Combined Ab Externo Cyclopexy and Cryopexy in Cyclodialysis Cleft Repair.

PURPOSE: To evaluate outcomes of an ab externo surgical technique combining cyclopexy with partial-thickness scleral flap dissection and suture reattachment of ciliary muscle and cryopexy through partial-scleral bed for cyclodialysis cleft repair. MATERIALS AND METHODS: Consecutive patients in a tertiary academic practice with cyclodialysis cleft confirmed by gonioscopy or ultrasound biomicroscopy and had received the combined procedure were reviewed. Primary outcomes included differences between the preoperative and postoperative best-corrected visual acuity (BCVA) and intraocular pressure (IOP). Secondary outcomes included complications and additional surgeries. RESULTS: Six consecutive patients (eyes) from October 2006 to November 2012 (6 y) were enrolled. No patient had received prior laser or surgical treatment for cyclodialysis cleft. Patient's age ranged from 14 to 81 years (median=37 y). Follow-up ranged from 1 to 72 months (median=12 mo). The cyclodialysis clefts of 3 patients (50%) were caused by blunt injuries and the other 3 (50%) from complicated intraocular surgery. Preoperative BCVA ranged from 20/40 to counting fingers with mean IOP of 2.3±2.1 mm Hg (range, 0 to 6 mm Hg). Final postoperative BCVA ranged from 20/20 to hand motions with mean IOP of 11.3±5.7 mm Hg (range, 3 to 18 mm Hg). Five patients (83%) had an increase in IOP and recovery of vision to 20/50 or better at the final visit (including further surgeries). No complication was noted and no additional cyclopexy was required. CONCLUSIONS: Combined ab externo cyclopexy with partial-thickness scleral flap dissection and suture reattachment of the ciliary muscle and cryopexy delivered on the partial-thickness scleral bed is safe and effective as primary surgical repair for cyclodialysis cleft.

Pattern Scanning Laser (PASCAL) for Peripheral Iridoplasty in Eyes With Plateau Iris Syndrome: A Novel Application.

PURPOSE: The purpose of this study was to evaluate safety and efficacy of pattern scanning laser (PASCAL) for peripheral iridoplasty in eyes with plateau iris syndrome. MATERIALS AND METHODS: This study was a retrospective review of cases that underwent PASCAL laser peripheral iridoplasty. Eyes with plateau iris syndrome confirmed on gonioscopy and ultrasound biomicroscopy were included in the study. Primary and secondary outcome measures were angle widening on gonioscopy and magnitude of intraocular pressure (IOP) reduction, respectively. RESULTS: Twelve eyes of 8 patients that completed 1-year follow-up were analyzed. Angle widening was noted in 46% of treated quadrants by at least 1 grade (Shaffer classification) at 1-month follow-up. A statistically significant IOP reduction was noted at 1 year from 20.6±4.8 to 17.8±3.8 mm Hg (P=0.01). At 1 month, 8 of 12 eyes (66.6%) achieved gonioscopic success (widening of the angle by at least 1 grade in 2 of 4 quadrants). At 1 year, 6 of 12 eyes (50%) achieved tonometric success (20% reduction or 3 mm Hg IOP reduction from the baseline without addition of new antiglaucoma medications). No adverse effects associated with PASCAL laser peripheral iridoplasty were observed. CONCLUSIONS: PASCAL laser iridoplasty can be a safe and effective alternative to argon laser peripheral iridoplasty in the management of eyes with plateau iris syndrome. Our findings need to be further validated on larger sample size and in different ethnicities.

An unusual complication of combined gonioscopy-assisted transluminal trabeculotomy and phacoemulsification: vision loss due to intracapsular hematoma.

PURPOSE: To report two cases with an acute vision loss due to intracapsular hemorrhage (hematoma) after an uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery. METHODS: Case report. RESULTS: Seventy-six-year-old male and 75-year-old female patients with cataract and pseudoexfoliative glaucoma (XFG) uncontrolled with maximum medical therapy both underwent GATT combined with phacoemulsification. Shortly after the surgery, intracapsular hematoma behind the intraocular lens (IOL) were noted in both patients. Hematoma cleared in both of them via IOL extraction-anterior vitrectomy and YAG-laser capsulotomy, respectively. Hematoma cleared in both patients without any surgical complications. CONCLUSIONS: Vision loss due to unclearing intracapsular hematoma might be an early complication of combined GATT and phacoemulsification surgery.

