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At least 1,261 records · Page 70Linked to original sources

PubMed2002

Treatment of central retinal vein occlusion by vitrectomy with lysis of vitreopapillary and epipapillary adhesions, subretinal peripapillary tissue plasminogen activator injection, and photocoagulation.

PURPOSE: To report a case of subretinal peripapillary tissue plasminogen activator (tPA) injection with vitreopapillary and epipapillary membrane dissection and peripheral photocoagulation in the treatment of central retinal vein occlusion. DESIGN: Interventional case report. METHODS: A 79-year-old woman with a history of branch vein occlusion in the left eye presented with visual loss in the right eye for 4 months secondary to unresolved central retinal vein occlusion. She underwent vitrectomy, right eye, with lysis of vitreopapillary and epipapillary adhesions and hyaloid separation, subretinal peripapillary tissue tPA injection, peripheral photocoagulation, and air-fluid exchange. RESULTS: Postoperatively, funduscopic and fluorescein angiographic features of venous obstruction improved rapidly, with prompt reduction in intraretinal hemorrhages and disk and macular edema. The patient reported subjective improvement of vision in her right eye, although measured improvement was modest, from finger counting to 20/400. CONCLUSION: Subretinal administration of tPA, lysis of adhesions, and endophotocoagulation may be of value in resolving the obstructive component of selected cases of chronic central retinal vein occlusion associated with vitreopapillary and epipapillary traction.

Aged↗

PubMed2003

Silicone oil migration in the eyelid after vitrectomy for retinal detachment.

PURPOSE: To report a case of silicone oil intrusion in the upper eyelid, expressed by ptosis occurrence 19 years after surgery. METHODS: Vitrectomy followed by transscleral subretinal fluid drainage and silicone oil tamponade was performed on a 57-year-old man for retinal detachment. Nineteen years later, the patient was referred for mobile subcutaneous lumps of the upper right eyelid. Preoperative examination showed total invasion of the eyelid by silicone oil, as confirmed by pathology. RESULTS: Silicone oil leak developed through the transscleral drainage lumen and worsened with ocular hypertension. We assume that ptosis was induced by the weight of inflammatory tissue and consequently the development of a lymphoedema. CONCLUSION: We report a case of silicone ptosis. Two concomitant factors induced oil leakage: the puncture site and postoperative hypertonia.

Blepharoptosis↗

PubMed2003

Technique to alter field of view during vitrectomy with phacoemulsification and aspiration in gas-filled eye.

PURPOSE: To describe a method to alter the angular field of view of the fundus in gas-filled eyes during pars plana vitrectomy and phacoemulsification with aspiration and intraocular lens implantation. v Description of a new surgical method. METHODS: The amount of viscoelastic material injected into the capsule is regulated, altering posterior capsule curvature. RESULTS: The visual field can be varied from 5 to 108 degrees. Surgery on more than 300 eyes with rhegmatogenous retinal detachment and cataract using this technique has been successful with no complications. CONCLUSIONS: This method effectively controls the field of view in gas-filled eyes.

Anterior Chamber↗

PubMed2003

Management of post-vitrectomy persistent vitreous hemorrhage in pseudophakic eyes.

PURPOSE: To prospectively assess the effect of neodymium:yttrium-aluminum-garnet peripheral capsulotomy on postvitrectomy hemorrhage in diabetic patients with a posterior chamber intraocular lens (IOL) implant and an intact posterior capsule. DESIGN: Interventional case series. METHODS: This is a prospective case series, clinical practice. PATIENTS: Five vitrectomized, diabetic, pseudophakic patients with persistent vitreous cavity hemorrhage remaining after vitrectomy were selected. They all had a posterior chamber IOL implant with an intact posterior capsule. Additionally, they had all undergone laser panretinal photocoagulation in the involved eye in the past for diabetic retinopathy. Neodymium:yttrium-aluminum-garnet laser capsulotomy outside the optic of the IOL was performed in victrectomized diabetic patients to treat the remaining vitreous cavity hemorrhage. Visual acuity, intraocular pressure (IOP), and fundus examination were measured and done immediately after the laser procedure, in 7 days and in approximately 3 months. RESULTS: The visual acuity was improved at the time of the first follow-up. However, a mild elevation of IOP was noticed in some patients, which was treated with topical dorzolamide. The final visual acuity was dramatically improved, to 20/30 or better, and the IOP was normalized without medication within a few weeks in all five cases. No neovascularization of the iris or elsewhere was noticed in any case. CONCLUSIONS: Neodymium:yttrium-aluminum-garnet laser peripheral capsulotomy appears to be a safe and effective management procedure in treating postvitrectomy hemorrhage in diabetic patients who have previously undergone cataract surgery with posterior chamber lens implant, intact posterior capsule, and extensive panretinal photocoagulation. The vitreous hemorrhage cleared completely in all five cases.

