Closed vitrectomy for severe retrolental fibroplasia in the infant

Fifteen infants between the ages of 5 months and 2 years suffering from severe retrolental fibroplasia with near total and total retinal detachment and retrolental scar tissue formation were operated upon with closed vitrectomy. The surgical technique and the problems related to the smallness of the eye and the changes caused by RLF are discussed in detail. Seven retinas were reattached completely and one retina partially reattached. Vision was definitely improved, although the visual acuity was probably low.     

Strabismus and pseudostrabismus with retrolental fibroplasia.

Three patients with temporal displacement of the macular secondary to retrolental fibroplasia had true strabismus in associations with amblyopia and pseudostrabismus related to a large, positive angle kappa. In one case, a headturn associated with the neutral point of nystagmus was also a presenting problem. Ocular deviation was measured by the light reflex test and the prism cover test, with particular attention paid to adequate cosmetic alignment. Large amounts of prism placed before the fixating eye resulted in loss of visual acuity, while eyes placed in a parallel position by surgical means may not appear to be straight. Thus, surgery can result in parallel ocular alignment while prismatic therapy may be required to center the pupillary light reflex and to provide satisfactory cosmetic appearance.     

Survey on retrolental fibroplasia in France

From 1964 to 1976, 20 cases of retrolental fibroplasia were recorded in the south of France while 38 cases were recorded in the north from 1970 to 1977. The more children are immature, the more they are liable to suffer from this disease. Etiological factors are apparently not limited to oxygen, which however plays the most important part in the process.     

Use of high-density fluorosilicone oil in open-sky vitrectomy

During prolonged open-sky vitrectomy, fluid accumulates in the suprachoroidal and subretinal spaces and the resultant ballooning of the choroid and of the retina interferes with the surgery. Fluorosilicone oil (polymethyl-3,3,3-trifluoropropylsiloxane) with a specific gravity of 1.28 was tested for use as a temporary vitreous substitute during open-sky vitrectomy. After open-sky vitrectomy and bullous retinal detachment in pigmented rabbits, fluorosilicone oil flattened the retina completely in nine of nine eyes, whereas 1% sodium hyaluronate solution flattened the retina completely in only four of nine eyes. The flattening effect of fluorosilicone oil on the retina was also better than that of 1% sodium hyaluronate in an experiment with retinal detachment and giant retinal tear after open-sky vitrectomy.     

Secondary angle-closure glaucoma in cicatricial retrolental fibroplasia

Five patients had cicatricial retrolental fibroplasia with a complication of secondary angle-closure glaucoma. In all the patients, the glaucoma occurred after age 2 years. All were treated with a pars plana lensectomy and anterior vitrectomy, which alleviated the glaucoma. They all achieved normal intraocular pressure and a pain-free eye. However, visual acuity was poor, in the range of light perception to hand motions. All patients have been followed up for one year and in only one patient has the fellow eye developed secondary angle-closure glaucoma.     

Endothelial cell density determined by specular microscopy and scanning electron microscopy.

Human eyes were photographed with a specular microscope and later examined wit a scanning electron microscope. Corneas from patients undergoing corneal transplantation in whom we were able to obtain preoperative specular micrographs were similarly analyzed. An attempt was made to correlate the counts obtained with both microscopic techniques by determining the amount of shrinkage the cornea undergoes while being processed for SEM. All specimens were counted with a planimeter. We found that the specular microscope adequately analyzes the endothelial cell density in the central and paracentral cornea of a normal eye, but because of its small sampling area specular microscopic counts are subject to significant error when dealing with nonhomogeneous populations such as postoperative cases. We found the peripheral corneal endothelial density to be less than the central endothelial density. Furthermore, we found that we could maximize the accuracy of counting by using a variable frame in a nonhomogeneous population, counting a minimum of four photographs per specimen, analyzing different areas, and analyzing larger areas.