Sympathetic ophthalmia from inadvertent ocular perforation during conventional retinal detachment surgery

Ahmed valve, suture-less implantation: A new approach to an easier technique

PURPOSE

Tissue adhesives have been used in ophthalmology instead of sutures to minimize the operating time. This case series investigated the effectiveness and safety of use of cyanoacrylate in Ahmed valve implantation through pars plana for refractory glaucoma.

PATIENTS AND METHODS

Seventeen eyes of 17 patients with refractory glaucoma underwent Ahmed valve scleral suture-less implantation through pars plana with a cyanoacrylate suture of the plate. Refractory glaucoma was defined as intraocular pressure (IOP) ≥ 21 mm Hg with antiglaucoma eye drops, good adherence to treatment, and no previous glaucoma surgery. IOP control and development of complications were evaluated during the follow-up (mean follow-up, 13.23 mo, 6 to 28 mo).

RESULTS

IOP control, defined as IOP ≤ 21 mm Hg with or without antiglaucoma eye drops, was achieved in 82.2% of patients, and 58.8% were able to eliminate antiglaucoma eye drops. Mean surgical time was 9.76 ± 2.60 and 6 ± 0.81 minutes in patients with previous vitrectomy (4 cases). Postoperative complications included transiently increased IOP, transient hyphema, early postoperative hypotony (4 cases), and tube block by the vitreous (2 cases): 1 resolved by Nd:YAG and the other by second vitrectomy. No cases of tube or plate extrusion, plate migration, choroidal or retinal detachment, or vitreous hemorrhage were observed.

CONCLUSIONS

These results are promising and demonstrate a safe and effective alternative to the traditional scleral suture. Our data suggest that Ahmed valve implantation through pars plana with cyanoacrylate is a safe and effective method for refractory glaucoma. Further studies are needed to confirm our observation.

Presumed sympathetic ophthalmia after scleral buckling surgery

PURPOSE

To report an unusual case of sympathetic ophthalmia after successful scleral buckling surgery.

METHODS

The authors reported the clinical manifestation, ocular and systemic workup, and outcome of a 23-year-old woman who presented with reduced vision 3 weeks after successful scleral buckling surgery.

RESULTS

Slit-lamp examination showed a mild anterior chamber and vitreous reaction. Fundus examination showed extensive serous retinal detachment in both eyes. Systemic workup was negative for extraocular disease. The patient was treated with intensive systemic steroid and azathioprine. The inflammation was controlled and serous detachment resolved.

CONCLUSION

Sympathetic ophthalmia can occur after successful scleral buckling surgery.

Progressive subretinal fibrosis and blindness associated with multifocal granulomatous chorioretinitis: A variant of sympathetic ophthalmia

OBJECTIVE

To report a case of bilateral progressive subretinal fibrosis and blindness with multifocal granulomatous chorioretinitis occurring after intraocular surgery. We propose that this is a variant of sympathetic ophthalmia.

DESIGN

Clinicopathologic case report.

METHODS

The left enucleated globe was examined by histopathologic methods. The patient's sera were subjected to immunohistochemical studies against retinal antigens, and collagen 2 types in areas of fibrosis were identified. Polymerase chain reaction was used to test for herpes virus DNA in microdissected, formalin-fixed, paraffin-embedded tissue.

RESULTS

The enucleated globe demonstrated histopathologic features similar to an entity previously described as progressive subretinal fibrosis with multifocal granulomatous chorioretinitis. The patient's sera demonstrated antibodies directed against retinal photoreceptors and pigment epithelium. Polymerase chain reaction for herpes virus was negative. Immunohistochemical studies demonstrated types III, IV, V, and VI collagen in areas of fibrosis.

CONCLUSIONS

The clinical history along with the histopathologic and immunohistochemical findings suggest that progressive subretinal fibrosis with multifocal granulomatous chorioretinitis may represent a variant of sympathetic ophthalmia and that retinal autoimmunity may play a role in its pathogenesis.