RESUMEN
BACKGROUND: To report a case of lenticular infection caused by Aspergillus, which was diagnosed 13 weeks after traumatic corneal laceration. CASE PRESENTATION: A 60-year-old woman presented with traumatic corneal laceration including anterior lens capsule rupture and traumatic cataract after being hit with a chestnut in the right eye. There were multiple injuries due to tiny thorns of the chestnut, including the conjunctiva, sclera, cornea, and anterior lens capsule. But no visible foreign body was detected by slit-lamp examination. Topical corticosteroid was prescribed to resolve the conjunctival inflammation induced by the thorns of chestnut, which could have caused persistent irritation. As conjunctival injection and edema being decreased during outpatient clinical follow-up, embedded conjunctival foreign body was detected and surgically removed (1st surgery). Approximately 10 weeks after the trauma, severe inflammation of the anterior segment accompanied with hypopyon developed suddenly and at the same time embedded scleral foreign body was revealed. After removal of scleral foreign body (2nd surgery), unspecified mold species was cultured from the scleral foreign body in SDA (Sabouraud dextrose agar) plate. Suspicious corneal foreign body was removed as 3rd surgery and phacoemulsification of traumatic cataract was planned as 4th surgery. Aspergillus was finally detected from removed anterior capsule and fibrotic membrane during the operation. Fungal infection resolved successfully after administration of topical (1% voriconazole and 5% natamycin) and systemic (fluconazole) antifungal agents and phacoemulsification of traumatic cataract. CONCLUSION: Chestnut thorns can damage multiple ocular tissues simultaneously. Lens capsular rupture could result in fungal inoculation and lead to delayed lenticular fungal infection with complicated cataract formation. In cases of ocular trauma due to organic substances such as thorns and branches, the possibility of fungal infection should be considered.
Asunto(s)
Aspergilosis/microbiología , Lesiones de la Cornea/etiología , Infecciones Fúngicas del Ojo/microbiología , Lesiones Oculares Penetrantes/etiología , Laceraciones/etiología , Enfermedades del Cristalino/microbiología , Antifúngicos/uso terapéutico , Aspergilosis/diagnóstico , Aspergilosis/terapia , Cuerpos Extraños en el Ojo/diagnóstico , Cuerpos Extraños en el Ojo/etiología , Cuerpos Extraños en el Ojo/cirugía , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/terapia , Femenino , Humanos , Presión Intraocular , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/terapia , Implantación de Lentes Intraoculares , Microscopía Acústica , Persona de Mediana Edad , Facoemulsificación , Microscopía con Lámpara de Hendidura , Agudeza VisualRESUMEN
Visual function demands coordinated responses to information over a wide field of view, involving both central and peripheral vision. Visually impaired individuals often seem to underutilize peripheral vision, even in absence of obvious peripheral deficits. Motivated by perceptual training studies with typically sighted adults, we examined the effectiveness of perceptual training in improving peripheral perception of visually impaired youth. Here, we evaluated the effectiveness of three training regimens: (1) an action video game, (2) a psychophysical task that combined attentional tracking with a spatially and temporally unpredictable motion discrimination task, and (3) a control video game. Training with both the action video game and modified attentional tracking yielded improvements in visual performance. Training effects were generally larger in the far periphery and appear to be stable 12 months after training. These results indicate that peripheral perception might be under-utilized by visually impaired youth and that this underutilization can be improved with only ~8 hours of perceptual training. Moreover, the similarity of improvements following attentional tracking and action video-game training suggest that well-documented effects of action video-game training might be due to the sustained deployment of attention to multiple dynamic targets while concurrently requiring rapid attending and perception of unpredictable events.
