| Three patients had a pars plana vitrectomy to remove retained nuclei within 72 hours after phacoemulsification performed by a surgeon making the transition from extra-capsular cataract extraction to phacoemulsification. After vitrectomy, the nuclei were brought to the midvitreous cavity from the retinal surface with a posterior segment phacofragmenter, emulsified, and completely removed. Then, a posterior chamber intraocular lens was implanted in the sulcus through the previous cataract surgery incision and remained well centered postoperatively. postoperative complications included cystoid macular edema in 1 patient and choroidal detachment in another. No other complications were detected. Final visual acuity ranged from 20/60 to 20/30. ( info) |
2/152. Transscleral fixation of foldable intraocular lens after pars plana lensectomy in eyes with a subluxated lens. Two patients had a subluxated crystalline lens: one with Marfan's syndrome and the other with traumatic cataract. A pars plana lensectomy with transscleral fixation of a foldable silicone intraocular lens rather than a conventional poly(methyl methacrylate) lens was performed. Excellent, rapid visual rehabilitation was obtained using this small incision technique. ( info) |
3/152. 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) |
4/152. Elastic cord-induced cyclodialysis cleft and hypotony maculopathy. We describe a case of hypotony maculopathy in which hypotony was due to a cyclodialysis cleft produced by an elastic cord injury. Sixteen months after being hit with an elastic cord, a 43-year-old white male presented with progressive loss of vision in the right eye. The visual acuity in the right eye was 1/200 due, in part, to a subluxated and cataractous lens. The intraocular pressure (IOP) was 4 mm Hg. gonioscopy revealed a cyclodialysis cleft at the 2 o'clock position, and fundus examination showed hypotony maculopathy. The patient underwent pars plana vitrectomy, pars plana lensectomy, repair of the cyclodialysis cleft, placement of an anterior chamber intraocular lens, and tightly sutured trabeculectomy without antimetabolite. Sixteen months following surgery, visual acuity was stable at 20/60 and IOP was 11 mm Hg but the chorioretinal folds persisted. ( info) |
5/152. Traumatic subconjunctival dislocation of the crystalline lens and its surgical management. The authors report a case of a 40-year-old female who had sustained a blunt ocular trauma resulting in anterior scleral rupture and subconjunctival dislocation of the crystalline lens. Anterior segment ultrasound aided in the diagnosis. Surgical exploration revealed a 6 mm long anterior scleral rupture which was repaired. Postoperatively the patient had a best corrected visual acuity of 6/18. ( info) |
| OBJECTIVE: The authors describe two cases of isolated sulfite oxidase deficiency found in one family. This is a rare autosomal-recessive disorder presenting at birth with seizures, severe neurologic disease, and ectopia lentis. It can be easily missed with metabolic screening; however, the finding of lens subluxation stresses the importance of ophthalmic assessment in making the diagnosis. DESIGN: Two observational case reports. INTERVENTION/methods: Ophthalmic assessment, biochemical assay for specific urinary and plasma metabolites, magnetic resonance imaging, and gene sequencing were used to make the diagnosis of the disease in the proband. The diagnosis was subsequently recognized in a previously affected sibling after the postmortem neuropathology was reviewed. mutation analysis was performed on cultured fibroblasts from the proband to identify and categorize the specific mutation responsible for the disease in the family. From this, future prenatal detection of sulfite oxidase deficiency is possible. MAIN OUTCOME MEASURES: The diagnosis of sulfite oxidase deficiency was established in this family, enabling appropriate genetic counseling and recurrence risk estimation. RESULTS: Point mutations were found in both alleles of the sulfite oxidase gene in the proband. The first is a 623C-->A mutation, which predicts an A208D substitution, and the second is a 1109C-->A, which predicts an S370Y substitution. Both residues A208D and S370Y are critical for sulfite oxidase activity. CONCLUSIONS: Isolated sulfite oxidase deficiency is a rare heritable disease for which mutation analysis can allow accurate prenatal screening. It often is difficult to diagnose by clinical presentation alone, but the critical finding of lens subluxation accompanying seizures and diffuse neurologic disease in an infant should alert the physician to the diagnosis. ( info) |
