Nontraumatic intracranial aneurysms have a 2-5% incidence in the population and most are asymptomatic. However, even though the risk of rupture is low, it has a high mortality and morbidity. We report an extremely rare case of concurrently rupture of bilateral nontraumatic carotid-ophthalmic aneurysm complicated with acute bilateral subdural hematoma in a postpartum woman. The imagistic examinations showed two saccular bilateral aneurysm located at the carotid-ophthalmic junction, bilateral basal frontotemporal subdural hematoma, a right frontotemporal intraparenchimatous hematoma and massive cerebral edema. Additionally, the autopsy revealed the location of rupture of both aneurysms, and the presence of recent bilateral thrombi in the lumen of the cervical segment of the internal carotid arteries (as a result of the mechanical occlusion of these arteries due to the massive cerebral edema). In the absence of any medical and antenatal checkups records of the patient, we concluded that in the pathogenesis of the development and rupture of these aneurysms could contributed the following factors: hemodynamic, blood, and arterial wall changes during pregnancy and puerperium, infection, presence of intraluminal aneurysm thrombus. We have suggested the possible pathogenic mechanism for the bilateral subdural hematoma based on the hypothesis of the aneurysm sentinel bleeding, sustained by the patient's symptomatology.
We describe a surgical technique for secondary stabilization of a bag-in-the-lens intraocular lens (BIL IOL) using 2 modified bean-shaped ring segments in cases of zonular dehiscence associated with pseudophakodonesis. The first modified bean segment is anchored in the sulcus with a suture to the sclera in the area of maximum zonular dehiscence, and the second segment is implanted in the opposite sulcus area. Both segments are placed in the BIL IOL interhaptic groove. The segments stabilize and center the BIL IOL by creating an artificial zonule that provides the necessary extra support for the IOL.
The fixation of the second eyelet allows a controlled insertion of the standard CTRs, which facilitates the intraocular implantation technique, reduces surgical complications associated with the blind maneuvering of the free end of the ring inserted by traditional methods, and has a less disruptive action on the integrity of the remaining undamaged zonular fibers in the lax zonules. The accessory attached to the typical injector tube reduces the risk of surgical incidents caused by the uncontrolled progression of the ring's free end inside the capsular bag.
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