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At least 865 records · Page 48Linked to original sources
PubMed2002

Phacovitrectomy with internal limiting membrane peeling for idiopathic macular hole.

BACKGROUND: Progressive nuclear sclerosis is a known complication of macular hole surgery that hinders patients' recovery to their best visual acuity postoperatively. We report the visual outcome, complications and efficacy of combined phacoemulsification, intraocular lens (IOL) insertion and vitrectomy with internal limiting membrane (ILM) peeling for patients with cataract undergoing macular hole surgery. METHODS: We reviewed the records of 32 consecutive patients (36 eyes) who underwent phacoemulsification with insertion of a polymethylmethacrylate lens into the capsular bag and pars plana vitrectomy with ILM peeling in one session for repair of idiopathic macular hole. Patients were assessed between February 1998 and August 2001. RESULTS: The mean age of the patients was 70 (range 52 to 83) years, and 25 (78%) were women. The median duration of the holes before surgery was 8.3 months; in 19 eyes (53%) the duration was 6 months or less. Twenty eyes (56%) had stage 3 holes. The preoperative vision was 20/200 or worse in 29 eyes (80%). The mean grade of nuclear sclerosis was 2.4. The average length of follow-up after surgery was 11 (range 1.5 to 37) months. Primary hole closure was achieved in 28 eyes (78%). In five of the remaining eight cases the patient consented to a second procedure, which was successful in four cases, for a final closure rate of 89%. Postoperatively, the visual acuity improved by 2 lines or more in 22 eyes (61%). Of the 32 eyes with final closure, 11 (34%) attained a visual acuity of 20/40 or better, and 25 (78%) had an acuity of 20/100 or better. The most common complication was posterior capsular opacification (27 eyes [75%]), an expected complication when perfluoropropane or other gases are used for tamponade. INTERPRETATION: The results are comparable to those with standard macular hole surgery. Combined surgery is reliable and safe; the benefits support its use as a routine procedure for patients with cataract undergoing macular hole repair.

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PubMed2004

Internal limiting membrane: ultrastructural relationships, with clinical implications for macular hole healing.

BACKGROUND: Recent data on macular hole formation have changed our understanding of the mechanisms involved. However, the mechanisms of macular hole closure, despite the introduction of internal limiting membrane (ILM) removal, are not fully understood. We reviewed the charts of patients who underwent surgery for macular hole with and without intentional removal of ILM and reviewed the basic science literature on the components and relationships of the ILM-glial cell interface to help interpret our surgical data. METHODS: We reviewed the records of 205 eyes with a clinical diagnosis of macular hole at a university centre in Montreal between 1998 and 2002. Of these, 117 eyes of 108 patients were included. Vitrectomy with intentional ILM removal was done under indocyanine green (ICG) staining. Macular hole stage and rates of hole closure, failure and reopening were recorded, comparing the eyes with intentional ILM peeling versus no ILM peeling. Anatomic success was defined as a flat/closed configuration. A basic science literature review was done through the PubMed search engine with the key words "internal limiting membrane," "internal limiting lamina," "macular hole," "retinal glial cells" and "retinal Müller cells." RESULTS: Eighty-four eyes had ICG-guided ILM removal (26 stage 2 macular holes, 45 stage 3 holes and 13 stage 4 holes), and 33 eyes had no ILM removal (10 stage 2 holes and 23 stage 3 holes). Of the 117 eyes 110 (94.0%) were successfully closed. Four (3.6%) of the closed holes reopened (none had ILM peeling), and 7 (6.0%) of the 117 eyes had primary failure. Ten of the 11 eyes that had primary failure or hole reopening were reoperated, and 8 were successfully closed after the second procedure. One patient refused reoperation. Including second procedures, the final anatomic closure rate was 97.4% (114/117). INTERPRETATION: Intentional ILM peeling is not mandatory for all macular holes to close but does play a role in preventing reopening. Removal of ILM increases the rate of flat/closed hole configuration on reoperation without the need for biologic adjuvants. Review of the basic science evidence helped clarify the possible role of ILM removal.

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PubMed2006

Identification of visually significant operculum without macular hole by optical coherence tomography.

