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At least 991 records · Page 55Linked to original sources
PubMed1993

Enhanced visualization of vitreoretinal interface by laser biomicroscopy.

BACKGROUND: The use of slit-lamp biomicroscopy provides valuable information for the diagnosis and management of vitreoretinal disorders. However, intense backscatter from the fundus often precludes the visualization of fine structures in the vitreoretinal interface. METHODS: Laser biomicroscopy is a new method designed to improve the visualization of fine vitreoretinal structures at the macula. This method was applied to eyes suspected of traction maculopathies. With this method, the contrast and the lateral separation between the vitreal and retinal images are optimized while preserving information on the location of the slit on the fundus. RESULTS: The results indicated that fine structures in the vitreoretinal interface, which were difficult to observe with conventional slit-lamp biomicroscopy, could be clearly visualized. CONCLUSION: Laser biomicroscopy may be a useful tool in the diagnosis and management of diseases with vitreoretinal abnormalities.

Aged↗
PubMed1993

The effect of pars plana vitrectomy and transforming growth factor-beta 2 without epiretinal membrane peeling on full-thickness macular holes.

PURPOSE: Surgical techniques for the treatment of macular holes generally include removal of the overlying cortical vitreous and/or epiretinal membranes. The authors demonstrate that by using vitrectomy, posterior hyaloid removal, fluid-gas exchange, and transforming growth factor-beta 2 (TGF-beta 2), a growth factor that modulates the wound healing process, epiretinal membrane peeling can be avoided and the surgical procedure thereby simplified without compromising results. METHODS: A total of 24 eyes of 24 patients with stage 2, 3, or 4 full-thickness macular holes were treated. Of 24 patients, 1 was lost to follow-up after suffering a stroke; the remaining 23 (17 females and 6 males) (age range, 11-81 years; mean, 64 years) were followed for 5 to 16 months (mean, 12 months). Preoperative best-corrected visual acuity ranged from 20/50 to 20/400 (mean, 20/125). A standardized vitrectomy was performed with posterior hyaloid removal and, after a near-complete fluid-air exchange, 0.1 ml of a solution containing 1330 ng of TGF-beta 2 was instilled over the macular hole. No attempts were made to peel epiretinal membranes or drain fluid from the macular hole. RESULTS: Of 23 eyes, 22 (96%) had resolution of the surrounding subretinal fluid and flattening of the macular hole (1 patient required a second procedure, in which visual improvement of 20/30 was achieved); 11 (48%) had visual acuities of 20/40 or better, 19 (85%) had visual acuities of 20/60 or better, and 19 (85%) showed an improvement in visual acuity of at least two lines (mean, 3.8 lines). The authors saw no retinal pigment epithelial mottling. CONCLUSION: The authors' results demonstrate that treatment of macular holes using vitrectomy, fluid-gas exchange, and the instillation of a solution containing TGF-beta 2, without epiretinal membrane peeling, maintains efficacy while simplifying surgery.

Adolescent↗
PubMed1993

Cryotherapy during surgery for giant retinal tears and intravitreal dispersion of viable retinal pigment epithelial cells.

BACKGROUND: Retinal pigment epithelial (RPE) cells are a major component of contractile cellular membranes in proliferative vitreoretinopathy (PVR). Displacement of viable RPE cells into the vitreous cavity is necessary for membrane formation. This study examines the effect of cryotherapy during surgery for giant retinal tears on the dispersion of viable cells into the vitreous cavity. METHODS: A total of seven eyes undergoing vitrectomy and retinal reattachment surgery were studied. Vitreous fluid from three eyes was aspirated immediately after cryotherapy; fluid from four eyes was aspirated after scleral indentation with the cryoprobe, but without cryotherapy. Colonies of pigmented cells routinely grew in flasks inoculated with fluid from eyes treated with cryotherapy. In contrast, flasks inoculated with fluid from eyes not treated with cryotherapy contained significantly fewer viable cells. CONCLUSION: Cryotherapy performed during retinal reattachment surgery in eyes with giant retinal tears is likely to enhance intravitreal dispersion of viable RPE cells. The findings in this study suggest that possible harmful effects of cryotherapy should be evaluated further and that alternative methods of creating a chorioretinal adhesion should be considered in cases with an especially high risk of PVR.

