Quistes secundarios de iris / Secondary Iris Cysts

Los quistes epiteliales del iris o de cámara anterior son una rara y grave complicación tras la cirugía o traumatismos penetrantes del segmento anterior del ojo. Son secundarios a la invasión epitelial de la cámara anterior. Se ha descrito una incidencia de 0,09-0,12 por ciento, aunque estudios histopatológicos en ojos enucleados, tras cirugía de cataratas señalan una incidencia del 16 por ciento. Frecuentemente evolucionan hacia un aumento progresivo de tamaño y la producción de complicaciones visuales como glaucoma (de ángulo abierto por liberación de contenido mucoso del quiste, o cerrado), uveítis, descompensación corneal y membranas retrocorneales. Se presenta el caso de un paciente masculino de 61 años de edad, que acude a consulta tras una cirugía de dos meses de evolución, en la que se le realizó una cirugía combinada de catarata y glaucoma Al examen en lámpara de hendidura le son detectados varios quistes retroiridianos(AU)

Iris epithelial or anterior chamber cysts are a rare and serious complication following surgery or penetrating trauma to the anterior segment of the eye. They are secondary to epithelial invasion of the anterior chamber. An incidence of 0.09-0.12 percent has been described, although histopathological studies in enucleated eyes after cataract surgery indicate an incidence of 16 percent. They frequently evolve towards a progressive increase in size and the production of visual complications such as glaucoma (open angle due to the release of mucous content of the cyst, or closed), uveitis, corneal decompensation and retrocorneal membranes. We present the case of a 61-year-old male patient, who came to the clinic after a two-month surgery, in which he underwent a combined cataract and glaucoma surgery(AU)

Characterization of deeply embedded corneal foreign bodies with anterior segment optical coherence tomography.

PURPOSE: The purpose of the study was to describe findings demonstrated by anterior segment spectral domain optical coherence tomography (AS-OCT) in various types of deeply embedded corneal foreign bodies. METHODS: In this experimental study, an ex vivo model of calf eyes was used and seven different foreign bodies were deeply embedded in the cornea, consisting of five different materials: glass, plastic, metal, wood, and pencil graphite. The eyes were photographed and then scanned by AS-OCT. The images were analyzed to determine distinguishing characteristics for each material. RESULTS: Various materials presented unique characteristics in AS-OCT. The opaque materials (pencil graphite, metals, and wood) demonstrated a hyper-reflective anterior border, whereas the posterior border signal could not be clearly identified due to the shadowing effect. Moreover, a chain of signals was characteristic of both pencil graphite and metals though a "mirroring effect" was unique for metals. Wood, as an opaque material, appears as a hyper-reflective mass with a spectrum of penetrability depending on the degree of concentration. Transparent materials demonstrated hyper-reflective sharp borders when surrounded by air or fluid, as opposed to when being embedded purely in the corneal stroma. CONCLUSIONS: This study shows that AS-OCT was used to systematically define a novel set of distinguishing characteristics specific to various materials extruding from the cornea, fully embedded in the cornea, and intruding into the anterior chamber. Hopefully, the described characteristics of each material can aid clinicians in diagnosing the type of the material embedded and the depth of its involvement in ocular injury.

Anterior Segment Injury by a High-Power Handheld Blue Laser Device.

PURPOSE: To report a case of severe anterior segment inflammation secondary to exposure to a high-power blue laser device. METHODS: Case report. RESULTS: A 14-year-old male presented with redness, pain and decreased vision in his left eye after exposure to blue laser. Examination indicated severe conjunctival injection associated with 4+ cells in the anterior chamber with fibrinous reaction. The posterior pole was normal. CONCLUSION: Blue laser devices are easily available through the Internet. These devices can cause devastating ocular injuries. National safety guidelines are required to regulate use.

CT in the Evaluation of Acute Injuries of the Anterior Eye Segment.

OBJECTIVE: Slit-lamp ophthalmologic examination and ocular B-scan sonography of the globe are frequently constrained by technical limitations in the setting of traumatic orbital injury. The main purpose of this study was to evaluate the diagnostic performance of CT in acute anterior segment ocular injuries as an adjunctive diagnostic modality. MATERIALS AND METHODS: We retrospectively identified 122 patients who presented to the emergency department from April 2011 through April 2016 with recent direct trauma to the anterior segment of the eye. Deidentified multiplanar thin-slice CT images were reviewed by two subspecialty board-certified neuroradiologists for the presence of anterior segment rupture and hyphema, as well as lens, ciliary body, and lacrimal gland injury. The CT findings were compared to slit-lamp, B-scan ultrasound, or operative data as the reference standard. RESULTS: The neuroradiologists' CT evaluation showed high sensitivity of 87.2% (95% CI, 74.3-95.2%) and specificity of 97.3% (95% CI, 90.7-99.7%) in diagnosing anterior globe rupture with high interrater agreement (κ = 0.876; 95% CI, 0.787-0.965). Detection of lens dislocation and anterior hyphema showed a sensitivity and specificity of 88.0% and 90.7% and 77.4% and 88.4%, respectively. A shallow anterior chamber was detectable with a sensitivity of 89.2% and specificity of 87.1%. This critically important sign predicted anterior globe rupture in 39 of 47 patients (odds ratio, 68.25; p < 0.0001). CONCLUSION: Subtle ocular findings are readily detectable at CT and can provide valuable information to the ophthalmologist concerning acute trauma to the ocular anterior segment.

Longitudinal Evaluation of Wound Healing after Penetrating Corneal Injury: Anterior Segment Optical Coherence Tomography Study.

PURPOSE: Ocular imaging can enhance our understanding of wound healing. We report anterior segment optical coherence tomography (ASOCT) findings in penetrating corneal injury. METHODS: Serial ASOCT was performed after repair of penetrating corneal injury. Internal aberrations of wound edges were labeled as "steps" or "gaps" on ASOCT images. The wound type was characterized as: type 1: continuous inner wound edge or step height ≤ 80 µm; type 2: step height > 80 µm; type 3: gap between wound edges; and type 4: intraocular tissue adherent to wound. Surgical outcomes of different wound types were compared. RESULTS: 50 consecutive patients were included (6 females, 44 males; mean age 33 ± 12 years). The average size of wound was 4.2 ± 2.6 mm (type 1, 8 eyes; type 2, 27 eyes; type 3, 12 eyes; type 4, 3 eyes). At the end of 3 months, 70% (n = 35) of the wounds were type 1. At the end of 6 months, all type 1 wounds had healed completely, whereas about half of type 2 (48.1%) and type 3 (50%) wounds had recovered to type 1 configuration. The wound type at baseline affected the height of step (p = 0.047) and corneal thickness at 6 months (p = 0.035). CONCLUSIONS: ASOCT is a useful tool for monitoring wound healing in cases with penetrating corneal injury. Majority of the wound edges appose between 3 and 6 months after trauma. In our study, baseline wound configuration affected the healing pattern.

[Visual rehabilitation of patients with large post-traumatic defects of the anterior eye segment through iris-lens diaphragm implantation]. / Sistema zritel'noi reabilitatsii patsientov s obshirnymi defektami struktur perednego otrezka glaznogo iabloka na osnove implantatsii iridokhrustalikovoi diafragmy.

The diversity of methodological approaches and lack of pathogenetically reasonable tactics for patients with combined ocular injuries became the basis for the development and systematization of surgical rehabilitation stages of patients, in whom post-traumatic cataract is combined with post-traumatic aniridia and corneal scarring. AIM: to construct a visual rehabilitation approach to patients with post-traumatic defects of the anterior eye segment following optical-reconstructive surgery that involved implantation of an iris-lens diaphragm (ILD). MATERIAL AND METHODS: We have analyzed 80 reconstructive cases with ILD implantation in patients with post-traumatic aniridia and corneal damage. These patients constituted the first study group (Group 1). We have also investigated 58 eyes with residual ametropy and stable visual function 1 year after ILD implantation before and after conducting a laser keratorefractive surgery. These patients were assigned to the second study group (Group 2). RESULTS: Rehabilitation approach to patients after anterior segment injuries that has been proposed allows to achieve high clinical and functional results and reduce the risk of intra- and postoperative complications. CONCLUSION: The proposed approach to patients after optical-reconstructive surgery with iris-lens diaphragm implantation followed by keratorefractive surgery is an effective method of visual rehabilitation of anterior eye segment post-traumatic defects.

