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At least 613 records · Page 34Linked to original sources
PubMed2006

Vitrectomy for macular holes associated with myopic foveoschisis.

PURPOSE: We reviewed the surgical results of vitrectomy for macular holes (MHs) associated with myopic foveoschisis (MF). DESIGN: Noncomparative, interventional case series. METHODS: setting: Institutional. participants: Eight eyes of eight patients with MHs associated with MF. intervention procedure: All patients underwent vitrectomy, internal limiting membrane peeling, and gas tamponade. main outcome measures: Slit-lamp-based biomicroscopy, optical coherence tomography examinations, and best-corrected visual acuity (BCVA) measurement. RESULTS: The MHs closed in two eyes (25%), and the BCVA improved more than 2 lines in three (37.5%) eyes, remained unchanged in three (37.5%), and worsened in two (25%). The MH size increased significantly in a case with an unresolved MH (P < .05). The postoperative BCVA was significantly correlated with the preoperative BCVA (P < .05). CONCLUSIONS: Although significant visual improvement occurs in less than 50% of cases, vitrectomy can be beneficial for some cases.

Aged↗
PubMed2006

Macular hole formation, spontaneous closure, and recurrence in a previously vitrectomized eye.

PURPOSE: To report a case of recurrent idiopathic macular hole after spontaneous closure in a previously vitrectomized eye. DESIGN: Case report. METHODS: A 69-year-old woman who had had vitrectomy for vitreous hemorrhage seven years earlier presented with decreased visual acuity and a macular hole. The hole spontaneously resolved within four months. One year later, the macular hole reopened. Internal limiting membrane peeling was performed, resulting in return of visual acuity. Optical coherence tomography (OCT) was obtained during all visits. RESULTS: Initial OCT revealed a macular hole with perifoveal cystoid degeneration and bridging elements. At subsequent visits, OCT showed resolution of the cystoid degeneration. The preoperative OCT demonstrates recurrence of the macular hole with similar perifoveal abnormalities. CONCLUSIONS: After vitrectomy, anteroposterior vitreofoveal traction associated with most macular hole formation does not apply. OCT demonstrates foveal structure and forces coincident with hole formation and resolution. Dynamic interaction between tensile and degenerative forces, and proliferative and reparative glial elements, may lead to hole remodeling.

Aged↗
PubMed2006

Spontaneous resolution of traumatic macular hole-related retinal detachment.

PURPOSE: To report a case of spontaneous resolution of traumatic macular hole-related retinal detachment. DESIGN: Observational case report. METHODS: Clinical examination and optical coherence tomographic (OCT) evaluation of a patient who experienced spontaneous resolution of a retinal detachment resulting from a traumatic macular hole. RESULTS: A 12-year-old boy developed a macular hole and retinal detachment after blunt ocular trauma. Spontaneous reattachment of the retina and closure of the macular hole were documented at clinical examination and by OCT three weeks after presentation. CONCLUSIONS: Spontaneous closure of traumatic macular hole and resolution of associated retinal detachment can occur.

Child↗
PubMed2006

Ultrastructure of the vitreomacular interface in full-thickness idiopathic macular holes: a consecutive analysis of 100 cases.

PURPOSE: To evaluate the ultrastructure of the vitreoretinal interface in stage III and stage IV idiopathic macular holes. DESIGN: A consecutive observational case series, laboratory investigation. METHODS: Pars plana vitrectomy with en-bloc removal of the internal limiting membrane (ILM) and epimacular tissue was performed by one surgeon in 80 eyes with stage III macular holes and in 20 eyes with stage IV macular holes. In total, 218 specimens were processed for light and transmission electron microscopy. RESULTS: Fibrocellular proliferation at the vitreal side of the ILM was found in 57 cases. Native vitreous collagen (NVC) was attached to the ILM in 36 eyes. The presence of NVC was considerably more frequent in eyes with stage IV (70%) than in eyes with stage III macular holes (26%). Mono- and multilayered cellular membranes were seen more frequently in stage IV macular holes. NVC, if present, was always associated with fibrocellular proliferation. In 39 eyes with stage III and in four eyes with stage IV macular holes, the ILM was devoid of any cells and collagen. CONCLUSIONS: Fibrocellular proliferation appears to be a secondary event instead of a primary feature in macular hole development. The severity of fibrocellular proliferation is associated with the presence of NVC. Incomplete vitreoretinal separation may contribute to the development of epimacular membranes in eyes with idiopathic macular holes. Remnants of the vitreous cortex remain more often attached to the ILM in eyes with spontaneous posterior vitreous detachment (PVD) than in eyes with surgical PVD induction.

