scholarly journals Iridotrabecular and Iridocorneal Contact Changes after Cataract Surgery and Endothelial Keratoplasty in Bilateral Iridoschisis

2021 ◽  
pp. 198-203
Author(s):  
Takashi Omoto ◽  
Chisato Agata ◽  
Reina Akiyama ◽  
Kohdai Kitamoto ◽  
Tetsuya Toyono ◽  
...  
Keyword(s):  
Cataract Surgery ◽  
Surgical Procedures ◽  
Vision Loss ◽  
Anterior Segment ◽  
Corneal Oedema ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Before And After ◽  
The Right ◽  
Endothelial Decompensation

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

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.

scholarly journals Accelerated corneal endothelial cell loss in two patients with granulomatosis with polyangiitis following phacoemulsification

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Fang-Chi Hsiao ◽  
Hung-Ta Chen ◽  
Kuan-Jen Chen ◽  
Yi-Jen Hsueh ◽  
Yaa-Jyuhn James Meir ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
Cataract Surgery ◽  
Granulomatosis With Polyangiitis ◽  
Corneal Edema ◽  
Cell Loss ◽  
Multiple Organs ◽  
First Case ◽  
Before And After ◽  
The Right

Abstract Background Generally, the loss rate of human endothelial cells (HCEC) in routine cataract surgery is 8.5%. When the corneal endothelial cells density (ECD) drops, the HCEC may decompensate to keep cornea dehydration which leads to corneal edema. Granulomatosis with polyangiitis (GPA) is an uncommon autoimmune disease involving multiple organs including eyes such as conjunctivitis, scleritis, uveitis, and corneal ulcer. In this study, we report two cases of GPA whose corneal ECD decreased significantly after phacoemulsification cataract surgery. Case presentation In the first case of 69-year-old male with GPA, the ECD dropped 39.6% (OD) four months after phacoemulsification and 38.1% (OS) six months postoperatively respectively. At the final follow-up, the residual ECD was only 55% in the right eye in the 49th month, and 56% remained in the left eye in the 39th month. In the second case of 54-year old female, left ECD dropped 63.9% at the 4th month after surgery and 69.6% ECD remained at the 15th month postoperatively while similar ECD of right eye before and after left eye surgery. Conclusion Extensive preoperative ophthalmic evaluation and meticulous postoperative inflammation control should be applied to prevent severe loss of HCEC in GPA patients.

scholarly journals Glaucoma Management in Carotid Cavernous Fistula

2016 ◽  
Vol 7 (2) ◽  
pp. 296-302 ◽  
Author(s):  
Silvia Calafiore ◽  
Andrea Perdicchi ◽  
Gianluca Scuderi ◽  
Maria Teresa Contestabile ◽  
Solmaz Abdolrahimzadeh ◽  
...  
Keyword(s):  
Vision Loss ◽  
Transarterial Embolization ◽  
Multidisciplinary Treatment ◽  
Clinical Signs ◽  
Field Testing ◽  
Laser Iridotomy ◽  
Mri Angiography ◽  
The Right ◽  
Carotid Cavernous Fistulas

Carotid cavernous fistulas (CCF) are vascular communications between the carotid artery and the cavernous sinus. Ophthalmologists are called to diagnose and manage the condition in cases that present with ocular features. A 73-year-old female was referred to our glaucoma center clinic. Eight years before, she had started receiving medication for glaucoma and had undergone laser iridotomy, but a satisfactory management of intraocular pressure (IOP) had not been achieved. The patient was complaining of intermittent diplopia, bilateral proptosis, and conjunctival chemosis over the past 6 months. Best-corrected visual acuity in the right (OD) and left eye (OS) was 9/10 and 10/10, respectively. Visual field testing showed slight paracentral field defects mostly in OS. IOP was 20 mm Hg in OD and 34 mm Hg in OS. We referred the patient to neuroradiology, and MRI angiography revealed a CCF with angiographic classification of Cognard grade 2. Closure of the CCF by transarterial embolization was performed in the neuroradiology department. One week following the procedure, the clinical signs of diplopia, proptosis, and conjunctival chemosis had greatly improved, and IOP was reduced to 12 mm Hg OD and 19 mm Hg in OS. Glaucoma treatment was maintained with topical brimatoprost, brinzolamide, and timolol. Owing to the risk of vision loss associated with vascular stasis, retinal ischemia, and high IOP, ophthalmologists must be aware of the clinical features of CCF and should request appropriate imaging studies such as MRI angiography in order to confirm the diagnosis and plan multidisciplinary treatment.