Alteraciones gonioscópicas del ángulo camerular en el glaucoma juvenil / Gonioscopic alterations of the camerular angle in the juvenile glaucoma

Introducción: El glaucoma juvenil es una entidad rara que se comporta de manera similar al glaucoma del adulto, en cuanto a sintomatología y evolución. Métodos: Realizamos un estudio retrospectivo comparativo de casos controles con el objetivo de describir las características gonioscópicas del ángulo camerular. Resultados: En el glaucoma juvenil es frecuente el antecedente en familiares de primera línea. En el examen gonioscópico es más frecuente el ángulo abierto y la ausencia de alteraciones embrionarias evidentes en pacientes con glaucoma juvenil y en pacientes sanos. Conclusiones: El glaucoma juvenil es una enfermedad multifactorial que se desarrolla en pacientes jóvenes que presentan o no alteraciones embrionarias del ángulo camerular. Recomendaciones: Realizar pesquisa de glaucoma juvenil en pacientes con factores de riesgo de glaucoma aunque el estudio gonioscópico resulte aparentemente normal; además, especificar en el examen gonioscópico del paciente la extensión y localización de las alteraciones embrionarias.

Introduction: Juvenile glaucoma is a rare disease that behaves in the same way as the adult glaucoma Methods: A retrospective comparative case- control study was performed. with the objective of describing the gonioscopic characteristics of the camerular angle in juvenile glaucoma. Results: A family history of glaucoma is common in the juvenile glaucoma. The open-angle glaucoma and the lack of evident embrionary alterations are the most frequent findings in the gonioscopic test in Juvenile Glaucoma and in healthy patients. Conclusions: Juvenile Glaucoma is a multifactorial disease, which develops in young patients presenting with embrionary alterations of the camerular angle or not. Recommendations: A screening should be carried out to look for juvenile glaucoma in patients with risk factors although the gonioscopic study seems to be normal, and also the gonioscopic exam of a patient should specify the extension and location of the embrionary alterations.

Alteraciones gonioscópicas del ángulo camerular en el glaucoma juvenil / Gonioscopic alterations of the camerular angle in the juvenile glaucoma

Introducción: El glaucoma juvenil es una entidad rara que se comporta de manera similar al glaucoma del adulto, en cuanto a sintomatología y evolución. Métodos: Realizamos un estudio retrospectivo comparativo de casos controles con el objetivo de describir las características gonioscópicas del ángulo camerular. Resultados: En el glaucoma juvenil es frecuente el antecedente en familiares de primera línea. En el examen gonioscópico es más frecuente el ángulo abierto y la ausencia de alteraciones embrionarias evidentes en pacientes con glaucoma juvenil y en pacientes sanos. Conclusiones: El glaucoma juvenil es una enfermedad multifactorial que se desarrolla en pacientes jóvenes que presentan o no alteraciones embrionarias del ángulo camerular. Recomendaciones: Realizar pesquisa de glaucoma juvenil en pacientes con factores de riesgo de glaucoma aunque el estudio gonioscópico resulte aparentemente normal; además, especificar en el examen gonioscópico del paciente la extensión y localización de las alteraciones embrionarias(AU)

Introduction: Juvenile glaucoma is a rare disease that behaves in the same way as the adult glaucoma Methods: A retrospective comparative case- control study was performed. with the objective of describing the gonioscopic characteristics of the camerular angle in juvenile glaucoma. Results: A family history of glaucoma is common in the juvenile glaucoma. The open-angle glaucoma and the lack of evident embrionary alterations are the most frequent findings in the gonioscopic test in Juvenile Glaucoma and in healthy patients. Conclusions: Juvenile Glaucoma is a multifactorial disease, which develops in young patients presenting with embrionary alterations of the camerular angle or not. Recommendations: A screening should be carried out to look for juvenile glaucoma in patients with risk factors although the gonioscopic study seems to be normal, and also the gonioscopic exam of a patient should specify the extension and location of the embrionary alterations(AU)

Bleeding during gonioscopy after deep sclerectomy.

PURPOSE: To show a new complication after deep sclerectomy (DS). METHODS: We described two eyes of two patients with open-angle glaucoma and cataract who were operated on of an uneventful phacoemulsification and DS with SK-gel implantation. RESULTS: Bleeding during gonioscopic examination occurred in both eyes 7 and 8 months after combined surgery. The blood originated from the vessels around the Descemet window, and was probably due to manipulation or rocking of the goniolens. Pressure was immediately applied to the gonioscopic lens and the hyphema was interrupted. CONCLUSION: These cases show the presence of new vessels around the Descemet window after DS with SK-gel. Bleeding from the Descemet window vessels can occur during gonioscopy even months after DS. We recommend conducting a careful gonioscopic examination in patients who have undergone DS to avoid this complication.