Anterior Chamber Hemorrhage Research Articles

Clinical evaluation of a newly developed graft inserter (NS Endo-Inserter) for Descemet stripping automated endothelial keratoplasty.

PurposeThe aim of this study was to describe the postoperative outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed using our newly developed graft inserter (NS Endo-Inserter) and compare the findings with those for DSAEK performed using the Busin glide.Patients and methodsIn this retrospective, case-control, institutional study, we studied the clinical outcomes of DSAEK performed using the NS Endo-Inserter (NS group, n=13) or the Busin glide (Busin group, n=10) for patients with corneal endothelial dysfunction. Clinical parameters, including the distance-corrected visual acuity (DCVA), endothelial cell (EC) loss, and intraoperative/postoperative complications, were assessed over a 6-month follow-up period.ResultsAt 6 months after surgery, the mean DCVA showed no significant difference between the two groups. EC loss at 3 and 6 months after DSAEK was 9.1%±20.7% and 18.2%±22.6%, respectively, in the NS group and 44.0%±25.5% and 46.5%±23.3%, respectively, in the Busin group; differences between groups were statistically significant at both 3 and 6 months (P=0.024 and P=0.016, respectively). Anterior chamber hemorrhage was observed in one patient in the Busin group. Rebubbling after surgery was required for one eye in the Busin group. No complications were observed in the NS group.ConclusionOur newly developed graft inserter for DSAEK may cause significantly less EC damage than the conventional pull-through technique using the Busin glide. Our inserter permits safe endothelial graft delivery without anterior chamber collapse and can result in successful graft attachment without complications at 6 months after surgery.

Analysis of ocular trauma in 475 inpatients

Objective To analyze the characteristics of hospitalized patients with ocular trauma. Methods The data of 487 eyes of 475 patients with ocular trauma from Jan. 2014 to Dec. 2016 were collected. The demographic characteristics, types of ocular trauma and causes of ocular trauma were analyzed retrospectively. Results The ratio of male to female was 3.95∶1. The occupation was more common farmers and students.High occurrence age of ocular trauma was ≤10 years and 40- 49 years. The types of ocular trauma were 148 cases (31.16%) contusion of eyeball, perforation of eyeball in 128 cases (26.95%), eye appendages contusion and laceration in 93 cases (19.58%). The main reason for the injury was sharp instrument injury (21.47%). Complications of ocular trauma were traumatic cataract in 144 cases, anterior chamber hemorrhage in 104 cases, vitreous hemorrhage in 92 cases, endophthalmitis in 51 cases. The visual acuity of monocular or binocular less than 0.05 occupyed for 40.31%. Conclusion In the process of production, the eyes are vulnerable to be damaged by metal sharp weapon, for example iron sheets, and the consequences are serious, so it should be given enough attention. Key words: Trauma, ocular; Inpatients; Epidemiology

Observation of the efficacy of femtosecond laser small incision lenticule extraction(SMILE) for myopia

Objective To observe the long-term efficacy of intravitreal injection of Conbercept before trabeculectomy combined with panretinal photocoagulation (PRP) in the treatment of neovascular glaucoma (NVG). Methods The data of 30 eyes of 30 NVG patients from Jan.2014 to Dec.2014 were collected and analyzed retrospectively. All cases were treated with intravitreal injection of Conbercerpt. After neovessels of iris disappeared, they underwent trabeculectomy combined with PRP. The follow-up time was 30 months. The visual acuity, intraocular pressure, iris neovascular vessels and complications were observed after operation. Results Iris neovascular vessels disappeared in 27 eyes (90.00%) after 3-7 days intravitreal injection of Conbercerpt. Iris neovascular vessels reduced significantly in 3 eyes 3 days after injection and disappeared 10 days after injection. The IOP after treatment decreased significantly from (41.23 ±8.96) mmHg to (15.23±2.91) mmHg (1 mmHg=0.133 kPa). The difference was statistically significant (P<0.05). The IOP was controlled successfully in 26 eyes (86.67%), partly controlled in 4 eyes (13.33%). The best corrected visual acuity improved in 3 eyes (10.00%), no changed in 25 eyes (83.33%)and decreased in 2 eyes (6.67%). No complication related with the intravitreal injection appeared. Hyphema occurred during trabeculectomy in 4 eyes (13.33%), no shallow anterior chamber or vitreous hemorrhage happened after trabeculectomy. Conclusion Intravitreal injection of Conbercept before trabeculectomy combined with PRP postoperatively is safe and effective for NVG.The surgery can control IOP for a long time with high success rate. Key words: Glaucoma, neovascular; Trabeculectomy; Conbercept, intravitreal injection; Photocoagulation, panretinal

