Case with postoperative acute angle-closure glaucoma

A 59-year-old man who had undergone biopsy of cervical lymph node under general anesthesia developed an attack of acute angle-closure glaucoma the night after the surgery. He had had no eye symptoms before. He complained of visual disorder, nausea, eye pain, and dizziness after the surgery. His intraocular pressure in the right eye was high (69 mmHg), and an ophthalmologist diagnosed it as acute angle-closure glaucoma. Dropping lotion in the eyes and the intravenous administration were not effective. His intraocular pressure decreased immediatery after laser iridotomy, and his symptoms improved. When the symptoms of eye pain and visual impairment appeared after the surgery, we should take acute angle-closure glaucoma into consideration and treat it as soon as possible.     

Bilateral acute angle-closure glaucoma as a complication of facedown spine surgery

Background contextMultiple studies have reported that facedown positioning can result in elevation of intraocular pressure (IOP) in individuals susceptible to angle-closure glaucoma. Before advances in diagnostic modalities, prone tests were popularly performed in ophthalmology practices as provocative tests for detecting potentially occludable angles. In patients with a positive test result, direct observation shows that the anterior chamber shallows and the angle closes over time, compromising aqueous humor outflow facility. Furthermore, the degree of angle narrowing is proportional to the rise in IOP. A common scenario involving a prone position is spine surgery, which can last several hours with the patient unconscious.PurposeTo report a case of a patient who developed bilateral acute angle-closure glaucoma after facedown spine surgery.Study designCase report and literature review.MethodsA 68-year-old Caucasian woman presented with persistent low back and left lower extremity pain. History was remarkable for L5 radicular pain, spinal stenosis, and an L3–L4 laminectomy performed 6 months previously. Plain films showed instability at the L4–L5 level and degenerative disc disease and scoliosis at L2–L4. The patient underwent spinal fusion surgery.ResultsPostoperatively, the patient complained of pain in the left eye accompanied with nausea and vomiting. Ophthalmology consultation confirmed the diagnosis of bilateral acute angle-closure glaucoma, requiring medical therapy initially followed by laser iridotomies in both eyes.ConclusionsBilateral acute angle-closure glaucoma may occur as a complication of facedown spine surgery. It is essential for anesthesiologists and surgeons to be aware of this complication for accurate diagnosis and timely intervention. A preoperative evaluation by an ophthalmologist should be considered for those individuals who are at increased risk of developing angle-closure glaucoma, such as certain ethnicities, including Asians, Canadians, and Eskimos; female gender; hyperopic eyes with a shorter axial length; family history; history of previous attacks in the subject; and so forth. Prophylactic laser iridotomy in eyes with potentially occludable angles is a simple and safe office procedure that can prevent potentially devastating visual outcomes.     

Oculomotor nerve palsy precipitating acute angle-closure glaucoma. A case report

A case of acute angle-closure glaucoma precipitated by oculomotor nerve palsy in a patient with shallow anterior chambers is reported. The different ways in which a palsy of the oculomotor nerve can influence the intra-ocular pressure are discussed.     

Corneal decompensation after argon laser iridectomy--a delayed complication

We report six eyes in six patients in which corneal decompensation developed 18 or more months after argon laser iridectomy (ALI). In addition to the level of laser energy used, other risk factors included performing ALI during an attack, diabetes, and a cornea damaged by glaucomatous attack. The interval between the ALI and corneal decompensation ranged from 18 months to 3 1/2 years.     

持续高眼压状态下手术治疗急性闭角型青光眼33例

目的探讨对降眼压治疗效果不佳的闭角型青光眼在高眼压状态下行手术治疗的疗效。方法回顾性分析笔者所在医院2007年5月～2010年10月治疗的33例33眼应用药物不能控制眼压的急性闭角型青光眼患者,所有患者均行复合式小梁切除术治疗。术后随访6～12个月。结果所有患者手术均顺利完成,术中术后均未出现严重并发症,术后视力获得明显的提高;术后1周所有患者眼压均在8～11mmHg,经6～12个月随访,患者眼压基本控制在14.36～21.58mmHg。结论原发性闭角型青光眼持续高眼压状态下的复合式小梁切除术是安全有效的。手术治疗的术前、术中、术后都应积极处理高眼压,提高手术的成功率,预防和减少术中及术后并发症的发生。     

