Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: 5 years follow-up

A series of 64 eyes, in 64 patients with giant retinal tears, treated by vitrectomy and fluid/silicone-oil exchange, has been reviewed after 5 years. Anatomical success was achieved in 73% of cases and visual function in successful cases ranged from 6/6 to NPL; 66% achieved acuities of 6/60 or better and 32% had vision of 6/18 or better. These results compare favourably with those in a previous series reported after 6 months and 18 months. Epiretinal membrane proliferation and shortening accounted for the majority of retinal redetachments while macular abnormalities, especially pucker, were responsible for a poor visual outcome. Glaucoma is the most serious long-term complication of the surgical method and occurs most frequently in aphakic eyes. Retention of the crystalline lens, whenever possible, the creation of a 6 o'clock iridectomy in aphakic eyes, early removal of silicone oil and a conservative approach to the use of scleral buckles are recommended.Presented at the XVIth Meeting of the Club Jules Gonin, Bruges, 4–8 September 1988     

Vitrectomy and fluid/silicone-oil exchange for giant retinal tears: results at six months.

The results of vitrectomy combined with fluid/silicone-oil exchange in 73 eyes with giant retinal tears are reported at six months after surgery. Initial anatomical success was achieved in 71 out of 73 eyes (97%) and, prior to removal of silicone-oil, in 66 out of 73 eyes (90%). In 63 eyes (86%) the retina remained attached six months after surgery. Of these visual acuity was 6/60 or better in 44 (70%). The high proportion of eyes with macular detachment before surgery and the frequency of macular abnormalities are thought to account for reduced vision in many of the anatomically successful cases.     

Aphakic macular oedema: a two-year follow-up study.

A 2-year follow-up study was carried out on patients known to have developed aphakic macular oedema 6 weeks postoperatively, and the results were compared with those in a control group who had not developed oedema. Four eyes (12%) still had macular oedema, the visual acuities ranging between 6/5 and 6/9. There was no significant difference in visual acuities at 2 years between the 2 groups of patients. Visual acuity had significantly improved between 6 weeks and 2 years in the eyes that had macular oedema at 6 weeks after extraction. Factors causing persistence of aphakic macular oedema are discussed.     

Incidence of cystoid macular edema after retinal detachment surgery and the use of topical indomethacin

We conducted a prospective, double-masked, controlled study to determine the effects of indomethacin in preventing the development of cystoid macular edema after retinal detachment surgery. In addition to routine medication, topical indomethacin was applied to 63 eyes (52 with intact lenses and 11 aphakic) and a placebo was applied to 61 eyes (51 with intact lenses and ten aphakic) that underwent retinal detachment surgery. Indomethacin drops or placebo were instilled once an hour for five hours preoperatively and three times daily for four weeks postoperatively. Fluorescein angiography, done before surgery and four to six weeks after surgery to detect cystoid macular edema, showed that cystoid macular edema developed in 11 of 63 eyes (13%) in the indomethacin-treated group and in 20 of 61 eyes (33%) in the placebo group (P less than .01). Five of 28 eyes (18%) with cystoid macular edema in both groups and 38 of 96 eyes (40%) without cystoid macular edema in both groups had visual acuities of 20/40 or better (P less than .05).     

Long-term diabetic vitrectomy results. Report of 10 year follow-up

Ten year follow-up examinations were obtained on 72 cases having pars plana vitrectomies for diabetic retinopathy complications from 1970 to 1973. Forty-two percent of the cases maintained 6/60 or better visual acuities through the tenth year. The visual results were quite stable, with 53% of the cases having the same or better visual acuities at ten years compared with six months. Neovascular glaucoma developed in 11 eyes, usually during the first six months, and open-angle glaucoma developed in 16 eyes, usually after the five-year follow-up examination. Both types of glaucoma occurred almost exclusively in aphakic eyes. Cataracts developed in 75% of retained clear lenses. The vitreous cavities remained clear in 67% of the eyes, and the maculas were attached in 65% of the eyes 10 years following vitrectomy. Fundus neovascularization did not recur.     

