JCRS Online Case Reports最新文献

{"title":"Challenging diagnosis and repair of an extensive cyclodialysis cleft","authors":"Sharon Braudo, Gil Neuman, Noa Shitrit, Mordechai Goldberg","doi":"10.1097/j.jcro.0000000000000125","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000125","url":null,"abstract":"Introduction: This report describes a challenging case involving the diagnosis and surgical repair of an extensive cyclodialysis cleft (CDC) in a young, phakic patient. Patient and Clinical Findings: A 25-year-old man presented with ocular pain, visual impairment, eyelid hematoma, subconjunctival hemorrhage, and Berlin edema after blunt trauma to the right eye. Initial conservative treatment with medications was converted to surgery due to hypotony-induced maculopathy. Diagnosis, Intervention, and Outcomes: Ultrasound biomicroscopy (UBM) and gonioscopy revealed extensive supraciliary and suprachoroidal fluid and a CDC whose dimensions were inconclusive. However, consequent intraoperative UBM provided precise real-time anatomical evidence of an extensive CDC extending 8 clock hours and mandating closure with a direct cycloplexy approach. Layered scleral dissection and direct suturing of the ciliary body to the sclera were performed with 8-0 nylon sutures, resulting in CDC resolution, supraciliary and suprachoroidal fluid absorption, visual acuity improvement, and intraocular pressure stabilization. Conclusions: This case highlights the innovative use of intraoperative UBM as a critical tool, offering real-time guidance in managing an extensive CDC. The successful closure and improved visual outcomes in this case further validate the efficacy of direct cycloplexy for extensive CDCs.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"4 1","pages":"e00125"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141335144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bilateral spontaneous Descemet membrane detachment after uneventful immediate sequential bilateral cataract surgery","authors":"Ore-oluwa Erikitola, A. Sekaran, Vera Zhang, Charles Diaper, D. Anijeet","doi":"10.1097/j.jcro.0000000000000126","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000126","url":null,"abstract":"Introduction: Immediate sequential bilateral cataract surgery (ISBCS) is a practice on the rise. To the authors' knowledge, this is the first reported case of bilateral Descemet membrane detachment (DMD) after uneventful same-day ISBCS, with emphasis on diagnosis and management. Patient and Clinical Findings: The case of a 66-year-old diabetic woman with chronic obstructive pulmonary disease and obstructive sleep apnea on home oxygen who developed spontaneous bilateral DMD after uneventful ISBCS for visually significant cataracts is presented. Although spontaneous DMD after uneventful phacoemulsification has been reported before, it has not been reported after same-day ISBCS to the authors' knowledge. The success rates with air pneumatic descemetopexy are excellent, with ranges between 90% and 95%. In this case, surgical intervention with gas injection in the anterior chamber and surgical peripheral iridotomies resulted in excellent visual acuity restoration in the patient. Diagnosis, Intervention, and Outcomes: Patient underwent same-day ISBCS under local anesthesia by different surgeons in either eye. Standard phacoemulsification techniques were used, and no intraoperative complications were noted. The patient returned with bilateral counting fingers vision 4 weeks postoperatively and reported her vision never improved after her cataract extraction. Anterior segment optical coherence tomography (AS-OCT) confirmed the presence of bilateral DMDs. Because of the patient's severely impaired vision, bilateral air descemetopexies were performed with clinical resolution of the DMD and excellent restoration of vision in both eyes. Conclusions: Sufficient evidence supports that performing ISBCS using internationally agreed protocols minimizes the risk of experiencing bilateral complications to a negligible level when compared with staged surgery. However, with ISBCS being on the rise, spontaneous bilateral DMDs may also be seen increasingly in those eyes with no underlying commonly recognized risk factors for spontaneous DMD. With unilateral DMD, watch and wait is a viable option. However, in bilateral DMD cases, earlier air or gas descemetopexy may be preferable to increase the likelihood of success and reduce the patient's period of decreased vision.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"7 48","pages":"e00126"},"PeriodicalIF":0.0,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141335371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relentless bilateral accommodation spasm in an adolescent treated with clear lens extraction","authors":"Renato Correia Barbosa, José Alberto Lemos","doi":"10.1097/j.jcro.0000000000000113","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000113","url":null,"abstract":"Introduction: Pathologic accommodation spasm occurs when persistent contraction of the ciliary muscle of the eye induces pseudomyopia. The purpose of this report was to describe the case of an adolescent with recurrent ciliary spasm, refractory to medical treatment for several years. Patient and Clinical Findings: A 10-year-old girl was evaluated because of complaints of decreased visual acuity (VA) and frequent headaches. Diagnosis, Intervention and Outcomes: The diagnosis of pseudomyopia due to accommodation spasm was established. No organic causes were detected. She started treatment with cycloplegics, which were successively titrated at different doses, along with the use of spectacles, over the following years. After 7 years of follow-up, the lack of efficacy of treatment and intolerance to its side effects demanded further action, so a clear lens extraction was performed, with the implantation of continuous focus transition multifocal intraocular lenses. Her final uncorrected distance VA was 6/6 in each eye, with good intermediate vision and J1 near vision with +2.00 addition. Conclusions: In severe cases of ciliary spasm, medical therapy and spectacle prescription may not be sufficient to control the disease. Intraocular lens implantation may be the only remaining therapeutic option to provide quality of life to the patient.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"13 1","pages":"e00113"},"PeriodicalIF":0.0,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138584617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical management of a nonoptimal vault and unexpected postoperative refraction in a patient implanted with a phakic intraocular lens","authors":"Ángel Sánchez-Trancón, António Manuel Baptista, Oscar Torrado Sierra, P. Serra","doi":"10.1097/j.jcro.0000000000000112","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000112","url":null,"abstract":"Introduction: This case reports the management of a bilateral toric implantable collamer lens (ICL) surgery with low vaulting and unilateral reduction in visual acuity (VA) associated with a combined effect of surgically induced astigmatism (SIA) and toric-ICL rotation. This case expands the common management of toric-ICL rotation, by adding surgically induced corneal changes. Patient and Clinical Findings: The patient presented with moderate myopia and high astigmatism and was implanted with a toric-ICL, resulting in bilateral low vault <150 μm and unilateral VA reduction (20/40) because of postoperative oblique astigmatism, observed at the 4-week follow-up. Diagnosis, Intervention and Outcomes: The low ICL vaulting was associated with a high crystalline lens rise and underestimation of the sulcus-to-sulcus distance. The VA reduction resulted from a combined effect of ∼1.0 diopter SIA and 8-degree ICL rotation. The authors associate the high SIA to abnormal corneal biomechanics indexes and the toric-ICL rotation to a lack of stability resultant from a small ICL size. The left eye toric-ICL has exchanged with one with larger size and the power recalculated using vectorial analysis. The toric-ICL exchange increased the vault 75 μm and improved VA. Conclusions: Detailed anterior chamber morphometry and corneal biomechanics may assist in improving the refractive outcome in toric-ICL surgery.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"91 1","pages":"e00112"},"PeriodicalIF":0.0,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cataract wound infection and endophthalmitis treated with partial conjunctival pedicle flap and pars plana vitrectomy","authors":"Landon J. Rohowetz, Julia L. Hudson, I. Sayed-Ahmed, G. Amescua, Harry W. Flynn","doi":"10.1097/j.jcro.0000000000000111","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000111","url":null,"abstract":"Introduction: Corneal wound infection is an infrequent complication of cataract surgery that can progress to endophthalmitis. Surgical treatment of endophthalmitis associated with microbial keratitis traditionally involves therapeutic penetrating keratoplasty and pars plana vitrectomy (PPV). In this case report, we describe a patient with cataract wound infection and endophthalmitis treated with PPV and partial conjunctival pedicle flap surgery. Patient and Clinical Findings: A 74-year-old female patient complained of eye pain and decreased corrected distance visual acuity (CDVA) to 2/200 4 weeks after cataract surgery in the left eye. Examination revealed an infiltrate overlying her cataract wound with posterior segment inflammation consistent with endophthalmitis. Diagnosis, Intervention, and Outcomes: Vitreous culture revealed methicillin-resistant Staphylococcus aureus. The patient was initially treated with topical and intravitreal antibiotics but demonstrated signs of disease progression, so the patient underwent PPV with partial conjunctival pedicle flap surgery. One month postoperatively, CDVA was 20/80 with resolution of the infection and no evidence of recurrence at 6 months. Conclusions: In conjunction with PPV, conjunctival flap surgery may be an effective alternative to therapeutic penetrating keratoplasty in patients with cataract wound-associated microbial keratitis and endophthalmitis.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"41 12","pages":"e00111"},"PeriodicalIF":0.0,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139274378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vitamin A deficiency with nyctalopia after bilateral cataract surgery with multifocal intraocular lenses","authors":"Madeleine Beaman, Patrick Flynn, Phoebe Moore","doi":"10.1097/j.jcro.0000000000000110","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000110","url":null,"abstract":"Introduction: The purpose of this case study was to report an unusual case of vitamin A deficiency (VAD) with nyctalopia that was diagnosed after bilateral cataract surgery with multifocal intraocular lenses (IOLs). Patient and Clinical Findings: After cataract surgery with multifocal IOLs, a 66-year-old man developed progressive intolerable night vision symptoms, requesting IOL exchange. Diagnosis, Intervention, and Outcomes: Only careful history and investigation revealed the cause to be VAD secondary to celiac disease, rather than lens-related. The patient was commenced on parenteral vitamin A resulting in a complete resolution of nyctalopia. Conclusions: To our knowledge, this is the only reported case of VAD diagnosed in this context. We reflect on the importance of thorough history taking, particularly in patients referred for cataract surgery by their optometrist, where the provided medical history may be incomplete.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"5 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135391532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Positive dysphotopsia after implantation of an EDOF intraocular lens","authors":"Joukje C. Wanten, Noël J.C. Bauer, Rudy M.M.A. Nuijts","doi":"10.1097/j.jcro.0000000000000108","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000108","url":null,"abstract":"Introduction: This report describes a case of positive dysphotopsia (PD) after refractive lens exchange (RLE) with implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL). Patient and Clinical Findings: A healthy 48-year-old man underwent RLE with bilateral implantation of a nontoric EDOF IOL and suffered from monocular triplopia in both eyes. The visual acuity was suboptimal with an uncorrected distance visual acuity of 20/25 in the right eye and 20/30 in the left eye. Diagnosis, Intervention and Outcomes: Slitlamp examination showed well-centered implanted IOLs, without capsular distension syndrome. Bilateral IOL exchange was performed with an aspheric monofocal IOL with a 7.0 mm optic diameter, which diminished the PD complaints. Conclusions: This case report describes disturbing PD after bilateral implantation of an EDOF IOL. Exchange of these EDOF IOLs with a larger optical diameter monofocal IOL resulted in resolution of symptoms.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"130 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135320937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fuchs endothelial corneal dystrophy masking an underlying postrefractive surgery ectasia","authors":"Ramya Gnanaraj, Michael Taravella, Richard Davidson","doi":"10.1097/j.jcro.0000000000000106","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000106","url":null,"abstract":"Introduction: This article describes a case presenting Fuchs endothelial corneal dystrophy (FECD) masking an underlying postrefractive surgery ectasia. Patient and Clinical Findings: A 69-year-old woman presented in January 2022 with blurriness, halos, and glare in the left eye. Ocular history included a photorefractive keratectomy performed twice in her left eye in 2007 for hyperopic