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PubMed2002

Penetrating keratoplasty for treatment of corneal protrusion in a great horned owl (Bubo virginianus).

A young adult great horned owl (Bubo virginianus) was examined following presumed trauma. The owl had soft tissue injury to its left wing as well as corneal protrusion, lens subluxation, and iridodialysis of the right eye. The bird's eye was treated surgically with a large, rectangular penetrating keratoplasty. Following escape from housing, the bird was found with partial wound dehiscence and iris prolapse 12 days post operation. Surgical repair was performed and healing progressed for 14 days, at which time the transplant dehisced and the globe was exenterated. The patient rehabilitated well until escaping from its cage again 4 weeks later, at which time it sustained an open comminuted humeral fracture and was euthanized.

Animals↗
PubMed2003

Bottle-cork injury to the eye: a review of 13 cases.

PURPOSE: To analyze the anatomic and functional consequences of wine-cork injury to the eye in relation to the patient's age and the type of cork and wine. METHODS: We retrospectively studied 13 patients, six women and seven men, presenting to our department with bottle-cork injury to the eye between January 1999 and June 2001. RESULTS: All patients presented with closed-globe injury according to Kuhn et al's classification. All the cases were injured by bottle corks from sparkling wine: white in ten cases and red in three. Mean visual acuity at admission was 20/100 (range, hand motion to 20/20). The most frequent early injury was anterior chamber hyphema (84.6%), followed by corneal injury (62.2%), ocular hypertension (46.1%), lens subluxation (30.8%), traumatic cataract (23.1%), and post-traumatic retinal edema (23.1%). Mean final visual acuity was 20/25; the follow-up ranged from 3 to 29 months, averaging 16.1 months. Late complications were as follows: pupil motility anomalies (38.5%), traumatic cataract (30.8%), iridodialysis (15.4%), traumatic optic neuropathy (7.7%), post-traumatic glaucoma (7.7%), and traumatic maculopathy (15.4%). Surgical treatment was necessary in two cases (15.4%). CONCLUSIONS: Bottle-cork eye injuries account for 10.8% of post-traumatic hospital admissions to our department. Most of them are due to sparkling white wine served at room temperature. There is no correlation between ocular injury and the eye-bottle distance or the type of cork.

Adult↗
PubMedDate not supplied

Pars plana vitrectomy and transscleral fixation of black diaphragm intraocular lens for the management of traumatic aniridia.

BACKGROUND AND OBJECTIVES: Partial or complete aniridia occurring after severe ocular trauma is a difficult therapeutic problem. Diaphragm intraocular lenses were developed for the correction of aniridia, but the safety and efficacy of implanting such lenses are not well established in traumatic cases because of very few reports, and the small number of cases studied. PATIENTS AND METHODS: Six patients, 4 men and 2 women with a mean age of 44 years, were treated for traumatic aniridia using pars plana vitrectomy and transscleral fixation of a black diaphragm intraocular lens. Total aniridia was observed in 3 eyes and partial aniridia in 3 eyes. Four eyes were aphakic and severe lens subluxation was seen in 2 eyes. Vitreous hemorrhage coexisted in 2 patients and bacterial endophthalmitis was present in 1 patient. Follow-up time ranged between 4 and 39 months (mean, 23 months). RESULTS: Best-corrected visual acuity improved in 5 patients and 1 remained unchanged. Good visual acuity (20/20 - 20/40) was achieved in all cases and all lenses were well-centered. No severe complications were noted. Three of 6 patients required glaucoma topical medications pre- and postoperatively achieving good intraocular pressure control. CONCLUSION: The management of traumatic aniridia using pars plana vitrectomy and implantation of scleral fixation black diaphragm intraocular lenses seem to be safe. Very good functional results and lack of severe complications are encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.

Adult↗
PubMed2006

Vitreoretinal disorders in anterior megalophthalmos.

PURPOSE: To describe vitreoretinal abnormalities in patients with anterior megalophthalmos (AM) and to report the results of vitreoretinal surgery in these cases. METHODS: In a retrospective, noncomparative case series, a diagnosis of AM was made according to the following criteria: megalocornea, iris hypoplasia, lens subluxation, cataract formation at an early age, and absence of congenital glaucoma. Vitreous biomicroscopy and funduscopy were performed in all patients. Patient records were also reviewed. RESULTS: Twenty-four patients with AM (12 male, 12 female), aged 4 months to 64 years, were included in this study. Funduscopy was possible in 46 eyes. Vitreous degeneration was the most common abnormal posterior segment finding, present in 34 eyes (73.9%). Nine eyes (19.5%) had optically empty vitreous with strands. Lattice degeneration was seen in five eyes (10.8%). Spontaneous vitreous hemorrhage occurred in three eyes, and peripheral retinal neovascularization was detected in two. Retinal detachment occurred in 18 eyes (37.5%); retinal breaks were detected in eight of these before surgery. Thirteen eyes underwent a total of 18 procedures. Retinal reattachment was finally achieved in 12 of the 13 eyes. CONCLUSIONS: Anterior megalophthalmic eyes seem to be affected by a type of vitreoretinopathy predisposing to retinal detachment. Current vitreoretinal surgical techniques usually achieve good anatomic results in these cases.

