Iris and ciliary body cysts and phakic intraocular lenses

Phakic intraocular lenses are used to correct refractive errors. The procedure is predictable and potentially reversible. The procedure is not free of complications though. The occurrence of iris cyst after implantation of a phakic intraocular lens was not described previously in the literature. We describe two cases of iris cysts in the presence of a phakic intraocular lens; the first case describes a cyst which was not present prior to the anterior chamber phakic intraocular lens implantation. The second case describes a hidden iris cyst that affected the posterior chamber phakic intraocular lens position and lead to glaucoma.

Iris Atrophy, Serous Detachment of the Ciliary Body, and Ocular Hypotony in Chronic Phase of Vogt-Koyanagi-Harada Disease

Purpose

To describe iris atrophy, serous detachment of the ciliary body, and ocular hypotony in a patient with chronic phase of Vogt-Koyanagi-Harada (VKH) disease.

Methods

Ocular examination and follow-up including digital infrared transillumination imaging of the iris was done in a 52-year-old woman with chronic phase of VKH disease.

Results

Infrared transillumination imaging showed extensive atrophy of the iris stroma and occasional pigment clumps both in the pupillary and ciliary zones of the iris, and detachment of the ciliary body in both eyes. Conventional transpupillary transillumination using white light showed only minute patchy atrophy of the pigment epithelium in the pupillary zone. Treatment did not normalize bilateral shallow retinal detachment of the posterior pole, serous detachment of the ciliary body, or severe ocular hypotony.

Conclusions

Severe atrophy of the iris stroma, retinal detachment of the posterior pole, serous detachment of the ciliary body, and ocular hypotony may occur in chronic phase of VKH disease.

Complications of retinal xenon-arc photocoagulation

The perioperative complications of xenon-arc photocoagulation of 245 eyes of 165 patients were reviewed. The follow-up ranged from 5 days in case of no complication to 5-30 days in case of complications. In 210 eyes (approximately 86%) photocoagulation could be carried out without any complication. Severe complications occurred in only 8 cases (approximately %). Among these were retrobulbar hematoma, keratopathy, secondary glaucoma, and persistent choroidal detachment. The number of burns per eye was of minor influence to the occurrence of complications.

Uveal effusion associated with an IgM lambda subtype monoclonal gammopathy

CASE REPORT

A 68-year-old man was referred to the hospital with progressive decreased vision in the right eye over the past year. A moderate cataract and annular choroidal thickening were found. The diagnosis of uveal effusion was confirmed by ultrasound and fluorescein and indocyanine green angiography. Laboratory studies showed an IgM lambda subtype monoclonal gammopathy of undetermined significance. The patient underwent cataract surgery, and a sub-Tenon's triamcinolone injection with a satisfactory short-term outcome.

CONCLUSION

This association has not been previously reported, and it shows that IgM lambda subtype monoclonal gammopathy of undetermined significance should be added to the list of disorders associated with uveal effusion.

Early post-operative pressure rise with ciliary body incarceration into Watson type trabeculectomy fistula

We studied six patients with early failure after Watson's trabeculectomy done due to chronic simple, neovascular, or chronic angle-closure glaucoma. After operation the eyes showed a maximum intraocular pressure (IOP) between 50 mmHg and 66 mmHg and no filtering bleb. Reoperation on the 5th to 14th post-operative day showed incarceration of ciliary body into the trabeculectomy fistula in all cases. The uveal protrusion was replaced and a deep corneoscleral block was removed in front of the scleral spur in three cases, and electrocoagulation of the anterior edges of the trabeculectomy fistula was done in other three cases. After a 4 months to 1.5 years follow-up IOP was 12 mmHg to 18 mmHg and only two eyes needed medical therapy. The results suggest that trabeculectomy in front of the scleral spur is indicated to avoid incarceration of the ciliary body into the trabeculectomy fistula.

Nanophthalmos and acquired retinoschisis

PURPOSE

To report three cases of nanophthalmos associated with acquired (senile) retinoschisis.

DESIGN

Observational case series.

METHODS

Complete ophthalmologic evaluation (including funduscopy with scleral indentation, total axial length measurement with A-scan, optical coherence tomography [Stratus 3 OCT; Carl Zeiss Meditec Inc, Dublin, California, USA], and fundus photography) of three consecutive patients presenting with nanophthalmos and acquired retinoschisis.

