1/40. Traumatic anterior lens dislocation: a case report.A 45-year-old man presented to the emergency department complaining of decreased vision and pain in the left eye after blunt trauma to the eye. On evaluation, the vision was limited to detecting hand motions, and the intraocular pressure was 37 mmHg. Secondary acute angle-closure glaucoma, with pupillary block due to anterior dislocation of the lens, was diagnosed. The intraocular pressure remained elevated after medical therapy, and the patient underwent intracapsular cataract extraction and anterior vitrectomy. The possibility of elevated intraocular pressure due to lens dislocation or other types of secondary glaucoma should be considered after blunt ocular trauma.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/40. Late traumatic intraocular lens extrusion after penetrating keratoplasty.BACKGROUND: Penetrating keratoplasty places a patient at risk for wound rupture from blunt trauma because the graft-host interface remains weakened for years after the surgery. Violent environments, contact sports, and strenuous activity put patients with compromised corneal structural integrity at high risk of traumatic injury. CASE REPORT: This case report presents a 42-year-old penetrating keratoplasty patient with a history of homelessness, polysubstance abuse, and domestic violence. This patient experienced a ruptured globe at the graft-host junction secondary to a direct blow by a fist, which extruded the intraocular lens from the eye. After emergency wound closure, the graft continued to degrade until bullous keratopathy developed. With little visual recovery potential for this graft, a Gunderson conjunctival flap procedure was implemented to decrease chronic ocular pain. CONCLUSIONS: After penetrating keratoplasty, patients should be periodically reminded of the susceptibility of the graft wound to injury from high-risk activity and violence. Constant use of protective eyewear should be recommended to corneal transplant recipients.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
3/40. Intracameral amphotericin b: initial experience in severe keratomycosis.PURPOSE: Fungal keratitis is a significant cause of ocular morbidity in india. The most commonly implicated fungi are Aspergillus spp. patients often present with hypopyon, which usually contains fungal elements. The treatment is difficult owing to poor intraocular penetration of most available antifungal agents. This study evaluated the results of intracameral injection of amphotericin b in natamycin resistant cases of severe keratomycosis. methods: Three patients of culture proven aspergillus flavus corneal ulcer with hypopyon not responding to topical natamycin 5%, amphotericin b 0.15%, and oral itraconazole were administered intracameral amphotericin b. The first case received 7.5 microg in 0.1 mL followed by two subsequent injections of 10 microg in 0.1 mL each, the second case received two injections of 10 microg in 0.1 mL, and the third patient received a single dose of 10 microg in 0.1 mL. culture of the aqueous sample also grew A. flavus in all three cases. RESULTS: All three cases responded favorably, with the ulcer and hypopyon clearing completely. There was no clinical evidence of corneal or lenticular toxicity in any patient. CONCLUSIONS: Intracameral amphotericin b may be a useful modality in the treatment of severe keratomycosis not responding to topical natamycin. It ensures adequate drug delivery into the anterior chamber and may be especially useful to avoid surgical intervention in the acute stage of the disease.- - - - - - - - - - ranking = 0.051671768668375keywords = drug (Clic here for more details about this article) |
4/40. Spontaneous closure of traumatic macular hole.PURPOSE: To report eight cases of spontaneous closure of traumatic macular hole. DESIGN : Consecutive observational case series. patients AND methods: In a consecutive series of 18 eyes of 18 patients with traumatic macular hole, eight patients achieved spontaneous closure of traumatic macular hole. Clinical records of the eight eyes of eight patients were reviewed, together with the results of optical coherence tomography performed in three eyes. RESULTS: All eight patients with spontaneous closure of traumatic macular hole were males, with a mean age of 14.6 years (range, 11-21 years). The major cause of blunt trauma was sports-related accidents. Six eyes developed visual symptoms immediately after trauma and two eyes 10 to 12 days later. In all eight eyes, contact lens biomicroscopy revealed a small, full-thickness macular hole not complicated by epiretinal membrane, cuff of subretinal fluid, or posterior vitreous detachment. The macular hole closed spontaneously 1 week to 4 months after trauma. All eight eyes had visual acuity improvement with the final best-corrected visual acuity of 0.5 