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At least 415 records · Page 23Linked to original sources
PubMed1989

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up.

A series of 64 eyes, in 64 patients with giant retinal tears, treated by vitrectomy and fluid/silicone-oil exchange, has been reviewed after 5 years. Anatomical success was achieved in 73% of cases and visual function in successful cases ranged from 6/6 to NPL; 66% achieved acuities of 6/60 or better and 32% had vision of 6/18 or better. These results compare favourably with those in a previous series reported after 6 months and 18 months. Epiretinal membrane proliferation and shortening accounted for the majority of retinal redetachments while macular abnormalities, especially pucker, were responsible for a poor visual outcome. Glaucoma is the most serious long-term complication of the surgical method and occurs most frequently in aphakic eyes. Retention of the crystalline lens, whenever possible, the creation of a 6 o'clock iridectomy in aphakic eyes, early removal of silicone oil and a conservative approach to the use of scleral buckles are recommended.

Adolescent↗
PubMed1989

Evaluation of the functional results after different techniques for treatment of retinal detachment due to macular holes.

A total of 50 eyes with retinal detachment due to macular holes were treated in the period from July 1986 to December 1987. In all, 10 eyes underwent pneumatic retinopexy using plain room air. A total of 30 eyes were treated by pars plana vitrectomy, followed by fluid/air exchange, with no treatment of the macular break; in 9 of these the detachment recurred, reflattening of the retina by air tamponade followed by laser photo-coagulation. The other 10 eyes underwent pars plana vitrectomy followed by silicone oil tamponading because of proliferative vitreoretinopathy (PVR). This paper compares the functional results for each group. The parameters used included visual acuity, color vision and visual fields.

Adult↗
PubMed1989

Specular and scanning electron microscopy in diffuse silicone keratopathy.

In a 50-year-old man, penetrating keratoplasty was carried out to treat a diffuse silicone keratopathy that developed 2 years after a pars plana vitrectomy combined with an intravitreal silicone injection for a complicated retinal detachment in the only aphakic eye. At 2 weeks after the intravitreal silicone injection, specular microscopy revealed a mild pleomorphism in the corneal endothelium and an endothelial cell loss of 26%. After 5 months, a small silicone drop floated in the anterior chamber and the first signs of diffuse keratopathy were observed. At the same time, specular microscopy revealed severe damage to the endothelial cells and a cell loss of 69%. After the keratoplasty, scanning electron microscopy of the corneal button showed a filamentous structure of the posterior surface of the cornea, with fibroblast-like cells; the endothelial cells were absent.

Anterior Chamber↗
PubMed1985

Resorption of subretinal fluid by transepithelial flow of the retinal pigment epithelium.

The efficiency of flow through the retinal pigment epithelium (RPE) was calculated by studying the postoperative course of the subretinal fluid after nondrainage surgery of rhegmatogenous retinal detachment. In ten eyes of ten patients the preoperative volume of the subretinal fluid, area of the RPE participating in resorption of the fluid, elapsed time until resorption of the fluid, and efficiency of the flow were studied using B-scan ultrasonography. The flow through the RPE was 261 microliter/cm2 per day and could drain more than 50% of the vitreous volume to the choroidal circulation. These data coincide well with early reattachment of neural retina in nondrainage surgery. No statistically significant difference in this flow was seen between young and old patients.

Absorption↗
PubMed1988

The development of severe proliferative vitreoretinopathy after retinal detachment surgery. Grade B: a determining risk factor.

A prospective clinical study was conducted to determine wether preoperative proliferative vitreoretinopathy (PVR), grade B, was a significant risk factor in the development of severe PVR after surgery for retinal detachment repair. Two series of consecutive retinal detachments associated with horseshoe retinal tears were compared. The first series included 40 eyes of 40 patients with preoperative PVR, grade O-A. The second series included 30 eyes of 27 patients with preoperative PVR, grade B. All eyes were operated on with conventional microsurgical techniques. At the first operation, no vitrectomies were carried out in any eyes. The incidence of postoperative PVR, grades C and D, was 20% (6/30 eyes) after a single operation in the series of eyes with preoperative PVR, grade B as compared to 0% in the series of eyes with preoperative PVR, grade O-A. The difference between the two groups was statistically significant (P = 0.01). It was also found that the incidence of postoperative proliferative PVR was significantly higher in eyes with preoperative vitreous hemorrhage (30.7%) as compared to eyes with no preoperative vitreous hemorrhage (0%; P = 0.02). Incomplete posterior vitreous detachment without collapse of the vitreous gel occurred significantly more frequently in eyes with preoperative proliferative vitreoretinopathy, grade B (68.4%, than in eyes with preoperative proliferative vitreoretinopathy, grade O-A (27.5%; P = 0.02).

