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At least 469 records · Page 26Linked to original sources
PubMed2003

Epimacular proliferative response following internal limiting membrane peeling for idiopathic macular holes.

PURPOSE: To present two patients who underwent surgery for an idiopathic macular hole (IMH) with internal limiting membrane (ILM) peeling and developed an epimacular proliferative response. METHODS: Observational case report. Two patients with an IMH underwent pars plana vitrectomy with ILM peeling. Ophthalmic examination including optical coherence tomography (OCT) was performed pre- and postoperatively. In both cases, scanning laser ophthalmoscopy (SLO) was performed postoperatively. RESULTS: In the first case, the closure of the macular hole (MH) was confirmed ophthalmoscopically and by OCT following the surgery. At 2 months postoperatively, a thin epiretinal membrane (ERM) developed over the nasal macula area where the ILM had been peeled. The patient's visual acuity had recovered to 1.0 but she complained of metamorphopsia. At 18 months postoperatively, the thin ERM around the nasal fovea remained and her visual acuity was still 1.0. In the second case, the MH was sealed after the surgery, and the patient's visual acuity had improved to 1.0 at 3 months, but an indistinct ERM developed in the macular region where the ILM had been peeled. Two years after the operation, her VA was still 1.0. One and two years postoperatively, a thin epimacular proliferation remained unchanged; in addition, the OCT and SLO images remained stable. CONCLUSION: Two patients who underwent IMH surgery with ILM peeling developed an epimacular proliferative response postoperatively. We suggest that the injury associated with the ILM peeling may have stimulated glial proliferation.

Adult↗
PubMed2004

Conventional buckling surgery or primary vitrectomy with silicone oil tamponade in rhegmatogenous retinal detachment with multiple breaks.

BACKGROUND: There is controversy about the most appropriate operating methods for complicated rhegmatogenous retinal detachment (RD) including multiple tears, and surgical techniques may be changed according to the preference of the surgeon. In this retrospective study, we compared the surgical results of conventional buckling surgery and vitrectomy with silicone oil tamponade for rhegmatogenous (RD) with multiple breaks. METHODS: Thirty patients who underwent scleral buckling surgery (group 1) and 22 patients who underwent pars plana vitrectomy with silicone oil tamponade (group 2) as the primary surgery for rhegmatogenous RD with multiple breaks were included in this study. The follow-up period was longer than 6 months after surgery. The anatomical success rates and complications were evaluated for both groups. RESULTS: Retinal reattachment was achieved in 24 of 30 eyes (80%) in group 1 and in 20 of 22 eyes (90.9%) in group 2 after the initial surgery. In group 1, subretinal hemorrhage developed due to the drainage of subretinal fluid in 2 eyes (6.6%) intraoperatively. Elevated intraocular pressure (3.3%), ocular motility disturbances (13.2%), and proliferative vitreoretinopathy (3.3%) were seen in the postoperative period. In group 2, iatrogenic breaks (7.3%) and lens damage (9.09%) occurred during the operation. Macular pucker (4.5%), postoperative cataract progression (22.7%), ocular hypertension (9.09%) and PVR (9.09%) were noted postoperatively. CONCLUSIONS: Both surgical procedures can achieve favorable and comparable anatomic outcomes in the majority of patients in the treatment of RD with multiple breaks. Intra-and postoperative complications are different in the two procedures.

Adolescent↗
PubMed2004

Infracyanine-assisted internal limiting membrane peeling in macular hole repair: does it make a difference?

PURPOSE: To investigate whether Infracyanine-assisted internal limiting membrane (ILM) peeling in macular hole repair affects the anatomical and functional outcome and complication rate. METHODS: A retrospective analysis of 139 consecutive cases of stage 2 and stage 3 macular hole repairs with or without Infracyanine-assisted ILM peeling. RESULTS: There were 67 eyes with Infracyanine staining of the ILM and 72 eyes in the non-ILM-stained group. The results are analyzed functionally, anatomically and in terms of complications. A similar anatomical and functional closure rate was obtained with one unclosed macular hole in the stained group and two in the non-stained group (P=1.0). Fifty-two percent of the eyes in the stained group and 59% of those in the non-stained group achieved 0.5 vision or better (P=0.40). The mean postoperative vision was 0.55 in the stained group and 0.54 in the non-stained group (P=0.65). The mean improvement in vision was 0.40 in the stained group and 0.36 in the non-stained group (P=0.21). CONCLUSION: Anatomical and functional results are similar with or without Infracyanine-assisted ILM peeling. There was no apparent adverse effect of Infracyanine use on visual function, and no apparent retinal toxicity was found.

