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Thrombin obtained from donor blood plasma was used to achieve hemostasis during vitrectomy for traumatic hemophthalmos. Analysis of the results of surgery in 21 patients and in 28 controls has shown a manifest hemostatic activity of the agent. If introduced intravitreally, it induced no local reaction of tissues. Thrombin is recommended for clinical application.
The author has developed a miniaturized vitrectomy system and its accessories with the size of a 23-gauge needle. The hand-piece can be inserted inside the eye through a Ziegler knife track. This instrument can be used for "atraumatic" removal of vitreous biopsy specimens and for removal of small pieces of retina. The system also seems to have application in vitreous surgery in premature infants' eyes.
The formation of contractile membranes on the inner retinal surface of the macula (macular pucker, epiretinal gliosis) has an increased incidence with age. They also occur in vascular or inflammatory disorders of the posterior segment, after blunt injuries, retinal detachment surgery, and coagulation therapy. Surgical removal of epiretinal membranes in the macula by vitrectomy is performed since 1978. Our analysis of 78 consecutive patients with a postoperative follow-up from 6 to 36 months showed good anatomical and functional results. Visual impairment caused by metamorphopsia decreased in all patients. Visual acuity improved two lines or more in 55 cases (70.5%). 22 (28.2%) were unchanged (including improvement of one line), and one eye (1.3%) became worse. Functional results were significantly better in eyes with macular pucker of less than 6 months duration and with thin, transparent membranes. The age of patients is not likely to play a significant role for functional outcome. Complications were cataracts in 10, retinal defects or detachments in 5 patients, and recurrence of the epiretinal membrane in 2 cases.
Vitrectomy and/or lensectomy was performed in 33 successive cases of traumatic and complicated cataracts. The discussed cases were divided into 2 groups: 1. late reconstructions of the anterior eye segment after injuries and 2. complicated cataracts. After surgery the visual acuity amounted 6/60 or better in 27 from 33 eyes (81.8 per cent). Full visual acuity was attained in 18 patients (54.5 per cent).
Infective endophthalmitis is a severe ophthalmological condition and may occur as a consequence of a perforating injury or of a surgical procedure. The paper presents personal results of treatment of this disease with the use of vitrectomy and application of intraocular antibiotics. The visual acuity after completion of the treatment was 6/6 to 6/8 in 35.7% of cases. Besides--contemporary opinions on the treatment of infective endophthalmitis are presented on the basis of experience and data from the literature.
Vitreous prolapse into the anterior chamber after cataract extraction is a severe complication in cases in which there is a contact between the vitreous and the cornea. The present paper discusses the result of treatment by vitrectomy in 15 patients with this complication. Anatomical and functional improvement was attained in 12 cases (89 p.c.) and in 5 among them--full visual acuity was obtained.
Thirty-three patients aged 4 to 63 months with extensive retinal detachment due to cicatricial retrolental fibroplasia (RLF) and two non-RLF patients aged 26 and 81 months with normal corneas underwent specular microscopy and ultrasonic pachymetry during examination under anesthesia. Thirty-six eyes of preoperative RLF patients without anterior synechiae and 4 eyes of the two non-RLF patients had high endothelial cell density (ECD) of 5,105 +/- 790.4/mm2 (mean +/- SD) and 4,377 +/- 141.7/mm2, respectively, and increased corneal thickness. The ECD value showed significant negative correlation with vertical corneal diameter (P less than 0.005), but not with age. The ECD values, corrected to average adult corneal size, were 3,900 +/- 550/mm2, which were close to values extrapolated from adult ECD data. The average cell loss for 10 eyes undergoing specular microscopy before and after open-sky vitrectomy was 15%, but 8 of these eyes showed an unchanged ECD ratio of 0.79-1.3 between the two measurements. Furthermore, 17 eyes which were examined only postoperatively also showed a high average ECD of 4,175 +/- 1,012/mm2.
Fourteen eyes with combined traction and rhegmatogenous retinal detachments from proliferative diabetic retinopathy were treated with pars plana vitrectomy (PPV) and daunomycin applied to the vitreous cavity using the technique described by Wiedemann et al. for the treatment of proliferative retinopathy. The operations were completed by filling the vitreous with silicone. The aim of our study was to investigate the effect of daunomycin and the reproliferation rate. After a follow-up period of at least 3 months, the post-operative results were compared with a control group of similar eyes treated with PPV and silicone tamponade alone. No evidence was found to the effect that daunomycin affects the rate of reproliferation.
