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1.
Clin Exp Ophthalmol ; 51(7): 663-672, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37608637

RESUMO

BACKGROUND: To compare graft survival of endothelial keratoplasty (EK) versus penetrating keratoplasty (PK) in patients with iridocorneal endothelial (ICE) syndrome and identify ocular features associated with graft survival. METHODS: Observational, prospective, cohort study. A total of 30 806 first grafts performed between 1985 and 2020 were identified through the Australian Corneal Graft Registry and included in this observational, prospective cohort study. A total of 196 eyes underwent a primary corneal graft for ICE syndrome. Kaplan-Meier graft survival plots and Chi-squared tests were performed to identify graft survival rates for EK and PK. A history of raised intraocular pressure (IOP) was also recorded and analysed. Graft survival of eyes with ICE syndrome were compared to that of other indications. RESULTS: Grafts performed for ICE syndrome increased to 0.8% of all cases during the 2005 to 2020 period compared with 0.5% between 1985 to 2004 (χ2 =9.35, p = 0.002). From 2010, EK surpassed PK as the preferred graft type. Survival of primary grafts in eyes with ICE syndrome was lower than for other indications (log-rank = 56.62, p < 0.001). Graft survival was higher following PK than Descemet stripping (automated) endothelial keratoplasty (DS(A)EK) (log-rank = 10.56, p = 0.001). Graft survival was higher in eyes without a history of raised IOP compared to those with a reported history of raised IOP (log-rank = 13.06, p < 0.001). CONCLUSIONS: ICE syndrome carries a poor prognosis for graft survival. DS(A)EK had a poorer prognosis than PK. A history of raised IOP is associated with higher risk of graft failure.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Glaucoma , Síndrome Endotelial Iridocorneana , Humanos , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/cirurgia , Síndrome Endotelial Iridocorneana/complicações , Estudos Prospectivos , Distrofia Endotelial de Fuchs/cirurgia , Estudos de Coortes , Acuidade Visual , Austrália , Endotélio Corneano/cirurgia , Ceratoplastia Penetrante , Glaucoma/cirurgia , Sistema de Registros , Sobrevivência de Enxerto , Estudos Retrospectivos , Doenças da Córnea/cirurgia , Doenças da Córnea/complicações
2.
Cornea ; 42(10): 1293-1296, 2023 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-37170404

RESUMO

PURPOSE: The aim of this study was to report the first case of successful use of corneal collagen cross-linking (CXL) to halt the progression of keratoconus in a patient with concurrent iridocorneal endothelial (ICE) syndrome. METHODS: A 30-year-old White man was referred to our subspecialty corneal clinic for further investigation of right corectopia. The patient was asymptomatic and was otherwise fit. Slit-lamp examination revealed a right oval-shaped pupil decentered superiorly, a transillumination defect at the 5-o'clock position, minimal gutta-like changes in the corneal endothelium, and few inferior peripheral anterior synechiae. Dilated fundoscopy was normal in both eyes, with healthy optic discs, maculae, and peripheral retinae. Specular microscopy and slit-lamp findings suggested ICE syndrome. Subsequent investigation with corneal tomography showed progressive signs of inferior corneal ectasia with steepening, and thinning in the right eye, consistent with keratoconus. The left eye was unremarkable. RESULTS: Epithelium-off accelerated corneal CXL was performed in the affected eye. Early post-CXL follow-up (1 week) was unremarkable, and further follow-ups were arranged at 3, 6, 12, and 24 months, respectively. In subsequent reviews, the patient's vision and corneal tomography findings were stable. CONCLUSIONS: We describe the first case of corneal CXL for progressive keratoconus with ICE syndrome. co-existing keratoconus and ICE syndrome can occur, and corneal cross-linking was used successfully in this case to halt keratoconus progression. However, further studies will need to establish the impact of epithelium-off corneal cross-linking, especially in more severely affected eyes.