Aged↗
PubMed2004

Ruptured internal limiting membrane associated with blunt trauma revealed by indocyanine green staining.

PURPOSE: Description of cases of traumatic macular hole that appeared concomitant with a ruptured internal limiting membrane (ILM) that was apparent during vitrectomy only after staining with indocyanine green (ICG). METHODS: Vitrectomy with ILM peeling was performed on a 20-year-old man and a 13-year-old boy for treatment of traumatic macular holes. RESULTS: During vitrectomy, the ILM was found to be ruptured along the area of an identified macular hole only after ICG staining. After the vitrectomy, the macular holes were closed and visual acuity improved. However, visual field defect associated with apparent inner-layer retinal damage remained. CONCLUSION: Blunt trauma can cause severe inner-layer retinal damage with rupture of the ILM as well as frank macular hole formation and choroidal rupture.

Adolescent↗
PubMed2004

Morphological changes in the optic disc after vitrectomy and fluid-air exchange.

BACKGROUND: Although many investigators have previously reported various ocular complications induced by vitrectomy, little is known about post-operative morphological changes in the optic disc. The purpose of this study is to evaluate the effect of vitrectomy and fluid-air (F-A) exchange on the post-operative morphology of the optic disc. METHODS: We examined 31 eyes that had undergone vitrectomy for macular holes (22 eyes) or epiretinal membranes (9 eyes). Only the patients with macular holes were treated by fluid-air exchange. Morphological changes in the optic disc were evaluated using the Heidelberg Retina Tomograph. RESULTS: C/D area ratios significantly decreased for 6 months post-operatively. The rim volumes significantly increased for 1 month following surgery. Cup volumes significantly decreased at 3 months after surgery. No significant change of mean cup depth was observed post-operatively. The eyes that had not been subjected to F-A exchange showed no significant morphological change following surgery. In contrast, the eyes that had undergone F-A exchange showed significant decrease in C/D area ratio and cup volume and an increase in rim volume and mean cup depth for considerable periods following surgery. Any of the patients showed no post-operative visual field loss. CONCLUSION: Whereas no visual field loss is observed, vitrectomy with F-A exchange induces morphological changes in the optic disc for significant periods following surgery.

Adult↗
PubMed2004

A clinicopathologic case report on macular hole associated with von Hippel-Lindau disease: a novel ultrastructural finding of wormlike, wavy tangles of filaments.

BACKGROUND: We describe a novel ultrastructural finding observed in an epiretinal membrane excised from a patient with von Hippel-Lindau disease. METHODS: This interventional case report presents a 45-year-old woman who noted decreased vision in her right eye and was referred for treatment of a macular hole secondary to von Hippel-Lindau disease. Blindness had occurred previously in the left eye because of exudative retinal detachment. Funduscopic examination revealed a macular hole associated with a delicate epiretinal membrane, multiple retinal angiomas, and multiple old laser scars. Vitrectomy was performed in her right eye. The epiretinal membrane was peeled off and processed for light and electron microscopy. RESULTS: Postoperatively the macular hole was successfully closed, and vision recovered to 20/20 from 20/40. In the excised epiretinal membrane, flattened glial cells and extracellular matrix containing fibrous elements formed a multilayered pattern. Ultrastructurally, the fibrous elements appeared as wormlike, wavy tangles of filaments (WWTF) with an orientation parallel to the surface of the epiretinal membrane. Just above the WWTF, flattened glial cells frequently extended thin cytoplasmic processes with pinocytotic vesicles. CONCLUSION: The ultrastructure suggested that retinal glial cells had induced a remodeling of the collagenous stroma in the posterior vitreous cortex, resulting in tangential macular traction.

