11/823. An unusual complication of retinal reattachment surgery. The authors report a case with an unusual late extraocular complication of scleral buckling and local silicone sponge implant. Four years after the reattachment surgery, a ptotic upper eyelid perforated by local silicone sponge implant and fistula between upper eyelid and sclera were detected. Primary repair of upper eyelid and removal of silicone sponge were performed. One year later, the retina was attached and there was no problem with the upper eyelid. cryotherapy, episcleral explant (scleral buckling), and local implant (sponge) are frequently used and effective methods for retinal reattachment surgery. Postoperative early and late complications have been reported. To our knowledge, there is no report of upper eyelid perforation, ptosis and fistula formation caused by silicone sponge implant rejection. ( info) |
12/823. Management of traumatic luxation of the globe. A case report. PURPOSE: To report the management of a patient who had LeFort type III fractures and traumatic luxation of the globe with avulsion of the optic nerve and all extraocular muscles except for the medial rectus. methods: Eight hours after the trauma, the detached and retracted superior and lateral recti muscles could be found and sutured to their original insertions. The inferior rectus could not be retrieved. RESULTS: Although the left eye had no light perception, most of its motility was restored resulting in an unblemished cosmesis. CONCLUSION: Avoiding primary enucleation helped to alleviate the psychological burden of the trauma on the patient. In case of the eventual development of phthisis bulbi, the patient will have a chance to be fitted with a prosthesis over his own eye with a resulting better motility. ( info) |
13/823. Enucleation for ritual practices. Five cases of enucleation performed on seeing eyes are presented, highlighting the dangers this procedure poses to the patient. It also presents the problems this can pose to the development of ophthalmology. ( info) |
14/823. Traumatic anterior lens dislocation: a case report. A 45-year-old man presented to the emergency department complaining of decreased vision and pain in the left eye after blunt trauma to the eye. On evaluation, the vision was limited to detecting hand motions, and the intraocular pressure was 37 mmHg. Secondary acute angle-closure glaucoma, with pupillary block due to anterior dislocation of the lens, was diagnosed. The intraocular pressure remained elevated after medical therapy, and the patient underwent intracapsular cataract extraction and anterior vitrectomy. The possibility of elevated intraocular pressure due to lens dislocation or other types of secondary glaucoma should be considered after blunt ocular trauma. ( info) |
15/823. corneal perforation during laser in situ keratomileusis. Two cases of corneal perforation that occurred during laser ablation but not during flap formation in laser in situ keratomileusis (LASIK) are reported. In the first case, no problem in flap formation occurred, and stromal bed thickness was assumed to be about 239 microns after laser application. However, a stromal bed perforation was found when 608 pulses were applied (theoretical ablation depth was 140 microns). Excessive dehydration due to prolonged exposure to the operating microscope light may change the ablation rate and cause corneal perforation. In the second case, LASIK retreatment was performed using the original flap for correction of regressed myopia (-4.0 diopters). Although the stromal bed thickness was assumed to be about 175 microns after the laser application, a stromal bed perforation was found when 151 pulses were applied (theoretical ablation depth was 37 microns). Unexpected corneal ectasia after the first LASIK treatment may cause a corneal perforation in LASIK retreatment. In conclusion, excessive dehydration of the cornea should be avoided, and careful examination of the corneal shape is necessary to prevent corneal perforation during laser ablation in LASIK. ( info) |
16/823. Posterior chamber intraocular lens dislocation with the bag. We report a rare case of a 46-year-old man presenting with a luxation of a posterior chamber intraocular lens (IOL) with the capsular bag after ocular contusion. Preoperative axial length was 36.58 mm. After trauma, pars plana extraction of the dislocated IOL inside the capsular bag was performed using a forceps. Capsular fibrosis had probably weakened the zonules, which were ruptured by the trauma. This observation confirms the necessity of a large continuous curvilinear capsulotomy and meticulous cleaning of the anterior and posterior capsules to minimize postsurgical fibrosis and capsule contraction. ( info) |
17/823. Focal retinal pigment epithelial dysplasia associated with fundus flavimaculatus. BACKGROUND: One or more focal dysplastic lesions of the retinal pigment epithelium (RPE) occurred in 15 eyes of 10 patients with fundus flavimaculatus. methods: review of patient records including an attempt to obtain follow-up information concerning a history of previous ocular trauma. RESULTS: Mild antecedent ocular trauma occurred to the eye with a dysplastic lesion in two patients. Dysplastic lesions were most frequently solitary and located temporal to the macula. Subretinal neovascularization accompanied two of the dysplastic lesions. The lesions were multifocal and present bilaterally in two patients. CONCLUSIONS: In fundus flavimaculatus, progressive lipofuscin storage is responsible for engorgement and hypertrophy of the RPE. Dysplastic lesions of the RPE probably result from reactive hyperplasia and fibrous metaplasia of RPE cells in response to acute disruption of fragile, hypertrophied RPE cells that may be enormously enlarged in the area of yellow flecks. This disruption may occur in response to trauma, focal inflammation, or other localized stimuli. patients with fundus flavimaculatus should be cautioned concerning the possible role of trauma in causing dysplastic changes in the RPE and visual loss. ( info) |
| An aphakic patient with severe chronic hypotony had an alternative treatment of a traumatic cyclodialysis cleft: a 3-port pars plana vitrectomy, cryotherapy of the cleft, and fluid-gas exchange with subsequent supine positioning. The therapeutic principle was mechanical apposition of the detached ciliary muscle to the scleral spur by the gas bubble and scar induction by cryotherapy. intraocular pressure increased to within normal ranges, and visual acuity improved over a 15 month follow-up. ( info) |
19/823. Traumatic cataract presenting with unilateral nasal hemianopsia. A 56-year-old man developed a nasal field defect in his left eye 3 months after a traumatic accident. An examination showed a posterior subcapsular cataract in the left eye with no neurologic deficits. Humphrey 24-2 visual field testing revealed a nasal hemianopsia in the left eye. After cataract extraction and intraocular lens implantation, the patient's visual field returned to normal. This case shows that a cataract can present with a localized visual field deficit, which may be corrected by cataract extraction. ( info) |
20/823. Venous collateral remodeling in a patient with posttraumatic glaucoma. PURPOSE: To photographically document venous collateral development, remodeling, and regression in a patient with traumatic glaucoma. methods: Consecutive fundus photographs were evaluated, labeled, and correlated with the clinical history of a patient with unilateral posttraumatic glaucoma. RESULTS: This report photographically documents the appearance, remodeling, and subsequent disappearance of collateral vessels from venous occlusion on the surface of the optic disk in an eye with increased intraocular pressure and progressive glaucomatous cupping. CONCLUSIONS: Asymptomatic chronic obstruction of a branch retinal vein on the optic disk may cause venous collaterals to develop in the absence of retinal hemorrhages or other signs of venous occlusive disease. Increased intraocular pressure, arteriolarsclerosis, and glaucomatous cupping are risk factors for these occlusions. ( info) |