Purpose
To report on the management of an unusual case of post-goniotomy hypotony.
Observation
A 41-year-old female with pigmentary glaucoma presented with a post-goniotomy cyclodialysis cleft and signs of hypotony maculopathy. Indirect cyclopexy closed the visible cleft but did not resolve her hypotony, despite neither ultrasonographic nor gonioscopic evidence of an open cleft or communication channel. Cryotherapy-induced cyclopexy and subsequent viscoelastic agent fill increased the intraocular pressure back to baseline.
Conclusions
This is the first reported case of cryotherapy correcting hypotony in a patient with no gonioscopic or ultrasonographic evidence of a cyclodialysis cleft. It demonstrates the utility of cryotherapy in the management of persistent ocular hypotony despite no detectable channel of aqueous outlet.
Introduction: Ophthalmology education during medical school is often very limited. To provide exposure to areas beyond its standard curriculum, the University of Pittsburgh School of Medicine offers mini-elective courses in various disciplines. We developed such a course to provide instruction in the basics of clinical ophthalmology to interested preclinical medical students. Methods: First-and second-year medical students electively enrolled in our course (mean number of students per year = 12), which included four sessions combining didactics and hands-on learning. Additionally, each student individually spent time with an ophthalmologist in the operating room. Our course was held each year from 2015 to 2019. Results: Participants completed pre-(n = 25) and postsurveys (n = 20), reflecting increased comfort with the ophthalmologic history and physical examination. In 2019, participants also completed pre-and posttests, demonstrating increased knowledge of ophthalmology. Discussion: The Ophthalmology Mini-Elective is a unique educational tool that introduces the principles of ophthalmology to preclinical medical students, addressing an area of medicine that is generally minimally included in the required curriculum.
Microphthalmia is defined by a globe axial length greater than or equal to 2 standard deviations below the age-adjusted mean and can occur as part of a broader syndrome. The presence of a colobomatous cyst with microphthalmia signifies failure of the embryonic neuroectodermal fissure to close appropriately during development of the globe, creating a protuberant globular appendage that inhibits normal growth and development of the eye itself. Cystic reaccumulation of fluid is common after aspiration or surgical removal. Here, the authors describe a case of a young boy with a colobomatous cyst who underwent eyelid-sparing orbital exenteration followed by reconstruction with absorbable gelatin sponge (Gelfoam, Pfizer, Inc.) and the chemotherapeutic agent bleomycin to promote scarring, achieving the equivalent of a biointegrated implant and facilitating satisfactory placement of an ocular prosthesis. A 2-year follow-up MRI revealed adequate volume in the posterior orbit.
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