Diffuse Corneal Edema after Uneventful Pterygium Surgery: Toxic Anterior Segment Syndrome or Toxic Keratopathy?

A 29-year-old woman was referred to our department for corneal edema after uneventful pterygium excision surgery with conjunctival autografting. She was prescribed topical dexamethasone and showed a complete response within 2 weeks of treatment. Specular microscopic examination revealed severe endothelial cell loss in the operated eye. Mild corneal haze causing a decrease in vision (20/50) was observed in long-term follow-up. This steroid-responsive complication was linked to two possible etiologies: mild toxic anterior segment syndrome or povidone-iodine (PVP-I) corneal toxicity. Surgeons should be careful during pterygium surgery to completely clear PVP-I and avoid any penetration into the anterior chamber to prevent possible serious complications. When diffuse corneal edema is encountered after pterygium surgery, intense steroid treatment should be prescribed as in the present case.

Evaluation of risk factors for complications after colostomy closure.

OBJECTIVE: The goal of the study is to describe postoperative complications observed after colostomy reversal and to define possible risk factor(s) for complication.s after colostomy closure PATIENTS-METHODS: Patients who underwent colostomy closure in Department of General Surgery, Dr Lutfi Kirdar Kartal Education and Research Hospital between January 2007 and January 2015 were enrolled. Patients with double-barrel ileo-colostomy, Devine's colostomy and tube cecostomy were excluded from study. Demographics, data regarding the first operation and those regarding the reversal operation were analyzed and compared. RESULTS: Total 168 patients [118 (70.1%) male, average age=52.8±15.6] were included. Most common reasons for stoma formation were malignancy [n=63 (37.5%)] and diverticular perforation [40 (23.8%)]. Index operation was performed under emergency conditions in 142 (84.5%) patients. End colostomy was the most common stoma type in emergent cases and loop sigmoidostomy in elective cases. Postoperative complication was observed in 36 (21.4%) patients. Nine (5.3%) patients developed anastomotic leak. Of those, 8 (4.8%) was necessitated reoperation and 1 (0.6%) was treated conservatively. Postoperative mortality was 5 (2.9%). At multivariate analysis, DM was the independent risk factor for surgical site infection and evisceration (p<0.01). DM was present in 6 (66.7%) cases who had had an anastomotic leak and leak was more common compared to non-diabetics (p<0.05). Patients waiting more than 3 months before stoma reversal had experienced more anastomotic leak compared to those waiting less (p<0.05). CONCLUSION: Closure of colostomy has a significant morbidity and mortality, and the physician should be more careful in postoperative follow-up in patients who had comorbidities, especially diabetes mellitus. KEY WORDS: Anastomotic leak, Colostomy, Postoperative complication.

The Course of the Changes in Anterior Chamber Parameters After Laser Peripheral Iridotomy: Follow-up for 6 Months With a Scheimpflug-Placido Disc Topographer.

PURPOSE: To evaluate the course of the changes in anterior chamber (AC) parameters using a Scheimpflug-Placido disc topographer before and through 6 months after laser peripheral iridotomy (LPI). MATERIALS AND METHODS: A total of 109 eyes of 56 consecutive patients classified as primary angle closure suspect (PACS), primary angle closure (PAC), and primary angle closure glaucoma (PACG) were included in this prospective, interventional, observational case series. Anterior chamber volume (ACV), central anterior chamber depth (CACD), and anterior chamber angle (ACA) were measured by Scheimpflug photography preoperatively and at 1, 3, and 6 months after LPI. With respect to the parameters above, alterations in the measurements were assessed to determine whether the effects induced by LPI on AC morphology persisted with time. RESULTS: At 1 month after LPI, mean ACV, CACD, and ACA increased significantly in all groups (P<0.05). However, in eyes with PACG, significant reductions at 3 months in ACA [0.00 (-1.00 to 0.00) degrees, median (Md) [quartile 1 (Q1) to quartile 3 (Q3)], P=0.032] and at 6 months in ACV [-1.00 (-2.25 to 1.00) µL, P=0.043) and CACD (-0.01 (-0.02 to 0.00) mm, P=0.006) were shown. On analysis of all eyes together, a weak correlation was found between axial length and the change in CACD (r=0.266, P=0.007). Eyes with ACA≤25 degrees widened by 6.6±2.8 degrees versus 4.9±2.4 degrees in eyes with ACA>25 degrees at 1 month after the procedure (P=0.002). CONCLUSIONS: Scheimpflug-Placido disc topographer detected significant changes in the AC parameters after LPI in all groups. However, compared with PACS and PAC, the PACG showed significant alterations in the AC parameters through 6 months.

Phacoemulsification in patients with nanophthalmos.

OBJECTIVE: To evaluate phacoemulsification surgery and its possible risks in patients with nanophthalmos. DESIGN: The surgical procedure, corneal diameter, keratometry, axial length, visual acuity, and intraoperative and postoperative complications were reviewed. Scleral thickness was determined by echography. PARTICIPANTS: 5 patients, 8 eyes. METHODS: The results of cataract surgery in nanophthalmic eyes were reviewed. Inclusion criteria was based on a clinical diagnosis of nanophthalmos and ocular surgery for cataract. Nanophthalmos was diagnosed according to a shorter than average axial length (usually less than 20.0 mm), typically a shallow anterior chamber, hyperopia, and scleral thickening greater than 1.5 mm. The procedure was planned as phacoemulsification, and foldable acrylic PCIOL implantation via a clear corneal tunnel. RESULTS: The procedure was planned as phacoemulsification. Six eyes had cataract extraction with posterior chamber intraocular lens implantation by phacoemulsification. It was necessary to change the procedure to extracapsular cataract surgery in 2 cases because of uncontrolled shallowing of the anterior chamber. Postoperative trabeculectomy was needed in 1 eye, and Nd:YAG laser capsulotomy was performed on 4 eyes. No postoperative uveal effusion or infections were seen in any of the eyes. Complications included iritis with posterior synechia (n = 1), transient choroidal hemorrhage (n = 1), vitreous loss (n = 1), posterior capsule opacity (n = 4), and glaucoma (n = 1). In 1 case retinal detachment developed 3 weeks postoperatively. Prophylactic laser iridoplasty or iridotomy was not performed for surgery. CONCLUSIONS: Although phacoemulsification seems to be relatively safe in nanophthalmic patients without performing any prophylactic surgical procedure, surgeons need to be attentive of the challenges of working through them when performing phacoemulsification in these high-risk eyes. However, with careful preoperative evaluation and planning, complications can be avoided.