Laser Peripheral Iridotomy in Primary Angle Closure: A Report by the American Academy of Ophthalmology

To examine the efficacy and complications of laser peripheral iridotomy (LPI) in subjects with primary angle closure (PAC). Literature searches in the PubMed and Cochrane databases were last conducted in August 2017 and yielded 300 unique citations. Of these, 36 met the inclusion criteria and were rated according to the strength of evidence; 6 articles were rated level I, 11 articles were rated level II, and 19 articles were rated level III. Reported outcomes were change in angle width, effect on intraocular pressure (IOP) control, disease progression, and complications. Most of the studies (29/36, 81%) included only Asian subjects. Angle width (measured by gonioscopy, ultrasound biomicroscopy, and anterior segment OCT) increased after LPI in all stages of angle closure. Gonioscopically defined persistent angle closure after LPI was reported in 2% to 57% of eyes across the disease spectrum. Baseline factors associated with persistent angle closure included narrower angle and parameters representing nonpupillary block mechanisms of angle closure, such as a thick iris, an anteriorly positioned ciliary body, or a greater lens vault. After LPI, further treatment to control IOP was reported in 0%-8% of PAC suspect (PACS), 42% to 67% of PAC, 21% to 47% of acute PAC (APAC), and 83%-100% of PAC glaucoma (PACG) eyes. Progression to PACG ranged from 0% to 0.3% per year in PACS and 0% to 4% per year in PAC. Complications after LPI included IOP spike (8-17 mmHg increase from baseline in 6%-10%), dysphotopsia (2%-11%), anterior chamber bleeding (30%-41%), and cataract progression (23%-39%). Laser peripheral iridotomy increases angle width in all stages of primary angle closure and has a good safety profile. Most PACS eyes do not receive further intervention, whereas many PAC and APAC eyes, and most PACG eyes, receive further treatment. Progression to PACG is uncommon in PACS and PAC. There are limited data on the comparative efficacy of LPI versus other treatments for the various stages of angle closure; 1 randomized controlled trial each demonstrated superiority of cataract surgery over LPI in APAC and of clear lens extraction over LPI in PACG or PAC with IOP above 30 mmHg.

Surgical treatment and visual outcomes of cataract with persistent hyperplastic primary vitreous.

To evaluate the surgical treatment and visual outcomes of eyes with cataract and persistent hyperplastic primary vitreous (PHPV). This retrospective study included patients with cataract and PHPV treated with various strategies. Anterior PHPV was treated using phacoemulsification with underwater electric coagulation on posterior capsule neovascularization, posterior capsulotomy, anterior vitrectomy, and intraocular lens (IOL) implantation. Posterior PHPV was treated with lensectomy, posterior vitrectomy, retinal photocoagulation, and IOL implantation or silicone oil tamponade. Visual acuity (VA), pattern visual evoked potential (P-VEP), anatomic recovery, postoperative complications, and amblyopia outcome were examined. Subjects were followed-up for 3-48mo after surgery. Of the 30 patients (33 eyes) with congenital cataract and PHPV included (average age, 39.30±35.47mo), 9 eyes had anterior PHPV and 24 had posterior PHPV. Thirty-two eyes were surgically treated. Eyes with anterior PHPV received an IOL during one-stage (6 eyes) and two-stage (3 eyes) implantation. Postoperative complications included retinal detachment (1 eye) and recurrent anterior chamber hemorrhage (1 eye). In eyes with posterior PHPV, 6 and 11 eyes received IOLs in one- and two-stage procedures, respectively. Silicone oil was retained in 2 eyes, and IOLs were not implanted in 4 eyes. VA significantly improved in 25 eyes following operations and 3-48mo of amblyopia treatment. P-VEP P100 was improved following surgery in both PHPV types. Our surgical strategies are appropriate and effective for anterior and posterior PHPV. Early surgical intervention and amblyopia therapy result in positive treatment outcomes.