Basement Membrane↗
PubMed2005

Pars plana vitrectomy with internal limiting membrane removal for macular hole associated with proliferative diabetic retinopathy.

BACKGROUND: We describe the outcome of vitreous surgery in three eyes of three patients with macular hole associated with proliferative diabetic retinopathy (PDR) in the absence of fibrovascular proliferation, a combination of conditions where efficacy is incompletely known. METHODS: The patients, all male were 62, 65, and 66 years old. Panretinal photocoagulation had been performed preoperatively in all, and one eye had undergone vitreous surgery. No fibrovascular tissue causing macular traction was observed in any case. Fluorescein angiography and optical coherence tomography (OCT) demonstrated persistent diabetic macular edema surrounding the hole. Affected eyes were treated with vitrectomy including internal limiting membrane (ILM) peeling; 20% sulfur hexafluoride gas (SF(6)) was introduced for tamponade. RESULTS: Anatomical closure of the macular hole as well as resolution of macular edema was achieved in all cases, and vision improved considerably by more than two Snellen lines. CONCLUSIONS: Vitreous surgery with ILM peeling was effective for macular hole associated with PDR, attaining not only macular hole closure but also resolution of persistent diabetic macular edema.

Aged↗
PubMed2005

A rare case of choroidal neovascularization following macular hole surgery.

BACKGROUND: Choroidal neovascularization occurs in a wide spectrum of conditions, including degenerative, inflammatory, traumatic and hereditary conditions, all of which are characterized by breaks in Bruch's membrane. A few cases of choroidal neovascular membrane (CNVM) have been reported in the literature following macular hole surgery. METHOD: We present a retrospective case study of a single patient who developed CNVM after successful macular hole surgery. The 70-year-old diabetic female underwent macular hole surgery in her right eye. Posterior hyaloid was separated with suction and vitrectomy was performed. Internal limiting membrane (ILM) was stained with trypan blue under air and ILM peeling was performed. Perfluoropropane (C3F8) gas was used as the tamponade. Six weeks post-operation, closure of macular hole was seen. Six months later, she presented with defective vision. Subfoveal classic CNVM was seen in the same eye. DISCUSSION: About 1%-3% of patients who undergo macular hole surgery develop CNVM. Age-related changes and surgical trauma are considered to be the predisposing factors in reported cases. Injury to the retinal pigment epithelium (RPE) during surgery may be an important factor in our case, since there were no pre-existing age-related changes. CONCLUSIONS: CNVM though rare can occur after macular hole surgery, especially in the setting of age-related changes. Injuries to the RPE should be avoided during surgery. We report a case of CNVM after macular hole in which trypan blue was used as a staining agent.

Aged↗
PubMed2006

Clinical evaluation of the use of indocyanine green for peeling the internal limiting membrane in macular hole surgery.

BACKGROUND: To evaluate the role of indocyanine green (infracyanine) in macular hole surgery. METHODS: A retrospective review of 38 consecutive eyes with macular hole, operated on with internal limiting membrane peeling (ILM), using or not using infracyanine (ICG), diluted in glucose 5% and filtered. Anatomical and functional results were analysed in each group, using visual field testing, fluorescein fundus angiography and particularly blue filter fundus photographs for the detection of retinal pigment epithelial changes and lesions of optic nerve fibres layer. RESULTS: Fifteen eyes underwent surgery without ICG and 23 eyes with ICG. The mean period of follow-up was 10 months. The duration of surgery was significantly lower in the group with ICG than without (P < 0.001). Overall, 84% of the holes closed without difference between both groups. The improvement in vision at 1, 6 and 12 months was similar in both groups. Fewer defects in the optic nerve fibres layer were observed in the group with ICG than without (P = 0.02). Staining with ICG revealed the presence of an associated epiretinal membrane in 61% of eyes, whereas it was clinically visible in only 17.5% before surgery. CONCLUSION: Using ICG for ILM peeling produced similar visual results to those obtained without ICG. It reduced significantly the duration of surgery and the trauma to the optic nerve fibres layer, without increasing the risk of retinal pigment epithelial damage. However, in the light of recent reports about the possible toxicity of ICG, its use should be restricted in clinical practice to difficult cases.

