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At least 505 records · Page 28Linked to original sources
PubMed1996

Vascular consequences of retinectomy.

OBJECTIVE: To define the vascular sequelae of retinectomy. DESIGN: Clinical and angiographic survey of patients who had undergone retinectomy procedures. PATIENTS: Twenty consecutive patients with ambulatory vision and attached posterior retina after retinectomy procedures underwent ophthalmic examination, including retinal biomicroscopy, indirect ophthalmoscopy with scleral indentation, and peripheral retinal fluorescein angiography. RESULTS: Ten eyes (50%) showed anterior retinal neovascularization (NV), with vessels derived from the ciliary body or posterior retina. Neovascularization occurred in residual anterior retina adjacent to the retinectomy, in detached anterior retina demarcated by laser in quadrants not involved by retinectomy, and in fibrinous membranes extending anterior to the retinectomy edge. This was associated with postoperative vitreous hemorrhages in two patients. Iris NV and inferior iridectomy occlusion were strongly associated with retinal NV (Fisher's exact test, P < .005). No patient had neovascular glaucoma or optic disc NV during a median follow-up of 250 days (range, 121 to 465). CONCLUSIONS: Retinectomy may have profound secondary effects on ocular vascular circulation, resulting in retinal NV in association with iris NV, occlusion of inferior iridectomies, and vitreous hemorrhage. Complete intraoperative removal of residual anterior retina to the ora serrata in quadrants involved by retinectomy, combined with prophylactic retinal laser treatment from the vitreous base to the ora in the remaining quadrants, is recommended to prevent the development of retinal NV and its associated complications.

Adult↗
PubMed1980

Argon laser iridotomy in primary angle-closure or pupillary block glaucoma.

This paper describes the use of a pulsed argon laser to perform iridotomies in 87 patients. Diagnosis include: primary angle closure glaucoma, narrow angle in the fellow eye of patients with primary angle glaucoma, pupillary block, and after incomplete surgical iridectomies. Laser iridotomy was achieved in 79% of patients. Blue eyes were slightly more difficult to penetrate. Success was almost 100% in those with pupillary block. Penetration was most difficult in patients with primary angle closure glaucoma (64%), but more easily accomplished in the fellow eyes of such cases (87%). In 13 patients surgical peripheral iridectomy was performed on one eye while the other eye was treated with laser iridotomy. No apparent significant long term differences were noted between the two eyes of the same individual. Complications of laser iridotomy include corneal burns, pupil distortion, synechia formation, lenticular opacities, iritis, marked pigment dispersion, sudden rise in intraocular pressure, and retinal burns. At this time a longer follow-up is required before it can be stated that a laser PI is more advantageous than a surgical PI. However, the laser's simplicity and ease of administration appear to warrant its continued use at this time.

Argon↗
PubMed1976

[Demonstration of aqueous outflow patterns of normal and glaucomatous human eyes through the injection of fluorescein solution in the anterior chamber (author's transl)].

After partially injecting the anterior chamber with a 0.2% fluorescein-Ringer solution we examined using a blue filter slitlamp normal eyes, eyes with open-angle glaucoma, and eyes following iridectomy, iridencleisis, Elliot's trephination, and trabeculectomy. In normal eyes at physiological intraocular pressure, 1--9 aqueous veins were found with a mean of 4.6. The distribution of these veins was usually irregular, being more numerous and of largest caliber in the lower nasal quadrant. With only a few exceptions the aqueous veins originated 1--2 1/2 mm peripheral from the limbus and joined the episcleral veins after a short course. The venae recipientes were characterized by a straight and deep course. In eyes with an open-angle glaucoma the average number of aqueous veins was found to be increased compared to the number found in healthy eyes. However, the caliber of these veins was smaller and distribution mor uniform. Eyes having undergone iridectomy do not differ from normal eyes in the mechanism of aqueous humor outflow. After iridencleisis and after trephination the transport of aqueous humor from the anterior chamber is achieved through a filtration bleb: (1) transconjunctival, (2) by bulk-flow through lymphatic vessels, (3) diffusely through lymphatic vessels or veins. In most cases the different transport mechanisms were combined and pure types were seldom found. There was a very definite relationship found between the size of the filtration bleb and the development of draining lymphatic vessels. After trabeculectomy the following drainage mechanisms of the aqueous humor were observed: 1. Subconjunctival outflow of aqueous humor. The further drainage in this case was achieved as in the old types of fistula building operations i.e., primarily through the lymphatic vessels. 2. Direct transport of aqueous humor into the surgical area through newly incorporated veins and lymphatic vessels. 3. Drainage of aqueous humor through still functioning aqueous veins.

