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Orejudo de Rivas M, Martínez Morales J, Pardina Claver E, Pérez García D, Pérez Navarro I, Ascaso Puyuelo FJ, Aramburu Clavería J, Ibáñez Alperte J. Descemet's Membrane Detachment during Phacocanaloplasty: Case Series and In-Depth Literature Review. J Clin Med 2023; 12:5461. [PMID: 37685527 PMCID: PMC10488042 DOI: 10.3390/jcm12175461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/17/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
This article presents three cases of Descemet's membrane detachment (DMD) occurring during 'ab externo' phacocanaloplasty procedures in three patients with uncontrolled primary open-angle glaucoma (OAG) and discusses the management of this condition by reviewing the available literature. Following a successful 360° cannulation of Schlemm's canal (SC), the microcatheter was withdrawn while an ophthalmic viscosurgical device (OVD) was injected into the canal. During passage through the inferonasal quadrant, a spontaneous separation of the posterior layer of the cornea was observed. Each case was managed differently after diagnosis, with the third case being drained intraoperatively based on experience gained from the previous cases. On the first postoperative day, slit-lamp biomicroscopy (BMC) revealed multiple DMDs in case one and a hyphema in the lower third of a deep anterior chamber. In the other two cases, a single DMD was observed. The second case developed hemorrhagic Descemet membrane detachment (HDMD), while the other two were non-hemorrhagic. In all three cases, anterior segment optical coherence tomography (AS-OCT) revealed the presence of retrocorneal hyperreflective membranes indicative of DMDs. These membranes were located in the periphery of the cornea and did not impact the visual axis. After evaluation, a small incision was made in the inferotemporal DMD of the first case. However, for the two remaining cases, a strategy of watchful waiting was deemed appropriate due to the location and size of the DMDs, as they did not affect the best-corrected visual acuity (BCVA). Over time, the patients demonstrated progressive improvement with a gradual reduction in the size of the DMDs.
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Affiliation(s)
- Marta Orejudo de Rivas
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Juana Martínez Morales
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Elena Pardina Claver
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Diana Pérez García
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Itziar Pérez Navarro
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Francisco J. Ascaso Puyuelo
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
- Aragon Health Research Institute (IIS Aragon), 50018 Zaragoza, Spain
- Department of Surgery, School of Medicine, University of Zaragoza, 50009 Zaragoza, Spain
| | - Julia Aramburu Clavería
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
| | - Juan Ibáñez Alperte
- Department of Ophthalmology, Lozano Blesa University Clinic Hospital, 50009 Zaragoza, Spain (F.J.A.P.); (J.I.A.)
- Aragon Health Research Institute (IIS Aragon), 50018 Zaragoza, Spain
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Mini-canaloplasty as a modified technique for the surgical treatment of open-angle glaucoma. Sci Rep 2020; 10:12801. [PMID: 32733032 PMCID: PMC7393495 DOI: 10.1038/s41598-020-69261-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/07/2020] [Indexed: 11/14/2022] Open
Abstract
Authors present a modified surgical technique for canaloplasty without preparing the classical trabeculo-Descemet’s membrane (TDM) and having to close sutures. Twelve patients with open-angle glaucoma (OAG) (aged 58–77 years) received the modified technique, which does not require the deep scleral flap to be excised, an intrascleral lake to be created, or TDM dissection. After accessing the Schlemm’s canal (SC), cannulation and placement of the sutures are made similar to those in the classical canaloplasty. The conjunctiva is closed via bipolar diathermy. The mean intraocular pressure (IOP) before surgery was 18.0 ± 8 mmHg, and the mean number of anti-glaucoma medications taken was 3 ± 1. Mean IOP at the end of the observation period (18.0 ± 6.0 months) was reduced by 23% (15.5 ± 4.1 mmHg), while the mean number of medications taken was reduced to 0.25 ± 1.0. In all eyes, the SC was successively opened, with no cheese-wiring. Adverse events included microhyphaema, mild corneal oedema, and folds in the TDM. The eyes recovered spontaneously within a few days after the procedure. The mini-canaloplasty technique may reduce the risk of complications associated with classical canaloplasty while effectively lowering the IOP in patients with OAG.
