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At least 793 records · Page 44Linked to original sources
PubMed1996

Ultrastructural features of tissue removed during idiopathic macular hole surgery.

PURPOSE: To compare the ultrastructural features of excised tissue removed during surgery for idiopathic macular holes with the preoperative stage of the macular hole. METHODS: Twelve consecutive patients with a unilateral idiopathic macular hole underwent vitrectomy with surgical removal of the internal limiting membrane of the retina and epiretinal tissue overlying and surrounding the hole. The excised specimens were evaluated with transmission electron microscopy, and findings were compared with the preoperative stage of the macular hole according to the classification of Gass. RESULTS: Surgery was performed on 12 eyes of 12 patients with stage 2, 3, or 4 macular holes. Internal limiting membrane was present in 11 of 12 specimens. Tissue from one of two eyes with stage 2 holes showed cellular elements enmeshed in cortical vitreous. Tissue from four of seven eyes with stage 3 holes and three of three eyes with stage 4 holes had cellular proliferation on the internal limiting membrane. Cells with myofibroblastic differentiation were present in five of the eight cellular proliferations. CONCLUSION: Our results support the clinical stages of idiopathic macular holes described by Gass. Idiopathic macular holes appear to form from contraction of the prefoveal vitreous, and the hole enlarges because of contraction of myofibroblasts on the inner surface of the internal limiting membrane. On the basis of the mechanical mechanisms of idiopathic macular hole formation, removal of the internal limiting membrane and adherent epiretinal tissue surrounding and overlying the macular hole is a reasonable surgical approach to close idiopathic macular holes.

Aged↗
PubMed1996

Retinal detachments by squash ball accidents.

PURPOSE: To evaluate the characteristics of retinal detachments caused by squash ball accidents. METHODS: Twenty-six patients had a retinal detachment after a squash ball hit their eyes. RESULTS: Characteristics of the 26 eyes with retinal detachment were large retinal tears parallel to the corneoscleral limbus located close to the ora serrata usually in the temporal superior fundus quadrant (in 14 [54%] of the 26 eyes) and in the temporal inferior quadrant (in seven eyes [27%]); primarily intact vitreous with a traumatic avulsion of the vitreous base in approximately one half the patients; relatively slow progression of the retinal detachment; and additional damage to the choroid and retinal pigment epithelium in the posterior fundus. The patients were young and did not have severe myopia. Reattachment of the retina was achieved in 22 (85%) of the 26 patients. In 11 patients (42%), visual acuity outcome was 20/40 or better with best correction. CONCLUSIONS: Retinal detachments after squash ball accidents show different characteristics with worse prognosis than do ordinary rhegmatogenous detachments. Protective eyewear should be worn when playing squash.

Adolescent↗
PubMed1996

Visual field defects after macular hole surgery.

PURPOSE: To describe a group of patients with dense visual field defects following macular hole surgery. METHODS: Nine (7%) of 125 patients reviewed noted onset of dense visual field defects following uncomplicated vitrectomy with gas-fluid exchange for the treatment of macular hole. Patient records were reviewed to investigate the etiology of these defects. RESULTS: Eight (89%) of nine eyes that had surgery for macular hole developed dense, wedge-shaped visual field defects in the temporal periphery. One eye had an inferonasal wedge-shaped defect extending to fixation. Seven (78%) of nine eyes had generalized or focal narrowing of the retinal arteriole extending into the area of retina corresponding to the visual field defect, and five (56%) of nine eyes developed mild to moderate segmental nasal optic disk pallor. Postoperative fluorescein angiography disclosed one eye with delayed filling of the retinal arteriole extending into the area of retina corresponding to the visual field defect. Vitrectomy specimens showed no evidence of nerve fiber layer or internal limiting membrane in eight (89%) of nine eyes. CONCLUSIONS: Visual field defects can occur following vitrectomy and gas-fluid exchange for macular hole. The most common visual field defect is dense and wedge-shaped and involves the temporal visual field. Although unclear, the etiology may involve trauma to the peripapillary retinal vasculature or nerve fiber layer during elevation of the posterior hyaloid or during aspiration at the time of air-fluid exchange, followed by compression and occlusion of the retinal peripapillary vessels during gas tamponade.

