Postmortem microscopic evaluation and clinical correlation of a pseudophakic eye with pseudoexfoliation and loss of zonular support.

We describe a pseudophakic patient with pseudoexfoliation who developed late intraocular lens (IOL) instability manifested by pseudophakodonesis, a change in refraction, and loss of glaucoma control. The patient subsequently required glaucoma surgery that was complicated by vitreous loss. Preoperative ultrasound biomicroscopy (UBM) failed to provide useful information regarding the zonular status. The patient died as a result of a malignancy, and the eye was donated for research. Anatomical evaluation confirmed the clinical impression of IOL placement in the bag and zonular laxity. Postmortem UBM helped explain some of the technical difficulties in examining zonules in the pseudophakic state.

Multiple bilateral iridociliary cysts: ultrasound biomicroscopy and clinical characteristics.

BACKGROUND: To describe the utility of ultrasound biomicroscopy in diagnosing multiple bilateral iridociliary cysts and to determine the clinical significance of this condition. METHODS: A retrospective review of 73 patients referred for ultrasound biomicroscopy who were found to have bilateral iridociliary cysts. RESULTS: Seventy-three patients were identified who demonstrated 2 or more cysts in 1 eye and at least 1 in the other with ultrasound biomicroscopy. A solitary iris elevation was the most common reason for referral (84.9%). There were 44 patients for whom sufficient follow-up data were available, with a mean follow-up of 40.4 months. Clinical sequelae included 1 case of sectoral cataract (2.3%) and 4 cases of cyst-related glaucoma (9.1%). INTERPRETATION: Multiple bilateral iridociliary cysts is a common condition with occasional clinical significance. Ultrasound biomicroscopy is a valuable technique in diagnosing this condition. Patients who have significant angle compromise should be followed and treated as required for glaucoma.

Ultrasound biomicroscopy for the assessment of zonules after ocular trauma.

PURPOSE: To evaluate the role of ultrasound biomicroscopy (UBM) as a method for assessing the zonules after trauma to the anterior segment. These patients might develop traumatic cataract or glaucoma requiring surgery. If occult zonular defects can be identified preoperatively, this might lead to a modified surgical technique and improved outcomes. DESIGN: Retrospective observational case series. PARTICIPANTS: Fifty-nine patients who were referred for UBM after anterior segment trauma. METHODS: UBM examinations were performed using the Humphrey Instruments Ultrasound Biomicroscope equipped with a 50-mHz transducer. A plastic eyecup filled with 2% methylcellulose solution was used in each case. The chart and UBM images of all anterior segment trauma patients examined between 1995 and 2000 were reviewed. The age, gender, and mechanism of injury were recorded for each patient. Follow-up data were obtained from the referring physician in patients who subsequently underwent ocular surgery. MAIN OUTCOME MEASURES: The number of studies judged to be of adequate quality to evaluate zonules was noted, and the number of cases in which zonular defects were found was recorded. The number of cases in which surgery was subsequently performed was noted, and postoperative results were obtained. RESULTS: Fifty-nine charts and 60 UBM studies were reviewed. Forty-nine studies were judged to be adequate for imaging zonules. Most poor-quality studies were in the early years of the study. Further analysis was carried out on the reliable studies. Occult zonular defects were identified in 21 of 49 patients (42.9%). Thirty-one patients went on to have cataract, filtering, and/or vitreoretinal surgery. One surgeon (ACS) performed 25 of the surgical cases, for which a summary is provided. Referring surgeons found the information helpful in surgical planning and anticipating complications in reliable study cases. CONCLUSIONS: UBM is an effective method for identifying occult zonular damage in patients with anterior segment trauma. There is a significant learning curve in the examination technique. The ability to diagnose zonular rupture preoperatively is of significant benefit to the surgeon and might reduce the chance of intraoperative complications.