[Dislocation of lens particles during cataract surgery]. / Przemieszczenie fragmentów soczewki podczas zabiegu usuwania zacmy.

BACKGROUND: The charts of 46 patients with dislocated lens particles during cataract surgery were reviewed. Forty patients had trans-pars plana vitrectomy; 5 were treated medically and one had retinal detachment repair only. MATERIAL AND METHODS: The following complications were associated with dislocated lens particles: uveitis 87%, glaucoma 66%, corneal edema 71%, retinal detachment 5%. RESULTS: The vision on the initial visit was 20/200 or worse in 85%. After vitrectomy the final vision was 20/40 or better in 58%. Visual acuity of 20/40 or better was obtained in 72% of patients who had surgery the same day; in 55% who had surgery later and in 64% with initial IOL placement. Insertion of an intraocular lens at the time of cataract surgery is not contraindicated. CONCLUSION: The best visual acuity occurred in patients who had vitrectomy the same day as cataract surgery. Small lens particles may be left in the eye. Trans-pars plana vitrectomy is a successful method of treatment of dislocated lens particles during cataract surgery.

Pure red cell aplasia in systemic lupus erythematosus.

Pure red cell aplasia (PRCA) is a rare hematologic disorder characterized by a severe progressive anemia and a marked decrease or absence of red cell precursors on bone marrow examination. PRCA can occur in the course of many other diseases of which thymoma is the most common. Rarely, PRCA has occurred in patients with connective tissue disorders, the most common being systemic lupus erythematosus (SLE), with 13 cases reported to date in the English literature. In this subset of patients, PRCA can be difficult to manage, and a high rate of mortality has been reported. Multiple therapeutic modalities have been reported, with no clear consensus on the optimal treatment. To date, splenectomy has not been reported in this subset of patients.We describe a patient with SLE who developed PRCA. Prednisone was the initial treatment, but unacceptably high doses were required to control the disease. Intravenous gamma globulin was given with prompt but temporary improvement. The patient subsequently underwent splenectomy with resolution of the PRCA. The patient continues to have a normal hemoglobin 3 years after splenectomy despite no interim therapy. This case represents the 14th case of PRCA occurring in patients with SLE and is the first case of PRCA in SLE treated with splenectomy. Splenectomy should be considered as a therapeutic modality in the management of corticosteroid-refractory PRCA occurring in patients with SLE.

Lymph node metastasis from carcinoma in situ of the penis: a case report.

Lymph node metastasis from carcinoma in situ of the penis is rare. We report a case of carcinoma in situ of the penis that was initially managed with circumcision and topical 5-fluorouracil. Subsequently inguinal and para-aortic lymph node metastasis developed, which was treated successfully with systemic chemotherapy and right inguinal lymph node dissection. The patient is free of disease 7 years after initial diagnosis and 3 years after the diagnosis of nodal metastasis.

Spontaneous resolution of hemorrhagic retinal pigment epithelial detachment.

Large hemorrhagic retinal pigment epithelial detachments (RPEDs) with presumed subretinal neovascularization (SRN) generally have a poor visual prognosis. We report the case of a 70-year-old woman who initially had a large serous hemorrhagic RPED associated with lipid exudation and juxtafoveal SRN. Without treatment, spontaneous resolution occurred with subsequent visual improvement.