Vitrectomy for diabetic traction retinal detachment involving the macula

We analyzed the surgical results for 197 eyes that underwent vitrectomy for diabetic traction detachment of the macula. The retina was successfully reattached in 130 of the 197 cases (66%), although the final level of vision depended on the amount of permanent macular damage from the previous detachment and on the effects of the retinal vascular disease. At the final examinations, 112 eyes (57%) had improved visual acuities, 68 eyes (35%) were worse, and 17 eyes (9%) were unchanged. Thirteen eyes (7%) had final visual acuities of 20/40 or better, 103 eyes (52%) had final visual acuities of 20/50 to 20/800, and 81 eyes (41%) had final visual acuities worse than 20/800. Two preoperative factors were associated with a worse prognosis for achieving a final visual acuity of 20/800 or better: preoperative vitreous hemorrhage (P less than .01) and the absence of preoperative scatter retinal photocoagulation (P less than .01). Additionally, two surgical factors, lens removal and the creation of iatrogenic retinal breaks, were associated with a poorer visual prognosis (P less than .002 and P less than .01, respectively). The group of eyes that underwent lens removal during vitrectomy also had a significantly higher incidence of postoperative iris neovascularization compared to eyes in which the lenses were not removed (P less than .05).     

Prognosis of traction retinal detachment in proliferative diabetic retiopathy

Considering the complications which may arise when traction retinal detachment (TRD) is treated surgically, the correct assessment of its course is important. The evolution of TRD in proliferative diabetic retinopathy is described and its pathogenesis discussed. In order to predict the course of a specific clinical situation we have to assess the activity of retinopathy and the localization and extension of vitreoretinal adhesions. Some guide lines for proper evaluation and proper management of the often complicated clinical picture of TRD in proliferative diabetic retinopathy are presented.     

玻璃体切除术治疗牵拉性视网膜脱离34例

目的：探讨玻璃体切除术治疗牵拉性视网膜脱离的方法和疗效.方法：各种病因导致的牵拉性视网膜脱离34例36眼,行玻璃体切除术治疗,术后观察视力、视网膜复位情况及手术并发症等,随访3-6（平均3.8）mo.结果：术后视网膜复位,视力有不同程度的提高者32眼（89%）;术后3mo内视网膜再脱离4眼,其中2眼经再次手术后复位,2眼眼球萎缩未再手术.手术并发症主要有术中牵拉性裂孔、术中及术后玻璃体积血、术后高眼压、视网膜再脱离等.结论：玻璃体切除术是治疗牵拉性视网膜脱离的有效方法,尤其对于存在广泛固定牵拉、视网膜大范围脱离、玻璃体积血、合并严重的增殖性玻璃体视网膜病变的患者是唯一有效的手术方法.     

松弛性视网膜切开治疗穿孔伤性视网膜脱离

目的 探讨松弛性视网膜切开对穿孔性牵引性视网膜脱离(perforating traction retinal detachment,PTRD)的治疗价值和效果。 方法 对1998～2001年本院住院行松弛性视网膜切开的21例PTRD患者作回顾性分析。 结果 出院时视网膜解剖均复位，数指(counting finger,CF)以上视力12例占57%，最好视力为0.05。18例患者随访时间6～24个月，解剖复位14例占77.8%。 结论 为了提高PTRD的解剖复位率，松弛性视网膜切开是有效方法之一。尤其适用于伴有视网膜嵌顿、前部增生性玻璃体视网膜病(anterior prolif erative vitreoretinopathy, aPVR)、机化条索的PTRD患者。 （中华眼底病杂志，2003，19：5-7）     

糖尿病视网膜病变黄斑牵拉视网膜脱离的手术治疗

目的 报告增殖性糖尿病视网膜病变黄斑部牵拉性视网膜脱离的手术结果。方法 对2000年3月～2003年4月初次采用玻璃体切除，并追踪观察6个月以上的49例51眼，术后解剖复位率。视力预后进行回顾性研究。结果 手术后解剖学复位51眼中41眼，占80．3％，最终视力提高24眼(47％)。不变16眼(31．3％)，下降者11眼(21．7％)，术中医源性裂孔29眼(56．9％)，术后视力0．1以上者多为黄斑脱离≤2个月，为12眼中6眼(50％)，与2个月以上者(39眼中5眼，占2．8％)相比有显著性差异。结论 在增殖性糖尿病性视网膜病变黄斑部牵拉性视网膜脱离患者中。黄斑视功能低下者较多，为了提高术后视力，早期玻璃体手术是必要的。     

Experimental retinal detachment in the owl monkey

Summary The ERG was used to assess the alteration of retinal function induced by experimental retinal detachment and surgical reattachment in owl monkeys.All electrical activity can be abolished within seven days after the production of total retinal detachment. Reattachment of the retina resulted in an early and progressive recovery of the ERG. The amplitude of the b-wave and the threshold intensity of light necessary to evoke an ERG were linearly related to the time after the retina was reattached.

