Sensory experiences with posterior vitreous detachment.
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Cryosurgery↗
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Results for “Retinal Perforations”
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Cyanoacrylate tissue adhesive in the management of recurrent retinal detachment caused by macular hole.
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Cyanoacrylates↗
Giant retinal tear as a complication of attempted removal of intravitreal lens fragments during cataract surgery.
PURPOSE: To report giant retinal tear and retinal detachment as a complication of attempted removal of intravitreal lens fragments at the time of cataract surgery and to evaluate the anatomic and visual acuity outcomes of pars plana vitrectomy and retinal reattachment surgery. METHODS: Retrospectively, 10 patients with giant retinal tear, retinal detachment, and intravitreal lens fragments in 10 eyes were reviewed. RESULTS: In 10 eyes, retrieval of intravitreal lens fragments using the limbal approach by deep vitrectomy, copious vitreous cavity irrigation, or deep vitreous cavity phacoemulsification had been attempted by the anterior segment surgeon at the time of cataract surgery in each patient. The average interval from cataract surgery to the initial vitreoretinal consultation was 8 days. Each of the 10 eyes had a giant retinal tear involving the inferior retina: in four eyes, of between 90 degrees and 180 degrees; in four, equal to 180 degrees; and in two, of greater than 180 degrees. After pars plana vitrectomy and retinal detachment repair, nine (90%) of 10 eyes had retinal reattachment, but seven patients required more than one operation. One eye had persistent retinal detachment, and one eye had corneal graft failure. Seven (70%) of the 10 eyes had best-corrected final visual acuity of 20/200 or better; three eyes had light-perception, hand-motion, and counting-fingers vision. CONCLUSIONS: Aggressive attempts at intravitreal lens fragment retrieval from a limbal-based approach should be avoided because these procedures may result in serious retinal complications, such as formation of a giant retinal tear.
Aged↗
Dehydration injury as a possible cause of visual field defect after pars plana vitrectomy for macular hole.
PURPOSE: To present the hypothesis that a visual field defect after pars plana vitrectomy for macular hole may be caused by dehydration injury to the nerve fiber layer during the fluid-air exchange. METHODS: In a consecutive nonrandomized series of 45 operations on 35 eyes of 34 patients with full-thickness macular hole, the surgical method was changed with postoperative visual field testing performed. RESULT: The incidence and location of the post-operative visual field defect was affected only by changing the location of the infusion cannula. CONCLUSION: Dehydration injury of the nerve fiber layer during the fluid-air exchange should be considered as a possible cause of visual field defect after pars plana vitrectomy for macular hole.
Desiccation↗
White dot fovea.
PURPOSE: To describe a newly identified clinical entity tentatively named white dot fovea. METHODS: We examined by scanning laser ophthalmoscopy 58 eyes of 30 patients (mean age, 64 years) who had white dots in the fovea (anatomically defined as the foveola) simulating macular hole. In addition, the retinal surfaces of 30 autopsy eyes from donors aged 70 years or older were observed by scanning electron microscopy. RESULTS: White dot fovea was bilateral in 28 of 30 patients (93%). It was characterized by the presence of numerous white dots on the foveal surface distributed either diffusely or along the foveal margin, forming a gray ring. There was no subjective symptom or visual disturbance. The condition was best seen by a scanning laser ophthalmoscope using argon blue laser as the light source. The white dots numbered from 100 to 300 per eye. Each dot was approximately 5 microns in diameter. Scanning electron microscopy showed foveal granules simulating the white dots in five of 30 autopsy eyes (17%). The granules had multiple protrusions with cilia-like structures resembling glial cells. This glia-like structure seemed to be a counterpart of clinically observed white dot fovea. CONCLUSION: White dot fovea is a new, frequent, and apparently innocuous clinical entity. It merits due attention in the differential diagnosis of macular holes.
Aged↗
Visual acuity and macular hole size after unsuccessful macular hole closure.
