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1.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33462040

RESUMO

An 86-year-old woman presented with symptomatic hypotony on the left eye since a few weeks, blurry vision and a very sensitive eye. She had a history of bilateral intracapsular cataract extraction (ICCE) in 1982 and secondary intraocular lens implantation in 1988. The patient mentioned a fall on the left side of the head 6 months earlier. The diagnosis of a superior scleral fistula was made, confirmed by gonioscopy and anterior segment optical coherence tomography. Direct surgical repair of the fistula led to a favourable outcome. This case demonstrates the occurrence of symptomatic hypotony due to the traumatic creation of a scleral fistula with an inadvertent filtering bleb many years after ICCE, and the resolution of signs and symptoms after surgical repair. Conventional as well as contemporary modalities can be valuable in the assessment of such fistulae. Management depends on the clinical course and the mechanism and extent of fistulation.


Assuntos
Vesícula/etiologia , Extração de Catarata/efeitos adversos , Fístula/etiologia , Implante de Lente Intraocular/efeitos adversos , Hipotensão Ocular/etiologia , Esclera/lesões , Idoso de 80 Anos ou mais , Vesícula/diagnóstico , Feminino , Fístula/diagnóstico , Humanos , Hipotensão Ocular/diagnóstico
2.
J Med Case Rep ; 15(1): 16, 2021 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-33468218

RESUMO

BACKGROUND: Use of perfluorocarbon liquid (PFCL) has been increasingly growing as an adjuvant in vitreo-retina surgeries. Some commonly encountered complications with its use include subretinal migration, formation of sticky silicone oil or retained PFCL in vitreous cavity and anterior chamber. Scleral rupture during PFCL injection has a rare occurrence. We report an unexpected event of scleral rupture during PFCL injection and discuss the management challenges faced by the surgeon. CASE PRESENTATION: A 66 year indo-aryan male was undergoing pars-plana vitrectomy (PPV) with diagnosis of subtotal rhegmatogenous retinal detachment (RD) with Proliferative Vitreo-retonipathy (PVR)-B. After near total vitrectomy PFCL was being injected and then there was sudden poor visualization of fundus with development of bullous RD and globe hypotony. The surgeon was not able to figure out the cause of hypotony and air was switched on in the infusion cannula. This further complicated the situation resulting in migration of air in the anterior chamber, posterior dislocation of intraocular lens complex, 180° inferior retinal dialysis and ballooning of the conjunctiva which gave a clue of probable scleral rupture. Conjunctival peritomy was performed superiorly and scleral defect was noted. Intraocular tissue incarceration and air leak was visible from the wound. This confirmed scleral rupture during PFCL injection. Repositioning of incarcerated retina was not possible and retinectomy was performed followed by repair of scleral rupture with lots of difficulty in a vitrectomised eye. CONCLUSION: PFCL injection, a crucial step of vitreoretina surgery, should be performed slowly with extreme caution maintaining an optimal intraocular pressure to prevent devastating complications like scleral rupture.


Assuntos
Fluorcarbonetos/administração & dosagem , Complicações Intraoperatórias/etiologia , Injeções Intravítreas/efeitos adversos , Descolamento Retiniano/cirurgia , Ruptura/etiologia , Esclera/lesões , Vitrectomia/métodos , Vitreorretinopatia Proliferativa/cirurgia , Idoso , Traumatismos Oculares/etiologia , Humanos , Masculino , Cirurgia Vitreorretiniana/métodos
4.
Ulus Travma Acil Cerrahi Derg ; 25(6): 631-634, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31701505

RESUMO

Globe rupture is a major postoperative complication after penetrating keratoplasty (PK). Because the corneal wound is never comparable with that of healthy corneal tissue, globe rupture following blunt trauma occurs at the corneal graft-host junction. In this study, we report a case of scleral rupture that arose from blunt trauma occurring after PK. A 60-year-old female presented with loss of vision, redness and pain in the left eye, which was the consequence of blunt trauma, was our case in this study. Slit-lamp examination revealed ecchymosis on the eyelids, diffuse subconjunctival hemorrhage and total hyphema. The donor cornea was intact. The right eye showed PK, the cornea was transparent, and the sclera was blue. A 2 mm rupture behind the limbus extending from 3 o'clock to 9 o'clock in the upper half of the sclera was observed during exploratory surgery. She did not report any coexisting medical conditions except for systemic hypertension. The differential diagnosis of the bluish discoloration of her sclera was investigated. In detailed anamnesis, the patient reported that she had been treated for severe allergic eye disease during childhood. Vernal keratoconjunctivitis complication was diagnosed. It should be kept in mind that closed scleral perforation may occur in the patient with PK and blue sclera due to blunt trauma.


