Resultados de tres alternativas quirúrgicas para la remoción del cristalino en el cierre angular primario agudo / Results of three surgical alternatives for the crystalline lens extraction in the acute primary angle- closure

Objetivo: evaluar la efectividad de la remoción del cristalino en el tratamiento del cierre angular primario agudo. Métodos: se realizó un estudio descriptivo, longitudinal y prospectivo de serie de casos en 27 ojos de igual número de pacientes con cierre angular primario agudo, distribuidos en tres alternativas: facoemulsificación (faco n= 7), túnel esclerocorneal (túnel n= 12) y túnel postrabeculectomía (túnel pos-TBT n= 8).Se analizaron las variables presión intraocular y número de colirios hipotensores en preoperatorio y posoperatorio a la semana, al mes, a los tres y a los seis meses, al año y a los dos años, así como las variables esfera, cilindro y agudeza visual mejor corregida en preoperatorio y a los dos años posoperatorios. Resultados: la presión intraocular posoperatoria fue estable en el tiempo en los 3 grupos (12-14 mmHg). A los dos años hubo reducción significativa de presión intraocular media en grupo túnel (3,83 ± 5,27 mmHg; p= 0,032); del número de colirios hipotensores en grupo faco (1,29 a 0,14; p= 0,038) y del grupo túnel (1,33 a 0,25; p= 0,006). Se indujo miopía en grupo túnel pos-TBT (-1,16 ± 1,12 D; p= 0,028) y astigmatismo en grupo túnel (1,00 ± 1,05 D; p= 0,016). La agudeza visual mejor corregida promedio se incrementó en los tres grupos, con significación en los grupos túnel y túnel pos-TBT (p= 0,003 y p= 0,012 respectivamente). Conclusiones: en pacientes con cierre angular primario agudo, la facoemulsificación y el túnel esclerocorneal reducen la presión intraocular y el número de colirios hipotensores en el mediano plazo de dos años, a la vez que se mantiene el poder hipotensor de una filtrante previa. Las tres variantes recuperan de manera efectiva la agudeza visual, mientras se induce el error miópico de 1 dioptría en pacientes con trabeculectomía previa y astigmatismo de 1 dioptría mediante túnel esclerocorneal(AU)

Objective: to evaluate the effectiveness of the crystalline lens extraction in the treatment of the acute primary angle-closure. Methods: prospective, longitudinal and descriptive study of a case series of 27 eyes from the same number of patients suffering acute primary angle-closure, distributed according to three alternatives: phacoemulsification (n=7, phaco), sclerocorneal tunnel (n=12, tunnel)and postrabeculectomy tunnel ( n=8, post-TBT tunnel). The variables intraocular pressure and number of hypotensive eyedrops used in the preoperative and postoperative period were analyzed a week, a month, three months, six months, one year and two years after the surgery as well as sphere, cylinder and best corrected visual acuity in the preoperative phase and two years after surgery. Results: postoperative intraocular pressure was steady in the course of time in the three groups (12-14 mmHg). Two years later, there had been a significant reduction of average intraocular pressure in the tunnel group (3.83 ± 5.27 mmHg; p= 0.032), of the number of hypotensive eyedrops used in the phaco group (1.29 to 0.14; p= 0.038) and the tunnel group (1.33 to 0.25; p= 0.006). Myopia in the post-TBT tunnel group(-1.16 ± 1.12 D; p= 0,028) and astigmatism in the tunnel group(1.00 ± 1.05 D; p= 0.016) were both induced. The best average corrected visual acuity increased in the three groups, being significant in the tunnel and the post-TBT tunnel groups (p= 0.003 and p= 0.012, respectively. Conclusions: in those patients with acute primary angle-closure, phacoemultification and sclerocorneal tunnel reduce the intraocular pressure and the number of hypotensive eyedrops to be used in 2 years-term and the hypotensive power of a previous filtering bleb. The three variants can effectively recover the visual acuity whereas the myopic error of one diopter is induced in patients with previous trabeculectomy and one diopter astigmatism through the sclerocorneal tunnel(AU)

Long-standing Asymptomatic Intralenticular Foreign Body

No abstract available.

Comparison of immersion ultrasonography, ultrasound biomicroscopy and anterior segment optical coherence tomography in the evaluation of traumatic phacoceles.

Blunt ocular trauma in the elderly can result in anterior dislocation of the crystalline lens into the subconjunctival space (phacocele). Although rare, this presentation can be missed, especially if the patient presents several days after the injury and if the lid is not everted on examination. While a careful clinical examination is adequate in the diagnosis, imaging techniques can be put to use for the accurate location of the associated sclera rupture. We report three cases of post-traumatic phacocele wherein ultrasound biomicroscopy (UBM) was compared to the anterior segment optical coherence tomography (AS-OCT) and B-scan ultrasonography (B-scan), in order to establish the best imaging tool for this condition. We concluded, based on image quality, that UBM could be the imaging modality of choice to aid in the diagnosis of phacocele.

Intralenticular foreign body with a clear lens

Intraocular foreign bodies [IOFBs] are not uncommon in patients of penetrating ocular trauma but intralenticular foreign bodies are rarely seen. Penetrating ocular injuries are observed more commonly in young men. Intralenticular foreign bodies cause visually significant cataract in almost all cases. We report here a case of a young soldier with intralenticular foreign body of about 1.5 mm in size sparing the visual axis and only causing focal cataractous changes. The foreign body remained innocuous for about 3 months of follow-up not causing any progressive cataract, glaucoma or uveitis. The foreign body was removed, lens aspiration was done and posterior chamber intraocular lens was implanted, as patient could not be followed on long-term basis. The vision was restored to normally within 2 months

Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract.

This study analyzes the results of cataract surgery with primary intraocular lens implantation in unilateral childhood traumatic cataract following penetrating trauma and its long term follow up. It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract who underwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamber intraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest 57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3 years. Postoperative inflammation and pupillary capture were two frequent complications seen during postoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8th week and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visual acuity (BCVA)>or=6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3 years with/without membranectomy/capsulotomy was evident in 73.3% of eyes. Meticulous case selection with insertion of "in the bag IOL" and subjecting the traumatized cataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome in unilateral traumatic cataract in children.

A Case of an Asymptomatic Intralenticular Foreign Body

The purpose of this article is to report a case of an asymptomatic intralenticular metallic foreign body that was retained for 6 months. A 66-year-old male visited our ophthalmology department because of decreased visual acuity in his left eye 6 months after he suffered ocular trauma while mowing. He had not been treated because he did not experience any discomfort. His corrected visual acuity was 0.4. Central corneal opacity, an intralenticular metallic foreign body, and an intact posterior capsule were observed on slit lamp examination. Phacoemulsification with posterior chamber lens implantation and simultaneous removal of the intralenticular foreign body was performed. Seventeen days after the operation, his corrected visual acuity was 1.0, the intraocular lens was well-seated, and there was no intraocular inflammation. In this case report, a patient was found to have an intralenticular metallic foreign body retained for 6 months. During this time he did not experience any ocular dysfunction due to the foreign body. Mowing accidents are common in Korea. Despite the absence of symptoms, patients reporting a history of lawn mowing should be thoroughly examined.

Traumatic phacocele: review of eight cases.

Blunt trauma can result in indirect scleral rupture with subsequent dislocation of the crystalline lens in the subconjunctival or subtenon space. This retrospective review of eight patients with traumatic phacocele highlights the clinical presentation, management and visual outcome. This study provides evidence that timely and effective intervention can ensure good visual recovery.

Combined aniridic intraocular lens implantation and vitreoretinal surgery.

A 45-year-old man presented with post-traumatic aniridia. We describe the combined surgery done to treat both aniridia and epiretinal membrane simultaneously. A combined aniridia intraocular lens and vitreoretinal surgery was done. The case report highlights the advantage of combined surgery in terms of cost factor and surgical time.

Intralenticular metal foreign body: case report / Corpo estranho metálico intracristaliniano: relato de caso

Intralenticular foreign bodies comprise about 5 percent to 10 percent of all intraocular foreign bodies and can result in serious complications. The management depends on some factors like size, location, material type and the risk of infection. We present a patient with an intralenticular metal foreign body in the left eye that, following initial treatment with topical steroid and antibiotic, underwent lens aspiration with removal of the intralenticular foreign body and insertion of a posterior chamber intraocular lens with good visual outcome.