CASE REPORT: We report a case that illustrates the effectiveness of optical coherence tomography (OCT) in identifying visually significant vitreoretinal interface opacities in the absence of a macular hole. A patient presented with a scotoma in the right eye. Fundoscopic examination revealed a small lesion in close proximity to the foveal avascular zone. OCT of the right eye revealed a small operculum in the vitreous anterior to the fovea without evidence of a macular hole. COMMENTS: To our knowledge, ours is the first reported case of the use of OCT to identify the presence of a visually significant operculum without an associated macular hole.

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PubMed2003

Elastic cord-induced ocular injuries.

PURPOSE: To evaluate the incidence and severity of ocular injuries caused by elastic cords. PATIENTS AND METHOD: A retrospective review of patients' records from the Emergency Department was conducted to identify cases of elastic cord-induced ocular injuries. Over a 67-month period starting in October 1996, 28 patients (24 males and 4 females, mean age 38.6 years) with elastic cord-associated ocular trauma were identified. Patient demographics, mechanism of injury, presenting and final visual acuity, ocular injuries, medical and surgical intervention and length of follow-up were noted. RESULTS: The most common anterior and posterior segment injuries were hyphaema/microhyphaema (71.4%) and commotio retinae (60.7%), respectively. The most severe injuries sustained were corneal or scleral lacerations (7.1%), formation of retinal tears (10.7%) or retinal detachment (3.6%), lens subluxation (7.1%) and traumatic cataract (7.1%). Eight patients (28.6%) were admitted for surgical or medical treatment. Mean visual acuity was 20/40 on presentation and 20/25 at the end of the follow-up period. CONCLUSIONS: Elastic cords may cause a wide range of ocular traumas of varying severity. Appropriate design modifications that would prevent the spontaneous release of their hooks are likely to make their use significantly safer.

Adult↗
PubMedDate not supplied

Comparison of scleral buckling and vitrectomy for retinal detachment resulting from flap tears in superior quadrants.

PURPOSE: To compare the surgical results of vitrectomy and scleral buckling for uncomplicated superior retinal detachment caused by flap tears. METHODS: Included in the study were 225 patients (225 phakic eyes) undergoing primary surgery by three surgeons between January 1990 and December 1996 for superior retinal detachment caused by flap tears (138 eyes by scleral buckling, 87 eyes by vitrectomy); all patients had been followed up for longer than 6 months after surgery. The choice of one of the two procedures was based on each surgeon's preference. The surgical outcome and the rate of complications were retrospectively compared between the two groups of eyes. RESULTS: Initial and final anatomical success rate were 92% and 100% after each procedure. Retinal redetachment after the initial procedure was due to new retinal breaks in 5 eyes, reopening of original breaks in 2 eyes of vitrectomy cases, and due to malpositioned buckle in 11 eyes of scleral buckling cases. Proliferative vitreoretinopathy occurred in 3 eyes of vitrectomy cases. CONCLUSION: Primary vitrectomy was as successful as scleral buckling for treating superior rhegmatogenous retinal detachment. Even though the high incidence of postoperative cataract formation was the major drawback, vitrectomy had some advantages over scleral buckling.

Adult↗
PubMedDate not supplied

Scleral infolding combined with vitrectomy and gas tamponade for retinal detachment with macular holes in highly myopic eyes.

PURPOSE: To describe the effectiveness of a surgical procedure, scleral infolding combined with vitrectomy and gas tamponade, for retinal detachment caused by macular holes in highly myopic eyes. METHODS: In a pilot study, scleral infolding was performed in 5 patients with macular holes, who were selected from 10 consecutive highly myopic patients with retinal detachment caused by macular holes (8 patients) or extramacular posterior-pole holes (2 patients), treated during 1 year at Okayama University Hospital. The patients were all women, 48-77 years of age (mean = 63.4 years), who had been followed-up for 1-2 years. Selection criteria for scleral infolding were either second surgeries for reopening of macular holes (2 patients) or residual retinal detachment around macular holes after complete fluid-air exchange with drainage of subretinal fluid at the initial surgery (3 patients). Following vitrectomy and complete epiretinal membrane removal in the posterior pole, the sclera was shortened by infolding on the temporal side. Three mattress sutures with 5-0 Dacron in each quadrant, 6 sutures in total, were placed at a 7-mm anteroposterior interval with posterior sutures located as deep as possible, near vortex veins. Fluid-gas exchange was then done, with or without endophotocoagulation applied around macular holes. RESULTS: After scleral infolding, macular holes were closed, and the retina was totally attached in all 5 patients. The final visual acuity ranged from 20/2000 to 20/70. CONCLUSION: Scleral infolding is a simple and effective procedure for treating retinal detachment with macular holes in highly myopic eyes and could be used as an optional procedure of reoperation for a failed initial vitrectomy.