or better in four (50%) eyes. Optical coherence tomography in three eyes revealed two distinct abnormalities. Two eyes presented with acute foveal dehiscence without involvement of the posterior vitreous cortex. The remaining eye showed at presentation perifoveal vitreous detachment with residual vitreous adhesion to the edge of updrawn fovea and developed release of the vitreofoveal adhesion at the time of hole closure. CONCLUSIONS: Spontaneous closure of traumatic macular hole is not uncommon. An observation for a period of up to four months may be a management of choice for traumatic macular hole. There may be clinically and pathogenetically two distinct mechanisms of traumatic macular formation; one type that causes immediate visual loss due to primary dehiscence of the fovea, and the other type that leads to delayed visual loss due to dehiscence of the fovea secondary to persistent vitreofoveal adhesion.- - - - - - - - - - ranking = 9keywords = closure (Clic here for more details about this article) |
5/40. Vitreous surgery combined with internal limiting membrane peeling for traumatic macular hole with severe retinal folds.PURPOSE: To report a case of a traumatic macular hole with severe retinal folds in which vitreous surgery combined with internal limiting membrane (ILM) peeling was beneficial. To demonstrate that the area from which the ILM was peeled can be clearly differentiated by scanning laser ophthalmoscopy. methods: A posterior hyaloid detachment was created during vitreous surgery on a 34 year old man with a traumatic macular hole. The remaining vitreous was resected and the ILM was peeled. The fundus was examined through a scanning laser ophthalmoscope before and after the surgery. RESULTS: The retinal folds disappeared concurrently with the detachment of the ILM, resulting in closure of the macular hole. The area from which the ILM was peeled was clearly observed through the scanning laser ophthalmoscope. CONCLUSION: In this patient, it was helpful to perform not only posterior hyaloid detachment but also ILM peeling. The scanning laser ophthalmoscope was highly useful for observing the area from which the ILM was peeled.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
6/40. Spontaneous closure of traumatic macular hole.PURPOSE: To investigate the mechanism by which traumatic macular hole closes spontaneously. DESIGN: Consecutive observational case series of three patients with unilateral traumatic macular hole who consulted medical staff at the Kansai Medical University between 1997 and 2000. methods: Three patients who sustained unilateral blunt trauma to the eye and developed traumatic macular hole were followed with ophthalmic examination, fundus photography, fluorescein angiography, and optical coherence tomography (OCT). RESULTS: Case 1 was an 11-year-old boy. He had neither a macular hole nor prominent macular edema at his first consultation, but a macular hole opened 3 weeks later. OCT showed macular edema and a full-thickness macular hole. The tissue around the edge of the macular hole protruded inward toward the center and finally closed spontaneously 18 weeks later. Case 2 was a 19-year-old man. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. OCT showed macular hole enlargement and worsening of the macular edema during follow up. The macular hole finally closed 4 months after injury. Case 3 was a 15-year-old boy. He had a tiny rough-edged macular hole at his first consultation with a local ophthalmologist. The macular hole finally closed 6 months after injury. CONCLUSION: Macular hole can be a result of severe damage from ocular concussion or damage to the retina. For 6 months following injury, traumatic macular hole should probably be observed rather than surgically repaired, because of the possibility that the macular hole may close spontaneously.- - - - - - - - - - ranking = 4keywords = closure (Clic here for more details about this article) |
7/40. Spontaneous closure of a large traumatic macular hole in a young patient.PURPOSE: To report the spontaneous resolution of a traumatic macular hole that was considerably larger than in previously reported cases.DESIGN: Observational case report. methods: The clinical and angiographic data of the patient were reviewed.RESULTS: A traumatic 600 x 400 micro macular hole was observed to spontaneously resolve 5 weeks after trauma in a 15-year-old patient. visual acuity only slightly improved consequently (from counting fingers at 4 meters to 20/200). The clinical appearance of the fovea after macular hole resolution raised the suggestion that a postconcussion retinal necrosis was the mechanism behind the lesion formation in this case.CONCLUSIONS: Spontaneous resolution of a traumatic macular hole is an outcome not limited to small lesions. Larger macular holes may represent retinal tissue loss and consequently a less favorable visual prognosis.- - - - - - - - - - ranking = 4keywords = closure (Clic here for more details about this article) |
