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ABSTRACT: Macular translocation by chorioscleral infolding has been proposed as a surgical intervention for exudative age-related macular degeneration, but the surgery is unpredictable and can be associated with severe complications. We tested a new surgical technique, macular translocation with chorioscleral outfolding secured by neurosurgical clips.
This was a prospective interventional study in two parts; the first in human cadaver eyes and the second in pigs. Chorioscleral infolding was performed on six human donor eyes, and chorioscleral outfolding was performed on an additional six. The inner surface of the eye wall was measured, and then the fold was unfolded and the distance was measured again. In the second half of the study, macular translocation surgery was performed on 33 pig eyes with one of three sclera shortening methods: 1) a circumferential chorioscleral infolding using 5-0 nylon sutures, 2) a circumferential chorioscleral outfolding using scleral clips, or 3) a radial chorioscleral outfolding using scleral clips. Foveal translocation was measured.
The inner wall of the human cadaver eye was shortened in the chorioscleral infolding group by a mean of 1.6 mm, and in the chorioscleral outfolding group by 3.0 mm. In the pig eyes, the fovea was translocated a mean 2377 microm by circumferential suturing, 2582 microm by circumferential clipping, and 3386 microm by radial clipping. Irregular deformation of the globe was more apparent in the circumferential suture group. Undesirable retinal folds often formed after circumferential infolding but not after radial clipping.
Radial chorioscleral outfolding with clips is more predictable and effective than infolding. It produces more translocation and prevents folds across the fovea, one of the most undesirable complications in macular translocation surgery.
American Journal of Ophthalmology 09/2001; 132(2):149-55. · 4.22 Impact Factor
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H Lewis
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ABSTRACT: A new surgical technique to translocate the macula was used to treat patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration (AMD).
Prospective, interventional case series.
Twenty-five eyes of 25 patients underwent macular translocation with either circumferential or radial chorioscleral outfolding using three clip sizes: 2-mm, 3-mm, and 4-mm. Postoperative photocoagulation was performed on only those eyes that had an extrafoveal choroidal neovascular membrane following surgery.
The surgery successfully displaced the fovea in 22 (88%) of the eyes. The median postoperative foveal displacement was 1142 microm (range 0 to 3200 microm). Patients who had radial outfolding with 4-mm clips had the greatest displacement of the fovea (range 1644 to 3200 microm median 1977 microm). The fovea was successfully displaced to a location outside the choroidal neovascular membrane in 17 (68%) of the 25 eyes. The best-corrected visual acuity improved in 11 eyes (median, 17 letters), remained unchanged in 4 eyes, and decreased in 10 eyes (median, 12 letters). Visual acuity increased by a median of 2 letters. The final best-corrected visual acuity was 20/64 in 3 eyes; 20/80 in 3 eyes; 20/100 in 4 eyes; 20/126 in 4 eyes; 20/200 in 4 eyes; 20/250 in 4 eyes; and 20/400 in 3 eyes.
Macular translocation with radial chorioscleral outfolding using 4-mm clips resulted in the best foveal displacement and improvement in visual function, and was associated with the least amount of vision loss and complications. Further refinements are needed to make this surgical procedure more predictable, and more research (randomized clinical trials) is needed to determine the role of macular translocation in the treatment of subfoveal choroidal neovascularization in patients with AMD.
American Journal of Ophthalmology 09/2001; 132(2):156-63. · 4.22 Impact Factor
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R N Johnson,
H R McDonald, H Lewis,
M G Grand,
T G Murray,
W F Mieler,
M W Johnson,
H C Boldt,
K R Olsen,
P E Tornambe,
J C Folk
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ABSTRACT: To review our experience with vitrectomy surgery techniques for the treatment of traumatic macular holes and the biomicroscopic and surgical findings.
Retrospective noncomparative, multicenter, case series.
Twenty-five patients with traumatic macular hole underwent surgical repair.
Vitrectomy with membrane peeling and gas injection followed by prone positioning for 7 to 14 days.
Postoperative evaluation included visual acuity testing, closure of the macular hole, and ocular complications.