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Zusammenfassung Das ERG wurde benutzt um Änderungen in der retinalen Funktion festzustellen, die hervorgerufen wurden durch experimentelle Netzhautablösung und operative Wiederanheftung der Netzhaut am Eulenaffen.Die elektrische Aktivität der Netzhaut war mit Entwicklung einer totalen Netzhautablösung innerhalb von 7 Tagen völlig ausgelöscht. Kurz nach Wiederanheftung der Netzhaut erholte sich kontinuierlich das ERG. Die Höhe der b-Welle und der Schwellenwert der Lichtintensität, die nötig waren, ein ERG hervorzurufen, waren linear abhängig von der Zeit der Wiederanheftung der Netzhaut.

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Read in part before the 69th meeting of the Deutsche Ophthalmologische Gesellschaft, Heidelberg, September 25, 1968.

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This investigation was supported in part by Public Health Service Research Grant NB-07575-01 from the National Institute of Neurological Diseases and Blindness, Bethesda, Maryland, in part by a Fight for Sight, Inc., New York, N. Y. Grand-in-Aid No. G-371 and G-387, and in part by Research to Prevent Blindness, Inc., New York, N.Y.The investigators were supported by a Public Health Service Research Career Development award # 1-K03-NB-14692-01 from the National Institutes of Health, Bethesda, Maryland, and a Fight for Sight, Inc., New York, N.Y., Postdoctoral Research Fellowship # F-211.

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Dedicated to my former chief, Professor DoctorWilhelm Hallermann, Universitäts-Augenklinik Göttingen, on the occasion of his 60. birthday.     

Clinical results in vitrectomy for diabetic traction retinal detachment.

A series of 75 eyes underwent pars plana vitrectomy for progressive diabetic traction retinal detachment of the macula. In all cases, the media was sufficiently clear to allow preoperative macular examination. The overall visual improvement was higher in phakic eyes (80%) than aphakic eyes (72%) and the rate of neovascular glaucoma was less in phakic eyes. The difference was not statistically significant, however. The final visual acuity corresponded to the degree of preoperative visual deterioration. Thus, surgery during the rapidly evolving proliferative and retracting process did not adversely affect the visual success rate when compared to previous reports on longstanding vitreous hemorrhage.     

Bevacizumab prior to vitrectomy for diabetic traction retinal detachment

Purpose

To assess the efficacy and safety of preoperative intravitreal bevacizumab (IVB) before vitrectomy for diabetic tractional retinal detachment (TRD).

Methods

Using ICD-9 codes, we located all patients with diabetic TRD who underwent 3-port 20-gauge vitrectomy primarily performed by one surgeon between January 2004 and January 2009. Eyes receiving IVB were compared with those not. The following outcomes were compared: visual acuity (VA), duration of surgery, and complication rates.

Results

A total of 99 eyes of 90 patients were included in the analysis. In all, 34 patients received IVB on an average of 11.5 (range, 3–30) days previtrectomy. Age was 46.5 and 51.6 in the IVB and non-IVB groups, respectively. VA was improved significantly in both groups: from 20/617 to 20/62 in the IVB group, and from 20/443 to 20/86 in the non-IVB group (P=0.11 between groups). Operating time and postoperative complications (glaucoma, RD, and revitrectomy rate) were similar in both groups. On comparing IVB and non-IVB eyes in younger patients (≤40), operating time was shorter (P=0.02) and a trend to better VA in the IVB group was seen.

Conclusions

Preoperative IVB may be a useful adjunct to vitrectomy for severe PDR complicated by TRD, particularly in younger diabetics.     

Experimental tractional retinal detachment in rabbits

A simple reproducible model for the creation of tractional retinal detachments in rabbits is presented. This model comprises retinal membranes composed of different cell types derived from ocular tissues, and eliminates the need for lengthy and expensive tissue culturing procedures. The injected cell bolus rapidly migrates to the optic disc and forms surface retinal membranes. These lead to tractional retinal detachment confined to the area of the vascular medullary rays. The rapidity and severity of the clinical process seems to be directly dependent upon the number of cells injected. Good visibility of the posterior pole is maintained throughout the course of the development of detachment.This model is acceptable for testing agents to suppress intraocular cellular proliferation. It can also serve to teach surgical techniques for the management of vitreo-retinal membranes without endangering human eyes.

