[Retinal detachment surgery: choice of indentation].
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Biocompatible Materials↗
Biomedical subjects
Y Le Mer
Publications and source records attributed to Y Le Mer.
TPA-assisted vitrectomy for proliferative diabetic retinopathy: results of a double-masked, multicenter trial.
OBJECTIVE: Some complications of vitrectomy are related to adherence of the vitreous body to the retina. We studied whether these complications could be decreased by injecting a proteolytic enzyme, tissue plasminogen activator (TPA), at the beginning of surgery to aid separation of the vitreous from the retina. METHODS: Fifty-six patients receiving surgery for complications of proliferative diabetic retinopathy were divided into two groups in this prospective, randomized, double-blind study. Group I patients received 25 microg of intravitreal TPA in buffered salt solution (BSS) 15 minutes before vitrectomy. Group II received BSS alone. Postoperative follow-up lasted up to 3 months. The major criteria for comparison were the number of perioperative iatrogenic tears, the gain in visual acuity, and the reattachment rate of tractional retinal detachments. RESULTS: No difference was found between the two groups for the principal indicators or for complications. CONCLUSION: In proliferative diabetic retinopathy, the use of 25 microg of TPA by intravitreal injection 15 minutes before vitrectomy does not improve the results. No specific complications of the method were noted. The failure can be attributed to a too-short delay between TPA injection and beginning of surgery, an insufficient dose, or an insufficient quantity of plasminogen in the vitreous at the beginning of the intervention.
Diabetic Retinopathy↗
[Neovascularization in severe myopia].
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Adult↗
[Prediction of functional recovery after surgery of macular epiretinal membranes. Value of interferometry using Lotmar's apparatus].
BACKGROUND: The predictability of the measurement of the macular function by white light interferometry was evaluated in a group of patients whose epiretinal membranes had been surgically removed. METHOD: Fifteen patients presenting either primitive or secondary epiretinal membranes were included. We used the apparatus described by W. Lotmar. The main evaluation criteria was the best corrected visual acuity (VA) chosen between the third month and the sixth month examinations. RESULTS: Preoperatively the mean visual acuity was 0.227 +/- 0.105. The mean final visual acuity was 0.507 +/- 0.198. The final visual acuity was predicted within an 0.1 interval in ten cases (67%). In two cases the predicted visual acuity was identical to the pre-operative VA and the final results confirmed the test. No improvement occurred. CONCLUSION: The Lotmar visometer is statistically predictive of the visual outcome after epi-retinal membranes surgery.
Female↗
[Value of prevention of congenital toxoplasmosis].
PURPOSE: To verify incidence of toxoplasmosis seroconversion during pregnancy and the interest of treating the mother. METHODS: Among 7044 infants born between January 1989 and December 1993, 78 (1.1%) born to mothers who developped toxoplasmosis seroconversion during pregnancy were followed. RESULTS: Among 69 mothers treated, there were only 9 cases of congenital toxoplasmosis (13.4%) including only 3 cases of patent toxoplasmosis. CONCLUSION: Treating the mother is an effective means of preventing toxoplasmosis. The cost of verifying seronegativity in women during pregnancy could be reduced by primary prevention.
Coccidiostats↗
[Anterior fibrovascular proliferation. A rare complication of vitrectomy for proliferative diabetic retinopathy].
PURPOSE: To present clinical and therapeutic features of anterior fibrovascular proliferation, a severe complication of vitrectomy for diabetic retinopathy. METHODS: Among 153 vitrectomies for complication of diabetic proliferative vitreo-retinopathy, six cases of anterior fibro-vascular proliferation were found. All presented initially with a tractional retinal detachment associated in some cases with a vitreous hemorrhage. The complication occurred after a mean follow-up of three months after initial vitrectomy, marked by intravitreal bleeding, rubeosis iridis and hypotony. A reoperation with peeling of proliferation, lensectomy, extensive panretinal photocoagulation, encircling band and silicone oil injection allowed reattachment of the anterior retina in all the six cases. RESULTS: A reproliferation occurred in five cases, requiring revision of dissection. Finally, silicone oil was removed in three cases, was definitively left in one eye and was not removed in two eyes. Final visual acuities range from 1/50 to 2/10. CONCLUSION: Anterior fibrovascular proliferation is an unfrequent complication after vitrectomy for diabetic retinopathy. The prognosis is poor, in spite of aggressive vitreoretinal surgery including repeated dissection and extensive photocoagulation.
