1/62. Severe ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy.PURPOSE: To report severe ocular and orbital toxicity after administration of intracarotid etoposide phosphate and carboplatin. METHOD: Case report. RESULTS: A 52-year-old man with glioblastoma multiforme underwent left intracarotid administration of eto poside phosphate and carboplatin inferior to the ophthalmic artery. Within 7 hours, a nonpupillary block angle-closure glaucoma developed secondary to uveal effusion in the ipsilateral eye, which was relieved by cycloplegia. Four days later, severe orbital inflammation resulted in a visual acuity of counting fingers, proptosis, optic neuropathy, and total external ophthalmoplegia in the eye. The patient's condition improved after a lateral cantholysis and administration of high-dose intravenous corticosteroids. Two weeks later, an anterior uveitis occurred in the left eye, which responded to topical corticosteroids. During a 2-month period, the patient recovered to a visual acuity of 20/70, near normal motility, and normal intraocular pressure, and the ocular and orbital inflammation resolved. Preexisting ipsilateral chemotherapy-induced maculopathy became more pronounced. CONCLUSION: Ocular and orbital toxicity after intracarotid etoposide phosphate and carboplatin therapy is infrequently reported.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/62. Massive suprachoroidal hemorrhage with retinal and vitreous incarceration; a vitreoretinal surgical approach.Suprachoroidal hemorrhage(SH) may cause the expulsion of the intraocular contents. Vitreous incarceration in the wound and retinal detachment with SH are extremely poor prognostic signs. Treatment modalities depend on the severity of eye damage. This particular patient had "kissing" hemorrhagic choroidal detachment which completely filled the vitreous cavity after cataract surgery. It seemed to be inoperable. Secondary surgery was delayed 3 days to lower IOP to normal levels. The eye underwent anterior drainage sclerotomy under constantly-maintained limbal or pars plana infusion fluid line pressure. The authors performed a pars plana vitrectomy, followed by perfluorocarbon liquid injection and a silicone oil tamponade. After this surgical approach, the patient attained an attached retina and a visual acuity of 5/200 at the 3 month follow-up.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/62. Motility disturbance due to true Tenon cyst in a child with a Baerveldt glaucoma drainage implant.Epithelial ingrowth of the bleb cavity, a true Tenon cyst, is a rare complication of a glaucoma drainage implant. Previous cases have been associated with persistent bleb leak, and most have occurred in eyes with prior extraocular surgery. We describe a case of a true Tenon cyst causing strabismus and an elevated intraocular pressure that was successfully treated by surgical revision.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/62. Juvenile xanthogranuloma: concurrent involvement of skin and eye.PURPOSE: To report a novel presentation of ocular involvement in juvenile xanthogranuloma (JXG). CASE REPORT: A 1-year-old boy with the concurrent skin and eye involvement of JXG is presented. The ocular problems included spontaneous hyphema, secondary glaucoma, and 360-degree involvement of the limbus, iris, and angle. RESULTS: To reduce the intraocular pressure (IOP), treatment was started with drops of timolol, betamethasone, and atropine and acetazolamide suspension. After 6 months of medical treatment, the skin lesions did not change, but the iris lesion enlarged without hyphema. The IOP in the right eye was controlled by the medications. CONCLUSION: Although JXG is an uncommon disease, it is one of the most important causes of spontaneous hyphema in children. iris involvement, spontaneous hyphema, and secondary glaucoma are the most common ocular problems. Corneal involvement often is characterized by a yellowish protrusion of the limbus along with blood staining of recurrent hyphema and elevated IOP. In this report, we describe an unusual case of JXG with 360-degree limbus, iris, and angle involvement. To our knowledge, this is the first report in the medical literature of 360-degree limbus involvement in JXG.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/62. glaucoma in episcleritis.Two patients had episcleritis and a secondary open angle glaucoma. Anterior uveitis was absent in three of the four eyes. The low facility of outflow suggests that increased episcleral venous pressure was not the mechanism of the glaucoma. The response of the intraocular pressure and, in one case, the outflow facility to steroid therapy suggests that inflammation of angle structures was the pathogenesis of the raised intraocular pressure.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
