1/65. Surgical treatment for severe diabetic macular edema with massive hard exudates.PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. methods: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.- - - - - - - - - - ranking = 1keywords = detachment (Clic here for more details about this article) |
2/65. Ultrasound biomicroscopy in a case of anterior hyaloidal fibrovascular proliferation.The authors describe the use of ultrasound biomicroscopy for the diagnosis and preoperative evaluation of anterior hyaloidal fibrovascular proliferation (AHFVP). Ultrasound biomicroscopy was performed on a 62-year-old man who presented after diabetic vitrectomy with a hyphema, vitreous hemorrhage, and hypotony. Images in the temporal and nasal meridians revealed thickened tissue bands extending from the peripheral retina to the ciliary body, and from the pars plicata to the posterior surface of the iris. A ciliary body epithelium detachment was seen in the nasal meridian. Ultrasound biomicroscopy demonstrated to be a potential tool in the diagnosis and surgical management of AHFVP.- - - - - - - - - - ranking = 1keywords = detachment (Clic here for more details about this article) |
3/65. Endoscopic vitreoretinal surgery for complicated proliferative diabetic retinopathy.PURPOSE: To evaluate the indication for endoscopic vitreoretinal surgery in proliferative diabetic retinopathy (PDR). methods: Chart review of consecutive cases of vitreoretinal surgery for PDR performed by one of the authors (Y.L.F.) over a 2-year period. RESULTS: Endoscopic vitreoretinal surgery was performed in 8 of 41 (19.5%) eyes. The surgical indications were small pupil (3), hyphema (3), pseudophakia with fibrotic posterior capsule (1), and pars plana neovascularization with anterior tractional retinal detachment (6). CONCLUSION: Endoscopic vitreoretinal surgery, by enhancing the visualization of the retroirideal space, is a useful technique in PDR with opaque ocular media and/or neovascularization of the pars plana and ciliary body.- - - - - - - - - - ranking = 1.466415364128keywords = detachment, retinal detachment (Clic here for more details about this article) |
4/65. vitrectomy for diabetic macular edema: the role of posterior vitreous detachment and epimacular membrane.PURPOSE: To evaluate the surgical efficacy of pars plana vitrectomy on eyes with diabetic macular edema in the presence or absence of a complete posterior vitreous detachment and with or without an epimacular membrane. methods: Pars plana vitrectomy was performed on 30 eyes of 29 cases with diabetic macular edema. visual acuity was measured, and retinal thickness was determined by optical coherence tomography before and after vitrectomy. To evaluate the relationship between the effects of vitrectomy and the presence or absence of posterior vitreous detachment and/or epimacular membrane, all eyes were placed into one of four groups: group A, eyes with posterior vitreous detachment and epimacular membrane; B, eyes with posterior vitreous detachment and without epimacular membrane; C, eyes without posterior vitreous detachment and with epimacular membrane; and D, eyes without posterior vitreous detachment and without epimacular membrane. The expression of vascular endothelial growth factor and interleukin-6 was investigated immunohistochemically in epimacular membrane specimens obtained from seven eyes with diffuse diabetic macular edema. RESULTS: The postoperative mean visual acuity (0.653 /- 0.350: mean /- SD logarithm of minimal angle of resolution [logMAR]) was significantly better than the mean preoperative visual acuity (0.891 /- 0.319 logMAR; Wilcoxon signed-rank test, P =.0007). The postoperative foveal thickness (264.5 /- 118.6 microm) was significantly thinner than the preoperative foveal thickness (477.8 /- 147.7 microm; Wilcoxon signed-rank test, P <.0001). There were no significant differences in the improvement of visual acuity and decrease of foveal thickness between the four groups (Kruskal-Wallis test, P =.13, P =.65, respectively). All of the epimacular membranes obtained at surgery expressed vascular endothelial growth factor and interleukin-6. CONCLUSIONS: These results demonstrated that vitrectomy with removal of epimacular membrane is generally an effective procedure in reducing diabetic macular edema, and the outcome does not depend on the presence absence of posterior vitreous detachment and epimacular membrane.- - - - - - - - - - ranking = 11keywords = detachment (Clic here for more details about this article) |
