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At least 757 records · Page 42Linked to original sources
PubMed2004

Triamcinolone acetonide-assisted peeling of the internal limiting membrane.

PURPOSE: We report on a new technique to peel the internal limiting membrane (ILM) using triamcinolone acetonide (TA) to facilitate visualization during surgery. DESIGN: Interventional case series. METHODS: In four eyes of four patients with macular hole, TA was used during vitrectomy to visualize the hyaloid. After the posterior hyaloid was surgically separated from the optic nerve head and posterior retina, TA suspension was injected over the posterior pole. Intraocular forceps was used to peel the ILM in a circumferential manner around the macular hole. RESULTS: Numerous particles of TA were dispersed over the posterior retina as white specks. Once the ILM was peeled, the peeled area was clearly visualized as an area lacking the white specks. In all patients, the macular holes closed. No adverse reactions were observed during the 3-month follow-up period. CONCLUSIONS: TA-assisted ILM peeling is an effective and safe technique for macular hole surgery.

Basement Membrane↗
PubMed2004

In vivo observation of internal limiting membrane in an eye with macular hole.

PURPOSE: To determine whether an internal limiting membrane (ILM) in the foveal area with a full-thickness idiopathic macular hole (MH) was intact. DESIGN: Interventional case report. METHODS: The ILM was stained with indocyanine green and peeled with forceps during pars plana vitrectomy for a full-thickness MH with a cuff. The stained membrane over the MH was carefully examined to determine whether a hole was present. RESULTS: The ILM was clearly observed by indocyanine green staining during pars plana vitrectomy; no hole was detected in the membrane over the MH. CONCLUSIONS: A full-thickness MH with a cuff can occur in the absence of a hole in the ILM.

Aged↗
PubMed2004

Histology of the vitreoretinal interface after staining of the internal limiting membrane using glucose 5% diluted indocyanine and infracyanine green.

PURPOSE: To evaluate the effect of indocyanine green (ICG) diluted with glucose 5% on the human retina in an experimental setting in postmortem eyes and during surgery for macular hole formation. DESIGN: Histopathological evaluation. METHODS: Possible adverse effects of two different solutions of 0.05% ICG (Pulsion, Munich, Germany; and Infracyanine, Laboratoire SERB, Paris, France) diluted with glucose 5% were evaluated in four eyes of two donors. In one eye of each donor, the ICG-stained macula was illuminated with 380 to 760 nm using the light source of a commonly used vitrectomy machine. In the other eye, ICG was applied to the macula without illumination. The retinal specimens were evaluated using light- and electron microscopy. Additionally, the ultrastructure of the internal limiting membrane (ILM) of four eyes that underwent ICG-assisted vitrectomy for macular hole formation was examined. RESULTS: In the postmortem study, both solutions of ICG caused significant morphologic alterations of the inner retina after light exposure. There was disorganization of the inner retina and complete loss of ILM after application of the dye and illumination. In contrast, no abnormalities were found after application of the dye without illumination and in unstained control specimens. No differences were noted between the two ICG products. Specimens of the ILM harvested during vitrectomy revealed cellular elements adjacent to the retinal side of the ILM. CONCLUSIONS: Staining of the ILM using ICG diluted in glucose 5% followed by illumination might induce an adverse effect on the inner retina and may result in an alteration of the cleavage plane from the ILM to the innermost retinal layers.

Adult↗
PubMed1994

Finding the retinal hole in the pseudophakic eye with detachment.

The recently developed wide-field indirect contact lenses, recommended and used for pancoagulation of the retina posterior to the equator, have proved to be unexpectedly advantageous for finding retinal breaks anterior to the equator in the pseudophakic eye. Through a 6-mm pupil, it is possible with some ocular rotations, tilting of the lens, and scleral depression to bring into view the retina anterior to the equator and frequently the ora serrata. We found or confirmed 45 small retinal breaks anterior to the equator in 24 retinal detachments in pseudophakic eyes with the wide-field indirect contact lens. The indirect contact lens eliminates the blur that occurs when viewing through the edge of the intraocular lens, and its image suffers less interference from lens and capsular opacities.

Cataract Extraction↗
PubMed1994

Relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment.

