PURPOSE: The use of pre- and intraoperative vitreous bevacizumab injection and combined lens extraction with vitrectomy in patients with proliferative diabetic retinopathy (PDR) is increasing. In this study we analyzed the incidence and risk factors of neovascular glaucoma (NVG) after vitrectomy for PDR. METHODS: Patients who underwent vitrectomy for PDR from January 2004 to June 2011 were retrospectively reviewed. The minimum follow-up was 12 months. The cumulative incidence of NVG was calculated using the Kaplan-Meier survival analysis. The patients were divided into 4 groups according to lens status (preoperative pseudophakic group, simultaneous cataract surgery group, sequential cataract surgery group, non-cataract surgery group). The differences in incidence between the groups were determined by the Chi-square test. Finally, to analyze the risk factors associated with the occurrence of NVG, the Cox's regression model was used. RESULTS: Of the 614 eyes (402 patients), 284 were males and 330 were females. The mean age was 55.8 +/- 10.46 years (range 30-81 years) and the mean follow-up period was 36.6 months (range 1-93 months). Thirty-four of 614 patients (5.5%) developed postoperative NVG after vitrectomy. The probability of NVG occurrence at 6 and 12 months after vitrectomy was 0.7% and 2.5%, respectively. The incidence between the 4 groups did not show a statistically significant difference. The risk factors for postoperative NVG were male gender (RR = 3.01 p = 0.004), preoperative intravitreal bevacizumab injection (RR = 7.20, p < 0.001), and reoperation (RR = 3.18, p = 0.0037). CONCLUSIONS: The frequency of NVG after vitrectomy in patients with PDR was 5.5%. Lens status was not associated with NVG occurrence. The risk factors related to NVG were male gender, preoperative intravitreal bevacizumab injection, and reoperation.
Cataract ; Diabetic Retinopathy* ; Female ; Follow-Up Studies ; Glaucoma, Neovascular* ; Humans ; Incidence ; Male ; Phacoemulsification ; Reoperation ; Retrospective Studies ; Risk Factors* ; Vitrectomy* ; Bevacizumab

PURPOSE: To report a case of malignant glaucoma in an eye vitrectomized 5 years previously due to endophthalmitis. CASE SUMMARY: A 55-year-old male visited clinic due to a painful right eye 2 days in duration. Five years ago, he suffered endophthalmitis in his right eye and underwent pars plana vitrectomy. On slit-lamp examination, shallow anterior chamber depth of 2 central corneal thickness and corneal edema were observed along with remnant cortical lens material behind the intraocular lens. Intraocular pressure was 68 mm Hg measured using applanation tonometry. Maximal medical treatment failed to lower the intraocular pressure on the first day of visit. The very next day, anterior chamber became shallower less than 0.5 central corneal thickness and intraocular pressure was 70 mm Hg. Posterior capsular syndrome was suspected on anterior optical coherence tomography and neodymium:yttrium-aluminum-garnet laser posterior capsulotomy was performed, however, normal anterior chamber could not be restored. Despite continuous medical therapy for 3 weeks, the patient's symptoms worsened and intraocular pressure increased over 99 mm Hg and therefore, the Ahmed glaucoma valve was implanted. One day after the operation, intraocular pressure decreased to 10 mm Hg and anterior chamber depth became deeper with the depth of over 5 central corneal thickness. At the final visit 4 months postoperatively, intraocular pressure and normal anatomy of the anterior segment were well maintained. CONCLUSIONS: Malignant glaucoma syndrome can occur even in vitrectomized eyes and capsular block syndrome can initiate this. Malignant glaucoma syndrome in a vitrectomized eye resistant to maximal medical treatment can be treated with Ahmed valve implantation.
Anterior Chamber ; Corneal Edema ; Endophthalmitis ; Glaucoma* ; Humans ; Intraocular Pressure ; Lenses, Intraocular ; Male ; Manometry ; Middle Aged ; Posterior Capsulotomy ; Tomography, Optical Coherence ; Vitrectomy

