ABSTRACT
Positive vitreous pressure (PVP) is common during open anterior segment surgery and penetrating keratoplasty (PKP) has a reported incidence rate of 40-50%. Despite adequate perioperative preventive precautions, positive pressure occurs during surgery and optimum management of PVP is required to avoid serious complications. Many pharmacological and mechanical approaches can be employed either preoperatively or intraoperatively to decrease vitreous pressure. Surgical techniques such as graft-over-host technique, the modified graft-over-host technique, techniques employed mattress sutures and needle, or Vitreous aspiration or vitrectomy can be effectively used to manage intraoperative PVP during PPK. This article reviews the incidence, risk factors, prevention, and different approaches to the management of positive vitreous pressure during PKP to analyze the available evidence in order to improve the safety profile of PKP and prevent sight-threatening complications.
ABSTRACT
PURPOSE: Intramuscular hemangiomas of the head and neck are rare and account for fewer than 1% of total cases. Reports of intramuscular hemangiomas in adults' eyelids, orbital and periorbital regions are especially scarce, conceivably because occurrence in the masseter muscle is more common. Herein we report a highly unusual case of hemangioma located in the pretarsal orbicularis oculi muscle of an adult patient. This report describes the clinical and pathological assessment of the patient, subsequent diagnosis of periorbital intramuscular hemangioma, and conception and implementation of a treatment approach using intralesional bleomycin injections. OBSERVATIONS: A 29-year-old female patient without other clinical complaints presented with an enlarged, painless mass in the upper left eyelid. Physical examination of the mass suggested a vascular origin, and hemangioma diagnosis was confirmed by computed tomography and incisional biopsy. The anatomical location was determined as the pretarsal orbicularis oculi muscle involving mixed capillary-sized and cavernous-sized vessels. The treatment strategy involved monthly intralesional bleomycin injections (1 mL volume; 3 IU/mL) for 4 consecutive months resulting in notable size reversion. The patients experienced no associated complications, and the size remained stable over the 2-year follow-up period. CONCLUSIONS: Intralesional bleomycin injections may offer an effective and safe treatment option for intramuscular hemangioma in the periorbital region. However, larger studies are needed to substantiate these findings further.
ABSTRACT
Eales' disease is an idiopathic vasculitis that affects the peripheral retina. It is characterized by recurrent vitreous hemorrhage as a complication of retinal neovascularization. It is more prevalent in India and affects young males. Here, we present a patient with neovascular glaucoma as a rare first presentation of Eales' disease. This is a 24-year-old Indian male, who complained of a sudden decrease in vision in the left eye over less than 24 hours, along with frontal headache and eye pain for the last three weeks. Ocular examination revealed peripheral retinal ischemia in the right eye, very high intraocular pressure, rubeosis iridis, vitreous hemorrhage and extensive retinal ischemia in the left eye, vascular sheathing and neovascularization in both eyes. The purified protein derivative skin test was positive. The patient was managed with anti-glaucoma, intravitreal anti-vascular endothelial growth factor and laser photocoagulation. Systemic steroids and anti-tuberculous therapy were also initiated. Neovascular glaucoma is an infrequent complication of Eales' disease. However, the lack of early detection of the disease in the early stages might lead to such serious complications.