Os corpos estranhos intracristalinianos representam cerca de 5 a 10 por cento de todos os corpos estranhos intra-oculares. A conduta depende de alguns fatores, como: tamanho, localização, tipo de material e probabilidade de infecção. Relatamos um caso de um paciente com um corpo estranho metálico intracristaliniano no olho esquerdo que, após realizar tratamento inicial com esteróide e antibiótico tópicos, submeteu-se à aspiração do cristalino, retirada do corpo estranho e implante de lente intra-ocular com bom resultado visual.

Household ocular injuries: a case series

To determine the nature and types of household eye injuries. We prospectively analyzed data from 100 consecutive patients with household eye injuries [104 eyes] referred to emergency room of Farabi Eye Hospital during October2003. Standardized international classification of ocular trauma [Birmingham Eye Trauma Terminology] was used for classification. Household ocular trauma represented 4.85% of all ocular emergencies [2061 patients] referred to the emergency room during that period. Male to female ratio was 1.13 and mean age was 26 +/- 18 years [range, 1-73]. The cornea was involved in 50.0% and the sclera, lens, and retina each was involved in 4.8%. There was severe visual loss [best-corrected distance visual acuity <20/200 due to trauma] in 4% of the patients. The most frequent household ocular injury was globe injury [93.7%] including mechanical [72.1% closed and 4.8% open], chemical [14.4%] and thermal [1.9%] injuries. Closed mechanical injuries were the most common type of household ocular injury in our series. Considering the high rate of household eye trauma, more effective preventive measures should be taken at home

Intralenticular foreign bodies: report of eight cases and review of management.

PURPOSE: The management of intralenticular foreign bodies (ILFBs) with or without cataract has varied from time to time in the last century. We evaluated the surgical removal of the ILFBs with cataract extraction as a single-stage procedure. METHODS: Eight consecutive cases with intralenticular foreign bodies presenting to the trauma centre at our institute, were included in the study. Planned ILFB removal with cataract extraction and IOL implantation as a single-stage procedure was done in all the patients. They were followed up from 2 months to 2 years after the surgery. RESULTS: ILFBs were removed with Kelman-Mcpherson forceps in seven cases and in one it was expressed with the nucleus during extra capsular cataract extraction. Co-existent posterior capsular tears were seen in two eyes, of which only one needed a localized vitrectomy. Posterior chamber intraocular lens implantation was possible without any complication in all the cases. Postoperative uveitis seen in three cases was easily controlled with periocular steroids. Best corrected visual acuity at last examination was 6/9 or better in 7 cases and 6/12 in one case with posterior capsular opacification. CONCLUSIONS: Timing and necessity of ILFB removal may be adjusted according to the foreign body characteristics and associated ocular trauma, choosing, as far as possible, the least traumatic procedure. Use of forceps rather than magnets is safer for the removal of the ILFB. Co-existent posterior capsular tears need to be anticipated and dealt with when encountered.

Intraocular cilia associated with perforating injury.

PURPOSE: To report a case series of penetrating injury complicated by occurrence of intraocular cilia. METHODS: Retrospective analysis of charts of 11 eyes of 11 patients with penetrating injury and intraocular cilia, presenting between September 1978 and November 1998. Ten eyes underwent surgery for trauma-related problems such as cataract, vitritis, retinal detachment etc., at which time intraocular cilia were removed. One eye did not have surgery and continues to harbour cilia at the posterior perforation site. RESULTS: Metallic wire was responsible for injury in 6 of 11 eyes with intraocular cilia. Five eyes had significant intraocular inflammation. The cilia were located in the anterior segment in 4 eyes; in the posterior segment in 6 eyes and in both in one eye. At the last follow up, 72.7% had 6/18 or better vision. Poor vision in the rest was due to recurrent retinal detachment (2 eyes) and macular scarring (1 eye). CONCLUSION: Intraocular cilia are more commonly associated with injury by a metallic wire. The presentation and management of an injured eye does not seem to be influenced by the presence of cilia in the eye.