Asunto(s)
Enfermedades del Cristalino/terapia , Degeneración Macular/terapia , Modalidades de Fisioterapia , Desempeño Psicomotor/fisiología , Retinitis Pigmentosa/terapia , Personas con Daño Visual/rehabilitación , Adolescente , Atención/fisiología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Aprendizaje/fisiología , Enfermedades del Cristalino/fisiopatología , Degeneración Macular/fisiopatología , Masculino , Retinitis Pigmentosa/fisiopatología , Factores de Tiempo , Juegos de Video/psicología , Visión Ocular/fisiología , Percepción Visual/fisiologíaRESUMEN
BACKGROUND: This case report describes an extremely rare Candida lens abscess in a premature infant (gestational age 24 weeks at birth). CASE REPORT: After birth the infant suffered from Candida sepsis which was successfully treated with an antifungal medication. The patient was referred at the age of 6 months because of greyish alterations in the pupils but an absence of other symptoms. The examination with the patient under general anesthesia revealed a grey pupillary membrane and behind it a whitish swollen lens. A lensectomy was performed. The vitreous body was inconspicuous. Candida albicans was identified microbiologically. CONCLUSIONS: In preterm infants dissemination of pathogens into the lens through the vascular coat of the lens is possible, which after regression of the coat is no longer accessible to systemic treatment and may thus be manifested as delayed abscess formation.
Asunto(s)
Absceso/diagnóstico , Candidiasis/diagnóstico , Infecciones Fúngicas del Ojo/diagnóstico , Enfermedades del Prematuro/diagnóstico , Enfermedades del Cristalino/diagnóstico , Absceso/terapia , Candidiasis/terapia , Diagnóstico Diferencial , Infecciones Fúngicas del Ojo/terapia , Humanos , Lactante , Recién Nacido , Enfermedades del Prematuro/terapia , Enfermedades del Cristalino/terapia , Resultado del TratamientoAsunto(s)
Infecciones Bacterianas del Ojo/terapia , Infecciones por Bacterias Grampositivas/terapia , Enfermedades del Cristalino/terapia , Facoemulsificación , Complicaciones Posoperatorias , Propionibacterium acnes/aislamiento & purificación , Succión/métodos , Capsulorrexis , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/microbiología , Humanos , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/microbiología , Implantación de Lentes Intraoculares , Masculino , Persona de Mediana Edad , Polimetil Metacrilato , Irrigación Terapéutica/métodosAsunto(s)
Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Comorbilidad , Enfermedad Coronaria/epidemiología , Humanos , Infecciones/epidemiología , Ataque Isquémico Transitorio/epidemiología , Enfermedades del Cristalino/congénito , Enfermedades del Cristalino/terapia , Persona de Mediana Edad , Neurofibromatosis/epidemiología , Adulto JovenRESUMEN
PURPOSE OF REVIEW: To review the recent literature addressing the surgical approaches to intraocular lens (IOL) fixation in the setting of inadequate capsular support. RECENT FINDINGS: Lack of capsular support is a commonly encountered problem facing the anterior segment surgeon. Recent reports suggest that visual outcomes are generally good with modern IOLs and surgical approaches. More recently described techniques include sutureless scleral fixation and intraocular endoscopy-guided suture placement. SUMMARY: Many clinical circumstances require extracapsular IOL fixation and multiple options exist in the setting of inadequate capsular support. Ultimately, there are many factors that must be considered in selecting an appropriate surgical approach. These include ocular history as well as the skill, experience, and comfort level of the individual surgeon. The myriad of options that now exist for IOL fixation increases the likelihood that patients with a wide variety of pathologic states will attain their best possible visual outcome.