Adult↗
PubMed1987

Effect of indomethacin on aqueous PGE2 levels in rabbits following ocular trauma.

Using a highly specific radioimmunoassay, post-traumatic aqueous PGE2 levels were measured in rabbit eyes treated with topical indomethacin aqueous solution, as well as in untreated eyes. In two groups of ten rabbits each, the surgical trauma consisted of corneoscleral incision (without injury to the iris); one of the two groups received prophylactic treatment (3 days) and therapeutic (21 days) indomethacin treatment. In two other groups of ten rabbits each, corneoscleral incision and iridectomy were performed. One group received indomethacin treatment as described above, while the other group was not treated. Surgery was performed in all 40 right eyes, the left eyes serving as controls. In 20 of the 40 left eyes, indomethacin therapy was applied. In all right and left eyes, aqueous samples were withdrawn 3 days and 21 days postoperatively, and PGE2 concentrations were determined. The results indicate that 3 days after corneal trauma and 3 days after corneal trauma plus iridectomy, there was a highly significant reduction in the elevated PGE2 concentrations as a result of indomethacin therapy. On postoperative day 21, indomethacin reduced even further the still slightly elevated aqueous PGE2 concentrations without, however, completely blocking prostaglandin activity. The latter was observed even in the control animals that were not operated upon; they showed minimal PGE2 levels in response to corneal puncture on postoperative day 3 for the purpose of drawing aqueous samples. Our study demonstrated that short-term indomethacin therapy has a significant inhibitory effect, but no unequivocal answers were found as to the value of long-term treatment.

Animals↗
PubMed1990

Intravitreal silicone oil injection: complications and treatment of 415 consecutive patients.

Silicone oil injection in conjunction with pars plana vitrectomy was carried out by five surgeons in 415 consecutive patients using the same surgical equipment, the same surgical techniques and the same highly purified silicone oil (viscosity, 5000 mPa.s). Indications for silicone oil injection after vitrectomy included advanced stages of proliferative vitreoretinopathy following rhegmatogenous retinal detachment (49%), severe proliferative diabetic retinopathy (38%), and proliferative vitreoretinopathy following retinal detachment due to ocular trauma (13%). Postoperative complications were noted in a 6- to 30-month follow-up period. Cataractous changes of varying degree were seen in all phakic eyes. Silicone oil entered the anterior chamber in 6% of all phakic and pseudophakic eyes. Subretinal silicone oil was noted in 4%. Other complications associated with the use of intravitreal silicone oil included biomicroscopically visible silicone oil emulsification (0.7%), keratopathy (5.5%), glaucoma (6%), closure of the inferior iridectomy (6%), and reproliferation of epiretinal and subretinal fibrous membranes (40%). We anticipate that the physico-chemical characteristics of the highly purified silicone oil (viscosity, 5000 mPa.s) and the routine performance of an inferior iridectomy in all aphakic eyes had a positive impact on the low incidence of silicone-oil-related complications such as emulsification, keratopathy and secondary glaucoma.

Anterior Chamber↗
PubMed2001

[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.

Anesthesia, General↗
PubMed2000

[Lens subluxation and glaucoma: indications and hazards of cataract surgery].

BACKGROUND: Iridodonesis is the clinical sign of lens subluxation. Acute glaucoma caused by a ciliolenticular block may develop. YAG iridotomy or peripheral iridectomy are rarely effective in controlling intraocular pressure. The results of phacoemulsification and posterior lens implantation for subluxated lens and glaucoma are reported. PATIENTS AND METHODS: Seven patients aged 69+/-9.5 years were followed up. All 10 eyes with subluxated lens and glaucoma had phacoemulsification and posterior chamber lens implantation. Two different groups relating to axial length could be analyzed. Intraoperative findings and postoperative glaucoma situation are reported. RESULTS: Six eyes had average axial length of 21.5+/-0.17 mm and previous acute glaucoma. Five of these eyes had therapeutic YAG iridotomy and one, peripheral iridectomy. All eyes had dysregulated glaucoma despite antiglaucomatous medications. After cataract surgery five of six eyes had regular intraocular pressure without any medication. Four eyes had average axial length of 24. 4+/-1.1 mm and chronic glaucoma. After complicated phacoemulsification three of these eyes had regular intraocular pressure with antiglaucomatous medication, one eye without. CONCLUSIONS: For short eyes with subluxated lens and preceding acute glaucoma, cataract surgery with posterior chamber lens implantation is an effective therapeutic procedure for IOP regulation. For chronic glaucoma with subluxated lens, conventional or surgical approach to glaucoma remains dominant.

