ABSTRACT
RESUMO Paciente do sexo feminino, portadora de glaucoma juvenil sem controle clínico adequado, foi submetida à trabeculectomia com mitomicina C, após a qual, desenvolveu hipotensão ocular refratária às medidas conservadoras, evoluindo com um quadro de maculopatia hipotônica. Foi realizado um implante de enxerto de retalho escleral de doador sobre a fístula, com resolução do quadro e ganho de acuidade visual. A enxertia de retalho escleral de doador mostrou-se uma terapia adequada para correção da hipotensão ocular por bolha hiperfiltrante pós trabeculectomia. O cirurgião deve considerar o emprego dessa técnica ao programar a revisão destes casos.
ABSTRACT A female patient with juvenile glaucoma without clinical control underwent a trabeculectomy with mitomycin C, and developed eye hypotension which did not respond to conservative treatment, with subsequent hypotonic maculopathy. The patient was treated using a scleral patch provided by a donor above the fistula, which improved intraocular pressure and visual acuity. The use of the scleral patch above the fistula seems an adequate therapy to treat ocular hypotension due to the over-filtering trabeculectomy bubble. The surgeon should consider this technique when planning surgical solutions for such cases.
Subject(s)
Humans , Female , Adult , Retinal Diseases/surgery , Retinal Diseases/etiology , Sclera/transplantation , Trabeculectomy/adverse effects , Ocular Hypotension/complications , Ocular Hypotension/chemically induced , Macula Lutea/pathology , Retinal Diseases/diagnosis , Glaucoma/diagnosis , Glaucoma/drug therapy , Mitomycin/adverse effects , Tomography, Optical Coherence , Slit Lamp Microscopy , Macula Lutea/surgeryABSTRACT
Cyclodialysis is a relatively rare condition usually caused by ocular injury; however, it can also be caused iatrogenically during intraocular surgery. Hypotony maculopathy is the most important complication and the primary reason for visual loss. Clinical diagnosis using gonioscopy may be difficult, and ultrasound biomicroscopy (UBM) can be an alternative. There are different kinds of treatments, and the optimal one remains controversial. Here we describe a case of traumatic cyclodialysis with persistent ocular hypotony treated by direct cyclopexy, as illustrated by UBM performed before and after surgery.
Ciclodiálise é uma condição relativamente rara, geralmente devido a um trauma ocular, mas também pode ser causada iatrogenicamente como consequência de cirurgia intraocular. A maculopatia hipotônica é a complicação mais importante e a principal razão para a perda visual nessa situação. O diagnóstico clínico por gonioscopia pode ser difícil e a biomicroscopia ultrassônica (UBM) pode ser uma alternativa. Existem diferentes tipos de tratamentos e algumas controvérsias sobre a melhor opção. Neste relato, nós descrevemos um caso de ciclodiálise traumática com hipotonia ocular persistente tratado por cyclopexia direta avaliado por UBM antes e depois da cirurgia.
Subject(s)
Adult , Humans , Male , Ciliary Body/injuries , Ciliary Body/surgery , Eye Injuries/surgery , Ocular Hypotension/surgery , Ciliary Body , Eye Injuries , Gonioscopy , Microscopy, Acoustic , Ophthalmologic Surgical Procedures , Ocular HypotensionABSTRACT
Objective To investigate the occurrence, progress and conversion of hypotony in anterior proliferative vitreoretinopathy (aPVR), and to provide knowledge about how to prevent and treat it. Methods Animal models of chronic hypotony by aPVR were made with cultured homologous dermal fibroblasts on pigmented rabbits. The intraocular pressure (IOP) and ultrasound biomicroscopy(UBM) examination were taken preoperatively and on days 7,14, 28 and 56 postoperatively. Rabbits were killed on days 14, 28 or 56 postoperatively, prepared for histology and ultrastructure examination. Results The average IOP of experimental group was lower than that of control group on days 7,14,28 and 56 significantly (P