We examined biomicroscopically the vitreous and retinal conditions of 902 consecutive symptomatic eyes (785 patients) to ascertain the relationship between floaters, light flashes, or both, and complications of posterior vitreous detachment. Of 785 patients, 785 symptomatic eyes were divided as follows: group 1, 342 eyes with floaters alone; group 2, 240 eyes with floaters and light flashes; and group 3, 203 eyes with light flashes alone. We also studied 636 asymptomatic fellow eyes. The prevalence of posterior vitreous detachment was significantly higher in groups 1 (138 of 342, 40%), 2 (214 of 240, 89%), and 3 (137 of 203, 67%) than in the asymptomatic eyes (127 of 636, 20%), in group 2 than in groups 1 and 3, and in group 3 than in group 1 (P = .01). The prevalence of retinal breaks in eyes with posterior vitreous detachment was 5% (seven of 138), 13% (27 of 214), 12% (16 of 137), and 4% (five of 127) in groups 1, 2, 3, and the asymptomatic eyes, respectively; the prevalence was significantly higher in groups 2 and 3 than in asymptomatic eyes (P = .02 and P = .04) and group 1 (P = .04 and P = .05). The prevalence of vitreous hemorrhage in eyes with retinal breaks was 71% (five of seven), 70% (19 of 27), and 6% (one of 16) in groups 1, 2, and 3, respectively. Of 117 patients with bilateral symptoms, 105 (90%) had the same symptoms and 104 (89%) had the same vitreoretinal relationship bilaterally.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1997

Sustained closure of surgically repaired macular holes after retinal detachment with submacular fluid.

PURPOSE: To examine the behavior of surgically repaired macular holes when subsequent retinal detachment with submacular fluid develops and to correlate these observations with current theories of macular hole formation and closure. METHODS: We reviewed the medical records of four patients who underwent successful surgical closure of macular holes and subsequently developed rhegmatogenous retinal detachment with macular involvement. RESULTS: No reopening of the original macular hole occurred in any of the four patients. No focal macular attachment was seen that would suggest firm adherence of the macular hole edges to the underlying retinal pigment epithelium. CONCLUSIONS: When retinal detachment with submacular fluid develops in patients with a successfully closed macular hole, sustained closure of the macular dehiscence is typically seen. These findings support reapproximation of the hole edges with an associated retinal wound healing response as the mechanism of hole closure.

Aged↗
PubMed1997

Indocyanine green videoangiography after acute retinal pigment epithelial tears in age-related macular degeneration.

PURPOSE: To determine the features of combined fluorescein and indocyanine green videoangiography after acute retinal pigment epithelial tears associated with age-related macular degeneration. METHODS: We performed combined fluorescein and indocyanine green videoangiography in three eyes of three patients 2 days to 2 months after the development of tears of the retinal pigment epithelium. RESULTS: The area of exposed choroid in a retinal pigment epithelial tear shows intense hyperfluorescence in fluorescein videoangiography; in contrast, this area demonstrates near-normal choroidal fluorescence on an indocyanine green videoangiogram. The folded and retracted flap of retinal pigment epithelium in a retinal pigment epithelial tear discloses marked hypofluorescence on the fluorescein videoangiogram; in contrast, this flap of retinal pigment epithelium displays varying degrees of hyperfluorescence on the indocyanine green videoangiogram. CONCLUSIONS: The angiographic differences between fluorescein and indocyanine green result from the distinct biophysical properties of these two dyes as well as from the differential penetration of their fluorescence through such pigmented structures as retinal pigment epithelium. Compared with fluorescein videoangiography, indocyanine green videoangiography allows better visualization of choroidal neovascular membranes within the rolled-up and retracted flap of the retinal pigment epithelial tear.

Acute Disease↗
PubMed1997

Bilateral macular holes resulting from septic embolization.

PURPOSE: To report a previously undescribed cause of bilateral macular hole formation. METHOD: Case report. RESULTS: Septic emboli were noted at the center of the macula in both eyes of a 32-year-old man with acute bacterial endocarditis. Bilateral full-thickness macular holes later developed at the site of these retinal lesions. CONCLUSION: This case represents the first report of fundus lesions in septicemia resulting in full-thickness macular hole formation.

Adult↗
PubMed1995

Prognosis of stage 2 macular holes.

