ABSTRACT
We present the case of a 68-year-old female who presented with a substantial cyclodialysis after phacoemulsification identified by anterior segment optical coherence tomography and ultrasound biomicroscopy. Gonioscopy is challenging because of its shallow anterior chamber. Due to lack of response to topical steroids and refusal by the patient for surgical treatment, topical steroids were tapered, and cycloplegic was initiated. After two weeks, the cyclodialysis cleft was closed on optical coherence tomography persisting residual subchoroidal fluid, topical treatment was mantained. Despite of this, visual acuity and hypotony were restored. Finally at 2 months visit subchoroidal fluid was reabsorbed and patient was discharged. Clinics should consider the possibility of cyclodialysis in cases of unjustified hypotony during postoperative period. In addition, we recommend performing anterior segment imaging which includes ultrasound biomicroscopy and optical coherence tomography, when the evaluation of angular structures is unfeasible. Finally, we propose medical management for severe cyclodialysis as the first option considering anti-inflammatory drugs could perpetrate the separation between scleral spur and ciliary muscle.
Subject(s)
Angiography , Early Diagnosis , Susac Syndrome/diagnostic imaging , Tomography, Optical Coherence , Adrenal Cortex Hormones/administration & dosage , Adult , Diagnosis, Differential , Female , Hearing Loss/etiology , Humans , Susac Syndrome/drug therapy , Susac Syndrome/pathology , Tinnitus/etiologyABSTRACT
The chronic fluid misdirection syndrome of aqueous humor is a rare and serious condition if not treated promptly. The case is presented of a woman attending the emergency department with an intraocular pressure of 43.00mmHg and shallow anterior chamber in her left eye. As clinical history of interest, she had cataract surgery in that eye several weeks before. Following the suspicion of malignant glaucoma, a capsulotomy and iridotomy were performed with an unfavourable outcome. For this reason, it was decided to perform a central vitrectomy, but the patient did not respond to this surgical treatment either. A second surgery was then performed with peripheral vitrectomy, anterior hyaloidectomy, zonulectomy, and iridectomy, obtaining good results. Finally, a decrease in intraocular pressure, and an opening of camerular angle were achieved. Thus, if malignant glaucoma is not resolved in medical consultation with iridotomy and capsulotomy, a vitrectomy, creating a unique chamber that restores the fluid mechanics of the aqueous humor, will be needed.
Subject(s)
Aqueous Humor , Phacoemulsification , Postoperative Complications , Aged, 80 and over , Chronic Disease , Female , Humans , Postoperative Complications/diagnosis , Postoperative Complications/surgery , SyndromeABSTRACT
Diabetic retinopathy (DR) is considered the most common cause of blindness in the working-age population in industrialised countries, with diabetic macular oedema being the most common reason of decreased visual acuity in diabetics. According to the results of large multicentre studies, blindness prevention for RD involves conducting periodic check-ups, which include examinations of the back of the eye, so they can be treated in time. The use of non-mydriatic cameras and telemedicine have been shown to be useful in this regard (sensitivity>80% and specificity>90%). If this procedure is followed, the first retinography should be performed 5 years from diagnosis in type 1 diabetics and immediately after diagnosis in type 2 diabetics. Therefore the role of the Primary Care physician is crucial to enable early diagnosis of this disease.
