Bilateral Isolated Spherophakia with Lens Subluxation, High Myopia and Secondary Angle Closure: A Case Report

2018 ◽  
Author(s):  
Ye Zhang ◽  
Ravi Thomas ◽  
Cong Wang ◽  
Xiangyu Shi
Keyword(s):  
Anterior Chamber ◽  
High Myopia ◽  
Rare Condition ◽  
Spherical Shape ◽  
Angle Closure ◽  
Lens Subluxation ◽  
Pars Plana Lensectomy ◽  
Shallow Anterior Chamber ◽  
One Year ◽  
The Right

Abstract Background: Spherophakia is a rare condition and compared to its occurrence with familial and systemic disorders, isolated spherophakia is even more uncommon. This rare case of isolated spherophakia will raise the alertness of physicians when dealing with a high myopia patient with shallow anterior chamber and relatively normal fundus. Case presentation: We report a case of a 17-year-old male who experienced painless decrease of vision in both eyes (OU) for 11 years, with progression of visual impairment and occasional ocular pain for one year. Examination revealed high myopia, increased intraocular pressures (IOP, 28 mmHg in the right eye (OD) and 33 mmHg in the left (OS)), shallow central anterior chambers, lenses of a spherical shape with superior subluxation, occludable angles without peripheral anterior synechiae, and healthy optic discs OU. A diagnosis of bilateral isolated spherophakia, lens subluxation, high myopia and secondary angle closure (AC) was made. Pars plana lensectomy with anterior vitrectomy and scleral suturing of an intraocular lens was performed. On postoperative follow-up at 19 days OD and 63 days OS, the visual acuity was 6/6 and the IOP was normal without any medication OU. Conclusions: A presentation with high myopia, shallow anterior chamber with a normal retina should alert the clinician to the possibility of spherophakia, as compared to high myopia caused by elongated axial length. Surgery should be considered in cases of spherophakia with AC where the IOP cannot be controlled by noninvasive means.

scholarly journals Ex-PRESS shunt implantation for intractable glaucoma with posterior chamber phakic intraocular lens: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rongrong Hu ◽  
Wei Xu ◽  
Baishuang Huang ◽  
Xiaoyu Wang
Keyword(s):  
Anterior Chamber ◽  
Intraocular Lens ◽  
High Myopia ◽  
Posterior Chamber ◽  
Filtration Surgery ◽  
Phakic Intraocular Lens ◽  
Glaucoma Filtration Surgery ◽  
Shallow Anterior Chamber ◽  
The Right ◽  
Intractable Glaucoma

Abstract Background Implantation of the posterior chamber phakic intraocular lens has been widely performed to correct high and extreme myopia. Chronic intraocular pressure (IOP) elevation may occur in its late postoperative period. For medically uncontrolled cases, surgical treatment is necessary, and benefits should be weighed against risks when determining whether to remove the lens. Case presentation A 32-year-old man with extremely high myopia presented with progressive blurred vision and medically uncontrolled IOP in the right eye. His past ocular history was significant for bilateral implantable collamer lens (ICL) implantation ten years ago. On ophthalmic examination, the ICL was well placed with a vault height of 456 µm in the right eye. The anterior chamber angles were open but narrow, and mild to moderate trabecular pigmentation was noted. Ex-PRESS glaucoma filtration surgery without ICL removal was performed to control IOP. During surgery, an Ex-PRESS P50 shunt was inserted into the anterior chamber via the front edge of the blue-grey transition zone between the sclera and cornea. Transient hypotony and shallow anterior chamber occurred in the first week after surgery, along with an ICL tilt towards the cornea with reduced vault height. No other complications related to either the ICL or the Ex-PRESS shunt were noted. IOP remained stable at 12 ~ 14 mmHg at the first 3-month follow-up. Conclusions Ex-PRESS glaucoma filtration surgery might be a safe and effective alternative treatment for intractable glaucoma with high myopia and ICL implantation. Careful assessment of the ICL position and anterior chamber angle is necessary to plan the appropriate surgical procedure. A postoperative shallow anterior chamber may result in ICL dislocation.

scholarly journals Clinical and morphological study of calf enlargement following S-1 radiculopathy

