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At least 793 records · Page 44Linked to original sources
PubMed2000

Recurrent fungal keratitis and endophthalmitis.

PURPOSE: To report a case of recurrent fungal sclerokeratitis and endophthalmitis with a very successful outcome due to aggressive combined surgical and medical therapy. To discuss the management of this potentially devastating infection. METHODS: A 65-year-old man presented with 6 months of left eye redness and irritation after injury from organic matter propelled from an airboat. Initially, he had been treated with foreign body removal, antibiotics, and steroids. He was diagnosed with reactive sclerokeratitis at presentation and was treated with steroids. However, when he did not improve, cultures were obtained and Acremonium species filamentous fungi was identified. Despite treatment with appropriate topical and systemic antifungals, his fungal sclerokeratitis progressed to endophthalmitis. Two therapeutic penetrating keratoplasties (PKs) with iridectomy and intraocular amphotericin B were necessary to eradicate the fungal infection. RESULTS: Visual acuity was restored to 20/25-3 with correction 9 months after initial presentation. There was no recurrence of fungal infection after the second therapeutic PK. CONCLUSION: The possible reasons for recurrence of fungal infection are discussed. The role of timely and aggressive medical and surgical intervention for fungal sclerokeratitis and endophthalmitis in restoring excellent vision is emphasized.

Acremonium↗
PubMed1992

Artificial iris diaphragm and silicone oil surgery.

In order to avoid contact between silicone oil and the cornea and subsequent painful corneal dystrophy in aniridial eyes, an artificial iris diaphragm was constructed. It consists of polymethylacrylat (PMMA) and simulates the situation of the iris with a central pupillary opening and inferior iridectomy. To date, these diaphragms have been implanted in 11 cases of the severest ocular trauma with accompanying aniridia and proliferative vitreoretinopathy. In the presence of sufficient residual secretion of the ciliary body (9 cases), the diaphragm assumes the function of normal iris and prevents the silicone oil from coming into contact with the corneal endothelium. The transparent diaphragm ensures a view through to the fundus. In the early postoperative period, there was, as anticipated, a fibrinous reaction in the area of the anterior segment.

Adult↗
PubMed1998

Long-term follow-up of perfluorocarbon liquid in the anterior chamber.

BACKGROUND: Perfluorocarbon liquids are used as a vitreous substitute in the operative management of several ophthalmologic conditions. We examined the effects of residual perfluorocarbon droplets in the anterior chamber in patients after retinal detachment surgery. METHODS: The study group consisted of seven patients (seven eyes) aged 28-74 years in whom droplets of perfluorocarbon appeared in the anterior chamber subsequent to retinal detachment surgery involving scleral buckling, perfluorodecalin injection, and perfluorocarbon liquid-silicone oil exchange. Mean follow-up was 9.4 months. RESULTS: From 1 -15 droplets of perfluorocarbon liquid were found in the anterior chamber. There were no corneal complications or inflammatory reactions or blood vessel invasion into the corneal stroma. Some of the droplets appeared to be encapsulated in a membrane-like material. Perfluorocarbon liquid and silicone oil had to be removed in three patients at 20, 12, and 4 months postoperatively because of an increase in intraocular pressure due to blockage of the inferior iridectomy by a droplet of perfluorocarbon, emulsification of the silicone oil, or residual perfluorocarbon liquid on the retina (one patient each). Increased intraocular pressure in a fourth patient was successfully treated pharmacologically. CONCLUSION: Based on our experience, residual perfluorocarbon liquid droplets in the anterior chamber are well tolerated and do not induce corneal damage or ocular inflammation. These patients should be closely followed, however, and the liquid removed if complications develop.

Adult↗
PubMed1985

Laser iridotomy for management of angle-closure glaucoma.

In this series, laser iridotomies were produced in 112 eyes, with a minimum of six months' follow-up. Despite the need to reopen some laser-produced iridotomies, it has proved to be safe and effective therapy. When the cornea is clear, laser iridotomy is an alternative to surgical iridectomy and can be used on outpatients without the risks of intraocular surgery. This alternative is especially beneficial to patients with combined-mechanism glaucoma and to patients in whom incisional surgery is contraindicated. There appears to be a definable curve of increased proficiency in producing patent laser iridotomies as the surgeon's experience increases.

