1/74. Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia.A 69-year-old woman with chronic lymphocytic leukemia developed segmental iris atrophy and iridocyclitis after routine surgery for exotropia. Both the clinical picture and fluorescein angiogram indicated anterior segment ischemia. It is postulated that this was related to hyperviscosity of the blood caused by a high white blood cell count (114,000/cu mm). The possibility of anterior segment ischemia should be kept in mind when contemplating strabismus or retinal detachment surgery in the presence of hematologic disorders likely to increase blood viscosity. In these cases a minimal amount of surgery should be done with proper supportive therapy. strabismus surgery should be done in stages allowing for hemodynamic compensation between procedures.- - - - - - - - - - ranking = 1keywords = iris (Clic here for more details about this article) |
2/74. Incising the thick retrolental fibrovascular tissue with a hooked sclerotome in persistent hyperplastic primary vitreous.A technique for incising thick retrolental fibrovascular tissue and extensive cyclitic membrane is reported in a case of anterior persistent hyperplastic primary vitreous. A membranectomy was performed in a 1-month-old post-lensectomy baby via a limbal approach. A sclerotome tip was hooked to cut through an extremely thick fibrovascular tissue by rotating the sclerotome by its grip. Sutherland microscissors (Grieshaber, switzerland) and a vitrectomy cutter were used for further membranectomy. The baby was followed-up until age 18 months. A total of 3 membranectomy sessions were required because of rapid cyclitic membrane formation, severe centripetal retraction of the membrane on the ciliary processes, and posterior synechia. Thorough membranectomy and cutting the iris edge maintained a clear pupillary area during the 13-month postoperative period. Extremely thick retrolental fibrovascular tissue is a challenging condition that can be dealt with by delicate instrumentation.- - - - - - - - - - ranking = 0.2keywords = iris (Clic here for more details about this article) |
3/74. Ultrasound biomicroscopy in a case of anterior hyaloidal fibrovascular proliferation.The authors describe the use of ultrasound biomicroscopy for the diagnosis and preoperative evaluation of anterior hyaloidal fibrovascular proliferation (AHFVP). Ultrasound biomicroscopy was performed on a 62-year-old man who presented after diabetic vitrectomy with a hyphema, vitreous hemorrhage, and hypotony. Images in the temporal and nasal meridians revealed thickened tissue bands extending from the peripheral retina to the ciliary body, and from the pars plicata to the posterior surface of the iris. A ciliary body epithelium detachment was seen in the nasal meridian. Ultrasound biomicroscopy demonstrated to be a potential tool in the diagnosis and surgical management of AHFVP.- - - - - - - - - - ranking = 0.2keywords = iris (Clic here for more details about this article) |
4/74. Two remarkable events in the field of intraocular foreign body: (1) The reversal of siderosis bulbi. (2) The spontaneous extrusion of an intraocular copper foreign body.Two unusual events concerning intraocular foreign bodies are presented. The first patient had an occult or unsuspected intraocular foreign body. He showed iridoplegia with mydriasis, siderosis iridis, and an intraocular piece of iron lying posteriorly near the retina. The foreign body was removed and the patient regained normal iris color and pupillary activity. His vision remains 20/15 six years postoperatively dispite ensuing retinal detachment one year after removal of the foreign body. The second patient was a young boy injured by a blasting cap explosion. He lost one eye from the injury and had a piece of intraocular brass in his left eye. In spite of the development of chalcosis and a mature cataract the lens gradually shrank in the pupillary space permitting a clear aphakic area and 20/25 vision. The brass fragment migrated forward and inferiorly and was finally extruded under the conjunctiva five years later, where it was removed and chemically analyzed by x-ray diffraction.- - - - - - - - - - ranking = 0.2keywords = iris (Clic here for more details about this article) |
5/74. Uveitis masquerade syndromes.BACKGROUND: Incorrect diagnosis of the uveitic masquerade syndromes (UMS) may have severe consequences. In this study, the frequency, clinical manifestations, and informative diagnostic tests for UMS are described. DESIGN: Retrospective observational case series. PARTICIPANTS: Forty patients with UMS were identified in a cohort of 828 consecutive patients with uveitis. The mean follow-up was 4.5 years. methods: A review of clinical, laboratory, photographic, and angiographic records was performed. MAIN OUTCOME MEASURES: Clinical features, associated systemic diseases, diagnostic procedures and their role in the diagnostic process, and systemic and visual outcomes. RESULTS: Nineteen patients had intraocular malignancy (48% of all with UMS; 2.3% of all with uveitis), mainly intraocular lymphoma (n = 13) and leukemia (n = 3). The ophthalmologist was the first to recognize malignant disease in 11 of 19 patients (58%). Of 21 patients with nonmalignant UMS, 10 had an ocular vascular disease and 5 a hereditary ocular disorder. The patients with malignant UMS were older than those with nonmalignant UMS (average age, 50 vs 44 years, P: < 0.05). During follow-up, 9 of 19 patients with malignant UMS died. The most informative diagnostic procedure for malignant UMS was intraocular fluid analysis; for nonmalignant UMS, fluorescein angiography. The cytologic analysis of intraocular fluids yielded the best results for diagnosing intraocular malignancies (7 of 11 patients, 64%); the association of negative cytologic results with the recent administration of systemic corticosteroids was noted. immunophenotyping of the aqueous confirmed the diagnosis of hematologic malignancy for 3 of 5 patients examined. panuveitis was the most frequent manifestation of malignant UMS. Intraocular lymphomas presented with isolated vitreitis (n = 6), chorioretinal lesions (n = 5) and iris infiltration (n = 2). Clinical presentation of nonmalignant UMS was diverse but consisted mainly of abnormalities of the retinal vasculature. CONCLUSIONS: UMS was diagnosed in 5% of the patients with uveitis at a tertiary center. Despite the variety of underlying disorders and different clinical presentations, a high frequency of malignant and vascular diseases was found. awareness of the clinical manifestations of UMS and application of the correct diagnostic procedures should promote timely diagnosis and treatment, which are essential not only for visual acuity but also for the life of the patient.