8/40. Management of scleral rupture during retinal detachment surgery: a case report.PURPOSE: rupture of the sclera occurring during retinal detachment surgery is generally associated with unfavourable anatomic and visual outcomes. Re-operation after a failed scleral buckle procedure and pre-existing scleral thinning are considered the main risk factors for scleral rupture. CASE REPORT: We describe the management and the favourable outcome of a case of scleral rupture in a 71-year-old woman during re-operation for retinal detachment. CONCLUSIONS: We managed this case of scleral rupture in accordance with current indications concerning the anatomical recovery, by scleral suture and patch graft, restoring IOP by gas tamponade. The positive outcome was partly related to the prompt closure of the retinal hole which led to reattachment, and partly to favourable events such as the moderate intensity of vitreous hemorrhage and the lack of any more serious intraoperative and postoperative complications.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
9/40. pupil block glaucoma from traumatic vitreous prolapse in a patient with posterior chamber lens implantation.BACKGROUND: Angle closure secondary to pupil block is an entity known to occur in aphakic and pseudophakic patients. In aphakic patients, typically the cause of the pupil block is vitreous prolapse (aphakic pupil block). In pseudophakic patients, the typical cause of the pupil block is an anterior chamber lens implant, often in the absence of an iridectomy (pseudophakic pupil block). Rarely, a hybrid of these two conditions can occur, in which vitreous prolapse causes a pupil block in a pseudophakic patient with a posterior chamber lens implant. methods: The case presented is that of an elderly pseudophakic man with a posterior chamber lens implant who experienced ocular trauma, and who subsequently also experienced a ruptured posterior capsule with resultant vitreous prolapse and pupil block angle closure. Key diagnostic features are presented, as well as patient-specific management for this uncommon condition. CONCLUSIONS: While diagnosis and management of acute primary angle closure are well-known and reported, acute secondary angle closure is not as well reported. It is imperative to understand the mechanism of angle closure, as this properly delineates the management plan. Use of management plans appropriate to acute primary angle closure with pupil block (the use of miotics) could potentially have disastrous consequences in cases of secondary angle closure from vitreous prolapse.- - - - - - - - - - ranking = 7keywords = closure (Clic here for more details about this article) |
10/40. Inadvertent conjunctival trauma related to contact with drug container tips: a masquerade syndrome.PURPOSE: To report the diagnosis, clinical course, and management of acute painful red eye syndrome associated with unintentional tube- or bottle-tip-induced conjunctival trauma. DESIGN: A small, noncomparative, interventional case series. PARTICIPANTS: Twelve eyes of 12 patients (8 female and 4 male, aged 21-84 years) who were urgently reported or referred with a variety of diagnoses resulting from acute onset of red, painful eye. Four eyes had corneal transplants, two were recovering from herpetic keratitis, two had undergone cataract surgery or a laser in situ keratomileusis procedure, one had a corneal neurotrophic ulcer, and one used a contact lens. All the patients had received new medications (ophthalmic ointments in nine patients, topical drops in three patients) within 1 week before onset of symptoms. INTERVENTION: Assessment of method of self-administration of topical medication, evaluation of the ocular surface lesion, and patient education. MAIN OUTCOME MEASURES: association of patient behavior with ocular surface lesions. RESULTS: All 12 patients presented red, painful eyes, congested lower palpebral conjunctiva, epithelial conjunctival erosions, and episcleritis. In all patients, direct contact of the tube or bottle-tip with the affected area of the conjunctiva was ascertained by inspection. Instructions on proper method of drug administration and eye patching with lubrication were followed, within 2 weeks, by healing of conjunctival lesions. CONCLUSIONS: Drug containers may cause nonintentional conjunctival trauma and simulate severe ocular disorders. physicians should be aware of this diagnosis in any case of prolonged and unexplained ocular irritation and should instruct patients as to the proper instillation of topical ophthalmic medications.- - - - - - - - - - ranking = 0.25835884334187keywords = drug (Clic here for more details about this article) |
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