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Zusammenfassung Es wird ein einfaches, reproduzierbares Modell zur Erzeugung einer Traktionsamotio bei Kaninchen vorgestellt. Dabei werden epiretinale Membranen, die von unterschiedlichen okulären Zelltypen abstammen, gebildet und so die Notwendigkeit langdauernder und kostspieliger Gewebekulturen eliminiert. Der injizierte Zellbolus wandert schnell in Richtung Papille, bildet Membranen auf der Netzhautoberfläche, und führt dann zum Auftreten einer Traktionsamotio, die auf das Gebiet der vascularisierten Markstrahlen beschränkt ist. Die Schnelligkeit und Schwere des klinischen Verlaufes scheint direkt proportional zur Zahl der injizierten Zellen zu sein. Während der gesamten Entwicklung der Traktionsamotio bleibt der Einblick auf den hinteren Augenpol ungestört.Dieses Modell eignet sich zur Testung von Mitteln zur Unterdrückung intraokularer Zellproliferation. Außerdem bietet es die Möglichkeit, chirurgische Techniken zur Behandlung vitreo-retinaler Membranen zu lernen, ohne dabei menschliche Augen zu gefährden.

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This investigation was supported in part by the Wasserman Professorship Fund     

Vitrectomy for diabetic traction retinal detachment using the multiport illumination system

OBJECTIVE: To examine the visual and anatomic results of bimanual vitrectomy surgery with the multiport illumination system (MIS) in eyes with advanced diabetic traction retinal detachment. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Sixty-seven consecutive eyes in 62 patients having vitrectomy with the MIS. METHODS: During surgery, the vitreous, the posterior hyaloid membrane, and fibrovascular proliferative tissue were removed by using bimanual dissection made possible by the MIS. MAIN OUTCOME MEASURES: Retinal reattachment rate, visual function, and postoperative complications were compared with previously published series of vitrectomy for diabetic traction retinal detachment. RESULTS: With a minimum of 6 months of follow-up, complete retinal reattachment was achieved in 62 eyes (93%), and macular attachment was achieved in all 67 eyes. Vision was stabilized or improved in 51 eyes (72%), and 5/200 vision was achieved in 47 eyes (70%). No unique complications, such as incision-related retinal tears, occurred. CONCLUSION: MIS allows bimanual surgery during vitrectomy for diabetic traction retinal detachment, with good visual and anatomic results.     

Treatment of diabetic traction retinal detachment with the pulsed neodymium-YAG laser

Three patients with diabetic traction retinal detachment not involving the central macula were treated with the pulsed neodymium-YAG laser. In each case, with energy levels of 9 to 11 mJ, vitreous traction bands were sectioned and the traction retinal detachment diminished or disappeared. Other than a small choroidal hemorrhage in one instance, no adverse side effects occurred. The pulsed neodymium-YAG laser may provide a new therapeutic modality in a few selected cases of diabetic traction retinal detachment.     

Pathogenesis and therapy of traction detachment in various retinal vascular diseases

We examined six patients with retinal vasculopathies (two cases each of angiomatosis retinae [von Hippel-Lindau disease], exudative vitreoretinopathy, and Coats' disease), who developed preretinal and vitreal membranes, retinal traction detachment, and exudation under the retina. The membranes consisted of a core of collagen of various diameter fibers usually covered on both sides by cells that displayed glial cell characteristics. The retina reattached spontaneously and exudates disappeared when traction was eliminated by vitreous surgery. Membrane formation did reoccur after vitrectomy if the vessels continued to leak, leading again to traction and subretinal exudation. Treatment consisted of surgical removal of vitreal and preretinal membranes and destruction of leaking vessels.     

Perifoveal traction retinal detachment following successful optic disc pit surgery

A 25-year-old male presented 8 years after a successful vitreoretinal operation for a left optic disc pit (ODP). On presentation his visual acuity had reduced from 6/5 (20/15) to 6/12 (20/40) in his operated eye. On examination an annular serous retinal detachment possibly secondary to tangential traction by either the internal limiting membrane (ILM) or residual lamellar vitreous cortex or both around the peripheral macular area was seen. The central fovea was flat. Following an uncomplicated vitrectomy and ILM peel, visual acuity improved to 6/6 (20/20) postoperatively. The author suggests that traction forces are responsible for the development of the serous detachment in eyes with ODP. Epiretinal membranes together with the ILM should be removed in all patients undergoing therapy for a retinal detachment associated with ODP in an effort to initially achieve a further relief of all forces and to try to avoid the late retinal detachment associated with epiretinal membrane or ILM contraction.     

视网膜脱离模型的实验研究

目的：尝试在兔眼上建立有效的实验性视网膜脱离（ｒｅｔｉｎａｌ ｄｅｔａｃｈｍｅｎｔ,ＲＤ）,为今后研究ＲＤ复位后视功能损害机理奠定基础。方法;１４只成年灰兔,分为实验组和对照组。实验组在显微镜下使用２７Ｇ前房注射针在中视网膜上造孔后,注射０．１％透明质酸钠０．２￣０．３ｍｌ,可见视网膜呈灰白色隆起。术后观察１￣４周后进行组织学观察。结果：术后１００％实验兔发生ＲＤ,范围达７５％￣８５％,所有眼反应