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PubMedDate not supplied

Shortening the duration of prone positioning after macular hole surgery- comparison between 1-week and 1-day prone positioning.

PURPOSE: To shorten the duration of prone positioning after macular hole surgery from 1 week to 1 day, and to evaluate preoperative factors and the initial hole closure rate. METHODS: The subjects were 33 patients (34 eyes) who underwent macular hole surgery between April 1998 and August 1999, and maintained the prone position for 1 week (1-week group) and 21 patients (21 eyes) who underwent this operation between September 1999 and March 2000, and maintained the prone position for only 1 day (1-day group). The criteria for macular hole surgery were no more than 6 months since symptom development and no flattening of the fluid cuff. Eyes treated by removal of the retinal pigment epithelium (RPE) or internal limiting membrane (ILM) were excluded. In all phakic eyes, cataract surgery was combined with macular hole surgery. In the 1-day group, the patients maintained the prone position for 1 day and were instructed to avoid only the supine position for the subsequent 1 week. RESULTS: Preoperative factors possibly affecting the hole closure rate did not differ significantly between the two groups. Initial hole closure rates were similar in the 1-week (91.2%) and 1-day (90.5%) groups. CONCLUSION: In eyes without symptoms of long duration, the duration of prone positioning after macular hole surgery may be shortened to 1 day even without using special techniques, such as removal of the RPE or ILM, in combination with macular hole surgery.

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PubMedDate not supplied

Monocyte chemotactic protein-1 levels in the vitreous of patients with proliferative vitreoretinopathy.

PURPOSE: To assess the potential role of monocyte chemotactic protein-1 (MCP-1) in the pathogenesis of proliferative vitreoretinopathy (PVR) and to investigate its possible interaction with the macrophage migration inhibitory factor (MIF). METHODS: We assayed MCP-1 and MIF levels in the vitreous samples of 85 consecutive patients with PVR (29 eyes), rhegmatogenous retinal detachment (RRD; 22 eyes), and macular hole or idiopathic epimacular membrane (controls; 34 eyes), by enzyme-linked immunosorbent assay. RESULTS: Vitreous levels of MCP-1 were 1760.7 +/- 471.3 pg/mL (mean +/- SD) in PVR patients, 1200.4 +/- 579.8 pg/mL in RRD patients, and 436.3 +/- 286.1 pg/mL in the controls. Vitreous MCP-1 levels in PVR patients were significantly higher than those in RRD patients and in the controls (P <.0001, respectively). MCP-1 levels in grade C of PVR (1883.7 +/- 479.5 pg/mL) were significantly greater than those in grade D (1437.8 +/- 258.8 pg/mL) (P =.0112). Vitreous concentrations of MCP-1 had no correlation with those of MIF. CONCLUSIONS: The results indicate the possibility that MCP-1 may have a role mainly in the early stage of PVR and that the role of MCP-1 in PVR may differ from that of MIF.

Adult↗
PubMedDate not supplied

An automated measuring system for fundus perimetry.

PURPOSE: In order to automate fundus perimetry, which is usually laborious because of the many manual operations and the frequent eye movements, we developed a new fundus perimeter with an automated measuring system using computer technology. METHODS: This fundus perimeter consists of an infrared fundus camera, a fundus-pursuit unit, and a target-display unit. Both units are personal computers operating on Windows. After presetting the measuring points on the fundus, perimetry is automatically performed. The fundus-pursuit unit recognizes and pursues the fundus reference region while calculating its coordinates in real time during perimetry. The target-display unit corrects the stimulus coordinates with data from the fundus-pursuit unit and even if eye movement occurs, automatically displays the stimulus targets at the correct retinal point that had been preset. RESULTS: Fundus perimetry can be automatically and precisely performed with this automated measuring system. It shortens the duration of the examination and frees the operator from the lengthy and laborious manual operations during perimetry. CONCLUSIONS: This automated measuring system will make fundus perimetry easier for the operator, as well as more popular for clinical use.

