RESUMEN
A 25-year-old man consulted us with a severe exacerbation of pustular psoriasis for 10 days (Figure 1). The patient had pustular psoriasis for the last 12 years. During his hospital stay, he suffered sudden painless and profound loss of vision in both eyes. Subsequently, he was referred to an ophthalmologist. Slit lamp examination of both eyes revealed the presence of a clot in anterior chamber with neovascularization of the iris and the fibrovascular membrane covering the pupil and iris bombe formation nasally and inferiorly (Figure 2a). B-scan ultrasonography showed bilateral vitreous hemorrhage with normal optic nerve head in the right eye and an optic nerve cyst in the left eye (Figure 3). His erythrocyte sedimentation rate was 32.0 mm/hour, while blood and urine screening tests along with review of other systems were found to be normal. The fundi were not visualized due to dense hemorrhage. There was no history of trauma, recent ocular surgery, diabetes, hypertension, hematologic abnormalities, and drug intake known to cause vitreous hemorrhage. Topical medication (eye drop atropine 1%, timolol 0.5%, moxifloxacin and dexamethasone combination) and oral prednisolone (60 mg per day for 2 weeks) were prescribed but were later withdrawn in view of no response and worsening of skin condition. In the past, he had received various treatments, including phototherapy, acitretin, methotrexate, apremilast, cyclosporine, and mycophenolate mofetil; however, his condition was recalcitrant.
Asunto(s)
Psoriasis , Hemorragia Vítrea , Adulto , Humanos , Iris , Masculino , Prednisolona , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologíaRESUMEN
A 47-year-old man presented with profound loss of vision in right eye and relative afferent pupillary defect. On fundus examination, posterior pole details were obscured due to dense vitreous haemorrhage. B-scan ultrasonography was performed that revealed a mushroom-shaped hyperechoic lesion with medium internal reflectivity on A-scan ultrasonography. After performing contrast-enhanced MRI of the orbit, a diagnosis of choroidal melanoma was established. Patient was managed using plaque brachytherapy based on multiplanar MRI. This was followed 10 months later by pars plana vitrectomy and cataract extraction. Vision postoperatively improved to 20/60. A systematic clinical assessment along with supportive ancillary investigations augments diagnostic accuracy and reduces delay in definitive management.
Asunto(s)
Braquiterapia , Neoplasias de la Coroides , Melanoma , Neoplasias de la Úvea , Neoplasias de la Coroides/complicaciones , Neoplasias de la Coroides/diagnóstico por imagen , Neoplasias de la Coroides/radioterapia , Humanos , Masculino , Melanoma/complicaciones , Melanoma/radioterapia , Persona de Mediana Edad , Vitrectomía , Hemorragia Vítrea/diagnóstico por imagen , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaRESUMEN
RATIONALE: Optic disk hemorrhage has been closely correlated with glaucoma for its development and progression. Phacoemulsification surgery results in large intraocular pressure (IOP) fluctuation. We report a case of optic disk hemorrhage and consequently progressive vitreous hemorrhage after an unsuccessful phacoemulsification surgery in an advanced normal tension glaucoma (NTG) patient. PATIENT CONCERNS: An advanced NTG patient of 82 years old with chronic hypertension underwent an unsuccessful phacoemulsification surgery complicated by posterior capsule rupture. During the postoperative 2 weeks, recurrent episodes of fresh hyphema occurred and B ultrasonography scan revealed the progressive vitreous hemorrhage. The IOP went out of control under the maximum tolerable IOP-lowering medications. DIAGNOSIS: Vitreous hemorrhage after phacoemulsification in an advanced NTG patient. INTERVENTIONS: Vitrectomy was performed to search for the cause of the progressive vitreous hemorrhage. After removal of the thick vitreous hemorrhage, a fresh spot of optic disk hemorrhage was detected at the nasal margin of the significantly-cupping disk. OUTCOMES: Postoperatively, the hemorrhagic vitreous opacity gradually resolved and the IOP remained stable at 10 â¼13âmmHg with topical prostaglandin analogue drops. Fundus examination revealed the dilated disk vessel with localized angiomatous change at the nasal disk margin. LESSONS: Severe optic disk hemorrhage may occur after phacoemulsification in advanced glaucoma patients. Systemic vascular factors, such as chronic hypertension and old age, and surgical complications, such as posterior capsule rupture and postoperative IOP elevation, would further increase the risk. For phacoemulsification in advanced glaucoma cases, extra care should be taken to control intraoperative IOP fluctuations and monitor postoperative IOP.
