Biomedical subjects
Publications and source records attributed to F U Huamonte.
Pars plana vitrectomy requiring a two-instrument technique successfully cleared the pupillary axis of dense persistent hyperplastic primary vitreous in a 29-year-old patient. To find PHPV in an adult eye with vision is so unusual that distinguishing it from the ocular sequelae of traumatic injury can be challenging. Hyperplastic primary vitreous persists with a wide variety of clinical features in both anterior and posterior segments of the eye.
We performed 400 consecutive pars plana vitrectomies, using the vitrophage. Most patients (68%) showed some degree of visual improvement; only 8% had a decline in visual acuity postoperatively. The major operative complications were controllable bleeding from iris vessels and intravitreal stalks (19%) and retinal tears (2%). No retinal dialysis was noted. The major, early postoperative complications were related to corneal decompensation in 38% of the cases; this persisted beyond two weeks in only 7%. Increased intraocular pressure occurred in 19% and postoperative rubeosis iridis developed in 10% of the diabetic patients. Complications related to rebleeding occurred in 18% of the diabetic patients within the first two weeks, and an additional 9% had late rebleeding. Less frequent complications included one case of endophthalmitis, late retinal detachment in 5%, and phthisis bulbi in 2% of all cases. All complications were considerably more frequent and severe in the diabetic population.
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To determine the incidence and causes of increased intraocular pressure (IOP) after pars plana vitrectomy with the vitrophage, we studied 118 eyes under-going vitrectomy during a one-year period. Fifty-one (43%) were in diabetic patients; 67 (57%) were in nondiabetics. Of the entire group, 33 (28%) developed a postoperative increase in IOP, which was defined as a rise in IOP of at least 10 mm Hg above the preoperative level by applanation tonometry. Of the diabetic eyes 25 (49%) developed increased IOP; 11 (22%) of these eyes required surgical intervention for control of IOP. Of the nondiabetic eyes eight (12%) developed increased IOP postoperatively; all were either transiently elevated or medically controllable. Postoperative rubeosis iridis occurred only in diabetic eyes.
One hundred consecutive eyes underwent vitrectomy with the disposable vitrophage via a pars plana approach. Eyes were divided into two main categories based on opacity location-in the anterior or posterior segment. Patients with posterior segment opacities had diabetic retinopathy, nondiabetic vitreous hemorrhages, retinal detachments associated with vitreous hemorrhage, bands, or membranes, and intraocular foreign bodies or silicone oil. Patients with anterior segment opacities were treated for pupillary membranes resulting from surgical trauma or perforating injuries, and for complications following cataract extraction, such as capsule breakage and vitreous loss. Postoperatively, visual acuity improved in 68% of eyes with posterior segment opacities and in 85% of eyes with anterior segment opacities. Overall, visual acuity was 20/300 or better in 45% of eyes. There were only two intraoperative retinal tears and one postoperative rhegmatogenous retinal detachment.
A total of 125 consecutive eyes, all registered blind with diabetic vitreous haemorrhage, underwent pars plana vitrectomy with the vitrophage. Sixty-six per cent experienced some improvement in their visual acuity; 24 per cent were unchanged and 10 per cent were worse postoperatively. The major surgical complication was controllable haemorrhage (23 per cent). No retinal dialysis occurred. Significant postoperative complications were transient (71 per cent) and persistent (11 per cent) corneal oedema, early (8 per cent) and late (13 per cent) vitreous haemorrhage, transient (30 per cent) and persistent (6 per cent) rise in intraocular pressure, and rubeosis iridis (5 per cent).
Fifty diabetics with severe background retinopathy or early proliferative retinopathy underwent retinal scatter photocoagulation with either the argon laser or the xenon arc photocoagulators. Choroidal detachment, exudative retinal detachment, shallowing of the anterior chamber, and secondary angle-closure glaucoma were observed. Exudative retinal detachment and choroidal detachment subsided in two days to 2-1/2 weeks. Glaucoma secondary to choroidal detachment with angle closure was observed in 11 eyes, three of which required medical treatment, although surgical therapy was not needed. This secondary glaucoma was detected in the first two days and subsided in subsequent days, with intraocular pressure reaching pretreatment values at the fifth day. No long-term sequelae were observed in these complications, except in one eye that developed macular edema that lasted for four months with decreased visual acuity; nevertheless, vision returned to the pretreatment level one year after photocoagulation.
Vitreous scissors with bent blades and forceps of larger than usual dimension were developed for removal of inflexible membranes and intraocular foreign bodies.
Vitreous involvement as a result of penetrating trauma complicates and worsens the prognosis in retinal detachment repair. Seven patients in whom poor visualization of the fundus seemed to preclude success by routine procedures underwent combined vitrectomy, scleral buckling, release of subretinal fluid, and intravitreal gas injection. The retina was successfully reattached in five of the seven patients, although postoperative visual acuity was limited - possible on account of the duration of retinal detachment prior to repair or because of the degree of macular involvement.
Twenty-one patients suffering from vitreous opacities caused by central- and branch-vein occlusion, sickle cell retinopathy, retinal vasculitis, endophthalmitis, hypertensive retinopathy, and uveitis underwent pars plana vitrectomy with the vitrophage. Intraoperative complications included retinal tears in two eyes with sickle cell retinopathy and tractional retinal detachment. Both were successfully treated. Postoperative complications were recurrent vitreous hemorrhage, hemolytic glaucoma, and corneal blood staining in a patient suffering from sickle cell retinopathy. Long-standing corneal edema was observed in patients suffering from endophthalmitis. Visual acuity improved in 95% of our patients and was worse in 5% of the patients.