1/5. diagnosis of hemophilia made after intraoperative bleeding during attempted penetrating keratoplasty in an elderly patient.PURPOSE: To report an unusual case where the diagnosis of hemophilia was made after attempted penetrating keratoplasty in an elderly patient. methods: A 75 year old white male with a full-thickness corneal scar in the visual axis and a visually significant cataract OD was to undergo penetrating keratoplasty and cataract extraction with lens implantation for visual rehabilitation. There was no history of bleeding diathesis given. RESULTS: During placement of the Flieringa ring, a progressively enlarging 360 degrees subconjunctival hemorrhage was observed. Given the unusual bleeding,the procedure was aborted and the patientwas referred to the hematology service for further evaluation. Laboratory studies revealed a diagnosis of atypical hemophilia of mild severity. CONCLUSIONS: The initial diagnosis of hemophilia in any elderly patient is unusual. This case is even more unusual asthe diagnosis of a bleeding disorder was first considered after excessive subconjunctival hemorrhage developed during attempted penetrating keratoplasty.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/5. Topical thrombin-related corneal calcification.PURPOSE: To report a highly unusual case of corneal calcification after brief intraoperative use of topical thrombin. methods: A 44-year-old man underwent sclerouvectomy for ciliochoroidal leiomyoma, during which 35 UNIH/mL lyophilized bovine thrombin mixed with 9 mL of diluent containing 1500 mmol/mL calcium chloride was used. From the first postoperative day, corneal and anterior lenticular capsule calcifications developed, and corneal involvement slightly enlarged thereafter. RESULTS: A year later, 2 corneal punch biopsies confirmed calcification mainly in the Bowman layer. Topical treatment with 1.5% ethylenediaminetetraacetic acid significantly restored corneal clarity. Six months later, a standard extracapsular cataract extraction with intraocular lens placement improved visual acuity to 20/60. CONCLUSION: This case suggests that topical thrombin drops with elevated calcium concentrations may cause acute corneal calcification in Bowman layer and on the anterior lens capsule.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/5. Management of traumatic rupture of the globe in aphakic patients.We report the successful treatment of three cases of traumatic ruptures of the globe complicated by massive choroidal hemorrhage, uveal prolapse and retinal detachment. All three of the eyes were aphakic prior to injury and all patients were age 64 or older. The presenting visual acuity in all patients was light perception. The blunt injury in each case caused a wound dehiscence at the site of previous cataract extraction. All injuries were associated with uveal prolapse. Secondary surgical intervention was performed when the hemorrhagic choroidal detachments had decreased as demonstrated by echography in the suprachoroidal space, occurring at an average of 14 days after injury. The management consisted of surgical drainage of the choroidal hemorrhage combined with vitrectomy and silicone oil injection. Successful reattachment of the retina was achieved in all cases. Postoperative epiretinal membranes formed in two cases but all were anatomically successful at six months. Final visual acuities varied from 20/70 to 1/200, visual acuity being a function of secondary contusive damage to the retina and choroid. We believe that in eyes sustaining severe blunt injuries resulting in rupture of the globe complicated by massive choroidal hemorrhage and retinal detachment, properly timed external drainage of the choroidal hemorrhage combined with pars plana vitrectomy and silicone oil injection is a useful approach.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/5. Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery.The incidence of acute intraoperative suprachoroidal hemorrhage (AISH) was studied in 2,839 consecutive extracapsular cataract extraction cases operated by nucleus expression and phacoemulsification. Twenty-five eyes (0.9%) were identified with this complication. Acute intraoperative suprachoroidal hemorrhage was defined as the acute accumulation of fluid in the suprachoroidal space which resulted from a presumed suprachoroidal hemorrhage at the time of surgery. Preoperative risk factors for the development of this complication included advanced age and the presence of glaucoma. sex, controlled hypertension, long axial length, and method of cataract removal could not be identified as significant risk factors. Recognition of the early signs of AISH and initiation of rapid wound closure followed by the completion of secondary operations performed the next day helped to meet the surgical objective and to provide excellent visual results, with 21 eyes (84%) having a visual acuity of 20/30 or better.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/5. vitrectomy and fluid infusion in the treatment of delayed suprachoroidal hemorrhage after combined cataract and glaucoma filtration surgery.I report the successful treatment of one case of massive, delayed suprachoroidal hemorrhage that occurred after combined intracapsular cataract extraction and trabeculectomy. Significant vitreous incarceration in the filtration site and consequent vitreoretinal traction were present so that a limbal approach anterior vitrectomy was necessary before choroidal drainage could be accomplished safely. An infusion of balanced salt solution through a limbal infusion cannula was employed during vitrectomy and also during drainage of suprachoroidal blood. The simultaneous intravitreal infusion helped to create an efficient, controlled choroidal drainage procedure. In addition to relieving vitreoretinal traction, this technique helps prevent the periods of extreme hypotony experienced when choroidal drainage and anterior chamber reformation are accomplished serially in step-wise fashion. This use of this method also obviates the compromised view of the peripheral retina which occurs when air is introduced into the vitreous cavity.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |