Iris en meseta secundario a quistes retroiridianos / Plateau iris secondary to iridociliary cysts

CASO CLÍNICO: Se presenta un caso de iris meseta con glaucoma por quistes iridociliares múltiples unilaterales. Fue tratado con iridotomía Nd:YAG e iridoplastia 360° sin conseguir el control tensional. Finalmente se realizó una facoemulsificación que mejoró la hipertensión. Se hicieron controles gonioscópicos y mediante OCT de segmento anterior. DISCUSIÓN: Los quistes iridociliares son una enfermedad benigna que modifica el perfil del iris, pudiendo dar un aspecto de iris meseta. Esta configuración puede originar una hipertensión ocular de difícil tratamiento. Se han propuesto como tratamiento la iridocistotomía y la iridoplastia periférica, entre otros

CASE REPORT: We present a case of plateau iris and glaucoma due to multiple unilateral iridociliary cysts. The patient was treated with iridotomy Nd: YAG laser and 360° iridoplasty, without achieving pressure control. Phacoemulsification improved the hypertension. Dynamic gonioscopy and OCT of the anterior chamber was also performed before and after treatment. DISCUSSION: Iridociliary cysts are a benign condition that can cause iris plateau configuration, and can produce a difficult to treat ocular hypertension. Cystotomy, peripheral iridoplasty, and other treatments have been proposed

Descemet stripping endothelial keratoplasty after Ophtec 311 iris reconstruction lens implantation.

PURPOSE: To describe the variations in intraoperative technique, postoperative complications, and visual outcomes associated with Descemet stripping endothelial keratoplasty (DSEK) after Ophtec iris reconstruction lens implantation. DESIGN: Retrospective, interventional, consecutive case series. PARTICIPANTS: Patients who underwent DSEK after Ophtec 311 iris reconstruction lens implantation at the Jules Stein Eye Institute, University of California, Los Angeles. METHODS: Medical records were reviewed for demographic information, ophthalmic history, DSEK surgical technique, and postoperative clinical course. MAIN OUTCOME MEASURES: Intraoperative and postoperative complications and visual outcomes. RESULTS: Four patients were identified (1 man and 3 women, age: 43-78). Three of the eyes had undergone prior penetrating keratoplasty (PKP), and each of the eyes had a history of glaucoma, with previous glaucoma surgery having been performed in 2 of the eyes. No intraoperative complications were encountered during the procedures, although an unplanned anterior vitrectomy was required in a previously vitrectomized eye. In each case, a complete air fill of the globe was obtained to ensure adherence of the donor button, and in 3 of the 4 cases, the donor button was sutured to the recipient cornea to prevent potential posterior dislocation. None of the cases developed donor button dislocation or primary graft failure. Corrected distance visual acuities improved to 20/40-20/160, corresponding to a mean improvement of 0.25 (range, 0.12-0.40), limited by irregular corneal astigmatism and advanced glaucomatous optic neuropathy. During a mean follow-up period of 15.6 months (range, 4.9-24.8 months), graft rejection developed in 2 of the 3 eyes with a history of endothelial rejection after PKP (0.42 episode per eye-year). Both of these eyes developed secondary graft failure, which also developed 14 months after DSEK in the other eye with a history of PKP failure before DSEK. CONCLUSIONS: DSEK can be successfully performed in eyes with partial or complete aniridia, such as those after Ophtec iris reconstruction lens implantation. Modifications to the standard DSEK technique increase the probability of successful donor adherence and decrease the risk of posterior dislocation of the donor corneal button. However, endothelial rejection may occur at an increased frequency, resulting in secondary graft failure.

Aspectos terapêuticos do cisto de íris / Therapeutic aspects of the iris cyst

Objetivo: Analisar as diferentes opções terapêuticas para o tratamento do cisto de íris. Embora seja uma patologia rara e de curso benigno, existe a possibilidade de evoluir com complicações diversas decorrentes de uma conduta inadequada. Local: Instituto de Oftalmologia Tadeu Cvintal, São Paulo, Brasil. Método: Foram revistos 15 casos de cisto de íris, nos quais as condutas terapêuticas seguiram critérios protocolados e seus resultados analisados. Resultados: Várias foram as opções terapêuticas aplicadas, as quais levaram em consideração características diversas como: etiologia, dimensão, tempo de duração e localização anatômica. Dessa forma, as alternativas variaram de simples acompanhamento periódico (26,6 por cento dos casos), passando pela aplicação de Yag Laser (33,3 por cento dos casos), até a ressecção cirúrgica (40 por cento dos casos). Conclusão: Nos casos analisados, verificou-se que a padronização terapêutica segundo critérios específicos permite um grande índice de sucesso, minimizando o risco de complicações.