RESULTS

Three patients with nanophthalmos presented with bilateral acquired retinoschisis. One patient underwent a course of systemic steroids to treat concurrent and bilateral uveal effusion with macular edema. In this patient, one eye responded to this course of therapy without recurrence, while the fellow eye required vortex vein decompression with scleral windows, with subsequent, successful resolution. The average follow-up period was 40 months (range, eight to 95 months). Retinoschisis cavities remained stationary in each case.

CONCLUSIONS

Bilateral acquired retinoschisis may occur in patients with nanophthalmos, suggesting that there may be correlation in the mechanisms underlying these ocular disorders.

Intravitreal triamcinolone reduces the morphologic changes of ciliary body after pars plana vitrectomy for retinal vascular diseases

PURPOSE

To investigate the early postoperative changes in ciliary body after pars plana vitrectomy (PPV) for retinal vascular disease and to determine whether intravitreal triamcinolone acetonide (IVTA) affects postvitrectomy changes of the ciliary body.

DESIGN

Prospective interventional case-control study.

METHODS

We recruited 46 patients who underwent uncomplicated PPV for retinal vascular disease (35 with proliferative diabetic retinopathy (PDR) and 11 with branch retinal vein occlusion) and divided the patients into two groups according to the use of IVTA at the end of the PPV. The morphologic changes of the anterior segments were measured by ultrasound biomicroscopy (UBM) one day before and one day, two days, three days, five days, two weeks, one month, and two months after the PPV. The main outcome measures were the thickness and area of the ciliary body, the frequency of supraciliary effusions (SEs), angle-opening, and anterior chamber depth (ACD). We compared the UBM parameters between the two groups.

RESULTS

The thickness and area of the ciliary body significantly increased from day 1 to day 5 postoperatively. Nineteen of 46 eyes had SEs that were frequently associated with divergent alterations of postoperative intraocular pressure (IOP). The angle-opening and ACD were significantly decreased and dependent upon the findings of ciliary body thickness and SEs. The degree of the morphologic changes of the ciliary body and the frequency of SEs were significantly lower and of shorter duration in the IVTA group compared to the non-IVTA group.

CONCLUSIONS

The PPV for retinal vascular disease induces the morphologic changes of the ciliary body associated with postoperative abnormalities in IOP during the early postoperative period. Administration of IVTA at the end of the PPV effectively reduces or shortens the duration of the postvitrectomy changes of the ciliary body.

Posterior microphthalmos with uveal effusion managed by lamellar sclerotomies

A 21-year-old male with bilateral low visual acuity since childhood was diagnosed with posterior microphthalmos. He underwent scleral windows surgery for one eye. Although visual acuity didn't improve significantly due to amblyopia, the papillomacular fold flattened and reduced in size postoperatively. We suggest early screening and management to prevent amblyopia especially in children of affected families.

[Reconstructive laser surgical treatment for posttraumatic traction ciliochoroidal detachment]

To treat patients with eye injuries remains a topical problem due to the high incidence of this type of pathology and the severity of clinical outcomes. Ciliochoroidal detachment (CCD) occurring in 1-9% of the victims is one of the most common complications of mechanical eye injury. The purpose of the study was to evaluate the efficiency of pathogenetically substantiated technology for a combined laser surgical reparative intervention in posttraumatic traction CCD. The results of treatment were analyzed in 70 patients with posttraumatic traction detachment of the choroid and ciliary body. There was evidence for the need for vitrectomy and lensectomy in combination with posterior sclerectomy to eliminate traction posttraumatic CCD.

Traumatic and spontaneous scleral rupture and uveal prolapse in osteogenesis imperfecta

Three cases of severe globe injuries due to scleral fragility in osteogenesis imperfecta patients between the ages of 4 and 15 years are reported. Patient 1 had complete loss of vision. Patients 2 and 3 suffered non-sight-threatening scleral perforation. All 3 patients had no previous knowledge of recommendation for eyewear protection.

Cyclodialysis cleft secondary to removal of an anterior chamber phakic intraocular lens

We present a patient who had decreased visual acuity and hypotony in the left eye 2 months after removal of an anterior chamber phakic intraocular lens (pIOL). Gonioscopy demonstrated a cyclodialysis cleft at the 6 o'clock position in the region of the IOL footplate, which was confirmed by ultrasound biomicroscopy. A cyclodialysis cleft formation is one possible complication of pIOL removal. Careful gonioscopy evaluation before removal of pIOLs should be mandatory to assess the amount of fibrosis and the presence of synechia between the IOL and the surrounding tissues.

A successful alternative: repair of a penetrating limbal wound by lamellar keratoplasty

PURPOSE

To report repair of a penetrating limbal wound by lamellar keratoplasty 1 year post-traumatically.

METHOD

Interventional case report.

RESULTS

A 5-year-old boy had a self-inflicted injury leading to a limbal penetrating wound. The wound closed spontaneously by prolapsed subconjunctival uveal tissue and no intervention was planned. One year later surgical closure of the defect was necessary, as the amount of prolapsed tissue had increased. After excising the prolapsed tissue the wound was closed with a lamellar corneal graft, resulting in a quiet and stable anterior segment and a best-corrected visual acuity of 20/16.

CONCLUSIONS

Lamellar keratoplasty can be a useful technique to repair a limbal penetrating wound. Corneal allografts have adequate tensile strength, low immunogenicity, and are easy to obtain.

Ciliochoroidal effusion syndrome associated with posterior scleritis

BACKGROUND

To determine the cause of angle-closure glaucoma in a case of posterior scleritis.

CASE

The patient was a 65-year-old woman with unilateral acute angle-closure glaucoma who did not respond to laser iridotomy.

OBSERVATIONS

Slit-lamp examination demonstrated a shallow anterior chamber in the left eye. Intraocular pressure was 22 mmHg even after application of two antiglaucoma eye-drop preparations. B-scan ultrasonography demonstrated scleral thickening and choroidal detachment in the left eye. Ultrasound biomicroscopy showed a shallow anterior chamber with angle closure, annular ciliochoroidal effusion with ciliary body edema, and an anterior rotation of the ciliary body. After instillation of cycloplegics, the ciliary body and ciliary processes rotated posteriorly, resulting in the release of the pressure on the iris. These changes led to the opening of the angle and subsequent normalization of intraocular pressure. A diagnosis was made of ciliochoroidal effusion syndrome associated with posterior scleritis.

CONCLUSIONS

Patients with posterior scleritis can develop ciliochoroidal effusion syndrome, which can lead to angle-closure glaucoma. The therapeutic strategy for acute angle-closure glaucoma induced by ciliochoroidal effusion syndrome differs completely from that for acute angle-closure glaucoma with pupillary block. In the case of ciliochoroidal effusion syndrome, it is important to relieve the compression of the angle by the iris by displacing the lens-iris diaphragm posteriorly by cycloplegics.

Spectacle-Induced Ocular Trauma

PURPOSE

To report an unusual, spectacle-related injury.

METHODS

A 16-year-old boy wearing spectacles with polycarbonate lenses presented with an unusual, spectacle-related injury. Impact with the ball during a ball sport (cricket) led to extreme torsion of the frame with resultant direct blunt trauma to the right eye by the spectacle arm. On examination, the patient had a 10 x 10-mm area of conjunctivalized scleral dehiscence superiorly in Zones 2 and 3, with uveal prolapse. Superior retinal detachment was also noted.

RESULTS

Patient underwent wound repair with a scleral patch graft with transscleral cryotherapy and sulfur hexafluoride injection.

CONCLUSION

Although increased impact resistance of newer spectacle lens materials is assumed to reduce the incidence of ocular trauma, such unusual mechanisms may still lead to severe ocular trauma. We report this case to highlight an unusual mechanism of spectacle injury, hitherto unreported, and to show the continued need for use of eye protection while wearing spectacles.

Scleral window surgery and topical mitomycin C for nanophthalmic uveal effusion complicated by renal failure: case report

PURPOSE

To describe the case of a 16-year-old patient with nanophthalmic uveal effusion associated with renal failure that was treated with scleral window surgery and topical administration of mitomycin C (MMC).

METHODS

Case report.

RESULTS

Total uveal effusion was restored in the nanophthalmic eyes. Partial-thickness scleral flap with deep sclerostomy was performed and topical MMC was administered to one quadrant of the equatorial sclera. The subretinal fluid resorbed gradually.

CONCLUSIONS

Topical MMC might relieve the blocked transscleral outflow of intraocular fluid in the small area of a sclerostomy in young patients with nanophthalmos or in patients with renal failure in whom uveal effusion occurs repeatedly.

Removal of traumatic cyclitic membranes: surgical technique and results

BACKGROUND

As most patients with a history of open globe injury and judged to have cyclitic membrane are denied further surgery because of poor prognosis, a technique for creating radial cuts in traumatic cyclitic membranes and its results are described.

METHOD

This is a retrospective non-comparative interventional case series of eight eyes with history of penetrating eye injury with fibrovascular membrane over the pars plicata observed during vitrectomy. All eyes were hypotonic; two had undergone previous vitrectomy and had developed RD. During vitrectomy after penetrating trauma, lens and its capsule or IOL was removed, fibrovascular membrane was visualized over pars plicata with the aid of external compression and after removal of the center of anterior hyaloid face, radial cuts were placed over the membrane. The resulting pieces were removed with vitrectomy probe. An encircling buckling element was placed in all eyes. Best corrected visual acuity, IOP, and postoperative complications are described.

RESULTS

Eight eyes of eight patients (F: 3, M: 5) with an age range of 2-22 years (median: 11.5) with traumatic cyclitic membranes treated with the above technique were included in the study. They were followed for 6-18 months (median: 12 months). Seven patients had visual acuity of light perception to hand motion before operation . Preoperative IOP was low in all eyes (2-5 mmHg, median: 4 mmHg). One eye with a history of large foreign body removal was finally visually lost due to PVR. The other eyes had visual acuity of more than 20/100 (more than 20/60 in six eyes) and a normal IOP (8-20 mmHg, median 11 mmHg) in the last visit.

CONCLUSION

Placement of radial cuts over traumatic cyclitic membranes followed by removal of the pieces is well tolerated by the ciliary epithelium with good retaining of its secretory function and normalization of IOP.

Toxic keratolysis from combined use of nonsteroid anti-inflammatory drugs and topical steroids following vitreoretinal surgery

PURPOSE

To evaluate the corneal complications associated with the combined use of non-steroid anti-inflammatory drugs (NSAIDs) and topical steroids following vitreoretinal surgery.

METHOD

Description of corneal lesions in three patients after vitrectomy with use of topical ketorolac and prednisolone acetate.

RESULTS

Three eyes of three patients developed an atrophic central corneal ulcer with stromal thinning following a pars plana vitrectomy under local anesthesia. Lesions were asymptomatic and were found during a routine examination 2, 3, and 8 weeks after surgery, respectively. Surgical indications were as follows: a preretinal membrane, choroidal neovascularization, and massive uveal effusion following cataract surgery. Topical postoperative treatment was as follows: ketorolac 4 times a day, a combination of prednisolone acetate, polymyxin B, and neomycin 6 times a day, and 1% cyclopentolate 3 times a day. Suspension of ketorolac and ocular occlusion led to the resolution of corneal lesions between 2.5 and 3 months later, yielding a central superficial scarring, which showed no changes after a follow-up of 3 years.

CONCLUSIONS

Toxic keratolysis may appear as a secondary effect of the combined use of topical NSAIDs and steroids following vitreo retinal surgery and must be taken into account in the differential diagnosis of postoperative corneal lesions.

TREATMENT OF RETINAL DETACHMENT RESULTING FROM POSTERIOR STAPHYLOMA–ASSOCIATED MACULAR HOLE IN HIGHLY MYOPIC EYES

PURPOSE

To evaluate the surgical outcome of retinal detachment resulting from a posterior staphyloma-associated macular hole in highly myopic eyes.

METHODS

Fifty-seven consecutive highly myopic eyes with retinal detachment resulting from a posterior staphyloma-associated macular hole diagnosed between January 1993 and June 2003 were retrospectively studied. Anatomical reattachment of the retina and best-corrected visual acuity were measured.

RESULTS

Six different operative methods were used to treat this condition with diverse retinal reattachment rates: long-acting gas tamponade only (12.5%); pars plana vitrectomy (PPV) with long-acting gas tamponade (42.8%); PPV with epiretinal membrane (ERM) peeling and long-acting gas tamponade (50.0%); encircling scleral buckling combined with PPV and long-acting gas tamponade (57.1%); encircling scleral buckling combined with PPV, ERM peeling, and long-acting gas tamponade (40.0%); and encircling scleral buckling combined with PPV and silicone oil tamponade (75.0%). Overall, successful retinal reattachment was achieved in 25 (43.9%) of 57 eyes after the first surgery. However, the ultimate success rate of retinal reattachment was 77.2% (44 of 57 eyes) after subsequent surgery. The mean preoperative visual acuity +/- SEM (in logarithm of the minimal angle of resolution units) was 2.08 +/- 0.55, and the mean postoperative visual acuity +/- SEM was significantly increased to 1.87 +/- 0.54 at the last follow-up (P = 0.038). The major cause of recurrent retinal detachment in the long-acting gas tamponade group was nonclosure of the macular hole. For vitrectomized eyes, the major cause was reopening of the macular hole, even with ERM formation and proliferative vitreoretinopathy. There was no obvious correlation between the extent of the detachment or lens status and the reattachment rate.