Implantation of Kelman-style, open-loop anterior chamber lenses during keratoplasty for aphakic and pseudophakic bullous keratopathy. A comparison with iris-sutured posterior chamber lenses

The clinical and specular microscopic results of 40 cases (39 patients) of penetrating keratoplasty during which a Kelman-style anterior chamber intraocular lens was implanted were reviewed retrospectively. Thirty-one pseudophakic eyes received an intraocular lens exchange and nine aphakic eyes received a secondary intraocular lens. Postoperative follow-up averaged 24.5 months (range, 3 to 51 months). At 1, 2, and 3 years after keratoplasty, 39.3%, 63.2%, and 63.6% of eyes, respectively, had visual acuities of 20/40 or better. Ninety-five percent of the grafts remained clear. Causes of poor postoperative visual acuity included cystoid macular edema (32.5%), new glaucoma (22.5%), and age-related macular degeneration (10.0%). Other causes were endothelial rejection leading to graft failure, corneal ulceration, and retinal detachment. Corneal endothelial cell loss by specular microscopy was 11.5% at 1 years, 21.3% at 2 years, and 25.0% at 3 years. These results were compared with cell loss associated with iris-sutured posterior chamber lenses in penetrating keratoplasty. Visual outcomes and complication rates were similar between these two methods; however, the endothelial attrition at 1 and 2 years for the sutured posterior chamber lens was greater than that of the Kelman anterior chamber lens.     

Natural course of choroidal neovascular membranes within the foveal avascular zone in senile macular degeneration

We divided 96 eyes (93 patients) with senile macular degeneration and choroidal neovascular membranes into two groups--those with juxtafoveal membranes (1 to 250 mu from the center of the foveal avascular zone) and those with subfoveal membranes (0 mu from the center of the zone). After an average follow-up period of 21 months, one of 38 eyes in the juxtafoveal group (3%) had improved two or more lines on the Snellen chart, three eyes (8%) had remained the same, and 34 eyes (89%) had lost two or more lines on the Snellen chart. Although 35 of the 38 eyes (92%) had had initial visual acuities of 6/30 (20/100) or better, 27 eyes (71%) had become legally blind. Of the 58 eyes in the subfoveal group, 18 (31%) had remained the same or improved and 40 (69%) had lost two or more lines on the Snellen chart; 41 (70%) had final visual acuities of 6/60 (20/20) or worse. Of the 26 eyes in the subfoveal group that had had initial visual acuities of 6/60 (20/100) or better (45%). four (15%) had stayed the same and 22 (85%) had lost two or more lines on the Snellen chart. Fourteen of the 26 eyes (54%) had final visual acuities of 6/60 (20/200) or worse. Exudative maculopathy developed in the second eye in 13% of patients who initially had unilateral choroidal neovascularization after 12 months, in 22% after 24 months, and in 29% after 36 months, using life table analysis.     

Reduction of severe macular edema in eyes with poor vision after panretinal photocoagulation for proliferative diabetic retinopathy

Currently available data from multicenter randomized trials on laser treatment of diabetic macular edema refer only to eyes with pretreatment visual acuities of 20/160 or better. After observing reduction of more severe macular edema and visual improvement following panretinal photocoagulation (PRP) alone in some patients, we reviewed our experience with this problem. In 18 eyes of 14 patients with proliferative diabetic retinopathy and visual acuity of 20/200 or worse, secondary to severe macular edema were identified. At 6 months after PRP without focal macular laser treatment, macular edema was reduced in 13 eyes, 8 of which improved by 2 lines of vision. Among the latter 8 eyes, the visual acuity of 4 recovered to 20/80 or better; the remaining 10 eyes, which had chronic retinal pigment epithelial atrophy or extensive macular ischemia, did not improve. Based on these observations, we suggest that peripheral PRP performed in multiple sessions over several months may have a beneficial effect on severe macular edema in some eyes with adequate macular perfusion.     

Clinical characteristics and surgical outcomes of pseudophakic and aphakic retinal detachments

We retrospectively evaluated the clinical characteristics and surgical outcomes of 20 pseudophakic retinal detachment (RD) patients (20 eyes) and 17 aphakic RD patients (17 eyes). Males were predominated in both groups. The time interval between cataract extraction and RD was 31 months on average in the pseudophakic group, 32 months with intact posterior capsule and 27 months with ruptured posterior capsule, and 148 months in the aphakic group. In 50% of cases with ruptured posterior capsule in the pseudophakic group, RD occurred within 1 year. The anatomic success rate was 95% in the pseudophakic group and 88% in the aphakic group. The most common cause of failure was the development of proliferative vitreoretinopathy. Visual acuities more than 20/40 after RD surgery were found in 13 pseudophakic (65%) and 6 aphakic (36%) eyes. Aphakic patients were more inclined to have silent RD than pseudophakic patients because of their poor visual acuity. Post-operative follow-up is required especially for the first 1 year in cases of damaged posterior capsule due to the high incidence of RD during this period.     

Long-term anatomic and visual acuity outcomes after initial anatomic success with macular hole surgery

PURPOSE: To investigate the anatomic and visual outcomes in patients with initial anatomic success after macular hole surgery and with at least 5 years of follow-up. DESIGN: Retrospective, noncomparative, consecutive case series. METHODS: Medical records of all patients who underwent surgery for idiopathic full-thickness macular holes by two surgeons (W.E.S., H.W.F.) at the Bascom Palmer Eye Institute between January 1, 1991, and December 31, 1996, were reviewed. All patients who had initial anatomic success with macular hole surgery and who had 5 years or more of follow-up postoperatively were included in the study. Main outcome measures included the rate of macular hole reopening and visual acuity outcomes. RESULTS: Seventy-four eyes of 66 patients with a median age of 68.0 years (range, 45.0-86.8 years) were identified. The median duration of macular hole was 6.0 months (range, 1.1-93.8 months), and the median duration of follow-up after macular hole surgery was 91.0 months (range, 60.0 to 114.8 months). The hole reopened in 9 eyes (12%) during the follow-up interval; 6 of these eyes underwent reoperation, and the hole closed in 4 of 6 (67%). Preoperative visual acuity ranged from 20/50 to 20/400 (mean, 20/129; median, 20/100). In the 62 eyes that underwent cataract extraction (CE) after macular hole surgery, CE was performed at a median of 13.9 months after macular hole surgery. Patients achieved their best postoperative visual acuity at a median of 28.5 months after macular hole surgery. Best postoperative visual acuity ranged from 20/20 to 20/400 (mean, 20/36; median, 20/30). Visual acuity at last follow-up ranged from 20/25 to counting fingers (mean, 20/56; median, 20/40). At last follow-up, 43 eyes (58%) had a visual acuity of 20/40 or better, and 57 (77%) had an improvement in visual acuity of 3 or more Snellen lines compared with their preoperative acuity. CONCLUSIONS: Macular hole closure and visual acuity improvement after initially successful macular hole surgery persist at follow-up of 5 years and longer in the majority of patients; delayed visual acuity improvement is not attributable to cataract surgery alone.     

Aphakic extended-wear contact lenses after penetrating keratoplasty

Fifteen aphakic eyes in 15 selected patients who underwent penetrating keratoplasty were successfully fitted with extended-wear contact lenses three to 42 months postoperatively. After an average follow-up of 17 months, there was no graft edema, no microbial corneal ulcers, and no episode of graft rejection. Three eyes developed minor (1 to 2 mm) graft neovascularization; the neovascularization was stable and did not require discontinuation of the contact lenses. Fourteen of the 15 patients had postoperative visual acuities of 20/70 or better; the one patient whose visual acuity was worse than 20/70 had a clear graft but also had senile macular degeneration.     

