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PubMed2003

Outcome results in macular hole surgery: an evaluation of internal limiting membrane peeling with and without indocyanine green.

PURPOSE: To evaluate the anatomic closure rate and visual outcome in patients undergoing pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) enhancement. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: One hundred ninety-three consecutive patients (204 eyes) seen at the Barnes Retina Institute with the clinical diagnosis of macular hole who underwent PPV between January 1998 and December 2000. INTERVENTION: A consecutive series of 97 patients undergoing PPV with or without unilateral epiretinal membrane removal without ILM peeling (group 1), 44 patients with PPV and ILM peeling without ICG (group 2), and 35 patients with ICG-assisted ILM peeling (group 3). RESULTS: Overall, 86.4% of the holes closed with one operation, with 75 of 97 (77.3%) eyes in group 1, 43 of 44 (97.7%) eyes in group 2, and 34 of 35 (97.1%) eyes in group 3 (chi(2)= 10.51, P = 0.007). Of the eyes that did not close, 18 patients in group 1 underwent repeat surgery, with 90 of 97 (92.8%) eyes ultimately achieving closure. Visual acuity after surgery was 20/50 or better in 55 of 97 (56.7%) patients, 31 of 44 (70.4%) patients, and 18 of 35 (51.4%) patients in groups 1, 2, and 3, respectively (chi(2) = 3.43, P = 0.18) and increased by 2 or more lines from their preoperative status in 63 of 97 (64.9%) patients, 34 of 44 (77.3%) patients, and 25 of 35 (71.4%) patients, respectively (chi(2)= 2.25, P = 0.32). Multivariate logistic regression demonstrated that use of ILM peeling during vitrectomy increases the chances of developing 20/50 vision or better (odds ratio [OR], 2.4; 95% confidence interval, 1.06-5.45; P = 0.04). No eyes received concurrent cataract extraction with macular hole surgery, but 75 of 166 (45.2%) required cataract extraction postoperatively. Complications included 20 retinal tears, 4 retinal detachments, and 34 patients with postoperative elevations in intraocular pressure (IOP; defined as IOP greater than 30 mmHg). CONCLUSIONS: Although this study is limited by the shorter follow-up in patients undergoing ILM peeling with or without ICG relative to the control group, our experience indicates that the use of ILM peeling is associated with a statistically significant improvement in the rate of primary macular hole closure with a single operation.

Adult↗
PubMed1994

Late re-opening of macular holes after initially successful treatment with vitreous surgery.

BACKGROUND: In more than 50% of eyes with idiopathic, full-thickness macular holes, vitrectomy results in clinical closure of the hole and improvement in visual acuity. Other than cataract formation, late complications of the procedure have not been reported. METHODS: Over a 4-year period, 167 eyes underwent successful vitreous surgery for idiopathic macular holes documented by clinical closure of the hole and an improvement in visual acuity of at least two Snellen lines. The authors retrospectively studied eight of these eyes. All initially had successful surgery; however, they subsequently had spontaneous late re-opening of the macular hole with acute diminution in vision. RESULTS: Late re-opening developed in these eyes between 2 and 22 months after initial surgery. The mean time for re-opening was 12.5 months. Three of eight eyes underwent a second vitrectomy, which was successful in improving visual acuity in two eyes. Another patient manifested the growth of an epiretinal membrane that apparently sealed the re-opened macular hole and improved vision. CONCLUSION: Late re-opening can complicate initially successful macular hole surgery and may occur in at least 4.8% (8 of 167) of initially successful operations. Re-opening has been documented as late as 22 months after initial surgery. Repeat vitrectomy with gas injection may result in reclosure of the hole and improvement in vision.

Aged↗
PubMed1983

Pars plana vitrectomy for complicated retinal detachments.

The authors used vitreous surgery to treat 514 cases with retinal detachment. Three hundred sixty-five (71%) of the 514 eyes had retinal detachment associated with proliferative diabetic retinopathy. A successful anatomic result was achieved in 245 (67%) of these 365 cases and 227 (62%) obtained final vision of 5/200 or better. Five factors were associated with a successful visual result in diabetic eyes: (1) preoperative visual acuity of 5/200 or better, (2) retaining the crystalline lens, (3) an attached macula preoperatively, (4) preoperative retinal detachment limited to the posterior pole or less than one quarter the fundus area, and (5) absence of iatrogenic retinal breaks. Of those cases without diabetic retinopathy, a successful anatomic result was achieved in (1) 27 (84%) of 32 eyes with nondiabetic traction detachment, (2) 13 (65%) of 20 giant retinal tears, (3) 21 (50%) of 42 eyes with opaque media complicating retinal detachment, (4) 9 (90%) of 10 eyes with posterior retinal breaks, (5) 29 (42%) of 69 eyes with advanced proliferative vitreoretinopathy (PVR), and (6) 29 (64%) of 45 eyes with retinal detachment complicating prior ocular trauma.