晶状体不全脱位致急性闭角型青光眼的显微手术处理方式探讨

目的探讨晶状体不全脱位致急性闭角型青光眼的临床诊治经验。方法回顾性分析我院确诊为晶状体不全脱位致急性闭角型青光眼的患者资料。本组病例共20例（21眼），临床表现均为急性闭角型青光眼；所有病例皆已根据患者晶状体移位程度及视力情况给予相应手术治疗。结果患者出院后平均随访（16．95±15．69）个月。1例患者经保守治疗后出院。余患者术后最佳矫正视力3眼0．01～0．10，7眼0．10—0．30，4眼0．30～0．50，7眼〉0．50，眼压均控制在正常范围。经保守治疗的患者眼压控制在正常范围，无晶状体移位加重的情况出现；手术后患者无一例严重并发症，无再次手术者，眼压控制及视力恢复良好。结论晶状体不全脱位致急性闭角型青光眼的临床特点与原发性急性闭角型青光眼类似，易误诊。细致的眼科检查将有助于提高正确诊断率。正确诊断是有效治疗的基础。     

Argon laser iridotomy in primary angle-closure or pupillary block glaucoma

This paper describes the use of a pulsed argon laser to perform iridotomies in 87 patients. Diagnoses include: primary angle closure glaucoma, narrow angle in the fellow eye of patients with primary angle closure glaucoma, pupillary block, and after incomplete surgical iridectomies. Laser iridotomy was achieved in 79% of patients. Blue eyes were slightly more difficult to penetrate. Success was almost 100% in those with pupillary block. Penetration was most difficult in patients with primary angle closure glaucoma (64%), but more easily accomplished in the fellow eyes of such cases (87%). In 13 patients surgical peripheral iridectomy was performed on one eye while the other eye was treated with laser iridotomy. No apparent significant long term differences were noted between the two eyes of the same individual. Complications of laser iridotomy include corneal burns, pupil distortion, synechia formation, lenticular opacities, iritis, marked pigment dispersion, sudden rise in intraocular pressure, and retinal burns. At this time a longer follow-up is required before it can be stated that a laser PI is more advantageous than a surgical PI. However, the laser's simplicity and ease of administration appear to warrant its continued use at this time.     

Corneal endothelial cell loss following trephination

The amount of endothelial cell loss that occurs to the donor cornea during the trephination process was evaluated in 40 porcine eyes. A vital staining technique (alizarin red S and acid violet 19) was used to quantify the extent of endothelial damage and removal. Two types of corneal punches (Weck and H&I0 were used for trephination. The average amount of endothelial loss from the peripheral cornea was 7.9%, accounting for only a 3% loss of endothelial cells over the total surface area of the corneal button. a comparison of the Weck and H&I corneal punches showed no significant difference (P greater than 0.1) by Student's test for both endothelial cell damage and removal.     

Acute angle-closure glaucoma after successful embolization of traumatic carotid-cavernous sinus fistula--case report

A 69-year-old woman developed acute angle-closure glaucoma 2 weeks after successful transvenous coil embolization of a traumatic carotid-cavernous sinus fistula. The angle-closure glaucoma was precipitated by oculomotor palsy caused by transvenous coil packing of the cavernous sinus. Emergency iridotomy resulted in normalization of the intraocular pressure and restoration of vision. Acute angle-closure glaucoma may develop in association with an oculomotor palsy caused by any etiology, including neurointervention.     

Corneal edema following argon laser iridotomy.

Laser iridotomy is generally a safe and effective procedure for narrow-angle glaucoma. However, since surgical success with the argon laser depends on a focal thermal effect, a corneal burn is a possible complication. I describe five patients with occludable anterior chamber angles and bilateral corneal guttata who developed uniocular progressive corneal edema with visual loss following argon laser iridotomy. These five patients underwent iridotomy with a total laser energy of 63, 48.5, 7, 25, and 25 J, respectively, and began to lose vision due to corneal edema immediately, and 5, 2, 4, and 2 years later, respectively. Following penetrating keratoplasty with cataract surgery, histopathology of the corneal buttons showed generalized endothelial cell loss in all five. Microstructural findings of guttata and thickened Descemet's membrane implied that prior endothelial dystrophy had predisposed these patients to laser-induced damage. Risk factors for immediate or delayed-onset bullous keratopathy after argon laser iridotomy include prior angle closure, preexisting endothelial guttata, and high laser energy with multiple applications. Recognizing the potential of this complication offers opportunities for preventive strategies.     

