DOCSLIB.ORG

Red Laser Cyclophotocoagulation for Treatment of Therapy-Resistant Glaucoma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Red Laser Cyclophotocoagulation for Treatment of Therapy-Resistant Glaucoma Department of Ophthalmology University of Helsinki Helsinki, Finland View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Red Laser Cyclophotocoagulation for Treatment of Therapy-resistant Glaucoma Virpi Raivio Academic dissertation To be publicly discussed, by the permission of the Medical Faculty of the University of Helsinki, in the Auditorium of the Department of Ophthalmology, Haartmaninkatu 4, Helsinki, on October 11th, 2002, at 12 o´clock noon. Helsinki 2002 Supervised by: Docent Ilkka Immonen, MD Department of Ophthalmology University of Helsinki, Finland and Päivi Puska, MD Department of Ophthalmology University of Helsinki, Finland Reviewed by: Professor (emer.) Ahti Tarkkanen, MD Department of Ophthalmology University of Helsinki, Finland and Docent Berit Calissendorff, MD Karolinska Institutet Stockholm, Sweden Discussed with: Professor Roger Hitchings, MD University College London London, UK © Virpi Raivio ISBN 952-91-4972-7 (nid.) ISBN 952-10-0632-3 (verkkojulkaisu, pdf) http://ethesis.helsinki.fi Helsinki 2002 Yliopistopaino Contents ABBREVIATIONS ................................................................................................................................... 7 LIST OF ORIGINAL PUBLICATIONS ................................................................................................. 8 1. INTRODUCTION ............................................................................................................................... 9 2. REVIEW OF THE LITERATURE 2.1. Glaucoma .................................................................................................................................... 10 2.1.1. Definition ......................................................................................................................... 10 2.1.2. Treatment options............................................................................................................. 10 2.2. Cyclodestruction.......................................................................................................................... 11 2.2.1. The pre-laser era of cyclodestruction ............................................................................. 11 2.2.2. Cyclophotocoagulation..................................................................................................... 11 History......................................................................................................................................... 11 Laser delivery to the ciliary body .............................................................................................. 11 Scleral transillumination ........................................................................................................... 12 Non-contact Nd:YAG laser CPC .............................................................................................. 12 Contact CPC .............................................................................................................................. 12 The contact probe ............................................................................................................ 12 Contact Nd:YAG laser CPC ............................................................................................ 13 Contact 810 nm diode laser CPC ................................................................................... 13 Contact red laser CPC ..................................................................................................... 13 Laser transmission and absorption ........................................................................................... 14 Mechanisms of IOP decrease .................................................................................................... 15 Morphological changes observed in the ciliary body epithelium, the stroma and the ciliary body vasculature ...................................................................................................... 16 The Nd:YAG laser .......................................................................................................... 16 The 810 nm diode laser ................................................................................................... 16 The visible red lasers ....................................................................................................... 17 Morphological changes observed elsewhere ............................................................................ 17 The conjunctiva ............................................................................................................... 17 The sclera ........................................................................................................................ 17 The ciliary muscle ........................................................................................................... 18 The iris, the lens, the intraocular lens, and the zonules .................................................. 18 Sympathetic ophthalmia.................................................................................................. 19 The retina ........................................................................................................................ 19 Mechanisms of treatment failure ............................................................................................... 19 Clinical outcome of cyclophotocoagulation .............................................................................. 20 Heterogeneous glaucoma population .............................................................................. 20 3 Posttraumatic glaucoma .................................................................................................. 20 Glaucoma in children and young adults .......................................................................... 22 Neovascular glaucoma .................................................................................................... 23 Corneal complications after cyclophotocoagulation ...................................................... 23 3. AIMS OF THE STUDY ..................................................................................................................... 26 4. PATIENTS AND METHODS ........................................................................................................... 27 4.1. Patients .................................................................................................................................... 27 4.1.1. Transscleral Contact Krypton Laser Cyclophotocoagulation for Treatment of Posttraumatic Glaucoma (I) ....................................................................................... 27 4.1.2. Transscleral Contact Krypton Laser Cyclophotocoagulation for Treatment of Glaucoma in Children and Young Adults (II) ............................................................ 29 4.1.3. Transscleral Red Laser Cyclophotocoagulation Combined with Limited Anterior Retinal Cryocoagulation in Neovascular Glaucoma (III) ............................................. 31 4.1.4. Corneal Innervation, Corneal Mechanical Sensitivity, and Tear Fluid Secretion after Cyclophotocoagulation with the Transscleral Contact 670 nm Diode Laser (IV) ........ 32 4.2. Methods .................................................................................................................................... 33 4.2.1. Clinical ophthalmological examination .......................................................................... 33 4.2.2. Cyclophotocoagulation ............................................................................................... 33 4.2.3. Limited anterior retinal cryocoagulation ........................................................................ 34 4.2.4. Definitions of success and failure.................................................................................... 35 4.2.5. In vivo confocal microscopy ............................................................................................ 35 4.2.6. The measurement of corneal sensitivity........................................................................... 35 4.2.7. The measurement of the rate of tear fluid secretion ....................................................... 36 4.2.8. Statistical methods ............................................................................................................ 36 5. RESULTS ..................................................................................................................................... 37 5.1. Transscleral Cyclophotocoagulation with the Contact Krypton Laser for Treatment of Posttraumatic Glaucoma (I) ....................................................................................................... 37 5.1.1. Success of IOP................................................................................................................. 37 5.1.2. Glaucoma medication ...................................................................................................... 38 5.1.3. Visual acuity .................................................................................................................... 38 5.1.4. Complications .................................................................................................................. 39 5.2. Transscleral Cyclophotocoagulation with the Contact Krypton Laser for Treatment of Glaucoma in Children and Young Adults (II)
Load more

Recommended publications
  • Microscopic Anatomy of the Eye Dog Cat Horse Rabbit Monkey Richard R Dubielzig Mammalian Globes Mammalian Phylogeny General Anatomy Dog
    Microscopic Anatomy of the eye Dog Cat Horse Rabbit Monkey Richard R Dubielzig Mammalian globes Mammalian Phylogeny General Anatomy Dog Arterial Blood Vessels of the Orbit General Anatomy Dog * Horizontal section Long Posterior Ciliary a. Blood enters the globe Short Post. Ciliary a Long Post. Ciliary a. Anterior Ciliary a. Blood Supply General Anatomy Dog Major arterial circle of the iris Orbital Anatomy Dog Brain Levator Dorsal rectus Ventral rectus Zygomatic Lymph node Orbital Anatomy Dog Orbital Anatomy Dog Cartilaginous trochlea and the tendon of the dorsal oblique m. Orbital Anatomy Dog Rabbit Orbital Anatomy Dog Zygomatic salivary gland mucinous gland Orbital Anatomy Dog Gland of the Third Eyelid Eye lids (dog) Eye lids (dog) Meibomian glands at the lid margin Holocrine secretion Eye lids (primate) Upper tarsal plate Lower tarsal plate Eye lids (rabbit) The Globe The Globe Dog Cat Orangutan Diurnal Horse Diurnal Cornea Epithelium Stromal lamellae Bowman’s layer Dolphin Descemet’s m Endothelium TEM of surface epithelium Cornea Doubling of Descemet’s Vimentin + endothelium Iris Walls: The vertebrate eye Iris Sphincter m. Dilator m Blue-eye, GFAP stain Iris Collagen Iris Cat Sphinctor m. Dilator m. Iris Cat Phyomelanocytes Iris Equine Corpora nigra (Granula iridica) seen in ungulates living without shade Ciliary body Pars plicata Ciliary muscle Pars plana Ciliary body Zonular ligaments Ciliary body Primarily made of fibrillin A major component of elastin Ciliary body Alcian Blue staining acid mucopolysaccharides: Hyaluronic acid Ciliary
    [Show full text]
  • Ultrasound Biomicroscopy of the Peripheral Retina and the Ciliary Body in Degenerative Retinoschisis Associated with Pars Plana Cysts
    976 Br J Ophthalmol 2001;85:976–982 Ultrasound biomicroscopy of the peripheral retina and the ciliary body in degenerative retinoschisis associated with pars plana cysts Giuseppe Mannino, Romualdo Malagola, Solmaz Abdolrahimzadeh, Gianfrancesco M Villani, Santi M Recupero Abstract pathogenetic mechanism has been attributed Aim—To evaluate the ciliary body and to circulatory disturbances, the motility of peripheral retina in degenerative retino- accommodation, vitreous traction, holes in the schisis associated with pars plana cysts inner lamina, autolysis of retinal cells in the using ultrasound biomicroscopy (UBM). peripheral retina, osmotic procedures, and Methods—18 eyes of 12 patients with transudate from the choriocapillaris.17 Histo- degenerative retinoschisis associated with chemical studies have shown that the content pars plana cysts were selected through of the cystoid spaces and schisis of the periph- binocular indirect ophthalmoscopy and eral retina is hyaluronic acid.18 The same mate- Goldmann three mirror lens examination, rial had been found in pars plana cysts,18–20 both with scleral depression. These pa- where it would accumulate owing to an active tients were studied in detail with UBM. secretion from the non-pigment epithelium of Results—Study of the ciliary body with the ciliary body and especially of the pars UBM showed pars plana cysts of diVerent plana.19 Subsequent splitting of the ciliary pig- size and uneven shape. In cross sections ment and non-pigment epithelial layers would the morphology of pars plana cysts in lead to pars plana cyst formation. Once the detail and the close relation of the cysts similarity of the content of pars plana cysts and with the oral region and the peripheral of cystoid degeneration and retinoschisis of the retina, where areas of cystoid degenera- peripheral retina had been disclosed, the tion and retinoschisis were present, were hypothesis that retinoschisis also was caused by observed.
    [Show full text]
  • Ciliary Body
    Ciliary body S.Karmakar HOD Introduction • Ciliary body is the middle part of the uveal tract . It is a ring (slightly eccentric ) shaped structure which projects posteriorly from the scleral spur, with a meridional width varying from 5.5 to 6.5 mm. • It is brown in colour due to melanin pigment. Anteriorly it is confluent with the periphery of the iris (iris root) and anterior part of the ciliary body bounds a part of the anterior chamber angle. Introduction • Posteriorly ciliary body has a crenated or scalloped periphery, known as ora serrata, where it is continuous with the choroid and retina. The ora serrata exhibits forward extensions,known as dentate process, which are well defined on the nasal side and less so temporally. • Ciliary body has a width of approximately 5.9 mm on the nasal side and 6.7 mm on the temporal side. Extension of the ciliary body On the outside of the eyeball, the ciliary body extends from a point about 1.5 mm posterior to the corneal limbus to a point 6.5 to 7.5 mm posterior to this point on the temporal side and 6.5 mm posterior on the nasal side. Parts of ciliary body • Ciliary body, in cross section, is a triangular structure ( in diagram it can be compared as ∆ AOI). Outer side of the triangle (O) is attached with the sclera with suprachoroidal space in between. Anterior side of the triangle (A) forms part of the anterior & posterior chamber. In its middle, the iris is attached. The inner side of the triangle (I) is divided into two parts.
    [Show full text]
  • Condensed Table of Contents
    Condensed Table of Contents 1 Introduction G.O.H. NAUMANN, FRIEDRICH E. KRUSE 1 2 General Ophthalmic Pathology: Principal Indications and Complications, Comparing Intra- and Extraocular Surgery G.O.H. NAUMANN, F.E. KRUSE 7 3 Special Anatomy and Pathology in Surgery of the Eyelids, Lacrimal System, Orbit and Conjunctiva L.M. HOLBACH 29 3.1 Eyelids L.M. HEINDL, L.M. HOLBACH 30 3.2 Lacrimal Drainage System L.M. HEINDL, A. JÜNEMANN, L.M. HOLBACH 45 3.3 Orbit L.M. HOLBACH, L.M. HEINDL, R.F. GUTHOFF 49 3.4 Conjunctiva and Limbus Corneae C. CURSIEFEN, F.E. KRUSE, G.O.H. NAUMANN 67 4 General Pathology for Intraocular Microsurgery: Direct Wounds and Indirect Distant Effects G.O.H. NAUMANN, F.E. KRUSE 76 5 Special Anatomy and Pathology in Intraocular Microsurgery 5.1 Cornea and Limbus C. CURSIEFEN, F.E. KRUSE, G.O.H. NAUMANN 97 5.2 Glaucoma Surgery A. JÜNEMANN, G.O.H. NAUMANN 131 5.3 Iris G.O.H. NAUMANN 152 5.4 CiüaryBody G.O.H. NAUMANN 176 5.5 Lens and Zonular Fibers U. SCHLÖTZER-SCHREHARDT, G.O.H. NAUMANN 217 Bibliografische Informationen digitalisiert durch http://d-nb.info/973635800 gescannt durch XII Condensed Table of Contents 5.6 Retina and Vitreous A.M. JOUSSEN and G.O.H. NAUMMAN with Contributions by S.E. COUPLAND, E.R. TAMM, B. KIRCHHOF, N. BORNFELD 255 5.7 Optic Nerve and Elschnig's Scleral Ring C.Y. MARDIN, G.O.H. NAUMANN 335 6 Influence of Common Generalized Diseases on Intraocular Microsurgery G.O.H.
    [Show full text]
  • Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical
    Anatomy of the Globe 09 Hermann D. Schubert Basic and Clinical Science Course, AAO 2008-2009, Section 2, Chapter 2, pp 43-92. The globe is the home of the retina (part of the embryonic forebrain, i.e.neural ectoderm and neural crest) which it protects, nourishes, moves or holds in proper position. The retinal ganglion cells (second neurons of the visual pathway) have axons which form the optic nerve (a brain tract) and which connect to the lateral geniculate body of the brain (third neurons of the visual pathway with axons to cerebral cortex). The transparent media of the eye are: tear film, cornea, aqueous, lens, vitreous, internal limiting membrane and inner retina. Intraocular pressure is the pressure of the aqueous and vitreous compartment. The aqueous compartment is comprised of anterior(200ul) and posterior chamber(60ul). Aqueous and vitreous compartments communicate across the anterior cortical gel of the vitreous which seen from up front looks like a donut and is called the “annular diffusional gap.” The globe consists of two superimposed spheres, the corneal radius measuring 8mm and the scleral radius 12mm. The superimposition creates an external scleral sulcus, the outflow channels anterior to the scleral spur fill the internal scleral sulcus. Three layers or ocular coats are distinguished: the corneal scleral coat, the uvea and neural retina consisting of retina and pigmentedepithelium. The coats and components of the inner eye are held in place by intraocular pressure, scleral rigidity and mechanical attachments between the layers. The corneoscleral coat consists of cornea, sclera, lamina cribrosa and optic nerve sheath.
    [Show full text]
  • Chapter 1 Anatomy
    LN_C01.qxd 7/19/07 14:37 Page 1 Chapter 1 Anatomy Learning objectives To learn the anatomy of the eye, orbit and the third, fourth and sixth cranial nerves, to permit an understanding of medical conditions affecting these structures. Introduction A knowledge of ocular anatomy and function is important to the understanding of eye diseases. A brief outline is given below. Gross anatomy The eye (Fig. 1.1) comprises: l A tough outer coat which is transparent anteriorly (the cornea) and opaque pos- teriorly (the sclera). The junction between the two is called the limbus. The extra- ocular muscles attach to the outer sclera while the optic nerve leaves the globe posteriorly. l A rich vascular coat (the uvea) forms the choroid posteriorly, which is lined by and firmly attached to the retina. The choroid nourishes the outer two-thirds of the retina. Anteriorly, the uvea forms the ciliary body and the iris. l The ciliary body contains the smooth ciliary muscle, whose contraction allows lens shape to alter and the focus of the eye to be changed. The ciliary epithelium secretes aqueous humour and maintains the ocular pressure. The ciliary body pro- vides attachment for the iris, which forms the pupillary diaphragm. 1 LN_C01.qxd 7/19/07 14:37 Page 2 Chapter 1 Anatomy Cornea Anterior chamber Schlemm's canal Limbus Iridocorneal angle Iris Conjunctiva Zonule Posterior chamber Lens Ciliary body Uvea Ora serrata Tendon of Choroid extraocular muscle Sclera Retina Vitreous Cribriform plate Optic nerve Fovea Figure 1.1 The basic anatomy of the eye. l The lens lies behind the iris and is supported by fine fibrils (the zonule) running under tension between the lens and the ciliary body.
    [Show full text]
  • Corneal Anatomy
    FFCCF! • Mantis Shrimp have 16 cone types- we humans have three- essentially Red Green and Blue receptors. Whereas a dog has 2, a butterfly has 5, the Mantis Shrimp may well see the most color of any animal on earth. Functional Morphology of the Vertebrate Eye Christopher J Murphy DVM, PhD, DACVO Schools of Medicine & Veterinary Medicine University of California, Davis With integrated FFCCFs Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail • Advanced imaging tools such as optical coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application http://dogtime.com/trending/17524-organization-to-provide-free-eye-exams-to-service- • The basis of any diagnosis of “abnormal” is animals-in-may rooted in absolute confidence of owning the knowledge of “normal”. • If you don’t “own” the knowledge of the terminology and normal functional morphology of the eye you will not be able to adequately describe your findings Why Does Knowing the Functional Morphology Matter? • The diagnosis of ocular disease relies predominantly on physical findings by the clinician (maybe more than any other specialty) • The tools we routinely employ to examine the eye of patients provide us with the ability to resolve fine anatomic detail http://www.vet.upenn.edu/about/press-room/press-releases/article/ • Advanced imaging tools such as optical penn-vet-ophthalmologists-offer-free-eye-exams-for-service-dogs coherence tomography (OCT) provide very fine resolution of structures in the living patient using non invasive techniques and are becoming widespread in application • The basis of any diagnosis of “abnormal” is rooted in absolute confidence of owning the http://aibolita.com/eye-diseases/37593-direct-ophthalmoscopy.html knowledge of “normal”.
    [Show full text]
  • Eye Anatomy Slides File
    EYE ANATOMY & PHYSIOLOGY Dr. Cesar Carrillo [email protected] Sight For All **Disclaimer** The images contained in this presentaon are not my own, they can be found on the web Eye Anatomy and Physiology A thorough understanding of the anatomy and physiology of the eye, orbit, visual pathways, upper cranial nerves, and central pathways for the control of eye movements is a prerequisite for proper interpretaon of diseases having ocular manifestaons. Furthermore, such anatomic knowledge is essen;al to the proper planning and safe execu;on of ocular and orbital surgery Eye Anatomy and Physiology Objecves: Brief overview of eye anatomy and relevant physiology — Embriology — The Orbit, Cranial Nerves, Blood supply and Venous drainage — The Ocular Adnexa — The Extraocular muscles — The Conjunc;va, Sclera and Cornea — The Uveal tract — The Lens — The Re;na, Vitreous and Op;c Nerve — The Visual Pathway Embryology The eye is derived from three of the primi;ve embryonic layers: — Surface ectoderm, including its derivave the neural crest — Neural ectoderm — Mesoderm — Endoderm does not enter into the formaon of the eye — Mesenchyme is the term for embryonic connecve ssue. Ocular and adnexal connec;ve ;ssues previously were thought to be derived from mesoderm, but it has now been shown that most of the mesenchyme of all of the head and neck region is derived from the cranial neural crest Embryology Development of the structures of the head and neck occurs between 3-8 weeks of gestation — Eye develops as an ectodermal diverticulum from the lateral
    [Show full text]
  • 2- Basic Anatomy and Physiology Edited.Pdf
    432 Ophthalmology Team 2- Basic Anatomy and Physiology Done by: Fatma Alshehry Revised by: Ghadah Alharbi Team Leader: Shaikha Aldossari Doctor's note Team's note Not important Important 431 teamwork in a yellow box 1 432 Ophthalmology Team The Orbit The Extraocular Muscles The Globe Coats of the Eye Conjunctiva Cornea Eye Chambers Iris and Pupil Embryology of the Eye Basic Anatomy and The Lens Physiology of the Eye Retina and Vitreous Optic Nerve The Visual Pathway The Lacrimal Apparatus Optics of the Eye Intraocular Pressure Vision 2 432 Ophthalmology Team Embryology of the Eye *This highly specialized sensory organ is derived from neural ectoderm, mesoderm and surface ectoderm. *The eye is essentially an outgrowth from the brain (neural ectoderm). *The Optic Nerve started as Optic vesicle connected to the forebrain by Optic stalk. *Surface ectoderm gives cornea and lens. Development of the Eye After Birth At birth, the eye is relatively large in relation to the rest of the body. *The eye reaches full size by the age of 8 years. The size got fixed at 3-6 years *The lens continues to enlarge throughout the life. *The iris has a bluish color due to little or no pigment on the anterior surface. *During early infant life, the cornea & sclera can be stretched by raised IOP → enlargement of the eye due to the high elasticity of the globe. The Orbit - As a socket contains and protect the eye. - The weakest parts are the floor & the medial wall. - Seven bones contribute the bony orbit. - Surrounded by nasal sinuses. - Nasal bone fracture is the most common facial fracture.