Aged↗
PubMed2006

Natural course of macular retinoschisis in highly myopic eyes without macular hole or retinal detachment.

PURPOSE: To investigate the natural course of macular retinoschisis in highly myopic patients. DESIGN: A prospective, observational case series. METHODS: Seven consecutive patients (eight eyes) with macular retinoschisis without macular hole or retinal detachment determined by optical coherence tomography (OCT) were followed at least two years without surgical intervention. The changes in the OCT findings and best-corrected visual acuity (BCVA) were analyzed. RESULTS: During follow-up, two eyes that had vitreoretinal adhesions developed a macular hole, one with and one without retinal detachment (RD), and two eyes without detectable vitreoretinal adhesion developed RD without a macular hole. BCVA in these four eyes was significantly reduced. The remaining four eyes did not develop complications, although the thickness of the macula increased significantly. CONCLUSIONS: These findings suggest that macular retinoschisis might be a progressive condition, and that complications appeared to be related to the presence of vitreoretinal tractions.

Aged↗
PubMed2006

Retinal pigment epithelial tears after pegaptanib injection for exudative age-related macular degeneration.

PURPOSE: To report two cases of retinal pigment epithelium (RPE) tears following intravitreal pegaptanib injections for occult choroidal neovascularization. DESIGN: Noncomparative case series. METHODS: The charts of two patients with pigment epithelial tears after receiving intravitreal pegaptanib were reviewed. Approval from the institutional review board and informed consent were obtained before chart review. Fundus photos, intravenous fluorescein angiograms, and optical coherence tomography (OCT) were obtained before and after therapy confirmed the diagnosis. RESULTS: Two patients had turbid pigment epithelial detachments (PEDs) and occult choroidal neovascular membranes (CNVMs) treated with intravitreal pegaptanib. Both patients developed RPE tears weeks following one intravitreal pegaptanib injection. CONCLUSIONS: This report describes the development of RPE tears after intravitreal pegaptanib injection. Caution should be taken in cases of turbid pigment epithelial detachments in the monocular patient when treatment with intravitreal pegaptanib is entertained. Future studies should be performed to evaluate which subtypes of lesions are most susceptible to this devastating visual complication.

Aged↗
PubMed2006

Disappearance of myelinated retinal nerve fibers after pars plana vitrectomy.

PURPOSE: To describe a case of extramacular myelinated retinal nerve fibers disappearing after pars plana vitrectomy for an epiretinal membrane and macular edema. DESIGN: Interventional case report. METHODS: A 61-year-old African-American man with extramacular myelinated retinal nerve fibers underwent pars plana vitrectomy for an epiretinal membrane. A posterior vitreous detachment was present preoperatively. Humidified air was used. A gas bubble was placed for an intraoperative macular hole. RESULTS: Nine months after surgery, the myelinated retinal nerve fibers had disappeared. CONCLUSIONS: Loss of myelinated retinal nerve fibers may occur after vitreoretinal surgery. Possible mechanisms include postoperative nerve fiber layer atrophy or ischemia.

Epiretinal Membrane↗
PubMed2006

Scleral buckling with macular plombe for eyes with myopic macular retinoschisis and retinal detachment without macular hole.

