Lupine Publishers | Bilateral Retinal Detachment after Implantable Collamer Lens Surgery

 Lupine Publishers | Trends in Ophthalmology Open Access Journal 

 

 

Abstract

A 46-year-old man, with moderate myopia, underwent Implantable Collamer Lens (ICL) surgery in both eyes on different dates. In the post-operative period, both of his eyes sustained the complication of rhegmatogenous retinal detachment (RD). After RD in the first eye, prophylactic 360-degree laser photocoagulation was performed on the second eye pre-operatively to hopefully reduce the risk of RD. This did not prevent RD from developing in this eye as well. RD is a potential complication of ICL surgery and all patients, regardless of degree of myopia, should be counselled about the risk pre-operatively. It will be prudent to monitor patients closely in the post-operative period, to detect this potential complication early. With subsequent early intervention, patients can have a good final visual outcome.

Keywords: Implantable Collamer Lens; Retinal detachment; Myopia; Laser photocoagulation

Abbreviation: ICL: Implantable Collamer Lens; RD: Retinal Detachment; PIOL: Phakic Intraocular Lenses; LASIK: Laser Assisted in Situ Keratomileusis; VA: Visual Acuity

Introduction

Various modern surgical options exist for correcting patients’ refractive errors. They range from minimally invasive surgery, such as Laser-assisted In Situ Keratomileusis (LASIK), to more invasive options such as Refractive Lens Exchange. To date, LASIK remains one of the most well-known and commonly performed procedures globally. Phakic intraocular lenses (PIOL), one of the more commonly used types being the Implantable Collamer Lens (ICL), remain a viable option for treating higher refractive error than that which can be safely managed by corneal refractive surgery. PIOL implantation also has the advantage of preserving natural accommodation. Its removable nature makes its refractive effect theoretically reversible. Retinal detachment (RD) is a known potential complication of ICL surgery, though relatively uncommon. We present such a case in the following section.

Case Description

A 46-year-old male with moderate myopia as his only ocular history presented to the refractive surgery service. He was keen for refractive surgery to avoid using glasses. His initial best corrected distance visual acuity (VA) was 6/6 bilaterally. Manifest refraction revealed -6.00D spherical and-1.00D cylindrical components in the right eye, and -5.00D spherical and -1.50D cylindrical components in his left eye. Intraocular pressures were normal, the corneas were healthy, and the anterior chambers were deep and quiet. The lenses were clear. Examination of the posterior segment was unremarkable. The optic nerves were healthy as well. Refractive surgical options were discussed. He opted for ICL surgery over LASIK, to preserve the option of multifocal intraocular lenses for future cataract surgery. Risks of surgery were advised, including anaesthesia complications, possibilities of blindness, retinal detachment, endophthalmitis, corneal decompensation, early cataract formation and refractive surprise. Pre-operative investigations, including endothelial cell count and ultrasound biomicroscopy, were normal. Bilateral laser peripheral iridotomies were done pre-operatively to prevent pupillary block. The patient subsequently underwent ICL implantation in his right eye. No issues were noted on post-operative day 1.

On post-operative day 4, the patient noticed a new onset of right eye floaters and blurring of vision. On examination, a right eye macula-sparing rhegmatogenous RD was diagnosed. He then underwent vitrectomy with pneumatic retinopexy for RD repair. Retinal reattachment ensued uneventfully. Fortunately, best corrected VA recovered to 6/7.5.

Due to anisometropia after unilateral ICL implantation, the patient was keen for ICL implantation in the left eye soon after right eye recovery. In view of his recent right-sided post-operative RD, he was counselled extensively regarding the risk of RD occurrence in the left eye. He underwent 360-degree laser photocoagulation intended to hopefully reduce the risk of RD recurrence, followed by ICL surgery for the left eye. One month after left eye ICL insertion, he presented with acute left eye blurring of vision. Examination revealed a macula-sparing superior rhegmatogenous RD (Figures 1,2 & 3). He subsequently required two retinal detachment repair operations to achieve retinal reattachment for his left eye.

Both eyes recovered well. 6 months after his second RD, manifest refraction showed best corrected VA of 6/7.5 bilaterally. He later developed left eye posterior subcapsular cataract, and underwent uneventful phacoemulsification with ICL removal 1 year after his RDs. His final VA was 6/6 bilaterally after left eye cataract surgery. Final manifest refraction showed -0.75D spherical and -0.50 cylindrical components for the right eye, and +0.25D spherical and -0.25D cylindrical components for the left eye.