1992 ◽  
Vol 50 (3) ◽  
pp. 383-386 ◽  
Author(s):  
Osvaldo J. M. Nascimento ◽  
Marcos R. G. de Freitas ◽  
Myrian D. Hahn ◽  
Abelardo Q. C. Araújo
Keyword(s):  
Gastrocnemius Muscle ◽  
Rare Condition ◽  
Satisfactory Explanation ◽  
Lower Back ◽  
Left Buttock ◽  
Left Calf ◽  
One Year ◽  
The Right ◽  
Gastrocnemius Muscles

Calf enlargement following sciatica is a rare condition. It is reported the case of a 28-year-old woman who complained of repeated episodes of lower back pain radiating into the left buttock and foot. One year after the beginning of her symptoms, she noticed enlargement of her left calf. X-ray studies disclosed L5-S1 disk degeneration. EMG showed muscle denervation with normal motor conduction velocity. Open biopsies of the gastrocnemius muscles were performed. The left gastrocnemius muscle showed hypertrophic type 2 fibers in comparison with the right gastrocnemius. Electron microscopy showed mildly increased number of mitochondria in these fibers. A satisfactory explanation for denervation hypertrophy has yet to be provided.

Anterior Segment OCT in Primary Angle Closure Compared to Normal Subjects with Similar Shallow Anterior Chamber

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Qinghong Xie ◽  
Ping Ma ◽  
Jutima Patlidanon ◽  
Murtaza Saifee ◽  
Sean Yonamine ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Anterior Segment ◽  
Normal Subjects ◽  
Angle Closure ◽  
Anterior Segment Oct ◽  
Primary Angle Closure ◽  
Shallow Anterior Chamber

scholarly journals P189 Duplication of the tricuspid valve (DOTV): case report of a rare congenital anomaly

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Moscatelli ◽  
G Trocchio ◽  
N Stagnaro ◽  
A Siboldi ◽  
M Derchi ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Atrial Flutter ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Right Atrium ◽  
Rare Condition ◽  
Systolic Pulmonary Artery Pressure ◽  
Severe Tricuspid Regurgitation ◽  
One Year ◽  
The Right

Abstract Introduction Tricuspid valve duplication is an extremely rare condition and in most of the cases it is associated with other congenital cardiac malformations. Because of its rarity, the clinical presentation and the management are not defined yet. Clinical Case We report the case of an 18 y/o caucasian male, who was admitted to our Hospital in February 2018 for rapid atrial flutter not responsive to medical therapy (propanolol and digossin). He had a pre-natal diagnose of ventricular septum defect (VSD) and tricuspid straddling. At 1 year of age he underwent pulmonary artery bandage and one year later VSD closure was performed. Blood test showed sub-clinic hypothyroidism, probably related to previous amiodaron therapy. A transthoracic echocardiogram was obtained. The right atrium (RA) was severely dilated and the atrial septum dislocated towards left ventricle (LV); two right atrioventricular valves (tricuspid valves) were detected: the ‘true’ tricuspid opening was inside the right ventricle, and an ‘accessory‘ opening was located inside the LV and severely regurgitant into the RA; the mitral valve was morphologically and functionally normal; both ventricles were dilated with preserved systolic function; systolic pulmonary artery pressure was not detectable. A Cardiac Magnetic Resonance clearly delineated the anomaly. Atrial flutter radio frequency transcatheter ablation was succesfully performed before corrective surgery. The regurgitant accessory tricuspid orifice was closed with an heterologous pericardial patch and a right reduction atrioplasty was also done. The post-operative course was uneventful and only a mild paraseptal tricuspid jet with LV to RA shunt was present at post op echocardiography. After one year follow-up the patient remained asymptomatic, without arrhythmia recurrence. Conclusion DOTV is an extremely rare condition that could be responsible of severe tricuspid regurgitation. At the moment, there are not sufficient data to establish the correct timing for surgical intervention. In our case, the presence of severe tricuspid regurgitation, right atrium dilatation, biventricular overload and atrial flutter guided the clinical management and suggested surgical correction. Abstract P189 Figure.

