Cases reported "Retinal Detachment"

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1/424. 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.
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2/424. vitrectomy in sickling retinopathy: report of five cases.

    The unique problems encountered in sickle patients include the need to remove peripheral vitreous if perfusing sea fans-which can bleed after vitrectomy-are present at the time of surgery. However, peripheral vitrectomy is riskier than central vitrectomy alone. If visualization of the sea fans is sufficient, it is safer to close the sea fans prior to vitrectomy in order to obviate the need for peripheral vitrectomy; then, only central vitrectomy is performed. When sea fans cannot be closed prior to vitrectomy, peripheral vitreous is removed to allow early photocoagulation of the sea fans before they bleed again. Four case presentations illustrate these principles. vitrectomy relieved severe vitreous traction that complicated retinal detachment in the fifth patient, thereby eliminating the need for a tight encircling structure, which can be poorly tolerated in patients with SC hemoglobin.
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3/424. Successful treatment of acute subretinal hemorrhage in age-related macular degeneration by combined intravitreal injection of recombinant tissue plasminogen activator and gas.

    Subretinal hemorrhage secondary to age-related macular degeneration (AMD) has a poor visual prognosis. Surgical drainage of the blood improves visual acuity only in selected patients. We report on two elderly patients with spontaneous subretinal hemorrhage from AMD. In one eye, recombinant tissue plasminogen activator (rTPA), combined with a long-acting gas (SF6), was injected into the vitreous cavity. The other eye was treated first by gas instillation followed 3 days later by rTPA injection. Both treatments led to nearly complete displacement of the subretinal hemorrhage from the macular region. In both eyes, an inferior exudative retinal detachment reabsorbed spontaneously within 2 weeks. Bilateral vitreous opacities after rTPA injection resolved without further treatment. Postoperative visual acuity increased to 0.3 and 0.4. The combined treatment is a valuable method for management of acute subretinal hemorrhage. Rapid displacement of this abnormality can minimize clot-induced damage of the highly sensitive macula and increase visual acuity.
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4/424. Vogt-Koyanagi-Harada syndrome in an 11-year-old Boy.

    An 11-year-old boy complained of headache, slight fever and decreased visual acuity. Intracameral cells and serous retinal detachment were found in both eyes. Pleocytosis was seen in the cerebrospinal fluid. Bilateral uveitis diminished rapidly in response to corticosteroid treatment. Depigmentation of the fundi developed several months later. We believe that Vogt-Koyanagi-Harada syndrome in a child, as demonstrated in our patient, may be uncommon.
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5/424. 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.
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6/424. 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.
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7/424. 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.
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8/424. Rapidly resorptive exudative retinal detachment in a patient with renogenic hypertension: case report.

    We present an 18-year-old woman who developed rapidly resorptive exudative retinal detachment (ERD) due to chronic renal failure and renogenic hypertension. In July 1998, the patient came to our clinic because of a 2-month-history of progressively deteriorating visual acuity. Initially examination of the fundi revealed typical hypertensive retinopathy. Two weeks later, the patient was admitted due to hypertension and consulted our ophthalmic department again. In addition to hypertensive retinopathy, the fundi showed high bullous ERD, involving the temporal retinas in both eyes. Intensive medical therapy was begun, including blood pressure control and maintenance of body fluid and electrolyte balance, resulting in almost complete regression of retinal detachment within two days. The visual acuity improved during the following 2 weeks. The clinical features and treatment response in this rare case indicate that multiple factors, including fluids overload, hypertension, and possibly renal failure, contributed to the development of ERD. blood pressure control and the balance of fluids are important in patients with renal failure, and may help to prevent the occurrence of ERD.
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9/424. 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.
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10/424. Removal of silicone oil with vision improvement after rhegmatogenous retinal detachment following CMV retinitis in patients with AIDS.

    PURPOSE: To report that silicone oil may be safely removed from immuno-recovered patients with acquired immunodeficiency syndrome (AIDS) after instillation for cytomegalovirus (CMV)-related rhegmatogenous retinal detachment. METHOD: We report two patients with CMV-related retinal detachment who had previously been treated with vitrectomy and silicone oil. RESULTS: Six months after removal of silicone oil, the retina remained attached in both patients. Without specific anti-CMV therapy, there was no relapse of CMV retinitis while patients were undergoing highly active antiretroviral therapy. Best-corrected visual acuity improved in both patients. CONCLUSION: It appears to be possible to remove silicone oil safely from patients with AIDS who show immune recovery, thus avoiding side effects of long-standing silicone oil and increasing quality of life. After silicone oil removal, visual acuity was improved.
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