The macular hole was successfully closed in 24 of 25 cases (96%). The visual acuity improved two or more lines in 21 (84%) cases, and 16 (64%) achieved 20/50 or better vision.
Vitrectomy surgery can successfully close macular holes associated with trauma and improve vision.
Ophthalmology 06/2001; 108(5):853-7. · 5.45 Impact Factor
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ABSTRACT: To report a case of visual improvement after macular translocation performed for a subfoveal choroidal neovascular membrane in a patient with pseudoxanthoma elasticum and angioid streaks.
The fovea was translocated inferiorly by scleral imbrication, intentional retinal detachment with a small posterior retinotomy, and partial fluid-air exchange. The choroidal neovascular membrane was photocoagulated 1 week later.
The visual acuity of the patient improved from 20/125 to 20/40. The center of the foveal avascular zone was moved inferiorly 844 microm. The choroidal neovascular membrane was extrafoveal after translocation and was treated with laser photocoagulation.
Macular translocation may be considered in the management of subfoveal choroidal neovascular membrane in patients with pseudoxanthoma elasticum and angioid streaks.
American Journal of Ophthalmology 04/2001; 131(3):390-2. · 4.22 Impact Factor
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ABSTRACT: Snapping or tearing of an extraocular muscle refers to its rupture across its width, usually at the junction between muscle and tendon several millimeters behind the insertion. Tearing occurs during strabismus or retinal reattachment surgery, or after trauma. If the proximal end of the muscle cannot be located, transposition procedures are necessary to achieve ocular realignment. These surgical procedures carry the risk of anterior segment ischemia, especially in the elderly. Anterior transposition of the inferior oblique muscle has been used for the treatment of inferior oblique overaction, especially in the presence of a dissociated vertical deviation, and in patients with fourth nerve palsy. We transposed the inferior oblique muscle insertion in a 73-year-old woman with a snapped inferior rectus muscle.
Journal of American Association for Pediatric Ophthalmology and Strabismus 03/2001; 5(1):52-4. · 1.03 Impact Factor
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ABSTRACT: To review the clinical, photographic, fluorescein angiographic, and optical coherence tomographic findings in patients with the diabetic macular traction and edema (DMTE) associated with posterior hyaloidal traction (PHT).
We performed a prospective review of nine eyes of nine patients with diabetic macular edema (DME) and PHT on clinical examination. The patients had a comprehensive ophthalmic history and examination, color photographs, fluorescein angiography, and optical coherence tomography (OCT).
All patients had diabetic retinopathy and DME. Of the nine eyes, eight patients had previous focal or grid photocoagulation. All nine eyes had a thickened, taut, glistening posterior hyaloid on clinical biomicroscopic examination with no posterior vitreous separation. Fluorescein angiography was performed on seven eyes, and all had early hyperfluorescence with deep, diffuse, late leakage in the macular area consistent with DMTE associated with PHT. Optical coherence tomography scans of the macular region revealed retinal thickening in all eyes with a mean retinal thickness of 556.9 +/- 114.7 microns. In addition, eight of the nine eyes had a shallow macular traction detachment associated with PHT.
Eyes with DME associated with PHT may have a shallow, subclinical, macular detachment. Optical coherence tomography may be useful in evaluating patients with DME to see if a macular detachment is present.
American Journal of Ophthalmology 02/2001; 131(1):44-9. · 4.22 Impact Factor
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ABSTRACT: To review the authors' experience in the management of aphakic or pseudophakic patients without an intact posterior capsule who had undergone glaucoma implant surgery complicated by vitreous incarceration in the tube, resulting in increased intraocular pressure or combined rhegmatogenous and tractional retinal detachment.
Retrospective review of the clinical features, treatment, and outcomes of eight patients who had vitreous incarceration in a glaucoma implant drainage tube. In each patient, a model 425 (7 patients) or model 350 (1 patient) Baerveldt glaucoma implant was used.
