Transfixion technique for the treatment of silicone oil pupillary block glaucoma refractory to Nd-YAG iridotomy.

BACKGROUND: Pupillary block induced by silicon oil in vitrectomized patients is a common condition usually treated with Nd-YAG laser iridotomy or with surgical removal of silicon oil. CASE REPORT: A case of silicone oil pupillary block glaucoma successfully treated with a 30 G needle transfixion technique is described. We performed a non-complicated vitrectomy surgery for retinal detachment with proliferative vitreoretinopathy that included lensectomy, inferior peripheral iridectomy, and silicone oil injection. After surgery, the iridectomy became occluded with fibrous tissue and the intraocular pressure raised to 50 mmHg. After an initial Nd-YAG iridotomy was unsuccessful, we passed a 30 Ga needle through the sclerocorneal limbus and cut the fibrous tissue that blocked the iridectomy. This procedure restored the aqueous humor flow through the iridectomy, pushed back the silicone oil bubble into the vitreous cavity and lowered the intraocular pressure to normal levels. CONCLUSIONS: 30 Ga needle transfixion technique could be an effective, low cost, simple alternative for the treatment of silicone oil pupillary block in aphakic patients.

ANTECEDENTES: El bloqueo pupilar secundario a aceite de silicón en pacientes vitrectomizados es una condición frecuente que normalmente se trata con apertura de la iridectomía con láser Nd-YAG o con el retiro del aceite de silicón. CASO CLÍNICO: Se describe un caso de glaucoma secundario a bloqueo pupilar por aceite de silicón tratado satisfactoriamente con técnica de transfixión con aguja de calibre 30. Realizamos una cirugía de vitrectomía sin complicaciones para el tratamiento de un desprendimiento de retina con vitreorretinopatía proliferativa, que incluyó lensectomía, iridectomía periférica inferior e inyección de aceite de silicón. Después de la cirugía, la iridectomía se ocluyó con tejido fibroso y la presión intraocular se incrementó a 50 mmHg. Después de que una iridotomía inicial con láser Nd-YAG no tuvo éxito, pasamos una aguja de calibre 30 a través del limbo esclerocorneal y cortamos el tejido fibroso que bloqueaba la iridectomía. Este procedimiento restauró el flujo de humor acuoso a través de la iridectomía, desplazando la burbuja de aceite de silicón a la cavidad vítrea, y la presión intraocular descendió a valores normales. CONCLUSIONES: La técnica de transfixión con aguja de calibre 30 puede ser una alternativa efectiva, simple y de bajo costo para el tratamiento del bloqueo pupilar con aceite de silicón en pacientes con afaquia.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória / Phacoemulsification in dogs with and without intraocular lens implantation in piggyback: Clinical study of postoperative inflammation

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.

Perioperative and postoperative uveitis is the main problem in cataract surgery in dogs, affecting short-term and long-term postoperative success. Numerous therapeutic methods involving both steroidal and non-steroidal anti-inflammatory agents have been used to reduce surgically-induced uveitis. The purpose of this study was to investigate the postoperative inflammatory reaction and intraocular pressure after phacoemulsification surgery for cataract extraction with and without intraocular piggyback lens (IOL) implantation in dogs. A total of 25 dogs were divided into two groups: Group 1 (with IOL implantation) and Group 2 (without IOL implantation). The performed surgical technique consisted of unilateral bimanual phaco-emulsification. Clinical assessment and intraocular pressure were measured before surgery (0) and at 3, 7, 14, 21, 28, 60 days after the surgery. Clinical assessment revealed inflammatory reaction more severe in dogs of G1 when compared to G2. Intraocular pressure did not differ significantly either between G1 and G2 or operated and non-operated eyes. Intraocular lens (IOL) implantation using piggyback technique with human IOL is a possible method to be performed in canine ophthalmology. However, nursing care is necessary as the the procedure induces inflammation and complications in the postoperative period.

