Management of Surgical Complications

Glaucoma ◽  
2012 ◽  
Author(s):  
Thomas Patrianakos
Keyword(s):  
Anterior Segment ◽  
Ultrasound Biomicroscopy ◽  
Risk Profile ◽  
Prednisolone Acetate ◽  
Common Complication ◽  
Glaucoma Filtration Surgery ◽  
Glaucoma Drainage Devices ◽  
Tuberculin Syringe ◽  
Bleb Failure

•Glaucoma filtration surgery (GFS) has been associated with higher long-term failure rates and a substantially higher risk profile than most other ophthalmic surgeries. •Identifying and properly managing complications associated with GFS is essential in ensuring the best possible outcome. •Infection is a devastating complication of GFS that must be considered in a separate category (please see Chapter 7 for blebitis and bleb-related endophthalmitis). •Complications unique to glaucoma drainage devices (GDD; see Chapter 12) will be discussed at the end of the chapter. •One simple way to diagnose a complication resulting from GFS is to subcategorize possibilities according to the IOP and anterior chamber (AC) depth. •Table 13.1 shows the four potential outcomes after GFS, and the text below provides additional details about each potential complication. •Usually occurs in the first few months after surgery. •The most common complication of trabeculectomy. •Due to progressive episcleral fibrosis and blockage under the scleral flap. •Incidence has decreased due to intraoperative use of antifibrotics. •Bleb appears constricted, shallow, or flat with increased vascularity and loss of microcysts. •Negative Seidel test. •Gonioscopy reveals an open sclerostomy site, which is essential to differentiate from an inadequate fistula or fistula blockage from iris, blood, fibrin, or vitreous. •Anterior segment optical coherence tomography (AS-OCT) and ultrasound biomicroscopy (UBM) may reveal adherence of Tenon’s capsule and conjunctiva to underlying sclera. •Approached in a stepwise fashion. • Decreases rate of episcleral fibrosis in hopes of rescuing the function of the bleb.•Prednisolone acetate 1% every 2 hours for first 1 to 2 weeks, then taper slowly over 2 to 3 months. •Administered if early signs of bleb failure/episcleral fibrosis are present. •Technique •Instill topical anesthesia followed by direct application of a cottontipped pledget approximately 90 to 180 degrees away from the bleb. •Use a 30-gauge needle on a tuberculin syringe to inject 5 mg (0.1 cc) of undiluted 5-fluorouracil (5-FU; available in a concentration of 50 ug/mL) under the conjunctiva at the anesthetized site. •Avoid areas of bleb elevation and areas that show increased conjunctival vascularity.

scholarly journals Assessment of the Capsular Tension Ring Implantation Effect on the IOL Position in the Long Term Period after Uncomplicated Phacoemulsification

2021 ◽  
Vol 18 (4) ◽  
pp. 827-832
Author(s):  
A. N. Kulikov ◽  
E. V. Danilenko ◽  
A. A. Dzilikhov
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Anterior Chamber Depth ◽  
Vertical Direction ◽  
Ultrasound Biomicroscopy ◽  
Position Change ◽  
Small Shift ◽  
Capsular Tension Ring ◽  
Observation Period

Purpose: To assess the capsular tension ring implantation effect on the IOL position according to different devices in the long term period after uncomplicated phacoemulsification.Patients and methods. The study enrolled 234 patients (273 eyes) with cataract without zonular weakness. A standard examination, optical biometry and Sheimpflug imaging were performed preoperatively. In all cases phacoemulsification with IOL implantation, supported by CTR in 11 % of cases (30 eyes) was performed in 1, 3, and 6 months after surgery autorefractometry, visual acuity, biometry, OCT of anterior segment and ultrasound biomicroscopy were provided.Results. By the 3rd month a small shift of IOL towards the retina was revealed without any refraction changes. In cases with CTR implantation the anterior chamber depth was stable. According to OCT data the angle of IOL tilt in the horizontal meridian gradually decreased, the dynamics was significant from 3 months (p = 0.032). There were no changes in the vertical direction. After CTR implantation IOL position did not significantly change. There was no difference between the groups (p > 0.05) by 6 month. The phenomenon of IOL “deflection” according to OCT data was observed in 20.87 % of cases was in 1 month after operation. In the presence of CTR its frequency decreased to 15.00 %, and in the absence, it increased to 21.63 %. In every fifth case of deformation the measurements did not give us a definite reason to further consider it a “deflection” by 6 months after the operation. In 4.24 % of cases fact of IOL “deflection” was absent at the first month but appeared by the 6 month. There was not any case of CTR implantation among described cases of IOL position change.Conclusion. Fluctuation of anterior chamber depth is observed up to 3 months after uncomplicated phacoemulsification. Changes in IOL tilt angle occur throughout the observation period with a significant decrease in the horizontal plane by 6 month. Implantation of the CTR should stabilize anterior chamber depth, block the IOL tilt and also reduce the percentage of IOL deflection cases in the defined group.