PURPOSE: We ascertained the natural course of stage 2 idiopathic macular holes to determine better treatment possibilities. METHODS: We reviewed 48 eyes with stage 2 idiopathic macular holes and followed them up for more than two years. At each examination, best-corrected Snellen visual acuity was measured by a physician masked to the hypothesis of the study. RESULTS: Stage 2 lesions progressed to stage 3 or 4 during the follow-up period in 32 (67%) and 14 (29%) of 48 eyes, respectively; two eyes (4%) remained in stage 2. In 41 (85%) of 48 eyes, the hole size enlarged during the follow-up: 32 (94%) of 34 eyes had vitreomacular attachment and nine (64%) of 14 eyes had vitreomacular separation at the final examination, for a statistically significant difference in prevalence (P = .03). Visual acuity decreased two or more Snellen lines during the follow-up period in 34 (71%) of 48 eyes, the prevalence of which was significantly higher in eyes with vitreomacular attachment at the final examination (28 of 34, 82%) than in eyes with vitreomacular separation at the final examination (six of 14, 43%) (P = .01). CONCLUSION: Even though vitreomacular separation may improve the prognosis of a macular hole, stage 2 lesions usually will develop an enlarged hole and decreased visual acuity.

Aged↗
PubMed1994

Differentiating macular holes from macular pseudoholes.

Surgical treatments of macular holes have become increasingly effective in inducing resolution of the cuff of surrounding subretinal fluid, resulting in increased vision in many patients. However, for many conditions that mimic a macular hole, either surgery is not indicated or different surgical manipulations are necessary. Differentiating macular holes from some forms of macular pseudoholes can be difficult or impossible based solely on clinical examination. Adjunctive tests that may enhance the accuracy of diagnosis are either not feasible or not available to most clinical practices. We evaluated three clinic-based tests for their value in allowing the differentiation between macular holes and macular pseudoholes: Amsler grid testing, Watzke-Allen sign, and laser aiming beam test. These tests were evaluated in three groups of clinically defined patients: those with full-thickness macular holes, those with macular pseudoholes, and those who had previously undergone successful macular hole treatment. Although the Amsler grid testing was sensitive in correlating with clinically defined macular holes, it was not specific. The Watzke-Allen sign and, to a greater extent, the laser aiming beam test were extremely sensitive and specific in correlating clinically defined full-thickness macular holes and pseudoholes. These tests improve the accuracy of diagnosis of full-thickness macular holes.

Aged↗
PubMed1996

Clinicopathologic correlation of an untreated macular hole and a macular hole treated by vitrectomy, transforming growth factor-beta 2, and gas tamponade.

PURPOSE: To study the clinicopathologic features of an untreated macular hole in the right eye and a macular hole in the left eye treated by vitrectomy, application of transforming growth factor-beta 2, and gas tamponade. METHODS: The patient, a 73-year-old man with bilateral macular holes, was studied clinically before and after surgical treatment of the macular hole in his left eye. The patient's eyes were obtained postmortem and serially step-sectioned through the macula and optic nerve head for electron microscopy. RESULTS: Examination of 1-micron thick plastic-embedded sections through the macula of the right eye disclosed a 0.6-mm macular hole with rounded gliotic margins, a thin epiretinal membrane, and parafoveal cystic changes. Examination of 1-micron thick plastic-embedded sections through the macula of the left eye disclosed a 0.25-mm defect in the fovea, which was bridged by glial cells. The glial cells were continuous with a thin hypocellular epiretinal membrane without contraction features on both sides of the defect. The ultrastructural features of the glial cells were consistent with Mueller cells. CONCLUSIONS: Treatment of a macular hole with vitrectomy, transforming growth factor-beta 2, and gas tamponade was followed by complete closure of the macular hole by Mueller cell proliferation.

Aged↗
PubMed1996

Initial clinical experience with an erbium:YAG laser for vitreoretinal surgery.

