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1/28. 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.
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2/28. Cilioretinal artery occlusion with central retinal vein occlusion.

    BACKGROUND: Combined cilioretinal artery and retinal vein occlusions are infrequently documented retinal vascular disorders of speculative origin. Occlusion of the cilioretinal artery is believed to result from either mechanical compression of the artery as a result of an increase in venous pressure or from a reduction in perfusion pressure in both the cilioretinal and retinal arteries. The ophthalmoscopic and angiographic features of this condition are reviewed. case reports: Two cases of cilioretinal artery occlusion after central retinal vein occlusion are presented, one of which evolved to the development of iris neovascularization. DISCUSSION: The incidence of cilioretinal artery occlusions due to central retinal vein occlusions is infrequently reported in the literature. Excluding those with chronic cystoid macular edema, most patients have a favorable visual outcome. It is possible that the incidence of combined cilioretinal artery and central retinal vein occlusions is grossly underestimated.
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3/28. The use of chemotherapy to facilitate surgical resection in pleomorphic xanthoastrocytoma: experience in a single case.

    The use of noncytotoxic chemotherapy as an adjuvant treatment to permit resection of a pleomorphic xanthoastrocytoma (PXA) is described. A 6-year-old girl with a large right occipito-temporo-parietal lesion presented with signs and symptoms of raised intracranial pressure. An initial attempt at resection was halted because of excessive blood loss, and tumour embolisation was not feasible as no suitable vascular pedicle was identified. Two cycles of vincristine and carboplatin were given, and these decreased the vascularity of the tumour allowing subsequent complete macroscopic resection 9 weeks later. The use of chemotherapy to decrease the vascularity of the tumour by way of its antiangiogenic effects is discussed.
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4/28. Intravitreal triamcinolone acetonide for cataract surgery with iris neovascularization.

    A 73-year-old patient with proliferative diabetic retinopathy presented with marked iris neovascularization and dense cataract that prevented retinal laser coagulation. To prevent postoperative progression of the iris neovascularization, the patient had standard cataract surgery with implantation of a foldable posterior chamber lens in combination with an intravitreal injection of 25 mg triamcinolone acetonide. During the 5.5-month follow-up, visual acuity increased from 0.10 to 0.20. With no additional retinal ablative treatment, the iris neovascularization markedly regressed within the first 5 postoperative weeks, after which a peripheral retinal laser treatment was performed, resolving the iris neovascularization. intraocular pressure was within the normal range.
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5/28. Intravitreal triamcinolone acetonide as treatment of ischemic ophthalmopathy.

    PURPOSE: To describe the clinical course of a patient receiving repeated intravitreal injections of triamcinolone acetonide (25 mg) as treatment of ischemic ophthalmopathy. methods: A 70-year-old patient with Waldenstrom disease presented with progressive iris neovascularization, vitreous hemorrhage, and ocular hypotony due to ischemic ophthalmopathy. visual acuity was 0.05. Within 2.5 years, he received three intravitreal injections of 25 mg of triamcinolone acetonide. Additionally, penetrating keratoplasty and synechiolysis were performed during the follow-up. RESULTS: After each intravitreal injection, visual acuity and intraocular pressure increased, iris neovascularization regressed, and vitreous haze cleared up. CONCLUSIONS: Intravitreal triamcinolone acetonide may induce regression of iris neovascularization, increase intraocular pressure, and improve visual acuity in eyes presenting with ocular hypotony, vitreous hemorrhage, and progressive intraocular neovascularization due to ischemic ophthalmopathy.
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6/28. A case of Chandler's syndrome revealed by ultrastructural studies of the trabecular meshwork.

    PURPOSE: To investigate ultrastructural changes in the aqueous outflow route and discuss the mechanisms associated with intraocular pressure (IOP) elevation in a patient with presumably early stage Chandler's syndrome. methods: A 47-year-old man underwent trabeculectomy because of elevated IOP. A specimen obtained during surgery was studied by transmission electron microscopy. RESULTS: Electron microscopy showed the presence of a monolayer composed of corneal endothelium-like cells and thick basement membrane-like material. Neovascularization was also observed in the corneoscleral trabeculum. CONCLUSIONS: Our results indicate that several mechanisms, including the formation of basement membrane-like tissue, infiltration of inflammatory cells and neovascularization, might contribute to the elevation of IOP in Chandler's syndrome. These may occur even when there is no history of conspicuous inflammatory reaction in the anterior ocular segments.
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7/28. Intravitreal bevacizumab in a patient with neovascular glaucoma.

    The utility of intravitreal bevacizumab injection in a patient with neovascular glaucoma following central retinal vein occlusion is explored. Bevacizumab (1 mg in 0.04 mL) was used after failed intraocular pressure (IOP) control with transscleral cyclophotocoagulation and panretinal photocoagulation. IOP improved within 2 days and the patient experienced marked improvement in comfort. Bevacizumab may be an effective medication for the treatment of neovascular glaucoma.
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8/28. Clinicopathological features of severe corneal blood staining associated with proliferative diabetic retinopathy.

    A 54-year-old man with a history of severe proliferative diabetic retinopathy in both eyes and profound visual impairment presented with severe corneal blood staining in the left eye secondary to a "spontaneous" total hyphaema and raised intraocular pressure in an eye with iris neovascularization. Despite anterior chamber washout, the cornea remained virtually opaque and thickened. The subject subsequently underwent pars plana vitrectomy with endolaser using a temporary keratoprosthesis, insertion of a Morcher iris-surround intraocular lens and penetrating keratoplasty. Histopathology of the excised corneal button revealed fine eosinophilic granules composed of aggregations of haemoglobin and its breakdown products dispersed throughout the stroma, with occasional foci of weakly positive Perl staining for intracellular haemosiderin. fluorescence confocal microscopy revealed a marked increase in fluorescence throughout the corneal stroma and the basal epithelial layer. This case highlights the microstructural features and aspects of the surgical management of severe corneal blood staining.
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9/28. iris neovascularization in sturge-weber syndrome.

    An unusual case of sturge-weber syndrome with raised intraocular pressure is presented. The slit lamp examination and anterior segment fluorescein angiography were consistent with iris neovascularization. Cause and effect relationship of iris neovascularization with glaucoma in this syndrome is discussed.
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10/28. Neovascular glaucoma and carotid artery obstructive disease.

    Carotid artery obstructive disease, although infrequently diagnosed as a primary or contributing cause of neovascular glaucoma, can produce distinctive characteristics. Decreased perfusion of the ciliary body may decrease aqueous humor production. As a result, such eyes with neovascular glaucoma may occasionally be normotensive or even hypotensive. fluorescein angiography may show an increased arm-to-retina time and leakage from the major retinal arterioles. Panretinal photocoagulation may not eliminate the anterior segment neovascularization because of anterior segment ischemia. endarterectomy can significantly increase intraocular pressure as perfusion to the ciliary body returns to normal. These characteristics were found in two patients, a 67-year-old woman and a 49-year-old man, with diabetes and hypertension. In both cases cyclocryotherapy significantly reduced the intraocular pressure and the rubeosis iridis regressed.
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