Assuntos
Síndrome Endotelial Iridocorneana , Ceratocone , Fotoquimioterapia , Masculino , Humanos , Adulto , Ceratocone/tratamento farmacológico , Crosslinking Corneano , Substância Própria , Raios Ultravioleta , Acuidade Visual , Reagentes de Ligações Cruzadas/uso terapêutico , Fármacos Fotossensibilizantes/uso terapêutico , Riboflavina/uso terapêutico , Topografia da Córnea , Fotoquimioterapia/métodos
3.
Medicine (Baltimore) ; 102(8): e32950, 2023 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-36827050

RESUMO

RATIONALE: Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient. PATIENT CONCERNS: A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye. DIAGNOSES: The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations. INTERVENTIONS: Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye. OUTCOMES: The patient's visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed. LESSONS: Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.


Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Fechado , Glaucoma , Síndrome Endotelial Iridocorneana , Masculino , Humanos , Adulto , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/cirurgia , Glaucoma de Ângulo Fechado/complicações , Glaucoma/cirurgia , Cirurgia Filtrante/efeitos adversos , Pressão Intraocular , Resultado do Tratamento
4.
Eur J Ophthalmol ; 33(3): NP40-NP44, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-34964381

RESUMO

Purpose: Iridocorneal endothelial (ICE) syndrome is well known to cause refractory glaucoma in young adults. Commonly acclaimed mechanism for trabeculectomy failure in these cases include accelerated subconjunctival fibrosis, abnormal endothelial proliferation, and closure of ostium. In the following article, we present a case of Iridocorneal endothelial syndrome that presented with refractory glaucoma after trabeculectomy due to rapidly progressive peripheral anterior synechiae causing angle closure and corneal decompensation that mandated a tailored surgical approach of management. Methods: This is a descriptive case report based on electronic medical records, patient observation, surgical intervention, and follow-ups. Case description: A thirty-eight-year-old-male presented to us with signs suggestive of iridocorneal endothelial syndrome with gonioscopy revealing peripheral anterior synechiae (PAS) over four clock-hours temporally. Uncontrolled intraocular pressure (IOP) despite maximal medical therapy mandated augmented trabeculectomy with anti-fibrotics. The bleb failed within 3 weeks of trabeculectomy, with evidence of progressive crawling PAS causing endothelial decompensation and raised IOP. He underwent Ahmed glaucoma valve (AGV) implant surgery with viscosynechiolysis and sectoral iridectomy under antiviral cover. This helped control IOP and retain corneal clarity, with no recurrence of PAS in the affected area. Conclusion: Progressive peripheral synechiae in ICE syndrome can cause early bleb failure and refractory glaucoma. Careful viscosynechiolysis and sectoral iridectomy alongside a second implant surgery can help salvage visual functions and preserve corneal clarity while preventing further progression of PAS in these eyes.


Assuntos
Doenças da Córnea , Glaucoma , Síndrome Endotelial Iridocorneana , Doenças da Íris , Trabeculectomia , Adulto Jovem , Masculino , Humanos , Adulto , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/cirurgia , Síndrome Endotelial Iridocorneana/complicações , Glaucoma/cirurgia , Doenças da Córnea/cirurgia , Doenças da Íris/etiologia , Doenças da Íris/complicações , Pressão Intraocular , Trabeculectomia/efeitos adversos , Iris
5.
Graefes Arch Clin Exp Ophthalmol ; 261(2): 545-554, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36038686