Asunto(s)
Cámara Anterior/cirugía , Enfermedades del Cristalino/terapia , Implantación de Lentes Intraoculares/métodos , Lentes Intraoculares , Segmento Posterior del Ojo/cirugía , Humanos , Implantación de Lentes Intraoculares/efectos adversos , Implantación de Lentes Intraoculares/clasificación , Resultado del TratamientoRESUMEN
This study investigated the encapsulation of newt iris pigment epithelial cells (PECs), which have the ability to regenerate a lens by trans-differentiation in vivo, within a biodegradable hydrogel of oligo(poly(ethylene glycol) fumarate) crosslinked with poly(ethylene glycol)-diacrylate. Hydrogel beads of initial diameter of 1 mm were fabricated by a molding technique. The swelling ratio and degradation rate of the hydrogel beads decreased with increasing crosslinking ratios. Confocal microscopy confirmed the cytocompatibility of crosslinking hydrogel formulations as evidenced by the viability of an encapsulated model cell line within a crosslinked hydrogel bead. Hydrogel beads encapsulating iris PECs were also implanted into lentectomized newts in vivo; histological evaluation of explants after 30 days revealed a regenerated lens, thus demonstrating that the presence of degrading hydrogel did not adversely affect lens regeneration. The results of this study suggest the potential of a method for lens regeneration involving oligo(poly(ethylene glycol) fumarate) hydrogels for iris PEC encapsulation and transplantation.
Asunto(s)
Hidrogeles/farmacología , Cristalino/fisiología , Epitelio Pigmentado Ocular/efectos de los fármacos , Poliésteres/farmacología , Polietilenglicoles/farmacología , Regeneración/efectos de los fármacos , Ingeniería de Tejidos/métodos , Implantes Absorbibles , Animales , Transdiferenciación Celular/efectos de los fármacos , Transdiferenciación Celular/fisiología , Células Cultivadas , Modelos Animales de Enfermedad , Composición de Medicamentos/métodos , Células Epiteliales/citología , Células Epiteliales/efectos de los fármacos , Células Epiteliales/fisiología , Células Epiteliales/trasplante , Hidrogeles/administración & dosificación , Hidrogeles/química , Enfermedades del Cristalino/patología , Enfermedades del Cristalino/terapia , Cristalino/efectos de los fármacos , Cristalino/trasplante , Microesferas , Epitelio Pigmentado Ocular/citología , Epitelio Pigmentado Ocular/fisiología , Epitelio Pigmentado Ocular/trasplante , Poliésteres/administración & dosificación , Polietilenglicoles/administración & dosificación , Ratas , Regeneración/fisiología , SalamandridaeRESUMEN
PURPOSE: To analyze cases with posttraumatic lenticular abscess and study the etiology, clinical presentation, management, and outcome. DESIGN: Retrospective case series. METHODS: Seventeen eyes of 17 patients with traumatic lenticular abscesses were managed with extracapsular cataract extraction after aspirating the abscess. RESULTS: The mean age of the patients was 40.3 years, and males constituted 82%. The mean time to presentation after injury was 14.35 days (range, one to 60 days), and the patients had a mean follow-up of 125.94 days (range, 21 to 300 days). Culture of the lenticular abscess revealed bacterial growth in eight cases (47%) and fungi in four cases (23.5%). In five (29.4%) cases, culture was negative. Staphylococcus epidermidis grew in seven cases (41%). Thirteen eyes (77%) had best-corrected visual acuity better than 20/120. CONCLUSIONS: Surgical removal of the abscess, with systemic and local antimicrobial treatment is effective in cases of posttraumatic intralenticular abscess.
Asunto(s)
Absceso/etiología , Infecciones Bacterianas del Ojo/etiología , Infecciones Fúngicas del Ojo/etiología , Lesiones Oculares Penetrantes/complicaciones , Enfermedades del Cristalino/etiología , Cristalino/lesiones , Absceso/terapia , Adulto , Antibacterianos/uso terapéutico , Extracción de Catarata , Terapia Combinada , Infecciones Bacterianas del Ojo/terapia , Infecciones Fúngicas del Ojo/terapia , Lesiones Oculares Penetrantes/terapia , Femenino , Humanos , Enfermedades del Cristalino/terapia , Implantación de Lentes Intraoculares , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
PURPOSE: To report the clinical presentation, management and outcome of eyes with traumatic intralenticular abscess. METHODS: In this interventional case series, records of eight patients (eight eyes) with intralenticular abscess developing following trauma were reviewed. All patients underwent extracapsular cataract extraction with intracameral antibiotics with or without pars plana vitrectomy. Main outcome measures studied were resolution of infection and final visual outcome. RESULTS: Lens abscess developed in six eyes following penetrating injury and in two eyes following intraocular penetration of caterpillar hair. Gram positive cocci were cultured from the lens aspirate in five eyes and Staphylococcus epidermidis was the most common organism isolated. Cataract extraction resulted in control of the infection in all eyes and seven eyes (87.5%) had a favourable visual outcome. CONCLUSION: Early lens extraction with intracameral antibiotics in eyes with intralenticular abscess allows control of infection with good visual outcome.
