1/246. Bilateral rhegmatogenous retinal detachments with unilateral vitreous base avulsion as the presenting signs of child abuse.PURPOSE: To describe a 7-year-old boy with bilateral rhegmatogenous retinal detachments and unilateral vitreous base avulsion as the presenting signs of child abuse. METHOD: Case report. RESULTS: Examination demonstrated no external signs of trauma or ocular findings typically found in battered child syndrome; however, findings of rhegmatogenous retinal detachments and vitreous base avulsion raised the suspicion of child abuse, which was confirmed with further history. A scleral buckle procedure and pars plana vitrectomy with silicone oil tamponade were performed in the right eye followed by a similar procedure in the left eye 1 week later. CONCLUSION: Vitreous base avulsion and rhegmatogenous retinal detachments may be the only presenting signs of child abuse.- - - - - - - - - - ranking = 1keywords = scleral (Clic here for more details about this article) |
2/246. A case of bacterial endophthalmitis following perforating injury caused by a cat claw.A case of bacterial endophthalmitis following a perforating ocular injury caused by a cat claw is reported. The scleral wound was sutured immediately following the injury and systemic antibiotics were administered. Despite this treatment, endophthalmitis occurred 3 days after the injury. The endophthalmitis was resolved by pars plana vitrectomy, however preretinal reproliferation and retinal detachment subsequently occurred. After reoperation the retina was reattached and the corrected visual acuity improved from 10 cm/HM to 20/200. pseudomonas aeruginosa was detected in cultured vitreous humor that was collected during surgery. This case illustrates the possibility of endophthalmitis being caused by gram negative bacillus in cases of perforating injuries caused by animal claws. Perforating ocular injuries caused by animal claws are relatively rare. Here we report a case of endophthalmitis due to pseudomonas aeruginosa that occurred after a perforating injury caused by a cat claw. The eye was treated by pars plana vitrectomy.- - - - - - - - - - ranking = 1keywords = scleral (Clic here for more details about this article) |
3/246. An unusual complication of retinal reattachment surgery.The authors report a case with an unusual late extraocular complication of scleral buckling and local silicone sponge implant. Four years after the reattachment surgery, a ptotic upper eyelid perforated by local silicone sponge implant and fistula between upper eyelid and sclera were detected. Primary repair of upper eyelid and removal of silicone sponge were performed. One year later, the retina was attached and there was no problem with the upper eyelid. cryotherapy, episcleral explant (scleral buckling), and local implant (sponge) are frequently used and effective methods for retinal reattachment surgery. Postoperative early and late complications have been reported. To our knowledge, there is no report of upper eyelid perforation, ptosis and fistula formation caused by silicone sponge implant rejection.- - - - - - - - - - ranking = 3keywords = scleral (Clic here for more details about this article) |
4/246. Surgical repair of cytomegalovirus-related retinal detachment without silicone oil in patients with AIDS.PURPOSE: To analyze visual and anatomic results following surgical repair of cytomegalovirus (CMV)-related retinal detachment (RD) without silicone oil permanent tamponade. methods: We analyzed five consecutive patients (six eyes) with acquired immunodeficiency syndrome and CMV-related RD that were repaired with pars plana vitrectomy with peeling of the posterior hyaloid, laser photocoagulation, encircling scleral buckle, and intraocular gas tamponade. RESULTS: Preoperative vision ranged from 20/40 to hand motion. Total retinal reattachment was achieved in five of six eyes (83%). Macular reattachment was achieved in all eyes. Mean postoperative visual acuity was 20/40 (range 20/30-20/60). Mean postoperative follow-up was 12 months (range 7-19 months). All patients in this series presented with low preoperative CD4 T-lymphocyte counts (mean, 24 cells per microL) and received highly active antiretroviral therapy. One retina (Patient 1) redetached 7 months after initial repair and was successfully reattached without using silicone oil. Postoperatively, visual acuity remains 20/30, and total retinal reattachment has been maintained for 16 months. CONCLUSION: Good anatomic and visual success can be achieved and maintained in CMV-related RD without the use of silicone oil.- - - - - - - - - - ranking = 1keywords = scleral (Clic here for more details about this article) |
5/246. Effective macular translocation without scleral imbrication.PURPOSE: To describe a case of effective macular translocation accomplished without scleral imbrication or extensive retinotomy. methods: A case report of a 59-year-old woman with subfoveal choroidal neovascularization in her left eye who underwent vitrectomy with macular detachment and fluid-air exchange. RESULTS: The macula was translocated approximately 500 microm inferiorly, allowing for photocoagulation of extrafoveal neovascularization. CONCLUSION: Limited macular translocation may be attained without scleral imbrication or significant retinotomy.- - - - - - - - - - ranking = 6keywords = scleral (Clic here for more details about this article) |