Adult↗
PubMed1987

The physical and surgical aspects of silicone oil in the vitreous cavity.

Silicone oil inside the vitreous cavity exerts forces on to the retina as a result of buoyancy, volume displacement, and surface tension. Surface tension rather than viscosity is the key to understanding why the oil seals retinal breaks effectively. The physics of the tamponade was studied quantitatively. Retinal traction can be counteracted by the oil up to a calculated threshold value, depending on the size and shape of the tear, the strength of the surface tension and, most importantly, the distance between the retina and choroid. For a nearly flat retinal hole, the tamponade is very effective. These theoretical results imply straightforward rules for surgery, rules that have been tested in 150 operations. An attempt must be made to fill 100% of the vitreous cavity. Since the air-water boundary has 3 times the surface tension of the water-oil boundary, the most effective procedure is to flatten the retina by means of a fluid-gas exchange and then clamp it in a flat position, implanting the silicone oil. Silicone in the subretinal space or the anterior chamber tends to retract spontaneously, for surface tension causes the smaller bubble to blow up the larger one. Surgical methods are described to make use of it.

Humans↗
PubMed1996

Vitreomacular observations. II. Data on the pathogenesis of idiopathic macular breaks.

BACKGROUND: The pathogenesis of idiopathic macular breaks is still uncertain. Their formation has been ascribed to anteriorly oriented intravitreous traction and to shrinkage of the prefoveal cortical vitreous. The validity of both hypotheses is considered in this paper. METHODS: In order to clarify the pathogenesis of idiopathic macular breaks 127 consecutive patients had their vitreous examined and photographed with the El Bayadi-Kajiura precorneal lens and a slit-lamp microscope. RESULTS: A comparison with 127 matched controls demonstrated that the vitreous was significantly more often attached in eyes with a macular break than in controls (P < 0.01). In eyes with a macular break the vitreous was significantly more often attached in early cases (Gass stage 1) than in Gass stages 3 and 4 (P < 0.01). Still photographs and observation of the movements of the operculum demonstrated that, in some cases of stage 3 and also in stage 4, it moved inside the partially liquefied posterior vitreous, anteriorly to the retinal surface and frequently without evidence of posterior vitreous detachment over the macular area. The following anatomical features characterize the vitreomacular area: extremely thin hyaloid membrane (< 100 microns) and inner limiting lamina (10 nm) that adhere strongly to each other and to the underlying Mueller cells. There is no evidence that these structures can shrink selectively to cause a macular break. The premacular vitreous gel contains collagen fibers that attach posteriorly to the macula and anteriorly to the vitreous base. CONCLUSIONS: Our working hypothesis is that when detachment of the posterior vitreous is abnormally delayed, anteroposterior traction by collagen fibers may pull a foveal operculum off the retina. Our observations make this hypothesis attractive. However, the generally accepted hypothesis of Johnson and Gass cannot be entirely dismissed. In reality, since the two hypotheses are not mutually exclusive, they may both the partially correct.

Aged↗
PubMedDate not supplied

Electroretinographic changes in eyes with idiopathic macular hole treated by vitrectomy.

We recorded full-field electroretinograms before and after vitrectomy in 18 eyes of 18 patients with idiopathic macular hole. The results were compared between affected and fellow eyes in the preoperative and early (within 10 days) and late (3 to 6 months) postoperative periods. No significant changes between affected and control eyes were found in the amplitude of the rod electroretinogram, mixed cone-rod electroretinogram, cone electroretinogram a- and b-waves or 30-Hz flicker electroretinogram in all stages of the study. The peak implicit times of the cone electroretinogram (a- and b-wave) and dark- and light- adapted oscillatory potential (O1-O4), however, were delayed. Also, the amplitude of the oscillatory potentials (O1+O2+O3+O4) was significantly reduced in the early postoperative period. By the late period, all of these changes had resolved. We concluded that electrophysiologic changes were derived from a transitory dysfunction of the inner retina. The possible causes of the electroretinographic changes would include mechanical trauma of the surgery, intravitreous air tamponade or the changes in vitreous electrolytes after surgery. Oscillatory potentials were more sensitive than a- and b-waves in eliciting dysfunction of the inner retina in operate on eyes.

Adult↗
PubMedDate not supplied

Electroretinographic findings in macular dystrophy.