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Improvement of the Safety Profile of Canaloplasty and Phacocanaloplasty: A Review of Complications and Their Management. J Ophthalmol 2020; 2020:8352827. [PMID: 32612854 PMCID: PMC7315305 DOI: 10.1155/2020/8352827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Research on the methods used to achieve persistent and safe control of intraocular pressure resulted in the implementation of novel surgical procedures, such as canaloplasty and phacocanaloplasty. Herein, we review the literature focused on the safety profile of canaloplasty and phacocanaloplasty and the management of related complications. The aim of canaloplasty is to restore the natural aqueous outflow. This goal is achieved via a surgical procedure that involves viscocanalostomy with catheterisation of Schlemm's canal (360°) and placement of a circumferential suture that tensions the canal walls. This improves Schlemm's canal drainage, choroidoscleral flow, and subconjunctival filtration. The efficacy of canaloplasty for reducing the intraocular pressure is similar to those of trabeculectomy with mitomycin C and deep sclerectomy augmented with an implant and mitomycin C. However, canaloplasty is associated with a lower complication rate than those conventional techniques. Novel microsurgical techniques for the treatment of glaucoma are unlikely to replace the conventional methods. However, these new techniques offer alternatives, especially for patients who have an early indication for surgical intervention. Nevertheless, canaloplasty is associated with the expectations of efficient, safe, and modern surgical treatment.
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Lages V, Coelho J, Abreu C, Menéres MJ, Barbosa I. Blood in a Haab Stria. Case Rep Ophthalmol 2018; 9:411-415. [PMID: 30283328 PMCID: PMC6167655 DOI: 10.1159/000492567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 07/31/2018] [Indexed: 11/19/2022] Open
Abstract
We describe a case of an asymptomatic and spontaneous intracorneal hemorrhage in an adult with congenital glaucoma and blood collected in a Haab stria.
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Affiliation(s)
- Vânia Lages
- Centro Hospitalar do Porto, Porto, Portugal
- *Vânia Lages, Centro Hospitalar do Porto, Largo do Prof. Abel Salazar, PT-4099-001 Porto (Portugal), E-Mail
| | - João Coelho
- Centro Hospitalar do Porto, Porto, Portugal
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | | | - Maria João Menéres
- Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Irene Barbosa
- Centro Hospitalar do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
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Alobeidan SA, Almobarak FA. Incidence and management of haemorrhagic Descemet membrane detachment in canaloplasty and phacocanaloplasty. Acta Ophthalmol 2016; 94:e298-304. [PMID: 26687402 DOI: 10.1111/aos.12936] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 10/17/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To report the incidence and management of haemorrhagic Descemet membrane detachment (HDMD) in canaloplasty and phacocanaloplasty. METHODS This study included 105 eyes of 92 patients with uncontrolled open angle glaucoma who underwent canaloplasty and phacocanaloplasty between 2010 and 2014. Eyes that developed either HDMD or non-HDMD were identified. The main outcome measures were the development of HDMD and non-HDMD, best corrected visual acuity, recovery time after Descemet membrane detachment (DMD), intra-ocular pressure (IOP) and number of antiglaucoma medications. Each eye was managed according to the time of development, type and extent of DMD. RESULTS Ten eyes (9.5%) developed DMD- four eyes underwent canaloplasty (3.8%) and six eyes underwent phacocanaloplasty (5.7%). Three of 10 eyes developed non-HDMD while seven of 10 developed HDMD, the majority of HDMD cases occurred in combination with phacocanaloplasty (five of seven). The non-HDMD eyes resolved completely within 2 weeks without intervention. One eye with HDMD was observed for 2 weeks, before a 15% sulphur hexafluoride (SF6) intracameral injection was given. The patient developed a dense corneal stain that was resolving slowly over 30 months. One eye with HDMD underwent YAG laser membranotomy 2 weeks after being identified, which regained corneal transparency 1 month after treatment, while the remaining five eyes underwent immediate surgical drainage and regained corneal transparency 1 day post-procedure. CONCLUSION HDMD occurred in up to 6.7% in canaloplasty and phacocanaloplasty procedures, mostly during catheter withdrawal and the viscodilation step. Early recognition and management prevented further manipulation.
