ABSTRACT
PURPOSE: Descemet's membrane detachment (DMD) is a rare but potentially serious complication of cataract surgery. Although there are no consensual guidelines regarding the diagnosis or treatment of DMD, incorrect treatment may result in irreversible corneal changes with visual sequellae. The purpose of our study is to describe the diagnosis and treatment of DMD. METHODS: We report a series of 9 cases of DMD, their diagnosis, treatment and outcomes. We tested the HELP protocol retrospectively against our 9 real-life cases. RESULTS: Two cases recovered with simple medical management, 4 required air-bubble descemetopexy, and three required keratoplasty. Our study revealed that the main factor associated with poor outcomes is late diagnosis and management. CONCLUSION: Our series illustrates the importance of proactive management and timely diagnosis by performing anterior segment OCT in the setting of persistent postoperative corneal edema.
Subject(s)
Corneal Diseases/diagnosis , Corneal Diseases/etiology , Descemet Membrane/surgery , Phacoemulsification/adverse effects , Postoperative Complications/diagnosis , Aged , Aged, 80 and over , Corneal Edema/diagnosis , Corneal Edema/etiology , Corneal Injuries/diagnosis , Corneal Injuries/etiology , Descemet Membrane/injuries , Descemet Membrane/pathology , Female , Humans , Male , Middle Aged , Postoperative Complications/etiology , Retrospective Studies , Tomography, Optical CoherenceABSTRACT
PURPOSE: To evaluate the applicability of anterior segment optical coherence tomography (AS-OCT) for objective diagnosis of punctal stenosis. METHODS: We report the use of AS-OCT in 3 cases of epiphora related to punctal stenosis. We followed the methodology described in previous studies. The examination was performed by a single technician using a single Spectralis OCT with the AS-OCT module. Three patients with complaints of epiphora (mean age=80 years) were examined. The external punctal diameter was measured on both infrared (IR) and OCT images. The internal diameter was measured on OCT images at a depth of 500µm. The diagnosis was confirmed by clinical examination. RESULTS: The external punctal diameters were 159µm in the right eye (Cases 1 and 2) and 195µm in the left eye (case 2; mean: 171µm). All measurements were lower than cadaveric measurements (200-500µm), as well as previously described average diameters, thus confirming the diagnosis of punctal stenosis. The AS-OCT diameter correlated moderately with the punctal diameter estimate on the IR photos (mean: 183µm). In addition, the mean internal diameter of the punctum at 500µm (cases 1 and 2) was 58µm, which is consistent with the mean diameter at 500µm described in previous studies. Case 3 involved an 88-year-old man who complained of chronic epiphora. Slit lamp examination showed total punctal stenosis associated with cicatricial ectropion in the left eye due to a cutaneous tumor treated with radiotherapy. AS-OCT confirmed the presence of total punctual stenosis and the absence of associated canalicular stenosis. LIMITATIONS: Our study is obviously limited by its small study population. The decision to resort to surgery was made by 2 different surgeons. There was thus no homogeneity in terms of stenosis. There is difficulty in everting the lid without applying pressure to the globe or changing the punctal or canalicular morphology. This maneuver was difficult in the postoperative setting after ectropion repair. CONCLUSION: Our study shows that AS-OCT can be a rapid, non-invasive method in diagnosing punctal stenosis. Further studies are necessary to assess the use of AS-OCT in punctal stenosis.
Subject(s)
Anterior Eye Segment/diagnostic imaging , Lacrimal Duct Obstruction/diagnosis , Tomography, Optical Coherence/methods , Aged , Aged, 80 and over , Anterior Eye Segment/pathology , Constriction, Pathologic/diagnosis , Dacryocystorhinostomy/methods , Female , Humans , Lacrimal Apparatus Diseases/diagnosis , Lacrimal Apparatus Diseases/surgery , Lacrimal Duct Obstruction/pathology , Lacrimal Duct Obstruction/therapy , MaleABSTRACT
Introducción: se presenta una serie de 3 casos de síndrome de retracción iridiana (SRI) asociados a desprendimiento de retina regmatógeno (DRR) y desprendimiento coroideo. Objetivo: dar a conocer las características clínicas y tomográficas de tres pacientes con SRI asociado a desprendimiento de retina regmatógeno. Diseño del estudio: serie de casos. Resumen del caso: tres pacientes que presentaron DRR asociado a SRI. El tiempo de evolución promedio fue de 21 días (15-30 días), 2 de los 3 pacientes tuvieron resolución del SRI posterior al inicio de midriáticos y antes de ser intervenidos por el desprendimiento de retina, y 2 tuvieron presencia de proliferación vitreoretiniana (PVR) a pesar del corto tiempo de evolución. Adicionalmente estos 2 pacientes cursaron con desprendimientos coroideos. Todos los pacientes tuvieron un buen resultado estructural, AV menor o igual a 20/400, no redesprendimientos ni recurrencias de SRI durante el seguimiento. Conclusión: ante un paciente con SRI en el cual no sea posible valorar polo posterior, se debe tener en cuenta el diagnóstico de desprendimiento de retina regmatógeno. El SRI puede considerarse como un factor de mal pronóstico en pacientes con desprendimiento de retina regmatógeno.
Background: to report a 3 cases series of patients with iris retraction syndrome (IRS). Objective: introduce the clinical and tomographic features of tree patients with IRS following RRD. Study design: case series. Case summary: three patients presented IRS following RRD. They presented with an average evolution of 21 days (15 to 30 days), 2 patients had resolution of the IRS after mydriatics and before receiving surgical treatment for retinal detacthment, and 2 had vitreoretinal proliferation despite the short time. Besides, these 2 patients had choroidal detachments discovered in the operating room. All patients had good structural outcomes, visual acuity less or equal than 20/400, no re-detachment of the retina and no recurrence of IRS during follow up. Conclusion: the presence of a retinal detachment should be suspected in a patient with IRS in which it´s not possible to assess the posterior pole, and it should be considered a bad prognostic factor if present.