PURPOSE: We tested the efficacy of an erbium:YAG laser for maneuvers in patients undergoing vitreoretinal surgery. METHODS: An erbium:YAG laser equipped with a flexible fiberoptic and interchangeable 20-gauge endoprobes of various tip configurations ranging from 100 to 365 microns was used for specific maneuvers in 13 patients referred for vitreoretinal surgery for diabetic traction detachment, proliferative vitreoretinopathy, retinal detachment with posterior break, and epimacular membrane. The following maneuvers were performed: (1) transection of elevated vitreous membranes, (2) incision of epiretinal membranes, (3) drainage and relaxing retinotomy, (4) transection of subretinal membranes, (5) noncontact ablation of epiretinal membranes in air-filled eyes, (6) ablation of lens remnants, (7) posterior capsulotomy, (8) iris surgery, and (9) retinal vascular coagulation. RESULTS: Forty-eight defined maneuvers were performed with energy levels ranging from 0.2 to 5.0 mJ and repetition rates of 2 to 30 Hz. Transection of elevated membranes, subretinal membranes, and retinotomies were easily performed. Fourteen incisions into vascularized epiretinal membranes in diabetic traction detachment surgery demonstrated a fine margin of coagulation that permitted hemostatic incision. Retinal breaks were created during one of these incisions. Lens remnant ablation, posterior capsulotomy, and iris tissue removal were successful, with a single complication consisting of damage to the posterior surface of an intraocular lens during a pars plana posterior capsulotomy accomplished by means of a side-firing probe. Epiretinal membrane ablations in air-filled eyes were effectively performed in a gradual fashion without hemorrhage. CONCLUSIONS: The erbium:YAG laser offers precise and effective tissue cutting and removal in vitreoretinal maneuvers. Further study will determine the role of this technology in vitreoretinal surgery.

Adult↗
PubMed1996

The role of the premacular liquefied pocket and premacular vitreous cortex in idiopathic macular hole development.

PURPOSE: To clarify the role of the vitreous in idiopathic macular hole formation. METHODS: We prospectively evaluated the vitreous before and during vitreous surgery in 64 consecutive eyes of 62 patients (stage 1B, four eyes; stage 2, ten eyes; stage 3, 43 eyes; stage 4, four eyes) with macular holes; another three eyes underwent a second vitrectomy. After core vitrectomy, the premacular vitreous cortex was examined by applying gentle suction. The detached posterior hyaloid face was observed under endoilluminiation. RESULTS: We observed in all eyes a liquefied lacuna anterior to the posterior fundus before and during vitreous surgery. The premacular vitreous cortex was extremely thin and elastic upon gentle suction. A premacular ring, the diameter two to four times that of the Weiss ring, was observed in 48 of 57 eyes (84%) with stages 1B, 2, and 3 macular hole. In most cases, the vitreous cortex within the premacular ring either was absent or had a break, resulting in a premacular round defect. The vitreous cortex peripheral to the premacular ring, which was thick and less deformed, never showed a break. In eyes that had undergone a second vitrectomy, we noted residual cortex or an epiretinal membrane around the macular hole. CONCLUSIONS: The premacular vitreous cortex is extremely thin and elastic. It is sharply demarcated by a ring from the thick peripheral vitreous cortex. Tangential traction, which causes macular holes, appears to originate exclusively in the premacular vitreous cortex that forms the posterior wall of the premacular liquefied pocket.

Eye Diseases↗
PubMed1996

Imaging of epiretinal membranes in macular holes by scanning laser ophthalmoscopy.

PURPOSE: Because recognition and removal of an epiretinal membrane are important in macular hole surgery, we used the scanning laser ophthalmoscope preoperatively to study epiretinal membranes in patients with idiopathic macular holes. METHODS: We studied 67 eyes (60 consecutive patients) with idiopathic macular holes. We evaluated the thickness and the extent of the epiretinal membrane by using a scanning laser ophthalmoscope. We then compared the fundus images obtained with the scanning laser ophthalmoscope with red-free monochromatic fundus photographs. RESULTS: Confocal imaging of the fundus with either argon blue (488 nm) or argon green (514 nm) laser illumination clearly showed the epiretinal membranes. In all eyes, we observed lesions ranging from a patchy glinting light reflex to a dense epiretinal membrane. A well-demarcated dense epiretinal membrane around the macular hole was observed in seven (44%) of 16 eyes with stage 2 macular holes and in 12 (40%) of 30 eyes with stage 3 holes, but in only two (10%) of 21 eyes with stage 4 holes. The prevalence of the dense epiretinal membrane in stage 2 or 3 holes was significantly higher than in stage 4 holes (P = .025 and .024, respectively). CONCLUSIONS: Fundus imaging using the scanning laser ophthalmoscope with argon laser illumination is useful preoperatively to evaluate epiretinal membranes in eyes with idiopathic macular holes.