Asunto(s)
Glaucoma/complicaciones , Disco Óptico , Facoemulsificación/efectos adversos , Complicaciones Posoperatorias/etiología , Hemorragia Retiniana/etiología , Hemorragia Vítrea/etiología , Anciano de 80 o más Años , Humanos , MasculinoRESUMEN
Objective: To evaluate the efficacy of large spot indirect ophthalmoscopy laser alone or combined with systemic chemotherapy in the treatment of early and middle stage retinoblastoma. Methods: Retrospective series case study. Clinical data of 21 patients (22 eyes) who were diagnosed as retinoblastoma (RB) in Peking University People's Hospital from March 2009 to August 2014 were collected. Medical and family history, ocular ultrasound, orbital and cranial MRI or CT examination of RB Children were detailed recorded. Ocular examination and laser treatment were performed under general anesthesia, once every 3-4 weeks until the tumor was under control. The observation period was at least 3 months after the last treatment. The ocular examination included intraocular pressure measurement, anterior segment and fundus examination and the fundus photography with Retcam. Laser therapeutic instrument was large spot indirect ophthalmoscopy laser of 810nm wavelength. Results: Of the 21 children, 16 were male and 5 were female. The range of age was 3 to 82 months averaged 17.3 months. Among 22 eyes, four with small tumor, eight with medium tumor, and ten with large tumor. Two eyes underwent laser treatment only and 20 eyes underwent laser treatment combined with systemic chemotherapy. During the average observation period of 33.9 months, 15 tumors were treated successfully, but 7 failed. The total success rate was 68.2%. The number and success rate of small, medium and large tumor eyes were 4 (100%), 5 (62.5%) and 5 (50%), respectively. There was one case of tumor brain metastases, and the classification of contralateral eye of the child was E phase. COMPLICATIONS: Iris burns happened in one eye, obvious vitreous proliferation in one eye and mild vitreous hemorrhage occurred in two eyes, which did not affect the treatment of laser. However, obvious tumor hemorrhage happened in two eyes and affected laser therapy. There was no complicated cataract, iatrogenic retinal hole and tumor intravitreal implant caused by laser blasting effect. Conclusions: Indirect ophthalmoscope laser in 810-nm diode laser with large-spot alone or combined with systemic chemotherapy may be effective treatment for retinoblastoma in earlier than stage C of international classification. It is suitable for large and multiple retinoblastoma.(Chin J Ophthalmol, 2016, 52: 745-748).
Asunto(s)
Terapia por Láser/métodos , Oftalmoscopía/métodos , Neoplasias de la Retina/terapia , Retinoblastoma/terapia , Niño , Preescolar , Terapia Combinada/métodos , Enucleación del Ojo , Femenino , Fondo de Ojo , Humanos , Hipertermia Inducida , Lactante , Iris/lesiones , Terapia por Láser/efectos adversos , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Resultado del Tratamiento , Hemorragia Vítrea/etiologíaRESUMEN
The purpose of this article is to report a case with rubeosis iridis treated by intravitreal aflibercept. A 61-year-old man had iris neovascularization and scanty vitreous hemorrhage secondary to proliferative diabetic retinopathy in the right eye. Neither neovascularization of angle nor elevation of intraocular pressure was found. Single intravitreal aflibercept 2 mg injection was performed. Rubeosis iridis disappeared on the next day. Scattered retinal laser photocoagulation was added 1 week later. There was no recurrence after 3-month follow-up. Aflibercept may serve as another anti-vascular endothelial growth factor (anti-VEGF) for treating rubeosis iridis.