Aged↗
PubMed2005

Central scotoma associated with intraocular silicone oil tamponade develops before oil removal.

BACKGROUND: Unexplained sudden visual loss after removal of silicone oil from the eye has recently been described. We report the occurrence and features of unexplained central scotoma developing with silicone oil in situ in the vitreous cavity. METHODS: A retrospective case series of five patients (from two centres) who reported a central scotoma commencing during silicone oil tamponade was studied. All patients had vitrectomy for macula-on retinal detachment, with ultra-purified silicone oil tamponade (four out of five had giant retinal tear). Investigations included visual acuity, intraocular pressure, optical coherence tomography, fluorescein angiography, visual fields and electrophysiology. RESULTS: All patients reported a central scotoma that appeared during oil tamponade. Visual acuity fell by a mean of 0.93 LogMAR units after onset of the scotoma. After cataract extraction and oil removal, vision remained reduced by a mean of 0.8 units. The mean duration of oil in the eye was 2.7 months when the scotoma was noted by the patient. Investigations were performed after removal of oil. Fluorescein angiography (FFA) was performed in two cases and optical coherence tomography (OCT) in five patients. No abnormality was demonstrated. Electrophysiology was performed in five patients with pattern electroretinography suggestive of macular dysfunction in four patients. CONCLUSION: This is the first case series describing central scotoma associated with silicone oil in situ. Electrophysiology indicated macular dysfunction in most cases. We suggest that early removal of oil in cases with good visual potential should be considered to avoid this sight-threatening complication.

Adult↗
PubMed2005

Does intravitreal triamcinolone acetonide-assisted peeling of the internal limiting membrane effect the outcome of macular hole surgery?

PURPOSE: To evaluate functional and anatomical outcome of triamcinolone acetonide assisted internal limiting membrane (ILM) peeling in patients with macular hole. METHODS: Fifteen eyes of 15 consecutive patients were identified with stage 3 and 4 idiopathic macular holes, these undergoing triamcinolone acetonide assisted ILM peeling for macular holes. These were matched retrospectively with 15 eyes of 15 patients with stage 3 and 4 idiopathic macular holes of less than six months duration, who underwent macular hole surgery with ILM peel augmented with indocyanine green (ICG). Functional and anatomical outcomes were compared between two groups. RESULTS: There were no significant differences between the two groups with reference to demographic features of age, sex, staging of the macular holes and the proportion subsequently undergoing cataract surgery. The mean follow-up period was 6.4 months in the triamcinolone acetonide group and 7.2 months in the ICG group. The hole closure rate was 100% in both group at primary operation. The mean Snellen line change was +1.24 in the intravitreal triamcinolone group and +1.1 in the ICG group. There was a significant improvement in Snellen and Logmar visual acuity in both groups. These differences in visual outcome between the groups were not statistically significant. CONCLUSIONS: Our data showed similar outcomes for patients with macular hole where ICG has been used when compared to patients where triamcinolone acetonide has been used for ILM peeling. Further study with longer follow-up and large series is warranted to assess the safety of the triamcinolone acetonide assisted ILM peeling in macular hole surgery.

Basement Membrane↗
PubMed2005

Macular hole and sub-hyaloid hemorrhage following filtering surgery with mitomycin C.

BACKGROUND: We report the occurrence of a macular hole with sub-hyaloid hemorrhage following filtering surgery with mitomycin C. METHODS: Combined trabeculotomy and trabeculectomy with mitomycin C was performed in the left eye for primary congenital glaucoma. RESULTS: Two weeks postoperatively the fundus showed a macular hole with subretinal and retinal hemorrhage along with sub-hyaloid bleeding. Optical coherence tomography confirmed the presence of a full-thickness macular hole. CONCLUSION: A full-thickness macular hole with subretinal and retinal hemorrhage is reported as a complication of glaucoma filtering surgery.

Child↗
PubMed2005

Vitreous collagen metabolism before and after vitrectomy.

