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At least 325 records · Page 18Linked to original sources
PubMed1993

Surgical management of complications associated with X-linked retinoschisis.

OBJECTIVE: To evaluate the role of surgical intervention in cases with severe, vision-threatening complications of X-linked retinoschisis. DESIGN: A retrospective survey of consecutive patients with X-linked retinoschisis who underwent surgery at our institution during a 16-year period. SETTING: A tertiary-care eye hospital. PATIENTS: Six eyes of four patients were identified. The mean age of the patients at the time of the first surgical procedure was 4.9 years (range, 18 months to 9 years). INTERVENTION: Scleral buckling procedure or pars plana vitrectomy. MAIN OUTCOME MEASURE: Surgical indications and long-term anatomic and visual outcome. RESULTS: Patients were initially operated on for rhegmatogenous retinal detachment (three eyes), exudative retinal detachment (one eye), and vitreous hemorrhage (two eyes). The surgical approach was scleral buckling for retinal detachment and vitrectomy for vitreous hemorrhage or proliferative vitreoretinopathy. Anatomic success and ambulatory vision (20/400 or better) was achieved in five of the six eyes with a mean follow-up of 3.8 years (range, 1 to 6 1/2 years). An average of 1.8 procedures per eye were performed. Two of the four eyes approached by primary scleral buckling eventually required vitrectomy. Proliferative vitreoretinopathy with retinal detachment was the major reason for reoperation. CONCLUSIONS: Surgery for X-linked retinoschisis-associated retinal detachment and vitreous hemorrhage can yield favorable anatomic and functional results. Multiple operations and the use of advanced vitreoretinal techniques to manage proliferative vitreoretinopathy-related complications, however, were necessary for ultimate success in certain cases.

Child↗
PubMed1994

Pars plana vitrectomy for treatment of stage 2 macular holes.

OBJECTIVE: To assess the anatomic outcome and visual acuities at follow-up after pars plana vitrectomy in the management of stage 2 macular holes. DESIGN: Retrospective. SETTING: Retina Consultants, Ltd, St Louis, Mo. PATIENTS: Thirty-three patients, aged 43 to 75 years, with stage 2 macular holes. INTERVENTION: Total pars plana vitrectomy with separation of the posterior hyaloid membrane and injection of intraocular gas followed by postoperative face-down positioning. MAIN OUTCOME MEASURES: Visual acuity and anatomic appearance of the macular hole. RESULTS: Postoperatively, 20 (61%) of 33 eyes attained a visual acuity of 20/50 or greater. Twenty (61%) of 33 eyes showed an improvement in visual acuity, while nine (27%) of 33 were stable. Four (12%) of 33 eyes showed a decline in postoperative visual acuity with progression to a stage 3 macular hole. Twenty-five (76%) of 33 eyes showed stabilization or improvement in the appearance of the macular hole. CONCLUSIONS: Pars plana vitrectomy in conjunction with postoperative intraocular gas tamponade may result in visual and anatomic stabilization or improvement in eyes with stage 2 macular holes. However, because of limited natural history data, it is unknown whether these results are any better than those that might occur without surgery.

Adult↗
PubMed1994

Observation of idiopathic full-thickness macular holes. Follow-up observation.

OBJECTIVES: To evaluate the long-term follow-up observation of idiopathic full-thickness macular holes, with emphasis on the incidence and process of disappearance. METHODS: The authors followed up 97 eyes with idiopathic full-thickness macular holes for a period ranging from 2 to 182 months (average, 66 months). RESULTS: Apparent disappearance of the hole was observed in six eyes. Although improvement in visual acuity of at least 2 lines resulted in all six eyes, visual acuity improved to 20/30 or better in those eyes in which macular holes disappeared within 24 months of the initial examination. CONCLUSION: The incidence of apparent disappearance of idiopathic full-thickness macular holes was low. Improvement in visual acuity was greater in those cases in which macular holes disappeared in a relatively short period of time.

Aged↗
PubMed1994

Treatment of cytomegalovirus retinitis with an intraocular sustained-release ganciclovir implant. A randomized controlled clinical trial.

BACKGROUND AND METHODS: We performed a randomized controlled clinical trial to assess the safety and efficacy of a 1 microgram/h ganciclovir implant for the treatment of newly diagnosed cytomegalovirus (CMV) retinitis in patients with the acquired immunodeficiency syndrome (AIDS). Patients with previously untreated peripheral CMV retinitis were randomly assigned either to immediate treatment with the ganciclovir implant or to deferred treatment. Standardized fundus photographs were taken at 2-week intervals and analyzed in a masked fashion. The study end point was progression of retinitis based on the photographic assessment. RESULTS: Twenty-six patients (30 eyes) were enrolled. The median time to progression of retinitis was 15 days in the deferred treatment group (n = 16) vs 226 days in the immediate treatment group (n = 14) (P < .00001, log-rank test). During the study, 39 primary implants and 12 exchange implants were placed in immediate-treatment eyes, deferred-treatment eyes that progressed, or contralateral eyes that developed CMV retinitis. Postoperative complications in the total series included seven late retinal detachments and one retinal tear without detachment. Final visual acuity was 20/25 or better in 34 of 39 eyes. The estimated risk of developing CMV retinitis in the fellow eye was 50% at 6 months. Biopsy-proven visceral CMV disease developed in eight (31%) of 26 patients. The median survival was 295 days. CONCLUSION: The ganciclovir implant is effective for the treatment of CMV retinitis. Patients with unilateral CMV retinitis treated with the implant are likely to develop CMV retinitis in the fellow eye, and some patients will develop visceral CMV disease.

AIDS-Related Opportunistic Infections↗
PubMed1994

Results of surgical treatment of recent-onset full-thickness idiopathic macular holes.

OBJECTIVE: To investigate whether the visual prognosis after macular hole surgery was different between recent and older holes and to evaluate preoperative characteristics and variations in surgical technique that may influence outcome. DESIGN: The medical charts of all our patients who underwent surgery for a full-thickness macular hole were retrospectively reviewed. PATIENTS: Forty-eight eyes of 48 patients in the "early" group (symptoms < or = 6 months), and 20 eyes of 19 patients in the "late" group (symptoms > 6 months). INTERVENTION: Vitrectomy, separation of the posterior hyaloid, gas tamponade, and instructions to be face down for 1 week. Most patients had epiretinal membrane dissection. MAIN OUTCOME MEASURES: The early and late groups were compared regarding anatomic and visual outcomes. In the early group we evaluated the effect on outcome of the stage of the hole, intraocular tamponade, membrane dissection, and travel distance. RESULTS: Median postoperative visual acuity in the early group was 20/40 at 3, 6, and 12 months. Fifteen (56%) of 27 patients gained at least three lines of vision at 12 months. Anatomic success was seen with one operation in 75% (36/48), and with two operations in 87.5% (42/48). Stage 2 holes had a final anatomic success rate of 94.4%. Of respondents to an informal survey, 63.4% (26/41) believed that vision was greatly improved, and 70.3% (26/37) said that they would definitely choose surgery again. In the late group, median postoperative visual acuity was 20/100 at 6 months, compared with 20/142 preoperatively. Closure of the hole with one operation was seen in 60% (12/20) of the patients in the late group. CONCLUSIONS: Surgery in patients with recent macular holes has a better prognosis for visual rehabilitation than with older holes and appears to be considered beneficial by most patients.

Aged↗
PubMed1995

Asymptomatic rhegmatogenous retinal detachments.