Facoemulsificação em cães, com e sem implante de lente intra-ocular em piggyback: estudo clínico da inflamação pós-operatória / Phacoemulsification in dogs with and without intraocular lens implantation in piggyback: Clinical study of postoperative inflammation

A uveíte peri e pós-operatória é o maior problema da cirurgia para extração de catarata no cão, sendo considerada o fator mais importante para o sucesso cirúrgico, imediato e tardio. Diversos protocolos pré e pós-operatórios utilizando agentes anti-inflamatórios esteroidais e não-esteroidais têm sido empregados na tentativa de controle da uveíte cirurgicamente induzida. O objetivo do presente estudo foi avaliar a reação inflamatória pós-operatória, clinicamente e por meio da pressão intraocular (PIO), após a cirurgia de facoemulsificação para extração de catarata em cães, com e sem implante de lente intraocular (LIO) em piggyback. Empregaram-se, 25 cães portadores de catarata, subdivididos em dois grupos: G1 (com implante de LIO), G2 (sem implante de LIO). A técnica cirúrgica adotada foi a facoemulsificação bimanual unilateral. Avaliações clínicas e mensurações da PIO foram aferidas antes do procedimento cirúrgico (0) e nos tempos 3, 7, 14, 21, 28 e 60 dias após o ato cirúrgico. Cães do grupo G1 apresentaram sinais clínicos de uveíte visivelmente mais intensos, relativamente aos do G2. Entretanto, a PIO não demonstrou diferença significativa entre os dois grupos analisados, nem entre os olhos operados e os contralaterais. A utilização de duas LIOs humanas em piggyback no cão é exequível, porém suscita mais inflamação e complicações no pós-operatório.(AU)

Perioperative and postoperative uveitis is the main problem in cataract surgery in dogs, affecting short-term and long-term postoperative success. Numerous therapeutic methods involving both steroidal and non-steroidal anti-inflammatory agents have been used to reduce surgically-induced uveitis. The purpose of this study was to investigate the postoperative inflammatory reaction and intraocular pressure after phacoemulsification surgery for cataract extraction with and without intraocular piggyback lens (IOL) implantation in dogs. A total of 25 dogs were divided into two groups: Group 1 (with IOL implantation) and Group 2 (without IOL implantation). The performed surgical technique consisted of unilateral bimanual phaco-emulsification. Clinical assessment and intraocular pressure were measured before surgery (0) and at 3, 7, 14, 21, 28, 60 days after the surgery. Clinical assessment revealed inflammatory reaction more severe in dogs of G1 when compared to G2. Intraocular pressure did not differ significantly either between G1 and G2 or operated and non-operated eyes. Intraocular lens (IOL) implantation using piggyback technique with human IOL is a possible method to be performed in canine ophthalmology. However, nursing care is necessary as the the procedure induces inflammation and complications in the postoperative period.(AU)

Blood-aqueous barrier changes after the use of prostaglandin analogues in patients with pseudophakia and aphakia: a 6-month randomized trial.

OBJECTIVES: To investigate the effects of prostaglandin analogues on the blood-aqueous barrier and to evaluate the occurrence of cystoid macular edema in aphakic or pseudophakic patients with glaucoma. METHODS: In this randomized, masked-observer, 6-month clinical trial, patients with primary open-angle, pseudophakic, or aphakic glaucoma were treated once daily with bimatoprost (n = 16), latanoprost (n = 15), or travoprost (n = 17) or twice daily with unoprostone (n = 16) or lubricant drops (control group) (n = 16). Blood-aqueous barrier status, which was assessed using a laser flare meter; intraocular pressure; the occurrence of angiographic cystoid macular edema; and conjunctival hyperemia were evaluated. RESULTS: Mean flare values were significantly higher in the bimatoprost, latanoprost, and travoprost groups throughout follow-up (P < .02). Four latanoprost-treated eyes, 1 bimatoprost-treated eye, and 1 travoprost-treated eye developed cystoid macular edema; all cases resolved after discontinuation of the prostaglandin analogue and treatment with topical diclofenac sodium. Mean intraocular pressure reductions after 6 months were higher for the latanoprost (26%), bimatoprost (28%), and travoprost (29%) groups than for the control (3%) and unoprostone (14%) groups (P< .05). Bimatoprost induced significantly higher hyperemia scores than latanoprost, unoprostone, and placebo (P< .01). CONCLUSION: Bimatoprost, latanoprost, and travoprost use may lead to disruption of the blood-aqueous barrier in patients with pseudophakia and aphakia.

Myopic and nonmyopic aphakic retinal detachment: time interval and location of breaks.

Of 471 retinal detachments occurring in aphakic patients after undergoing intracapsular cataract extraction, we reviewed 318 eyes with uncomplicated aphakia (no vitreous loss). Myopic eyes had equatorial breaks 38% of the time versus 19% for nonmyopic eyes. The time interval between aphakia and detachment was shorter for myopic than for nonmyopic eyes. Our results showed a significant incidence of: (1) equatorial breaks in myopic eyes versus nonmyopic eyes (P less than 0.005), and (2) earlier detachments for myopic eyes versus nonmyopic eyes (P less than 0.005). The presence of equatorial breaks seemed to be associated with earlier retinal detachments.