Adult↗
[Use of liquid perfluorocarbons in vitrectomy for difficult cases of proliferative diabetic retinopathy].
PURPOSE: Thanks to their physical properties, could perfluorocarbon liquids (PFCL) be useful during vitrectomy for severe cases of proliferative diabetic vitreo-retinopathy (PDVR)? METHODS: Among 120 vitrectomies for PDVR performed in a period of time from August 1992 to July 1993, we reviewed 24 cases with a minimal follow-up of six months for which we have used PFCL as intraoperative tool. Among these eyes, three (12%) were preoperatively attached, seven (29%) presented with a tractional retinal detachment sparing the macular area and 14 (59%) with a retinal detachment involving the macula. The indication for PFCL injection was either to flatten the retina in case of iatrogenic tear or retinotomy (15/24 eyes) or to stop a bleeding coming from the optic disc (9/24). The aim was to allow a good laser endophotocoagulation in all the cases and to inject an intraocular tamponade on a reattached retina if needed. As final tamponade, silicone oil was used in 10 eyes, gas in nine eyes and none in five eyes. RESULTS: At the end of the study, 20 (83%) eyes had a totally reattached retina and four (17%) a detached retina. The postoperative compared to the preoperative visual acuity was improved in 13 eyes (54%), unchanged in seven eyes (30%) and decreased in four eyes (16%). In one case (4%), some droplets of PFCL were noticed in the vitreous cavity, under the silicone oil bubble, with a good clinical tolerance. No specific complication of PFCL injection could be found in the 23 other eyes. CONCLUSION: In some selected cases of severe PDVR, the use of PFCL may help to flatten the retina, to stop bleeding from the optic disc and to perform a good endolaser photocoagulation. This allows to achieve good anatomical and visual results with few specific complications.
Adolescent↗
[Systematic search of the posterior vitreous cortex during vitrectomy. Technique, complications and results].
We present the results of a prospective study trying to answer the question: when a clinical or echographic premacular vitreous detachment occurs, is it still possible to find a preretinal membrane at the surface of retina? We looked for such a membrane in 50 consecutive vitrectomies for various indications. We found and removed such a membrane in 42 cases but were unable to obtain histological examinations. Our conclusions are: most of the time, the diagnosis of total vitreous detachment is very difficult and the finding of a premacular membrane during vitrectomy is a frequent event.
Adolescent↗
Reports by the Silicone Study Group.
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Eye Diseases↗
Secondary management of suprachoroidal hemorrhages.
Ten cases of postoperative suprachoroidal hemorrhages involving the macular area, following eight cataract extractions and two trabeculectomies, were drained through an anterior temporal sclerostomy. Vitrectomy was performed only in case of vitreous incarceration in the corneal wound and through the same sclerostomy. This simple procedure gave good anatomical results in eight cases and good visual results in seven cases. Since this postoperative complication can spontaneously heal well, we limit the indications for drainage to cases of kissing choroidal detachments, of associated serous retinal detachment, and when a vitrectomy is needed.
Aged↗
[Liquid perfluorocarbons in the surgical treatment of retinal detachment caused by retinal inversion].
Surgical procedures used today to treat retinal detachment with an inverted giant retinal tear have considerably improved. Vitrectomy associated with perfluorocarbon liquid injection has replaced old procedures necessary to unfold the inverted retinal flap. Seventeen patients were operated on with an anatomic success rate of 76% and an average follow up of fifteen months. The successive surgical stages (lensectomy, retinopexy, internal tamponade, circular scleral buckle) are discussed. Proliferative vitreoretinopathy is the maill postoperative complication explaining the high rate of reoperation (56%). In high myopia, a prophylactic circular scleral buckle of the fellow eye has become systematic.
Adolescent↗
Simulation of the growth pattern of the central retinal artery using a fractal modeling technique.
Assisted by computer, we simulated the typical growth pattern of the central retinal artery by a fractal modeling technique. When processing was started with two fertile sides, an iterative processing function generated a ramiform fractal. The branching angle was chosen at random within a certain range. In addition, a feedback restriction forbade any intersection of branches. We demonstrated that the curved shape of the temporal vessels is caused by simultaneous growth of the vessels and the retina. When processing was begun with only one fertile side, the typical vascular pattern of a retinal coloboma was designed.
Computer Simulation↗
[Failures of the surgical treatment of rhegmatogenous retinal detachment].