Adult↗

PubMed1997

Ultrasound biomicroscopy in the diagnosis of persistent hypotony after vitrectomy.

PURPOSE: To describe a case of persistent hypotony after an otherwise successful vitreous surgery for epiretinal membrane, in which ciliochoroidal detachment was detected by ultrasound biomicroscopy but not by ophthalmoscopy. METHOD: We used ultrasound biomicroscopy to determine the cause of persistent postoperative hypotony. RESULTS: Ultrasound biomicroscopy clearly disclosed ciliochoroidal detachment. In an attempt to resolve ciliochoroidal detachment, we performed vitrectomy and fluid-gas exchange combined with diathermy around the sites of sclerotomy. Postoperatively, the regression of ciliochoroidal detachment was confirmed by ultrasound biomicroscopy. CONCLUSIONS: Using ultrasound biomicroscopy, we were able to visualize ciliochoroidal detachment and its regression clearly, which we had not observed during ophthalmoscopy.

Choroid Diseases↗

PubMed1997

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↗

PubMed1991

Nuclear sclerotic cataract after vitrectomy for idiopathic epiretinal membranes causing macular pucker.

We evaluated the occurrence or progression of nuclear sclerosis of the crystalline lens in 100 eyes after vitrectomy for removal of idiopathic epiretinal membranes causing macular pucker. The follow-up period ranged from six to 99 months (average, 29 months). Visually significant nuclear sclerosis was present preoperatively in three of the operated on eyes and four of the fellow eyes. The rate of occurrence or progression of visually significant nuclear sclerosis was far greater in the operated on eyes (P less than .0001). Of 100 patients, 80 operated on eyes and 24 fellow eyes had visually significant nuclear sclerosis or had undergone previous cataract extraction at the conclusion of the study. Different concentrations of glucose in the intraocular irrigating solution did not affect occurrence of later nuclear sclerosis. Patients older than 50 years of age had a far greater incidence of later nuclear sclerosis than patients younger than 50 years of age (P = .0003). Nuclear sclerosis may be caused by altered lens metabolism after removal of part of the vitreous gel, since nuclear sclerosis also occurs in other conditions associated with vitreous liquefaction.

Adolescent↗

PubMed1994

Fluorescein angiographic characteristics of macular holes before and after vitrectomy with transforming growth factor beta-2.

We evaluated the fluorescein angiographic features of full-thickness macular holes before and after vitrectomy, fluid-gas exchange, and instillation of transforming growth factor beta-2 in 43 eyes in a masked fashion to evaluate the angiographic characteristics of macular holes preoperatively and the changes that occur with successful and unsuccessful closure of the macular hole. Hyperfluorescence was present in the base of the macular hole preoperatively in 34 of 43 eyes (79.1%), was questionable in eight of 43 eyes (18.6%), and was definitely absent in only one of 43 eyes (2.3%). The hyperfluorescence in the base of the macular hole disappeared in 19 of 20 eyes (95%) with successful closure of the macular hole (P < .00001) and appeared to be caused by blocked fluorescence at the site of the macular hole. The photographic features of eyes with unsuccessful closure of the macular hole changed little, except that the size of the cuff of neurosensory detachment around the hole increased and was associated with decreased postoperative visual acuity. These angiographic changes support the presence of a glial tissue plug bridging a small defect in the fovea of eyes with successful closure of a macular hole.

Combined Modality Therapy↗

PubMed1985

The influence of aphakia and vitrectomy on experimental retinal toxicity of aminoglycoside antibiotics.

To study the effect of lens and vitreous surgery on the dose threshold of aminoglycoside-induced retinal toxicity, we performed extracapsular lens extraction (Group 1) or lensectomy and vitrectomy (Group 2) on Dutch Belted rabbits. A single dose of amikacin or gentamicin ranging from 100 to 4,000 micrograms was administered intravitreally. Retinal toxicity was examined by light and transmission electron microscopy seven days after injection. Both groups showed retinal toxicity after 400 micrograms of gentamicin or 1,500 micrograms of amikacin, doses identical to those causing toxicity in intact, phakic rabbit eyes. Thus, neither surgical procedure increased the toxic threshold of injected aminoglycoside. Given the accelerated aminoglycoside clearance reported in aphakic eyes, these findings imply that the mechanism of aminoglycoside toxicity may be related to peak drug concentration rather than duration of tissue exposure.

