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1/41. Primary vitrectomy for rhegmatogenous retinal detachment: an analysis of failure.

    PURPOSE: To find the cause of failure in primary vitrectomy for rhegmatogenous retinal detachment. methods: Retrospective review of 171 consecutive cases of RRD treated by primary pars plana vitrectomy (PPV) from a tertiary referral centre to identify the 25 cases in which surgery had failed. Detachments with giant or macula breaks at initial presentation, with proliferative diabetic retinopathy or with PVR greater than grade B were excluded. RESULTS: The failure rate after the first operation was 14.6% and the commonest cause of failure was missed retinal breaks, accounting for 64.3% of failures. CONCLUSION: Missed retinal breaks are the commonest cause of failure of primary PPV for RRD although proliferative vitreoretinopathy may contribute to surgical failure. This re-emphasises the importance of assiduous peroperative retinal examination. ( info)

2/41. 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 ( info)

3/41. Long-term posterior and anterior segment complications of immune recovery uveitis associated with cytomegalovirus retinitis.

    PURPOSE: To identify and describe long-term posterior and anterior segment complications of immune recovery uveitis in patients with inactive cytomegalovirus retinitis who are undergoing highly active antiretroviral therapy-mediated recovery of immune function.methods: A prospective cohort study at a university medical center. Twenty-nine eyes of 21 patients with immune recovery uveitis and inactive cytomegalovirus retinitis were followed for 14.5 to 116 weeks (median, 43 weeks) after diagnosis of immune recovery uveitis. RESULTS: Nine eyes of nine patients developed visually important complications involving the posterior segment, anterior segment, or a combination of both. Posterior segment complications included severe proliferative vitreoretinopathy in three eyes and spontaneous vitreous hemorrhage from avulsion of a blood vessel secondary to contraction of the inflamed vitreous in one eye. Proliferative vitreoretinopathy recurred in all cases after surgery, severely compromising the visual outcome. Anterior segment complications included posterior subcapsular cataracts with vision decrease in five eyes and persistent anterior chamber inflammation after cataract extraction, resulting in posterior synechiae and large visually important lens deposits in three eyes.CONCLUSION: Persistent inflammation in immune recovery uveitis may lead to vision-threatening complications, such as proliferative vitreoretinopathy, posterior subcapsular cataracts, and severe postoperative inflammation. Immune recovery uveitis is a chronic inflammatory syndrome that may result in complications months to years after the onset of inflammation. ( info)

4/41. A new locus for autosomal dominant familial exudative vitreoretinopathy maps to chromosome 11p12-13.

    We report a new locus for familial exudative vitreoretinopathy (FEVR), on chromosome 11p12-13 in a large autosomal dominant pedigree. Statistically significant linkage was achieved across a 14-cM interval flanked by markers GATA34E08 and D11S4102, with a maximum multipoint lod score of 6.6 at D11S2010. FEVR is a disease characterized by the failure of development of peripheral retinal blood vessels, and it is difficult to diagnose clinically because of the wide spectrum of fundus abnormalities associated with it. The identification of a new locus is important for genetic counseling and potentiates further studies aimed toward the identification of a gene with an important role in angiogenesis within neuroepithelial tissues. Such a gene may also have a role in the genetic predisposition to retinopathy of prematurity, a sporadic disorder with many clinical similarities to FEVR. ( info)

5/41. Endoscopic vitreoretinal surgery for complicated proliferative diabetic retinopathy.

