1/41. Corneal epithelial toxic effects and inflammatory response to perfluorocarbon liquid.We report an unusual case of corneal epithelial toxic effects associated with perfluorocarbon liquids (PFCLs). The clinical and histopathologic findings are described. An elderly man underwent vitreoretinal surgery for a complicated retinal detachment. Perfluorodecalin was used to repair the retina. It was left in situ for 8 weeks and removed via the pars plana. One month after removal of heavy liquids the patient developed a nonhealing corneal epithelial defect associated with limbitis. Perfluorodecalin was found under the superior conjunctiva. A conjunctival biopsy revealed the presence of vacuoles in the conjunctival stroma surrounded by an inflammatory response that consisted of lymphocytes, macrophages, and giant cells. On surgical removal of the PFCL from the subconjunctival space, the epithelial defect healed. The histopathologic and clinical evidence suggest that the inflammatory response and corneal epithelial ulceration were caused by the prolonged presence of PFCL in the subconjunctival space. To the best of our knowledge, PFCLs have not previously been reported to cause corneal epithelial defects or incite an inflammatory response in the human eye.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/41. vitrectomy update for macular traction in ocular toxocariasis.PURPOSE: To study the results of modern vitrectomy in traction and combined traction-rhegmatogenous retinal detachment involving the macula in cases of ocular toxocariasis. methods: 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. RESULTS: 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. CONCLUSION: 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.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/41. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of failure.PURPOSE: To find the cause of failure in primary vitrectomy for rhegmatogenous retinal detachment. methods: Retrospective review of 171 consecutive cases of RRD treated by primary pars plana vitrectomy (PPV) from a tertiary referral centre to identify the 25 cases in which surgery had failed. Detachments with giant or macula breaks at initial presentation, with proliferative diabetic retinopathy or with PVR greater than grade B were excluded. RESULTS: The failure rate after the first operation was 14.6% and the commonest cause of failure was missed retinal breaks, accounting for 64.3% of failures. CONCLUSION: Missed retinal breaks are the commonest cause of failure of primary PPV for RRD although proliferative vitreoretinopathy may contribute to surgical failure. This re-emphasises the importance of assiduous peroperative retinal examination.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/41. Early rhegmatogenous retinal detachment following laser in situ keratomileusis for high myopia.PURPOSE: Four eyes had early rhegmatogenous retinal detachment within 3 months of laser in situ keratomileusis (LASIK) for correction of high myopia using the microkeratome, Clear Corneal Molder. methods: In two eyes, retinal detachment resulted from horseshoe tears, one occurring in an otherwise normal region of the retina and the other at the margin of an area of lattice degeneration detected during preoperative examination. The first eye was treated with retinopexy using a 287 encircling scleral exoplant, drainage of subretinal fluid, and laser photocoagulation by indirect ophthalmoscopy. The other eye was treated with pneumatic retinopexy and cryotherapy. In the other eyes, retinal detachment was the result of giant tears with no evidence of prior retinal degeneration. These eyes were treated with pars plana vitrectomy, fluid-gas exchange with 15% perfluoropropane (C3F8), endolaser photocoagulation, and a 42 encircling scleral exoplant. RESULTS: After treatment, the first two eyes achieved spectacle-corrected visual acuity of 20/40. In the last two eyes, final spectacle-corrected visual acuity was 20/400 in one eye and light perception in the other. CONCLUSIONS: Although no cause-effect relationship between LASIK and retinal detachment can be stated, these cases suggest that LASIK may be associated with retinal detachment, particularly in highly myopic eyes. Further studies are necessary to determine high-risk patient characteristics.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
5/41. Perfluorodecalin-induced intravitreal inflammation.OBJECTIVE: To report an unusual case of intravitreal inflammation in a human eye caused by the presence of residual perfluorodecalin in a case of giant retinal tear and retinal detachment. methods: The posterior capsule of the lens, which was infiltrated with deposits, was collected during surgery. The specimen was stained with hematoxylin and eosin, with periodic acid-Schiff, and for melanin. Part of it was examined with electron microscopy. Immunohistochemical staining was performed to demonstrate CD68 antigens, cytokeratin, and glial fibrillary acid protein. RESULTS: Vacuolated macrophages and retinal pigment epithelial cells infiltrated the posterior capsule. Electron microscopy showed the presence of membrane-lined vacuoles within the macrophages. A monolayer of epithelial cells covered the cellular infiltration. CONCLUSION: Residual perfluorodecalin can induce an intraocular chronic macrophage response.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