astigmatism. A diagnosis of asymptomatic Fuchs dystrophy was noted in 2010. She had acute decompensation of the cornea in the left eye because of FECD, and the first Descemet-stripping automated endothelial keratoplasty (DSAEK) with cataract surgery was performed in 2018. Diagnosis, Intervention, and Clinical Findings: The patient had a failed DSAEK graft in the left eye. A repeat DSAEK was performed in 2022, and 6 months postoperatively, the patient started showing signs of ectasia in the left eye. The authors believe the ectasia was preexisting but masked by the failed DSAEK graft and FECD and started showing after corneal deturgescence postoperatively. Conclusions: The presence of FECD and corneal ectasia can complicate diagnosis because of overlapping clinical and topographic features. This case highlights the importance of preoperative topography with epithelial/stromal thickness mapping in patients with a history of multiple refractive corneal procedures to consider the possibility of ectasia and prevent unforeseen outcomes and complications. Further research is necessary to determine standardized imaging techniques, particularly in cases of concurrent diseases.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of positive dysphotopsia with multifocal intraocular lenses by hormone replacement therapy","authors":"Koji Komatsu, Yoichiro Masuda, Takaaki Hayashi, Tadashi Nakano","doi":"10.1097/j.jcro.0000000000000105","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000105","url":null,"abstract":"Introduction: The case of a patient with positive dysphotopsia (PD) affected by hormone replacement therapy (HRT) after multifocal intraocular lens (IOL) insertion is reported. Patient and Clinical Findings: A 66-year-old woman underwent bilateral cataract surgery and multifocal IOL implantation. Postoperatively, the uncorrected distance and near visual acuity improved bilaterally. The patient experienced mild PD symptoms in the left eye. She had been using an estradiol patch for menopausal disorders. 6 months postoperatively, the use of an estradiol patch was discontinued because of dermatitis and she noticed a marked worsening of her PD. Diagnosis, Intervention, and Outcomes: With the patient's cooperation, full-field electroretinography (ERG) and contrast sensitivity tests were performed before and after estradiol discontinuation. After the discontinuation, the amplitude of both rod and cone ERGs decreased, contrast sensitivity decreased, and PD deteriorated. There were no changes in anterior-segment condition and retinal shape. Conclusions: PD symptoms worsened after the discontinuation of estrogen hormone therapy. ERG amplitude and contrast sensitivity decreased when HRT was discontinued, suggesting that retinal function in the presence of estrogen receptors may be related to the development of PD.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"146 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134936129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Late recurrence of corneal dystrophy treated with phototherapeutic keratectomy combined with epikeratophakia using double lenticules","authors":"Bingqing Sun, Zhe Zhang, Fei Xia, Yu Zhao, Dan Fu, Haipeng Xu, Xingtao Zhou, Jing Zhao","doi":"10.1097/j.jcro.0000000000000104","DOIUrl":"https://doi.org/10.1097/j.jcro.0000000000000104","url":null,"abstract":"Phototherapeutic keratectomy (PTK) combined with epikeratophakia (EP) using double lenticules through small-incision lenticule extraction (SMILE) after late recurrence was used in a patient with Reis-Bückler corneal dystrophy (RBCD) who underwent bilateral PTK 9.5 years previously. Opacity recurred at 4 years, with PTK + EP being performed using SMILE-derived lenticules, and at 5.5 years with an uncorrected visual acuity of 20/100 and disrupted counting fingers in the right and left eyes. PTK + EP in the right eye and PTK on the original lenticule in the left eye were performed. Manifest refraction was −4.25/−2.5 × 155 with a corrected distance visual acuity (CDVA) of 20/20 and −3.50/−0.75 × 140 with a CDVA of 20/20 in the right and left eyes, respectively, 2 months postoperatively. Lenticules remained transparent and well-attached to the corneal stroma, and the corneal epithelium reshaped successfully. The feasibility of repeated PTK + EP in patients with multiple RBCD recurrences was demonstrated, delaying the need for corneal transplantation.","PeriodicalId":14598,"journal":{"name":"JCRS Online Case Reports","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135552376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}