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At least 397 records · Page 22Linked to original sources
PubMed1997

Macular holes: migratory gaps and vitreous as obstacles to glial closure.

PURPOSE: Retinal glia may play an important role in the closure of macular holes. This in vitro study examines whether and how the specific pathoanatomy, including foveal eversion and foveal vitreous, may interfere with glial closure of macular holes. METHODS: Culture dishes used to grow glial cells were modified by the placement of slopes, vertical steps, and gaps to mimic the in vivo migratory surface in and surrounding macular holes. In separate experiments, defects were made in a rodent glial monolayer. These defects were exposed to hyaluronic acid (HA) and to rabbit (RV) and bovine (BV) vitreous gel. The migratory behavior and completeness of closure of defects were compared to controls. RESULTS: As expected, glial cells migrated further and in greater numbers on a smooth surface. Slopes and steps were moderate obstacles to migration; gaps in the surface were absolute obstacles. HA modified the pattern of adhesion of cells at the bottom of defects. Defects in the glial monolayer were repaired in 5-7 days. Compared to these controls, repair was inhibited by 11% (n.s.), 28% (P = 0.02), and 58% (P = 0.004) after direct exposure of defects to HA, RV and BV, respectively. CONCLUSION: The elevated and everted margins of macular holes represent slope, step, and gap-like obstacles to the migration of glial cells and hence to the healing of defects. The defect allows extension of extracellular matrix into it and the subretinal space. Our results indicate that gaps in the migratory surface caused and aggravated by eversion and the presence of vitreous present obstacles to glial migration and closure of macular holes.

Animals↗
PubMed1992

Influence of exogenous gangliosides on the three-dimensional sprouting of goldfish retinal explants in vitro.

To investigate the 3-dimensional outgrowth of ganglion cells of normal and regenerating goldfish retina, retinal explants were cultured in a serum free 3-D fibrin matrix. Daily applications of exogenous gangliosides (GM1), injected either intraocularly (i.o.) or intraperitoneally (i.p.) had no significant effect on the sprouting activity of retinal explants prepared from lesion-activated goldfish whose corresponding optic nerve had been transected. However, in normal, unlesioned animals, a local i.o. injection of GM1 or mixed gangliosides led to a significant enhancement of the basal retinal sprouting activity as compared to controls, which were injected with a 0.9% NaCl solution. This ganglioside related stimulation was maximal after i.o. injection of low concentrations (3 micrograms/eye), didn't occur at high concentrations (30 micrograms/eye) and was similar to the response obtained after i.o. injection of NGF or insulin. I.o. injected phospholipids had no or a slightly inhibitory effect on the sprouting activity as compared to NaCl controls. Daily in vivo i.o. injections of the monoclonal antibody Q211, specifically recognizing c-pathway polysialogangliosides, led to a dose dependent inhibition of the in vitro sprouting of goldfish retina explants. In summary, these data suggest an involvement of gangliosides in the complex process of induction of neuronal sprouting.

Animals↗
PubMed1994

Contribution of scanning laser ophthalmoscopy to the functional investigation of subjects with macular holes.

A study was designed to validate a functional investigation performed with the scanning laser ophthalmoscope before surgery for macular holes in 12 eyes: The assessment included fundus examination, a functional examination resulting in evaluation of the preferred retinal lows, visual acuity and recording of visual evoked potentials. The preferred retinal locus was evaluated by presenting a small square area, and visual acuity was determined by means of calibrated figures. The visual evoked potentials were evoked by three alternating checkerboards (check size, 30', 2 Hz) centered over the hole and seen at an angle of 6.5 x 6.5 degrees, 2.5 x 2.5 degrees and 6.5 x 6.5 degrees with central exclusion of 2.5 x 2.5 degrees. The appearance of the fundus visualized by scanning laser ophthalmoscopy consisted of a clear central disk corresponding to the hole, surrounded by a very dark ring, associated with a second, less dark ring with unclear margins. Fixation was unstable in one case with a visual acuity of 20/70. In 11 cases, fixation was localized to the superior retina with a visual acuity superior to 20/70. The visual evoked potentials evoked by 6.5 x 6.5 degrees were discernible in all 12 eyes; visual evoked potential by annular stimuli were discernible in 11 cases. The 2.5 x 2.5 degrees stimulus evoked no response in eight cases, proving the area of the hole was nonfunctional. A response was recorded in the four other cases, where the dimension of the holes was less than 2 degrees. The results of this scanning laser ophthalmoscopic assessment demonstrated a precise evaluation of the residual macular function in the cases of full-thickness macular holes.

