ABSTRACT
ABSTRACT A rare case of bilateral congenital microcoria associated with antimetropia in a 47-year-old man is here described. The patient presented with a chief complaint of progressive vision loss in his right eye over the past five years. A slit-lamp examination and ultrasound biomicroscopy confirmed congenital microcoria and cataracts. Phacoemulsification was performed using an iris expansion device and the anterior capsule was stained using the "trypan down under" technique. Preoperative considerations, the surgical approach, and postoperative management are discussed.
RESUMO Um caso raro de microcoria congênita bilateral associada à antimetropia em um homem de 47 anos de idade é descrito aqui. O paciente queixava-se de perda visual progressiva em seu olho direito nos últimos 5 anos. Um exame com lâmpada de fenda e biomicroscopia ultrassônica confirmaram microcoria congênita e catarata. A facoemulsificação foi realizada usando dispositivo de expansão iriana, e a cápsula anterior foi corada através da técnica "trypan down under". Considerações pré-operatórias, abordagem cirúrgica e manejo pós-operatório são discutidos.
Subject(s)
Humans , Male , Adult , Middle Aged , Ophthalmic Solutions/administration & dosage , Atropine/administration & dosage , Cataract/complications , Cataract Extraction , Pupil Disorders/congenital , Phacoemulsification/methods , Pupil Disorders/surgery , Pupil Disorders/complications , Microscopy, AcousticABSTRACT
ABSTRACT Here we report a case of surgical pupilloplasty in an adult with true polycoria. A 44-year old man was referred to our clinic with a best-corrected visual acuity (BCVA) of 0.5 diopters (D) in his left eye. Biomicroscopy revealed two pupils within a 2.5-mm central zone, with diameters of 1.2 and 1.1 mm. Both pupils had real iris sphincters and responded to light and chemical stimulation. Therefore, we surgically cut the bridge between the two pupils without any intraoperative or postoperative complications. One month after the surgery, BCVA had improved to 0.9 D, and the final pupil was almost round, measuring 2.7 mm in diameter.
RESUMO Relatamos um caso de pupiloplastia cirúrgica em um paciente adulto com policoria verdadeira. Um homem de 44 anos de idade foi encaminhado ao nosso serviço com acuidade visual melhor corrigida (BCVA) de 0,5 em seu olho esquerdo. Biomicroscopia revelou 2 pupilas, dentro de uma zona central de 2,5 milímetros com dimensões de 1,2 mm e 1,1 mm de diâmetro. Ambas as pupilas apresentavam esfíncteres irianos reais que respondiam à luz e a drogas. A ponte entre as 2 pupilas foi cortada cirurgicamente. Não houve complicações transoperatórias ou pós-operatórias. A BCVA melhorou para 0,9, e a pupila ficou quase circunferencial com 2,7 mm de diâmetro, um mês após a cirurgia.
Subject(s)
Humans , Male , Iris/abnormalities , Iris/surgery , Pupil Disorders/surgery , PupilABSTRACT
INTRODUÇÃO: O fenômeno de Marcus Gunn é uma ptose congênita rara e pouco conhecida, de origem neurogênica, de fisiopatogenia ainda não esclarecida. Os autores relatam um caso de ptose acentuada e recidivada após quatro correções cirúrgicas, e fazem uma breve revisão bibliográfica. RELATO DE CASO: Adulto jovem de 19 anos, sexo masculino, foi submetido a quatro tentativas de correção de ptose palpebral a direita em outros serviços, sem diagnóstico da origem da ptose congênita. O paciente apresentava abertura palpebral do olho direito ao abrir a boca, ao lateralizar o olhar para o lado ipse-lateral, e ao fechamento do olho contra-lateral. A última cirurgia foi realizada 2 anos antes, com posicionamento e fixação de fitas de silicone. O paciente não apresentava nenhum déficit neurológico ou visual. Foi submetido à cirurgia para remoção das fitas de silicone anteriormente posicionadas, confecção de enxertos em fita de técido fibroconectivo da fáscia lata do membro inferior direito, miectomia do musculo elevador da pálpebra ptosada, fixação dos enxertos da fáscia lata na borda superior do tarso com tração e fixação ao musculo frontal ipsilateral. Evoluiu com movimentos sincrônicos das pálpebras bilateralmente, e sem recidiva do ptose até o presente momento.
INTRODUCTION: Marcus Gunn syndrome is a rare and little known congenital ptosis of neurogenic origin. Its physiopathological mechanism has not been clarified. The authors report a case of pronounced ptosis that relapsed after four surgical corrections, along with a brief literature review. CASE REPORT: A 19-year-old young adult underwent four surgical corrections of the right palpebral ptosis in other services, without a definite diagnosis of the origin of the congenital ptosis. The patient showed eyelid opening in the right eye on opening the mouth, when the eye is lateralized to the ipsilateral side, and with contralateral eye closure. The last surgery was performed 2 years prior, during which silicone bands were placed and fixated. The patient did not present any visual or neurological deficit. He underwent surgery in order to remove the silicone bands that were previously placed, to prepare the strip grafts made of fibrous connective tissue from the fascia lata of the right inferior limb, and to perform myectomy of the levator muscle of the palpebral ptosis, fixation of the fascia lata grafts at the upper edge of the tarsus with traction and fixation to the ipsilateral frontal muscle. The patient progressed with synchronic movements of the eyelids bilaterally, and without relapse of the ptosis until the present date.