PURPOSE: To evaluate the visual acuity, change in macular hole size, and change in subretinal fluid cuff size after unsuccessful macular hole closure. METHODS: Forty-two consecutive eyes with macular hole and unsuccessful surgery for macular hole were studied. Preoperative and postoperative best-corrected visual acuities were tested according to the Early Treatment Diabetic Retinopathy Study (ETDRS) protocol, and changes were compared. Preoperative and postoperative fundus photographs were analyzed on a photograph documenter for changes in diameter of the macular hole and surrounding subretinal fluid cuff. RESULTS: Mean visual acuity decreased from 20/133 preoperatively to 20/154 postoperatively (mean loss, 0.79 ETDRS line). Mean diameter of the macular hole enlarged 22%; mean diameter of the visible surrounding subretinal fluid cuff enlarged 36%. A decrease in best-corrected visual acuity postoperatively was correlated with better preoperative visual acuity, earlier macular hole stage, and shorter duration. Enlargement in the diameter of the macular hole and fluid cuff did not correlate with better preoperative best-corrected visual acuity, earlier macular hole stage, or shorter duration. In 23 eyes that had failed previous surgery, macular hole surgery was anatomically successful in 17 (65%) (mean improvement, 3.7 ETDRS lines; mean best-corrected final visual acuity, 20/74). CONCLUSION: After macular hole surgery, anatomically unsuccessful closure of the hole correlates with small enlargements in the diameter of the macular hole and its surrounding subretinal fluid cuff, and with a slight decrease in visual acuity. Macular hole closure after repeat surgery improves visual acuity outcome in the majority of retreated eyes.
Aged↗
Retinal detachment associated with type III retinoblastoma regression after cryotherapy and external-beam radiotherapy.
PURPOSE: To report a child with rhegmatogenous retinal detachment originating from a focus of type III retinoblastoma regression after cryotherapy and external-beam radiation therapy. METHOD: Retinal detachment and multiple retinal holes, which were closely associated with the calcified mass of the regressed retinoblastoma, were treated with cryotherapy and scleral buckle. RESULTS: Positioning the regressed tumor and the retinal holes on the scleral buckle closed the holes. Subretinal fluid gradually reabsorbed after surgery, and complete retinal reattachment resulted. CONCLUSION: Rhegmatogenous retinal detachment is rare in patients with retinoblastoma, and scleral buckle can successfully manage such cases. In our patient, the detachment probably resulted from retinal necrosis secondary to cryotherapy and external-beam radiation therapy.
Calcinosis↗
Vitreous cells as an indicator of retinal tears in asymptomatic or not recently symptomatic eyes.
PURPOSE: To define the relationship between vitreous cells and retinal tears in eyes without recent flashes or floaters. METHODS: Five hundred eighty-five consecutive patients who complained of light flashes, floaters, or both in one eye had their asymptomatic or not recently symptomatic fellow eye examined prospectively for vitreous cells and retinal tears. RESULTS: Of these fellow eyes with 2+ or more vitreous cells (10 or more cells per 1-mm slit-lamp field), 31.6% (6/19) had one or more tears vs 1.6% (9/566) of those with 1+ or fewer cells (less than nine cells per 1-mm slit-lamp field) (P = .0001). CONCLUSIONS: A substantial number of vitreous cells, even in an eye with no recent symptoms, is correlated with the presence of a retinal tear. Additionally, a retinal tear may exist in an eye with 1+ or fewer cells.
Adolescent↗
Combined macular hole and cataract surgery.
PURPOSE: Cataract often develops after macular hole surgery, necessitating cataract surgery. We report a combination of macular hole surgery and cataract surgery on four eyes of four patients. METHODS: Four eyes of four patients had a full-thickness stage III or IV macular hole and some degree of cataract. Combined cataract surgery with intraocular lens implant and macular hole surgery was associated with intravitreal perfluoropropane at 15% concentration and with face-down positioning for 21 days. RESULTS: After combined cataract and macular hole surgery, the rim of subretinal fluid resolved successfully in four eyes of four patients. Twelve months after surgery, the macular hole reopened in one eye in association with the new onset of macular pucker. Best-corrected visual acuities ranged from 20/25 to 20/100 12 months after surgery, while preoperative visual acuities with best correction were 20/70 to 20/200. CONCLUSIONS: In selected cases, a combination of cataract surgery with intraocular lens implant and macular hole surgery offers advantages. This combined approach warrants consideration.
