A rare case of spontaneous expulsive suprachoroidal haemorrhage in a glaucomatous eye treated with topical alpha-adrenergic agonist

Spontaneous expulsive suprachoroidal hemorrhage is a rare ocular condition, which usually occurs after sudden decompression of the eyewall. Most of the cases of expulsive hemorrhage reported had a predisposing glaucoma with the combination of corneal pathology. We are reporting a case of spontaneous expulsive suprachoroidal hemorrhage in a glaucoma patient probably due to perpetuated inflammatory reaction and frequent eye rubbing induced by allergic reaction to topical alpha adrenergic agonist in a compromised cornea.

Visual Outcome after Manual Small Incision Cataract Surgery for Phacolytic Glaucoma

Aim: To evaluate the visual outcome after manual small incision cataract surgery (MSICS) as a treatment of phacolytic glaucoma. Methods: The study included 43 patients with phacolytic glaucoma treated by manual small incision cataract surgery with intraocular lens implantation. Preoperative and postoperative visual acuity and intraocular pressure have been recorded and compared at the end of six weeks after surgery. Results: The mean preoperative intraocular pressure was 36.23 (± 10.86) mm of Hg. There were no significant intraoperative complications such as posterior capsular tear or expulsive hemorrhage. Post operative mean intraocular pressure (IOP) was 12.58 (± 3.45) mm Hg. Pre operative visual acuity in all the affected eyes were perception of light with projection of rays in all quadrant. Postoperative best corrected visual acuity was 6/6-6/18 in 27 patients (62.80%), 6/24- 6/36 in 10 patients (23.25%) and ≤ 6/60 in 6 patients (13.95%). Conclusion: Manual small incision cataract surgery is a safe and effective method of treatment for phacolytic glaucoma and the visual outcome and IOP reduction is satisfactory.

The Evaluation of Silicon Oil Evacuation Procedure In Cipto Mangunkusumo Hospital Indonesia

Background: Injection of Silicon oil is a standard procedure for vitreous replacement in vitrectomy procedure for retinal detachment cases. It acts as a great tamponading agent for reattachment of retinal breaks or retinal detachment. Despite its minor side effect, silicon oil could cause several complications such as cataract, endothelia decompensation, increased intraocular pressure, and secondary glaucoma. Thus needed to be evacuated after the retinal reattachment is stabilized. Following evacuation procedure, visual acuity are known to be significantly improved. However, some cases shows decreased of visual acuity due to retinal redetachment, optic nerve damage due to secondary glaucoma, hypotonym vitreous hemorrhage, expulsive hemorrhage, and cornea abnormality. Methods: A retrospective descriptive study of retinal detachment patients underwent silicon oil evacuation procedure in Cipto Mangunkusumo Hospital, Indonesia from September 2017 until Januari 2018. Results: There were seventy seven cases of retinal detachment undergoes silicon oil evacuation within period of September 2017-Januari 2018. There were improvement of visual acuity (greater than 6/60) after one month of silicon oil evacuation. Anatomical retinal reattachment was successfully observed in 91% patient. The most occuring complication after silicon oil evacuation includes secondary glaucoma and retinal redetachment. Conclusion: Silicon oil evacuation is a standard procedure following a vitrectomy in retinal detachment cases. The evacuation procedure yields in positive benefit for patient in term of visual acuity and anatomical structure.

Baerveldt tube shunt implantation through a long scleral tunnel

Purpose: To develop a new technique for the placement of a Baerveldt glaucoma implant tube through a long scleral tunnel. Materials and methods: Patients with refractory glaucoma undergoing the maximum tolerated medical therapy were recruited. We created a scleral tunnel with a 24-gauge catheter needle and used the external tube for guidance when introducing a Baerveldt glaucoma implant tube. Main outcome measures included intraocular pressure, supplemental medical therapy score, intraoperative complications, and postoperative complications. Results: Nine eyes of six patients were included in the study. The mean preoperative intraocular pressure (score) was 41.0 mmHg (4.78). Mean postoperative intraocular pressures were 18.3 mmHg (0.22), 18.8 mmHg (0.13), and 16.9 mmHg (0.50) at postoperative 1, 3, and 6 months, respectively. Minor vitreous hemorrhages were observed in three cases. Postoperative hypotony (<5 mmHg) was observed only in the first case at postoperative day 3. In one case, a stent suture could not be placed because the patient was restive intraoperatively, which resulted in an expulsive hemorrhage at 3 months postoperatively. The tube could have penetrated into the anterior chamber in another case. Tube exposure and corneal erosions were not observed in all cases. Conclusion: We developed a new technique to place a Baerveldt glaucoma implant tube through a long scleral tunnel. The outcomes were comparable to other reports of Baerveldt glaucoma implant surgery, although the number of cases was limited in this study. A long scleral tunnel can substitute for a preserved scleral patch and self-scleral flap to avoid tube-related complications.