Gonioscopy and Ultrasound Biomicroscopy in the Detection of Angle Closure in Patients with Shallow Anterior Chamber

2014 ◽  
Vol 29 (4) ◽  
pp. 204-207 ◽  
Author(s):  
Shan-shan Cui ◽  
Yan-hong Zou ◽  
Qian Li ◽  
Li-na Li ◽  
Ning Zhang ◽  
...  
Keyword(s):  
Anterior Chamber ◽  
Ultrasound Biomicroscopy ◽  
Angle Closure ◽  
Shallow Anterior Chamber

Persistent cough associated with osteophyte formation and vagus nerve impingement following cervical spinal surgery

2013 ◽  
Vol 19 (2) ◽  
pp. 167-169 ◽  
Author(s):  
Kadir Serkan Orhan ◽  
Şenol Acar ◽  
Murat Ulusan ◽  
Aydın Aydoseli ◽  
Yahya Güldiken
Keyword(s):  
Vagus Nerve ◽  
Spinal Surgery ◽  
Rare Condition ◽  
Cervical Collar ◽  
Pharyngeal Plexus ◽  
Persistent Cough ◽  
Fascia Lata Graft ◽  
Prevertebral Fascia ◽  
One Year ◽  
The Right

Persistent cough due to irritation of the vagus nerve by osteophytes resulting from cervical spinal surgery is a very rare condition. The authors report the case of a 49-year-old woman who presented with a persistent cough subsequent to cervical spinal surgery. One year after the initial operation, the patient underwent surgery to free the larynx from the prevertebral fascia and cut the pharyngeal plexus, but her symptoms persisted. In order to control the cough, she used a soft cervical collar with padding inserted in the left side so that the larynx would be pushed to the right, a solution she discovered on her own. Without the collar, she coughed uncontrollably. A CT scan was performed and showed an osteophyte that had developed at the level of the prosthesis. Based on these findings, the authors hypothesized that the cough was caused by vagus nerve irritation due to the osteophyte. The osteophyte was resected and the vagus nerve was moved to a position anterior to the carotid artery and was isolated by means of an autogenous tensor fascia lata graft. The patient's symptom disappeared immediately after the surgery. At the most recent follow-up visit, 18 months after surgery, the patient was symptom free and was pursuing regular daily activities without using a cervical collar.

scholarly journals Clinical management of a rare Peters’ anomaly-induced secondary childhood glaucoma: A case report

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Eva Imelda ◽  
Fany Gunawan
Keyword(s):  
Anterior Chamber ◽  
Light Exposure ◽  
Anterior Segment ◽  
Corneal Edema ◽  
Timolol Maleate ◽  
Post Surgery ◽  
Peters Anomaly ◽  
Shallow Anterior Chamber ◽  
Nasal Region ◽  
The Right

Childhood glaucoma is a rare disorder that occurs from birth until teenage years caused by an abnormality of aqueous humor pathways. About 50–70% of Peters' anomaly is accompanied by secondary childhood glaucoma. The presence of glaucoma will affect the prognosis. We reported the evaluation and treatment of secondary childhood glaucoma due to Peters’ anomaly. A 5 months-old boy was presented with the complaint of a enlarged left eye since 3 months old. The complaint was accompanied by a watering eye and frequently closed upon light exposure. The left eye looked opaquer than contralateral. Examination under anesthesia showed that the intraocular pressure (IOP) was 35 mmHg in the left eye and the corneal diameter was 14 mm. Other findings were keratopathy, diffuse corneal edema, buphthalmos, shallow anterior chamber, anterior synechiae, and linear slit shaped pupils in the nasal region. Patient was treated with ophthalmic timolol maleate which was later followed by trabeculectomy. After 1 week post-surgery, IOP assessment by palpation suggested the right eye within normal range while the IOP of left eye was higger than normal. Blepharospasm, epiphora, photophobia, bleb on superior, subconjunctiva bleeding, buphthalmos, keratopathy, minimal corneal edema, anterior chamber with shallow image, and posterior synechia were found in left eye anterior segment. In conclusion, trabeculotomy and trabeculectomy are recommended if there is no reduction of IOP observed after receiving timolol maleate therapy. The choice of surgical management is dependent on the feasibility of the protocol.

