1/13. 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 = 1keywords = membrane (Clic here for more details about this article) |
2/13. indocyanine green-assisted peeling of the epiretinal membrane in proliferative vitreoretinopathy.BACKGROUND: We stained the internal limiting membrane of patients suffering from proliferative vitreoretinopathy with indocyanine green solution during proliferative vitreoretinopathy surgery to improve the visibility of the membranes, and thereby histopathologically confirmed the excised epiretinal membranes. methods: Three patients underwent a standard three-port pars plana vitrectomy with indocyanine green staining. After performing a subtotal vitrectomy we spread 0.5% indocyanine green solution, approximately 1 ml, on the retinal surface and peeled off the epiretinal membranes. RESULTS: The epiretinal membranes did not stain clearly, while the internal limiting membranes did stain clearly. We could therefore distinguish the epiretinal membranes from the retina. We cut the internal limiting membrane, grasped it, and peeled off the internal limiting membrane underlying the epiretinal membranes using vitreoretinal forceps. A histopathologic examination confirmed the presence of proliferative cells and an extracellular matrix underlying the internal limiting membranes. CONCLUSION: The technique for staining the epiretinal membranes in proliferative vitreoretinopathy using indocyanine green gives better visualization and allows surgeons to remove the epiretinal membranes more safely and effectively, as well as with less risk of retinal damage.- - - - - - - - - - ranking = 2.125keywords = membrane (Clic here for more details about this article) |
3/13. Ocular toxicity of intravitreal indocyanine green.We report 6 cases of indocyanine green (ICG)-related ocular toxicity after intravitreal ICG usage. Five cases had preoperative diagnosis of macular hole, 1 case had preoperative rhegmatogenous retinal detachment complicated with proliferative vitreoretinopathy. All cases received vitrectomy, ICG-assisted internal limiting membrane (ILM) peeling and air-fluid exchange. All eyes had residual ICG left at the end of surgery. patients were followed up with indirect ophthalmoscopy, visual acuity, color fundus photography, fluorescein angiography, and ocular coherence tomography. Circular foveal retinal pigment epithelium atrophy larger than the area of macular hole and surrounding cuff was noted in 4 of 5 cases with preoperative macular hole. The other eye with preoperative diagnosis of macular hole had shallow anterior chamber and low intraocular pressure lasting for 1 week postoperatively. Diffuse retinal pigment epithelial atrophy was noted in the eye with preoperative proliferative vitreoretinopathy. Four eyes demonstrated optic atrophy postoperatively. Ocular toxicity caused by ICG may present as pigment epithelial atrophy, which is characteristically larger than the previous area of macular hole and surrounding cuff. Disc atrophy, retinal toxicity, and ocular hypotony were also observed in some cases. To prevent toxicity, residual ICG and ICG-stained ILM must be removed as completely as possible.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
4/13. Idiopathic cyclitic retrolental membrane in children.BACKGROUND: Cyclitic retrolental membranes (CRM) in children are usually associated with chronic uveitis or genetic syndromes. We report two rare cases of idiopathic CRM. patients AND methods: Two girls aged 9 and 13 years with visual acuities (VA) of 0.05 underwent lensectomy and anterior vitrectomy with dissection of the central part of the retrolental membrane and intraocular lens (IOL) implantation. RESULTS: The clinical evolution was excellent for the 9 year old girl who recovered 1.0 VA after 2 months. Histological examination revealed a fibroelastic tissue of unknown origin without inflammatory components. The 13 year old girl showed VA of 0.6 within 1 month. However, a recurrent CRM developed with retinal detachment and proliferative vitreoretinopathy (PVR). vitrectomy, complete excision of the CRM and 360 degrees retinotomy with silicon oil tamponade attached the retina with limited visual recovery. histology showed fibrovascular tissue with inflammatory components infiltrating the CRM. CONCLUSIONS: Idiopathic CRM in children are rare and can be composed of different histological tissues with very different clinical outcomes.- - - - - - - - - - ranking = 0.75keywords = membrane (Clic here for more details about this article) |