CONCLUSIONS

The major causes of recurrent retinal detachment in the long-acting gas tamponade and vitrectomized groups were nonclosure of the macular hole and reopening of the macular hole, respectively. Furthermore, a lesser extent of retinal detachment was not associated with a higher anatomical success rate. More aggressive treatment such as silicone oil tamponade may need to be performed to overcome reduced natural adhesion due to posterior staphyloma with marked chorioretinal atrophy. Failure to initiate aggressive treatment can result in an unsatisfactory outcome and repeated surgery.

Ciliary Body Edema after Scleral Buckling Surgery for Rhegmatogenous Retinal Detachment

PURPOSE

Choroidal detachment and anterior chamber (AC) shallowing develop in some cases after scleral buckling surgery for rhegmatogenous retinal detachment (RD). Postoperative angle-closure glaucoma has been reported to occur in 4% of cases. It is supposed that compression by the local scleral buckling induces ciliary body edema and angle narrowing. This study aimed to evaluate quantitatively the time course of changes in ciliary body thickness and AC depth (ACD) before and after the scleral buckling procedure using ultrasound biomicroscopy.

DESIGN

Prospective consecutive case series.

PARTICIPANTS

Forty-six eyes of 44 patients (43.7+/-18.1 years old [mean +/- standard deviation]) undergoing rhegmatogenous RD surgery.

METHODS

Ciliary body thickness and ACD were measured before and 3, 7, 14, and 28 days after the procedure. Ultrasound biomicroscopy was used to evaluate ACD and ciliary body thickness.

MAIN OUTCOME MEASURE

Time course of changes in ciliary body thickness and ACD.

RESULTS

The surgery caused significant increases in ciliary body thickness at 3, 7, and 14 days postoperatively (P<0.0001, Bonferroni multiple comparison). Ciliary body edema reached its peak 3 days after surgery, followed by a gradual decrease thereafter. Ciliary body thickness in the encircling group was statistically greater than in the segmental buckling group at 3 and 7 days postoperatively (P<0.001, Student's t test). The ciliary body was significantly thicker in the direction of buckling than on the opposite side 3 days after surgery (P = 0.0079). In the encircling group, retinal reattachment surgery significantly decreased ACD 3 days after surgery (P = 0.018), whereas no significant fluctuations were found in the buckling group.

CONCLUSIONS

Even without apparent choroidal detachment and a shallow AC, subclinical ciliary edema existed in all directions of all eyes for at least 1 month after the scleral buckling procedure. The ciliary body in the direction of scleral buckling showed greater edema than the other areas. Eyes treated with the encircling band showed greater ciliary edema than those treated with segmental buckling alone.

Phacoemulsification, persistent hypotony, and cyclodialysis clefts

A retrospective noncomparative case-note analysis of 3 men presenting with persistent hypotony after routine phacoemulsification cataract surgery was performed. All patients had a previous history of significant blunt ocular trauma. All patients had surgical repair of the cyclodialysis clefts, 1 with cleft cryopexy and 2 with formal cleft closure with a limbal-based double scleral flap technique. All patients achieved closure of the cyclodialysis clefts following surgical intervention with complete resolution of hypotony. Mean preoperative intraocular pressures improved from 3, 4 and 3 mm Hg in the 3 cases to 11, 16, and 17 mm Hg postoperatively. Visual acuities improved from preoperative readings of counting fingers, 6/36 and 6/24 in the 3 cases to 6/6, 6/9, and 6/9 postoperatively. Persistent hypotony because of possible activation of a preexisting doormant cyclodialysis cleft following routine atraumatic phacoemulsification cataract surgery in previously traumatized eyes has not been reported.