Adolescent↗
PubMed1983

Biomicroscopic study of the vitreous in macular breaks.

The vitreous in 74 eyes with macular breaks was studied using the El Bayadi-Kajiura preset lens mounted on a slit lamp. Fifteen of the eyes had macular breaks secondary to various causes, and 59 eyes had idiopathic senile macular breaks. Vitreous traction, indicated by the presence of opercula or visible vitreous strands, was present in 29 (49%) of the idiopathic cases. In 17 of 31 eyes without posterior vitreous detachment (PVD), an operculum was seen. In these eyes, intravitreous traction was suspected to be the cause of macular breaks. Opercula were seen attached to the posterior hyaloid membrane in six of the nine eyes with partial PVD. An operculum corresponding to the macular break was observed on the posterior hyaloid membrane in only five of 19 eyes with complete PVD. Of the 15 eyes with macular breaks secondary to various causes, complete PVD was seen in 10 eyes, one of which had an operculum. One eye had no PVD, and four eyes had partial PVD. Opercula were detected in two of the latter eyes. In one eye of the senile group and one eye of the secondary group, partial PVD caused traction at the edges of the macular break, resulting in retinal detachment.

Adult↗
PubMed1983

Vitreous floaters.

The vitreous changes in 148 eyes with sudden onset of floaters were evaluated biomicroscopically and documented photographically using an El Bayadi-Kajiura aspherical preset lens mounted on a photo slit lamp. Posterior vitreous detachment (PVD) was found in 83% of the eyes. In those eyes, the primary causes of floaters were prepapillary glial tissue on the posterior hyaloid membrane and minimal vitreous hemorrhage. In eyes with no PVD, intravitreous fiber-like opacities corresponding to the patient's symptoms were present in the posterior vitreous cavity near the retina. These opacities were found on the plicated membranes of Cloquet's canal, or were associated with liquefaction of the gel. The symptoms of patients 50 years of age or older were related to the acute onset of PVD in 95% of the cases. The complaint of multiple small floaters was frequently associated with vitreous hemorrhage and retinal breaks.

Adult↗
PubMed1984

Severe proliferative vitreoretinopathy and retinal detachment. II. Surgical results with scleral buckling.

Prior to the era of vitrectomy, scleral buckling was used to treat 521 eyes with total retinal detachment and proliferative vitreoretinopathy (PVR) of various degrees of severity. The retina was reattached for at least six months in 46.9% of eyes; the anatomic success rate decreased with increasing severity of PVR. Within each grade of PVR, the reattachment rate was higher for eyes with smaller breaks than for eyes with larger breaks, and the prognosis was not worse when smaller breaks were found than when no breaks were found. The cumulative success rate rose with increasing number of reoperations. None of the anatomically successful cases had a final visual acuity of no light perception; 82.9% of them achieved a visual acuity of counting fingers or better. The prognosis for visual improvement after successful scleral buckling was unrelated to the preoperative severity of PVR. Severe intraoperative complications occurred in 5.0% of the eyes, all of which resulted in failure.

Eye Diseases↗
PubMed1984

Severe proliferative vitreoretinopathy and retinal detachment. I. Initial clinical findings.

We studied 716 eyes of 697 patients with retinal detachment associated with the more advanced stages of proliferative vitreoretinopathy (PVR). The factors that influenced the severity of PVR and our criteria for surgical treatment were analyzed using statistical methods. The more severe cases of PVR showed a higher prevalence of cases with (1) retinal detachment exceeding 12 months' duration, (2) no retinal breaks observed, (3) the largest retinal break of a size equal to or exceeding one clock hour, and (4) poor initial visual acuity. Compared with the unoperated group, the eyes on which we subsequently operated were characterized by a greater prevalence of (1) patients with bilateral retinal detachment complicated by PVR, (2) cases with relatively recent onset of retinal detachment, (3) phakic eyes, (4) eyes without vitreous hemorrhage, (5) eyes with one or more visible retinal breaks and with smaller breaks, (6) relatively better initial visual acuity, and (7) less severe degrees of PVR.

Eye Diseases↗
PubMed1984

Choroidal neovascularization can digest Bruch's membrane. A prior break is not essential.

A novel form of retinal phototoxicity has facilitated investigation of the effect of retinal pigment epithelial (RPE) damage on the choriocapillaris of the rat. In response to isolated RPE injury, the choriocapillaris buds, digests the endothelial basement membrane, and projects pseudopodia that erode Bruch's membrane. The development of subretinal neovascularization in one of the rats demonstrates that breaks in Bruch's membrane may result from this lytic process and that neither degeneration of Bruch's membrane nor a preexisting break is essential for subretinal neovascularization to occur.

