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PubMed2003

EBV-induced polymorphic lymphoproliferative disorder of the iris after heart transplantation.

BACKGROUND: Posttransplantation lymphoproliferative disorder (PTLD) of the iris is a rare entity with only ten cases having been published as yet. Its clinical aspect is typical. Therapy is multimodal and affords an interdisciplinary approach. METHODS: A 7-year-old boy developed a lymphoproliferative mass of the iris with uveitis 4 years after heart transplantation and immunosuppression. A progressive, flesh-colored thickening of the iris with secondary angle closure glaucoma necessitated a diagnostic and therapeutic iridectomy. Morphological investigation of the iris specimen disclosed a polymorphic posttransplantation lymphoproliferative disorder (PTLD) and the presence of Epstein-Barr virus (EBV) within the tissue. The EBV load in peripheral blood monocytes was massively elevated, thus indicating a chronic EBV infection. After conservative treatment and radiation therapy, the iris mass quickly resolved. There was no evidence of systemic PTLD. CONCLUSIONS: PTLD is a well-known, EBV-induced entity that rarely affects the eye. EBV is principally detectable in specimens of iris PTLD. If conservative, antiviral treatment fails, the iris lesions can be treated by local radiation therapy with very good success. In the near future, patients with PTLD of the eye may benefit from immunologic treatment with ex vivo generation of virus-specific T-lymphocytes.

Antiviral Agents↗
PubMed2004

Artisan aphakic intraocular lens in children with subluxated crystalline lenses.

PURPOSE: To evaluate the results of Artisan (Ophtec) aphakic intraocular lens (IOL) implantation in children with idiopathic subluxated lenses. SETTING: Department of Ophthalmology, Soroka University Medical Center, Beer-Sheva, Israel. METHODS: This retrospective small case series comprised 4 eyes (3 children) with idiopathic essential subluxated lenses that had lens washout, lens capsule removal, Artisan IOL implantation, and peripheral iridectomy. The indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measures were postoperative refraction and change in best corrected visual acuity (BCVA). RESULTS: The postoperative follow-up ranged from 8 to 10 months. After surgery, the BCVA was 6/12 or better in the 3 cases that could be recorded. Visual acuity improved by 2 or more Snellen lines in all 4 eyes. The postoperative spherical equivalent was within +/-1.00 diopter in all cases. No significant postoperative complications were observed. CONCLUSIONS: In 4 eyes with a subluxated crystalline lens, implantation of an Artisan aphakic IOL improved visual acuity. Studies with a larger number of patients and longer follow-up are necessary to confirm these results.

Biocompatible Materials↗
PubMed2005

Clinical results of ZSAL-4 angle-supported phakic intraocular lenses in 190 myopic eyes.

PURPOSE: To evaluate the efficacy and safety of angle-supported phakic intraocular lenses (IOLs) in myopia. SETTING: Private practice, Siena, Italy. METHODS: This prospective noncomparative single-surgeon interventional case series comprised 190 consecutive myopic eyes of 115 patients having implantation of a ZSAL-4 IOL (Morcher GmbH) through a 5.5 mm x 3.0 mm sclerocorneal tunnel along the steepest meridian with a surgical iridectomy. Preoperatively, the mean spherical equivalent was -14.37 diopters (D) +/- 4.40 (SD) and the mean astigmatism, 1.66 +/- 1.36 D. RESULTS: Postoperatively, the mean defocus equivalent (DEQ) was 1.55 +/- 1.06 D and the mean astigmatism, 1.41 +/- 1.11 D. The mean surgically induced astigmatism (vector analysis) was 1.03 +/- 0.77 D (95% confidence interval [CI], 0.92 to 1.15); 146 eyes (77%) were within +/-2.0 D of the DEQ, 76 eyes (40%) were within +/-1.0 D, and 36 eyes (19%) were within +/-0.5 D. The safety index was 1.25 and the efficacy index, 0.78. The improvement in best spectacle-corrected visual acuity (0.17) was statistically significant (95% CI, 0.14 to 0.2). Complications were intraocular pressure spike due to topical steroids, 18%; chronic iridocyclitis, 1%; explantation of unstable IOL, 1%; explantation of IOL for iridocyclitis, 0.5%; pupil ovalization, 11%; halos, 18%; and macular hemorrhage, 1%. CONCLUSIONS: Angle-supported IOLs can effectively correct high myopia, although residual refractive errors may require secondary procedures. The main intraoperative and postoperative complications were halos, steroid response, and incorrect IOL sizing. The role of surgery in inducing macular hemorrhages should be assessed further.

