Lesão escleral durante o agulhamento com mitomicina C: relato de caso / Scleral injure caused by needling revision with adjunctive mytomicin-C: case report

Paciente de 70 anos foi submetida à cirurgia de catarata e glaucoma no olho esquerdo em 1996. Onze anos depois, com a pressão intraocular descontrolada (32 mmHg), foram realizados dois agulhamentos episclerais com mitomicina-C, na tentativa de recuperar a função da trabeculectomia. Após o segundo agulhamento, a paciente evoluiu com importante hiperfiltração, atalamia grau III e iminente descompensação da córnea. Foi tentado o tratamento clínico com corticóide, cicloplégico, inibidores da produção do aquoso e lente de contato terapêutica, sem sucesso. A câmara anterior foi sucessivamente preenchida com ar, metilcelulose 4 por cento e hialuronato de sódio 1 por cento, com melhora apenas temporária. Foram feitas suturas compressivas sobre a bolsa filtrante, sem sucesso. Realizou-se, então, a revisão cirúrgica da fístula, que evidenciou grande área de exposição do corpo ciliar e da coróide, correspondente ao local do agulhamento. O quadro estabilizou-se após recobrimento com enxerto de esclera de cadáver e reintrodução de terapia hipotensora tópica. A gravidade da complicação descrita por um procedimento relativamente fácil e seguro, ressalta a importância deste relato de caso.

A 70-year-old female patient underwent cataract and glaucoma surgery on her left eye in 1996. Eleven years later, we performed two bleb needling revisions with adjunctive mytomicin-C, in order to decrease an uncontrolled intraocular pressure of 32 mmHg. After the second needling, she developed severe overfiltration, with flat anterior chamber, choroidal effusion, and impending corneal decompensation. Conservative treatment with cycloplegic and corticosteroid eye drops, acetazolamide and therapeutic contact lenses was unsuccessfully tried. Anterior chamber reformation was successively tried with air, 4 percent ophthalmic viscosurgical device and 1 percent sodium hyaluronate, with only temporary results. Compressive sutures above the overfiltering bleb were applied, unsuccessfully. In order to avoid additional corneal endothelium damage, a surgical bleb revision was performed and revealed a large area of ciliary body and choroidal exposure under the conjunctiva. It was covered by a donor scleral patch graft providing successful resolution. Nevertheless, we had to reintroduce hypotensive eyedrops. While bleb needling is a relatively safe and effective procedure, ophthalmologists should be aware of the possibility of potentially serious complications, such as in this case report.

Erosão trans-escleral porsutura de Arruga pós retinopexia / Intrascleral erosion post retinopexy surgery with Arruga surgery

Os autores descrevem uma rara complicação de cirurgia de retinopexia com uso de fio de sutura de cerclagem de Arruga, evoluindo com erosão escleral e perfuração intra-ocular.

The authors relate an uncommon complication of retinopexy with encircling scleral buckle employing Arruga Suture, that has evolved to scleral erosion and intraocular damage.

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.

Personal apparel endangering life.

Survival after accidental pressure exerted over neck is not common. In the literature also only few cases are available. Further, the victims or their relatives seek medical assistance only if complications arise and also it is not mandatory on the part of treating private practitioner to report such cases to the police. Findings in the living on the 4th day after accidental compression of the neck by the personal apparel are described in this article. Red eyes due to scleral haemorrhages are the most striking feature and the position of knot with ligature mark is also well marked.

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

Outcome of corneal scleral laceration in Yazd

The aim of this study is to define the epidemiologic characteristics and clinical profile and evaluation of final visual outcome of corneal scleral laceration. A prospective survey was conducted over a two year period from March 2000 to March 2002 on 79 consecutively admitted patients who underwent corneal scleral repairment at Yazd Eye Hospitals. This study included 79 eye injuries. Fifty nine of cases [74.7%] occurred in males and 20 cases [25.3%] in females. Mean age was 17.08 years. Left eye was more commonly involved [57%]. Initial VA was an important predictor of final VA. Good initial VA > 20/200 leading to excellent final VA. 40.6% of traumas occurred in the first decade of life. Injuries less than 10 mm and related to zone I and II predicted a good visual outcome. In this study endophthalmitis [5.1%] was much less likely to develop in eyes with primary repairment within 24 hours from the injury [1.5%] than in eyes being repaired after 24 hours [21.4%] and the difference was significant [P==0.016]. Significant predictive factors for final VA after corneal scleral injury include: initial VA, wound length, wound and location,, and the time of primary repair

Traumatic subconjunctival crystalline lens.Dislocation by the tail of a cow

Traumatic subconjunctival crystalline lens is a rare phenomena; we report a case of ocular trauma by the tail of a cow. A 60-year-old female presented with history of trauma to her left eye by the tail of a cow, she had severe headache, redness and pain in her left eye. She was admitted and the crystalline lens was found in the subconjunctival space and was removed surgically

Management of ocular perforations resulting from peribulbar anaesthesia.

