Indications and results of relaxing retinotomy

The authors report their results of a consecutive series of 40 eyes undergoing relaxing retinotomy during vitrectomy to achieve retinal reattachment for the following indications: proliferative vitreoretinopathy (PVR), 21 eyes (52%); trauma, 10 eyes (25%); diabetic retinopathy, 6 eyes (15%); and expulsive choroidal hemorrhage, 3 eyes (8%). Thirty eyes (75%) had undergone previous vitreoretinal procedures. Extended tamponade was achieved in all cases with either silicone oil (27 eyes, 68%) or long-acting gas (13 eyes, 32%). Retinotomy size ranged from 45 degrees to 360 degrees. Intraoperative retinal attachment was possible in all eyes with 33 (83%) achieving total or subtotal retinal attachment including the macula for 5 months or more. Twenty-seven eyes (68%) achieved 3/200 visual acuity or better and 10 (37%) achieved 20/400 or better. Thirteen eyes (32%) failed to achieve 3/200 visual acuity secondary to recurrent detachment (18%), corneal decompensation (8%), macular dysfunction (5%), and glaucoma (3%).     

Towards a Neurotransmitter-Based Retinal Prosthesis Using an Inkjet Print-head

Electronic chips that provide a patterned stimulus to cells in the retina may provide a viable treatment for age-related macular degeneration. A surrogate MEMS device, in the form of a print-head from a desktop printer, has been used to eject a pattern of neurotransmitters (bradykinin) onto living rat pheochromocytoma (PC12) cells. Fluorescent calcium imaging was used to measure the patterned stimulation of individual cells. The chemical stimulation of cells by directed microfluidic delivery may have applications in retinal prosthetic devices, and in other prosthetic implants in the nervous system.     

眼前节内眼手术应用5％吡咯烷酮碘两种不同用法的前瞻性随机化比较研究

目的：确定5％吡咯烷酮碘采用两种不同的方法（结膜囊滴两滴和10ml溶液穹窿结膜冲洗）对降低结膜囊菌群的功效。方法：在这项前瞻性对照实验中。将行眼前节手术的200只眼随机分为对照组和研究组。两组病例术前均给予氧氟沙星滴眼液局部点眼和5％吡咯烷酮碘眶周区域皮肤擦洗消毒。术前对照组眼结膜囊内给予2滴5％吡咯烷酮碘溶液，研究组眼用5％吡咯烷酮碘溶液冲洗穹窿结膜。分别于术前和术后4个时间点行结膜细菌培养。结果：研究组78只眼中20只眼（26％）术前结膜细菌培养阳性：对照组94只眼中40只眼（43％）为阳性（P=0．02）。手术结束时。研究组78只眼中14只眼（18％）、对照组94只眼中30只眼（32％）结膜细菌培养阳性（PP=0．05）。结论：手术时应用5％吡咯烷酮碘溶液冲洗穹窿结膜与结膜囊仅点入两滴相比。前者显著降低了结膜细菌培养阳性率。     

Treatment of dislocated crystalline lens and retinal detachment with perfluorocarbon liquids.

Removal of a crystalline lens dislocated into the vitreous cavity can be hazardous, particularly in the presence of a retinal detachment. Hard pieces of nuclear material may be difficult to extract and may repeatedly fall onto the retina when emulsification is attempted in the vitreous cavity. Cases involving four eyes with dislocated crystalline lens and rhegmatogenous retinal detachment, into which liquid perfluorocarbon was injected after vitrectomy to float the dislocated lens material off the retina and reattach the retina, are reported. The dislocated lens was removed while floating on the perfluorocarbon liquid, which also provided a cushion that prevented dropped fragments of lens from traumatizing the retina. In all four cases, surgery was not associated with complications and resulted in improvement in visual acuity and retinal reattachment.     

