Pub Date : 2023-02-10DOI: 10.1097/j.jcro.0000000000000091
Jaime D. Martinez, H. Levine, H. Flynn, S. G. Schwartz
Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emphasis on diagnostic and treatment challenges. Patient and Clinical Findings: A 64-year-old woman with a history of cognitive impairment, seizure disorder, and no prior ocular surgery presented with dense visually significant cataracts and visual acuity of fix and follows in both eyes. Diagnosis, Intervention, and Outcomes: Patient underwent ISBCS under general anesthesia and without intracameral antibiotics or corneal sutures. The patient returned with unilateral acute-onset endophthalmitis 2 weeks postoperatively. Because of the patient's limited ability to comply with treatment, and lack of emergency general anesthesia needed for vitreous cultures, intravitreal vancomycin injection (1 mg/0.1 mL) was empirically given, with clinical resolution of the infection and visual acuity of fix and follows. Conclusions: Acute-onset postoperative endophthalmitis in the setting of cognitive impairment is challenging because emergency general anesthesia may not be available, and the patient can tolerate only limited interventions. In this patient, empiric intravitreal vancomycin injection without cultures led to a satisfactory clinical outcome.
{"title":"Unilateral endophthalmitis after immediate sequential bilateral cataract surgery in a cognitively impaired patient: diagnosis and treatment","authors":"Jaime D. Martinez, H. Levine, H. Flynn, S. G. Schwartz","doi":"10.1097/j.jcro.0000000000000091","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000091","url":null,"abstract":"Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a reasonable approach for cataract surgery in patients needing general anesthesia, such as those with cognitive impairment. To our knowledge, this is the first reported case of unilateral acute-onset postoperative endophthalmitis in a patient with cognitive impairment after ISBCS, with emphasis on diagnostic and treatment challenges. Patient and Clinical Findings: A 64-year-old woman with a history of cognitive impairment, seizure disorder, and no prior ocular surgery presented with dense visually significant cataracts and visual acuity of fix and follows in both eyes. Diagnosis, Intervention, and Outcomes: Patient underwent ISBCS under general anesthesia and without intracameral antibiotics or corneal sutures. The patient returned with unilateral acute-onset endophthalmitis 2 weeks postoperatively. Because of the patient's limited ability to comply with treatment, and lack of emergency general anesthesia needed for vitreous cultures, intravitreal vancomycin injection (1 mg/0.1 mL) was empirically given, with clinical resolution of the infection and visual acuity of fix and follows. Conclusions: Acute-onset postoperative endophthalmitis in the setting of cognitive impairment is challenging because emergency general anesthesia may not be available, and the patient can tolerate only limited interventions. In this patient, empiric intravitreal vancomycin injection without cultures led to a satisfactory clinical outcome.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00091"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47094333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-28DOI: 10.1097/j.jcro.0000000000000086
Danny A. Mammo, Phuoc-Hanh Le, Sruthi Arepalli, S. Srivastava, Sumit Sharma
Introduction: To the authors' knowledge, these are 2 of the longest reported time periods between cataract surgery and diagnosis of chronic postoperative endophthalmitis. The clinical course and outcomes are discussed. Patient and Clinical Findings: 2 patients underwent uneventful cataract surgery and presented with recurrent anterior segment inflammation years after the surgery. In the first case, an 88-year-old man presented with granulomatous uveitis in the left eye 4 years after intracapsular cataract extraction and posterior chamber intraocular lens (CE/PC IOL) placement. In the second case, a 79-year-old woman presented with iritis 7 years after CE/PC IOL. Diagnosis, Intervention, and Outcomes: Both patients were treated for presumed idiopathic uveitis for years before the diagnosis of chronic endophthalmitis caused by Cutibacterium acnes. 1 case required endolaser photocoagulation to an infectious nidus. Conclusions: Chronic postoperative endophthalmitis can present many years after uneventful cataract surgery.