Asunto(s)
Retinopatía Diabética/complicaciones , Iris/irrigación sanguínea , Neovascularización Patológica/tratamiento farmacológico , Receptores de Factores de Crecimiento Endotelial Vascular/administración & dosificación , Proteínas Recombinantes de Fusión/administración & dosificación , Humanos , Inyecciones Intravítreas , Terapia por Luz de Baja Intensidad/métodos , Masculino , Persona de Mediana Edad , Neovascularización Patológica/etiología , Factor A de Crecimiento Endotelial Vascular/antagonistas & inhibidores , Hemorragia Vítrea/etiologíaRESUMEN
PURPOSE: The purpose of this study is to evaluate the efficacy of preoperative intravitreal bevacizumab (IVB) for improving outcomes in vitrectomy for diabetic retinopathy-related non-clearing vitreous haemorrhage and/or tractional retinal detachment. METHODS: Medical record from patients undergoing vitrectomy for proliferative diabetic retinopathy (PDR) were retrospectively analysed (2003-2011). From 2007, IVB (1.25 mg 2-4 days before operating) was used on all eyes. Eyes receiving IVB were compared with those that did not receive IVB. Intraoperative complications, reoperation rates, and final visual acuity were the core outcome measures. RESULTS: Data were analysed for 88 patients (101 eyes). In all, 41 (41%) patients had received IVB, whereas 60 (59%) patients had not. Significant intraoperative haemorrhage occurred in six eyes (10%) in the non-IVB group and in one (2.4%) IVB eyes (P=0.24). Silicon oil was used in 29 (48%) non-IVB eyes and in 11 (27%) IVB eyes (P=0.03). The non-IVB eyes underwent significantly more vitreoretinal reoperations (P=0.01) and were significantly more likely to lose two or more lines of vision at the final follow-up (P=0.03). The numbers needed to treat (NNT) blindness (<3/60) was four for non-IVB eyes and two for the IVB group. CONCLUSIONS: IVB reduces surgical complications, the use of silicon oil, and the need for further retinal surgery. The NNT to restore useful vision (≥3/60) to a blind eye were significantly lower in the IVB group. Vitreoretinal surgery for the complications of PDR is effective in an East African context, and IVB should be considered a valuable adjunct.
Asunto(s)
Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Retinopatía Diabética/terapia , Desprendimiento de Retina/terapia , Cirugía Vitreorretiniana/métodos , Hemorragia Vítrea/terapia , Adulto , África Oriental , Anciano , Análisis de Varianza , Bevacizumab , Estudios de Casos y Controles , Quimioterapia Adyuvante/métodos , Retinopatía Diabética/complicaciones , Femenino , Humanos , Complicaciones Intraoperatorias/prevención & control , Masculino , Persona de Mediana Edad , Periodo Preoperatorio , Reoperación/estadística & datos numéricos , Desprendimiento de Retina/etiología , Estudios Retrospectivos , Agudeza Visual , Hemorragia Vítrea/etiología , Adulto JovenAsunto(s)
Terapia por Acupuntura/instrumentación , Lesiones Oculares Penetrantes/etiología , Agujas/efectos adversos , Lesiones por Pinchazo de Aguja/etiología , Retina/lesiones , Perforaciones de la Retina/etiología , Terapia por Acupuntura/efectos adversos , Anciano , Antihipertensivos/uso terapéutico , Tartrato de Brimonidina , Terapia Combinada , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/cirugía , Glaucoma/terapia , Humanos , Coagulación con Láser , Masculino , Lesiones por Pinchazo de Aguja/diagnóstico , Lesiones por Pinchazo de Aguja/cirugía , Quinoxalinas/uso terapéutico , Perforaciones de la Retina/diagnóstico , Perforaciones de la Retina/cirugía , Timolol/uso terapéutico , Agudeza Visual , Vitrectomía , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaRESUMEN
A 50-year-old man presented with uncontrolled erythroclastic glaucoma and recurrent vitreous hemorrhage from a previously irradiated choroidal melanoma. Despite trabeculectomy, intraocular pressure became uncontrolled due to increasing bleeding from the melanoma. The vitreous hemorrhage became voluminous and could not be stopped with multiple vitrectomies with endolaser, transpupillary thermotherapy, and transscleral laser. Endoresection of the regressed tumor and its bleeding vasculature resulted in immediate cessation of the bleeding and control of the intraocular pressure.