Acute haptic-induced ciliary sulcus irritation associated with single-piece AcrySof intraocular lenses

We report an analysis of 3 single-piece hydrophobic acrylic intraocular lenses (IOLs) that were explanted because of complications related to the presence of their haptics in the ciliary sulcus. In 2 cases, the IOL was primarily implanted in the ciliary sulcus because of inadequate posterior capsule support. In the third case, postoperative displacement of 1 haptic in the sulcus was associated with hyphema and vitreous hemorrhage. Ultrasound biomicroscopy confirmed the contact between the haptic and iris. Areas of iris atrophy were observed in all cases. Light microscopy and scanning electron microscopy of the explanted lenses revealed the presence of pigmentary dispersion on the anterior surfaces. In Case 3, the pigments were concentrated on the surface of the haptic that was displaced from the capsular bag and on the corresponding optic-haptic junction. Scanning electron microscopy also showed the IOL's squared edges and unpolished side walls. The flexibility and thickness of the single-piece hydrophobic acrylic haptics, as well as the square optic and haptic edges, may increase the risk for iris chafing when the haptics are in the sulcus. Therefore, sulcus fixation of this IOL design is not recommended.

Transscleral diode laser therapy for cyclodialysis cleft induced hypotony

In order to evaluate the efficacy of transscleral diode laser therapy for treatment of cyclodialysis cleft associated with ocular hypotony, transscleral diode laser therapy was used in two patients with cyclodialysis cleft. It was applied over the cleft area in two rows of 14 applications in a post-traumatic patient and of 8 applications in a post-trabeculectomy patient at a power setting of 2500 mW and duration of 2000 msec. The clefts were closed with restoration of normal intraocular pressure and recovery of visual function in both patients. Transscleral diode laser therapy seems to be a safe, simple and non-invasive method for closure of the cyclodialysis clefts, especially in patients inappropriate for argon laser photocoagulation and those with opaque cornea.

Severe vitreous hemorrhage associated with closed-globe injury

BACKGROUND

The presence of marked vitreous hemorrhage is associated with poor visual prognosis in ocular trauma involving the posterior segment. The purpose of this study was to investigate the clinical features, prognostic factors, and visual outcomes in such eyes after closed-globe injury.

METHODS

Retrospective chart review of patients with severe vitreous hemorrhage after closed-globe injury between January 2000 and December 2002.

RESULTS

The study included 33 eyes in 32 patients with a mean age of 41.5 (range, 3-78 years) and a median follow-up period of 12 (range, 3-50 months). Presenting visual acuity was between 4/200, and there was light perception in 32 eyes (97%) and no light perception in one eye (3%). Fifteen eyes (45%) had one or more posterior segment pathologies beneath the vitreous hemorrhage. There were retinal tears in six eyes (18%), retinal detachment in six (18%), submacular hemorrhage in six (15%), choroidal rupture in three (9%), macular pucker in three (9%), retinal dialysis in one (3%), macular hole in one (3%), and retinal vessels occlusion in one (3%). Seven eyes (21%) had final visual acuity 20/40 or better, and 18 eyes (54%) had less than 20/200. Poor prognostic factors included presenting visual acuity of light perception or lower (p=0.032), hyphema (p=0.007), traumatic cataract (p=0.027), and age 55 years or younger (p=0.039). The most common cause of poor visual outcome was macular scar.

CONCLUSION

The visual prognosis of severe vitreous hemorrhage after closed-globe injury was guarded. This was frequently associated with various anterior and posterior segment pathologies. In order to provide early visual rehabilitation and management of any potentially treatable posterior pathology, early vitrectomy may be considered.

Postoperative secondary glaucoma and anterior staphyloma in a patient with homocystinuria

We describe recurrent bilateral homocystinuria-related lens dislocation into the anterior chamber in a patient who had postoperative anterior staphyloma and secondary intractable aphakic glaucoma in only one eye. We discuss the possible causes of and treatment modalities for this complication.

Uveal effusion in primary angle-closure glaucoma

PURPOSE

To determine the prevalence of uveal effusion in acute and chronic primary angle-closure glaucoma (PACG) or primary angle closure (PAC) and to compare it with the prevalence in eyes with open-angle glaucoma (OAG) or ocular hypertension.

DESIGN

Prospective consecutive case series.

