1/70. Ocular explosion during cataract surgery: a clinical, histopathological, experimental, and biophysical study.INTRODUCTION: An increasing number of cases are being recognized in which a peribulbar anesthetic for cataract surgery has been inadvertently injected directly into the globe under high pressure until the globe ruptures or explodes. We reviewed the records of 6 such cases (one of which was reported previously by us), and one additional case has been reported in the literature. Surprisingly, 2 of these 7 cases went unrecognized at the time, and the surgeons proceeded with the cataract operation; all of the patients ultimately developed severe visual loss and/or loss of the eye. OBJECTIVES: To reproduce this eye explosion in a live anesthetized rabbit model and to perform a clinical, histopathological, experimental, biophysical, and mathematical analysis of this injury. methods: Eyes of live anesthetized rabbits were ruptured by means of the injection of saline directly into the globe under high pressure. The clinical and pathological findings of the ruptured human and animal eyes were documented photographically and/or histopathologically. An experimental, biophysical, and mathematical analysis of the pressures and forces required to rupture the globe via direct injection using human cadavers, human eye-bank eyes, and classic physics and ophthalmic formulas was performed. The laws of Bernoulli, LaPlace, Friedenwald, and Pascal were applied to the theoretical and experimental models of this phenomenon. RESULTS: The clinical and pathological findings of scleral rupture, retinal detachment, vitreous hemorrhage, and lens extrusion were observed. In the exploded human and rabbit eyes, the scleral ruptures appeared at the equator, the limbal area, or the posterior pole. In 2 of the 7 human eyes, the anterior segments appeared entirely normal despite the rupture, and cataract surgery was completed; surgery was canceled in the other 4 cases. In 4 of the 5 injected and ruptured rabbit eyes, the anterior segments appeared essentially normal. The experiments with human eye-bank eyes and the theoretical analyses of this entity show that the pressure required to produce such an injury is much more easily obtained with a 3- or 5-mL syringe than with a syringe 10 mL or larger. CONCLUSIONS: Explosion of an eyeball during the injection of anesthesia for ocular surgery is a devastating injury that may go unrecognized. The probability of an ocular explosion can be minimized by careful use of a syringe 10 mL or larger with a blunt needle, by discontinuing the injection if resistance is met, and by inspecting the globe prior to ocular massage or placement of a Honan balloon. When ocular explosion occurs, immediate referral to and intervention by a vitreoretinal surgeon is optimal. Practicing ophthalmologists should be aware of this blinding but preventable complication of ocular surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/70. Management of traumatic cyclodialysis cleft associated with ocular hypotony.BACKGROUND AND OBJECTIVE: To evaluate the efficacy of direct cyclopexy for treatment of traumatic cyclodialysis cleft associated with ocular hypotony. patients AND methods: Eyes with traumatic cyclodialysis cleft were treated with direct cyclopexy or 1.0% atropine eyedrop. RESULTS: Five eyes with a large cyclodialysis cleft were treated with direct cyclopexy. Postoperatively, these eyes obtained normal intraocular pressure. Four of the 5 eyes had good visual acuity, and 1 eye that had preoperative subretinal hemorrhage in the macula had poor visual acuity. Of the 3 eyes treated with 1.0% atropine eyedrops, 1 had good visual acuity, and 2 with retinal folds had fairly good and poor visual acuity. CONCLUSION: The present study showed that direct cyclopexy is useful for the treatment of traumatic cyclodialysis cleft associated with ocular hypotony, and that the cyclodialysis should be surgically treated before irreversible retinal folds develop.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
3/70. 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 = 0.75keywords = pressure (Clic here for more details about this article) |
4/70. Treatment of traumatic cyclodialysis with vitrectomy, cryotherapy, and gas endotamponade.An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
5/70. Venous collateral remodeling in a patient with posttraumatic glaucoma.PURPOSE: To photographically document venous collateral development, remodeling, and regression in a patient with traumatic glaucoma. methods: Consecutive fundus photographs were evaluated, labeled, and correlated with the clinical history of a patient with unilateral posttraumatic glaucoma. RESULTS: This report photographically documents the appearance, remodeling, and subsequent disappearance of collateral vessels from venous occlusion on the surface of the optic disk in an eye with increased intraocular pressure and progressive glaucomatous cupping. CONCLUSIONS: Asymptomatic chronic obstruction of a branch retinal vein on the optic disk may cause venous collaterals to develop in the absence of retinal hemorrhages or other signs of venous occlusive disease. Increased intraocular pressure, arteriolarsclerosis, and glaucomatous cupping are risk factors for these occlusions.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
