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La retinopatía por descompresión es una complicación infrecuente de la cirugía ocular. Aunque después de una trabeculectomía con o sin antimetabolitos se ha reportado la mayoría de los casos, también se ha comunicado en otros procederes oculares. La presión intraocular preoperatoria elevada y sus bruscas variaciones intra- y posoperatorias juegan un rol en su fisiopatología. Las hemorragias retinales son su signo distintivo y la oclusión de la vena central de la retina su diagnóstico diferencial más complejo. En la mayoría de los pacientes se resuelve el cuadro clínico en las primeras ocho semanas sin necesidad de intervención terapéutica. Para minimizar su riesgo, se recomienda una reducción gradual y controlada de la presión intraocular pre- e intraoperatoria. Para la actualización del conocimiento sobre retinopatía por descompresión se realizó una revisión de las publicaciones más relevantes relacionadas con el tema durante los últimos años, con el objetivo de profundizar y mejorar el entendimiento sobre retinopatía por descompresión(AU)
Decompression retinopathy is an infrequent complication of ocular surgery. Most cases have been reported after trabeculectomy with or without antimetabolites, but it has also been described in other ocular procedures. High preoperative intraocular pressure and its sudden intra- and postoperative variations play a role in its physiopathology. Retinal hemorrhage is its distinguishing sign, and central retinal vein occlusion its most complex differential diagnosis. In most patients the clinical picture is resolved within the first eight weeks without any therapeutic intervention. A gradual, controlled reduction in pre- and intraoperative intraocular pressure is recommended to minimize risk. With the purpose of updating knowledge about decompression retinopathy, a review was conducted of the most relevant studies about the topic published in recent years(AU)
Subject(s)
Humans , Retinal Hemorrhage , Trabeculectomy/methods , Diagnosis, Differential , Antimetabolites/adverse effects , Review Literature as Topic , Intraocular PressureABSTRACT
ABSTRACT: The objective of this study was to evaluate the acute effects of ropivacaine hydrochloride on the corneal endothelium of horses. Forty-eight eyes were obtained from a commercial slaughterhouse and were randomly divided into three groups. In group A, the corneal endothelium was exposed to 0.75% ropivacaine hydrochloride for 60 seconds. In group B, the corneal endothelium was exposed to 0.75% ropivacaine hydrochloride for 15 minutes. In group C, the corneal endothelium was exposed to a balanced saline solution for 60 seconds. Afterwards, all samples were prepared for evaluation with scanning electron microscopy. Random electromicrographs were obtained from each sample. The images were analysed and, with the aid of software, areas with no endothelial cells were measured. The average endothelial loss, expressed as a percentage in relation to the total area, of the samples in group A was 5.28%. The average endothelial loss of samples from group B, expressed as a percentage in relation to the total area, was 20.39%. The damage to the corneal endothelium was significantly greater in group B compared to groups A and C. It was possible to conclude that 0.75% ropivacaine hydrochloride induced acute damage to corneal endothelium cells.
RESUMO: Objetivou-se avaliar os efeitos agudos do cloridrato de ropivacaína no endotélio da córnea de equinos. Quarenta e oito olhos de equinos foram divididos aleatoriamente em três grupos. No grupo A o endotélio da córnea foi exposto a cloridrato de ropivacaína a 0,75% por 60 segundos. No grupo B o endotélio da córnea foi exposto a cloridrato de ropivacaína a 0,75% por 15 minutos. No grupo C o endotélio da córnea foi exposto à solução salina balanceada por 60 segundos. As amostras foram preparadas para avaliação com microscopia eletrônica de varredura. Eletromicrografias eletrônicas de varredura foram obtidas aleatoriamente de cada amostra. As imagens foram analisadas e, com o auxílio de um programa para morfometria foram medidas as áreas sem células endoteliais. A perda endotelial média foi expressa em porcentagem em relação à área total das amostras do grupo A foi de 5,28%. A perda endotelial média de amostras do grupo B foi expressa em porcentagem em relação à área total, foi de 20,39%. O dano ao endotélio da córnea foi significativamente maior no grupo B, comparado aos grupos A e C. O cloridrato de ropivacaína a 0,75% induziu dano agudo nas células do endotélio da córnea de equinos.
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@#AIM: To investigate the clinical application value of anterior segment OCT(AS-OCT)in diagnosis and treatment of descemet's membrane detachment(DMD)after intraocular surgery. <p>METHODS: Totally 23 eyes of 21 patients with corneal edema after intraocular surgery in our hospital from June 2016 to April 2019 were analyzed retrospectively. The degree of corneal edema and the descemet's membrane detachment(DMD)were observed by AS-OCT. The patients with mild or above descemet's membrane detachment were treated with anterior chamber gas tamponade, the patients with other corneal edema were treated with drug conservative treatment, and the corneal edema and adhesion of descemet's membrane were observed.<p>RESULTS: In this study, 21 patients(23 eyes)had corneal edema of different degrees, 14 eyes with descemet's membrane detachment,11 eyes with mild or above descemet's membrane detachment were re-examined by AS-OCT one day after anterior chamber gas tamponade. 10 eyes had good adhesion, 1 eye had poor adhesion, and the adhesion was good after anterior chamber gas tamponade again. After 1mo follow-up, the cornea of all the patients recovered to be transparent and their vision recovered well.<p>CONCLUSION:AS-OCT can timely and accurately diagnose and evaluate descemet's membrane detachment and its therapeutic effect.
