A Case of Malignant Glaucoma in a Vitrectomized Eye

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

A Case of Secondary Macular Hole Formation after Phacoemulsification in a Vitrectomized Eye

PURPOSE: To report a case of secondary macular hole formed after phacoemulsification in a vitrectomized eye which was treated with macular hole surgery. CASE SUMMARY: A 53-year-old man with a history of pars plana vitrectomy developed a cataract in his left eye. Uncomplicated cataract surgery involving phacoemulsification with posterior chamber intraocular lens implantation was performed. At his routine 3-month post-operative visit, he reported metamorphopsia. Fundus examinations and optical coherence tomography revealed a cystoid macular edema and a full thickness macular hole. He underwent repair of the macular hole including internal limiting membrane peeling and gas injection. Three months later, post-operative examinations showed anatomical closure of the macular hole. CONCLUSIONS: When performing cataract surgery, even in a previously vitrectomized eye, clinicians should be aware of the possibility of cystoid macular edema. A thorough pre- and post-operative assessment, including fundus examinations and optical coherence tomography must be carefully performed in order to detect a macular hole associated with cystoid macular edema. And prompt treatment is required when a macular hole is detected.

The 23-Gauge Sutureless Vitreoretinal Surgery in Previously Vitrectomized Eyes

PURPOSE: To investigate the incidence and risk factors of major complications including postoperative hypotony after 23-gauge transconjunctival sutureless vitrectomy in previously vitrectomized eyes. METHODS: The authors retrospectively reviewed medical records of 52 eyes, which underwent 23-gauge transconjunctival sutureless vitrectomy of previously vitrectomized eyes by a single surgeon. Major outcomes were postoperative hypotomy (<6 mmHg), intraoperative sclera shrinkage during sclerotomy,and other postoperative complications. Multiple logistic regression analysis was performed that included 212 eyes with primary vitreoretinal surgery in order to validate secondary vitreoretinal surgery as a significant risk factor of postoperative hypotony. RESULTS: Postoperative hypotony occurred in 4 eyes (7.7%) out of 52 eyes that underwent a second vitrectomy. The odds ratio of the second vitreoretinal surgery (OR=1.15, p=0.283) was not significant by multiple logistic regression analysis that included age, sex, axial length of globe, and the number of surgeries as the independent variables. Choroidal detachment occurred in one eye but disappeared three days later. The intraocular pressure was normalized within one week in all cases. Scleral shrinkage during sclerotomy occurred in five eyes (9.6%), and there were no other major complications, such as endophthalmitis. CONCLUSIONS: A 23-gauge transconjunctival sutureless vitrecomy of previously vitrectomized eyesshowed a 7.7% incidence of postoperative hypotony and favorable prognosis.

Phacoemulsification in Previously Vitrectomized Eyes; Results of a 5-Year Period in Surgical Outcome

PURPOSE: To compare the incidence of complications and the outcome of phacoemulsification surgery in patients with and without previous vitrectomy. METHODS: We retrospectively investigated 60 patients in a study group that received phacoemulsification with posterior chamber IOL implantation (PC-IOL) in the vitrectomized eye and 60 patients in a control group that received only phacoemulsification with PC-IOL implantation from January 2003 to December 2007. The interval from PPV to cataract extraction, sex, age, type of cataract, intraoperative and postoperative complications, pre- and postoperative refraction were reviewed. RESULTS: The most common indication of pars plana vitrectomy was diabetic retinopathy. Nucleosclerosis was the most common type of cataract. The most common intraoperative complication was posterior capsular rupture, but there was no statistical significance when compared with the control group (p=0.116). In addition, the most common postoperative complication was posterior capsular opacity. After phacoemulsification, the rate at which a BCVA of 0.5 or better was obtained was lower in the study group than the control group. The spread between actual and expected refraction showed no statistically significant difference when compared with the control group (p=0.309). CONCLUSIONS: Experienced surgeons can safely perform phacoemulsification and PC-IOL implantation in previously vitrectomized eyes. However, the outcome of visual acuity is limited by vitreoretinal pathology that requires vitrectomy.

The Outcome of Inferonasal Trabeculectomy in Diabetic Patients Who Expected or Had Vitrectomy

PURPOSES: We evaluated the outcome of trabeculectomy using inferonasal bleb in diabetic retinopathy patients awaiting vitrectomy or on whom vitrectomy was performed. METHODS: We retrospectively reviewed the medical records of patients who had undergone trabeculectomy with an inferonasal bleb from December 2002 to May 2005. Seven eyes had neovascular glaucoma secondary to the proliferative diabetic retinopathy, 6 eyes primary open angle glaucoma, and 4 eyes steroid induced glaucoma. We evaluated postoperative complication, intraocular pressure, the number of ocular hypotensive eye drops, and preoperative and postoperative best corrected visual acuity. RESULTS: Mean follow-up period was 20.47+/-5.55 months. Most common complication was early ocular hypotony (4 eyes, 24%), but no blebitis and bleb associated endophthalmitis were observed. Mean intraocular pressure was reduced from 30.77+/-5.61 mm Hg preoperatively to 13.72+/-4.61 mm Hg at the most recent follow-up. The number of preoperative ocular hypotensive eye drops was 2.9+/-0.3 and that of postoperative eye dros was 1.4+/-1.0. The difference between these was statistically significant (p=0.000). Eleven eyes (61.11%) had a stable or improved visual acuity. CONCLUSIONS: Trabeculectomy using an inferonasal bleb appears to be a safe and effective surgical option that may be helpful in certain clinical situations, such as medically uncontrolled glaucomatous eyes with expected vitrectomy or vitrectomized eyes.

Clinical Study on Anterior Chamber Intraocular Lens Implantation in Completely Vitrectomized Eyes

PURPOSE: We studied the result and clinical significance of anterior chamber lens implantation in completely vitrectomized eyes without capsular support. METHODS: We evaluated 15 aphakic eyes of 15 patients. According to the cause of pars plana vitrectomy, there were 6 eyes for lens dislocation, 5 for intraocular foreign body, and 4 for rhegmatogenous retinal detachment. RESULTS: The final available postoperative best-corrected visual acuity was 0.5 or better in 9 eyes (60%). No statistically significant difference was noted in preoperative and postoperative IOP. The average of postoperative astigmatism was 1.14 +/- 0.79D. The most common early complication was temporary increase in IOP, but we could control IOP within normal limit with transient treatment. The postoperative late complications were glaucoma, IOL decentration and cystoid macular edema, but serious postoperative complications such as bullous keratopathy and retinal detachment were not found. CONCLUSIONS: The anterior chamber IOL implantation appears to be well tolerated and represents a simple alternative to transscleral fixation of a posterior chamber IOL in completely vitrectomized aphakic eyes.

Migration of Photoreceptor Cells Into the Subretinal Space in Rabbit Retina

The migration of photoreceptors into the subretinal space has been reported to occur in developing and aged rat retina, in aged human retina, in detached owl monkey, and in detached cat retina. Subretinal photoreceptor cells have been observed in aphakic-vitrectomized rabbit eyes with or without intravitreal saline or antibiotic injection. Variety of photoreceptor cell nuclei can be distinguished. The nuclei of photoreceptor cells change their shape so as to pass easily through the juncition and thereafter they returned to their original shape in sub retinal space. The mechanisms and biological significance of this phenomenon are not yet certain, but it may by one of the important factors contributing to decreased vision with aging.