An illuminated blade for vitreoretinal membrane dissection.
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Dissection↗
Biomedical subjects
G W Abrams
Publications and source records attributed to G W Abrams.
Stability of recombinant tissue plasminogen activator.
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Drug Stability↗
Illuminated retinal picks for vitreous surgery.
We developed a new illuminated disposable retinal pick system for use in vitreoretinal surgery. These instruments facilitate bimanual dissection of proliferative tissue while allowing ocular endoillumination. We have found these instruments to be helpful in the management of complicated retinal detachment due to proliferative diabetic retinopathy or proliferative vitreoretinopathy.
Disposable Equipment↗
Ab interno sclerostomy with a high-powered argon endolaser. Clinicopathologic correlation.
A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a patient undergoing enucleation for a blind painful eye. Despite the presence of diffuse rubeosis, 360 degrees peripheral anterior synechiae, and superior conjunctival scarring, it was possible to create a full-thickness defect from the anterior chamber angle to the subconjunctival space without operative complications. Six laser applications were required using 8 W of power per pulse and 0.1-second pulse duration. The eye was enucleated immediately after the laser procedure, prepared for light microscopy, and sectioned serially. Histologic analysis demonstrated a patent fistula approximately 300 microns in diameter with sharp wound margins. Tissue damage was localized to within 150 microns of the sclerostomy. The overlying conjunctiva was intact.
Adult↗
Subretinal membranes in proliferative vitreoretinopathy.
Subretinal membranes (SRMs) are an important but rarely identified component of proliferative vitreoretinopathy (PRV). In 153 consecutive cases that had vitreoretinal surgery for this condition and were followed for at least 6 months, SRMs were encountered in 72 eyes (47%). In 20 (28%) of the 72 eyes, the SRMs prevented complete retinal reattachment and needed to be removed or excised through one or multiple retinotomies. Intraoperative complications related to the SRMs or their removal included choroidal or retinal hemorrhage in three eyes (15%), subretinal air in three eyes (15%), and unplanned extension of the retinotomies in two eyes (10%). The 20 eyes requiring SRMs removal were followed for a median of 11 months. Retinas were reattached in 13 eyes (65%), although only 4 eyes (20%) had a visual acuity of 5/200 or better. Recognizing SRMs as a component of PVR is important in helping to maximize the anatomic success rate although the effects on visual function are not fully known.
Adult↗
Results of vitrectomy for diabetic traction retinal detachments using the en bloc excision technique.
En bloc excision is a technique in which fibrovascular diabetic membranes and the posterior hyaloid are separated from the retina as a single unit. In a consecutive series of 69 eyes with diabetic traction retinal detachment treated with this technique, initial retinal reattachment was accomplished in 100% (69/69) of the eyes. With a minimum of 6 months' follow-up, the retina remained completely attached in 83% (57/69) of eyes, while the macula was attached in 88% (61/69) of eyes. Final visual acuity was 5/200 or better in 71% (49/69) of eyes. While current surgical techniques allow a high rate of anatomic success in the repair of diabetic traction retinal detachment, visual results remain limited by irreversible alterations in retinal function.
Adolescent↗
Complications of endodrainage retinotomies created during vitreous surgery for complicated retinal detachment.
The authors report nine cases of endodrainage retinotomy site complications that occurred after vitreous surgery for complicated retinal detachments (RDs). Postoperative subretinal neovascularization developed in four eyes at the retinotomy drainage site. In two eyes, postoperative proliferation at a posteriorly placed endodrainage site created traction macular detachments. Redetachment due to retinotomy opening caused by postoperative drainage site proliferation developed in three eyes. The retinas of all nine eyes were eventually reattached, and vision improved from the preoperative level. These complications are related to retinal pigment epithelium and/or Bruch's membrane damage during internal subretinal fluid drainage and retinotomy endolaser photocoagulation. Careful evaluation of extrusion instruments, drainage techniques, retinotomy placement, and subsequent endolaser treatment is necessary to minimize these complications.
Adolescent↗
Vitrectomy for traumatic retinal incarceration.
