"Double scleral tunnel in tandem" technique for glaucoma drainage tube implants.

PURPOSE: To describe a new technique of Ahmed glaucoma valve implantation in patients with refractory glaucoma and present the long-term results. METHODS: Twenty-eight eyes of 28 patients with refractory glaucoma participated in the study. "Double scleral tunnel in tandem" technique was used for glaucoma valve implantation in all patients. The technique consists of the formation of two scleral tunnels in tandem so as to completely cover the extraocular part of valve's tube and facilitate a parallel to the iris placement of the intraocular part of the tube. RESULTS: Postoperative hypotony developed in two (7.1%) cases which resolved within 3 days in all cases. One (3.6%) eye manifested postoperative hyphema that resolved without complications within a week, and two (7.1%) cases presented with exposure of the tube. The average highest postoperative intraocular pressure (IOP) during the follow-up period was 19 mmHg (range 8-38 mmHg) without medications, and the average IOP at the last follow-up visit was 14.5 mmHg (range 8-22 mmHg). Additional treatment for IOP control was necessary in 11 (39.3%) cases. The average follow-up period was 60 months. CONCLUSION: This novel technique was found to be easy to master, effective and with low cost and rate of complications.

Postoperative eccentric macular holes after vitrectomy and internal limiting membrane peeling.

The purpose of this study was to describe the incidence, clinical characteristics, and outcome of eccentric macular holes presenting after vitrectomy and internal limiting membrane (ILM) peeling for the treatment of macular pathology and discuss the pathogenesis of holes formation. A retrospective, noncomparative, interventional case-series study of five patients who developed eccentric macular holes postoperatively following vitrectomy in 198 consecutive patients who underwent ILM peeling for idiopathic macular hole and epiretinal membrane formation between 2008 and 2015. Five patients (2.5 %) developed full-thickness eccentric macular holes postoperatively. Three patients presented with a single eccentric macular hole, one patient had an eccentric hole after a failed idiopathic macular hole surgery and one patient developed four eccentric macular holes. The mean diameter of the holes was 584 µm (range 206-1317 µm) and the average time of holes formation after vitrectomy was 27.7 weeks (range 1-140 weeks). Postoperative best-corrected visual acuity ranged from "counting fingers" to 20/25. The eyes with the holes distant from the fovea had the best final visual acuity. No further intervention was attempted and no complications occurred. The mean follow-up time was 26.8 months. The postoperative macular holes after vitrectomy and ILM peeling were variable in number, size, and time of appearance but remained stable and were not associated with any complications. The pathogenesis of macular holes is most consistent with contraction of the residual ILM or secondary epimacular proliferation probably stimulated by ILM peeling.

PREVALENCE OF THE COMPLEMENT FACTOR H AND GSTM1 GENES POLYMORPHISMS IN PATIENTS WITH CENTRAL SEROUS CHORIORETINOPATHY.

PURPOSE: The purpose of our study was to investigate the potential association between the complement factor H (CFH) (rs3753394, rs800292, rs2284664, rs1329428, and rs1065489) and GSTM1 gene polymorphisms, and central serous chorioretinopathy (CSCR) susceptibility in a well-defined Greek cohort. METHODS: We enrolled a case-control study in a Greek population with 41 cases and 78 controls. Five milliliters of peripheral blood was collected from each participant, and DNA was extracted using the PureLink Genomic DNA kit. The CFH (rs3753394, rs800292, rs2284664, rs1329428, and rs1065489) single nucleotide polymorphisms and GSTM1 polymorphism were tested using polymerase chain reaction assays. RESULTS: Between CSCR (n = 41) cases and controls (n = 78), the TT rs3753394, GG rs1329428, and TT rs1065489 genotypes' frequencies of the CFH gene were found to be significantly associated with risk of CSCR. The genotype frequency of the CFH rs2284664, rs800292, and of the GSTM1 gene polymorphisms was not found to be significantly associated with CSCR. CONCLUSION: Our results demonstrated a significant association between CSCR and single nucleotide polymorphisms in the CFH gene (rs3753394, rs1329428, and rs1065489), suggesting that disturbances in choroidal vasculature, through intercorrelation with adrenomedullin, play a significant role in CSCR pathogenesis.

Generalized seizures and transient contralateral hemiparesis following retrobulbar anesthesia: a case report.

BACKGROUND: Retrobulbar block is a local anesthetic technique widely used for intraocular surgery. Although retrobulbar anesthesia is considered to be relatively safe, a number of serious adverse events have been reported. To our knowledge, immediate onset of generalized seizures with contralateral hemiparesis after retrobulbar anesthesia has not been reported. CASE PRESENTATION: A 62-year-old Caucasian healthy male with a right eye retinal detachment was admitted for pars plana vitrectomy. During retrobulbar anesthesia with ropivacaine and before needle withdrawal, the patient developed twitching of the face which rapidly progressed to generalized tonic-clonic seizures. Arterial oxygen saturation decreased to 75 %. Chin lift was performed and 100 % oxygen was administrated via face mask, which increased saturation to 99 %. Midazolam 2 mg was administrated intravenously to control seizures. After cessation of seizures, left-sided hemiparesis was evident. Brain computed tomography and electroencephalogram were normal 3 h later. The patient underwent pars plana vitrectomy under general anesthesia 4 days later. CONCLUSION: Serious complications of local anesthesia for ophthalmic surgery are uncommon. We present a case in which generalized tonic-clonic seizures developed during retrobulbar anesthesia, followed by transient contralateral hemiparesis. The early onset of seizures indicated intra-arterial injection of the anesthetic. Our case suggested the need for close monitoring during the performance of retrobulbar anesthesia and the presence of well-trained personnel for early recognition and immediate management of the complications.

Intravitreal cilium associated with retinal detachment 40 years following penetrating eye injury: a case report.

BACKGROUND: The presence of an intraocular cilium is very rare and the response of the eye to the cilium is variable. We present the case of a patient with a cilium found in the vitreous cavity during vitrectomy for rhegmatogenous retinal detachment 40 years following penetrating eye injury. To our knowledge, this is the longest reported presence of a cilium in the vitreous cavity. CASE PRESENTATION: A 70-year-old Caucasian woman presented to the emergency department of our hospital complaining of sudden visual impairment and floaters of her right eye initiated 2 weeks earlier. Ophthalmic history included a penetrating injury of the right eye with a sharp metallic object 40 years ago and an uncomplicated phacoemulsification surgery in the same eye 2 years earlier. Fundoscopy revealed an inferior macula off rhegmatogenous retinal detachment. No inflammation was present. During vitrectomy and under scleral indentation at 5-o'clock position, a cilium was found at far retinal periphery. One end of the cilium was embedded in the retina, whereas the other end floated freely in the vitreous. The cilium was removed through the pars plana sclerotomy with intraocular foreign body forceps. The procedure was completed without any complications. CONCLUSION: Penetrating eye injury is the most possible cause of cilium entrance in vitreous cavity in this case, which suggests that cilium can be well tolerated in vitreous cavity for as long as 40 years.