ABSTRACT
During extraocular muscle surgery, an uneventful scleral suture pass is very essential. In presence of normal intraocular tension, the surgery is quite predictable and safe. However, in the presence of significant hypotony, it becomes challenging. Therefore, to mitigate complication rate in these cases, we have adopted a simple technique, that is, the “pinch and stretch” technique. The surgical steps of this technique are as follows: In eyes with significant ocular hypotony, the surgery is initiated with a routine forniceal/limbal peritomy, following which the muscle is sutured and dis-inserted. Using three tissue fixation forceps, the scleral surface is stabilized. Using first forceps, the surgeon rotates the globe toward themself from the muscle stump, and with the remaining two forceps, the assistant pinches and stretches the episcleral tissue in an outward and upward direction just beneath the intended marks. This creates a flat scleral surface with significant firmness. Sutures are passed over this rigid sclera and the surgery is completed without any complications.
ABSTRACT
Background: Postoperative hypotony is associated with choroidal effusion, suprachoroidal haemorrhage, aqueous misdirection syndrome (malignant glaucoma), choroidal folds and hypotony maculopathy, anterior chamber (AC) shallowness or loss and subsequent failure of the original filtration of procedure. This work aimed to study the causes, risk factors, adverse effects, and management plans of ocular hypotony after different glaucoma surgeries.Methods: This retrospective study was carried out on 205 eyes underwent glaucoma surgery with follow up for more than 3 months. Patients were divided into two groups: 30 cases were diagnosed with post-operative hypotony, 175 eyes were without hypotony. Patients were subjected to glaucoma diagnosis, type of glaucoma operation and recorded IOP for 3 months at least.Results: CPC, Visco-Trab, Phaco Visco-Trab Visco and express valve were significantly different between the two groups (P=0.049, P=0.012, P=0.043 and P<0.001 respectively) and other types of operation were insignificantly different between the two groups. IOP was significantly decreased at first diagnosis of hypotony and at last follow up compared to before operation (P value <0.001). IOP at last follow up was significantly increased compared to first diagnosis of hypotony (P value <0.001). Criteria of hypotony eyes were insignificantly different between patients needed surgical intervention and no surgical intervention.Conclusions: Postoperative hypotony was most common in pseudo-exfoliative glaucoma cases compared to other glaucoma types. While the most type of glaucoma surgery that was associated with postoperative hypotony was viscocanalostomy combined with express shunt. The adverse effects reported in our study were choroidal effusion and hypotony maculopathy.
ABSTRACT
Purpose: Chronic uveitis can lead to hypotony that may result in severe visual impairment. We highlight the use of ultrasound biomicroscopy (UBM) as an imaging tool to decide the modality of therapy and management of uveitic hypotony. Methods: This was a retrospective hospital?based interventional case?series study that included a total of 36 eyes of 25 patients with uveitic hypotony seen between January 1997 and January 2020. Results: Thirty?six eyes of 25 patients with uveitic ocular hypotony were included. Unilateral involvement was seen in 56%. The median age of presentation was 21 years with a median follow?up of 21.5 months. Anterior uveitis was noted in 13.88%, intermediate uveitis in 52.77%, and panuveitis in 33.33% eyes. UBM findings commonly noted were pars plana membranes, supraciliary effusion, blunted ciliary process, and ciliary body traction. Other findings included ciliochoroidal detachment and ciliary body edema. Moreover, 22.2% eyes were managed with medical therapy alone, whereas 77.8% eyes received both medical and surgical intervention based on UBM findings. Furthermore, 66.7% eyes showed improvement in intraocular pressure, 13.9% eyes maintained the same IOP, whereas 19.4% eyes had worsening of IOP at final follow?up. Conclusion: We found UBM as a useful imaging tool in evaluating and judiciously deciding the mode of management of uveitic hypotony.
ABSTRACT
A 42-year-old male presented to us after an episode of acute anterior human leukocyte antigen (HLA)-B27-associated uveitis, and intraocular pressure (IOP) in the right eye was 4 mmHg. Ultrasound biomicroscopy revealed ciliary body edema with supraciliary effusion. He was on a frequent topical corticosteroid, and oral steroid in addition to receiving a periocular injection depot corticosteroid 20 days back. He was started on treatment with subcutaneous golimumab (GLM). After a month, his IOP in the right eye was 14 mm of Hg with UBM showing resolution of ciliary body edema. GLM can be useful in the management of steroid-resistant cases of HLA B-27-associated ocular hypotony.
ABSTRACT
Progressive hemifacial atrophy (PHA) is a disease of unknown etiology affecting one‑half of the face. Ocular involvement is uncommon. Atrophy of iris is rare, with only a few cases of partial atrophy being reported in the literature. We report a case of total atrophy of iris and ciliary body with associated ocular hypotony in a 16‑year‑old girl with PHA. We believe this is the Access this article online Quick Response Code: Website: www.ijo.in DOI: 10.4103/0301-4738.151474 PMID: *** first reported case of complete atrophy of iris and ciliary body in PHA. Ocular hypotony in PHA was thought to be due to intra‑ocular inflammation. However in our case it appears to be secondary to severe atrophy of the ciliary body.
ABSTRACT
PURPOSE: To examine the influence of irradiation methods on the long-term results of contact transscleral Nd:YAG laser cyclophotocoagulation and to evaluate the factors that affect changes in intraocular pressure (IOP) and occurrence of ocular hypotony after cyclophotocoagulation. METHODS: In this retrospective study, 36 refractory glaucomatous eyes of 36 patients were observed for at least one year after a cyclophotocoagulation procedure. Contact transscleral Nd:YAG laser cyclophotocoagulation was performed with 7 to 10 Watts of power, a duration of 0.7 seconds, with one or two rows, and ranges of either greater or less than 180 degrees. The change in IOP, the success rate of the procedure, and the occurrence rate of hypotony were analyzed with regard to the methods of cyclophotocoagulation. RESULTS: In this series of patients with refractory glaucoma, the final IOP and success rate were not significantly influenced by the laser application method or by the total energy used. The eyes with ocular hypotony showed significantly decreased IOP one year after cyclophotocoagulation when compared with eyes without ocular hypotony. The IOP percent reduction in the patients with ocular hypotony tended to decrease more rapidly than did that of the patients without hypotony, beginning three months after the operation. CONCLUSIONS: The application methods of cyclophotocoagulation appear to have no significant influence on success rate, IOP or ocular hypotony rate. The percent reduction in IOP was higher in the hypotony group, including during the early postoperative periods.