Traumatic retinal incarceration into a scleral wound may prevent successful surgical rehabilitation of eyes with severe posterior segment injury. We managed 15 consecutive eyes with traumatic retinal incarceration and associated retinal detachment with vitrectomy techniques. We based our approach on the anteroposterior location of the incarceration site and the amount of retina incarcerated into the wound. Despite successful anatomic reattachment in six of seven eyes with retinal incarceration posterior to the vortex vein ampullae, only two of seven eyes achieved visual acuity of 5/200 or better. In eyes with more peripheral retinal incarceration, anatomic reattachment was achieved in five of eight eyes and visual acuity of 5/200 or better was achieved in four eyes. Overall, a visual acuity of 5/200 or better was achieved in six (40%) of 15 eyes with a minimum follow-up of six months.
Adolescent↗
Surgical excision of the attached posterior hyaloid.
When vitrectomy is performed in eyes without posterior vitreous detachment, complete removal of the posterior hyaloid may be important to relieve existing vitreoretinal traction or to remove a surface for subsequent cellular proliferation. We used two alternative techniques of detaching the posterior hyaloid in an unselected consecutive series of ten patients; we used either a tapered extrusion needle or a microvitreoretinal blade to initiate separation of the posterior hyaloid at the optic disc margin. After surgical peeling of the posterior hyaloid from the retina, complete removal of the posterior vitreous and surgical relief of posterior vitreoretinal traction were facilitated.
Dissection↗
Treatment of postvitrectomy fibrin formation with intraocular tissue plasminogen activator.
Twenty-five micrograms of human recombinant tissue plasminogen activator (tPA) was injected intracamerally into the eyes of three aphakic patients who developed severe intraocular fibrin formation within 24 hours after vitrectomy surgery. Fluid obtained from gas-fluid exchange specimens taken 24 hours after tPA injection was analyzed for tPA by an enzyme-linked immunosorbent assay and a spectrophotometric solid-phase fibrin assay. In each of the three patients, complete fibrin resolution occurred within four hours after the tPA injection. There were no complications associated with the intraocular tPA injections. There was measurable tPA activity 24 hours after the initial injection ranging from 0.23 to 1.4 micrograms. In contrast, tPA was undetectable in gas-fluid exchange specimens obtained from seven patients who did not receive intraocular tPA injections. Intraocular tPA is an effective means of treating postvitrectomy fibrin formation in selected aphakic patients.
Adolescent↗
Results and prognostic factors in penetrating ocular injuries with retained intraocular foreign bodies.
Of 105 eyes with ocular injuries involving retained intraocular foreign bodies, 63 (60%) had a final visual acuity of 20/40 or better; 20 (19%) were 20/50 to 5/200; and 15 (14%) were worse than 5/200. Six eyes (6%) were enucleated. The extent of visual recovery was limited in selected cases by the characteristics of the initial injury. Multivariate analysis was used to identify prognostic factors. Predictive of a good visual outcome (greater than or equal to 20/40) were: (1) initial visual acuity better than 20/40 and (2) the need for only one or two operations in the treatment of the injury. Predictive of a poor visual outcome (less than 5/200) were: (1) initial visual acuity worse than 5/200 and (2) a wound 4 mm or longer in length, independent of wound location. The visual outcome in this series of patients was compared with other large series of intraocular foreign bodies reported before the development of vitreous microsurgical techniques. The percentage of patients with a visual outcome of 20/40 or better has remained the same, whereas the incidence of enucleation has diminished.
Adolescent↗
Perisilicone proliferation after vitrectomy for proliferative vitreoretinopathy.
From 1983 to 1986, silicone oil injections were used to treat 31 patients with retinal detachment (RD) and advanced proliferative vitreoretinopathy (PVR). In 19 eyes (61%), perisilicone proliferation (PSP) developed causing recurrent RDs in 15 eyes (49%). At an average of 5 weeks after surgery, PSP occurred and was characterized by extensive transparent preretinal membranes with denser focal areas. Microscopic examination of five preretinal membranes showed droplets of silicone oil and necrotic cells on the silicone side and glial or retinal pigment epithelial cells, or both, on the retinal side, often in layers separated by extracellular matrix. Silicone oil was present in periretinal membranes removed several months after the intraocular silicone had been evacuated indicating that silicone within cells may persist despite the removal of silicone. The use of silicone oil to provide tamponade in eyes with recurrent PVR is associated with a high incidence of periretinal proliferation that frequently leads to recurrent RD and visual failure.