Degeneración nodular de Salzmann / Salzmann's nodular degeneration

La degeneración nodular de Von Salzmann constituye una entidad clínico-patológica en la que aparecen nódulos lisos y opacos, blanco grisáceos o algo azulados en las capas anteriores de la córnea. La afectación suele ser bilateral y los nódulos tienden a disponerse en anillo sobre la media periferia corneal. Pueden estar relacionados o no con un proceso inflamatorio previo y su tratamiento puede ser sintomático o quirúrgico si compromete el área pupilar y con ella la visión del paciente.Se presenta un paciente masculino, de 57 años de edad, coloración de la piel blanca, quien acudió a la consulta y refirió enrojecimiento de ambos ojos (predominio del ojo derecho), con picor, escozor y lagrimeo, de más de 6 meses de evolución. Asociado a esto notó una zona de color blanquecina en ambos ojos. En la exploración oftalmológica se observaron lesiones blanquecinas sobrelevadas de aspecto hialino, en el tercio inferior de la córnea en el ojo derecho y en el ojo izquierdo hacia la región nasal. Se concluye que el caso presenta una degeneración nodular de Salzmann(AU)

Von Salzmann nodular degeneration constitutes a clinical pathological condition in which flat and opaque, white-grayish or bluish nodules appear in the anterior layers of the cornea. The effect is usually bilateral and the nodules tend to spread in a ring form upon the corneal peripheral media. It can be related or not with previous inflammatory process and its treatment can be symptomatic or surgical if the papillary area and the patient's vision are compromised. Here is the case of a 57 years-old male Caucasian patient, who went to the doctor´s and complained of reddened eyes (mainly the right eye), itching and tearing for more than six months. In addition to this, he observed a whitish area in both eyes. The eye screening showed overelevated whitish lesions of hyaline aspect in the lower third of the right eye cornea and in the left eye towards the nasal region. It was concluded that this is a case of Von Salzmann nodular degeneration(AU)

Degeneración nodular de Salzmann / Salzmann's nodular degeneration

La degeneración nodular de Von Salzmann constituye una entidad clínico-patológica en la que aparecen nódulos lisos y opacos, blanco grisáceos o algo azulados en las capas anteriores de la córnea. La afectación suele ser bilateral y los nódulos tienden a disponerse en anillo sobre la media periferia corneal. Pueden estar relacionados o no con un proceso inflamatorio previo y su tratamiento puede ser sintomático o quirúrgico si compromete el área pupilar y con ella la visión del paciente.Se presenta un paciente masculino, de 57 años de edad, coloración de la piel blanca, quien acudió a la consulta y refirió enrojecimiento de ambos ojos (predominio del ojo derecho), con picor, escozor y lagrimeo, de más de 6 meses de evolución. Asociado a esto notó una zona de color blanquecina en ambos ojos. En la exploración oftalmológica se observaron lesiones blanquecinas sobrelevadas de aspecto hialino, en el tercio inferior de la córnea en el ojo derecho y en el ojo izquierdo hacia la región nasal. Se concluye que el caso presenta una degeneración nodular de Salzmann(AU)

Von Salzmann nodular degeneration constitutes a clinical pathological condition in which flat and opaque, white-grayish or bluish nodules appear in the anterior layers of the cornea. The effect is usually bilateral and the nodules tend to spread in a ring form upon the corneal peripheral media. It can be related or not with previous inflammatory process and its treatment can be symptomatic or surgical if the papillary area and the patient's vision are compromised. Here is the case of a 57 years-old male Caucasian patient, who went to the doctor´s and complained of reddened eyes (mainly the right eye), itching and tearing for more than six months. In addition to this, he observed a whitish area in both eyes. The eye screening showed overelevated whitish lesions of hyaline aspect in the lower third of the right eye cornea and in the left eye towards the nasal region. It was concluded that this is a case of Von Salzmann nodular degeneration(AU)

A case of perforating injury of eyeball and traumatic cataract caused by acupuncture.

