Analysis of Autologous Blood Injection for Late-onset Filtering Bleb Leak after Trabeculectomy

PURPOSE: To evaluate the effect of autologous blood injections for late-onset filtering bleb leakage after trabeculectomy METHODS: Retrospective chart review was done on 15 patients 16 eyes that had autologous blood injection(s) for filtering bleb leak occurring later than 2 months after trabeculectomy at the Masan Samsung Hospital. Successful treatment was defined as resolution of the bleb leak and no need for additional glaucoma medications. Failure was defined as a persistent bleb leak, intraocular pressure greater than 21 mm Hg, or the occurrence of a vision-threatening event related to the procedure. RESULTS: The mean age of the patients was 53.9 years old (38~74 years). Ten eyes were men (62.5%) and 6 were women (37.5%). Sixteen eyes of 15 patients had autologous blood injection for filtering bleb leak and were followed for a mean of 12.7 months (SD, 5.8; range, 3 to 25 months). Eleven eyes (68.7%) were classified as failures because of persistence of the leak. Five eyes (31.3%) had an initially successful outcome, but the success rate decreased over time as bleb leaks recurred in one of the five eyes at 3 month. Mean intraocular pressure increased from 4.9mmHg at pretreatment to 7.6 mmHg at final examination (P<0.05). Snellen visual acuity (with correction or pinhole) remained within 2 lines of pretreatment acuity in 12 eyes (75%). Blood seepage into the anterior chamber after autologous blood injection was the common complication, but it was transient. CONCLUSIONS: Although it showed limited success, autologous blood injection for late-onset bleb leak may be considered as a supportive measure before preforming invasive incisional surgery.

A Case of Recurrent Valsalva Retinopathy Associated with Exercising a Barbell

PURPOSE: To report one case of recurrent Valsalva retinopathy presented as subretinal hemorrhage associated with exercising a barbell in a healthy man. METHODS: A 47-year-old healthy man visited our hospital complaining of a pericentral blind-spot in the right visual field. At first visit, visual acuity was 20/20 without correction. Anterior segment examination was unremarkable and dilated fundus examination revealed a subretinal hemorrhage in the inferior area of the macula. We followed up the visual acuity, anterior segment exam, fundus examination, and fluorescein angiography for several weeks. RESULTS: Three weeks after the first visit, the size of subretinal hemorrhage decreased, but recurrent subretinal hemorrhage presented after exercising a barbell at the existing hemorrhagic part and its inferior area. Six weeks after the recurrent hemorrhage, the hemorrhage was resolved completely and the pericentral blind-spot was recovered. CONCLUSIONS: Valsalva hemorrhagic retinopathy is characterised by retinal hemorrhage occurring in healthy individuals due to a rapid rise in intrathoracic or intra-abdominal pressure. In this case, there was recurrent subretinal hemorrhage after repeatedly exercising a barbell. So, it is very important to educate patients about the restriction of excessive Valsalva maneuver to prevent recurrent Valsalva retinopathy.

The Effect of 5HT(3) Receptor Agonist on Intraocular Pressure and Pupil Diameter in Rabbits

PURPOSE: The effects of 5HT3 receptor agonist and antagonist on rabbit intraocular pressure (IOP) and pupil size were evaluated. METHODS: A 5HT3 receptor agonist, I-Phenylbiguanide (PBG, 1%) and a 5HT3 receptor antagonist, 3-Tropanyl-indole-carboxylate methiodide (ICS-205,930) were applied topically to the rabbit eye, and intraocular pressure and pupil diameter were checked with a Tono-PenTM XL and a ruler. RESULTS: Topical application of 1% PBG significantly increased IOP by 4.6+/-1.2 mmHg (p<0.001) over a period of up to 2 hours, the IOP maximum reached at 1 hour and caused pupil dilatation by 3.3+/-0.3mm (p<0.001) over a period of up to 5 hours, the dilation maximum reached at 2 hour. Topical preadministration of 1% ICS-205,930 prevented a rise in IOP but did not counteract on the pupil dilatation brought about by 5HT3 receptor agonist. CONCLUSIONS: These findings indicate that topically applied 5HT3 receptor agonist could raise IOP and dilate pupil.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.

A case of Orbital Infarction Syndrome Caused by Compression of Bulky Bicoronal Scalp Flap

PURPOSE: To report a case of orbital infarction syndrome induced by compression due to hard and bulky scalp flap. METHODS: Subject and METHODS: A 27-year-old female presented to our clinic, complaining of orbital pain, proptosis, ptosis, ophthalmoplegia and unilateral blindness, immediately after removal of cavernous hemangioma induced by the radiotherapy at 7 years earlier in right frontal lobe. Her scalp was hard and thick due to previous scar change and radiotherapy. Ophthalmologic examination demonstrated optic nerve injury, cranial nerve III, IV and VI palsy, diffuse retinal edema and cherry red spot in macula. Brain CT and MR angiography were done to evaluate the cause of orbital infarction. RESULTS: The cause of orbital infarction syndrome in this case appeared to be the compression of orbit by the hard and bulky scalp flap, and blindness was caused by the ischemia of intraorbital and intraocular structure.