Cases reported "Glaucoma, Open-Angle"

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1/10. A false-positive Seidel test after Ahmed valve insertion.

    An 80-year-old monocular man with long-standing primary open angle glaucoma underwent successful filtering surgery in his sighted right eye in 1980. He subsequently developed a cataract and had an uncomplicated clear cornea phacoemulsification with posterior chamber intraocular lens in 1996. Post-operatively, the filtration bleb remained very avascular but shallowed; the intraocular pressure increased and remained uncontrolled despite maximally tolerated medical therapy. His vision improved to 6/7.5 and automated perimetry revealed a less than 5 degrees small central island of vision. His left eye was phthisical with no light perception.
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ranking = 1
keywords = phacoemulsification
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2/10. Transient intraocular pressure elevation after trabeculotomy and its occurrence with phacoemulsification and intraocular lens implantation.

    PURPOSE: To elucidate the characterization of intraocular pressure (IOP) spike after trabeculotomy, and after the combined procedure of phacoemulsification and aspiration (PEA) and intraocular lens (IOL) implantation. methods: Included in this study were 39 patients (53 eyes) with primary open-angle glaucoma with IOPs uncontrolled even with anti-glaucoma medication. We conducted a retrospective study for the following two groups: patients who underwent trabeculotomy alone (25 eyes) and patients undergoing trabeculotomy combined with PEA and implantation of an IOL (28 eyes). RESULTS: In 7 (28%) of the 25 eyes after trabeculotomy alone and 7 (25%) of the 28 eyes after the combined procedure, transient IOP elevation was found postoperatively. The incidence of hyphema-related IOP spike was significantly higher in eyes after trabeculotomy alone (16%) than after the combined procedure (0%). After removal of the blood present in the anterior chamber in eyes with hyphema-related IOP spikes, the IOP levels were well controlled. CONCLUSIONS: hyphema-related IOP spike is one of the common complications in eyes after trabeculotomy alone, and the combined procedure decreases the incidence of this complication. It is thought that removal of prolonged massive hyphema is effective as treatment for hyphema-related IOP spike.
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ranking = 5
keywords = phacoemulsification
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3/10. Acute haptic-induced pigmentary glaucoma with an AcrySof intraocular lens.

    A 49-year-old man had uneventful endocapsular phacoemulsification with in-the-bag implantation of an AcrySof SA60AT single-piece intraocular lens (IOL) (Alcon) in the right eye. Twenty-seven days postoperatively, he presented with ocular pain, intraocular pressure of 48 mm Hg, 360 degrees of hyperpigmentation of the trabecular meshwork, and iris pigment epithelial atrophy in the region of the upper temporal haptic, which had dislocated into the sulcus. The patient made an excellent recovery following IOL removal and exchange. Scanning electron microscopy of the explanted IOL demonstrated that the haptic had a rough lateral surface and anterolateral edge. We do not think this IOL should be implanted in the sulcus placement of the heptics. In this article, we report the case of a patient with an AcrySof SA60ATIOL (Alcon) who developed acute pigmentary glaucoma when the inferior haptic slipped out of the bag and came into contact with the pigmented iris and ciliary body.
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ranking = 1
keywords = phacoemulsification
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4/10. Bleeding during gonioscopy after deep sclerectomy.

    PURPOSE: To show a new complication after deep sclerectomy (DS). methods: We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. RESULTS: Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. CONCLUSION: These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.
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ranking = 1
keywords = phacoemulsification
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5/10. Dense membrane formation after combined phacoemulsification-trabeculectomy surgery.

    A case is reported of formation of a dense intraocular membrane following combined phacoemulsification-trabeculectomy surgery. The membrane might have originated from a loose piece of pigment epithelium or might have resulted from dense pigment deposition on a postoperative pupillary membrane. Postoperative membranes have been reported particularly after combined procedures. A combination of intensive topical dexamethasone, homatropine and a Nd:YAG laser was used to speed resolution of the membrane.
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ranking = 5
keywords = phacoemulsification
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6/10. vitrectomy-phacoemulsification-vitrectomy for the management of aqueous misdirection syndromes in phakic eyes.