RESUMO

PURPOSE: To compare the surgical outcomes of the Aurolab aqueous drainage implant (AADI) and trabeculectomy with mitomycin C (MMC) in patients with glaucoma secondary to iridocorneal endothelial (ICE) syndrome. MATERIALS AND METHODS: This retrospective comparative case series included 41 eyes of 41 patients with ICE syndrome and glaucoma who underwent either a trabeculectomy with MMC (n = 20) or AADI surgery (n = 21) with a minimum of 2 years follow-up. Outcome measures included intraocular pressure (IOP), the use of glaucoma medications, visual acuity, additional surgical interventions, and surgical complications. Surgical failure was defined as IOP > 21 mmHg or reduced < 20% from baseline, IOP ≤ 5 mmHg, reoperation for glaucoma or a complication, or loss of light perception vision. RESULTS: The cumulative probability of failure at 2 years was 50% in the trabeculectomy group (95%CI = 31-83%) and 24% in the AADI group (95%CI = 11-48%) (p = 0.09). The IOP was consistently lower in the AADI group compared with the trabeculectomy group at 6 months and thereafter. Surgical complications occurred in 13 eyes (65%) in the trabeculectomy group and 12 eyes (57%) in the AADI group (p = 0.71). Reoperations for glaucoma or complications were performed in 12 eyes (60%) in the trabeculectomy group and 5 patients (24%) in the tube group (p = 0.06). Cox proportional hazards showed that AADI had a 53% lower risk of failure at 2 years (p = 0.18; HR = 0.47; 95%CI = 0.16-1.40). CONCLUSION: AADI surgery achieved lower mean IOPs than trabeculectomy with MMC in managing glaucoma secondary to ICE syndrome. A trend toward lower rates of surgical failure and reoperations for glaucoma and complications was observed following AADI placement compared with trabeculectomy with MMC in eyes with ICE syndrome.


Assuntos
Implantes para Drenagem de Glaucoma , Glaucoma , Síndrome Endotelial Iridocorneana , Trabeculectomia , Humanos , Trabeculectomia/efeitos adversos , Mitomicina/uso terapêutico , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/cirurgia , Estudos Retrospectivos , Implantes para Drenagem de Glaucoma/efeitos adversos , Seguimentos , Resultado do Tratamento , Glaucoma/tratamento farmacológico , Pressão Intraocular
6.
Med Arch ; 76(3): 224-228, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36200117

RESUMO

Background: Iridocorneal endothelial (ICE) syndrome is a group of ophthalmic disorders, first reported by Eagle and Yanoff in 1979, a disease characterized by abnormalities of the iris and the corneal endothelium, and mainly occurs unilaterally in young and middle-aged women, with no family history. ICE syndrome comprises a spectrum of three clinical variants: Progressive essential iris atrophy (corectopia, iris atrophy or iris hole), Chandler syndrome (corneal oedema with mild to absent iris change), and Cogan - Reese syndrome (nodular pigmented lesion of the iris). Objective: We are presenting this case because of its rarity, diagnostic intricacy and therapeutic challenge. Case report: We report in this study a case of Essential Progressive Iris Atrophy, an Iridocorneal Endothelial Syndrome variant in a 40 years old patient, female, complaining about the shape of the pupil in the left eye, as well as photophobia in the same side.In the first evaluation, we observed visual acuity of 1.0 in both eyes.Intraocular pressure was 14 mm Hg in the right eye and 12 mm Hg in the left eye. On the biomicroscope, we had a proper right eye finding, on the left eye Iris atrophy with deformity in the direction from 12 to 6 hours. We performed gonioscopy, an ultra sound (UBM), spectral microscopy, pachymetry, OCT and Octopus perimetry. Conclusion: We confirmed the diagnosis of essential iris atrophy based on the clinical findings, and in abnormalities in complementary exams. Nowadays, the patient is being followed in the Ophthalmology department at JZU Brcko District Bosnia and Herzegovina.