The flash and pattern electroretinogram were investigated in a group of families with rare forms of inherited macular dystrophy, which included Sorsby's fundus dystrophy, X-linked retinoschisis and macular dystrophy of uncertain classification and variable expression. Flash electroretinograms, under both photopic and scotopic conditions, were attenuated in both Sorsby's fundus dystrophy and X-linked retinoschisis--with some effect on implicit time being noted in the latter condition--but in the unknown group the effect was less demonstrable, only 50% having attenuated flash electroretinograms. Pattern electroretinograms were reduced in all three conditions and in almost all cases. The study demonstrates that some so-called macular dystrophies also have widespread abnormalities affecting the peripheral retina. These findings may contribute to a better understanding of the underlying pathophysiologic mechanisms in these rare forms of retinal dysfunction.

Adult↗
PubMedDate not supplied

Pneumatic retinopexy versus scleral buckling: a randomised controlled trial.

Pneumatic retinopexy (PR) is a technique for repairing certain retinal detachments which is easier to perform than conventional sceral buckling (SB) surgery but has comparable results. We performed a prospective, randomised, controlled trial to determine for ourselves whether PR is a safe and acceptable procedure. Twenty patients presenting consecutively with retinal detachments which fulfilled the selection criteria were randomised to have their detachments repaired by either PR or SB, ten patients in each group. The suitable patients had a single retinal break or small group of breaks of not greater than one clock hour in size, situated within the superior eight clock hours of retina. Patients with significant proliferative vitreoretinopathy or other fundus disorders were excluded. All patients in the PR group had local anaesthesia while all those in the SB group had general anaesthesia. Successful reattachment of the retina was achieved with one or more procedures in 90 percent of the PR group and in 100 percent of the SB group. We feel that narrowing the selection criteria for PR may further improve the success rate.

Cryosurgery↗
PubMed2004

Proliferative vitreoretinopathy--at what risk is the fellow eye?

PURPOSE: To find out if patients with proliferative vitreoretinopathy (PVR) due to complicated retinal detachment are at risk to acquire the same disease or other vision-threatening retinal abnormalities in the fellow eye. To furthermore assess in what time-period they appear and if subgroups of patients have special risks. METHODS: 100 consecutive PVR-patients were studied retrospectively. 21 patients with PVR graded lower than C3, traumatic PVR, diabetic retinopathy or congenital vitreoretinal diseases were excluded. Age, gender, best-corrected visual acuity at the first and last visit, refraction, ocular disease in both eyes and observation-time were recorded. RESULTS: After a mean follow-up of 8.5 years, 42 of 79 patients (53.4%) showed vision-threatening abnormalities in their fellow eyes: among them, 9 patients (11.4%) had PVR, 13 (16%) simple retinal detachments and 14 (17.3%) retinal breaks. Abnormalities in the fellow eye did not develop after a certain time following surgery of the primary eye; 71.4% appeared within 5 years. Aphakic and pseudophakic patients had retinal breaks significantly more often (p = 0.011) than phakic patients. Myopia did not increase the risk for any abnormality. Men developed retinal detachment (p = 0.037) and PVR (p = 0.025) significantly more often than women. CONCLUSION: Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye. Because of this increased risk, these patients need regularly-scheduled long-term follow-up. SUMMARY STATEMENT: Patients with PVR have a greater than 50% risk of developing vision-threatening retinal abnormalities in their fellow eye and a 37% risk to develop PVR from rhegmatogenous retinal detachment. More than two thirds of abnormalities in the fellow eye developed within five years of surgery of the primary eye.

Adult↗
PubMed2002

[Treatment of primary retinal detachment. Minimal extraocular or intraocular?].

The developments in treatment modalities for a primary retinal detachment over the last 70 years have been reviewed. There was a change from a surgery limited to the area of the break to a form of prophylactic surgery including the extent of the detachment. In between Rosengren had limited the treatment to the break with an intraocular gas bubble. A change was brought about by Custodis in 1953 who limited surgery to the break and omitted drainage. This procedure had serious postoperative complications which were eliminated by Lincoff by developing the cryosurgical detachment operation which was subsequently refined to extraocular minimal surgery. The ultimate realization of a minimal extraocular approach was the operation with a temporary balloon. Two additional intraocular procedures evolved, pneumatic retinopexy and primary vitrectomy, following one or the other pattern of treatment. With all four methods reattachment can result in 94-99% of the cases but differences can be seen in the morbidity and rate of reoperations.

Catheterization↗
PubMed2002

[Macular holes. A treatable disease picture with unsolved problems].

