25-Gauge Catheter as a Surrogate to Anterior Chamber Maintainer in Trabeculectomy

A flat anterior chamber (AC) is a distinctive feature in status post vitrectomy eyes during trabeculectomy. The use of AC maintainers is useful to help prevent this peroperative situation. We herein describe the surgical technique using a 25-gauge intravenous catheter as a surrogate to conventional AC maintainers. A potential advantage of this approach is the low cost in the current economic environment with limited health restraints.

Bullous choroidal detachment requiring drainage following endoscopic cyclophotocoagulation

Endoscopic cyclophotocoagulation is a relatively safe cyclodestructive procedure with a lower complication rate compared to trans-scleral cyclophotocoagulation. Serous choroidal detachment is a complication that has been reported following endoscopic cyclophotocoagulation; however, it is usually mild and transient. A case of bullous choroidal detachment with a flat anterior chamber requiring drainage after endoscopic cyclophotocoagulation is presented, along with a discussion on the risk factors precipitating such complication.

Management of Glaucoma Capsulare: Outcomes and Complications of Trabeculectomy

Purpose: To analyze the results of filtration surgery in cases of Glaucoma Capsulare. Study Design: Experimental study. Place and Duration: Al-Ibrahim Eye Hospital, Karachi, from January 2018 to December 2018. Methods: Forty eyes of forty patients, between 50 to 80 years of age, with Glaucoma Capsulare, not controlled with topical medication were included in the study. Patients not willing for filtration surgery and those who had any other ocular disease were excluded. Pre-operative examination, including visual acuity, retinoscopy, intra ocular pressure and fundus examination was done. Complete blood count, blood sugar and urine complete were also carried outto rule out any other illness. All collected data was analyzed through software SPSS version 20. Results: There were 26 (65.0%) males and 14 (35.0%) females. Mean age was 62.1 ± 12.44 years. Mean IOP was 34.0 ± 2.43 mm of Mercury. At first follow-up mean IOP (mm.Hg) was 11.44 ± 3.2 and at 12 weeks follow-up, the IOP was 10.14 ± 4.1. Angle 0 – I (closed angle) was seen in 6 (15.0%), Angle grade II – III (Open angle) was seen in 10 (25.0%) and grade III – IV (open angle) was seen in 24 (60.0%) patients. Visual acuity 6/9 were in 4 (10.0%), 6/12 – 6/18 in 10 (25.0%), 6/18 – 6/24 was in 12 (30.0%) and visual acuity 6/36 – 6/60 was noted in 14 (35.0%) patients. Early complications were flat anterior chamber in 4 (10%) and corneal edema in 4 (10%) patients. However late complications were hyphema and cataract in 2 (5%) and 25 (62.5%) patients respectively. Conclusion: Trabeculectomy significantly lowers the intraocular pressure in patients with Glaucoma Capsulare. Key Words: Glaucoma Capsulare, Trabeculectomy, Gonioscopy, Hyphema, Pseudoexfoliation glaucoma.

Ultrasound Biomicroscopy Detects Peters’ Anomaly and Rieger’s Anomaly in Infants

Aim. Congenital corneal opacities (CCOs) are the major causes of early visual deprivation in infants. Balloon ultrasound biomicroscopy (UBM) examination is an effective method to diagnose CCO. However, whether it is suitable for children examination is still unknown. Methods. 26 Peters’ anomaly (PA) or Rieger’s anomaly (RA) infants with congenital corneal opacities (CCO) (40 eyes) underwent UBM examinations to study their imaging features. Results. Based on the results, they were divided into UBM Dx-Type I: Descemet’s membrane (DM) and endothelium have heterogenous or discontinuous echo accompanied with corneal stroma echo-enhanced or shallow anterior chamber. Type II: Type I alteration plus abnormal strand of iris extended to the border of the posterior corneal defect or iridocorneal adhesion. Type III: Type I or II combined with the abnormal hyperechoic lens, lens luxation, or keratolenticular adhesion. Type IV: echoes of the DM and the endothelium are continuous, corneal stroma echo is enhanced, and an abnormal strand of peripheral iris extends to the prominent Schwalbe line, accompanied by iris stroma or pupil heteromorphism and a shallow or flat anterior chamber. Conclusion. UBM not only could accurately evaluate the anterior segment abnormalities in CCO infants but also would be a step forward for the management of PA- and RA-associated CCO.

Late onset pupillary block glaucoma following phacoemulsification with posterior chamber intraocular lens implantation

Secondary angle closure in a pseudophakic eye due to pupillary block, more than a decade following phacoemulsification, has not been reported. We managed a 75-year-old female presenting with sudden, painful diminution of vision and raised intraocular pressure in the right eye. The key finding was an almost flat anterior chamber with intraocular lens in normal position clinically as well as on ultrasound biomicroscopy. The posterior chamber was ballooned up by vitreous, which was cleared surgically to restore the anatomy. Meticulous clinical examination augmented by ultrasound biomicroscopy findings helped us to diagnose and manage this case for satisfactory intraocular pressure and visual outcome.

LATE COMPLICATIONS UNFAVORABLE RESULTS OF CICATRICAL RETINOPATHY OF PREMATURITY

Purpose. The study of the frequency and structure of complications in IV-V degree of retinopathy of prematurity and the development of tactics for their prevention and treatment. Material and methods. A total of 134 patients (268 eyes) with IV-V degree of cicatricial retinopathy of premature infants aged 6 months - 17 years were examined. In addition to the standard ophthalmological examination, ultrasound methods were used: biometrics, echography, biomicroscopy. Results. Late complications were detected on 153 (57,1%) from 268 eyes with IV-V degrees of cicatrical ROP. The main types of complications were: flat anterior chamber, corneal and lens opacities, secondary glaucoma, progressive phthisis bulbi. Conclusions. All patients with cicatricial ROP require constant follow-up and differentiated tactics of prevention and treatment of late complications.

A Case Report of Preoperative, Intraoperative, and Postoperative Anterior Chamber Shallowing Resulting from Different Mechanisms

A 54-year-old woman with an epiretinal membrane in her left eye accompanied by a shallow anterior chamber due to primary angle closure glaucoma underwent vitrectomy and cataract surgery. During the cataract surgery, immediately after the ultrasonic tip had been removed from the anterior chamber, anterior chamber flattening occurred. An intraoperative fundus examination showed the development of acute intraoperative choroidal effusion. Postoperatively, the anterior chamber remained shallow even after the choroidal detachment had subsided; capsular bag distension seen by ultrasound biomicroscopy suggested the development of early postoperative capsular block syndrome. After neodymium:yttrium-aluminium-garnet laser capsulotomy, the anterior chamber deepened. Depending on the perioperative period, the mechanism of a flat anterior chamber can change, and understanding the underlying mechanisms is required for appropriate treatment.