[Ultrasonographic observations of the vitreous body in perforating retinal detachment].
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In 1977-1987 the authors operated, using the cryosurgical method post-traumatic retinal detachment in 69 patients. Retinal detachment developed in 37 patients after simple perforation of the eye by a foreign intraocular body. In all patients the perforation penetrated as far as the vitreous space. In patients with retinal detachment the authors investigated the following: the patient's age, refraction, period of retinal detachment, extent of retinal detachment, the state of the macula, the characteristics of the retinal defect (site, size and number), type of retinal detachment and associated adverse factors. In the characteristics of retinal detachment after perforating eye injuries the first place was held by prognostically adverse vitreous traction in 73.9%.
Perforating diathermy coagulation can be used efficiently to destroy large angiomas of the retina. Five patients who had developed large angiomas (greater than 5 disc diameters) in association with various retinal diseases were treated with this technique. The follow-up period ranged from 1 1/2 to 7 years, except for one case in which the patient died five days after the surgical procedure. Several techniques of perforating diathermy are described, and the indications, surgical precautions, and complications of each method are discussed.
The authors operated in 1977-1987 by the cryosurgical method 69 patients after injuries on account of detachment of the retina. Detachment developed in 37 patients after simple perforation of the eye and in 32 patients after perforation of the eye with a foreign intraocular body. In all patients the perforation reached as far as the vitreous body. The interval injury--detachment was assessed retrospectively. The authors found that for the development of post-traumatic detachment of the retina a period of two years after the injury is decisive--within this period detachment of the retina occurred in 55% of the cases. Another 31.9% of the cases occurred during the late post-traumatic period, i.e. 6-40 years after injury. In 21.7% patients anamnestic data were found which were, no doubt, associated with the detachment of the retina: surgical trauma in 8.7%, direct contusion of the eye in 10.1% and lifting a heavy burden in 2.9%.
Hemorrhage and retinal perforation are two sight-threatening complications associated with techniques employed to drain subretinal fluid in rhegmatogenous retinal detachment. We hypothesized that the carbon dioxide (CO2) laser would reduce these complications because of its cauterizing action and high absorption in water. The CO2 laser was compared with a conventional technique of using a penetrating diathermy electrode to drain subretinal fluid in rabbits with experimentally detached retinas. No hemorrhage occurred in 223 drainage trials using the CO2 laser, whereas hemorrhage occurred in 21 (4.8%) of 434 trials using the penetrating diathermy electrode. Furthermore, a depth of saline of only 45 microns protected the retina from perforation at CO2 laser dose adequate for drainage. These results indicate that further evaluation of the CO2 laser in treating human retinal detachment is warranted.
In the period 1978-1987 20 eyes were operated for retinal detachment with a hole in the posterior pole. Various surgical methods were applied with a preponderance of the extrascleral surgery in 1978-1985. In cases of existence of a hole at the posterior pole reattachment of the retina was achieved in 63.7%. Instead in cases of a hole at the posterior pole and at the periphery the reattachment of the retina was observed in 55.6%. In the years 1985-1987 after application of endotamponade with a gas and a laser photocoagulation the percentage of a cure increased (3 cases--3 reattachments).
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A rip or rupture of the detached retinal pigment epithelium (RPE) with subsequent retraction of that layer is an often misdiagnosed affection of the posterior pole of the eye. The histologic appearance of this entity has to our knowledge not yet been published, but the fundus aspect and fluorescein angiography show that the focal absence of the pigmentepithelial layer is very likely. A rip is only seen in older age and it always appears in a detached RPE that often exists in combination with other features of a senile macular degeneration. Mostly the rip arises spontaneously but it may develop sometimes directly after laser coagulation of the detached RPE.
We have developed two related clinical tests that offer potential in better assessing visual function behind an ocular opacity. The tests are resistant to the effects of opacities because they utilize a localization task (vernier acuity) rather than a resolution task. In this paper we report the initial trials in which we apply the two tests together. Results from six case studies (some with actual opacities and some with simulated opacities) illustrate both the conduct of the tests and their potential capabilities in detecting even very modest retinal dysfunction in the presence of opacities. These techniques offer considerable potential in the separation of a given acuity loss observed in the presence of cataract into a portion due to the opacity and a portion due to retinal dysfunction.
