Biomedical subjects
Publications and source records attributed to C M Millsap.
A technique of performing a relaxing retinotomy under the perfluorocarbon liquid perfluoroperhydropenanthrene (Vitreon, Vitrophage, Inc., Lyons, IL) is described. This procedure allows perfluorocarbon liquid to be used to maintain the retina in the desired position and to dissect proliferative membranes prior to the retinotomy without having to remove the Vitreon to perform the retinotomy.
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Retinopathy of prematurity with retinal detachment continues to present a challenge to the vitreoretinal surgeon despite many advances in technique. We report on two eyes with stage 4 and 5 ROP operated on using vitrectomy techniques and a perfluorocarbon liquid (Vitreon). The surgical technique is described in detail.
A total of 140 consecutive patients underwent repair of retinal detachment associated with grade C2 to D3 proliferative vitreoretinopathy with perfluoroperhydrophenanthrene (Vitreon) as an intraoperative hydrokinetic tool. In seven patients the Vitreon was left in the eye for extended tamponade. Intraoperative reattachment was obtained in 98% of patients. At the final follow-up examination (mean 7 months) 84% of retinas remained attached, and 92% of patients had stable or improved visual acuity. Vitreon was found to be safe and effective in the repair of complicated retinal detachments. No complications were directly related to Vitreon when used intraoperatively or when left in the eye for extended tamponade.
We describe a series of 28 patients in whom a posteriorly dislocated crystalline or intraocular lens was successfully removed with the intraoperative use of perfluoroperhydrophenanthrene (Vitreon), a heavy liquid perfluorocarbon. The Vitreon was used to float the lens into the midvitreous cavity, thereby avoiding hazardous micromanipulation with intraocular instruments in the macular area. In addition, the Vitreon served to protect the posterior retina by keeping the posteriorly dislocated lens fragments from falling backward onto the posterior pole as the lens was being removed from the eye. Postoperative visual acuity improved in 73% of the patients, remained the same in 15%, and worsened in 12%.
Forty-one eyes underwent surgery for complex vitreoretinal disease, with perfluoroperhydrophenanthrene (Vitreon) used as an intraoperative tool and postoperative vitreous substitute. Postoperative use of Vitreon ranged from 3 days to 9 weeks (mean, 3.3 weeks). All retinas were reattached intraoperatively; 73% remained attached after the initial surgery. The final macular attachment rate was 100% after additional surgery. Four eyes that received a combination of Vitreon and silicone oil for simultaneous superior and inferior tamponade were successfully reattached after the initial procedure. Visual acuity improved or remained stable in 80% of the eyes. No toxic effects directly attributable to Vitreon were observed. Mean follow up was 9 months.
Fifty cases of retinal detachment with a giant retinal tear were managed using perfluoroperhydrophenanthrene (Vitreon) as an intraoperative and postoperative tool. The giant tear was less than 180 degrees in 76% of the eyes, greater than 180 degrees in 22%, and greater than 270 degrees in 2%. Proliferative vitreoretinopathy was present in 40%. Vitreon was used only intraoperatively in 84% of the eyes, and was left in 16% for up to 4 weeks. Intraoperative retinal reattachment was achieved in 98%. Retinal attachment was maintained in 88%, with a mean follow up of 8.6 months. Postoperative visual acuity was better than 20/400 in 52%. Postoperative complications included cataract in 23%, choroidal effusion in 2%, hypotony in 4%, and recurrent retinal detachment with proliferative vitreoretinopathy in 26%.
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Our patient had uncommon features of conjunctival lymphoid infiltrates, including patient age, bilaterality, and lesion location. We describe his case and discuss the prognosis based on a literature review.
We report posterior segment complications encountered with the use of the liquid perfluorocarbon, perfluoroperhydrophenanthrene (Vitreon) as an intraoperative adjunct to vitreoretinal surgery in 640 patients participating in the Vitreon Collaborative Study. We also evaluated postoperative complications in 60 patients in whom Viteron was intentionally left inside the vitreous cavity for periods ranging from 5 days to 4 weeks as a short-term retinal tamponade. The five most common postoperative complications among these patients as a whole were recurrent retinal detachment, with or without proliferative vitreoretinopathy (11.28%); macular pucker (5.85%); fibrinous reaction (4%); residual Vitreon (3.85%); and vitreous hemorrhage (2.57%).
Perfluoroperhydrophenanthrene (Vitreon) was used as an intraoperative hydrokinetic retinal manipulator, followed by C3F8 or SF6 gases, silicone oil, or Vitreon as postoperative tamponading agents in 234 eyes. Two chronic intraoperative pressure abnormalities were defined: hypotony (5 mm Hg or less) and elevated intraocular pressure (IOP) (25 mm Hg or more at three or more postoperative visits). Postoperatively, 28 eyes (12%) had chronically elevated IOP, and 41 (18%) had chronic hypotony. There was no significant difference in the incidence of abnormal IOP among the groups of eyes in which the various tamponading agents had been used. In particular, the use of Vitreon as an intraoperative tool or as a short-term tamponade did not affect the incidence of chronic abnormal IOP any more than did the use of silicone oil, C3F8, or SF6 as tamponading agents.
We report a case of subretinal hemorrhage associated with age-related macular degeneration, in which tissue plasminogen activating factor was used to help remove the subretinal blood. The surgical technique involved using multiple small retinotomy sites and alternating suction and backflushing to produce fluid flow from the subretinal space to the vitreous cavity.
We describe two cases in which a new retinotomy technique is used to remove subretinal neovascular membranes. The direction and location of the retinotomy are of ultimate importance in prevention of damage to retinal nerve fibers and the corresponding visual field loss. The retinotomy is made with an angled 20-gauge needle in nondiathermized retina. The direction of the retinotomy is parallel to the nerve fiber layer and located over the subretinal neovascular membrane. No laser retinopexy was necessary after removal of the subretinal neovascular membrane.