Retinal redetachment after removal of intraocular silicone oil tamponade. (65/740)

AIM: To evaluate frequency and risk factors of retinal redetachment after removal of intraocular silicone oil tamponade. METHODS: The study included 225 patients who consecutively underwent intraocular silicone oil removal at a mean interval of 10 months after pars plana vitrectomy had been performed by one of two surgeons. Mean follow up time was 17.37 (SD 14.40) months (range 3.02-67.42 months). RESULTS: In 57 of 225 (25.3%) patients, the retina detached after removal of silicone oil. Risk factors for retinal redetachment were the following: number of previously unsuccessful retinal detachment surgeries (p=0.0008); surgeon (p=0.007); visual acuity before silicone oil removal (p=0.009); incomplete removal of vitreous base (p=0.01); absence of an encircling band in eyes with proliferate vitreoretinopathy in which an inferior retinotomy had not been performed (p=0.01); and indication for pars plana vitrectomy. Rate of retinal redetachment was statistically (p>0.05) independent of the technique of silicone oil removal and duration of silicone oil endotamponade. CONCLUSION: Retinal redetachment after removal of silicone oil endotamponade can occur in approximately a fourth of patients, depending on the criteria to use and to remove silicone oil. Risk factors for recurrent detachment included the following: number of previously unsuccessful retinal detachment surgeries, surgeon, preoperative visual acuity, incomplete removal of the vitreous base, absence of an encircling band, and reason for pars plana vitrectomy. The rate of retinal redetachment is independent of the technique of silicone oil removal and duration of silicone oil endotamponade, with a minimal duration of silicone oil tamponade of about 3 months in the present study.  (+info)

Treatment of early giant retinal tears with domestic perfluorodecalin and perfluoropropane. (66/740)

OBJECTIVE: To explore the methods of lens-sparing (without lensectomy), non-silicone oil tamponade and no scleral buckling for treatment of early giant retinal tears. METHODS: Thirteen cases of early retinal detachment of proliferative vitreoretinopathy (PVR) grade C2-D1, with giant tear extending from 135 degrees to 270 degrees were chosen. Transscleral cryotherapy was first applied to treat each end of the giant tear up to the oral serrate. And then conventional three-port pars plana vitrectomy was performed. Perfluorodecalin liquid was injected to manipulate the flap of the retinal tear. The flap with no cryotherapy before was treated with endolaser or cryotherapy under optimal visual condition, then air-fluid was exchanged completely and C3F8 was injected properly. RESULTS: With a mean follow-up of 8.2 months, the retina was reattached completely in 12 eyes. Success rate was 92.3%, and visual acuity improved. Most postoperative complications were slight. The retina failed to reattach only in 1 case with severe vitreous blood. CONCLUSIONS: In treating early retinal giant tears without severe PVR, the lens-sparing, non-silicone oil tamponade and no scleral bucking are helpful to simplify operation and to improve the success rate of the retinal surgery and to yield satisfactory outcome of visual acuity. Besides, it can also avoid the initial side effects of silicone oil tamponade and diopter irregularity after lensectomy.  (+info)

Phacovitrectomy without prone posture for full thickness macular holes. (67/740)

AIMS: To investigate the role of phacovitrectomy surgery without prone posture for stage 2 and 3 macular holes. METHODS: A pilot study was performed on 20 patients (20 eyes) having phacoemulsification lens removal and vitrectomy surgery with 20% C(2)F(6) tamponade. Patients were advised to avoid lying on their backs for 10 days following surgery but no other posturing instructions were given. Closure rates and improvement in visual acuity were compared with a group of historical controls in whom phacovitrectomy with gas tamponade and face down posturing was performed. RESULTS: Anatomical hole closure was noted in 18 of the 20 eyes (90%). 19 eyes (95%) showed an improvement of at least 0.3 logMAR units. This compares favourably with the postured group in which anatomical hole closure was noted in 11 of 13 eyes (85%) and nine of 13 eyes (69%) showed an improvement of at least 0.3 logMAR units. CONCLUSION: Combined surgery facilitates the use of a large gas bubble. Sufficient tamponade of the hole occurs for closure without prone posturing. Combined surgery prevents patients posturing and returning for cataract surgery.  (+info)

Macular hole surgery using silicone oil tamponade. (68/740)

BACKGROUND/AIMS: Most surgeons performing macular hole surgery using long acting gas recommend strict postoperative face down posturing for 10-15 days. Patients with chronic systemic illness such as arthritis may be unable to carry out this postoperative regime. Thus there is a need for alternative techniques that would eliminate such a regime. The authors review a series of patients who underwent macular hole surgery using silicone oil without any postoperative posturing. METHODS: A retrospective case note review was performed of patients who had undergone macular hole surgery with silicone oil tamponade. The patients were unable to posture due to chronic illness and had stage 2, 3, or 4 full thickness macular holes. Removal of silicone oil performed with or without cataract surgery was arranged 3 months or more after surgery. RESULTS: 10 eyes of 10 patients underwent surgery. Duration of oil tamponade ranged from 3-9 months. Following oil removal the hole was closed in eight eyes (80%), of which only three showed any improvement in visual acuity (38%) even after cataract extraction. All eyes developed cataract to varying degrees and one eye developed raised intraocular pressure which settled after oil removal. A serious complication, endophthalmitis, occurred in one eye following removal of sutures after cataract extraction. CONCLUSION: The anatomical results (80%) in this series are in keeping with those reported in other studies using gas tamponade. The visual results are disappointing and less rewarding than those obtained after successful surgery using gas tamponade.  (+info)