7/152. Transpupillary argon laser cyclophotocoagulation in the treatment of traumatic glaucoma. PURPOSE: A patient with traumatic glaucoma who underwent transpupillary argon laser cyclophotocoagulation for management of uncontrolled intraocular pressure (IOP) despite maximally tolerated medical therapy is discussed. methods: In this patient, pars plana vitrectomy, lensectomy, and removal of 180 degrees of necrotic iris had been performed after a blunt trauma with a bungee cord. Six weeks after surgery, the patient presented with an IOP of 40 mmHg despite therapy with three aqueous suppressants. The patient refused further surgical intervention and opted for transpupillary argon laser cyclophotocoagulation (talc). The laser setting was 1,000 mW, with a 50-micron spot size for 0.1 second. A total of 293 laser exposures through a Goldmann contact lens was administered to all visible ciliary processes over 180 degrees where iris structures were absent. RESULTS: Ten weeks after talc, the patient's IOP remained controlled with medications at 16 mmHg, and visual acuity had improved to 20/25 with an aphakic contact lens. CONCLUSION: In selected patients whose ciliary processes are visible with indirect gonioscopy due to the defect in the iris, talc may be an effective alternative cyclodestructive procedure to lower IOP when conventional medical or laser treatments are not successful. ( info) |
8/152. eye injuries associated with paintball guns. AIMS: This study identifies the various types of ocular injuries sustained after blunt trauma with a paintball fired from a paintball gun. methods: We report two patients who sustained injury to an eye after being shot with a paintball and review similar cases presented in the world literature. The type of injury sustained and the final visual acuity obtained after a paintball hit to the eye are examined. RESULTS: The two boys presented were hit in the eye with a paintball resulting in lens subluxation, hyphema formation, and angle recession. cataract extraction was required in both cases. One boy also had an optic neuropathy and a choroidal rupture. A review of the literature reveals a variety of injuries occur after a paintball hit to the eye. In some of the cases, the damage to the eye has led to loss of vision and at times loss of the eye. CONCLUSIONS: Paintball guns can cause devastating ocular injuries. Wearing protective eye and face gear during this game is essential. We recommend that an anti-fog face mask with a one-piece polycarbonate eye shield be worn by those participating in paintball games. ( info) |
| PURPOSE: To determine the successful treatment of unilateral phacolytic glaucoma by vitrectomy and trabeculectomy in a patient with homocystinuria whose lens had dislocated into the vitreous at least 15 years earlier. methods: In a 32-year-old woman with homocystinuria, bilateral dislocation of the lens into the vitreous, and phacolytic glaucoma in her left eye a three-port pars plana vitrectomy was performed with the patient under general anesthesia. The lens was removed and a trabeculectomy fashioned. Special precautions for general anesthesia included preoperative aspirin and compression stockings for thromboembolic prophylaxis and intraoperative dextrose infusion, 5%, to maintain intravascular volume and prevent hypoglycemia. RESULTS: The intraocular pressure and uveitis resolved postoperatively with improvement in the visual acuity and intraocular pressure, which returned to normal without further treatment. CONCLUSIONS: Phacolytic glaucoma is best resolved by removal of the exciting lens material. Pars plana vitrectomy with the patient under general anesthesia can be carried out safely despite the risks traditionally associated with homocystinuria. ( info) |
| BACKGROUND: weill-marchesani syndrome is a rare systemic connective tissue disorder consisting of brachymorphy, brachydactyly, ectopia lentis, spherophakia and glaucoma. methods: We report 6 patients with weill-marchesani syndrome (with or without ocular involvement) in three generations, identified by screening 26 members of two families. This is the largest family in the literature showing an autosomal dominant pattern of inheritance. RESULTS: Presenile vitreous liquefaction was present in all the younger cases. weill-marchesani syndrome was full-blown in two cases in the third generation, in which asymmetrical axial length and glaucomatous damage were present. To our knowledge this is the first report regarding asymmetrical axial length and glaucomatous damage, and presenile vitreous liquefaction in weill-marchesani syndrome with or without ocular involvement. CONCLUSIONS: The longer axial length might be the precursor of impending severe glaucomatous damage. Presenile vitreous liquefaction in subtle young cases should alert the physician to the diagnosis of weill-marchesani syndrome on screening of the family members. ( info) |