Animals↗
PubMed1984

Vitrectomy for macular pucker.

Vitreous surgery was used to treat 130 consecutive cases with epiretinal membranes causing macular pucker. The membrane: (1) occurred after otherwise successful retinal reattachment surgery in 78 eyes (60%), (2) was idiopathic in 28 eyes (22%), (3) was associated with other ocular disorders in 20 eyes (15%), and (4) in four eyes may have been developmental. The abnormal tissue was successfully removed in 128 of 130 eyes, and vision improved at least two lines on the Snellen chart in 108 eyes (83%). Postoperative visual acuity was 20/20 in five eyes (4%), 20/25 to 20/40 in 41 eyes (31.5%), 20/50 to 20/100 in 64 eyes (49%), 20/200 in 15 eyes (11.5%), and 20/400 in five eyes (4%). Complications included one case of sterile endophthalmitis and one case of infective endophthalmitis (Staphylococcus epidermidis). Peripheral retinal tears occurred in six eyes (5%). No posterior retinal breaks occurred in this series. Later retinal detachment occurred in eight eyes (6%) requiring further retinal surgery. Progressive postoperative nuclear sclerotic lens changes occurred in 31 (34%) of 90 phakic eyes. Sizable amounts of epiretinal tissue recurred postoperatively in four eyes (3%).

Adolescent↗
PubMed1985

Removal of epimacular membranes.

Vitreous surgery was used to remove epiretinal macular membranes in 328 cases, 184 (56%) of which had membranes that were considered idiopathic and 144 (44%) which were due to other causes. The 12- to 92-month follow-up showed that visual acuity improved two lines or more in 243 (74%) of the eyes, 79 (24%) were unchanged and 6 (2%) became worse. Recurrence of membranes was seen in 24 (7.3%) eyes and 27 (8%) eyes developed complications. In the idiopathic cases visual results were significantly better and complications fewer. Rapidly progressive nuclear sclerosis was noted in 23 (12.5%) eyes. The degree of cystoid edema had no relationship to the final visual result. Pseudoholes which were present in 14 (8%) of the idiopathic cases either became smaller or disappeared following successful surgery with an average increase in acuity of five lines.

Adolescent↗
PubMed1985

Retinal complications following YAG laser capsulotomy.

Eighteen patients (19 eyes) developed retinal complications following YAG laser capsulotomy. Complications included one retinal flap tear, two macular holes, six eyes with cystoid macular edema, and ten retinal detachments. The retinal complications resulted from opening the capsule and were not a specific complication of the YAG laser.

Aged↗
PubMed1986

Management of rhegmatogenous retinal detachment with macula detached. Steroids, choroidal detachment, and acuity.

One hundred thirty-four consecutive eyes with rhegmatogenous retinal detachment involving the macula were evaluated with reference to the effectiveness of systemic steroids in preventing choroidal detachment after scleral buckling surgery and in facilitating both anatomic and functional success. The occurrence of postoperative choroidal detachment was inversely related to the routine intravenous administration of steroids under antibiotic coverage beginning in the recovery room (P = 0.014). Eyes so treated were free of both clinically significant infection and extrusion. The infrequent but worrisome complication of angle closure sufficient to require choroidal tap did not occur among treated eyes. Routine steroid use may have been associated with increased preservation of acuity at the level of 20/200 or better (P = 0.043).

Choroid↗
PubMed1986

Treatment of giant retinal tears combined with proliferative vitreoretinopathy.

Giant retinal tears with foreshortened and stiffened retina secondary to advanced proliferative vitreoretinopathy (PVR) pose a complex problem for the retinal surgeon. In the past, tractional forces on the retina in these eyes have been counteracted temporarily by retinal sutures, retinal incarceration, or retinal tacks, often combined with fluid-gas exchange in the prone position. These techniques are complex and add multiple additional maneuvers to the surgical procedure. The current report describes the use of a simple, stepwise fluid-gas exchange technique with the patient in the supine position in which the expanding gas bubble traps the edge of the stiffened and foreshortened retina against the pigment epithelium. Long-term counteraction of tractional forces was achieved by the use of intraocular silicone oil. Using this technique, 18 of 19 eyes with giant retinal tears and PVR Grade D1 to D3 could be successfully reattached. Four of these successfully reattached eyes had 360 degrees giant retinal tears. The most common and significant complication in our series was the recurrence of periretinal membranes. All 18 eyes that were initially reattached suffered the recurrence of significant periretinal membranes. Four of those 18 eyes developed recurrent interior traction detachments on to four months postoperatively.

Adolescent↗