Cases reported "Ocular Hypotension"

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11/113. Ocular side-effects from systemic HPMPC (Cidofovir) for a non-ocular cytomegalovirus infection.

    PURPOSE: To report a case of anterior uveitis and ocular hypotony during HPMPC treatment of a cytomegalovirus infection without ophthalmic involvement. methods: A 61-year-old bisexual white man with AIDS presented with moderate anterior uveitis and ocular hypotony after 8 weeks of intravenous HPMPC and oral probenecid co-treatment of a presumed recurrence of cytomegalovirus encephalitis. RESULTS: There was no evidence of an ocular cytomegalovirus infection. Cidofovir-related uveitis was diagnosed, and the HPMPC-probenecid co-treatment was switched to ganciclovir monotherapy. The ocular inflammation was successfully managed with topical steroids and mydriatics. CONCLUSIONS: This description of ophthalmic side effects from systemic HPMPC in the absence of ocular cytomegalovirus infection supports the hypothesis that anterior uveitis and ocular hypotony result from a direct interaction between the drug and the ciliary body. ( info)

12/113. Management of hypotony maculopathy and a large filtering bleb after trabeculectomy with mitomycin C: success with argon laser therapy.

    We report a patient with postkeratoplasty glaucoma that developed a large, filtering bleb following trabeculectomy with intraoperative antimetabolite treatment. The hypotony and the bleb were managed using argon laser photocoagulation. A 26-year-old female patient underwent penetrating keratoplasty in the left eye for keratoconus. Postoperatively, her elevated intraocular pressure could not be controlled medically, and the patient underwent a trabeculectomy with intraoperative antimetabolite application. Two months later, hypotony maculopathy, optic disc edema, and choroidal folds developed, and her vision dropped. Steroid treatment and soft contact lenses did not help. Photocoagulation was applied twice to the surface of the bleb and the surrounding area. After the photocoagulation therapy, the patient's vision improved, intraocular pressure increased, and the optic disc edema and macular folds had resolved. argon laser photocoagulation applied to a large filtering bleb associated with hypotony maculopathy is a useful treatment for bleb remodeling and elevating intraocular pressure. ( info)

13/113. Paradoxical hypotony after laser in situ keratomileusis.

    We present a case of paradoxically low (0 to 2 mm Hg) intraocular pressure (IOP) measured by Goldmann applanation and Tono-Pen tonometry in an eye with corticosteroid-induced high IOP after laser in situ keratomileusis. The patient complained of blurred vision and ocular pain in both eyes. The eyes were firm by palpation, and the IOP measured by Schiotz indentation tonometry was 38 mm Hg. An interface fluid pocket was identified by slitlamp examination, and the corneal surface became steeper. These findings resolved after flap relifting, interface irrigation, and addition of antiglaucoma medications. We postulate that the paradoxically low reading by applanation tonometry was due to fluid accumulation within the flap-bed interface. The applanation tonometry reflected the interface fluid pocket pressure rather than the real high IOP. An exceedingly low IOP should be verified by palpation or by Shiotz indentation tonometry, and interface fluid should be identified. ( info)

14/113. Ibopamine treatment in chronic hypotony secondary to long-lasting uveitis. A case report.

    PURPOSE: To assess the clinical efficacy of ibopamine eye drops in severe hypotony secondary to chronic progressive uveitis. methods: Case report. A 47-year-old man with a 37-year history of diffuse uveitis and severe refractory hypotony was treated with topical 2% ibopamine (Trazyl) six times a day. intraocular pressure, visual acuity, visual field and side effects were recorded during 15 months of follow-up. RESULTS: IOP, visual acuity and visual field increased after four days of therapy and lasted for two months when the drug was suspended because of the onset of filamentous keratopathy. A new course of treatment with 2% ibopamine eye drops in a different solvent (BSS) resulted in a stable increase in IOP, VA and visual field, with no side effects in a follow-up of 13 months. CONCLUSIONS: Ibopamine 2% eye drops in BSS solvent seem effective in the treatment of uveitis-related hypotony. ( info)

15/113. Ultrasound biomicroscopy of chronic hypotony after cataract extraction.

    Ultrasound biomicroscopy was performed with a UBM 840 (Zeiss-Humphrey) equipped with a 50 MHz probe on a patient with chronic hypotony 1 year after cataract surgery by phacoemulsification with intraocular lens implantation in the capsular bag. This sonographic technique, which provides high-resolution imaging of the anterior segment, showed aqueous humor leakage through the former scleral tunnel incision. Ultrasound biomicroscopy helped detect this patient's postoperative complication and is a good tool for diagnostic procedures in patients with chronic hypotony. ( info)

16/113. Serous retinal detachment and cystoid macular edema in hypotony maculopathy.