The Acute Retinal Necrosis Syndrome: Part 2: Histopathology and Etiology

The acute retinal necrosis syndrome is manifested by diffuse uveitis, vitritis, retinal vasculitis, and acute necrotizing retinitis (see Part 1). We studied the histopathology and electron microscopic findings of an eye enucleated from a 67-year-old man with typical acute retinal necrosis. Histology showed profound acute necrosis of the retina, retinal arteritis, and eosinophilic intranuclear inclusions in retinal cells. Electron microscopy demonstrated a herpes group virus in all layers of affected retina. The implications of these findings for antiviral and other treatments are discussed.     

Clinicopathologic study after submacular removal of choroidal neovascular membranes treated with verteporfin ocular photodynamic therapy

PURPOSE: To report the clinicopathologic findings after submacular removal of choroidal neovascular membranes (CNV) treated with verteporfin ocular photodynamic therapy. DESIGN: Interventional case series. METHODS: Retrospective review of eight eyes of eight patients who underwent submacular surgery for CNV after having previously received verteporfin ocular photodynamic therapy for presumed ocular histoplasmosis (one patient), age-related macular degeneration ([AMD] three patients) pathologic myopia (two patients), punctate inner choroiditis (one patient), and idiopathic CNV (one patient). All cases had undergone ocular photodynamic therapy with verteporfin using standard protocols. Six of eight patients suffered a submacular hemorrhage after ocular photodynamic therapy, and two of eight patients refused further ocular photodynamic therapy. All patients subsequently had submacular surgery with removal of the CNV. One membrane was routinely processed, sectioned, and stained with hematoxylin and eosin. Five membranes were stained with toluidine blue for light microscopic examination. Semithin (1.0 microm) sections were cut and stained with uranyl acetate-lead citrate for transmission electron microscopy. RESULTS: Choroidal neovascular membranes were removed at 3 days (presumed ocular histoplasmosis), 29 days (punctate inner choroiditis), 63 days (AMD, pathologic myopia), 66 days (AMD), 107 days (pathologic myopia), 116 days (AMD), and 152 days (idiopathic) after verteporfin ocular photodynamic therapy. Histopathologic and ultrastructural examination showed areas of vascular occlusion at 3 days that were not seen at later time points. All specimens had patent CNV. There were signs of vascular damage with extravasated erythrocytes and fibrin, pigment clumping in cells, and inflammatory cells in all but the 3-day specimen.CONCLUSIONS: This case series presents data only from patients who refused repeat treatment with ocular photodynamic therapy or who developed submacular hemorrhage after initial photodynamic therapy. Histopathologic evaluation of CNV 3 days after verteporfin ocular photodynamic therapy showed partial vascular occlusion that was not present in later specimens. These later specimens demonstrated evidence of vascular damage. Verteporfin ocular photodynamic therapy does not appear to lead to permanent and complete occlusion of the CNV. Thus, treatments that lead to permanent closure of CNV without damage to the retinal pigment epithelium and sensory retina are still needed.     

Risk factors in age-related maculopathy complicated by choroidal neovascularization

We evaluated previously reported and hypothesized risk factors for the development of age-related maculopathy (ARM) in a case-control study. We compared 26 patients with documented disciform scarring or choroidal neovascularization with 23 age- and sex-matched controls. Systolic and diastolic blood pressure, smoking history, glucose, lipoprotein profiles, and serum levels of vitamins A, C, and E did not differ significantly between the two groups. Statistically significant associations (P less than 0.05) identified by univariate analysis include degree of dermal elastotic degeneration in sun-exposed and sun-protected skin, white blood count, increasing age and small posterior lenticular opacities. Using an interactive multivariate model, only extent of elastosis in sun protected dermis, age and white blood count were predictive (Mult R = 0.652, P less than .001). Our data support the concept of a multifactorial etiology of ARM but suggest that generalized increased susceptibility of elastic fibers to photic or other degenerative stimuli is a new and important risk factor for choroidal neovascularization.