1/78. A malignant glaucoma-like syndrome following pars plana vitrectomy.OBJECTIVE: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. DESIGN: Two interventional case reports. INTERVENTION: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. MAIN OUTCOME MEASURES: Axial anterior chamber depth and intraocular pressure (IOP). RESULTS: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. CONCLUSION: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/78. Rapidly resorptive exudative retinal detachment in a patient with renogenic hypertension: case report.We present an 18-year-old woman who developed rapidly resorptive exudative retinal detachment (ERD) due to chronic renal failure and renogenic hypertension. In July 1998, the patient came to our clinic because of a 2-month-history of progressively deteriorating visual acuity. Initially examination of the fundi revealed typical hypertensive retinopathy. Two weeks later, the patient was admitted due to hypertension and consulted our ophthalmic department again. In addition to hypertensive retinopathy, the fundi showed high bullous ERD, involving the temporal retinas in both eyes. Intensive medical therapy was begun, including blood pressure control and maintenance of body fluid and electrolyte balance, resulting in almost complete regression of retinal detachment within two days. The visual acuity improved during the following 2 weeks. The clinical features and treatment response in this rare case indicate that multiple factors, including fluids overload, hypertension, and possibly renal failure, contributed to the development of ERD. blood pressure control and the balance of fluids are important in patients with renal failure, and may help to prevent the occurrence of ERD.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
3/78. Massive suprachoroidal hemorrhage with retinal and vitreous incarceration; a vitreoretinal surgical approach.Suprachoroidal hemorrhage(SH) may cause the expulsion of the intraocular contents. Vitreous incarceration in the wound and retinal detachment with SH are extremely poor prognostic signs. Treatment modalities depend on the severity of eye damage. This particular patient had "kissing" hemorrhagic choroidal detachment which completely filled the vitreous cavity after cataract surgery. It seemed to be inoperable. Secondary surgery was delayed 3 days to lower IOP to normal levels. The eye underwent anterior drainage sclerotomy under constantly-maintained limbal or pars plana infusion fluid line pressure. The authors performed a pars plana vitrectomy, followed by perfluorocarbon liquid injection and a silicone oil tamponade. After this surgical approach, the patient attained an attached retina and a visual acuity of 5/200 at the 3 month follow-up.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/78. Acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment in age-related macular degeneration: case reports and literature review.PURPOSE: Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases. methods: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. RESULTS: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. CONCLUSIONS: diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
5/78. pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection.PURPOSE: To describe pupil block glaucoma in phakic and pseudophakic patients after vitrectomy with silicone oil injection. DESIGN: Interventional case series. methods: Cases were collected from January 1997 to July 2000 from three tertiary referral centers. RESULTS: Seven phakic patients (seven eyes) and one pseudophakic patient (one eye) presented 1 to 90 days after vitrectomy and silicone oil injection with intraocular pressures of 36 to 70 mm Hg. Five patients had an observed or potential weakness of the iris-lens diaphragm. Treatment with Nd:YAG-laser peripheral iridotomy or inferior iridectomy provided a temporary reduction in intraocular pressure for some patients, but all eventually required removal of silicone oil. CONCLUSION: pupil block glaucoma after silicone oil injection is well recognized in aphakic patients, but ophthalmologists should be aware that it can occur in phakic and pseudophakic patients, particularly in complicated cases and patients with a weakness of the iris-lens diaphragm.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
6/78. Hypotony caused by scleral buckle erosion in marfan syndrome.PURPOSE: To describe hypotony caused by erosion of the conjunctiva and sclera by a silicone scleral buckle. methods: Interventional case report. A 33-year-old man with marfan syndrome presented with hypotony maculopathy and a collapsed globe 17 months after repair of retinal detachment with a silicone sponge and silicone encircling band. RESULTS: Examination in the operating room revealed extrusion of the buckle through the conjunctiva and full-thickness scleral erosion. The silicone buckle was removed, and the scleral defect was closed with interrupted 8-0 nylon sutures. Postoperative glaucoma was treated with cyclophotocoagulation. Eight months after scleral repair, visual acuity was RE: 20/40, intraocular pressure was 10 mm Hg, and the retina was attached. CONCLUSION: Full-thickness scleral erosion secondary to a silicone exoplant causing hypotony is a rare long-term complication in patients with thin sclera.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
