Spontaneous Closure of Cyclodialysis Cleft in a Case of Normal-Tension Glaucoma Post Ab-Interno Trabeculotomy.

A cyclodialysis cleft (CDC) is the detachment of longitudinal ciliary muscle from scleral spur, causing an unusual communication between anterior chamber and suprachoroidal space, resulting in possible hypotony. We report a case of a 63-year-old woman with normal-tension glaucoma (NTG), who developed a shallow anterior chamber with relatively low intraocular pressure (IOP, 6-8 mmHg) after combined ab-interno trabeculotomy and phacoemulsification. Her vision reached good (20/20) with the mild myopic shift. After detecting subtle signs of clinical hypotony, CDC was confirmed and monitored using anterior segment optical coherence tomography. Five months after surgery, she encountered an episode of eye pain, with transient IOP elevation and deepening of the anterior chamber. Spontaneous closure of CDC was suspected and confirmed gonioscopically. To the best of our knowledge, this is the first case to describe the clinical course of spontaneous CDC closure in a patient with NTG after ab-interno trabeculotomy. It is advisable to inform the patient about potential IOP spike after spontaneous closure once CDC is diagnosed.

A refractory malignant glaucoma posttrabeculectomy in vitrectomized eye: A case report and review of the literature.

The objective of this study is to report a case of refractory malignant glaucoma post trabeculectomy in vitrectomized eye and review of previous literature in PubMed database. A 63-year-old male encountered malignant glaucoma after trabeculectomy in vitrectomized eye. We had tried vitreous tapping with peripheral iridectomy and vitreous tapping with intracameral injection of room air (Chandler procedure). All of previous procedures were in vain. Finally, the yttrium-aluminum-garnet laser membranectomy with zonulectomy was done. The intraocular pressure is within normal range without any topical glaucoma eye drops during 3-year outpatient department regular follow-up. Complete vitrectomy with a patent tunnel from posterior chamber to anterior chamber (iridectomy-zonulectomy) is the effective procedure to manage of malignant-like glaucoma.

Descemet's membrane detachment following uneventful phacoemulsification surgeries: A case report.

RATIONALE: Descemet's membrane detachment (DMD) may occur during or following cataract surgery, causing corneal edema and visual loss1. The incidence of DMD after phacoemulsification surgery is only approximately 0.5%, and mostly surgical-related. Late onset bilateral spontaneous DMD after sequential uneventful cataract surgeries, is even rarer, and may result from not only surgery itself, but also from an underlying anatomic abnormality 2. PATIENT CONCERNS: We present a 80 year old female developed bilateral descemet's membrane detachment after sequential uncomplicated cataract surgeries. DIAGNOSIS: Bilateral Descemet's membrane detachment. INTERVENTIONS: One eye (left eye) was treated with intracameral air injection and the fellow eye (right eye) was treated with medical treatment only. OUTCOMES: The DMDs were reattached in both eyes after treatment. Surgical intervention accelerated the duration of recovery and there were no significant outcome differences between the right and the left eye. LESSONS: Even if there is a large area of DMD with visual axis involvement, conservative treatment with close observation might still provide a satisfactory result if Descemet's membrane is separated from the posterior corneal stroma by ≤1 mm.

Management of hypotony after glaucoma filtering surgery.

A 39-year-old male with open angle glaucoma in both eyes visited our clinic. The intraocular pressure (IOP) of both eyes fluctuated between 15 mmHg and 25 mmHg. The best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/100 in the left eye. He underwent trabeculectomy with an adjunctive agent (mitomycin C; concentration, 0.2 mg/mL) smoothly on the right eye. After the removal of releasable sutures, the filtering bleb was prominent over the superior limbus for 3 consecutive clock hours with an IOP of about 4-5 mmHg. The Seidel test result was negative, and the anterior chamber depth was moderate to deep. The BCVA of the right eye decreased to 20/100, and optical coherence tomography revealed macular edema. We injected sodium hyaluronate (Healon, Abbott Medical Optics, Santa Ana, CA, USA) into the anterior chamber 2 months after the operation, and repeated the same procedure 4 days later. After each injection, the IOP spiked up to 50 mmHg, and an intravenous infusion of mannitol was required. Sodium hyaluronate was found migrating into the bleb on post-injection day 1. Then we decided to revise the bleb by suturing the scleral flap at two sides. The IOP of the right eye returned to 10 mmHg 4 days after the revision surgery. The BCVA of the right eye recovered to 20/20 6 months after the revision. Optical coherence tomography also showed recovery from macular edema. One IOP-lowering agent (1% brinzolamide ophthalmic suspension) was required for IOP control after bleb revision. Early revision of the scleral flap may resolve hypotony and associated serious complications.

Suture fixation technique for posterior chamber intraocular lenses.

We describe a modified method for scleral fixation of posterior chamber intraocular lenses (IOLs). A double-armed, 10-0 polypropylene (Prolene) suture on a curved long needle is passed through a groove in the sclera and retrieved within the barrel of a bent 25-gauge needle through the opposite groove. Double transscleral passages enable 4-point fixation and provide better stability and centration. Knots are buried completely in the scleral groove. In a series of 10 cases, the IOLs were well centered, no sutures protruded from the scleral groove, and the vision in all eyes improved. In 1 case, a ciliary hemorrhage occurred during insertion of the 25-gauge needle, but the bleeding stopped after ocular pressure reform. This technique is easy to perform, improves centration and stability of the IOL, and avoids suture exposure.