Asunto(s)
Sangre , Neoplasias de la Coroides/cirugía , Glaucoma/cirugía , Melanoma/cirugía , Hemorragia Vítrea/cirugía , Braquiterapia , Neoplasias de la Coroides/diagnóstico por imagen , Neoplasias de la Coroides/radioterapia , Glaucoma/etiología , Humanos , Hipertermia Inducida , Presión Intraocular , Radioisótopos de Yodo , Masculino , Melanoma/diagnóstico por imagen , Melanoma/radioterapia , Persona de Mediana Edad , Recurrencia , Trabeculectomía , Ultrasonografía , Agudeza Visual , Vitrectomía , Hemorragia Vítrea/etiologíaRESUMEN
INTRODUCTION: Local anesthesia for eye surgery was first described in 1884; later Knapp popularized retrobulbar anesthesia. To reduce risks, peribulbar anesthesia appeared in the 1970s. Still used today, periocular anesthesia is not without complications, in particular the risk of ocular perforation. PATIENTS AND METHODS: Three patients were referred to our department for diagnosis and treatment of an intravitreous hemorrhage following cataract surgery. We report the clinical features, treatment, and visual outcome for these three patients. RESULTS: The most common presentation was vitreous hemorrhage: the three eyes were found to have associated retinal detachment on initial assessment. One patient presented severe vitreoretinal proliferation with two postoperative recurrences; the globe was finally enucleated. The two other patients presented attached retina after surgery but had achieved very poor visual recovery. CONCLUSION: Inadvertent globe perforation during local ocular anesthesia is rare. Careful attention to risk factors, early recognition, and prompt referral for management are recommended to improve the visual prognosis. Surgical management must be adapted to the severity of the perforation (vitreous hemorrhage, retinal detachment, vitreoretinal proliferation). The problems treating these patients with severe, often recurrent, retinal detachment, with poor visual prognosis, in a tricky forensic context should be emphasized.
Asunto(s)
Anestesia Local/métodos , Extracción de Catarata , Lesiones Oculares Penetrantes/etiología , Inyecciones/efectos adversos , Complicaciones Posoperatorias/etiología , Retina/lesiones , Desprendimiento de Retina/etiología , Anciano , Electrocoagulación , Enucleación del Ojo , Femenino , Fluorocarburos , Humanos , Laceraciones/etiología , Fotocoagulación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Prótesis e Implantes , Recurrencia , Reoperación , Desprendimiento de Retina/cirugía , Vitrectomía , Hemorragia Vítrea/etiologíaRESUMEN
BACKGROUND: Though a needleless jet injection device (NJI device) has advantages over a conventional needle attached syringe for injecting anesthetics, safety of using it for lid surgery is not proved. We report a case of posterior segment injury suspected caused by a NJI device. METHODS: A 47-year-old woman presented with decreased visual acuity after regional anesthesia at the lower eyelids with a NJI device. RESULTS: Vitreous and subretinal hemorrhage was found associated with retinal edema adjacent to the optic disc of the right eye and around the inferior temporal arcade of the left eye. Fluorescein angiography revealed choroidal rupture in the both eyes. By 2 months, although the hemorrhage resolved, subretinal fibrosis and chorioretinal atrophy developed. Her vision decreased to 20/60 in the right eye and 20/40 in the left eye. CONCLUSION: The energy generated by the NJI device seemed to have reached the eyeballs to cause the blunt-typed posterior segment injuries. As choroidal rupture may result in a permanent visual loss, the risks associated the off-labeled use of the device for lid surgeries should be awakened.