{"title":"Outcomes of very delayed onset chronic postoperative endophthalmitis caused by Cutibacterium acnes including treatment with endolaser photocoagulation","authors":"Danny A. Mammo, Phuoc-Hanh Le, Sruthi Arepalli, S. Srivastava, Sumit Sharma","doi":"10.1097/j.jcro.0000000000000086","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000086","url":null,"abstract":"Introduction: To the authors' knowledge, these are 2 of the longest reported time periods between cataract surgery and diagnosis of chronic postoperative endophthalmitis. The clinical course and outcomes are discussed. Patient and Clinical Findings: 2 patients underwent uneventful cataract surgery and presented with recurrent anterior segment inflammation years after the surgery. In the first case, an 88-year-old man presented with granulomatous uveitis in the left eye 4 years after intracapsular cataract extraction and posterior chamber intraocular lens (CE/PC IOL) placement. In the second case, a 79-year-old woman presented with iritis 7 years after CE/PC IOL. Diagnosis, Intervention, and Outcomes: Both patients were treated for presumed idiopathic uveitis for years before the diagnosis of chronic endophthalmitis caused by Cutibacterium acnes. 1 case required endolaser photocoagulation to an infectious nidus. Conclusions: Chronic postoperative endophthalmitis can present many years after uneventful cataract surgery.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"11 1","pages":"e00086"},"PeriodicalIF":0.0,"publicationDate":"2022-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48534554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-08-31DOI: 10.1097/j.jcro.0000000000000088
Alexander Thompson, R. Osher, L. Werner, S. Park, Samuel W. Wilkinson
Introduction: A large foreign body entered the anterior chamber through the infusion tubing during phacoemulsification. Patient and Clinical Findings: A 70-year-old woman presented for routine cataract extraction with implantation of a posterior chamber intraocular lens. During the phacoemulsification, a white fleck was captured on video entering the eye through the infusion tubing. Diagnosis, Intervention, and Outcomes: The fleck was removed immediately with a forceps through the main incision, and the surgery was completed. The fragment was preserved and sent for analysis. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to determine its composition. Conclusions: The origin of the fragment was consistent with the spike used to pierce the bag containing the balanced salt solution.
{"title":"Intraocular foreign body during cataract surgery","authors":"Alexander Thompson, R. Osher, L. Werner, S. Park, Samuel W. Wilkinson","doi":"10.1097/j.jcro.0000000000000088","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000088","url":null,"abstract":"Introduction: A large foreign body entered the anterior chamber through the infusion tubing during phacoemulsification. Patient and Clinical Findings: A 70-year-old woman presented for routine cataract extraction with implantation of a posterior chamber intraocular lens. During the phacoemulsification, a white fleck was captured on video entering the eye through the infusion tubing. Diagnosis, Intervention, and Outcomes: The fleck was removed immediately with a forceps through the main incision, and the surgery was completed. The fragment was preserved and sent for analysis. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were used to determine its composition. Conclusions: The origin of the fragment was consistent with the spike used to pierce the bag containing the balanced salt solution.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00088"},"PeriodicalIF":0.0,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43315326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.1097/j.jcro.0000000000000087
Aman Mittal, S. Garg
Introduction: This report describes a case of belantamab mafodotin–associated corneal toxicity. The patient presented with refractive changes, which has not been previously reported with this condition. Patient and Clinical Findings: A 58-year-old man with refractory multiple myeloma and myopia presented for screening before the initiation of belantamab mafodotin (belamaf or Blenrep, an antibody-drug conjugate [ADC] with known corneal toxicity). After 1 infusion, he returned complaining of loss of uncorrected near vision and was found to have bilateral keratopathy with microcyst-like epithelial changes (MECs) in the midperipheral cornea. Diagnosis, Intervention, and Outcomes: A hyperopic refractive error was seen with manifest refraction, and central flattening was seen on corneal topography. The patient was diagnosed with corneal epithelial toxicity secondary to belamaf. The medication was discontinued, and the MECs migrated centrally causing a refractive shift and eventually resolving. The patient was ultimately happy with his visual outcome because his uncorrected vision returned to baseline. Conclusions: Any vision changes in patients on ADCs should be carefully worked up, including with manifest refraction and appropriate testing, because they may indicate early ocular side effects that can be treated. This case introduces evidence of hyperopic and myopic changes directly correlating with slitlamp examination findings and imaging of a patient with belamaf-induced MECs.