Adult↗
PubMed1994

Natural history of posterior vitreous detachment with early management as the premier line of defense against retinal detachment.

PURPOSE: This study was designed to elucidate various aspects of the natural history of posterior vitreous detachment (PVD), in particular the relation between symptomatology and prognosis as it relates to management of patients with the earliest symptoms of PVD. METHODS: A prospective study of 350 consecutive patients with PVD was performed, excluding all patients referred from an ophthalmologist, those with symptoms of more than 3 months in duration, and those with a history of ocular trauma, except for cataract surgery. Aphakia was present in 21 eyes, and 50 patients were bilaterally involved. RESULTS: Of 163 patients who had one to two floaters as their presenting symptom, with or without light flashes, a retinal tear developed in 12 (7.3%). Of 31 phakic eyes with secondary retinal tears on initial examination, 9 (29%) had one to two floaters and light flashes as the only symptoms. Of eight phakic eyes that initially, or eventually, had a retinal detachment, three (37%) had an interval of 2 1/2 to 3 weeks before visual field loss, during which they noticed only one to three visual floaters plus light flashes as their only symptoms. This early stage in which symptoms are detectable is crucial in terms of providing an opportunity for early treatment that might prevent retinal detachments. CONCLUSIONS: The prompt and conscientious vitreoretinal examination of each patient older than 45 years of age who experiences vitreous floaters, even though limited to one or two, should be undertaken without delay. This practice, combined with expeditious treatment of any secondary retinal tears, provides the most effective known means of preventing rhegmatogenous retinal detachment, and currently it appears to be neglected. A national public educational effort should be pursued to publicize the importance of these symptoms.

Adult↗
PubMed1994

Effects of intraocular bubble duration in the treatment of macular holes by vitrectomy and transforming growth factor-beta 2.

PURPOSE: To compare the effect of a long-acting (16% perfluoropropane [C3F8]) versus a short-acting (air) intraocular gas tamponade on visual outcome and macular hole closure rate after vitrectomy and intravitreal instillation of transforming growth factor-beta 2 (TGF-beta 2) on the macula. METHODS: Vitrectomy with removal of the posterior hyaloid fluid-gas exchange with instillation of TGF-beta 2 was performed in 15 eyes treated with air and 37 eyes treated with 16% C3F8 using identical surgical techniques (mean follow-up, 5.6 months). RESULTS: The macular hole was closed successfully in 36 (97%) of 37 eyes treated with 16% C3F8 and in 8 (53.3%) of 15 eyes treated with air (P = 0.00007). The visual acuity improved by a mean of 3.1 lines on the Early Treatment of Diabetic Retinopathy Study chart for eyes treated with 16% C3F8 and 1.3 lines for eyes treated with air (P = 0.003). CONCLUSIONS: A longer duration intraocular gas tamponade from 16% C3F8 gives a much higher rate of successful closure of macular holes and improved visual acuity using vitrectomy and TGF-beta 2 than does air.

Aged↗
PubMed1994

Vitrectomy for prevention of macular holes. Results of a randomized multicenter clinical trial. Vitrectomy for Prevention of Macular Hole Study Group.

PURPOSE: The purpose of this study is to assess the benefit of vitreous surgery in preventing full-thickness macular holes in patients with impending (stage 1) macular holes. METHODS: A prospective randomized multicenter clinical trial was conducted on patients with full-thickness macular holes in their first eye (stage 3 or 4) and signs and symptoms of stage 1 macular holes in their fellow eye (study eye). The study eye was randomized to vitreous surgery or observation. Outcome was assessed by standardized measurement of visual acuity, detailed clinical examination, fundus photographs, and fluorescein angiography. RESULTS: A full-thickness macular hole developed in 10 (37%) of 27 patients in the vitrectomy group compared with 14 (40%) of 35 patients randomized to observation (P = 0.81). This difference of 3% has a 95% confidence interval of (-21%, 27%). CONCLUSION: The study was terminated because of low recruitment. The authors were unable to prove (or disprove) the benefit of vitreous surgery in patients with stage 1 macular holes. The authors can state, however, that should a beneficial effect from vitrectomy exist, it would probably be minimal. Considering the cost and morbidity of vitreous surgery, a conservative approach for stage 1 macular hole might be appropriate.