Aged↗
PubMed1996

Prospective randomized trial of vitrectomy or observation for stage 2 macular holes. Vitrectomy for Macular Hole Study Group.

PURPOSE: To determine the risks and benefits of vitrectomy surgery in eyes with stage 2 macular holes. METHODS: A multicentered, controlled, randomized clinical trial was performed with participation of 16 community and university-based ophthalmology clinics. Thirty-six eyes with stage 2 macular holes and 12 months of follow-up were studied. Pars plana vitrectomy with separation of the posterior hyaloid membrane and intraocular injection of perfluoropropane (C3F8) was followed by postoperative face-down positioning for two weeks. This protocol was compared with observation alone. Outcome variables included anatomic closure of the macular hole, macular hole size, and four standardized measures of vision. RESULTS: At 12 months, 15 (71%) of 21 eyes randomly assigned to observation progressed to stages 3 or 4, compared with three (20%) of 15 eyes randomly assigned to surgery (P < .006). Compared with eyes randomly assigned to observation, eyes randomly assigned to surgery had significantly smaller hole diameters (P < .01) and significantly better visual acuity outcomes, as measured by the Word Reading (P = .02) and Potential Acuity Meter (P = .002) charts. No significant differences were found for the Early Treatment Diabetic Retinopathy Study chart and Contrast Sensitivity test. CONCLUSION: Compared with observation alone, surgical intervention in stage 2 macular holes resulted in a significantly lower incidence of hole enlargement and appeared to be associated with better outcome in some measures of visual acuity.

Aged↗
PubMed1996

Increased intraocular pressure after macular hole surgery.

PURPOSE: To determine the incidence and timing of increased intraocular pressure in eyes with an idiopathic macular hole treated with bovine transforming growth factor-beta 2 (TGF-beta 2) with different intraocular gas concentrations, recombinant TGF-beta 2, or placebo. METHODS: Intraocular pressure was measured preoperatively and two days, two weeks, six weeks, and three months postoperatively in two prospective studies of the treatment of idiopathic macular hole with vitrectomy. Group 1 consisted of 95 eyes treated with bovine TGF-beta 2. Eyes in this group were treated with different concentrations of air and perfluoropropane (C3F8) intraocular gas bubbles. Fifteen eyes were treated with air, 15 eyes with 5% perfluoropropane, 15 eyes with 10% perfluoropropane, and 50 eyes with 16% perfluoropropane. Group 2 consisted of 29 eyes treated with recombinant TGF-beta 2. Twenty-six eyes were treated with placebo in a double-masked, randomized, placebo-controlled study evaluating recombinant TGF-beta 2 with a 16% perfluoropropane intraocular gas bubble. RESULTS: At the two-week examination, the intraocular pressure in Group 1 eyes was > 30 mm Hg in four (26.7%) of 15 eyes treated with air, two (13.3%) of 15 eyes treated with 5% perfluoropropane, one (8.3%) of 12 eyes treated with 10% perfluoropropane, and nine (19.1%) of 47 eyes treated with 16% perfluoropropane. There was no statistically significant difference in the risk of increased intraocular pressure in eyes treated with short-, intermediate-, or long-duration gas tamponade using bovine TGF-beta 2. The intraocular pressure in Group 2 was > 30 mm Hg at the two-week examination in 11 (39.3%) of 28 eyes receiving recombinant TGF-beta 2 compared with one (4.3%) of 23 eyes receiving a placebo (P = .006). CONCLUSIONS: Some eyes develop increased intraocular pressure after vitreous surgery for macular hole, and the increase occurs most frequently between two days and two weeks postoperatively. The risk of increased intraocular pressure is somewhat increased in eyes treated with bovine TGF-beta 2 but is markedly increased in eyes in which recombinant TGF-beta 2 is used as an adjunctive agent for macular hole surgery. Intraocular injection of growth factors produced by similar recombinant DNA techniques may result in potentially dangerous increased intraocular pressure several weeks after surgery. Impurities in the recombinant TGF-beta 2 may explain the relatively high risk of increased intraocular pressure.

Chemotherapy, Adjuvant↗