{"title":"Refractive shifts due to belantamab mafodotin–associated corneal toxicity","authors":"Aman Mittal, S. Garg","doi":"10.1097/j.jcro.0000000000000087","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000087","url":null,"abstract":"Introduction: This report describes a case of belantamab mafodotin–associated corneal toxicity. The patient presented with refractive changes, which has not been previously reported with this condition. Patient and Clinical Findings: A 58-year-old man with refractory multiple myeloma and myopia presented for screening before the initiation of belantamab mafodotin (belamaf or Blenrep, an antibody-drug conjugate [ADC] with known corneal toxicity). After 1 infusion, he returned complaining of loss of uncorrected near vision and was found to have bilateral keratopathy with microcyst-like epithelial changes (MECs) in the midperipheral cornea. Diagnosis, Intervention, and Outcomes: A hyperopic refractive error was seen with manifest refraction, and central flattening was seen on corneal topography. The patient was diagnosed with corneal epithelial toxicity secondary to belamaf. The medication was discontinued, and the MECs migrated centrally causing a refractive shift and eventually resolving. The patient was ultimately happy with his visual outcome because his uncorrected vision returned to baseline. Conclusions: Any vision changes in patients on ADCs should be carefully worked up, including with manifest refraction and appropriate testing, because they may indicate early ocular side effects that can be treated. This case introduces evidence of hyperopic and myopic changes directly correlating with slitlamp examination findings and imaging of a patient with belamaf-induced MECs.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00087"},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45194640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-07DOI: 10.1097/j.jcro.0000000000000084
Vasiliki Gliagias, A. Pandey, Isha Cheela
Introduction: This is a case of Purtscher-like retinopathy with an unusual etiology of retrobulbar anesthesia, evidenced by optical coherence tomography-angiography (OCT-A) images. Patient and Clinical Findings: After cataract surgery with a retrobulbar block, a 65-year-old woman experienced sudden dramatic visual reduction with superficial white retinal patches on fundus examination and corresponding capillary bed infarcts on fluorescein angiography and OCT-A. Diagnosis, Intervention, and Outcomes: Using advanced OCT-A, fluorescein angiography imaging, and fundus photography, the patient was diagnosed with Purtscher-like retinopathy. The patient was treated with topical steroids, nonsteroidal anti-inflammatory drops, and antibiotic drops, with gradual and nearly complete resolution of visual acuity. Conclusions: This case represents a rare but possible complication of retrobulbar anesthesia associated with cataract surgery. Despite dramatic changes on OCT-A, and in contrast to other reports with similar characteristic findings, our patient regained significant vision.
{"title":"Multimodal imaging findings in Purtscher-like retinopathy after retrobulbar anesthesia","authors":"Vasiliki Gliagias, A. Pandey, Isha Cheela","doi":"10.1097/j.jcro.0000000000000084","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000084","url":null,"abstract":"Introduction: This is a case of Purtscher-like retinopathy with an unusual etiology of retrobulbar anesthesia, evidenced by optical coherence tomography-angiography (OCT-A) images. Patient and Clinical Findings: After cataract surgery with a retrobulbar block, a 65-year-old woman experienced sudden dramatic visual reduction with superficial white retinal patches on fundus examination and corresponding capillary bed infarcts on fluorescein angiography and OCT-A. Diagnosis, Intervention, and Outcomes: Using advanced OCT-A, fluorescein angiography imaging, and fundus photography, the patient was diagnosed with Purtscher-like retinopathy. The patient was treated with topical steroids, nonsteroidal anti-inflammatory drops, and antibiotic drops, with gradual and nearly complete resolution of visual acuity. Conclusions: This case represents a rare but possible complication of retrobulbar anesthesia associated with cataract surgery. Despite dramatic changes on OCT-A, and in contrast to other reports with similar characteristic findings, our patient regained significant vision.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00084"},"PeriodicalIF":0.0,"publicationDate":"2022-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49536729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-02DOI: 10.1097/j.jcro.0000000000000083
M. Kim, Dooho B. Kim
Introduction: Repositioning and scleral fixation of 20+-year-old dislocated intraocular lenses (IOLs) was performed using the trailing-haptic-first modification of the Yamane technique. Patient and Clinical Findings: 2 separate patients presented with late dislocation of their 3-piece IOLs, and the original surgeries were performed over 20 years ago. 1 patient had a Rezoom IOL and the other had an SI30 IOL. Diagnosis, Intervention, and Outcomes: The 2 patients underwent successful repositioning of the existing IOLs using the trailing-haptic-first modification of the Yamane technique. Both had good refractive outcomes without complication. Conclusions: To the authors' knowledge, these are the first cases reported of using 20+-year-old dislocated IOLs for successful intrascleral haptic needle fixation with the trailing-haptic-first modification of the Yamane technique. Surgeons should consider IOL repositioning with intrascleral haptic needle fixation instead of explantation for an easier and less-invasive approach.
