Ophthalmic surgery and lasers最新文献

Epibulbar osseous choristoma is a choristomatous lesion of the conjunctiva containing bone. Originally called epibulbar osteoma, this lesion was first described by von Graefe in 1863. We discuss a case of a 4-year-old patient who presented with an epibulbar lesion consistent histopathologically with an epibulbar osseous choristoma, and report a review of the literature. The differential diagnosis of osseous choristoma should include classical limbal dermoids, epithelial inclusion cysts, prolapsed orbital fat, papillomas, dermolipomas, and complex choristomas. Although the rarest of epibulbar choristomas, 51 epibulbar osteomas have now been reported in the medical literature. Most commonly, this variety of choristoma presents as an isolated epibulbar lesion within the supratemporal quadrant but may occur in other locations on the surface of the globe and possibly in conjunction with other choristomatous tissue as much as 10% of the time. Frequently, they may involve the muscle or have dense attachments to the underlying sclera. Osseous choristomas most likely represent congenital lesions with a potential for slow growth but may occur in association with trauma. Options for management include observation or surgical excision. When surgery is contemplated, preoperative radiographic imaging may be helpful for assessing adhesion to the sclera or extraocular muscles.

Submacular surgery is a current alternative technique for the treatment of subfoveal choroidal neovascular membranes (CNVM). One of the difficulties often encountered with this technique is the actual removal of the neovascular membrane complex from the eye. It is often too large and fibrotic to be removed directly through a sclerotomy site without risking significant sclerotomy site complications. The vitreous cutter can be used, but despite high aspiration settings, the large, fibrotic neovascular membrane complex may still not be able to be completely removed safely and expeditiously. We describe an alternative technique using the phacofragmentation handpiece to remove large fibrotic neovascular membranes from the vitreous cavity thereby reducing sclerotomy site complications and surgical time.

This report describes a potential complication following the repair of a traumatic cyclodialysis cleft in a pediatric patient using a novel technique. A healthy 11-year-old boy suffered a blunt traumatic tennis ball injury to his left eye. He underwent repair of a retinal dialysis with detachment shortly after the injury. Postoperatively, he developed persistent hypotony, shallow anterior chamber, and hypotony maculopathy. An occult cyclodialysis cleft was suspected. Examination under anesthesia revealed a small cyclodialysis deft. The cleft was closed by transchamber placement of prolene sutures across the cleft under direct visualization through a Tano lens. Postoperative course was complicated by severe pupillary distortion despite subsequent suture removal.

Background and objectives: Partial or complete aniridia occurring after severe ocular trauma is a difficult therapeutic problem. Diaphragm intraocular lenses were developed for the correction of aniridia, but the safety and efficacy of implanting such lenses are not well established in traumatic cases because of very few reports, and the small number of cases studied.

Patients and methods: Six patients, 4 men and 2 women with a mean age of 44 years, were treated for traumatic aniridia using pars plana vitrectomy and transscleral fixation of a black diaphragm intraocular lens. Total aniridia was observed in 3 eyes and partial aniridia in 3 eyes. Four eyes were aphakic and severe lens subluxation was seen in 2 eyes. Vitreous hemorrhage coexisted in 2 patients and bacterial endophthalmitis was present in 1 patient. Follow-up time ranged between 4 and 39 months (mean, 23 months).

Results: Best-corrected visual acuity improved in 5 patients and 1 remained unchanged. Good visual acuity (20/20 - 20/40) was achieved in all cases and all lenses were well-centered. No severe complications were noted. Three of 6 patients required glaucoma topical medications pre- and postoperatively achieving good intraocular pressure control.

Conclusion: The management of traumatic aniridia using pars plana vitrectomy and implantation of scleral fixation black diaphragm intraocular lenses seem to be safe. Very good functional results and lack of severe complications are encouraging. Additional cases with a longer follow-up study are necessary to support our opinion.

We report a case of uveitic acute angle closure glaucoma in a patient with acquired immunodeficiency syndrome (AIDS) associated with inactive cytomegalovirus retinitis and immune recovery vitritis. We conducted a long-term, follow-up examination of a 47-year-old male with AIDS and inactive cytomegalovirus retinitis caused by immune recovery on highly active antiretroviral therapy (HAART). We found vitritis and ultimate development of uveitic glaucoma in the postoperative periods following repair of retinal detachment and extracapsular cataract extraction with intraocular lens implant. An episode of acute angle closure secondary to posterior synechiae and iris bombé subsequently developed, requiring peripheral laser iridotomy. Immune recovery in the setting of inactive cytomegalovirus retinitis can result in intraocular inflammation severe enough to cause angle closure glaucoma and profound ocular morbidity.

We discuss a clinicopathologic correlation of orbital metastasis from a contralateral choroidal melanoma wherein the orbital tumor was removed completely by surgical resection. In October 1982, a 29-year-old woman was treated with cobalt-60 plaque radiotherapy for a choroidal melanoma in her right eye. The tumor responded well but recurred after 9 years, necessitating enucleation. In August 1999, 17 years after initial presentation, metastatic melanoma to liver, lung, and brain were found and the patient had a favorable response to chemotherapy and brain irradiation. Five months later, in November 2000, an enlarging orbital mass was documented to be compressing the left optic nerve. Complete surgical removal of the tumor was achieved by a superotemporal orbitotomy. Histopathologically, the tumor was a malignant melanoma with features similar to the choroidal tumor. The contralateral orbit can be the site of late metastasis from choroidal melanoma. In rare instances, an orbital metastasis can be completely removed surgically without subjecting the patient to orbital irradiation.