Assuntos
Traumatismos Oculares , Ceratoplastia Penetrante , Ruptura , Esclera , Ferimentos não Penetrantes , Acidentes , Traumatismos Oculares/patologia , Traumatismos Oculares/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Ruptura/patologia , Ruptura/cirurgia , Esclera/lesões , Esclera/patologia , Esclera/cirurgia , Acuidade Visual , Ferimentos não Penetrantes/patologia , Ferimentos não Penetrantes/cirurgia
5.
BMJ Case Rep ; 12(9)2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31519722

RESUMO

Monocular elevation deficit can result from either inferior rectus restriction, superior rectus palsy or from supranuclear causes. We report a case of monocular elevation deficit after scleral perforation repair which was managed by surgery on contra lateral eye. This improved elevation of the affected eye with no diplopia in the postoperative period.


Assuntos
Diplopia/etiologia , Transtornos da Motilidade Ocular/cirurgia , Oftalmoplegia/etiologia , Esclera/lesões , Adulto , Diagnóstico Diferencial , Diplopia/diagnóstico , Diplopia/prevenção & controle , Movimentos Oculares/fisiologia , Humanos , Masculino , Transtornos da Motilidade Ocular/fisiopatologia , Músculos Oculomotores/patologia , Músculos Oculomotores/fisiopatologia , Músculos Oculomotores/cirurgia , Oftalmoplegia/fisiopatologia , Período Pós-Operatório , Esclera/patologia , Esclera/cirurgia , Perfuração Espontânea/cirurgia , Resultado do Tratamento
6.
Exp Eye Res ; 186: 107717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31265829

RESUMO

Scleral defects can result as a consequence of trauma, infectious diseases or cancer and surgical repair with allogeneic scleral grafts can be required. However, this method has limitations and novel alternatives are needed. Here, the efficacy of acellular nanostructured fibrin-agarose hydrogel-based substitutes (NFAH) in the repair of scleral defects in rabbits was studied. For this, scleral defects of 5-mm diameter were made on 18 adult-male New Zealand rabbits and repaired with acellular NFAH, NFAH crosslinked with genipin (NFAH-GP) or glutaraldehyde (NFAH-GA), allogeneic scleral grafts as control (C-CTR) or not repaired (negative control N-CTR) (n = 3 each). Macroscopic and histological analyses were performed after 40-days. Macroscopy confirmed the repair of all defects in a comparable manner than the C-CTR. Histology showed no degradation nor integration in C-CTR while NFAH-GP and NFAH-GA biomaterials were encapsulated by connective and inflammatory tissues with partial biodegradation. The NFAH were fully biodegraded and replaced by a loose connective tissue and sclera covering the defects. This in vivo study demonstrated that the NFAH are a promising biocompatible and pro-regenerative alternative to the use of allogeneic cadaveric grafts. However, large defects and long-term studies are needed to demonstrate the potential clinical usefulness of these substitutes.


Assuntos
Traumatismos Oculares/cirurgia , Adesivo Tecidual de Fibrina/administração & dosagem , Nanoestruturas/uso terapêutico , Esclera/cirurgia , Sefarose/administração & dosagem , Animais , Materiais Biocompatíveis/uso terapêutico , Masculino , Coelhos , Esclera/lesões
9.
Indian J Ophthalmol ; 67(4): 547-548, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30900593

RESUMO

Surgical skill enhancement for the residents under training can be performed through various efforts. Here in this report, the authors describe a technique of corneoscleral perforation repair on goat's eye, as the tissue resemblance and the reality of experience while performing crucial steps are similar to human eyes. Beginning from tissue handling, optimal suture placement was taught with an intention to impart quality techniques of traumatic globe injury repair. Therefore, rather than training on expensive artificial eye model, training budding surgeons on goat's eye gives much more realistic tissue handling experiences in the presence of constant challenges almost similar to human eyes.


