Intrusion of Dacron suture knot 15 years after scleral buckling

Background

We present a case of intrusion of a suture knot 15?years after scleral buckling surgery.

Case presentation

A 62-year-old woman with high myopia had undergone scleral buckling surgery in her left eye 15?years previously for rhegmatogenous retinal detachment. She recently displayed highly elevated intraocular pressure, with hyphema and vitreous hemorrhage. After the blood was cleared, a ring-shaped protrusion was noted around the equator of the eyeball, with a blue suture knot standing out on its surface and extending into the vitreous cavity at 5 o’clock. The suture knot was removed successfully. Mass spectrometry revealed that the material of the suture was polyethylene terephthalate, or Dacron. One week later, at the place where the suture knot had been located, the choroidal and retinal tissue disappeared and the silicone buckle remained an uncovered intrusion, whereas the rest of the retina was still attached.

Conclusions

The suture knot was possibly the one used to close the drainage port for subretinal fluid, which was covered by the encircling band. During the buckling procedure, covering a nonabsorbable suture, which is usually placed where the sclera is compromised by trauma or the surgical incision, with an encircling band may lead to the intrusion of the suture. Therefore, a soft absorbable suture may be preferable, if possible.

     

Long-term results of 360A° scleral buckling and vitrectomy with silicone oil tamponade for management of gunshot-perforating ocular injury

Purpose

This is a retrospective consecutive study to assess the long-term results of combined scleral buckling and pars plana vitrectomy (PPV) with silicone oil for the management of perforating ocular injury caused by gunshots.

Methods

Data were gathered from medical records of patients who underwent scleral buckling and PPV with silicone oil 2 weeks after primary repair elsewhere, in Magrabi eye center (Tanta, Egypt), from June 2005 to May 2010.

Results

The evaluated group consisted of 49 cases, out of which 26 cases presented with gunshot injury. Twenty-two were male (84.62%) and four were female (15.38%), with a mean age of 27.19+12.7 years. The follow-up ranged from 12 to 72 months, with a mean period of 32.04+8.9 months. The t-test was used to determine the visual outcome and main prognostic factors. Visual acuity improved in 22 of 26 eyes (76.92%), was unchanged in 4 eyes (15.38%), and worsened in 2 eyes (6.69%). Ten eyes (38.46%) achieved visual acuity between (20/40) and (20/100), and eight eyes (30.76%) had visual acuity between (20/200) and (20/400). The 18 eyes (69.23%) with visual acuity better than counting fingers (CF) had an attached retina with no signs of active proliferation after removal of the silicone oil.

Conclusion

POI due to gunshot is usually a terminal event for the eye. Eyes with perforating injury can be saved and may attain useful vision after performance of combined scleral buckling and PPV with silicone oil tamponade. The final visual outcome depends on the macular or the optic nerve involvement and the final retinal stability, and phthisis bulbi can also be prevented.     

Extrusion and infection incidence in scleral buckling surgery with the use of silicone sponge: to soak or not to soak? An 11-year retrospective analysis

PURPOSE: To assess the incidence of extrusion and infections of encircling silicone sponges in scleral buckling surgery for retinal detachment with and without the use of an intraoperative antibiotic soaking procedure. METHODS: The authors performed a retrospective analysis reviewing the charts of 1127 patients who underwent episcleral buckling surgery operated by the same surgeon in three different institutions during a period of 11 years. The authors reviewed the charts of patients treated with a single episcleral silicone sponge (Labtician) indentation in three different models. The infection prophylaxis on the operating field was the same in all cases and only since February 1997 was the silicone sponge preoperatively treated with an antibiotic soaking procedure. RESULTS: No immediate postoperative infections were reported in the operated eyes. Three eyes had an implant extrusion and in all these cases silicone sponge removal was performed. All three extrusion cases developed when sponge soaking was not adopted. CONCLUSIONS: The data indicate that the soaking procedure does not decrease extrusion and infection incidence in scleral buckling surgery when both accurate surgical technique and disinfection prophylaxis are performed.     

The effect of a preoperative subconjuntival injection of dexamethasone on blood–retinal barrier breakdown following scleral buckling retinal detachment surgery: a prospective randomized placebo-controlled double blind clinical trial

Background  

Blood–retinal barrier breakdown secondary to retinal detachment and retinal detachment repair is a factor in the pathogenesis of proliferative vitreoretinopathy (PVR). We wished to investigate whether an estimated 700 to 1000 ng/ml subretinal dexamethasone concentration at the time of surgery would decrease the blood–retinal barrier breakdown postoperatively.     

