Transmuscular migration of 240 silicone encircling band.
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Adult↗
Biomedical subjects
E H Bovey
Publications and source records attributed to E H Bovey.
Vitrectomy in the management of uveitis.
OBJECTIVE: To review the indications for vitrectomy in uveitis cases. PATIENTS AND METHODS: Charts of patients seen at the uveitis clinic of the Jules Gonin Eye Hospital from January 1993 to August 1998 and who had undergone vitrectomy were reviewed. Patients with infectious uveitis occurring within three months after intraocular cataract surgery were excluded. The types of uveitis were recorded and indications for vitrectomy were analyzed. RESULTS: A total of 630 patients were examined at the uveitis clinic. Fifty-one of these patients (51 eyes, 8.1%) were referred for vitrectomy and were included in this study. Vitrectomy was performed for three reasons: 1) to treat the complications of uveitis (90%), including vitreous opacification in 35 eyes (69%), retinal detachment in seven eyes (14%), epimacular membrane in seven eyes (14%), and dense opacification of the posterior capsule after cataract surgery in six eyes (12%)(the mean delay between uveitis and vitrectomy in this group was 8.4 years); 2) for diagnostic purposes in 19 eyes (37%); and 3) to remove confined infectious foci in 16 eyes (31%) and allow a thorough intraocular distribution of antibiotics. Visual acuity improved in 41 patients (80.4%), remained unchanged in three (5.8%), and decreased in seven (13.7%) because of secondary or persistent retinal detachment or cystoid macular edema. CONCLUSION: Vitrectomy was indicated to treat the complications of uveitis, to provide vitreous for diagnostic purposes, and to allow a better diffusion of intraocular antibiotics. Long-standing uveitis did not seem to be influenced by vitrectomy.
Adolescent↗
Rhegmatogenous retinal detachment after treatment of retinoblastoma.
PURPOSE: To determine the rate of retinal detachment after treatment of retinoblastoma, to describe the clinical features and management, and to discuss possible pathogenic mechanisms. METHODS: We retrospectively analyzed the charts of 80 patients (83 eyes) with retinoblastoma treated conservatively between 1963 and 1994, looking specifically for cases that developed a retinal detachment after treatment. RESULTS: Five patients (5 eyes, stages IVa to Vb) developed a retinal detachment after treatment. Of these, four had undergone external radiotherapy and one had an episcleral cobalt plaque. Retinal detachment developed within three months after radiotherapy and relentlessly progressed in all four eyes over a period of five months to four years. In the eye that received the episcleral cobalt plaque, the detachment remained localized inferiorly. Even though no retinal break could be detected in four eyes, the clinical features were suggestive of a rhegmatogenous detachment: there was retinal thinning adjacent to the regressed tumors, and the evolution was much longer than that of an exudative retinal detachment. A scleral buckling procedure was performed in two eyes and the retina was successfully reattached. The retinal detachment was not operated on in the three other eyes: the hole was too posterior in one eye; retinal surgery was refused in the second eye; and the retinal detachment remained localized inferiorly in the third eye. CONCLUSION: A retinal detachment developed in 6% of eyes after conservative treatment of retinoblastoma. The possibility of a rhegmatogenous origin should be considered even if no retinal break is detected. In the absence of tumor activity, a scleral buckling repair could be carefully considered if the retinal detachment threatens the macula, and if its evolution is not indicative of an exudative detachment.
Child, Preschool↗
Transscleral diathermy: an additional tool in the management of retinal detachment due to posterior breaks in highly myopic eyes.
PURPOSE: To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. METHODS: We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). RESULTS: After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. CONCLUSIONS: In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.
Adult↗
[Surgical treatment of retinal detachment in pseudophakia: comparison between vitrectomy and scleral buckling].