5/65. Migration of intraocular silicone oil into the subconjunctival space and orbit through an Ahmed glaucoma valve.PURPOSE: To report a patient with intraocular silicone oil migration into the subconjunctival space and orbit through an Ahmed glaucoma valve implant. methods: Observational case report. A 29-year-old female with diabetes mellitus and proliferative diabetic retinopathy underwent three left eye pars plana vitrectomies and ultimately intraocular silicone oil placement for tractional retinal detachment. Subsequently, she developed neovascular glaucoma and underwent an inferotemporal Ahmed glaucoma tube implant, left eye. RESULTS: Intraocular silicone oil migrated through the Ahmed glaucoma valve into the subconjunctival space and orbit. Left eye evisceration with silicone oil removal was performed for a blind painful left eye and improvement of appearance. CONCLUSION: Silicone oil migration through an Ahmed valve may be observed after retinal detachment repair with intraocular silicone oil. An Ahmed valve may be contraindicated in eyes of patients with intraocular silicone oil.- - - - - - - - - - ranking = 2.932830728256keywords = detachment, retinal detachment (Clic here for more details about this article) |
6/65. Silicone oil-induced secondary glaucoma: a case study.Silicone oil intraocular tamponade is a widely accepted procedure in the management of complex retinal detachments caused by proliferative diabetic vitreoretinopathy. Silicone oil has a high surface tension that mechanically limits fibrovascular reproliferation resulting in successful retinal reattachments. However, postoperative secondary glaucoma is a relatively frequent complication that may require intensive nursing management focused at intraocular pressure monitoring, positioning compliance, pain management, fluid and electrolyte balance, and glucose control. This article presents the postoperative clinical course of a 51-year-old man with diabetes and recurrent proliferative diabetic vitreoretinopathy who developed secondary glaucoma after silicone oil injection with a dramatic rise in intraocular pressure on the first postoperative day. nursing management concurrent with medical and surgical management is discussed and the necessary nursing plan of care is identified.- - - - - - - - - - ranking = 1.466415364128keywords = detachment, retinal detachment (Clic here for more details about this article) |
7/65. A controlled study of vitrectomy for diabetic macular edema.PURPOSE: To compare eyes that underwent surgery with untreated fellow eyes to assess the efficacy of vitrectomy for diabetic macular edema. methods: In a nonrandomized clinical trial, seven adult patients with mean age of 53 years (range 42 to 64) and the same degree and duration of diabetic macular edema in both eyes were followed up for more than 5 months after unilateral vitrectomy. The treated eye was selected at random, but if visual disparity between the both eyes was more than 3 lines, we operated on the worse side. We compared the preoperative and postoperative foveal thicknesses (the distance between the inner retinal surface and retinal pigment epithelium) and the best-corrected visual acuity by a certified examiner with those of the untreated fellow eye. RESULTS: In the seven eyes that underwent surgery, the foveal thickness decreased by an average of 622 to 269 microm (P =.027, Wilcoxon signed-rank test). In the fellow eyes, the average decrease in foveal thickness was from 617 to 546 microm (P =.176, Wilcoxon signed-rank test). The best-corrected postoperative visual acuity in the eyes that underwent surgery improved more than 2 lines in four eyes (57%) and remained the same in three eyes (43%). In the fellow eyes, it improved more than 2 lines in one eye (14%), remained the same in three eyes (43%), and decreased more than 2 lines in three eyes (43%). CONCLUSION: In eyes with diabetic macular edema that underwent surgery, the foveal thickness significantly decreased after vitrectomy. vitrectomy may be effective for treating diabetic macular edema.- - - - - - - - - - ranking = 0.043616779552845keywords = retinal pigment, pigment (Clic here for more details about this article) |