Adolescent↗
PubMed1997

Ultrasound biomicroscopy in anterior ocular trauma.

BACKGROUND AND OBJECTIVE: The authors investigated the role of ultrasound biomicroscopy after ocular trauma. PATIENTS AND METHODS: Ultrasound biomicroscopy was performed in six eyes of six patients at the New York Eye and Ear Infirmary after a variety of traumatic ocular injuries. RESULTS: Eyes with angle recession, iridodialysis, cyclodialysis, hyphema, an intraocular foreign body, scleral laceration, and subluxed crystalline lens were imaged without complication. Ultrasound biomicroscopy aided in the diagnosis when visualization was limited by media opacities or distorted anterior segment anatomy. CONCLUSION: Ultrasound biomicroscopy is a safe and effective adjunctive tool for the clinical assessment and management of ocular trauma, especially when visualization is limited and multiple traumatic injuries are involved.

Adult↗
PubMed1985

[Indications and results of lens removal using the pars plana approach].

Pars plana lensectomy has both advantages and disadvantages. Therefore, a differentiated indication is required. This procedure can be regarded as the method of choice in traumatic cataracts when there is simultaneously endothelial damage of the cornea and a subluxated lens (following injury with contusion or perforation). Relative indications are for subluxated lenses without endothelial damage, for cataracts with endothelial but not vitreous problems, for cataracts with chronic uveitis, and for undilatable pupils. Anatomical and functional results - as far as they could be determined in the patients treated by the present authors - are excellent.

Adolescent↗
PubMed2001

A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange.

PURPOSE: To compare the visual results and the postoperative complications in eyes with posterior chamber intraocular lens (PCIOL) dislocation that underwent pars plana vitrectomy with lens repositioning with eyes that underwent pars plana vitrectomy with lens exchange. DESIGN: Nonrandomized consecutive comparative case series. PARTICIPANTS: Fifty-nine eyes (27 right eyes and 32 left eyes) of 56 subjects (28 women and 28 men) ranging in age from 59 to 90 years. Mean follow-up was 34 months. METHODS: A comparison of the best-corrected preoperative visual acuities, final visual acuities, and postoperative complications in subjects with dislocated PCIOLs that underwent pars plana vitrectomy. Logarithm of the minimum angle of resolution (LogMAR)-converted visual acuities were used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by a pooled Student's t test. MAIN OUTCOME MEASURES: Final mean visual acuities, change in mean visual acuities, and postoperative complications. RESULTS: For all 59 eyes the mean preoperative visual acuity was 20/152, and the mean final visual acuity was 20/48. Final visual results were similar between the eyes that underwent lens repositioning (20/55) and the eyes that underwent lens exchange (20/43; P = 0.19). Final visual results were also similar between the eyes that underwent lens exchange with sutured PCIOL placement (20/51) and the eyes that underwent lens exchange with anterior chamber intraocular lens (ACIOL) placement (20/38; P = 0.26). Final mean visual acuity in eyes that received an ACIOL (20/38) was better than in eyes that underwent repositioning of the dislocated lens into the ciliary sulcus (20/65; P = 0.01). The mean increase in visual acuities was greater for eyes with ACIOL placement compared with eyes with sutured PCIOL placement (P = 0.01). For all eyes, final visual results were unaffected by a concurrent diagnosis of age-related macular degeneration (20/52; P: = 0.71), glaucoma (20/48; P = 0.95), or postoperative cystoid macular edema (20/55; P = 0.45). Final visual acuities were significantly worse in eyes with a detectable preoperative afferent pupillary defect (20/200; P<0.0001). Postoperative retinal detachments developed in 4 of 29 eyes (14%) that underwent lens repositioning and in 2 of 30 eyes (7%) that had lens exchange (P = 0.42). Postoperative lens subluxations occurred in 6 of 29 eyes (21%) that underwent lens repositioning and in 1 of 30 eyes (3%) that underwent lens exchange (P = 0.05). CONCLUSIONS: The final visual results in eyes with dislocated PCIOLs that underwent pars plana vitrectomy with lens repositioning were similar to the visual results obtained in eyes that underwent pars plana vitrectomy with lens exchange. For eyes that underwent lens exchange, final visual results in eyes that received an ACIOL were similar to the visual results obtained in eyes that received a PCIOL; however, eyes with an ACIOL showed a greater increase in mean visual acuity. Eyes with a preoperative afferent pupillary defect had worse final visual results.