Adult↗
PubMed2003

Clinicopathologic correlation and genetic analysis in a case of posterior polymorphous corneal dystrophy.

PURPOSE: To evaluate the clinical history, histopathology, and genetics of posterior polymorphous corneal dystrophy (PPMD) in a woman with a prominent retrocorneal membrane. DESIGN: Observational case report and genetic analysis of her family, UM:139. METHODS: Records were reviewed from a case and associated family members. The diagnosis of PPMD was based on clinical examination, immunohistochemical staining, electron microscopy, and screening of genetic markers from regions previously reported to be associated with PPMD. RESULTS: Over 17 years, the proband with PPMD had 25 ocular procedures performed for glaucoma, cataract, cornea, retina, and postoperative problems. A prominent retrocorneal membrane grew onto the crystalline lens and intraocular lens (IOL). Histopathology revealed stratified epithelial-like cells on iris from an iridectomy and stratified corneal endothelium on a corneal button. Electron microscopy on the cornea revealed microvilli, tonofilaments, and desmosomes consistent with endothelial transformation, which was confirmed by positive anticytokeratin (CK) AE1/AE3 and CAM 5.2 immunoreactivity. Negative immunoreactivity in epithelium and positive in endothelium with anti-CK 7 supported the diagnosis of PPMD rather than epithelial downgrowth. Multiple relatives were affected with PPMD with apparent autosomal dominant inheritance, but surprisingly, the PPMD, congenital hereditary endothelial dystrophy 1 (CHED1) and CHED2 loci on chromosome 20 and the collagen, type VIII, alpha-2 (COL8A2) gene were excluded by linkage and haplotype analyses. CONCLUSIONS: We are unaware of previous PPMD reports describing the unusual feature of a retrocorneal membrane extending onto the crystalline lens and IOL. In addition, this family suggests another PPMD locus.

Biomarkers↗
PubMed2005

Use of ultrasound biomicroscopy to diagnose Ahmed valve obstruction by iris.

BACKGROUND: We report 2 cases in which ultrasound biomicroscopy (UBM) was used to diagnose Ahmed valve obstruction by the iris. METHODS: Two patients underwent unilateral placement of Ahmed implants, one into the anterior chamber and the other into the ciliary sulcus. RESULTS: Intraocular pressures increased in the early postoperative period. In each case, a clear view of the aqueous drainage tube was precluded. Occlusion of the end of the tube by iris tissue was demonstrated by UBM. An iridectomy over the tip of the tube instituted filtration in each case. INTERPRETATION: UBM was instrumental in diagnosing the presence and cause of occlusion of aqueous drainage tubes.

Adult↗
PubMed2003

Interventions for angle-closure glaucoma: an evidence-based update.