Astigmatic refraction using peaks of the interferogram Fourier transform for a Talbot Moiré interferometer

PURPOSE: To calculate the spectacle correction from a Talbot Moiré wavefront sensor using the location of peaks in the Fourier transform of the interferogram image. METHODS: A relationship was developed between the spectacle correction for an ocular wavefront and the location of Fourier transform peaks in the aberrated interferogram. These spectral peaks were located to sub-pixel accuracy using a two-dimensional polynomial fit. A Talbot Moiré wavefront system was developed to collect examination images from an astigmatic model eye and human eyes. The authors' Fourier transform calculation procedure was applied to captured interferogram and results were tabulated. RESULTS: Five examinations were made of the astigmatic model eye. The mean sphere and cylinder were -4.26 D (SD = 0.004) and -2.90 D (SD = 0.008), respectively. The axis for all measurements was 92 degrees. These values were consistent with the model eye design parameters. The patient was a 46-year-old man with best spectacle-corrected visual acuity of 20/20. Ten examinations were made of the patient's eye. The mean sphere and cylinder were -0.09 D (SD = 0.11) and -1.45 D (SD = 0.14), respectively. The mean axis was 69.1 degrees (SD = 1.29 degrees). The calculation time was 46 ms per image running on a 3.6-GHz PC using 512x512 fast Fourier transforms. This processing time is fast enough for real-time acquisition and display of a patient's refractive state. CONCLUSIONS: The Fourier transform calculations provided a fast and simple method of determining the spectacle correction in an aberrated ocular wavefront imaged by a Talbot Moiré wavefront sensor.     

Mapping owl’s eye cells of patients with cytomegalovirus corneal endotheliitis using in vivo laser confocal microscopy

Purpose

To produce a two-dimensional reconstruction map of owl’s eye cells using in vivo laser confocal microscopy in patients with cytomegalovirus (CMV) corneal endotheliitis, and to demonstrate any association between owl’s eye cells and coin-shaped lesions observed with slit-lamp biomicroscopy.

Method

Two patients (75- and 77-year-old men) with polymerase chain reaction-proven CMV corneal endotheliitis were evaluated in this study. Slit-lamp biomicroscopy and in vivo laser confocal microscopy were performed. Images of owl’s eye cells in the endothelial cell layer were arranged and mapped into subconfluent montages. Montage images of owl’s eye cells were then superimposed on a slit-lamp photo of the corresponding coin-shaped lesion. Degree of concordance between the confocal microscopic images and slit-lamp photos was evaluated.

Results

In both eyes, a two-dimensional reconstruction map of the owl’s eye cells was created by computer software using acquired confocal images; the maps showed circular patterns. Superimposing montage images of owl’s eye cells onto the photos of a coin-shaped lesion showed good concordance in the two eyes.

Conclusions

This study suggests that there is an association between owl’s eye cells observed by confocal microscopy and coin-shaped lesions observed by slit-lamp biomicroscopy in patients with CMV corneal endotheliitis. The use of in vivo laser confocal microscopy may provide clues as to the underlying causes of CMV corneal endotheliitis.     

Do patients undergo changes of their personality due to visual field defects? An investigation with FPI-R and NEI-VQ

BACKGROUND: Visual restrictions can lead to anxiety and possibly to social retirement. Therefore it makes sense to assess the patients' degree of handicap. The goal of the present study was to investigate if patients show changes in their personality or a reduced quality of life as a result of their visual field defect. METHODS: 15 patients with visual field defects were asked to fill out the revised version of the Freiburger Pers?nlichkeitsinventar (FPI-R) and the National Eye Institute Visual Function Questionnaire (NEI-VFQ). The FPI-R encompasses the standardised recording of many personality traits whereas the NEI-VFQ addresses the visual quality of life. RESULTS: In the total sample all FPI-R scales were appropriate for the study in the inconspicuous standard range. Slight shifts resulted toward increased willingness to make contacts (scale 4, ST 4.2), reduced physical strain (scale 7, ST 4.3) and lower physical discomfort (scale 8, ST 3.7). The size of the visual field defect does not correlate with the satisfaction with life, with the physical discomfort and with the state of health but with the dependency on others (p = 0.047) and with the exertion of their social roles (p = 0.043). The scale "satisfaction with life" of the FPI-R correlated with the scale "psychic condition" of the NEI-VFQ (p = 0.028) and the physical discomfort showed a significant correlation with the scale "eye strain" (p = 0.006) in the NEI-VFQ. DISCUSSION: Contrary to our presumptions, patients with visual field defects did not show any changes in their personality. It is supposed that they have learned to compensate for their reduced visual functions.     