Assuntos
Síndrome Endotelial Iridocorneana , Iris , Adulto , Atrofia/patologia , Endotélio Corneano/patologia , Feminino , Humanos , Pressão Intraocular , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/patologia , Iris/patologia
8.
Am J Ophthalmol ; 243: 83-90, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-35870489

RESUMO

PURPOSES: To report the efficacy of a bleb-independent penetrating canaloplasty in the management of glaucoma secondary to iridocorneal endothelial syndrome (GS-ICE). DESIGN: Prospective, non-comparative clinical study. METHODS: Penetrating canaloplasty was performed on 35 eyes from 35 patients with GS-ICE and medically uncontrolled intraocular pressure (IOP) between January 2018 and April 2020. Patients were followed up at 1 week, months 1, 3, 6, 12 postoperatively, and semi-annually thereafter. The IOP, anti-glaucoma medication, and surgery-related complications were recorded. Surgical success was defined as IOP ≥ 5 mmHg and ≤ 21 mmHg without (complete success) or with/without (qualified success) IOP-lowering medication. RESULTS: A total of 29 eyes (82.9%) had 360° catheterization and successfully received penetrating canaloplasty. Of these eyes, 24 (82.8%) achieved qualified success and 22 (75.9%) achieved qualified success at 12 months after surgery. The mean IOP decreased from 39.5 ± 11.8 mmHg on 2.9 ± 1.0 medications before surgery to 16.6 ± 5.3 mmHg (P < .001) on 0.2 ± 0.6 medications (P < .001) at 12 months postoperatively, respectively. Hyphema (37.9%), transient hypotony (34.5%), and transient postoperative IOP elevation (≥ 30 mmHg, 17.9%) were the most commonly observed early complications at the 1 week and 1 month visits. From 1 month and beyond, all treated eyes showed no obvious bleb at the operation quadrant. CONCLUSIONS: Penetrating canaloplasty rescued the inner aqueous outflow in ICE eyes and demonstrated acceptable success in IOP control with few complications, providing a new option for the management of GS-ICE.


Assuntos
Cirurgia Filtrante , Glaucoma de Ângulo Aberto , Glaucoma , Síndrome Endotelial Iridocorneana , Trabeculectomia , Humanos , Agentes Antiglaucoma , Cirurgia Filtrante/métodos , Glaucoma/complicações , Glaucoma/cirurgia , Glaucoma de Ângulo Aberto/complicações , Glaucoma de Ângulo Aberto/cirurgia , Pressão Intraocular , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/diagnóstico , Síndrome Endotelial Iridocorneana/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Trabeculectomia/métodos , Resultado do Tratamento
11.
Cornea ; 41(11): 1418-1425, 2022 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-35120350

RESUMO

PURPOSE: The purpose of this study was to report the long-term outcomes of Descemet membrane endothelial keratoplasty (DMEK) with goniosynechialysis in eyes with iridocorneal endothelial syndrome with an emphasis on the surgical technique. METHODS: This was a retrospective series of 5 eyes of 5 patients undergoing a DMEK procedure at a tertiary eye care institute by a single surgeon. Modifications in the standard surgical technique, including the release of peripheral anterior synechiae, peripheral descemetorhexis, the release of adherent membranes, maneuvers in the anterior chamber with or without cataract extraction were logged. Long-term outcomes of the surgery in these patients are reported. RESULTS: Five DMEK procedures were performed in 5 eyes of 5 patients. The average age of the patients was 48.2 ± 10.8 years, and the donor was 55.2 ± 3.2 years with a mean endothelial cell density (ECD) of 2784.6 ± 231 cells/mm 2 . After a mean follow-up period of 29.6 months (24-41 mo), all the 5 grafts remained clear; the mean BCVA at the last follow-up was 0.18 ± 0.17 logarithm of the minimum angle of resolution with a mean ECD of 1086.2 ± 338 cells/mm 2 with a 61.1% reduction in ECD. intra ocular pressure was normal in all the cases. None of the patients had graft detachments that required rebubbling, and all eyes had a clear graft at the last follow-up. CONCLUSIONS: DMEK can be performed successfully in a case with iridocorneal endothelial syndrome with good visual outcomes with modifications to the surgical technique, including peripheral anterior synechiae release and minimizing surgical manipulation.


