ABSTRACT
CASE DESCRIPTION: We present a case of a 65-year-old patient who underwent heart transplantation. After the surgery, left proptosis, conjunctival chemosis, and ipsilateral palpebral ecchymosis were found while he was still intubated. A retrobulbar hematoma was suspected, confirmed by a computed tomography scan. Initially, expectant management was considered, but with the appearance of an afferent pupillary defect, the patient underwent orbital decompression and posterior collection drainage, which prevented visual impairment. CONCLUSION AND IMPORTANCE: Spontaneous retrobulbar hematoma after heart transplantation is a rare condition that risks vision. We intend to discuss the importance of postoperative ophthalmologic examination after heart transplantation in intubated patients for early diagnosis and rapid treatment. Spontaneous retrobulbar hematoma (SRH) after heart transplantation is an exceptional condition that risks vision. Bleeding in the retrobulbar space provokes an anterior ocular displacement, extending the vessels and the optic nerve, which can generate ischemic neuropathy and, finally, a loss of vision [1]. A retrobulbar hematoma is usually associated with trauma or eye surgery. Though, in non-traumatic cases, the underlying cause is not evident. An adequate ophthalmologic examination is usually not performed in complex surgeries like heart transplantation. However, this simple measure can prevent permanent vision loss. Non-traumatic risk factors should also be considered, which include vascular malformations, bleeding disorders, use of anticoagulants, and increased central venous pressure usually triggered by a Valsalva maneuver [2]. The clinical presentation of SRH consists of ocular pain, decreased visual acuity, conjunctival chemosis, proptosis, abnormal extraocular movements, and elevated intraocular pressure (IOP). Its diagnosis is often clinical; however, it can be confirmed with computed tomography or magnetic resonance imaging. Treatment aims to reduce IOP with surgical decompression or pharmacologic measures [2]. In the reviewed literature, less than 5 spontaneous ocular hemorrhages related to cardiac surgery have been reported [3-6], of which only one is related to heart transplantation [3]. A clinical challenge of an SRH after heart transplantation is presented below. Surgical management was performed with a favorable result.
Subject(s)
Exophthalmos , Heart Transplantation , Retrobulbar Hemorrhage , Male , Humans , Aged , Retrobulbar Hemorrhage/diagnostic imaging , Retrobulbar Hemorrhage/etiology , Orbit/injuries , Orbit/surgery , Exophthalmos/complications , Hematoma/diagnostic imaging , Hematoma/etiology , Hematoma/therapy , Heart Transplantation/adverse effectsABSTRACT
RESUMEN Se estudió la biología reproductiva del Bocachico, Prochilodus magdalenae, en el río San Jorge, Colombia. La especie es un pez con proporción sexual hembra: macho de 1,2:1, diferente a lo esperado. Presenta desarrollo ovocitario sincrónico en dos grupos, un desove anual que se extiende de abril a septiembre asociado al ciclo hidrológico del río San Jorge, talla media de madurez sexual estimada en 30,2 cm LT, ovocitos grandes de 950 μm y fecundidad promedio de 109 972 ovocitos, cuya ecuación fue F =7271,6 WO0,60, r =0,93, n =14.
ABSTRACT The reproductive biology of the Bocachico, Prochilodus magdalenae, in the San Jorge River, Colombia, was studied. The species is a fish with sexual proportion female: male of 1.2:1, different than expected. It presents synchronous ovocitary development in two groups, an annual spawning that extends from April to September associated to the hydrological cycle of the San Jorge River, length at first maturity estimated in 30.2 cm TL, large oocytes of 950 μm, and average fecundity of 109 972 oocytes, whose equation was F = 7271,6 OW0,60, r = 0,93, n = 14.
ABSTRACT
PURPOSE: To evaluate the clinical outcomes of an accommodating dual-optic intraocular lens (IOL). SETTING: Private practice and university centers. METHODS: A prospective noncomparative case series with retrospective control comprised 21 patients (26 eyes) scheduled for small-incision extracapsular cataract extraction by phacoemulsification with implantation of the Synchrony dual-optic accommodating IOL (Visiogen) (accommodating IOL group) and 10 patients who had small-incision extracapsular phacoemulsification with implantation of a monofocal, single-optic IOL at least 6 months previously (control group). Patients were examined 1, 3, 6, and 12 months after surgery. Defocus curves in the accommodating IOL group were compared with those in the control group. The main outcome measures were postoperative distance uncorrected and best corrected visual acuity; near uncorrected, distance corrected, and near corrected visual acuity; and accommodative range based on defocus curves. RESULTS: Twenty-four eyes were available at the 6-month follow-up visit. All eyes had best corrected distance visual acuity of 20/40 or better, and 19 eyes (79%) had an uncorrected distance visual acuity of 20/40 or better. Uncorrected near visual acuity was 20/40 or better in all eyes. With distance correction, 23 eyes (96%) had an acuity of 20/40 or better at near. Defocus curve analysis suggested a mean accommodative range of 3.22 diopters (D) +/- 0.88 (SD) (range 1.00 to 5.00 D) in the accommodating IOL group and 1.65 +/- 0.58 D in the control group (range 1.00 to 2.50 D) (P<.05). CONCLUSION: The Synchrony dual-optic IOL shows promise as an option to provide accommodative function in pseudophakic patients.
