Biomedical subjects
Publications and source records attributed to K J Blinder.
Local excision of uveal melanoma is an intriguing therapeutic modality in selected cases. An internal choroidectomy under a retinal flap has been developed as an alternative to retinochoroidectomy in managing posterior pole melanomas. This technique offers more adequate preservation of retinal architecture, thus potentially enhancing central visual function in patients with tumors located close to the fovea.
BACKGROUND: Suprachoroidal hemorrhage may cause the expulsion of intraocular contents. Generally, cases of nonexpulsive suprachoroidal hemorrhage have a better outcome than their expulsive counterparts. Those cases with massive nonexpulsive suprachoroidal hemorrhage do better with treatment than without. Treatment modalities have included suprachoroidal hemorrhage drainage with or without intraocular volume reformation, and vitrectomy. METHODS: The authors used the liquid perfluorocarbon perfluoroperhydrophenanthrene in the treatment of three patients with nonexpulsive suprachoroidal hemorrhage. The perfluorocarbon was injected into the vitreous cavity while the suprachoroidal blood was drained through anterior sclerotomies. RESULTS: With 5 months of follow-up, complete resolution of the suprachoroidal blood was noted in all patients. All three patients had attached retinas, and postoperative visual acuities were improved over preoperative visual acuities. CONCLUSION: Perfluoroperhydrophenanthrene and other perfluorocarbon liquids may be beneficial in the treatment of certain cases of nonexpulsive suprachoroidal hemorrhages.
This investigation of the liquid perfluorocarbon, perfluorophenanthrene (Vitreon), establishes its safety and efficacy as a short-term vitreoretinal tamponade. We utilised Vitreon as an intraoperative tool and postoperative vitreoretinal tamponade in 16 patients. Proliferative vitreoretinopathy (PVR) (six), giant retinal tear (four), rhegmatogenous retinal detachment (three), retinal detachment with keratoprosthesis (two), and submacular and vitreous haemorrhage (one) were successfully repaired. Vitreon was left in the eye and removed 5 days to 4 weeks postoperatively. Complications encountered included proliferative PVR (five), limited peripheral retinal detachment (three), macular pucker (two) cataract (three), hypotony (two), excessive fibrin reaction (one), and elevated intraocular pressure (one). At the latest evaluation, all retinas are attached with a follow-up of 1.25 to 12 months (mean 6.8 months).
Fifteen eyes with complicated retinal detachments--11 with proliferative vitreoretinopathy (C3 D3), 2 with posterior segment trauma, and 2 with inflammatory retinopathy--were treated with vitrectomy, membrane peeling, and large posterior retinotomy. All posterior relaxing retinotomies were circumferential, including temporal quadrants in all cases. With a minimum follow up of 6 months, 12 eyes (80%) were attached posterior to the retinotomy. Reproliferation resulted in redetachment in 3 eyes (20%). Visual acuity improved in 53%, remained unchanged in 20%, and decreased in 27%. Of the 11 eyes that achieved stable or improved visual acuity, 5 (45%) achieved 20/400 to 20/25 vision, 5 achieved counts fingers perception, and 1 patient remained stable at hand motion perception. Of all the eyes undergoing surgery, hypotony (intraocular pressure < 5 mm Hg) occurred in 6 eyes (40%); 3 of these were among the 12 eyes with attached retinas.
A case of a 27-year-old white male with acquired immunodeficiency syndrome (AIDS) who had a maxillary sinus tumor with secondary orbital involvement was reported. Marked proptosis and distortion of the globe were present. Biopsy by the Caldwell-Luc approach disclosed an immunoblastic lymphoma of B-cell origin. To the best of our knowledge, this is the first reported case of a maxillary sinus lymphoma extending into the orbit in a patient with AIDS.