Aged↗
PubMed1987

Does vitrectomy followed by intraocular gas tamponade offer sufficiently effective treatment of retinal detachment due to holes in the posterior pole?

We report on 17 consecutive cases of retinal detachment due to macular hole surgically treated by one of the authors (S.B.) between the fall of 1982 and 1985. The standard method used was pars plana vitrectomy and intraocular air tamponade. In cases of subsequent reaccumulation of subretinal fluid, the macular hole was cautiously coagulated. With repeated redetachment and as a last resort, silicone oil was injected into the vitreous cavity. After a follow-up period ranging from 5 to 42 months, 13 of the 17 eyes were cured; in 2 aphakic eyes treatment remained unsuccessful; in 2 eyes a small central detachment with some accumulation of subretinal fluid persisted but did not progress. Vitrectomy and gas tamponade alone, without coagulation, constitute the safest and most sparing treatment of this type of retinal detachment. Unfortunately, approximately one half of these cases require subsequent additional photocoagulation because of renewed accumulation of subretinal fluid. In about one fourth of macular hole retinal detachments, however, lasting reattachment is achieved only by silicone oil tamponade following initial vitrectomy and air/gas tamponade.

Adult↗
PubMed1986

Recovery of differential light sensitivity following surgery for rhegmatogenous retinal detachment.

Sixteen patients with phakic, nontraumatic rhegmatogenous retinal detachment were used in a prospective study on the change of the visual field following surgical treatment of the disease. The differential light threshold was measured across the visual field before and after surgery up to 1 year by means of the Octopus automated static perimeter. The visual sensitivity recovered prominently in the initial one to two months, followed by a slight improvement for up to a year. The final prognosis of visual sensitivity was correlated with the duration of detachment, but not with its extent or height. The recovery in the peripheral visual field was less remarkable, with residual slight defect. There was more improvement in visual sensitivity at the fovea than in visual acuity.

Adult↗
PubMed1986

Ultrasonography as a routine examination before treatment of retinal detachment due to macular hole.

Twelve of 25 patients were treated at the University Eye Clinic in Münster because of retinal detachment due to a macular hole. Partial fluid gas exchange (SF6), vitrectomy and SF6, or vitrectomy and silicone instillation, were used, and the patients were examined both pre- and postoperatively by ultrasonography with particular attention to the situation at the posterior pole. These echographical examinations enabled us to evaluate the following three criteria: staphyloma posticum, stiffness of the retina, and vitreous adhesions. All of these conditions mean that the prognosis will be worse if SF6 gas instillation is used alone. In these cases, a vitrectomy should also be performed or a Klöti-Klemme procedure is useful when stiffness of the retina or staphyloma posticum is present. Preoperative ultrasonography is useful when setting up an adequate therapy plan.

Eye Diseases↗
PubMed1986

Surgical treatment of retinal detachment from macular hole.

Six cases of retinal detachment from the macular hole were treated by a procedure including closed vitrectomy, air-fluid exchange, and prone positioning of the patient. All of these detachments were of the idiopathic type. Five patients had myopia ranging from -13 to -20 diopters; one was emmetropic. The initial success rate can be considered 100%: in all six cases the retina remained attached during follow-up periods ranging from 4-10 months at least. One later recurrence was not caused by the macular hole. This new technique, which allows permanent releasing of vitreous traction and temporary closure of the hole, shows that idiopathic retinal detachment is caused by vitreous traction.

Aged↗
PubMed1986

Q-switched neodymium: YAG laser surgery of the vitreous.