Vitreous incarceration in the tube was first diagnosed 1 day to 49 weeks after surgery (mean, 7.5 weeks; median, 1 week). The interval between glaucoma implant surgery and pars plana vitrectomy ranged from 22 to 365 days (mean, 125 days). Before management with pars plana vitrectomy or neodymium:yttrium-aluminum-garnet laser vitreolysis, intraocular pressure ranged from 25 to 62 mm Hg (mean, 40 mm Hg). Four patients were initially treated with neodymium:yttrium-aluminum-garnet laser vitreolysis, which was successful in only one patient. Six patients were successfully treated with pars plana vitrectomy, and one patient declined surgery. Follow-up after treatment of the incarceration ranged from 5 weeks to 15 months (mean, 8.3 months). After pars plana vitrectomy, intraocular pressure ranged from 9 to 24 mm Hg (average, 14 mm Hg). Postoperative visual acuity remained within one line of the preoperative visual acuity in each of the six patients undergoing pars plana vitrectomy.
Pars plana vitrectomy is effective in managing vitreous incarceration in glaucoma implant tubes. Previous anterior vitrectomy does not prevent incarceration.
Journal of Glaucoma 09/2000; 9(4):311-6. · 1.78 Impact Factor
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ABSTRACT: Tissue plasminogen activator (tPA) is a thrombolytic agent that activates plasminogen into plasmin almost exclusively in the presence of fibrin. Intraocular injection of tPA has been proposed for the treatment of vitreoretinal diseases, such as vitreous hemorrhage, postvitrectomy fibrin formation, submacular hemorrhage, retinal vascular occlusive disorders, suprachoroidal hemorrhage and endophthalmitis. Currently, intraocular tPA is only used in the treatment of postvitrectomy fibrin formation and submacular hemorrhage. For other indications, tPA has not been shown to be safe or effective. This article reviews the use of tPA in the treatment of vitreoretinal disorders.
Seminars in Ophthalmology 04/2000; 15(1):44-50. · 0.90 Impact Factor
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H I Amin,
H R McDonald,
D P Han,
G J Jaffe,
M W Johnson, H Lewis,
P F Lopez,
W F Mieler,
J Neuwirth,
P Sternberg,
J C Werner,
E Ai,
R N Johnson
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ABSTRACT: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis.
This was a cohort study of patients seen in different institutions in the United States. Ten eyes of 10 patients were studied. Vitrectomy was performed in all eyes, combined with membrane removal, scleral buckle, fluid-gas exchange, silicone oil, or lensectomy in certain cases. The anatomic and visual results of surgery were reviewed.
Ten eyes from 10 patients ranging in age from 2 to 33 years (median, 6 years) were reviewed. Follow-up ranged from 3 months to 8 years (median, 2 years). All eyes achieved macular attachment following surgery; vision improved in 5 (50%) eyes, and was unchanged in 5 (50%). Histologic specimens from six eyes were reviewed, and revealed combinations of fibrous tissue, eosinophils, plasma cells, lymphocytes, and giant cells. One specimen revealed an encysted Toxocara canis organism.
Inflammation created in response to Toxocara larvae may lead to traction retinal detachment of the macula. Vitreoretinal surgery has a good chance of reattaching the macula and improving vision.
Retina 02/2000; 20(1):80-5. · 2.81 Impact Factor
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ABSTRACT: To report the use of indocyanine green angiography in the diagnosis of retinal arterial macroaneurysms associated with preretinal and subretinal hemorrhage.
Retrospective case series. Indocyanine green angiograms of five consecutive patients with dense preretinal, intraretinal, and subretinal hemorrhages in which the cause of hemorrhage was still in question after clinical evaluation and fluorescein angiography.
In five eyes of five patients, indocyanine green angiography demonstrated acquired retinal arterial macroaneurysms as the cause of hemorrhage. Each diagnosis was confirmed after the hemorrhages spontaneously resolved or were surgically removed.
Indocyanine green angiography is useful in the diagnosis of acquired retinal arterial macroaneurysms when fluorescein angiography is inconclusive because of preretinal, intraretinal, or subretinal hemorrhage. Establishing the diagnosis of retinal arterial macroaneurysm can influence the management of patients with submacular and premacular hemorrhage.
American Journal of Ophthalmology 02/2000; 129(1):33-7. · 4.22 Impact Factor
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ABSTRACT: Intravitreal injections of tissue plasminogen activator have been used to lyse fibrin from blood in the subretinal space, despite the lack of proof that tissue plasminogen activator can diffuse across the retina. We tested whether tissue plasminogen activator injected into the vitreous could penetrate the neural retina and enter the subretinal space.