Asunto(s)
Anestesia Local/instrumentación , Coroides/lesiones , Lesiones Oculares/etiología , Inyecciones a Chorro/efectos adversos , Heridas no Penetrantes/etiología , Anestésicos Locales/administración & dosificación , Lesiones Oculares/diagnóstico , Párpados/efectos de los fármacos , Femenino , Angiografía con Fluoresceína , Humanos , Persona de Mediana Edad , Hemorragia Retiniana/diagnóstico , Hemorragia Retiniana/etiología , Rotura , Trastornos de la Visión/diagnóstico , Trastornos de la Visión/etiología , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiología , Heridas no Penetrantes/diagnósticoRESUMEN
PURPOSE: To describe the complications of ganciclovir implant surgery in patients with cytomegalovirus retinitis. METHODS: Prospective data collection within the context of a randomized, controlled clinical trial, comparing a regimen of the ganciclovir implant plus oral ganciclovir to one of intravenous cidofovir for the treatment of cytomegalovirus retinitis in patients with AIDS. Adverse events were compared for patients undergoing implant surgery in the following groups: primary versus replacement implant surgery, inpatient versus outpatient surgery, and general versus local anesthesia. RESULTS: Fifty-six eyes of 42 patients underwent a total of 74 ganciclovir implant surgeries. Vitreous hemorrhage was the most common adverse event, occurring in 10% of eyes undergoing surgery with local anesthesia but in no eyes undergoing surgery with general anesthesia. All vitreous hemorrhages resolved within 60 days. Patients in the general anesthesia and inpatient surgery groups tended to have a lower risk of complications in the first 30 days than did patients in the local anesthesia and outpatient surgery groups, but no differences in the complication rate were found after 60 days. Visual acuity was similar among these different groups. There were no cases of endophthalmitis. CONCLUSION: Ganciclovir implant surgery in patients with AIDS and cytomegalovirus retinitis was associated with a low risk of serious complications in the first 60 days after surgery. Vitreous hemorrhage was the most commonly observed complication and resolved in all cases.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antivirales/uso terapéutico , Retinitis por Citomegalovirus/tratamiento farmacológico , Citosina/análogos & derivados , Implantes de Medicamentos/efectos adversos , Complicaciones Intraoperatorias , Organofosfonatos , Complicaciones Posoperatorias , Administración Oral , Adulto , Anestesia General , Anestesia Local , Cidofovir , Citosina/uso terapéutico , Femenino , Ganciclovir/uso terapéutico , Humanos , Infusiones Intravenosas , Masculino , Compuestos Organofosforados/uso terapéutico , Estudios Prospectivos , Agudeza Visual , Hemorragia Vítrea/etiologíaAsunto(s)
Neovascularización Coroidal/terapia , Oftalmopatías/etiología , Hemorragia/etiología , Hipertermia Inducida/efectos adversos , Anciano , Enfermedades de la Coroides/diagnóstico , Enfermedades de la Coroides/etiología , Neovascularización Coroidal/diagnóstico , Oftalmopatías/diagnóstico , Angiografía con Fluoresceína , Fóvea Central , Hemorragia/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/etiologíaRESUMEN
PURPOSE: To report a rare complication of retrobulbar anesthesia with ipsilateral globe penetration and transient contralateral amaurosis. DESIGN: Interventional case report. METHODS: A 63-year-old woman complained of vision loss in the right eye immediately following cataract surgery on the left eye. RESULTS: Right eye vision decreased to no light perception with clear media and normal fundus. The vision recovered to baseline in 12 hours. Left eye vision was checked and demonstrated only light perception. Fundus examination disclosed preretinal and vitreous hemorrhage. During vitrectomy of the left eye, a penetrating wound below the optic disk with retinal detachment was found. CONCLUSION: The ipsilateral globe penetration wound depicts the mechanism of contralateral amaurosis following retrobulbar anesthesia of the case.
