1/9. Preretinal haemorrhages: an unusual manifestation of intravitreal amikacin toxicity.PURPOSE: To report a case with multiple preretinal haemorrhages after intravitreal amikacin. METHOD: A 58-year-old patient developed postoperative endophthalmitis following a routine extracapsular cataract extraction in his left eye. He received two intravitreal injections of cephazoline (2.25 mg) and amikacin (0.4 mg), given 48 h apart. RESULTS: The patient presented to us with large preretinal haemorrhages at the posterior pole. Multiple large areas of blocked fluorescence were seen on fundus fluorescein angiography. CONCLUSION: Widespread posterior pole preretinal haemorrhages may be an unusual manifestation of intravitreal amikacin toxicity.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/9. Combined cataract extraction and submacular blood clot evacuation for globe perforation caused by retrobulbar injection.A 45-year-old woman, originally scheduled for cataract surgery in the left eye, was referred for management of a globe perforation noticed after the retrobulbar injection of an anesthetic solution. There was a moderate degree of vitreous hemorrhage, and initial visual acuity was hand movement. A submacular blood clot of about 4-disc diameter was detected when the vitreous hemorrhage gradually cleared. One week after the incident, combined phacoemulsification, intraocular lens implantation, pars plana vitrectomy, and submacular clot removal using tissue plasminogen activator (tPA) as an adjunct were performed. Recovery was uneventful. At the last follow-up 6 months after surgery, best corrected visual acuity was 20/30.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
3/9. Complications of glaucoma surgery. Ocular decompression retinopathy.In seven eyes of four patients, retinal hemorrhages were observed following trabeculectomy under both local and general anesthesia. The hemorrhages were diffuse, both deep and superficial, and many had white centers when first observed. Two patients were young healthy male myopes undergoing primary trabeculectomy. The third patient was a young man with chronic uveitis. The fourth patient was an elderly man with primary open angle glaucoma who had an acute rise in intraocular pressure following cataract extraction. intraocular pressure and visual results appeared unaffected by the hemorrhages. Retinal hemorrhages associated with ocular decompression appear to be relatively benign.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
4/9. Nontraumatic ghost cell glaucoma--a case report.Ghost cell glaucoma (GCG) has recently been described following vitrectomy, cataract extraction, and penetrating or blunt trauma. We describe the occurrence of GCG in a phakic eye with no prior ocular trauma or surgery following vitreous hemorrhage from diabetic retinopathy. We postulate the occurrence of a spontaneous rupture of the anterior hyaloid face which allowed passage of ghost cells into the anterior chamber. A therapeutic vitrectomy was complicated by intraoperative vitreous hemorrhage. Two weeks postvitrectomy, GCG recurred and was successfully controlled by irrigation through an anterior chamber approach. This is the procedure of choice in GCG following vitrectomy and may eliminate the need for a second vitrectomy.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/9. Exacerbation of senile macular degeneration following cataract extraction.Six eyes in four patients had hemorrhagic detachment of the retinal pigment epithelium following cataract extraction. All eyes had evidence of nonexudative senile macular degeneration preoperatively as manifested by drusen or alterations in the retinal pigment epithelium, or both. Postoperatively, all eyes had evidence of a subretinal neovascular membrane manifested by the presence of subretinal hemorrhage or by evidence on fluorescein anglography. We believe cataract extraction may cause changes in the choroidal hemodynamics that allow pre-existing new blood vessels to leak or bleed, or induces the formation of choroidal neovascularization in a predisposed eye.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
6/9. Choroidoretinal neovascularisation following radon seed treatment of retinoblastoma in two patients.Two patients who developed localised radiation retinopathy many years after brachytherapy for retinoblastoma are described. In both patients extracapsular cataract extraction and YAG laser capsulotomy were followed by preretinal and vitreous haemorrhage and in one patient there was deterioration of existing radiation retinopathy with macular oedema. Premacular and vitreous haemorrhage occurred from focal, preretinal neovascular membranes which appeared to originate from residual choroidal vascular radicals. Laser photocoagulation was successful in ablating preretinal neovascular membranes and limiting the extent of macular oedema from incompetent retinal capillaries adjacent to the atrophic macular scars.