6/41. Giant tear retinal detachment after laser in situ keratomileusis--a case report.A 42-year-old woman with a refractive error of -10.00S - 2.00C x 105 degrees in the right eye underwent laser in situ keratomileusis (LASIK) at our hospital. LASIK was performed using the Schwind excimer laser (Keratom Multiscan, Schwind, Kleinostheim, germany) and Moria LSK--One manual microkeratome with a 130 microns ablation plate. The uncorrected visual acuity improved postoperatively, and the patient was very satisfied. However, nine months later, she complained of sudden loss of visual acuity in the right eye. Indirect ophthalmoscopy revealed a giant retinal tear extending from 10:00 to 2:00 o'clock position with retinal detachment and vitreous hemorrhage. We performed scleral buckling procedure (with silicone band encircling), vitrectomy, and fluid-gas exchange with air/SF6 mixture. The retina attached postoperatively and remained so during 3-month follow-up period, but cellophane maculopathy was noted.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
7/41. Giant retinal tear and meningococcus endogenous endophthalmitis.Giant retinal tear is seen in association with Stickler's syndrome, marfan syndrome, homocystinurea and after ocular trauma. Although bacterial meningitis(1) is not common since the advent of various antibiotics, meningococcus is the second most common cause of bacterial meningitis. Endogenous endophthalmitis(2) remains a challenge to clinicians despite the success of antibiotics in reducing its frequency and severity. The association of giant retinal tear and meningococcal endogenous endophthalmitis is not yet reported in the literature. We report here on a 14-year-old girl who developed a giant retinal tear after meningococcal meningitis and endogenous endophthalmitis, and we discuss the possible factors of its cause.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
8/41. Ocular findings six years after intravitreal silicone injection.A case of giant retinal tear treated by injection with dimethicone 350 (medical fluid silicone) was observed for six years before enucleation. About four months after the injection, signs of anterior segment ischemia were evident. A year after the injection, an injury resulted in displacement of dimethicone 350 into the anterior chamber. Enucleation was done because of pain.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/41. Prophylactic 360 degrees cryotherapy in fellow eyes of patients with spontaneous giant retinal tears.PURPOSE: To assess the effect of prophylactic 360 degrees peripheral retinal cryotherapy in fellow eyes of patients with spontaneous giant retinal tears (GRTs) on the incidence of retinal detachment. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Forty-eight consecutive patients (31 male, 17 female) with spontaneous GRTs were included. The average age was 41 /- 2 years. The average refraction of the fellow eye was -4.0 /- 0.8 diopters (D). INTERVENTION: patients underwent vitrectomy and silicone oil tamponade in the affected eye and 360 degrees peripheral cryotherapy in the unaffected fellow eye during the same anesthetic. MAIN OUTCOME MEASURE: Attachment of the retina in the fellow eye was determined clinically by indirect ophthalmoscopy. RESULTS: During a mean follow-up of 84 /- 10 months after cryotherapy, one patient (2%) experienced a retinal tear without retinal detachment, and three patients (6%) experienced a retinal detachment in the fellow eye. These occurred 18 /- 9 months after prophylactic treatment and were the result of a small retinal break in two cases and a GRT posterior to the treated area in one case. CONCLUSIONS: Prophylaxis of fellow eyes with 360 degrees cryotherapy appears to be associated with a lower incidence of retinal detachment than that reported in natural history studies. A prospective, randomized clinical trial of such prophylaxis is desirable but would require a sample size of at least 645 patients in each arm of the study, as well as long-term follow-up of at least 5 years to show an unequivocal difference in outcome.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
10/41. Visual loss following removal of intraocular silicone oil.AIM: To investigate the cause of visual loss following removal of intraocular silicone oil in patients who underwent vitrectomies for retinal detachment or giant retinal tear. methods: The clinical records of three cases with visual loss following removal of silicone oil were reviewed. Investigations carried out included fundus fluorescein angiogram, optical coherence tomography, and electrophysiological studies. RESULTS: Visual acuities dropped from 6/9 to 6/36 in two cases and 6/24 to 3/24 in the third. None of the three cases had macula detachment at any stage. Fundus fluorescein angiogram and optical coherence tomography were normal in all cases. Pattern electroretinogram showed reduced amplitudes of the P50 and N95 components. Multifocal electroretinogram indicated a selective damage to the central part of the macula. CONCLUSIONS: The results suggest that the abnormality arises predominantly in the central part of the macula, especially the outer and middle layers. However, the exact mechanism still remains obscure.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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