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@#AIM:To explore clinical characteristics of supracho-roidal hemorrhage(SCH)complicated by intraocular surgery and to observe visual prognosis. <p>METHODS:A total of 13 eyes(13 cases)with SCH related to intraocular surgery from June 2005 to June 2015 were included and respectively studied. The age of our cases ranged from 22 to 76. Of all, 4 eyes(31%)were concomitant with hypertension, 6 eyes(46%)with high myopia and 6 eyes(46%)with oculi hypertonia, respectively. Intraoperative expulsive SCH occurred in 8 eyes, while postoperative delayed SCH in 5 eyes. The most SCH(7 eyes)happened during the surgery of removing silicone oil, 4 eyes with SCH were related to extracapsular cataract extraction(ECCE), 1 SCH eye was complicated by ECCE combined with trabeculectomy and 1 SCH eye by lensectomy and vitrectomy. As for treatment, 5 eyes took medication alone, 4 eyes were performed drainage sclerotomy and gas tamponade, while the other 4 eyes were accomplished vitrectomy with adjunctive perfluoro-carbon liquids and silicone oil tamponade. <p>RESULTS:At the 10-month of follow-up, all eyes with SCH were resolved. Except 1 eye with no light perception owing to abandoning treatment, the sights of the other 12 eyes were between light perception and 0.4. <p>CONCLUSION:SCH complicated by intraocular surgery was rare but with devastating outcome. Aged patients, hypertension, high myopia and oculi hypertonia may be risk factors. In addition, surgical methods in the early years were likely correlated to the occurrence of SCH. Certain sight of the patients with SCH may be maintained after positive treatment.
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PURPOSE: To present clinical features of central retinal artery occlusion (CRAO) following retrobulbar anesthesia for intraocular surgery. METHODS: This observational case series describes 5 consecutive patients with acute CRAO following retrobulbar anesthesia for intraocular surgery. Data collected for this study included subject characteristics, retrobulbar anesthesia technique, treatment type, initial and final best-corrected visual acuity, and other ophthalmologic examinations. RESULTS: Mean subject age was 67.0 +/- 8.2 years (range, 53 to 72 years). All patients had one or more vascular risk factors (e.g., hypertension, cerebral infarction, carotid artery stenosis) and presented with acute vision loss 1 day after uneventful intraocular surgery (cataract surgery in 2 eyes and vitrectomy in 3 eyes). All 5 patients received retrobulbar anesthesia during surgery, 4 of which involved the use of a sharp needle. No immediate complications were noted during intraocular surgery. Final visual prognosis was poor (from finger count to no light perception) although intraocular thrombolysis was attempted in 3 patients. CONCLUSIONS: Iatrogenic CRAO is a potential complication of retrobulbar anesthesia for intraocular surgery in elderly patients with vascular risk factors. Unfortunately, this complication can lead to severe vision loss. We conclude that retrobulbar anesthesia for intraocular surgery should be performed with great care and special consideration for elderly patients with vascular risk factors.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anesthesia/adverse effects , Anesthetics, Local/administration & dosage , Fluorescein Angiography , Follow-Up Studies , Fundus Oculi , Iatrogenic Disease , Ophthalmologic Surgical Procedures/adverse effects , Orbit , Postoperative Complications , Retinal Artery Occlusion/diagnosis , Retrospective Studies , Visual AcuityABSTRACT
Descemet's membrane detachment (DD) is a rare but serious complication of intraocular surgery. In rare cases where corneal edema is severe and we may not be able to visualize DD on slit-lamp examination, anterior segment optical coherence tomogram (AS-OCT) would be helpful. We describe two patients with DD, highlighting the role of AS-OCT in early diagnosis and management of patients with DD. One of the patients had DD with rolled in edge, which could only be visualized with AS-OCT. In such a situation, AS-OCT can identify the edge of detachment and show the exact position of the rolled edge, which can allow us to plan the surgical strategy to unroll the DD.