Assuntos
Doenças da Córnea , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Distrofia Endotelial de Fuchs , Síndrome Endotelial Iridocorneana , Adulto , Contagem de Células , Doenças da Córnea/cirurgia , Lâmina Limitante Posterior/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Endotélio Corneano/transplante , Distrofia Endotelial de Fuchs/cirurgia , Humanos , Síndrome Endotelial Iridocorneana/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual
12.
Zhonghua Yan Ke Za Zhi ; 58(2): 146-148, 2022 Feb 11.
Artigo em Chinês | MEDLINE | ID: mdl-35144355

RESUMO

Iridocorneal endothelial syndrome is a rare ophthalmic disease, most of which are unilateral and common in women. The rate of misdiagnosis and missed diagnosis is relatively high due to its various clinical manifestations. In this case, the patient presented uncontrollable high intraocular pressure, corneal edema leading to difficult observation of corneal endothelium morphology, and accompanied by a small amount of iris neovascularization. No clearly diagnosis was made before glaucoma surgery. Further examination was performed after corneal clearance, and the final diagnosis was iris corneal endothelial syndrome (Chandler syndrome).


Assuntos
Doenças da Córnea , Edema da Córnea , Glaucoma , Síndrome Endotelial Iridocorneana , Doenças da Íris , Endotélio Corneano , Feminino , Glaucoma/diagnóstico , Humanos , Síndrome Endotelial Iridocorneana/diagnóstico , Iris/diagnóstico por imagem , Doenças da Íris/diagnóstico
13.
Zhonghua Yan Ke Za Zhi ; 58(1): 35-40, 2022 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-34979791

RESUMO

Objective: To investigate the clinical features in patients with iridocorneal endothelial (ICE) syndrome. Methods: A retrospective case series study. Data of clinical manifestations of patients with ICE syndrome including clinical subtypes, presenting visual acuity, clinical features and secondary glaucoma were collected from January 2014 to May 2020 in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University. The Wald's Chi-square test of generalized estimating equations was performed to analyze the differences in three clinical subtypes. Results: A total of 127 eyes of 114 subjects (64 females and 50 males) were included. Mean±SD age at presentation was (49±13) years. There were 53 patients (46.5%) with Chandler's syndrome (CS), 36 patients (31.6%) with progressive iris atrophy (PIA), 24 patients (21.0%) with Cogan-Reese syndrome (CRS) and one patient (0.9%) with an undetermined subtype. And 101 patients (88.6%) had uniocular ICE syndrome. Approximately 81.7% (49/60), 56.1% (23/41) and 41.7% (10/24) of eyes presented visual acuity <0.3 in patients with CS, PIA and CRS, respectively. Corneal edema was most common in CS (52.5%, 32/61), followed by PIA (29.3%, 12/41) and CRS (20.8%, 5/24). Corectopia was found in 95.8% (23/24) of eyes with CRS, 95.1% (39/41) of eyes with PIA and 78.7% (48/61) of eyes with CS. Polycoria was observed in 29.3% (12/41) of eyes with PIA, 3.3% (2/61) of eyes with CS and 8.3% (2/24) of eyes with CRS. Ectropion uvea was most common in CRS (54.2%, 13/24), followed by 16.4% (10/61) in CS and 12.2% (5/41) in PIA. Glaucoma was found in 94 eyes (74.0%, 94/127). Among them, 60.7% (37/61) of CS, 80.5% (33/41) of PIA and 95.8% (23/24) of CRS had secondary glaucoma. The difference of presenting visual acuity, corneal edema, corectopia, polycoria, ectropion uveae and secondary glaucoma in three clinical subtypes all had statistical significance (Wald χ2=13.87, 10.77, 965.78, 11.45, 15.00, 222.04; all P<0.05). And 86.2% of eyes (81/94) had glaucoma surgeries and 41 eyes (43.6%, 41/94) had the intraocular pressure well controlled with various interventions. Conclusions: ICE syndrome is mostly uniocular and more common in middle-aged patients. CS is the most common clinical subtype with poor presenting visual acuity. About 3/4 of eyes have secondary glaucoma, and the majority of them require surgical interventions, but prognoses are discouraging.