Aged↗
Spontaneous disappearance of traumatic macular holes in young patients.
PURPOSE: To report the disappearance of traumatic macular hole in three eyes of three patients. METHODS: Clinical data of the patients were reviewed. RESULTS: The three patients were relatively young, ranging in age from 12 to 18 years old. In one eye of each patient, a small traumatic macular hole was observed at the first visit. Visual acuities ranged from 20/100 to 20/40. The macular holes resolved spontaneously 3 to 4 months after the trauma, and final visual acuity improved to 20/20 in all patients. CONCLUSION: Small traumatic macular holes in young patients can resolve spontaneously, and this can be associated with good visual recovery.
Accidents, Traffic↗
Clinical correlation of ultrasonographic findings in macular holes.
PURPOSE: Theoretically, idiopathic macular holes develop because of tangential vitreous traction on the fovea. The purpose of this study was to demonstrate ultrasonographically the vitreomacular relationships in a series of 44 consecutive patients with macular holes and to correlate the ultrasonographic findings with the clinical and intraoperative findings of these patients. METHODS: I examined 47 eyes with a macular holes by using contact lens biomicroscopy and clinically staged the macular hole and the status of the vitreous. A kinetic B-scan ultrasonographic examination of the vitreomacular relationships was performed in each study eye and in the fellow eye by using a contact method, with topical anesthesia. RESULTS: The clinical stage of macular hole in 47 eyes of 44 patients included eight holes in stage 1, five in stage 2, 22 in stage 3, and 12 in stage 4. The vitreous was attached to the macular region by ultrasound interpretation in seven of eight stage 1 holes, two of five stage 2 holes, 21 of 22 stage 3 holes, and zero of 12 stage 4 holes. The correlation between the clinical status of the vitreous and the ultrasonographic findings was high (94%). The status of the vitreous by ultrasound was confirmed intraoperatively in all 14 patients undergoing subsequent surgery. CONCLUSIONS: Ultrasonographic examination of the vitreomacular relationships provides an accurate assessment of vitreomacular attachment or detachment. The ultrasonographic findings in these 47 eyes with macular holes support the vitreomacular traction theory of macular holes.
Aged↗
Resolution of an absolute scotoma and improvement of relative scotomata after successful macular hole surgery.
Visual loss in eyes with full-thickness macular holes is thought to be caused by the absence of retinal function in the area of the neurosensory defect as well as reduction in retinal function in the surrounding area of neurosensory retinal detachment. To improve characterization of the visual function of eyes after successful macular hole surgery, we studied six eyes preoperatively and postoperatively with macular microperimetry using the scanning laser ophthalmoscope. Best-corrected visual acuity was improved postoperatively in all eyes. Microperimetry performed preoperatively demonstrated an absolute scotoma that corresponded to the neurosensory defect in all eyes, with surrounding concentric isopters of relative scotomata. No detectable absolute scotoma was found in any eye postoperatively. All eyes showed partial or complete resolution of the surrounding relative scotomata. Improvements in visual acuity after successful macular hole surgery may be related to disappearance of a detectable absolute scotoma as well as improvement in the surrounding retinal function.
Aged↗
Vitrectomy surgery for full-thickness macular holes.
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Humans↗
Effect of the vitreous on the prognosis of full-thickness idiopathic macular hole.
We studied 112 eyes with full-thickness idiopathic macular holes (mean follow-up period, 5.7 years) to ascertain the effect of the vitreous on prognosis. Eyes were divided as follows: group 1, 58 eyes with no posterior vitreous detachment; group 2, 25 eyes with no posterior vitreous detachment initially and development of complete posterior vitreous detachment during follow-up; and group 3, 29 eyes with complete posterior vitreous detachment. In group 1, the macular hole enlarged in 37 eyes (64%), and the surrounding retinal detachment enlarged in 29 (50%); visual acuity decreased in 20 eyes (34%) by two or more Snellen lines. These percentages were significantly higher than in group 3 (14%, 10%, and 10%; P = .01, P = .01, and P = .03, respectively). Eyes with a full-thickness macular hole with no posterior vitreous detachment may have a greater risk of enlargement of the macular hole and surrounding retinal detachment, and thus a worse prognosis than eyes with posterior vitreous detachment.