PURPOSE: To determine the effectiveness of scleral buckling with a macular plombe in eyes with myopic macular retinoschisis and retinal detachment without a macular hole. DESIGN: A prospective, consecutive interventional case series. METHODS SETTING: Clinical practice at university hospitals. PATIENT POPULATION: Six eyes of five consecutive patients with myopic macular retinoschisis and retinal detachment without a macular hole. Intervention Procedure: Scleral buckling with a macular plombe. MAIN OUTCOME MEASURES: The best-corrected visual acuity (BCVA), ophthalmoscopic appearance of fundus, and optical coherence tomographic images were recorded preoperatively, and at two weeks, at one, three, and six months, and then every three months thereafter. RESULTS: The mean retinal thickness was reduced significantly by the macular plombe (P < .05). The BCVA was improved by 2 lines or more in four eyes (66%), and remained within 2 lines of the preoperative BCVA in two eyes (34%). The complications were subretinal hemorrhage without choroidal neovascularization in one eye, and a progression of choroidal neovascularization with subretinal hemorrhage, which caused a transient visual impairment in one eye. CONCLUSIONS: We recommend that macular scleral buckling with a macular plombe be considered for eyes with myopic macular retinoschisis and retinal detachment without a macular hole.

Aged↗
PubMed2006

Functional assessment of the possible toxicity of indocyanine green dye in macular hole surgery.

PURPOSE: To evaluate the possible toxicity of indocyanine green (ICG) dye in macular hole surgery by comparing functional results after successful surgeries performed with and without staining. DESIGN: Prospective observational case series. METHODS: In a study conducted at our department, 30 eyes of 29 patients with idiopathic macular hole underwent pars plana vitrectomy, with peeling of the internal limiting membrane (ILM). In 21 eyes (group A), ICG staining was used to visualize the membrane; in nine eyes (group B), no dye was applied. Pre- and postoperative examinations (at three, six, 12, and 20 months) included visual acuity (VA) (Snellen chart), slit-lamp biomicroscopy, multifocal electroretinography (mfERG), and optical coherence tomography (OCT). For statistical analysis, the Mann-Whitney U test and Newman-Keuls post hoc analysis were used. RESULTS: The macular hole was closed in all patients. At 20 months, VA improvement (logarithm of minimal angle of resolution units) compared with baseline was more pronounced in group B (P < .001) than in group A (P = .022); VA was also better for group B compared directly with group A (P = .048). For mfERG, preoperative responses were subnormal. Postoperatively, responses initially decreased, but at 20 months significant improvement was seen in both groups (P < .001). When data from the groups are compared at 20 months, significantly greater mfERG improvement was found in group B in both central and perimacular areas (P < .001). CONCLUSIONS: The significantly better outcomes without staining may suggest dye toxicity. Alternative internal limiting membrane visualization substances with fewer adverse effects (trypan blue, triamcinolone) may be preferable.

Aged↗
PubMed2006

Optical coherence tomographic documentation of the formation of a traumatic macular hole.

PURPOSE: To assess how optical coherent tomography 3 (OCT3) images help explain the mechanism of traumatic macular hole formation. DESIGN: Observational case report. METHOD: A patient presented with an altered foveal depression after a unilateral blunt eye trauma. After four days, the injury developed into an impending macular hole. Follow-up was done by ophthalmic examination, fundus photography, and OCT3. RESULTS: Fundus examination showed a macular edema at first presentation, with a dot hemorrhage next to the fovea and a perifoveal little yellow ring. Minimal macular edema and a small foveal depression were seen on OCT3. After four days, an impending hole had formed. The foveal cyst closed after one month, but subretinal fluid persisted for months. After six months, full recovery was observed. CONCLUSIONS: Subclinical foveal changes occurred directly after the trauma, preceding macular hole formation. OCT3 allows detection of small lesions, which helps explain the pathogenesis of traumatic macular hole formation.

Adult↗
PubMed2006

Optical coherence tomography evaluation of idiopathic macular hole treatment by gas-assisted posterior vitreous detachment.

PURPOSE: To report a series of patients with Stage II macular hole (MH) treated by gas-assisted posterior vitreous detachment (GAPVD). DESIGN: Interventional case series. METHODS: Six patients (six eyes) with Stage II MH were submitted to a 0.4 ml perfluoropropane (C(3)F(8)) intravitreal injection. Comprehensive ophthalmic examination including best-corrected visual acuity, fundus photography, and optical coherence tomography (OCT) was performed at baseline and one, three, and six months after the procedure. RESULTS: Preoperative OCT revealed Stage II MH in all cases. In five cases, improvement in visual acuity and closure of the macular hole on OCT was observed at one, three, and six months after GAPVD. In one case, although vitreofoveal traction was released, MH closure was not achieved; a full-thickness retinal defect persisted and final visual acuity was 20/100. CONCLUSION: GAPVD may be a viable alternative treatment for Stage II MH.