睫状体冷凝联合小梁切除术治疗新生血管性青光眼25例疗效观察

目的：探索睫状体冷凝术联合小梁切除术治疗新生血管性青光眼的疗效。方法：选择2012.1~2014.12于昆明医科大学第一附属医院眼科住院治疗的新生血管性青光眼患者，共25例(25眼)，先进行全视网膜激光光凝，所有患者均给予经睫状体平坦部玻璃体腔注射Lucentis 0.1 ml (1.0 mg)。注药3天后，行睫状体冷凝术联合小梁切除术，观察手术前至术后1 w、1 m、3 m、6 m，分别记录两组的病人自觉症状、眼压、视力、并发症情况。结果：术后所有患者的眼部胀痛消失，术后1 w、1 m、3 m、6 m平均眼压较术前明显降低，分别降低22.64 mmHg，23.6 mmHg，24.2 mmHg，26.16 mmHg。差异有统计学意义(P < 0.001)。1例术后低眼压，1例浅前房，8例前房积血，3例眼球萎缩，2例行眼内容物剜出。结论：睫状体冷凝术联合小梁切除术对于治疗新生血管性青光眼有显著效果。 Objective: To observe the results of cyclocryotherapy combined with trabeculectomy to neovascular glaucoma. Methods: 25 eyes in 25 cases with neovascular glaucoma in the First Affiliated Hospital of Kunming Medical University from Jan. 2012 to Dec. 2014 were analyzed retrospectively. Pan-retina photocoagulations were executed firstly. All patients were treated with intravitreal injection of Lucentis 0.1 ml (1.0 mg) pars plana at first. 3 days latter, 25 eyes were treated by cyclocryostherapy combined with trabeculectomy. Pre- and post-operative (1 week, 1 month, 3 months, 6 months) swelling pain of eye, intraocular pressures (I0P), visual acuity and complications were observed. Results: All the swelling pain of the eye disappeared. The average IOP reduced greatly. The IOP decreased 22.64 mmHg, 23.6 mmHg, 24.2 mmHg, 26.16 mmHg in 1 week, 1 month, 3 months and 6 months in post-operation, respectively. The difference was statistically significant (P < 0.001). After operations, intraocular hypotension in 1 case, shallow anterior chamber in 1 case, anterior chamber hemorrhage in 8 cases, and eyeball atrophy in 3 cases were observed, respectively. 2 eyes were enucleated lastly. Conclusions: Cyclocryotherapy combined with trabeculectomy should be a good method for controlling neovascular glaucoma.

Study on postoperative effect of comfortable nursing in senile cataract patients

Objective To study the effect of comfortable nursing to postoperative effect after cataract operations in elderly patients.Methods 64 elderly patients with cataracts from our hospital were divided into two groups evenly an observation group and a control group.The observation group took comfortable nursing after the cataract surgery during the period of September 2012 to September 2013.The control group was given routine nursing from September 2009 to September 2010.This case study compared two groups of patients for their postoperative visual acuity with overall averages for quality of life,patient satisfaction and complications.Results The postoperative average vision value,the quality of life scores and patient satisfaction of the observation group patients were (0.67 ± 0.19),(94.6± 4.2) and 96.9％ respectively,significantly higher than those of control group,(0.48 ± 1.24),(81.7 ± 5.3) and 81.3％,showing statistical significant difference,P ＜ 0.05.Length of hospital stay in patients of observation group was (4.6 ± 1.7) d,notably shorter than that of the control group (7.6 ± 2.0) d; difference was statistically significant,P ＜ 0.05.The complication incidence of observation group such as elevated intraocular pressure,the crystals fall off,corneal edema aud anterior chamber hemorrhage were 3.1％,0,12.5％ and 0,lower than those of control group (9.4％,9.4％,34.4％,12.5％),P ＜ 0.05.Conclusion The implementation of comfort nursing for senile cataract patients in the hospital shortens the hospitalization time of patients and reduces the occurrence of postoperative complications and improve the patients' quality of life and satisfaction. Key words: Comfortable nursing; Senile cataract; Postoperative effect