Discussion

ICL implantation has many known potential complications, including but not limited to cataract formation, pigmentary dispersion, and endothelial cell loss. Cataract formation remains the most frequent complication [1]. RD is relatively uncommon but not unheard of. Fortunately in most cases, RD repair surgery can be carried out safely while preserving the PIOL [2]. The risk of post-operative RD is generally low across various studies of PIOL implantation [3-6]. One study found the incidence to be 1.5% in 530 eyes over a two-year follow-up period [6]. Surgical reattachment was achieved in the eyes affected by RD, with mean best corrected VA of 6/24 after RD repair [6]. Authors have previously described the occurrence of RD in ICL implantation, but only in those with high myopia, such as a case in a patient’s eyes with -15.00D and -21.00D [7]. This is due to RD having a tendency to occur in eyes with greater axial length [5]. The patient in our case only had moderate myopia, but RD still occurred. This may suggest that the risk exists in all myopic patients, and not only in those with high myopia. Hence, it is essential that all patients are advised regarding this risk.

In our case, the patient developed a RD in his right eye as soon as 4 days after ICL implantation. The earliest onset of RD ever described after ICL insertion was 3 hours [8]. Given the possibility of rapid RD onset, it would be prudent to monitor patients closely in the post-operative period. This will allow a RD, should it occur, to be treated sooner rather than later. After the patient suffered his first RD, even with prophylactic 360-degree laser done for his second eye, he still developed a post-operative RD in this eye. Preventive measures seek to hopefully reduce the risk of RD, but it is possible that in certain patients, the risk of RD remains high despite prior prophylactic laser photocoagulation. This case report highlights the potential risk of RD in ICL surgery, and the need to always counsel patients regarding this risk. This holds true not only for highly myopic patients, but for all myopic patients. RD can occur very early post-operatively, hence it is vital to warn patients regarding RD symptoms and to monitor patients closely. If detected early, treatment can be instituted quickly, which can lead to good visual outcomes

 

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Lupine Publishers | Opthalmology and Optometric Studies

 Lupine Publishers | Trends in Ophthalmology Open Access Journal 

Short Communication

I have no Doubt, so in the Medical Branch Ophthalmology there many repeated similar situation with Decision making - and It be very supporting - when on this specific Tasks to keep human abilities to vision well - could be solved more better - with sharing the best medical experiences from the best Ophthalmology Clinics of the world (OECD). I have for your medical branch only a view notices -the Encyclopedic Medical Literature has concept in a content with false priorities for Practical usage.....it should be organized with differenced structure.....coherent to education in Ophthalmology a Ground for Home amateur. for Medical students - and then other parts with explanations aspects to regards 120 very frequential and risky Ophthalmology Diagnoses....... since to detection first serious aspects ....always with possibilities of some prevency in Family Life.... for your Children, for your members in Gerent Age, and when we should immediately going to Ophthalmology Ambulancy. When we are informed about distributions of some serious eyes diseases...... we could recognize some local clever Life styles and Eyes-regularly exercises in home self rehabilitation to efficiency Home prevency some diseases of Visions. The Encyclopedic for Eyes-surgeries are oriented in either Aims and Well educated Ophthalmologists - There a re-probable many situation, where we should take the new processing in Diagnostics, modern Processing by Surgeries, many News for post operational rules of hospitalized Patients...there are many interactions with other Medical Branches....with working with Patients wit Diabetes Mellitus, with Patients over Ages 75+, with some Patients with HIV, etc. There should be more coherent concept and deep levels of important aspects for Health status of patients, probable prognoses an out Vision abilities, usage of some transplantation, etc. There should be more important the private practical experiences of Doctors for some surgeries.....The ion dividable activities in surgery hall could be agreement only - when the young Doctor preliminary realized about 60 similar surgeries with carefully supervisions very skilled Doctors.

I am recommending for your Eyes Clinic to be in 5 specified Types of Eyes-surgeries as The Best of TOP TEN in the whole OECD! You should be pride to cooperating with your Teams of Doctors, Quality managers, Programmers, Staticians, expert for EHRs and sharing data’s with best Eyes-Clinic in Branch from OECD, you should take as standard Instrument - the Video records from the each complicated Surgeries in your Hall as a duties to EHRs for internal usage, with regularly next agreement from responsible of supervision of Prime Doctor from Surgery hall.....It seems to be as the professional industrial produce.....with minimum false steps in duration Day, Week, Month, Years...with regularly SAMPLINGS to suggest the best next innovation in the Produce Channel Eyes Clinic XXXX! Always with perfect defined prevency of last risky or false situation in Produce Channel! There are no problem to detect Medical Mistakes, there are False to camouflage Medical Mistakes.... there are betrayal to Medical Ethics to repeat Medical mistakes!!!! Health Assurances should be supporting reliabilities to care the personalities Doctors so as personalities maybe so as Health satisfactions for Patients - it must be guaranteed!