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/9. Surgical management of submacular hemorrhage. A series of 47 consecutive cases.BACKGROUND: The development of a thick submacular hemorrhage usually carries a poor visual prognosis. The surgical removal of submacular blood may improve the otherwise poor outlook in these cases. SUBJECTS AND methods: Forty-seven consecutive patients underwent vitrectomy with surgical removal of submacular hemorrhage. The patient population consisted of two consecutive groups. Group 1 (1989 to 1991) included 23 patients (20 with age-related macular degeneration [ARMD], one with idiopathic submacular hemorrhage, one with presumed ocular histoplasmosis syndrome [POHS], and one with angioid streaks) who underwent mechanical clot extraction. Group 2 (1991 to 1993) included 24 patients (19 with ARMD, two with POHS, two with arterial macroaneurysm, and one with angioid streaks) who underwent tissue plasminogen activator-assisted drainage of thick submacular hemorrhage. The dose of tissue plasminogen activator ranged from 10 to 40 micrograms. All patients had surgery within 72 hours of diagnosis. RESULTS: In group 1, the mean size of the submacular hemorrhage was 11 disc areas (range, 1 to 16 disc areas). Mean follow-up was 40 weeks. Mean postoperative visual acuity for eyes with ARMD was 20/200. (visual acuity improved in six eyes, was stable in seven eyes, and deteriorated in seven eyes.) All three of the eyes without ARMD had visual improvement with a mean postoperative visual acuity of 20/70. overall, visual acuity stabilized or improved in 13 (57%) of 23 patients and decreased in 10 (43%) patients. In group 2, the mean size of the submacular hemorrhage was 11 disc areas (range, 3 to 16 disc areas). Mean follow-up was 24 weeks. Mean postoperative visual acuity for eyes with ARMD was 20/480 (visual acuity was stable in 15 eyes, improved in two eyes, and deteriorated in two eyes). Four of five eyes without ARMD had visual improvement and one was stable, with a mean postoperative visual acuity of 20/60. visual acuity stabilized or improved in 22 (92%) of 24 patients and decreased in two (8%). The degree of clot lysis was variable. CONCLUSIONS: Submacular hemorrhage secondary to ARMD has a poor visual prognosis, with or without surgical drainage. The addition of tissue plasminogen activator-assisted clot lysis does not appear to significantly improve the visual outcome following surgery. The determination of whether surgical intervention is appropriate in these cases requires a prospective, randomized clinical trial.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/9. A randomized comparison of vacuum extraction delivery with a rigid and a pliable cup.OBJECTIVE: To compare the effectiveness and complications of obstetric vacuum extraction with a rigid and a pliable cup, with a focus on neonatal retinal hemorrhage. methods: One hundred women requiring assisted delivery who met predefined criteria for vacuum extraction were randomly assigned to be delivered by the classic rigid Malmstrom cup or the pliable Silastic cup. RESULTS: Because of the faster induction of vacuum, delivery occurred more rapidly with the pliable cup, but the pliable cup detached significantly more often than the rigid cup. The overall failure rate was not significantly different between the cups. There were no significant differences between the groups with regard to Apgar scores, umbilical artery pH, birth canal trauma, or maternal blood loss, but scalp injury occurred less frequently with the soft than with the rigid cup. retinal hemorrhage in the newborns showed a similar incidence of about 50%, and neonatal neurologic examination showed no significant differences between the groups. CONCLUSION: In comparison with the rigid cup, the advantage of the pliable cup is limited to a smaller incidence of neonatal scalp injury.- - - - - - - - - - ranking = 6keywords = extraction (Clic here for more details about this article) |
9/9. Accidental subretinal injection of triamcinolone acetonide.Approximately one-third of the contents of a 1-ml, 40-mg ampule of triamcinolone acetonide was accidentally injected into the subretinal space of the left eye of a 30-year-old man with chronic uveitis. The manufacturer provided a list of the contents of the ampule. A large, white subretinal mass was seen in the superotemporal quadrant. In subsequent days, the medication was seen to migrate inferiorly. visual acuity in the left eye was 20/400. Subretinal hemorrhage and mild atrophy of the retinal pigment epithelium and choroid were observed superotemporally. visual acuity returned to 20/100 (preinjection level) in 1 week. Four months postinjection, the superotemporal atrophy was more severe; the inferotemporal medication was minimally visible without producing significant chorioretinal atrophy. The visual acuity remained at 20/100 until the patient underwent cataract extraction and intraocular lens implantation; his vision then improved to 20/40. steroids, when not accompanied by harmful vehicle substances, may be well tolerated by ocular tissues.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |