The eye and orbit
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
This usually occurs in older, often hypermetropic, patients. The prevalence is much higher in some Asian populations. The cornea becomes hazy, the pupil oval, dilated and nonreacting, the vision poor and the eye feels hard. In severe cases pain may be accompanied by vomiting and the condition can be mistaken for an acute abdominal problem. Tonometry (intraocular measurement) and examination of the iridocorneal angle by gonioscopy (using a prism placed on the cornea) is diagnostic. Urgent treatment to reduce the pressure with pilocarpine eyedrops, oral acetazolamide and, if refractory, mannitol should be started, followed by YAG laser iridotomy, laser iridoplasty, anterior chamber paracentesis or surgical iridectomy. The condition is usually bilateral and the second eye usually needs a prophylactic iridotomy at the same time.
How to master MCQs
Chung Nen Chua, Li Wern Voon, Siddhartha Goel in Ophthalmology Fact Fixer, 2017
Pigment dispersion syndrome is associated with pigmentary glaucoma and the risk factors are myopia and raised intraocular pressure. In this condition, the pigment dispersion is believed to be caused by the rubbing of the iris against the lens. This is caused by concavity of the iris as a result of a more posteriorly inserted iris. Iridotomy is useful in reducing the iris-lens contact and hence the amount of pigment dispersed. Lattice degeneration is increased in pigment dispersion syndrome as most of the sufferers are myopic.
Laser Surgery in the Treatment of Glaucoma
Neil T. Choplin, Carlo E. Traverso in Atlas of Glaucoma, 2014
The patient examination with a Zeiss four-mirror or similarly shaped gonioscope should show occludable or occluded angles that open with compression. In patients with pigment dispersion (Figure 15.11a), laser iridectomy reverses iris concavity and iridozonular contact although additional pilo-carpine therapy may be necessary for residual iridociliary contact (Figure 15.11b). Lastly, an iridectomy may be useful in treating postoperative complications, such as iris bombé, caused by posterior synechiae formed in eyes with chronic inflammation (Figure 15.12).
Outcomes of Using Sutureless, Scleral-Fixated Posterior Chamber Intraocular Lenses
Published in Seminars in Ophthalmology, 2019
Vinay Kansal, Oluwadara Onasanya, Kevin Colleaux, Nigel Rawlings
The most frequent postoperative complications encountered were transient IOP elevations (26.8%), cystoid macular edema (14.3%) and UGH-syndrome (11.6%). These complications may be, in part, related to the pre-operative ocular comorbidities in our cohort. For example, 25.9% of the cohort had a diagnosis of glaucoma, prior to SSFIOL implantation. This would potentially account for the high rate of IOP elevations observed. Similarly, many of the complications related to a floppy iris-lens diaphragm (UGH syndrome, iris capture) may have been predisposed by pre-operative complex pathologies such as previous surgery for retinal detachment (16.1%), trauma (blunt trauma-8.0%, globe rupture-4.5%) and high myopia. In order to mitigate the risk of UGH syndrome, surgeons can consider a surgical iridectomy at the time of scleral fixation. An iridectomy, laser or surgical, can be effective in shifting the iris diaphragm anteriorly away from the scleral-fixated IOL.
Phacoemulsification with Intraocular Lens Implantation in Pediatric Uveitis: A Retrospective Study
Published in Ocular Immunology and Inflammation, 2018
Sudha K. Ganesh, Saurabh Mistry
All surgical procedures were performed under general anesthesia using a standard phacoemulsification technique by a single surgeon, using a standard superior scleral tunnel incision. Flexible self-retaining iris hooks were used when intraoperative pupillary dilatation was poor due to posterior synechiae. Posterior synechiae, when present, were lysed by injecting viscoelastic against the adherent iris, or by sweeping the pupil free from the lens capsule with an iris spatula. Trypan blue was used to stain the anterior capsule when required. A continuous circumlinear capsulorrhexis of approximately 5.5 mm was performed. After hydrodissection, irrigation/aspiration of the nucleus and a complete cortical cleanup was carried out. Primary posterior capsulorrhexis (PCC) was not performed because the mean age of the children at the time of cataract surgery was 10.9 years (range 7 years to 15 years). The surgeon believed that a PCC in uveitic eyes could initiate or worsen pre-existing cystoid macular edema. A posterior chamber IOL was placed in the capsular bag. Surgical peripheral iridectomy was performed in one case. No surgical complications were noted.
Neuroanniversary 2020
Published in Journal of the History of the Neurosciences, 2019
Prussian pioneer of ophthalmology Friedrich Wilhelm Ernst Albrecht von Gräfe (1828–1870; see Figure 2) made many contributions to ophthalmology and is considered perhaps the most important ophthalmologist of the nineteenth century. Among his achievements were a new surgical technique for the treatment of cataracts and the introduction of iridectomy for glaucoma. He described the combination of retinitis pigmentosa and perceptive deafness in Usher’s syndrome, and he also provided early descriptions of optic neuritis (1860), chronic progressive external ophthalmoplegia (1868), and papilledema. In addition, he is credited with designing the “Von Gräfe knife,” a special knife for cataract surgery, which was used until the 1960s. In 1855, he founded the Archiv für Ophthalmologie. In 1863, he founded the Deutsche Ophtalmologische Gesellschaft.
Related Knowledge Centers
- Cataract Surgery
- Glaucoma
- Intraocular Pressure
- Melanoma
- Surgery
- Iris
- Intraocular Hemorrhage
- Aqueous Humour
- Anterior Chamber of Eyeball
- Intraocular Lens