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Affiliation(s)
- Saleh A. Alobeidan
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
- Glaucoma Research Chair; King Saud University; Riyadh Saudi Arabia
| | - Faisal A. Almobarak
- Department of Ophthalmology; College of Medicine; King Saud University; Riyadh Saudi Arabia
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Xia X, Tian Y, Wu Z, Wen D, Song W. Comparison of 1-Site and 2-Site Phacotrabeculectomy in the Small Adult Eyes With Concomitant Cataract and Glaucoma. Medicine (Baltimore) 2016; 95:e2405. [PMID: 26844453 PMCID: PMC4748870 DOI: 10.1097/md.0000000000002405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to compare the outcomes after phacotrabeculectomy at 1 or 2 sites in the small adult eyes with concomitant cataract and glaucoma.Patients who had 1-site (n = 26) or 2-site (n = 14) phacotrabeculectomy over a 4-year period at an eye surgery center were included. Eighteen eyes of 18 patients with glaucoma using any 1 prostaglandin analogue (latanoprost, travoprost, or bimatoprost) were compared with 8 normal control patients. The records of patients were reviewed, and intraocular pressure, best-corrected visual acuity, axial length, anterior chamber depth, corneal endothelial cell (CEC) density, Diopter were measured. The outcome was compared with postoperative and preoperative measurements for 3-month follow-ups.The follow-up time was 3 months. There was no difference between the operations in improving best-corrected visual acuity, lowering intraocular pressure, shortening axial length, and deepening anterior chamber depth. However, 2-site surgery was associated with significantly more CEC loss and refractive error. Postoperative complications were not different between the 2 groups.The CEC loss and the refractive error in 2-site group were higher than that of 1-site group. One-site surgery seems to cause less CEC damage and refractive error than the 2-site operation during the follow-up time of 3 months.
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Affiliation(s)
- Xiaobo Xia
- From the Department of Ophthalmology, Xiangya Hospital, Central South University, Changsha, China
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Violette NP, Ledbetter EC. Intracorneal stromal hemorrhage in dogs and its associations with ocular and systemic disease: 39 cases. Vet Ophthalmol 2016; 20:27-33. [PMID: 26748469 DOI: 10.1111/vop.12340] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To describe clinical features of dogs diagnosed with stromal intracorneal hemorrhage (ICH). ANIMALS STUDIED Retrospective case series of 39 dogs (44 eyes) with ICH. PROCEDURES Medical records of dogs evaluated by the Cornell University ophthalmology service were searched to identify animals with a clinical diagnosis of ICH between 2005 and 2014. Signalment and clinical details, including concurrent ocular disease, concurrent systemic disease, diagnostic tests performed, outcome of hemorrhage, presenting client complaint, and treatment, were recorded. RESULTS Intracorneal hemorrhage was identified in 44 eyes of 39 dogs. The mean (±standard deviation) age of dogs was 11.5 years (±2.8 years). The Bichon Frise breed and older dogs were statistically over-represented relative to the entire ophthalmology service canine referral population during the same time period. Concurrent ocular disease was present in 40 eyes (91%) and included keratoconjunctivitis sicca, cataracts, and corneal ulcers. Twenty-three dogs (59%) suffered from concurrent systemic disease, most frequently diabetes mellitus, hyperadrenocorticism, hypothyroidism, and systemic hypertension. Less commonly, life-threatening systemic conditions were identified in dogs with ICH including immune-mediated hemolytic anemia, immune-mediated thrombocytopenia, metastatic neoplasia, and sepsis. Intracorneal hemorrhage was found in all corneal locations, and corneal vascularization was present in each affected eye. CONCLUSIONS Intracorneal hemorrhage is an uncommon condition in dogs that occurs in association with corneal vascularization. The risk of ICH may be increased due to certain ocular and systemic diseases. Although uncommon, ICH may also be an ocular manifestation of severe immune-mediated, infectious, and neoplastic systemic diseases in dogs.