Aged↗
PubMed1994

Clinicopathologic correlation of a macular hole treated by cortical vitreous peeling and gas tamponade.

PURPOSE: To study the histopathology of a stage III macular hole that had been treated by vitrectomy with cortical vitreous and epicortical vitreous membrane peeling and gas tamponade. METHODS: The light and electron microscopic features of a treated macular hole were studied. RESULTS: A 16-microns-wide break was present in the external limiting membrane. This was sealed by Müller cell processes. Photoreceptors adjacent to the healed defect appeared normal. No cystoid macular edema was present. CONCLUSION: Cortical vitreous peeling and gas tamponade can allow the macular hole to settle and the edges to re-approximate. The residual defect can be sealed by Müller cells.

Aged↗
PubMed1994

Pneumatic retinopexy for giant retinal tears.

BACKGROUND: New techniques adapted for vitrectomy surgery, including the use of silicone oil and perfluorocarbon liquids, have been applied very successfully to giant retinal tears. Most surgeons thus turn immediately to vitrectomy for all giant tears. The authors have found that patients with giant tears usually have such rapid flow of fluid from the vitreous to the aqueous that repeated paracenteses can be performed without shallowing the anterior chamber, thus allowing injection of sufficient gas into the vitreous cavity to unroll and tamponade the giant tear without the need for vitrectomy. This makes pneumatic retinopexy a feasible alternative for those selected fresh giant tears that have mobile flaps and extend less than 180 degrees. METHODS: Five consecutive patients with giant retinal tears were treated with pneumatic retinopexy using paracentesis and two or more gas injections. They were followed at least 2 years. RESULTS: Four of the five tears were successfully reattached, although a new tear developed in one, and scleral buckling surgery was performed 11 months after the pneumatic retinopexy. CONCLUSION: The authors conclude that pneumatic retinopexy is a reasonable alternative for selected patients with giant retinal tears.

Adult↗
PubMed1994

A prospective natural history study and kinetic ultrasound evaluation of idiopathic macular holes.

BACKGROUND: The role of vitreoretinal traction in the macular region as a causative factor for the development of idiopathic macular holes is widely accepted. The purpose of this study is to provide a prospective evaluation of patients with idiopathic macular holes to determine the risk of hole formation in the fellow eye. METHODS: The authors performed a prospective study of 50 patients with unilateral idiopathic macular holes combining complete ocular examination, including slit-lamp biomicroscopy, with kinetic B-scan ultrasound evaluation of the status of the vitreoretinal interface. Natural history data were obtained by follow-up examinations performed at 3-month intervals throughout the course of the study. RESULTS: During a median follow-up of 33 months, a full-thickness macular hole developed in 1 (2%) of 46 normal fellow eyes. Full-thickness holes also developed in three (75%) of the four eyes that had premacular hole changes (stages 1A and 1B) in the fellow eye on initial examination. All macular holes in fellow eyes occurred within 24 months of entry into the study. Kinetic ultrasound evaluation determined that fellow eyes with separation of the posterior hyaloid membrane in the foveal region were protected from future macular hole development. Those patients with attachment of the posterior hyaloid membrane in both eyes were at highest risk of holes forming in the fellow eye. Patients with posterior hyaloid membrane separation in the macular hole eye only, with an attached vitreous in the fellow eye, were at intermediate risk. CONCLUSION: The authors suggest that fellow eyes in patients with unilateral idiopathic macular holes have a relatively favorable natural history and that kinetic ultrasound examination may help determine which of these fellow eyes is at highest risk for full-thickness macular holes developing.

Adult↗
PubMed1995

Vitrectomy, fluid-gas exchange and transforming growth factor--beta-2 for the treatment of traumatic macular holes.

