1/18. Visually significant calcification of hydrogel intraocular lenses necessitating explantation.PURPOSE: To report two cases of HydroviewR (Storz H60M) hydrogel intraocular lens (IOL) opacification necessitating explantation. To analyse the explanted lenses and compare them with a new lens in order to determine the cause of opacification. methods: Two cases are presented. Both patients complained of subjective decreases in vision approximately 1 year following uneventful cataract extraction and implantation of hydrogel lenses by the same experienced surgeon in the same institution. The reduced contrast sensitivity was thought to be due to failure of the hydrogel lenses which appeared opacified at the slit-lamp.They were then exchanged for acrylic lenses. Pre- and postoperative contrast sensitivity testing was performed using the VectorvisionR CSV-1000E instrument. A detailed comparative analysis of the opacified explanted lenses and a new lens was undertaken. This included surface microscopy, infrared spectral analysis, X-ray elemental analysis, scanning electron microscopy, and electron microscopy of lens slices. RESULTS: Lens exchange resulted in an improvement in subjective visual acuity (VA) and in objective contrast sensitivity testing. Analysis revealed deposits of calcium phosphate (hydroxyapatite) on the explanted lens' surfaces. CONCLUSIONS: The surface of the HydroviewR H60M intraocular lens is subject to opacification as a result of calcium phosphate (hydroxyapatite) deposition, thereby limiting the patient's visual outcome, and in some cases necessitating explantation. The reason for surface calcification requires further study.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/18. Visual symptoms after lung transplantation: a case of progressive multifocal leukoencephalopathy.After solid organ transplantation, signs and symptoms of the central nervous system may present a diagnostic challenge. A 43-year-old patient developed a decrease in vision 15 months after bilateral lung transplantation. The initial diagnosis was a left posterior cataract, but left eye cataract extraction did not improve his vision. seizures led to investigation of a broader differential diagnosis (cyclosporine intoxication, post-transplant lymphoproliferative disorder, infectious disease, chronic lymphatic leukemia). The clinical diagnosis of progressive multifocal leukoencephalopathy (PML) was confirmed by demonstration of jc virus in the cerebrospinal fluid and by autopsy findings. Modulation of the immunosuppressive regimen was unsuccessful. This case illustrates that decreased vision in immunocompromised patients may be the first manifestation of PML.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
3/18. Posterior ischemic optic neuropathy after uncomplicated cataract extraction.PURPOSE: We report a case of posterior ischemic optic neuropathy after uncomplicated cataract extraction. DESIGN: Observational case report. methods: Retrospective description of the natural course of posterior ischemic optic neuropathy in one patient seen at an academic institution. RESULTS: The patient had sudden vision loss after uncomplicated cataract surgery with the features of an optic neuropathy, no acute disk swelling, and delayed optic nerve head perfusion on fluorescein angiography. CONCLUSIONS: Posterior ischemic optic neuropathy rarely occurs after uncomplicated cataract surgery, and should be considered in the setting of postoperative vision loss.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
4/18. Progressive opacification of hydrophilic acrylic intraocular lenses in diabetic patients.Four patients with diabetes mellitus had cataract extraction with implantation of a hydrophilic acrylic intraocular lens (IOL) (ACRL-C160, Ophthalmed). The IOLs showed progressive and generalized opacification 10 to 20 months after implantation, decreasing visual acuity. All 4 IOLs were removed. By light microscopic examination, the IOL surfaces were wrinkled and encrusted with microspheres. Electron microscopy revealed the material to be crystalline in nature. Energy dispersive x-ray spectrum analysis showed that the deposits were mainly composed of calcium and phosphate.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
5/18. Macular phototrauma after cataract extraction and multifocal lens implantation: case report.PURPOSE: To report a patient who developed photic injury after cataract surgery and multifocal MF4 lens implantation methods: A 41-year-old caucasian woman without antecedents of interest was subjected to left catarct surgery involving phacoemulsification with capsular sac implantation of a new type of multifocal lens. A coaxial light microscope was used for surgery. The operation was filmed and anterior pole photographs were obtained. RESULTS: Two days after the operation, the patient noted a paracentral scotoma and hand movement visual acuity in the left eye. Indirect ophthalmoscopy revealed an oval, hyperpigmented macular lesion compatible with phototoxic maculopathy. CONCLUSIONS: Phototoxic injury to the macula may occur after cataract extraction. Implantation of an intraocular lens is an important factor in the producion of maculopathy, on account of its light-focusing effect on the retina. This effect was probably increased in our patient by the use of a new autofocus multifocal lens.- - - - - - - - - - ranking = 5keywords = extraction (Clic here for more details about this article) |