Aged↗
Giant retinal pigment epithelial tears in acute retinal necrosis.
We observed large peripheral tears of the retinal pigment epithelium in two patients, a 59-year-old man and a 15-year-old girl, who had acute retinal necrosis. These tears ranged from 90 to 180 degrees of the circumference of the peripheral retinal pigment epithelium and occurred in areas of previous retinal viral infection. Both patients had curled folds of tissue at the posterior edge of the retinal pigment epithelial tear. During vitrectomy at the time of fluid-air exchange, we noted the edge of these tears to sag posteriorly. Because of the area that was denuded of retinal pigment epithelium by the tears, we selected a more posterior location for argon laser endophotocoagulation in both patients. These large retinal pigment epithelial tears did not appear to have an adverse effect on the outcome of surgical treatment of the retinal detachments.
Acyclovir↗
Tractional elevations of the retina in patients with diabetes.
Tractional retinoschisis and tractional retinal detachment are both complications of proliferative diabetic retinopathy. The two conditions are frequently confused because they are similar in diagnostic features. We determined the respective incidence of tractional retinoschisis and tractional retinal detachment in 200 eyes with tractional elevations of the retina in patients with diabetes. In 39 eyes, the diagnosis was unequivocally tractional retinoschisis because the retinal elevation maintained its concave contour despite the development of retinal holes. In 65 eyes, tractional retinal detachment was diagnosed with equal certainty, either because pigment lines were present or because the elevation, after a retinal hole developed, rapidly became convex and extended to the ora serrata. The remaining 96 eyes, in which retinal holes or pigment lines were absent, were classified by other features that had been tested for significance in the already diagnosed eyes. On that basis, the diagnosis was retinoschisis in 46 eyes and retinal detachment in 50 eyes.
Diabetes Mellitus, Type 1↗
Visual field loss after vitrectomy for full-thickness macular holes.
PURPOSE: To report the results of a prospective study of the incidence of peripheral visual field loss after macular hole surgery. METHODS: Prospectively, 30 eyes of 30 consecutive patients with full-thickness macular holes operated on between December 1995 and April 1996 had preoperative and postoperative Goldmann visual field tests. The surgical procedure consisted of three-port pars plana vitrectomy, posterior hyaloid removal, nonexpansile fluid-hexafluoroethane (C2F6) exchange, and, in 19 of 30 patients, autologous platelet injection, followed by face-down positioning. RESULTS: Twenty-nine of these 30 cases were considered to be anatomic successes. Comparison of preoperative and postoperative visual fields disclosed that four patients (13%) had a peripheral scotoma, including one patient with stage 4 macular hole. Three other patients (10%) had a postoperative relative arcuate defect. Mean postoperative intraocular pressure was higher in the latter group. None of the patients complained of peripheral scotoma. CONCLUSIONS: Overall, seven of 30 patients (23%) had a postoperative visual field defect. Two categories of scotomas were observed: peripheral and relative arcuate. The cause of peripheral visual field loss is unclear. Increased intraocular pressure may be the cause of relative arcuate scotomas.
Adult↗
Risk of retinal tears in patients with vitreous floaters.
A total of 589 patients (369 women and 220 men, 123 of whom were less than 40 years old and 52 of whom were more than 70 years old) with photopsia, vitreous floaters, or both participated in a prospective study designed to identify patients at particularly high risk for retinal tears. The patients were graded on a number of factors before undergoing peripheral retinal examinations. Computer analysis showed that the following factors had the strongest associations (P less than .001) with retinal tears: visual symptoms of diffuse dots (62 of 120 patients, or 51.7%), many vitreous cells (graded 2+ or worse) (61 of 94 patients, or 64.9%), and grossly visible vitreous or preretinal blood (51 of 56 patients, or 91.1%). Of the 176 eyes that had at least one of these three conditions, 93 (52.8%) had retinal tears compared to 16 of the remaining 413 eyes (3.9%). Although other factors correlated with retinal tears to some degree, the associations were not strong enough to help select the high-risk group.
Adult↗