Cases reported "Glaucoma"

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1/9. Bilateral cataract surgery combined with implantation of a brown diaphragm intraocular lens after trabeculectomy for congenital aniridia.

    A 17-year-old male patient was referred for poorly controlled glaucoma on maximal medication, congenital aniridia, cataract, nystagmus, and hypoplasia of the macula. A bilateral filtering procedure was performed to control the glaucoma. Three months later, a slow motion phacoemulsification and implantation of a brown diaphragm intraocular lens (IOL) was attempted. Despite the presence of nystagmus and hypoplasia of the macula, the visual acuity improved from 20/300 to 20/100 in the right eye and from 20/400 to 20/150 in the left eye. Both aniridia IOLs were well centered, the anterior segment was quiet with normal intraocular pressure without medication, and all of the patient's glare symptoms disappeared. A single-piece iris diaphragm and optical lens offer a safe alternative for patients who previously had no viable options for iris reconstruction. The most serious postoperative problem, glaucoma, should be addressed before the cataract and lens implantation is performed to avoid a possible acceleration of the glaucoma progression by the large aniridia IOL.
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ranking = 1
keywords = phacoemulsification
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2/9. Surgical management of crystalline lens dislocation into the anterior chamber with corneal touch and secondary glaucoma.

    We present a 53-year-old man with a crystalline lens that spontaneously dislocated anteriorly with corneal touch and secondary glaucoma. A dry anterior vitrectomy and partial intercapsular lensectomy were performed using a limbal approach to control intraocular pressure (IOP) and decrease the lens volume. The lens capsule was gently separated from the corneal endothelium with viscoelastic material, after which a bimanual lensectomy was performed with a vitrectomy probe and a phacoemulsification microflow tip. The risk for expulsive choroidal hemorrhage, which can occur during large-incision, open-chamber surgery; a sudden IOP decrease; and significant damage to the corneal endothelium were avoided with this technique. After secondary intraocular lens scleral fixation, the final visual acuity was 20/25.
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ranking = 1
keywords = phacoemulsification
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3/9. Capsular bag distension syndrome after combined cataract and glaucoma surgery.

    PURPOSE: To report four cases of capsular bag distension syndrome (CBDS) after combined cataract and glaucoma surgery. methods: We describe the clinical features and evolution of each case after individual treatment. case reports: We report four cases of CBDS after phacoemulsification, combined with trabeculectomy in two cases and with an Ahmed aqueous drainage device implantation in the other two cases. The space between the intraocular lens (IOL) and the posterior capsule was occupied by an optically clear liquid in two cases and by a turbid liquid in the other two cases, with posterior bowing of the capsule into the anterior vitreous. A myopic shift and anterior chamber shallowing occurred in three cases. After posterior Nd:YAG laser capsulotomy, the CBDS resolved in three cases. In case 1, a surgical posterior capsulotomy and anterior vitrectomy were necessary. DISCUSSION: Capsular bag distension syndrome should be included in the differential diagnosis of a shallow anterior chamber after combined cataract and glaucoma surgery.
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ranking = 1
keywords = phacoemulsification
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4/9. Corneal honeybee sting.

    BACKGROUND: We report the complications and management of a retained bee sting injury to the cornea. The case highlights the acute and chronic management of an uncommon injury and its pathogenesis. methods: A 67-year-old man was attacked by a swarm of bees and was referred for severe chemosis on the right eye. A retained corneal bee stinger (ovipositor) was seen but removal was only partially successful. He subsequently developed a large corneal epithelial defect, anterior uveitis, intractable glaucoma, traumatic cataract, toxic optic neuropathy, and corneal scarring. We reviewed the literature on corneal bee sting injuries and their complications. RESULTS: inflammation was controlled with topical steroids and the patient underwent a combined phacoemulsification and trabeculectomy with mitomycin-C for uncontrolled glaucoma. However, optic neuropathy did not resolve. INTERPRETATION: Corneal bee sting injuries are uncommon but can result in severe sight-threatening complications such as toxic optic neuropathy. Early recognition of the possible complications and appropriate treatment may help to prevent permanent loss of vision. Removal of a retained corneal bee stinger remains controversial.
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ranking = 1
keywords = phacoemulsification
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5/9. Presumed herpetic endotheliitis following phacoemulsification surgery.

    The authors present an observational case series. Three cases of presumed herpetic endotheliitis presented as cases of pseudophakic bullous keratopathy many years after successful phacoemulsification surgery. All patients had reduction of vision in the involved eye, corneal oedema and secondary glaucoma. The patients were treated with medical therapy consisting of topical corticosteroids, antiviral and antiglaucoma drugs. Resolution of corneal oedema, control of glaucoma and restoration of visual acuity were achieved in all cases. Specular microscopy performed thereafter demonstrated relatively normal endothelial cell counts. The authors conclude that pseudophakic bullous keratopathy occurring after phacoemulsification surgery may be caused by herpetic endotheliitis.
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ranking = 6
keywords = phacoemulsification
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6/9. 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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7/9. 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 = 1
keywords = phacoemulsification
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8/9. Pathologic findings of an explanted silicone intraocular lens.

    We present a clinicopathological analysis of an explanted STAAR model B silicone intraocular lens (IOL) that was sent to the Center for Intraocular Lens research for evaluation. Extracapsular cataract extraction (ECCE), using phacoemulsification and insertion of the silicone IOL, had been accomplished through a 3-mm scleral tunnel incision. The IOL was folded and inserted into the ciliary sulcus. Complications, including blurred vision, movement of the IOL within the eye, and glaucoma, eventually led to IOL exchange at three months post-ECCE. After removal of the silicone IOL, a modified J-loop IOL was placed in the intact capsular bag, with subsequent resolution of the increased intraocular pressure and a 20/20 3 visual acuity. Pathologic examination of the explanted silicone lens revealed grooves indented into the optic, extensive molding flash, and opalescence of the optic.
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ranking = 1
keywords = phacoemulsification
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9/9. Pars plana vitrectomy in the management of pupillary block glaucoma following irrigation and aspiration.

    Pupillary block glaucoma developed in 3 children treated with irrigation and aspiration using the Cavitron phacoemulsification system. One had a congenital cataract, 1 had blunt trauma, and 1 had a penetrating injury. The factors contributing to pupillary block included excessive retained lens material, severe post-traumatic inflammation with synechia formation in 2 cases, and the lack of iridectomy in a case requiring a membrane discission. The pupillary block was successfully treated by pars plana vitrectomy in all cases; however, vision in 1 eye was lost owing to secondary glaucoma resulting from delay in treatment and the development of 360 degrees peripheral anterior synechiae.
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ranking = 1
keywords = phacoemulsification
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