Ex-Press P50 device filtering failure due to non-visible intraluminal blockages

2020 ◽  
pp. 112067212095203
Author(s):  
Brahim Azarfane ◽  
Marta Castany Aregall ◽  
Jaume Rigo Quera ◽  
Sandra Banderas García ◽  
Antonio Dou Saenz De Vizmanos ◽  
...  
Keyword(s):  
Fibrous Tissue ◽  
Surgical Revision ◽  
Slit Lamp ◽  
Scleral Flap ◽  
Slit Lamp Examination ◽  
Common Cause ◽  
Filtering Bleb ◽  
Cause Of Failure ◽  
Aqueous Flow

Purpose: To describe Ex-Press P50 failures due to an internal blockage. Methods: A retrospective series of 248 eyes of 219 patients with Ex-Press P50 surgery was conducted. Of these cases, 18 (7.2%) required surgical revision due to filtration failure with no visible blockages in the gonioscopy and no filtering bleb in the slit lamp examination. In all of these cases, we found fibrosis on the edges of the scleral flap. After dissecting the scleral flap, filtration through the implant was restored spontaneously in 10 (4.0%) cases. In two cases fibrous tissue was observed on the tip of the implant and was necessary to remove it. In 6 (2.4%) cases, there was no filtration despite no visible obstruction and attempts to restore the flow were unsuccessful, requiring extraction of the implant and reconverting to trabeculectomy. Two of the removed devices were sanded until the lumen was visible to ascertain the nature of the obstruction. Results: In our series, the most common cause of failure was episcleral fibrosis. In 2.4% of the cases, the blockage was intraluminal and aqueous flow could not be restored. Conclusion: In the Ex-Press P50 implant an internal blockage, that is not visible through the proximal or distal orifices, may be the cause of failure. Unblocking by surgical maneuvers is not feasible due to the intraluminal design. These cases can be solved by extraction of the implant and conversion to trabeculectomy.

Elevated IOP with a Deep Anterior Chamber

2013 ◽  
Author(s):  
Annie K. Baik ◽  
James D. Brandt
Keyword(s):  
Anterior Chamber ◽  
Postoperative Bleeding ◽  
Anterior Segment ◽  
Early Postoperative Period ◽  
Slit Lamp ◽  
Scleral Flap ◽  
Slit Lamp Examination ◽  
Subconjunctival Hemorrhage ◽  
Digital Manipulation ◽  
Early Fibrosis

Early postoperative elevation of intraocular pressure (IOP) in the setting of a deep anterior chamber following trabeculectomy can generally be attributed to either mechanical obstruction or underfiltration. A careful clinical exam will almost always reveal the cause of elevated IOP and guide the clinician to logical, step-wise management. First, one should confirm that the anterior chamber is deep and the conjunctival wound is intact. Further investigation is directed by clinical signs, such as blood or fibrin in the anterior chamber, the pupil configuration, the appearance of the filtering bleb, internal obstruction of the sclerostomy, blood under the scleral flap, or subconjunctival hemorrhage. In the absence of such findings, underfiltration is most likely due to an inadequately sized sclerostomy, tight sutures on the scleral flap, or early fibrosis of the external sclerostomy site. Gonioscopy, in conjunction with anterior segment slit-lamp examination, is crucial in the evaluation of elevated IOP in the early postoperative period. Although adequate flow may have been established at the time of surgery, continued patency of the trabeculectomy should be confirmed to distinguish between underfiltration and obstruction. Obstruction of the sclerostomy site by blood, fibrin, vitreous, iris tissue, or fragments of Descemet’s membrane should be visible on gonioscopy examination. If the trabeculectomy site appears internally patent, examination of the scleral flap may further demonstrate causes for elevated IOP. Intraoperative or postoperative bleeding may lead to development of subconjunctival hemorrhage. Even in the absence of subconjunctival hemorrhage, blood and fibrin can occlude the trabeculectomy flap. If there is no evidence of physical obstruction, intrinsic properties of the trabeculectomy itself (such as ostium size and/or tension on the scleral flap sutures) may be contributing to elevated IOP. Gentle massage or digital manipulation serves both diagnostic and therapeutic purposes. If gonioscopy has not yet been performed and the bleb is unresponsive to digital manipulation, an internal obstruction may be present. Since internal obstruction of the ostium may not be readily apparent on routine slit-lamp examination, the threshold for gonioscopy should be low.