Fluorocarbons↗
PubMed2006

Idiopathic macular hole surgery with low-concentration infracyanine green-assisted peeling of the internal limiting membrane.

PURPOSE: To evaluate the efficacy of pars plana vitrectomy with infracyanine green (IFCG)-assisted internal limiting membrane peeling for the treatment of idiopathic macular hole. DESIGN: Prospective, noncomparative interventional case series. METHODS: Thirty-eight consecutive eyes of 35 patients with idiopathic macular hole were included in the study. Patients underwent early treatment diabetic retinopathy (ETDRS) visual acuity examination, dilated ophthalmoscopy, and optical coherence tomography before treatment and during follow-up. Fluorescein angiography was done in selected cases. Patients underwent a three-port pars plana vitrectomy with complete posterior hyaloid and epiretinal membrane removal. The internal limiting membrane (ILM) was stained with 0.5 cc of IFCG (0.5 mg/ml, 308 mOsm) and peeled up to the vascular arcades. Perfluoropropane gas (C(3)F(8)) 10% was used as tamponade. RESULTS: Mean follow-up duration was 10 +/- 5 months (range, 3 to 24 months). Six eyes had stage 2 macular hole, 15 eyes stage 3, and 16 eyes stage 4. Overall, 37 of 38 macular holes closed after a single surgery. Median visual acuity was 20/100 (range, 20/400 to 20/50) before surgery and 20/50 (range, 20/640 to 20/25) after surgery. Visual acuity after surgery was 20/50 or better in 24 of 38 (63.1%) eyes. Twenty-five (65.8%) eyes improved by 2 or more lines, nine (23.7%) eyes were stable, and four (10.5%) eyes worsened by 2 or more lines. CONCLUSIONS: This study suggests that IFCG (0.05%) effectively stains the ILM with apparent safety, and that IFCG-assisted peeling of the ILM may be useful in the treatment of idiopathic macular hole.

Aged↗
PubMed2006

Retinal pigment epithelium tear after intravitreal bevacizumab for exudative age-related macular degeneration.

PURPOSE: To report on the development of retinal pigment epithelium tears after intravitreal injections of bevacizumab as treatment of exudative age-related macular degeneration (AMD). DESIGN: Interventional case series. METHODS: The study included 63 patients who received an intravitreal injection of 1.5 mg bevacizumab as treatment of a detachment of the retinal pigment epithelium attributable to AMD and who had a follow-up of at least two months. RESULTS: Four patients (6%) developed a tear of the retinal pigment epithelium in the parafoveal region. Compared with the baseline value, visual acuity at the end of follow-up remained stable in three patients and declined in the fourth patient. CONCLUSIONS: Intravitreal injections of bevacizumab may be followed by a tear of the retinal pigment epithelium in eyes with exudative AMD and a retinal pigment epithelium detachment.

Angiogenesis Inhibitors↗
PubMed2006

Retinal pigment epithelial tear after intravitreal bevacizumab injection.

PURPOSE: To report two cases of a retinal pigment epithelial (RPE) tear after intravitreal bevacizumab injection for exudative age-related macular degeneration (AMD). DESIGN: Observational case series. METHODS: Two patients presented with occult choroidal neovascularization secondary to AMD. Both patients received intravitreal bevacizumab injections. RESULTS: The first patient developed a RPE tear shortly after a third intravitreal bevacizumab injection. The second patient developed a RPE tear 10 days after a second intravitreal bevacizumab injection. CONCLUSIONS: Although RPE tears may occur spontaneously as part of the natural history of exudative AMD, patients may develop visually devastating RPE tears after repeat intravitreal bevacizumab injection. Further studies are needed to determine the incidence of RPE tears after intravitreal bevacizumab injections.