Cataract surgery in children with chronic uveitis

OBJECTIVE: To evaluate the visual outcome of cataract surgery in children's eyes with chronic uveitis and the feasibility of intraocular lens (IOL) implantation in these cases. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: Seventeen children (20 eyes) with chronic uveitis, dense cataract, and a preoperative visual acuity of 6/120 or less with follow-up of 5 years after the initial cataract surgery. METHODS: In 10 eyes of 10 children (five with juvenile rheumatoid arthritis [JRA] and five with non-JRA-associated uveitis) with uniocular or markedly unequal binocular disease, surgery was carried out through the limbus and a posterior chamber IOL was implanted. In seven children (10 eyes), three with JRA and four with non-JRA-associated disease, a pars plana approach was used, and contact lenses or glasses (for the bilateral cases) were prescribed. RESULTS: The postoperative course and immediate restored visual acuities were similar whether an IOL was implanted or not. One month after the surgery, visual acuity improved in all operated eyes. After monocular surgery, in the younger children, contact lenses were poorly tolerated and their use discontinued. These aphakic eyes remained with low vision, developing strabismus on longer follow-up. Children with JRA-associated uveitis were younger, demonstrated an active intraocular inflammation for an extended period after surgery, and tended to have secondary membranes develop, necessitating a second surgical intervention. Five years after the initial surgery, only two of nine eyes (22%) in the JRA group (one aphakic of a bilaterally affected child and one pseudophakic in a child undergoing cataract surgery in one eye) retained a visual acuity of 6/9 and 6/6, respectively. In the other seven eyes, the visual acuity was 6/60 in one pseudophakic eye and 6/240 or less in six eyes (three aphakic and three pseudophakic). In children with non-JRA-associated uveitis, 6 (four aphakic in two patients bilaterally affected and two pseudophakic) of 11 eyes (54.5%) retained a vision of 6/12 or better. CONCLUSIONS: Cataract surgery in children's eyes with uveitis may be beneficial. IOL implantation seems preferable to correction with contact lenses in young children needing surgery in one eye. In children with JRA-associated uveitis, the final visual results remain guarded because of irreversible amblyopia and a more complicated postoperative course. For these cases, a modified management approach and a better surgical technique are needed.     

Results of penetrating keratoplasty in 123 eyes with pseudophakic or aphakic corneal edema

The clinical records of 123 eyes that received a penetrating keratoplasty for aphakic or pseudophakic corneal edema with a mean follow-up time of 18 months were studied retrospectively. Thirty-five eyes from which an intraocular lens (IOL--85% iris fixated) was removed at the time of keratoplasty were compared with 88 eyes that never had an IOL. The mean interval between initial cataract surgery and penetrating keratoplasty was 28 months for the pseudophakic group from which the IOL was removed and 67 months for the aphakic group without IOL. In both groups, 97% had an anterior vitrectomy. Corneal grafts remained clear in 91% of the previously pseudophakic eyes and in 81% of the aphakic eyes (P less than or equal to 0.05). The final corrected visual acuity was worse in the pseudophakic eyes with IOL removed (16% saw 6/6 to 6/12 while 22% saw worse than 6/60) than in the aphakic eyes (34% saw 6/6 to 6/12 while 7% saw worse than 6/60). Postoperative maculopathy occurred in 43% of eyes from which IOLs were removed and in 22% of aphakic eyes.     