Aged↗
PubMed1983

[Comparative study of different fixation methods of 4-loop Binkhorst intraocular lens implants].

Intra- and postoperative complications of iris-fixated 4-loops Binkhorst intraocular lens implants were studied. The horizontally placed lens implants, iris-fixated with two prolene sutures, were found to be the best placed, considering complications like lens subluxation or dislocation. Iris angiography, done 9 days to 18 months after lens implantation, revealed no local iris damage at the suture sites.

Adult↗
PubMed2005

[Two different intra-corneal inlay surgical technique in rabbit eyes].

OBJECTIVE: To compare two different surgical techniques of intracorneal lens implantation. To determine the incidence of corneal and lens complications in two groups of rabbits subjected to such surgery. METHOD: The first group (7 rabbits) initially had a keratectomy performed with the microkeratome following which the corneal flap was sutured to the stromal layer. In the second group (7 rabbits), a pocket-shaped stromal dissection was performed manually. Both groups of rabbits had a secondary lens implantation in the corneal inlay. The follow up period was of 2 months duration. RESULTS: The incidence of corneal edema in the first month was higher in group 1 (71.4%) than in group 2 (14.3%) (p = 0.0155); during the second month, the incidence was 42.9% in group 1 and 28.6% in group 2 (p= 0.2927). Flap dislocation and retraction of the flap was seen in 4 of the 7 rabbits in group 1, whereas no complication of this type was observed in the manual pocket group (group 2). The incidence of lens subluxation was 28.6% in group 1 and 0% in group 2. Finally, there was a 71.4% (5/7) loss of the intracorneal lens in the rabbits treated with the microkeratome (group 1) while only 1 of 7 rabbits (14.3%) lost the lens in group 2 (P = 0.0155). DISCUSSION: Eyes in which the corneal pocket shape was made by manual stromal dissection had a higher stability of the lens and less post-operative corneal complications.

Animals↗
PubMedDate not supplied

Ultrasonographic and computed tomographic examinations of the avian eye: physiologic appearance, pathologic findings, and comparative biometric measurement.

Ultrasonography (US) and computed tomography (CT) were performed after routine ophthalmologic and ophthalmoscopic examinations in 190 eyes of six various diurnal (common buzzard [Buteo buteo L., 1758], n = 20; common kestrel [Tinnunculus tinnunculus L., 1758], n = 20) and nocturnal raptor species (barn owl [Tyto alba L., 1758], n = 22; tawny owl [Strix aluco L., 1758], n = 8; long-eared owl [Asio otus L., 1758], n = 5; horned owl [Bubo bubo L., 1758], n = 1); and domestic pigeons (Columba livia, Gmel., 1789; n = 19), with a total of 95 individuals. Pathologic findings such as lens subluxation and luxation, intravitreal hemorrhage, detached retina, post-traumatic partial sequestration, or malformation of the pecten could be demonstrated with diagnostic imaging tools, while opacities of cornea or lens constrained direct ophthalmoscopic examination. The results proved US to be a quick noninvasive imaging technique for detailed ocular diagnoses. CT provided detailed information of the bony skull and bony scleral rings as well as adequate visualization of shape, size, and margination of the eye and lens. Nevertheless, CT was unable to differentiate subtle structures within the vitreous like the pecten oculi or hemorrhage. Biometric measurements were carried out to objectify imaging results. Results showed good correlation of depth and width of the anterior eye chamber, lens and vitreous, length of the bulbus, and the pecten but no correlation of cornea and posterior wall thickness was found.

Animals↗
PubMed2006

Incidence and risk factors for glaucoma after pediatric cataract surgery with and without intraocular lens implantation.

