1/67. Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy. PURPOSE: To document and study the cross-sectional structures of polypoidal elements using optical coherence tomography in eyes with idiopathic polypoidal choroidal vasculopathy. methods: Optical coherence tomography images of two eyes with idiopathic polypoidal choroidal vasculopathy were correlated with slit-lamp biomicroscopic findings, fundus photographs, fluorescein angiograms, and indocyanine green angiograms. RESULTS: Cross-sectional optical coherence tomographic images of retinochoroidal structures showed prominent anterior protrusion of the orange subretinal mass corresponding to the polypoidal structure in the indocyanine green angiogram. Hemorrhagic detachment of the retinal pigment epithelium was contiguous with the cone-shaped nodule beneath the retinal pigment epithelium in one eye, and an apparent discontinuity was observed in the highly reflective layer that delineates the polypoidal structure. CONCLUSIONS: Some of the polypoidal structures in eyes with idiopathic polypoidal choroidal vasculopathy are anteriorly protruding lesions in the inner choroid that may cause serosanguineous detachment of the retinal pigment epithelium through damage of the overlying bruch membrane, retinal pigment epithelium, and the adhesion between them. Cross-sectional optical coherence tomographic images may increase understanding of the pathophysiology of idiopathic polypoidal choroidal vasculopathy. ( info) |
2/67. Spontaneous suprachoroidal haemorrhage in a patient receiving low-molecular-weight heparin (fraxiparine) therapy. Spontaneous suprachoroidal bleeding is a rare event. Of the six previously reported cases, five had identifiable mechanisms for the development of choroidal bleeding in addition to concurrent systemic anticoagulation/thrombolytic therapy. We report a case of spontaneous suprachoroidal haemorrhage in a patient who received subcutaneous low-molecular-weight heparin therapy but without any identifiable ocular condition predisposing to choroidal bleeding. ( info) |
3/67. Dissecting aneurysm of the anterior choroidal artery: angiographical and MR imaging findings. BACKGROUND: Intracranial dissecting aneurysms are relatively rare. We present a rare case of a dissecting aneurysm originating from the anterior choroidal artery; this is the first reported case.CASE DESCRIPTION: A 42-year-old man suffered sudden onset of right hemiparesis and dysarthria. Computed tomography on admission revealed a small low density area in the posterior limb of the internal capsule. MR imaging revealed aneurysmal dilatation of the anterior choroidal artery, and angiography revealed aneurysmal dilatation and stasis of dye in the venous phase at the anterior choroidal artery, which resolved in the chronic stage.CONCLUSION: We describe a rare case of a dissecting aneurysm of the anterior choroidal artery. The radiological findings were characteristic of dissecting aneurysms in spite of the rare location. ( info) |
| We present a case of acute suprachoroidal hemorrhage that developed during routine phacoemulsification in an 85-year-old patient after uneventful administration of periocular anesthesia. Pre-existing risk factors included advanced age, glaucoma, myopia, and hypertension. The scleral tunnel prevented major expulsion of intraocular contents; however, raised intraocular pressure prevented intraocular lens implantation. The rarity of this condition raises questions regarding the further management and precautions related to it. ( info) |
5/67. Suprachoroidal hemorrhage during silicone oil removal in marfan syndrome. A 30-year-old male with marfan syndrome underwent pars plana lensectomy and vitrectomy combined with silicone oil injection for the treatment of retinal detachment with proliferative vitreoretinopathy (PVR). Four months after vitrectomy, the silicone oil was removed using an anterior chamber maintainer (AC) and a self-sealing clear corneal incision at the upper temporal quadrant. Suprachoroidal hemorrhage (SCH) developed at the end of the operation. It was limited to the nasal side of the retina. Suprachoroidal hemorrhage remained to be limited and did not show progression. ( info) |
6/67. Massive suprachoroidal hemorrhage with retinal and vitreous incarceration; a vitreoretinal surgical approach. Suprachoroidal hemorrhage(SH) may cause the expulsion of the intraocular contents. Vitreous incarceration in the wound and retinal detachment with SH are extremely poor prognostic signs. Treatment modalities depend on the severity of eye damage. This particular patient had "kissing" hemorrhagic choroidal detachment which completely filled the vitreous cavity after cataract surgery. It seemed to be inoperable. Secondary surgery was delayed 3 days to lower IOP to normal levels. The eye underwent anterior drainage sclerotomy under constantly-maintained limbal or pars plana infusion fluid line pressure. The authors performed a pars plana vitrectomy, followed by perfluorocarbon liquid injection and a silicone oil tamponade. After this surgical approach, the patient attained an attached retina and a visual acuity of 5/200 at the 3 month follow-up. ( info) |
