1/38. trabeculectomy for adolescent onset glaucoma in the sturge-weber syndrome.Two patients with adolescent onset glaucoma associated with sturge-weber syndrome have been presented. Both patients were successfully treated with ab externo trabeculectomy. This procedure is suggested as an additional means for controlling the late onset glaucoma associated with the syndrome without provoking additional complications or deterioration. Early treatment is emphasized before the irreversible changes of chronic glaucoma become manifest.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
2/38. 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 = 1keywords = size (Clic here for more details about this article) |
3/38. Congenital nonprogressive facial hemiatrophy with ipsilateral eye abnormalities and juvenile glaucoma.Congenital nonprogressive facial hemiatrophy is reported in association with anisometropia and ipsilateral cornea, iris, angle abnormalities, and juvenile glaucoma. The importance of complete ocular examination in patients with this uncommon abnormality is emphasized.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
4/38. Repair of a late-onset filtering bleb leak using a corneal graft shaped with an excimer laser.A new method for repairing an area of late scleral necrosis and bleb leak after glaucoma-filtering surgery using mitomycin C (MMC) is described. In a 33-year-old female patient diagnosed with bilateral juvenile glaucoma, a bleb leak occurred 41 months after trabeculectomy with MMC in the left eye. A corneal stromal patch-graft shaped to the desired size using an excimer laser (Excimer-Laser-Corneal-Shaping-System, ELCS-S) was used to cover the scleral defect. This step was followed by water-tight closure of the conjunctiva. During the follow-up period of 12 months the leak remained successfully repaired and the intraocular pressure stayed between 8 and 14 mm Hg without medication. This technique that uses lamellar grafts of very large size should be considered when a surgical repair of a large leaking bleb is required, especially in cases with scleral tissue necrosis.- - - - - - - - - - ranking = 2keywords = size (Clic here for more details about this article) |
5/38. The histopathology of pigmentary dispersion syndrome with glaucoma.iris tissue and trabecular meshwork, obtained at time of trabeculectomy, was studied using the light and electron microscope in a 54-year-old woman with pigmentary dispersion syndrome with glaucoma. The specific defect was a loss of the outer epithelial cells of the iris with marked thinning of the remaining outer layers so that the two-cell architecture of the iris epithelium was maintained. In addition, the radial muscle layer was increased in both number and size of muscle fiber. It would appear that the pigmentary dispersion syndrome may represent a congenital or developmental abnormality of the iris epithelium, or both, and that the glaucoma which occasionally occurs in conjunction with this syndrome is of the usual open-angle type.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
6/38. 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 = 1keywords = size (Clic here for more details about this article) |
7/38. An unusually large human eye with abnormal scleral collagen.Severe progressive ocular enlargement of late onset accompanying chronic uveitis and secondary glaucoma occurred in an 18-year-old man. Electron microscopy of the thin sclera from the unusually large eye (40x40x37 mm) disclosed collagen fibrils with mean widths that exceeded that of controls, but that were within the range of the fibril size typically present in the outer sclera. Thinner fibrils that normally occur particularly within the inner sclera were conspicuously absent. Morphologic observations on corneal and cutaneous collagen from the patient were unremarkable. No abnormality was detected on chemical analysis of cutaneous collagen. The abnormal morphologic pattern of the scleral collagen is interpreted as a probable arrest in scleral collagen synthesis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
8/38. Granulomatous anterior uveitis associated with bimatoprost: a case report.PURPOSE: To describe a previously unreported case of anterior granulomatous uveitis in a patient using bimatoprost. methods: A 72-year-old woman with a long-standing history of anisometropic amblyopia and pseudoexfoliative glaucoma in the right eye started therapy with bimatoprost 0.03% once a day in the right eye. She had no previous history of ocular inflammation or ocular surgery. Her medical history was negative for systemic diseases associated with ocular inflammation. RESULTS: After one week, the patient developed severe conjunctival injection, cells and flare, and numerous 'mutton fat' keratic precipitates in the right eye. Examination of the left eye revealed no evidence of inflammation. Bimatoprost was discontinued; no topical steroid therapy was started. Systemic investigations were normal. The inflammation resolved over two weeks, solely with the discontinuation of bimatoprost. CONCLUSIONS: Bimatoprost is a synthetic prostamide, chemically related to prostamide F. Prostamides are naturally occurring substances, biosynthesized from anandamide in a pathway that includes COX2. Even though anandamide has proven suggestive potential pro-inflammatory effects, the mechanism of induction of inflammation by bimatoprost remains uncertain and speculative. In our report, the onset of acute uveitis in a patient using bimatoprost, after a long-term and well-tolerated treatment with a prostaglandin analog, suggests a distinct potential pro-inflammatory action of prostamides. This can indirectly support the concept that the target receptor of bimatoprost is different, and that the mechanism of action of prostamides is pharmacologically unique.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
9/38. Goniodysgenesis of the eye with arthrogryposis multiplex congenita.We report an autopsy case of 4-day-old male infant with arthrogryposis multiplex congenita studied by histological methods in respect to the ocular tissues. The eye examined was normal in size, and the retina, optic nerve, choroid, sclera and extracocular muscle showed no remarkable histological changes. However, the cornea was thickened, and the iris, trabecular tissue and ciliary body showed maldevelopmental changes, which were all compatible with goniodysgenesis. The clinical data of this case did not demonstrate any signs of congenital glaucoma, but the present study indicates that an infant with arthrogryposis multiplex congenita has a potential for infantile glaucoma with goniodysgenesis.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
10/38. cataract and glaucoma after wear of contact lens soaked in steroid solution: a rare complication.PURPOSE: To report an unusual case of steroid-induced cataract and glaucoma after wearing soft contact lens soaked in steroid solution. methods: Case report of a 28-year-old man who presented with progressive decrease in vision of both the eyes of 2 years' duration. He was wearing conventional soft contact lens from the past 3 years. He used to buy the lenses from an optician and started storing the lenses in steroid solution overnight for the last 2 years. RESULTS: His best-corrected visual acuity was 20/40 in both the eyes. Anterior segment evaluation revealed posterior subcapsular cataract in both the eyes. IOP was 12 mm of Hg in the right eye and 22 mm of Hg in the left eye. Fundus examination showed a cup disc ratio 0.9:1 in the right eye and 0.8:1 in the left eye. Humphrey visual fields revealed incomplete biarcuate scotoma in both the eyes. CONCLUSIONS: Steroid-induced cataract and glaucoma in a contact lens wearer is an extremely rare complication. To our knowledge, there is no previous case of steroid-induced cataract and glaucoma in a conventional soft contact lens wearer. This case emphasizes the role of optometrists and ophthalmologists in patient education while dispensing contact lenses, especially in developing countries.- - - - - - - - - - ranking = 1keywords = size (Clic here for more details about this article) |
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