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At least 343 records · Page 19Linked to original sources
PubMed1996

Visual field loss following vitreous surgery.

OBJECTIVE: To assess possible causes of visual field loss following vitreous surgery. DESIGN: Charts of 8 patients prospectively identified, who developed visual field loss following vitreous surgery, were reviewed to characterize this newly recognized syndrome and assess possible causes. RESULTS: Two patients had preexisting chronic open-angle glaucoma and 1 had ocular hypertension. Indications for surgery included 4 eyes with macular holes, 1 eye with epiretinal membrane, 2 eyes with rhegmatogenous retinal detachment, and 1 eye with retinal detachment and giant retinal tear. All patients received retrobulbar anesthesia. Seven of 8 patients had fluid/gas exchange with installation of long-acting bubbles. In 1 patient with a macular hole, a small hemorrhage was noted along a vessel coming off the nerve superotemporally while attempting to engage the posterior cortical vitreous intraoperatively. This patient developed an inferior visual field defect. No intraocular pressure (IOP) measurements greater than 26 mm Hg were recorded in any eye perioperatively. Visual field defects included 4 eyes with inferotemporal defects, 2 eyes with inferior altitudinal defects, 1 eye with a cecocentral scotoma, and 1 eye with a superonasal defect. Only 1 patient had worsened visual acuity. A relative afferent pupillary defect was observed in 4 eyes and disc pallor in 5 eyes. CONCLUSIONS: Central or peripheral visual field loss can now be recognized as a possible complication of vitreous surgery. In some cases, a relative afferent pupillary defect and optic disc pallor are present, suggesting that the optic nerve is the site of injury. Possible mechanisms include ischemia due to elevated IOP or fluctuations in IOP, optic nerve damage from retrobulbar injection, direct intraoperative mechanical trauma to the optic nerve, indirect injury from vigorous suction near the optic nerve leading to shearing of peripapillary axons or vessels, or a combination of these. Certain optic nerves may be more susceptible to injury because of preexisting compromise from glaucoma or vascular disease.

Adult↗
PubMed1997

Vitrectomy for the treatment of full-thickness stage 3 or 4 macular holes. Results of a multicentered randomized clinical trial. The Vitrectomy for Treatment of Macular Hole Study Group.

OBJECTIVE: To prospectively assess the risks and benefits of vitrectomy surgery for eyes with stage 3 or 4 macular holes. DESIGN: A multicentered, controlled, randomized clinical trial. SETTING: Community- and university-based ophthalmology clinics. PATIENTS: One hundred twenty patients (129 eyes) with stage 3 or 4 macular holes. INTERVENTIONS: Standardized macular hole surgery vs observation alone. MAIN OUTCOME MEASURES: Four measures of best-corrected visual function, standardized photographic evaluation of the extent of hole closure, evaluation of lens opacification, and determination of adverse events. Outcomes were determined at 6 months after randomization. RESULTS: Compared with observation alone, a significant benefit due to surgery was found in the rate of hole closure (4% vs 69%, P < .001). After adjusting for baseline visual acuity, hole duration, and maximum hole diameter, a significant benefit due to surgery was found in visual acuity for the Bailey-Lovie Word Reading (P = .02) and the Potential Acuity Meter (P < .01) tests; a marginally significant benefit due to surgery was found in visual acuity for the Early Treatment Diabetic Retinopathy Study chart (P = .05). Although the proportion of eyes achieving a change in visual acuity of 2 or more lines on the Early Treatment Diabetic Retinopathy Study chart was significantly greater for the surgery group vs the observed group (11 [19%] of 59 eyes vs 3 [5%] of 58 eyes, adjusted P = .05), 20 (34%) of 59 eyes randomized to surgery had a loss in visual acuity of 1 or more lines. Compared with the observation group, eyes randomized to surgery had higher nuclear sclerosis scores (2.4 vs 1.3, P < .001). Fourteen adverse events were noted in the surgery group; none were noted in the observed group. CONCLUSIONS: Some visual benefit of vitrectomy surgery for macular holes exists, despite a notable incidence of adverse events. The large variability in visual acuity outcome in the surgical group may be because of complications or progressive cataract. A study of the long-term outcome after macular hole surgery is needed.

Aged↗
PubMed1997

Osseous metaplasia in a preretinal membrane.

A highly myopic patient had surgery for retinal detachment in both eyes. After 3 procedures, the left eye developed phthisis bulbi. After multiple procedures, the right eye underwent a vitrectomy for proliferative vitreoretinopathy. A plaque of preretinal tissue was removed. We found bone on pathologic examination. The retina remains attached, and visual acuity is 20/200. Ultrasonography showed additional evidence of calcification of both eyes, presumably metaplastic bone.

Adult↗
PubMed1997

Membranectomy and autologous serum for the retreatment of full-thickness macular holes.