Fifty-nine eyes underwent vitreous surgery (vitreolysis) with the Q-switched Nd: YAG laser. This was used to cut vitreoretinal bands and membranes in 16 eyes and to clear persistent vitreous opacities in 25 eyes. The use of appropriate specialized contact lenses and modification of the standard slit-lamp delivery system were essential for vitreous YAG laser surgery. Successful results occurred in eyes where the target tissues were located at distances greater than 2 mm from the crystalline lens and the retina. Vision was improved in 18 eyes, unchanged in 40 eyes, and worse in 1. Complications included focal opacities of the crystalline lens in 5 eyes, retinal holes with detachment in 1 eye, and minor retinal hemorrhages in 4. Methods of preventing complications are discussed.

Cataract↗
PubMed1986

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at 18 months.

Sixty-five eyes with giant retinal tears previously reviewed at 6 months after vitrectomy and fluid/silicone-oil exchange were again reviewed 18 months after surgery. The retina remained attached in 54 eyes (83%), and of these 32 (57%) had visual acuities of 6/60 or better. Poor acuities were attributed in most cases to cataract associated with silicone-oil contact or macular damage from preoperative macular detachment. Glaucoma occurred chiefly in those eyes which were aphakic prior to surgery, or were rendered aphakic at surgery, but did not influence the visual outcome at this stage. Encouraging results of surgery after 6 months were confirmed after 18 months, although the level of vision had fallen in some cases due to the development of lens opacities.

Adolescent↗
PubMed1986

Treatment of retinal detachment with macular hole.

Of 21 retinal detachments with a macular hole, 18 (86%) were cured by cerclage, combined with drainage of the subretinal fluid and light (laser) coagulation of the macula. By means of this simple procedure, recommended by Meyer-Schwickerath in 1961, many surgical difficulties and possible complications, especially posterior pole hemorrhages, can be avoided and relatively good function of the central retina can be achieved. Even highly myopic eyes with moderate staphyloma can be treated successfully by this technique.

Drug Implants↗
PubMed1986

The treatment of difficult retinal detachments with an expanding gas bubble without vitrectomy.

In a prospective study on the use of perfluorocarbon gases (CF4, C2F6, C3F8) without prior mechanical vitrectomy, 51 retinal detachments that were not suitable for scleral buckling were treated by injection of a small bubble of gas into the vitreous to form a tamponade. There were 23 patients with giant tears, 16 with posterior holes, 9 with breaks at different latitudes, and 3 in whom the gas was used for diagnostic purposes. The gases were sustained at therapeutic volumes for 10-70 days. The tears were sealed with argon or krypton laser. The overall reattachment rate was 71%. Postoperative visual acuity improved or remained the same in all patients with reattached retina. In a follow-up of 1 year-38 months there were no late complications, such as cataract, glaucoma, keratopathy, or subsequent visual deterioration.

Adolescent↗
PubMed1986

The treatment of macular holes by pars plana vitrectomy and internal air/SF6 exchange.

The results of a series of patients with full-thickness macular holes treated by pars plana vitrectomy are described. A air/gas mixture is used to tamponade the retinal hole and no adhesion is applied. Eleven eyes, including six high myopes, were treated using this method and sustained reattachment was achieved in eight eyes (73%). Three cases failed due to the presence of preretinal membrane formation and retinal shortening. This method is technically easy, allows good tamponade of the retinal hole with controlled internal drainage of subretinal fluid, and appears much safer than previously described techniques.

Air↗
PubMed1986

A refined experimental model for proliferative vitreoretinopathy.

Animal models of proliferative vitreoretinopathy (PVR) in which the intact vitreous is injected with large numbers of tissue cultured fibroblasts do not accurately represent the disease as it is found in humans. A refined model of PVR is presented, in which the vitreous is compressed and partially detached using intravitreally injected perfluorpropane, followed by injection of 25,000 homologous fibroblasts. Proliferation occurred on the retinal surface, causing retinal detachments with the same frequency as models using greater numbers of cells.

Animals↗
PubMed1987

Pars plana vitrectomy for retinal detachment with unseen retinal holes.

