Air Bubble In Anterior Chamber Research Articles

Full-Thickness Compressive Corneal Sutures with Removal of Anterior Chamber Air Bubble in the Management of Acute Corneal Hydrops

Acute hydrops is a rare complication of corneal ectatic disease, which occurs secondary to Descemet membrane break. Spontaneous resolution of this condition is associated with longstanding ocular discomfort and corneal scar. Intracameral gas/air injection with or without corneal suturing, anterior segment ocular coherence tomography (ASOCT)-guided drainage of intrastromal fluid, and penetrating keratoplasty are some of the described surgical interventions to manage this condition. The purpose of our study was to assess the effect of full-thickness corneal suturing as a solo treatment in the management of acute hydrops. A total of five patients with acute hydrops received full-thickness corneal sutures perpendicular to their Descemet break. A complete resolution of symptoms and corneal oedema was observed between 8 to 14 days post-operation with no complications. This technique is simple, safe, and effective in the management of acute hydrops and saves patients from a corneal transplant in an inflamed eye.

DMEK Without Postoperative Supine Posturing.

The purpose of this study was to describe the incidence of graft detachment after Descemet membrane endothelial keratoplasty (DMEK) without postoperative supine posturing. A total of 106 eyes of 84 patients with Fuchs endothelial corneal dystrophy or bullous keratopathy (BK) were operated by a single experienced surgeon with DMEK with a 99% anterior chamber air bubble fill, recovered in an upright (seated) position, and then discharged without instructions to remain supine. Postoperatively, all eyes were evaluated for graft detachment through anterior segment optical coherence tomography at predetermined intervals (1 d, 1 wk, and 1 mo). Detachments were regarded as clinically significant if they subtended 30% of the total graft surface area or involved the visual axis. Clinically significant graft detachments were observed in 23 of 106 eyes (22%) in the no-supine posturing cohort, including 22 of 85 eyes (26%) operated for Fuchs endothelial corneal dystrophy and 1 of 21 eyes (5%) operated for BK. Compared with a historical comparison group of eyes undergoing DMEK with 48 hours of postoperative supine posturing, the risk of graft detachment was not increased. In both cohorts, 6% of operated eyes required regrafting for either persistent detachment or primary graft failure. No additional intraoperative or postoperative complications were experienced. Particularly in eyes operated for BK, the supine posturing requirement after DMEK may be eliminated without increasing the absolute risk for clinically significant graft detachment.

Intraoperative fundus inspection during surgery.

We describe a technique of intraoperative fundus visualization during anterior segment surgery using an anterior chamber air bubble. An air bubble that occupies one-half to two-thirds of the anterior chamber is injected via existing corneal incisions at any time during surgery. By focusing downwards and looking through the air bubble, an upright image of the posterior pole of the fundus is seen. The technique is demonstrated in a series of cases in the form of photos and supplementary video files. Visualization of the fundus can be safely and effectively performed regardless of the lens status (phakic/pseudophakic/aphakic) of the eye. This technique allows the posterior pole and up to mid-peripheral fundus to be quickly inspected at any stage of surgery. This technique may help surgeons to briefly inspect the fundus in cases of unusual light reflex or following complicated surgery without any additional instrumentation.

Closed-Chamber Anterior Capsulorhexis Under Air Tamponade In White Cataract.

PurposeTo evaluate the efficacy and safety of a closed-chamber air bubble capsulotomy technique to prevent the Argentinean flag sign (AFS) in patients with white and intumescent cataracts.SettingSohag University, Faculty of Medicine, Ophthalmology Department, Sohag, Egypt.DesignProspective interventional noncomparative case series.MethodsEighty-two eyes of 80 patients with white and intumescent cataracts were included. Eyes with any ocular pathology other than cataract or eyes subjected to previous intraocular surgery were excluded. Needle capsulorhexis was performed under a large air bubble tamponade without capsular staining. Efficacy of the technique was assessed intraoperatively by successful completion of capsulorhexis. Safety of the technique was assessed by the occurrence of intraoperative or postoperative complications.ResultsComplete capsulorhexis by the closed-chamber air bubble technique was successful in 75 eyes (91.5%), while capsulorhexis extension occurred in seven eyes. In four eyes with extension, the procedure was shifted to the standard technique of CCC (circular curvilinear capsulorhexis), using a viscoelastic device. A shift to extracapsular cataract extraction (ECCE) surgery occurred in the remaining three eyes, as the extension was so far-gone. No intraoperative or postoperative complications were observed.ConclusionThe closed anterior chamber air bubble technique for capsulorhexis is a novel, safe, and effective technique to prevent AFS in white and intumescent cataracts. It is also time-saving and cost-effective, with less likelihood of capsulorhexis extension. The technique is considered a valuable addition to previously described techniques.