5/13. Quantitative assessment of macular edema with optical coherence tomography.OBJECTIVE: To evaluate optical coherence tomography, a new technique for high-resolution cross-sectional imaging of the retina, for quantitative assessment of retinal thickness in patients with macular edema. DESIGN: Survey examination with optical coherence tomography of patients with macular edema. SETTING: Referral eye center. patients: Forty-nine patients with the clinical diagnosis of diabetes or diabetic retinopathy and 25 patients with macular edema secondary to retinal vein occlusion, uveitis, epiretinal membrane formation, or cataract extraction. MAIN OUTCOME MEASURES: Correlation of optical coherence tomograms with slit-lamp biomicroscopy, fluorescein angiography, and visual acuity. RESULTS: Optical coherence tomograms of cystoid macular edema closely corresponded to known histopathologic characteristics. Quantitative measurement of retinal thickness is possible because of the well-defined boundaries in optical reflectivity at the inner and outer margins of the neurosensory retina. Serial optical coherence tomographic examinations allowed tracking of both the longitudinal progression of macular thickening and the resolution of macular edema after laser photocoagulation. In patients with diabetic retinopathy, measurements of central macular thickness with optical coherence tomography correlated with visual acuity, and optical coherence tomography was more sensitive than slit-lamp biomicroscopy to small changes in retinal thickness. CONCLUSIONS: Optical coherence tomography appears useful for objectively monitoring retinal thickness with high resolution in patients with macular edema. It may eventually prove to be a sensitive diagnostic test for the early detection of macular thickening in patients with diabetic retinopathy.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
6/13. Proliferative vitreoretinopathy in Coats' disease. Clinicohistopathological case report.We report the clinicohistopathological findings of the proliferative vitreoretinopathy in an eye with Coats' disease using the tissue obtained during surgery. A 28-year-old man, who had experienced poor vision in his right eye for a period of 4 years, was referred to our hospital. Examination revealed an extensive yellow exudate in the subretinal space and a tractional retinal detachment. Prominent teleangiectatic retinal vessels were also temporally present. Evident epiretinal membranes were present in the postequatorial area. We performed a scleral buckling, vitrectomy, membrane peeling, endophotocoagulation and silicone oil tamponade. A histological examination revealed that the epiretinal membrane consisted of collagen fibers, glial proliferation, foam cells and lymphocytes. The foam cell in the epiretinal membrane is a characteristic finding in an eye with Coats' disease.- - - - - - - - - - ranking = 0.5keywords = membrane (Clic here for more details about this article) |
7/13. Histopathologic study of epiretinal proliferations after vitrectomy with daunomycin and silicone oil.PURPOSE: The cellular composition of primary and recurrent periretinal proliferations has been widely described. The use of daunomycin, an antiproliferative antibiotic, has been recommended to reduce these proliferations. Two recurrent membranes after intraoperative application of daunomycin were examined. methods: Two epiretinal membranes, which were removed 5 months and 20 months after vitrectomy with daunomycin, were examined by light and electron microscopy to determine the structure and cellular composition of these membranes. RESULTS: The matrix of the membranes consisted of new collagen with fiber diameters between 20 and 22 nm. Fibrocytes and macrophages were present in both specimens. Retinal pigment epithelial cells and fibrous astrocytes were present in only one specimen. CONCLUSION: Retinal pigment epithelial cells, which are consistently present in primary periretinal membranes, were found in only one of the two specimens examined. myofibroblasts, also normally present, were not found. The other cells found are typically seen in primary periretinal proliferations.- - - - - - - - - - ranking = 0.625keywords = membrane (Clic here for more details about this article) |
