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J Roider

Publications and source records attributed to J Roider.

At least 19 recordsLinked to original sources
PubMed2007

[Comparison of ILM peeling with and without the use of indocyanine green. Functional results for idiopathic macular hole after pars plana vitrectomy].

BACKGROUND: Pars plana vitrectomy with internal limiting membrane (ILM) peeling is the best known therapy for idiopathic macular holes. Indocyanine green (ICG) is useful for staining the ILM, although there is a dose related toxic effect on the inner retinal layers. We compared outcome results with and without the use of ICG. METHOD: Data from 61 patients with idiopathic macular holes, who underwent macular hole surgery were analyzed retrospectively. ICG was used on 36 eyes while for 25 eyes it was not used. After calculating logMAR, differences in visual acuity between both groups were analyzed for significance using the Mann-Whitney-U-Test. RESULTS: The logMAR for the entire group was 0.71+/-0.30 (20/100) preoperatively, after 1 month 0.71+/-0.36 (20/100), after 3 months 0.57+/-0.26 (20/80), after 6 months 0.54+/-0.38 (20/66) and after 12 months 0.36+/-0.32 (20/50). There were no significant differences between groups. CONCLUSION: There seem to be no significant differences in the development of visual acuity and the occlusion rate between patients treated with or without the use of ICG.

Aged↗
PubMed2007

Treatment of central retinal vein occlusion by radial optic neurotomy in 107 cases.

BACKGROUND: To evaluate the potential role of radial optic neurotomy (RON), a new surgical technique has been recently proposed for treating central retinal vein occlusion (CRVO). It is hypothesized that CRVO constitutes a neurovascular compartment syndrome at the site of the lamina cribrosa, which can be alleviated by performing a radial incision at the nasal part of the optic nerve head, relaxing the cribriform plate and the adjacent sclera. METHODS: One hundred and seven patients were treated with RON for CRVO at five collaborating ophthalmologic centers. All patients were evaluated by a standardized protocol. For analysis of the angiographic and fundus findings, reference images were used. Intraoperative and postoperative complications were reviewed. RESULTS: On 55 right and 52 left eyes of 107 patients (55.6% male, 44.4% female) with a median age of 68 years (range 21-91 years), RON was performed. The median follow-up time was 6 months (range 1-24 months). The median preoperative visual acuity (VA) was 0.05 (logMAR 1.3), increasing to a median postoperative VA of 0.08 (logMAR 1.1). Patients with an interval of more than 90 days between RON and onset of CRVO showed no significant change in VA at the 6-month follow-up. Severe peripapillary swelling of the optic nerve head prior to RON resulted in an average increase of 4.2 lines in VA at the 6-month follow-up. Angiographic findings of shunt vessels were seen in 18/30 cases after 12 months and were accompanied by an average improvement of VA of six lines. Visual field tests showed various defects in 86.8% of all cases. In one patient an iatrogenic injury of the central retinal artery occurred (0.9%). CONCLUSION: Despite the potential risk of visual field defects, RON seems to be a quite safe procedure. The majority of patients showed rapid normalization of the morphologic fundus findings, with an improvement in VA uncommon for the natural history of CRVO. No significant change in VA was seen in patients with an interval of more than 90 days between the onset of CRVO and RON. A prospective study is warranted for further investigation.

Adult↗
PubMed2006

Detection of Treponema pallidum in the vitreous by PCR.

