1/205. Suspected ciliary block associated with Viscoat use. Ciliary block or malignant glaucoma is thought to be caused by the misdirection of aqueous into the vitreous. It is refractory to medical treatment and often requires vitreous aspiration. We present a case of ciliary block glaucoma caused by sodium chondroitin sulfate-sodium hyaluronate (Viscoat) gaining access to the vitreous through an unsuspected, small zonular dialysis. vitrectomy performed through a peripheral iridectomy resolved this severe condition. ( info) |
| OBJECTIVE: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. DESIGN: Two interventional case reports. INTERVENTION: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. MAIN OUTCOME MEASURES: Axial anterior chamber depth and intraocular pressure (IOP). RESULTS: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. CONCLUSION: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma. ( info) |
3/205. Acute angle closure glaucoma precipitated by intranasal application of cocaine. We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication. ( info) |
| Laser photocoagulation has become the standard for treatment of retinopathy of prematurity. In general, it has been found to be a safe and effective means of retinal ablation. We report a case of angle-closure glaucoma in an infant after diode laser treatment for retinopathy of prematurity, which required bilateral surgical peripheral iridectomies. ( info) |
5/205. Pars plana vitrectomy during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. PURPOSE: To report the use of pars plana vitrectomy as a prophylactic measure during cataract surgery for prevention of aqueous misdirection in high-risk fellow eyes. methods: Chart review of two patients with severe aqueous misdirection in their first eye at the time of cataract surgery that only responded to pars plana vitrectomy. RESULTS: In both patients, cataract extraction with posterior chamber intraocular lens implantation was initially performed after pars plana vitrectomy, with the creation of hyaloido-capsulo-iridotomy to establish a communication between the vitreous cavity and the anterior chamber. CONCLUSION: Pars plana vitrectomy as a prophylactic measure during cataract surgery may have a beneficial role in fellow eyes at high risk for developing aqueous misdirection. ( info) |
6/205. Laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to iris cysts. PURPOSE: To report laser iridocystotomy for bilateral acute angle-closure glaucoma secondary to peripheral iris cysts. METHOD: Case report. RESULTS: In a 55-year-old man with increased bilateral intraocular pressure, gonioscopy revealed varied angle narrowing. Bilateral angle-closure glaucoma secondary to peripheral iris cysts was diagnosed by ultrasound biomicroscopy. The peripheral iris cysts could not be seen in mydriasis by gonioscopy. Therefore, we decided to perform laser iridocystotomy with argon and Nd:YAG laser. Collapse of the cysts after laser treatment was demonstrated by ultrasound biomicroscopy. At follow-up, 9 months after laser treatment, intraocular pressure had dropped below 20 mm Hg in both eyes without further therapy. The iris cysts did not recur, which was demonstrated by ultrasound biomicroscopy. CONCLUSIONS: Peripheral iris cysts may produce angle closure and may cause secondary angle-closure glaucoma. If transpupillary laser cystotomy is not possible, laser iridocystotomy may produce collapse of the iris cysts and correction of secondary angle closure. ( info) |
7/205. Acute angle-closure glaucoma after hyperopic laser in situ keratomileusis. We report a case of acute angle-closure glaucoma 1 year after hyperopic laser in situ keratomileusis (LASIK). The glaucoma was resolved with laser iridotomy, and a prophylactic iridotomy was performed in the fellow eye. corneal topography was performed 2, 5, and 18 weeks after the acute episode. A myopic shift occurred after the episode and resolved within 3 months. Hyperopic patients with narrow angles are at risk for angle closure and should be carefully monitored. ( info) |
8/205. Angle-closure glaucoma as a presumed presenting sign in patients with syphilis. BACKGROUND: Angle-closure glaucoma is a well-known sequel to syphilitic interstitial keratitis. This study describes angle-closure glaucoma in the absence of corneal opacity as a presumed presenting sign of syphilis. CASES: Two patients presented with angle-closure glaucoma with high peripheral anterior synechiae to the level over Schwalbe's line extending the whole circumference of the angle. Neither corneal opacity nor aqueous inflammation was present. Diffuse or localized retinochoroidal degeneration with pigmentation was found in 1 eye of 1 patient and in both eyes of the other patient. OBSERVATIONS: fluorescein angiography revealed dotty retinal pigment epithelial damage even in normal appearing areas of the fundus. The patients showed a positive test for treponema pallidum hemagglutination and also a low titer of serological tests for syphilis. No systemic activity, such as skin rashes, had been noted. CONCLUSIONS: syphilis should be considered in patients presenting high peripheral anterior synechiae involving the whole circumference of the angle even in the absence of preceding interstitial keratitis. ( info) |
9/205. Inadvertent corneal indentation can cause artifactitious widening of the iridocorneal angle on ultrasound biomicroscopy. A 70-year-old Asian female with narrow angles underwent ultrasound biomicroscopy (UBM) darkroom provocative testing. The angle was narrow under light conditions and occluded in the dark, except for the inferior quadrant where the angle was wide and the iris concave. This was reproducible in four quadrants with the use of a small UBM eye cup but not the large one. A small eye cup can indent the cornea, resulting in artifactitious angle widenening. Care must be taken when using the small eye cup not to press on the cornea. ( info) |
| PURPOSE: To report the results of primary phacoemulsification to treat uncontrolled angle-closure glaucoma. SETTING: private practice and teaching hospital department. methods: This retrospective interventional case series assessed 3 patients having phacoemulsification and posterior chamber intraocular lens implantation for uncontrolled intraocular pressure (IOP) after acute primary angle-closure glaucoma. RESULTS: intraocular pressure control was achieved in all patients postoperatively. CONCLUSIONS: Primary phacoemulsification with the option of future trabeculectomy should be considered in selected patients with persistent appositional angle closure and uncontrolled IOP after angle-closure glaucoma. ( info) |