{"title":"Intrascleral haptic needle fixation of 20+-year-old dislocated intraocular lenses using trailing-haptic-first modification","authors":"M. Kim, Dooho B. Kim","doi":"10.1097/j.jcro.0000000000000083","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000083","url":null,"abstract":"Introduction: Repositioning and scleral fixation of 20+-year-old dislocated intraocular lenses (IOLs) was performed using the trailing-haptic-first modification of the Yamane technique. Patient and Clinical Findings: 2 separate patients presented with late dislocation of their 3-piece IOLs, and the original surgeries were performed over 20 years ago. 1 patient had a Rezoom IOL and the other had an SI30 IOL. Diagnosis, Intervention, and Outcomes: The 2 patients underwent successful repositioning of the existing IOLs using the trailing-haptic-first modification of the Yamane technique. Both had good refractive outcomes without complication. Conclusions: To the authors' knowledge, these are the first cases reported of using 20+-year-old dislocated IOLs for successful intrascleral haptic needle fixation with the trailing-haptic-first modification of the Yamane technique. Surgeons should consider IOL repositioning with intrascleral haptic needle fixation instead of explantation for an easier and less-invasive approach.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00083"},"PeriodicalIF":0.0,"publicationDate":"2022-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46177267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-25DOI: 10.1097/j.jcro.0000000000000082
Eduardo Gonzalez-Lubcke, A. Navas, Enrique O. Graue-Hernández, A. Ramirez-Miranda, A. Gómez-Bastar
Introduction: To report a case of accommodative esotropia and high hyperopia managed with the Visian implantable collamer lens (ICL) phakic intraocular lens. Patient and Clinical Findings: The patient is a 21-year-old man with cycloplegic refraction of +7.50 −2.00 × 180 in both eyes. In addition, he presented a 30 prism diopters (PD) esotropia for both distance and near, which improved to 5 PD wearing his full cycloplegic prescription. Diagnosis, Intervention, and Outcomes: A patient with high hyperopia and accommodative esotropia with unchanged ocular alignment along with stable cycloplegic refraction for 2 years underwent bilateral ICL implantation. No intraoperative or postoperative complications were observed during the 12-month follow-up. The manifest refraction improved to +0.75 −0.75 × 180 postoperatively in the right eye and to +0.25 −0.50 × 180 in the left eye. No eyes lost lines of visual acuity. The esotropia improved to 5 PD at both distance and near without the need for spectacles. Conclusions: Hyperopic ICL implantation for accommodative esotropia may be considered a viable option to achieve spectacle independence and maintain proper eye alignment.
