Surgical techniques in anterior and posterior lamellar corneal surgery. Management of postblepharoplasty chemosis aesthetic surgery. Corneal dellen from subconjunctival hemorrhage after strabismus surgery. Corneal dellen as a complication of strabismus surgery eye nature. Corneal dellen in the limbal approach to rectus muscle surgery. They occur most often following processes which produce a paralimbal elevation. It consists of two lakes, northern dellen and southern dellen, appreciated among flyfishermen for their distinct population of brown trout. To study the subconjunctival silicone oil scso parameters associated with dellen formation following. Rentier a large nasal perilimbal elevation was produced in both eyes of 17 rabbits by implantation of silastic sponges subconfunctivally. The histopathology of experimental dry spots and dellen in.
The type of lens most notorious for this is the hard type of lens, which is. Nine cases of such dellen were encountered in a series of 97 consecutive trabeculectomies. Click here for the professional version click here for the professional version the cornea is the clear layer in front of the iris and pupil. Dellen causing disappearance of vogts limbal girdle ii.
Preserved human amniotic membrane transplantations were performed in 84 eyes of 78 patients for corneal surface reconstruction. This is a prospective, nonrandomized, interventional study, in which 42 eyes of 29 candidates for eom surgery for strabismus correction at cairo university hospitals, aged 1437 years, were recruited. Corneal epithelial damage and impaired tear functions in. Shallow, saucerlike, clearly defined excavations at the margin of the cornea, about 1. Studies have reported dellen formation in the corneal periphery due to a limbic elevation of various causes, such as filtering bleb and. Corneal dellen with corneal perforation is a rare but serious complication of the bare sclera technique in surgery for primary pterygium. This cornea has a small dellen thinning of the corneal stroma that occured after cataract surgery. Application of preserved human amniotic membrane for. Sir, scleral thinning and necrosis is a serious complication of pterygium surgery. The corneal epithelium is hydrophobic and, in the absence of mucin, will repel water and produce a dry spot. Pdf corneal dellen as a complication of strabismus surgery. Corneal dellen in the limbal approach muscle surgery.
Theresults ofour study are, however, compatible with the theory ofcomealdesiccation as the cause of. Eversion of the upper eyelid showed a retracted and buckled tarsal plate and the presence of a 5. In this case report, we describe a 60yearold man who underwent a corneal perforation in the centre of corneal dellen in his right eye and corneal dellen in his left eye after the surgical treatment of a bilateral pterygium with a bare sclera technique without adjunctive therapy. Trantas, n on two cases of local intense and transitory corneal. He stated that the incidence of dellen decreased with the limbal approach and he observed only twodellen in 6oo eyes operated on by the limbal technique. Dellen formation as a complication of subconjunctival silicone oil following microincision vitrectomy mohamed m mahgoub,1,2 maged m roshdy,1,2 sherine s wahba1,2 1ophthalmology department, ain shams university, 2ophthalmology department, al watany eye hospital, cairo, egypt purpose.
Dellen represent a characteristic phenomenon involving the cornea. Degenerations dystrophy peripherally located most often centrally located asymmetric bilateral and symmetric older age group young age progression could be slow or rapid progression is slow not inherited corneal vascularisation inherited no vascularisation corneal degenerations refer to the conditions in which the. Dellen are caused by a cascade of events, incited by a focal absence of the mucin layer over the epithelium. Oculus pentacam interpretation manual pdf download. May 08, 2015 peripheral corneal ulcers and corneal degenerations 1. Dellen and corneal perforation after bilateral pterygium. Peripheral corneal ulcers and corneal degenerations 1. The case where the initial treatment may have delayed the.
Dellen associated with filtering blebs jama ophthalmology. The cornea thins when it is dehydrated, and in this case, a localized area of conjunctival edema next to the limbus interfered with the normal tearblink mechanism. The patient was given bacitracin and vigamox moxifloxacin and was pressurepatched. The indications were limbal stem cell deficiency from stevenjohnson syndrome, chemical burn and. We describe a patient with corneal and scleral dellen, which occurred after. A central corneal dellen may be associated with longterm, overnight use. They occur most often following processes which produce a paralimbal elevation that is able to induce a localized break in the precorneal oily layer of the tears which, in turn, causes a localized dehydration and thinning of the cornea. In this study, we evaluated corneal epithelial integrity and tear film parameters in patients with inflamed pinguecula and compared these findings with their fellow eyes and with healthy controls. The next day corneal dellen had already began to retreat and four days later the contact lens was removed since there was no sign of dellen in the slit lamp examination. The patient underwent exploration under local anaesthesia. It occurs as a result of a nonspecific delayed hypersensitivity reaction to bacterial and viral antigens. You can also see the funny reflection it causes on the iris underneath.
