Accidental macular hole following Neodymium:YAG posterior capsulotomy

Introduction. Posterior capsular opacification (PCO) is the commonest complication of cataract surgery, occurring in up to one-third of patients in a period of five years. The treatment of choice is the Neodymium:YAG laser posterior capsulotomy. This treatment can be associated with several complications, some of them severe. A rare complication of this procedure is the accidental induced macular hole. Case Outline. A 54-year-old female patient was referred to our Department because of a severe loss of vision and a central scotoma at the right eye. The patient underwent a Nd:YAG posterior capsulotomy 2 days ago, for a PCO. The fundus examination at presentation revealed a round retinal defect in the macular region, a massive inferior preretinal hemorrhage and a mild vitreous hamorrhage. A 6-months follow-up of the case, including retinography and fluorescein angiography, is presented. Conclusion. Although the Nd:YAG laser capsulotomy is a safe, noninvasive, and effective outpatient procedure to improve vision hindered by PCO, it must be recognized that it carries a low but definite risk of serious complications. Physicians and patients should be aware of these rare but severe complications regarding this otherwise safe procedure. Fortunately, most of the complications related to this procedure are transient and can be managed by proper medication.

Download Full-text

A Study of Nd:YAG Laser Capsulotomy in the Management of Posterior Capsular Opacification

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2016/v3/i1/718 ◽

2016 ◽

Vol 3 (1) ◽

pp. 18

Author(s):

Mrunal Suresh Patil ◽

Dhiraj Namdeo Balwir ◽

Swapnil Vidhate

Keyword(s):

Visual Acuity ◽

Nd:Yag Laser ◽

Visual Outcome ◽

Detailed Examination ◽

Posterior Capsular Opacification ◽

Exclusion Criteria ◽

Posterior Capsulotomy ◽

Transient Rise ◽

Nd:Yag Laser Capsulotomy

Aims: To study the visual outcome following Nd:YAG laser posterior capsulotomy and to study the complications associated with Nd:YAG laser posterior capsulotomy. Material and Methods: The study included a total of 100 eyes of 100 patients who fulfilled the inclusion and exclusion criteria. Once diagnosed to have posterior capsular opacification they were subjected to a detailed clinical examination. All patients underwent Nd:YAG laser capsulotomy. Patients were followed up at 1 hour, 4 hour, 1 day, 1 week, 1 month, 3 month. At every follow up detailed examination was done. BCVA and any complications were noted. Results: Post-laser, 87% patients had BCVA 6/12 or more at 3 month follow up. 10% patients had BCVA 6/24 to 6/18. Only 3% patients had visual acuity improved to less than 6/24. Out of 3 patients, 1 patient had visual acuity improved to 6/60&in remaining 2 visual acuity improved to 6/36. The complications were seen in 31 (31%) patients. Most common complication observed was transient rise in IOP. 17 eyes (17%) had transiently raised IOP. Second most common noted was pitting of IOL. Pitting was present in 7 (7%) patients, 3 (3%) patients had ruptured anterior face of vitreous, 2 (2%) patients had iritis, 1 (1%) had hyphema and 1 (1%) developed CME. IOP rise was related to grade of PCO and energy used. Conclusion: Improvement in visual acuity after Nd:YAG laser posterior capsulotomy is excellent. Complications associated with Nd:YAG laser capsulotomy are minimal. Nd: YAG laser capsulotomy is a safe method of restoring vision in patients with posterior capsule opacification.

Download Full-text

Ab interno 180-degree trabeculectomy with a dual blade in a patient with refractory primary congenital glaucoma

European Journal of Ophthalmology ◽

10.1177/11206721211010402 ◽

2021 ◽

pp. 112067212110104

Author(s):

Mehmet Talay Koylu ◽

Fatih Mehmet Mutlu ◽

Alper Can Yilmaz

Keyword(s):

Intraocular Pressure ◽

Female Patient ◽

Congenital Glaucoma ◽

Safe Procedure ◽

Primary Congenital Glaucoma ◽

History Of ◽

Kahook Dual Blade ◽

The Right ◽

Ab Interno

A 13-year-old female patient with refractory primary congenital glaucoma (PCG) in the right eye who had a history of multiple glaucoma operations underwent ab interno 180-degree trabeculectomy with the Kahook Dual Blade (KDB) targeting the nasal and inferior angles. On postoperative day 1, the intraocular pressure (IOP) of the right eye reduced from 43 to 15 mmHg while on medical therapy. The patient maintained this IOP level throughout the 6-month follow-up. Ab interno KDB trabeculectomy targeting both nasal and inferior angles may be an effective and safe procedure for the treatment of PCG even in eyes with a history of previously failed glaucoma procedures.