Aged↗
PubMed2002

Laser-grid trabeculectomy in rabbits: an experimental in-vivo study.

BACKGROUND: Laser-grid trabeculectomy (TE) is a modification of micro-TE designed to enhance the intra- and postoperative safety of filtering surgery by creating several small oval fistulas (max. diameter <200 microm) beneath a scleral flap without peripheral iridectomy. METHODS: After dissecting the conjunctiva and a conventional scleral flap, 10 small perforating fistulas were created in five pigmented rabbits in the region of the gray-white border using an erbium:YAG laser with a beveled side-firing 200 microm endoprobe; conventional TE with iridectomy was performed in another five animals. Anterior chamber inspection and IOP measurements of both eyes were conducted on days 1, 4, and 14 after operation. After the last inspection eyes were saved for morphological analysis. RESULTS: Both procedures (laser-grid and conventional TE) led to a reduction of intraocular pressure in the treated eye compared to the control eye. Differences between the outcomes for the two procedures were not statistically significant. Morphology of the eyes treated by laser-grid TE revealed dense scarring of perforations around the center of the ligamenta pectinata and loose tissue refilling of the more peripheral openings. CONCLUSIONS: The functional outcome of laser-grid TE in rabbits was similar to that of conventional TE in the short term. Histological examination of microperforations in the area of the trabecular meshwork after 2 weeks indicated that tissue repair was less pronounced than in the more anterior perforations. This morphologic finding may be of importance for non-penetrating glaucoma surgery.

Animals↗
PubMed1982

Argon laser treatment for medically unresponsive attacks of angle-closure glaucoma.

Seven patients with medically unresponsive attacks of angle-closure glaucoma were successfully treated with the argon laser. Three methods may be used either singly or in combination to cut short an attack: (1) peripheral iridoplasty, (2) pupilloplasty, and (3) laser iridectomy. Laser treatment is preferable to and safer than intraocular iridectomy in such cases. Pilocarpine, which increases the axial length of the lens and shallows the anterior chamber, may worsen angle closure by increasing the pupillary block. An enlarged lens or forward movement of the lens may be a significant factor in medically unresponsive attacks. The routine use of copious amounts of pilocarpine should be avoided in treating angle-closure glaucoma.

Aged↗
PubMed1986

Pseudophakic pupillary block with angle-closure glaucoma in diabetic patients.

Six diabetic patients (five women and one man, 63 to 79 years old) developed pseudophakic pupillary block with angle-closure glaucoma two days to one year after undergoing extracapsular cataract extraction. None of the six had had a peripheral iridectomy during the procedure. Symptoms included pain and visual loss. Corneal edema and intraocular pressures as high as 80 mm Hg were also present. Laser iridotomies decreased the intraocular pressure in three cases but failed in a fourth. In one case corneal edema prevented laser treatment but a surgical peripheral iridectomy was successful. One eye with central retinal vein occlusion was treated with panretinal photocoagulation and trabeculectomy.

Aged↗
PubMed1976

The effect of taget organ removal on the development of sympathetic neurons.

The role of target organs in the maturation of adrenergic neurons was studied in the neonatal rat. The superior cervical ganglion (SCG) and its end organs, the salivary glands and iris were employed as a model system. Unilateral sialectomy and iridectomy in 3-day-old animals prevented the normal development of ganglion tyrosine hydroxylase (T-OH) and DOPA decarboxylase activities. These enzymes are highly localized to adrenergic neurons in the SCG, and were used to monitor maturation of these cells. Enzyme activity remained depressed for at least two months, the longest time tested. In contrast, total ganglion protein, a measure of ganglion growth as a whole, initially developed normally. Six weeks after surgery, however, protein content was significantly lower in ganglia deprived of the normal field of innervation. Failure of normal enzyme maturation was apparently dependent on removal of ipsilateral end organs only, since bilateral sialectomy exerted no greater effect than unilateral sialectomy. In adults, unilateral sialectomy and iridectomy did not significantly alter ganglion T-OH activity or protein in rats followed up to one month after surgery.

