Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen

Slides:



Advertisements
Similar presentations
Corneal complication of phacoemulsification Historical cataract surgery lens dislocation Extracapsular cataract extraction Intracapsular cataract extraction.
Advertisements

F. Kianersi M.D 1387 / 12 / 1.  Patients with uveitis have cataracts: More often, and at an Earlier Age than the general population.  Main etiological.
postoperative cataract complications
Clinicopathologic Case
INTRA-OPERATIVE MANAGEMENT OF CATARACT SURGERY COMPLICATIONS Dr. H. Razmjoo Isfahan University of Medical Sciences.
Acute Glaucoma Conditions Acute Eye Conditions Course Dr. Sonya Bennett May 2011.
DR ALI SALEHI TOXIC ANTERIOR SEGMENT SYNDROM (TASS)
Uveal Tract Diseases.
Katsuya Yamazoe, MD, Takefumi Yamaguchi, MD, Kazuki Hotta, MD, Yoshiyuki Satake, MD, Kenji Konomi, MD, Seika Den, MD, Jun Shimazaki, MD Presented by: Abdulrahman.
Protecting the Corneal Endothelium
Yüksel Totan, Ramazan Yaĝcı, Zeynel Arslanyılmaz, Uĝurcan Keskin The authors have no financial interest.
Clear Corneal Vitrectomy Combined with Phacoemulsification and Foldable Intraocular Lens Implantation. Takeshi Iwase , Tsuyoshi Yoshita  and Kazuhisa.
Phaco-drainage Phacosection Amporn technique
Intraocular lens dislocation secondary to haptic torsion Lawrence E. Lohman, MD FACS Matthew C. Willett, MD.
Agents Used in the Treatment of Conditions of the Eye
So-Hyang Chung, MD, PhD, Choun-Ki Joo, MD, PhD Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul,
Kendall R.B. Dobbins, MD Geisinger Medical Center
V G S Brar MD Dilraj Grewal MD Rajeev Jain, MD SPS Grewal MD Postoperative IOP and Anterior Chamber Inflammation Following Intracameral Injection of Pilocarpine.
The authors have no financial interest in the subject matter of this e-poster M. K. Kummelil, S. Nagappa, A. Shetty Cataract and Refractive Surgery Services,
Painful diminution of vision
The red eye. –Aim to distinguish acute emergency from less urgent Vision affected? Pain?Unilateral/bilateral? Distinguish conjunctival injection from.
Josephine-Liezl Cueto, M.D.* Kendall R. Dobbins, M.D.* Geisinger Medical Center, Department of Ophthalmology Danville, PA *No financial interest.
Phacoemulsification in eyes with previous anterior chamber phakic IOL surgery Walton Nosé, MD, PhD 1,2 Adriana dos Santos Forseto, MD 1 Mariana Ávila,
1 Cytotoxicity of topical medications after cataract surgery for human corneal endothelial/epithelial cells, and conjunctival epithelial cells 1) Masahiko.
Adult Medical-Surgical Nursing Neurology Module: Glaucoma.
Management of Aniridic Keratopathy with Allograft Limbal Stem Cell Transplantation Followed by Phacoemulsification Surgery Sibel Aksoy, MD, Yonca A. Akova,
Acute and Chronic visual loss By Dr. ABDULMAJID ALSHEHAH Ophthalmology consultant Anterior Segment and Uveitis consultant.
Descemet Stripping Automated Endothelial Keratoplasty in patients with Toxic anterior segment syndrome induced endothelial failure First and Presenting.
AlphaCor TM : A Novel Approach to Minimize Late Post-operative Complications V. Ngakeng MD, M. Price PhD. MBA, F. Price MD.