Download Full-text

Use of micropulse trans-scleral cyclophotocoagulation for acute rise in intraocular pressure due to anterior segment inflammation

European Journal of Ophthalmology ◽

10.1177/1120672120924341 ◽

2020 ◽

pp. 112067212092434

Author(s):

Shotaro Asano ◽

Victor Koh Teck Chang ◽

Maria Cecilia Domingo Aquino ◽

Paul Chew Tec Kuan

Keyword(s):

Intraocular Pressure ◽

Rescue Therapy ◽

Anterior Segment ◽

Poor Response ◽

Posterior Capsular Opacification ◽

Nd:Yag Laser Capsulotomy ◽

Pressure Spike ◽

History Of ◽

The Right ◽

Rescue Procedure

Purpose The aim of this study was to report the use of micropulse trans-scleral cyclophotocoagulation as an adjunct therapy for two cases of medically uncontrolled intraocular pressure spikes due to anterior segment inflammation. Case description: Case 1 had previous cataract surgery and exhibited an intraocular pressure spike due to phacoantigenic uveitis (right eye intraocular pressure = 52 mmHg). Despite medical treatment, the right eye intraocular pressure remained high (43 mmHg), thus micropulse trans-scleral cyclophotocoagulation was carried out as a rescue therapy. After micropulse trans-scleral cyclophotocoagulation, the intraocular pressure at 1 day and 3 weeks was 9 and 16 mmHg, respectively. Case 2 had a history of previous blunt ocular trauma and 180° of angle recession. Both eyes were pseudophakia and underwent right eye Nd:YAG laser capsulotomy for posterior capsular opacification. Immediately after the procedure, the right eye intraocular pressure increased to 64 mmHg. Due to poor response to medical therapy, rescue micropulse trans-scleral cyclophotocoagulation was performed. After micropulse trans-scleral cyclophotocoagulation, the intraocular pressure at 1 day and 2 months was 12 and 21 mmHg, respectively. Conclusion Micropulse trans-scleral cyclophotocoagulation successfully decreased intraocular pressure in both cases of acute rise in intraocular pressure. Micropulse trans-scleral cyclophotocoagulation can potentially be useful as a rescue procedure to safely reduce medically uncontrollable intraocular pressure spike due to anterior segment inflammation.

Download Full-text

Giant Intrahepatic Subcapsular Haematoma: A Rare Complication following Laparoscopic Cholecystectomy—A Case Report and Literature Review

Case Reports in Surgery ◽

10.1155/2020/6410790 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Eltaib Saad ◽

Lauren O’Connell ◽

Anne M. Browne ◽

W. Khan ◽

R. Waldron ◽

...

Keyword(s):

Rare Complication ◽

Rare Event ◽

Decisive Role ◽

Postoperative Monitoring ◽

Refractory Hypotension ◽

Life Threatening ◽

The Right ◽

Tomography Scan

We report on a 59-year-old female with symptomatic cholelithiasis on a background of morbid obesity who underwent an elective LC with an uncomplicated intraoperative course; however, she experienced a refractory hypotension within one hour postoperatively with an acute haemoglobin drop requiring fluid resuscitation and blood transfusion. A triphasic computed tomography scan revealed a large intrahepatic subcapsular haematoma (ISH) measuring 21 cm × 3.1 cm × 17 cm surrounding the lateral surface of the right hepatic lobe without active bleeding. She was managed conservatively with serial monitoring of haemoglobin and haematoma size. A follow-up ultrasound scan after eight weeks confirmed complete resolution of the haematoma. Giant ISH is a fairly rare, but life-threatening complication following LC which merits special attention. This case demonstrates the necessity of close postoperative monitoring of patients undergoing LC and considering the possibility of ISH, although being rare event, in those who experience a refractory postoperative hypotension. It also highlights the decisive role of diagnostic imaging in securing a timely and accurate diagnosis of post LC-ISH.