Asunto(s)
Absceso/microbiología , Lesiones Oculares Penetrantes/microbiología , Enfermedades del Cristalino/microbiología , Infecciones Estafilocócicas/microbiología , Absceso/diagnóstico , Absceso/terapia , Adolescente , Adulto , Antibacterianos/administración & dosificación , Extracción de Catarata , Terapia Combinada , Lesiones Oculares Penetrantes/diagnóstico , Lesiones Oculares Penetrantes/terapia , Femenino , Humanos , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/terapia , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/terapia , Staphylococcus aureus/aislamiento & purificación , Staphylococcus epidermidis/aislamiento & purificación , Agudeza Visual , VitrectomíaAsunto(s)
Cápsula del Cristalino/patología , Enfermedades del Cristalino , Lentes de Contacto , Técnicas de Diagnóstico Oftalmológico/instrumentación , Anteojos , Humanos , Enfermedades del Cristalino/clasificación , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/terapia , Procedimientos Quirúrgicos Oftalmológicos/métodos , PronósticoRESUMEN
PURPOSE: We sought to assess the success of amblyopia treatment in patients with small posterior lens opacities as well as the factors associated with a good visual outcome. METHODS: This was a retrospective study of patients with posterior lens opacities that initially were thought to be too small in size to warrant cataract surgery. The following variables were examined: cataract type, location, diameter, persistent hyaloid vessel, anisometropia, strabismus, and age of detection. Success of treatment of amblyopia was defined as improvement by at least 0.3 logMAR units. Good visual outcome was defined as 20/40 or better. Amblyopia was treated by glasses, patching, and/or atropine. Patients who failed with conservative treatment or had an increase in cataract size underwent surgery. RESULTS: Forty-eight (91%) of 53 eyes were amblyopic. Thirty amblyopic eyes had pre- and post-treatment Snellen acuities. Twenty (67%) had their visual acuity (VA) improved by 0.3 logMAR units or greater. None of the measured variables were associated with successful amblyopia treatment. Twenty-five (49%) of 51 patients had a final VA of 20/40 or better. The only variable associated with good visual outcome was cataract type: 18 of 25 (72%) posterior subcapsular cataract and 6 of 23 (32%) posterior lenticonus eyes achieved VA of 20/40 or better (P = 0.008). Six patients who went on to have cataract surgery experienced a larger improvement in BCVA (4.50 logMar units +/- 2.52 lines) compared with patients treated without cataract surgery (2.36 logMar units +/- 3.11 lines). DISCUSSION: Amblyopia treatment was successful in most cases. A small group of patients who underwent cataract surgery experienced a greater VA improvement; however, it was not statistically significant. Further studies are needed to determine which patients would benefit from cataract surgery.
Asunto(s)
Ambliopía/terapia , Catarata/complicaciones , Anteojos , Enfermedades del Cristalino/complicaciones , Midriáticos/uso terapéutico , Privación Sensorial , Agudeza Visual/fisiología , Ambliopía/complicaciones , Ambliopía/fisiopatología , Atropina/administración & dosificación , Atropina/uso terapéutico , Catarata/terapia , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Lactante , Enfermedades del Cristalino/terapia , Masculino , Midriáticos/administración & dosificación , Soluciones Oftálmicas , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
The lens is the second most powerful structure for refraction in the eye, and is important in the fine-focusing ability in individual species. Specific disorders of the feline lens are frequent in clinical practice and include: congenital anomalies, nuclear sclerosis, cataracts, lens subluxations and luxations, intraocular sarcomas, and anterior lens displacement associated with aqueous misdirection glaucoma. Clinical signs and current therapeutic options are discussed for the general practitioner. A close working relationship with the regional veterinary ophthalmologist is advised.
