Massive intraocular hemorrhage, presumably from the central retinal artery after cataract surgery, and difficult hemostasis during vitrectomy: a case report.

BACKGROUND: Severe intraocular hemorrhage is a rare complication of cataract surgery due to the recent generalization of minimal-incision cataract surgery. We report a case of a massive intraocular hemorrhage that probably originated from the central retinal artery after cataract surgery, in which hemostasis was difficult to achieve during vitrectomy. CASE PRESENTATION: An 86-year-old woman was referred to our department for intraocular lens (IOL) dislocation after undergoing cataract surgery. Massive intraocular hemorrhage was observed during the initial visit to our department. She underwent pars plana vitrectomy (PPV) and IOL repositioning under local anesthesia. However, the hemorrhage could not be removed completely because of continued massive intraoperative bleeding from the posterior fundus, and it was extremely difficult to achieve hemostasis during the initial surgery. At 7 days after the initial surgery, PPVs were performed under general anesthesia. Bleeding significantly decreased in the second surgery compared to the first. The bleeding probably originated from the central retinal artery on the optic disc; hemostasis was obtained by coagulation of the bleeding site with intraocular diathermy. After the second surgery, there was no exacerbation of bleeding and the patient's condition was stable. However, the patient's visual acuity showed no light perception after the second surgery. CONCLUSIONS: Massive intraocular hemorrhage may occur from the central retinal artery after undergoing cataract surgery. In such cases, surgery with general anesthesia with a lower maintained blood pressure (instead of surgery under local anesthesia) should be recommended, considering the possibility of difficult hemostasis in the event of bleeding from the retinal artery.

Intraocular endoscopy for the evaluation and treatment of hypotony due to a traumatic cyclodialysis: a case report.

BACKGROUND: A cyclodialysis cleft often leads to direct communication between the anterior chamber and the suprachoroidal space. It is a rare condition that is encountered with blunt trauma, and less commonly, after surgery. Hypotony is the major sequelae that may lead to hypotonous maculopathy, optic disc edema, corneal folds, and astigmatism. These may cumulatively lead to visual loss. We describe how endoscopy in a cyclodialysis repair allowed us to accurately locate the cleft and guided its appropriate management avoiding unnecessary cryopexy. CASE PRESENTATION: A 41-year-old male experienced a traumatic cyclodialysis cleft, which resulted in persistent hypotony. Pars plana vitrectomy was performed to treat vitreous hemorrhage. Scleral indentation was attempted to visualize the cyclodialysis cleft. However, the depression distorted the visualization. Intraocular endoscopy was therefore used to evaluate the cleft. Guided by this assessment, only intraocular gas tamponade was used to reposition the ciliary body. The patient's intraocular pressure was restored to 13 mmHg 3 days after the operation, and OCT confirmed cleft closure 1 month after the operation. CONCLUSION: Endoscopy-assisted repair of cyclodialysis is an approach that enhances visualization and can guard against common causes of persistent cleft and hypotony, as well as reveal the causes of recurrent failure. Hence, it can eliminate unnecessary cryopexy that might worsen the hypotonous state. In our case, intraocular endoscopy was effective for the evaluation of a cyclodialysis cleft and the subsequent selection of an appropriate management technique, gas tamponade, that was more conservative than other approaches initially considered.

[Bilateral eye injuries by external transversal force]. / Bilaterale Augenverletzung durch transversale Gewalteinwirkung.

A 49-year-old female victim of violent crime with an acute bilateral loss of vision was referred to our hospital. The ophthalmological evaluation showed complete subconjunctival hemorrhage of both eyes, bilateral hemophthalmos and hypotonia of the left eye. These raised the suspicion of an occult scleral rupture. We immediately performed exploratory surgery and found a perforating scleral lesion of the left eye and a penetrating scleral lesion of the right eye. Furthermore, a small, cruciform wound was detected on the left temple. In cooperation with the department of radiology, the extraordinary injury pattern was reconstructed: a horizontal stab wound with perforation of the left eye and penetration of the right eye caused by a screwdriver. Visual rehabilitation necessitated further surgical interventions. Besides the intraoperative approach, immediate primary wound management within 100 h of trauma plays a pivotal role for long-term outcome.