Triple procedure in posterior segment intraocular foreign body.

Three patients with intraocular foreign bodies and traumatic cataracts underwent single stage pars plana lensectomy with anterior capsule preservation, vitrectomy, removal of the foreign body, and intraocular lens implantation. The preserved anterior capsule permitted support for the placement of an intraocular lens in the posterior chamber in the ciliary sulcus. The procedure enabled early visual rehabilitation. This procedure seems useful in the management of posterior segment intraocular foreign body associated with cataract.

Patología del Cristalino / Lens pathology

La patología del cristalino es variada siendo las alteraciones en su transparencia, por la formación de catarata, la patología más común, la causa más importante de disminución de la función visual y la primera indicación de estudio ecográfico en la práctia clínica oftalmológica. La ultrasonografía modo A y B es un estudio útil para la valoración de la forma, volumen, posición y transparencia del cristalino existiendo patrones ecográficos característicos ante la existencia de alteraciones como catarata, sub-luxación o luxación, traumatismos y cuerpos extraños intraoculares, mostradas en imágenes del presente trabajo

Traumatismos oculares / Eye injuries

O trauma ocular ocupa lugar proeminente na infortunística médica, representando assunto vasto e destacado no estudo da oftalmologia.O presente trabalho faz uma revisao das lesoes traumáticas mais prevalentes, salientando os aspectos clínicos, propedêuticos e terapêuticos mais importantes.Enfase especial é dada aos avanços cirúrgicos que vieram modificar de forma significativa o prognóstico e a recuperaçao funcional de olhos extensamente lesados, no tratamento dos traumatismos do pólo posterior.

Resistencia del vitreo primario hiperplásico / Persistent hyperplastic primary vitreous

Pacientes con leucocoria debida a la persistencia del vítreo primario hiperplástico (PVPH), fueron estudiados en un protocolo realizado en el Instituto Nacional de Oftalmología. Se encontraron diez casos en el período de 1984 a 1989 y se tabularon la características clínicas obteniéndose los siguientes resultados: (1) La mayoría de los casos fueron diagnosticados antes del año de edad. (2) El compromiso unilateral fue el más frecuente. (3) Se encontró la cámara anterior estrecha en el 70 por ciento de los pacientes. (4) Se pudo observar un tejido blanquecino retrolenticular vascularizado en gran parte de los pacientes. Otras características clínicas notables fueron: microftalmos, cristalino transparente, alteraciones corneales y como complicación más frecuente se encontró glaucoma secundario

Trauma ocular penetrante grave e bilateral / Penetrating ocular trauma severe and bilateral

Seis casos de ferimentos oculares penetrantes, graves e bilaterais, foram analisados retrospectivamente quanto a epidemiologia, apresentaçäo clínica, tratamento e resultado visual final. Todos os casos foram decorrentes de acidentes automobilísticos em que os pacientes se encontravam no banco dianteiro dos veículos sem o uso de cintos de segurança. Somente 2 pacientes apresentaram traumatismos graves em outros órgäos, os demais apresentaram apenas ferimentos de face junto ao trauma ocular. Quando do trauma penetrante somente foi feita a reconstiruiçäo microscópica do globo ocular. Três olhos foram enucleados de imediato devido a perda total ou quase total do conteúdo intraocular, com laceraçöes que frequentemente se extendiam até o nervo óptico. Todos os olhos foram submetidos a vitrectomia pars plana e a outros procedimentos adicionais, dependendo de cada caso, entre 1 e 4 semanas após a reconstituiçäo inicial do globo ocular. A acuidade visual após a reconstituiçäo inicial do globo, mas antes da vitrectomia, era apenas de projeçäo luminosa no melhor olho. O tempo de seguimento pós-operatório variou de 3 a 18 meses. Todos os olhos operados obtiveram melhora da acuidade visual que variou de acordo com o tipo de lesäo pré-existente. A importância da vitrectomia nestes casos é demonstrada através de estudo experimental usando o modelo de Cleary- Ryan1 para trauma ocular penetrante