PURPOSE: To assess vitreous metabolism by measuring C-propeptide levels of type II procollagen (pCOL-II-C) and hyaluronan levels in the vitreous and in the vitreous fluid after vitrectomy for macular hole. METHODS: We obtained 1-ml vitreous samples during vitrectomy from 34 patients (34 eyes) with a macular hole (age range 50-77 years, mean 64 years). After vitrectomy, we performed fluid-air exchange in six eyes because of unresolved macular holes and collected 4-ml fluid samples. Gel-filtration high-performance liquid chromatography (HPLC) was used to determine the molecular weight of pCOL-II-C in the samples. The pCOL-II-C level was measured by sandwich enzyme immunoassay and hyaluronan by sandwich binding protein assay. RESULTS: HPLC showed that pCOL-II-C in the vitreous samples corresponded to purified pCOL-II-C from cartilage. The vitreous pCOL-II-C level (4.7+/-0.3 ng/ml) was similar to reported synovial fluid levels. In six eyes that underwent fluid-air exchange, pCOL-II-C in the fluid samples remained at a level similar to that in the vitreous samples, while hyaluronan levels in the fluid samples were significantly lower than in the vitreous samples. CONCLUSIONS: The molecular weight and concentrations of pCOL-II-C in the vitreous are similar to those in joint fluid. In patients with a macular hole, type II procollagen may be secreted persistently into the vitreous cavity before and after vitrectomy.

Aged↗
PubMed2007

Early vitrectomy for fundus-obscuring dense vitreous haemorrhage from presumptive retinal tears.

BACKGROUND: Published literature on the management of patients with fundus-obscuring dense vitreous haemorrhage due to presumptive retinal tears is sparse and advocates waiting for spontaneous resolution. Surgery is indicated only when a definite retinal tear or retinal detachment is identified. METHODS: A retrospective review of all patients who underwent early vitrectomy for vitreous haemorrhage associated with posterior vitreous detachment was carried out. A comparison of initial visual acuity versus final visual acuity after vitrectomy was performed. The number of eyes that were found to have retinal tears and retinal detachment were documented. Initial and final Snellen acuities were used for statistical analysis. Categorical data were analysed using Fisher's exact test and statistical significance was considered to be p < 0.05. RESULTS: Sixteen eyes were identified and all these patients presented or were referred soon after the onset of vitreous haemorrhage. Associated ocular pathology (choroidal neovascular membrane, retinal branch vein occlu-sion, macroaneurysm) was suspected to be the source of the haemorrhage in 4 eyes. Vitrectomy was carried out in 12 eyes soon after presentation (mean time 6.3 days, range 1-28 days). Nineteen retinal breaks were seen in these eyes and 5 eyes had more than two breaks. None of the eyes were found to have proliferative vitreoretinopathy at the time of surgery. Two eyes needed repeat surgery for new retinal breaks. Excluding the eyes found to have an ocular pathology as the cause of vitreous haemorrhage, the mean visual acuity improved from hand movements to 6/12 (p < 0.001). CONCLUSIONS: Early vitrectomy for spontaneous dense fundus-obscuring vitreous haemorrhage and posterior vitreous detachment is safe. Since the number of patients in this study was small, a prospective randomised controlled study comparing early versus late vitrectomy is needed to see whether early surgery also prevents proliferative vitreoretinopathy formation.

Aged↗
PubMed2006

Modified technique for safer indocyanine-green-assisted peeling of the internal limiting membrane during vitrectomy for macular hole repair.

