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1.
BMC Ophthalmol ; 18(Suppl 1): 222, 2018 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-30255798

RESUMEN

BACKGROUND: The surgical management of patients with uncontrolled glaucoma and scleroderma is challenging, as the hostile ocular surface poses a challenge to surgery. A serious complication is tube erosion, with the risk of subsequent endophthalmitis. Here, we present a novel technique of harvesting autologous tissue to successfully manage recurrent tube extrusion. CASE PRESENTATION: MG is a 60-year-old Arabic lady diagnosed with scleroderma, that was previously managed with systemic corticosteroids. She has chronic open angle glaucoma, with a failed left eye trabeculectomy, which was then managed by a Baerveldt tube (BVT) insertion. Eight months after this primary surgery, she developed an anterior uveitis. This was further complicated by conjunctival erosion, tube exposure, leak around the sclerostomy site and hypotony. The erosion was likely secondary to her tight eyelids as a result of her scleroderma. She was taken back to theatre for tube revision, with single layer amniotic membrane transplant (AMT) over the exposed area, but the tube was eroding again after 2 months. She eventually underwent tube extraction, pars plana tube plate stabilisation, pars plana vitrectomy (PPV), pars plana tube insertion, phacoemulsification and intra-ocular lens insertion, jointly with the vitreo-retinal surgeons and with high dose prednisolone cover both pre- and post-operatively. We harvested the capsule which had grown over the end plate of the original tube. We sutured this over the new tube, specifically over a single layer of tutoplast prior to conjunctival closure. Almost a year on, the pars plana tube remains in place with no complications. CONCLUSIONS: This case highlights the role of a pars plana tube in cases of cicatricial disease, with the use autologous tissue instead of grafts wherever possible. In patients with systemic disease such as scleroderma, pre-operative immunosuppression helps to reduce the of erosion in difficult cases.


Asunto(s)
Enfermedades de la Conjuntiva/cirugía , Implantes de Drenaje de Glaucoma/efectos adversos , Glaucoma de Ángulo Abierto/cirugía , Presión Intraocular , Procedimientos Quirúrgicos Oftalmológicos , Falla de Prótesis/etiología , Esclerodermia Sistémica/complicaciones , Enfermedades de la Conjuntiva/etiología , Femenino , Humanos , Implantación de Lentes Intraoculares , Persona de Mediana Edad , Facoemulsificación , Recurrencia , Uveítis Anterior/etiología , Vitrectomía
2.
J Refract Surg ; 39(10): 654-661, 2023 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-37824303

RESUMEN

PURPOSE: To evaluate the visual outcome, light distortion index (LDI), and quality of life (QoL) of patients implanted with two complementary intraocular lenses (IOLs) to treat cataract and presbyopia. METHODS: Twenty-seven consecutive patients with cataract were treated with the implantation of the Artis Symbiose Mid (Mid) IOL (Cristalens Industrie) in the distance-dominant eye and the Artis Symbiose Plus (Plus) IOL (Cristalens Industrie) in the contralateral eye following phacoemulsification. The primary objective was to ascertain the monocular and binocular defocus curves. Secondary endpoints included uncorrected distance visual acuity, corrected distance visual acuity, uncorrected intermediate visual acuity, and distance-corrected intermediate visual acuity at 90 and 70 cm, uncorrected near visual acuity and distance-corrected visual acuity at 40 cm, contrast sensitivity, LDI with a halometer, stereopsis, and patients' QoL with the validated Visual Function Index (VF-14) questionnaire. These measurements were collected in two visits, at 4.14 ± 3.13 and 10.30 ± 3.14 months postoperatively. RESULTS: Statistically significant differences in the monocular defocus curves were found at the defocus steps of -1.00, -1.25, -1.50, -1.75, -2.50, -2.75, -3.00, -3.50 diopters and the -4.00 diopters (P < .050). The mean binocular defocus curve was 0 logMAR or better from the +0.50 to the -2.50 D defocus steps. Contrast sensitivity was within normal values. The LDI was 12.57 (6.61)% for the Mid eyes, 14.99 ± 5.70% for the Plus eyes, and 10.36 ± 4.42% binocularly. The patients' stereopsis was 40.0 (12.5) arc-seconds. The QoL score was 95.99 (7.14) at 10 months. CONCLUSIONS: The implantation of the Artis Symbiose IOLs was a safe and effective treatment for presbyopia compensation in patients with cataract. Both IOLs are complementary and may produce a binocular depth-of-field of 3.00 diopters over 0 logMAR when used together. [J Refract Surg. 2023;39(10):654-661.].


Asunto(s)
Catarata , Lentes Intraoculares , Facoemulsificación , Presbiopía , Humanos , Calidad de Vida , Implantación de Lentes Intraoculares , Presbiopía/cirugía , Visión Binocular , Estudios Prospectivos , Percepción de Profundidad , Diseño de Prótesis , Satisfacción del Paciente , Refracción Ocular
3.
Eur J Ophthalmol ; : 11206721211050338, 2021 Oct 08.
Artículo en Inglés | MEDLINE | ID: mdl-34623172

RESUMEN

PURPOSE: To report a case of bilateral iatrogenic pigmentary glaucoma secondary to cosmetic iris-lightening laser treatment. CASE REPORT: A 39-year-old patient presented with bilateral iatrogenic pigmentary glaucoma. She had elevated intraocular pressures (IOPs), scattered iris pitting, and intense angle pigmentation secondary to the cosmetic laser treatment she underwent 4 weeks prior to presentation. Her IOPs were refractory to maximal medical treatment and she subsequently underwent trabeculectomy. CONCLUSION: The true scale of complications related to cosmetic laser treatments is as yet unknown. Robust clinical investigations into its safety profile, including long-term data, are required. Prospective patients should consider this with great care. Clinicians should be aware of the potential risks of this procedure, as early recognition of cosmetic laser-induced pigmentary glaucoma may avert further sequelae.

