Kendall R.B. Dobbins, MD Geisinger Medical Center

Slides:

Advertisements

Similar presentations

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

Advertisements

“Cataract formation after implantation of phakic posterior chamber intraocular lenses: A brief overview and review of the literature” Liliana Werner, MD,

DR ALI SALEHI TOXIC ANTERIOR SEGMENT SYNDROM (TASS)

Corneal melting after collagen cross-linking for keratoconus Journal of Medical Case Reports,2011 By Ibrahim almahuby Dr.Georgios Labiris.

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

Cataract Surgery Using Biaspheric IOLs in Patients With Corneal Irregularities James P. Gills, MD St. Luke’s Cataract & Laser Institute Tarpon Springs.

Dislocation of the DSEK Donor Graft into the Posterior Segment An Intraoperative Complication in DSEK Surgery Mark M Fernandez MD, Mark S Gorovoy MD, George.

Clinical evaluation of foldable acrylic phakic IOL (fP) implantation ASCRS, San Diego, 2011 A.John Kanellopoulos, MD Professor NYU Medical School, NY Director,

Anterior Chamber Depth, Iridocorneal Angle Width, and Intraocular Pressure Changes After Phacoemulsification: Narrow vs Open Iridocorneal Angles Huang.

Phaco-drainage Phacosection Amporn technique

Implantation of a single-piece acrylic intraocular lens using an anterior chamber maintainer Tomoyuki Kunishige, Hisaharu Suzuki, Toshihiko Shiwa, Hiroshi.

Intraocular lens dislocation secondary to haptic torsion Lawrence E. Lohman, MD FACS Matthew C. Willett, MD.

Pop and Pre-Chop A Safe Supracapsular Phacoemulsification Technique

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,

Josephine-Liezl Cueto, M.D.* Kendall R. Dobbins, M.D.* Geisinger Medical Center, Department of Ophthalmology Danville, PA *No financial interest.

Occlusion Controlled Phaco and Shallow Anterior Chamber Dr. Bekir Sıtkı Aslan TOBB ETU Hospital Ankara Turkey Financial Interest-Alcon Speakers Bureau.

1 Cytotoxicity of topical medications after cataract surgery for human corneal endothelial/epithelial cells, and conjunctival epithelial cells 1) Masahiko.

Purpose: Introduction:  At initial evaluation: For post-op day # 0 patients: Pre-op VA was 20/50.6 (0.395 ± 0.198); Post-op VA was 20/102.0 (0.196 ± 0.162);

Spending 40 cc in an entire Cataract Surgery. Comparative study. Arturo Pèrez-Arteaga M.D. Medical Director & Founder Centro Oftalmològico Tlalnepantla,

*Financial Interest: The authors have no financial interest in the subject matter of this poster. *Disclosure of Unapproved/Off-Label Use: The use of cholesterol.

Evaluation of Systane® versus Placebo in Corneal Epithelial Healing Following Photorefractive Keratectomy (PRK) Lt Col Charles D. Reilly Major Vasudha.

DSAEK Outcomes in Normal and Abnormal, High-Risk Eyes at an University Practice Hugo Y. Hsu and Sean L. Edelstein The authors have no financial interest.

PRESENCE OF FREE RADICALS IN INTRACAMERAL AGENTS COMMONLY USED DURING CATARACT SURGERY ELISABETH CA MACDONALD, DAVID LOCKINGTON, KANNA RAMAESH Authors.

Arslan Osman Sevki, Toker Mustafa Ilker, Yildirim Rengin, Ozdamar Akif, Sevim Okay, Gursoy Huseyin, Ozkok Ahmet Department of Ophthalmology Istanbul University.

EVALUATION OF ANTERIOR CHAMBER SULCUS SUPPORTED INTRAOCULAR LENS BY PROF. HAMED NASER EL- DIN TAHA HAED OF OPHTHALMOLOGY DEPT. SAUDI GERMAN HOSPITAL JEDDAH.

Riley Hall BSc α, Robert Mitchell MD, FRCSC β University of Saskatchewan α, University of Calgary β Authors have no financial interest Comparison of postoperative.

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.