Asunto(s)
Enfermedades de los Gatos/diagnóstico , Enfermedades de los Gatos/terapia , Enfermedades del Cristalino/veterinaria , Animales , Gatos , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/terapiaRESUMEN
Anterior lenticonus is a rare condition in which the lens presents a conical protrusion of its anterior cortex. Sometimes isolated, it may be an ocular manifestation of Alport syndrome, a hereditary nephritis accompanied by deafness and other ocular signs such as flecked retinopathy or posterior polymorphous corneal dystrophy. All these manifestations are a result of a genetic defect in type IV collagen, a major component of basal membranes in the human body. The clinical aspects and therapy of anterior lenticonus and Alport syndrome are described, as well as the exploration that must begin when anterior lenticonus is discovered. This exploration is essential so that this diagnosis can be made as soon as possible.
Asunto(s)
Enfermedades del Cristalino/etiología , Nefritis Hereditaria/complicaciones , Humanos , Enfermedades del Cristalino/diagnóstico , Enfermedades del Cristalino/terapia , Nefritis Hereditaria/diagnóstico , Nefritis Hereditaria/terapiaRESUMEN
Capsular block syndrome (CBS) has been recognized as a cause of immediate or delayed postoperative accumulation of fluid behind an intraocular lens/capsulorhexis complex. Hydrodissection-related rupture of the posterior capsule may be considered a variant of CBS that can manifest intraoperatively. We describe another intraoperative situation related to CBS in which fluid loculation during hydrodissection mimics a threatened expulsive hemorrhage.
Asunto(s)
Hemorragia del Ojo/diagnóstico , Complicaciones Intraoperatorias , Cápsula del Cristalino/lesiones , Enfermedades del Cristalino/etiología , Facoemulsificación/efectos adversos , Anciano , Cámara Anterior/patología , Diagnóstico Diferencial , Femenino , Humanos , Presión Intraocular , Cápsula del Cristalino/patología , Enfermedades del Cristalino/patología , Enfermedades del Cristalino/terapia , Masaje , Rotura , SíndromeRESUMEN
Posterior lenticonus is a protrusion of the posterior capsule and cortex into the vitreous. The etiology is widely debated because of the rare nature of the condition. Lenticonus can present with concurrent ocular conditions, which can disrupt normal visual development. Currently, the only treatment option for posterior lenticonus is lensectomy, which may still have a reduced chance of visual success secondary to the associated disease. Although strabismus and amblyopia are commonly associated, keratoconus has not previously been reported with unilateral posterior lenticonus. Considering treatment of the associated condition may allow the patient to delay or forego surgical intervention.