Assuntos
Perfuração da Córnea/cirurgia , Educação de Pós-Graduação em Medicina/métodos , Ferimentos Oculares Penetrantes/cirurgia , Internato e Residência/métodos , Procedimentos Cirúrgicos Oftalmológicos/educação , Oftalmologia/educação , Esclera/lesões , Animais , Competência Clínica , Modelos Animais de Doenças , Cabras , Humanos
10.
Med Hypotheses ; 124: 64-66, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30798919

RESUMO

The probable chain of events responsible for choroidal rupture is as follows. During high-speed orbital injuries, the protective ocular reflexes position the eye in an elevated, and abducted position. At this point in time, the anteroposterior compressive forces on to the globe create an eccentrically positioned circle of damaging currents along the posterior ocular coats against a relatively static optic nerve. Because of this eccentricity, a longer radius of curvature is expected to lie along the temporal half of the globe leading to an elastic recoil of the retinal and scleral layers and a fracture along the RPE-Bruch's-Choriocapillaris complex manifesting clinically as choroidal rupture.


Assuntos
Corioide/lesões , Traumatismos Oculares/diagnóstico , Ruptura/diagnóstico , Hemorragia da Coroide , Traumatismos Oculares/fisiopatologia , Angiofluoresceinografia , Humanos , Modelos Anatômicos , Nervo Óptico/patologia , Reflexo , Retina/lesões , Ruptura/fisiopatologia , Esclera/lesões , Ferimentos não Penetrantes
11.
Cornea ; 38(4): 498-501, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30601290

RESUMO

PURPOSE: To report a case of partial scleral rupture after laser in situ keratomileusis (LASIK) surgery. METHODS: This is a retrospective case report describing a late complication of LASIK surgery. RESULTS: A 32-year-old white woman with a history of LASIK surgery performed with a mechanical microkeratome 4 years previously presented for evaluation of partial bilateral scleral ruptures. An arcuate filtering bleb along the contour of the cornea was found on the right eye with associated hypotony and corneal astigmatism. There were no signs or symptoms of prior inflammation, and rheumatologic workup was negative. Imaging revealed scleral microbreaks in the absence of adjacent thinning. CONCLUSIONS: The pattern and location of thinning without findings consistent with inflammatory disease suggest that the partial bilateral scleral rupture was because of mechanical damage at the time of LASIK, possibly compounded by the hormonal changes of pregnancy.


Assuntos
Traumatismos Oculares/etiologia , Ceratomileuse Assistida por Excimer Laser In Situ/efeitos adversos , Esclera/lesões , Adulto , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Ruptura
12.
Int Ophthalmol ; 39(9): 2015-2021, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30353259

RESUMO

PURPOSE: The purpose of this study was to investigate the thermal injuries caused by ultrasonic pars plana phacoemulsification and aspiration (PPPEA) using pig eyes. METHOD: Using a 20-gauge (G) vitrectomy system (Accurus®, Fragmatome; Alcon Laboratories) in both the 'open-tip' and 'closed-tip' techniques, PPPEA was performed in pig eyes and the subsequent thermal injuries generated around the scleral wound were measured by infrared thermal imaging (thermography). Post surgery, the state of the scleral wound was observed under a microscope, and a tissue slice containing the scleral wound was then prepared and observed under an optical microscope. RESULTS: Thermography measurements revealed a slight temperature rise around the scleral wound in the open-tip case, yet a marked temperature rise in the closed-tip case. The scleral wound incision produced by the open tip was linear, while that produced by the closed tip was expanded. Histological examination revealed mild degeneration of the sclera around the wound in the open-tip case, yet marked tissue degeneration by thermal injuries in the closed-tip case. CONCLUSION: Our findings showed that in PPPEA, the temperature of the tip of a 20G vitrectomy system rapidly increases due to the closed-tip technique, thus producing obvious thermal damage to the scleral wound. In order to prevent thermal injuries to the scleral wound during PPPEA, it is important to shorten the time of ultrasonic oscillation during surgery as much as possible while the tip is occluded with nuclear fragments.


