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Biomedical subjects

T A Rice

Publications and source records attributed to T A Rice.

At least 37 records · Page 2Linked to original sources
PubMed1984

The crystalline lens after vitrectomy for diabetic retinopathy.

We reviewed the records of 596 consecutive cases of vitrectomy performed for complications of diabetic retinopathy at the Wilmer Eye Institute. Accidental lens damage occurred during surgery in three eyes. Fourteen (8%) of 180 phakic eyes underwent later cataract removal. Follow-up of at least six months and detailed description of the lens at final examination were available in 151 eyes. Of these, visually significant opacities occurred in 32 eyes (21%), and the lens opacities accounted for substantial loss of final vision in 6 (19%) of these 32 eyes. Moderate or severe lens opacities that developed postoperatively were as follows: anterior subcapsular or cortical changes in 2 eyes (1%), nuclear sclerosis in 11 eyes (7%), posterior subcapsular changes in 25 eyes (17%). One hundred twenty-five preoperative, operative and postoperative factors were analyzed for each patient to detect correlations with postoperative lens changes. Nuclear sclerotic changes correlated with older patient age. Posterior subcapsular changes correlated with three intraoperative factors: longer duration of the operation, use of intravitreal gas, and use of a gas bubble filling more than 50% of the vitreous cavity. Posterior subcapsular changes were progressive with longer follow-up.

Adult↗
PubMed1983

The effect of lensectomy on the incidence of iris neovascularization and neovascular glaucoma after vitrectomy for diabetic retinopathy.

We analyzed a consecutive series of 596 eyes that underwent vitrectomy for complications of diabetic retinopathy to determine the postoperative incidence of iris neovascularization and neovascular glaucoma. Survival curves for various factors were plotted, showing the cumulative incidence of these complications at various postoperative times up to one year. Eyes in which the lens was removed during vitrectomy had a statistically significant (P less than .001 by log-rank test) increase in the postoperative incidence of both iris neovascularization and neovascular glaucoma compared to eyes in which the lens was not removed. Lens removal at vitrectomy increased the risk of postoperative iris neovascularization by a factor of more than three and the risk of neovascular glaucoma by a factor of more than four. Other factors associated with a significantly increased incidence of postoperative iris neovascularization were severe preoperative retinal neovascularization and the absence of preoperative scatter retinal photocoagulation. Neither of these two factors nor postoperative retinal detachment invalidated or reduced the effect of lensectomy on increased postoperative iris neovascularization when all factors were considered simultaneously. This study showed a statistically significant increase in the postoperative incidence of neovascular glaucoma in eyes undergoing combined lensectomy and vitrectomy compared to eyes in which the lens was not removed.

Cataract Extraction↗
PubMed1983

Vitrectomy for diabetic vitreous hemorrhage.

The surgical results for 248 eyes that underwent vitrectomy for diabetic vitreous hemorrhage showed that at the final examinations, 194 (78%) had improved visual acuities, 43 (17%) had worse visual acuities, and 11 (4%) were unchanged. Of the 248 eyes, 60 (24%) had final visual acuities of 20/40 or better, 128 eyes (52%) had final visual acuities of 20/50 to 20/800, and 60 (24%) had final visual acuities worse than 20/800. Eyes with preoperative iris neovascularization had a substantially worse visual result than eyes without this complication. Eyes in which the lenses were removed during vitrectomy also had worse visual results, primarily because they had a higher cumulative incidence of postoperative iris neovascularization and neovascular glaucoma.

Adult↗
PubMed1983

Vitrectomy for diabetic traction retinal detachment involving the macula.

We analyzed the surgical results for 197 eyes that underwent vitrectomy for diabetic traction detachment of the macula. The retina was successfully reattached in 130 of the 197 cases (66%), although the final level of vision depended on the amount of permanent macular damage from the previous detachment and on the effects of the retinal vascular disease. At the final examinations, 112 eyes (57%) had improved visual acuities, 68 eyes (35%) were worse, and 17 eyes (9%) were unchanged. Thirteen eyes (7%) had final visual acuities of 20/40 or better, 103 eyes (52%) had final visual acuities of 20/50 to 20/800, and 81 eyes (41%) had final visual acuities worse than 20/800. Two preoperative factors were associated with a worse prognosis for achieving a final visual acuity of 20/800 or better: preoperative vitreous hemorrhage (P less than .01) and the absence of preoperative scatter retinal photocoagulation (P less than .01). Additionally, two surgical factors, lens removal and the creation of iatrogenic retinal breaks, were associated with a poorer visual prognosis (P less than .002 and P less than .01, respectively). The group of eyes that underwent lens removal during vitrectomy also had a significantly higher incidence of postoperative iris neovascularization compared to eyes in which the lenses were not removed (P less than .05).

