ExPRESS miniature glaucoma shunt for intractable secondary glaucoma in superior vena cava syndrome - a case report

A Case of Unilateral Intraocular Pressure Elevation in a Patient With Glaucoma

A 52-year-old man with a history of severe primary open-angle glaucoma in both eyes presented with an intraocular pressure above target in the left eye. A 24-2 Humphrey visual field showed new glaucoma progression. What would you do next?

Vascular spinal cord obstruction associated with superior vena cava syndrome: A case report and literature review

RATIONALE

Superior vena cava syndrome (SVCS) is the obstruction of blood flow through the SVC, causing complete or partial blockade of the collateral circulation of returning venous blood. SVCS is frequently presented with facial, neck, trunk, and upper limbs swelling and so on. However, to the best of our knowledge, the obstruction of the venous return in the spinal veins is rarely a manifestation of SVCS.

PATIENT CONCERNS

We presented a rare case of a 52-year-old male patient with 2-month history of progressive right upper limb numbness and swelling and 10-day history of extremities malfunctioning. Cervical magnetic resonance imaging (MRI) detected obstruction of the spinal venous return. Lung computed tomography (CT) revealed lesions in the esophagus, which indicated esophageal cancer with mediastinal lymph nodes metastasis and signified SVCS.

DIAGNOSES

With the results of laboratory findings, cervical MRI, lung CT findings, and physical examination, the patient was diagnosed with SVCS manifesting as spinal vein obstruction.

INTERVENTIONS AND OUTCOMES

The family abandoned further treatment, and the patient passed away 2 months after discharge.

LESSONS

The case indicates that SVCS can induce systemic and spinal cord diseases affecting the venous return. Further studies are necessary to reveal the mechanism for SVCS inducing spinal veins obstruction and to explore whether SVCS patients with and without vascular spinal cord obstruction have different prognoses.

Intraocular pressure in children after congenital heart surgery: A single-center study

Background:

The impact of varied cardiac physiologies on intraocular pressure (IOP) among children undergoing heart operations is unknown.

Aim:

The aim of this study was to determine the IOP among children with varying cardiovascular physiologies and varying hemodynamics after their heart operation.

Setting and Design:

This was a prospective, observational study.

Materials and Methods:

Patients ≤18 years undergoing congenital heart surgery were included in this study. IOP measurement was performed by Icare® tonometer between 3 and 14 days after heart operation.

Statistical Analysis:

Summary statistics were estimated for all demographic, anthropometric, and clinical data.

Results:

A total of 116 eyes from 58 children were included. The mean and standard deviation age was 28.4 (45.8) months. Single-ventricle anatomy was present in 26 patients (45%). Despite similar heart rate and blood pressure, the mean IOP among the patients with single-ventricle anatomy was significantly elevated as compared to patients with two-ventricle anatomy (18 mm Hg vs. 12 mm Hg, P < 0.001). There was no difference in IOP measurements based on the complexity of operation performed. We noted that patients undergoing surgical palliation with central shunt (21 mm Hg), Fontan operation (19 mm Hg), bidirectional Glenn operation (19 mm Hg), Norwood operation (19 mm Hg), or definitive repairs such as tetralogy of Fallot repair (17 mm Hg), and atrioventricular canal repair (19 mm Hg) were associated with the highest IOPs in the study cohort.

Conclusions:

This study demonstrates that IOPs vary with varying cardiovascular physiology after pediatric cardiac surgery.