Late-onset malignant glaucoma

2020 ◽  
Vol 3 ◽  
pp. 1
Author(s):  
Ramiro José Daud ◽  
Horacio Freile ◽  
Mauricio Freile ◽  
Soledad Mariano
Keyword(s):  
Intraocular Pressure ◽  
Case Report ◽  
Acute Pain ◽  
Late Onset ◽  
Slit Lamp ◽  
Normal Range ◽  
Slit Lamp Examination ◽  
Complete Occlusion ◽  
Malignant Glaucoma ◽  
The Right

A case report on a 49-year-old female with diagnoses of ocular hypertension in her left eye (LE) treated with 250 mg/day acetazolamide for 2 years. During the slit-lamp examination, complete occlusion of both iridocorneal angles was detected. Intraocular pressure (IOP) was 10 and 35 mmHg in the right eye and LE, respectively. Phacotrabeculectomy was performed in the LE. After 1 month of the procedure, the patient developed a slowly progressive miopization from −1 to −3 diopters (D) the following months. Approximately 3 months after surgery, the patient developed an episode of acute pain, athalamia, and IOP 45 mmHg in her LE. Late-onset malignant glaucoma was suspected and the patient was treated with topical hypotensive and cycloplegic agent until a prompt vitrectomy was performed. Deepening of the anterior chamber and restoration of IOP to normal range was obtained after surgery.

scholarly journals Identification of a Novel Missense KRT12 Mutation in a Vietnamese Family with Meesmann Corneal Dystrophy

2020 ◽  
Vol 11 (1) ◽  
pp. 120-126
Author(s):  
Pham Ngoc Dong ◽  
Le Xuan Cung ◽  
Tran Khanh Sam ◽  
Do Thi Thuy Hang ◽  
Doug D. Chung ◽  
...  
Keyword(s):  
Sanger Sequencing ◽  
Novel Mutation ◽  
Family Members ◽  
Corneal Dystrophy ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Corneal Epithelial ◽  
Epithelial Phenotype ◽  
History Of ◽  
Characteristic Features

Meesmann epithelial corneal dystrophy (MECD) is a rare dominantly inherited disorder that is characterized by corneal epithelial microcysts and is associated with mutations in the keratin 3 (KRT3) and keratin 12 (KRT12) genes. In this study, we report a novel mutation in the KRT12 gene in a Vietnamese pedigree with MECD. Slit-lamp examination was performed on each of the 7 recruited members of a Vietnamese family to identify characteristic features of MECD. After informed consent was obtained from each individual, genomic DNA was isolated from saliva samples and screening of KRT3and KRT12 genes was performed by Sanger sequencing. The proband, a 31-year-old man, complained of a 1-year history of eye irritation and photophobia. Slit-lamp examination revealed intraepithelial microcysts involving only the corneal periphery in each eye with clear central corneas and no stromal or endothelial involvement. Three family members demonstrated similar intraepithelial microcysts, but with diffuse involvement, extended from limbus to limbus. Sanger sequencing of KRT3 (exon 7) and KRT12 (exons 1 and 6) in the proband revealed a novel heterozygous KRT12 variant (c.1273G>A [p.Glu425Lys]) that was present in the three affected family members but was absent in the three family members with clear corneas. This study is the first report of a Vietnamese family affected with MECD, associated with an atypical peripheral corneal epithelial phenotype in the proband and a novel mutation in KRT12.

scholarly journals Severe Corneal Morphological Alterations after Excimer Laser Surface Ablation for a High Astigmatism

2021 ◽  
pp. 492-496
Author(s):  
Anna M. Roszkowska ◽  
Giovanni W. Oliverio ◽  
Giuseppe A. Signorino ◽  
Mario Urso ◽  
Pasquale Aragona
Keyword(s):  
Excimer Laser ◽  
Corneal Stroma ◽  
Corneal Topography ◽  
Laser Surface ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Morphological Alterations ◽  
Surface Ablation ◽  
Confocal Images

We report long-term alterations of anterior corneal stroma after excimer laser surface ablation for a high astigmatism. The patient claimed progressive visual loss in his right eye (RE) during the last 3 years after bilateral laser-assisted subepithelial keratectomy (LASEK) surgery. His examination comprised visual acuity (UDVA and CDVA), slit-lamp examination, corneal topography and tomography, AS-OCT, and confocal microscopy. The UDVA was 0.1 in his RE and 1.0 in the left eye. The CDVA in the RE was 0.8. The slit-lamp examination showed a stromal lesion in the inferior paracentral corneal zone, with multiple vertical tissue bridges and severe thinning. Corneal topography and tomography showed central flattening with inferior steepening and severe alteration in elevation maps. AS-OCT showed void areas in the anterior stroma with thinning of the underlying tissue, and confocal images were not specific. In this case, progressive corneal steepening and thinning that manifest topographically as inferior ectasia occurred in correspondence to the singular stromal alterations after LASEK.