Scheimpflug imaging in a case of Aqueous Misdirection Syndrome Michael R. Gagnon, M.D. Valley EyeCare Center Clinical Instructor Stanford University School.
Dr. Thiruvengada Krishnan , M.D. , Aravind Eye Hospital
Mohamed Abdelzaher M.Sc. FOURTH YEAR BRAIN STORMING.
Combined cataract surgery and endoscopic cyclophotocoagulation in patients with glaucoma without prior incisional glaucoma surgery Matthew P. Traynor,
Nursing care of patient with eye disorders
Modern Cataract Surgery Professor Ejaz Ansari, FRCOphth MD.
Siderosis Bulbi Zamzam Al-baker,MD Consultant Opthalmology
Abdulrahman Al-Muammar, MD, FRCSC
After Cataract Surgery…
No author has any financial or proprietary interest in any materials or methods mentioned Seung Hyun Kim M.D. ; Tae Hoon Oh M.D. Department of Ophthalmology.
Posner-Schlossman Syndrome Bianka Sobolewska, MD Manfred Zierhut, MD Centre of Ophthalmology University of Tuebingen, Germany.
CASE III NEOVASCULAR GLAUCOMA. Patient History 68 year old white female. Ocular History: CRAO, Medical history: Diabetes Renal Problems.
Lens induced Uveitis Dr. Rathinam Sivakumar HOD - Uveitis Services Dr. Radhika. T Consultant, Uveitis Service Dr. Vedhanayaki Rajesh Dr. Vedhanayaki Rajesh.
Uveitis-Glaucoma-Hyphema Syndrome Constanze Kortuem, Daniela Suesskind, Manfred Zierhut Centre for Ophthalmology University of Tuebingen, Germany.
ACUTE RETINAL NECROSIS
Tubulointerstitial Nephritis and Uveitis (TINU) Syndrome Sana Khochtali Imen Ksiaa Anis Mahmoud Bechir Jelliti Department of Ophthalmology Fattouma Bourguiba.
Posterior Scleritis associated with Orbital Pseudotumor Nikolas London, MD Retina Consultants San Diego.
Rubella-virus associated uveitis
A CASE OF INFECTIOUS AND AUTOIMMUNE DISEASE COEXISTENCE Elisabetta Miserocchi MD Department of Ophthalmology and Visual Sciences University Hospital San.
Yonca Aydin Akova MD, Leyla Erkanli Asena MD
Department of Cornea, Cataract & Refractive Surgery and *Ocular Microbiology Dr Rajendra Prasad Centre For Ophthalmic Sciences, AIIMS Dr. Manoj Sharma,
Chronic Endophthalmitis
Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,
The effects of Nd:YAG (neodymium: yttrium-aluminum-garnet) laser peripheral iridotomy (PI) on contra-lateral eye anterior chamber parameters of patients.
Andrés Suárez-Campo, María López-Valladares
SECONDARY GLAUCOMAS Dr. Shinisha Paul.
B. Kozomara, E. Potkonjak, R. Lazic, N. Gabric
Authors have no any financial interest in the subject matter
TOXIC ANTERIOR SEGMENT SYNDROME(TASS)
World Cornea Congress VI April 7-9, 2010
Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,
Overview of Common Eye Conditions
PRIMARY ANGLE-CLOSURE GLAUCOMA
Prospective Study Comparing Outcomes of Torsional versus Traditional Phacoemulsification Systems on Dense Cataracts Bonnie An Henderson MD, Kelly J Grimes.
"Visual outcomes with traumatic cataract surgery in mexican children"
In The Name of God.
Wylegala Edward, Nowinska Anna
The authors have no financial interest
Consultant, Uveitis Service
Continuous vs Pulsed Oscillatory Ultrasound in cataract phacoemulsification The authors have not financial interest in the subject matter of this poster.
Eye Clinic Day Hospital - SÃO Paulo - Brazil
Presentation transcript:

Relationship Between Postphaco TASS and U/S Tip and Sleeve Lumen Soaked in Ortho-Phthalaldehyde Guadalupe Cervantes-Coste MD Victoria Mercado-Banegas MD Authors have no financial interest Asociación Para Evitar la Ceguera en México, Hospital “Dr. Luis Sánchez- Bulnes”

Toxic Anterior Segment Syndrome Sterile post-op inflammatory reaction caused non-infectious substance TOXIC damage to intraocular tissues ACUTE… …after anterior segment Surgery 12- 48 hours post-op

Etiologies: Clinical Findings: Ocular medications Antiseptics Preservatives Sterilizing agents Cleaning agents Talc IOLs Viscosurgical devices Endotoxins Clinical Findings: Descemet´s membrane folds Anterior segment inflammation Diffuse, limbus-to-limbus, corneal edema Widespread endothelial damage Fibrin deposits Irregular and unreactive pupil Ocular hypertension & trabecular damage

Clinical Case: Phaco tip and sleeve cleaned Uneventful phacoemulsification cataract surgery + acrylic IOL Infinity Alcon, 2.8 mm incision , continuous OZil CDE: 9 trans-op medication: Intracameral vacomycin Phaco tip and sleeve cleaned Ortho-Phthalaldehyde 2% solution

TASS Medical History: Anterior segment: DM II treated with insulin 48 yr woman with metabolic cataracts OU DM II treated with insulin BCVA: OU: Count fingers 2 m Anterior segment: OU: Cataracts : N+++ posterior sub capsular opacity + (LOCS III) IOL calculation (immersion ultrasound) SRK-T formula power: +24.00 D

Treatment: 1st day post-phaco: moderate ocular pain conjunctival injection limbus-to-limbus corneal edema +++ , irregular endothelium cells +++ fibrin bands in 4 quadrants mydriatic and a-reflective pupil IOP 10 mmHg Treatment: Transeptal , topical and oral steroids Topical antibiotic

Adding treatment: Ultrasound: normal Pain decreased, blurring 3er day post-phaco: Ultrasound: normal Pain decreased, blurring Anterior segment: no changes Adding treatment: Hypotensors , NaCl 0.5% & vitamin C 13 days post-phaco: No pain but blurring Corneal edema in 3 quadrants Fibrin bands at 360° Cells +++ Iridocorneal synechiaes

Same treatment Decreased pain BCVA: 1/10 Corneal edema in 3 quadrants 20 days post-phaco: Decreased pain BCVA: 1/10 Corneal edema in 3 quadrants Cells ++ Fibrin bands extending to irido-corneal angle IOP 18 mmHg Same treatment

Anterior capsulotomy (YAG) 22 days post-phaco: intense ocular pain, headache and blurring conjunctival injection epithelial corneal edema cells ++ IOP: 38 mmHg 360° angle closure Unresponsive to treatment Charbonic anhidrase inhibitors Beta- blocker Adrenergic agonist

Amhed Valve implant clear cornea, Valve tube in-situ 1st day post-Valve: clear cornea, Valve tube in-situ AC: cells ++ IOP: 4 mmHg optic nerve cup: 7/10 Treatment: Topical steroids & antibiotics Lubricants 8–15 days post-Valve: vision “subjectively” improved clear cornea IOP 7 -12 mmHg fibrin membrane without changes

“Corneal decompensation” 22 days post-Valve: intense pain and blurring ciliary injection ++ epithelial corneal edema AC: cells++ IOP: 38 mmHg 360° angle closure Unresponsive to treatment: 1 month post-Valve: “blurring” , VA: CF 10 cm diffuse corneal edema in 4 quadrants IOP 14 mmHg Final diagnosis: “Corneal decompensation”

Differential Diagnosis signs of infectious absent ultrasound NO disturbance of vitreous NO response topical prednisolone and non-steroidal final Visual Acuity NO improvement during follow-up irregular pupil NOT reactive to light or medication Conclusions colorless liquid & best disinfectant cold sterilization enzymes of detergents deactivated to 140° C or most autoclaves reach 120 to 130° C small lumen instruments… … possibly reservoirs sterilizing solution residue TASS from sterilizing solutions residue PREVENTABLE Glutaraldehyde