PURPOSE: To evaluate whether vitreous surgery is successful in closing full-thickness traumatic macular holes and whether there is subsequent improvement in visual acuity. METHODS: Twelve eyes from 12 consecutive patients with traumatic macular holes underwent vitrectomy, fluid-gas exchange and instillation of bovine or recombinant transforming growth factor (TGF)-beta-2. Three of four eyes underwent repeat vitrectomy with TGF-beta-2 after the initial procedure failed to close the macular hole. RESULTS: Eleven (92%) of 12 eyes had closure of the macular hole. Follow-up ranged from 3 to 33 months. Visual acuity improved by 2 or more lines in 8 (67%) of 12 eyes. Six (50%) of 12 eyes improved to 20/40 or better. All 3 eyes that underwent reoperation had successful closure of the macular hole and achieved 2 or more lines of visual improvement. CONCLUSION: Treatment of full-thickness traumatic macular holes with vitrectomy, fluid-gas exchange, and TGF-beta-2 may result in successful anatomic closure and visual improvement.

Adolescent↗
PubMed1995

Baseline characteristics, natural history, and risk factors to progression in eyes with stage 2 macular holes. Results from a prospective randomized clinical trial. Vitrectomy for Macular Hole Study Group.

PURPOSE: The purpose of this study is (1) to determine baseline characteristics and natural history of immature full-thickness macular holes, (2) to describe progression and resolution, and (3) to present new aspects of pathogenesis of idiopathic macular hole. METHODS: The authors analyzed 41 eyes with stage 2 macular holes (37 patients) in a multicentered prospective randomized trial; 19 eyes were randomized to observation (versus surgery) and had more than 12 months of follow-up, allowing determination of the natural course. Baseline and subsequent examinations included best-refracted visual acuity (Early Treatment of Diabetic Retinopathy Study, potential acuity meter, Pelli-Robson contrast sensitivity, and Bailey-Lovie reading vision), of clinical examinations, photography, and fluorescein angiography. RESULT: Mean Snellen visual acuity was 20/66 at baseline. Centric holes usually had a small break (201 microns average mean diameter) with a dark yellow ring and without significant retinal elevation. Eccentric holes had a high maximum/minimum diameter ratio (mean, 1.88 +/- 0.7) and an incomplete cuff of subretinal fluid or yellow ring. Posterior vitreous detachment prevalence was 32% (8/25) in the centric hole group and 0% (0/ 16) in the eccentric hole group (P < 0.05). For the 19 eyes with 12 months of followup, progression rate to stage 3 (or 4) was 74% (n = 14). The diameter of the stage 2 holes increased significantly between baseline and 12 months (P < 0.001). Progression rate to stage 3 was 100% (8/8) in the eyes with pericentral hyperfluorescence (PCH) and 55% (6/11) in eyes without PCH (P < 0.05). Enlargement occurred in 100% of eccentric holes and 60% of centric holes (P = 0.09). Different progression patterns in eccentric and centric holes suggest different mechanisms of pathogenesis. CONCLUSION: Eccentric and centric stage 2 macular holes may have a different pathogenesis. Most stage 2 macular holes, especially with PCH (P < 0.05) or eccentric holes, progressed to stage 3 or 4. In addition to purely tangential traction, some component of obliquely oriented anteroposterior vitreous traction component may be important for pathogenesis of senile macular holes, particularly eccentric stage 2 macular holes.

Aged↗
PubMed1995

Full-thickness macular hole formation in eyes with a pre-existing complete posterior vitreous detachment.

BACKGROUND: Tangential macular traction by the posterior vitreous cortex has been widely accepted as the major causative factor in the development of idiopathic macular holes. Separation of the posterior cortical vitreous should relieve this vitreoretinal traction. METHODS: The authors report five patients with idiopathic full-thickness macular hole formation that occurred in the presence of a well-documented pre-existing complete posterior vitreous detachment. RESULTS: Of five eyes, three underwent pars plana vitrectomy and instillation of transforming growth factor-beta. No residual prefoveal cortical vitreous was present at the retinal surface at the time of surgery. Additionally, clinically identifiable epiretinal membranes were present in three of five eyes, but these epiretinal membranes were extremely thin, transparent, induced minimal traction, and did not warrant surgical peeling. CONCLUSION: It is likely that, in these five patients, some mechanism other than tangential traction by prefoveal vitreous cortex is responsible for idiopathic full-thickness macular hole formation.