PARTICIPANTS

Five hundred one eyes of 351 consecutive patients with PAC and 156 eyes of 116 randomly selected primary OAG or ocular hypertension patients. The PAC group included 40 eyes of 35 patients with acute PACG and 30 unaffected fellow eyes, 39 eyes and 35 fellow eyes with a history of acute PACG, and 357 eyes with chronic PAC.

METHODS

Ultrasound biomicroscopic examination was performed to diagnose uveal effusion and to measure anterior chamber depth (ACD).

MAIN OUTCOME MEASURES

Presence of uveal effusion and ACD.

RESULTS

Uveal effusion was demonstrated in 23 eyes (58%) with acute PACG and 7 fellow eys (23%) (chi2 = 8.17, P = 0.0043). Among eyes with chronic PAC, uveal effusion was present in 69 [corrected](14%[corrected]), a higher prevalence than was found in open-angle patients (2 eyes [1.3%]) (chi2 = 19.3, P<0.001). In the chronic PAC group, the ACD of phakic eyes with uveal effusion (1.92+/-0.42 mm) was significantly shallower than that of phakic eyes without effusion (2.06+/-0.32 mm) (P = 0.019).

CONCLUSIONS

Uveal effusion diagnosed by ultrasound biomicroscopy is a special feature in PAC, and is prevalent in acute PACG. Uveal effusion in phakic eyes with PAC is associated with shallowing of ACD.

Multiple sclerosis and neuro-ophthalmologic manifestations

The authors report clinical features of ocular manifestations in patients with multiple sclerosis (MS), those that affect the visual sensory system and those that affect the ocular motor system. Disturbances of visual sensory function may precede, manifest coincidentally or follow the neurologic manifestations. Visual disturbances are common in MS and often a result of acute demyelinating optic neuropathy. Careful examination of MS patients, who have never suffered optic neuritis, may also reveal asymptomatic visual loss. Asymptomatic visual loss seems to be a universal feature of MS. Patients with multiple sclerosis may develop disorders of fixation, ocular motility and ocular alignment. Disorders of ocular motor system are frequently the initial sign of multiple sclerosis and occur as its presenting sign weeks, month, or years before other neurologic symptoms and signs develop.

Bilateral anterior granulomatous uveitis associated with cutaneous Rosai-Dorfman disease

BACKGROUND

Rosai-Dorfman disease (RDD) is a benign, rare, histiocytic disorder of unknown etiology. We describe the case of a 61-year-old woman who presented to the ophthalmology clinic with bilateral granulomatous anterior uveitis.

METHODS

The uveitis was controlled on topical prednisolone acetate 1%. One month after presentation, she developed generalized macules and papules, and dermatologic and systemic evaluations were performed.

RESULTS

On the basis of skin biopsy, purely cutaneous RDD was established.

CONCLUSION

Anterior granulomatous uveitis may be the presenting sign of cutaneous RDD. Consultation is necessary for accurate diagnosis.

Vitreoretinal endoscope for the assessment of the peripheral retina and the ciliary body after large retinectomies in severe anterior PVR

PURPOSE

We evaluated endoscopically the changes of the peripheral retina and the ciliary body after large retinectomies.

METHODS

The peripheral retina and the ciliary body of 5 patients with anterior proliferative vitreoretinopathy after large retinectomies (> 180 degrees) were visualized endoscopically.

RESULTS

The endoscope allowed a complete assessment of the peripheral retina and the ciliary body. Even the 12 o'clock part of the eye could be evaluated with the 30 degrees optic. The peripheral retina, a fibrosis and a detachment of the ciliary body can be visualized and assessed. The cause of the postoperative hypotony after large retinectomies is mainly related to fibrosis and detachment of the ciliary body. Surgeons can expect a postoperative hypotony if fibrosis and a large detachment of the ciliary body is seen during surgery with the help of an endoscope.

CONCLUSION

Endoscopic vitreoretinal visualization of the pars plana and ciliary body is a useful additional technique after large retinectomies in the treatment of anterior PVR.