Cataract Extraction↗
PubMed1983

Vitrectomy for diabetic rhegmatogenous retinal detachment.

The surgical results for 107 eyes that underwent vitrectomy for diabetic rhegmatogenous retinal detachment showed that the rhegmatogenous component of the detachment was successfully treated in 79 eyes (74%), although in 11 of the 79 eyes (14%) traction detachment of the macula persisted. At the final examinations, 57 eyes (53%) had improved visual acuities, 44 (41%) had worse visual acuities, and six (6%) were unchanged. Eleven eyes (10%) had final visual acuities of 20/40 or better, 48 eyes (45%) had final visual acuities of 20/50 to 20/800, and 48 eyes (45%) had final visual acuities worse than 20/800. Two preoperative factors were associated with a worse prognosis for achieving a final visual acuity of 20/800 or better: preoperative iris neovascularization (P less than .01) and preoperative detachment of the macula (P less than .05).

Diabetic Retinopathy↗
PubMed1983

Pars plana vitrectomy for complicated retinal detachments.

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.

Adolescent↗
PubMed1983

Complications of vitreous surgery for diabetic retinopathy. I. Intraoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of intraoperative complications during vitrectomy for proliferative diabetic retinopathy. Inadvertent corneal epithelial defects occurred in 51 eyes (28%). The lens was removed in 42 (25%) of 170 phakic eyes. This was done through a pars plana approach. Accidental mechanical lens damage occurred in one eye, and mild pharmacologic lens damage occurred in two eyes. Some bleeding from fibrovascular tissue occurred in nearly every case, but this was controlled with diathermy except in seven eyes (4%) in which severe bleeding required premature termination of the operation. Latrogenic retinal tears occurred in 36 (20%) of the 179 eyes. Fifteen (34%) of the total of 44 retinal tears were anterior to the equator, and 11 (73%) of the 15 anterior tears were located posterior to the sclerotomy through which the vitrectomy probe was introduced. Twenty-nine (66%) of the 44 retinal tears were posterior to the equator, and 19 of the 29 occurred within 15 degrees radius of the fovea.

Adult↗
PubMed1983

Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of postoperative complications after vitrectomy for proliferative diabetic retinopathy. One hundred twenty-nine (72%) of the 179 eyes achieved improved vision, and 117 (65%) were considered visual successes with final vision in the functional range of 5/200 or better. Corneal epithelial defects occurred in 51 eyes (28%), but severe corneal complications were rare, and no eye developed corneal clouding as the sole cause of later visual loss. The lens was retained in 128 eyes (75%), and visually significant lens opacities occurred later in 17% of the phakic eyes. Postoperative iris neovascularization was reduced by not removing the lens, and rubeosis iridis occurred in 15 (13%) of 114 phakic eyes and in 21 (32%) of 65 aphakic eyes (P = 0.012). Vitreous hemorrhage was present in 75% of eyes immediately after surgery and cleared in an average of 6.2 weeks in phakic eyes and 5.4 weeks in aphakic eyes. Fifty-two eyes (29%) had recurrent vitreous hemorrhage after the initial postoperative period. New retinal detachment occurred after surgery in 16% of eyes and was treated successfully in 38%. Reoperations were done in 45 eyes (25%), and 32 (71%) of these were for repair of retinal detachment or removal of nonclearing vitreous hemorrhage. Six eyes (3%) developed phthisis bulbi, and one other eye was enucleated.

Adult↗
PubMed1983

Surgical techniques for selected giant retinal tears.

Based on clinical experience, improved methods for treating giant retinal tears with an inverted retinal flap are described. In all cases a broad encircling scleral buckle is used in conjunction with a broad zone of peripheral chorioretinal adhesion produced by cryotherapy and, often, supplemented by postoperative photocoagulation. This virtually eliminates recurrent retinal detachment from an anterior location, if the retinal flap can be properly unfolded and the retina is initially reattached. Vitrectomy is done in all these cases, and an intraocular bubble is used to unfold and reposition the retinal flap during or after surgery. If the retinal flap is especially stiff or foreshortened, special techniques are used to incarcerate the edge of the retinal flap in the pars plana or the peripheral choroid, or transvitreal suturing techniques are used to secure the edge of the retinal flap to the eyewall before fluid-gas exchange is performed. This insures proper unfolding of the flap by the intraocular bubble. Applying retinal cryotherapy before performing the vitrectomy seems to reduce the occurrence of postoperative proliferative vitreoretinopathy (PVR), perhaps because retinal pigment epithelial cells in the vitreous cavity are removed during vitrectomy. Frequent, detailed examination during the first three weeks after surgery and use of postoperative photocoagulation to supplement the cryotherapy seem to prevent recurrent detachment from anterior leakage of subretinal fluid beneath the retinal flap or through other anterior retinal breaks.