BACKGROUND: Ocular involvement of syphilis still poses a clinical challenge due to the chameleonic behaviour of the disease. As the serodiagnosis has significant limitations, the direct detection of Treponema pallidum (TP) in the vitreous represents a desirable diagnostic tool. METHODS: Real-time polymerase chain reaction (PCR) for the detection of TP was applied in diagnostic vitrectomies of two patients with acute chorioretinitis. Qualitative verification of TP by real-time PCR and melting point analysis according to a modified protocol was ruled out. Patients underwent complete ophthalmological examination with fundus photographs, fluorescein angiography, serological examination, antibiotic treatment and follow-up. RESULTS: In two cases of acute chorioretinitis of unknown origin, real-time PCR of vitreous specimens of both patients provided evidence of TP and was 100% specific. Initial diagnosis of presumed viral retinitis was ruled out by PCR of vitreous specimen. Patients were treated with systemic antibiotics and showed prompt improvement in visual function and resolution of fundus lesions. CONCLUSIONS: With real-time PCR, detection of TP in the vitreous was possible and delivered a sensitive, quick and inexpensive answer to a disease rather difficult to assess. In cases of acute chorioretinitis, the use of PCR-based assays of vitreous specimens in the diagnostic evaluation of patients is advisable. Although syphilitic chorioretinitis is a rare disease, PCR should include search for TP, as diagnostic dilemmas prolong definitive treatment in a sight-threatening disease.

Adult↗
PubMed2006

[Diagnostics of metamorphopsia in retinal diseases of different origins].

We investigated the ability of preferential hyperacuity perimeter (PHP) and Amsler grid testing to detect metamorphosia in patients with macular hole (MH), central serous retinopathy (CSR), epiretinal membranes (EM), intermediate AMD (iAMD), classic and occult choroidal neovascularization (CNV) due to AMD, and compared the results. A total of 147 patients (n =153 eyes) with classic (35 eyes) and occult (38 eyes) CNV, iAMD (13 eyes), MF (23 eyes), RCS (11 eyes), EM (13 eyes) and control group (20 eyes) were involved. All of these patients underwent corrected visual acuity and eye examinations inclusive of the Amsler grid. The PHP test was performed after pupil dilation. In all patients, fundus photography and optical coherence tomography (OCT) (Humphrey/Zeiss OCT III) were performed. In patients with CNV and CSR a fluorescein angiography was also performed. Metamorphopsia detection rates by Amsler grid and PHP were compared statistically. The sensitivity of PHP vs Amsler grid in detecting metamorphosia was 69% vs 85% in patients with MH, for CSR 64% vs 73%, EM 77% vs 100%, iAMD 85% vs 100%, classic CNV 83% vs 94% and occult CNV 81% vs 71%. The results for patients with occult CNV were significant (P =0.046), using the chi(2)-test. The PHP-test showed high sensitivity for diagnosing CNV. In occult CNV, PHP was superior to the Amsler grid in detecting metamorphopsia. In the other diseases involving the macular (MH, EM, CSR, iAMD), the detection rate and sensitivity of the Amsler grid was superior to PHP.

Adult↗
PubMed2006

[Selective retina therapy in patients with diabetic maculopathy].

Selective Retina Therapy (SRT) is a new laser treatment that selectively targets the retinal pigmen epithelium (RPE). In this study, we treated 39 patients presenting with nonischemic, focal and focal-diffuse diabetic maculopathy with SRT. In the main. the results indicate that SRT had stabilizing effects on visual acuity, angiographic leakage, lipid exudation, and foveal retinal thickness. SRT is safe and is especially useful for treating pathologies that are located close to the fovea, which cannot be treated with conventional argon laser photocoagulation.

Aged↗
PubMed2006

[Selective retina therapy in central serous chorioretinopathy with detachment of the pigmentary epithelium].