PURPOSE: We sought to report the incidence of glaucoma in the eyes of children who underwent cataract surgery with and without intraocular lens implantation and to report the risk factors for developing glaucoma. METHODS: We undertook a retrospective review of pediatric cataract surgery charts, excluding traumatic cataract, aniridia and Lowe syndrome, steroid-induced cataract, lens subluxation, uveitis, retinoblastoma, radiation-induced cataract, retinopathy of prematurity, secondary IOL implantation, and patients with less than 1 month of postoperative follow-up. RESULTS: After pediatric cataract surgery, 10 (3.8%) of 266 eyes with primary intraocular lens implantation were diagnosed with glaucoma, whereas 8 (17.0%) of 47 aphakic eyes were diagnosed with glaucoma. During the initial analyses, we noted that all of the patients who developed glaucoma underwent cataract surgery when they were 4.5 months or younger. For all patients who underwent surgery during the first 4.5 months of their life, the glaucoma incidence was 24.4% (10/41) in children with pseudophakic eyes and 19.0% (8/42) in age-matched children with aphakic eyes (risk ratio=1.1, CI=0.7-1.9; P=.555). In patients who underwent surgery during the first 4.5 months of their life, the average age of the patients who developed glaucoma was not significantly different than those who did not develop glaucoma in pseudophakic eyes (2.0 months+/-1.4 vs. 1.9 months+/-1.0, P=.700) or aphakic eyes (2.6 months+/-1.5 vs. 1.4 months+/-0.9, P=.070). The corneal diameter of the eyes that developed glaucoma versus eyes that did not was not significantly different in patients with pseudophakic eyes (P=.860) or aphakic eyes (P=.254). Glaucoma was diagnosed in patients at an average of 8.6 months and 117.9 months after cataract surgery in those with pseudophakic eyes and aphakic eyes, respectively. CONCLUSIONS: Patients undergoing cataract surgery at an early age are at high risk for the development of glaucoma with or without an intraocular lens implant.

Age Factors↗
PubMed1995

Retinal detachment and giant retinal tears in aniridia.

Clinical findings in aniridia may include corneal epitheliopathy, glaucoma, lens subluxation and cataract, and hypoplasia of the fovea and optic nerve. We report the occurrence of retinal detachment due to giant tears in four eyes of three children with aniridia. All eyes were buphthalmic and none had undergone lens or posterior segment surgery. All operated eyes underwent vitreolensectomy and silicone oil injection; useful vision was restored in two eyes. The pathogenesis and management of this previously unreported complication are discussed.

Aniridia↗
PubMed1998

Causes of severe decentration and subluxation of intraocular lenses.

BACKGROUND: Severe decentration and subluxation of intraocular lenses (IOLs) may lead to double vision, glare and deterioration of vision to the point of functional aphakia. The purpose of the present study was to analyse causes for severe IOL dislocation. MATERIAL AND METHODS: Between January 1989 and January 1996, 37 patients required IOL exchange because of decentrated or subluxated posterior chamber lenses. Twenty-five of the exchanged lenses were implanted in our hospital, 12 lenses elsewhere. After explantation the lenses were examined by light and electron microscopy. RESULTS: In 10 eyes, asymmetric implantation of the posterior chamber lens was responsible for decentration. Three of the lenser concerned were multifocal IOLs. Asymmetric implantation led to a significantly higher rate of explantations in eyes with multifocal lenses (P < 0.005). In five eyes decentration developed due to asymmetric capsular shrinkage, in four eyes due to posterior synechiae. A lens subluxation developed in three eyes as a result of rupture of the posterior capsule and in nine eyes because of zonular defects. In three cases decentrations were induced by an extensive secondary cataract. Macroscopically visible changed geometry of the haptics was found in nine lenses; eight of these had polypropylene haptics. Seven lenses showed severely altered haptics on electron-microscopic examination. In four eyes subluxated lenses had to be explanted together with the capsular bag because of severe defects of the zonula, which caused decentration in nine eyes. CONCLUSIONS: Asymmetric implantation of posterior chamber lenses should be strictly avoided. Multifocal lenses require special attention concerning symmetric capsulorhexis and positioning of their haptics.

Aged↗
PubMed1998

Management of ophthalmic complications of homocystinuria.

