Slit-lamp Needling of the Anterior Capsule for Aqueous Misdirection After Hyaloido-zonulectomy and Iridectomy
| Autor: | Marc E. Mardelli, Pierre G. Mardelli |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Reoperation
medicine.medical_specialty Intraocular pressure Iridectomy genetic structures medicine.medical_treatment Intraocular lens Vitrectomy Trabeculectomy Slit Lamp Microscopy 03 medical and health sciences 0302 clinical medicine Ophthalmology medicine Glaucoma surgery Humans Glaucoma Drainage Implants Intraocular Pressure Aged Slit lamp Phacoemulsification business.industry Glaucoma eye diseases Prosthesis Failure Vitreous Body Surgery Computer-Assisted Needles 030221 ophthalmology & optometry Capsulotomy Anterior Capsule of the Lens Female sense organs business 030217 neurology & neurosurgery |
| Zdroj: | Journal of glaucoma. 27(4) |
| ISSN: | 1536-481X |
| Popis: | Introduction We present a case of persistent aqueous misdirection, after Ahmed glaucoma valve surgery, despite undergoing an anterior vitrectomy with hyaloido-zonulectomy and iridectomy. Case report A 73-year-old female patient, 4 months after phacotrabeculectomy, was referred with persistent high intraocular pressure (IOP). Postoperatively, she developed aqueous misdirection with a flat anterior chamber (AC) but with an IOP of 15 mm Hg. On presentation, her AC was shallow with peripheral iris-cornea touch, and her IOP was 39 mm Hg. Posterior Nd:Yag capsulotomy with disruption of anterior hyaloid face partially deepened the AC. With failure of the trabeculectomy and high IOP, an Ahmed valve was placed. On the first operative day the AC was deep with an IOP of 10 mm Hg. On day 6 the patient presented with pain, flat AC, and an IOP of 10 mm Hg. Fundus examination revealed no choroidal effusion. Despite repeated reformation with viscoelastic, the AC failed to deepen. An anterior vitrectomy with hyaloido-zonulectomy was performed. Initially, the AC was deep, but, a few days later, it was flat. Multiple reformations and vitreous tap failed to keep the AC deep. A 30-G needle was passed at the slit lamp across the temporal cornea, iris, and anterior capsule into the anterior vitreous cavity. The needle was then partially withdrawn and used to create a space between the intraocular lens and anterior capsule. This immediately deepened the AC and remained so for the duration of follow-up (4 mo). Conclusion Slit-lamp needling of the anterior lens capsule can be successfully performed to help resolve a persistent case of aqueous misdirection after anterior vitrectomy. |
| Databáze: | OpenAIRE |
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