Adolescent↗
Regression of disc neovascularization by photocoagulation in the acute retinal necrosis syndrome.
Disc neovascularization developed in one eye of a 40-year-old white woman with the acute retinal necrosis syndrome. Krypton laser scatter photocoagulation was placed in areas of nonnecrotic and segmentally nonperfused retina that were demonstrated by fluorescein angiography. Marked reduction in disc neovascularization was noted clinically 16 days after laser treatment and was confirmed angiographically 4 weeks after treatment. Neovascularization was completely regressed at 9 weeks after treatment. The authors postulate that the retinal vasculitis and nonperfusion produced retinal ischemia which stimulated neovascular proliferation, and that photocoagulation caused regression of the neovascularization.
Adult↗
Anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy.
Vitrectomy was performed to treat 74 consecutive eyes for complications of diabetic retinopathy. Eight (13%) of 61 eyes followed up for an average of 12 months developed anterior hyaloidal fibrovascular proliferation. This was the most common postoperative complication, whose features included recurrent hemorrhages into the vitreous cavity or anterior vitreous, or both; vessels or fibrovascular tissue on the posterior lens capsule; anterior extraretinal vascularization extending toward the lens on the anterior hyaloid; traction detachment of the peripheral retina or ciliary body; and hypotony. Patients who developed this complication tended to be young males with severe retinal neovascularization and extensive retinal ischemia; traction retinal detachment as an indication for surgery; placement of a scleral buckle; postoperative rubeosis iridis, recurrent vitreous hemorrhages, and retinal detachment; and multiple surgeries. Four eyes progressed to atrophia bulbi. Early recognition followed by additional surgery in two patients and extensive additional photocoagulation in two other patients was successful in preserving good visual function.
Adult↗
Clinicopathologic findings in anterior hyaloidal fibrovascular proliferation after diabetic vitrectomy.
Two young patients (27 and 30 years old, respectively) with long-standing diabetes mellitus underwent vitreoretinal surgery for traction retinal detachment and vitreous hemorrhage. The postoperative course in each was characterized by early recurrence of the hemorrhage into the vitreous cavity, hypotony, and severe visual loss. Histopathologic examination of both operated on eyes showed anterior extraretinal fibrovascular proliferation extending along the anterior hyaloid to the posterior lens surface, causing traction detachments of the peripheral retina and ciliary body. The vessels originated from the anterior retina. There was no evidence of excess fibrous tissue at the well-healed sclerotomy wounds.
Adult↗
Evulsion of the retina associated with optic nerve evulsion.
We examined two patients with optic nerve evulsion as well as nasal peripapillary retinal and retinal pigment epithelial evulsion after ocular trauma. Fluorescein angiography demonstrated an intact peripapillary choriocapillaris, loss of peripapillary retina and retinal pigment epithelium, and complete disruption of retinal perfusion. We have postulated a mechanism for traumatic peripapillary retinal evulsion involving severe anterior displacement and abduction of the globe that may explain how the disruptive force was transmitted to the nasal retinal nerve fiber layer. We have provided a clinical correlation with magnetic resonance imaging of the optic nerve and globe of a normal individual.
Adult↗
"En bloc" excision of diabetic membranes.
We treated 16 eyes with diabetic tractional retinal detachment with a new method of surgical dissection whereby diabetic preretinal membranes and adherent posterior hyaloid were excised and removed as a single unit. This method differs from previously reported methods of diabetic membrane dissection by utilizing the posterior hyaloid to lift and immobilize the membrane as the membrane is excised with horizontally cutting scissors. The preservation of the posterior hyaloid facilitates the separation of the membrane from the retina. Fibrovascular proliferation was more completely removed and bleeding was less than with membrane sectioning techniques. The major surgical complication was posterior retinal break (seven eyes), but with near complete relief of traction all breaks were successfully treated with gas tamponade and laser photocoagulation. Thirteen retinas were completely reattached with a minimum follow-up of four months. One eye developed an extramacular tractional retinal detachment, and two eyes developed peripheral (retrolenticular) fibrovascular proliferation. Eleven eyes had 5/200 or better visual acuity.
Cryosurgery↗
Vitreoretinal photography using the 90-diopter lens.
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Fundus Oculi↗