BACKGROUND: Selective Retina Therapy (SRT) is a new and innovative laser treatment modality that selectively treats the retinal pigmentary epithelium while sparing the photoreceptors. This therapeutic concept appears to be particularly suitable for treating patients with acute or chronic central serous chorioretinopathy (CSC). We present preliminary results obtained in five patients who had CSC associated with pigmentary epithelium detachment (PED) and serous subretinal fluid (SRF) and who were treated with SRT. METHODS: This case series was made up of five male patients (mean age 47 years) with chronic CSC and SRF resulting from PED. Examinations performed before and at 1 month and 3 months after the treatment were: BCVA, FLA, OCT (Zeiss OCT III). For SRT, confluent treatment of the PED (area of leakage) was carried out using a pulsed frequency-doubled, Q-switched Nd-YLF prototype laser (lambda=527 nm, t= 1.7 s, 100 Hz, energy = 150-250 J). RESULTS: Best corrected visual acuity at baseline was 0.53, while after 4 weeks it was 0.56 and after 12 weeks, 0.5. At baseline leakage was seen at the PED on fluorescein angiography in all patients. After 4 weeks leakage activity was no longer noted on angiography in 4 of 5 patients. OCT at baseline showed SRF at the edge of the PED in all patients, but in 4 of the 5 patients this was no longer detectable after 4 weeks. CONCLUSION: SRT is a safe and effective treatment for patients with CSC in which PED has caused SRF. Not a single case of rip syndrome was observed in this study, even though the PED was treated confluently. Since SRT spares the photoreceptors it is particularly suitable for the treatment of CSC, especially when the origin of leakage is located close to the fovea. The results indicate that SRT leads to reconstruction of the outer blood-retina barrier.

Adult↗
PubMed2006

[Selective retina therapy: methods, technique, and online dosimetry].

Selective retina therapy (SRT) is currently under evaluation, as a new and very subtle laser method, for the treatment of retinal disorders associated with a degradation of the retinal pigmentary epithelium (RPE). SRT makes it possible to selectively effect the RPE, sparing the adjacent neural retina with the photoreceptors and also the choroid below the RPE. In the best case, the therapy leads to regeneration of the RPE and a long-term metabolic increase at the chorio-retinal junction. In contrast to conventional laser photocoagulation, which is associated with complete thermal necrosis of and around the treated site, absolutely no scotoma occurs in SRT. This paper reviews the methods and mechanisms behind the selective effects of the RPE. In vitro and preclinical results are used to describe the bandwidth of selective effects with respect to different irradiation settings. An optoacoustic technique is introduced to visualize effects that cannot be seen by ophthalmoscopy and to facilitate dosimetry control without recourse to angiography completes the report.

Humans↗
PubMed2006

Selective retina therapy in patients with central serous chorioretinopathy.

BACKGROUND: Central serous chorioretinopathy (CSC) is a disease with a localized breakdown of the outer blood-retinal barrier located within the retinal pigment epithelium (RPE) causing subretinal fluid accumulation. Selective retina therapy (SRT) is a new, minimally invasive laser technology that has been designed to selectively target the RPE. SRT spares retinal tissue. METHODS: Twenty-seven eyes of 27 patients with active CSC were treated with SRT using a pulsed double-Q-switched Nd-YLF prototype laser (lambda=527 nm, t=1.7 micros). At baseline, best-corrected visual acuity was determined and fluorescein angiography and optical coherence tomography were performed. The patients were followed for up to 3 months. RESULTS: After 4 weeks 85.2% of patients showed complete resolution of subretinal fluid and in 96.3% there was no leakage visible on fluorescein angiography. After 3 months 100% of patients demonstrated no subretinal fluid and 100% of patients had no leakage activity on fluorescein angiography. Visual acuity, 20/40 at baseline, improved to 20/28 after 4 weeks and to 20/20 after 3 months. CONCLUSION: SRT is a safe and effective treatment for active CSC. Especially if the RPE leak is located close to the fovea, SRT is the favoured therapeutic option. We recommend earlier treatment of patients with acute CSC in order to prevent development of chronic changes due to CSC with irreversible anatomical and functional damage. SRT might be considered as a first-line treatment for active CSC.

Adult↗
PubMed2005

Macular function and morphology after peeling of idiopathic epiretinal membrane with and without the assistance of indocyanine green.

