Patient creates filtering bleb: hypotony following traumatic rupture of an old scleral incision for intracapsular cataract surgery

2021 ◽  
Vol 14 (1) ◽  
pp. e239035
Author(s):  
Sophie Lemmens ◽  
Minh-Tri Hua ◽  
Ingeborg Stalmans
Keyword(s):  
Surgical Repair ◽  
Anterior Segment ◽  
Signs And Symptoms ◽  
Cataract Extraction ◽  
Favourable Outcome ◽  
Traumatic Rupture ◽  
Filtering Bleb ◽  
History Of ◽  
Blurry Vision ◽  
Secondary Intraocular Lens Implantation

An 86-year-old woman presented with symptomatic hypotony on the left eye since a few weeks, blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1982 and secondary intraocular lens implantation in 1988. The patient mentioned a fall on the left side of the head 6 months earlier. The diagnosis of a superior scleral fistula was made, confirmed by gonioscopy and anterior segment optical coherence tomography. Direct surgical repair of the fistula led to a favourable outcome. This case demonstrates the occurrence of symptomatic hypotony due to the traumatic creation of a scleral fistula with an inadvertent filtering bleb many years after ICCE, and the resolution of signs and symptoms after surgical repair. Conventional as well as contemporary modalities can be valuable in the assessment of such fistulae. Management depends on the clinical course and the mechanism and extent of fistulation.

scholarly journals Traumatic scleral wound dehiscence with filtering bleb formation after surgical repair of penetrating globe injury

2013 ◽  
Vol 5 (1) ◽  
pp. 136-137 ◽  
Author(s):  
A Ozkaya ◽  
Z Alkin ◽  
Y Acet ◽  
U Yigit
Keyword(s):  
Surgical Repair ◽  
Ocular Trauma ◽  
Anterior Segment ◽  
Wound Dehiscence ◽  
Rare Occurrence ◽  
Filtering Bleb ◽  
Bleb Formation ◽  
The Right ◽  
Blunt Ocular Trauma

Backgropund: Filtering bleb formation after surgical repair of penetrating globe injury is a rare occurrence. Case: A 45-year-old male who had undergone surgical repair of a corneoscleral laceration 16 months earlier presented to emergency room after blunt trauma to the left eye. His best-corrected visual acuities were 20/20 in the right eye and 20/25 in the left. An anterior segment examination found a conjunctival filtering bleb formation on scarred sclera at superotemporal location near the limbus. Anterior chamber was slightly shallow and the Seidel test was negative. Intraocular pressures were 17 mm Hg in the right eye, 7 mm Hg in the left. The fundus examination revealed no abnormal findings. The patient was treated with topical aplication of a steroid and a cycloplegic drop during three weeks. After 16 months follow-up, the visual acuity remained unchanged with the persistence of filtering bleb. IOP was 8 mm Hg in the left eye. Follow-up examinations showed no complications related to trauma. Conclusion: Blunt ocular trauma can cause dehiscence in old scleral scars and subsequent filtering bleb formation. Nepal J Ophthalmol 2013; 5(9):136-137 DOI: http://dx.doi.org/10.3126/nepjoph.v5i1.7843

scholarly journals CASE REPORT Management Cataract Complication and Malignant Glaucoma After Viterectomy Surgery and C3F8 Gas Tamponnade

2020 ◽  
Vol 4 (1) ◽  
pp. 11
Author(s):  
Frisma Sagara Brilliyanto ◽  
Wimbo Sasono
Keyword(s):  
Anterior Segment ◽  
Cataract Extraction ◽  
Gas Tamponade ◽  
Narrow Angle ◽  
Malignant Glaucoma ◽  
Blurry Vision ◽  
Intravitreal Gas ◽  
The Right ◽  
Gas Expansion ◽  
Aqueous Misdirection

Report a clinical presentation of patient with rhematogenous retinal detachment by viterectomy and high myopia with C3F8 gas tamponade. A 20-year-old female came into the outpatient clinic with blurry vision on the right eye as her chief complaint. It had been happening since 1 month ago. In examination, we found result of visual acuity RE 1/300 and LE 1/60 correction Sferis-16.00 5/7.5, anterior segment in a normal range. In posterior segment evaluation, there were RE detachment on 3-11 o’clock position and hole on 6 and 8 o’clock position. Then we performed vitrectomy and  C3F8 gas tamponade. The first day after surgery, we found IOP 19,6 mmHg and Von Herrick III. Then after the second day, we found a pain on the right eye, TIO 47.3 mmHg, Von Herrick 0 and opaque lens. Then we performed iridectomy and intravitreal gas aspiration. After it were done, we found IOP 17.3 mmHg and Von Herrick 0. In anterior segment OCT evaluation, we found a narrow angle anterior segment. Then we planned to do a cataract extraction with using viscoelastic to perform the anterior chamber.Malignant glaucoma can occur in cases after vitrectomy action due to aqueous misdirection and emphasis on gas expansion on tamponade. Cataract extraction and gas aspiration can help open the anterior chamber and the intraocular pressure returns to normal

scholarly journals Trabeculectomy in Staphyloma Eye with High Intraocular Pressure Following Ocular Trauma – A Case Report