    PURPOSE: To evaluate the indication for endoscopic vitreoretinal surgery in proliferative diabetic retinopathy (PDR). methods: Chart review of consecutive cases of vitreoretinal surgery for PDR performed by one of the authors (Y.L.F.) over a 2-year period. RESULTS: Endoscopic vitreoretinal surgery was performed in 8 of 41 (19.5%) eyes. The surgical indications were small pupil (3), hyphema (3), pseudophakia with fibrotic posterior capsule (1), and pars plana neovascularization with anterior tractional retinal detachment (6). CONCLUSION: Endoscopic vitreoretinal surgery, by enhancing the visualization of the retroirideal space, is a useful technique in PDR with opaque ocular media and/or neovascularization of the pars plana and ciliary body. ( info)

6/41. Laser photocoagulation in preproliferative retinopathy of incontinentia pigmenti.

    incontinentia pigmenti is a rare, X-linked, dominant disorder in which affected female infants develop characteristic abnormalities of the skin, central nervous system, hair, teeth, and eyes. Ocular abnormalities occur in about 35% of patients and consist of proliferative vitreoretinopathy, retinal detachment, strabismus, cataract, microphthalmia, optic nerve atrophy, and iris hypoplasia. Retinal vascular abnormalities, ranging from peripheral retinal avascularity to neovascular and fibrous proliferation with traction retinal detachment, are the primary cause of severe visual dysfunction in patients. Therapeutic intervention with laser photocoagulation and cryotherapy for the proliferative vitreoretinopathy of incontinentia pigmenti has met with variable success. We report a case in which laser photocoagulation was used at the onset of retinopathy with subsequent resolution of the vasculopathy. ( info)

7/41. Vitreoretinopathy with phalangeal epiphyseal dysplasia, a type II collagenopathy resulting from a novel mutation in the C-propeptide region of the molecule.

    A large family with dominantly inherited rhegmatogenous retinal detachment, premature arthropathy, and development of phalangeal epiphyseal dysplasia, resulting in brachydactyly was linked to COL2A1, the gene encoding proalpha1(II) collagen. Mutational analysis of the gene by exon sequencing identified a novel mutation in the C-propeptide region of the molecule. The glycine to aspartic acid change occurred in a region that is highly conserved in all fibrillar collagen molecules. The resulting phenotype does not fit easily into pre-existing subgroups of the type II collagenopathies, which includes spondyloepiphyseal dysplasia, and the Kniest, Strudwick, and Stickler dysplasias. ( info)

8/41. Immunohistochemical study of epiretinal proliferative cellular tissue from a patient with sarcoidosis.

    BACKGROUND: sarcoidosis is a granulomatous disease causing uveitis. Although steroid therapy is usually effective for many patients, some are resistant to this therapy. In such cases, vitrectomy may be chosen as the therapeutic method to treat intraocular inflammation. CASE: A 26-year-old Japanese man was diagnosed as having sarcoidosis by clinical findings and histological examination of bronchoalveolar lavage. observation: One year after diagnosis, vitreous opacity worsened and pars plana vitrectomy (PPV) was performed. Six months later, recurrence of vitreous opacity appeared and severe retinal exudative changes with proliferative vitreoretinopathy developed. One year after the first operation, PPV was repeated and the epiretinal proliferative tissue was removed and examined. CONCLUSIONS: Histologic examination of the specimen showed scattered noncaseating granulomatous inflammation mainly consisting of epithelioid histiocytes and lymphocytes. plasma cells as well as T cells were identified and the predominance of CD8-positive T cells was demonstrated. Taking everything into consideration, a new finding of CD8 predominance in the epiretinal proliferative tissue was demonstrated. ( info)

9/41. 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. ( info)

10/41. Intraocular dispersion of perfluorocarbon liquids in silicone oil.

    PURPOSE: To report one case of intraocular emulsification of perfluorocarbon liquids (PFCLs) and silicone oil after vitrectomy surgery. DESIGN: Interventional case report. methods: Retrospective review of the clinic, and surgical record of a 39-year old female referred for persistent retinal detachment after vitrectomy surgery; PFCLs and silicone oil were left in the eye at the end of the surgery. RESULTS: There was intraocular emulsification of PFCLs into silicone oil. Electron microscope examination of the silicone oil surgically extracted from the eye demonstrated emulsification of small PFCL bubbles into the silicone oil. CONCLUSION: Perfluorocarbon liquids are surgical tools. They should be completely removed from the eye at the end of the surgery; PFCLs and silicone oil tend to emulsify together, originating an opaque fluid, which contains both silicone oil and dispersed PFCL bubbles. ( info)
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