- - - - - - - - - - ranking = 0.2keywords = iris (Clic here for more details about this article) |
6/74. Vascular anastomoses between the iris and persistent hyperplastic primary vitreous.Prominent radial iris blood vessels created small but definite pupillary notches in five children with persistent hyperplastic primary vitreous and persistence of the tunica vasculosa lentis. Detection of these abnormal iris vessels suggested the presence of persistent hyperplastic primary vitreous and related syndromes even when the diagnosis was obscured by the presence of an opaque lens. These vessels represented early developmental arrest and may have been associated with abnormal development of the macula and optic nerve. Surgical and amblyopia therapy, therefore, may not provide useful vision, and should be undertaken with caution.- - - - - - - - - - ranking = 1.2keywords = iris (Clic here for more details about this article) |
7/74. Juvenile xanthogranuloma: concurrent involvement of skin and eye.PURPOSE: To report a novel presentation of ocular involvement in juvenile xanthogranuloma (JXG). CASE REPORT: A 1-year-old boy with the concurrent skin and eye involvement of JXG is presented. The ocular problems included spontaneous hyphema, secondary glaucoma, and 360-degree involvement of the limbus, iris, and angle. RESULTS: To reduce the intraocular pressure (IOP), treatment was started with drops of timolol, betamethasone, and atropine and acetazolamide suspension. After 6 months of medical treatment, the skin lesions did not change, but the iris lesion enlarged without hyphema. The IOP in the right eye was controlled by the medications. CONCLUSION: Although JXG is an uncommon disease, it is one of the most important causes of spontaneous hyphema in children. iris involvement, spontaneous hyphema, and secondary glaucoma are the most common ocular problems. Corneal involvement often is characterized by a yellowish protrusion of the limbus along with blood staining of recurrent hyphema and elevated IOP. In this report, we describe an unusual case of JXG with 360-degree limbus, iris, and angle involvement. To our knowledge, this is the first report in the medical literature of 360-degree limbus involvement in JXG.- - - - - - - - - - ranking = 0.6keywords = iris (Clic here for more details about this article) |
8/74. Pinwheel rubeosis iridis following argon laser coreoplasty.Rubeosis iridis developed in the right eye of a 10-year-old boy with Marfan's syndrome. This eye had a chronic retinal detachment which we could study adequately only after coreoplasty of the iris was carried out with the argon laser. The purpose of this paper is to describe our experience using the argon laser for coreoplasty, and to report the unique pinwheel configuration of the iris neovascularization that developed around the laser lesions. We believe the rubeosis iridis was most likely a sequelae of the chronic retinal detachment, and that the atrophic laser lesions probably acted as templates for the neovascularization, giving rise to its peculiar configuration.- - - - - - - - - - ranking = 0.4keywords = iris (Clic here for more details about this article) |
9/74. Inadvertent injection of corticosteroid into the choroidal vasculature.A 21-year-old woman with pars planitis was treated with a subtenon's depot corticosteroid injection that was complicated by the appearance of the corticosteroid suspension within the choroidal vasculature. White, flocculent material was observed in the anterior chamber and 24 hours later this settled on the iris surface. Similar material was located in the major choroidal vessels. Two months after the incident, the choroid was normal appearing but the pars planitis was unchanged.- - - - - - - - - - ranking = 0.2keywords = iris (Clic here for more details about this article) |
10/74. Myotonic pupils in charcot-marie-tooth disease. Successful relief of symptoms with 0.025% pilocarpine.Twenty-seven members of a family with dominantly inherited charcot-marie-tooth disease (CMTD) were examined. Fifteen members had CMTD and 13 of these had varying amounts of myotonic pupillary abnormalities similar in some ways to Adie tonic pupil syndrome. Those with graver neurologic disease showed greater pupillary abnormalities. Ten of the 15 patients had pupillary constriction with methacholine chloride (Mecholyl) and some of these had extensive iris atrophy. Several affected patients received symptomatic relief from 0.025% pilocarpine. Seven other patients with CMTD who were not related to our initial family were checked for myotonic pupils; two had findings similar to our initial family. Pupillary abnormalities in certain patients with CMTD appear secondary to a parasympathetic denervation of the iris sphincter and ciliary muscle, as shown by a positive methacholine test, and probably represent part of the autonomic nervous system dysfunction associated with the polyneuropathy in CMTD.- - - - - - - - - - ranking = 0.4keywords = iris (Clic here for more details about this article) |
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