Penetrating ocular trauma associated with blank cartridge

BackgroundBlank cartridge guns are generally regarded as being harmless and relative safe. However recent published articles demonstrated that the gas pressure from the exploding propellant of blank cartridge is powerful enough to penetrate the thoracic wall, abdominal muscle, small intestine and the skull. And there has been a limited number of case reports of ocular trauma associated with blank cartridge injury. In addition, no report on case with split extraocular muscle injury with traumatic cataract and penetrating corneoscleral wound associated with blank cartridge has been previously documented. This report describes the case of patient who sustained penetrating ocular injury with extraocular muscle injury by a close-distance blank cartridge that required surgical intervention.Case presentationA 20-year-old man sustained a penetrating globe injury in the right eye while cleaning a blank cartridge pistol. His uncorrected visual acuity at presentation was hand motion and he had a flame burn of his right upper and lower lid with multiple missile wounds. On slit-lamp examination, there was a 12-mm laceration of conjunctiva along the 9 o'clock position with two pinhole-like penetrating injuries of cornea and sclera. There was also a 3-mm corneal laceration between 9 o'clock and 12 o'clock and the exposed lateral rectus muscle was split. Severe Descemet's membrane folding with stromal edema was observed, and numerous yellow, powder-like foreign bodies were impacted in the cornea. Layered anterior chamber bleeding with traumatic cataract was also noted. Transverse view of ultrasonography showed hyperechoic foreign bodies with mild reduplication echoes and shadowing. However, a computed tomographic scan using thin section did not reveal a radiopaque foreign body within the right globe.ConclusionTo our best knowledge, this is the first case report of split extraocular muscle injury with traumatic cataract and penetrating ocular injury caused by blank cartridge injury. Intraocular foreign bodies undetectable by CT were identified by B-scan ultrasonography in our patient. This case highlights the importance of additional ultrasonography when evaluating severe ocular trauma. And ophthalmologists should consider the possibility of penetrating injury caused by blank ammunition.

Anterior Chamber Bleeding After Laser Peripheral Iridotomy

To our knowledge, this is the first study to describe the correlation of anterior chamber bleeding after laser peripheral iridotomy (LPI) and antiplatelet therapy. To determine the incidence and amount of anterior chamber bleeding after laser peripheral iridotomy in patients whose condition is suggestive of primary angle-closure glaucoma (PACS) who continued their antiplatelet or anticoagulant treatment before undergoing LPI compared with when they discontinued treatment. A prospective controlled trial. Patients with suspected bilateral primary angle-closure and no other ocular disease who take antiplatelet or anticoagulant medications regularly (from January 2010-October 2011) were enrolled. The incidence of anterior chamber bleeding with and without antiplatelet and anticoagulant therapy. A total of 104 patients (208 eyes) participated in the study. Thirty-six eyes (34.6%) in the treated and untreated arms bled. The amount of bleeding did not differ significantly when the patient was on or off antiplatelet or anticoagulant treatment, nor did the immediate postprocedure mean intraocular pressure (P = .13). The type of antiplatelet or anticoagulant, total laser energy, age, sex, or color of irides were not risk factors for increased bleeding (P = .156 for all parameters). No indication was noted for discontinuing these medications before a high-powered pulsed laser peripheral iridotomy.

