Trochlear nerve palsy as a complication of trigeminal radiofrequency rhyzolysis

We report a patient with right trochlear nerve palsy after percutaneus radiofrequency trigeminal rhizolysis involving the ophthalmic division of the right trigeminal nerve. Of the postoperative complications of percutaneous radiofrequency trigeminal rhizolysis, extraocular nerve injuries are uncommon and the sixth nerve is the frequently affected one. This is a case report of isolated trochlear nerve palsy as a complication of percutaneous radiofrequency trigeminal rhizolysis.     

Unilateral blindness as a complication of nasal septoplasty: case report

Blindness as a complication of nasal septoplasty is a devastating occurrence with only a few cases reported in the literature. In most of these cases, visual loss was attributed to retinal embolism following intra-arterial injection of substances into the nasal turbinate. This paper documents one case of complete unilateral blindness from direct optic nerve trauma following an apparently uneventful septorhinoplasty. Ophthalmologists and otolaryngologists should therefore be aware of the possible occurrence of such complication.     

Sudden blindness after thermocoagulation of the trigeminal ganglion

Sudden blindness during percutaneous thermocoagulation of the gasserian ganglion occurred in a 72-year-old woman with trigeminal neuralgia. Considered a safe procedure, we highlight the possibility of this serious complication which was probably due to direct damage of the optic nerve.     

Monocular blurring. A complication of YAG laser iridotomy

Laser iridotomy is the procedure of choice for primary angle-closure glaucoma. The authors report a new visual disturbance after neodymium (Nd): YAG laser iridotomy. Thirteen patients presented with monocular blurring or a bluish or colored line after the laser procedure. Each eye had a patent iridotomy partially exposed by the upper lid. When the iridotomy was fully covered or fully exposed, symptoms disappeared. Symptoms also were relieved with tinted lenses. The authors suggest close preoperative examination with careful placement of the laser iridotomy entirely under the upper lid to prevent this potential visual disturbance.     

Corneal burn: a rare complication of radiofrequency diathermy capsulotomy

We present 2 patients with accidental corneal burns inflicted during clear cornea cataract surgery using radiofrequency diathermy for anterior capsulotomy. During the capsulotomy procedure, the anterior capsule was not opened and only a small air bubble appeared when the energy was turned on. Meanwhile the area of the corneal tunnel that contacted the shoulder of the diathermy tip became opaque and shrank with a small defect in the anterior corneal lip. Postoperatively, focal corneal shrinkage with iris incarceration into the defect of the corneal tunnel and resultant peaking pupil were noted in the 2 patients. The corneal burns resulted in temporary irregular astigmatism with mild visual acuity impairment. To our knowledge, this is the first report of a corneal burn as a complication of radiofrequency diathermy for anterior capsulotomy in clear cornea cataract surgery.     

Blepharoptosis as a complication of pregnancy

The complication of blepharoptosis occurred in an otherwise normal pregnancy. Its onset during the sixth month of the pregnancy suggests an etiology related to the increased estrogen levels normally occurring at this time. Infiltration of water molecules into the collagen ground substance of the levator muscle and its tendon is suggested as a possible mechanism of action. Similarities with other conditions in young individuals causing blepharoptosis are discussed.     

三叉神经半月节射频温控热凝术对眼表的影响

背景 射频温控热凝术是目前普遍认同的治疗三叉神经痛最为有效的方法之一,是一种微创伤性神经损毁疗法.眼表的大多数感觉神经纤维来自三叉神经眼支,对维持眼表功能的完整性起重要作用.三叉神经痛患者用射频温控热凝术治疗后对眼表的影响尚不清楚. 目的 观察和分析三叉神经痛患者行射频温控热凝术后眼表感觉和功能的变化. 方法 对28例28眼三叉神经痛患者行三叉神经半月节射频温控热凝术,术前1d、术后3d、术后1个月进行眼部检查.检查项目包括:角膜知觉敏感度检查、泪液分泌试验I(SIt)、泪膜破裂时间(BUT)测定、角膜荧光素染色评分和共焦显微镜观察角膜上皮下神经.均以未行手术侧的眼作为对照. 结果 术前三叉神经半月节射频热凝术组与对照组的角膜知觉敏感度、泪液分泌量、BUT、角膜荧光素染色评分和角膜上皮下神经纤维的密度比较,差异均无统计学意义(Z=-1.511、-1.119、-0.428、-0.378、-0.854,P=0.131、0.263、0.669、0.705、0.393).术后3d三叉神经半月节射频热凝术组与对照组相比BUT无明显变化,泪液分泌量稍有增加,角膜荧光素染色数量增加,但差异均无统计学意义(Z=-0.620、-0.315、-1.732,P=0.535、0.753、0.083);角膜知觉敏感度相比下降,上皮下神经纤维数量减少,差异均有统计学意义(Z=-2.708、-2.813,P=0.007、0.005).术后1个月三叉神经半月节射频热凝术组与对照组的角膜知觉敏感度、泪液分泌量、角膜荧光素染色评分和角膜上皮下神经纤维的密度比较,差异均有统计学意义(Z=-3.888、-2.373、-3.311、-2.535,P=0.000、0.018、0.001、0.011).三叉神经半月节射频热凝术组术后角膜上皮下神经纤维与术前相比明显稀疏、纤细、连续性差;部分患者可见树突状细胞浸润.结论 三叉神经痛患者行射频温控热凝术后泪膜稳定性及泪液分泌量下降,可出现明显的干眼症状,角膜知觉敏感性与角膜上皮下神经纤维的数量也有不同程度的减少,术后应给予干预和治疗.     