{"title":"Correction of accommodative esotropia using hyperopic implantable collamer lenses","authors":"Eduardo Gonzalez-Lubcke, A. Navas, Enrique O. Graue-Hernández, A. Ramirez-Miranda, A. Gómez-Bastar","doi":"10.1097/j.jcro.0000000000000082","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000082","url":null,"abstract":"Introduction: To report a case of accommodative esotropia and high hyperopia managed with the Visian implantable collamer lens (ICL) phakic intraocular lens. Patient and Clinical Findings: The patient is a 21-year-old man with cycloplegic refraction of +7.50 −2.00 × 180 in both eyes. In addition, he presented a 30 prism diopters (PD) esotropia for both distance and near, which improved to 5 PD wearing his full cycloplegic prescription. Diagnosis, Intervention, and Outcomes: A patient with high hyperopia and accommodative esotropia with unchanged ocular alignment along with stable cycloplegic refraction for 2 years underwent bilateral ICL implantation. No intraoperative or postoperative complications were observed during the 12-month follow-up. The manifest refraction improved to +0.75 −0.75 × 180 postoperatively in the right eye and to +0.25 −0.50 × 180 in the left eye. No eyes lost lines of visual acuity. The esotropia improved to 5 PD at both distance and near without the need for spectacles. Conclusions: Hyperopic ICL implantation for accommodative esotropia may be considered a viable option to achieve spectacle independence and maintain proper eye alignment.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00082"},"PeriodicalIF":0.0,"publicationDate":"2022-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42741740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-28DOI: 10.1097/j.jcro.0000000000000081
T. Seiler, Karim Kozhaya, T. Seiler, S. Awwad
Introduction: 3 cases of atypical sterile opacifications during the early-postoperative phase after corneal crosslinking (CXL) have been described. Patient and Clinical Findings: On a routine follow-up 4 days after CXL, sterile anterior stromal opacifications were observed on slitlamp examination of patients with keratoconus (KC). Their presentations ranged from a crescentic opacification located at the margin of the irradiation zone at a depth of 270 μm (Case 1) to a peripheral well-delineated, disc-shaped opacification (Case 2) to disseminated multifocal infiltrates (Case 3). All reported eyes had completely healed epithelium with the onset of opacifications, more than 24 hours after CXL. After an interval of 6 months, only minor changes on slitlamp biomicroscopy were observed in each case, and optical coherence tomography was suggestive of a scar formation. Diagnosis, Intervention, and Outcome: The occurrence of these sterile infiltrates in KC eyes with thinnest pachymetry superior to 400 μm and their shape, location, and depth were remarkable. These infiltrates were labeled as atypical because they failed to respond to topical steroids and resulted in scar formation. Conclusions: A collection of atypical sterile anterior stromal infiltrates originating from the very early-postoperative course after accelerated or customized CXL have been reported.
{"title":"Atypical sterile infiltrates after corneal crosslinking","authors":"T. Seiler, Karim Kozhaya, T. Seiler, S. Awwad","doi":"10.1097/j.jcro.0000000000000081","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000081","url":null,"abstract":"Introduction: 3 cases of atypical sterile opacifications during the early-postoperative phase after corneal crosslinking (CXL) have been described. Patient and Clinical Findings: On a routine follow-up 4 days after CXL, sterile anterior stromal opacifications were observed on slitlamp examination of patients with keratoconus (KC). Their presentations ranged from a crescentic opacification located at the margin of the irradiation zone at a depth of 270 μm (Case 1) to a peripheral well-delineated, disc-shaped opacification (Case 2) to disseminated multifocal infiltrates (Case 3). All reported eyes had completely healed epithelium with the onset of opacifications, more than 24 hours after CXL. After an interval of 6 months, only minor changes on slitlamp biomicroscopy were observed in each case, and optical coherence tomography was suggestive of a scar formation. Diagnosis, Intervention, and Outcome: The occurrence of these sterile infiltrates in KC eyes with thinnest pachymetry superior to 400 μm and their shape, location, and depth were remarkable. These infiltrates were labeled as atypical because they failed to respond to topical steroids and resulted in scar formation. Conclusions: A collection of atypical sterile anterior stromal infiltrates originating from the very early-postoperative course after accelerated or customized CXL have been reported.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00081"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46244725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-22DOI: 10.1097/j.jcro.0000000000000080
Isabella V. Wagner, S. Dorairaj, Darby D. Miller, R. T. Ten Hulzen, M. Stewart
Introduction: To the author's knowledge, this is the first reported case of a delayed intracapsular hematoma after complex femtosecond laser–assisted cataract surgery (FLACS) and the use of iris retractor hooks for intraoperative floppy-iris syndrome. It is important that cataract surgeons be aware of this association. Patient and Clinical Findings: An 83-year-old man underwent FLACS with astigmatic keratotomy and intraocular lens implantation. Iris retractor hooks were used to counter intraoperative miosis. Hyphema, corneal edema, and subconjunctival hemorrhage were observed on postoperative day (POD) 1. The patient returned on POD 3 with further decrease in vision due to Descemet folds, advanced corneal edema, layered hyphema, and a dense intracapsular hematoma. Diagnosis, Intervention, and Outcomes: Minimal improvement of the hematoma occurred through 4 weeks, at which time the hematoma was drained with Nd:YAG laser posterior capsulotomy. The hematoma reabsorbed within 1 month with full recovery of vision. Conclusions: The iris retractor hooks in the setting of complex FLACS likely caused postoperative bleeding with accumulation of blood within the capsule. Nd:YAG laser posterior capsulotomy is an effective treatment option for nonclearing intracapsular hematoma.