Who is working with repeated Camouflages of repeated serious Medical working Problems without adequate prevency - they are Gangsters only - such Doctors should be excluded for lack of Medical Ethics! We all - time to time we are doing the Mistakes, but we could be better - and only Idiots could repeat the same similar mistakes on the private bill of other Citizens! You should working with elementary carefully managing all preliminary perfect Clinic Planning, you should be preparing in surgery hall on the most frequential 30 catastrophic complications “AD HOC”, you should educate your Doctors with simulating problems - similar as it is usual for Pilots in Airplanes transports, may be you need the new types of Simulators .......maybe your Eyes Clinic should be very famous in the whole world - when you will be taken the Best Education Medical Equipment, Best Professors in Branch, best Medical Devices in surgery hall.......You should offered: minimum patient risks in your safety specific Health care......Your functional practical behaviour should be prefect always - since perfect Inputs processing of tne coming Patients, including knowledge’s of Family anamnesis, private anamnesis, perfect preliminary testing Health status, perfect Diagnostics Eyes Problems, perfect choice the Treatments with well education of your Patients....with qualified agreement for next Treatments - with continual controlling Technician and Medical processing - step by steps...with long time supervisions your Patients after Health care…. with guaranty Well Being for long time with perfect Vision abilities...with education your Patient for perfect self-rehabilitation and the descriptions the risk situation. when you are recommending next Ophthalmology support, etc. Maybe you could recommend any other best specialized cooperating Eyes-Clinic in your State, etc.

 

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Lupine publishers | The Caspian Littoral Strip in Azerbaijan is Concerned with the State of Ecology of Heavily Exposed Metals

Lupine Publishers | Trends in Ophthalmology Open Access Journal 

Abstract

The presented article considers the natural-geographic location of Absheron, analyzes the presence of heavy metals such as zinc, mercury, arsen, copper in soils and plants remoteness from sources of pollution. Also, the presence of microorganisms was revealed, depending on the degree of soil contamination with heavy metals.

Keywords: Heavy metals; Microorganisms; Bacteria; Critical level

 Introduction

Pollution of the environment has become one of the most important tasks of our time; a special role belongs to heavy metals, which have the ability to accumulate in soils and through them to enter food products, while contributing to soil degradation. Absheron Peninsula is an anthropogenic load; it is the most tense in Azerbaijan. The peninsula is located on the western shore of the Caspian Sea and is the southeastern tip of the Greater Caucasus Range, occupying a total area of 200 thousand hectares. In the middle part its width is 28 km, and the length from east to west is 62 km. Absolute marks of hypsometric level of the surface from 25 to 300-350 m above sea level. The relief is characterized by soft, smoothed and weakly dissected, representing a slightly wavy plain, with a progress toward the west, where it gradually elevates, which is explained, first of all, by the young age in geological terms of the relief and the insignificant height of the peninsula above the basis of erosion.

Aridity of the climate in the presence of sandy transformations and crowding of soil-forming rocks on the Absheron Peninsula contributed to the wide development of arid-denudation, solonchakdeflation and eolian relief forms. Peninsula corresponds Periclinal immersion southeast Grand continuation megaantiklinoriya Caucasian and folded complex sedimentary formations Mesozoic (Upper Cretaceous) paleogene, Quaternary systems, power to 8000-9000m. The most widespread productive stratum deposits (average Pliocene), expressed sands lithological, sandstones, silts and clays and constitutes almost half of power (up to 3400m) the cut-Paleogenic neogene complex which assembled into a complex folds system [1]. The Absheron peninsula is characterized by a climate of moderately warm semi-deserts and dry steppes with dry summers. The greatest share of sunshine, about 30-35% (1900- 2500 hours per year) falls on summer. The total solar radiation throughout the territory varies from 120 to 135 kcal/cm2. The radiation balance is rather high 50-52 kcal/cm2. The average annual air temperature is 13.5-13.7°C in the northern and lowers central parts, 14.2-14.6°C in the extreme south of the peninsula [2].