Adult↗
PubMedDate not supplied

Retinal detachment in the mentally retarded.

PURPOSE: To report the clinical features and surgical outcomes of retinal detachment in mentally retarded patients. METHODS: Retrospective review of records of mentally retarded patients who had retinal reattachment surgery at the authors' institutions between February 1994 and February 2000. There were 8 patients with 13 surgically treated eyes. Demographic and clinical data were abstracted from the patients' medical records. RESULTS: The retina of 12/13 (92%) eyes remained reattached after a follow-up ranging from 9 to 78 months. In 6 eyes of the 4 patients whose visual acuity (VA) could be determined, VA improved in 5 eyes of 3 patients. In the remaining 4 patients whose VA could not be determined, improved behavioral patterns suggesting a successful surgical outcome were observed in 3 patients with bilateral retinal detachment, although in one of these patients only unilateral retinal reattachment was achieved. The findings in the eyes in this study agree with the findings in reports on patients with traumatic retinal detachment. CONCLUSIONS: The retinal reattachment rate is fair in the mentally retarded compared with the rate in other segments of the population. Ophthalmological examinations should be provided regularly for mentally retarded persons to keep open the possibility for early sight-improving surgery.

Adult↗
PubMedDate not supplied

Late-onset retinal detachment associated with regressed retinopathy of prematurity.

PURPOSE: To study the characteristics of late-onset retinal detachments in patients with regressed retinopathy of prematurity (ROP) and the condition of their fellow eyes. METHODS: We carried out a retrospective review of 29 patients (38 eyes) who had been treated at two institutions, one in the US and the other in Japan, between 1986 and 1997. The age at the time of treatment ranged from 6 to 51 years (mean=23.1). Five of the 38 eyes with tractional detachment were treated with either open-sky vitrectomy, closed vitrectomy, or scleral buckling; 27 of the 38 eyes with rhegmatogenous retinal detachment underwent scleral buckling or closed vitrectomy or both. The remaining 6 of the 38 eyes had subclinical rhegmatogenous detachment and were treated with photocoagulation or cryopexy, or followed without treatment. The most characteristic retinal breaks were multiple holes with a prevalence of equator and posterior types. RESULTS: Overall, anatomical reattachment was accomplished in 27/32 eyes (84%) that underwent surgery. Two thirds of the patients who underwent vitrectomy either initially or at a later time had poor postoperative visual acuity. More than half of the fellow eyes had retinal detachment and others had various characteristic fundus changes of regressed ROP. CONCLUSIONS: Long-term, probably life-long follow-up of high-risk patients is necessary so that diagnosis and treatment can be instituted at an early stage of retinal detachment.

Adolescent↗
PubMedDate not supplied

Macular hole surgery with internal limiting membrane removal, air tamponade, and 1-day prone positioning.

PURPOSE: The internal limiting membrane (ILM) removal has been combined with macular hole surgery in recent years, which facilitates shortening of the prone-positioning period after surgery. In this study, surgical outcome of macular hole surgery with ILM removal, air tamponade, and 1-day prone positioning was evaluated. METHODS: In a prospective study, 23 patients (23 eyes) underwent vitrectomy for idiopathic macular holes. Macular holes <0.4 disc diameter and without apparent atrophy of retinal pigment epithelium (RPE) were selected for study. After vitrectomy combined with the ILM removal and fluid-air exchange, patients were instructed to keep prone positioning for only 1 day. The initial hole-closure rate, complications and visual outcome were evaluated. RESULTS: Anatomical closure of macular holes was achieved in 21 (91.3%) of the 23 eyes by one operation. The postoperative visual acuity of 0.5 or better and 1.0 were achieved in 19 eyes (82.6%) and 6 eyes (26.1%), respectively. Postoperatively, intraocular pressure was elevated temporarily in 2 eyes (8.7%); retinal break and posterior synechia occurred in 1 eye (4.3%) each. These complications were treated successfully and did not threaten visual acuity. CONCLUSION: Air tamponade with ILM removal followed by 1-day prone positioning was considered to be a useful method for macular holes with small diameter and without apparent atrophy of RPE. This method facilitated early recovery to a normal social life.

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PubMedDate not supplied

Surgical management of retinal detachment secondary to acute retinal necrosis: clinical features, surgical techniques, and long-term results.

