Cases reported "Acute Disease"

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1/11. Acute suprachoroidal hemorrhage during phacoemulsification.

    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.
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ranking = 1
keywords = phacoemulsification
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2/11. Postoperative inflammation in a patient with multiple sclerosis.

    We report a 51-year old white woman with a history of relapsing episodes of multiple sclerosis (MS) who developed acute anterior uveitis 11 days after having uneventful phacoemulsification with posterior chamber intraocular lens implantation. Topical corticosteroids relieved the pain and inflammation within hours. A week after the episode of anterior uveitis, the patient had a severe systemic relapse of MS. Acute inflammation in MS patients during the postoperative period may be noninfectious and could be a prodrome for a relapse of MS.
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ranking = 0.2
keywords = phacoemulsification
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3/11. Acute bilateral postoperative endophthalmitis in a HLA-DQ5-positive patient: possible susceptibility to infections.

    An unusual case of bilateral acute endophthalmitis in association with the HLA-DQ5 histocompatibility antigen is reported. A 35-year-old woman with high myopia and cataracts in both eyes underwent phacoemulsification procedures performed in separate sessions using different viscoelastic substances and following the same strict prophylactic measures. After each surgical procedure, she developed S. epidermidis acute endophthalmitis in the right eye and propionibacterium acnes acute endophthalmitis in the left eye; both were successfully treated with capsular bag irrigation and intracameral vancomycin (1 mg/0.1 mL). She tested positive for the HLA-DQ5 (DQ1), DQ2 antigen. The question is raised as to whether the HLA-DQ5 histocompatibility antigen may be a predisposing factor for both staphylococcal and P. Acnes acute endophthalmitis. A multicenter prospective study is proposed to identify this HLA antigen in all patients scheduled for cataract surgery who have a history of postoperative endophthalmitis in the fellow eye.
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ranking = 0.2
keywords = phacoemulsification
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4/11. Acute postoperative endophthalmitis caused by actinomyces neuii.

    PURPOSE: To describe a case of acute postoperative endophthalmitis caused by actinomyces neuii after uncomplicated phacoemulsification with posterior chamber intraocular lens implant. methods: Interventional case report. A 58-year-old male underwent phacoemulsification, right eye, with posterior chamber intraocular lens implant. On postoperative day 6, he presented with pain, redness, and decreased visual acuity, right eye, and was found to have endophthalmitis. RESULTS: Vitreous cultures revealed the gram-positive, anaerobe actinomyces neuii. After appropriate intraocular, periocular, topical, and systemic therapy, the infection cleared, but the vision of the patient never improved as a result of a central vein occlusion. CONCLUSION: actinomyces species can rarely cause postoperative endophthalmitis, and it should be considered in cases of severe postoperative intraocular inflammation.
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ranking = 0.4
keywords = phacoemulsification
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5/11. Bilateral acute postoperative retinal detachment after cataract extraction: case report and review of the literature.

    A 57-year-old white man had extracapsular cataract extraction complicated by vitreous loss. On postoperative day 1, he was noted to have a total retinal detachment (RD) with vitreous hemorrhage. No predisposing anatomic risk factors were present except for the vitreous loss. During the RD repair, 2 small superior tears were discovered. Eleven months later, the patient had uneventful phacoemulsification in the fellow eye. On postoperative day 1, he again had a total RD with a superior retinal tear. Meticulous retinal evaluation had been performed preoperatively, and no holes or tears were discovered. The RD was repaired, and the best corrected visual acuity at the last examination was 20/40 in both eyes.
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ranking = 0.2
keywords = phacoemulsification
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6/11. Acute suprachoroidal hemorrhage during clear corneal phacoemulsification using topical and intracameral anesthesia.

    Shallowing of the anterior chamber and hardening of the eye occurred just before commencement of irrigation/aspiration of cortex in an 80-year-old man having temporal clear corneal cataract surgery under topical and intracameral anesthesia. Nucleus removal had been completed and was uneventful. Intraoperative fundus examination with the indirect ophthalmoscope disclosed a choroidal hemorrhage. The wound was immediately closed with sutures, and intravenous mannitol was administered. The hemorrhage remained localized. The red reflex remained unchanged at all times, and there was no prolapse of intraocular contents. A high index of suspicion is critical to the early diagnosis and management of choroidal hemorrhage.
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ranking = 0.8
keywords = phacoemulsification
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7/11. Postoperative morganella morganii endophthalmitis associated with subclinical urinary tract infection.