2021 ◽  
Vol 9 (T3) ◽  
pp. 23-25
Author(s):  
Masitha Dewi Sari
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Anterior Chamber ◽  
Ocular Trauma ◽  
Anterior Segment ◽  
Rectus Muscle ◽  
Tissue Destruction ◽  
Corneal Scar ◽  
History Of ◽  
Blurry Vision

BACKGROUND: Ocular trauma may alter the anterior segment condition that may lead to secondary glaucomas such as inflammation, hyphema, angle recession, and lens subluxation. One of the most common procedures to decrease intraocular pressure (IOP) is trabeculectomy by creating pathways that allow aqueous humor to flow out of the anterior chamber. Scleral tissue destruction can cause damage in thin areas (such as posterior to the rectus muscle insertions) as in case of scleritis. CASE REPORT: An 11-year-old boy presented to the Ophthalmology Department of Universitas Sumatera Utara Hospital with a bigger white grayish mass and blurry vision. There was a history of the left ocular trauma 6 years ago, followed by redness of the eye, but not treated properly. On the general examination, the patient’s left eyes looked cloudy. On ocular examination, the left eye visual acuity was 1/300 and IOP was 28 mmHg. Segment anterior examination showed staphyloma from 9 to 12 o’clock, conjunctival injection, corneal scar, shallow anterior chamber, and cloudy lens. We could not asses the posterior segment due to cloudy media. We gave anti-glaucoma medication for 1 month, but the IOP did not decrease. We performed a trabeculectomy to control IOP and to prevent staphyloma from getting bigger. CONCLUSION: Trabeculectomy was an effective procedure to control IOP in a staphyloma eye following ocular trauma.

Surgical Repair of Large Cyclodialysis Clefts

2016 ◽  
Vol 27 (3) ◽  
pp. 382-385 ◽  
Author(s):  
Jacob B. Gross ◽  
Garvin H. Davis ◽  
Nicholas P. Bell ◽  
Robert M. Feldman ◽  
Lauren S. Blieden
Keyword(s):  
Surgical Repair ◽  
Anterior Segment ◽  
Cataract Extraction ◽  
Ultrasound Biomicroscopy ◽  
Anterior Segment Oct ◽  
Capsular Tension Ring ◽  
Pressure Spike ◽  
Pars Plana ◽  
Oct Imaging ◽  
New Surgical Technique

Purpose To describe a new surgical technique to effectively close large (>180 degrees) cyclodialysis clefts. Methods Our method involves the use of procedures commonly associated with repair of retinal detachment and complex cataract extraction: phacoemulsification with placement of a capsular tension ring followed by pars plana vitrectomy and gas tamponade with light cryotherapy. We also used anterior segment optical coherence tomography (OCT) as a noninvasive mechanism to determine the extent of the clefts and compared those results with ultrasound biomicroscopy (UBM) and gonioscopy. Results This technique was used to repair large cyclodialysis clefts in 4 eyes. All 4 eyes had resolution of hypotony and improvement of visual acuity. One patient had an intraocular pressure spike requiring further surgical intervention. Anterior segment OCT imaging in all 4 patients showed a more extensive cleft than UBM or gonioscopy. Conclusions This technique is effective in repairing large cyclodialysis clefts. Anterior segment OCT more accurately predicted the extent of each cleft, while UBM and gonioscopy both underestimated the size of the cleft.

Unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia

2019 ◽  
pp. 112067211987715
Author(s):  
Pablo Sanjuán ◽  
Borja Salvador-Culla ◽  
Maria Isabel Canut ◽  
Rafael I Barraquer
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
High Myopia ◽  
Anterior Segment ◽  
Cataract Extraction ◽  
Posterior Chamber ◽  
Visual Axis ◽  
Filtering Bleb ◽  
Corrected Visual Acuity ◽  
Best Corrected Visual Acuity

