An Adenocarcinoma Associated with Bilateral, Diffuse, Uveal Melanocytic Proliferation

Purpose@#We report bilateral, diffuse, uveal melanocytic proliferation caused by a stomach adenocarcinoma.Case summary: A 78-year-old male complained of visual impairment 3 months in duration. He had diabetes and had undergone cataract surgery on both eyes 4 years prior. His best-corrected visual acuity was counting fingers in the right eye and 20/160 in the left eye. Both intraocular pressures were normal. The anterior segments yielded no specific findings. The maculae exhibited multiple, round, patchy, pigmented or depigmented lesions with exudative retinal detachment. Fluorescein angiography revealed multiple hyperfluorescent lesions. Optical coherence tomography revealed that the hyper-reflective exudates lay between the neurosensory retina and the retinal pigment epithelium. We diagnosed bilateral, diffuse, uveal melanocytic proliferation and performed a systemic evaluation. Computed tomography revealed several mass lesions in the lung, stomach, and lymph nodes; these appeared to be malignant. An esophagogastroduodenoscopic biopsy confirmed that the lesions were adenocarcinomas. @*Conclusions@#A bilateral, diffuse, uveal melanocytic proliferation induced by a primary malignant tumor exhibited multiple, pigmented subretinal exudates associated with exudative macular retinal detachment. In patients with such findings, it is necessary to evaluate the malignant tumor status of remote organs.

Trabeculectomy Following Vitrectomy in Refractory Glaucoma with Vitreous Filling of the Anterior Chamber: a Case Series

Purpose@#To evaluate the 1-year clinical outcome of subsequent trabeculectomy following 25-gauge transconjunctival sutureless vitrectomy in refractory glaucoma with vitreous filling of the anterior chamber. @*Methods@#This study was a retrospective and consecutive case series study. We reviewed the medical records of pseudophakic and aphakic glaucoma patients with vitreous filling of the anterior chamber who underwent subsequent trabeculectomy with mitomycin C (MMC), following 25-gauge transconjunctival sutureless vitrectomy. All patients had been followed up for more than 12 months. Complete surgical success was defined as an intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without glaucoma medication. Qualified surgical success was defined as IOP ≤18 mmHg and an IOP reduction ≥20% with or without glaucoma medication. @*Results@#Eight eyes of seven patients (four eyes of four patients with pseudophakic glaucoma and four eyes of three patients with aphakic glaucoma) were included in this study. The cumulative probability of qualified success was 87.5%, and the cumulative probability of complete success was 62.5% at 12 months after trabeculectomy. The mean IOP decreased from 28.1 ± 3.5 mmHg preoperatively to 15.0 ± 3.7 mmHg at the final visit (p = 0.012). The mean number of glaucoma medications decreased from 4 ± 0 to 1.5 ± 2.1 at the final visit (p = 0.010). Complications including retinal detachment, vitreous hemorrhage, cystoid macular edema, and vitreous incarceration into the fistula were not observed. @*Conclusions@#Transconjunctival sutureless vitrectomy and subsequent trabeculectomy with MMC is an effective method for controlling IOP in pseudophakic and aphakic glaucoma with vitreous filling of the anterior chamber.

Case Series of Descemet Membrane Detachment Associated with Cataract Surgery

Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.

Trabeculectomy Following Vitrectomy in Refractory Glaucoma with Vitreous Filling of the Anterior Chamber: a Case Series

Purpose@#To evaluate the 1-year clinical outcome of subsequent trabeculectomy following 25-gauge transconjunctival sutureless vitrectomy in refractory glaucoma with vitreous filling of the anterior chamber. @*Methods@#This study was a retrospective and consecutive case series study. We reviewed the medical records of pseudophakic and aphakic glaucoma patients with vitreous filling of the anterior chamber who underwent subsequent trabeculectomy with mitomycin C (MMC), following 25-gauge transconjunctival sutureless vitrectomy. All patients had been followed up for more than 12 months. Complete surgical success was defined as an intraocular pressure (IOP) ≤18 mmHg and IOP reduction ≥20% without glaucoma medication. Qualified surgical success was defined as IOP ≤18 mmHg and an IOP reduction ≥20% with or without glaucoma medication. @*Results@#Eight eyes of seven patients (four eyes of four patients with pseudophakic glaucoma and four eyes of three patients with aphakic glaucoma) were included in this study. The cumulative probability of qualified success was 87.5%, and the cumulative probability of complete success was 62.5% at 12 months after trabeculectomy. The mean IOP decreased from 28.1 ± 3.5 mmHg preoperatively to 15.0 ± 3.7 mmHg at the final visit (p = 0.012). The mean number of glaucoma medications decreased from 4 ± 0 to 1.5 ± 2.1 at the final visit (p = 0.010). Complications including retinal detachment, vitreous hemorrhage, cystoid macular edema, and vitreous incarceration into the fistula were not observed. @*Conclusions@#Transconjunctival sutureless vitrectomy and subsequent trabeculectomy with MMC is an effective method for controlling IOP in pseudophakic and aphakic glaucoma with vitreous filling of the anterior chamber.

Case Series of Descemet Membrane Detachment Associated with Cataract Surgery

Purpose@#We report the therapeutic efficacy of using 18% SF6) injection into the anterior chamber or interrupted corneal sutures for Descemet membrane detachment related to cataract surgery. Case summary: Case 1) A 74-year-old female showed localized detachment of Descemet membrane of the cornea on the first day after cataract surgery on the left eye; her visual acuity was hand motion only. Non-expansible sulfur hexafluoride (18% SF6) gas was injected into the anterior chamber to treat the detachment and achieved improvement of vision due to relief of the corneal edema and adhesion of the Descemet membrane. Case 2) A 76-year-old male had poor visual acuity of the right eye after cataract surgery performed at a local eye clinic. Folding and detachment of the Descemet membrane was found before the postoperative 3-months follow-up. We injected 0.3 mL 18% SF6 gas into the anterior chamber twice. The corneal edema disappeared and visual acuity improved. Case 3) A 75-year-old female who had undergone cataract surgery was suspected of having Descemet membrane detachment. She was injected with 18% SF6 into the anterior chamber twice, but the detached membrane persisted in the lower right cornea, combined with pupillary block glaucoma. We performed interrupted corneal sutures of the detached Descemet membrane, and resolution of the detachment was confirmed by corneal optical coherence tomography. @*Conclusions@#Re-attachment of Descemet membrane of the cornea can be obtained by performing repeated injections of 0.3-0.4 mL of non-expansible 18% SF6 gas, or by direct corneal suture in cases of persistent detachment.