ABSTRACT
Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.
Subject(s)
Macular Edema , Scleroderma, Systemic , Humans , Macular Edema/etiology , Scleroderma, Systemic/complications , Female , Middle Aged , Tomography, Optical Coherence , Fluorescein AngiographyABSTRACT
PURPOSE: To determine the pathophysiology and to discuss possible solutions for tube obstruction since this is a frequent complication in glaucoma drainage device surgery. MATERIAL AND METHODS: 81 eyes with a glaucoma drainage device (GDD) fitted by our Department during the last twelve years (1991-2002) were retrospectively reviewed and eleven cases of tube obstruction were detected. The treatments included Nd-Yag laser, anterior vitrectomy, blood clot removal and intracamerular rTPA. RESULTS: The obstruction was proximal in ten cases and distal in one. Of the former, the obstruction was caused by a blood clot in six cases, by vitreous in three cases and by a fibrinous membrane in one case. The nature of the distal obstruction was not determined. One case of vitreous obstruction occurred after a posterior capsulotomy with Nd-Yag laser two years after positioning the GDD. Complete success was achieved in five cases, and partial success in three where antiglaucoma therapy had to be maintained postoperatively. Complete failure was found in the other three cases. CONCLUSIONS: The material which most frequently caused the tube obstruction was blood and although in some cases this may resolve spontaneously, clot removal with forceps or rTPA intracameral injection may be helpful. In vitreous obstruction, Nd-Yag laser may temporariril clear the tube, but extensive anterior vitrectomy is required to maintain long-term permeability. We suggest carrying out a small posterior capsulotomy in pseudophakic patients with a GDD.
Subject(s)
Glaucoma Drainage Implants , Prosthesis Failure , Aged , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Propósito: Determinar la patofisiología y presentar posibles soluciones a la obstrucción del tubo de los dispositivos de drenaje para glaucoma (DDG), ya que es una complicación frecuente en esta cirugía. Material y métodos: Se realizó una revisión retrospectiva de 81 ojos a los que se les había implantado un DDG durante un período de doce años (1991-2002) y se identificaron once casos de obstrucción del tubo. Los tratamientos empleados fueron: lavado de cámara anterior con extracción de coágulo, rTPA intracamerular, vitreolísis con láser Nd-Yag y vitrectomía anterior. Resultados: En diez casos la obstrucción fue proximal, debida a coágulos de sangre en seis ojos, vítreo en tres ojos y una membrana de fibrina en un ojo. En un caso la obstrucción fue distal, no pudiéndose identificar la causa. Un caso de obstrucción por vítreo se produjo tras realizar una capsulotomía posterior con láser Nd-Yag, dos años después de la colocación del DDG. Obtuvimos éxito en cinco casos, en tres éxito parcial que requirió mantener el tratamiento antiglaucomatoso. En tres casos el resultado fue fracaso. Conclusiones: La causa más frecuente de obstrucción del tubo fue sangre y aunque se puede resolver espontáneamente, la inyección de rTPA intracameral o el lavado de cámara anterior con extracción del coágulo son tratamientos eficaces. En la obstrucción por vítreo, una vitrectomía anterior amplia es más eficaz que la vitreolisis con láser Yag. Es recomendable realizar una capsulotomía posterior pequeña en pacientes pseudofáquicos con un DDG(AU)
Purpose: To determine the pathophysiology and to discuss possible solutions for tube obstruction since this is a frequent complication in glaucoma drainage device surgery. Material and Methods: 81 eyes with a glaucoma drainage device (GDD) fitted by our Department during the last twelve years (1991-2002) were retrospectively reviewed and eleven cases of tube obstruction were detected. The treatments included Nd-Yag laser, anterior vitrectomy, blood clot removal and intracamerular rTPA. Results: The obstruction was proximal in ten cases and distal in one. Of the former, the obstruction was caused by a blood clot in six cases, by vitreous in three cases and by a fibrinous membrane in one case. The nature of the distal obstruction was not determined. One case of vitreous obstruction occurred after a posterior capsulotomy with Nd-Yag laser two years after positioning the GDD. Complete success was achieved in five cases, and partial success in three where antiglaucoma therapy had to be maintained postoperatively. Complete failure was found in the other three cases. Conclusions: The material which most frequently caused the tube obstruction was blood and although in some cases this may resolve spontaneously, clot removal with forceps or rTPA intracameral injection may be hepful. In vitreous obstruction, Nd-Yag laser may temporariril clear the tube, but extensive anterior vitrectomy is required to maintain long-term permeability. We suggest carrying out a small posterior capsulotomy in pseudophakic patients with a GDD(AU)
