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      Corneal Opacification and Spontaneous Recovery following Injection of Healon5 into the Corneal Stroma during Intervention for Postoperative Hypotony

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          Abstract

          We report the self-limited nature of corneal opacification after accidental injection of Healon5 into the corneal stroma. A 52-year-old male with a new diagnosis of severe stage, primary open-angle glaucoma underwent successful trabeculectomy OS, which was complicated by ocular hypotony and shallow anterior chamber (AC) on postoperative day 1. Healon5, a hyaluronic acid-containing viscoelastic device, was accidentally introduced into the corneal stroma during attempted injection into the AC. The cornea hydrodissected and opacified, leading to precipitous loss of best-corrected visual acuity (BCVA). The corneal opacification spontaneously resolved over a 7-month period without specific intervention. During this period, the patient also underwent cataract extraction with posterior chamber intraocular lens placement and YAG capsulotomy, after which his BCVA returned to approximately baseline. Though intrastromal injection of sodium hyaluronate-containing material has been reported elsewhere, this complication with Healon5 use specifically has yet to be described in the literature and may occur in any procedure involving Healon5 in the AC. This case report is important, since the precipitous loss of BCVA can be alarming to the ophthalmologist and the patient. The affected patient may be counseled that the opacification should improve with time.

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          Most cited references 14

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          Use of viscoelastic substance in ophthalmic surgery – focus on sodium hyaluronate

          Among viscoelastic substances, sodium hyaluronate has become the most popular for intraocular surgeries since the introduction of Healon® (sodium hyaluronate 1%, 4 × 106 daltons) in 1979. This review focuses on the recent development of a new generation of sodium hyaluronate agents with new rheologic properties and the relevant new techniques used in cataract, glaucoma, corneal, and vitreoretinal surgeries. The introduction of sodium hyaluronate agents with different rheologic properties has improved the safety and reliability of intraocular surgeries. Although there have been numerous studies reporting the effectiveness of viscoelastic substances in intraocular surgeries, rigorous validation by multi-center randomized control trials is lacking in many cases. At present, no single viscoelastic agent is most suitable to all of the various intraocular surgical techniques. Therefore, ophthalmologic surgeons should keep up with recent developments of viscoelastic agents and relevant surgical techniques for better patient care.
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            Stabilization of flat anterior chamber after trabeculectomy with Healon5.

            A 64-year-old phakic patient had a trabeculectomy complicated by complete shallowing of the anterior chamber 10 days postoperatively. Despite repair of a conjunctival wound dehiscence and reformation of the anterior chamber with sodium hyaluronate 3.0%-chondroitin sulfate 4.0% (Viscoat), he had a flat anterior chamber again the following day with 360 degrees of pupillary synechias and lens-to-cornea touch. Sodium hyaluronate 2.3% (Healon5) instilled through a paracentesis at the slitlamp lysed the synechias, stabilized the anterior chamber, facilitated filtration, and prevented complications from hypotony. The unique properties of Healon5 allowed for a conservative and less invasive approach in the management of this particular complication.
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              Intracameral 2.3% sodium hyaluronate to treat postoperative hypotony in patients with glaucoma.

              To evaluate the intracameral use of Healon5 (2.3% sodium hyaluronate) (Advanced Medical Optics, Santa Ana, CA) in patients with hypotony.
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                Author and article information

                Journal
                COP
                COP
                10.1159/issn.1663-2699
                Case Reports in Ophthalmology
                S. Karger AG
                1663-2699
                2020
                May – August 2020
                03 July 2020
                : 11
                : 2
                : 263-267
                Affiliations
                aUniversity of Florida College of Medicine, Gainesville, Florida, USA
                bDepartment of Ophthalmology, University of Florida, Gainesville, Florida, USA
                Author notes
                *Charles Richard Blake, Department of Ophthalmology, University of Florida, 2000 SW Archer Road, Gainesville, FL 32610 (USA), crichardblake@ufl.edu
                Article
                508604 Case Rep Ophthalmol 2020;11:263–267
                10.1159/000508604
                7383178
                © 2020 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC). Usage and distribution for commercial purposes requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Pages: 5
                Categories
                Case Report

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