Aged↗
PubMed1995

Three-dimensional measurements of idiopathic macular holes using a scanning laser tomograph.

PURPOSE: The diagnosis of macular holes is difficult. Confocal laser tomographic analysis of the retina permits the precise measurements of the macular surface. The authors used this technique to study the macular area of patients with full-thickness macular holes. The purposes of these studies is to perform three-dimensional measurements of the macular holes and their rims and to search for a correlation between these parameters. METHODS: Thirty-one eyes with idiopathic full-thickness macular holes underwent scanning of their affected macular area using the Heidelberg retinal tomograph (HRT). The authors evaluated the following parameters: area of the hole and its elevated rim, the maximal depth of the hole, and the maximal elevation of the rim at 12, 3, 6, and 9 o'clock. RESULTS: The average hole area was 0.33 mm2, and the rim area average was 2.99 mm2. The average area of the rim was found to be 9.06 times larger than that of the hole (P < 0.001). The depth of the hole averaged 144 microns. CONCLUSIONS: The area of the rim is usually bigger than that of the hole and in direct correlation to it. Also, the bigger the hole area, the greater its depth. The average height in each of the four quadrants (12, 3, 6, and 9 o'clock) correlates to the other quadrant heights (P < 0.001).

Aged↗
PubMed1995

Distribution of iatrogenic retinal breaks in macular hole surgery.

BACKGROUND: Intraoperative peripheral iatrogenic retinal breaks can be a serious complication of vitreous surgery. This study was undertaken to determine whether vitreous surgical techniques used for macular hole surgery were associated with a different incidence or distribution of retinal breaks. METHODS: The authors prospectively evaluated a series of 181 consecutive eyes undergoing macular hole surgery. Contemporaneous reporting of intraoperative and postoperative retinal breaks and postoperative retinal detachments was performed. Comparison was made to historic controls of two case series of patients undergoing vitreous surgery for other indications. RESULTS: Of 181 eyes, 10 (5.5%) had 15 intraoperative retinal breaks. Of the 15 breaks, 3 (20%) were in the quadrant near the surgeon's right-hand sclerotomy, 9 (60%) were in the two inferior quadrants, and 11 (73%) were in the two temporal quadrants. By comparison to previously reported case series, tears in our series were less likely to be near the right-hand sclerotomy (P = 0.00055) and more likely to occur in the two inferior retinal quadrants (P = 0.00015) and two temporal retinal quadrants (P = 0.0042). Two patients (1.1%) of 181 had postoperative retinal detachments. CONCLUSIONS: Patients undergoing vitreous surgery for macular hole have a similar incidence but different location of iatrogenic retinal breaks when compared with patients undergoing pars plana vitrectomy for other indications. These breaks are not distributed near sclerotomy sites and tend to be in the inferior and temporal retina. This establishes the need for greater intraoperative surveillance in these areas.

Humans↗
PubMed1995

Pattern of retinal breaks and retinal detachments in eyes with choroidal coloboma.

PURPOSE: To describe the type of breaks that occur in the diaphanous tissue within the coloboma of the choroid and the types of retinal detachment that are associated with these breaks. METHODS: This is a retrospective study of 36 eyes of 36 patients with retinal detachments that extended into the choroidal coloboma. Preoperative findings were documented using detailed fundus drawings and color photographs. Intraoperative identification of retinal breaks was possible using high magnification of the operating microscope. RESULTS: Based on the identifiable breaks inside the coloboma and the extent of retinal detachment, these patients were divided into five subgroups. Three distinct types of breaks were identified within the coloboma: (1) breaks at the edge of the detachment inside the coloboma; (2) oval atrophic breaks; and (3) breaks in anatomic macula that was involved in the coloboma. Multiple breaks were common. CONCLUSIONS: Retinal detachments that extend into the colobomatous area always are associated with breaks in the diaphanous tissue. Intraoperative identification of these breaks is relatively easy. Commonly, the breaks are seen at the edge of the retinal detachment inside the coloboma or as oval breaks within the detached diaphanous tissue. Macula, if involved in the coloboma, occasionally can harbor a retinal break.

Adolescent↗