The surgical treatment of rhegmatogenous retinal detachment, has considerably improved. But there are still a lot of failures, at least after the first surgical procedure. Out of a group of 320 retinal detachments, a one stage surgical procedure allowed the retina to reattach in 84% of cases. Out of the 51 failures, we defined 2 subgroups: the early recurrences were mainly caused by undiagnosed breaks or insufficient scleral buckling, and the delayed recurrences by a vitreo-retinal proliferation or a new tear. Though a second operation increased the success rate to 97%, it is certainly desirable to lower the failure rate of the first surgical procedure.
Adult↗
[Is vitrectomy cataractogenic? Study of changes of the crystalline lens after surgery of retinal detachment].
In order to assess the relationships between vitrectomy and postoperative crystalline lens changes we reviewed the records of 298 selected cases of operated retinal detachments in phakic eyes. We compared two groups: 155 eyes were operated with cryotherapy, vitrectomy and gas injection. 143 eyes received cryotherapy and retro-hyaloid fluid-gas exchange. Follow-up of at least 12 months and detailed description of the lens were available in 90 cases and 82 cases of the two groups respectively. Postoperative lens changes were as follows: nuclear sclerosis occurred in 63% of the vitrectomised eyes, mild in 14%, moderate in 16%, severe in 32%. In contrast, nuclear sclerosis occurred in only 4% of the non vitrectomised eyes, all these cases were noted as moderate. Posterior subcapsular opacities occurred in 4.5% of the vitrectomised eyes versus 2.4% of the non vitrectomised eyes. Nuclear sclerotic changes were correlated with vitrectomy and longer follow-up. Posterior subcapsular cataract was correlated with vitrectomy and larger intraocular gas bubble.
Adult↗
[Ultrasonic treatment of hypertonia caused by intraocular silicone oil].
The authors treated 53 patients with uncontrolled glaucoma in silicone oil filled eyes with high intensity focused ultrasound. The silicone oil filled eyes present unusually difficult problems in glaucoma management, since the silicone oil rapidly obstructs filtration openings, and laser techniques have not been effective. The mean pretreatment pressure was 34.2 mmHg. The patients were followed for a mean of 17 months. Seventy-five per cent of ultrasound treated eyes had successful reduction of intraocular pressure to below 20 mmHg with or without concomitant medical treatment at two years after treatment. The complication rate was low in this group of eyes. Five eyes developed hypotonia and three eyes had full thickness scleral perforations but were effectively controlled and developed no other complications during two years of follow-up. This technique appears more effective than cyclo-destructive techniques alone.
Adolescent↗
[Long-term results of successful surgical treatment of retinal detachment by vitrectomy and silicone oil injection. Effect of removal of the tamponade on further complications].
We present, with a minimal follow up of six months, the results of 118 silicone oil removals following successful treatment of retinal detachment by pars plana vitrectomy and silicone oil injection. A recurrent retinal detachment occurred in 8.5% of cases, 13% of the 61 phakic eyes at the time of silicone oil removal maintained a clear lens, 29.6% of the eyes had a raised intraocular pressure and 6.8% had a keratopathy. The visual acuity improved in 72.8% of eyes after silicone oil removal. The main reasons for a late decrease in visual acuity were recurrence of the detachment, hypertonia, chronic hypotonia and keratopathy. All the eyes with late complications after silicone oil removal had a clinically significant droplet dispersion in the anterior chamber. Only complete and early silicone oil removal seems to decrease the complication rate.
Adolescent↗
[Posterior luxation of lens or implant: surgical treatment using a perfluorocarbon solution. Technique and results of 13 cases].
We used perfluorocarbon liquids in the management of 6 cases of posterior dislocation of the lens and 7 cases of (sub-) luxation of a posterior chamber intraocular lens (IOL). The perfluorocarbon liquid was injected into the vitreous cavity after complete vitrectomy, to bring back the lens or IOL to the posterior chamber where it can be easily removed. The main characteristics of perfluorocarbon liquids used in this indication are their high specific gravity and their good surface tension. Because of these two qualities, when injected in a vitrectomized eye, the perfluorocarbon liquid forms a bubble, filling the vitreous cavity from the posterior pole to the ora serrata with the dislocated lens or IOL floating on its surface. We found this technique to be helpful and quite atraumatic in this difficult surgical situation. Complications included regressive corneal edema in 6 cases and retinal dialysis with localized detachment in 3 cases.
Fluorocarbons↗