The patient had a routine examination by his pediatric ophthalmologist 2 days prior. At the time, red reflex and retinoscopy streak in his right eye was noted to be clear, but the examination was lengthy and difficult and attempts at a slit-lamp examination were unsuccessful. He presented to the http://www.selleckchem.com/products/epz-5676.html emergency room the next day complaining of severe pain behind the right eye with no obvious eyelid swelling. Examination was limited since he was unwilling to open the eye, and he was referred to the ophthalmology clinic the next day. The parents denied a history of the patient rubbing his eye. The family was of Turkish descent, and the patient��s paternal and maternal grandfathers were distant relatives. The patient��s Inhibitors,Modulators,Libraries older sister had also been diagnosed with congenital glaucoma and had received extensive treatment.
Genetic testing found the patient Inhibitors,Modulators,Libraries to be autosomal recessive for the Cyp1B1 gene, which has been mapped to the 2p21 region and linked with primary congenital glaucoma.1 The patient Inhibitors,Modulators,Libraries had an extensive ophthalmic history, having been diagnosed with congenital glaucoma at birth and having undergone multiple bilateral trabeculectomies since 4 weeks of life. His left eye suffered from unresolved corneal haze since birth and was assumed to have no visual potential. Aggressive treatment in order to preserve vision in his right eye included a goniotomy in December 2008, the insertion of an Ahmed valve aqueous shunt (FP7, New World Medical Inc, Rancho Cucamonga, CA) in September 2010, and, most recently, a trimming of the tube (which was touching the cornea) via two corneal incisions in December 2010.
The tube was last noted to be in normal position in the anterior chamber during a follow-up visit at the end of February 2011, Inhibitors,Modulators,Libraries 11 weeks before presenting to our clinic. Blood cultures were drawn and an examination under anesthesia was performed with a vitreal tap and intravitreal injection of vancomycin, ceftazidime, and dexamethasone as well as injection of gentamicin subconjunctivally. The upper lid was found to be swollen and tense with an intact but chemotic and hyperemic conjunctiva superotemporally. The cornea was diffusely hazy and a hypopyon was present, clouding the entire anterior chamber. Two corneal 10-0 nylon sutures were removed, and the corneal incisions were intact; no leak was evident via the cornea or conjunctiva. There was no view of the lens or fundus. B-scan ultrasonography showed some Inhibitors,Modulators,Libraries vitreous debris with a flat retina (Figure 1A). An attempt was made to find the Ahmed valve via an anterior surgical approach using a large superotemporal peritomy, but neither the tube/reservoir complex nor the scleral patch graft could be located. Cultures were sent from the conjunctival discharge, Brefeldin_A the vitreous tap, and the sutures.