Adolescent↗
PubMed1999

Transplantation of autologous iris pigment epithelium to the subretinal space in rabbits.

BACKGROUND: Transplantation of autologous iris pigment epithelium (IPE) into the subretinal space has been suggested as one approach for the treatment of age-related macular degeneration. Autologous rabbit IPE cells were transplanted to the subretinal space to define the technique of transplantation and examine the survival of the transplanted cells. METHODS: Autologous IPE cells were harvested by iridectomy and transplanted directly to the subretinal space of the fellow eye in 25 rabbits, using the parsplana approach. Animals were killed over a period of 5 months, and the retinas were examined morphologically by light and electron microscopy. RESULTS: Autologous IPE cells survived and formed a polarized monolayer above the retinal pigment epithelium in the subretinal space, with apical microvilli adjacent to photoreceptors. Fragments of phagocytosed photoreceptor rod outer segments were observed in phagosomes in the cytoplasm of IPE cells. Adjacent rod outer segments remained healthy throughout the experimental period. No signs of a cell-mediated immunologic response were observed. CONCLUSIONS: Our results show that in rabbits, autologous IPE cells transplanted to the subretinal space survive and do not adversely affect the photoreceptors. These results suggest that in humans, IPE cells might provide a substitute for retinal pigment epithelium cells as autologous transplants for the treatment of age-related macular degeneration.

Animals↗
PubMed2002

Management of glaucoma after retinal detachment surgery.

Secondary glaucoma may complicate retinal detachment surgery. Intraocular pressure (IOP) elevation has been described after scleral buckling procedures and vitrectomy with intravitreal injection of gas or silicone oil. Angle-closure glaucoma after scleral buckling develops because of congestion and anterior rotation of the ciliary body. Medical therapy and laser iridoplasty are usually successful in controlling IOP, but the presence of conjunctival scarring and recession and retinal hardware after scleral buckling procedures can make surgical management challenging. Intravitreal injection of expansile gases like sulfur hexafluoride (SF6) and perfluoropropene (C3F8) may produce secondary angle-closure glaucoma with or without pupillary block. Aspiration of a portion of the intraocular gas may be needed, especially if IOP is elevated to a level that may compromise ocular perfusion. Glaucoma also can develop after intravitreal injection of silicone oil secondary to pupillary block, inflammation, synechial angle closure, rubeosis iridis, or migration of emulsified or nonemulsified silicone oil into the anterior chamber. A prophylactic inferior iridectomy at the time of surgery serves to prevent pupillary block. Patients with medically uncontrolled glaucoma after silicone oil injection may require oil removal with or without concurrent glaucoma surgery.

Fluorocarbons↗
PubMed2003

Angle-closure glaucoma: impact, etiology, diagnosis, and treatment.

PURPOSE OF REVIEW: Recent studies underscore the importance of angle-closure glaucoma (ACG) as a cause of world blindness. A major contribution in assessing the true impact of this disease has been an article estimating the number of persons with occludable angles, angle closure, and blindness from ACG in China as 28.2 million, 9.1 million, and 1.7 million, respectively. Although these numbers are based on data from Singapore and Mongolia, which may be applied to China only with caution, they emphasize the blinding potential of ACG, which is three times as likely to be associated with blindness as open-angle glaucoma (OAG). RECENT FINDINGS: Recent reports in the Chinese literature on ACG prevalence suffer from definitional problems that would appear to lead to systematic overestimates of ACG prevalence and underestimates of OAG prevalence. Nonetheless, data from studies by Chinese investigators further emphasize the strong association between ACG and blindness, with fully 16% of subjects with ACG blind in one report-a far higher proportion than for OAG in China and elsewhere. The importance of topiramate as a cause of secondary angle closure has recently been understood, in part, because of a series of 19 such cases reported by investigators at the Food and Drug Administration. SUMMARY: Angle closure in this setting appears to be caused by uveal effusion and anterior rotation of the ciliary body with resultant closure of the angle. The condition is not always responsive to laser iridectomy, and elimination of the causative agent appears to be critical. Ultrasonic biomicroscopy is a potential new diagnostic modality for ACG, allowing the measurement of novel parameters, such as the angle opening distance (AOD) at 500 microm (AOD 500). The efficacy of such parameters in improving screening for ACG can only be established by prospective studies of potentially at-risk eyes. A number of novel treatments for AC and angle closure have recently been proposed, including cataract extraction, paracentesis, and argon laser iridoplasty. As with proposed new diagnostic modalities, the efficacy of these treatments remains to be demonstrated with prospective studies, ideally organized in a controlled, randomized fashion.

