Bilateral macular coloboma and pigmented paravenous retinochoroidal atrophy.

A patient had bilateral macular coloboma with aggregations of pigment clumps located perivascularly, predominantly paravenously, and in other parts of the retina. The Toxoplasma IgG antibody was negative. The diagnosis of bilateral macular coloboma with pigmented paravenous retinochoroidal atrophy was made and seemed to be a developmental abnormality in origin.     

Laser treatment of a subretinal neovascular membrane associated with retinochoroidal coloboma

Subretinal neovascularization associated with retinochoroidal coloboma is a rare finding. Only two other cases have been reported in the literature, neither of which were treated with photocoagulation. Here, the author reports a case of subretinal neovascular net associated with a retinochoroidal coloboma, which was treated with laser photocoagulation. The patient's vision improved from 20/200 to 20/30-1 following two argon green laser treatments, with a 33-month follow-up since the initial treatment.     

Bilateral non-traumatic carotid cavernous sinus fistula with spontaneous closure

A case of bilateral spontaneous carotid cavernous sinus fistula is presented. The diagnostic value of Doppler ultrasound examination is discussed, as well as therapeutic measurements, such as manual compression of the carotid artery and embolization treatment. The frequent spontaneous closure of these fistulas is emphasized, and a conservative attitude is recommended.     

Defect closure with scleral grafts

BACKGROUND: Excessively draining fistulas may lead to enucleation when primary suture closure is not effective. In these cases preserved cadaver tissues such as sclera, fascia lata, dura mater and peritoneum have been used for patch graft repair with variable results. In this study, the clinical outcomes after transplantation of scleral patch grafts have been investigated. METHOD: Twenty-eight eyes of twenty-seven patients underwent surgery with homologous scleral patch grafts for repair of excessively draining scleral fistulas after cataract surgery (n = 2), leaking filtering blebs following full-thickness filtration surgery (n = 7), large scleral perforations due to trauma (n = 7), corneo-scleral ulcerations due to severe eye burns (n = 9) or after radiotherapy of malignant melanoma (n = 3). The mean size of the rectangular grafts was 8.6 x 6.7 mm (+/- 2.8/3.1 mm). Clinical follow-up was up to 73 months (median 30 months). RESULTS: Twenty-three of 28 eyes (82.1 %) showed functional closure after initial surgery without any wound complication such as patch retraction or leakage and without evidence of inflammation. In five eyes surgical revision was necessary. Two of these eyes had to be enucleated due to uncontrollable dehiscence after the second operation. Two eyes were enucleated at the patient's demand due to pain. The fifth eye showed effective closure after the second operation. CONCLUSION: In our study scleral patch grafts were useful in adequately closing large corneo-scleral defects in 24 of 28 eyes (85.7 %). The antigen load and, therefore, the rejection of the scleral grafts is minimized due to the denaturation of proteins during the alcohol treatment before storage.     

先天性眼组织缺损一家系基因排除定位研究

目的对1个3代常染色体显性遗传性先天性眼组织缺损家系进行致病基因的定位。方法对家系所有成员进行详细的临床检查,排除其他系统疾患。提取家系成员外周血DNA,选取20个位于4、7、10、11号染色体上已知与先天性眼组织缺损相关的4个致病基因及已知基因位点20q13.1附近的微卫星标记物进行多重PCR扩增,经ABI3130型遗传分析仪,Genscan2.1收集数据,Genotyper2.1进行基因分型,Linkage软件计算两点LOD值。研究过程遵循赫尔辛基宣言。结果未发现所选微卫星位点与该家系疾病表型共分离,LOD值均为负值。致病基因与已知的先天性眼组织缺损候选基因不存在连锁关系。结论该家系的遗传与目前已知的致病基因无关,是否存在新的致病基因有待进一步研究。     

Effects of scleral buckling and encircling procedures on human optic nerve head and retinochoroidal circulation

AIMS: To study the effects of segmental scleral buckling and encircling procedures on tissue circulation in the human optic nerve head (ONH) and choroid and retina. METHODS: Using the laser speckle method, the normalised blur (NB) value, a quantitative index of tissue blood velocity, was measured every 0.125 seconds and averaged over three pulses in the optic nerve head (NB(ONH)) and choroid and retina (NB(ch-ret)) in 10 patients with unilateral rhegmatogenous retinal detachment (mean age 52 (SD 17)). NB(ONH), NB(ch-ret), and intraocular pressure (IOP) in both eyes, and blood pressure (BP) were measured before, and 1, 4, and 12 weeks after the scleral buckling and encircling procedure. RESULTS: NB(ch-ret) on the buckled side was significantly reduced after surgery and smaller than that in the unoperated contralateral eye throughout the study period (ANOVA, p<0.0001). NB(ch-ret) on the unbuckled side, in the foveal area, NB(ONH), IOP, and BP showed no significant change. CONCLUSIONS: It was indicated that the segmental scleral buckling procedure with encircling elements decreased tissue blood velocity in the choroid and retina on the buckled side but caused no significant change on tissue circulation in other areas of the fundus or ONH.     

Angle closure in carotid-cavernous fistula

The case reported is one of the angle closure and pupillary block associated with carotid-cavernous fistula. Pathophysiologic mechanisms, involving elevated orbital venous pressure, are explored.     