AIM: To investigate macular function and morphology after surgical removal of idiopathic epiretinal membrane (IEM) with and without assistance of indocyanine green (ICG). METHODS: A retrospective study as a consecutive case series, of 39 patients with IEM. 39 patients, 23 female, 16 male, mean age 67 years, underwent standard three port pars plana vitrectomy with removal of epiretinal membrane. Two groups of patients were consecutively operated: in 20 patients ICG 0.1% in glucose 5% was used to stain the epiretinal membrane. 19 patients underwent the identical procedure but without use of ICG. Postoperative follow up was 1-92 months (mean 15.5 months). Functional outcome was assessed with subjective improvement, best corrected visual acuity (BCVA), Amsler grid test, 10 degrees and 30 degrees automated perimetry (Heidelberg visual field analyser) (HFA), and Goldmann kinetic perimetry. Macular morphology was assessed with stereoscopic biomicroscopy and optical coherence tomography (OCT). The main outcome measures were macular function as determined by BCVA, presence of visual field defects, and metamorphopsia as determined by Amsler grid test, macular morphology as determined by slit lamp biomicroscopy, and OCT. RESULTS: BCVA improved in 28 patients, remained unchanged in eight patients, and decreased in three patients. Improvement of BCVA was statistically significant in both groups (p = 0.003). Mean BCVA in patients operated with ICG improved from 0.33 preoperatively to 0.53 postoperatively. Mean BCVA in patients operated without ICG improved from 0.32 preoperatively to 0.54 postoperatively. Reduction of macular oedema as measured by OCT was statistically significant in both groups (p<0.01). There was no statistically significant difference in postoperative BCVA, macular oedema as measured by OCT, postoperative Amsler grid test, and subjective improvement between the two groups. The incidence of residual or recurrent epiretinal membrane was greater in the group operated without ICG (p = 0.014). Visual field defects were detected in one patient operated with ICG and in three patients operated without ICG. CONCLUSIONS: Removal of epiretinal tissue with or without assistance of ICG improved visual function and reduced macular oedema in most patients. Adverse effects clearly attributable to the use of ICG were not observed but further investigation is warranted.

Adult↗
PubMed2003

Selective intraarterial fibrinolysis of acute central retinal artery occlusion.

PURPOSE: To evaluate the outcome of our patients with central retinal artery occlusion after local fibrinolysis and to compare these data with results reported in the literature. MATERIAL AND METHODS: Over a period of 7 years, 22 patients (11 male, 11 female, mean age 64.6 +/- 12.1 years) were treated with super-selective local fibrinolysis. In 1 case, treatment was carried out via the maxillary-ophthalmic anastomoses due to preexisting occlusion of the ipsilateral internal carotid artery. The latency period from the onset of symptoms to the beginning of therapy was 7.6 +/- 1.8 h. Urokinase was used in 7 cases (300,000-1.1 million units) and recombinant tissue plasminogen activator (20-40 mg) was applied in 15 patients. Visual acuity and fundus were examined before and after treatment. RESULTS: One patient (1/22 = 4.6%) recovered completely and regained a visual acuity of 20/20. Six patients (6/22 = 27.3%) showed a marked improvement with a range of visual outcome from 20/800 to 20/320. In 2 cases (2/22 = 9.1%) only a slight improvement was observed, with a visual outcome allowing detection of hand movements. In 13 cases (13/22 = 59.1%) no change in visual acuity as a result of treatment was observed. In 2/22 cases (9.2%) reversible neurological side-effects occurred, in 1 case suffered a stroke, and in another case intracerebral bleeding was observed. CONCLUSION: In our study, the recovery of visual acuity and the complication rate were not as positive as reported in the literature.

Acute Disease↗
PubMed2002

[Fundus autofluorescence after selective RPE laser treatment].