{"title":"Delayed intracapsular hematoma after use of iris retractor hooks","authors":"Isabella V. Wagner, S. Dorairaj, Darby D. Miller, R. T. Ten Hulzen, M. Stewart","doi":"10.1097/j.jcro.0000000000000080","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000080","url":null,"abstract":"Introduction: To the author's knowledge, this is the first reported case of a delayed intracapsular hematoma after complex femtosecond laser–assisted cataract surgery (FLACS) and the use of iris retractor hooks for intraoperative floppy-iris syndrome. It is important that cataract surgeons be aware of this association. Patient and Clinical Findings: An 83-year-old man underwent FLACS with astigmatic keratotomy and intraocular lens implantation. Iris retractor hooks were used to counter intraoperative miosis. Hyphema, corneal edema, and subconjunctival hemorrhage were observed on postoperative day (POD) 1. The patient returned on POD 3 with further decrease in vision due to Descemet folds, advanced corneal edema, layered hyphema, and a dense intracapsular hematoma. Diagnosis, Intervention, and Outcomes: Minimal improvement of the hematoma occurred through 4 weeks, at which time the hematoma was drained with Nd:YAG laser posterior capsulotomy. The hematoma reabsorbed within 1 month with full recovery of vision. Conclusions: The iris retractor hooks in the setting of complex FLACS likely caused postoperative bleeding with accumulation of blood within the capsule. Nd:YAG laser posterior capsulotomy is an effective treatment option for nonclearing intracapsular hematoma.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00080"},"PeriodicalIF":0.0,"publicationDate":"2022-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43897609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-09DOI: 10.1097/j.jcro.0000000000000072
K. Balparda, L. A. Silva-Quintero, Tatiana Herrera-Chalarca
Introduction: The requirement to perform immediate sequential bilateral cataract surgery (ISBCS) is controversial. Most surgeons who do not adhere to this approach cite the possibility of bilateral complications occurring. Patient and Clinical Findings: A 35-year-old woman underwent bilateral implantation of phakic intraocular lenses the same day. She complained of pain and significantly decreased quality of vision in her right eye 12 hours postoperatively and was immediately examined. Physical examination of the right eye showed significant corneal edema extending from limbus to limbus and a dilated fixed pupil unresponsive to light. Diagnosis, Intervention, and Outcomes: Physical examination showed toxic anterior segment syndrome ensued in one eye. The complication was timely managed, preventing further damage to the eye. The contralateral eye showed no signs of complication. Conclusions: This case highlights that, when performed with utmost care, protocols designed to avoid bilateral occurrence of complications in same-day surgeries can work in the real-world settings. This is further evidence that ISBCS may not pose an additional risk to patients.
{"title":"Unilateral toxic anterior segment syndrome after immediate sequential bilateral phakic intraocular lens implantation","authors":"K. Balparda, L. A. Silva-Quintero, Tatiana Herrera-Chalarca","doi":"10.1097/j.jcro.0000000000000072","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000072","url":null,"abstract":"Introduction: The requirement to perform immediate sequential bilateral cataract surgery (ISBCS) is controversial. Most surgeons who do not adhere to this approach cite the possibility of bilateral complications occurring. Patient and Clinical Findings: A 35-year-old woman underwent bilateral implantation of phakic intraocular lenses the same day. She complained of pain and significantly decreased quality of vision in her right eye 12 hours postoperatively and was immediately examined. Physical examination of the right eye showed significant corneal edema extending from limbus to limbus and a dilated fixed pupil unresponsive to light. Diagnosis, Intervention, and Outcomes: Physical examination showed toxic anterior segment syndrome ensued in one eye. The complication was timely managed, preventing further damage to the eye. The contralateral eye showed no signs of complication. Conclusions: This case highlights that, when performed with utmost care, protocols designed to avoid bilateral occurrence of complications in same-day surgeries can work in the real-world settings. This is further evidence that ISBCS may not pose an additional risk to patients.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"10 1","pages":"e00072"},"PeriodicalIF":0.0,"publicationDate":"2022-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47690001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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