Predictive factors for anterior chamber fibrin formation after vitreoretinal surgery / Fatores preditivos para formação de fibrina na câmara anterior após cirurgia vitreorretiniana

Purpose: The aim of this study was to investigate possible predictive factors related to anterior chamber fibrin formation after vitreoretinal surgery in a large series of patients. Methods: The data of 185 eyes of 185 patients submitted to vitreoretinal surgery was reviewed. The following variables were evaluated: the postoperatively presence of fibrin, age, diabetes mellitus, the vitrectomy system gauge (20, 23 or 25 gauge), the type of vitreous substitute, the influence of prior surgical procedures and the combination with cataract extraction. To evaluate predictive factors for anterior chamber fibrin formation, univariate analysis was performed. A multivariate stepwise logistic regression model was adjusted to investigate factors associated with fibrin formation (p<0.05). Results: Fibrinoid anterior chamber reaction was found in 12 (6.4%) patients. For multivariate logistic regression analysis, balanced salt solution (BSS), the chance of fibrin occurrence was 5 times greater (odds ratio 4.83, CI 95% 1.302 - 17.892; p=0.019), while combination with phacoemulsification increased the chance of fibrin formation by 20 times (odds ratio 20, CI 95% 2.480 - 161.347; p=0.005). No significant difference was found regarding other variables. Conclusion: Anterior chamber fibrin formation is an unwanted complication after vitreoretinal surgery. Factors such as combined performance of phacoemulsification and the use of balanced salt solution as a vitreous substitute may predispose the occurrence of this complication. .

Objetivo: Avaliar os possíveis fatores relacionados à formação de fibrina na câmara anterior após cirurgia vitreorretiniana em uma grande série de casos. Métodos: Foi realizado um estudo retrospectivo, observacional, caso-controle, onde os dados de 185 olhos de 185 pacientes submetidos à cirurgia vitreorretiniana foram avaliados. Os seguintes dados foram analisados: presença ou não de fibrina na câmara anterior na primeira semana de pós-operatório, idade, presença ou não de diabetes mellitus, calibre do sistema de vitrectomia utilizado (20,23 ou 25 gauge), substituto vítreo, a influência de cirurgias oftalmológicas prévias e a realização de cirurgia de catarata combinada. Para avaliação dos fatores preditivos para formação de fibrina, a análise univariada foi realizada. O modelo de regressão logística multivariada foi utilizado para investigar os fatores associados com a formação de fibrina (p<0,05). Resultados: A presença de fibrina na câmara anterior foi encontrada em 12 (6,4%) pacientes. Pela análise de regressão logística multivariada, o uso de solução salina balanceada (BSS) como substituto vítreo, a chance da presença de fibrina foi 5 vezes maior (odds ratio 4,83, IC 95% 1,302 - 17,892; p=0,019), enquanto que a realização de cirurgia facoemulsificação combinada aumentou a chance de formação de fibrina 20 vezes (odds ratio 20, IC 95% 2,480 - 161,347; p=0,005). Nenhuma diferença estatisticamente significativa foi encontrada para as outras variáveis. Conclusão: A formação de fibrina na câmara é uma complicação indesejada após cirurgia vitreorretiniana. Fatores como realização de cirurgia de facoemulsificação combinada e ...

A Case of Cholesterosis Bulbi with Secondary Glaucoma Treated by Vitrectomy and Intravitreal Bevacizumab

We report on a case of cholesterosis bulbi concurrent with secondary glaucoma. A 36-year-old man, with a history of long-standing retinal detachment in his right eye after the irrigation and aspiration of a congenital cataract, presented with a clinical picture of elevated intraocular pressure and ocular pain. Upon slit-lamp examination, we found a ciliary injection and a pseudohypopyon of polychromatic crystals. Gonioscopic examination revealed a large amount of crystals deposited on the trabecular meshwork and mild rubeosis iridis, but the neovascularization of the angle could not be clearly confirmed due to the presence of so many crystals. Pars plana vitrectomy was performed to remove clusters of crystals and bevacizumab was injected intravitreally to treat iris neovascularization. Aqueous aspirate was examined by light microscopy and the typical highly refringent cholesterol crystals were identified. Intraocular pressure returned to a normal level after the bevacizumab injection, although severe cholesterosis was still evident in the anterior chamber. To our knowledge, this would be the first Korean case of cholesterosis bulbi combined with chronic retinal detachment and presumed neovascular glaucoma, which was treated by pars plana vitrectomy and intravitreal bevacizumab injection.

Anterior chamber exudative mass due to Scedosporium apiospermum in an immunocompetent individual.

Endogenous intraocular infection of fungal etiology is extremely rare in an immunocompetent individual. Usually, an antecedent history of trauma, surgery, intravenous drug abuse or an immunocompromized state can be elicited. Scedosporium apiospermum is a known cause of keratomycosis after traumatic implantation and can cause fatal disseminated infection in immunocompromized patients. However, cases of S. apiospermum intraocular infection in immunocompetent individuals have been very rarely reported in literature. We report here a case of an anterior chamber exudative mass due to S. apiospermum in an immunocompetent individual which was managed successfully with anterior chamber wash and intravitreal injection of voriconazole.

Outflow of aqueous humor following cyclodialysis or ciliochoroidal detachment in rabbit

Cyclodialysis and ciliochoroidal detachment were performed in three eyes of three rabbits and in three eyes of another three rabbits, respectively. After aspiration of the aqueous humor, 0.1 ml of 10% sodium fluorescein was injected intracamerally, and the eyeball was enucleated between 30 minutes and one hour after injection and prepared for fluorescence microscopy. Sodium fluorescein concentrations in the supraciliary space were much greater in the group with cyclodialysis or ciliochoroidal detachment than in the normal control group. These results suggest that (1) in the eye with cyclodialysis, the aqueous humor may freely gain access to the supraciliary space through the cleft between the anterior chamber and the supraciliary space and then be removed rapidly and (2) in the eye with ciliochoroidal detachment, the aqueous humor may pass through the uveoscleral outflow pathway.