PURPOSE: To describe the clinical features of complicated retinal detachment secondary to acute retinal necrosis (ARN) and to present the long-term results of vitreous surgery in these cases. METHODS: A retrospective study was conducted on 16 immunocompetent patients (18 eyes). The average follow-up period was 60 months. RESULTS: Proliferative vitreoretinopathy (PVR) grade C, with the predominance of anterior PVR, and characteristic changes in the vitreous base area were present in all cases before surgery. All eyes underwent vitrectomy, membrane peeling, endolaser photocoagulation, and intraocular tamponade without scleral buckling. Additional procedures were performed in 13 eyes. Retinal reattachment was achieved in the 18 eyes (100%) in the short term. Variable degrees of reproliferation occurred in all cases after surgery. Other delayed complications included ocular hypotony, macular pucker, peripheral retinal neovascularization, and severe preretinal fibrosis. Improvement of visual acuity occurred in 13 eyes (72.2%). Eleven eyes (61.1%) achieved final ambulatory visual acuity of 5/200 or better. CONCLUSIONS: Rhegmatogenous retinal detachment secondary to ARN has characteristic clinical features. Severe proliferative vitreoretinopathy with the predominance of anterior PVR develops rapidly. Reproliferation is the most important late postvitrectomy complication necessitating multiple surgical procedures in these cases. The visual results remain unfavorable due to the destructive nature of ARN.

Adult↗
PubMedDate not supplied

Treatment of full-thickness macular holes with autologous serum.

A total of 28 patients (29 eyes) with stage 2-4 idiopathic full-thickness macular holes were treated with the use of autologous serum. Autologous serum (20-30 microL) was placed over each macular hole followed by injection of 16% perfluoropropane gas. Postoperatively, 28 eyes (97%) had flattening of the macular hole, and the hole could not be detected in 27 eyes (93%). Twenty-two eyes (76%) showed visual acuity improvement by at least two lines or more. Preoperative factors such as good visual acuity, earlier stage, and younger age were correlated with postoperative good visual acuity. These results suggest that autologous serum is beneficial in the treatment of full-thickness macular holes.

Adult↗
PubMedDate not supplied

Indocyanine green angiographic findings of lacquer cracks in pathologic myopia.

Lacquer cracks are thought to represent healed mechanical breaks in the retinal pigment epithelium, Bruch's membrane, and choriocapillaris complex. In this study, we analyzed the indocyanine green (ICG) angiographic features of lacquer cracks and compared them with findings using fluorescein angiography. Complete ophthalmologic examinations, fluorescein angiography, and ICG angiography were performed in 29 consecutive patients (37 eyes) with lacquer cracks. Fluorescein angiograms of the cracks revealed linear hyperfluorescence in all 37 eyes. Using ICG angiography, we observed linear hypofluorescence in all 37 eyes. In 15 of 37 eyes, the length of the hypofluorescent lesion detected by ICG angiography was longer than the hyperfluorescent lesion observed by fluorescein angiography. In 17 of 37 eyes, more lacquer cracks were observed by ICG angiography than by fluorescein angiography. These findings indicate that ICG angiography can detect the development of the lesion more precisely, and may provide useful information for diagnosing pathologic myopia.

Adolescent↗
PubMedDate not supplied

Risk of retinal detachment in patients with lattice degeneration.

To determine the risk of retinal detachment in patients with lattice degeneration of the retina, we statistically analyzed the incidence of retinal detachment in these patients. The data of hospital patients with retinal detachment associated with lattice degeneration in Kumamoto Prefecture, Japan, in 1990 were collected. The prevalence of lattice degeneration in Kumamoto was reported to be 9.5% in 1980. Based on population data from the 1990 census, the cumulative incidence of retinal detachment associated with lattice degeneration was calculated in this study. Among 1,840,000 residents in Kumamoto, there were 110 patients with retinal detachment associated with lattice degeneration; 72 with detachment resulting from tractional tears (tears), and 38 with detachment from atrophic holes. The cumulative incidence of retinal detachment from atrophic holes was 1.5% at the age of 40 years; from tears it was 3.6% at the age of 80 years. The cumulative incidence of detachment from both atrophic holes and tears was 5.3% at the age of 80 years. The results of this study are useful for clarifying the natural course of lattice degeneration.

Adolescent↗