Closed vitrectomy was carried out in 26 patients with traumatic hemophthalmia. Measures for the prevention of the possible complications of this operation are considered. The efficacy of intramuscular ethamzylate, dicinon angioprotector, is confirmed for reducing the risk of a hemorrhage recurrence in the course of surgery and after it.
Argon laser endophotocoagulation capability during vitrectomy surgery represents a significant technological advance. This report details the initial experience with this technique at the University of Minnesota in 18 patients with particularly high-risk complications of proliferative diabetic retinopathy. Overall, 13 of the 18 eyes (72%) were stabilized anatomically. In comparison with preoperative levels, visual acuity improved in 11 eyes, remained unchanged in 1 eye and deteriorated in 6 eyes. The technique is used intraoperatively to treat existing, iatrogenic or purposeful retinal breaks and to do panretinal scatter therapy to reduce the incidence of postoperative neovascular complications affecting either the anterior or posterior segment of the globe.
One hundred eyes of 95 patients were operated with vitrectomy and silicone oil injection. The patients were divided into 3 groups: Penetrating trauma (PT)-22 eyes, proliferative diabetic retinopathy (PDR)-14 eyes, and proliferative vitreoretinopathy (PVR)-64 eyes. All of the eyes had retinal detachment including the macula. Final attachment of the retina was achieved in 40% of PT, 50% of PDR, and 60% of PVR. Improvement of visual acuity following the operation was noted in 54% of PT, 43% of PDR, and 67% of PDR. Postoperative complications included band keratopathy, elevation of IOP, hypotony, and cataract. Neovascularization of the iris, either preoperative or postoperative, is associated with very poor prognosis.
The authors evaluate the results of pars plana vitrectomy (PPV) with intravitreal implantation of silicon oil (ISO) in 19 eyes of 17 patients with gigantic tears of the retina. During the mean observation period of 22 months the operation was successful in 15 of 19 eyes (78%). The retina adhered on the entire surface in 12 eyes (65%), in three eyes (15%) there remained a defined flat elevation of the retina in the periphery of the lower half of the fundus which did not go as far as the macula. In successfully operated eyes the visual acuity was 0.4 in two eyes, visual acuity of 0.3-0.1 in 7 eyes and visual acuity less than 0.1, making spatial orientation possible, in six eyes. The cause of reduced visual acuity of successfully operated eyes were macular abnormalities which were associated with the fundamental disease, degenerative myopia, injury, impaired nurture of the macula during prolonged detachment, a membrane-forming process. As to late complications of ISO, the most frequent were glaucoma in 42% and complicated cataract u 78% phakic eyes. Extraction of a cataract with iridectomy VI and supplementation of silicon oil into the intravitreal space did not cause in any of the patients a relapse of detachment of the retina. The final evaluation of PPV with ISO in the surgery of gigantic lesions of the retina will be possible only after the long-term follow up of larger groups of patients.