PURPOSE: To assess the interventions to treat acute angle closure (AAC) and primary angle closure (PAC) with or without glaucomatous optic neuropathy. CLINICAL RELEVANCE: Primary angle closure is one of the leading causes of blindness in East Asia. At present, there are few clinical guidelines on the optimal treatment of AAC or PAC in the affected or contralateral eye. METHODS: All randomized clinical trials, prospective controlled clinical trials, nonprospective controlled clinical trials, and retrospective case series with >50 cases that evaluated treatments for AAC or PAC were included. Studies published in the English language were identified from MEDLINE, PubMed, EMBASE, and the Cochrane Collaborations, as well as by a hand search of the reference lists of important articles. RESULTS: Nine randomized clinical trials and 24 nonrandomized clinical trials and large case series were evaluated. Laser peripheral iridotomy (LPI) has been found to be as effective as surgical peripheral iridectomy in randomized clinical trials of the affected and contralateral eyes of AAC or PAC patients with or without evidence of glaucoma. In another randomized clinical trial, latanoprost was found to decrease intraocular pressure (IOP) more than timolol for PAC in patients for whom LPI alone failed. CONCLUSIONS: This review suggests that LPI should be recommended for the treatment of affected and contralateral eyes of AAC patients. In patients with PAC and insufficient treatment with LPI, latanoprost eye drops may decrease IOP more than timolol. There is still insufficient evidence about other interventions for the treatment of AAC and PAC.

Acute Disease↗
PubMed2004

Combined trabeculectomy and vitrectomy for pseudophakic malignant glaucoma and extensive peripheral anterior synechia-induced secondary glaucoma.

We report combined trabeculectomy and vitrectomy in a 66-year-old woman with combined-mechanism glaucoma. Trabeculectomy supplemented with mitomycin-C was done first. Before the scleral and conjunctival flap were sutured, an anterior vitrectomy was performed via the peripheral iridectomy until a pathway between the anterior chamber and aqueous pool in the vitreous cavity was established. One day postoperatively, the intraocular pressure (IOP) was 10 mm Hg. Six months later, the IOP was 13 mm Hg and the bleb remained formed.

Aged↗
PubMed2005

Trabeculectomy with internal tube shunt: a novel glaucoma surgery.

PURPOSE: To describe a pilot study that evaluates the efficacy and mechanism of action of a new glaucoma operation, trabeculectomy with internal tube shunt. METHODS: Twenty-three patients underwent the new operation in one eye for open angle glaucoma. Under a scleral flap, a deep sclerectomy was performed, resulting in an intrascleral lake. Laterally, on both sides, a small silicone tube was placed between the intrascleral lake and the suprachoroidal space. A trabeculectomy stoma and a peripheral iridectomy permitted easy access of aqueous to the tube. Postoperative and preoperative results were analyzed and also compared with results of 45 eyes that underwent a conventional trabeculectomy. RESULTS: After a mean follow-up time of 324 days, the mean postoperative IOP was 13.8 mm Hg compared with a preoperative value of 25.4 mm Hg. The mean number of postoperative medications was only 1.1 compared with a preoperative value of 3.0. No significant change in outflow facility was seen. The bleb size was very small. In comparison, in conventional trabeculectomy eyes, the outflow facility and bleb size were significantly larger. CONCLUSION: Trabeculectomy with internal tube shunt is very effective in lowering IOP. It is postulated to work, to a large extent, by allowing access of the aqueous humor to the suprachoroidal space where the protein colloid osmotic pressure of uveal blood causes its absorption. This new procedure offers many advantages over other filter procedures and tube shunts.

Adult↗
PubMed2004

Tapioca melanoma of the iris mimicking a vascular tumour: a clinicopathological correlation.

Although vascular iris processes are usually benign, they may be a clinical manifestation of iris melanoma, and this should be considered in the differential diagnosis. The case is reported of a 20-year-old man with a highly vascularized tapioca melanoma of the left iris without involvement of the anterior chamber angle or ciliary body, but with observed growth tendency. Sector iridectomy was performed 2 months after first examination. In addition, two separate floating tumour nodules were observed in the anterior chamber angle at 6 o'clock and were removed by aspiration. After 1 year follow up, no recurrence of melanoma cells was observed. In tapioca iris melanomas, diagnostic differentiation from congenital, inflammatory, vascular and neoplastic iris processes is required. Careful biomicroscopic examination of the iris in patients with vascular iris tumours may help the ophthalmologist to identify malignant iris melanomas (tapioca type) and plan appropriate surgical treatment.

