Massive retinal gliosis: a late complication of retinal detachment surgery

Purpose Massive retinal gliosis is a rare, benign, intraocular tumor. It develops mostly in long-standing ocular disease such as chronic inflammation, vascular disorders, glaucoma, trauma, or congenital abnormalities. We report on a case of massive retinal gliosis, which developed 17 years following retinal detachment surgery.Methods Case report.Results A 64-year-old woman developed a peripheral fundus tumor 17 years after successful retinal detachment surgery. Follow-up examination demonstrated growth of the mass. The tumor was treated by pars plana vitrectomy and local endoresection. Histopathological study revealed massive reactive gliosis of the retina.Conclusions To our knowledge, this is the first histopathologically proven case of a massive retinal gliosis, which developed after a non-drainage retinal detachment surgery. Endoresection is a therapeutic option in suspected massive retinal gliosis. It provides material for histological diagnosis which obviates unnecessary intervention in a functioning eye.     

Accumulation of milky fluid: a late complication of cataract surgery.

We describe 3 patients who presented with an accumulation of homogeneous milky fluid in the capsular bag several years after continuous curvilinear capsulorhexis, phacoemulsification, and posterior chamber intraocular lens (IOL) implantation. In each case, the entire edge of the anterior capsule opening was tightly attached to the peripheral IOL optic. The milky fluid was present in the closed chamber between the IOL optic and the posterior capsule. The fluid was sampled in 2 patients, and its concentration of sodium hyaluronate was determined by high-performance liquid chromatography. The concentration of sodium hyaluronate resembled that in normal aqueous humor. In 1 case, the protein concentration was measured and found to be elevated. Electrophoresis showed that human serum albumin was the main protein constituent. While the outcome was favorable in all 3 patients, this delayed complication of cataract surgery merits further study to clarify its etiology and pathogenesis.     

Brain-stem anesthesia as a complication of regional anesthesia for ophthalmic surgery.

Brain-stem anesthesia is a serious complication of orbital regional anesthesia that may occur when the injected local anesthetic agent gains access to the central nervous system by direct spread from the apex of the orbit via submeningeal pathways. In most studies the reported incidence rate during retrobulbar block is one case per 350 to 500 patients. Failure to recognize the condition or to treat it adequately may be life threatening. Treatment includes reassurance, intravenous administration of fluids, pharmacologic circulatory support or suppression of convulsions, and cardiopulmonary resuscitation. With proper treatment complete recovery is the rule. In all situations in which orbital block is to be done, basic cardiopulmonary resuscitation equipment and personnel familiar with its use are essential. Monitoring of the blood pressure, electrocardiography and pulse oximetry should be routine. Having the globe in primary gaze renders the optic nerve less vulnerable, and avoidance of deep penetration of the orbit is of great importance.     

Orbital cysts lined with both stratified squamous and columnar epithelia: a late complication of silicone implants

Two patients presented with orbital cysts 5 and 7 years after orbital blowout fracture repair with silicone plate implants. The orbital cysts caused significant exophthalmos and restriction in ocular motility. Surgical excision revealed thick-walled cysts that were displacing the globe and encapsulating the silicone implant. On histopathologic examination, the cysts were lined with both stratified squamous and ciliated columnar (respiratory) epithelia. We propose that squamous and respiratory epithelial cells may have been deposited during surgery from the conjunctival and sinus epithelia, respectively. This case series illustrates that although an uncommon complication, epithelium-lined inclusion cysts may develop several years after orbital fracture repair with a silicone implant. A transconjunctival surgical approach is a possible risk factor.     