Assuntos
Glaucoma , Síndrome Endotelial Iridocorneana , Doenças da Íris , Endotélio Corneano , Feminino , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
Cornea ; 41(2): 159-164, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34351729

RESUMO

PURPOSE: To evaluate the long-term outcomes of Descemet-stripping endothelial keratoplasty (DSEK) in 52 eyes with iridocorneal endothelial (ICE) syndrome. METHODS: Retrospective study of 52 eyes of 52 patients who were diagnosed with ICE syndrome and underwent DSEK between January 2010 and December 2019 with a follow-up of at least 6 months. RESULTS: The mean age was 48.8 ± 10.8 years. Female patients (n = 33) constituted 63.5%. The median duration of follow-up was 2.4 years (range, 0.5-9.1 yrs). The mean best-corrected visual acuity improved significantly after surgery and remained stable (∼20/50) through 5 years. The mean endothelial cell loss was 28%, 37.9%, 43.6%, and 56.9% at 6 months and at 1, 2, and 3 years, respectively. Graft rejection was noted in 5 eyes (9.6%). Postoperatively, increased intraocular pressure (IOP) was seen in 17 eyes (32.7%), and 10 eyes (19.2%) underwent glaucoma surgeries. Fourteen eyes (26.9%) had secondary graft failures. The estimates of graft success were 93.6% ± 3.6% at 1 year, 85.6% ± 5.5% at 2 years, 79.3% ± 6.7% at 3 years, 69.0% ± 8.9% at 4 years, and 59.1% ± 11.9% at 5 years. Postoperative increased IOP was found to be the only significant (P = 0.05) risk factor (hazard ratio 8.92) associated with graft failure. The clinical variant of ICE syndrome did not seem to influence the graft survival (P = 0.68). CONCLUSIONS: In this study, DSEK had a success rate of ∼60% at 5 years. Increased IOP post-DSEK is a significant risk factor for graft failure. Graft survival is not affected by the clinical variant of ICE syndrome.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/métodos , Rejeição de Enxerto/epidemiologia , Síndrome Endotelial Iridocorneana/cirurgia , Acuidade Visual , Adulto , Idoso , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Incidência , Índia/epidemiologia , Síndrome Endotelial Iridocorneana/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
16.
Arch Soc Esp Oftalmol (Engl Ed) ; 96(8): 430-433, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34340781

RESUMO

Our purpose is to report the intermediate-term results of the Ex-PRESS® implant as the first surgical option in patients with Iridocorneal Endothelial (ICE) Syndrome. We describe two patients diagnosed from ICE syndrome with medically uncontrolled glaucoma and finally treated with an Ex-PRESS® implant, associating a cataract surgery in one of them. Three years after surgery, intraocular pressure remains stable without any additional medical antiglaucomatous treatment, with a well-located implant surrounded by a diffuse filtering bleb and no sight-threatening adverse events have been documented. In addition, no progression of the disease has been registered. This report encourage the Ex-PRESS® implant to be considered the first surgical option in this patients as it allows a permeable ostium in spite of the progressive synechial angle closure typical of the ICE syndrome.