Prognostic factors in severely traumatized eyes managed with vitrectomy

Objective To explore the prognostic factors of functional outcome in severely traumatized eyes managed with vitrectomy.Methods 130 eyes of 116 cases with severe trauma were retrospectively analyzed to determine the factors in predicting functional outcome after vitrectomy.The potential factors were confirmed in univariate analyses and the statistical significant indicators were tested by nonconditional logistic regression mode for multivariate analysis.Results Atrophy of eyeball occurred in 29 eyes after surgery.The rest eyes had normal contour.The short-term efficant rate was 77.6％.These potential prognostic indicators included prolapse of intraocular contents into anterior chamber,vitreous hemorrhage,retinal damage,retinal detachment,multiple wounds,preoperative infection,time interval between injury and operation.Based on the logistic regression mode results,the prognostic indictors for poor visual outcome were found to be prolapse of total intraocular contents,anterior chamber and vitreous hemorrhage,retinal damage more than 90％,multiple wounds and preoperative infection.Conclusion Poor predictors of visual outcome for severely traumatized eyes managed with vitrectomy were prolapse of total intraocular contents,anterior chamber and vitreous hemorrhage,retinal damage more than 90％,multiple wounds and preoperative infection. Key words: Vitrectomy; Trauma,ocular; Efficacy; Indicator

Maintenance of perioperative antiplatelet and anticoagulant therapy for vitreoretinal surgery

The objective of this study was to prospectively assess the risk of bleeding from vitreoretinal surgery in a continuous unbiased cohort of patients taking unsuspended antiplatelet or anticoagulant therapy. Prospective hospital-based study. Eighty-five patients taking unsuspended aspirin, clopidogrel and/or warfarin therapy undergoing all forms of vitreoretinal surgery at The Mater Misericordiae University and The Mater Private Hospital, Dublin, Ireland. Consecutive patients undergoing vitreoretinal surgery taking unsuspended antiplatelet or anticoagulant therapy over a 1-year period were included in this prospective study to evaluate the intraoperative and postoperative bleeding complications. The intraoperative and postoperative bleeding rates. One hundred and seven vitreoretinal procedures were performed on 85 patients taking unsuspended antiplatelet or anticoagulant therapy. The intraoperative bleeding rate was 23%, the majority of which consisted of mild bleeding into the vitreous cavity during vitrectomy. The postoperative bleeding rate was 22%, consisting of 3.7% anterior chamber haemorrhage, 11% dispersed vitreous cavity haemorrhage, 4.7% dense vitreous cavity haemorrhage, 0.9% subretinal haemorrhage and 1.9% localized choroidal haemorrhage. The single greatest significant independent predictor of intraoperative bleeding was proliferative diabetic retinopathy and of postoperative bleeding was the presence of diabetes mellitus. There were no cases of uncontrolled intraoperative haemorrhage or serious postoperative choroidal haemorrhage. Mild haemorrhagic oozing during vitrectomy and dispersed vitreous cavity haemorrhage postoperatively were common. For the majority of patients taking antiplatelet or anticoagulant medication, these agents can be safely continued in the vitreoretinal surgical perioperative period.

Little known ophthalmic interests of Emil von Behring, the first Nobel Prize Laureate in Medicine or Physiology

Although the work for which Emil von Behring (1854-1917) was awarded the first Nobel Prize Winner for Medicine or Physiology in 1901 was on serum therapy, not only was he trained and worked as an ophthalmologist but he also wrote his doctoral dissertation on a practical ophthalmological topic whilst in Berlin under Carl Schweigger (1830-1905). He later worked for 3 years as an assistant and co-worker with the famous Polish ophthalmologist Boleslaw Wicherkiewicz (1847-1915), in Poznan where he described an interesting ophthalmic case in a scientific journal. His life and work in other fields have been well studied, but his interests and relationship to ophthalmology that played an important role in, at least part of, Behring's life have never previously been analysed thoroughly.