Analysis of factors related to truncal decompensation following Cotrel-Dubousset instrumentation.

Spinal imbalance following Cotrel-Dubousset (CD) instrumentation for adolescent idiopathic scoliosis is a problem that is recognized with increasing frequency. We reviewed the clinical records and radiographs of 41 consecutive patients treated with CD instrumentation and attempted to identify factors related to postoperative worsening of spinal balance. Spinal balance was determined by the perpendicular distance of C7 to the center sacral line. Twenty-five were decompensated postoperatively. Sixteen patients had balance that was worse relative to the preoperative films. Eleven of 16 patients with worsened balance postoperative were King type III curves. Of 16 patients with worsened balance postoperatively, 13 had been fused to or below the lower neutral vertebra. Overcorrection of either the primary curve or the composite curve (sum of the measurable curves) relative to the preoperative bending films was not related to postoperative worsening of spinal balance. Fusion to the neutral or stable vertebra with CD instrumentation runs a high risk for postoperative worsening of spinal balance when the derotation maneuver is used. Consideration should be given to avoiding the derotation maneuver in larger type II curves in order to preserve spinal balance and avoid extension of instrumentation into the middle or lower lumbar spine.     

Acute hemodynamic decompensation following patent ductus arteriosus ligation in premature infants.

INTRODUCTION: Patent ductus arteriosus (PDA) ligation can lead to postoperative hemodynamic instability requiring inotropic support, termed hemodynamic decompensation. The purpose of this study was to prospectively determine the incidence, predictors, and clinical impact of hemodynamic decompensation after PDA ligation in preterm infants. METHODS: All infants undergoing PDA ligation were eligible for this prospective cohort study. After undergoing ligation, patients were followed until 30 days after successful extubation, discharge from the NICU, or death. Data collection included perinatal and preoperative clinical information, operative details, postoperative course, and outcome. RESULTS: Ninety-six preterm infants were enrolled and underwent PDA ligation. Hemodynamic decompensation occurred in 27 patients (28%). Overall in-hospital mortality rate was 18%. Mortality was significantly higher among infants that developed hemodynamic decompensation (33% vs 11%, p = .012). Hemodynamic decompensation was associated with an adjusted odds ratio (OR) for death of 3.1 (95% confidence interval: 1.0-9.5, p = .05). Lower estimated gestational age, lower corrected age, and higher rate of preoperative mechanical ventilation were significant predictors of hemodynamic decompensation. CONCLUSION: Hemodynamic decompensation occurred in 28% of patients after PDA ligation, resulting in a significantly higher mortality. Younger patients requiring higher ventilator support are most likely to develop hemodynamic decompensation.     

Ghost cell glaucoma following lens implantation

When intraocular hemorrhage occurs following cataract surgery and lens implantation, ghost cell glaucoma may develop. An intraocular lens (IOL) may be a factor in recurrent bleeding, particularly in the predisposed patient. Six patients with ghost cell glaucoma following cataract surgery and lens implantation are described. Because intraocular pressure (IOP) was uncontrolled, vitrectomy was performed to remove the reservoir of ghost cells. In each case, postoperative visual acuity improved to 20/40 or better and IOP was controlled with the use of medications.     

Corneal wedge resection for high astigmatism following penetrating keratoplasty

Fourteen corneal wedge resections performed between April 1980 and January 1986 at the Wills Eye Hospital were retrospectively reviewed. Mean pre-operative refractive (subjective) astigmatism was 8.13 diopters (D), with a range of 3.75 to 15.0 D. Following wedge resection, the mean residual astigmatism was 3.04 D, with a range of 0 to 5.0 D. Although the mean keratometric astigmatism measurements were generally similar to the astigmatism measured during refraction, there was little correlation between them on a case-by-case basis. Corneal wedge resection appears to remain an effective and moderately predictable technique for managing high astigmatism following penetrating keratoplasty.     

Pupillary block glaucoma following pediatric cataract extraction

We present a case of pupillary block glaucoma that developed after cataract extraction in a pediatric patient. To prevent pupillary block and secondary glaucoma after cataract surgery we recommend that all pediatric cataract patients be given a prophylactic peripheral iridectomy.