosis have been used as an in vivo indicator of capsular production. copper stimulation and hence inclusion impregnation lasted 5 years and was stopped 2 years before removal of the lens by extraction of a foreign body. The amount of capsule produced in the two year period varied at different locations but it greatly exceeded the previously measured quantities. A capsular turnover is postulated with a capsular production by the epithelial cells and a surface resorption process. The production rate is considered to be relatively high in childhood and gradually subsides with increasing age.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
9/38. Pseudo-exfoliation pattern on posterior IOL.Extracapsular cataract extraction with posterior chamber lens implantation was performed in a 75-year-old man. Eight months later PE syndrome had developed with a distinct peripheral band on the anterior surface of the pseudophacos. This case clearly shows that the peripheral band is added to the lens surface from outside, and is not derived from the lens epithelium.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
10/38. Inflammatory pigmented paravenous retinochoroidal atrophy.A 47-year-old Japanese man had a progressive degeneration of the retina and choroid along the retinal veins associated with uveitis of two years' duration. The lesion was characteristic of paravenous retinochoroidal atrophy: a contiguous atrophy of the retinal pigment epithelium and choroid of one-half to one disc diameter in size was present along most of the veins from the posterior pole to the far periphery. fluorescein angiography showed a window defect in the retinal pigment epithelium, with hyperfluorescence representative of retinal pigment epithelium and choriocapillaris degeneration. Good visual acuity was attained after extracapsular cataract extraction for complicated cataract and vitrectomy for severe vitreous opacity had been performed in both eyes. The cause of this new inflammatory disease was unknown.- - - - - - - - - - ranking = 0.2keywords = extraction (Clic here for more details about this article) |
| | Next -> |