Reconstruction of corneal stroma with decellularized porcine xenografts in a rabbit model

To evaluate the potential use of decellularized porcine stromal matrix (PSM) for reconstruction of corneal stroma in a rabbit model. Ten chinchilla bastard rabbit corneas were exposed to a circular half-thickness keratotomy with a 3.0 mm diameter at the central cornea. Porcine corneas were decellularized using hypotonic tris buffer, ethylene diamine tetra-acetic acid (EDTA, 0.1%), aprotinin (10 K IU/ml) and 0.3% sodium dodecyl sulphate (SDS). The 3.0 mm in diameter decellularized corneal stromal xenograft was inserted into the pocket, and the incision was closed with four 10.0 nylon sutures. Clinical photographs were taken at day 1, day 7, day 30 and on a monthly basis for up to 6 months after transplantation. Six months after surgery, the rabbits were killed and eyes were enucleated. Haematoxylin-eosin (HE) and 4,6-diamidino-2-phenylindole (DAPI) staining were performed to confirm the complete removal of the corneal cells after decellularization of porcine corneas and repopulation with rabbit cells. Alcian blue staining was performed for analysing the structure of the extracellular matrix (ECM). Efficient elimination of porcine cells was achieved by our decellularization protocol and confirmed via HE and DAPI stainings. Moreover, the major histoarchitectural ECM structure had been maintained as visualized by the alcian blue stain. Finally, the PSM was biocompatible with the host's epithelium evidenced as a regrowth covering the exposed xenograft. This novel technique of tissue engineering may provide one of many solutions to addressing anterior corneal pathological conditions in the face of a shortage of human corneal material.

Do true preretinal (subhyaloid) hemorrhages occur in infants?

The recent educational paper by Taylor [4] uses the ambiguous descriptor “preretinal” to describe intraocular hemorrhages. Clinically, this term has been used to describe both “true” preretinal (subhyaloid) hemorrhages and subinternal limiting membrane (subILM) hemorrhages. Emerson et al. [1] uses neither subhyaloid nor preretinal in his pathological description of intraocular hemorrhage and indeed finds the blood to be subILM in all 41 of his cases with macular hemorrhage. Why this is so may be explained by Sebag’s [2] demonstration of a “sheetlike” adherence of the vitreous that encompasses the macula as well as the peripapillary posterior pole in individuals 20 years of age or younger. Thus, although as Srinivasan and Kyle’s [3] picture of a subhyaloid hemorrhage in the macula overlying a subILM hemorrhage in the same eye in a 46 year old proves hemorrhage can occur in either space in an adult, it is possible that in infants the adhesive force between the vitreous and ILM exceeds the cohesive force of the vitreous and thus the blood cannot dissect between the vitreous and the ILM but instead breaks into the vitreous as seen in almost 40% of Emerson’s cases. Taylor also references a piglet study by Coats et al. This study used rotational accelerations over 50 times those achieved by human shaking yet produced only microscopic retinal hemorrhage at the retina/ciliary body junction and anterior chamber hemorrhage (hyphema) and ciliary body disruption. These are findings associated with direct eye trauma. They are not the extensive posterior retinal hemorrhage associated with abusive head trauma. Thus, this study would suggest that the eye findings of abusive head trauma are not produced by rotational acceleration.

Efficacy of perioperative management for vitrectomy of patients with severe systemic disease