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Affiliation(s)
- Nathaniel P Violette
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
| | - Eric C Ledbetter
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853, USA
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Rękas M, Byszewska A, Jünemann A. Reply: To PMID 25450241. J Cataract Refract Surg 2015; 41:1123-4. [PMID: 26049852 DOI: 10.1016/j.jcrs.2015.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 02/22/2015] [Indexed: 11/17/2022]
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Evacuating a pre-Descemet hematoma through a clear corneal incision during a canaloplasty procedure. J Cataract Refract Surg 2014; 40:1953-7. [DOI: 10.1016/j.jcrs.2014.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/16/2014] [Accepted: 05/02/2014] [Indexed: 11/21/2022]
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Kagemann L, Wang B, Wollstein G, Ishikawa H, Nevins JE, Nadler Z, Sigal IA, Bilonick RA, Schuman JS. IOP elevation reduces Schlemm's canal cross-sectional area. Invest Ophthalmol Vis Sci 2014; 55:1805-9. [PMID: 24526436 DOI: 10.1167/iovs.13-13264] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Previously, we demonstrated reduced Schlemm's canal cross-sectional area (SC-CSA) with increased perfusion pressure in a cadaveric flow model. The purpose of the present study was to determine the effect of acute IOP elevation on SC-CSA in living human eyes. METHODS The temporal limbus of 27 eyes of 14 healthy subjects (10 male, 4 female, age 36 ± 13 years) was imaged by spectral-domain optical coherence tomography at baseline and with IOP elevation (ophthalmodynamometer set at 30-g force). Intraocular pressure was measured at baseline and with IOP elevation by Goldmann applanation tonometry. Vascular landmarks were used to identify corresponding locations in baseline and IOP elevation scan volumes. Schlemm's canal CSA at five locations within a 1-mm length of SC was measured in ImageJ as described previously. A linear mixed-effects model quantified the effect of IOP elevation on SC-CSA. RESULTS The mean IOP increase was 189%, and the mean SC-CSA decrease was 32% (P < 0.001). The estimate (95% confidence interval) for SC-CSA response to IOP change was -66.6 (-80.6 to -52.7) μm(2)/mm Hg. CONCLUSIONS Acute IOP elevation significantly reduces SC-CSA in healthy eyes. Acute dynamic response to IOP elevation may be a useful future characterization of ocular health in the management of glaucoma.
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Affiliation(s)
- Larry Kagemann
- Department of Ophthalmology, UPMC Eye Center, Eye and Ear Institute, Ophthalmology and Visual Science Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Matlach J, Freiberg FJ, Leippi S, Grehn F, Klink T. Comparison of phacotrabeculectomy versus phacocanaloplasty in the treatment of patients with concomitant cataract and glaucoma. BMC Ophthalmol 2013; 13:1. [PMID: 23360243 PMCID: PMC3564772 DOI: 10.1186/1471-2415-13-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 01/22/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cataract and glaucoma are both common comorbidities among older patients. Combining glaucoma surgery with minimal invasive phacoemulsification (phaco) is a considerable option to treat both conditions at the same time, although the combination with filtration surgery can produce a strong inflammatory response. Combined non-penetrating procedures like canaloplasty have shown to reduce intraocular pressure (IOP) comparable to trabeculectomy without the risk of serious bleb-related complications. The purpose of this retrospective study was to compare the outcomes of phacotrabeculectomy and phacocanaloplasty. METHODS Thirty-nine eyes with concomitant cataract and glaucoma who underwent phacotrabeculectomy (n=20; 51.3%) or phacocanaloplasty (n=19; 48.7%) were included into this trial on reduction of IOP, use of medication, success rate, incidence of complications and postsurgical interventions. Complete success was defined as IOP reduction by 30% or more and to 21 mmHg or less (definition 1a) or IOP to less than 18 mmHg (definition 2a) without glaucoma medication. RESULTS Over a 12-month follow-up, baseline IOP significantly decreased from 30.0 ± 5.3 mmHg with a mean of 2.5 ± 1.2 glaucoma medications to 11.7 ± 3.5 mmHg with a mean of 0.2 ± 0.4 medications in eyes with phacotrabeculectomy (P< .0001). Eyes with phacocanaloplasty had a preoperative IOP of 28.3 ± 4.1 mmHg and were on 2.8 ± 1.1 IOP-lowering drugs. At 12 months, IOP significantly decreased to 12.6 ± 2.1 mmHg and less glaucoma medications were necessary (mean 1.0 ± 1.5 topical medications; P< .05). 15 patients (78.9%) with phacotrabeculectomy and 9 patients (60.0%) in the phacocanaloplasty group showed complete success according to definition 1 and 2 after 1 year (P= .276). Postsurgical complications were seen in 7 patients (36.8%) of the phacocanaloplasty group which included intraoperative macroperforation of the trabeculo-Descemet membrane (5.3%), hyphema (21.1%) and bleb formation (10.5%). Although more complications were observed in the phacotrabeculectomy group, no statistically significant difference was found. CONCLUSIONS Phacocanaloplasty offers a new alternative to phacotrabeculectomy for treatment of concomitant glaucoma and cataract, although phacotrabeculectomy yielded in better results in terms of IOP maintained without glaucoma medications.
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Affiliation(s)
- Juliane Matlach
- Department of Ophthalmology, University of Wuerzburg, Josef-Schneider-Str, 11, D-97080, Wuerzburg, Germany.
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