Blindness↗
PubMed2001

Intraocular pressure and silicone oil endotamponade.

PURPOSE: To evaluate intraocular pressure after instillation and eventual removal of silicone oil in patients undergoing pars plana vitrectomy combined with silicone oil endotamponade. METHODS: The study included 198 patients who underwent pars plana vitrectomy with silicone oil endotamponade (5,000 centistoke viscosity), in whom silicone oil was removed and in whom follow-up after oil removal was at least 3 months. All patients were operated on by one of two surgeons. RESULTS: After silicone oil instillation, intraocular pressure increased significantly (P < 0.001) from 12.9 +/- 4.4 mm Hg preoperatively to 16.1 +/- 5.5 mm Hg postoperatively. Intraocular pressure was statistically (P > 0.20) independent of the duration of silicone oil tamponade. Twenty percent of the 198 patients had at least one postoperative intraocular pressure measurement that was higher than 21 mm Hg. Main reasons for increased intraocular pressure were closed inferior iridectomy, iris neovascularisation, silicomacrophagocytic open-angle glaucoma secondary to silicone oil emulsification, and preoperative history of glaucoma. Glaucomatous optic nerve damage was detected in 14 (14 of 198, 7.1%) eyes, including 8 eyes with preoperative antiglaucoma treatment. Silicone oil emulsification occurring in 40 (40 of 198, 20.2%) patients did not statistically influence intraocular pressure after oil removal. Ocular hypotony occurred in 10 (10 of 198, 5.1%) patients after oil release leading to intraocular hemorrhages and loss of vision in 3 patients. CONCLUSION: Clinically significant increased intraocular pressure after pars plana vitrectomy with silicone oil endotamponade occurs relatively rarely, can usually be well controlled by topical antiglaucoma medication, and is reversible in most patients after oil removal. In patients with increased intraocular pressure and silicone oil endotamponade, oil removal may be preferred to invasive antiglaucoma surgery to reduce intraocular pressure.

Adolescent↗
PubMed2002

Slit-lamp needle revision for aqueous misdirection after trabeculectomy.

PURPOSE: To describe a slit-lamp needle procedure for the management of aqueous misdirection after trabeculectomy in which more conventional therapies have failed. The pathophysiology of aqueous misdirection and explanation for the efficacy of this procedure are reviewed. METHODS: Two patients in whom aqueous misdirection developed after trabeculectomy refractory to standard medical and laser therapy underwent transcorneal needling to disrupt the anterior vitreous face and reform the anterior chamber. RESULTS: In both cases there was immediate resolution of clinical signs, with normalization of intraocular pressure throughout the 9-month follow-up period. One of the two eyes showed a slow but progressive advance in preexisting peripheral anterior synechia; however, intraocular pressure and axial anterior chamber depth remained normal in both eyes. CONCLUSION: Transcorneal needle disruption of the anterior hyaloid through the peripheral iridectomy was effectively managed two cases of aqueous misdirection. Even if only transiently useful, this simple intervention may serve to minimize corneal damage from iris and lens trauma due to a flat anterior chamber.

Aged↗
PubMed1985

Laser therapy for glaucoma.

Three laser techniques for the treatment of glaucoma are described. The short-burn technique of argon laser iridotomy permitted perforation of the peripheral iris in one session without serious complications, thereby alleviating pupillary block in angle-closure glaucoma. The rates of successful intraocular pressure (IOP) control and visual acuity loss due to cataract progression were similar in laser iridotomy and surgical iridectomy. The tonographic outflow facility remained unchanged after argon laser iridotomy. Techniques of argon laser trabeculoplasty (ALT) to the anterior and posterior aspects of the trabecular band were evaluated. The anterior ALT gave fewer complications, but a lower IOP control rate than the posterior ALT. Posterior ALT over 180 degrees with about 50 burns gave fewer complications than treatment over 360 degrees with about 100 burns, yet the final effects in IOP control were better after the 180 degrees than after the 360 degrees treatment. Nd-YAG laser irradiation can separate dysgenetic iris insertion from the trabecular band in developmental glaucoma without serious complications. This Nd-YAG laser goniotomy may be useful for the treatment of juvenile primary developmental glaucoma.

