A case of internal ophthalmoplegia associated with varicella zoster.

The authors report a case of internal ophthalmoplegia in a 5-year-old boy presenting after primary varicella infection. This is an uncommon and mostly irreversible ocular manifestation after chickenpox. The internal ophthalmoplegia showed a potential mild improvement with oral acyclovir. Consideration should be given to starting treatment on presentation in such cases.

Calcification of a Rayner Centerflex 570H hydrophilic acrylic intraocular lens following vitrectomy for retinal detachment: a clinicopathologic report.

PURPOSE: The case of a 71-year-old man who complained of progressive, unilateral visual blurring following vitrectomy for retinal detachment due to opacification of his Rayner Centerflex 570H intraocular lens (IOL) implant is reported. Intraocular lens exchange was carried out and the explanted lens analyzed. The same model lens in his fellow eye has remained clear. METHOD: Clinicopathologic case report. RESULTS: Scanning electron microscopy and energy-dispersive x-ray analysis confirmed the presence of hydroxyapatite deposits within the anterior surface of the IOL. CONCLUSIONS: To our knowledge, this is the first clinicopathologic case report of calcification of this model IOL in an adult patient. The sequence of events, unilaterality, and pathologic findings suggest secondary calcification, which could have been related to severe postoperative inflammation and associated blood-aqueous barrier breakdown.

Calcification of hydrophilic acrylic intraocular lenses in combined phacovitrectomy surgery.

UNLABELLED: Two cases of postoperative intraocular lens (IOL) calcification in patients implanted with the Akreos Adapt IOL at the time of combined phacovitrectomy are described, along with clinical review of all patients implanted with this IOL type at our institution between November 2006 and September 2008. The IOLs explanted from the 2 cases were examined using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX). The SEM of the explanted IOLs showed crystalline anterior surface and subsurface deposits; by EDX, the deposits showed high concentrations of calcium and phosphorous, consistent with calcium apatite. Twenty patients (20 eyes) attended for cohort review, and none showed IOL opacification. The reason calcification occurred in the 2 cases remains unknown, but clinicians should be aware of this potential complication. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a longterm follow-up.

PURPOSE: To study the outcome of viscocanalostomy (VC) and deep sclerectomy (DS) for the surgical management of medically uncontrolled glaucoma. PATIENTS AND METHODS: A non-randomized, prospective study of all consecutive non-penetrating glaucoma filtering procedures was carried out in two centres. In the first centre, one surgeon (MSW) performed VC in 105 eyes (27 VC and 78 phaco VC). In the second centre, one surgeon (PKW) performed DS in 87 eyes (52 DS and 35 phaco DS). RESULTS: The mean follow-up was 36 months (range 9-60 months). At final follow-up the complete success rate (intraocular pressure < or = 21 Hg without medication) was 92.6% for VC eyes, 96% for phaco VC eyes, 77% for DS eyes and 94% for phaco DS eyes. Kaplan-Meier survival analysis for complete success showed no significant difference between DS and VC nor between phaco VC and phaco DS (p > 0.05). By 36 months postoperatively, mean IOP was 16.8 mmHg (SD 3) in VC eyes, 16.6 mmHg (SD 3.1) in phaco VC eyes, 16.7 mmHg (SD 5.7) in DS eyes and 15 mmHg (SD 3.2) in phaco DS eyes. Postoperative Nd:YAG laser goniopuncture was necessary in 10 eyes in the DS group. Large or cystic drainage blebs occurred only in the DS eyes. CONCLUSIONS: Viscocanalostomy and DS are effective and safe methods of achieving sustained IOP reduction in glaucomatous eyes and both techniques can be successfully combined with cataract extraction.

Viscocanalostomy and phacoviscocanalostomy: long-term results.

PURPOSE: To determine the safety and efficacy of viscocanalostomy and cataract extraction by phacoemulsification combined with viscocanalostomy (phacoviscocanalostomy) in the management of medically uncontrolled glaucoma. SETTING: Department of Ophthalmic Surgery, Warrington Hospital, Warrington, England. METHODS: This prospective nonrandomized study comprised 101 consecutive eyes of 73 patients with medically uncontrolled glaucoma having viscocanalostomy or phacoviscocanalostomy. Outcomes measured were intraocular pressure (IOP) control, visual acuity, gonioscopy, bleb morphology, and complications associated with surgery. Examinations were performed preoperatively and 1 and 7 days and 1, 3, 6, 9, and 12 months postoperatively and then at 6-month intervals. The mean follow-up was 23.9 months +/- 11 (SD) (range 6 months to 3.5 years). RESULTS: The mean preoperative IOP was 24.9 +/- 5.7 mm Hg on 2.27 +/- 0.8 medications and the mean postoperative IOP at last follow-up, 16.14 +/- 2.9 mm Hg on 0.1 medications. A postoperative IOP of 21 mm Hg or less was achieved in 93% of eyes. In the remaining 7%, an addition of a mean of 1.4 medications achieved an IOP less than 21 mm Hg. No case required further glaucoma surgery. The mean percentage of IOP reduction in eyes having viscocanalostomy alone was 37% and in eyes having phacoviscocanalostomy, 33%. Complications were minor and included 4 small hyphemas, 5 small choroidal detachments, 1 iris prolapse through the phaco incision, and 10 intraoperative microperforations of the trabeculo-Descemet's window. Transient postoperative pressure elevations secondary to topical steroids occurred in 18% of eyes. CONCLUSIONS: Viscocanalostomy and phacoviscocanalostomy were safe and effective in the surgical management of glaucoma and combined glaucoma and cataract. There was a low incidence of complications postoperatively and throughout the long-term follow-up.