8/13. Visual field loss following vitreous surgery.OBJECTIVE: To assess possible causes of visual field loss following vitreous surgery. DESIGN: charts of 8 patients prospectively identified, who developed visual field loss following vitreous surgery, were reviewed to characterize this newly recognized syndrome and assess possible causes. RESULTS: Two patients had preexisting chronic open-angle glaucoma and 1 had ocular hypertension. Indications for surgery included 4 eyes with macular holes, 1 eye with epiretinal membrane, 2 eyes with rhegmatogenous retinal detachment, and 1 eye with retinal detachment and giant retinal tear. All patients received retrobulbar anesthesia. Seven of 8 patients had fluid/gas exchange with installation of long-acting bubbles. In 1 patient with a macular hole, a small hemorrhage was noted along a vessel coming off the nerve superotemporally while attempting to engage the posterior cortical vitreous intraoperatively. This patient developed an inferior visual field defect. No intraocular pressure (IOP) measurements greater than 26 mm Hg were recorded in any eye perioperatively. Visual field defects included 4 eyes with inferotemporal defects, 2 eyes with inferior altitudinal defects, 1 eye with a cecocentral scotoma, and 1 eye with a superonasal defect. Only 1 patient had worsened visual acuity. A relative afferent pupillary defect was observed in 4 eyes and disc pallor in 5 eyes. CONCLUSIONS: Central or peripheral visual field loss can now be recognized as a possible complication of vitreous surgery. In some cases, a relative afferent pupillary defect and optic disc pallor are present, suggesting that the optic nerve is the site of injury. Possible mechanisms include ischemia due to elevated IOP or fluctuations in IOP, optic nerve damage from retrobulbar injection, direct intraoperative mechanical trauma to the optic nerve, indirect injury from vigorous suction near the optic nerve leading to shearing of peripapillary axons or vessels, or a combination of these. Certain optic nerves may be more susceptible to injury because of preexisting compromise from glaucoma or vascular disease.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
9/13. Partial laser ablation of massive peripapillary subretinal neovascularization.BACKGROUND: Although peripapillary subretinal neovascular membranes (PSRNs) are less common and often larger than neovascular complexes arising near the fovea, they may lead to severe visual loss. Very large (massive) PSRNs (MPSRNs) are 3.5 disc areas or greater in overall size, are even less common, and may contain a significant occult component, leading to slow and unpredictable growth. Such massive lesions may begin at the nasal margin of the disc and do not become symptomatic until they have extended around the disc toward the macula, threatening central vision. Although complete laser ablation has been used for symptomatic PSRNs with variable success, the optimal treatment of MPSRNs remains controversial. methods: The authors reviewed the clinical course of 12 eyes of seven patients with MPSRNs. Ten eyes received laser treatment, which was limited to the temporal portion of the subretinal neovascular complexes only and two received no treatment. RESULTS: Of the ten eyes receiving laser treatment, six showed stabilization of visual acuity, whereas in four the neovascular membrane progressed beneath the fovea with severe visual loss. In the two untreated eyes, the subretinal neovascular membrane progressed beneath the macula with the loss of central vision. CONCLUSIONS: In contrast to the small symptomatic PSRNs, which are usually treated by complete laser ablation, MPSRNs may stabilize with only partial laser treatment. However, both types of lesions may remain stable for long periods of time without any treatment and require treatment only if progression toward the fovea occurs.- - - - - - - - - - ranking = 0.375keywords = membrane (Clic here for more details about this article) |
10/13. Rhegmatogenous retinal detachments in hiv-positive patients with ocular syphilis.The purpose of this study is to report retinal manifestations of lues in human immunodeficiency virus (hiv)-positive patients and to suggest a method for treatment of rhegmatogenous retinal detachments in these patients. Two hiv-positive patients with bilateral retinitis were examined and treated at the authors' institution for a period of 14 months. Ocular syphilis was diagnosed clinically, confirmed by cerebrospinal fluid serologic testing, and treated with intravenous penicillin. Both patients experienced bilateral rhegmatogenous retinal detachments complicated by proliferative vitreoretinopathy after resolution of the active retinitis. All four eyes underwent surgical repair with trans pars plana vitrectomy, epiretinal membrane delamination, gas-fluid exchange, endolaser, scleral buckle, and silicone oil instillation. The recognition of ocular syphilis as a cause of retinal detachment in hiv-positive patients is important. Prompt intervention with the appropriate medical and surgical treatments may result in the preservation of vision in these patients.- - - - - - - - - - ranking = 0.125keywords = membrane (Clic here for more details about this article) |
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