We injected a mixture of 50 microg of tissue plasminogen activator (70 kD) labeled with fluorescein isothiocyanate and rhodamine B isothiocyanate-labeled dextran, which has a lower molecular weight (20 kD), into the midvitreous cavity of one eye in each of 18 rabbits. The eyes were enucleated after 3, 6, and 24 hours, and cryosections were examined with epifluorescent microscopy to determine the distribution of the labeled molecules. We also evaluated tissue plasminogen activator pharmacokinetics in one eye each of 18 rabbits in which a subretinal clot was induced by injecting autologous blood (50 microL) into the subretinal space through the sclera. Fluorescein isothiocyanate-labeled tissue plasminogen activator was injected into the vitreous 2 days after induction of the subretinal clot.
Fluorescein isothiocyanate-labeled tissue plasminogen activator was present at the vitreal surface of the retina in a linear array in all 36 eyes studied, whereas the rhodamine B isothiocyanate-labeled dextran had diffused throughout the neural retina in the same sections. No fluorescein isothiocyanate signal was observed in the neural retina or in the subretinal clot. Vitreous hemorrhage caused by retinal perforation was observed in all eyes with intraretinal hemorrhage in which fluorescein isothiocyanate fluorescence was seen in the neural retina and inside the clot.
Intravitreal tissue plasminogen activator did not diffuse through the intact neural retina to reach a subretinal clot. This study demonstrates no scientific rationale for the intravitreal tissue plasminogen activator treatment of submacular hemorrhage without vitreous hemorrhage presumably caused by an overlying retinal break.
American Journal of Ophthalmology 12/1999; 128(6):739-46. · 4.22 Impact Factor
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ABSTRACT: To conduct a prospective study of macular translocation in patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration.
In 10 eyes of 10 patients with subfoveal choroidal neovascularization and best-corrected visual acuity ranging from 20/50 to 20/800 (median, 20/111), the fovea was relocated by means of scleral imbrication, intentional retinal detachment with small posterior retinotomies, and partial fluid-air exchange. In two eyes, the choroidal neovascular membranes were removed at the time of macular translocation; in seven eyes they were photocoagulated in the postoperative period; and in one eye the membrane was removed during reoperation to unfold a macular fold.
All 10 eyes were followed up for 6 months. The median postoperative foveal displacement was 1286 microm (range, 114 to 1,919 microm). In three eyes (30%), a foveal fold formed postoperatively requiring reoperation, with one of these eyes requiring a second reoperation for a rhegmatogenous retinal detachment. Best-corrected visual acuity improved in four eyes (median, 10.5 letters) and decreased in six eyes (median, 14.5 letters). The median change in visual acuity was a decrease of 5 letters. The final best-corrected visual acuity was 20/80 in two eyes, 20/126 in one eye, 20/160 in four eyes, 20/200 in one eye, 20/250 in one eye, and 20/640 in one eye.
Our initial experience with limited macular translocation suggests that this surgical technique is unpredictable. However, in patients with subfoveal choroidal neovascularization from age-related macular degeneration, it offers the potential for improving visual function and may be associated with less loss of vision than the disease itself, if allowed to progress. Further refinements in surgical indications and technique are needed to make this procedure safer, more predictable, and more beneficial.
American Journal of Ophthalmology 09/1999; 128(2):135-46. · 4.22 Impact Factor
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ABSTRACT: To report the authors' clinical experience with submacular surgery for subfoveal membranes in children and to evaluate the histopathologic findings of membranes in children with various etiologies of choroidal neovascularization.
Retrospective, noncomparative, interventional case series.
Twelve eyes of 12 consecutive children with subfoveal choroidal neovascularization treated by vitrectomy and excision of the choroidal neovascular complex.
Vitrectomy, excision of the choroidal neovascular complex, and air-fluid exchange.
Visual acuity and recurrence of choroidal neovascular membrane.