A study was made of a consecutive series of 47 cases of rhegmatogenous retinal detachment treated by pars plana vitrectomy in which no holes were identified preoperatively. The view of the fundus during preoperative examination varied from being totally clear to completely obscured by media opacities. The role of pars plana vitrectomy in finding retinal holes peroperatively is considered. The incidence of discovering holes and the locations of those found at the time of surgery are presented. The significance of these findings is discussed. Where the preoperative view was good and the extent of proliferative vitreoretinopathy (PVR) did not exceed grade C2, retinal reattachment was achieved in 75% of the cases. A review made of a similar group of patients treated with conventional retinal buckling before the introduction of pars plana vitrectomy revealed that successful retinal reattachment was achieved in 70% of cases. The study concludes that pars plana vitrectomy, while being necessary for cases of rhegmatogenous retinal detachment when the view of the retina is obscured, will not always reveal the presence of a retinal break. If the preoperative view of the retina was good and the extent of PVR did not exceed grade C2, pars plana vitrectomy did not seem to offer obvious advantages over conventional buckling procedures.

Humans↗
PubMed1987

Tearing of retinal pigment epithelium after glaucoma surgery.

Tearing of the retinal pigment epithelium following trabeculectomy for chronic open-angle glaucoma in two patients is reported. In one patient, the tear was diagnosed on the 4th postoperative day. It started a few disc diameters above the temporal vascular arcade, crossed the temporal part of the macula and extended to the equator in the lower temporal periphery. At the acute stage, hypotonia and exudative retinal detachment were found. In the other patient, the tear was equatorial extending from the upper nasal to the lower nasal quadrant. At the acute stage, hypotonia and choroidal detachment, but no exudative retinal detachment, were present. After 1 year, the retina was flat in both eyes and no further complications were noted.

Aged↗
PubMed1986

Ocular abnormalities associated with cutaneous melanoma and vitiligolike leukoderma.

Several varieties of ocular pathology are associated with acquired cutaneous hypomelanosis (leukoderma; vitiligo). Our current study was undertaken to investigate the relationship between ophthalmologic disorders and a specific depigmentary phenomenon, the vitiligolike leukoderma of cutaneous melanoma. Over the past 14 years, eight patients with cutaneous melanoma and widespread areas of hypopigmentation were identified at the Pigmented Lesion Clinic of the Massachusetts General Hospital. The seven patients who underwent ophthalmologic examination had pigment-related ocular abnormalities. Among these were inflammations of the uveal tract in three patients, heterochromia in two, halo nevi of the choroid in one, and hypopigmentation and/or atrophy of the retinal pigment epithelium or choroid in four. Our findings demonstrate that ocular disease may be a component in a syndrome consisting also of cutaneous melanoma and vitiligolike leukoderma and suggest the need for complete ophthalmologic examinations in patients with melanoma and leukoderma.

Adult↗
PubMed1987

Alteration of the visual evoked potential by macular holes: comparison with optic neuritis.

Nine patients with maculopathy (macular holes, macular cysts, and lamellar holes) and ten patients with optic neuritis were examined in order to determine changes in the visual evoked potential (VEP) in response to pattern-reversal stimulation. Eyes with lamellar holes had normal P100 latency, but eyes with macular cysts and macular holes had prolonged P100 latency. Eyes with optic neuritis exhibited greater prolongation of the P100 latency than eyes with macular holes. In contrast, eyes with macular holes had a greater reduction in the steady-state VEP amplitude than eyes with optic neuritis. The prolonged latency occurring in maculopathy may be due to a peculiar amplitude summation noted with half-field VEP, rather than to a true conduction delay like that seen in eyes with optic neuritis. The amplitude slope, which is usually positive in normal controls, was negative for 85.7% of eyes with macular holes and 69.2% of eyes with optic neuritis. The negative amplitude slope may represent a subtle defect in retinal ganglion X cells. Eyes with significantly lower values for four or more of the nine central test points on quantitative automated perimetry had negative amplitude slopes and prolonged P100 latency.

Adult↗