OBJECTIVE: To determine the efficacy of reoperation with rigorous epiretinal membrane dissection and autologous serum for full-thickness macular holes remaining open after initial surgery. METHODS: Forty-six consecutive eyes that had previously undergone unsuccessful macular hole surgery were re-treated with epiretinal membrane dissection, adjunctive autologous serum, and 16% perfluoropropane (C3F8) gas tamponade. Anatomical closure and improvement of best-corrected Snellen visual acuity were used as outcome measures, and nuclear sclerosis was graded clinically before and after reoperation. RESULTS: Epiretinal membrane was identified and dissected in 29 (63%) of the 46 eyes and anatomical closure was achieved in 37 (80%) of the 46 eyes. Of these, 23 (62%) of 37 improved by at least 2 Snellen lines, 12 (35%) of 37 by at least 3 Snellen lines, and 6 (16%) of 37 by at least 4 Snellen lines. Increase in nuclear sclerosis occurred in 30 (65%) of the 46 eyes postoperatively, leading to cataract extraction in 12 (26%) of the eyes at last follow-up (mean, 10.3 months). A longer total duration (P<.001) and a worse preoperative visual acuity (P=.001), prior to reoperation, were associated with a worse final visual acuity after surgery. CONCLUSIONS: Retreatment with rigorous membranectomy and autologous serum seems to be beneficial in most eyes in which initial macular hole surgery has failed. Although the anatomical closure rate is similar to that reported after primary surgery, final visual acuity improvement seems to be less than after successful primary closure, owing to the longer mean duration of holes in which initial surgery has failed.

Aged↗
PubMed1997

Macular hole opercula. Ultrastructural features and clinicopathological correlation.

OBJECTIVE: To investigate the ultrastructural features of idiopathic full-thickness macular hole (FTMH) opercula excised during vitrectomy and to correlate them with the outcome of surgery. METHODS: Opercula were collected from eyes undergoing vitrectomy for stage 3 FTMH using noncrushing, cupped foreign body forceps. Following immediate fixation, specimens were processed for transmission electron microscopy. The ultrastructural features were correlated with the clinical data recorded for each patient before and after surgery. RESULTS: Eighteen specimens were studied. Native vitreous collagen was identified on the surface of all 18, while fragments of internal limiting membrane were present in 11 (61%). Eleven (61%) were found to contain only glia, comprising fibrous astrocytes and Müller cells in variable proportions. The remaining 7 (39%) were found to contain, in addition to glia, neurites and synaptic complexes, of which some were typical of cone photoreceptors. The initial surgical closure rate was significantly better in eyes in which only glia were present (9/11 [82%]), compared with those with neurites (1/7 [14%]) (P = .01). Once closure had been achieved with reoperation, the median final visual acuity was 20/60 in both groups (P = .26), although the likelihood of achieving an acuity of 20/40 or better was greater in the former (50%) than the latter group (17%). CONCLUSIONS: Two distinct types of opercula occur in association with stage 3 FTMH--those containing only glia (pseudo-opercula), which are probably associated with a foveal dehiscence and little or no loss of foveal tissue, and those containing both glia and a significant number of avulsed foveal cones (true opercula), which arise from a full-thickness foveal tear. Although the loss of foveal tissue in true opercula would seem to explain the worse initial anatomical and more modest visual results in some eyes, significant visual improvement may still be achieved after successful closure. The presence of neurites in true opercula suggests that, in at least some cases, direct traction on the foveal retina leads to macular hole formation.

Aged↗
PubMed2001

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

BACKGROUND: Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina, because such symptomatic retinal breaks are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven. OBJECTIVES: The purpose of this review is to evaluate the effects of interventions for asymptomatic retinal breaks and lattice degeneration. SEARCH STRATEGY: We searched the Cochrane Controlled Trials Register - CENTRAL (which includes the Cochrane Eyes and Vision Group specialized register), MEDLINE and EMBASE. Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed in an effort to find additional study reports. Experts in the field were contacted for details of other published and unpublished studies. SELECTION CRITERIA: This review was designed to include randomised controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment. DATA COLLECTION AND ANALYSIS: One reviewer assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed. MAIN RESULTS: No trials were found that met the inclusion criteria for this review. REVIEWER'S CONCLUSIONS: No conclusions could be reached about the effects of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

Humans↗
PubMed2005

Interventions for asymptomatic retinal breaks and lattice degeneration for preventing retinal detachment.