Preoperative visual acuities ranged from 20/60 to 20/800 (median, 20/300). Postoperative visual acuities ranged from 20/25 to 20/400 (median, 20/80) after an average follow-up of 20 months (range, 7-62 months). Ten of 12 eyes improved from immediate preoperative visual acuity, and four eyes developed recurrence of neovascular membranes over a mean follow-up of 18 months. Histopathologic examination of six excised membranes showed that the most common components of the membranes were retinal pigment epithelium, fibrocytes, vascular endothelium, and collagen.
Selected eyes of children with subfoveal neovascular membranes and no evidence of membrane regression may benefit from submacular surgery. The histopathologic findings were similar to adult choroidal neovascularization not associated with age-related macular degeneration.
Ophthalmology 06/1999; 106(5):920-4. · 5.45 Impact Factor
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ABSTRACT: A prototype multiple-drug delivery implant has been developed for the intraocular management of proliferative vitreoretinopathy (PVR). Because of the recurrent nature of the disease, PVR causes blindness in approximately 7% of patients who have undergone retinal re-attachment surgery. The poly(dl-lactide-co-glycolide) 50/50 (PLGA) implant consists of three cylindrical segments, each of which contains one of the following drugs: 5-fluorouridine (5FUrd, an antimetabolite), triamcinolone (Triam, a corticosteroid), and human recombinant tissue plasminogen activator (t-PA, a thrombolytic agent). The device can be inserted through a 20-gauge syringe needle into the vitreous body of the eye. The implant also possesses a PLGA coating over the t-PA-containing terminal segment, which creates a lag-time to deliver t-PA when most needed and to decrease the risk of postoperative bleeding. Two methods of cylinder fabrication were investigated: heat and solvent extrusion. The release behavior of several drugs was examined as a function of the processing variables including: extrusion method, drug loading, polymer molecular weight, and drug particle size. The presence of either the organic solvent (acetone) during processing or a highly water-soluble drug (5FUrd) in the formulation increased the polymer porosity, which in turn, increased the drug release-rate. Drug loading effects were consistent with percolation concepts, and a low-molecular-weight PLGA (e.g., Mw=42000 for inherent viscosity=0.58 dl/g) was desirable to produce controlled release close to one month. Based on pharmacological and pharmacokinetic data of these compounds and our clinical experience with this disease, several design criteria for a combined implant were devised. Optimal cylindrical segments from the formulation studies were selected and combined in series to form a contiguous implant. After successful combination and coating procedures were developed, prototype implants were prepared. From the 3-drug prototype, 5FUrd and Triam were released approximately 1 microgram/day for over 4 weeks and 10-190 microgram/day over 2 weeks, respectively. The solvent-extrusion procedure did not significantly alter the stability of the encapsulated t-PA (>94+/-5% serine protease activity after preparation). After a lag-time of approximately 2 days, t-PA was released active at a rate of approximately 0.2-0.5 microgram/day in approximately 2 weeks. The release characteristics from the combined implant largely met our initial design criteria. Hence, controlled-release implants of this kind may have potential use for intraocular treatment of PVR.
Journal of Controlled Release 12/1998; 55(2-3):281-95. · 5.73 Impact Factor
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ABSTRACT: Experience is reported with intraoperative pharmacologic lysis of recent submacular hemorrhage with tissue plasminogen activator followed by surgical drainage of the unclotted blood in patients with retinal arterial macroaneurysms.
Nine eyes (nine patients) with a recent (< or = 7 days old) submacular hemorrhage involving the center of the fovea secondary to retinal arterial macroaneurysm that were managed with recombinant tissue plasminogen activator-assisted subretinal hemorrhage evacuation, including subretinal injection of tissue plasminogen activator and removal of the liquefied blood. Patients were followed for a mean 18 +/- 7 months (range, 7 to 30 months).
All nine eyes had improved final corrected visual acuity after surgery, and eight eyes (89%) attained a corrected visual acuity of 20/60 or better (mean, 20/40; range, 20/20 to 20/200). Final corrected visual acuity was limited to 20/200 in one eye. Two eyes developed a cataract that required surgery.
Submacular surgery with tissue plasminogen activator-assisted thrombolysis achieved improved best-corrected visual acuity in eyes with recent submacular hemorrhage involving the center of the fovea associated with retinal arterial macroaneurysm.