Ultrasound Biomicroscopy in Nonperforating Filtering Surgery with Intraoperative 5-fluorouracil and no implant: Long-term Results

2009 ◽  
Vol 19 (4) ◽  
pp. 601-606 ◽  
Author(s):  
Consuelo Gutiérrez-Ortiz ◽  
Eduardo Vleming ◽  
Jesus Pareja ◽  
Miguel A. Teus
Keyword(s):  
Anterior Segment ◽  
Case Series ◽  
Ultrasound Biomicroscopy ◽  
Long Term Results ◽  
Filtering Surgery ◽  
Scleral Flap ◽  
Filtering Bleb ◽  
Suprachoroidal Space ◽  
Case Series Study

Purpose To evaluate the long-term morphologic changes in the anterior segment structures after nonpenetrating filtering surgery (NPFS) supplemented with 5-fluorouracil (5-FU) and no scleral implant using ultrasound biomicroscopy (UBM). Methods Thirteen eyes of 13 consecutive patients who underwent NPFS with intraoperative 5-FU under the conjunctiva and the scleral flap and no implant were evaluated in an observational nonrandomized, consecutive case series study conducted 2 years postoperatively. Patients were assessed for the presence of a subconjunctival filtering bleb, the volume of an intrascleral cavity, and a suprachoroidal hypoechoic area. The intraocular pressure (IOP) was measured preoperatively and postoperatively at the time of UBM. Results The IOP decreased significantly (p=0.01) from 24±7.6 mmHg to 13.7±4.1 mmHg. In most patients (69.2%), the postoperative IOP decreased at least 30% from the preoperative value without medications and in 84.6% with medication. UBM showed a subconjunctival empty space in 92.3% of eyes. In 84.6% of patients, an intrascleral cavity was seen, the mean volume of which was 1.68 mm3 (range, 0–4.07). We found a negative correlation between the height, width, and volume of the intrascleral lake and the IOP. In 92.3% of eyes, a hypoechoic area in the suprachoroidal space also was seen. Conclusions UBM showed a filtering intrascleral cavity, subconjunctival filtering bleb, and a suprachoroidal space after NPFS supplemented with 5-FU under the conjunctiva and the scleral flap without an implant.

Pediatric Free-floating Anterior Chamber Cyst of the Iris Pigment Epithelium

2018 ◽  
Vol 1 ◽  
pp. 3
Author(s):  
Joshua S Agranat ◽  
Yoshihiro Yonekawa
Keyword(s):  
Optical Coherence Tomography ◽  
Anterior Chamber ◽  
Incidental Finding ◽  
Pigment Epithelium ◽  
Anterior Segment ◽  
Ultrasound Biomicroscopy ◽  
Optical Coherence ◽  
Visual Axis ◽  
Associated Malignancy ◽  
Anatomic Locations

Iris pigment epithelial (IPE) cysts are a subset of iris cysts that arise from the IPE. They are spontaneously erupting epithelial-lined cavities that are found in various anatomic locations of the iris, including the iris pupillary margin, midzone, periphery, and free floating in the vitreous or anterior chamber. We report the case of an asymptomatic 13-year-old boy with an incidental finding of a dislodged anterior chamber cyst diagnosed on routine examination. Modern multimodal image analysis of the cyst including anterior segment optical coherence tomography and ultrasound biomicroscopy (UBM) was utilized to characterize the microstructural anatomy of the lesion. The patient was managed conservatively without complications. Cysts of the IPE typically do not affect vision or ocular health and can be monitored and observed after ascertaining no associated malignancy. Initial diagnostic investigation can include UBM and anterior segment optical coherence tomography. Intervention should be reserved only for cases where the cyst growth leads to obstruction of the visual axis and/or other secondary complications.

scholarly journals Posterior Uveal Effusion after Cataract Surgery

2021 ◽  
pp. 62-67
Author(s):  
Annegret Abaza ◽  
Özlem Dikmetas ◽  
Irmingard Neuhann ◽  
Faik Gelisken
Keyword(s):  
Cataract Surgery ◽  
Corticosteroid Therapy ◽  
Anterior Segment ◽  
Subretinal Fluid ◽  
Posterior Pole ◽  
Functional Improvement ◽  
Long Term Observation ◽  
The Right ◽  
Uveal Effusion