Adolescent↗
PubMed1985

Argon laser trabeculoplasty and the open-angle glaucomas.

Argon laser trabeculoplasty (ALT) was used to treat 237 eyes of 156 presurgical patients with various open-angle glaucomas. Patients with primary open-angle glaucoma formed the largest group; intraocular pressure (IOP) control judged clinically to be adequate was achieved in 77.3% of eyes. Eyes with pseudoexfoliative glaucoma demonstrated the greatest IOP reduction achieving control in 90.7%. Eyes with combined-mechanism glaucoma underwent argon laser iridectomy prior to ALT. One month after ALT the IOP was considered adequate in 70% of eyes. ALT may benefit eyes with low-tension glaucoma, pigmentary glaucoma and aphakic open-angle glaucoma. Treatment failures were frequent in eyes with angle recession and uveitis. Complications included IOP elevation (7.8%) and mild iritis; technique modifications minimized their frequency and intensity. ALT demonstrated an excellent benefit-to-risk ratio. Its effect additive to medications, ALT often permitted a reduction in the medical regimen, but rarely cessation of drug therapy. ALT is recommended as an alternative to drainage surgery.

Adult↗
PubMed1995

Acute glaucoma--1941.

PURPOSE: To describe the treatment of acute glaucoma before the technological and pharmacological advances that followed World War 2. METHOD: A narrative of personal experience is presented. CONCLUSIONS: In 1941, acute congestive glaucoma received heroic treatment - strong miotics, blood-letting by leeches, purging with mercury. If satisfactory response did not occur within four hours, a broad iridectomy was performed on the hard, congested eye. Affected eyes commonly remained blind or with severely reduced vision.

Acute Disease↗
PubMed1995

Silicone oil insertion. A review of 127 consecutive cases.

Silicone oil was used in combination with vitrectomy to treat 127 cases of complicated retinal detachments. An initial anatomic success in 120 cases (94%) was reduced to 68 (54%) after an average follow-up of 32 months and was attributable to ongoing proliferative vitreo-retinopathy (PVR). The indications for the use of silicone oil were: 1. Retinal detachment complicated by PVR (107 cases), 20 of which required multiple operations. Anatomic success was achieved in 59 (55%) and of these 23 (40%) had a visual acuity of 6/60. 2. Giant retinal tears (GRT) (7 cases). Four (57%) of these remained attached, three (75%) having a final vision of 6/36. 3. GRTs complicated by PVR (8 cases). Four (50%) were anatomically successful and two had a final vision of 6/60. 4. Proliferative diabetic retinopathy (5 cases). Two (40%) remained attached and one of these (50%) had hand movements vision. The silicone oil was removed electively in 23 eyes, 16 (70%) of these being anatomically successful. Oil was removed in 43 eyes because of complications, and in 20 (46%) of these, the retina remained attached at the end of follow-up. Complications included cataract in all 14 phakic eyes; rubeosis in 19 eyes (15%); corneal opacification in 52 eyes (41%), there being no clear cut difference between those eyes with an inferior iridectomy (35 of 85 eyes--41%) and those without (12 of 29 eyes--41%); and raised intraocular pressure in 55 eyes (43%). We conclude that although far from being ideal, silicone oil appears to have played some part in achieving the successful results reported in this study.

Adolescent↗
PubMed2006

Iris melanoma in 12-year-old boy.

A 12-year-old boy presented with an incidental finding of an iris lesion after blunt injury. Ocular examination revealed a large atypical brown vascular nodule in the nasal iris, extending to the pupillary margin. There were smaller scattered nodules scattered within the iris and anterior chamber. Ultrasound biomicroscopy examination revealed no tumour behind the iris. Fundal examination findings were normal. Sector iridectomy revealed mixed spindle and epitheliod melanoma. The eye was enucleated. Histopathologic examination confirmed malignant melanoma confined to the iridocorneal angle, iris, ciliary body and inner layer of the anterior sclera. Iris melanomas are very rare in the prepubertal age group.