Objective To evaluate the efficacy of perioperative management for vitrectomy of patients with severe systemic disease. Methods The clinical data of 21 patients (22 eyes) with severe systemic disease who underwent vitrectomy were retrospectively analyzed. There were 11 patients (12 eyes) with proliferative diabetic retinopathy, 9 patients (9 eyes) with rhegmatogenous retinal detachment, and 1 patient (1 eye) with intraocular lens dislocation. The preoperative visual acuity ranged from hand movement to 0.6.There were 4 patients (5 eyes) with renal insufficiency undergoing renal dialysis, 7 patients (7 eyes) with myocardtal infarction or coronary artery stenosis received cardiac bypass surgery or coronary stent implantation, 2 patients (2 eyes) with severe arrhythmia received cardiac pacemaker implantation or radiofrequency catheter ablation, 5 patients (5 eyes) with cerebral infarction, 2 patients (2 eyes) with hemophilia, and 1 patient (1 eye) with aplastic anemia. For patients with cardiac bypass surgery or coronary stent implantation, anticoagulants were switch to low molecular heparin at 7 days before vitrectomy. For patients undergoing renal dialysis, 0.4 ml low molecular heparin was used during renal dialysis at one day before vitrectomy, protamine and heparin were administered after vitrectomy. Prothrombin complex was infused from 1 day before surgery to 5 days after surgery for Hemophilia B patients. 6 patients (6 eyes)underwent phacoemulsification, and 1 patient (1 eye) underwent ciliary sulcus fixed intraocular lens implantation. 14 patients (14 eyes) underwent silicone oil tamponade, 5 patients (6 eyes) underwent C3F8tamponade. Results The postoperative visual acuity ranged from light perception to 1.0. The vision increased in 18 patients (19 eyes), unchanged in 2 patients (2 eyes), and decreased in 1 patient (1 eye).The retina attached in all eyes postoperatively. The postoperative complications mainly included mild anterior chamber bleeding in 4 patients (4 eyes), severe anterior chamber bleeding in 1 patient (1 eye) , mild retinal hemorrhage in 2 patients (2 eyes), optic disc bleeding in 2 patients (3 eyes), temporary elevation of intraocular pressure in 1 patient (1 eye), and neovascular glaucoma in 1 patient (1 eye). Serum creatinine increased in 1 patient and hypertension in 1 patient within 1 week postoperatively. Conclusions Severe systemic disease is not an absolute contraindication for vitrectomy. Vitrectomy can be successfully performed with better outcomes under the proper perioperative management of systemic disease. Key words: Retinal detachment/ surgery; Diabetic retinopathy/surgery; Intraoperative period; Vitrectomy

Results and Complications after Implantation of a Black Iris-Lens Diaphragm in Patients with Traumatically Induced Aphakia and Aniridia

The black iris-lens diaphragm (ILD) can be used in the treatment of traumatic aniridia and aphakia. The aim of our study was to show postoperative functional and anatomic results and complications in a small case series. We retrospectively analyzed the files of 16 patients managed with a black ILD or a sole iris diaphragm in the period 1994-2007. Four of them were female and 12 were male. The mean age of the group was 50±17 years. At the time of the implantation, all of the eyes had already undergone primary surgical repair. The preoperative best-corrected visual acuity in half of the patients was =0.1 and remained stable after the first postoperative year. During the follow-up years, one eye developed a subluxation of the implant and one eye an anterior chamber hemorrhage. At the same time, out of 8 eyes carrying a silicone tamponade in the vitreous cavity, silicone oil entered the anterior chamber in 3 cases. In one case, enucleation was undertaken due to phthisis. In the case of severely traumatized eyes with aniridia and aphakia, the implantation of a black ILD can have a positive effect on functional and anatomic stabilization.

Use of the Anterior Chamber Maintainer in Trabeculectomy Following Vitrectomy

Purpose: To retrospectively observe the effects of anterior chamber maintainer (ACM) placement in glaucoma patients undergoing trabeculectomy following vitrectomy.Methods: Trabeculectomy was performed on 51 secondary glaucoma patients (51 eyes), all of whom had undergone vitrectomy. During trabeculectomy, an ACM was placed in 27 eyes (group A), but not in the remaining 24 (group B). Intra- and post-operative complications were recorded. Intraocular pressure (IOP) measurements were recorded pre-operatively and repeated post-operatively on follow up days 1, 3, and 7, and months 1, 3, 6, 12, 18, and 24. Surgical success rates were recorded.Results: Mean pre-operative IOPs of groups A and B were 32.74 ± 11.25 and 34.29 ± 9.68 mmHg, respectively. In group A, anterior chamber bleeding (two cases), and choroidal detachment and/or ciliary detachment (four cases) occurred. In group B, anterior chamber bleeding (five cases), and choroidal detachment and/or ciliary detachment (11 cases) occurred. There was a statistically significant difference between the two groups. There also was statistically significant difference in post-operative IOPs between the two groups at 12 and 24 months. The surgical success rate of group A was higher than that of group B.Conclusion: ACM is effective in maintaining IOP and reducing complications during trabeculectomy following vitrectomy, thereby increasing surgical success rates.

