1/194. Optical coherence tomography of idiopathic polypoidal choroidal vasculopathy.PURPOSE: To document and study the cross-sectional structures of polypoidal elements using optical coherence tomography in eyes with idiopathic polypoidal choroidal vasculopathy. methods: Optical coherence tomography images of two eyes with idiopathic polypoidal choroidal vasculopathy were correlated with slit-lamp biomicroscopic findings, fundus photographs, fluorescein angiograms, and indocyanine green angiograms. RESULTS: Cross-sectional optical coherence tomographic images of retinochoroidal structures showed prominent anterior protrusion of the orange subretinal mass corresponding to the polypoidal structure in the indocyanine green angiogram. Hemorrhagic detachment of the retinal pigment epithelium was contiguous with the cone-shaped nodule beneath the retinal pigment epithelium in one eye, and an apparent discontinuity was observed in the highly reflective layer that delineates the polypoidal structure. CONCLUSIONS: Some of the polypoidal structures in eyes with idiopathic polypoidal choroidal vasculopathy are anteriorly protruding lesions in the inner choroid that may cause serosanguineous detachment of the retinal pigment epithelium through damage of the overlying bruch membrane, retinal pigment epithelium, and the adhesion between them. Cross-sectional optical coherence tomographic images may increase understanding of the pathophysiology of idiopathic polypoidal choroidal vasculopathy.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/194. The etiology and treatment of macular detachment associated with optic nerve pits and related anomalies.PURPOSE: Up to two thirds of patients with optic disc pits develop a sight-limiting maculopathy. There is confusion regarding the etiology and nature of the maculopathy in these cases. We present 7 cases of serous macular detachment occurring in association with optic pits or related cavitary anomalies and identify a rhegmatogenous etiology. methods: We reviewed the records of 7 patients with optic nerve anomalies and macular detachment. patients were treated with observation, barricade laser, vitrectomy, and/or gas tamponade. RESULTS: Seven patients were noted to have serous macular detachment associated with an optic nerve pit or other cavitary anomaly. A hole or tear in the diaphanous tissue overlying the optic pit was identified in all cases. None of the patients had a posterior vitreous detachment. Two were treated with photocoagulation only, and 5 underwent pars plana vitrectomy with fluid-gas exchange with or without photocoagulation. Pretreatment visual acuity ranged from 20/30 to 6/200. Posttreatment acuity ranged from 20/25 to 20/100. Five of 7 eyes had final acuities of 20/30 or better, and all treated eyes improved. CONCLUSIONS: A tear in the diaphanous tissue overlying the optic nerve pit is responsible for the development of serous macular detachment and is consistent with findings in similar conditions, such as retinal detachment in association with chorioretinal coloboma. These tears may be quite subtle, and careful biomicroscopic examination is required to appreciate them. The treatment of this condition remains controversial. However, because of the relatively poor prognosis, we believe treatment should include the formation of a barricade to fluid movement as well as sealing and relief of traction from the hole. The value of laser treatment may be increased by the early identification of a defect in the diaphanous membrane prior to the development of macular detachment. Consideration of prophylactic laser might then reduce the need for later, more invasive measures, and improve the prognosis.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
3/194. Repair of scleral rupture and total retinal detachment in a self-injuring psychotic patient under local anesthesia: a case report.PURPOSE: Ocular self-injury by psychotic patients is an uncommon cause of ocular morbidity that poses peculiar problems. This report describes a schizophrenic self-injuring patient with scleral rupture and retinal detachment (RD), treated under loco-regional anesthesia. CASE REPORT: A 65-year-old man presented with scleral rupture, hyphema, traumatic lens luxation, vitreous prolapse, vitreous hemorrhage and total RD after deliberately hitting his head. The fellow eye had been successfully operated with scleral buckle surgery for the same reason two years earlier. The patient underwent a two-step surgical procedure under local anesthesia, with repositioning and resection of the uveal prolapse and scleral rupture repair and, separately, lens removal pars plana vitrectomy (PPV), membrane peeling, retinotomy, laser treatment and SiO tamponade. RESULTS: Twelve months after PPV, the cornea was clear, IOP was 16 mmHg, the retina was attached and VA was 20/200. The fellow eye maintained 20/30 VA. CONCLUSIONS: In psychotic patients the intrinsic difficulty of a traumatic RD is combined with systemic illness, no compliance and the risk of recurrence. Although ocular traumas usually require general anesthesia, this patient underwent both interventions under local anesthesia with sedation, because of his psychotic condition and chronic liver failure. Local anesthesia and sedation proved effective in controlling pain and intra-operative compliance even in such a difficult patient. Although it is reasonable to question operating on such patients, we nonetheless believe that every attempt should always be made at gaining useful vision in both eyes since these patients are at a high risk of recurrent ocular trauma.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