Flurbiprofen is a water-soluble, non-steroid anti-inflammatory agent and is capable of marked inhibition of prostaglandin synthesis. In a previous study by the authors, it was determined that the optimum concentration of flurbiprofen for intraocular irrigation solution in monkey retinas is 4 to 40 micrograms/ml. The present study was conducted to determine the optimum concentration of flurbiprofen for the irrigation solution, as well as to evaluate its toxic effects on the anterior segment tissues. In a pilot experiment, flurbiprofen was injected directly into the anterior chamber of pigmented Japanese rabbits to investigate its overall toxicity and to quantify the concentration at which it could become toxic to the cornea. This experiment showed that aqueous concentrations of flurbiprofen greater than 1,000 micrograms/ml were toxic. In a subsequent study, the twelve eyes of six Japanese monkeys (Macaca fuscata) underwent vitrectomy using balanced salt solution (BSS) containing concentrations of flurbiprofen from 4 to 800 micrograms/ml and BSS alone. This experiment showed that BSS containing 4 to 100 micrograms/ml of flurbiprofen prevented post-operative occurrence of edema in non-pigmented epithelial cells in the ciliary body. Furthermore, it was observed that infiltration of inflammatory cells into the trabecular meshwork and swollen mitochondria in the corneal endothelial cells were likewise prevented. This is thought to be due to the pharmacological action of flurbiprofen; which has an inhibitory effect on leucocyte migration and prostaglandin synthesis as well as stabilization of the cell membrane. However, these effects were not observed in the eyes vitrectomized with flurbiprofen concentrations between 400 and 800 micrograms/ml.(ABSTRACT TRUNCATED AT 250 WORDS)
From 1980-1986 46 unselected aphakic patients suffering from persisting cystoid macular edema and vitreous incarceration to the surgical wound were treated by closed vitrectomy and removal of displaced vitreous through a limbal incision. In 30 eyes visual acuity improved averaging 0.35 if the revision was done within one year. In 12 eyes, treated usually after intervals of more than 1 year, vision remained unchanged and in 4 eyes visual acuity decreased, in two of them due to retinal detachment and in other two because of advance macular changes. When medical therapy fails the decision to undertake surgical revision should not be delayed. This releases also the coexisting traction to the retinal periphery.
We present a retrospective study on keratopathy following vitrectomy and injection of SF96 silicone oil (viscosity 1000 centipoise, n = 232 eyes) and the purified OP 1000 silicone oil (viscosity 1000 centipoise, n = 129 eyes). In cases with aniridia, with closed inferior basal iridectomy (IBI) or without IBI, keratopathy was found in 74 of the 166 eyes (45%) injected with silicone SF96 and in 14 of the 30 eyes (47%) injected with silicone OP 1000. An intact IBI reduced the incidence of keratopathy to 0% (SF96, 0/45 eyes) or 6% (OP1000, 5/88 eyes) when the anterior chamber was free of silicone. When silicone oil was in contact with the corneal endothelium (due to periretinal reproliferation, hypotony, overfilling or droplet formation), there was corneal decompensation in 66% (SF96, 14/21 eyes) or 55% (OP1000, 6/11 eyes). The keratopathy presents as calcified band keratopathy or diffuse bullous corneal edema as in "endothelial decompensation." These variations in keratopathy are in agreement with the following basic diagnoses: 77% (43/56 eyes) of trauma patients (n = 130) develop calcified band keratopathy, and 47% (24/51 eyes) of patients with idiopathic proliferative vitreoretinopathy (n = 182) present with diffuse bullous corneal edema.
In fourteen eyes in thirteen patients, dislocated lenses into the vitreous were extracted using the techniques of vitreous surgery. Our surgical techniques of the extraction, as well as the indication and the prognosis, were described in this paper. Techniques of the lens extraction were basically Barraquer's method, but in modified form. Vitrectomy was carried out by open sky approach (in 2 cases) or pars plana approach (in 12 cases). In cases complicated by acute phacolytic uveitis, excellent results were obtained by these surgical techniques after the complete control of inflammation with steroid. Before surgical extraction, intraocular pressure had been elevated over 21 mm Hg in eight cases. But in all these cases intraocular pressure was controlled without medication after surgery. Visual acuity was improved unless chorioretinal atrophy or glaucoma were not accompanied. From these surgical results, it seems to be reasonable to extract surgically the dislocated lens before the eye is severely damaged.
The authors describe the technique of extracapsular cataract extraction and posterior chamber lens implantation in conjunction with pars plana vitrectomy. In persons with the sequelae of proliferative diabetic retinopathy and retinal branch vein obstruction, as well as those with rhegmatogenous retinal detachment, the procedure enables visual rehabilitation with one operation and seemingly no increase in morbidity.
The main indications of pars plana vitrectomy are opacities of the vitreous without tendency to be absorbed, proliferating retinopathies, complicated retina detachment, heavy ocular injuries and states after the injuries, infective endopthalmitis and epimacular membranes. There is paid attention also to the indication for the inner tamponade using gases and silicone oil. Author emphasizes the cooperation between the all ophthalmologists with specialized vitreoretinal surgical units, because this is extremely needed for the repair of the urgent cases where early performance of PPV is operation of choice.