Kanaloplastie und transiente Vorderkammerblutung: ein prognostischer Faktor?

An attempt has been made to evaluate transient anterior chamber haemorrhage after canaloplasty. In the period from November 2008 to October 2009 a total of 21 eyes in 17 patients underwent canaloplasty for primary open angle glaucoma in our clinic. At the end of surgery all eyes left the surgical table with an intraocular pressure (IOP) of 5 - 10 mmHg and a deep anterior chamber without any bleeding. The IOP on day 1 after surgery was 9.6 mmHg in average. By that time 15 of 21 eyes showed anterior chamber haemorrhage with a hyphaema between 0.5 - 2 mm in height. Eyes without hyphaema showed an IOP of > 15 mmHg at the same time. In no case was there further haemorrhage, the blood was absorbed in all cases within a maximum of 1 week without further complications. In contrast to trabeculectomy, where the natural anterior chamber water outflow is by-passed via an artificial fistula, canaloplasty attempts to re-establish the physiological anterior chamber water draining system by means of a 360 degree viscocanalostomy and a thread mediated dilation of Schlemm's canal and its collector channels. If the anterior chamber pressure temporarily lowers the level of the venous capillary pressure, it is consistent with a patent piping system when a reverse flow with blood reflux into the anterior chamber can be observed as long as a minimal physiological pressure gradient from the anterior chamber in the direction of channel Schlemm's canal has been restored. Thus, in the authors opinion, anterior chamber haemorrhage shows the desired consistency of the water draining system and should therefore logically be expected after each successful operation in all cases where hypotony in the postoperative period occurs.

Spontaneous hyphaema and acute ocular hypertension associated with severe lens-induced uveitis

to report the occurrence of spontaneous hyphaema and acute ocular hypertension in four patients with severe lens-induced anterior uveitis. retrospective case series. four patients with mature cataract developed severe acute, unilateral, anterior uveitis associated with spontaneous hyphaema formation and acutely elevated intraocular pressure. None of the patients had a history of trauma or evidence of angle, iris, or retinal neovascularization. Prompt cataract removal led to resolution of the inflammation, clearing of the anterior chamber haemorrhage, and normalization of intraocular pressure in all four affected eyes. spontaneous hyphaema and acute ocular hypertension can occur in patients with severe lens-induced intraocular inflammation in the absence of trauma or ocular neovascularization.

Clinical application of irrigation in therapeutic keratoplasty for suppurative keratitis with severe hypopyon

To investigate the safety and clinical efficacy of anterior chamber irrigation combined with corneal transplantation in the treatment of corneal ulcer with severe hypopyon. Non-randomized retrospective case series. Twenty patients (20 eyes) suffered from corneal ulcer with severe hypopyon were enrolled in Shandong Eye Hospital from January 2008 to June 2009, and 13 patients with significant corneal endothelial plaque, which hard to determine the lesion edge under microscope. Twenty patients received anterior chamber irrigation combined with penetrating or lamellar keratoplasty treatment; the donors were preserved in the medium-term preservation solution or freeze-dry preservation of glycerine. Intraoperative and postoperative complications, visual acuity, immune rejection were collected as outcome measures. Twenty cases received anterior chamber irrigation combined with corneal transplantation successfully, eleven of which received penetrating keratoplasty (PK) and 9 received lamellar keratoplasty (LK). Ten cases that underwent PK using donors preserved in medium-term solution, and the remaining using donors cryopreserved at -20 degrees C. Intraoperative complications include bleeding iris (11 cases), postoperative complications including iris adhesions (8 cases), transient high intraocular pressure (4 cases), anterior chamber hemorrhage (5 cases), and were cured after drug treatment. One case suffered recurrence of fungal keratitis and received repeat PK. Four cases occurred endothelial immune rejection, 3 cases were controlled and 1 case occurred graft failure after anti-rejection treatment. In the final follow-up in December 2009, 17 grafts were clear and 3 grafts were edema. In the treatment of severe corneal ulcer with hypopyon, anterior chamber irrigation combined with penetrating or lamellar keratoplasty is an effective and a safety method.