1/226. Cataracts, bilateral macular holes, and rhegmatogenous retinal detachment induced by lightning.PURPOSE: To report ocular injuries, including a unilateral rhegmatogenous retinal detachment, induced by lightning. METHOD: Case report. A 30-year-old man was injured by lightning. RESULTS: The patient developed a severe decrease in visual acuity in both eyes, an afferent pupillary defect in his left eye, bilateral cataracts, posterior vitreous detachments, macular holes, and an inferotemporal retinal detachment with an associated flap retinal tear in his left eye. CONCLUSIONS: This is a case of bilateral cataracts, posterior vitreous detachments, macular holes, and a unilateral retinal detachment associated with lightning. We postulate that the heating of the retinal surface, the concussive forces on the eye, and a sudden lateral contraction of the attached vitreous resulted in bilateral posterior vitreous detachments and a unilateral peripheral retinal break.- - - - - - - - - - ranking = 1keywords = vitreous detachment, posterior vitreous detachment, detachment, posterior (Clic here for more details about this article) |
2/226. Macular hole formation: new data provided by optical coherence tomography.OBJECTIVE: To establish the sequence of events leading from vitreofoveal traction to full-thickness macular hole formation. methods: Both eyes of 76 patients with a full-thickness macular hole in at least 1 eye were examined by biomicroscopy and optical coherence tomography. RESULTS: Sixty-one fellow eyes had a normal macula. Optical coherence tomograms showed central detachment of the posterior hyaloid over the posterior pole in 19 cases (31%) and a perifoveal hyaloid detachment not detected on biomicroscopy in 26 cases (42%). In the 4 impending macular holes, optical coherence tomography disclosed various degrees of intrafoveal split or cyst, with adherence of the posterior hyaloid to the foveal center and convex perifoveal detachment. In the 14 stage 2 holes, eccentric opening of the roof of the hole was observed, and in the 24 stage 3 holes, the posterior hyaloid was detached from the entire posterior pole. CONCLUSIONS: In fellow eyes of eyes with macular holes posterior hyaloid detachment begins around the macula, but the hyaloid remains adherent to the foveolar center, indicating the action of anteroposterior forces. This results in an intraretinal split evolving into a cystic space, and then to the disruption of the outer retinal layer and the opening of the foveal floor, thus constituting a full-thickness macular hole.- - - - - - - - - - ranking = 0.064163667180492keywords = detachment, posterior (Clic here for more details about this article) |
3/226. A malignant glaucoma-like syndrome following pars plana vitrectomy.OBJECTIVE: To report two cases of a malignant glaucoma-like syndrome following pars plana vitrectomy. DESIGN: Two interventional case reports. INTERVENTION: The first patient was treated with a neodymium:YAG laser peripheral iridectomy with hyaloidectomy and with intracameral tissue plasminogen activator. The second patient was treated with a posterior approach iridectomy through residual hyaloid, zonules, and iris. MAIN OUTCOME MEASURES: Axial anterior chamber depth and intraocular pressure (IOP). RESULTS: The interventions resulted in deepening of the anterior chambers and normalization of IOPs. CONCLUSION: A pseudomalignant glaucoma syndrome may be related to obstruction of aqueous flow, either by residual anterior hyaloid or by fibrin and other inflammatory debris at the level of the ciliary body-zonular apparatus. Treatment of this syndrome involves restoring aqueous flow to the anterior chamber by disrupting the residual anterior hyaloid or clearing fibrin or inflammatory debris. The clinician should not disregard the possibility of a pseudomalignant glaucoma syndrome following vitrectomy despite the fact that vitrectomy has traditionally been considered a curative treatment for malignant glaucoma.- - - - - - - - - - ranking = 1.082376315837E-5keywords = posterior (Clic here for more details about this article) |
4/226. Retinal tears associated with panuveitis and Behcet's disease.To report retinal tears formation in 3 eyes of 2 patients with active panuveitis and Behcet's disease. We describe 2 patients that were diagnosed and treated for Behcet's disease with active panuveitis. Retinal tears developed while the inflammation was active. The patients were treated with topical, oral steroids, and cyclosporine therapy for bilateral panuveitis. One patient presented with a retinal tear located at the periphery of the active retinal lesion. The other had multiple tears associated with active retinal lesions in both eyes. argon laser photocoagulation was performed in both patients as soon as the tears were detected. Ocular inflammation was controlled with this therapy, and only a few mild flare-ups occurred. The patients have been followed up for 8 and 16 months, respectively. During this period no new retinal tears have developed. Although retinal tear formation is rarely associated with Behcet's panuveitis, the clinician should be aware of this as a possible complication. When structural changes are present in the vitreous, detailed ophthalmoscopy is indicated to assess for retinal tears. If a tear is detected in a patient with panuveitis and Behcet's disease, laser photocoagulation therapy should be performed immediately to prevent retinal detachment.- - - - - - - - - - ranking = 0.016021975209596keywords = detachment (Clic here for more details about this article) |