Download Full-text

1220 A CASE OF HYPOGLOSSAL NERVE STIMULATOR CERVICAL LEAD CUFF DISLODGEMENT

SLEEP ◽

10.1093/sleep/zsaa056.1214 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A466-A466

Author(s):

Hamed Ali ◽

Sowjanya Duthuluru

Keyword(s):

Hypoglossal Nerve ◽

Pulse Generator ◽

Rare Complication ◽

Alternative Therapy ◽

Distal Portion ◽

Clinic Visit ◽

Nerve Stimulator ◽

Obstructive Sleep ◽

The Right

Abstract Introduction Hypoglossal Nerve Stimulation (HGNS) has become an alternative therapy for moderate to severe obstructive sleep apnea (OSA) patients intolerant to PAP therapy. HGNS devices typically comprise of implantable pulse generator (IPG) placed surgically in an infraclavicular subcutaneous pocket. An electrode cuff attached to the IPG wraps around the distal portion of the of the hypoglossal nerve. This device has an implantable chest sensor that monitors the respiratory efforts. Report of Case A 76-year-old male with history of severe OSA (AHI 39 /hour) was intolerant to PAP therapy. HGNS was implanted in the right infraclavicular pocket under general anesthesia without any complications. Patient had successful tongue motion to stimulus per protocol intra- operatively in the OR. However, no tongue movement was noted despite maximum stimulation up to 4.5 V at follow up clinic visit. Follow up C spine x ray showed very low-lying HGNS cervical lead cuff, and possible dislodgement. Patient was taken back to the OR. Intraoperatively it was noted that the previously placed cervical lead cuff has folded back and was lying on the surface of the submandibular gland /digastric anchor site. It was dissected free and replaced on the distal inclusion branches of the hypoglossal nerve with loupe magnification and EMG confirmation (tongue deviation at 1.5 volts). Patient developed tongue neuropraxia with difficulty swallowing, difficulty speaking and right sided tongue deviation lasting for months, that gradually improved. Patient had successful HNS activation 6 months later using 2.2 V. Conclusion (HGNS) failure secondary to cervical lead cuff dislodgement is a rare complication and should be taken in consideration. Post-operative imaging and comprehensive clinical examination are crucial in detecting such problems. Temporary tongue neuropraxia post Hypoglossal nerve stimulator placement is another possible complication.

Download Full-text

Retrograde venous bullet embolism after thoracic gunshot

Jornal Vascular Brasileiro ◽

10.1590/jvb.2013.061 ◽

2013 ◽

Vol 12 (4) ◽

pp. 324-328 ◽

Cited By ~ 2

Author(s):

Leonardo Pessoa Cavalcante ◽

Marcos Velludo Bernardes ◽

Ricardo Dias da Rocha ◽

Marcos Henrique Parisati ◽

Jose Emerson dos Santos Souza ◽

...

Keyword(s):

Ct Scan ◽

Gunshot Wound ◽

Rare Complication ◽

Iliac Vein ◽

X Rays ◽

Abdominal Injuries ◽

Internal Iliac Vein ◽

Internal Iliac ◽

The Right

Bullet embolism is a rare complication of penetrating gunshots. We present a case of a 24-year-old man with a gunshot wound in the left scapular area, with no exit wound. Abdominal X-rays and a computed tomography (CT) scan suggested that the bullet was located within the intra-abdominal topography (intrahepatic), but laparotomy revealed no intra-abdominal injuries. After surgery, a sequential CT scan showed that the bullet had migrated to the right internal iliac vein (IIV). Venography confirmed the diagnosis of right IIV embolism and the decision was taken to attempt snare retrieval of the bullet, which was unsuccessful. It was therefore decided to leave the missile impacted inside the right IIV and the patient was put on oral anticoagulation. The patient recovered and was event free at 6 months' follow up.