PURPOSE: To analyze the clinical presentation and outcome of treatment for globe perforation secondary to peri-bulbar anaesthesia. METHODS: Eight patients (3 females and 5 males) aged 66-84 years were included in the study. Ocular perforations were suspected in 3 cases before or during surgery, in 4 cases diagnosis was established within one week and in one case at 3 weeks. Three patients underwent indirect argon laser photocoagulation to seal the retinal break, one patient had cryotherapy, 3 patients underwent a pars plana vitrectomy with fluid gas exchange and endo-laser; and one patient refused any further treatment. RESULTS: The final visual acuity after a mean follow up of 14 months was better than 6/9 in 2 patients, between 6/9-6/12 in 4 patients, and perception of light in 2 patients. CONCLUSION: If diagnosed early and treated adequately, a majority of patients with globe perforation during periocular anaesthetic could be saved.

review of penetrating injuries treated at Al-Shifa trust eye hospital, rawalpindi during a two year period

A retrospective study was done of fifty cases with penetrating eye injuries treated at Al Shifa Eye Hospital, Rawalpindi presenting between August, 1992 and August, 1994. Out of the fifty cases, 36 [72%] were male and 14 [28%] female. There were 29 [58%] children in this study. The number of lost eyes were 14 [28%]. Men follow up duration was 4.7 months with a range of 01 month-20 months. The final vision was 6/12 or better in only 6 cases. Poor prognostic factors in this study were poor vision on presentation i.e. perception of light only, large wound size, corneal wounds, vitreous haemmorrhage, retinal detachment, uveal prolapse, and infection [endophthalmitis]. While increased time interval between injury and treatment statistically did not affect the final vision, poor follow up was an important negative factor in this study regarding the final vision

Use of cornel patch graft to repair scleral pr corneoscleral defects

Different types of graft materials, such as bucal mucosal membrane, auricular cartilage, conjunctiva, fascia lata, periosteum and dermal autografts, aortic and scleral homografts and synthetic materials have been used in order to repair or reinforce scleral or corneoscleral defects with variable results. We report patients with a minimum one year follow-up, successfully treated with corneal patch graft. In all cases, the corneal patch graft healed well without any evidence of further melting, infection or rejection. The grafts remained intact and able to support the defect, with a favorable final cosmetic appearance. Therefore, we emphasize the importance of human donor cornel tissue as an excellent alternative graft material to reinforce or repair scleral or corneoscleral defect.

Impregnaçäo sui generis conjuntivo-escleral por clofazimina em um paciente portador de hanseníase / Impregnation sui generis of the conjunctiva and sclera by clofazimine in a carrier Hansen's disease

Os autores apresentam o caso de um paciente de 40 anos de idade, portador de hanseníase forma virchoniana que recebeu, por via oral, durante 9 anos, clofazimina, numa dose total de 324 gramas. Apresentou intensa pigmentaçäo na conjuntiva e esclera por este medicamento. A biomicroscopia observavam-se com facilidade cristais policromáticos na conjuntiva e esclera de ombos os olhos. O estudo destes cristais também foi possível à microscopia óptica de fragmento da conjuntiva a fresco. O caso é discutido com os achados na literatura e os autores chamam a atençäo para os diagnóticos diferenciais

Evaluación de las heridas perforantes esclerales año 1988: Asistencia Pública de Santiago Dr. Alejandro del Río / Evaluation of the perforant scleral wounds in 1988: Asistencia Pública de Santiago Dr. Alejandro del Río

Se presentan los resultados clínicos de todos aquellos pacientes operados de heridas perforantes esclerales, más allá de tres mm del limbo y que tengan pérdida vítrea asociada, y que fueron atendidos en el Servicio de Oftalmología de la Asistencia Pública Dr. Alejandro del Río, de Santiago, durante el año 1988. Sólo se logró un seguimiento a largo plazo en 19 de los 24 pacientes atendidos con este diagnóstico. Todos los pacientes fueron operados con diatermia, sutura escleral y sección del vítreo prolapsado, sin vitrectomía en las primeras etapas de la enfermedad. De esta serie un 36,8% de los pacientes terminó en fracaso visual, y 61,6% de los pacientes presentó resultados visuales satisfactorios

Management of damaged sclera in re-operations of retinal detachment

Two hundred and sixty cases has been operated in the past ten years for recurrent retinal detachment which revealed relative damage off the sclera. These patients had either an encircling procedure segmental expolant or implants. Proper diagnosis of the degree off damage, was noticed before surgery and during re-operations. Management included either a trasvitreal or extrascleral approach, a delicate procedure with special exposure techniques. In 90%, the retina was re-attached, 75% off those had visual acuity ranging from 3/60 to 6/12, and 15% had ambulatory vision only

Contribución del signo escleral (signo del tatuaje) a la cirugía de los cuerpos extraños intraoculares magnéticos / Contribution of scleral sign (tattooing sign) to the surgery of magnetic intraocular foreign bodies

El autor hace un breve comentario en relación con la cirugía de los cuerpos extraños intraoculares magnéticos en la etapa prerrevolucionaria, y se destaca cómo posteriormente al triunfo de la Revolución el auge de dicha cirugía adquirió un gran desarrollo, debido al mejor diagnóstico de localización de los cuerpos extraños intraoculares. Se destaca la gran ayuda que en ese aspecto aportaron los oftalmólogos soviéticos. El trabajo recoge la experiencia de más de 25 años en la extracción de los cuerpos extraños intraoculares magnéticos y se valora lo positivo o no del signo escleral (signo del tatuaje). Se hace una explicación de dicho signo, definición, metodología de su investigación, características. Se exponen los resultados obtenidos en un estudio de 220 pacientes