Metallic Foreign Body Embedded in the Posterior Lens Capsule Helen R. Moreira, MD; Michele S. Todman, MD; Paul J. Botelho, MD Division of Ophthalmology,

Relocating corneal endothelial area by non-contact specular microscopy Tomoyuki Kunishige, M.D., Hisaharu Suzuki, M.D., Hideaki Oharazawa, M.D., Toshihiko.

Reproducibility of Optical Measurements in Pseudophakic eyes Using Double-Pass Measurement System St Thomas Hospital, London Anish Dhital, David Spalton,

The Effect of Corneal Anterior Surface Eccentricity on Astigmatism after Cataract Surgery Choul Yong Park MD 1 Sung Jun Lee MD 1 Prabjot Channa MD 2 Roy.

Combined cataract surgery and endoscopic cyclophotocoagulation in patients with glaucoma without prior incisional glaucoma surgery Matthew P. Traynor,

Urrets-Zavalia Syndrome After Lamellar Corneal Transplant: Two Case Reports Timothy Y. Chou, MD, Sujata P. Prabhu, MD, Justin Dexter, MD Department of.

SALK IN REFRACTIVE SURGERY INDUCED CORNEAL OPACITY- A VIABLE OPTION Anita Ganger, Radhika Tandon, Murgesan Vanathi Cornea & Ocular Surface Services, Dr.

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

Zonular Weakness in Patients with Primary Angle-Closure Glaucoma Yong Yeon Kim 1, Keny Kirti 2, Bokun Rho 1 Department of Ophthalmology, Korea University.

Visual and IOP Outcomes after PRK in Pigment Dispersion Syndrome [Poster Number: P190] Kraig S. Bower, Denise A. Sediq, Charles D. Coe, Keith Wroblewski,

Johns Hopkins Hospital

Ultrasound Biomicroscopy Diagnosis of Benign Iris Cysts in Patient Presenting for Implantation of Copolymer Phakic IOL Muhammad Aman-Ullah MD Howard V.

Corneal edema following Photorefractive Keratectomy (PRK) Gerald W Zaidman, MD, FAAO,FACS Professor of Ophthalmology Sarah E. Eccles Brown, BA Westchester.

DSEK for the treatment of endothelial disease in India -Initial Experience in 80 eyes- Authors have no financial interest Dr Ashish Nagpal MD, FRCS Dr.

Endoscopic Management of Displaced IOL Causing Recurrent Hyphema in Patient With Pseudoexfoliation J. M. Rouse, M. A. Khaimi Dean McGee Eye Institute,

Minimizing Risk in Visian ICL Implantation.

Corneal shape and corneal aberrations after MicroIncision Cataract Surgery (MICS) NOCHEZ Y, BUREL B, MAJZOUB S, PISELLA PJ C.H.U.

Liquifaction Method and Extent of Posterior Capsule Opacification: Two-Year Follow-up Marie Kalfertova, Mariya Burova, Pavel Rozsival, Nada Jiraskova Nada.

Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,

Pseudoexfoliation syndrom and cataract: results and complication frequency in immature and mature cataract surgery Marijana Bilen Babić Department of.

Comparison of Endothelial Cell Loss After Phacoemulsification Performed by Third Year Residents and Anterior Segment Surgeons Alexandra Braunstein, MD.

Jennifer H. Hung, MD Kristiana D. Neff, MD Department of Ophthalmology

Late In-the-bag Intraocular Lens Dislocation:

Authors have no any financial interest in the subject matter

TOXIC ANTERIOR SEGMENT SYNDROME(TASS)

Blood Reflux In Schlemm’s Canal Of Normal Cataract Patients: Simple Way To Identify The Trabecular Meshwork With Healthy Collector Channel Masahiro Maeda1,

Nienke Visser, Tos T.J.M. Berendschot, Rudy M.M.A. Nuijts

Prospective Study Comparing Outcomes of Torsional versus Traditional Phacoemulsification Systems on Dense Cataracts Bonnie An Henderson MD, Kelly J Grimes.

In The Name of God.

Effects of the “Pop & Prechop” Supracapsular Phacoemulsification Technique on Endothelial Cell Counts and Corneal Clarity Brandon Rodriguez, MD Michael.