Subject(s)
Aged , Anterior Eye Segment/pathology , Corneal Diseases/pathology , Corneal Diseases/surgery , Corneal Edema/etiology , Descemet Membrane/pathology , Early Diagnosis , Female , Humans , Ophthalmologic Surgical Procedures/adverse effects , Postoperative Complications , Tomography, Optical CoherenceABSTRACT
Se presentan 2 casos clínicos de pacientes con edema macular cistoideo, provocado por cirugía intraocular (por extracción extracapsular del cristalino y lente intraocular) y operación convencional del desprendimiento de retina, entre otras causas, atendidos en el Centro Oftalmológico del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, con el fin de analizar el efecto terapéutico de antiinflamatorios no esteroideos, corticoides tópicos y peribulbares, así como evaluar la evolución clínica a través de la tomografía de coherencia óptica. En ambos casos hubo una gran mejoría de la visión, con 0,6 y 0,5, respectivamente.
The case reports of 2 patients with macular cystoid edema, caused by intraocular surgery (extracapsular extraction of the crystalline lens and intraocular lens) and conventional surgery for retinal detachment, among other causes, assisted in the Ophthalmologic Center of "Dr. Juan Bruno Zayas Alfonso" teaching General Hospital in Santiago de Cuba are presented, with the purpose of analyzing the therapeutic effect of anti-inflammatory non-steroid drugs, topical and peribulbar corticoids, as well as evaluating the clinical course through the tomography of optic coherence. In both cases there was a great improvement of vision, with 0,6 and 0,5, respectively.
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Objective To evaluate clinical application of irrigating solution of conjunctival sac be-fore intraocular surgery,which can clean the conjunctival sac with low irritability and low environmental pollution. Methods Patients (210 cases) without systemic inflammatory response and with expected in-traocular surgery were divided into three groups randomly (70 cases in each group). Group A used normal saline(200 ml). Group B used the mixed solution of 0.02% mercury bichloride(100 ml) and normal saline(100 ml). Group C used the mixed solution of 0.4% gentamicin (100 ml) and normal saline (100 ml).The specimens of conjunctival sac were collected and sent to check before and after irrigating.In 15 and 30 min-utes after irrigating,the conjunctival congestions of three groups were compared. Results There was no statistical difference in bacterial positive rate among three groups before and after irrigating:, bacterial posi-tive rate was 62.86% in group A, 54.29% in group B, 50.00% in group C before irrigating; 31.43% in group A, 27.14% in group B, 20.00% in group C after irrigating. There were statistical difference in bacterial cul-ture of conjunctival sac among three groups before and after irrigating (P< 0.05). The comparison of con- junctival congestion: group B had the most serious irritation, group C was median, group A had lightest irri-tation. Conclusions Normal saline as irrigating solution of conjunctival sac for intmecular surgery can reduce chemical irritation and toxicity by reducing use of antibiotics. It can supply clear visual operativefield for doctors so it can substitute traditional irrigating solution of conjunctival sac.
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Objective To investigate the efficacy and safety of hydrogel soft contact lens(HSCL) for persistence corneal epitheliopathy after intraocular surgery.Design Retrospective case series.Participants 36 patients(36 eyes) with bullous keratopathy(n=5) or other keratopathy(n=31) including corneal erosion,epithelium missing,and dendritic keratopathy after intraocular surgery,which failed to medicine treatment 2 weeks ago.Method All patients were fitted with HSCL after suitable processing of the corneal foci.The lenses were removed immediately as long as the keratopathy recovered.A new lens was replaced after 3 weeks if still needed.Main Outcome Measures Changes of keratopathy,pain relief and complications.Result 35 patients(97.22%) fitted with HSCL were very comfort within 3 days.At the follow-up of 6 months,30 patients(83.33%) achieved complete remission of keratopathy,6 patients (16.67%) remarkable remission.30 patients(86.11%) had vision increase.All of the non-bullous keratopathy recovered within 3 weeks,while the lenses were fitted much longer in bullous keratopathy.No other lens-related complications appeared.Conclusion The application of hydrogel soft contact lens to persistence corneal epitheliopathy after intraocular surgery is safe,effective,and practical.
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The occurrence of ptosis after trabeculectomy has been a common postoperative complication. Many factors have been implicated in the development of postoperative ptosis. The purpose of this study was to investigate the incidence of ptosis following trabeculectomy and whether or not it was influenced by combined cataract surgery, type of conjunctival flap, and previous intraocular surgery. We reviewed 386 eyes of 386 patients who underwent either trabeculectomy alone or trabeculectomy combined with cataract surgery, with greater than 6 month follow-up. Ptosis occurred in 10.7% (18 of 150 eyes) after trabeculectomy alone and in 12.7% (30 of 236 eyes) after trabeculectomy with combined cataract surgery (p = 0.96). The incidence of ptosis was 12.3% (10 of 81 eyes) after limbus-based conjunctival flap and 12.5% (38 of 305 eyes) after fornix-based conjunctival flap (p = 0.98). There was no significant difference in the incidence of ptosis between primary surgery eyes (12.5%, 34 of 273 eyes) and secondary surgery eyes (12.4%, 14 of 113 eyes) (p = 0.97). The incidence of ptosis after trabeculectomy was about 12% overall and not significantly influenced by combined cataract surgery, type of conjunctival flap or previous ocular surgery.