scholarly journals Ultrasonography and Ultrasound Biomicroscopy in Ophthalmology

2017 ◽  
pp. 75-80
Keyword(s):  
Cataract Surgery ◽  
Real Time ◽  
Anterior Segment ◽  
Ultrasound Biomicroscopy ◽  
Sound Waves ◽  
Significant Information ◽  
Screening Techniques ◽  
Basic Features ◽  
The Right ◽  
Biometric Information

In this review, we aimed to give information about the basic features of screening techniques and major indications of ultrasonography in ophthalmology. This is a cheap, modern visualization modality and provides images in real-time. Sound waves travel through the eye reflect and these echoes form a picture of the structure of the eye. It also measures the size of the eye. These measurements determine the right power of a lens implant before cataract surgery. In addition realtime images help clinicians to evaluate inside of the eye that cannot be seen directly. Ultrasound biomicroscopy provides diagnostically significant information about anterior segment structures (Anatomic or pathologic structures, crucial biometric information.).

scholarly journals Purtscher-like retinopathy presented a honeycomb-like pattern in optical coherence topography angiography

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Bing Li ◽  
Donghui Li ◽  
Youxin Chen
Keyword(s):  
Blood Flow ◽  
Vision Loss ◽  
Acute Onset ◽  
Pathological Process ◽  
Optical Coherence ◽  
Cotton Wool Spots ◽  
Before And After ◽  
Retinal Oedema ◽  
Hypointense Signal ◽  
The Right

Abstract Background To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and OCT angiography (OCT-A) findings before and after treatment. Case presentation A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination revealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT presented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and choriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed resolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern turned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the choriocapillaris. Conclusion This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the choriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process.

scholarly journals Wheel Spokes Technique for Endothelial Keratoplasty for Extremely Mydriatic Bullous Keratopathy Eyes without Capsular Support

2018 ◽  
Vol 9 (1) ◽  
pp. 238-242 ◽  
Author(s):  
Hidenori Tanaka ◽  
Koji Hirano ◽  
Masayuki Horiguchi
Keyword(s):  
Cataract Surgery ◽  
Argon Laser ◽  
Vitreous Cavity ◽  
Bullous Keratopathy ◽  
Sphincter Muscle ◽  
Endothelial Keratoplasty ◽  
Laser Iridotomy ◽  
Acute Glaucoma ◽  
A New Technique ◽  
Capsular Support

We describe a new technique to prevent an endothelial donor graft from dropping into the vitreous cavity during non-Descemet stripping automated endothelial keratoplasty (nDSAEK) for extremely mydriatic bullous keratopathy (BK) eyes without capsular support. The patient was a 79-year-old woman who underwent nDSAEK for an extremely mydriatic BK eye with an incomplete barrier between the anterior and posterior chambers. She had undergone argon laser iridotomy for acute glaucoma at the age of 59 years and cataract surgery 3 years later. The pupil was extremely mydriatic as a result of iris sphincter muscle damage associated with an acute glaucoma attack and cataract surgery. After cataract surgery, the dislocated intraocular lens (IOL) sometimes touched the corneal endothelium. Despite simultaneous surgery to remove the dislocated IOL and lens capsule, vitrectomy, and intrascleral IOL fixation, her corneal endothelial decompensation progressed to BK. During nDSAEK, three 9-0 Prolene suture threads were placed through the recipient’s cornea, limbus-to-limbus, resembling wheel spokes, to prevent the graft from dropping into the vitreous cavity. With the aid of these pre-placed sutures, the graft was inserted safely and was well attached to the host’s posterior cornea by air tamponade without suturing. The wheel spokes technique prevented the endothelial graft from dropping during intraoperative manipulation, suggesting that nDSAEK is possible even in an extremely mydriatic aphakic BK eye without capsule support.