Removable-suture closure of the lamellar scleral flap in trabeculectomy

Removable-suture closure of the lamellar scleral flap was attempted in trabeculectomy, with the goal of increasing the degree of filtration during the immediate postoperative period by removing the suture so as to undo the closure whenever the need arose. The incorporation of the removable-suture closure of the lamellar scleral flap resulted in an additional mechanism of control over the degree of filtration after trabeculectomy. Furthermore, the availability of such a mechanism allowed the surgeon to close the lamellar scleral flap relatively tightly; this resulted in a decreased incidence of postoperative complications.     

Tight versus loose scleral flap closure in trabeculectomy surgery

Thirty-two consecutive trabeculectomy patients were randomized to receive a tight scleral flap closure (15 eyes) with postoperative laser suture lysis, or a loose scleral flap closure (18 eyes) to determine differences in the surgical results. Three months postoperatively no statistical difference in intraocular pressure (loose closure 15.1 ± 3.3 mm Hg, tight closure 15.0 ± 3.6 mm Hg,p > 0.05) or number of glaucoma medicines (loose closure 1.6, tight closure 1.3,p > 0.05) existed between treatment groups. In the early postoperative period, no statistical difference between groups was observed in the anterior chamber depth, visual acuity or intraocular pressure (p > 0.05). Laser suture lysis was performed without complication in nine patients with a statistically significant reduction in intraocular pressure (p < 0.01). This study suggests, by the technique used, that no obvious benefit exists in using a tight versus a loose scleral flap closure when performing a trabeculectomy.     

巩膜瓣顶角可调节缝线在闭角型青光眼手术中的应用

目的:探讨巩膜瓣顶角可调节缝线在闭角型青光眼患者小梁切除联合巩膜瓣下生物羊膜植入术中的应用价值.方法:回顾性分析行小梁切除联合巩膜瓣下生物羊膜植入术的闭角型青光眼患者94例106眼临床资料,根据其术中是否应用巩膜瓣顶角可调节缝线的情况分为研究组54例60眼(术中应用巩膜瓣顶角可调节缝线)和对照组40例46眼(术中未应用巩膜瓣顶角可调节缝线).观察比较两组患者术后2 wk内早期浅前房、持续性浅前房及相关并发症发生情况,分析其术后3 mo内功能性滤过泡形成情况,记录术前及术后1 mo眼压改善情况.结果:术后2 wk内,研究组早期浅前房及持续性浅前房发生率均明显低于对照组,差异有统计学意义(P<0.05),两组并发症发生率比较差异无统计学意义(P>0.05).术后1mo,两组患者眼压均较术前明显降低,差异有统计学意义(P<0.05),且研究组手术前后眼压差值显著大于对照组,差异有统计学意义(P<0.05).术后3mo时,研究组功能性滤过泡形成率明显高于对照组,差异有统计学意义(P<0.05).结论:将巩膜瓣顶角可调节缝线用于小梁切除联合巩膜瓣下生物羊膜植入术中,可有效降低浅前房发生风险,对改善闭角型青光眼患者眼压、功能性滤过泡形成等具有积极意义.     

A two-layer closure of sino-orbital fistula

A two-layer closure of sino-orbital fistulae using tension-free local flaps is described. For small fistulae, the opening is first closed with a mucosal turnover flap; this is combined on the orbital surface with a local rotational advancement flap of the orbital skin. For larger fistulae where a mucosal turnover flap cannot be fashioned, a two-stage, delayed, composite mucocutaneous rotational flap is used. The advantages of these techniques are: (1) a mucous membrane to provide nasal or sinus lining, insulating the raw ventral surface of the skin flap; (2) each flap has an independent blood supply; (3) local flaps are used, avoiding the use of a pedicle flap from forehead; (4) excellent cosmesis since tissues outside the orbital rim are not disturbed; and (5) does not require refitting of exenteration prosthesis since the integrity of the orbital rim is maintained. The authors have used these techniques in six patients with chronic sino-orbital fistulae of the exenterated socket. In one patient, a wound dehiscence occurred and a small fistula measuring 3 to 4 mm in diameter persisted. The fistulae of the remaining five patients were successfully closed.     

Clinical spectrum of spontaneous carotid-cavernous fistula

A carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system. A CCF is divided into two categories, direct and indirect. Direct fistulas usually account for 70 to 90% of all CCF. Spontaneous, low-flow fistulas are usually associated with atherosclerosis, hypertension and collagen vascular disease or may develop in females during peripartum period. The elderly age group, especially women are at increased risk. We report three cases of spontaneous CCF presenting with ocular manifestations and hypertension, without any collagen vascular disease. One case was a direct variety and the other two were of indirect variety.     

Successful closure of traumatic macular holes.

PURPOSE: To establish the efficacy of vitreoretinal surgery without the use of transforming growth factor-beta or autologous platelet concentrate in the repair of traumatic macular holes. METHODS: This retrospective review consisted of 16 eyes from 16 consecutive patients treated by five vitreoretinal surgeons at a single institution between 1993 and 1997. Intervention included pars plana vitrectomy with creation of posterior vitreous detachment, placement of 14% to 16% C3F8 gas, and postoperative face-down positioning. Ten eyes received intraoperative autologous plasmin to facilitate formation of posterior vitreous detachment. Main outcome measures were anatomic closure rate and visual outcome. RESULTS: Anatomic closure of the macular holes was achieved in 15 (94%) of 16 eyes, with an average follow-up of 7 months. Six (38%) eyes achieved visual acuity of 20/40 or better. Visual acuity improved by 2 or more lines in 11 (69%) of 16 eyes. The average preoperative logMAR-converted visual acuity of 20/175 improved to 20/60 postoperatively. CONCLUSION: Traumatic macular holes can be closed successfully with substantial visual recovery without the use of transforming growth factor-beta or platelet concentrate.