Delayed Superficial Migration of Retained Hyaluronic Acid Years Following Periocular Injection.

Cosmetic injection of hyaluronic acid (HA) and other fillers is increasingly common, and the late complications of these relatively new procedures are now coming to medical attention. Three patients with delayed periocular swelling that began years after injection of HA are described, with CT, MRI, and histopathologic characterization. While HA fillers are marketed as having a temporary effect of several months, the authors demonstrate that they may persist in the body for up to 9 years. Unlike most previous reports, there was no inflammatory reaction or encapsulation, simply infiltration into more superficial subcutaneous layers. All cases improved after surgical biopsy and hyaluronidase injections. Delayed periocular swelling after filler injections from several years prior can mimic serious medical conditions. With a detailed history and high index of suspicion, one may avoid a costly and invasive workup.

Revisiting secondary capsulotomy for posterior capsule management in pediatric cataract surgery.

PURPOSE: To evaluate the development and treatment of visual axis opacification following pediatric cataract extraction with intraocular lens placement (IOL) without primary posterior capsulotomy and anterior vitrectomy (PPC+AV). METHODS: The medical records of children who underwent cataract extraction and IOL at an academic medical center were reviewed retrospectively for development of posterior capsular opacification (PCO) to identify risk factors for development of treatment-requiring posterior capsular opacification. RESULTS: A total of 63 eyes of 47 children 7 months to 16 years of age were included. The rate of PCO formation following cataract extraction without PPC+AV was 90%. Of those, 96% required a secondary capsular procedure to clear the visual axis; 55% had a clear visual axis after 1 procedure, almost exclusively with a YAG capsulotomy, and 3.5% did not require any secondary capsular procedure. Younger age was the only statistically significant characteristic associated with both PCO formation and need for more than one secondary capsular procedure. Children <3 years of age had an average of 2.1 capsular procedures. CONCLUSIONS: Cataract extraction and IOL without PPC+AV leads to an expected high rate of PCO formation, which can be effectively managed with a secondary capsular procedure in all age groups. Leaving the posterior capsule intact at primary surgery is an option to discuss with parents to avoid a more complicated primary surgery.

Intracranial pressure and glaucoma.

Our understanding of the potential role intracranial pressure (ICP) may play in the pathophysiology of glaucoma is evolving. ICP can have a profound effect on the optic nerve; edema of the optic disc is an accepted consequence of elevation in ICP, and optic disc blood flow is known to be affected by ICP. Deformation of the orbit also is a known consequence of aberrations in ICP. Therefore, it is plausible that local alterations in optic nerve structure, blood supply, or axonal transport could result from changes in ICP. This article will summarize the relationship between ICP and the eye, specifically focusing on hypothesized relationships between ICP and glaucoma and the current evidence supporting or refuting ICP as a risk factor for glaucoma.