Age Factors↗
PubMed1977

Target organ regulation of sympathetic neuron development.

The role of target organs in the morphological and biochemical development of sympathetic neurons was examined in the neonatal rat. The superior cervical ganglion (SCG) and its end organs, the salivary glands and iris were employed as a model system. Unilateral sialectomy and iridectomy prevented the normal developmental increase in ipsilateral ganglion tyrosine hydroxylase (T-OH) activity, a marker for adrenergic maturation. Enzyme activity remained depressed by approximately 30% for at least 6 months, the longest time tested. Ganglion morphometry was performed to investigate the basis of the abnormal biochemical ontogeny. Target organ removal significantly decreased the number of adrenergic neurons in the Scg by approximately 30%. Total ganglion volume was reduced in a parallel fashion. Thus, end organ extirpation may prevent the biochemical maturation of the SCG by decreasing adrenergic neuron survival. Sialectomy without iridectomy prevented the normal postnatal increase in ganglion T-OH activity, but did not alter iris activity. These observations suggest that target removal prevents the development of only those neurons destined to innervate that organ. In addition to preventing normal adrenergic neuron ontogeny, target extirpation also prevented the normal development of presynaptic choline acetyltransferase activity. Presynaptic ganglion terminal may have failed to mature normally secondary to adrenergic destruction, or may have responded in some other manner to target organ extirpation.

Animals↗
PubMedDate not supplied

Diffuse malignant melanoma of iris with metastases.

A 66-year-old man had decreased visual acuity in the left eye. Slit-lamp examination showed hyperpigmentation of the periphery of the iris from 2:30 to 9 o'clock. Gonioscopy disclosed an ill-defined mass involving the angle and extending from 5 to 7:30 o'clock with diffuse pigmentation of the meshwork for 360 degrees. A sector iridectomy was performed inferiorly in his left eye. Histopathologic examination disclosed a diffuse malignant melanoma of the iris, mixed cell type. The patient was free of recurrence when examined at 18, 24 and 30 months following surgery. Two years and ten months following the iridectomy, the patient developed multiple metastatic bony lesions and a mass in the liver. Bone marrow aspiration from the sternum and biopsy from the iliac crest, respectively, showed metastatic malignant melanoma. He died shortly thereafter and an autopsy was not performed. The remote possibility of an occult, intraocular tumor such as a ciliary body melanoma or an internally located melanoma cannot be excluded. Assuming that this is indeed an iris melanoma, as our studies indicate, the rarity of this metastatic iris neoplasm is emphasized by noting that only 37 cases of iris melanomas with presumed metastases have been reported in the literature.

Aged↗
PubMed2004

Topiramate-associated acute, bilateral, secondary angle-closure glaucoma.

PURPOSE: To evaluate spontaneous reports of ocular side effects associated with topiramate use. DESIGN: Retrospective case series. METHODS: One hundred fifteen case reports, primarily of a specific ocular syndrome (acute secondary angle-closure glaucoma), were collected from spontaneous reporting systems: the Drug Safety section of Ortho-McNeil Pharmaceuticals, Inc. (Raritan, NJ), the Food and Drug Administration (Rockville, MD), the World Health Organization (Uppsala, Sweden), the National Registry of Drug-Induced Side Effects (Casey Eye Institute, Oregon Health & Science University, Portland, Oregon), and the world literature. MAIN OUTCOME MEASURES: The data were evaluated using the World Health Organization Causality Assessment Guide to the certainty of a suspected adverse drug reaction. RESULTS: Eighty-six cases of acute-onset glaucoma (83 bilateral and 3 unilateral), 17 cases of acute bilateral myopia (up to 8.75 diopters), 9 cases of suprachoroidal effusions, 3 cases of periorbital edema, and 4 cases of scleritis were reported. In those cases for which management was reported, 38% had laser or surgical peripheral iridectomy (21 cases). CONCLUSIONS: In the "certain" category of the World Health Organization classification system, the following are caused by topiramate therapy: abnormal vision, acute secondary angle-closure glaucoma, acute myopia, and suprachoroidal effusions. All findings are reversible if recognized early and if the drug is discontinued. The first presenting symptom of acute secondary angle-closure glaucoma in many patients was blurring of vision. Peripheral iridectomy is ineffective for this type of angle-closure glaucoma.