Brachytherapy of intra ocular tumors using ‘BARC I-125 Ocu-Prosta seeds’: An Indian experience

Aim:

To report our experience of brachytherapy using ‘BARC I-125 Ocu-Prosta seeds’ for the management of intraocular tumors with regard to tumor control, globe preservation visual outcome, and patient survival at Sankara Nethralaya, Chennai, India between September 2003 and May 2011.

Materials and Methods:

We reviewed records of 35 eyes of 35 patients who underwent ophthalmic brachytherapy between September 2003 and May 2011. Twenty-one cases had choroidal melanoma, nine had childhood retinoblastoma, two had adult-onset retinoblastoma, and there were one case each of vasoproliferative tumor, retinal angioma, and ciliary body melanoma. Brachytherapy was administered using a 15- or 20-mm gold plaque with or without a notch. Brachytherapy was the primary treatment modality in all tumors other than retinoblastoma, wherein brachytherapy was done post chemoreduction for residual tumor.

Results:

For choroidal melanomas, the mean radiation dose was 68.69 ± 15.07 (range, 47.72-94.2) Gy. The eye salvage rate was 13/20 (65%) and tumor control rate was 16/20 (80%) at an average follow-up of 24.43 ± 24.75 (range, 1.5-87.98) months. For retinoblastoma, the mean dose was 45.85 ± 3.90 (range, 39.51-50.92) Gy. The eye salvage rate and tumor control rate was 5/6 (83.3%) at an average follow-up of 38.36 ± 31.33 (range, 4.14-97.78) months. All eyes with retinoblastoma needed additional focal therapy for tumor control and eye salvage.

Conclusion:

The results of this retrospective study confirms that the use of ‘BARC I-125 Ocu-Prosta seeds’ in episcleral plaques to treat intraocular tumors offers a viable option for the management of intraocular cancers.     

Pulsed and continuous accelerated scleral cross-linking using riboflavin and ultraviolet A irradiation for the prevention of myopia progression in a guinea pig model北大核心CSCD

Objective: To evaluated the effect of oral administration of riboflavin combined with pulsed and continuous light accelerated scleral cross-linking on the histological and biomechanical properties of sclera in a guinea pig model to control the progression of myopia. Methods: Thirty 4-week-old guinea pigs were divided into 5 groups, or the control group, non cross-linking group, conventional cross-linking group, pulse light cross-linking group and continuous light cross-linking group with 6 guinea pigs in each group.Three cross-linking groups were administered 0.1% riboflavin solution with vitamin C by gavage from 3 days before modeling to modeling process.The conventional cross-linking group underwent cross-linking with 1 hour of (ultraviolet A (UVA) exposure at 0.67 mW/cm2, the pulse light cross-linking group received a pulsed-light accelerated crosslinking for 8 minuctes (1 second on/1 second off) of UVA exposure at 10 mW/cm2, and the continuous light accelerated cross-linking group was crosslinked with continuous-light accelerated crosslinking at 10 mW/cm2 for 4 minuctes.The same procedure was conducted on the non cross-linking group without UVA irradiation and 0.1% riboflavin solution before modeling and modeling process.No any intervene was carried out in the control group.Retinoscopy and the axial length measurement were performed before and after experiment.The animals were euthanized 2 weeks after experiment and then biomechanical and histopathological examinations of scleras were conducted.The use and care of the animals complied with Regulations for the Administration of Affair Concerning Experimental Animals by State Science and Technology Commission. Results: Myopia models were established with an increased axial length and myopic diopter 2 weeks after myopic modeling process.Axial length in the non cross-linking group was longer than that of the control group at 2 weeks, with a siginificant difference between them (P<0.01). The myopic Diopter in the non cross-linking group was significantly increased in comprasion with the control group at 2 weeks (P<0.01). Compared with myopic eyes in the non cross-linking groups, axial length, diopter and strain assessment values were decreased significantly in three scleral cross-linking groups (all at P<0.01). The sclera ultimate load and stress assessment in the conventinal cross-lingking group, pulse light cross-linking group, continuous light cross-linking group were significantly higher than those in the non-cross-linking group Max stress: [2.20±0.03], [2.67±0.05], [2.41±0.04]Mpa vs.[1.30±0.02]Mpa; Max load: [1.92±0.03], [2.33±0.28], [1.91±0.03]P vs.[1.54±0.06]P) (all at P<0.01). Collagenous tissue of the scleras in the pulse light cross-linking group and continious ligh cross-linking group was similar in appearance to the control group.In addition, MMP2 expression of pulse light cross-linking group and continuous light cross-linking group was significantly increased, and TIMP-2 expression showed a reduce. Conclusions: Pulsed and continuous light accelerated scleral cross-linking using oral administration of riboflavin and riboflavin UVA irradiation can effectively prevent the myopia development by increasing scleral biomechanical strength in guinea pig. Copyright © 2018 by the Chinese Medical Association.     