8/65. Use of perfluorocarbon liquid during vitrectomy for severe proliferative diabetic retinopathy.AIM: To evaluate the value of using perfluorocarbon liquid (PFCL) during vitrectomy in eyes with proliferative diabetic retinopathy (PDR). methods: The surgical records of eyes with PDR (291 eyes of 228 patients) that underwent vitrectomy in the vitreoretinal service of Osaka Medical College (April 1999 to October 2001) were reviewed. From these, 18 eyes of 15 patients had PFCL used during vitrectomy, and the preoperative and postoperative findings of these eyes were analysed. RESULTS: All of the 18 eyes had advanced PDR with tractional and/or rhegmatogenous retinal detachment. PFCL enabled easier flattening of the retinal folds and effective endophotocoagulation. In two cases, PFCL was used to flatten a bullous retinal detachment that developed when a tight vitreoretinal adhesion was loosened. In two other cases with combined traction/rhegmatogenous retinal detachment, PFCL was used to tamponade the detached retina which then allowed successful membrane dissection. Anatomical success was obtained in 16 of the 18 cases (mean follow up time 13.3 months) with visual acuity of 20/200 or better in nine eyes (50%). CONCLUSIONS: PFCL is considered to be a useful adjunct during vitrectomy for the treatment of severe PDR.- - - - - - - - - - ranking = 4.399246092384keywords = detachment, retinal detachment (Clic here for more details about this article) |
9/65. Acute onset of rubeosis iridis after diabetic vitrectomy can indicate peripheral traction retinal detachment.Acute onset or exacerbation of rubeosis iridis associated with peripheral retinal detachment after vitrectomy represents a rare but serious complication of advanced diabetic retinopathy that indicates a poor prognosis. The clinical features, surgical procedures, and anatomical and functional results for a series of 13 eyes presenting with this complication are reported. In addition to rubeosis iridis and peripheral retinal detachment, anterior hyaloidal fibrovascular proliferation (APH) was also present in 10 eyes. All eyes had undergone one or more previous vitrectomies for diabetic complications such as nonclearing vitreous hemorrhage and traction retinal detachment. Treatment modalities for iris neovascularization and peripheral retinal detachment included reattachment procedures with an encircling band, peripheral membrane peeling, and, if necessary, peripheral retinectomy. Peripheral coagulation therapy was performed in all eyes. Eight eyes received an intraocular silicone-oil tamponade. Early results (4 weeks post-surgery) showed regression or stabilization of rubeosis iridis in all eyes. Later results (mean, 9 months post-surgery) revealed nine eyes with stabilized anterior ocular neovascularization and reattachment of the retina. Four eyes were anatomic failures due to recurrent rubeosis iridis/AHP or traction retinal detachment, and three of them also developed ocular hypotony. None of the eyes has thus far been lost as a result of neovascular glaucoma or painful phthisis. Ambulatory vision was retained in ten eyes, but function was limited to a low level as a result of the underlying ischemic disease. Immediate reattachment surgery in combination with anterior/peripheral coagulation therapy was shown to be an effective measure for controlling iris neovascular activity in eyes afflicted with acute anterior ocular neovascularization.- - - - - - - - - - ranking = 13.197738277152keywords = detachment, retinal detachment (Clic here for more details about this article) |
10/65. Foreign body episcleral granulomas complicating intravitreal silicone oil tamponade: a clinicopathological study.PURPOSE: To report two patients with lipid granulomas of the episclera complicating vitrectomy and silicone oil tamponade. DESIGN: Two observational case reports. INTERVENTION: Patient 1, a 41-year-old woman, underwent vitrectomy with silicone oil tamponade for proliferative diabetic retinopathy. Four weeks later, she sought treatment for inflamed episcleral nodules adjacent to one of the sclerostomy sites. The oil was removed and the episcleral nodules were excised. Patient 2, a 33-year-old man, underwent vitrectomy and silicone oil tamponade for tractional retinal detachment. He experienced a painful blind eye with episcleral nodule that required enucleation. MAIN OUTCOME MEASURES: On histopathological analysis, both specimens demonstrated episcleral granulomas caused by silicone oil. CONCLUSIONS: Episcleral nodules adjacent to vitrectomy entry sites with silicone oil tamponade may represent lipid granulomas, probably caused by silicone oil leakage from scleral entry ports.- - - - - - - - - - ranking = 1.466415364128keywords = detachment, retinal detachment (Clic here for more details about this article) |
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