Surgical Drainage of Lymphangiectasia Haemorrhagica Conjunctivae.

PURPOSE: To report a case of nonresolving lymphangiectasia haemorrhagica conjunctivae (LHC) successfully treated with surgical drainage. METHODS: Retrospective case report. RESULTS: A 17-year-old white girl presented with a history of a large red lesion affecting her right eye. Approximately 1 year earlier, she had noticed a small painless "red spot" affecting the inferior aspect of the conjunctiva of her right eye. Three months before presentation, she noticed a sudden increase in the size of the lesion. There was no history of trauma, and she was not a contact lens wearer. Her medical history was remarkable for a remote seizure disorder which had been stable on levetiracetam. Magnetic resonance imaging/magnetic resonance angiography of the brain and orbits was unremarkable. Anterior segment fluorescein angiography did not show any flow in the lesion, indicating a lymphatic origin of channels. Surgical drainage of the lesion was performed while sparing the affected conjunctiva resulting in an excellent cosmetic outcome. Incisional biopsy confirmed the diagnosis of LHC. The patient remained free of recurrence 6 months after the procedure. CONCLUSIONS: Nonresolving LHC can be managed successfully with conjunctival sparing surgical drainage with an excellent cosmetic outcome.

Management of traumatic haemorrhage in the Berger's space of a 4-year-old child.

We are reporting an unusual case of haemorrhage in the Berger's space after an episode of blunt ocular trauma in an eye of a 4-year-old boy, who enjoyed premorbid normal vision. A secondary posterior subcapsular cataract developed as a complication of the haemorrhage after 6 months of observation. Surgery comprised cataract extraction, removal of a residual retrolenticular haematoma via opening of posterior continuous curvilinear capsulorhexis (CCC), anterior vitrectomy and placement of an intraocular lens. This yielded a reasonable visual outcome. Complete spontaneous resolution of haemorrhage in the Berger's space is unlikely and may cause secondary cataracts in children. We suggest early intervention in such conditions in order to prevent the development of amblyopia.

Correlation Between Recurrent Subconjunctival Hemorrhages and Conjunctivochalasis by Clinical Profile and Successful Surgical Outcome.

OBJECTIVE: To characterize the clinical profile of patients with recurrent subconjunctival hemorrhages (SCHs) and evaluate the effect of conjunctivochalasis (CCh) surgery on disease recurrences. METHODS: Three hundred and sixty-two patients with SCHs (mean age, 56.4±16.0 years) were enrolled in this multicenter epidemiologic study. The severity of CCh, lifestyle at the time of SCH onset, and the frequency of previous SCHs were compared. Thirty-eight patients with 2 or more episodes of SCHs (mean age, 68.2±8.9 years) underwent surgery for CCh. The effectiveness of surgery was evaluated by comparing the frequency of SCH preoperatively and postoperatively. RESULTS: Patients with three or more recurrent SCHs showed a significantly (P=0.003) higher grade of CCh and tended to be engaged in activities that require visual concentration, such as watching a visual display terminal, knitting, reading, and driving. More than 80% of eyes that underwent surgery to CCh showed no recurrence of the hemorrhages, and the frequency of SCH significantly (P<0.0001) decreased postoperatively. CONCLUSIONS: Moderate or severe CCh and activities that may cause dry eye can be considered to be risk factors for recurrent SCHs. Surgery to treat CCh is a useful option for patients with frequent recurrences of SCHs.

An epibulbar chocolate cyst: a rare complication of silicone-based scleral buckle.

A patient with a history of vitreoretinal surgery presented with nasal dystopia, diplopia and epibulbar bluish black mass simulating a chocolate cyst in the right eye. After a non-conclusive ocular examination, he underwent CT of the orbit along with volume rendition and three-dimensional reconstruction, which demonstrated intact globe with laterally displaced band-buckle assembly along with peri-scleral buckle element (SBE) soft tissue proliferation. Imaging-assisted exploration of the lesion was performed and retained scleral buckle element (SBE) was removed in toto; thus relieving the patient long-standing dystopia.