Aged↗
PubMed1996

Bilateral exudative retinal detachment complicating systemic corticosteroid therapy in the presence of renal failure.

PURPOSE: We describe an elderly patient with chronic renal failure who developed bilateral exudative retinal detachments after initiation of systemic corticosteroid therapy, followed by prompt resolution of the retinal detachments after the corticosteroids were discontinued. METHODS: The medical record was examined and reviewed to document the clinical course, treatment, and therapeutic response. RESULTS: Two weeks after receiving systemic corticosteroids for deteriorating renal failure, the patient had painless bilateral visual loss. Rapid tapering of the corticosteroids concurrent with hemodialysis and subsequent improvement of renal failure resulted in resolution of the exudative retinal detachments. The right eye developed a 360-degree retinal pigment epithelial tear in the macula. CONCLUSIONS: Exudative retinal detachments may complicate systemic corticosteroid therapy.

Aged↗
PubMed1995

Visual field loss after pars plana vitrectomy with air/fluid exchange.

PURPOSE: To report the postoperative finding of a dense, permanent, peripheral temporal visual field defect in the treated eyes of three patients who underwent pars plana vitrectomy with air/fluid exchange. METHODS: The patient's charts were reviewed. RESULTS: Visual field loss after pars plana vitrectomy and air/fluid exchange occurs and may be caused by mechanical trauma to the optic nerve head. CONCLUSION: Great caution is advised when aspirating directly over the optic nerve with any extrusion instrument.

Adult↗
PubMed1991

Quantitative analysis of lens changes after vitrectomy by fluorophotometry.

We measured the amount of autofluorescence in the lens to evaluate quantitatively lens changes after vitrectomy. Thirteen phakic patients, ranging in age from 12 to 75 years, were studied after unilateral vitrectomy, with a follow-up period of more than two years (range, 26 to 55 months). Autofluorescence in the lens was measured at the center along the ocular axis by fluorophotometry. Lens autofluorescence in the eyes that underwent vitrectomy was significantly higher than in the contralateral eyes that were not operated on (P = .0003). The increase of autofluorescence was correlated significantly with the age at time of vitrectomy (P = .0008). There was no correlation between the increase in autofluorescence and the length of postoperative follow-up or the use of air during vitrectomy. Based on these results, we believe that oxidation of lens proteins intraoperatively may be one of the causes of development of nuclear cataract after vitrectomy.

Adolescent↗
PubMed1990

Observations concerning patients with suspected impending macular holes.

Between September 1987 and April 1989, 18 patients (21 eyes) with suspected impending Stage 1 macular holes were referred to the Bascom Palmer Eye Institute. Only one patient had a Stage 1 hole. The others had an aborted stage of macular hole formation (eight eyes), Stage 2 holes (four eyes), a Stage 3 hole (one eye), or other lesions unrelated to hole formation. We believed that most of the apparently incorrect referring diagnoses were the product of incorrect interpretation of the biomicroscopic and fluorescein angiographic findings, and were not caused by changes occurring before our examination.

Fluorescein Angiography↗
PubMed1994

Pneumatic retinopexy for the treatment of giant retinal dialyses.

PURPOSE: We sought to evaluate the effectiveness of pneumatic retinopexy as an alternative technique for retinal detachment repair in patients with retinal dialyses that were greater than three clock hours in size and located in the superior eight clock hours of the retina. METHODS: We reviewed four consecutive cases of retinal detachment secondary to large superior retinal dialyses, extending at least three clock hours, that were successfully treated with pneumatic retinopexy. RESULTS: Follow-up ranged from nine to 28 months. All patients had postoperative corrected visual acuity of 20/40 or better. Within two years, one patient was noted to have a new break in the inferior retina not contiguous with the original dialysis that was successfully repaired with laser photocoagulation. CONCLUSION: Pneumatic retinopexy offers a less invasive alternative to scleral buckling surgery in certain cases of superior retinal dialyses.