Outcome after silicone oil removal. (69/740)

BACKGROUND: Combined with vitreoretinal surgery, silicone oil injection has become a standard technique and improves the prognosis of complex retinal detachment. As silicone oil leads to long term complications, removal of silicone oil from the eye is recommended. To evaluate the outcome after silicone oil removal, retinal redetachment, visual acuity, and complications were analysed. METHODS: The authors analysed 115 consecutive cases of silicone oil removal (115 eyes), all operated by one surgeon. The series consisted of retinal detachments associated with proliferative vitreoretinopathy (103 eyes), proliferative diabetic retinopathy (six eyes), or ocular trauma (six eyes). The mean duration of intraocular silicone oil tamponade was 13.3 months, with a mean postoperative follow up of 1.8 years. RESULTS: Anatomic success after silicone oil removal, defined as a complete retinal attachment, was achieved in 95 of 115 eyes (82.6%). Redetachment occurred in 20 eyes (17.4%), mostly within the first 6 months after silicone oil removal. Including the successfully reoperated eyes, the authors present a final anatomic success rate of 108 eyes (93.9%). Visual acuity improved or remained unchanged in 93 eyes (80.9%). CONCLUSION: While reattachment and complication rates were quite similar to other studies, a better visual outcome was achieved in these cases. The duration of the silicone oil tamponade had no significant effect on the reattachment rate. The authors recommend not to apply standard criteria for the timing of silicone oil removal, but to decide individually, considering the underlying disease, as well as the previous operations.  (+info)

Vitreoretinal surgery: pre-emptive analgesia. (70/740)

AIM: Vitrectomies are performed either under general anesthesia (GA), local anesthesia (LA), or a combination of both. Postoperative pain is expected to be less in patients with LA because of prolonged action of the local anaesthetic. Pre-emptive analgesia is based on the idea that analgesia initiated before a nociceptive event will be more effective than analgesia commenced afterwards. The authors compared postoperative analgesia in patients with GA combined with preoperative or postoperative LA. METHODS: 90 patients scheduled for vitrectomy without buckling were enrolled in the study. 60 patients underwent GA, 30 without LA, 15 with preoperative LA, and 15 with postoperative LA. 30 patients received LA alone. Subjective postoperative pain was determined using the visual analogue scale. RESULTS: Postoperative pain was less under LA alone compared to GA alone (p < 0.0001). Additional preoperative application of LA resulted in less pain than additional postoperative application (p <0.05). Additional postoperative peribulbar aneasthesia did not differ from GA alone. CONCLUSION: The authors conclude that LA alone or preoperatively in addition to GA provides the best comfort for the patient in vitreoretinal surgery.  (+info)

New visual acuity chart for patients with macular hole. (71/740)

PURPOSE: To evaluate the usefulness of a new multiple-letter visual acuity chart (MLAC) for the measurement of visual acuity in patients with macular hole. METHODS: Visual acuity was measured using a standard visual acuity chart (Landolt rings, also referred to as C's) and with the MLAC in normal subjects and in patients with a cataract or a macular hole. The MLAC has 14 plates (45 x 45 cm), and on one plate, many Landolt C's were printed with the gaps pointing in the same direction and all of one size. The sizes of the letters and gaps were made to give equivalent visual acuities of 0.1, 0.15, 0.2, 0.3, 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, 1.0, 1.2, 1.5, and 2.0. The spacing between the letters was 33.3% of the diameter of the C's. Each chart projected many C's onto the macular area (5 degrees x 5 degrees ), which permitted the measurement of visual acuity at an extrafoveal point without the patient having to search for the extrafoveal point with the best acuity. RESULTS: There was no difference in the acuity measurement determined with the standard chart and the MLAC in normal subjects and patients with cataracts. Twelve of 16 patients with open macular hole, however, demonstrated higher acuity measurement (more than two lines) on the MLAC than on the standard chart. The improvement of visual acuity measurement after successful macular hole surgery was significantly less with the MLAC than with the standard chart. CONCLUSIONS: Our results suggest that the standard acuity chart, when administered before surgery, underestimates the patient's potential visual acuity after surgery, whereas the MLAC provides a better estimate of the patient's postoperative acuity. The MLAC can be a useful tool for measuring visual acuity in patients with macular hole.  (+info)

Bilateral endogenous Candida endophthalmitis after induced abortion. (72/740)

AIM: Analysis of the development and treatment of bilateral Candida endophthalmitis after induced abortion in a healthy 31-year-old patient. METHOD: A diagnosis of bilateral Candida endophthalmitis was established on the basis of positive vaginal culture, serological finding, and culture for Candida hyphae from the vitreous aspirate. The treatment of the disease consisted of prolonged systemic therapy with amphotericin B and fluconazole and pars plana vitrectomy with intravitreal amphotericin B injection. RESULTS: After the combined systemic therapy with antibiotics, fungistatics, and corticosteroids proved to be insufficient, pars plana vitrectomy with intravitreal instillation of amphotericin B was performed, which led to the improvement of visual function. After surgery, visual function was maintained with prolonged systemic therapy with fluconazole and methylprednisolone. CONCLUSION: Complicated induced abortion may cause bilateral Candida endophthalmitis in a young healthy woman. Elimination of the cause of fungemia and adequate systemic treatment did not cure bilateral endophthalmitis. Pars plana vitrectomy with intravitreal instillation of 5-microg amphotericin B proved as a method of choice in treating this severe ophthalmic disease.  (+info)