7/78. [Perioperative management of a patient with purpura fulminans syndrome due to protein c deficiency]PURPOSE: Protein C is a vitamin k-dependent anticoagulant and homozygous protein C deficiency is a rare fatal thrombotic disease. This report describes the perioperative management of homozygous protein c deficiency in a patient who underwent a total of three surgical procedures under general anesthesia and the successful use of activated protein C concentrate. CLINICAL FEATURES: A female baby, who developed disseminated intravascular coagulation and purpura fulminans shortly after birth, was diagnosed as purpura fulminans syndrome due to homozygous protein c deficiency. At one month of age, she suffered bilateral retinal detachment and glaucoma due to retinal hemorrhage. After marked improvement of her condition after administration of activated protein C concentrate, she underwent a left iridectomy and implantation of a Broviak catheter under general anesthesia. Her intraoperative course was uncomplicated but, on postoperative day four, she presented another episode of massive cutaneous necrosis and gangrene. Activated protein C concentrate was administered again, with good results. She underwent replacement of a Broviak catheter at four months of age, and right iridectomy for glaucoma at eight months. Both were uneventful. CONCLUSION: The perioperative management of homozygous protein c deficiency and purpura fulminans requires appropriate measures for thromboembolic prophylaxis. Sufficient iv fluid administration is necessary. attention should be paid to decrease the risk of tissue compression such as that associated with positioning, blood pressure cuff, and endotracheal intubation, which may cause necrosis over pressure points. Replacement therapy with activated protein C concentrate appears safe and effective. The anesthetic management is reviewed and discussed.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
8/78. Silicone oil-induced secondary glaucoma: a case study.Silicone oil intraocular tamponade is a widely accepted procedure in the management of complex retinal detachments caused by proliferative diabetic vitreoretinopathy. Silicone oil has a high surface tension that mechanically limits fibrovascular reproliferation resulting in successful retinal reattachments. However, postoperative secondary glaucoma is a relatively frequent complication that may require intensive nursing management focused at intraocular pressure monitoring, positioning compliance, pain management, fluid and electrolyte balance, and glucose control. This article presents the postoperative clinical course of a 51-year-old man with diabetes and recurrent proliferative diabetic vitreoretinopathy who developed secondary glaucoma after silicone oil injection with a dramatic rise in intraocular pressure on the first postoperative day. nursing management concurrent with medical and surgical management is discussed and the necessary nursing plan of care is identified.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
9/78. Massive choroidal hemorrhage associated with low molecular weight heparin therapy.An 84-year-old woman with unstable angina pectoris was treated with subcutaneous enoxaparine (Clexane) for several days before presenting with severe pain and decreased vision in her left eye. The intraocular pressure was 70 mmHg, and fundus examination showed a pigmented choroidal lesion and associated choroidal and retinal detachment. ultrasonography was consistent with choroidal hemorrhage, and she was diagnosed as having acute glaucoma secondary to massive subchoroidal hemorrhage. Medical control of the intraocular pressure resulted in a significant clinical improvement. Intraocular hemorrhage and angle-closure glaucoma are rare and previously unreported complications in patients treated with low molecular weight heparin. It is important to be aware of this ocular complication as these drugs are so often used.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/78. retinal detachment in preeclampsia.Preeclampsia is an obstetric disease of unknown cause that affects approximately 5% of pregnant women. The visual system may be affected with variable intensity, being the retinal detachment a rare complication. The retinal detachment in preeclampsia is usually bilateral and serous, and its pathogenesis is related to the choroidal ischemia secondary to an intense arteriolar vasospasm. The majority of patients have complete recovery of vision with clinical management, and surgery is unnecessary. This is a case report of a 27 year old patient who developed the severe form of preeclampsia on her first pregnancy. She had progressive blurred vision, until she could see only shadows. Ophthalmic examination diagnosed spread and bilateral retinal detachment. With blood pressure control at postpartum, the patient had her retina reattached, and recovery of vision.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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