1/352. Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia. A 69-year-old woman with chronic lymphocytic leukemia developed segmental iris atrophy and iridocyclitis after routine surgery for exotropia. Both the clinical picture and fluorescein angiogram indicated anterior segment ischemia. It is postulated that this was related to hyperviscosity of the blood caused by a high white blood cell count (114,000/cu mm). The possibility of anterior segment ischemia should be kept in mind when contemplating strabismus or retinal detachment surgery in the presence of hematologic disorders likely to increase blood viscosity. In these cases a minimal amount of surgery should be done with proper supportive therapy. strabismus surgery should be done in stages allowing for hemodynamic compensation between procedures. ( info) |
2/352. 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. ( info) |
3/352. Unexpected difficult intubation in the patient with Morning Glory syndrome. Morning Glory syndrome is an uncommon congenital optic disc anomaly with occasional systemic associations. A case of unsuspected difficult intubation in a three-year old patient is described in this case report. ( info) |
| 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. ( info) |
5/352. ciliary body detachment caused by capsule contraction. A 74-year-old woman developed capsule contraction associated with hypotony and choroidal effusion 18 months after uneventful phacoemulsification with 3-piece poly(methyl methacrylate) intraocular lens implantation. Ultrasound biomicroscopy revealed ciliary body detachment and stretched zonules. A radial neodymium: YAG anterior capsulotomy was performed, resulting in the resolution of the ciliary body detachment and choroidal effusion as well as in normal intraocular pressure over 4 days. ( info) |
6/352. Sclerotomy in uveal effusion syndrome. PURPOSE: To report visual and anatomic outcomes after modified scleral surgery in patients with uveal effusion syndrome with retinal and choroidal detachment. methods: In five eyes of four patients with retinal and choroidal detachment and uveal effusion syndrome due to nanophthalmos, we performed pars plana full-thickness unsutured sclerotomies without sclerectomy. RESULTS: In all cases, uveal effusion with choroidal and retinal detachment resolved within 3 weeks, and all patients showed improved vision. The functional and anatomic results remained stable for over 2 years. CONCLUSIONS: Uveal effusion syndrome that is refractory to medical treatment (high-dose systemic corticosteroids) can be managed effectively by pars plana full-thickness unsutured sclerotomy without sclerectomy. ( info) |
7/352. Treatment of a cyclodialysis cleft by means of ophthalmic laser microendoscope endophotocoagulation. PURPOSE: To report on the repair of a cyclodialysis cleft by means of endolaser photocoagulation. METHOD: Case report. We describe treatment of a cyclodialysis cleft by means of endolaser photocoagulation with a diode laser. RESULTS: In a 8-year-old boy with pseudophakia and secondary glaucoma in the right eye, combined trabeculectomy/trabeculotomy was performed. Ten months later, the patient was seen with persistent hypotony with a flat filtration bleb. The hypotony was unresponsive to all forms of medical therapy. Reformation of the anterior chamber along with synechialysis revealed a 2.5 clock-hour cyclodialysis cleft by means of gonioscopy. A laser microendoscope probe was used and laser was applied to both the internal scleral and external ciliary body surfaces within the depths of the cleft. Within 3 weeks after treatment, intraocular pressure increased to 15 mm Hg and has remained at that level as of 9 months after the endolaser photocoagulation procedure. CONCLUSION: Endolaser photocoagulation with the ophthalmic laser microendoscope may be an appropriate procedure, after failure of medical therapy, for the diagnosis and repair of a cyclodialysis cleft, especially in the pediatric population. ( info) |
8/352. Choroidal effusions and hypotony caused by severe anterior lens capsule contraction after cataract surgery. PURPOSE: To report the clinical features and management of two patients with pseudophakic anterior capsule contraction with secondary tractional ciliary body detachments and hypotonous choroidal effusions. methods: case reports. RESULTS: In two eyes of two patients with pseudophakia, severe anterior lens capsule contraction and tractional ciliary body detachments, anterior capsulotomy (one Nd:YAG laser, one surgical), was followed by resolution of the ocular hypotony and resolution/nonrecurrence of the choroidal effusions. In both cases, continuous curvilinear capsulorhexis was used during cataract surgery. CONCLUSION: Anterior capsule contraction following pseudophakia may result in tractional ciliary detachment and secondary ocular hypotony. Radial anterior capsulotomy appeared to be effective in both cases. ( info) |
| Astrocytic hamartomas of the retina are the principal ocular manifestation of tuberous sclerosis complex. iris abnormalities are rare in tuberous sclerosis complex and include focal areas of stromal depigmentation and atypical colobomata. We describe 2 patients who were found on histopathological examination to have lesions consistent with hamartomas of the iris pigment epithelium and ciliary body epithelium. iris abnormalities, including pupillary irregularities, were noted on clinical examination prior to the development of iris neovascularization in both patients. These observations suggest that iris abnormalities, including atypical colobomas, may be caused by hamartomas of the iris pigment epithelium and ciliary epithelium in some patients with tuberous sclerosis complex. To our knowledge, hamartomas of tissues derived from the anterior part of the neuroectodermal optic cup have not been reported in cases of tuberous sclerosis complex. ( info) |
| PURPOSE: To describe clinical and pathologic features of an iridociliary lacrimal gland choristoma in which the diagnosis was made clinically and confirmed histopathologically. methods: Case report with clinical, ultrasound biomicroscopic, and histopathologic observations. RESULTS: We examined a 12-month-old male for a large iris mass that had been present since birth. We suspected it to be a lacrimal gland choristoma based on characteristic clinical features. The lesion was removed by iridocyclectomy, and the diagnosis of lacrimal gland choristoma was confirmed. CONCLUSION: Intraocular lacrimal gland choristoma has unique clinical features that should suggest the diagnosis. ( info) |