6/18. Hemeralopia in an older adult.An elderly male was referred for evaluation of hemeralopia when cataract extraction did not alleviate his symptom of difficulty seeing in bright illumination. visual acuity was 20/40 OU. Funduscopic examination revealed marked arteriolar attenuation, disc pallor, and retinal pigment epithelial changes. visual fields demonstrated relative paracentral scotomata. An ERG was consistent with widespread photoreceptor degeneration. A diagnosis of visual paraneoplastic syndrome was made and an extensive systemic evaluation revealed a squamous cell carcinoma of the lung. The presentation and evaluation of acquired photoreceptor dysfunction in adulthood is discussed.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
7/18. Anterior subcapsular plaque cataract in hyperornithinaemia gyrate atrophy--a case report.Hyperornithinaemia gyrate atrophy (HOGA) is a rare autosomal recessive disorder in which chorioretinal degeneration occurs with cataracts, myopia, and hyperornithinaemia. We report the case of an 18-year-old female who presented with the typical features of HOGA, including posterior subcapsular cataracts and elevated plasma ornithine. She later developed distorted vision in both eyes owing to wrinkling of the anterior lens capsules. Histological examination following lens extraction showed the wrinkling was caused by focal distortion from capsular fibrosis (anterior subcapsular plaque cataract). This specific lens change has not been linked previously with HOGA.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
8/18. Presumed optic nerve sheath meningioma diagnosed after complicated retrobulbar anesthesia.We present a patient who developed acute visual loss and light flashes at retrobulbar anesthesia for cataract extraction. Vision improved only slightly after cataract surgery. Although traumatic optic neuropathy was suspected, the patient was diagnosed one year later with an optic nerve sheath meningioma (ONSM). ONSM is a rare, slow growing, benign tumour with highly variable clinical features. diagnosis is often delayed. This case report demonstrates the diagnostic difficulty of this tumour.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
9/18. Clear lens extraction for the treatment of persistent accommodative spasm after head trauma.We report the case of a 28-year-old man with decreased visual acuity after closed head trauma sustained in a motor vehicle accident 16 weeks earlier. Several structures thought to be associated with the control of accommodation were injured. The patient had a persistent accommodative spasm causing up to 7.0 diopters of pseudomyopia. We present the patient's progress through the clinic, including manifest and cycloplegic refractions and results of a trial with atropine drops, and successful transition to bilateral pseudophakia 2 years and 9 months after the accident.- - - - - - - - - - ranking = 4keywords = extraction (Clic here for more details about this article) |
10/18. Isolated visual symptoms at onset in sporadic Creutzfeldt-Jakob disease: the clinical phenotype of the "Heidenhain variant".BACKGROUND: The Heidenhain variant of sporadic Creutzfeldt-Jakob disease (sCJD) is commonly understood to represent cases with early, prominent visual complaints. The term is clarified to represent those who present with isolated visual symptoms. This group may pose diagnostic difficulties and often present to ophthalmologists where they may undergo needless invasive procedures. METHOD: A retrospective review of 594 pathologically proved sCJD cases referred to the UK National CJD Surveillance Unit over a 15 year period to identify Heidenhain cases. RESULTS: 22 cases had isolated visual symptoms at onset with a mean illness duration of 4 months. The mean age at disease onset was 67 years. Most displayed myoclonus, pyramidal signs, and a delay in the onset of dementia for some weeks. 17 (77%) were referred initially to ophthalmology. Two underwent cataract extraction before diagnosis. All tested cases were homozygous for methionine at codon 129 of the prion protein gene. CONCLUSIONS: This rare, but clinically distinct, group of patients with sCJD may cause diagnostic difficulties. Because ocular intervention carries with it the risk of onward transmission awareness of this condition among ophthalmologists is important.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
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