Humans↗
PubMed1982

Central retinal artery occlusion without retrobulbar hemorrhage after retrobulbar anesthesia.

Four patients had central retinal artery occlusions after retrobulbar anesthesia with lidocaine HCl was administered before photocoagulation. One of these four had two separate episodes of closure. Only one had permanent visual loss, and none had evidence of retrobulbar hemorrhage. Each patient had a severe hematologic or vascular disorder. We think that direct trauma to the central retinal artery behind the globe, the pharmacologic or compressive effects of the injected solution, or both caused the occlusions in these patients.

Adult↗
PubMed1982

Optic disc neovascularization associated with ocular involvement in acute lymphocytic leukemia.

A case of vitreous involvement in acute lymphoblastic leukemia associated with neovascularization of the optic nerve head is presented. The diagnosis was made from a vitreous biopsy specimen obtained by pars plana vitrectomy and prepared by a membrane filter and modified Papanicolaou stain technique. Fibrovascular membranes and leukemic cells were seen on microscopic examination of the vitreous biopsy specimen. Retinal neovascularization associated with acute lymphoblastic leukemia is discussed.

Biopsy↗
PubMed1982

Idiopathic progressive unilateral vitreous fibrosis and secondary traction retinal detachment.

Two eyes with idiopathic progressive avascular fibrocellular proliferation involving the posterior vitreous surface and causing visual loss due to traction on the optic nervehead, peripapillary retina, and macula were studied. This occurred in one eye of each of two elderly patients. There were no other apparent abnormalities. Vitreous surgery was used to remove the posterior vitreous surface and most of the abnormal tissue. This reduced the traction on the retina, although partial visual loss persisted because of chronic macular edema in each case. Ultrastructural examination of the excised tissue confirmed the fibrocellular nature of the membranes. New-formed collagen was identified in one case, indicating collagen synthesis by the cellular elements. The cells were identified as fibrocytes and myofibrocytes. The latter cells contained cytoplasmic microfilaments thought to be contractile protein, and contraction of the cells was thought to account for the vitreoretinal traction observed clinically. The origin of these cells could not be established by ultrastructural criteria, although clinical features suggest that cells (possibly fibrous astrocytes) from the optic nervehead were responsible for the cellular proliferation.

Aged↗
PubMed1981

Diagnostic vitrectomy.

The histopathologic and cytopathologic study of ocular fluids obtained for diagnostic purposes is presented. The analysis of fluid specimens with millipore filter, celloidin bag-cell block, and transmission electron microscopy techniques has proved to be effective for establishing and confirming clinical diagnoses. Diagnostic vitrectomy can be readily used to evaluate such conditions as intraocular tumors, lens and blood-induced glaucoma, inflammatory conditions, amyloidosis, persistent hyperplastic primary vitreous (PHPV), epithelial ingrowth, and tractional vitreoretinal membranes.

Adult↗
PubMed1981

Late results of initially-successfully vitrectomy in diabetes.

Long-term follow-up of 135 eyes that had initially-successful vitreous surgery for complications of proliferative diabetic retinopathy indicates that most of these eyes remain visually and anatomically stable and do not develop new retinal neovascularization. The nature and incidence of important complications during the early and later postoperative periods are discussed.

Diabetic Retinopathy↗
PubMed1980

Angioma-like mass in a patient with retrolental fibroplasia.

A 13-year-old boy had mild vitreous hemorrhage in the left eye, and a red angioma-like epiretinal mass in the equatorial zone of the temporal fundus. The retina anterior to the mass was nonvascularized, and similar nonvascularization of the pre-equatorial retina was present in the temporal quadrants of the fellow eye. Fluorescein angiography showed intraretinal neovascularization along the margin of the perfused and nonperfused retina and leakage from portions of the angioma-like mass, suggesting that it was composed of neovascular tissue and adjacent hemorrhage. The patient had been a premature infant, with a birth weight of 1,092 g, supporting the presumptive diagnosis of previously asymptomatic retrolental fibroplasia. Photocoagulation was successful in obliterating the neovascular tissue.

Adolescent↗
PubMed1980

Long-term anatomic and functional results of vitrectomy for diabetic retinopathy.

A long-term follow-up study of 130 eyes that had had initially successful vitrectomies for complications of proliferative diabetic retinopathy showed that only ten (8%) eyes had significant worsening of visual acuity at final examination (18 to 68 months after surgery), compared to the best visual acuity recorded during the first six months after surgery. Active flat retinal neovascularization was present at final examination in only three eyes (2%), and in no case did elevated fibrovascular proliferation occur. The type and incidence of important complications during the early and later postoperative periods indicated a low rate of late complications.

Adult↗