    PURPOSE: To report the foveal structural findings of hypotony maculopathy imaged with optical coherence tomography. methods: Case report of a 39-year-old white woman with a 20 year history of uveitis, who underwent pars plana vitrectomy and pars plana Baerveldt implant for intractable glaucoma. Four months postoperatively, decreased vision and hypotony maculopathy ensued. Optical coherence tomographic (OCT) images were taken horizontally through the macula. RESULTS: OCT demonstrated large intraretinal cysts, serous macular detachment, and choroidal folds, which resolved upon resolution of hypotony. CONCLUSION: Cystic macular changes and serous macular detachment can be prominent features of hypotony maculopathy. ( info)

17/113. Occult wound leak diagnosed by ultrasound biomicroscopy in patients with postoperative hypotony.

    PURPOSE: To describe the ability of high-frequency ultrasound biomicroscopy (UBM) to diagnose occult wound leaks as a cause for hypotony after cataract surgery. methods: Six patients with persistent hypotony after cataract surgery were sent for UBM examination. Slitlamp examination and gonioscopy of the 6 eyes had not revealed a cause for the hypotony. RESULTS: Ultrasound biomicroscopy showed subtle wound separation with shallow conjunctival elevation at the site of the cataract wound in the 6 patients. Two eyes had surgical repair of the subconjunctival wound leak, and the other 4 were treated medically. In the 2 eyes with surgically repaired wounds, the hypotony cleared after wound closure. Of the 4 medically treated eyes, hypotony resolved in 2 and 1 had a recurrence of hypotony. The other 2 eyes had fluctuating intraocular pressure for an extended period. CONCLUSIONS: Hypotony after cataract surgery occurred in 6 eyes due to subtle wound leaks difficult to detect by clinical observation. Ultrasound biomicroscopy can be a helpful aid to clinical examination in detecting these leaks. ( info)

18/113. A simple treatment for chronic postoperative hypotony of unknown etiology: the injection of balanced salt solution into the anterior chamber.

    Postoperative hypotony is not rare. When it occurs, effective treatment must be initiated to avoid secondary complications. We report two cases of postoperative hypotony that have been treated successfully with a single injection of balanced salt solution (BSS) into the anterior chamber. One patient developed hypotony three months after combined cataract surgery and trabeculectomy with the use of mitomycin C (MMC). The cause of hypotony remained unknown. Leakage, hyperfiltration, cyclodialysis, and other possible causes had been excluded. With a single injection of BSS into the anterior chamber the long-standing hypotony was successfully managed. A second patient with hypotony after pars plana vitrectomy was also treated successfully with an injection of BSS into the anterior chamber. We conclude that an injection of BSS into the anterior chamber is an inexpensive and efficacious remedy for postoperative hypotony of unknown etiology. ( info)

19/113. Autologous blood injection for marked overfiltration early after trabeculectomy with mitomycin C.

    PURPOSE: After trabeculectomy with mitomycin C, extremely low intraocular pressure (IOP) with excess filtration may cause hypotonous maculopathy in the early postoperative period. We evaluated the effect of injecting autologous blood on reversing early postoperative marked hypotony after trabeculectomy with mitomycin C. methods: trabeculectomy with mitomycin C was performed in 258 eyes between 1994 and 1998. Peribleb autologous blood injection was performed in five eyes in which pressure patches were ineffective in reversing excess filtration. Approximately 0.1 to 0.3 ml of whole unclotted blood was slowly injected at least 3 mm from the edge of the flap using a sterile 27-gauge needle. RESULTS: None of these eyes developed hypotonous maculopathy after injection. After a mean 31-month follow-up, all eyes had well-controlled IOP and visual acuity in three eyes was much improved. postoperative complications included mild IOP elevation in one eye treated with laser suturelysis, and fibrinous pupillary membrane in one eye. CONCLUSION: In the early postoperative period, autologous blood injection is effective in reversing excess filtration. ( info)

20/113. Hypotony caused by scleral buckle erosion in marfan syndrome.

    PURPOSE: To describe hypotony caused by erosion of the conjunctiva and sclera by a silicone scleral buckle. methods: Interventional case report. A 33-year-old man with marfan syndrome presented with hypotony maculopathy and a collapsed globe 17 months after repair of retinal detachment with a silicone sponge and silicone encircling band. RESULTS: Examination in the operating room revealed extrusion of the buckle through the conjunctiva and full-thickness scleral erosion. The silicone buckle was removed, and the scleral defect was closed with interrupted 8-0 nylon sutures. Postoperative glaucoma was treated with cyclophotocoagulation. Eight months after scleral repair, visual acuity was RE: 20/40, intraocular pressure was 10 mm Hg, and the retina was attached. CONCLUSION: Full-thickness scleral erosion secondary to a silicone exoplant causing hypotony is a rare long-term complication in patients with thin sclera. ( info)
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