American Journal of Ophthalmology 10/1998; 126(3):358-61. · 4.22 Impact Factor
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ABSTRACT: To determine whether lysing subretinal fibrin with tissue plasminogen activator (t-PA) before excising subfoveal choroidal neovascularization improves visual acuity in patients with age-related macular degeneration.
Randomized, double-masked trial.
Eighty eyes of 80 patients with subfoveal choroidal neovascularization secondary to age-related macular degeneration were studied.
Each eye underwent pars plana vitrectomy and received a subretinal injection of t-PA or balanced salt solution (BSS) before the neovascular membrane was excised. Preoperative and postoperative protocol refraction, ophthalmic examination, color photography, and fluorescein angiography were performed in all 80 eyes.
Visual acuity and fluorescein angiographic evidence of leakage after 1 year.
Visual acuity did not differ between the t-PA group (n = 40) and the BSS group (n = 40), and median best-corrected visual acuity was 20/320 for both groups (P = 0.38). Changes in visual acuity from baseline were also equal, with a median loss of 1 line in each group (P = 0.78). Patients whose initial visual acuity was 20/250 or less were more likely to improve by 2 or more lines (P = 0.01) and less likely to lose 2 or more lines (P < 0.001). Patients with choroidal neovascularization of at least 4 disc areas were more likely to improve by 2 or more lines (P = 0.02) and less likely to lose 2 or more lines (P < 0.001). After 1 year, choroidal neovascularization was present in seven of the t-PA eyes and in eight of the BSS eyes (P = 0.78).
With current surgical techniques, the use of t-PA before surgical excision of subfoveal choroidal neovascularization is of no visual or anatomic benefit to patients with age-related macular degeneration.
Ophthalmology 11/1997; 104(11):1847-51; discussion 1852. · 5.45 Impact Factor
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ABSTRACT: To report a child with leukocoria caused by occult penetrating trauma.
Case report. The clinical findings and surgical repair of acquired leukocoria of the right eye in a 2-year-old boy are presented.
In the right eye, slit-lamp examination disclosed a retrolenticular cyclitic membrane and moderately severe (3+) cells and flare anterior chamber reaction. The eye was hypotonous, and B scan showed that the membrane was associated with a retinal detachment. Surgery was performed to repair the retinal detachment and to remove the retrolenticular membrane. Two months before initial examination, the patient had been attacked by a rooster.
Occult penetrating trauma should be considered in the differential diagnosis of pediatric leukocoria.
American Journal of Ophthalmology 08/1997; 124(1):117-9. · 4.22 Impact Factor
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ABSTRACT: To determine whether vitreoretinal surgery to release anterior traction in eyes with chronic hypotony and attached posterior retinas increases the intraocular pressure and prevents atrophia bulbi.
In this prospective study, we operated on and followed-up postoperatively 17 eyes of 17 consecutive patients with previous vitreoretinal surgeries for retinal detachments and severe proliferative vitreoretinopathy. These eyes had developed chronic hypotony (intraocular pressure < or = 5 mm Hg for at least one month) and anterior proliferative vitreoretinopathy.
After a minimum of six months of postoperative follow-up (mean, 10.6 months), mean intraocular pressure had increased significantly after surgery from 1.7 to 7.2 mm Hg (P < .001), and ten (59%) of the 17 eyes had a final intraocular pressure greater than 5 mm Hg. Visual acuity did not change significantly after surgery (P = .25). In 13 (76%) of the 17 eyes, visual acuity improved or remained the same. Factors associated with higher postoperative intraocular pressure included hypotony of less than three months' duration (P = .007), preoperative visual acuity of 2/200 or more (P = .02), extent of anterior proliferative vitreoretinopathy of less than 90 degrees (P = .003), absence of tissue over the pars plicata (P = .001), and no anterior reproliferation after surgery (P = .04).
Early surgery to release traction over the anterior retina and uveal tissue in eyes with chronic hypotony and anterior proliferative vitreoretinopathy can increase intraocular pressure and stabilize visual acuity.