scholarly journals Visual outcomes of Visian ICL implantation for high myopia in patients with shallow anterior chamber depth

2019 ◽  
Author(s):  
Lingling Niu ◽  
Huamao Miao ◽  
Tian Han ◽  
Lan Ding ◽  
Xiaoying Wang ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Observational Study ◽  
Anterior Chamber ◽  
High Myopia ◽  
Anterior Chamber Depth ◽  
Distance Visual Acuity ◽  
Visual Outcomes ◽  
Icl V4c ◽  
Shallow Anterior Chamber

Abstract Background: High myopia with shallow anterior chamber depth (ACD less than 2.8 mm) is not rare. This observational study aims to evaluate visual outcomes after implantation of the Visian Implantable Collamer Lens with a central hole (ICL V4c) in these patients. Methods: A prospective cohort of consecutive 51 eyes of 31 patients (20 to 42 years old) was followed for at least 12 months (average 15.35 ± 4.90 months, rangers from 12 to 25 months). The preoperative ACD was 2.74 ± 0.04 mm (2.65 to 2.79 mm). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure (IOP), manifest refraction, vault, and endothelial cell density (ECD) were measured during the follow-ups after surgery. Results: All surgeries were performed safely and no complication was observed during the follow-up. At the last follow-up, the safety index (postoperative CDVA / preoperative CDVA) was 1.33 ± 0.60 and the efficacy index (postoperative UDVA / preoperative CDVA) was 1.14 ± 0.54. After the surgery, no eye had decreased CDVA and 59% (30 eyes) of the eyes gained at least one line. Forty-seven eyes (92%) were within ± 1.0 D and 35 eyes (69%) were within ± 0.5 D of the attempted refraction. The mean postoperative vault was 380.00 ± 152.84 µm (90 to 700µm). The ECD was reduced by 8.38 ± 0.06% as compared to the preoperative value (p < 0.001). No significant change was observed in IOP (p = 0.061) at the last follow-up. Ultrasound Biomicroscopy (UBM) showed none of the eyes had trabecular-iris angle closed. Conclusions: In this prospective observational study, ICL V4c implantation in patients with high myopia and shallow ACD achieved satisfying and stable visual outcomes. Its long-term safety and stability require further investigation. Trial Registration: This trial was retrospectively registered on 05/08/2018 under the number (ChiCTR1800017594)

scholarly journals Repeatability and reproducibility of axial length, anterior chamber depth and crystalline lens thickness measurements using the Nidek US-500 Echoscan

2015 ◽  
Vol 74 (1) ◽  
Author(s):  
Khathutshelo P. Mashige
Keyword(s):  
Anterior Chamber ◽  
Axial Length ◽  
Repeated Measures ◽  
Anterior Chamber Depth ◽  
Correlation Coefficients ◽  
Crystalline Lens ◽  
Angle Closure ◽  
Lens Thickness ◽  
Primary Angle Closure Glaucoma ◽  
The Right

Aim: The reliability of an instrument used to collect data for clinical and research purposes is greatly important, especially when it is used to determine changes in measured ocular parameters over time. The purpose of this study was to determine the intra-session repeatability and inter-session reproducibility of axial length (AL), anterior chamber depth (ACD) and crystalline lens thickness (LT) measurements using the Nidek US-500 Echoscan.Method: Fifty successive automatic measurements of the above parameters were taken on the right eyes only of 12 healthy subjects aged 23–44 years old, followed by similar repeated measures after 1 week. Sample standard deviations (s.d.), precision (P) and coefficient of repeatability (COR) were calculated to determine intra-session repeatability. Coefficient of reproducibility (CRP), Bland and Altman plots, concordance correlation coefficients (CCC) and paired t-tests that compared measurements obtained in the first and second sessions, were used to determine inter-session reproducibility.Results: Both the intra-session repeatability and inter-session reproducibility were within acceptable limits for the three variables assessed.Conclusion: The study showed that the Nidek US-500 Echoscan provides accurate, repeatable and reproducible measurements of AL, ACD and LT in healthy eyes. This finding will be of interest to optometrists and ophthalmologists who measure these parameters when diagnosing, managing and investigating conditions such as primary angle-closure glaucoma and keratoconus.

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