Aged, 80 and over↗
PubMed2006

Intraoperative sclerotomy-related retinal breaks for macular surgery, 20- vs 25-gauge vitrectomy systems.

PURPOSE: To compare the rate of intraoperative sclerotomy-related retinal breaks (SRRB) between 20- and 25-gauge vitrectomy systems for the correction of macular pucker (MP) and macular hole (MH). DESIGN: Retrospective interventional case series. METHODS: Single institution review of 347 consecutive eyes of 333 patients between August 2003 and May 2005 receiving pars plana vitrectomy (PPV) for MP or MH repair. Eyes were excluded if they had any form of proliferative retinopathy, or if there was an intraoperative conversion of any sclerotomy from 25- to 20- gauge. RESULTS: Fourteen (6.4%) of 219 eyes in the 20-gauge group had SRRB vs 4 (3.1%) of 128 eyes in the 25-gauge group (Fisher exact test, P value = .22). CONCLUSIONS: There was a trend for slightly lower rates of intraoperative sclerotomy-related retinal breaks, single or multiple, with 25-gauge PPV compared with 20-gauge PPV, but the differences were not statistically significant.

Adolescent↗
PubMed2006

Thermal injury caused by chandelier fiber probe.

PURPOSE: To investigate thermal changes produced by a chandelier fiber probe (CFP). DESIGN: Interventional single case report and laboratory investigation. METHODS: When CFP was used for 25-gauge vitrectomy, an abnormal odor was emitted, and the CFP was instantly removed. To investigate this incident, the thermal change produced by the CFP was measured in air by means of an infrared sensor. Porcine Tenon capsular tissue was used to reproduce the intraoperative phenomenon. RESULTS: In our patient, the CFP tip melted, but this did not affect visual function. In the experiment, the uncoated CFP reached 49 C (120 F) at maximum illumination. When porcine Tenon capsular tissue was attached to the CFP tip, a temperature of 144 C (291 F) was reached at 50% of maximum illumination, and over 201 C (394 F) at 75%. The tip melted under these conditions. CONCLUSIONS: At present, we avoid the use of CFP during air exchange. This potential hazard of the CFP needs to be addressed.

Body Temperature↗
PubMed2006

Pars plana vitrectomy and perfluoropropane (C3F8) tamponade for retinal detachment due to myopic macular hole: a prognostic factor analysis.

PURPOSE: To determine the prognostic factors associated with anatomical success in the treatment of retinal detachment (RD) due to myopic macular hole by pars plana vitrectomy (PPV) and perfluoropropane (C3F8) gas tamponade. DESIGN: Retrospective, interventional, comparative case series. METHODS: In an institutional setting, 57 eyes with myopic macular hole RDs treated by PPV and C3F8 tamponade, with or without concomitant internal limiting membrane (ILM) peeling, endolaser photocoagulation, and/or phacoemulsification, were analyzed. Outcome measures were anatomical success, defined as closure of macular hole with reattachment of the surrounding retina, and postoperative best-corrected visual acuity (BCVA). RESULTS: The mean postoperative follow-up was 26.9 +/- 16.5 months. The anatomical success rate after primary PPV and C3F8 tamponade was 63.2%. Regression analysis showed that shorter axial lengths (odds ratio [OR] = 6.73, 95% confidence interval [95% CI] 1.86 to 12.22, P = .010), concomitant ILM peeling (OR 1.59, 95% CI 1.14 to 2.38, P = .013), and shorter duration of macular hole RD (OR 0.81, 95% CI 0.67 to 0.98, P = .033) were associated with a higher anatomical success. The mean pre- and postoperative BCVAs were 1.430 +/- 0.273 (range, 0.523 to 1.700) and 1.403 +/- 0.271 (range, 0.699 to 1.800) logarithm of minimal angle of resolution units, respectively. The postoperative BCVA was significantly better in eyes with macular hole closure than in eyes without (P = .021). CONCLUSIONS: Axial length, concomitant ILM peeling, and duration were important prognostic factors for PPV and C3F8 tamponade in the treatment of myopic macular hole RDs.

Adult↗