Adolescent↗
PubMed1995

Clinicopathologic correlation of surgically removed macular hole opercula.

PURPOSE: To determine the ultrastructural characteristic of the operculum associated with macular holes. METHODS: We developed instrumentation and a technique to capture the operculum observed with macular holes. Two opercula were studied by transmission electron microscopy. RESULTS: The two specimens were attached to a layer of native collagen identified as cortical vitreous and were composed primarily of Mueller cells and fibrous astrocytes without adjacent inner limiting membrane. No distinct retinal neuronal tissue was present. CONCLUSIONS: Our findings indicate that proliferation of fibrous astrocytes and Mueller cells occurs with the formation of a macular hole, that this reparative tissue may be dislodged, and it is the reparative tissue that previously has been interpreted as an operculum.

Aged↗
PubMed1995

Macular epiretinal membrane formation and treated retinal breaks.

PURPOSE: We sought to determine the incidence of macular epiretinal membrane formation in eyes treated for retinal breaks after three different modalities of treatment: laser photocoagulation, cryotherapy, or both. METHODS: We reviewed the charts of 262 consecutive patients with a diagnosis of retinal tears and included 205 patients who had more than six months of follow-up. RESULTS: One hundred ninety-five patients were treated. One hundred seventy of these patients had retinal breaks in one eye and 25 patients had breaks in both eyes, for a total of 220 treated eyes. Cryopexy was applied in 125 eyes, laser retinopexy in 73 eyes, and both modalities in 22 eyes. Macular epiretinal membranes developed in a total of 26 eyes: 12 in the cryopexy group, ten in the laser-treated group, and four in the dual modality group. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation between the different treatment modalities. No statistically significant difference, at a level of P < or = .01, was seen in the rate of epiretinal membrane formation in the presence or absence of vitreous hemorrhage or in the type of precedent retinal break. CONCLUSIONS: After treatment of retinal breaks with laser photocoagulation and cryotherapy, no statistically significant difference in the incidence of macular epiretinal membrane formation was demonstrated.

Adolescent↗
PubMed1995

Tractional elevation of Henle's fiber layer in idiopathic macular holes.

PURPOSE: We sought to clarify the morphologic features of macular hole development. METHODS: Using scanning laser ophthalmoscopy, we examined 47 eyes with macular holes before and after vitrectomy. Cases included three eyes with stage 1B disease (foveal detachment), 14 with stage 2 (break at the fovea), 21 with stage 3 (full-thickness macular hole), and nine with stage 4 (detached operculum), according to Gass's classification. Ten eyes with central serous chorioretinopathy served as controls. RESULTS: Radiating striae of Henle's fibers were seen around the elevated rim of the macular cyst or hole when the intraretinal structures were illuminated by helium-neon laser. Granularity was observed on the macular hole floor. A granular reflex corresponding to the macular break or hole, but no radiating striae were seen by argon blue laser. In 40 eyes in which macular holes were successfully closed by vitrectomy, radiating striae of Henle's fiber layer disappeared, and the normal foveal depression was restored. The ten eyes with central serous chorioretinopathy had a normal foveolar depression and no detectable radiating striae of Henle's fiber layer, despite full-thickness retinal detachment in the macular area. CONCLUSIONS: Tractional elevation of Henle's fiber layer with intraretinal foveolar cyst formation is the initial feature of macular hole development. A macular hole is formed when the anterior cyst wall containing Henle's fiber layer is operculated. Remnants of the photoreceptor cell layer remain on the hole floor in the early stage of macular hole development and subsequently degenerate.

Adult↗
PubMed1995

Spontaneous resolution of foveal detachments and macular breaks.