scholarly journals Purtscher-like retinopathy presented a honeycomb-like pattern in optical coherence topography angiography

2019 ◽  
Author(s):  
Bing Li ◽  
Youxin Chen ◽  
Donghui Li
Keyword(s):  
Blood Flow ◽  
Vision Loss ◽  
Acute Onset ◽  
Pathological Process ◽  
Optical Coherence ◽  
Cotton Wool Spots ◽  
Before And After ◽  
Retinal Oedema ◽  
Hypointense Signal ◽  
The Right

Abstract Background: To report a case of Purtscher-like retinopathy (PUR) and the optical coherence tomography (OCT) and OCT angiography (OCT-A) findings before and after treatment. Case presentation: A 65-year-old male presented with acute onset of vision loss for 2 weeks. Fundus examination revealed cotton-wool spots, retinal haemorrhage, and Purtscher flecken spread around the optic disc in the right eye. He was diagnosed with Purtscher-like retinopathy because he lacked any traumatic medical history. OCT presented some band-like hyperreflective lesions at the inner nuclear layer, which are indicative of paracentral acute middle maculopathy (PAMM). OCT-A revealed apparent reduction in blood flow signal at the deep retina and choriocapillaris layers with a honeycomb-like hypointense signal pattern. After 3 months of follow-up, OCT revealed resolution of retinal oedema, but PAMM lesions remained visible. Based on OCT-A, the honeycomb-like pattern turned into a homogeneous reduction in blood flow with small patches of hypointense signal areas in the choriocapillaris. Conclusion: This case presented a new OCT-A sign in PUR with a honeycomb-like hypointense signal at the choriocapillaris layer, indicating the involvement and ischaemia of the choroid during the pathological process.

Interface fluid syndrome secondary to endothelial failure due to toxic anterior segment syndrome after cataract surgery

2018 ◽  
Vol 29 (3) ◽  
pp. NP1-NP4
Author(s):  
Burcu Kasım ◽  
Yusuf Koçluk ◽  
Ayşe Burcu
Keyword(s):  
Cataract Surgery ◽  
Cell Function ◽  
Anterior Segment ◽  
Laser In Situ Keratomileusis ◽  
Blurred Vision ◽  
Endothelial Cell Function ◽  
History Of ◽  
Toxic Anterior Segment Syndrome ◽  
The Right

Purpose: To present a case of previous laser in situ keratomileusis with interface fluid syndrome secondary to toxic anterior segment syndrome following cataract surgery. Case report: A 52-year-old woman, complaining blurred vision in her right eye for 18 months after cataract surgery, was referred to our clinic. She was diagnosed with toxic anterior segment syndrome, postoperatively, which resolved in 3 days. She had a history of laser in situ keratomileusis surgery 15 years ago. Slit-lamp examination of the right eye showed corneal haze, limited to laser in situ keratomileusis flap. The patient was diagnosed with interface fluid syndrome secondary to endothelial decompensation due to toxic anterior segment syndrome. Descemet’s membrane endothelial keratoplasy was performed along with full thickness fenestrations in the laser in situ keratomileusis flap to the right eye of the patient. The fluid was resolved in 1 week and visual acuity was improved rapidly. Conclusion: This case shows the importance of considering the diagnosis and determining the specific etiology of interface fluid syndrome, even years after the laser in situ keratomileusis surgery, when endothelial cell function has been compromised with any factor, such as intraocular surgery and its complications.

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