Subject(s)
Humans , Male , Adult , History, 21st Century , Silicones , Blepharoptosis , Case Reports , Pupil Disorders , Blepharoplasty , Eyelids , Fixation, Ocular , Silicones/therapeutic use , Silicones/chemistry , Blepharoptosis/surgery , Blepharoptosis/pathology , Pupil Disorders/surgery , Pupil Disorders/pathology , Blepharoplasty/methods , Eyelids/surgery , Eyelids/pathologyABSTRACT
El cierre angular agudo o glaucoma agudo como es conocido mundialmente es un cuadro clínico característico producido por un cierre angular brusco, constituye una urgencia oftalmológica que pone en peligro la función visual si no es resuelto satisfactoriamente en las primeras horas de instaurado. El mecanismo fisiopatológico más frecuente es el bloqueo pupilar primario y el tratamiento de elección es la iridotomía láser periférica. Se debe realizar el diagnóstico diferencial con el bloqueo pupilar secundario y con otras causas sin bloqueo pupilar en las que la iridotomía no es suficiente. El cierre angular agudo es generalmente unilateral aunque se puede presentar de forma bilateral desencadenado por el empleo de drogas que producen dilatación pupilar como en el caso clínico que se describe a continuación
The acute angle closure or acute glaucoma as it is worldwide known is a characteristic clinical picture that is caused by sudden angle closure, It represents ophthalmological emergency that endangers the visual function if not satisfactorily solved in the first hours of occurrence. The most frequent physiopathological mechanism is primary pupil blocking and the treatment of choice is peripheral laser iridotomy. The differential diagnosis must be made with the secondary pupil blocking and with other causes without pupil blocking in which iridotomy is not enough. The acute angular closure is generally unilateral, although it may appear bilaterally and be caused by the use of drugs that give rise to pupil dilation like the clinical case which was described here
Subject(s)
Humans , Female , Aged , Benzodiazepines/adverse effects , Glaucoma, Angle-Closure/complications , Iridectomy/methods , Pupil Disorders/surgeryABSTRACT
PURPOSE: To determine safety, clinical and visual results, and potential complications of early radial optic neurotomy (RON) surgery in eyes with central retinal vein occlusion (CRVO), with relative afferent pupillary defect and visual acuity MATERIALS AND METHODS: This prospective, interventional case-series included 24 patients of CRVO who underwent RON within 2 months of disease onset. The preoperative examination included slitlamp biomicroscopy, fundus photography and fluorescein angiography. Foveal thickness was measured using optical coherence tomography (OCT) in the last 6 eyes only. In each case, RON was performed after informed consent. Two radial incisions were placed in the nasal quadrant of the optic disc, using a micro-vitreoretinal blade. The postoperative change in vision, clinical picture, fundus photographs, angiograms and foveal thickness by OCT were the main outcome variables studied. The Wilcoxan signed test was used to assess the results. RESULTS: Average symptom duration was 37.8 +/- 15.2 days (range 15-60 days, median: 34.5 days) and follow-up 7.7 +/- 2.1 months (range 1-12 months, median: 8 months). Visual outcome: 2 (8.33%) eyes each had fall and preservation of pre-RON visual acuity respectively. Twenty eyes (83.33%) showed increase in vision (of average 3 lines). Pre and postoperative vision ranged from 0.017-0.1 (average:0.061) and 0.017-0.667 (average: 0.17) respectively (P < 0.05). Clinical and angiographic outcome: decline in macular oedema, decreased or resolved intraretinal haemorrhages, resolution of venous dilatation and disc oedema could be appreciated in all cases. Foveal thickness: average pre and postoperative foveal thickness was 834.17 microm and 556.17 microm respectively (P < 0.05) in the 6 eyes where it was measured before and after RON. One eye developed retinal-detachment. CONCLUSION: Radial optic neurotomy is better than the natural course in eyes with CRVO, with vision < 6/60.
Subject(s)
Adult , Aged , Aged, 80 and over , Connective Tissue/surgery , Decompression, Surgical , Female , Fluorescein Angiography , Humans , Male , Middle Aged , Optic Disk/pathology , Prospective Studies , Pupil Disorders/surgery , Retinal Vein Occlusion/pathology , Safety , Tomography, Optical Coherence , Treatment Outcome , Visual AcuityABSTRACT
Poco se ha escrito en la literatura odontológica sobre el conocido síndrome Marcus Gunn llamado también mandíbula parpadeo. Sin embargo es relevante el conocimiento de las características clínicas de esta entidad donde hay una asociación de movimientos involuntarios de elevación del párpado, en sincronismo con la lateralidad de la mandíbula. Se presenta un caso de este síndrome donde se observó una blefaroptosis leve, en una niña de 7 años de edad, la cual fue evidenciado en una consulta odontológica. El conocimiento de la existencia de esta patología reviste gran importancia pues requiere de varios cuidados postoperatorios y su remisión a los especialistas adecuados. Con este artículo se pretende hacer un aporte en el reconocimiento de enfermedades que aunque no están relacionadas directamente con el odontólogo, este debe conocer para su correcto manejo
Subject(s)
Humans , Female , Blepharoptosis/diagnosis , Blepharoptosis/surgery , Blinking , Pupil Disorders/diagnosis , Pupil Disorders/surgery , Eye Diseases/etiology , VenezuelaABSTRACT
The work was carried out on 18 eyes of fifteen patients with inadequate pupillary zone due to different causes. A completely occluded pupil was found in nine eyes [50%] while after cataract and retained lens matter was present in eight eyes [44.4%] and a seccluded pupil with a papillary membrane was the presenting sign in one eye [5.6%]. Preoperative ultrasonography [A and B mode] was carried out for 10 eyes [55.5%]. Pars plana coreoplasty with anterior vitrectomy was done for all the selected eyes. Anatomical success was achieved in all of the operated eyes [100] while visual success was achieved in 86.7% of the operated eyes. The complications and difficulties during and after the operation were recorded