Retinal hemorrhages occur with increased frequency in neonates following prolonged or difficult labor, especially if associated with primipara, surgical or mechanical intervention, low Apgar scores, perinatal hypoxia, low birth weight or coagulopathy. When involvement occurs peripheral to the arcades resolution occurs generally without sequelae. Hemorrhages involving the macula are much more serious since resolution in these cases may result in degenerative changes or an exudative or glial scar, resulting in amblyopia and possible strabismus. Early examination is warranted in high-risk infants in order to facilitate intervention and the prevention of more serious visual sequelae.
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Disciform scars secondary to age-related macular degeneration were surgically removed in three patients. Postoperative visual acuity improved minimally in one case and decreased in the other two cases. The results suggest further investigation is needed with possible modifications of our technique for future studies.
The authors report the successful repair of a retinal detachment following Cardona prosthokeratoplasty. The surgical technique included pars plana vitrectomy, endolaser photocoagulation, peripheral cryopexy, scleral buckling, and the use of a liquid perfluorocarbon derivative, perfluorophenanthrene, to achieve and maintain reattachment. Perfluorophenanthrene was removed 3 weeks postoperatively. Postoperative visual acuity stabilized at functional levels. No ocular complications, adverse reactions, or redetachment were observed.
We evaluated a new liquid perfluorocarbon, perfluorophenanthrene (Vitreon). This material has proven to be non-toxic in vitrectomised rabbit eyes for up to six weeks. Present investigation under FDA guidelines establishes both the safety and efficacy of Vitreon in human eyes. We used Vitreon for intraoperative hydrokinetic retinal manipulation in 15 patients. In cases of proliferative vitreoretinopathy (6), rhegmatogenous retinal detachment (5), giant retinal tear (2), retinal dialysis (1), and tractional retinal detachment (1) the retina was successfully reattached. Postoperatively two patients developed proliferative vitreoretinopathy necessitating further surgery, and one patient developed hypotony. Follow-up showed 100% reattachment rate with a mean duration of 6.3 months. Postoperative visual acuity ranges from light perception to 20/30.
We used tissue plasminogen activator (tPA) to aid in the surgical evacuation of subretinal hemorrhages. Subretinal hemorrhage secondary to a ruptured retinal macroaneurysm was treated in two patients. The surgical technique involved using a micropipette to fashion a small retinotomy through which tPA was injected into the subretinal space and through which the dissolved clot was removed. Visual acuity improved from counts fingers to 20/50 in one patient and from counts fingers to 20/70 in the other. Three additional patients, with massive subretinal hemorrhages secondary to age-related macular degeneration, were similarly treated. In one, visual acuity improved from counts fingers to 20/400; in two others, visual acuity was stabilized; in the first patient, at 20/300, and in the second patient at 20/400. The use of tPA minimizes surgical manipulation of the sensory retina and greatly reduces the size of the retinotomy required for evacuation of subretinal blood.
We describe the surgical excision of submacular scar in end-stage age-related macular degeneration and transplantation of autologous and homologous retinal pigment epithelial (RPE) cells. The technique involves the preparation of a large retinal flap encompassing the macula and the arcades, removal of the submacular scar, and replacement of the RPE cells, using either an autologous pedicle graft or homologous RPE cells and Bruch's membrane. Fourteen months following the procedure, visual acuity in a patient with a pedicle graft had improved from counts fingers to 20/400 and the patient fixated over the transplanted RPE cells. After 10 months, a homologous graft in a second patient had become encapsulated with a fine subretinal membrane without neovascular tissue; visual acuity had not improved. No intraoperative or postoperative complications resulting from the surgery occurred in either patient.
The effect of acquired optociliary veins on visual acuity after ischemic central retinal vein occlusion in patients 45 years of age or older was assessed retrospectively. Fundus photographs and medical records of 21 patients, 45 years of age or older, with photographically documented central retinal vein occlusion and at least six-months follow-up were analyzed. Eleven of 21 patients developed acquired optociliary veins. Patients with acquired optociliary veins were more likely to experience stable or improved visual acuity (nine of 11 patients) than were patients without them (four of ten patients) over a mean follow-up period of 30 months (P = .049).
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