Periocular Mohs micrographic surgery: Results of a dual-site day-surgery service

PURPOSE . To assess the feasibility of day-surgery Mohs Micrographic Surgery (MMS) at dual sites. METHODS . MMS now has an established position for the management of skin tumour removal. The literature reports excellent results in terms of tissue preservation, complete tumour excision and recurrence rate. MMS involves an initial stage undertaken by dermatologists. The subsequent reconstructive phase can be undertaken either by the dermatologist or by an oculoplastic surgeon in cases of extensive defects. In the latter cases, special expertise is needed in order to achieve satisfactory cosmetic results. Centres offering MMS are few and are usually located in tertiary referral hospitals. In a large city of 12 million inhabitants like London there is only one centre offering MMS on the National Health Scheme. We have set up a dual-site day-surgery service since 1997, whereby a Mohs trained dermatologist in the first unit undertakes the initial ablative stage. The patient is then transferred to the second location, which is approximately three miles away; a trained oculoplastic surgeon then undertakes the reconstruction the same day. Rarely, defects are deemed too large for reconstruction and the patient discharged on the same day; patients are then admitted as inpatients for reconstruction the following day with oculoplastic, plastic, craniofacial and facio-maxillary services at hand. RESULTS . To date we have operated on 59 patients for removal of basal cell carcinomas (BCC). All patients had a biopsy-proven diagnosis of BCC before being referred to the dermatologist. Following liaison with the Dermatology Unit, surgery was scheduled so that the reconstruction could be undertaken in the Oculoplastic Unit at the second hospital on the same day. All patients' defects were reconstructed successfully. With the longest follow-up being 39 months so far, tumour recurrence has been 0%. CONCLUSIONS . A dual-site day-surgery service seems to be a feasible option where a MMS dermatologist is not present onsite. The logistic problem can be easily overcome with a proper liaison between the departments. A dual-site day-surgery MMS service provides a superior service compared with the 2 mm tumour-free margin excision and delayed surgical repair following histological examination advocated by other authors where MMS is not available on site. It is only with MMS that one can ensure complete tumour excision. Day-surgery is the preferred choice, both for patients and for financial considerations. We would therefore support the establishment of dual-site day-surgery MMS services where the reconstruction is undertaken in hospitals located away from the MMS dermatology unit, provided close collaboration exists between the two units to ensure the smooth transfer of patients.     

Periocular Mohs micrographic surgery: Results of a dual-site day-surgery service

PURPOSE. To assess the feasibility of day-surgery Mohs Micrographic Surgery (MMS) at dual sites. METHODS. MMS now has an established position for the management of skin tumour removal. The literature reports excellent results in terms of tissue preservation, complete tumour excision and recurrence rate. MMS involves an initial stage undertaken by dermatologists. The subsequent reconstructive phase can be undertaken either by the dermatologist or by an oculoplastic surgeon in cases of extensive defects. In the latter cases, special expertise is needed in order to achieve satisfactory cosmetic results. Centres offering MMS are few and are usually located in tertiary referral hospitals. In a large city of 12 million inhabitants like London there is only one centre offering MMS on the National Health Scheme. We have set up a dual-site day-surgery service since 1997, whereby a Mohs trained dermatologist in the first unit undertakes the initial ablative stage. The patient is then transferred to the second location, which is approximately three miles away; a trained oculoplastic surgeon then undertakes the reconstruction the same day. Rarely, defects are deemed too large for reconstruction and the patient discharged on the same day; patients are then admitted as inpatients for reconstruction the following day with oculoplastic, plastic, craniofacial and facio-maxillary services at hand. RESULTS. To date we have operated on 59 patients for removal of basal cell carcinomas (BCC). All patients had a biopsy-proven diagnosis of BCC before being referred to the dermatologist. Following liaison with the Dermatology Unit, surgery was scheduled so that the reconstruction could be undertaken in the Oculoplastic Unit at the second hospital on the same day. All patients' defects were reconstructed successfully. With the longest follow-up being 39 months so far, tumour recurrence has been 0%. CONCLUSIONS. A dual-site day-surgery service seems to be a feasible option where a MMS dermatologist is not present onsite. The logistic problem can be easily overcome with a proper liaison between the departments. A dual-site day-surgery MMS service provides a superior service compared with the 2 mm tumour-free margin excision and delayed surgical repair following histological examination advocated by other authors where MMS is not available on site. It is only with MMS that one can ensure complete tumour excision. Day-surgery is the preferred choice, both for patients and for financial considerations. We would therefore support the establishment of dual-site day-surgery MMS services where the reconstruction is undertaken in hospitals located away from the MMS dermatology unit, provided close collaboration exists between the two units to ensure the smooth transfer of patients.     