This can be accomplished by prescribing artificial tears, lubricating. Multilayered amniotic membrane transplantation for partial. A central corneal dellen may be associated with longterm, overnight use of orthokeratology lenses. They are caused by interruptions of the tear film and local dehydration of the cornea. Evaluation of corneal irregular astigmatism although there is no inherent problem in performing cataract surgery in patients with mild pterygium, subclinical keratoconus, or mild corneal scar, it is possible for. The effect of strabismus muscle surgery on corneal.
Mar 28, 2014 corneal dellen are small saucerlike excavations at the margin of the cornea. To evaluate the efficacy of preserved human amniotic membrane transplantation for reconstruction of the corneal surface diseases. To report the first case of dellen like keratopathy with superior corneal thinning associated with implantation of glaucoma drainage devices. This somewhat benign condition generally results from poor corneal wetting or hydration. On the nature of dellen jama ophthalmology jama network.
Persistent dry spots andor dellen occurred in 28 eyes, 1 to 8 days after surgery. In conclusion, the use of a large diameter soft contact lens was an effective alternative solution for the treatment of corneal dellen in our patient. The etiology, clinical management and the possible differential diagnosis of the central cornea dellen are discussed. Mar 23, 2016 dellen localised saucershaped thinning of the cornea caused by localised tear film instability. Although corneal dellen usually respond to minimal treatment, failure to treat lesions can result in ocular irritation, epithelial breakdown and secondary infection. They typically occur at the corneal limbus near areas of adjacent elevation. These dimples cause little disturbance, and rarely last more than fortyeight hours. Fuchs, a pathological dimples dellen of the cornea, amer j ophthal 12. The thinned area was initially thought to be a corneal dellen resulting from the large amount of adjacent chemosis. Case report dellen and corneal perforation after bilateral. Davson, 1969 were last revised, there have been few major advances in our understanding of how the cornea carries out its function, but, rather, earlier concepts have been consolidated or modified. Central corneal epitheliopathy in a longterm, overnight.
On postoperative day 1, there was still residual esotropia, and the forced duction test fdt revealed a residual tightness of the medial rectus muscle. Eye examination nsw agency for clinical innovation. Dellen may occur in the corneas of eyes with filtering blebs. From the motility clinic, university ofillinois eye. Corneal dellen occurs in quiet eyes and does not involve epithelial loss. A 28yearold male patient underwent uneventful surgery for right sensory esotropia. In the absence of inflammation, one of the more likely causes of the thinning is a dell, or an area of nonwetting that thins and then breaks down, observes sadeer hannush, md, a corneal specialist and attending surgeon at the wills eye institute. Pdf corneal and scleral dellen after an uneventful pterygium. Pathological dimples dellen of the cornea sciencedirect. An adventure platformershooter in which you awake in a strange void, infested with dangerous flying eyeballs. Jillian grasso, clinical nurse consultant, ophthalmology. Eye education for emergency clinicians 2 these presentations have been prepared by. Corneal and scleral dellen after an uneventful pterygium.
Dellen are areas of corneal thinning secondary to stromal dehydration. Corneal infections are responsible for a large proportion of this scarring. All cases with dellen had scso within 2 mm of the limbus p. This uncommon condition may be misconstrued as a corneal ulcer. You can see it at the limbus in the bottomright of this picture. The code is valid for the year 2020 for the submission of hipaacovered transactions. The purpose of this study was to report a case of corneal dellen in a patient implanted with a boston type 1 keratoprosthesis kpro, which rapidly appeared after the loss of the largediameter soft contact lens. Dellenlike keratopathy associated with glaucoma drainage. A retrospective study of 170 cases of horizontal rectus muscle surgery performed during the years 1969 and 1970 at the university of illinois eye and ear infirmary revealed a 65 per cent incidence of dellen with the limbal approach to the muscle and a 22 per cent of incidence of dellen with the nonlimbal or direct approach to the muscle. Introduction to corneal disorders eye disorders merck. A 70yearold male with a history of primary open angle glaucoma and dry eye disease underwent placement of glaucoma drainage devices with antimetabolite application in both eyes. In conclusion, the use of a large diameter soft contact lens was an effective alternative solution for the treatment of corneal dellen. In two such patients, the dell progressed to a deep corneal ulcer, although in most cases.