BACKGROUND: The selective RPE laser treatment is a new technique which selectively damages the RPE and avoids adverse effects to the neural retina. A problem is the ophthalmoscopically non-visibility of the laser lesions. The aim of the study was to investigate whether fundus autofluorescence (AF), which is derived from the lipofuscin contained by the RPE cells, is changed due to the RPE damage, and thus may be used for non-invasive treatment control. METHODS: A total of 26 patients with macular diseases, i.e. diabetic maculopathy (DMP), soft drusen maculopathy (AMD) and central serous retinopathy (CSR), were treated with repetitive short laser pulses (800 ns) from a green Nd:YAG laser (parameters: 532 nm, 100 and 50 pulses at 500 and 125 Hz, retinal spot diameter 200 micrometer, pulse energies 70-175 microJ). AF was excited by 488 nm and detected by a barrier filter at 500 nm (HRA, Heidelberg engineering). Patients were examined by ophthalmoscopy, fluorescein angiography and autofluorescence measurements at various times after treatment (i.e. 1 h, 1 and 6 weeks, 3, 6 and 12 months). RESULTS: None of the laser lesions was ophthalmoscopically visible during treatment although fluorescein angiography showed leakage of the irradiated areas. Identification of the lesions was possible by AF imaging showing an intensity decay in the irradiated area in 22 out of 26 patients, predominantly in patients with CSR and AMD. Lesions could be identified as hypoautofluorescent spots 1 h after treatment. During follow-up the laser spots became hyperautofluorescent. In patients with DMP some AF images were less helpful due to diffuse edema and larger retinal thickness. CONCLUSION: Imaging of non-visible selective RPE laser effects can be achieved by AF measurements predominantly in patients without retinal edema. Thus AF may replace invasive fluorescein angiography in many cases to verify therapeutic laser success.

Adult↗
PubMed2002

Autofluorescence imaging after selective RPE laser treatment in macular diseases and clinical outcome: a pilot study.

AIM: Selective retinal pigment epithelium (RPE) laser treatment is a new technique which selectively damages the RPE while sparing the neural retina. One difficulty is the inability to visualise the laser lesions. The aim of the study was to investigate whether fundus autofluorescence (AF) is changed because of the RPE damage, and thus might be used for treatment control. Additionally, the clinical course of patients with various macular diseases was evaluated. METHODS: 26 patients with macular diseases (diabetic maculopathy (DMP), soft drusen maculopathy (AMD), and central serous retinopathy (CSR)) were treated and followed up for at least 6 months. Treatment was performed with a train of repetitive short laser pulses (800 ns) of a frequency doubled Nd:YAG laser (parameters: 532 nm, 50 and 500 pulses at 100 and 500 Hz, retinal spot diameter 200 micro m, pulse energies 75-175 micro J). AF was excited by 488 nm and detected by a barrier filter at 500 nm (HRA, Heidelberg Engineering, Germany). Patients were examined by ophthalmoscopy, fluorescein angiography, and autofluorescence measurements at various times after treatment (10 minutes, 1 hour, 1 and 6 weeks, 3, 6, and 12 months). RESULTS: Fluorescein angiography showed leakage from the irradiated areas for about 1 week after treatment. None of the laser lesions was ophthalmoscopically visible during treatment. Identification of the lesions was possible by AF imaging showing an intensity decay in the irradiated area in 22 out of 26 patients, predominantly in patients with CSR and AMD. Lesions could be identified 10 minutes after treatment as hypoautofluorescent spots, which were more pronounced 1 hour later. During follow up the laser spots became hyperautofluorescent. In patients with DMP some AF images were less helpful because of diffuse oedema and larger retinal thickness. In these cases ICG angiography was able to confirm therapeutic success very well. Most of the patients have had benefit from the treatment, with best results obtained for CSR patients. CONCLUSION: Imaging of non-visible selective RPE laser effects can be achieved by AF measurements predominantly in patients without retinal oedema. Therefore, AF may replace invasive fluorescein angiography in many cases to verify therapeutic laser success. Selective laser treatment has the potential to improve the prognosis of macular diseases without the risk of laser scotomas.

Adult↗
PubMed2001

[Conventional ablation surgery or primary vitrectomy in complicated retinal holes].