Aminoglycosides↗

PubMed1995

Open-angle glaucoma after pars plicata lensectomy and vitrectomy for congenital cataracts.

PURPOSE/METHODS: We examined an infant with familial cataracts in whom bilateral open-angle glaucoma developed shortly after pars plicata lensectomy with anterior vitrectomy. RESULTS/CONCLUSIONS: Some eyes with congenital nuclear cataracts have a predisposition to develop glaucoma after removal of the cataract, which is irrespective of the method chosen to remove the cataract. Careful monitoring of the intraocular pressure is indicated.

Cataract↗

PubMed1987

Long-term results of successful vitrectomy with silicone oil for advanced proliferative vitreoretinopathy.

We have analyzed the six-month, one-year, and two-year follow-up examinations in 47 patients who had silicone oil injection in combination with revision of vitrectomy for intractable retinal detachment and advanced proliferative vitreoretinopathy. A visual acuity of 5/200 or better was attained in 22 eyes at six months (47%), 17 eyes at one year (36%), and 14 eyes at two years (30%). Of eyes that were completely attached posterior to the buckle at six months, 77% remained attached at two years. In those eyes that were attached at six months, corneal decompensation was the most frequent cause of a loss of vision between six months and two years. Silicone oil was removed in 22 eyes (47%).

Corneal Diseases↗

PubMed1987

Management of fibrin pupillary-block glaucoma after pars plana vitrectomy with intravitreal gas injection.

After pars plana vitrectomy and fluid-gas exchange, two patients developed fibrin membranes across the pupillary space resulting in pupillary block and subsequent glaucoma. In one case the angle was closed; in the second case the angle was open because of gas in the anterior chamber. In both cases the argon laser made permanent openings in the fibrin pupillary membrane that relieved the pupillary block.

Adult↗

PubMed1992

Long-term results of vitrectomy and perfluorocarbon gas for the treatment of severe proliferative vitreoretinopathy.

The results of 87 patients who underwent vitrectomy, scleral buckling, and injection of perfluorocarbon gas in one eye each for proliferative vitreoretinopathy of grade C3 (marked, involving three quadrants) or worse were studied. The retinas of 60 of the 87 patients (69%) were attached posterior to the scleral buckle one month after disappearance of the gas, with the initial reattachment rate being inversely proportional to the severity of proliferative vitreoretinopathy. Follow-up data ranging from six to 106 months were available on 54 eyes with attached retinas. Final visual acuity in those patients ranged from light perception to 20/40 and was not related to severity of proliferative vitreoretinopathy or duration of reattachment. Thirty-eight of the 54 patients (70%) had a visual acuity of 20/400 or better. Twenty-nine of the 37 patients (78%) with retinas attached 24 months or longer had the same or better visual acuity than at six months postoperatively. Macular pucker was observed in 16 of the 54 eyes (30%) and was the most frequently seen long-term retinal complication affecting visual acuity.

Adolescent↗

PubMed1990

Complications of tissue plasminogen activator therapy after vitrectomy for diabetes.

Human recombinant tissue plasminogen activator (25 micrograms) was injected into seven eyes of six patients who had developed massive fibrin deposition after vitrectomy surgery for diabetes. Six eyes had developed pupillary membranes and recurrence of tractional retinal detachment from fibrin membranes, and one eye had developed only a pupillary membrane. All pupillary membranes resolved within one hour of administration of tissue plasminogen activator, and five tractional retinal detachments resolved within 24 hours. All eyes developed evidence of intraocular bleeding after tissue plasminogen activator injection. Subsequently, six of seven eyes developed recurrence of fibrin accumulation and tractional retinal detachment.

Adult↗

PubMed1999

Spectacle-mounted prisms as an aid in face-down positioning after vitrectomy surgery.

