1/17. Intracorneal inclusion of high-molecular-weight sodium hyaluronate following detachment of Descemet's membrane during viscocanalostomy.PURPOSE: Viscocanalostomy in accordance with Stegmann's technique is a new surgical option in the treatment of glaucoma. There are few reports available describing the specific complications of viscocanalostomy. We report a case of intracorneal inclusion of high-molecular-weight sodium hyaluronate following viscocanalostomy. CASE REPORT: A 66-year-old man with uncontrolled primary open angle glaucoma of his right eye and a history of argon laser trabeculoplasty underwent viscocanalostomy in accordance with Stegmann's technique. During the filling of Schlemm's canal, a limited lysis of Descemet's membrane advanced centrally in the clear cornea adjacent to the site of canalostomy forming an intracorneal bubble of high-molecular-weight sodium hyaluronate. Postsurgical slit-lamp biomicroscopy showed an intracorneal clear bubble within the corneal periphery without evidence of adjacent corneal edema and with no contact between the corneal endothelium and the iris. Follow-up examinations determined that the appearance of the corneal inclusion, essentially, was unchanged, with only a slight tendency of resorption. No signs of corneal scarring or endothelial decompensation could be noted. CONCLUSION: To date, we could not determine a significant corneal damage in conjunction with the described complication. However, it is difficult to predict the long-term clinical course of our patient. Corneal decompensation as a result of possible endothelial toxicity of high-molecular weight sodium hyaluronate as well as spontaneous absorption seem possible.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/17. Differential diagnosis of corneal oedema assisted by in vivo confocal microscopy.The purpose of this study was to demonstrate microstructural differences between clinically similar, but aetiologically different, cases of corneal oedema in four subjects. In vivo confocal microscopy highlighted oedema of the basal epithelium, prominent nerve-keratocyte interactions, and typical 'epithelialization' of the endothelium in a case of iridocorneal endothelial syndrome; however, a similar microstructural appearance was observed in a case of presumed herpetic disciform keratitis. The latter diagnosis was subsequently revised on this basis. Confocal examination of fuchs' endothelial dystrophy demonstrated oedema of the basal epithelium, prominent wing cells, anterior stromal alterations, fibrosis of Descemet's membrane and a typical 'strawberry' appearance of the endothelium. In contrast, in vivo microstructural examination of bilateral keratoconus with hydrops confirmed oedema mainly involving the epithelium and anterior stroma. In vivo confocal microscopy allows the clinician to observe the living cornea at a microstructural level and to better diagnose and differentiate borderline or unusual cases of corneal oedema.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
3/17. Late spontaneous resolution of a massive detachment of Descemet's membrane after phacoemulsification.We report the spontaneous resolution of a massive detachment of Descemet's membrane 10 months after uneventful phacoemulsification. diagnosis of the detachment was delayed because of severe corneal edema; thus, surgery was not performed. We propose that this complication of severe corneal edema after cataract surgery be considered and, given its excellent outcome, we recommend surgical treatment.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/17. descemet membrane detachment after nonpenetrating filtering surgery.PURPOSE: To make surgeons performing nonpenetrating filtering surgery aware of an unusual complication namely descemet membrane detachment. methods: We retrospectively reviewed nine eyes of nine patients seen in our hospital with descemet membrane detachment occurring after nonpenetrating filtering surgery from January 1994 to December 2000. RESULTS: Both planar and nonplanar detachments were reported. Neither scrolls nor tears in the descemet membrane were observed in any patient. After viscocanalostomy (four patients), the detachment was generally noticed shortly after the procedure and the cornea maintained its clarity. After deep sclerectomy with a collagen implant (five patients), it developed weeks to months postoperatively with adjacent corneal edema. Four patients had descemetopexy. None required more than one procedure. However, at the last visit, two detachments persisted although they had diminished in size: one after viscocanalostomy and conservative treatment and one after descemetopexy after deep sclerectomy with a collagen implant. To date otherwise, no signs of significant corneal damage could be observed clinically nor by specular microscopy and pachymetry. CONCLUSIONS: The diagnosis of descemet membrane detachment can be easily overlooked or misdiagnosed. The clinical presentation, clinical course, and pathogenesis depend on the type of nonpenetrating filtering surgery performed. Ophthalmologists should be aware of this unusual complication, which is likely to be more common after nonpenetrating filtering surgery than after trabeculectomy. A period of observation before attempting descemetopexy is recommended.- - - - - - - - - - ranking = 1.6keywords = membrane (Clic here for more details about this article) |
