MAY 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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14 EW NEWS & OPINION May 2013 Bungee continued from page 13 edema with an increase in his pachymetry to 700 µm compared to 540 in the other eye, suggesting that the edema was due to inflammation and not the increased IOP. Despite maximum medical therapy, the IOP only came down into the high 30s. I discussed the case with many glaucoma and retina colleagues who mostly agreed with my thoughts that this was a form of phacoantigenic uveitis due to seeding of the vitreous with lens proteins. We agreed that he should be treated aggressively with steroids and if the IOP did not come down, a more aggressive pars plana vitrectomy would need to be considered followed by glaucoma surgery if the vitrectomy did not resolve the problem. Fortunately, over the next weeks as the inflammation resided the IOP gradually came down and within a few weeks, the vision was 20/25 and the IOP dropped into the teens. The patient was gradually tapered off all medications and has done very well since. I think that there are some important teaching points here. When presented with such a case, it is important to be aware that posterior capsule blowout can occur with blunt trauma and to have clinical suspicion to look for such pathology. If present, the discovery of a Fechtner Fechtner Fechtner ech e htne EX-PRESS® EX-PRESS XMarker Marker K3-8977 r r r r r king perimeter rate sertion ed posterior capsule blowout may dramatically alter the management of such a case in terms of consideration of surgical timing and approach. Dr. Ayres commented: "This is a great case. I've had one or two cases of blunt trauma causing ruptured posterior capsules. I try to take care of them ASAP because the eye can get very inflamed." I agree with Dr. Ayres that these cases should be managed expeditiously to prevent progressive inflammation and glaucoma as well as seeding of the vitreous with lens proteins, which may lead to postoperative complications. Dr. Pyfer said, "I reviewed an article from the American Journal of Ophthalmology last year for the Yearbook of Ophthalmology that found a 20 MHz ultrasound probe to be useful in evaluating the status of the posterior capsule in traumatic cataract. That article also references an Indian Journal of Ophthalmology paper that showed Pentacam [Oculus, Arlington, Wash.] images of a ruptured PC in a pediatric closed globe injury." Given that the B-scan in this case was normal, it may be worthwhile to keep an open mind about the possibility of posterior capsule damage and to consider these alternative methods of imaging when confronted with such a case. If one sees a patient with blunt trauma or hyphema who is developing increasing inflammation, especially in the presence of cornea edema and/or increasing IOP, I would consider evaluating the posterior capsule with dilated retroillumination views at the slit lamp. If that is not possible or conclusive enough, then UBM or Scheimpflug imaging may be considered. EW References r e for sibility Watch Watch it! Alcon® 1. Tabatabaei A, Kiarudi MY, Ghassemi F, Moghimi S, Mansouri M, Mirshahi A, Kheirkhah A. Evaluation of posterior lens capsule by 20-MHz ultrasound probe in traumatic cataract. Am J Ophthalmol. 2012 Jan;153(1):51-4. 2. Grewal DS, Jain R, Brar GS, Grewal SP. Scheimpflug imaging of pediatric posterior  capsule rupture. Indian J Ophthalmol. 2009 May-Jun;57(3):236-8. Editors' note: The physicians have no financial interests related to the article. Contact information ® 973-989-1600 r800-225-1195 r www.katena.com r80 Ayres: brandonayres@me.com Nasser: rnasser@mac.com Pyfer: mpyfer@verizon.net Safran: safran12@comcast.net

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