BACKGROUND: During macular hole surgery, indocyanine green (ICG) has access to the subretinal space and can lead to toxic and phototoxic damage of the retinal pigment epithelium (RPE). To reduce its toxicity and to avoid contact between ICG and the RPE, we have developed a modified technique by using autologous whole blood. METHODS: Thirty-one eyes underwent vitrectomy for idiopathic macular hole repair. Autologous whole blood (0.1 ml) was injected into the buffered saline solution (BSS)-filled vitreous cavity over the posterior pole and aspirated with a flute cannula. A small clot remained covering the macular hole. The internal limiting membrane (ILM) was stained by using 0.05% ICG solution. The ICG was dissolved in 5% glucose to obtain an iso-osmotic solution. This ICG was injected into the BSS-filled vitreous cavity over the posterior pole and removed after 10 s. The ILM was peeled and a long-acting gas tamponade applied. Pre- and postoperative best-corrected visual acuity and optical coherence tomography (OCT) findings are reported. RESULTS: Macular hole closure was achieved in 30 of 31 eyes (97%). The mean preoperative logMAR acuity was 0.99 (range: 0.4 to 2.0). Mean postoperative logMAR acuity was 0.496 (range: 0.0 to 1.0). The average improvement in vision was 0.66 logMAR units (range: 1.5 to 0.0). No postoperative RPE alterations were observed biomicroscopically or on OCT. CONCLUSION: This surgical technique leads to favorable anatomic and functional results. ICG toxicity is reduced by modifying osmolarity, concentration and contact time and by injecting ICG under BSS. Autologous whole blood acts as a mechanical barrier and prevents ICG from entering in the subretinal space.

Aged↗
PubMed2006

Management of macular hole and submacular hemorrhage in the same eye.

BACKGROUND: To report the management of patients with a macular hole and submacular hemorrhage in the same eye. METHODS: Case reports of two eyes of two patients undergoing pars plana vitrectomy (PPV), subretinal injection of tissue plasminogen activator (t-PA) and air-fluid exchange to displace a submacular hemorrhage. In one eye with a submacular hemorrhage due to age-related macular degeneration, a macular hole formed during subretinal t-PA injection. In another patient with a submacular hemorrhage due to a ruptured retinal arterial macroaneurysm (RAM), a sub-internal limiting membrane (ILM) hemorrhage was noted, and a macular hole was found after peeling the ILM, overlying the subretinal hemorrhage. RESULTS: In the first case, after 45 min was allowed for the subretinal clot to liquefy, the macular hole was noted to be closed. A partial air-fluid exchange was performed and the patient was positioned upright, to displace the submacular hemorrhage and tamponade the macular hole. Two weeks later, visual acuity had improved from 20/400 with eccentric viewing to 20/100, the macular hole was closed by optical coherence tomography, and the patient subsequently underwent two sessions of verteporfin photodynamic therapy (PDT) to treat choroidal neovascularization detected by fluorescein angiography. At last follow-up 7 months after surgery, vision was 20/200, the CNV was active angiographically, and another session of PDT was performed. In the second case, PPV was combined with phacoemulsification and intraocular lens implantation. An 80% air-fluid exchange was performed after injecting the subretinal t-PA, the air was exchanged for 14% perfluoropropane gas, and the patient was positioned upright. Visual acuity improved from 20/400 to 20/200 at last follow-up 4 months after surgery, with the RAM spontaneously sclerosed and the macular hole closed clinically and angiographically. CONCLUSIONS: Intraoperative evacuation of subretinal hemorrhage is not necessary in cases with coexisting macular hole and submacular hemorrhage. The submacular hemorrhage can be displaced using air or gas, and the bubble can be used to tamponade the macular hole.

Aged↗
PubMed2006

Postoperative retinal break after 25-gauge transconjunctival sutureless vitrectomy: report of four cases.

BACKGROUND: A 25-gauge transconjunctival sutureless vitrectomy (TSV) has been reported effective. However, complications such as postoperative retinal detachment have been reported. In this study, we report four cases of retinal breaks found after 25-gauge TSV. In this study, we investigated factors contributing to occurrence of postoperative complications. METHODS: Seventy-five patients (75 eyes) underwent 25-gauge TSV surgery at Kanazawa University hospital between April 2004 and September 2005. Postoperative follow-up monitoring was done for at least 3 months. The surgical charts were reviewed. RESULTS: Retinal breaks not accompanied by retinal detachment were noted postoperatively in four patients. All four of these patients had preoperative idiopathic macular holes. In all cases, there was no vitreous traction around the retinal break and photo coagulation was performed. One eye with age-related macular degeneration developed intraoperative rhegmatogenous retinal detachment. No other complications were observed during the intraoperative and postoperative periods. CONCLUSION: Upon performing 25-gauge TSV for macular hole repair, care should be taken to detect retinal breaks and retinal detachment intraoperatively and postoperatively.

Conjunctiva↗