6/70. Bilateral orbital emphysema from compressed air injury.PURPOSE: To describe a patient who developed bilateral subconjunctival and orbital emphysema after an automobile tire explosion. METHOD: Case report. RESULTS: A 60-year-old man sustained bilateral ocular injury after a tire explosion. Ophthalmic examination disclosed bilateral subconjunctival air, with no visible conjunctival laceration. Computed tomography showed orbital emphysema, with no evidence of orbital fracture. Follow-up examination 2 weeks after the injury disclosed resolution of the subconjunctival air. Best-corrected visual acuity in the right eye was decreased after the explosion but improved to the baseline level of 20/40 2 weeks after the injury. CONCLUSION: Subconjunctival and orbital emphysema can occur from high-pressure air injury in the absence of an obvious entry site.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
7/70. Elastic cord-induced cyclodialysis cleft and hypotony maculopathy.We describe a case of hypotony maculopathy in which hypotony was due to a cyclodialysis cleft produced by an elastic cord injury. Sixteen months after being hit with an elastic cord, a 43-year-old white male presented with progressive loss of vision in the right eye. The visual acuity in the right eye was 1/200 due, in part, to a subluxated and cataractous lens. The intraocular pressure (IOP) was 4 mm Hg. gonioscopy revealed a cyclodialysis cleft at the 2 o'clock position, and fundus examination showed hypotony maculopathy. The patient underwent pars plana vitrectomy, pars plana lensectomy, repair of the cyclodialysis cleft, placement of an anterior chamber intraocular lens, and tightly sutured trabeculectomy without antimetabolite. Sixteen months following surgery, visual acuity was stable at 20/60 and IOP was 11 mm Hg but the chorioretinal folds persisted.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
8/70. Transpupillary argon laser cyclophotocoagulation in the treatment of traumatic glaucoma.PURPOSE: A patient with traumatic glaucoma who underwent transpupillary argon laser cyclophotocoagulation for management of uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy is discussed. methods: In this patient, pars plana vitrectomy, lensectomy, and removal of 180 degrees of necrotic iris had been performed after a blunt trauma with a bungee cord. Six weeks after surgery, the patient presented with an IOP of 40 mmHg despite therapy with three aqueous suppressants. The patient refused further surgical intervention and opted for transpupillary argon laser cyclophotocoagulation (talc). The laser setting was 1,000 mW, with a 50-micron spot size for 0.1 second. A total of 293 laser exposures through a Goldmann contact lens was administered to all visible ciliary processes over 180 degrees where iris structures were absent. RESULTS: Ten weeks after talc, the patient's IOP remained controlled with medications at 16 mmHg, and visual acuity had improved to 20/25 with an aphakic contact lens. CONCLUSION: In selected patients whose ciliary processes are visible with indirect gonioscopy due to the defect in the iris, talc may be an effective alternative cyclodestructive procedure to lower IOP when conventional medical or laser treatments are not successful.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
9/70. indocyanine green angiographic findings in 3 patients with traumatic hypotony maculopathy.PURPOSE: Little is known about the choroidal circulation in human eyes with ocular hypotony. Recently, indocyanine green angiography (IA) became a useful method for examining choroidal circulation. The present study using IA was designed to determine choroidal circulatory disturbances in patients with traumatic hypotony maculopathy. methods: indocyanine green angiography was performed on 3 consecutive patients (3 eyes) with traumatic hypotony. One patient underwent IA using an infrared fundus camera only during the hypotony stage. The other 2 patients underwent IA using a scanning laser ophthalmoscope before and after recovery of intraocular pressure (IOP). RESULTS: During the hypotony stage, IA revealed multiple hypofluorescent spots in many parts of the fundus, sector hypofluorescent areas, dilatation, and tortuosity of the choroidal vessels in the posterior pole. These findings had not been detected by fluorescein angiography. After surgical treatment, IOP returned to the normal range and visual acuity improved. indocyanine green angiography showed improvement of the sector hypofluorescent areas, and dilatation and tortuosity of choroidal vessels in the posterior pole. However, most of the hypofluorescent spots and regional delay of choroidal filling remained. CONCLUSIONS: indocyanine green angiography revealed that choroidal circulatory disturbances occurred during the hypotony stage and that some remained during the recovery stage.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
10/70. Latent proliferative sickle cell retinopathy in sickle cell trait.PURPOSE: To describe a patient with sickle cell trait who developed latent proliferative sickle cell retinopathy after mild blunt trauma. METHOD: Case Report. A 20-year-old man with unilateral Stage 3 sickle retinopathy associated with an ischaemic ridge presenting three years after the initial mild blunt ocular trauma. RESULTS: Fundus examination of the left eye showed an ischaemic ridge delineating avascular from vascular retina. fluorescein angiography of the left eye showed an avascular peripheral retina and multiple sea fan neovascularization. blood studies showed him to be Hb AS. CONCLUSIONS: In our patient the proliferative changes were the result of his initial mild trauma associated with an increase in the intraocular pressure. The latent development of the sea-fan neovascularization associated with an ischaemic ridge is unusual. Advice about potential complications to patients with Hb AS after ocular trauma is advocated.- - - - - - - - - - ranking = 0.25keywords = pressure (Clic here for more details about this article) |
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