C2F6气体在黄斑裂孔性视网膜脱离手术中的应用

目的 探讨Ｃ２Ｆ６气体在黄斑裂孔性视网膜脱离手术中的应用。方法 对２７例２８眼黄斑裂孔性视网膜脱离的患者进行玻璃体切割气液交换及效气体填充。结果 随访１～３个月总的 风膜复位率为８２．１％,３例视网膜未复位的原因为后巩膜葡萄肿较重,裂孔大致使裂孔周围的视网膜与脉络膜不能紧密相贴,２例再行硅油填充,视网膜复位良好,２７例２８眼手术后视力提高者２２眼,未变者５眼,下降１眼。结论 Ｃ２Ｆ６气体应用于黄斑     

Scleral resection technique combined with vitrectomy for a macular hole retinal detachment in highly myopic eyes

PURPOSE: To evaluate scleral resection technique combined with vitrectomy for macular hole retinal detachment of highly myopic eyes. MATERIALS AND METHODS: Seventeencases (17 eyes) of macular hole retinal detachment in highly myopic eyes, in which the patient underwent vitrectomy combined with scleral resection technique formacular hole retinal detachment between January 1996 and December 2003 at Fukuoka University Chikushi Hospital, were studied.Following pars plana vitrectomy, as much as possible of the residual vitreous and/or epiretinal membrane was removed. A scleral resection was performed in 2 quadrants of the equatorial region of the temporal sclera. Finally, a fluid-air exchange with SF(6) gas injection was performed to achieve retinal attachment. Pre- and postoperative axial length of the eyeballs were measured by B-scan ultrasonography. RESULTS: All cases had the retina reattached at the initial surgery, and visual acuities were stabilized or improved after the surgery. The posterior staphyloma became obscure in 13 out of 17 eyes (76.8%). The macular hole closed in 14 of 17 eyes (82.4%) ophthalmoscopically. There were no cases in which retinal redetachment occurred during follow-up periods of more than 6 months. CONCLUSION: In cases of macular hole retinal detachment of a highly myopic eye, scleral resection technique combined with vitrectomy changed the shape of the eyeballs and allowed successful retinal reattachment at the initial surgery.     

高度近视黄斑裂孔性视网膜脱离的玻璃体手术疗效观察

目的 研究玻璃体视网膜手术对高度近视黄斑裂孔性视网膜脱离的疗效及手术并发症.方法 回顾性分析2009年4～9月连续住院诊断为高度近视黄斑裂孔性视网膜脱离的病例,共17例17只眼,其中男6例,女11例.手术采用玻璃体切除联合长效气体或砖油充填术,术后患者保持头低位7～14d,术后随访1～6月,平均4个月.结果 黄斑裂孔闭合,视网膜解剖复位15只眼(88.2%).术后视力提高13只眼(76.5%),无变化2只眼.结论 玻璃体视网膜手术术中松解玻璃体牵引,剥除黄斑前膜,联合膨胀气体或硅油填充,提高了高度近视黄斑裂孔性视网膜脱离手术成功率.

Abstract：

Objective To investigate the efficacy ofvitreoretinal surgery for retinal detachment with macular hole caused by high myopia and surgical complication. Methods A total of 17 patients (17 eyes)with retinal detachment of macular hole caused by high myopia underwent vitrectomy from Apr. 2009 to Sep.2009 were analyzed retrospectively. Of 6 cases were male while 11 cases were female. The pars plana vitrectomy with long acting gas of silicon oil tamponade was used. After the surgery, the patients were kept lying face down at least 7-14 days. The follow-up ranged from 1 to 6 months (4 months in average). Results Macular hole closed in 15 cases, retina reattached in 15 out of 17 eyes (88.2%). Postoperative visual acuities of 13 eyes(76.5%) were improved while the other 2 eyes ofmacular hole did not change after surgery. Conclusions Vitreoretinal surgery can relax vitreous traction, peel preretinal membrane. The therapy of vitrectomy combined with C3F8 or silicon oil tamponade is safe and available to cure retinal detachment of macular hole caused by high myopia and increase the rate of success.     