5/226. Optical coherence tomography images of spontaneous macular hole closure.PURPOSE: To investigate optical coherence tomography images of spontaneous macular hole closure. METHOD: Case report. In a 60-year-old woman with full-thickness macular hole, posterior vitreous detachment, and previous branch retinal vein occlusion, we observed the entire course of spontaneous macular hole closure by use of optical coherence tomography. RESULTS: Spontaneous macular hole closure began as the inward protrusion of the tissue around the margin of the macular hole. The protruding tissue then connected to bridge the macular hole, which mimicked a foveal retinal detachment. The bridged tissue gradually thickened, and the foveal detachment and perifoveal cysts resolved. The fovea eventually regained its normal configuration. CONCLUSIONS: The bridging of the protruding retinal tissue over the macular hole plays a key role in spontaneous macular hole closure.- - - - - - - - - - ranking = 0.32799267493013keywords = vitreous detachment, posterior vitreous detachment, detachment, posterior (Clic here for more details about this article) |
6/226. 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 = 0.11224041657244keywords = detachment, posterior (Clic here for more details about this article) |
7/226. Long-term incidence of reopening of macular holes.OBJECTIVE: To report the incidence of macular hole reopening after initial successful surgery. DESIGN: A noncomparative retrospective case series. PARTICIPANTS: From a series of 137 consecutive cases of idiopathic macular holes operated on between August 1993 and May 1996, the authors analyzed the charts of 116 cases of successful surgery. SETTING: A single university-based ophthalmology department. INTERVENTION: Pars plana vitrectomy, posterior hyaloid peeling, fluid-air and air-gas exchange with a nonexpansile 17% C2F6 mixture followed by face-down positioning. Eighty-eight patients (64%) received autologous platelets as a biologic adjuvant. The anatomic success rate at the first postoperative month was 116 of 137 (85%). One hundred and six patients (91%) were followed up for more than 2 years. MAIN OUTCOME MEASURE: Macular anatomic status. RESULTS: Mean follow-up was 27 months. Eleven eyes of 11 patients (9.5%) had reopening of the macular hole. The mean period between hole surgery and reopening was 15.4 months (range, 8-29). In 8 of these 11 cases, reopening occurred after cataract extraction. In two cases, an epiretinal membrane was noted. In another case cystoid macular edema was present. The final anatomic success rate with one surgical procedure was 105 of 137 (77%). Eight reopened holes were reoperated on and all were anatomic successes at 1 month. However, four patients experienced a second reopening. CONCLUSIONS: Macular hole reopening occurred in 9.5% of cases (11 of 116). The cause of reopening might have been any anatomic stress such as epiretinal membrane formation or macular edema. However, in most of our reopened cases, no definite cause was evident. Four patients experienced recurrent reopening.- - - - - - - - - - ranking = 1.082376315837E-5keywords = posterior (Clic here for more details about this article) |
8/226. Dome-shaped detachment of premacular vitreous cortex in macular hole development.PURPOSE: To clarify the role of the posterior vitreous cortex in macular hole development, we evaluated the follow-up findings of clinical observations and optical coherence tomography (OCT) images of macular holes in early stage. methods: The vitreoretinal tomography was examined and followed in eyes with stage 1 and 2 macular holes with OCT. RESULTS: The posterior cortical vitreous was identified in 12 of 17 eyes with early-stage macular holes by OCT (71%). In these eyes, the detached posterior vitreous appeared to be merged to the fovea and the disc. The vitreoretinal separations showed typically dome-shaped. A long scan along the papillomacular axis also delineated the posterior vitreous face as dome-shaped perifoveal vitreous detachment with adhesion to the fovea and disc. Repetitive OCT examinations clearly demonstrated the course of development of the macular hole. CONCLUSIONS: The dome-shaped vitreoretinal separation seen with OCT gives rise to an idea that the posterior vitreous cortex may not be taut but slack, and would not cause a continuous tractional force even in early-stage macular holes. This finding brings us an idea that the tangential traction at the fovea may be generated by fluid movements, rather than by contraction of the cortical vitreous.- - - - - - - - - - ranking = 0.23927266965653keywords = vitreous detachment, detachment, posterior (Clic here for more details about this article) |
9/226. retinal detachment and retinoschisis detected by optical coherence tomography in a myopic eye with a macular hole.The authors describe a myopic patient with a full-thickness macular hole that was accompanied by both retinal detachment and retinoschisis. A 51-year-old woman presented with a localized retinal elevation of three disc diameters around the macular hole in a myopic eye. Optical coherence tomography (OCT) showed features of both retinal detachment and retinoschisis. After vitreous surgery and postoperative intraocular gas tamponade, the macular elevation resolved, and separation of the neurosensory retina from the retinal pigment epithelium band disappeared on the OCT images. OCT is a useful tool for examining macular conditions associated with a macular hole in myopic patients.- - - - - - - - - - ranking = 0.096131851257575keywords = detachment (Clic here for more details about this article) |
10/226. Confirmation of persistent closure of surgically repaired macular hole in subsequent retinal detachment by optical coherence tomography.Idiopathic macular holes have shown response to surgical intervention with vitrectomy, presumably because of glial cell proliferation in the reapproximated tissue. We describe a patient with postoperative closure of a macular hole who subsequently developed a retinal detachment involving the macular area. Despite the detachment, the macular hole remained closed as evidenced by biomicroscopy and optical coherence tomography (OCT). OCT provides accurate documentation and assessment of pre- and postoperative conditions in macular hole surgery.- - - - - - - - - - ranking = 0.096131851257575keywords = detachment (Clic here for more details about this article) |
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