Progressive multifocal leukoencephalopathy in a patient with occult hypogammaglobulinemia experiencing bilateral visual impairment

2021 ◽  
pp. 112067212199053
Author(s):  
Sameera Hettipathirannahelage ◽  
Sidath Wijetilleka ◽  
Hugh Jewsbury
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Visual Impairment ◽  
Demyelinating Disease ◽  
Parietal Lobe ◽  
Previous History ◽  
White Matter Lesions ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
History Of ◽  
Ishihara Test

Introduction: Progressive multifocal leukoencephalopathy (PML) is a rare, lethal, demyelinating disease classically seen in profoundly immunosuppressed individuals. It is caused by intracerebral infection by John Cunningham polyomavirus (JCV). We report a rare case of PML in a man with presumed immunocompetence at presentation experiencing bilateral painless visual impairment. Case Description: A 60-year-old man with a 3-week history of bilateral painless visual impairment attended our ophthalmology department. Unusually, he navigated around the room well and was able to read 4 of 13 Ishihara test plates in spite of a best-corrected visual acuity of counting fingers at 1 m bilaterally. Slit lamp examination, routine blood tests and optical coherence tomography (OCT) of the maculae and discs were unremarkable. Diffuse hyperintense white matter lesions on T2-weighted magnetic resonance imaging of the brain and detection of JCV within the parietal lobe tissue obtained by biopsy confirmed PML. Additional investigations identified an underlying hypogammaglobulinaemia, which may have initiated PML. He received intravenous immunoglobulin but passed away 2 months after diagnosis. Conclusions: To our knowledge this case is one of only a handful worldwide to describe PML developing in a patient with presumed immunocompetence at presentation – there was no previous history of recurrent, chronic, or atypical infections. There has only been one other report of visual symptoms presenting as the primary complaint. The case illustrates the importance of ruling out organic, central nervous system pathology in patients presenting with visual loss and normal objective visual function tests such as slit lamp examination and OCT.

scholarly journals Corneal Pyogenic Granuloma Secondary to Toxic Epidermal Necrolysis Syndrome

2020 ◽  
Vol 3 (4) ◽  
pp. 01-04
Author(s):  
Vincent Borderie
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Pyogenic Granuloma ◽  
Minor Trauma ◽  
Slit Lamp ◽  
Slit Lamp Examination ◽  
Histopathological Findings

A 30–year man was referred to our institution for progressive bilateral keratoconjunctivitis following toxic epidermal necrolysis. Slit-lamp examination showed an elevated, red, vascularized lesion covering the entire cornea. The lesion was removed by superficial lamellar keratectomy. The histopathological findings confirmed the diagnosis of corneal pyogenic granuloma. These uncommon lesions usually develop in adults after minor trauma or surgery. To our knowledge, this is the first reported case of corneal pyogenic granuloma related to toxic epidermal necrolysis.

When the Trauma Draws a Rose: Rosette Cataract

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Madbouhi K ◽  
◽  
Cherkaoui O ◽  
Keyword(s):  
Visual Acuity ◽  
Emergency Room ◽  
Male Patient ◽  
Slit Lamp ◽  
Posterior Subcapsular Cataract ◽  
Slit Lamp Examination ◽  
Corrected Visual Acuity ◽  
The Hours ◽  
Rose Rosette

A 40-year-old male patient referred to the ophthalmologic emergency room for complaints of diminution of vision in the left eye since three months after a trauma. Examination of the left eye showed a corrected visual acuity of 20/70. Slit-lamp examination revealed a rosette cataract (Figure 1). The patient underwent phacoemulsification with implantation of an IOL in the bag. The rosette cataract is a posterior subcapsular cataract due to a violent contusion with a closed globe. It can develop in the hours that follow, or on the contrary several years later.

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