BACKGROUND: We retrospectively evaluated 100 difficult cases out of 803 consecutive eyes with retinal detachment in order to determine the best surgical procedure in cases with difficult break configurations such as multiple, large, and central holes. METHODS: We treated the eyes either with conventional buckling surgery (n = 60) encircling buckle (EB) plus sponge exoplant (SP) (n = 45) or multiple sponge exoplants (n = 15) or with primary vitrectomy (PV) (n = 40). From the 40 patients in the PV group, 10 underwent vitrectomy plus intraocular gas only, in the other cases an encircling band was used (n = 30). RESULTS: In the EB/SP group the retina was attached directly after surgery in 59/60 cases. During a mean follow-up of 14.5 months redetachment occurred in 4/60 cases. In the PV group the retina was attached in 37/40 cases after resorption of gas and during the mean follow-up of 9.3 months redetachment occurred in an additional 4/40 cases. Complications during surgery in the EB/SP group were retinal incarceration (n = 2) and subretinal hemorrhage (n = 2). In the PV group intraoperative complications included choroidal detachment (n = 1) and iatrogenic holes (15%). Postoperative complications were choroidal detachment in 6/60 vs 0/40, transitory increased intraocular pressure (30% vs 68%). Double vision, however correctable by means of prisms, occurred in 4/60 vs 0/40. CONCLUSIONS: The primary attachment rate is high and similar with both procedures. The spectrum of intra- and postoperative complications is however different between both groups.

Aged↗
PubMed2001

[Central retinal artery occlusion. Importance of selective intra-arterial fibrinolysis].

BACKGROUND: Conventional treatment of a central retinal artery occlusion usually has a poor prognosis but intra-arterial fibrinolysis (IF) of the ophthalmic artery is an invasive treatment option. The importance of IF was evaluated in 62 patients with central retinal artery occlusion and in addition the risk spectrum for this disease was considered. MATERIAL AND METHODS: Data from charts of 62 patients were retrospectively analysed. Visual recovery after IF (n = 17) was compared to conventional treatment (e.g. decrease of IOP, improvement of rheological conditions, n = 45). Patients were excluded from IF if the occlusion was present for more than 8 h, if there was a history of bleeding and previous operations, or if they were older than 85 years. IF was performed using either urokinase (n = 7) or tPA (n = 10). RESULTS: Out of 62 patients, 22 (35%) with central retinal artery occlusion underwent catheterisation. Stenosis of the carotid artery excluded IF in 5 out of these 22 cases, therefore only 17 patients were treated by IF. Of the patients, 40 (65%) were excluded from IF for various reasons: 47% (19/40) arrived later than 8 h after occlusion, 17% (7/40) did not consent to IF, 15% (6/40) had medical contraindications and 13% (5/40) were over 85 years of age. Two patients required no IF because of a cilioretinal anastomosis with moderate visual acuity and another patient showed spontaneous visual recovery during ophthalmic examination. Of the 17 patients treated with IF, 4 achieved an improvement of visual acuity by more than 2 lines, no change of visual acuity was observed in 12/17 patients and 1/17 lost more than 2 lines after treatment. Of the 45 conservatively treated patients, 16 achieved improvement by more than 2 lines and no change occurred in 29/45 patients. Three patients treated with IF suffered from a stroke during treatment. The main risk factor for central retinal artery occlusion was high blood pressure in 32% of all cases and nicotine abuse in 16%. CONCLUSIONS: Many patients presented too late for IF. However, there was no statistical difference between patients with IF and conventional treatment with regards to the improvement of visual acuity. Additionally there is an increased risk of a stroke from IF, therefore a prospective study is necessary to evaluate the importance of IF. Stabilisation of high blood pressure may be the best prophylaxis for preventing a central retinal artery occlusion.

Adult↗
PubMed2001

Exudative retinal detachment in macular hole surgery using platelet concentrates--a case report.