Intracameral air injection after completion of phacoemulsification cataract surgery: Evaluation of corneal incisions with optical coherence tomography

PurposeTo evaluate the effects of air bubbles on clear corneal incision (CCI) in patients who had phacoemulsification surgery, and to compare this type of CCI architecture with patients who had no air bubbles after phacoemulsification surgery, using anterior segment optical coherence tomography (AS-OCT). MethodsEyes which had undergone uneventful phacoemulsification cataract surgery with implantation of a posterior chamber intraocular lens (IOL) were equally randomized into two groups. Group 1 comprised patients with anterior chamber air bubble injection after phacoemulsification, and Group 2 comprised patients who had undergone phacoemulsification surgery without anterior chamber air bubble. Postoperative evaluation included AS-OCT (Heidelberg Engineering, Germany) and pneumatic tonometry (Nidek NT-1000 Pneumatic Tonometer, Japan) in the 2nd hour, then at 1 week, and 1 month. Astigmatic changes assessed with corneal topography after phacoemulsification cataract surgeries were noted. ResultsEvaluation was made of 40 eyes of 28 patients (10 female, 18 male) as 20 eyes in Group 1 and 20 eyes in Group 2. On the first postoperative day, the endothelial gap rate was 13.3% in Group 1 and 57.1% in Group 2 (P = 0.02), and this continued until the 1-month follow-up examination. The Descemet's membrane detachment (DMD) rate was 0% in Group 1 and 42.8% in Group 2 on postoperative day 1 (P = 0.006), and this continued at the 1-month follow-up examination. At 1 month postoperatively, the rates of optical coherence tomography (OCT) parameters were similar. There were no significant differences between preoperative astigmatism and postoperative astigmatism in the group analyses. ConclusionIn this study, air bubbles decreased the rate of DMD and of endothelial and epithelial gap during the early postoperative period.

Air bubble in anterior chamber as indicator of full-thickness incisions in femtosecond-assisted astigmatic keratotomy

Femtosecond-assisted astigmatic keratotomy is predictable and precise but may occasionally lead to a full-thickness incision on the cornea and the attendant complications. The presence of an air bubble in the anterior chamber soon after creation of the keratotomy by the femtosecond laser may indicate a full-thickness incision. We present a case in which recognition of this clinical finding early in the procedure might have prevented undesirable complications, such as leakage of aqueous and the potential for intraocular infection.

Effect of anterior chamber air bubble on prevention of experimental Staphylococcus epidermidis endophthalmitis

Bacterial endophthalmitis is a serious complication of penetrating ocular trauma and cataract surgery. The purpose of this study is to assess the ability of an anterior chamber air bubble to prevent experimental Staphylococcus epidermidis endophthalmitis. The anterior chamber was opened with a clear corneal incision to drain the aqueous humor in one eye of 24 rabbits. S. epidermidis was injected into the anterior chamber. The infected rabbits were randomly divided into two groups. Animals in group 1 (n = 12) received an air bubble to reconstruct the anterior chamber, and animals in Group 2 (n = 12) received Balanced Salt Solution (BSS) for reconstruction. Clinical examination in each group was performed 2, 3 and 7 days after inoculation of the bacteria. Clinical examination scores were recorded. All eyes were enucleated for histophatological examination. Clinical endophthalmitis was seen in 7/12 (58.3%) in group 2, but in only 1/12 (8.3%) in group 1 (p = 0.027). Mean clinical scores of groups 1and 2 on the 3rd day were 2.6 +/- 1.4 and 7.2 +/- 1.7 respectively. (p < 0.001). The mean clinical scores of groups 1and 2 on the 7th day were 2.3 +/- 1.2 and 6.8 +/- 1.5 respectively (p < 0.001). Histopathological examination confirmed clinical findings. An air bubble in the anterior chamber may have protective effects against the development of experimental S. epidermidis endophthalmitis.

HIV Incidence Among Men Diagnosed With Early Syphilis in Atlanta, San Francisco, and Los Angeles, 2004 to 2005

To assess surgeon satisfaction with precut corneal tissue from 1 eye bank for Descemet stripping automated endothelial keratoplasty (DSAEK). Surgical techniques and predictors of procedural success were also examined. A 19-question survey was completed by 53 surgeons around the United States for 197 DSAEK cases using prepared corneal allograft tissue from the Iowa Lions Eye Bank. Surgeries were performed between April 1 and December 31, 2006; surveys were completed retrospectively within a few weeks of surgery. Tissue was found to be acceptable in 98% of DSAEK cases reported. Difficulties with precut tissue (eg, lack of anterior cap adherence to the posterior lamella, not visible or decentered central dot, anterior edge undermining) were reported in approximately 10% of cases. A rebubbling procedure was performed in 23% of cases for donor dislocations. The donor lenticule adhered, with resulting corneal deturgescence, in 86% of cases. Surgeons declared a successful procedure in 92% of cases. Of the 14 unsuccessful cases, donor tissue quality was the underlying etiology in only 1 case. Procedural success rates were related to surgeon experience (P = 0.002), lenticule adherence after only 1 anterior chamber air bubble (P = 0.005), no small perforations to release fluid (P = 0.005), and the presence of corneal deturgescence (P = 0.002). The use of precut tissue for DSAEK is not associated with increased risk of complications related to tissue preparation. With standardization of precutting donor tissue, safety of DSAEK surgery may be improved while increasing surgeon efficiency.

Pupillary Block, Angle-closure Glaucoma Produced by an Anterior Chamber Air Bubble in a Nanopthalmic Eye-Reply

Pupillary Block, Angle-closure Glaucoma Produced by an Anterior Chamber Air Bubble in a Nanopthalmic Eye-Reply