ABSTRACT
A 91-year old man with a history of senile cataract and chronic lymphocytic leukemia (CLL), with a platelet count of 75,000/µL, presented for phacoemulsification and intraocular lens implantation in the left eye. A paracentesis made at the beginning of the procedure caused a small but not unusual amount of anterior chamber decompression. Spontaneous bleeding subsequently occurred from multiple sights on the iris surface. The bleeding was stopped by injecting hyaluronic acid into the anterior chamber to increase intraocular pressure. The remainder of the procedure was performed without complication, and resulting visual acuity improved from 20/70 preoperatively to 20/20(-2) with refraction 1 week postoperatively. In previously reported cases of intraocular bleeding during cataract surgery in thrombocytopenic patients, platelet counts were all ≤55,000/µL.
Subject(s)
Anterior Chamber/diagnostic imaging , Blood Loss, Surgical , Cataract/complications , Phacoemulsification/adverse effects , Thrombocytopenia/complications , Aged, 80 and over , Humans , Male , Thrombocytopenia/bloodABSTRACT
PURPOSE: To report sight-threatening complications following extensive bulbar conjunctival resection and postoperative mitomycin C therapy for cosmetic eye-whitening in the United States. DESIGN: Retrospective noncomparative case series. METHODS: Multicenter report of 9 patients referred for evaluation and management of complications following bilateral cosmetic eye whitening. RESULTS: Seventeen eyes of 9 patients underwent cosmetic eye-whitening performed between 2 and 48 months prior to referral to one of the centers. Sixteen of the 17 eyes had persistent conjunctival epithelial defects, with 10 eyes requiring amniotic membrane grafting to facilitate re-epithelialization. Four eyes of 2 patients developed limbal stem cell compromise confirmed with in vivo confocal laser scanning microscopy. One patient developed infectious scleritis and diplopia resulting from Tenon capsule scarring. Another patient developed scleral necrosis, secondary infectious scleritis, and infectious endophthalmitis. This patient subsequently developed noninfectious scleritis that required 3-drug-regimen immunosuppression. CONCLUSION: Severe adverse effects can occur after extensive cosmetic conjunctival resection followed by topical mitomycin C application. Patients and physicians should be aware of the potential sight-threatening complications associated with this eye-whitening procedure.
Subject(s)
Conjunctiva/surgery , Cosmetic Techniques/adverse effects , Mitomycin/adverse effects , Ophthalmologic Surgical Procedures/adverse effects , Postoperative Complications , Adult , Alkylating Agents/adverse effects , Conjunctiva/drug effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , Retrospective StudiesABSTRACT
A technique for removal of retained lens material is described with a three-port 23-gauge vitrectomy system. Removal of the core vitreous is first performed, followed by removal of the cortical vitreous. All vitreous adhesions to the lens are cleared. The cut rate is then decreased to 1,500 cuts per minute, and vacuum increased to 600 mm Hg. The cortical lens material is cleared first, and then the nuclear material is taken with the same vitrectomy probe using the light pipe to assist in crushing the nuclear fragments. With this technique, even large dense nuclear and cortical retained lens material can be removed from the vitreous chamber without the need for a fragmatome.