[Treatment of uveal effusion syndrome after filtering surgery (2 case reports)]

The purpose of this article is to report the surgical treatment of two patients. After the filtering surgery a dehiscence of the conjunctiva emerged and was followed by an extreme hypotony of the eyeball and an extensive uveal effusion. The first patient, 82 years old lady, was treated with the diagnosis of chronic open angle glaucoma for 25 years. The right eye with an absolute glaucoma, the left eye had normal intraocular pressure (IOP) and was after a combined filtering surgical procedure with phacoemulsification and posterior chamber intraocular lens (PC IOL) implantation in 1998. In autumn 2000, the patient suffered conjunctivitis, and the prominent filtering bleb was damaged due to frequent rubbing of the eye because of itching. Severe hypotony of the eyeball with secondary uveal effusion followed. Considering the age of the patient and the only functional eye, an extreme surgery was indicated: PC IOL explantation (removal), pars plana vitrectomy (ppV) with silicone oil implantation. After the surgery the eyeball was anatomically stabilized and the VA (visual acuity) improved from initial uncertain light perception to 0.08 (1/12 or 3/36) and certain light perception. The second patient, 35 years old man suffered in 1995 a serious penetrating injury with an intraocular foreign body of the right globe. During the following five years the patient underwent in altogether six intraocular surgeries due to posttraumatic cataract and rhegmatogenous and tractional detachment of the retina. In the year 2000, trabeculectomy due to secondary glaucoma was indicated and 8 months later, on patients demand an anterior chamber intraocular lens (AC IOL) was implanted. During the first week after the surgery severe hypotonia of the globe and secondary uveal effusion caused by conjunctival dehiscence in the upper nasal quadrant of the eyeball developed. Because of complicated ocular history of the patient who underwent on the whole eight eye surgeries a relative minimal procedure was indicated: AC IOL removal and insufflation of 1 ml of 100% hexafluorosulfide (SF6) expansive gas into the anterior chamber and vitreous cavity. The globe was stabilized and the VA (visual acuity) improved from initial uncertain light perception to 0.25 (6/24 or 20/80) with certain light perception.

Repair of a ruptured globe using topical anesthesia

We present a 76-year-old patient who had ocular trauma with dehiscence of the wound and scleral rupture with a prolapsed iris, ciliary body, intraocular lens, and vitreous after uneventful cataract surgery with a self-sealing sclerocorneal tunnel incision. General anesthesia was not possible because the patient had a history of lung cancer with extensive emphysema and unstable coronary disease. Local retrobulbar or peribulbar anesthesia was not considered because of the risk for further extrusion of intraocular contents. Topical anesthesia was applied with a 10.0 mm x 2.5 mm cellulose sponge soaked in oxybuprocaine 0.4% (Novesine) placed under the upper and lower lid for 20 minutes. Surgical repair of a 14.0 mm scleral wound was achieved without complication or pain during the procedure.

[Explantation and replacement of intraocular lenses]

PURPOSE

to evaluate the reasons for explantation of different types of intraocular lenses.

MATERIAL AND METHOD

We studied 27 eyes operated previously for cataract and which developed in postoperative period intraocular induced complication, demanding explantation.

RESULTS

In 51.85% cases we explanted anterior chamber IOL, in 40.74% eyes posterior chamber IOL and in the rest pupillary IOL. Reasons of explantation were according to the artificial lens: in 4 cases for edematous keratopathy, chronic uveitis in 2 eyes and descentration in 8 eyes. Reimplantation was performed at 19 eyes, in 10 cases with standard posterior chamber IOL and in 9 cases with scleral sutured posterior chamber IOL.

CONCLUSIONS

The main reason for explantation in anterior chamber IOL is the edematous keratopathy and malpositions for posterior chamber IOL.

Prevalence of ciliochoroidal effusion after prophylactic laser iridotomy

PURPOSE

To study the prevalence of ciliochoroidal effusion (CE) after prophylactic laser iridotomy (LI).

METHODS

An ultrasound biomicroscope (UBM) examination was performed before, 2, and 24 hours after LI to investigate the changes in supraciliary-choroidal space after LI in circumference of 38 eyes in 23 chronic primary angle-closure patients. Subjects were divided randomly into two groups based on LI settings: 21 eyes by argon laser (Ar-LI group) and argon combined with yttrium-aluminum-garnet (YAG) laser in 17 eyes (Ar-YAG-LI group). Ciliochoroidal effusion was observed predominantly in the inferior sector (12 of 12 eyes, 100%) and rare in nasal part of the eyes (4 of 12 eyes, 33%). Ciliochoroidal effusion appeared more often in the Ar-LI group (10 eyes, 52%) than in the Ar-YAG-LI group (2 eyes, 12%). All CE disappeared 7 days after by UBM observation.

CONCLUSIONS

Subclinical CE observed by UBM frequently occurs after LI.