Opciones quirúrgicas en el cierre angular primario por iris en meseta / Surgical options for the primary angle closure in a plateau iris case

Se describen dos casos clínicos (hermanos), con el objetivo de mostrar diferentes opciones terapéuticas en el glaucoma por cierre angular primario por iris en meseta. El primer caso representa una paciente femenina con antecedentes de iris en meseta e iridectomía periférica quirúrgica, quien presentaba cifras de tensión intraocular elevadas y progresión del daño glaucomatoso, por lo que se decidió realizar trabeculectomía en ambos ojos, con evolución satisfactoria. El segundo caso se trata de un paciente masculino, con antecedentes de salud, quien acudió por molestias oculares. Tras examen físico oftalmológico se constató glaucoma por cierre angular por iris en meseta, con presión intraocular elevada y opacidad del cristalino asociada, por lo que se realizó trabeculectomía en ojo derecho más extracción del cristalino en ambos ojos. Como complicaciones posoperatorias presentó desprendimiento coroideo y edema macular, resueltos con tratamiento médico. La trabeculectomía luego de la extracción del cristalino en ojo derecho falló, por lo que actualmente se encuentra compensado con tratamiento médico. La elección de la terapéutica adecuada debe tener en cuenta los factores fisiopatológicos involucrados y la forma de presentación(AU)

Different therapeutic options for the primary angle closure glaucoma by plateau iris were described in two clinical cases. The first one was a female patient with a a history of plateau iris and peripheral iridectomy. Elevation of intraocular pressure and progression to glaucoma was confirmed, so it was decided to perform trabeculectomy in both eyes and the result was satisfactory. The second case was a male patient with history of health problems, who suffered with eye disturbances. After ophthalmological exam, a primary angle closure glaucoma caused by plateau iris was confirmed with marked eye hypertension and associated crystalline lens opacity. Trabeculectomy of right eye and lens extraction in both eyes was applied. Choroidal detachment and macular edema were the postoperative complications, but the medical treatment managed to solve this situation. After the lens extraction, trabeculectomy in the right eye failed and today it is compensated with medical treatment. The right therapeutic choice should take into consideration the physiopathologic factors and the form of presentation(AU)

Raised intraocular pressure; frequency after Nd: YAG laser capsulotomy

To measure the rise in intraocular pressure after neodymium:yttrium-aluminum-garnet [Nd:YAG] Laser capsulotomy in pseudophakic patients aged 50 years and above. Prospective study. Study was done from May 2005 to Dec 2005. [Eight months duration] Eye department Military Hospital Rawalpindi. A total of 100 patients, presenting in Eye department, Military Hospital Rawalpindi, fulfilling inclusion and exclusion criteria were included. With a minimum number of bursts of 3.6 mj / shot energy level with Nd: YAG laser, a 3 to 4 mm hole in the posterior capsule was created. The intraocular pressure was measured 1 hour, 3 hours, 1 day and 1 week after the laser. The rise in intraocular pressure was noticed in 6 [6%] patients after Nd:YAG laser capsulotomy. Five out of six patients had fibrous type of posterior capsular opacification while one patient had Elschnig's pearl. Male to female Ratio was 7:3. Our findings suggest that the rise in intraocular pressure is an infrequent complication of Nd:YAG Laser capsulotomy

[Prediction of visual outcome after penetrating keratoplasty for pseudophakic and aphakic corneal edema]

To evaluate the ability to predict visual outcome after penetrating keratoplasty [PKP] in patients with pseudophakic or aphakic corneal edema [PCE or ACE]. Medical records of 34 patients [34 eyes] who underwent PKP for PCE or ACE during 1994-2004 in Ahvaz were retrospectively analyzed for variables in the history and ocular examination before PKP and visual outcome after PKP. The predictive value of each preoperative variable including age, gender, method of intraocular lens [IOL] implantation, vitreous loss during cataract surgery, time between cataract and PKP surgery, and history of glaucoma or increased intraocular pressure [IOP] before PKP surgery on post-PKP visual outcome was assessed using logistic regression analysis. Odds ratio [OR] with 95% confidence interval [95% CI] was calculated for predictive factors. Mean follow-up was 23.6 months. Best corrected visual acuity [BCVA] of 20/200 or better was achieved in 17 patients [50%]. The strongest predictors of this outcome were time between cataract surgery and PKP [P=0.008, OR=3.50, 95% CI; 0.48-31.18], aphakia [P=0.027, OR=4.29, 95% CI; 0.36-114.8] and no history of glaucoma or increased IOP before PKP [P=0.020, OR=3.75, 95% CI; 0.71-21.41]. In patients with PCE and ACE who are candidates for PKP, time between cataract and PKP less than 20 month, no history of glaucoma or increased IOP before PKP, aphakia versus presence of IOL are associated with a better visual outcome