OBJECTIVE: To determine the safety and efficacy of surgical versus medical management in the treatment of ophthalmic complications of homocystinuria, and also to document ocular complications of homocystinuria other than lens dislocation. DESIGN: Retrospective case series. PARTICIPANTS: Forty-five patients with ophthalmic complications of homocystinuria participated. INTERVENTION: Eighty-four surgical procedures were performed on 40 patients. There were 82 procedures done with the patients under general anesthesia and 2 with the patients under local anesthesia. Medical therapy was attempted initially in all patients with lens dislocation and was the sole therapy used for five patients. MAIN OUTCOME MEASURES: Complications resulting from medical or surgical treatment and final visual acuity were studied. RESULTS: All patients had a history of lens subluxation or dislocation. Fourteen (31%) were receiving dietary treatment at the time of presentation and 29 (64%) were mentally retarded. Eighty-two procedures were performed with the patients under general anesthesia with 2 surgical complications and 1 postsurgical complication. Lens dislocation into the anterior chamber was the most frequent indication for surgery (50%) followed by pupillary block glaucoma (12%). Prophylactic peripheral iridectomy was not successful in preventing lens dislocation into the anterior chamber in five patients. Anesthetic precautions such as stockings to prevent deep venous thrombosis, preoperative hydration, or aspirin were given in 85% of cases. Other common ophthalmic complications found include optic atrophy (23%), iris atrophy (21%), anterior staphylomas (13%), lenticular opacities (9%), and corneal opacities (9%). CONCLUSION: Laser iridectomy was unsuccessful in preventing lens dislocation into the anterior chamber. With appropriate anesthetic precautions and modern microsurgical techniques, the risks associated with the surgical management of ocular complications of homocystinuria are reduced. Surgical treatment should be considered, especially for cases of repeated lens dislocation into the anterior chamber or pupillary block glaucoma. If a conservative, nonsurgical approach is undertaken, these patients must be observed carefully for repeat episodes of lens dislocation.

Adolescent↗
PubMed2006

Correction of high myopia with the PRL phakic intraocular lens.

PURPOSE: To assess the predictability, efficacy, safety, and complications of the PRL (CIBA Vision) phakic intraocular lens (pIOL) in the correction of high myopia. SETTING: Clínica Oftalmológica Pasteur, Santiago, Chile. METHODS: This prospective study comprised 53 eyes of 39 patients who received a PRL pIOL. The spherical equivalent (SE), uncorrected visual acuity (UCVA), efficacy index (postoperative UCVA/preoperative best spectacle-corrected visual acuity [BSCVA]), safety index (BSCVA/preoperative BSCVA), intraocular pressure (IOP), iridocorneal angle, and distance between the crystalline lens and PRL were prospectively assessed during the follow-up period. RESULTS: The mean patient age was 39 years. The mean power of the implanted pIOL was -12.73 diopters (D) +/- 2.87 (SD) (range -20.00 to -7.00 D), for a preoperative SE of -17.27 +/- 4.58 D (range -31.50 to -8.75 D). The mean preoperative BSCVA was 0.50 +/- 0.70 (logMAR equivalent), and the mean follow-up was 8 +/- 9.4 months. The mean postoperative SE was -0.23 +/- 1.05 D; 71.2% of eyes were within +/-1.00 D. Sixty percent of patients had UCVA of 20/40 or better, and 88.2% of patients had BSCVA of 20/40 or better. Ninety-two percent maintained or gained 1 or more lines of BSCVA; 5.7% lost more than 1 line. There was no significant change in IOP (P = .40), and the mean distance between the crystalline lens and pIOL was 370 microm (ultrasound) and 604 microm (optical coherence tomography). Late complications included 1 case each of retinal detachment and lens subluxation. CONCLUSIONS: Although PRL implantation in high myopia was predictable and effective, retinal detachment and IOL subluxations occurred. Other posterior chamber pIOLs should be used until the complications associated with the PRL pIOL are resolved.

Accommodation, Ocular↗
PubMed1999

Iridocorneal adhesions in patients with the Marfan syndrome.

Marfan syndrome is an autosomal dominant connective tissue disorder characterized by skeletal, cardiovascular, and ocular anomalies. Ectopia lentis is the most common ocular manifestation. We report an ocular sign not previously described in Marfan syndrome, iridocorneal adhesions secondary to anterior lens subluxation. Three patients with the Marfan syndrome had iridocorneal adhesions on slit-lamp examination. One patient developed adhesions following treatment with pilocarpine. She underwent pars plana vitrectomy and lensectomy in both eyes due to progression of the iridocorneal adhesions. Treatment with miotics rotates the lens-iris diaphragm anteriorly and may contribute to the formation of such adhesions. The two other patients remained stable and did not received lensectomy or vitrectomy. Careful slit-lamp examination of the anterior segment should be conducted in patients with dislocated lenses.

Adolescent↗
PubMed2001

Management of ectopia lentis in children.

Marfan syndrome, homocystinuria, trauma, and simple ectopia lentis are the most common causes of pediatric lens subluxation. Many patients are best treated with a careful refraction of the phakic or aphakic pupillary axis. For those patients not achieving satisfactory refractive results, endocapsular lensectomy using modern automated vitreous cutting devices is relatively safe and successful. Given the lack of postoperative capsular support and our current level of intraocular lens technology, postoperative optical correction is most safely achieved with aphakic contact lenses or spectacles.

Child↗