Download Full-text

Migration of the Anterior Spinal Rod to the Right Thigh, a Rare Complication of Anterior Spinal Instrumentations: A Case Report and a Literature Review

Case Reports in Orthopedics ◽

10.1155/2015/532412 ◽

2015 ◽

Vol 2015 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Camino Willhuber Gaston ◽

Taype Zamboni Danilo ◽

Carabelli Guido ◽

Barla Jorge ◽

Sancineto Carlos

Keyword(s):

Rare Complication ◽

Spinal Instrumentation ◽

Unusual Complication ◽

Anterior Fusion ◽

Long Term Follow Up ◽

The Right ◽

Rod Migration ◽

Surgical Treatments

Posterior and anterior fusion procedures with instrumentation are well-known surgical treatments for scoliosis. Rod migration has been described as unusual complication in anterior spinal instrumentations; migration beyond pelvis is a rare complication. A 32-year-old female presented to the consultant with right thigh pain, rod migration was diagnosed, rod extraction by minimal approach was performed, and spinal instrumentation after nonunion diagnosis was underwent. A rod migration case to the right thigh is presented; this uncommon complication of spinal instrumentation should be ruled out as unusual cause of sudden pain without any other suspicions, and long-term follow-up is important to prevent and diagnose this problem.

Download Full-text

Case report: Recovery after large intramyocardial dissecting haematoma of the ventricular septum—a rare complication of myocardial infarction

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa579 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

David Lovasz ◽

Daniele Camboni ◽

Judith Zeller ◽

Christof Schmid

Keyword(s):

Myocardial Infarction ◽

Plaque Rupture ◽

Rare Complication ◽

Coronary Intervention ◽

Ventricular Septum ◽

Feasible Option ◽

Life Threatening ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echocardiography and confirmed by both computed tomography (CT) and magnetic resonance imaging (MRI). With non-surgical treatment, the patient remained clinically stable. Repeated echocardiography showed gradual regression of the haematoma. Follow-up echocardiography 3 months after the initial diagnosis demonstrated no evidence of septal haematoma. Discussion This report suggests that even large intramyocardial haematoma may recede without operative intervention. Echocardiography, CT, and MRI are all helpful in quantifying the size of the haematoma. The appropriate management should be patient-oriented, depending on clinical stability and progression of the haematoma. Conservative treatment in clinically stable patients suffering from septal haematoma following MI and coronary intervention can be a feasible option.

Download Full-text

A rare entity of non-filarial lymphedema

Journal of Clinical Images and Medical Case Reports ◽

10.52768/2766-7820/1037 ◽

2021 ◽

Vol 2 (2) ◽

Author(s):

Christopher Stauch ◽

◽

Moein Jafari ◽

Hyma Polimera ◽

◽

...

Keyword(s):

Rare Complication ◽

Body Part ◽

Venous Stasis ◽

Rare Entity ◽

Dermatology Clinic ◽

Subcutaneous Tissues ◽

The Right ◽

Chronic Lymphedema ◽

Lymphatic Obstruction

Patient is a 77 year old female who presented to the outpatient dermatology clinic due to progressive massive leg swelling. Physical exam demonstrated bilateral lower extremity chronic lymphedema with stasis dermatitis changes with the left more significant than the right. The patient was diagnosed with elephantiasis nostras verrucosa (ENV) and was treated with leg elevation and arranged for follow-up with a chronic lymphedema clinic. ENV is a rare complication of non-filarial chronic lymphedema. Its pathogenesis is characterized by long-standing lymphatic obstruction, which may occur due to a variety of obstructive diseases. This can lead to accumulation of proteinaceous fluid in the dermis and subcutaneous tissues causing further lymphatic obstruction and edema followed by hyperkeratosis, fibrosis, and formation of papillated, verrucous papules. Differential diagnoses to consider include venous stasis dermatitis, cellulitis, lipodermatosclerosis, pretibial myxedema, and lymphatic filariasis. Mainstays of treatment of ENV include elevation of the affected body part, compressive hosiery, and antibiotic prophylaxis for superimposed infection [1].

Download Full-text