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To study the retinal surface in the human eye in normal and diseased states we used laser scanning tomography. The confocal arrangement of the laser tomographic scanner permits examination of retinal topography in the axis perpendicular to the retinal surface. The eyes examined with the laser tomographic scanner included normal eyes, eyes with macular holes, impending macular holes, radiation retinopathy, macular edema, photocoagulation scars, subfoveal scars, and serous detachment of the fovea associated with subretinal neovascularization. The laser tomographic scanner is a new method that allows measurements of the topography of the internal limiting membrane in the macular area and may improve our understanding of the pathophysiologic characteristics and treatment of a variety of disorders of the macula.
Combined rhegmatogenous and traction retinal detachments associated with branch vein occlusions occurred in five eyes of five patients between Jan. 1, 1986 and Dec. 31, 1987. Four patients underwent surgery with pars plana vitrectomy and intravitreal gas, with or without scleral buckling. One patient refused treatment. All operated on eyes had attached retinas at a mean follow-up of seven months. Because posterior traction plays an important role in these unusual detachments, consideration should be given to pars plana vitrectomy and air-fluid exchange rather than scleral buckling alone.
Seventeen patients with the acquired immune deficiency syndrome and cytomegalovirus retinitis were treated with the antiviral drug ganciclovir (9-[1,3-dihydroxy-2-propoxy-methyl]-guanine, DHPG). Eight eyes of five patients developed rhegmatogenous retinal detachment after initiation of treatment. Multiple breaks in areas of peripheral, healed, atrophic retina accounted for the detachments. All seven eyes that underwent surgery had extensive retinal detachments that were reattached with vitrectomy and silicone oil. Retinotomy and retinal tacks were necessary in two cases that were complicated by severe proliferative vitreoretinopathy. In the fellow eye of one patient, laser treatment was used prophylactically to wall off a peripheral patch of healed retinitis. Endoretinal biopsies and culture were taken in five eyes; evidence of persistent cytomegalovirus was seen in two cases despite concurrent and clinically effective antiviral therapy.
It is often the sequelae of intraocular inflammation that is most damaging to the patient's vision. Macular alterations are frequently seen and include neovascularization, both subretinal and retinal; pre-retinal membranes, particularly in young patients with recurrent vitreal hemorrhages; macular holes; and cystoid macular edema, by far the most common alteration. The goal in assessing the maculae of these patients is to determine if and what type of therapy might be applicable. In addition to fluorescein angiography, we have found that laser interferometry is a useful tool in predicting the visual outcome of patients with uveitis. Therapeutic modalities center around corticosteroids, while cyclosporine also has been found to be effective in treating cystoid edema. Vitrectomy has been suggested as a therapeutic approach to both the uveitis and cystoid edema, but this approach still needs to be more scientifically evaluated. A well-defined therapeutic approach to uveitis-induced macular changes is lacking, with well-designed clinical trials sorely needed.
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A total of 358 patients with branch retinal vein occlusion (BRVO) were reviewed to examine the relationship between branch retinal vein occlusion with neovascularization elsewhere (NVE), vitreous hemorrhage, and posterior tractional retinal breaks. Twenty-eight of 358 (7.8%) BRVO patients had vitreous hemorrhage. In this group of 28 patients, 24 of the 28 (85.7%) had NVE. Of the 24 BRVO patients with vitreous hemorrhage and NVE, six (21.4%) were found to have posterior tractional retinal breaks adjacent to avulsed neovascular tissue. These data indicate a strong association between BRVO patients with vitreous hemorrhage and posterior tractional retinal breaks due to avulsion of neovascular tissue.
We present here a patient suffering from an unilateral retinal arteriovenous communication, belonging to group 2 in Archer classification, associated to a homolateral vascular malformation into the ophthalmic artery area, and a full-thickness macular hole. This is the first case with such an association reported in the literature.