A rat model of radiofrequency ablation of trigeminal innervation via a ventral approach with stereotaxic surgery

Neurotrophic keratopathy (NK), a consequence of sensory denervation of the cornea, must be better understood in order to develop new approaches to therapy. The purpose of this study was to create a rat model for neurotrophic keratopathy by denervating the trigeminal nerve through a ventral approach with stereotaxic surgery. Stereotaxic coordinates were measured in 46 male Sprague Dawley rat cadavers for localization of V1. After further refining the coordinates in nine live animals, radiofrequency ablation was chosen as an effective method of disrupting the innervation to the cornea. Fifty-two live rats were treated with radiofrequency ablation to define the anatomical localization of the lesion by utilizing gross and histopathological studies. A gross lesion of the trigeminal nerve and/or ganglion was observed in 47 (90%) of the 52 animals. Histopathological studies revealed that all 52 animals had anatomical damage of the trigeminal innervation to the eye. Low mortality and little morbidity were observed in these animals. We have developed a rat model for neurotrophic keratopathy that is simple to produce, accurate in creating a lesion by utilizing stereotaxic techniques combined with radiofrequency ablation, and successful in decreasing morbidity and mortality.     

Acanthamoeba keratitis as a complication of orthokeratology

PURPOSE: To present four cases of Acanthamoeba keratitis as a complication of orthokeratology. DESIGN: Observational case report. METHODS: Four patients with Acanthamoeba keratitis had histories of overnight orthokeratology lens wear of 6 months to 2 years. RESULTS: Three cases were diagnosed with Acanthamoeba keratitis by corneal scraping and one by confocal microscopy examination. The patients were treated with chlorhexidine, metronidazole, and neomycin sulfate, resulting in a rapid resolution of ocular inflammation. CONCLUSION: Overnight wear of orthokeratology lenses may induce Acanthamoeba keratitis.     

Suprachoroidal hemorrhage as a complication of vitrectomy

OBJECTIVE: To study the risk factors, management, and end results of suprachoroidal hemorrhage that occur during or after vitrectomy. MATERIALS AND METHODS: This retrospective study involves patients suffering from this complication either during the curing process or immediately after vitrectomy. Preoperative risk factors, operative management, postoperative picture, and end results are reported. RESULTS: During the study period, surgery was performed on 3342 patients with primary vitrectomy. Complications were experienced by 4 patients: 2 occurred near the end of vitrectomy, and 2 in the first postoperative day. The 4 patients were myopic more than 7 diopters, 2 were pseudophakic and 2 were aphakic. Cryopexy was used to treat the retinal breaks in the operative cases. Perfluorophenanthrene was used as a postoperative tamponade in one operative case. Reoperation was done in the 4 patients 3 to 8 weeks after surgery. Silicone oil was used as a prolonged tamponade in all cases. Hypotony persisted in operative cases. All the patients had vision more than 20/400 at the end of follow-up (6 to 24 months). CONCLUSION: The risk factors for suprachoroidal hemorrhage were old age, high myopia, aphakia or pseudophakia, retinal detachment, and scleral buckle. Postoperative suprachoroidal hemorrhage has a better prognosis than the operative type. Perfluorophenanthrene "vitreon" as an operative and postoperative tamponade has a beneficial effect in keeping the retina attached and in preventing pooling of blood under the macula.     

Subconjunctival emphysema as a complication of PEEP

This report describes the unusual case of a four-year-old girl who developed subconjunctival emphysema as a complication of mechanical ventilatory support with high positive expiratory pressure (PEEP)--which was applied after she sustained multiple injuries in a motor vehicle accident. The patient's left lower palpebral conjunctiva ballooned outward with air collection subconjunctivally, but it was crepitant and deflatable with light pressure. Saline, garamycin ointment, and Lacrilube were used to prevent drying. The condition persisted during the period when the patient required high PEEP (more than 18 cm H2O) but resolved after PEEP was decreased to below 5 cm H2O. The patient eventually died on the 66th ventilatory day due to complications of intractable tracheobronchial fistula and Pseudomonas pneumonia.