Macular holes have a special position in the paradigmatic change of vitreoretinal surgery during the past 10 years. While the rationale for existence of retinal and vitreal surgery is based largely on invasive mechanical intervention in cases of large-surface epiretinal tractions, e.g., in diabetic traction amotio or detached retina with PVR, the intention of surgical treatment for macular holes is to employ a minimally invasive method, using less direct mechanical manipulation and taking into consideration physical and cell biological aspects to induce local repair processes. Whereas the classification according to Gass is still completely based on the perspective of epiretinal traction via retracted vitreal material, newer theories, relying on more subtle diagnostic examination techniques, assume a complex interaction of tractive and proliferative effects.

Epiretinal Membrane↗
PubMed2003

[Glaucoma diagnosis with the GDx and measurement of nerve fibre thickness (RTA)].

Damage of retinal nerve fibres is an early sign of glaucoma.Therefore, a quantitative determination of nerve fibres would be an ideal technique for early glaucoma diagnosis. This can be realized by the GDx which uses nerve fibre polarimetry to measure the thickness of the parapapillary nerve fibre layer.A single GDx measurement in a glaucoma patient may be an important adjunct to the clinical findings.However, at present the method is not suitable for general screening. Presumably the most important application of the device is longitudinal monitoring. In contrast to the GDx,RTA determines the thickness of the whole retina, not specifically the nerve fibre layer. This might be a reason why the discrimination between normal subjects and glaucoma patients is somewhat more difficult than with the GDx.Again, longitudinal monitoring should be the most common application of the RTA in glaucoma patients. Besides glaucoma,RTA also allows examination of macular pathologies.RTA is a promising new technique which so far is not as frequently used as the GDx or the HRT.

Disease Progression↗
PubMed2003

[Incidence and extent of postoperative macular edema following vitreoretinal surgery with and without combined cataract operation].

PURPOSE: In the majority of patients with full-thickness macular hole, closure can be achieved with vitreoretinal surgery techniques. However, postoperative function is variable and the prognostic determinants for visual acuity are incompletely understood. We evaluated the incidence and extent of macular edema after macular foramen surgery with and without combined cataract-surgery. METHODS: Between October 1997 and March 2001 macular foramen surgery was performed in 125 eyes from 116 patients. Fluorescein angiograms with sufficient quality were obtained from 59 eyes using a confocal scanning laser ophthalmoscope (Heidelberg Retina Angiograph, HRA, Heidelberg Engineering, Heidelberg) and were evaluated by two independent observers. RESULTS: Angiographic macular edema was noted on average 4.2 months after the operation in 47 out of 59 (79.7%) eyes. The incidence of macular edema was 87% in eyes after a combined cataract operation compared to 66.7 % in eyes with no simultaneous operation ( p=0.735). Mean postoperative visual acuity was 0.4 (min 0.1-max 1.2) with no significant difference between eyes with (4.1 lines) and without macular edema (3.5 lines) with regard to visual improvement from baseline. CONCLUSIONS: The results indicate a high incidence of macular edema in eyes after macular hole surgery with subsequent anatomical success. Apparently, the presence of macular edema is not associated with short term visual impairment. Furthermore it seems that a combined cataract operation compared to a consecutive procedure is not associated with disadvantages regarding the functional outcome.

Aged↗
PubMed2004

[Vitreoretinal secondary procedures following elective macular surgery].

OBJECTIVE: The spectrum of reoperations after macular surgery was investigated retrospectively in a large group of patients. All secondary surgical procedures except for cataract surgery were considered. METHODS: Between July 1995 and June 2001 353 eyes underwent macular surgery (218 due to macular pucker, 135 due to macular hole) with a pars-plana vitrectomy (PPV), creation of vitreous detachment, membrane peeling and SF(6)/air-instillation. The vitrectomies were performed by 4 different surgeons. In all patients a preoperative circular peripheral cryoretinopexy was performed 3-4 weeks before macular surgery. The follow-up was 20.9 months on average. The number of revitrectomies as well as the postoperative retinal detachment rate were investigated. RESULTS: In 33 cases (9.3%) a second vitrectomy had to be performed due to an unsatisfying postoperative macular finding: 17/218 (7.8%) after macular pucker surgery with a recurrent pucker and 16/135 (11.8%) after macular hole surgery with persistent or recurrent macular hole. In 7/353 (2.0%) a postoperative rhegmatogenous retinal detachment was observed and in 2/353 (0.6%) a postoperative endophthalmitis had to be treated. CONCLUSION: In 9.3% of our patients a second PPV due to an unsatisfying macular finding became necessary. The rate of postoperative retinal detachment of 2.0% is considerably lower than in most other studies. Therefore, a possible prophylactic effect of the preoperative circular peripheral cryoretinopexy is suggested to reduce the risk of postoperative retinal detachment.

Elective Surgical Procedures↗