The average annual precipitation is 130-150 mm per year. The greatest amount of precipitation up to 200 mm is observed in the Sumgait region. The soil cover of the Absheron peninsula was first investigated by VP Smirnov-Loginov [3]. Then Gasanov VG [4] composed of a large-scale soil map Absheron peninsula (1: 50,000), where the gray-highlighted brown swamped primitive gray-brown, gray-brown incompletely, gray-brown saline soils and sands. “We must clearly realize that the anthropogenic transformation of the biosphere in a sense has the nature of a global catastrophe and anthropogenic landscape-a landscape of the future. Apparently, in 100-200 years it will occupy the whole territory of the earth’s surface with the possible exception of eternal ice and mountain peaks. The reasons for this lie in an uncontrolled and progressive growth of the Earth’s population, non-stop building industry and agriculture, in the constant human need for energy sources other processes related “triumph of civilization” [2].

Measures to be taken by individuals, stakeholders and governments are important, complementary steps aimed at protecting the life support systems that not only ensure human well-being, but also the richness of the diversity of life on this planet [5]. The problems that arise in the design and operation of chemical enterprises have led to the fact that environmental problems have reached a critical level. The study of environmental problems occurring at the industrial site, the identification of the potential for environmental hazards in the industrial complex, is an urgent problem. Absheron was chosen as an array as a satellite to reduce the density of the industrial center of Baku. First, an industrial base of the petrochemical complex was created, on the basis of which other profiles also began to appear.

The basis of the chemical industrial complex of Sumgait consists of such enterprises as “Orgsyntez”, “Superphosphate”, “CAM”, and “Synthesis-rubber” (ethylene polyethylene), etc. The highest toxicity values are found in heavy metals such as mercury, lead, cadmium, arsenic, vanadium, zinc, copper, cobalt, molybdenum and nickel. They enter the active biological cycle of substances. The soil has a certain capacity for exchange and absorption capacity. In turn, these properties depend on the content of organic matter, particle size distribution, and the reaction of the soil environment, which means that the soil and even their different horizons capable of absorbing and retaining in its composition various amounts of manmade emissions [6]. Contamination of soils by heavy metals is due to air when watering wastewater in formulating oil, exhaust gases, when making organic (rich cadmium), phosphorus (impurities have uranium and lead) fertilizers. When using pesticides (preparations with mercury) [7,8].

Due to the fact that the soil is an object accumulating and supplying heavy metals to the biological chain, interest in studying its composition increases every year. At the same time, it is necessary to take into account that annually 350 kg/ha of harmful substances enter the soil with atmospheric emissions. It is noteworthy that in urban gardens, lead is concentrated in soil, zinc, copper is much larger than in arable soils. An increase in the concentration of heavy metals and aromatic hydrocarbons occurs in soils due to atmospheric precipitation from motorways [9]. Table 1 gives data on the content of heavy metals in the soil along the perimeter of industrial facilities.

According to the content of microelements, the investigated soils in the north-western and southern parts of the Absheron peninsula can be grouped according to the degree of concentration. Zinc, copper and cadmium are the most concentrated in comparison with others. Depending on the location of key areas of man-made emissions, the content of heavy metals varies. So in the Sumgait massif, 150 m northwest of the superphosphate plant, the concentration of zinc is 1.5 times, copper is 3-3.5 times higher than the allowable concentration in clarks. Retaining to the north by 500 m, their concentration decreases by an order of magnitude. Compounding, zinc 88 and cadmium 0.36 (mg/kg). In the northwest direction, the concentration of copper is markedly low; at the top of the soil is 5-9 mg / kg. To the south of the source of pollution, the values of the elements increase, amounting to: zinc- 84, cadmium-0.94 and copper-67 (mg/kg).

Probably, the excess of the concentration of elements in the soils located to the south in comparison with the northern part, despite the longer distance, is due to the prevalence of winds of the northern direction on the peninsula [10]. Many of the elements have a tendency to wash soil from the surface and accumulate in the lower layers, and cadmium inherent properties accumulate in the top layer of soil and poorly resist degradation in natural environment, which greatly complicates their purification. The next group includes lead, the indices of which are close to the Clark units. This element has fairly high values in sedimentary deposits, in some cases exceeding the geochemical background. Concentration of lead is close to clark units in the north-west, northeast and south directions (9 mg/kg), almost 2-3 times higher than the southern direction. Such an increased content of lead is probably due to the influence of the elevation of highly mineralized chloride waters to the surface.