Assuntos
Implantes para Drenagem de Glaucoma , Síndrome Endotelial Iridocorneana , Seguimentos , Humanos , Síndrome Endotelial Iridocorneana/cirurgia , Tonometria Ocular , Resultado do Tratamento
18.
Semin Ophthalmol ; 36(7): 561-568, 2021 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-33750265

RESUMO

PURPOSE: To investigate endothelial imaging patterns in ICE syndrome and correlate these with the observed clinical features in the affected eye. METHODS: Of the 70 patients of ICE syndrome referred from the glaucoma clinic between 2017 and 18, 17 patients had a clear cornea for reliable endothelial imaging were included in the study. RESULTS: Mean age was 47(range 29-63) years; 9 males and 8 females. The right eye was involved in 10 and left eye in 7 patients. Mean best corrected visual acuity was 20/30 (20/20-20/80) in the affected eye. All 17 patients had clear and compact central cornea and reasonably good vision at the time of specular microscopy. Those with best corrected visual acuity <20/20 had cataract as a co-morbidity. Endothelial abnormalities were noted in all patients and were documented using Hirst and modified Sherrard's classification system. As per the modified Sherrard's classification system, 9 eyes were categorised into total ICE, 5 eyes into subtotal ICE, in 3 eyes grading could not be applied. Of the 4 subtotal ICE, 1 was subtotal ICE (+) and 3 were subtotal ICE (-). 12/17 patients had glaucomatous disc. CONCLUSIONS: Specular microscopy provides information on the various morphological pattern of endothelial abnormalities and helps in mapping out the areas with abnormal/diseased endothelium. These have implications in the management of ICE syndrome.


Assuntos
Edema da Córnea , Síndrome Endotelial Iridocorneana , Adulto , Córnea , Edema da Córnea/diagnóstico , Endotélio Corneano , Feminino , Humanos , Síndrome Endotelial Iridocorneana/diagnóstico , Masculino , Microscopia , Pessoa de Meia-Idade
19.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563680

RESUMO

To report the outcomes of endothelial keratoplasty (EK) combined with near total iridectomy in the management of iridocorneal endothelial (ICE) syndrome with severely disorganised anterior segment. Three patients with ICE syndrome, who had a severely disorganised anterior segment underwent near total iridectomy, with/without cataract surgery, followed by EK at the same time. Mean age was 35 years. Prior to EK, the intraocular pressure (IOP) was in the range of 12-15 mm Hg. One patient (patient 2) had advanced disc damage prior to EK. Two eyes (patients 1 and 2) had a glaucoma drainage device, and in one, the IOP was controlled with two antiglaucoma medications. All grafts were clear, and IOP was well controlled till the last mean follow-up of 53 (range 30-72) months. The outcomes of EK with this surgical approach are favourable and should be considered in selective cases of ICE syndrome.


Assuntos
Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Iridectomia , Síndrome Endotelial Iridocorneana/cirurgia , Adulto , Feminino , Humanos , Acuidade Visual
20.
Exp Eye Res ; 205: 108495, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33596440

RESUMO

The corneal endothelial monolayer and associated Descemet's membrane (DM) complex is a unique structure that plays an essential role in corneal function. Endothelial cells are neural crest derived cells that rest on a special extracellular matrix and play a major role in maintaining stromal hydration within a narrow physiologic range necessary for clear vision. A number of diseases affect the endothelial cells and DM complex and can impair corneal function and vision. This review addresses different human corneal endothelial diseases characterized by loss of endothelial function including: Fuchs endothelial corneal dystrophy (FECD), posterior polymorphous corneal dystrophy (PPCD), congenital hereditary endothelial dystrophy (CHED), bullous keratopathy, iridocorneal endothelial (ICE) syndrome, post-traumatic fibrous downgrowth, glaucoma and diabetes mellitus.


Assuntos
Edema da Córnea/etiologia , Substância Própria/patologia , Endotélio Corneano/patologia , Transtornos da Visão/etiologia , Vesícula/complicações , Vesícula/patologia , Distrofias Hereditárias da Córnea/complicações , Distrofias Hereditárias da Córnea/patologia , Distrofia Endotelial de Fuchs/complicações , Distrofia Endotelial de Fuchs/patologia , Humanos , Síndrome Endotelial Iridocorneana/complicações , Síndrome Endotelial Iridocorneana/patologia
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