PURPOSE: To report a modification in the design of bed spectacles to provide an aid for patients who undergo face-down positioning after vitrectomy with gas-fluid exchange and postoperative gas tamponade. METHODS: New equipment design. Bed spectacles that use prisms to move the image 90 degrees around the horizontal meridian were modified by rotating the prisms in the frame 180 degrees and adding nosepads and cable temples. The spectacles were given to 12 patients for use during postoperative face-down positioning. A questionnaire was used to evaluate the helpfulness of the spectacles during face-down positioning. RESULTS: Patients ranked the spectacles as "helpful" to "very helpful" with a mean and SD of 8.3+/-1.6 on a scale of 1 to 10, where 1 was "a hindrance" and 10 was "very helpful." Patients wore the spectacles an average of 5.7+/-4.5 hours a day (range, 1.5 to 15 hours). CONCLUSION: Modified bed spectacles appear to be a portable aid to patients who undergo face-down positioning while sitting, standing, or prone.

Gases↗

PubMedDate not supplied

Magnifying prismatic lenses for vitrectomy.

PURPOSE: Viewing the fundus at higher magnification during vitrectomy makes surgical procedures much safer; however, the scope of magnification of the peripheral fundus has been limited. For better visualization of the periphery of the fundus, we have developed two new contact lenses called magnifying prismatic lenses. METHODS: The magnifying 15 degrees and 30 degrees prismatic lenses are made of a glass with a high index of refraction (n = 1.883). The lenses have a convex upper surface to provide a magnified view of the peripheral fundus. RESULTS: These magnifying 15 degrees and 30 degrees prismatic lenses provide an approximately 2x magnified view of the peripheral fundus. They also provide a more extensive view of the peripheral fundus than a regular (plano-concave) prismatic lens when the eye is tilted. CONCLUSION: The magnifying prismatic lenses are useful for viewing into the peripheral fundus with higher magnification.

Fundus Oculi↗

PubMedDate not supplied

Posterior synechia of the iris after combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation.

PURPOSE: Combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation has become a widely accepted treatment for cataracts in patients with vitreoretinal diseases. We examined factors influencing the development of posterior synechia after this triple procedure. METHODS: One hundred and three patients (107 eyes) were evaluated. The frequency of postoperative posterior synechia, the preoperative diagnosis, whether gas tamponade was used, and the type of lens implanted were reviewed. RESULTS: Twenty-one eyes (19.6%) developed posterior synechia, and the highest rate (12/39 eyes, 30.8%) was in patients with proliferative diabetic retinopathy. Posterior synechia was more frequent after gas tamponade (28.1%) than in eyes without tamponade (10.1%). In proliferative diabetic retinopathy (PDR) patients, fibrin deposition and the amount of retinal photocoagulation were causative factors for posterior synechia. CONCLUSIONS: Factors promoting postoperative synechia after the triple procedure included (1) the existence of PDR, (2) expanding gas tamponade, (3) fibrin deposition in PDR, and (4) the amount of photocoagulation in PDR.

Adult↗

PubMed2000

Characteristics after cataract extraction or secondary lens implantation among patients screened for the Endophthalmitis Vitrectomy Study.

PURPOSE: This report describes the presenting clinical ophthalmic features and historical findings in patients with a clinical diagnosis of endophthalmitis after cataract extraction or secondary lens implant surgery screened for enrollment in the Endophthalmitis Vitrectomy Study (EVS). DESIGN: Clinic-based, cross-sectional study. PARTICIPANTS: Eight hundred fifty-four patients suspected to have endophthalmitis after cataract extraction or secondary lens implantation. METHODS: As part of the screening process for the study, an eye examination, a medical history, and demographic data were recorded in standardized form for all patients with endophthalmitis after cataract extraction or secondary lens implant surgery referred to the clinical centers, regardless of whether the patient met entry criteria. MAIN OUTCOME MEASURES: Demographics, presenting signs, and symptoms. RESULTS: The median age of individuals presenting with suspected bacterial endophthalmitis was 75 years (range, 9-100 years). Most of those screened (57.7%) were women. Seventy-nine percent of patients sought treatment within 6 weeks of surgery. Blurred vision, conjunctival injection, pain, and lid swelling were the predominant presenting symptoms in order of prevalence. Ocular pain and hypopyon, widely regarded as diagnostic of endophthalmitis, were each absent in 25% of patients. The median hypopyon height, when present, was 1.5 mm. CONCLUSIONS: The classic presentation of postoperative endophthalmitis includes reduced vision, conjunctival hyperemia, pain, hypopyon, and lid swelling within days after cataract surgery or secondary lens implantation. These were the prominent clinical findings in the EVS as well. Because pain and hypopyon, although common, were not always present, clinicians must be vigilant in postsurgical monitoring of patients.

Adolescent↗