American Journal of Ophthalmology 09/1996; 122(2):228-35. · 4.22 Impact Factor
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ABSTRACT: As part of the design of the Silicone Study, a new classification of proliferative vitreoretinopathy (PVR) was developed that distinguishes the different types of contraction found in PVR. In contrast to the original Retina Society system that emphasized the post-equatorial retinal pathology (posterior PVR), the Silicone Study classification system included the characteristic types of contraction found in both the equatorial region and the pre-equatorial retina and vitreous base (anterior PVR).
The authors contrast (1) preoperative and intraoperative findings and (2) vision and anatomic outcomes in the cohort of anterior PVR eyes with the cohort of posterior-only PVR eyes. For the cohort of eyes randomized to perfluoropropane gas (C3F8) or silicone oil, the authors carry out univariate and multivariate analyses to assess the predictive value of baseline and intraoperative parameters on vision and anatomic outcome.
Anterior PVR was present in 321 eyes (79%) and was more prevalent in eyes that had undergone an unsuccessful vitrectomy before study entry than in eyes that underwent a primary vitrectomy for PVR (88% versus 73%; P < 0.001). Compared with eyes that had posterior PVR at the preoperative examination, eyes that had anterior PVR tended to (1) be graded (Retina Society classification system) as D-1 or worse (86% versus 49%; P < 0.0001), (2) have worse (< 2/200) visual acuity (93% versus 86%; P = 0.003), (3) have more hypotony (24% versus 11%; P = 0.03), more edema (8% versus 2%; P = 0.04), more aqueous flare (P = 0.02), more macular pucker (69% versus 52%; P = 0.005), and more intravitreal contraction (21% versus 6%; P = 0.002). When compared with eyes that had anterior PVR, eyes with posterior PVR had a better outcome at the 6-month postoperative examination: complete attachment of the retina (76% versus 62%; P = 0.04), visual acuity of 5/200 or better (64% versus 45%; P = 0.006), and normal intraocular pressure (86% versus 71%; P = 0.04). For eyes with anterior PVR, significant predictors of poor (< 5/200) visual acuity were a preoperative PVR grade D-1 or worse and the use of C3F8 gas as the intraocular tamponade.
The Silicone Study classification of anterior PVR permits greater specificity in characterizing PVR and is prognostic of anatomic and vision outcome. Eyes with anterior PVR and clinically significant posterior PVR changes had a better visual prognosis if silicone oil was used. With the current understanding of the pathoanatomy of anterior PVR and the recent development of new surgical techniques, the incidence of anterior PVR in eyes that previously underwent vitrectomy may decline, and the prognosis in eyes with anterior PVR may improve.
Ophthalmology 08/1996; 103(7):1092-9. · 5.45 Impact Factor
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ABSTRACT: Peripheral angiomas have been associated with epiretinal membranes and traction retinal detachment. The authors investigated the timing, results, and complications of vitreous surgery to remove the retinal traction and treat the peripheral vascular tumor.
The authors reviewed the results of ten eyes that had undergone vitrectomy for macular pucker and/or traction retinal detachment. These eyes had either preoperative or intraoperative treatment of the peripheral tumor.
Patients were followed 4 to 95 months. Six eyes had nonfamilial peripheral acquired retinal hemangioma, three had von Hippel angiomas, and one had multiple large peripheral retinal angiomas associated with extensive retinal telangiectasis. Four eyes received cryotherapy and/or laser photocoagulation 2 to 3 months before surgery. In the remaining six eyes, initial treatment to the peripheral angioma was performed at the time of vitreous surgery. At final follow-up, all eyes were attached without retinal traction. Vision improved in all eyes; six (60%) achieved 20/50 or better visual acuity. Complications included recurrent epiretinal membrane (n=3); nonregressed angiomas (n=3); increased nuclear sclerosis (n=2); and retinal detachment (n=1).
Vitreous surgery, when applied to epiretinal membranes or traction retinal detachments associated with peripheral vascular tumors, has a good chance of improving vision. Treatment of the hemangioma, before or during vitrectomy, usually results in tumor regression.
Ophthalmology 03/1996; 103(2):329-35 ; discussion 334-5. · 5.45 Impact Factor
