PurposeIn modern medicine forceps‐induced birth trauma to the eye is a rare clinical event. Forceps injury to the cornea occurs during complicated forceps delivery. The break in Descemet's membrane is the most common complication.MethodsInterventional case report showing the rupture of Descemet's membrane due to a complicated forceps delivery.ResultsA 2 days‐old boy was referred for severe and diffuse corneal edema. Medical history was significant for forceps delivery. On examination, he was found to have a rupture of the Descemet's membrane. Conservative treatment and application of hypersomolar solution was decided. Corneal edema was resolved in three months. Actually the cornea remained clear but persists a residual corneal astigmatism of 6D.ConclusionsThe application of the forceps can cause accidental rupture of the cornea at the level of the Descemet's membrane. The edema resolves spontaneously within a few weeks or months eventually leaving the visible edges of the break and a clear cornea. Rupture of Descemet's membrane is not presented as an Ophtalmologic urgency but it′s crucial to follow these patients because failure to intervene leads to amblyopia or ‘lazy eye’.
PurposeOcular damage after electric injury is a rare complication. The most commonly described damages are cataract, papillitis, and more rarely vascular complications. Optic nerve and retina have a low resistance, what can lead easily to their damage, affected by ischemia resulting from coagulation and necrosis from vascular structures.MethodsWe report two cases of middle aged, otherwise healthy men, who suffered an episode of retinal vein occlusion, both occurring following a low‐voltage shock. Both patients came to the Emergency department complaining a decreased visual acuity without any systemic damage due to the electric injury.ResultsBoth patients were diagnosed of a retinal vein occlusion and underwent intravitreal therapy with corticosteroids and antiangiogenic drugs. They were followed for 4 and 5 years and kept a visual acuity of 0.2 and 0.8, respectively.ConclusionsOphthalmologists should be aware of an infrequent complication such as retinal vein occlusion when receiving a patient who has suffered an electric injury.
PurposeOrbital cellulitis and preseptal cellulitis are the major infections of the ocular adnexal and orbital tissues. Orbital cellulitis is an infection of the soft tissues of the orbit, posterior to the orbital septum.The purpose of this text is to point out sickle‐cell disease as an important risk factor in a 2‐year‐old boy with sinusitis.MethodsWe evaluated a 2‐year‐old boy with sickle‐cell disease and sinusitis treated with oral amoxicillin (80 mg/kg/day). He presented a remarkable proptosis, intense ophthalmoplegia and conjunctival chemosis, with a temperature of 39°C and leukocytosis with left shift. We treated him with clindamycin 30 mg/kg, cefotaxime 200 mg/kg and prednisolone IV.ResultsAxial image CT scan demonstrated sinusitis of the left ethmoid sinus. Furthermore, there was a left sided subperiosteal abscess between the medial wall of the left orbit and the left medial rectus muscle. Due to the bad evolution and the CT scan image, the sinus was drainage in a surgical procedure under general anesthesia. Appropriate patient evolution was achieved without the need for additional therapy.ConclusionsPatients with sickle‐cell anemia show anincreased risk of severe bacterial infections due to loss of functioning spleen tissue. Daily penicillin prophylaxis is the most commonly used treatment during childhood. Orbital cellulitis can result in orbital and intracranial complications. Blindness may occur secondary to elevated intraorbital pressure. This is the reason we must control the patient at least daily and evaluate the antibiogram. Finally, when medical treatment is not working and there is an elevated intraorbital pressure with involvement of the eyeball, the surgery cannot be postponed.
Purpose To describe a case report of a 35 years old metal worker with a corneal ulcer in his right eye treated with an antibiotics ointment by a primary care doctor that presented blurry vision two days later. Methods Examination of the anterior chamber by slit lamp, tonometry was used to determine intraocular pressure, funduscopy, Swept‐Source OCT and CT scan were performed. Results The patient right eye presented intense epibulbar and tarsal hyperemia, and it had a 1x1 mm corneal ulcer, positive in the fluorescent test, and an iridium hole below. Tyndall 2+ and IOP of 18 mmHg. No cataract was detected. Funduscopy examination showed a moderate amount of vitreous hemorrhage. A CT scan, retinography and a Swept‐Source OCT were performed and they revealed an intraocular foreign body located in the optic nerve area. The foreign body was removed via pars plana vitrectomy 23G surgery, requiring a magnet a demarcating laser. After four months the patient has a 20/20 visual acuity with no cataract. Conclusions This case underlines that although CT scan is considered the “gold standard” for the detection, localization and characterization of intraocular foreign bodies, new image techniques as Swept‐Source OCT can be a non invasive and accurate search tool in cases of intraocular foreign body.
PurposeOzurdex® implant is a 700 micrograms implant of Dexamethasone approved for the treatment of macular edema secondary to diabetic retinopathy or retinal vein occlusion. The purpose is to describe the uncommon Ozurdex® injection into the crystalline lens and its management.MethodsWe present the case of a woman diagnosed with cystoid macular edema who underwent intravitreal Ozurdex® injection. During the procedure the implant was accidentally injected into the lens body. We also discuss about the surgical management of this complication.ResultsThe patient was scheduled for phacoemulsification surgery of the lens with implantation of a 3‐piece lens into the sulcus because a tear in the posterior capsule was identified during the surgery.ConclusionsFew problems involving the anterior segment in Ozurdex® implants have been described. However, the injection of the dispositive into the crystalline lens is a rare complication we must take into account. Cataract surgery should be performed as soon as possible and we must keep in mind the posible damage of the structures such as posterior capsule or lens zonules. We recommend the management of these cases with a 3‐pieces IOL into the sulcus.
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