6/62. Ophthalmic complications of slit-ventricle syndrome in children.OBJECTIVE: To present the ophthalmic features and visual prognosis of patients with slit-ventricle syndrome (SVS). DESIGN: Observational case series. PARTICIPANTS: Six patients diagnosed and treated with SVS at the Montreal Children's Hospital between 1985 and 1999. methods: patients were included in this study if they had an appropriate ophthalmologic follow-up and if they fulfilled the criteria for the diagnosis of SVS based on intracranial pressure monitoring and neuroimaging studies. MAIN OUTCOME MEASURES: Features studied included patients' baseline ophthalmologic evaluation, visual outcome, and neurosurgical characteristics. RESULTS: The follow-up ranged from 1 to 14 years. The average number of shunting procedures was 3.7. Ocular examination performed on the initial visit revealed a normal visual acuity in four patients, esotropia in three of six patients, and nystagmus in two of six patients. Cycloplegic refraction was normal in all the subjects. Initial funduscopic evaluation revealed optic atrophy in a 4-month-old infant, whereas two children developed optic atrophy later in the course of the disease. One child developed severe visual field defects. The two children with optic atrophy had moderate to severe loss of visual acuity associated with SVS. CONCLUSIONS: A prompt recognition of patients with SVS is crucial, because these individuals are at an increased risk for significant visual loss.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/62. 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) |
8/62. Hemorrhagic cyst following remote alloplastic implantation for orbital floor fracture repair.Hemorrhagic cyst formation may occur within months or years following repair of orbital fractures with alloplastic materials. patients present with a sensation of pressure in the involved orbit, double vision, and globe displacement. Evaluation must rule out infectious, inflammatory, and vascular etiologies. Computerized tomography scans reveal a soft tissue density surrounding the alloplastic implant. drainage of the cyst and fibrous capsule, with excision of the capsule and removal of the alloplastic implant, is curative. This article presents three clinical cases, highlighting the evaluation and management of this postsurgical development. Use of the protocol described resulted in complete resolution of all clinical symptoms, and the CT scans were normal. As these materials will continue to be utilized, surgeons should be aware of this potential delayed complication and its management.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/62. 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 = 2keywords = pressure (Clic here for more details about this article) |
10/62. Vitreal pathogenic role in optic pit foveolar retinoschisis and central serous retinopathy.PURPOSE: To expand on current theories concerning the vitreal-induced mechanism underlying the development of foveolar retinoschisis and macular sensory detachments associated with optic nerve head pits. To propose the notion that vitreal traction may contribute to the pathogenesis of serous detachments in central serous chorioretinopathy (CSC). REPORTS: We describe two patients, one with macular retinoschisis and the other with central serous detachment. The first patient, a 45-year-old Hispanic female, presented with a temporally located optic nerve head pit, foveolar retinoschisis and schisis retinal spaces extending to the surrounding macula and to the disc. The second patient, a 43-year-old Haitian male, developed a central serous retinal detachment OS with decreased visual acuity one day following in-office administration of Apraclonidine (0.5 per cent Iopidine, Alcon) and Dorzolamide-timolol Maleate (Cosopt, Merck) to lower elevated intraocular pressure (IOP). Macular retinal pigment mottling and epiretinal membrane sheen OU had been observed on his initial visit. visual acuity improved within a three-day period with resolution of the serous detachment. CONCLUSION: We suggest that the persistence of Cloquet's canal may permit fluid leakage into the proximal vitreous in cases of congenital optic nerve head pits. Tangential vitreal traction may promote the opening of a fistula at the optic pit and additionally thrust vitreal fluid into the pit and retinal space inducing the formation of schisis spaces, foveolar-schisis and underlying sensory serous detachment. We question whether a reduction in vitreous volume, induced by initial administration of anti-glaucoma medications, may contribute to the development and/or recurrence of central serous choroidopathy in predisposed individuals.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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