Hemorrhagic descemet membrane detachment after classic canaloplasty.

PURPOSE: Canaloplasty is a safe and effective alternative in glaucoma surgery, avoiding the risk for hypotony and bleb-related complications. Two cases of hemorrhagic Descemet membrane detachment (DMD) after canaloplasty are reported in patients who did not have previous surgery. RESULTS: Two patients with primary open-angle glaucoma underwent canaloplasty because of medically uncontrolled intraocular pressure (IOP). Canaloplasty was performed using a flexible microcatheter, viscoelastic material and a tensioning suture. The day after surgery, hemorrhagic DMD was observed in the inferior quadrants in both patients on slit-lamp biomicroscopy. THERAPY: For the size and location (occlusion of the visual axis), aspiration of blood and descemetopexy with air tamponade were performed promptly. In both cases, a small translucent scar remained. CONCLUSIONS: Circumferential cannulation and viscodilation of the Schlemm canal increases the risk for DMD, which may be aggravated by blood reflux resulting from the tensioning suture and low postoperative IOP. Surgeons should be aware of this specific and potentially sight-threatening complication in classic canaloplasty. Immediate intervention is recommended for good visual prognosis.

Bloody tears and recurrent nasolacrimal duct obstruction due to a retained silicone stent.

A 6-year-old girl with a history of bilateral nasolacrimal duct obstruction presented with recurrent tearing, discharge, and bloody tears from the right eye. The patient had a history of multiple prior probing and stenting procedures on the right nasolacrimal system. Endoscopic dacryocystorhinotomy revealed a retained portion of a prior stent and accompanying pyogenic granuloma, removal of which resolved her symptoms.

Successful argon and diode laser photocoagulation treatment of an iris varix with recurrent hemorrhage.

PURPOSE: To report successful laser treatment of an iris varix. 
 METHODS: A 66-year-old man presented with an incidental finding of a cystic lesion within the iris stroma in his right eye. He developed a blood-filled and partly thrombosed tumor of the iris stroma and complained about blurred vision due to spontaneous hyphema during follow-up. 
 RESULTS: Ultrasound biomicroscopy showed a prominent and liquid-filled lesion within the iris stroma. Iris fluorescein angiography revealed a thrombosed iris tumor without intrinsic vascularization or feeding vessels. Therefore, diagnosis of an iris varix was made clinically. Recurrent bleeding occurred during follow-up and led to decreased visual acuity. Combined argon and diode laser photocoagulation was successful in terminating rebleeding and resulted in a scarred iris varix. 
 CONCLUSIONS: Symptomatic iris varices can be treated safely by combined argon and diode laser photocoagulation, facilitating a less invasive approach than surgical excision.

Fugo blade-assisted lens aspiration in a case of intra- and retro-lenticular hemorrhage.

Hemorrhage into the crystalline lens is exceedingly rare but has been described following ocular trauma [1, 2], glaucoma surgery [3-5], laser iridotomy [6], pediatric cataract surgery [7], and also in the absence of an obvious pathology [8]. We describe a case of intra- and retro-lenticular organised bleed which presented 9 years following repair of open globe injury and which was treated using fugo blade-assisted lens aspiration. The fugo blade provided adequate endocoagulation of retrolenticular blood during posterior capsulotomy and prevented undue anterior segment hemorrhage.

Subhyaloid haemorrhage in dengue fever.

In India, the dengue disease has attained an unprecedented proportion with a sharp increase in the size of human population at risk recently. Presentation of the disease varies from asymptomatic illness to haemorrhagic manifestations and shock. Previously ocular findings were considered rare in dengue fever; but due to increased number of cases various types of ocular complications are described in present day case series. Here, is presented a case of a girl with serologically proven dengue fever who developed a subhyaloid premacular haemorrhage in one eye with superficial retinal haemorrhages and cotton wool spots in both eyes.