Acute Disease↗
PubMed1994

Trabeculectomy for traumatic hyphema with increased intraocular pressure.

We reviewed the medical records of 11 consecutive patients who underwent trabeculectomy with anterior chamber washout and peripheral iridectomy as the primary surgical treatment for traumatic hyphema that was unresponsive to medical management. The mean intraocular pressure before surgery was 48 mm Hg. In ten of the patients the intraocular pressure was lowered to 21 mm Hg or lower after surgery and remained below that level up to the most recent follow-up visit, which ranged from eight to 97 months. One patient required a topical beta-blocker and oral acetazolamide to lower pressure to this level after surgery. Eight patients had visual acuity of 20/60 or better at last follow-up. Corneal blood staining occurred in eight patients. Compared with other techniques for surgical management of traumatic hyphema, trabeculectomy provides a means to keep intraocular pressure lowered while the remaining blood is clearing from the anterior chamber. Trabeculectomy with anterior chamber washout and peripheral iridectomy appears to be a safe and reliable procedure in the management of traumatic hyphemas in which medical management fails to control intraocular pressure.

Adolescent↗
PubMed1987

Iris lymphocytic infiltration in patients with clinically quiescent uveitis.

Iridectomy specimens from 16 patients with clinically quiet chronic uveitis were analyzed by immunoperoxidase staining and compared to control iridectomy specimens from 11 non-uveitic patients. Nine of 16 uveitis specimens and none of the control specimens demonstrated a lymphocytic infiltrate consisting of interleukin-2 receptor-negative T helper and suppressor cells (P less than .003). Class II antigens were detected in the iris stroma in all uveitis specimens and six of the controls (P less than .006). Despite a quiescent clinical state, patients with chronic uveitis have increased expression of class II antigens in uveal tissue and have significant uveal infiltration of T helper and suppressor cells. These findings in a variety of types of uveitis give additional support for the importance of delayed type hypersensitivity mechanisms in human uveitic disease.

Adolescent↗
PubMed1992

Ultrasound biomicroscopy in plateau iris syndrome.

Ultrasound biomicroscopy is a new technique that uses high-frequency ultrasound (50 to 100 MHz) to produce images of the entire anterior segment at high resolution (20 to 50 microns). The iridocorneal angle, iris, ciliary body, and posterior chamber can be imaged in detail and the dimensions and anatomic relationships of these structures determined. Plateau iris syndrome is a condition in which the angle remains appositionally closed or occludable after iridectomy for angle-closure glaucoma. How the iris remains in a position that allows it to occlude the angle has been uncertain. We performed ultrasound biomicroscopy eye examinations on eight patients with clinically diagnosed plateau iris syndrome. In all the patients, ciliary processes were situated anteriorly compared to the position in normal subjects and in patients with angle closure caused by pupillary block. The ciliary processes provide structural support beneath the peripheral iris, preventing the iris root from falling away from the trabecular meshwork after iridectomy.

Anterior Eye Segment↗
PubMed1990

Biometric variables in patients with occludable anterior chamber angles.

Biometric studies of the ocular dimensions in eyes with narrow anterior chamber angles provide insight into the pathophysiology of pupillary block and may show which eyes are more prone to develop angle-closure glaucoma. We reviewed the records of 56 patients with occludable angles examined between 1980 and 1984. Initial biometric data obtained on the patients included corneal diameter, anterior chamber depth, lens thickness, and ocular axial length. The average length of follow-up was five years. Of 54 patients with complete clinical records, 20 (37%) eventually required peripheral iridectomy after a mean duration of 16 months from the initial examination. Cox's survival analysis showed a strong correlation between shortened duration to peripheral iridectomy and increasing lens thickness/ocular axial length ratio factor (P = .03). No other variables were significantly related to outcome. This suggests that the lens thickness/ocular axial length ratio may be useful as a predictor of clinical outcome in narrow-angle glaucoma.

Anterior Chamber↗