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Uveitis
Published in Mostafa Khalil, Omar Kouli, The Duke Elder Exam of Ophthalmology, 2019
Mostafa Khalil, Omar Kouli, Obaid Kousha
The ciliary body consists of three layers: stroma (connective tissue where the vascular supply is found), muscle (parasympathetic innervation via CNIII) and epithelium. The blood supply to the ciliary body is via the anterior and long posterior ciliary arteries. The ciliary body is divided into two parts: pars plana and pars plicata. Pars plana: Avascular. Lies between the ora serrata and ciliary processes of the pars plicata. Functionless, often used as a site for intravitreal injections or vitreous removal (pars plana vitrectomy).Pars plicata: Highly vascularized. Forms attachments for the lens zonules. Functions include aqueous humour formation, lens accommodation and aqueous drainage via uveoscleral outflow.
Management of traumatic lens subluxation and dislocation
Published in A Peyman MD Gholam, A Meffert MD Stephen, D Conway MD FACS Mandi, Chiasson Trisha, Vitreoretinal Surgical Techniques, 2019
Zonular loss and vitreous extrusion around the subluxated lens often occur. The prolapsed vitreous is cut away by introducing the vitrector in the area of zonular loss and into the anterior chamber (Fig. 48.3). An extensive core vitrectomy is not performed, because the visualization is often poor through a cataractous lens and the vitreous can help to support the lens and fragments during the lensectomy. A 20-gauge microvitreoretinal (MVR) blade is reintroduced through the sclerotomy (on the side where the lens is less subluxated), penetrating directly into the substance of the lens. The blade is rotated 180° to create a passage into the lens. Next, an infusion needle is introduced into this passage into the lens. This needle is used to fixate and soften the lens during phacofragmentation (Fig. 48.3). The needle may be used to bring the posteriorly subluxated lens back into its anatomic position.
The globe: A brief overview
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
The crystalline lens is suspended by the suspensory ligaments (zonules) from the ciliary body and lies behind the iris. It is clear to allow light rays to pass through unhindered. It changes shape so light rays can be focussed on the retina for near vision, a process known as accommodation.
Continuous Curvilinear Capsulorhexis – A Practical Review
Published in Seminars in Ophthalmology, 2022
Various conditions are associated with weak zonules.16,22 The most common are pseudoexfoliation syndrome and ocular trauma. Diagnosing zonular abnormalities before surgery is important.16,22 In some cases, the lens may seem normal during the preoperative slit-lamp examination, but may tilt deeper towards the posterior segment when the patient lies supine on the operation bed.22 If severe zonular dehiscence is identified before surgery, alternative approaches such as ECCE or ICCE should be considered. Otherwise, CCC should be performed very carefully, with tearing directed tangentially to the capsular edge near the weakened zonules.16 Capsular hooks may be useful for stabilizing the capsule during CCC.4,22 A larger capsulorhexis is sometimes needed to enable easier lens maneuvering within the capsule.
Trabeculectomy with Mitomycin-C in Post-Traumatic Angle Recession Glaucoma in Phakic Eyes With no Prior Intraocular Intervention
Published in Seminars in Ophthalmology, 2022
Sirisha Senthil, Divya Dangeti, Mayuri Battula, Harsha L Rao, Chandrasekhar Garudadri
The impact of trauma causing zonular damage with lens subluxation with or without vitreous disturbance is expected in these eyes. Although there was no gross phacodonesis preoperatively, during the surgery, vitreous prolapse was noted at the osteum after surgical iridectomy in two eyes, which was managed with limited vitrectomy using an automated vitrector. This complication should be anticipated and necessary precautions are taken to prevent consequences like the failure of trab or retinal detachment. Limited anterior vitrectomy followed by injection of air bubble in the anterior chamber helped to prevent hypotony and further vitreous loss or osteum block in both cases. One of these eyes had early bleb fibrosis at one month and needed AGM for IOP control. The intraoperative manipulation and inflammation postoperative could have contributed to early failure. One eye had a tenons cyst that developed at twomonths post-surgery, which was treated with topical aqueous suppressants and was considered a failure for complete success. One eye developed central posterior subcapsular cataract 11 months after trabeculectomy; however, the patient was not keen on surgery. None in our series had bleb-related infection or loss of light perception until the follow-up; however we do acknowledge the fact that these complications are time dependent, hence were not encountered with limited follow-up.
Endoscopy-assisted pars plana lensectomy for brunescent cataracts in eyes with microcornea with microphthalmos
Published in Seminars in Ophthalmology, 2022
Deepika C Parameswarappa, Vivek Pravin Dave, Mudit Tyagi, Rajeev R Pappuru
While a posterior approach would help in obviating the obvious problems of reduced AC depth and will reduce the incidence of corneal edema, there are intrinsic problems with this approach too. A poor corneal surface and small and non-dilating pupil pose difficulty in visualization with the conventional operating microscopic view and the status of zonules remains unassessed. Apart from this, there may be a problem in visualization and correct placement of pars plana infusion cannulas in cases with dense brunescent cataracts. An endoscopy-assisted pars plana approach can overcome all the above-mentioned difficulties and help in achieving better outcomes in these cases. Here in this case series, we describe the outcomes of endoscopy-assisted pars plana lensectomy in eyes with cataract and associated microcorneas