Child↗
PubMed1984

The effect of autonomic receptor blockers on the ocular response to topical chemical irritation.

Topical chemical irritants induce an acute reaction in the eye, consisting of an increased intraocular pressure (IOP), breakdown of the blood-aqueous barrier, anterior uveal vasodilation and miosis. In the present study these effects were studied in the rabbit eye after topical application of neutral formaldehyde by measuring IOP continuously using electromanometrical equipment. The protein content of the aqueous humour was measured and miosis as well as anterior hyperemia were analyzed. Intravenously injected sodium fluorescein was used to visualize the site of the disruption of the blood-aqueous barrier in freeze-dried specimens. Iridectomies were performed to study the mechanisms of hypertension and disruption of the blood-aqueous barrier. In iridectomized rabbits the acute irritative response was very similar to that of normal eyes. Breakdown of the blood-aqueous barrier, miosis and anterior hyperemia occurred. However, the increase in IOP was only partially reduced. This indicates that a pupillary block due to the intense miosis plays a minor role in the hypertensive reaction or in the breakdown of the barrier. The effect of three autonomic receptor blocking agents: phentolamine (alpha-adrenergic antagonist), timolol (beta-adrenergic antagonist) and biperiden (cholinergic antagonist) on the irritative ocular response caused by formaldehyde was studied. Phentolamine proved to be an efficient inhibitor of the hypertensive reaction. It also effectively prevented the breakdown of the blood-aqueous barrier. Biperiden inhibited only slightly the increase in IOP caused by formaldehyde. Timolol had no significant effect. None of these three antagonists was able to prevent the miosis or hyperemia. The present findings indicate that a part of the irritative response is mediated by a phentolamine-sensitive neuronal pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Topical↗
PubMed1979

Corneal endothelial cell density after an attack of acute glaucoma.

The corneal endothelial cells of 25 patients with unilateral acute glaucoma were photographed with a clinical specular microscope. Photography was performed as soon as (average 6-12 h) the IOP had been lowered with iv Acetazolamide and/or Mannitol and topical Pilocarpine therapy, and the corneas had become clear. Peripheral iridectomy was performed on the affected eye and prophylactically on the fellow eye in most of these patients. The follow-up endothelial photographs were taken 6-24 months postoperatively. High intraocular pressure lasting 3 days or more lowered the central endothelial cell density. But a rise in pressure lasting from only a few hours to 2 days did not affect the endothelial cell count. Operative glaucoma procedures caused a loss of central endothelial cells of approximately 4.8% in the series. There was a clear correlation between the duration of elevated pressure and the number of central corneal endothelial cells lost.

Acute Disease↗
PubMed1988

Exfoliation syndrome as a risk factor for vitreous loss in extracapsular cataract surgery (preliminary report). Erlanger-Augenblätter-Group.

Exfoliation syndrome is a major risk factor for extracapsular cataract surgery. In a series of unselected prospectively evaluated extracapsular cataract extractions performed by 9 surgeons the incidence of vitreous loss was 1.8% in 1205 cataracts without EX; in those with EX 9%. This fivefold increased incidence of vitreous loss appears related to the difficulties to obtain a satisfactory mydriasis, to the fragility of the zonula and potential, subluxation of the lens. As precautionary measures we recommend Flieringaring, in case of doubt sector iridotomy and sector iridectomy. Exfoliation syndrome is not a harmless anomaly but a potentially disastrous disease of the anterior segment of the eye.

Anterior Eye Segment↗
PubMed1991

Iris vasculopathy in exfoliation syndrome. An immunocytochemical study.

Samples of control iris tissue obtained from seven enucleated eyes and nine exfoliative iridectomy specimens were prepared for an immunocytochemical study of the matrix in the walls of iris vessels. The distribution of collagen types I, IV and laminin was studied in normal and exfoliative vessels. Laminin was an integral component of exfoliation material and was present mainly in the matrix of the outer surface of normal vascular cohort cells. The laminin content in the latter location was reduced in vessels in which exfoliation aggregates were not visible. Collagen type IV was absent from exfoliation material. While type I was present in the deposits, it was considered to represent a residue of native normal tissue. Exfoliation deposits appeared to stimulate the synthesis of collagen types I and IV at an early stage of the disease.

Aged↗