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The method of treatment of intralamellar sclerocorneal abscesses in the area of tunnel incision after phacoemulsification

Session Details

Session Title: Inflammation

Session Date/Time: Tuesday 08/10/2013 | 16:30-18:00

Paper Time: 17:40

Venue: Auditorium (First Floor)

First Author: : E.Kasparova RUSSIA

Co Author(s): :                  

Abstract Details

Purpose:

To elaborate the method of treatment of intralammelar sclerocorneal abscesses in the area of tunnel incision after phacoemulsification (PE). According to our assumption, the scleral tunnel incision when hit by a pathogen, can become an abscessed cavity in the scleral zone valve, covered with earlier temporarily separated conjunctiva. Our further observation of patients have shown that within the next 2-4 and more weeks after surgery, infection spread to the deeper layers of the sclera, anterior tissue of the vascular tract, and along the tunnel section in the layers of the cornea, forming intracorneal abscesses. Intralamellar corneal abscesses were generally stable sign of inflammation in the zone of tunnel incision and s?lerokeratitis. Their saturation incresed at the next recurrence and decreased during the course of anti-inflammatory treatment. Despite the active anti-inflammatory therapy (antibiotics, corticosteroids, non-steroid antiinflammatory agents etc.) arrest of the inflammation was not fully achieved, the process recurred within 2.5-6 months after the PE.

Setting:

Evgeniya Kasparova phd, Arcady Kasparov prof. Elizaveta Kasparova phd Institution of Russian Academy of Medical Sciences Scientific Research Institute of Eye Diseases Rams. Moscow, Russia.

Methods:

We observed 4 patients (4 eyes) who underwent PE through scleral tunnel, with a diagnosis of "post-operative recurrent uveitis." Recurrency of purulent sclerokeratitis were observed in the period from 2.5 to 6.0 months after PE. Three patients were operated on the presented method immediately upon admission to the hospital institution. In one patient this operation was not carried out in connection with the complete absence of visual functions due to the development of chronic endophtalmitis. Our proposed targeted surgical impact on intralammelar sclero-corneal abscesses after phacoemulsification includes an incision and excision of the abnormal areas of the conjunctiva in the area of the tunnel incision, excision of the sclera and cornea within healthy tissues, irrigation of the resected zone with an antibiotic solution, substitution of the resulting defect with corneal or corneal-scleral donor graft and sheltering intervention area with mobilized autoconjunctiva.

Results:

Conduction of reconstructive conjuctivo-sclerokeratoplasty in 3 patients allowed to stop the inflammatory process and restore the visual functions with terms of observations from 1 to 3 years.

Conclusions:

Corneal intralammelar abscesses that arose after PE was a significant enough biomocroscopic indicator of the beginning signs of chronic endophtalmitis. The proposed surgical method-Reconstructive Conjuctivo-Sclerokeratoplasty for the treatment of intralammelar sclerocorneal abscesses after PE, conducted through sclerocorneal insicion, can jugulate local inflammatory process, which proceeds during the first weeks after the PE occultly. The method allows also to prevent endophthalmitis beginning and preserve vision.

Financial Interest:

NONE