    OBJECTIVE: To describe vitrectomy-phacoemulsification-vitrectomy, a sequential 3-step surgical approach, in the management of malignant glaucoma/aqueous misdirection syndromes in phakic eyes. DESIGN: Retrospective, noncomparative, interventional case series. PARTICIPANTS: Five eyes (4 angle-closure glaucoma and 1 open-angle glaucoma) of 5 patients with mean age of 66 years (range, 56-78). Four patients presented with aqueous misdirection syndrome and 1 patient presented for cataract extraction, having previously had malignant glaucoma in the fellow eye after phacoemulsification surgery. INTERVENTION: The operation performed had three steps: vitrectomy, phacoemulsification, and vitrectomy. Step 1: Preliminary vitrectomy involved limited core vitrectomy to "debulk" the vitreous and soften the eye. Step 2: phacoemulsification was performed in a standard manner. Step 3: Residual vitrectomy, zonulohyaloidectomy and peripheral iridectomy (if not already present) were performed to create a free communication between the posterior and anterior segments. MAIN OUTCOME MEASURES: intraocular pressure, visual acuity, biomicroscopic anterior chamber depth, and complications. RESULTS: The time interval between the onset of malignant glaucoma and surgery ranged from 2 weeks to 3 months. All 4 patients with aqueous misdirection syndrome had relief of the aqueous misdirection postoperatively with anterior chamber deepening. Intraocular pressures on day 1 ranged from 6 to 28 mmHg (mean 15.6, mmHg), and at the last visit ranged from 8 to 30 mmHg (mean, 20.4 mmHg). One eye developed an early choroidal serosanguinous effusion requiring drainage. CONCLUSIONS: The vitrectomy-phacoemulsification-vitrectomy approach was effective in this pilot series in the management of aqueous misdirection syndromes and malignant glaucoma in phakic eyes.
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ranking = 8
keywords = phacoemulsification
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7/10. Anterior segment imaging using optical coherence tomography and ultrasound biomicroscopy in secondary pigmentary glaucoma associated with in-the-bag intraocular lens.

    A 43-year-old man with high myopia developed unilateral pigmentary glaucoma with recurrent episodes of painless blurred vision in the left eye following uneventful phacoemulsification. Bilateral cataract surgery was performed with capsular bag implantation of a 4.00 diopter AcrySof MA60 intraocular lens (IOL) (Alcon laboratories) followed by a neodymium:YAG laser capsulotomy. Secondary iatrogenic dispersion syndrome in the left eye with subsequent intraocular pressure elevation was suspected in the presence of anterior chamber pigmented cells, circular epithelial iris loss around the pupil, and trabecular hyperpigmentation. Close contact between the edge of the IOL and the posterior pigmented iris epithelium, which was clinically suggested by anterior biomicroscopy, was documented by ultrasound biomicroscopy and optical coherence tomography of the anterior segment.
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ranking = 1
keywords = phacoemulsification
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8/10. Reduced vision secondary to pigmented cellular membranes on silicone intraocular lenses.

    PURPOSE: Visually significant, pigmented cellular membranes may form on intraocular lenses after implantation. We studied a series of patients to determine the onset, visual significance, treatment, and recurrent nature of these pigmented membranes in patients who underwent surgery with silicone lens implantation. methods: In nine eyes (eight patients) with visually significant pigmented cellular membranes on their Allergan Medical Optics (Irvine, california) silicone intraocular lenses (model SI18NGB or SI26NB), eight underwent combined phacoemulsification, intraocular lens implantation, and trabeculectomy; one underwent phacoemulsification and lens implantation only. We reviewed medical records to identify preoperative, operative, and postoperative similarities and differences in care. Clinical examinations and slit-lamp photographs, over an average of 21.3 /- 7.2 months (range, 11 to 31 months), documented the effects of different treatment modalities. RESULTS: The patients sought treatment ten to 20 weeks (mean, 15 weeks) postoperatively. Except for the cellular membranes, each eye was without evidence of inflammation or cystoid macular edema. Subjective complaints decreased, and best-corrected Snellen visual acuity improved with topical corticosteroid therapy alone. Pretreatment best-corrected visual acuities ranged from 20/40 to 20/400 (mean, 20/70 using Snellen fractions) and improved two to eight (mean, five) Snellen lines, to a range of 20/20 to 20/50 (mean, 20/25). All nine eyes had recurrence of the membranes after treatment terminated and required a maintenance regimen of corticosteroid eyedrops. CONCLUSION: The pigmented cellular membranes observed on these silicone lenses were visually significant to each patient. The membranes resolved and visual acuity improved with topical corticosteroid treatment alone but recurred in all patients on cessation of treatment.
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ranking = 2
keywords = phacoemulsification
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9/10. Cracked cartridges during foldable intraocular lens implantation.

    We describe five routine phacoemulsification procedures in which a longitudinal split in the injector cartridge occurred during foldable intraocular lens (IOL) implantation. In some cases, this was associated with a broken lens. All lenses (STAAR AA-4203VF) were folded, and implantation was attempted through a 3.5 mm corneal or scleral incision. Visual outcome was not adversely affected in any case. The systems for introducing foldable IOLs have not been perfected, and further refinements in materials and techniques are required.
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ranking = 1
keywords = phacoemulsification
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10/10. Recurrent severe hypotony after cataract surgery in an eye with previous trabeculectomy.

    This report describes a patient who developed severe recurrent hypotony after uneventful phacoemulsification and intraocular lens (IOL) implantation 4 years after trabeculectomy. Hypotony was first noticed 1 month postoperatively and treated successfully with topical steroids. However, it reappeared 2 months later and slowly subsided only with steroid and cycloplegic treatment. There was no anterior chamber shallowing, leakage, or signs of inflammation. The cause of hypotony in this patient remains unknown. One possible explanation is subclinical postoperative inflammation as a foreign-body reaction to the IOL.
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ranking = 1
keywords = phacoemulsification
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