Perforating globe injury is the leading cause of monocular blindness and vision loss. A 58-year-old male was injured by acupuncture needle during acupuncture treatment for his cerebral infarction. To the best of our knowledge, this is the first case report of perforating injury of the eyeball and traumatic cataract caused by acupuncture. The patient was hospitalized due to diagnosis of perforating ocular injury, traumatic cataract, and corneal and iris perforating injury. Moreover, he had to accept treatments of phacoemulsification, anterior vitrectomy along with intraocular lens implantation in the sulcus to improve his visual acuity. As acupuncture therapy has been widely performed for various diseases and achieved highly approval, the aim of this report is to remind acupuncturists operating accurately to avoid unnecessary injury during the treatment process, or the cure can also become the weapon.

Role of B-scan ultrasonography in the localization of intraocular foreign bodies in the anterior segment: a report of three cases.

BACKGROUND: The accurate localization of intraocular foreign bodies (IOFBs) is very important for the management of ocular trauma patients. B-scan ultrasonography is usually used to detect IOFBs in the posterior segment. Here, we report three cases with IOFBs in the anterior segment near the posterior lens capsule, which were accurately localized by B-scan ultrasonography under dynamic transversal scanning. CASE PRESENTATION: All three patients had a history of ocular trauma, and their clinical symptoms were compatible with the persistence of IOFBs. It was difficult to get a direct visualization of IOFBs with slit-lamp biomicroscopy because of opacities of the cornea and traumatic cataract. A computed tomography scan detected IOFBs in the anterior segment, but could not determine the exact location. Ultrasound biomicroscopy was performed but failed to show any IOFBs owing to the limited depth of penetration. B-scan ultrasonography was further applied but also failed to show any intraocular foreign bodies using axial scanning, a routine procedure of B-scan ultrasonography examination. However, using dynamic transversal scanning of B-scan ultrasonography, the accurate location of IOFBs was eventually shown to be embedded in the posterior lens cortex in case 1, adjacent to the posterior lens capsule in case 2, and located in the anterior vitreous close to the posterior lens capsule in case 3. Different surgical procedures were designed according to localization by B-scan ultrasonography, and all IOFBs were successfully removed. CONCLUSION: B-scan ultrasonography is a simple and effective imaging modality in the localization of IOFBs in traumatic cataract. Transversal scanning is more suitable than axial scanning to detect IOFBs in the anterior segment near the posterior lens capsule.

Removal of intracameral metallic foreign body by encapsulation with an intraocular lens injector.

UNLABELLED: We describe a technique in which a metallic foreign body in the anterior chamber is safely removed by encapsulation with an intraocular lens (IOL) injector instead of with a forceps or a magnet. A forceps sometimes provides inadequate grip over an intraocular foreign body and requires a large incision, which may damage the surrounding tissue. A magnet is an alternative to a forceps; however, magnets are ineffective in removing nonmagnetic foreign bodies and are seldom available in every operating room. We propose that the IOL injector can be used as an effective tool for extracting both magnetic and nonmagnetic intracameral foreign bodies. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Prickly pear spine keratoconjunctivitis.

OBJECTIVES: To study the ocular and extra-ocular features, clinical presentation, and treatment of prickly pear glochids. MATERIALS AND METHODS: This retrospective study included 23 eyes of 21 patients with ocular prickly pear spines who were seen between August and October 2011 in the outpatient ophthalmic clinic at Prince Rashid Bin Al Hassan military hospital in Jordan. Medical records of patients including age, gender, history of exposure to prickly pear plants, and ocular examination were reviewed. All glochids were localized and removed with forceps under topical anesthesia with the patient at the slit lamp. Patients were followed up after one week. RESULTS: The mean age of patients was 37.1 years with a male to female ratio of 1.6: 1. Involvement of the right eye was seen in 61.9% patients, left eye in 28.6% patients, and bilateral involvement in 9.5% patients. Glochids were most commonly found in the upper subtarsal conjunctival space (47.6%) followed by inferior palpebral conjunctiva in 23.8% eyes. The most common complaint was eye irritation in 95.2% patients. Pain was a complaint in 57.1% patients. Superior corneal epithelial erosions or ulcer were found in 33.3% patients, inferior corneal epithelial erosions in 19.1% patients, and diffuse epithelial erosions in 9.5% patients. Glochids were found in other parts of the body in 38.1% patients. CONCLUSION: Although prickly pear glochid ocular surface injury is not uncommon in the region during summer, it should be considered in patient with eye pain during that period. Farmers who are in close contact with prickly pears should use protective eyeglasses and gloves.