    [Show full text]
  • June 2018 Examination
    June 2018 Examination 1 CLINICAL MANAGEMENT GUIDELINES Atopic Keratoconjunctivitis (AKC) Aetiology Severe ocular surface disease affecting some atopic individuals Complex immunopathology Sometimes follows childhood Vernal Keratoconjunctivitis (VKC) (see Clinical Management Guideline on Vernal Keratoconjunctivitis) Predisposing factors Typically affects young adult atopic males There may be a history of asthma, hay fever, eczema and VKC in childhood Most patients have atopic dermatitis affecting the eyelids and periorbital skin There is a strong association with staphylococcal lid margin disease Specific allergens may exacerbate the condition Symptoms Ocular itching, watering, usually bilateral Blurred vision, photophobia White stringy mucoid discharge Onset of ocular symptoms may occur several years after onset of atopy Symptoms usually year-round, with exacerbations Signs Eyelids may be thickened, crusted and fissured Associated chronic staphylococcal blepharitis Tarsal conjunctiva: giant papillary hypertrophy, subepithelial scarring and shrinkage Entire conjunctiva hyperaemic Limbal inflammation Corneal involvement is common and may be sight-threatening: beginning with punctate epitheliopathy that may progress to macro-erosion, plaque formation (usually upper half), progressive corneal subepithelial scarring, neovascularisation, thinning, and rarely spontaneous perforation These patients are prone to develop herpes simplex keratitis (which may be bilateral), corneal ectasia such as keratoconus, atopic (anterior or posterior polar) cataracts,
    [Show full text]
  • Glaucoma Overview
    Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low. We still don’t know the exact mechanism of axonal death in glaucoma—but die they do. Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low. We still don’t know the exact mechanism of axonal death in glaucoma—but die they do. In addition to being the strongest risk factor for glaucoma, IOP has another quality that renders it unique: It is the only glaucoma risk factor that is modifiable in a manner proven to mitigate the risk of glaucoma progression. Thus, at present IOP reduction is the sole arrow in our glaucoma-treatment quiver. IOP reduction can be accomplished via hypotensive drops, laser surgery, or incisional (aka filtering) surgery; which modality is employed depends upon a number of clinical factors including (but far from limited to) glaucoma type and severity. Glaucoma Overview Glaucoma refers to a group of optic neuropathies that present with progressive optic nerve head (ONH) damage and characteristic visual field (VF) loss. Elevated intraocular pressure (IOP) is the strongest risk factor for glaucoma, but it need not be present—IOP can be normal, or even relatively low.
    [Show full text]
  • Long-Term Visual Results After Pars Plicata Lensectomy- Vitrectomy for Congenital Cataracts
    Br J Ophthalmol: first published as 10.1136/bjo.72.8.601 on 1 August 1988. Downloaded from British Journal of Ophthalmology, 1988, 72, 601-606 Long-term visual results after pars plicata lensectomy- vitrectomy for congenital cataracts STEPHEN A GROSSMAN' AND GHOLAM A PEYMAN2 From the 'Department of Ophthalmology, Eye and Ear Infirmary, University of Illinois College of Medicine at Chicago, and 2S U Eye Center, Louisiana State University Medical Center School of Medicine, New Orleans, USA SUMMARY We performed a pars plicata lensectomy-vitrectomy on 32 patients (47 eyes) with congenital cataracts. Ocular abnormalities, mainly nystagmus, strabismus, and microphthalmia, were present in 29 patients. No complications occurred intraoperatively or postoperatively in 39 eyes with up to 81/2 years' follow-up (average 2-2 years). The pars plicata approach is a good surgical technique for the management of congenital cataracts. and developmental Congenital and early developmental cataracts have who have had congenital copyright. resulted in a large percentage of cases of childhood cataracts managed with this approach. blindness.2 The surgical management of such eyes has been debated in the literature for over 50 years. Material and methods Early techniques such as discission, linear extraction, and intracapsular extraction were plagued by a Thirty-two patients (47 eyes) were referred to the persistently high rate of surgical complications.?7 vitreous service of the University of Illinois Eye and More recently the discission and aspiration technique Ear Infirmary between 1974 and 1986. Six patients for congenital cataracts has been advocated.'" between the ages of 5 weeks and 18 years had a http://bjo.bmj.com/ However, the incidence of complications with this unilateral cataract.
    [Show full text]