Purpose: To report a case of a unilateral spontaneous filtering bleb dissecting into the cornea in a patient with high myopia. Clinical case: A 33-year-old woman with high myopia (–18 D) presented with discomfort in the left eye. Ocular history included pars plana vitrectomy and cataract extraction and posterior chamber intraocular lens implantation in the left eye. Best-corrected visual acuity was 0.65 and intraocular pressure was 20 mmHg. Slit-lamp examination showed a filtering bleb in the upper-temporal quadrant, which extended and dissected the proximal cornea without affecting the visual axis. The morphology and content of the bleb was studied with anterior segment optical coherence tomography, which ruled out a corneal-scleral fistulization into the subconjunctival space. The spontaneous filtering bleb was resected surgically. Due to her high myopia, two strips of fascia lata were used to strengthen the area. In the postoperative period, a complete resection of the bleb was confirmed, without apparent leaking points and with a well-vascularized conjunctiva. No complications were noted. The patient maintained the same best-corrected visual acuity and intraocular pressure than before surgery. Conclusion: The formation of a spontaneous filtering bleb is a rare entity in patients with high myopia, whose risk increases due to their thinned sclerae. The risk is even greater if they have undergone ocular surgeries. Resection of the filtering bleb in our case halted the progression of the corneal dissection, therefore respecting the transparency of the visual axis and preserving visual acuity.

scholarly journals Ruptured Coronary Sinus of Valsalva in the Setting of a Supracristal Ventricular Septal Defect

2020 ◽  
Vol 4 (2) ◽  
pp. 154-157
Author(s):  
Abilio Arrascaeta-Llanes ◽  
Akanksha Kashyap ◽  
Diana Meyler ◽  
Ravi Gupta ◽  
Zubin Tharayil ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Ventricular Septal Defect ◽  
Coronary Sinus ◽  
Septal Defect ◽  
Surgical Repair ◽  
Signs And Symptoms ◽  
Sinus Of Valsalva ◽  
Sinus Of Valsalva Aneurysm ◽  
History Of

A sinus of Valsalva aneurysm (SOVA) is usually a silent entity until one of its complications arises, such as heart failure. SOVA itself is uncommon, but it is more frequently associated with a supracristal ventricular septal defect (SVSD). We present a 67-year-old man with a history of an asymptomatic SVSD who presented to the emergency department with signs and symptoms of heart failure. He was subsequently found to have a ruptured SOVA and underwent urgent surgical repair.

Penile Fracture-Report of Two Cases and Review of Current Literature

KYAMC Journal ◽  
2019 ◽  
Vol 10 (2) ◽  
pp. 122-125
Author(s):  
Ashraf Uddin Mallik ◽  
Mostafizur Rahman ◽  
Fatema Bagum ◽  
Uttam Karmaker ◽  
Baikali Ferdous ◽  
...  
Keyword(s):  
Tunica Albuginea ◽  
Traumatic Rupture ◽  
Penile Fracture ◽  
Corpora Cavernosa ◽  
Effective Treatment Modality ◽  
Special Cases ◽  
History Of ◽  
Penile Injury ◽  
Urological Emergency ◽  
Erect Penis

Penile fracture is an uncommon urological emergency, especially in Bangladesh. The other name is traumatic rupture of the tunica albuginea and corpora cavernosa in the erect penis. It occurs when an erect penis face to buckle under the pressure of a blunt sexual trauma. Patient gives the typical history of immediate detumescence, severe pain, swelling and eggplant deformity of the penile shaft due to penile injury. Immediate surgical exploration and repair of corpora Cavernosa with tunica albugenia is the most effective treatment modality. In normal cases diagnosis is made from history, physical examination alone. In some special cases ultrasonogram, radiological images, including retrograde urethrography or cavernosography are mandatory for proper diagnosis. KYAMC Journal Vol. 10, No.-2, July 2019, Page 122-125

SMAD4 juvenile polyposis syndrome and hereditary haemorrhagic telangiectasia presenting in a middle-aged man as a large fungating gastric mass, polyposis in both upper and lower GI tract and iron deficiency anaemia, with no known family history

2020 ◽  
Vol 13 (12) ◽  
pp. e236855
Author(s):  
Wendy Chang ◽  
Patricia Renaut ◽  
Casper Pretorius
Keyword(s):  
Family History ◽  
Autosomal Dominant ◽  
Signs And Symptoms ◽  
Juvenile Polyposis ◽  
Hereditary Haemorrhagic Telangiectasia ◽  
Gi Tract ◽  
Juvenile Polyposis Syndrome ◽  
Polyposis Syndrome ◽  
History Of ◽  
Gastric Mass

Juvenile polyposis syndrome (JPS) and hereditary haemorrhagic telangiectasia (HHT) are rare autosomal dominant diseases, where symptoms manifest at childhood. A 32-year-old man with no family history of JPS or HHT with SMAD4 gene mutation who developed signs and symptoms only at the age of 32, when he was an adult. In this article, we highlight the steps taken to diagnose this rare pathology, explain its pathophysiology and management.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

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