Spontaneous dislocation of intraocular lens as a late complication of uncomplicated cataract surgery: a case series

Five patients having uncomplicated phacoemulsification were implanted with CT-Asphina 603P intraocular lenses into the capsular bag. After a few months, three of the patients had haptic flexion anterior to the optic despite minimal capsular fibrosis. One patient had spontaneous dislocation of the intraocular lens into the anterior chamber with only minimal capsular fibrosis. Another patient had one haptic dislocated out of the bag. Late intraocular lens dislocation is also seen in newly designed preloaded intraocular lenses despite the absence of significant capsular fibrosis. Haptic-optic junction design and intraocular lens material play important roles in such complication. A slightly large capsulorhexis might be a deterrent for implantation of this intraocular lens.     

外伤植入性虹膜囊肿的临床分析及手术治疗

目的 探讨外伤植入性虹膜囊肿临床特点及手术治疗效果.设计 回顾性病例系列.研究对象 36例外伤植入性虹膜囊肿.方法 对36例外伤植入性虹膜囊肿临床资料进行回顾性分析.主要指标 虹膜囊肿患者年龄分布、手术史、发病时间、手术治疗效果.结果 所有外伤植入性虹膜囊肿均发生于眼球穿通伤后,其中10例有外伤性白内障摘除手术史,发病时间在6个月～1年及1年～10年的患者各占总数的30.56%,所有患者均手术切除虹膜囊肿,手术切除后2例复发,均为儿童患者.结论 外伤植入性虹膜囊肿多发生于眼球穿通伤后,手术切除是治疗外伤植入性虹膜囊肿的有效手段.     

Suppurative keratitis: a late complication of radial keratotomy

A 21-year-old man who had radial keratotomy performed two years previously presented with a painful, red right eye. Suppurative keratitis was found in one of the eight radial incisions and Staphylococcus epidermidis was isolated by culture. Lack of stromal healing of the infected incision and the presence of epithelial cysts in four other incisions in the same eye suggest that the cause of the corneal infection was loss of the epithelial barrier function because of epithelial breakdown.     

Interpseudophakos intraocular lens surface opacification as a late complication of piggyback acrylic posterior chamber lens implantation

We present a case involving opacification of the apposing surfaces of 2 acrylic intraocular lenses (IOLs) that had been implanted in a piggyback fashion 16 months previously. Clinical observations derived from our experience with piggyback acrylic lens implantation are presented, along with a discussion of late complications of piggyback IOL implantation and recommendations.     

Panuveitis as a possible ophthalmic complication of Kikuchi-Fujimoto disease

CLINICAL CASE: A 37 year old female with histologically proven Kikuchi-Fujimoto disease is presented. She developed panuveitis, vasculitis and subretinal macular infiltrate, probably as a recurrence of the disease. Immunosuppressive treatment (methotrexate) was initiated in the absence of response to systemic steroid therapy and threat to vision owing to macular involvement. DISCUSSION: Ophthalmic complications of Kikuchi-Fujimoto disease are unusual. We discuss differential diagnosis and emphasize the aggresiveness of our case.     

Interpseudophakos Elschnig pearls associated with late hyperopic shift: a complication of piggyback posterior chamber intraocular lens implantation.

We report 3 cases of bilateral piggyback lens implantation in which late hyperopic shift occurred associated with Elschnig pearl formation in the peripheral interface between the 2 lenses.