PURPOSE: To report a case of pigment dispersion syndrome and reverse pupillary block secondary to the implantation of implantable collamer lens (ICL) with a central hole (AQUA ICL®) that was treated with ICL removal and laser peripheral iridotomy (LPI). CASE SUMMARY: A 29-year-old woman with myopia in both eyes underwent implantation of AQUA ICL®. Four weeks postoperatively, the intraocular pressure (IOP) increased to 34 mm Hg and the patient showed pigment dispersion syndrome in both eyes. Since the IOP did not reduce with the maximum tolerable medical therapy, the ICLs were removed 8 weeks after implantation. The pigment dispersion subsided and IOP reduced shortly after ICL removal. However, 4 weeks after removal of ICL, posterior iris bowing and reverse pupillary block occurred in the right eye and the IOP increased to 46 mm Hg. LPI was performed in the right eye, and the reverse pupillary block was dissolved after a reduction in pigment dispersion. The IOP subsequently normalized to 13 mm Hg. Two weeks later, prophylactic LPI was performed in the left eye. Four weeks after prophylactic LPI, selective laser trabeculoplasty was performed on both eyes. As a result, the IOP was 11 mm Hg in the right eye and 12 mm Hg in the left eye after 4 weeks of treatment with topical IOP-lowering medications. CONCLUSIONS: The present case indicates that implantation of ICL with a central hole can lead to early postoperative pigment dispersion syndrome. When this condition persists and is accompanied by reverse pupillary block after ICL removal, LPI can be partially effective.
Adult ; Female ; Humans ; Intraocular Pressure ; Iris ; Myopia ; Trabeculectomy

Fournier’s gangrene is infectious, necrotizing, life-threatening fasciitis of the perineal, genital, and perianal regions leading to soft-tissue necrosis and sepsis, and is treated with aggressive surgical debridement and antimicrobial agents. Negative-pressure wound therapy can be used if septic risk is controlled. An 82-year-old woman presented with Fournier’s gangrene and septic shock. After emergency debridement, perineal resection, a colostomy, and daily wound debridement was performed under general anesthesia (1 week). Multiple intubations and extubations under general anesthesia are a risk factor for poor patient outcomes. Therefore, negative-pressure wound therapy was performed under light sedation using noninvasive ventilation in the intensive care unit after extubation and for wound debridement. One month later, the perineum was reconstructed. Procedures performed under light sedation should be considered for patients requiring periodic invasive surgical procedures who are burdened by repeated general anesthesia. The number of general anesthesia sessions was significantly reduced by using noninvasive ventilation.

Fournier’s gangrene is infectious, necrotizing, life-threatening fasciitis of the perineal, genital, and perianal regions leading to soft-tissue necrosis and sepsis, and is treated with aggressive surgical debridement and antimicrobial agents. Negative-pressure wound therapy can be used if septic risk is controlled. An 82-year-old woman presented with Fournier’s gangrene and septic shock. After emergency debridement, perineal resection, a colostomy, and daily wound debridement was performed under general anesthesia (1 week). Multiple intubations and extubations under general anesthesia are a risk factor for poor patient outcomes. Therefore, negative-pressure wound therapy was performed under light sedation using noninvasive ventilation in the intensive care unit after extubation and for wound debridement. One month later, the perineum was reconstructed. Procedures performed under light sedation should be considered for patients requiring periodic invasive surgical procedures who are burdened by repeated general anesthesia. The number of general anesthesia sessions was significantly reduced by using noninvasive ventilation.

Fournier’s gangrene is infectious, necrotizing, life-threatening fasciitis of the perineal, genital, and perianal regions leading to soft-tissue necrosis and sepsis, and is treated with aggressive surgical debridement and antimicrobial agents. Negative-pressure wound therapy can be used if septic risk is controlled. An 82-year-old woman presented with Fournier’s gangrene and septic shock. After emergency debridement, perineal resection, a colostomy, and daily wound debridement was performed under general anesthesia (1 week). Multiple intubations and extubations under general anesthesia are a risk factor for poor patient outcomes. Therefore, negative-pressure wound therapy was performed under light sedation using noninvasive ventilation in the intensive care unit after extubation and for wound debridement. One month later, the perineum was reconstructed. Procedures performed under light sedation should be considered for patients requiring periodic invasive surgical procedures who are burdened by repeated general anesthesia. The number of general anesthesia sessions was significantly reduced by using noninvasive ventilation.