We report a case of posterior uveal effusion (UE) with a long-term follow-up that has occurred following cataract surgery. A 64-year-old woman presented with diminished vision of the right eye (RE) 3 weeks after an uneventful phacoemulsification and intraocular lens implantation. Complete ophthalmic examination including fluorescein angiography (FA), indocyanine green angiography (ICGA), echography and optical coherence tomography (OCT) were performed. Best corrected visual acuity (BCVA) of the RE was 20/50. Anterior segment and intraocular pressure were unremarkable. OCT revealed prominent folds of the choroid and retina, subretinal fluid and darkening of the choroid with reduced visibility of the choroidal vessels and the scleral border. The left eye (LE) was unremarkable. BCVA of the LE was: 20/20. After topical anti-inflammatory and systemic corticosteroid therapy for 5 months, no morphological change of the macula was seen. The patient was observed without any treatment. Forty-three months after the cataract surgery and 38 months after cessation of the corticosteroid therapy, OCT revealed a normal macular morphology and the BCVA improved to 20/25. Even though rare, UE at the posterior pole may occur after modern cataract surgery. OCT examination is a reliable tool in monitoring the macular morphology. Since morphological and functional improvement can be seen in long-term, observation may be considered for some cases of posterior UE with resistance to the therapy.

Ultrasound biomicroscopy in anterior segment inflammatory disorders

2000 ◽  
Vol 32 (4) ◽  
pp. 301-306
Author(s):  
Jyotirmay Biswas ◽  
Muna P. Bhende ◽  
Sandeep V. Mondkar
Keyword(s):  
Anterior Segment ◽  
Ultrasound Biomicroscopy ◽  
Inflammatory Disorders

scholarly journals Clinical Features of Iris Cysts in Long-Term Follow-Up

2021 ◽  
Vol 10 (2) ◽  
pp. 189
Author(s):  
Joanna Konopińska ◽  
Łukasz Lisowski ◽  
Zofia Mariak ◽  
Iwona Obuchowska
Keyword(s):  
Visual Acuity ◽  
Ultrasound Biomicroscopy ◽  
Anatomical Location ◽  
Long Term Follow Up ◽  
Temporal Quadrant ◽  
The Mean ◽  
Multiple Cysts ◽  
Cyst Growth

This study evaluated the characteristics and clinical course of patients with iris cysts in the long-term follow-up (24–48 months). We retrospectively analyzed the medical records of 39 patients with iris cysts (27 women and 12 men). Age, visual acuity, intraocular pressure (IOP), slit-lamp evaluation, and ultrasound biomicroscopy images were assessed. The mean age at diagnosis was 40.6 ± 17.48 years. Thirty (76.9%) cysts were peripheral, five (12.8%) were located at the pupillary margin, two (5.1%) were midzonal, and two (5.1%) were multichamber cysts extending from the periphery to the pupillary margin. A total of 23 (59%) cysts were in the lower temporal quadrant, 11 (28.2%) were in the lower nasal quadrant, and 5 (12.8%) were in the upper nasal quadrant. Cyst size was positively correlated with patient age (rs = 0.38, p = 0.003) and negatively correlated with visual acuity (rs = −0.42, p = 0.014). Cyst growth was not observed. The only complication was an increase in IOP in three (7.7%) patients with multiple cysts. The anatomical location of the cysts cannot differentiate them from solid tumors. The vast majority of cysts are asymptomatic, do not increase in size, and do not require treatment during long-term follow-up.

Estimating Long Term Major Maintenance and Capital Spending Requirements of Trinidad’s Aging Power Plants

2006 ◽  
Author(s):  
Robert R. Richwine ◽  
Michael Joseph ◽  
Charles Huguenard ◽  
Hafeez Baksh ◽  
Mike Elenbass
Keyword(s):  
Power Plants ◽  
Probabilistic Approach ◽  
Risk Profile ◽  
Periodic Review ◽  
Total Cost ◽  
Financial Decisions ◽  
Capital Spending ◽  
Generation Company ◽  
Insight Into

This paper describes the process used by the Power Generation Company of Trinidad and Tobago (PowerGen) to estimate the range of major (expenditures greater than US$50,000) recurring and non-recurring costs that can be expected to be incurred from 2006–2025 by PowerGen’s three existing generating facilities: Port of Spain, Point Lisas and Penal. Since many of these Capital and O&M costs are not 100% certain, a probabilistic approach was used that incorporates a Monte Carlo methodology. The results of this approach allowed PowerGen to better understand the range of possible major capital and O&M expenditures that would likely be required over the next 20 years along with a quantification of the risk profile of those ranges. By adding these costs to the routine O&M costs, a total cost cash flow timeline was able to be developed that more realistically forecast the actual financial requirements of PowerGen’s power plants. Periodic review and updates of the data will also provide PowerGen with a continuing sound basis for long term technical and financial decisions. Additionally, a benchmarking analysis was performed that compared the reliability trends of similar but older technologies to those plants in PowerGen’s fleet in order to gain an insight into the reliability expectations for PowerGen plants over the next twenty years.

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