Adult↗
PubMedDate not supplied

Results of anterior chamber clearance via the pars plana in pseudophakic endophthalmitis.

PURPOSE: Patients with endophthalmitis have extensive fibrinous exudates in the anterior chamber. Clearance of these exudates in pseudophakic patients during vitrectomy is difficult. We evaluated the results of the pars plana approach for clearing these exudates. MATERIAL AND METHODS: Eighteen patients with pseudophakic endophthalmitis underwent clearance of anterior chamber exudates through the pars plana approach after initial creation of a peripheral iridectomy with a vitrectome. RESULTS: The exudates were adequately cleared in all 18 patients with good posterior segment visualization during vitrectomy. Minor punctate iris bleeds (4 patients), intraoperative dislocation of the intraocular lens (IOL) (1 patient) and postoperative dislocation of the IOL following blunt trauma, 9 months after vitrectomy (1 patient) were the complications noted. CONCLUSION: This technique is simple, safe and helps clearing anterior chamber exudates. It also permits excellent visualization during vitrectomy for pseudophakic endophthalmitis.

Anterior Chamber↗
PubMed2003

[Angle-closure glaucoma: important points in the diagnosis and follow-up].

A 74-year-old woman visited her local physician complaining of fever, cough, headache, hyperemic left conjunctiva, and blurred vision. She was diagnosed as having common cold and medicated for it, and later, she visited our department. She had a shallow left anterior chamber with moderately dilated pupil. Gonioscopic examination of the left eye revealed a narrow angle corresponding to grade 1 by Shaffer grading system. Left intraocular pressure was 16 mmHg. She was diagnosed to have had a spontaneous recovery from a subacute attack of angle-closure glaucoma. Laser iridectomy was performed and she was put on a regular ophthalmological follow-up. Three years later, she experienced an attack of left angle-closure glaucoma secondary to lens intumescence. She was treated by phacoemulsification and aspitaion which resulted in the eventual cure.

Aged↗
PubMedDate not supplied

Cataract formation with a primary iris stromal cyst.

An 11-year-old boy was diagnosed with a primary acquired iris stromal cyst. A 5-year follow-up showed growth of the cyst with visual impairment. An inferior iridectomy was performed including the whole cystic lesion. The presence of a cataract is rare, especially in adolescents, but requires treatment to preserve the globe and vision.

Cataract↗
PubMed1954

Diagnosis and treatment of glaucoma; a review of recent developments.

Tonography is helpful in the diagnosis of doubtful cases of chronic simple glaucoma. If also gives a good indication of the status of the disease in a given eye. The most useful miotic in the treatment of glaucoma is still pilocarpine. Carbachol is more potent but must be used in an anhydrous base ointment or in a solution of a wetting agent. DFP (diisopropyl fluorophosphate) produces undesirable side effects because of the hyperreactivity of the ciliary body and iris sphincter which it causes. These can be partly overcome by using pilocarpine first. Diamox is a carbonic anhydrase inhibitor that is effective when given orally. In many cases it produces at least a temporary lowering of tension in glaucomatous eyes, apparently by reducing the secretion of intraocular fluid. Its ultimate value in glaucoma remains to be seen. The cyclodiathermy operation which has been modified somewhat by Weekers has had a recent increase in use but the long-term results have been somewhat disappointing. The importance of early operation in narrow angle glaucoma is becoming more and more apparent. Following iridectomy the wound should be tightly sutured to insure the prompt reformation of the anterior chamber.

Anterior Chamber↗
PubMed1956

Surgical repair of corneal injury.

Operations on the cornea relating to trauma are discussed, and included are tangential flaps, corneal injuries, old adherent leukoma, and optical iridectomy. Variations from the usual technique and the immediate surgical closure of corneal wounds are emphasized.

Cornea↗
PubMed2003

The application of topical anesthesia combined with subconjunctival anesthesia for glaucoma surgery.