Assuntos
Queimaduras Oculares/diagnóstico , Paracentese/efeitos adversos , Facoemulsificação/efeitos adversos , Esclera/diagnóstico por imagem , Doenças da Esclera/diagnóstico , Animais , Modelos Animais de Doenças , Queimaduras Oculares/complicações , Queimaduras Oculares/fisiopatologia , Complicações Pós-Operatórias , Esclera/lesões , Doenças da Esclera/etiologia , Doenças da Esclera/fisiopatologia , Suínos , Termografia , Índices de Gravidade do Trauma , Procedimentos Cirúrgicos Ultrassônicos/efeitos adversos
13.
BMJ Case Rep ; 11(1)2018 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-30567246

RESUMO

Ozurdex (Allergan, Irvine, California, USA) is a biodegradable sustained release intravitreal implant containing 0.7 mg dexamethasone in a solid polymer drug delivery system. In the UK, it is approved for use in patients with macular oedema secondary to retinal vein occlusion, diabetic maculopathy and non-infectious uveitis. Although the implant is meant to be injected into the vitreous cavity, it can be inadvertently injected into the crystalline lens. This can also migrate into the anterior chamber, under altered anatomical conditions of the anterior segment. We report a case of incompletely penetrated dexamethasone implant, in a patient undergoing treatment for macular oedema secondary to retinal vein occlusion. The partially penetrated implant was managed conservatively with a good outcome.


Assuntos
Implantes de Medicamento/efeitos adversos , Migração de Corpo Estranho/complicações , Edema Macular/cirurgia , Oclusão da Veia Retiniana/complicações , Esclera/lesões , Idoso , Dexametasona/administração & dosagem , Feminino , Glucocorticoides/administração & dosagem , Humanos , Edema Macular/etiologia
15.
BMJ Case Rep ; 20182018 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-29866677

RESUMO

A 35-year-old man presented after a high-speed motor vehicle accident and the driver's side curtain air bag causing blunt force trauma rupturing his right globe. The tangential force of the air bag resulted in an unusual arcuate horseshoe-shaped rupture through the lateral rectus insertion, causing avulsion of the muscle and tearing the sclera, with the apices of the tear extending anteriorly towards the limbus. Repair of the globe rupture was undertaken, and secondary vitrectomy revealed that the scleral tear had not involved the retina abutting the ora serrata. Silicone oil tamponade was used to fill the globe and the postoperative best corrected vision was 6/9. This is the first reported case of a ruptured globe caused by a side curtain air bag, resulting in a uniquely shaped arcuate scleral wound combined with lateral rectus avulsion, not associated with rhegmatogenous retinal damage, and is the first air bag-related globe rupture with scleral involvement to report a final best-corrected visual acuity better than 6/60.


Assuntos
Acidentes de Trânsito , Air Bags/efeitos adversos , Traumatismos Oculares/etiologia , Ruptura/etiologia , Adulto , Traumatismos Oculares/diagnóstico por imagem , Traumatismos Oculares/cirurgia , Humanos , Masculino , Músculos Oculomotores/diagnóstico por imagem , Músculos Oculomotores/lesões , Músculos Oculomotores/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Ruptura/cirurgia , Esclera/diagnóstico por imagem , Esclera/lesões , Esclera/cirurgia , Tomografia Computadorizada por Raios X , Acuidade Visual , Vitrectomia
16.
Ophthalmologica ; 240(3): 179-180, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29635232

RESUMO

PURPOSE: To describe innovative ways of removal of complicated difficult large retained intraocular foreign bodies (RIOFBs). SETTINGS: Both cases were treated at Disha Eye Hospitals, Kolkata, a tertiary eye hospital in eastern India. METHODS: Innovative approaches were taken to remove 2 difficult RIOFBs. In the first case, a large RIOFB was just beyond the posterior exit wound, trapped in the sclera. A 23-G MVR blade was used to create multiple radial releasing scleral nicks and bimanually moving the RIOFB into the vitreous cavity using a bent-tip 24G needle and magnet, and the RIOFB was removed through the limbal section. In the second case, a 21-mm long thick nail was deeply embedded in the superior sclera with partial localised retinal detachment with its bulbous end just behind the clear lens. A lasso technique was used to remove the RIOFB without lens touch. RESULTS: In the first case, the patient finally achieved logMAR 0.2 vision after silicone oil removal and glued scleral fixation of the intraocular lens. In the second case, the patient finally achieved logMAR 0.3 vision after silicone oil removal and phacoemulsification with intraocular lens implantation. CONCLUSION: Each case of RIOFB is unique and challenging. Here, innovative techniques are helpful to rescue these difficult RIOFB situations, which can result in excellent outcomes.