7/67. Suprachoroidal hemorrhage as a complication of vitrectomy. OBJECTIVE: To study the risk factors, management, and end results of suprachoroidal hemorrhage that occur during or after vitrectomy. MATERIALS AND methods: This retrospective study involves patients suffering from this complication either during the curing process or immediately after vitrectomy. Preoperative risk factors, operative management, postoperative picture, and end results are reported. RESULTS: During the study period, surgery was performed on 3342 patients with primary vitrectomy. Complications were experienced by 4 patients: 2 occurred near the end of vitrectomy, and 2 in the first postoperative day. The 4 patients were myopic more than 7 diopters, 2 were pseudophakic and 2 were aphakic. Cryopexy was used to treat the retinal breaks in the operative cases. Perfluorophenanthrene was used as a postoperative tamponade in one operative case. reoperation was done in the 4 patients 3 to 8 weeks after surgery. Silicone oil was used as a prolonged tamponade in all cases. Hypotony persisted in operative cases. All the patients had vision more than 20/400 at the end of follow-up (6 to 24 months). CONCLUSION: The risk factors for suprachoroidal hemorrhage were old age, high myopia, aphakia or pseudophakia, retinal detachment, and scleral buckle. Postoperative suprachoroidal hemorrhage has a better prognosis than the operative type. Perfluorophenanthrene "vitreon" as an operative and postoperative tamponade has a beneficial effect in keeping the retina attached and in preventing pooling of blood under the macula. ( info) |
8/67. Spontaneous expulsive suprachoroidal hemorrhage. PURPOSE: To present a 90-year-old patient with spontaneous expulsive suprachoroidal hemorrhage (SESCH). This unique case suggests a mechanism of SESCH, which is still under debate. methods: The patient, who had corneal inflammatory disease and diabetes mellitus, atherosclerosis, and glaucoma, presented with active ocular bleeding and expulsion of intraocular tissues. Almost the entire cornea was absent, except for several small and irregular areas in its periphery. Histopathologic evaluation of the eviscerated contents was performed. RESULTS: Clinicopathologic evaluation revealed acute inflammation of the corneal remains as well as intraocular inflammation. Inflammatory necrosis of choroidal vessels was evident. CONCLUSION: The findings point to the assumption that choroidal bleeding, secondary to vascular inflammatory necrosis, was the initial event in this case of spontaneous expulsive suprachoroidal hemorrhage. Presumedly, the intraocular pressure level was very high owing to continuous bleeding, which could result in a very large, rather than localized, tearing of the peripherally inflamed cornea. ( info) |
9/67. Infusion misdirection syndrome during trabeculectomy for primary trabeculodysgenesis. PURPOSE: To report a case of infusion misdirection syndrome, simulating an intraoperative suprachoroidal hemorrhage, in an eye undergoing trabeculectomy for primary trabeculodysgenesis. methods: A 21-year-old woman underwent trabeculectomy for primary trabeculodysgenesis. Congenitally abnormal intraocular anatomy led to intraoperative and postoperative complications. RESULTS: Intraoperative anterior chamber irrigation was followed by vitreous prolapse. eye pain, globe hardening, and shallowing of the anterior chamber were caused by infusion misdirection into the posterior segment. The eye was rapidly closed after a limited wound-site vitrectomy. Intraoperative and postoperative management led to a successful outcome. CONCLUSION: Altered intraocular anatomy set the stage for infusion misdirection syndrome, a rare but manageable complication that mimicked an expulsive suprachoroidal hemorrhage. ( info) |
10/67. Intraoperative choroidal hemorrhage in the Osler-Rendu-Weber syndrome. PURPOSE: To describe a patient with Osler-Rendu-Weber syndrome who developed a nonsimultaneous intraoperative choroidal hemorrhage in each eye. METHOD: Interventional case report. A 65-year-old Caucasian woman with Osler-Rendu-Weber syndrome developed a choroidal hemorrhage in the left eye during vitrectomy for a complicated retinal detachment with a poor visual outcome. Fifteen years later, she developed a macula on retinal detachment in the right eye, which also had a dense cataract. Immediately after uncomplicated phacoemulsification and intraocular lens implantation, under monitored anesthesia care and retrobulbar block, and without valsalva stress, ophthalmoscopy demonstrated a choroidal hemorrhage. A planned scleral buckle was replaced by pneumatic retinopexy. RESULTS: Seven months postoperatively, the retina remained attached with resolution of the choroidal hemorrhage. visual acuity was 20/30.CONCLUSION: Choroidal hemorrhage may occur more commonly in individuals with Osler-Rendu-Weber syndrome. Recognition of this possible association and institution of appropriate intraoperative precautions may facilitate a good visual outcome. ( info) |