PURPOSE: To evaluate the feasibility, reliability and analgesia effect of topical anesthesia combined with subconjunctival anesthesia in anti-glaucomatous surgery. METHODS: Two hundred and four cases (357 eyes) underwent anti-glaucomatous surgeries under topical anesthesia with 0.5% Alcaine eye drops combined with subconjunctival anesthesia with 2% Lidocaine. The analgesic effect was analysed with visual analogue pain scale. RESULTS: Among all of 357 eyes, 62 eyes underwent peripheral iridectomy, 67 eyes underwent simple trabeculectomy, 167 eyes underwent compound brabeculectomy and 12 eyes nonpenetrating trabecular surgery. The effects of anesthesia were as follows: 304 eyes (85.2%) were painless (Grade I), 50 eyes (14.0%) were slight painful (Grade II), and 3 eyes (0.8%) were more painful (Grade III) during surgery. And no severe complications were observed in all the cases during surgery and postoperatively. Amaurosis fugax was not observed in the glaucoma patients at the late stage with narrow visual fields and poor visual ability. CONCLUSION: Topical anesthesia combined with subconjunctival anesthesia is effective, safe and simple anesthesia alternative in routine anti-glaucomatous surgery, especially for the glaucoma patients at the late stage with narrow visual fields and poor visual ability. It is worthy of being applied widely.

Adolescent↗
PubMed2004

[Acute glaucoma crisis].

Acute glaucoma crisis is an emergency in ophthalmology. Ocular and systemic clinical signs are typical and due to a paroxystic and severe increase of intraocular pressure. It is a biometric disease: little eye with a big lens. Main factors triggering the acute crisis are: stress, sympathicomimetics, parasympathicomimetics and parasympathicolytics drugs. Treatment is surgical: iridectomy, cataract extraction, trabeculectomy or combined surgery.

Acute Disease↗
PubMed2005

[Surgical management of iris melanoma].

PURPOSE: To describe the own experiences of surgical treatment of iris melanomas. MATERIAL AND METHODS: 56 patients with iris melanoma were treated between January 1995 and June 2001. Two surgical modalities were used depend on tumor location: partial iridectomy (in 45 cases) or transscleral iridotrabeculectomy (in 11 cases with the iridocorneal angle involvement). Additional ruthenium brachytherapy was performed in 3 cases. RESULTS: There were no any complications during surgery. Filtration bleb occurred in 1 patient during post-operative follow-up. Local recurrence of melanoma successfuly treated with ruthenium plaque appeared in one person. Histologically, the majority were spindle B melanomas (70%), mixed in 27% and epithelioid in 3%. The visual acuity was better or not changed in 90% of cases. CONCLUSIONS: Surgical management of iris melanoma seems to be save and effective treatment.

Adolescent↗
PubMed1998

Angle-closure glaucoma associated with occult annular ciliary body detachment.

OBJECTIVE: To evaluate the role of annular ciliary body detachment in the development of postoperative angle-closure glaucoma. DESIGN: Case series. SETTING: Tertiary care glaucoma referral center. METHODS: High-resolution, anterior segment ultrasound biomicroscopy, ophthalmoscopy, and B-scan ultrasonography were performed on 6 eyes of 6 patients with a clinical diagnosis of postoperative malignant glaucoma. RESULTS: Each eye had an elevated intraocular pressure, a shallow anterior chamber, 1 or more patent iridectomies, and no ophthalmoscopic or B-scan ultrasound evidence of serous or hemorrhagic ciliochoroidal detachment. Ultrasound biomicroscopy revealed annular ciliary body detachment in each eye. In 4 eyes, observation with topical medical treatment was associated with deepening of the anterior chamber, reduced intraocular pressure, and resolution of the detachment. Drainage of the supraciliary fluid was performed in 2 eyes. CONCLUSION: Occult, annular, serous detachment of the ciliary body may cause postoperative angle-closure glaucoma. This entity is clinically indistinguishable from malignant glaucoma. Ultrasound biomicroscopy facilitates the diagnosis.

Aged↗