OBJECTIVE: For the primary treatment of pseudophakic retinal detachment, vitrectomy could be preferred to episcleral buckle because it does not induce myopia, it clears opacities of the posterior capsule and/or of the vitreous and allows a good visualization of the fundus. This study was determined to compare the anatomic and functional results of vitrectomy and episcleral buckle. METHODS: from 1990 to 1995, 93 pseudophakic eyes were operated on for retinal detachment. 75 eyes were treated with episcleral buckle (group I) and 18 eyes were treated with vitrectomy (group II). In the latter group, 4 eyes had a giant tear, and 4 other eyes had a macular hole associated with high myopia. The anatomic and functional results were analyzed retrospectively. RESULTS: The retina was reattached with one operation in 67 eyes of group I (89%) and 16 of group II (89%). More than one month after the first operation, the retina redetached in 6 eyes of Group I (8%) and one eye of group II (6%). The causes of failure were a) new or missed retinal tears [Group I: 10 eyes (13%), group II: 3 eyes (17%)] and b) vitreoretinal proliferation (group I: 4 eyes, group II: 0). The number of subsequent reoperations for failures or recurrences was higher in group I than in group II. At the final examination, the retina was attached in 73 eyes of group I (97%) and in 18 eyes of group II (100%). The Kruskal-Wallis test did not detect any difference between the two groups concerning the pre- or postoperative visual acuities. CONCLUSION: Vitrectomy seems as effective as episcleral buckle for the treatment of pseudophakic retinal detachment and offers additional advantages.
Adolescent↗
[Laser treatment of macular holes].
OBJECTIVE: To study a new technic of laser treatment of macular holes. METHODS: 21 eyes with stage II-IV macular hole were treated with Argon-green laser. Pigment epithelium in the area of the hole was whitened with spots of 100-200 microns, 100-300 mW. We expected this treatment to create a cellular proliferation that could close and contract the hole. Follow-up after treatment ranged from 3 to 24 months (mean: 9.3 months). RESULTS: Within one month after treatment, the macular hole was closed in 7 eyes (33%) and partially closed in 5 eyes (24%). The visual acuity increased from 1 to 5 lignes (ETDRS chart) in 9 eyes (43%), it remained the same in 9 eyes (43%) and decreased from 1 to 2 lignes in 3 eyes (14%). CONCLUSION: Laser treatment of macular holes seems to be effective and could be proposed as an alternative to the patients who cannot be operated on by vitrectomy and gas tamponade.
Adult↗
[Principal vitreo-retinal disorders treated with vitrectomy].
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Diabetic Retinopathy↗
A new device for noncontact wide-angle viewing of the fundus during vitrectomy.
Noncontact wide-angle viewing of the fundus during vitrectomy has heretofore relied on an image inverter and a 90-diopter lens fixed with a tube under the microscope. A new device in which the 90-diopter lens is not connected to the microscope but, rather, is connected to an independent support system is described. This device offers many advantages: (1) focusing on the various parts of the eye during vitreous surgery need not be done manually but is achieved by the up or down movement of the microscope, (2) translation of the microscope is easier during tilting of the eye, (3) a lateral slit-lamp can be easily added for illumination of the fundus, and (4) there is no risk that the 90-diopter lens will touch the cornea.
Equipment Design↗
[Retinal detachment and laser drainage].
OBJECTIVE: To compare laser and 30G needle perforation of the choroid for drainage of subretinal fluid. METHOD: Hundred and six cases of retinal detachment were operated on by episcleral buckle, retinopexy and external drainage of subretinal fluid. After radial sclerotomy, the choroid was perforated in 53 cases with Argon laser (group I) and in 53 other cases with 30G needle (group II). Complications were compared between both groups. RESULTS: Group I (laser drainage): In one of 53 eyes (1.8%), a retinal perforation occurred. In this eye, the retinal detachment was shallow. In an other eye (1.8%), retinal perforation occurred secondary to incarceration of the retina at the drainage site. Two eyes (3.6%) had limited hemorrhage at the drainage site. Group II (30G needle drainage): Three of 53 eyes (3.6%) had direct retinal perforation, and three (3.6%) had perforation secondary to retinal incarceration at the drainage site. Seven eyes (13.2%) had subretinal hemorrhage. CONCLUSION: Laser is safer than 30G needle for perforation of the choroid and drainage of subretinal fluid, and is associated with a lower incidence of retinal perforations and subretinal hemorrhages.
Adolescent↗
Retinotomies of 180 degrees or more.