PURPOSE: To evaluate the mechanism of spontaneous resolution of foveal detachments and idiopathic macular breaks. METHODS: We reviewed the records of 139 consecutive eyes (94 patients) with either a foveal detachment or a macular break in patients who were examined between 1989 and 1992. There were 26 men and 68 women (mean age, 66.9 +/- 6.9 years). They were either unoperated on or observed during the period that preceded surgery. Each patient underwent complete ophthalmic examination in addition to slit-lamp photography of the vitreomacular interface and microperimetry with the scanning laser ophthalmoscope. RESULTS: Eight eyes demonstrated spontaneous resolution. A foveal detachment was noted in five eyes (five patients) and a stage 2 macular break in three eyes (three patients). The mean duration of observation was 33 months (range, one to 144 months). Resolution of the foveal detachments occurred without the development of posterior vitreous detachment. In each eye, the presence of a pseudo-operculum, indicating vitreofoveal separation, was accompanied by flattening of the foveal detachment without detectable posterior vitreous detachment. The three eyes with stage 2 macular break resolved after premature development of a posterior vitreous detachment. CONCLUSIONS: Foveal detachment and macular break resolution seem to result from the release or weakening of vitreous traction on the fovea. Reattachment of the foveal retina preserves fair to good visual acuity. Surgical intervention is contraindicated (1) in eyes in which foveal detachment flattens and develops a pseudo-operculum and (2) when a posterior vitreous detachment develops in an eye with a stage 2 macular break. Careful biomicroscopic vitreous examination and microperimetry with the scanning laser ophthalmoscope are extremely useful methods for adequate examination of these patients.

Aged↗
PubMed1995

Reappraisal of biomicroscopic classification of stages of development of a macular hole.

PURPOSE: To update the biomicroscopic classification and anatomic interpretations of the stages of development of age-related macular hole and provide explanations for the remarkable recovery of visual acuity that occurs in some patients after vitreous surgery. METHODS: Recent biomicroscopic observations of various stages of macular holes are used to postulate new anatomic explanations for these stages. RESULTS: Biomicroscopic observations include the following: (1) the change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) during the early stages of foveal detachment is unique to patients at risk of macular hole; (2) the prehole opacity with a small stage 2 hole may be larger than the hole diameter; and (3) the opacity resembling an operculum that accompanies macular holes is indistinguishable from a pseudo-operculum found in otherwise normal fellow eyes. CONCLUSIONS: The change from a yellow spot (stage 1-A) to a yellow ring (stage 1-B) is caused primarily by centrifugal displacement of retinal receptors after a dehiscence at the umbo. The hole may be hidden by semiopaque contracted prefoveolar vitreous cortex bridging the yellow ring (stage 1-B occult hole). Stage 1-B occult holes become manifest (stage 2 holes) either after early separation of the contracted prefoveolar vitreous cortex from the retina surrounding a small hole or as an eccentric can-opener-like tear in the contracted prefoveolar vitreous cortex, at the edge of larger stage 2 holes. Most prehole opacities probably contain no retinal receptors (pseudo-opercula). Surgical reattachment of the retina surrounding the hole and centripetal movement of the foveolar retina induced by gliosis may restore foveal anatomy and function to near normal.

Aging↗
PubMed1995

Accidental Nd:YAG laser injuries to the macula.

PURPOSE: To study the clinical course of accidental, single-focus Nd:YAG laser injuries to the macula. METHODS: We reviewed the clinical course of five eyes (four patients) that sustained macular injuries from a Nd:YAG laser. All patients were examined within 24 hours of injury and were observed without surgical intervention for a mean of 20 months (range, 12 to 32 months). RESULTS: A single full-thickness foveal or parafoveal retinal hole was apparent in all eyes either on initial examination or within two weeks of injury. All macular holes were within 650 microns of the foveal center. The mean final visual acuity was 20/60 (range, 20/25 to 20/400) and was related to the distance between the macular hole and the foveal center. None of the eyes developed either subretinal neovascularization or clinically significant epiretinal membrane formation during the study period. CONCLUSIONS: Despite initial poor visual acuity in patients who had a full-thickness foveal or parafoveal retinal hole, visual acuity improved without treatment when the site of the laser injury was located outside the foveal center.

Adult↗