BACKGROUND: Asymptomatic retinal breaks and lattice degeneration are visible lesions that are risk factors for later retinal detachment. Retinal detachments occur when fluid in the vitreous cavity passes through tears or holes in the retina and separates the retina from the underlying retinal pigment epithelium. Creation of an adhesion surrounding retinal breaks and lattice degeneration, with laser photocoagulation or cryotherapy, has been recommended as an effective means of preventing retinal detachment. This therapy is of value in the management of retinal tears associated with the symptoms of flashes and floaters and persistent vitreous traction upon the retina in the region of the retinal break, because such symptomatic retinal tears are associated with a high rate of progression to retinal detachment. Retinal tears and holes unassociated with acute symptoms and lattice degeneration are significantly less likely to be the sites of retinal breaks that are responsible for later retinal detachment. Nevertheless, treatment of these problems is frequently recommended, in spite of the fact that the effectiveness of this therapy is unproven. OBJECTIVES: The purpose of this review is to evaluate the effectiveness of interventions for asymptomatic retinal breaks and lattice degeneration. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials - CENTRAL (which includes the Cochrane Eyes and Vision Group Trials Register) on The Cochrane Library (Issue 3 2004) MEDLINE (1966 to July 2004) and EMBASE (1980 to August 2004). Textbooks regarding retinal detachment and the reference lists of relevant reports were reviewed for additional study reports. Experts in the field were contacted for details of other published and unpublished studies. SELECTION CRITERIA: This review was designed to include randomised controlled trials in which one treatment for asymptomatic retinal breaks and lattice degeneration was compared to another treatment or to no treatment. DATA COLLECTION AND ANALYSIS: One reviewer assessed the search results and collected relevant studies. Since no studies met the inclusion criteria, no studies were assessed for methodological quality. No data were extracted and no meta-analysis could be performed. MAIN RESULTS: No trials were found that met the inclusion criteria for this review. AUTHORS' CONCLUSIONS: No conclusions could be reached about the effectiveness of surgical interventions to prevent retinal detachment in eyes with asymptomatic retinal breaks and/or lattice degeneration. Some current recommendations for treatment, based upon a consensus of expert opinion, are contradicted by the best available evidence.

Humans↗
PubMed1984

Argon laser photocoagulation in the management of retinal detachment and predisposing lesions.

During the years 1979-1982 we treated by argon laser photocoagulation 863 eyes of 551 patients affected by peripheral retinal degenerations and breaks. No case of progression to retinal detachment has been registered so far. In the same period, we treated 42 patients affected by retinal detachment of different topography (three posterior pole and 39 peripheral detachments) and size (mostly limited detachments, 12 as large as a quadrant, two larger than a quadrant). In 41 of these 42 eyes, the retina is still firmly attached after a 1- to 4-year follow-up, while in one case it was necessary to proceed surgically following a relapse. While argon laser photocoagulation is certainly the first choice treatment of retinal degenerations and breaks, it also appears to be a reliable alternative to scleral buckling in the management of specific cases of retinal detachment.

Adult↗
PubMed1995

Alteration of pulse configuration affects the pain response during diode laser photocoagulation.

BACKGROUND AND OBJECTIVE: The shape of the treatment pulse of the diode laser (810 nm) can be easily altered electronically in contrast to ion laser photocoagulators. We investigated whether changes in laser pulse shape influenced the subjective pain responses in patients undergoing retinal photocoagulation when only topical anesthesia was used. STUDY DESIGN/MATERIALS AND METHODS: Twenty consecutive patients required peripheral retinal photocoagulation for proliferative diabetic retinopathy or extensive retinal breaks. Three diode pulse waveforms including a square wave, shaped-wave, and an envelope of micropulses were compared to one another. Power was adjusted so that each waveform delivered the same total energy. The patients subjectively ranked the intensity of any pain they experienced for each group of lesions. Responses were compared to one another using an analysis of variance. RESULTS: 40% of patients found the standard square wave pulse to be significantly more painful (P < 0.05) than the shaped pulse mode and 30% found the square wave significantly more painful (P < 0.05) than the micropulse mode. CONCLUSION: Modification of the laser pulse waveform may ameliorate pain induced by diode laser photocoagulation of the retinal periphery.

Analysis of Variance↗
PubMedDate not supplied

Pars plana transvitreal carbon dioxide laser photocautery: a new surgical technique.

Intraocular carbon dioxide laser photocautery has been used experimentally as well as clinically to surround and seal retinal tears and to treat fibrovascular fronds and blood vessels at the time of vitrectomy. All biologic tissue will absorb the 10.6-microm infrared wavelength; thus the tissue does not have to be pigmented in order to absorb infrared energy. This technique involves no electrical hazard to the patient or surgeon. We have followed patients treated with the carbon dioxide laser, and they have retained improved vision for over 18 months. Intraocular carbon dioxide laser photocautery appears to be a safe, reliable, and effective means of performing intraocular photocautery at the time of vitrectomy.

Animals↗
PubMed2000

Structure of abnormal molecular assemblies (collagen VI) associated with human full thickness macular holes.

Transversely banded deposits with an approximately 100-nm periodicity have been seen in association with a number of eye pathologies (e.g., age-related macular degeneration). Recently such aggregates have also been discovered in the cortical vitreous of a patient suffering from full thickness macular holes. The aggregates in the vitreous were of sufficient size and regularity for us to attempt 3D ultrastructural studies in the electron microscope. The molecules forming this aggregate pack in a centered tetragonal unit cell of dimensions approximately 26 x 26 x 180 nm. A real-space (r-weighted back projection) 3D reconstruction was computed. The aggregate is discussed in terms of its possible protein constituents. Collagen VI has been singled out as the most likely protein to form the aggregate. Two alternative models for the molecular packing are proposed, comprising aggregates of molecular tetramers or octamers. Understanding the structure of these abnormal banded deposits in the eye should help to throw light on the pathophysiological mechanisms of the diseases, including age-related macular degeneration, in which they occur.

Bruch Membrane↗