5.
Neurodegener Dis Manag ; 7(2): 157-172, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28540772

RESUMEN

Glaucoma is a neurodegenerative disease with an estimated prevalence of 60 million people, and the most common cause of irreversible blindness worldwide. The mainstay of treatment has been aimed at lowering intraocular pressure, currently the only modifiable risk factor. Unfortunately, despite adequate pressure control, many patients go on to suffer irreversible visual loss. We first briefly examine currently established intraocular pressure lowering-treatments, with a discussion of their roles in neuroprotection as demonstrated by both animal and clinical studies. The review then examines currently available intraocular pressure independent agents that have shown promise for possessing neuroprotective effects in the management of glaucoma. Finally, we explore potential future treatments such as immune-modulation, stem cell therapy and neural regeneration as they may provide further protection against the neurodegenerative processes involved in glaucomatous optic neuropathy.


Asunto(s)
Glaucoma/tratamiento farmacológico , Enfermedades Neurodegenerativas/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Animales , Humanos , Enfermedades Neurodegenerativas/terapia , Trasplante de Células Madre
6.
J Cataract Refract Surg ; 41(1): 230-3, 2015 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-25532648

RESUMEN

UNLABELLED: We report the case of a 65-year-old immunocompetent woman who developed Scedosporium apiospermum keratitis after clear-corneal phacoemulsification. A 3.5 mm by 2.7 mm full-thickness stromal infiltrate, corresponding to the superior 2.75 mm clear-corneal incision, was observed 44 days postoperatively. Treatment included preservative-free voriconazole 1.0% hourly, ofloxacin 0.3% 6 times a day, oral voriconazole 200 mg once daily, natamycin 5.0% hourly, dexamethasone 0.1% 4 times a day, and ocular cyclosporine 4 times a day. After 4 months of treatment, the new vessels had regressed, the infiltrate had disappeared, and residual deep scarring remained; the uncorrected distance visual acuity was 0.8 logMAR. To our knowledge, this is the first case of S apiospermum keratitis following clear-corneal phacoemulsification. Another unusual feature is that there were no risk factors for fungal keratitis, specifically no history of trauma, systemic illness, immunosuppression, or contact lens wear. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.


Asunto(s)
Úlcera de la Córnea/microbiología , Micosis/microbiología , Facoemulsificación/efectos adversos , Scedosporium/aislamiento & purificación , Anciano , Antifúngicos/uso terapéutico , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/tratamiento farmacológico , Quimioterapia Combinada , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/microbiología , Femenino , Humanos , Inmunocompetencia , Implantación de Lentes Intraoculares , Microscopía Confocal , Micosis/diagnóstico , Micosis/tratamiento farmacológico , Factores de Riesgo , Agudeza Visual/fisiología
7.
J Cataract Refract Surg ; 40(12): 1985-93, 2014 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-25465684

RESUMEN

PURPOSE: To review cases of central toxic keratopathy (CTK) occurring over a period of 46 days. SETTING: Moorfields Eye Hospital, London, United Kingdom. DESIGN: Retrospective consecutive case series. METHODS: This was a review of patients with CTK after uneventful laser in situ keratomileusis (LASIK) performed by 1 of 5 surgeons at a single institute. The following parameters were analyzed: corrected distance visual acuity (CDVA), manifest refraction, and central corneal thickness from Scheimpflug pachymetry readings (Pentacam). RESULTS: The cohort consisted of 15 eyes of 9 patients. Thirteen eyes were diagnosed within 7 days after LASIK, while the remaining 2 eyes developed CTK 12 days postoperatively. In 10 eyes, the time to resolution was 1 to 8 months. Five eyes still had residual signs at the last outpatient visit. At the final follow-up, 3 eyes (20%) had a CDVA worse than 0.0 logMAR. CONCLUSIONS: Although a rare entity, CTK can occur in clusters. Although a cause was not fully isolated, ultimately each eye achieved excellent CDVA (all better than 0.2 logMAR) at the last follow-up.


Asunto(s)
Sustancia Propia/patología , Queratitis/etiología , Queratomileusis por Láser In Situ/métodos , Láseres de Excímeros/uso terapéutico , Complicaciones Posoperatorias , Colgajos Quirúrgicos/patología , Adulto , Androstadienos/uso terapéutico , Antialérgicos/uso terapéutico , Topografía de la Córnea , Humanos , Hiperopía/cirugía , Queratitis/diagnóstico , Queratitis/tratamiento farmacológico , Etabonato de Loteprednol , Masculino , Microscopía Confocal , Miopía/cirugía , Refracción Ocular/fisiología , Estudios Retrospectivos , Agudeza Visual/fisiología
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