Posterior subtenon infusion of triamcinolone acetonide as adjunctive treatment to panretinal photocoagulation using pattern scan laser for diabetic retinopathy

Purpose

To estimate the effect of sub-Tenon’s capsule triamcinolone acetonide injection (STTA) combined with panretinal photocoagulation (PRP) using pattern scan laser (PSL) for high risk non-proliferative diabetic retinopathy (NPDR), in terms of the inflammation and the progression of diabetic macular edema (DME).

Study design

Retrospective comparative analysis.

Methods

NPDR patients who underwent PRP using PSL with (STTA+PSL group, n=24) or without (PSL group, n=19) pretreatment of STTA were enrolled. We measured anterior flare intensity (AFI) and central retinal thickness (CRT) at day of STTA (day 0), and at 1, 3, 7, 11 and 15 weeks.

Results

The CRT of the STTA+PSL group was significantly lower than that of the PSL group at 7 (308.15±69.16 μm versus 340.21±77.91 μm, p = 0.04), 11 (283.8±60.75 μm versus 335.7±67.70 μm, p = 0.01) and 15 weeks (281.13±35.29 μm versus 316.58±54.89 μm, p = 0.02). AFI levels in the STTA+PSL group were significantly lower than those in the PSL group at 11 (10.47±3.40 versus 15.85±8.38, p = 0.007) and 15 weeks (11.38±3.31 versus 14.37±3.85, p = 0.009). The significant improvement in CRT from baseline was noticed through the observational periods in STTA+PSL group, but not in the PSL group.

Conclusion

Pretreatment of STTA has the potential to not only prevent the worsening of DME, but also reduce the CRT and AFI of eyes with NPDR after PRP using PSL.

     

Is it feasible to use the supratrochlear artery for inducing intra-arterial fibrinolysis in cases of central retinal artery occlusion? An anatomical investigation

Background In order to investigate a possible alternative approach for catheterizing the ophthalmic artery, the detailed anatomy of the intraorbital arteries was examined in eight half-heads.

Results The supratrochlear artery was found beneath or at the lateral border of the superior oblique muscle. In six cases the supratrochlear artery was the largest branch of the ophthalmic artery, continuing in the same direction as the latter vessel. In the other two orbits it branched off from the parent vessel at angles of 90⁰ and 115⁰. In five orbits, the ophthalmic artery divided distally into the supratrochlear and supraorbital arteries, the angles between the two measuring 25^o, 30⁰, 40⁰, 40⁰ and 6o. In one case the supraorbital followed a course at right-angles to the supratrochlear, and in two cases it was absent.

The mean intraorbital length of the vessels was as follows: supratrochlear: 3.94 cm (1.8 to 6.4 cm); ophthalmic: 3.13 cm (2.1 to 4.3 cm); supraorbital: 3.06 cm (2.1 to 3.8 cm).

The following mean external diameters were measured: supratrochlear artery: 0.96 mm (0.6 to 1.5 mm) proximally and 0.72 mm (0.5 to 1.0 mm) distally; ophthalmic artery: 1.79 mm (1.5 to 2.0) proximally and 1.34 mm (1.0 to 1.5 mm) distally; supraorbital artery: 0.68 mm (0.5 to 1.0 mm) throughout its length.

Conclusion The orbital arteries investigated varied greatly in external diameter, course, length and pattern of distribution. It is very difficult to catheterize the supratrochlear artery because of its highly tortuous intraorbital course and its narrow diameter.