Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber.

AIM AND OBJECTIVE: To report an unusual and difficult case of malignant glaucoma induced by a traumatic mature cataract that had migrated into the anterior chamber in a developmentally delayed patient. BACKGROUND: Malignant glaucoma can present due to multiple mechanisms, including trauma-induced cataract migration into the anterior chamber. CASE DESCRIPTION: A developmentally delayed female in her 40s with a history of self-abuse was found to have malignant glaucoma in the setting of a traumatic cataract that had migrated in front of the iris into the anterior chamber. Exam under anesthesia and ultrasound biomicroscopy (UBM) demonstrated complete subluxation of the lens into the anterior chamber. Perioperative techniques included prophylactic pars plana vitrectomy to alleviate posterior pressure as well as the creation of an irido-zonulo-hyaloido-vitrectomy (IZHV), which allowed for reformation of the anterior chamber. These maneuvers allowed for cataract surgery to be performed through a clear corneal incision, with anterior chamber intraocular lens implantation. The patient had improved vision, pressure, and pain. CONCLUSION: Malignant glaucoma can present in unique ways and the presence of a flat anterior chamber and increased posterior pressure can make surgery challenging. Initial pars plana vitrectomy in addition to the creation of an IZHV can help relieve posterior pressure and facilitate cataract extraction. It is important to factor in patient-specific situations and goals while selecting an intraocular lens. CLINICAL SIGNIFICANCE: Traumatic cataracts and malignant glaucoma can present in unique scenarios that may prove difficult to treat. Certain techniques can facilitate these challenging surgeries and provide the optimal outcome for patients. HOW TO CITE THIS ARTICLE: Sarrafpour S, Davies I, Ahmed O, et al. Cataract Surgery in Malignant Glaucoma from Complete Subluxation of Lens into Anterior Chamber. J Curr Glaucoma Pract 2021;15(3):164-167.

Gray Optic Disc Crescent: Evaluation of Anatomic Correlate by Spectral-Domain OCT.

PURPOSE: To test the hypothesis that the anatomic correlate of the gray optic disc crescent is pigmentation of externally oblique border tissue of Elschnig. DESIGN: Retrospective study. PARTICIPANTS: African-American adult men with or without clinically apparent gray optic disc crescents. METHODS: McNemar's test for paired data and kappa statistic with 95% confidence intervals were used to examine the relationships between eyes with or without gray optic disc crescents and corresponding spectral-domain (SD) OCT images with enhanced depth imaging (EDI). MAIN OUTCOME MEASURES: Correlation between clinical gray optic disc crescents and hyperreflectivity of externally oblique border tissue of Elschnig by SD OCT with EDI. RESULTS: Twenty-five eyes had clinically apparent gray optic disc crescents, of which SD OCT with EDI revealed hyperreflectivity (interpreted as increased pigmentation) of externally oblique (obtuse angle) border tissue of Elschnig in 22 eyes, that is, extending into Bruch's membrane opening and presumably visible by funduscopy. Thirty-two eyes from matched participants had no apparent gray optic disc crescent, of which SD OCT with EDI revealed hyperreflectivity of the border tissue of Elschnig in 23 eyes, but with a nonoblique (right angle) or internal (acute angle) angle, which would presumably obstruct funduscopic visualization. CONCLUSIONS: Observations by SD OCT with EDI suggest that the anatomic correlate of the gray optic disc crescent is pigmentation of externally oblique border tissue of Elschnig.

Aids for eye drop administration.

One aspect to eye drop adherence is successful instillation of the drops; however, it is well known that many patients struggle with this task. Difficulties may include aiming their drops, extending their neck, preventing excess drop leakage, avoiding contamination of the bottle tip, and generating enough force to expel a drop from the bottle. Instillation aids are devices that aim to ameliorate one or more of these barriers. We review the literature on instillation aids to describe the options available to patients and to report evaluations of their efficacy. Most instillation aids studied improved objective or subjective outcomes of eye drop instillation, including improved rates of successful administration and increased patient satisfaction compared with standard eye-drop bottles. Although further research is warranted, instillation aids may be an underutilized resource for the many patients who struggle to administer their own eye drops.

An upright eyedrop bottle: accuracy, usage of excess drops, and contamination compared to a conventional bottle.

PURPOSE: This study tested the feasibility of using an upright eyedrop bottle (UEB), a device designed to assist patients with eyedrop placement without reclining their head. PATIENTS AND METHODS: Experienced eyedrop users were enrolled who answered "yes" to the question, "Do you ever have trouble getting your eyedrops in?" After being shown a multimedia presentation and answering a questionnaire regarding eyedrop usage, participants were observed instilling eyedrops. Participants were instructed to instill a single eyedrop in each eye with both a standard bottle and the UEB. They repeated this process three times. With each trial, the amount of time taken to instill drops was recorded, as well as whether a drop landed in the eye (accuracy), if excess drops were used, and if the bottle tip was contaminated. RESULTS: Forty participants were enrolled, with an average age of 72.4±8.9 years; the majority were females (24 females). Thirty-four participants had been using eyedrops for at least 1 year. The time required to instill eyedrops was significantly less with the UEB in the second and third trials. There was no difference in accuracy between the conventional bottle and the UEB in the left or right eye in any trials. Significantly more participants used excess number of drops while using the conventional bottle in both the left and right eyes in all three trials. The bottle tip was never contaminated with the UEB. Depending on the trial and the eye, the conventional bottle was contaminated by between 42% and 53% of participants. CONCLUSION: The UEB has the potential to assist patients with eyedrop placement. Although there was no difference in accuracy between the UEB and the conventional bottle, the UEB was associated with less use of excess drops and less contamination of the bottle tip, compared to the conventional bottle.