Assuntos
Corpos Estranhos no Olho/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Esclera/lesões , Tamponamento Interno , Fluorcarbonetos/administração & dosagem , Humanos , Técnicas de Sutura
17.
Surv Ophthalmol ; 63(5): 694-699, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29649485

RESUMO

Occult globe rupture is a traumatic dehiscence of the sclera at or posterior to the rectus muscle insertions without a visible eye wall defect on slit lamp examination. Occult scleral ruptures are important because they can be difficult to diagnose, but normally require preoperative protection against external pressure to reduce risk of herniation of ocular contents through the rupture and then urgent surgical repair to restore eye wall structural integrity and achieve optimum prognosis. A deeper-than-normal anterior chamber with posteriorly retracted plateau iris seen immediately after acute ocular trauma is virtually pathognomonic of posterior globe dehiscence. Three additional less specific signs are helpful: extensive chemosis that is often hemorrhagic, relative hypotony, and vitreous hemorrhage. Although the diagnosis is normally clinical, made by history of direct severe ocular trauma and careful anterior-segment slit lamp examination, computed tomography and ultrasonography can be helpful when thorough slit lamp examination is not possible. Strong suspicion of occult rupture should engender surgical exploration. Vitreous hemorrhage, vitreous or retinal incarceration, and retinal tears or detachment may necessitate subsequent pars plana vitrectomy or other vitreoretinal surgery. When pars plana vitrectomy is indicated, special precautions are suggested if watertight closure of the globe rupture has not been possible.


Assuntos
Traumatismos Oculares/diagnóstico , Segmento Posterior do Olho/lesões , Esclera/lesões , Técnicas de Diagnóstico Oftalmológico , Traumatismos Oculares/fisiopatologia , Traumatismos Oculares/cirurgia , Humanos , Hipotensão Ocular/diagnóstico , Ruptura/diagnóstico , Ruptura/cirurgia , Esclera/cirurgia , Tomografia Computadorizada por Raios X , Ultrassonografia/métodos , Vitrectomia/métodos , Hemorragia Vítrea/diagnóstico
20.
Cornea ; 37(2): 211-217, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29140861

RESUMO

PURPOSE: Watertight closure of perforating corneoscleral lacerations is necessary to prevent epithelial ingrowth, infection, and potential loss of the eye. Complex lacerations can be difficult to treat, and repair with sutures alone is often inadequate. In this study, we evaluated a potentially sutureless technology for sealing complex corneal and scleral lacerations that bonds the amniotic membrane (AM) to the wound using only green light and rose bengal dye. METHODS: The AM was impregnated with rose bengal and then sealed over lacerations using green light to bond the AM to the deepithelialized corneal surface. This process was compared with suture repair of 3 laceration configurations in New Zealand White rabbits in 3 arms of the study. A fourth study arm assessed the side effect profile including viability of cells in the iris, damage to the blood-retinal barrier, retinal photoreceptors, retinal pigment epithelium, and choriocapillaris in Dutch Belted rabbits. RESULTS: Analyses of the first 3 arms revealed a clinically insignificant increase in polymorphonuclear inflammation. In the fourth arm, iris cells appeared unaffected and no evidence of breakdown of the blood-retinal barrier was detected. The retina from green light laser-treated eyes showed normal retinal pigment epithelium, intact outer segments, and normal outer nuclear layer thickness. CONCLUSIONS: The results of these studies established that a light-activated method to cross-link AM to the cornea can be used for sealing complex penetrating wounds in the cornea and sclera with minimal inflammation or secondary effects.


Assuntos
Âmnio/transplante , Lesões da Córnea/cirurgia , Corantes Fluorescentes/uso terapêutico , Lacerações/cirurgia , Fotoquimioterapia/métodos , Rosa Bengala/uso terapêutico , Doenças da Esclera/cirurgia , Animais , Modelos Animais de Doenças , Lasers de Estado Sólido/uso terapêutico , Coelhos , Esclera/lesões
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