Corneal Endothelial and Anterior Lenticular Deposits Due to Clozapine

Three-Year Follow-up after LASIK in Eye with Extremely Thin Corneal Bed Hidemasa Torii, MD, Kazuno Negishi, MD, Murat Dogru, MD, Takefumi Yamaguchi, MD,

The authors have no financial interest

Michael R. Banitt, MD, João Baptista Malta, MD, Roni M

Roxana Ursea, MD Matthew T. Feng, MD Ovette Villavicencio, PhD

Nathalie M. Guibord,MD Geisinger Medical Center

DARIUSZ DOBROWOLSKI¹, EDWARD WYLĘGAŁA¹ ², DOROTA TARNAWSKA¹

Early Experience With Anterior Chamber Phakic IOL

Long term PCO preventive effect of capsular bending ring

Five-Year Experience With Routine Use of Healon5 in Cataract Surgery

The Effect of Corneal Thickness on Ocular Drug Penetration

Presentation transcript:

Kendall R.B. Dobbins, MD Geisinger Medical Center Severe Iris Pigment Epithelium Desquamation After Routine Cataract Surgery Kendall R.B. Dobbins, MD Geisinger Medical Center Author has no financial interest

Purpose: To present a unique case of severe iris pigment epithelial desquamation following routine cataract surgery and to investigate whether the case could be an unusual variant of toxic anterior segment syndrome (TASS).

Methods: A 66 year-old woman with no pre-operative history of pigment dispersion syndrome underwent routine clear-corneal cataract surgery OS. Below is an image of the iris OD to provide a sense of the pre-op status of the iris OS.

Methods At the one-day post-operative visit, there were 4+ diffuse iris trans-illumination defects, 4+ iris pigment cells suspended in the anterior chamber, a significant amount of pigment cells coating the corneal endothelium and iris stroma, and pigment dispersion-related ocular hypertension with an IOP of 31 OS (see images).

Methods The intraocular lens remained well-positioned within the capsular bag (see images), ruling out a mechanical cause for the severe pigment dispersion. An investigation was undertaken to try to determine the etiology of the event and to clarify whether or not the case could be a variant of Toxic Anterior Segment Syndrome (TASS).

Results There was nothing unusual about the substances used in the eye or on the surface of the eye Substances in the eye: 500cc BSS with 0.5cc Epi 1:1000 (Alcon) Amvisc Plus (B+L) Substances on the surface the eye: BSS 15cc (Alcon) Povidone Iodine 5%--diluted from 10% solution by hospital pharmacy under sterile conditions (Aplicare) Prednisolone acetate, Gatifloxacin, and Timolol GFS drops immediately post-operatively

Results However, further investigation of the cleaning and sterilization processes at our ASC revealed that enzymatic detergent had been used when cleaning instruments in the ultrasonic cleaner and tap water had been used to flush the hand-pieces, both of which were considered potential sources of endotoxin.

Results Literature Search Brouzas et al. Severe toxic effect of methylene blue 1% on iris epithelium and corneal endothelium. Cornea 2006 May;25(4):470-1. Monson, Mamalis, Olson. Toxic anterior segment inflammation following cataract surgery. JCRS 1992 Mar;18(2)184-9. 3 cases with widespread corneal edema, fixed pupil, and significant iris atrophy. No reports of isolated acute pigment dispersion S/P routine Phaco with IOL (without corneal edema).

Results Discussions with the head of the U.S. TASS task force deemed that this case was unlikely to be TASS since the corneal endothelium remained essentially intact while the iris pigment epithelium was so severely affected. In the two years following this case, there have been no further repeat cases in our department.

Conclusion There are no reports of isolated acute diffuse non-mechanical pigment dispersion without associated corneal edema after routine cataract surgery, making this case very unique. While the etiology of this event remains unknown, this case demonstrates how a thorough evaluation of the sterilization process of cataract surgical instruments should be performed at all surgery centers.

Conclusion Changes in sterilization in our ASC: Instruments placed in ultrasonic cleaner without enzymatic detergent (thought to be a possible source of endotoxin). Handpieces are flushed with sterile distilled water instead of tap water. Instruments put through washer/disinfector machine daily.