Corneal dellen are small saucerlike excavations at the margin of the cornea. Pdf we describe a patient with corneal and scleral dellen, which occurred after an uneventful pterygium excision without adjunctive. Choose from 500 different sets of cornea flashcards on quizlet. Corneal dellen in the limbal approach to rectus muscle. Corneal dellen are localized depressions in the periphery of the cornea that are usually adjacent to the elevated surface. Dellen were first described in 1911 as saucerlike excavations of the corneal margin. If the cornea was illumi nated from the temporal side one saw on the grey iris a striking, dark, sharply defined spot, looking nearly like a pigmented nevus, but recognizable as a shadow by its movement. Studying the early effect of different extraocular muscle eom surgeries on corneal biomechanics. The authors described the occurrence of nine cases of dellen of the cornea encountered in a series of 97 consecutive trabeculectomies. Pathological dimples dellen of the cornea american journal of.
We evaluated the fluorescein staining properties and performed the tear breakup time tbut test and schirmer 2 test st2 measurements of 32 patients who had symptomatic. We evaluated the fluorescein staining properties and performed the tear breakup time tbut test and schirmer 2 test st2 measurements of 32 patients who had. Fluorescein pools in the depression, and at times there is overlying staining. The next day the area of thinning was largely unchanged, although it. Corneal dellen from subconjunctival hemorrhage after. Adalbert f u c h s v i e n n a, austria in 1911 ernst fuchs described as dellen dimples saucerlike excavations at the margin of the cornea, usually forming ellipses parallel with the limbus. They are original pdf, epub, chm, and can not be found anywhere on the internet. Dellen is a localized area of corneal thinning in the periphery next to the limbus. It protects the iris and lens and helps focus light on the retina. Peripheral corneal ulcers and corneal degenerations. Degenerations dystrophy peripherally located most often centrally located asymmetric bilateral and symmetric older age group young age progression could be slow or rapid progression is slow not inherited corneal vascularisation inherited no vascularisation corneal degenerations refer to the.
Corneal perforation associated with dellen is a rare but serious complication of a primary pterygium excision. Free download ophthalmology books, ebooks ophthalmology, eyes pdf, epub, chm videos. The condition involves compacted corneal stroma rather than true necrosis. Dellen occur when the tear film does not cover the eye. Dellen are small, saucerlike excavations at the margin of the cornea. Corneal dellen as a complication of strabismus surgery eye. Corneal dellen in the limbal approach to british journal of. Anterior amorphous corneal opacity and corneal thinning. Corneal delle secondary to conjunctival chemosis decision.
I read with interest the article by soong and quigley in the march archives 1983. A conservative approach consisting of the use of arti. We report two cases of partial thickness scleral thinning scleral dellen with thinning of. This photo shows a dellen thinning of the cornea that occurs from dehydration. It is suggested that this paralimbal elevation induces a localized break in the precorneal oily film layer of the tears which, in turn, causes a localized dehydration and thinning of the cornea. It is important to break this feedback cycle using lubrication or patching to achieve resolution of chemosis figures 3 5. This article is from case reports in ophthalmology, volume 5. The next day the area of thinning was largely unchanged, although it now stained with fluorescein. Treatment of corneal dellen with a large diameter soft. Clinical features include a round or oval depression in the cornea, typically located in the periphery or mid periphery. Corneal and scleral dellen after an uneventful pterygium surgery. Scleral dellen following strabismus surgery bmj case reports. Corneal warpage warpage of the cornea refers to a distortion in the shape of the cornea, usually due to the use of rigid contact lenses, and especially poorly fitting rigid lenses. Corneal dellen definition of corneal dellen by medical.
We describe a patient with corneal and scleral dellen, which occurred after an uneventful pterygium. Full text dellen formation as a complication of subconjunctival. Stromal hydration can usually be restored with frequent ocular lubrication. Dellen is a lake system in the province of halsingland, sweden. Central corneal dellen developed in a 60yearold woman 3 months after a tarsotomy procedure for correction of cicatricial upper eyelid entropion. Fortunately, this thinning quickly resolved with aggresive lubrication.
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