The third group of metals-chromium, copper (Cu-only in certain directions), cobalt and nickel have a lower content of elements in soils - in tens, even hundreds of times, less than the permissible standards in all directions of the superphosphate plant. The lower content of these elements in soils is caused by their low mobility in the alkaline medium. Zinc exceeds the permissible concentration 100 m south of the plant by almost 2 times, amounting to 170 mg/ kg. Concentration of lead has approximate values for clarks, making 9 mg/kg to the south (100m from the enterprise) and exceeding them in 1, 5-2 times, closer to the highway (50 m from the road), making 16-21 mg/kg Concentration Copper in this part of the object exceeds the clark units in 4 times (85 mg/kg). The absorption of copper and zinc in the dissolved state differs from the damage of the applied elements in the form of a powder. Since this chemical element is absorbed 3 times more in the dissolved state than in the solid state. Mercury enters the lithosphere and the atmosphere in the form of waste. Mercury sludge belongs to the 1st category of hazardous substances.

When mercury sludge is in open space for a long time, it is a serious threat, as waste that occupies a huge area spreads through the open airspace and penetrates into water sources and the atmosphere of residential areas. Considering that mercury is an active substance and can quickly evaporate the waste can be considered a source of danger, which accumulates mainly on the surface of the soil. In addition to determining the presence of heavy metals in the soil around the perimeter of industrial plants, several kinds of fertilizers have been used in our studies for beet and coniferous trees. Of these, vermikompostnoe as an organic - mineral, manure of cattle - as an organic, and as a mineral-ammonium nitrate and potassium sulfate. The results of the analyzes showed that due to the use of fertilizers and vermicomposts, heavy metals were deactivated from the soil, which is the result of the primary stage.

Microorganisms present in the soil composition, influence the dissolution of heavy metals and their direct appropriation by plants. For example, as a strain called Pseudomonas Maltophili can turn a toxic Cr+6 into a harmless form of Cr+3, unevenly spreading in its various organs and tissues. Zn (zinc) mainly accumulates in the aerial part and especially in the old leaves. Heavy metals accumulate in the reproductive organs of plants less often than in vegetative organs. Absorption, transport, metabolism, distribution in tissues and organs of heavy metals, is related both to the species and to the variety of plants grown, Which are also affected by environmental and anthropogenic factors. Studies have shown that in the lower part of contaminated light gray-brown soils, depending on the type of contaminants, some changes in the color of the morphogenetic layers in gray-brown occur. These kinds of pollution cause serious negative damage not only to the morphology of the soil, but also to the biocenosis as a whole.

The absorption of heavy metals and atmospheric contaminants of plants can be considered as a complex chemical biological and physical process. In recent years, scientists strongly suggest planting trees and other plant species, where plants are regarded as a factor that purifies the air of the atmosphere. In a number of studies it was proved that the vegetation cover is an important factor contributing to the protection of the environment from contaminants. It should be noted that as a result of research, ecologists in recent years have identified such specific species of plant groups and endemic flora that adapt to soil contaminated with metals such as zinc, copper and nickel. Since adapting to the environment, plants are getting used to being resistant to soils contaminated with heavy metals. Metals are usually stored in plant leaves. But when the content of metal in the soil exceeds the permissible norm, the plants are able to synthesize them. In particular, from the degree of contamination, the number of bacteria and microbacteria in the soil changes drastically.

The amount of saprophytes of fungi of actinomycetes of Azotobacteria is considerably reduced. Oxidation-reduction reaction reduces the number of oxidizing bacteria and microbacteria. The presence of microorganisms in the soil, compared to heavy metals polluted with heavy metals, has an incomparable increase in the number of microorganisms in the variant with beet plantings, with the use of mineral and organomineral fertilizers up to 4400. Moreover, under coniferous plantations their number was 4200, and in variants without fertilizers Decreasing to 3,800 (beet) and 3600 (pine), while in areas contaminated with heavy metals their presence is practically not fixed.

 Conclusion

A. It was established that in the soil cover of the Sumgait massif, the concentration of zinc around the perimeter of industrial enterprises varies with distance from the source of pollution, amounting to (Zn-48-84 mg/kg, Pb-5-9 mg/kg, Cd- 0.82-0.94 mg/kg.

B. It was revealed that the productivity of the dominant plant communities and the largest reserves of phytomass of the Sumgait massif falls on the eastern part of the superphosphate plant (15.7-17.2 c/ha)

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