Asunto(s)
Anestesia Local/efectos adversos , Ceguera/etiología , Lesiones Oculares Penetrantes/etiología , Lesiones por Pinchazo de Aguja/complicaciones , Retina/lesiones , Esclerótica/lesiones , Ceguera/fisiopatología , Ceguera/cirugía , Extracción de Catarata , Lesiones Oculares Penetrantes/fisiopatología , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , Persona de Mediana Edad , Órbita , Desprendimiento de Retina/etiología , Desprendimiento de Retina/fisiopatología , Desprendimiento de Retina/cirugía , Hemorragia Retiniana/etiología , Hemorragia Retiniana/fisiopatología , Hemorragia Retiniana/cirugía , Agudeza Visual , Vitrectomía , Hemorragia Vítrea/etiología , Hemorragia Vítrea/fisiopatología , Hemorragia Vítrea/cirugíaRESUMEN
We report 3 cases of globe rupture after peribulbar anesthesia. We discuss the predisposing factors, presenting features, and visual outcome after this complication. Globe explosion is a severe complication of inadvertent intraocular injection during peribulbar anesthesia. Visual outcome after vitrectomy is generally poor; however, cases that do not develop a retinal detachment may achieve good results.
Asunto(s)
Anestesia Local/efectos adversos , Hemorragia de la Coroides/etiología , Lesiones Oculares Penetrantes/etiología , Inyecciones/efectos adversos , Lesiones por Pinchazo de Aguja/etiología , Esclerótica/lesiones , Hemorragia Vítrea/etiología , Adulto , Anciano , Extracción de Catarata , Hemorragia de la Coroides/patología , Hemorragia de la Coroides/cirugía , Lesiones Oculares Penetrantes/patología , Lesiones Oculares Penetrantes/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Lesiones por Pinchazo de Aguja/patología , Lesiones por Pinchazo de Aguja/cirugía , Rotura , Hemorragia Vítrea/patología , Hemorragia Vítrea/cirugíaRESUMEN
We report the clinical management of a patient who sustained scleral perforation and intraocular injection of local anesthetic agent during retrobulbar block. We discuss the management options for this rare complication of local anesthesia in cataract surgery.
Asunto(s)
Anestesia Local/efectos adversos , Anestésicos Locales/efectos adversos , Lesiones Oculares Penetrantes/etiología , Inyecciones/efectos adversos , Lesiones por Pinchazo de Aguja/etiología , Esclerótica/lesiones , Cuerpo Vítreo/efectos de los fármacos , Anciano , Anciano de 80 o más Años , Bupivacaína/efectos adversos , Lesiones Oculares Penetrantes/diagnóstico por imagen , Lesiones Oculares Penetrantes/cirugía , Humanos , Masculino , Lesiones por Pinchazo de Aguja/diagnóstico por imagen , Lesiones por Pinchazo de Aguja/cirugía , Facoemulsificación , Desprendimiento de Retina/diagnóstico por imagen , Desprendimiento de Retina/etiología , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/diagnóstico por imagen , Perforaciones de la Retina/etiología , Perforaciones de la Retina/cirugía , Rotura , Ultrasonografía , Agudeza Visual , Hemorragia Vítrea/diagnóstico por imagen , Hemorragia Vítrea/etiología , Hemorragia Vítrea/cirugíaRESUMEN
PURPOSE: To report a case of globe perforation while initiating posterior subtenon's anesthesia. METHODS: Case report. A 40-year-old man with a history of retinal detachment in both eyes presented for repair of a second retinal detachment in the LE. RESULTS: Upon dissecting a space beneath the Tenon capsule with scissors, the globe was perforated. CONCLUSION: In patients with prior ophthalmologic surgery, thinned sclera, or excess scar tissue, increased caution should be employed during initiation of sub-Tenon anesthesia or an alternative method should be used.