5/17. Uveal effusion and angle-closure glaucoma in primary pulmonary hypertension.PURPOSE: To report a patient with uveal effusion and intermittent angle-closure glaucoma associated with primary pulmonary hypertension. methods: Observational case report. RESULTS: A 78-year-old woman with primary pulmonary hypertension noticed pain and decreased vision in her right eye. Ocular examination disclosed excessive dilation of conjunctival and episcleral veins and uveal effusion with annular ciliochoroidal detachment in both eyes. The right eye revealed corneal edema with folds in the descemet membrane, congested iris vessels, and a markedly shallow anterior chamber with a partially closed angle, corresponding to a recent attack of angle-closure glaucoma. Systemic treatment of her congestive heart failure with an angiotensin-II receptor antagonist resulted in a partial resolution of the uveal effusion and complete normalization of the anterior chamber depth. CONCLUSION: Primary pulmonary hypertension may cause uveal effusion, leading to a forward displacement of the lens-iris diaphragm and intermittent angle-closure glaucoma.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
6/17. Clinical and pathologic findings of aphakic peripheral corneal edema: Brown-McLean syndrome.Twenty-two patients (36 eyes) are reported with Brown-McLean syndrome, which consists of peripheral corneal edema associated with peripheral endothelial pigment deposits, usually after intracapsular cataract extraction. This group, the largest reported to date, had a spectrum of corneal alterations, those at the more severe end of the spectrum being both progressive and symptomatic. Some patients required medical and surgical treatment, including keratoplasty. Four corneas (two obtained surgically, two postmortem) were examined by light and electron microscopy (EM). Centrally, the corneas were relatively normal, but peripherally there were disintegrated endothelial cells with an abnormal posterior collagenous layer of Descemet's membrane. Scanning EM showed a somewhat distinct junction between the normal central endothelium and the diseased peripheral endothelium.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
7/17. corneal edema following argon laser iridotomy.Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
8/17. Permanent corneal edema resulting from the treatment of PTK corneal haze with mitomycin: a case report.A 39-year-old man underwent phototherapeutic keratectomy via excimer laser for recurrent corneal erosions secondary to basement membrane dystrophy with the subsequent development of irregular astigmatism and central stromal opacity. The cornea was scraped and treated with 0.02% mitomycin C using a total of 14 drops over a period of 6 days. corneal edema developed as a consequence of low endothelial cell count with dysfunctional cells. A corneal transplant restored acuity of 20/20 with binocular vision. It is believed that the underlying endothelium was exposed to toxic doses of mitomycin C sufficient to damage and destroy vital cells. The author reports this case not to criticize the use of mitomycin C in visually disabling post-phototherapeutic keratectomy or photorefractive keratectomy haze but to apprize colleagues of a potential pitfall. The author believes that the use of mitomycin C as a 1-time application at the end of surgery is a safe and valuable adjunct to recover vision when no other is known. However, continued topical application of mitomycin C to the central cornea, in the face of an epithelial defect or an epithelium with inadequate barrier function, increases the risk of endothelial damage.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
9/17. A case of developmental glaucoma presenting with abdominal colic and subnormal intraocular pressure.A healthy baby boy presented with abdominal colic. He was subsequently noted to have enlarged, edematous corneas. A clinical diagnosis of developmental glaucoma was made despite ocular hypotony. Trabeculectomies were designed to include peripheral cornea. This served as a biopsy to confirm the diagnosis and as a surgical treatment for the condition. Morphological examination of the outflow system revealed findings compatible with a diagnosis of developmental glaucoma: a hypoplastic trabecular meshwork which contained an abundance of abnormal collagenous tissue in the extracellular spaces and the presence of endothelial cells overlying a continuous collagenous membrane. In the iris stroma there were numerous abnormal blood vessels, with a paucity of mural contractile cells.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
10/17. Spontaneneous hydrops in pellucid marginal degeneration: documentation by OCT-III.Corneal pellucid marginal degeneration (PMCD) is an idiopathic condition characterized by non-inflammatory, non-ulcerative thinning of inferior peripheral cornea. PMCD has been reported occasionally complicated with hydrops owing to break in descemet membrane. We herein report a 38-year-old man, who presented with sudden dimness of vision in right eye. Clinical findings and Orbscan II were suggestive of PMCD in both eyes with hydrops in right eye. Slit-lamp and optical coherence tomography of right eye showed central descemet's detachment without any break. Patient underwent descemetopexy by isoexpansile C3F8 (14%) and is doing well with significant improvement in the hydrops.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
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