INTRODUCTION: Retinal detachment after macular hole surgery is a rare complication, usually occurring because of small, peripheral holes. We present a patient with a high bullous exudative retinal detachment following pars plana vitrectomy. CASE REPORT: A healthy 69-year-old patient presented with a macular hole stage III of the left eye. Corrected visual acuity was 20/200. Pars plana vitrectomy was performed without peeling of the internal limiting membrane or an epiretinal membrane, a few drops of platelet concentrate were instilled onto the hole, and the bulbus was filled subtotally with a non-expanding SF6/air mixture. On the 3rd postoperative day a small retinal detachment of the inferior half of the retina was noticed that increased over the next 3 days until it reached the inferior vascular arcade. During the following 3 days a spontaneous remission occurred with complete reattachment of the retina. Six weeks after operation the retina was completely reattached, the macular hole was closed, and the visual acuity was 20/200 with a slight cataract. CONCLUSION: Retinal detachments after macular hole surgery are not always of rhegmatogenous nature but may also be exudative and related to an inflammatory reaction caused by adjuvants. When a retinal detachment occurs immediately after macular hole surgery without detectable holes it may be advisable to wait for some days before reoperation.

Aged↗
PubMed2001

Retina-sparing laser treatment of occult CNV by vitrectomy and localised detachment of the macula.

BACKGROUND: Occult choroidal neovascularisation (CNV) was treated by a novel surgical approach. In order to spare the retina during laser photocoagulation of occult CNV, the retina was detached by subretinal infusion of a ringer solution. After localised detachment of the neural retina the CNV was transretinally coagulated by an endoprobe of a diode laser. METHODS: Twelve patients with occult CNV were treated in such a way. The mean duration of follow-up was 3.5 +/- 1.6 months. After 4 weeks fluorescein angiography and indocyanine green angiography were performed in all patients. Laser exposure time was 1.1 +/- 0.7 s and laser energy was 1.2 +/- 0.7 W. RESULTS: In 10 of 12 patients the retina could be successfully detached and performed. In all cases the retina remained unchanged during laser photocoagulation. After 5 days subtle RPE atrophy and after 1 month obvious RPE atrophy was found. After 4 weeks, in 8 of 10 cases the CNV was completely occluded and no late leakage was found. Three months after operation, retinal atrophy could be seen in all cases. Visual acuity was lower in 6 and unchanged in 4 of 10 patients. CONCLUSION: Despite acute sparing of the neural retina the long-term effects are not better than after conventional laser photocoagulation, because secondary atrophy of the retina develops.

Aged↗
PubMed2001

Results of vitrectomy and the no-touch-technique using autologous adjuvants in macular hole treatment.

BACKGROUND: Anatomic and functional results of macular holes using vitrectomy and platelet-concentrate (PC) or autologous whole blood (WB) were investigated without peeling any epiretinal membrane in order to minimize retinal trauma. METHODS: 44 patients with macular holes stage II, III and IV underwent a vitrectomy with removal of posterior cortical vitreous (in stage II and III) and C2F6 gas endotamponade. No peeling of any epiretinal membrane or the ILM was performed. In 14 patients autologous WB was injected and in 30 patients autologous PC. The mean follow-up time was 9.3 months. RESULTS: An anatomic closure was observed in 36.4% of patients in the WB-group and in 93.9% of patients in the PC-group. SLO-microperimetry showed a reduction of absolute scotomas in 80% of the WB- and in 75% of the PC-group. In the WB-group 1 retinal detachment and 1 branch vein occlusion occurred; in the PC-group 3 retinal detachments, 1 central artery occlusion, 1 macular pucker, 1 cystoid macular edema, 1 late reopening and 1 secondary glaucoma were observed. In both groups no endophthalmitis occurred. CONCLUSION: If autologous platelet concentrate is available, high anatomic success rates can be achieved without aggressive membrane removal, which may cause retinal damage. Autologous whole blood cannot be recommended as an alternative adjunct for the treatment of macular holes without membrane removal.

Adult↗