PURPOSE: To investigate the anatomic and functional results of large retinotomies. METHODS: The charts of 33 consecutive patients who underwent peripheral retinotomy of 180 degrees or more and silicone oil injection during vitrectomy for retinal detachment with proliferative vitreoretinopathy were reviewed. Silicone oil was removed from 26 eyes (79%), but 2 hypotonic eyes (6%) required reinjection of silicone. RESULTS: After a minimum follow-up of 6 months, the retina was completely attached in 28 eyes (85%). Twenty-eight eyes (85%) achieved a final visual acuity of 5/200 or better, and seventeen eyes (51%) achieved visual acuity of 20/200 or better. Intraocular pressure did not change significantly from the initial to the final examination. At the last follow-up, hypotony (intraocular pressure < or = 5 mmHg) was seen in 1 of the 28 eyes with reattached retina (3.6%). A new macular epiretinal membrane, related to the duration of silicone oil tamponade, developed and was peeled off in 12 eyes (36%) in an additional procedure. No association could be found between the anatomic or functional results and the extent of the retinotomy. Presented herein is the largest series of retinotomies of 180 degrees or more followed up after silicone oil removal. CONCLUSION: Large retinotomy (> or = 180 degrees) in selected cases of vitreoretinal surgery seems to be an effective procedure.
Adolescent↗
[Prospective study of 163 retinal detachments operated by episcleral technique (preoperative examination)].
The predominance of retinal breaks in the superior temporal quadrant is well known. This predominance was found to be related to age and refraction (p < 0.01). The distribution of breaks plotted across the 12 meridians shows a predilection for the superior temporal quadrant and half of the inferior temporal and superior nasal one. However, in this area the distribution is irregular (p >> 0.001) with a predominance in the 10-11 and 12-1 o'clock section (if we consider the right eye). The H/T ratio (holes/tears for each case) is positive for patients under 40 years of age and becomes negative after 50 years.
Adolescent↗
[Pars plana vitrectomy in uveitis].
A vitrectomy was performed in 30 eyes suffering from different forms of uveitis. An improvement of visual acuity was obtained in 29 cases and was explained by removal of vitreous haze and/or of the cataract, but not by the improvement of the inflammatory process.
Adolescent↗
[Value of the ophthalmologic examination in diagnosing patients with Anderson-Fabry disease and in heterozygote detection].
A 45-year-old man with Fabry's disease is presented. 27 relatives are examined. Among the different examinations (serum activity of alpha-galactosidase, urinary excretion of trihexosyl ceramide, renal function, ocular examination) ocular examination remains the easiest and cheapest test for detection of heterozygotes. The ocular manifestations of this enzymatic defect are reviewed.
Corneal Opacity↗
Autosomal dominant ichthyosis and X-linked ichthyosis. Comparison of their clinical and histological phenotypes.
The clinical and histologic distinction between X-linked recessive and autosomal dominant ichthyosis was studied by evaluating 12 classical differential parameters in 85 patients. Thirty-three of them had X-linked and 52 autosomal dominant ichthyosis. Eight of these parameters were generally helpful in the differential diagnosis: age of onset, severity of involvement, scale size, chapping of hands and feet, atopic background, influence of warm weather, corneal opacities and state of the granular layer. Involvement of skin folds, keratosis pilaris, increased palmo-plantar markings and improvement with age were unreliable. In the literature, age of onset and corneal opacities were additionally found unreliable; the histology was of limited value in two reports. Therefore, we concluded that the herein evaluated differential criteria seem to be valid mainly when considering groups of patients. For the individual case, an error in diagnosis, particularly in X-linked ichthyosis, is not rare when relying solely on these criteria. When in doubt, determination of steroid sulphatase activity is mandatory.
Adolescent↗
Can AZT treatment in AIDS patients aggravate pre-existing CMV retinitis?
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Acquired Immunodeficiency Syndrome↗
Visual acuity after vitrectomy and epiretinal membrane peeling with or without premacular indocyanine green injection.
PURPOSE: To compare postoperative visual acuity of eyes operated for an epiretinal membrane (ERM), with or without intraoperative intraocular indocyanine green (ICG) injection. METHODS: Retrospective study of 75 pseudophakic eyes with epiretinal membrane operated by vitrectomy-peeling. In 20 cases operated in 2001 and 2002 (Group 1), ICG diluted in 5% glucose solution was injected intraoperatively into the vitreous. In another group of 55 cases operated between 1996 and 1999 (Group 2), ICG was not used. RESULTS: The mean visual acuity was 0.32(+1) and 0.32(+2) preoperatively, 0.4(+2) and 0.5 at 1 month, and 0.63 and 0.63(+2) on the final examination in Groups 1 and 2, respectively. Visual acuities were not significantly different between the two groups. CONCLUSIONS: Premacular injection of ICG during vitrectomy to facilitate epiretinal membrane peeling did not appear to compromise postoperative improvement of visual acuity. However, its use is questioned since it did not yield better postoperative results and because potential toxic adverse reactions could not be excluded by this study.
Adolescent↗