    We report a case of morganella morganii acute endophthalmitis following clear corneal phacoemulsification cataract surgery in which a coincident asymptomatic chronic urinary tract infection was detected postoperatively. morganella morganii is a gram-negative bacillus that inhabits the gastrointestinal tract and is part of the normal fecal flora. It is an opportunistic pathogen usually encountered in postoperative and nosocomial settings, causing urinary tract and wound infections. Chronic urinary tract infection may be a risk factor for postoperative endophthalmitis. A dipstick urinalysis before elective cataract surgery in elderly patients with a history of recurrent urinary tract infections may be considered.
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ranking = 0.2
keywords = phacoemulsification
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8/11. Unusual presentation of angle-closure glaucoma treated by phacoemulsification.

    We report the case of a 70-year-old woman with a history of acute primary angle-closure glaucoma (PACG) in the left eye who, 2 hours after a fundus examination and mydriasis, experienced acutely elevated intraocular pressure (IOP) up to 40 mm Hg in the presence of fully dilated pupil and a patent iridotomy. gonioscopy revealed appositional angle closure in 3 quadrants. After medical control of the IOP, sutureless cataract surgery was performed, including clear corneal incision, phacoemulsification, and soft acrylic posterior chamber intraocular lens (IOL) implantation. Eighteen months after the operation, improvement of visual acuity, widening of anterior chamber angle, and deepening of anterior chamber depth were found. Intraocular pressures are now normal without medication, even after mydriasis. Modern cataract surgery is an effective treatment for selected patients with appositional angle closure and IOP elevation after acute PACG.
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ranking = 1
keywords = phacoemulsification
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9/11. Treatment of acute postoperative endophthalmitis without hospital admission: do we dare?

    INTRODUCTION: We report the successful management of a culture positive case of APE, without the need for hospital admission and discuss the merits of this strategy. CASE: A 79-year-old lady underwent uncomplicated cataract surgery in her left eye using phacoemulsification under topical and intracameral anaesthesia. She reported to eye casualty four days later, with pain and vision reduced to 6/60 in the left eye. A diagnosis of acute postoperative endophthalmitis was made. A vitreous biopsy was performed and antibiotics injected intravitreally on the same day. The patient was discharged on oral and topical antibiotics on the same day and reviewed subsequently in the clinic as an outpatient. Vision steadily improved and at one month following intravitreal injection her vision had improved to 6/9 unaided. The cornea remained clear, with a quiet anterior chamber and a clear view of the fundus. DISCUSSION: Current management of acute postoperative endophthalmitis in the UK includes a vitreous biopsy, administration of antibiotics into the vitreous cavity, admission of patients to a hospital ward and daily review. It is our opinion that under the circumstances where patients are fit and well, without significant co-morbidity, hospital admission is not necessary as demonstrated by the patient in our report.
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ranking = 0.2
keywords = phacoemulsification
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10/11. Acute intraoperative suprachoroidal hemorrhage in extracapsular cataract surgery.

    The incidence of acute intraoperative suprachoroidal hemorrhage (AISH) was studied in 2,839 consecutive extracapsular cataract extraction cases operated by nucleus expression and phacoemulsification. Twenty-five eyes (0.9%) were identified with this complication. Acute intraoperative suprachoroidal hemorrhage was defined as the acute accumulation of fluid in the suprachoroidal space which resulted from a presumed suprachoroidal hemorrhage at the time of surgery. Preoperative risk factors for the development of this complication included advanced age and the presence of glaucoma. sex, controlled hypertension, long axial length, and method of cataract removal could not be identified as significant risk factors. Recognition of the early signs of AISH and initiation of rapid wound closure followed by the completion of secondary operations performed the next day helped to meet the surgical objective and to provide excellent visual results, with 21 eyes (84%) having a visual acuity of 20/30 or better.
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ranking = 0.2
keywords = phacoemulsification
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