6/246. Rhegmatogenous retinal detachment after treatment of retinoblastoma.PURPOSE: To determine the rate of retinal detachment after treatment of retinoblastoma, to describe the clinical features and management, and to discuss possible pathogenic mechanisms. methods: We retrospectively analyzed the charts of 80 patients (83 eyes) with retinoblastoma treated conservatively between 1963 and 1994, looking specifically for cases that developed a retinal detachment after treatment. RESULTS: Five patients (5 eyes, stages IVa to Vb) developed a retinal detachment after treatment. Of these, four had undergone external radiotherapy and one had an episcleral cobalt plaque. retinal detachment developed within three months after radiotherapy and relentlessly progressed in all four eyes over a period of five months to four years. In the eye that received the episcleral cobalt plaque, the detachment remained localized inferiorly. Even though no retinal break could be detected in four eyes, the clinical features were suggestive of a rhegmatogenous detachment: there was retinal thinning adjacent to the regressed tumors, and the evolution was much longer than that of an exudative retinal detachment. A scleral buckling procedure was performed in two eyes and the retina was successfully reattached. The retinal detachment was not operated on in the three other eyes: the hole was too posterior in one eye; retinal surgery was refused in the second eye; and the retinal detachment remained localized inferiorly in the third eye. CONCLUSION: A retinal detachment developed in 6% of eyes after conservative treatment of retinoblastoma. The possibility of a rhegmatogenous origin should be considered even if no retinal break is detected. In the absence of tumor activity, a scleral buckling repair could be carefully considered if the retinal detachment threatens the macula, and if its evolution is not indicative of an exudative detachment.- - - - - - - - - - ranking = 4keywords = scleral (Clic here for more details about this article) |
7/246. 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 = 8keywords = scleral (Clic here for more details about this article) |
8/246. retinal detachment in myopic eyes after laser in situ keratomileusis.PURPOSE: To analyze the incidence and characteristics of retinal detachment in myopic patients treated by laser-assisted in situ keratomileusis. methods: We retrospectively studied the retinal detachments observed in 1,554 consecutive eyes (878 patients) undergoing laser-assisted in situ keratomileusis for the correction of myopia (follow-up, 30.34 /-10.27 months; range, 16 to 54). Mean patient age was 33.09 /-8.6 years (range, 20 to 60). Before treatment with laser-assisted in situ keratomileusis, all patients had a comprehensive examination, and detected lesions predisposing to retinal detachment were treated before performing the laser-assisted in situ keratomileusis procedure. RESULTS: retinal detachment occurred in four (0.25%) of 1,554 eyes of four (0.45%) of 878 patients. All four patients who developed retinal detachment in one eye were women. Degree of preoperative myopia was -13.52 /-3.38 diopters (range, -8.00 to -27.50). The time interval between refractive surgery and retinal detachment was 11.25 /-8.53 months (range, 2 to 19 months). In all cases retinal detachment was spontaneous. In all eyes the retina was reattached successfully at the first retinal detachment surgery. Mean best-corrected visual acuity after laser-assisted in situ keratomileusis and before retinal detachment development was 20/43 (range, 20/50 to 20/30). After retinal detachment repair, best-corrected visual acuity was 20/45 (range, 20/50 to 20/32). Differences between best-corrected visual acuity before and after reattachment were not statistically significant (P = .21, paired Student t test). A myopic shift was induced in three eyes that had retinal detachment repaired by scleral buckling, from -0.58 /-0.72 diopter (range, 0.25 to -1.00) before retinal detachment and -2.25 /-1.14 diopters (range, -1.00 to -3.25) after retinal detachment surgery (P = .03, paired Student t test). CONCLUSIONS: Laser-assisted in situ keratomileusis for correction of myopia is followed by a low incidence of retinal detachment. Conventional scleral buckling surgery was successful in most cases and did not cause significant changes in the final best-corrected visual acuity. A significant increase in the myopic spherical equivalent was observed after scleral buckling in these patients.- - - - - - - - - - ranking = 3keywords = scleral (Clic here for more details about this article) |
9/246. Transscleral diathermy: an additional tool in the management of retinal detachment due to posterior breaks in highly myopic eyes.PURPOSE: To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. methods: We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). RESULTS: After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. CONCLUSIONS: In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.- - - - - - - - - - ranking = 9keywords = scleral (Clic here for more details about this article) |
10/246. Sclerotomy in uveal effusion syndrome.PURPOSE: To report visual and anatomic outcomes after modified scleral surgery in patients with uveal effusion syndrome with retinal and choroidal detachment. methods: In five eyes of four patients with retinal and choroidal detachment and uveal effusion syndrome due to nanophthalmos, we performed pars plana full-thickness unsutured sclerotomies without sclerectomy. RESULTS: In all cases, uveal effusion with choroidal and retinal detachment resolved within 3 weeks, and all patients showed improved vision. The functional and anatomic results remained stable for over 2 years. CONCLUSIONS: Uveal effusion syndrome that is refractory to medical treatment (high-dose systemic corticosteroids) can be managed effectively by pars plana full-thickness unsutured sclerotomy without sclerectomy.- - - - - - - - - - ranking = 1keywords = scleral (Clic here for more details about this article) |
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