Intraocular pressure before and after capsulorhexis using two viscoelastic substances and two surgical approaches in enucleated porcine eyes

AIM:To investigate the influence of ophthalmic viscoelastic devices(OVDs)and different surgical approaches on the intraocular pressure(IOP)before and after creation of the curvilinear circular capsulorhexis(CCC)as a measure for anterior chamber stability during this maneuver.METHODS:Prospective experimental WetLab study carried out on enucleated porcine eyes.IOP was measured before and after CCC with the iCare Rebound tonometer(iCare ic200;iCare Finland Oy,Vantaa,Finland).The OVDs used were a cohesive one[Z-Hyalin,Carl Zeiss Meditec AG,Germany;hyaluronic acid(HA)]and a dispersive[Z-Celcoat,Carl Zeiss Meditec AG,Germany;hydroxy propylmethylcellulosis(HPMC)].The CCC was created using Utrata forceps or 23 g microforceps in different combinations with the OVDs.RESULTS:Using the Utrata forceps the IOP dropped from 63.65±6.44 to 11.25±3.63 mm Hg during the CCC.The use of different OVDs made no difference.Using the 23 g microforceps the IOP dropped from 65.35±8.15 to 36.55±6.09 mm Hg.The difference between IOP drop using either Utrata forceps or 23 g microforceps was highly significant regardless of the OVD used.CONCLUSION:Using the sideport for the creation of the capsulorhexis leads to a lesser drop in IOP during this maneuver compared to the main incision in enucleated porcine eyes.The use of different OVD has no significant influence on IOP drop.

Corneal perforation and rare primary adenocarcinoma of the lacrimal gland: A case report

Rationale:Primary adenocarcinoma of the lacrimal gland is rare,and its presentation as corneal perforation is even rarer.Corneal perforation is an ocular emergency that warrants urgent ophthalmic surgery,yet complete staging of lacrimal gland tumor pre-operatively is essential for optimal oncological management.Patient's concerns:A 57-year-old man presented with left eye pain was found to have left eye proptosis and fleshy tissue mass around the eyeball.Uveal tissue was prolapsing over the perforated keratitis cornea,and the eye was full of discharge.Diagnosis:Bedside ultrasound B-scan confirmed vitreous haze,and emergency contrast computed tomography(CT)revealed soft tissue density mass(>40 mm)molding around the left globe and optic nerve without any rim enhancing abscess.Left exogenous endophthalmitis from exposure keratopathy secondary to proptosis caused by the bulky lacrimal tumor located in the confined orbital cone was diagnosed.Interventions:Emergency enucleation surgery of the left eyeball was done for this painful blind eye to control the infection from spreading.Orbital walls were biopsied intra-operatively,and tumor staging was completed by positron emission tomography-CT scan and magnetic resonance imaging.Without evidence of metastasis,left orbital exenteration was followed by adjuvant orbital chemoradiotherapy for the sake of close proximity of resection margin.Outcomes:Left exenterated orbit was fully epithelialized at around 2 months,and there was no recurrence of the disease up to present at the 1 year follow-up.Lessons:Thorough workup on the staging of the disease to minimize the number of operations for oncological patients is always a top priority,yet it may not always be possible as in our case presenting with corneal perforation.