Congenital cataract and intraocular lenses

We implanted nine intraocular lenses for the aphakic correction of congenital monocular cataracts in eight children (eight eyes). During follow-up periods ranging from 18 to 50 months in six children, there were no major complications connected to the surgery. Parental cooperation with treatment for amblyopia was satisfactory in all cases. The degree of strabismus, the fixation pattern, and the optokinetic nystagmus responses improved postoperatively in all six. Three children old enough to cooperate during visual testing had visual acuities better than 20/200 and two of these had visual acuities of 20/40. In all six children the sound eye is still patched for three to six hours a day. All six attend regular kindergartens and participate in their normal activities without difficulty.     

Use of 10-Hz flash visual evoked potentials in prediction of final visual acuity in diabetic eyes with vitreous hemorrhage

In 44 diabetic eyes with vitreous hemorrhage, monocular steady-state visual evoked potentials were elicited through closed eyes by a 10-Hz flash. Visual evoked potentials were rated as normal or abnormal on the basis of amplitude and waveform. Abnormal visual evoked potentials were subdivided into mildly abnormal, markedly abnormal and nonrecordable categories. Patients with normal potentials were predicted to have visual acuities of 6/15 (20/50) or better. Patients with abnormal potentials were predicted to have visual acuities of 6/18 (20/60) or worse. Final visual acuities were the best visual acuities recorded in the 6 months after vitreous surgery (vitrectomy) or spontaneous clearing of the vitreous hemorrhage. The visual evoked potential categories and final acuities were compared with a 2 × 2 contingency table. The accuracy was 86%. The visual evoked potential categories and final acuities were associated at a statistically significant level.     

The Natural History of Gyrate Atrophy of the Choroid and Retina

Twenty-nine Finnish patients (8–80 years old during follow-up) with hyperornithinemia and gyrate atrophy (HOGA) were followed 2 to 31 years to determine when and how rapidly visual acuities and visual functions were affected by the disease. Considerable variability was observed both in the age at which visual acuities began to decrease and the age at which visual acuities reached 20/200. Acuities in phakic eyes tended to decrease from 20/30 to 20/200 in ten years or less, while aphakic eyes exhibited generally slower loss of vision. Without benefit of cataract surgery, the percentage of eyes with acuity 20/200 or worse would have been 37% at age 30 and 64% at age 40, but through surgery actually performed was 20% at age 40. Constriction of visual fields with age was marked and correlated well with diminution in dark adaptation.     

Improvement of visual acuity one-year after vitreous surgery in eyes with residual triamcinolone acetonide at the macular hole

PURPOSE: To investigate whether triamcinolone acetonide in the macular hole after surgery interferes with anatomic macular hole repair or visual acuity improvement. DESIGN: Prospective, interventional case series with historical comparison. METHODS: Pars plana vitrectomy and triamcinolone acetonide-assisted internal limiting membrane peeling were performed in 26 eyes (24 patients) with stage 3 or 4 idiopathic macular hole. The visual acuities one-year after surgery were compared between eyes with and without residual triamcinolone acetonide after surgery. RESULTS: The macular holes were closed successfully in all 26 eyes. Nine eyes (35%) had residual triamcinolone acetonide in the macular hole at the end of the surgery and in the fovea on day 3 after surgery. The mean preoperative logarithm of the minimum angle of resolution (logMAR) visual acuity +/- standard deviation was 0.73 +/- 0.36 and improved significantly to 0.20 +/- 0.29 one-year after surgery (P = .010). In the nine eyes with residual triamcinolone acetonide, the preoperative mean logMAR triamcinolone acetonide was 0.81 +/- 0.33, which improved to 0.20 +/- 0.19 one-year after surgery (P = .013). In the remaining 17 eyes, the mean visual acuity also improved from 0.71 +/- 0.38 before surgery to 0.21 +/- 0.28 after surgery (P = .001). No significant difference was found between the groups in preoperative and postoperative logMAR visual acuities. CONCLUSIONS: Residual triamcinolone acetonide in the macular hole does not interfere with anatomic or visual improvement.