OBJECTIVE: To describe the clinical characteristics and risk of progression of asymptomatic rhegmatogenous retinal detachments. METHODS: We retrospectively reviewed the clinical records of 28 patients (31 eyes) with asymptomatic rhegmatogenous retinal detachments followed up without surgery for 0.5 to 12.1 years (mean, 3.4 years). Tractional tears were present in six eyes and atrophic holes in 25 eyes. In five patients, the asymptomatic retinal detachment was noted when the patient presented with a symptomatic retinal detachment in the fellow eye. RESULTS: Twenty-nine of the 31 eyes remained asymptomatic without progression of the retinal detachment. Two eyes progressed to a symptomatic retinal detachment 2.25 and 3.3 years after the initial examination, underwent a successful scleral buckling procedure, and maintained 20/20 visual acuity. CONCLUSIONS: Observation can be considered a reasonable option in the treatment of patients with asymptomatic retinal detachments. Chart documentation of the risks and benefits of observation and instruction of the patient on self-monitoring of the peripheral visual field are necessary in such patients.

Adolescent↗
PubMed1995

Illustration of the stages of idiopathic macular holes by laser biomicroscopy.

BACKGROUND: The determination of the developmental stage of macular holes is difficult to assess clinically. This may be the reason for the conflicting reports on the risk of vision loss in patients with macular holes and on the value of prophylactic surgery. We have developed a new method, laser biomicroscopy, which provides visualization and photographic record of vitreoretinal structures at the macula. OBJECTIVE: To test the applicability of this method to the identification of macular holes stages. METHODS: Laser biomicroscopy and slit-lamp biomicroscopy were used to examine 18 patients with macular holes, identify the lesions, and classify them according to the various stages of development of idiopathic macular holes as proposed by Gass. RESULTS: Reflections considered to originate from the hyaloid membrane were observed more frequently by laser biomicroscopy than by conventional slit-lamp biomicroscopy. Two fellow eyes were diagnosed by laser biomicroscopy as having stage 1 lesions while slit-lamp biomicroscopy failed to yield a clear diagnosis. In four eyes with stage 3 holes the vitreoretinal separation was apparent only on laser biomicroscopy. Four cases were selected to illustrate the laser biomicroscopic findings in the different stages of macular hole development. CONCLUSIONS: The ease of visualization of the macular lesions with laser biomicroscopy may facilitate the evaluation of the early stages of macular holes and reduce the incidence of misdiagnosis. Furthermore, photographs obtained by laser biomicroscopy may be a useful tool in studies of early stages of macular holes.

Aged↗
PubMed1996

Cataract patients in a defined Swedish population, 1986 to 1990. V. Postoperative retinal detachments.

OBJECTIVE: To estimate the risk of retinal detachment after cataract surgery. DESIGN: Prospective study from December 17, 1985, through December 31, 1992 of all cataract surgeries performed in a single referral region of the Lund (Sweden) Health Care District from December 17, 1985, through December 31, 1990. SETTING: The University Hospital of Lund. PATIENTS: Data were collected on 5878 consecutive cataract operations. The study population was complete enough to represent all cataract surgery in the referral region during this period. RESULTS: Two years after cataract surgery, the risk of retinal detachment was 0.18%. The follow-up period after cataract surgery in this study was up to 7 years, with a mean of 50.7 months (>4 years), and the total risk of retinal detachment or detachment-related conditions was 0.71%, all cases included. The relative risk of detachment was 4.9 after YAG laser capsulotomy. It changed by a factor of 1.3 with an increase in the axial length of 1 mm and by 0.94 for each added year of patient age. CONCLUSION: A young patient with axial myopia operated on because of cataract and postoperatively treated with YAG laser capsulotomy runs an important increased risk of developing retinal detachment.

Adolescent↗
PubMed1996

Microholes of the macula.

OBJECTIVE: To describe the clinical syndrome of microholes of the macula. PATIENTS: Fourteen patients with acute symptoms caused by full-thickness microholes of the macula. RESULTS: Patients with macular microholes had the acute onset of central scotoma with mild to moderate visual acuity loss. Examination revealed a detachment of the vitreous over the fovea, often with an operculum or a total posterior vitreous detachment, and a sharply demarcated, 50- to 133-micrometer round hole in the center of the macula. On follow-up, all patients had a stable or improved scotoma and visual acuity. CONCLUSIONS: Macular microholes appear to be caused by an acute detachment of the vitreous from the fovea and can be distinguished from Gass stage 2 idiopathic macular holes.

Acute Disease↗