4/194. radiation-associated choroidal neovasculopathy, exudative detachment and neovascular glaucoma. A case report.radiotherapy remains a controversial type of therapy for subfoveal neovascularization. Recently a peculiar pattern of neovascular growth of the irradiated choroidal neovascular membrane has been described. This evolution may be associated with extensive exudative reaction. In one of our patients with this complication, the disease progressed to a total exudative retinal detachment and neovascular glaucoma.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
5/194. 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 = membrane (Clic here for more details about this article) |
6/194. Retinal pigment epithelial tear and extensive exudative retinal detachment following blunt trauma.BACKGROUND: A peripheral retinal pigment epithelial tear and an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane are extremely rare. A peripheral retinal pigment epithelial tear has not been reported in an eye with retinochoroidal folds after blunt ocular trauma. methods: Case report. RESULTS: The course of a large nasal peripheral retinal pigment epithelial tear that occurred after blunt ocular trauma in a patient with retinochoroidal folds was followed. The inferior retinal detachment caused by leakage from the denuded Bruch's membrane following the development of the tear gradually worsened. Initial treatment with cryotherapy was ineffective, but the retinal detachment eventually resolved after the patient underwent sclerectomy and sclerostomy. CONCLUSION: A large peripheral retinal pigment epithelial tear can occur in patients with retinochoroidal folds following blunt ocular trauma, and extensive retinal detachment can be induced. Sclerectomy and sclerostomy can be beneficial in patients with an extensive exudative retinal detachment caused by choroidal leakage from the denuded Bruch's membrane.- - - - - - - - - - ranking = 3keywords = membrane (Clic here for more details about this article) |
7/194. Subretinal "napkin-ring" membrane in proliferative vitreoretinopathy.A "napkin-ring" subretinal membrane is an unusual expression of subretinal proliferation associated with retinal detachment. An 80-year-old man with a total funnel-shaped retinal detachment underwent pars plana vitrectomy, 360 degrees relaxing retinotomy, excision of a subretinal napkin-ring membrane, and silicone oil injection. Histopathologic examination of the removed napkin-ring subretinal membrane revealed the presence of retinal pigment epithelium (RPE) as the major source of cells within the membrane. myofibroblasts were the most common cellular constituents; the total number of these cells may have correlated with the degree of clinical contraction, causing a funnel-shaped retinal detachment. Arch Ophthalmol. 2000;118:1287-1289- - - - - - - - - - ranking = 8keywords = membrane (Clic here for more details about this article) |
8/194. A traumatic macular hole secondary to a high-energy Nd:YAG laser.A case is reported of a traumatic macular hole caused by a high-energy Nd:YAG laser. The initial ocular examination revealed an explosive, crater-shaped, full-thickness macular hole surrounded by local edema and detachment. By the 12th day after the injury, the hole had shrunk progressively and was covered by a thin fibrin-like membrane. A thick epiretinal membrane covered the injured area 1 month after the injury. Nine months after the injury, the macular hole closed spontaneously with a partially detached epiretinal membrane. This case demonstrates one of the natural healing processes of a traumatic macular hole. Although the hole finally closed, the patient did not regain his vision because of the severe damage to the photoreceptors, retinal pigment epithelium, and choroid.- - - - - - - - - - ranking = 3keywords = membrane (Clic here for more details about this article) |
9/194. indocyanine green facilitates removal of epiretinal and internal limiting membranes in myopic eyes with retinal detachment.PURPOSE: To describe the use of intravitreal indocyanine green as an aid to identifying epiretinal membranes and internal-limiting membranes during surgery for a retinal detachment resulting from a macular hole. methods: A 62-year-old man who had a retinal detachment resulting from a macular hole underwent vitrectomy. During the surgery, intravitreal indocyanine green was injected intravitreally. RESULTS: The internal-limiting membrane was stained green, but the epiretinal membrane was unstained. Because the epiretinal membrane and internal-limiting membrane were clearly identified, they could be completely removed. The clinical observations of the epiretinal membrane and internal-limiting membrane excised were confirmed by electron microscopy. Successful reattachment was obtained without damage to the retina. CONCLUSION: Removal of epiretinal membrane and internal-limiting membrane can be facilitated by using intravitreal indocyanine green during vitrectomy. We recommend further studies to confirm the benefit of this technique.- - - - - - - - - - ranking = 14keywords = membrane (Clic here for more details about this article) |
10/194. Macular star associated with posterior hyaloid detachment.PURPOSE: To report a patient with a Leber's idiopathic stellate neuroretinitis-like lesion that was caused by vitreous traction accompanying a posterior hyaloid detachment. methods: We present a 49-year-old woman who showed segmental optic disc edema, peripapillary retinal detachment, and a macular star. RESULTS: An incomplete posterior hyaloid detachment was present, and the posterior hyaloid membrane was attached to the nasal margin of the optic disc. fluorescein angiography revealed a bent retinal artery on the upper margin of the optic disc, and leakage of fluorescein was observed from this area. CONCLUSION: Vascular damage to the optic disc due to vitreous traction should also be considered as a mechanism for the ophthalmoscopic appearance of the fundus when lesions suggestive of Leber's idiopathic stellate neuroretinitis are present in an adult.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
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