Asunto(s)
Lentes de Contacto , Queratocono/terapia , Enfermedades del Cristalino/terapia , Adulto , Extracción de Catarata , Córnea/patología , Topografía de la Córnea , Humanos , Queratocono/complicaciones , Queratocono/diagnóstico , Queratoplastia Penetrante , Enfermedades del Cristalino/complicaciones , Enfermedades del Cristalino/diagnóstico , Implantación de Lentes Intraoculares , Cristalino/patología , Masculino , Agudeza VisualRESUMEN
BACKGROUND: Marfan syndrome, a genetic connective tissue disorder, manifests many problems: high myopia, astigmatism, crystalline lens subluxation, and cataracts. No published studies have described the contact lens corrections that can be used with Marfan syndrome patients. This report describes the variety of contact lens modalities used for a subpopulation of patients with Marfan syndrome. METHODS: The clinical records of eight patients with Marfan syndrome (16 eyes) from two hospital-based contact lens practices were retrospectively reviewed. Seven different contact lens modalities were used for this subpopulation. RESULTS: Mean unaided visual acuities were 20/296, while mean best-corrected optimal spectacle refraction visual acuities were 20/33. Contact lenses improved the mean visual acuity to 20/27. Patients wore the contact lenses for an average of 12 hours per day. Complications of contact lens wear occurred in approximately 70% of eyes and included neovascularization, giant papillary conjunctivitis, 3 and 9 o'clock staining, and central superficial punctate staining. Additionally, ocular non-contact lens-related complications occurred in 50% of patients. CONCLUSIONS: A variety of contact lens designs may be used during the care of patients with Marfan syndrome. However, patients may experience an increased rate of complications associated with contact lens wear or unrelated to lens wear, and thus they deserve more intensive follow-up care than non-Marfan syndrome patients.
Asunto(s)
Lentes de Contacto , Enfermedades del Cristalino/terapia , Síndrome de Marfan/complicaciones , Errores de Refracción/terapia , Adolescente , Adulto , Afaquia/etiología , Afaquia/patología , Afaquia/terapia , Femenino , Estudios de Seguimiento , Humanos , Enfermedades del Cristalino/etiología , Enfermedades del Cristalino/patología , Subluxación del Cristalino/etiología , Subluxación del Cristalino/patología , Subluxación del Cristalino/terapia , Masculino , Síndrome de Marfan/patología , Persona de Mediana Edad , Errores de Refracción/etiología , Errores de Refracción/patología , Estudios Retrospectivos , Agudeza VisualRESUMEN
After the ultrasonic tip is introduced into the highly myopic eye and inflow is activated, the anterior chamber deepens, the lens-iris diaphragm is displaced posteriorly, the iris becomes concave, and the pupil dilates from the weight of the water column above the eye. We define a known but undescribed syndrome--the lens-iris diaphragm retropulsion syndrome (LIDRS)--which is thought to be caused by abnormally loose zonules. The surgeon's reflexive action, lowering the infusion bottle height, reduces the weight of the water column but also reduces the infusion limit. We managed this situation with an inflow-splitting technique in which the infusion bottle height was lowered significantly and a Lewicky chamber maintainer connected to a second infusion bottle at the same height as the first bottle was introduced into the anterior chamber. Pressure monitoring that enabled simultaneous, synchronized recording of phacoemulsification and intraocular pressure fluctuations was used.
Asunto(s)
Extracción de Catarata/efectos adversos , Enfermedades del Iris/etiología , Enfermedades del Iris/terapia , Enfermedades del Cristalino/etiología , Enfermedades del Cristalino/terapia , Adulto , Anciano , Cámara Anterior/patología , Extracción de Catarata/métodos , Femenino , Humanos , Presión Intraocular , Complicaciones Intraoperatorias , Masculino , Miopía/complicaciones , SíndromeAsunto(s)
Ambliopía/terapia , Hiperopía/terapia , Miopía/terapia , Ortóptica , Adolescente , Astigmatismo/terapia , Niño , Preescolar , Anteojos , Humanos , Lactante , Enfermedades del Cristalino/terapia , Agudeza VisualRESUMEN
We studied 21 patients with 23 eyes with posterior lenticonus. Twenty-one of the eyes developed progressive cataractous changes that required lens aspiration in 19 eyes when vision reduction was 6/30 (20/100) or less. The inherent weakness of the diaphanous portion of the posterior lens capsule contributed to disruption of the normal lamellar arrangement of the lens fibers resulting in cataractous changes. Amblyopia was the most significant visual problem associated with posterior lenticonus. Fifteen of the 19 operated eyes in this study were amblyopic and nine of the 15 were improved to 6/15 (20/50) or better vision with occlusion therapy, after surgical aspiration of the cataractous lens and contact lens therapy.