Retinal detachment following congenital cataract surgery

It is hoped that the results of surgery for retinal detachment after surgery for congenital cataract, when discission and aspiration or phacoemulsification under the microscope are used, will approach the present reattachment rate that has been achieved with improved examination, instrumentation, and surgical technique in cases of senile retinal detachment. Further studies of the role of retinal pathology as lattice degeneration, vitreous pathology, and the place for prophylactic cryotherapy all must be reevaluated. In summary, the low incidence of retinal detachment following the extraction of congenital cataracts as seen in major retinal referral centers suggests that the risks of detachment are not as high as previously reported, that the cure rate approaches that of senile aphakic detachment; therefore early operative intervention to prevent amblyopia, nystagmus, and strabismus is indicated.     

Vitreoretinal complications in cataract surgery. I. Retinal detachment

OBJECTIVE: We raise the issue of scanning multifetal pregnancies of higher order as early as possible. A rare case of monochorionic/quadramniotic pregnancy seeking multifetal pregnancy reduction and its clinical management is presented. METHODS: Transabdominal scanning at 16 weeks was performed correctly diagnosing the monochorionic quadruplet pregnancy. RESULTS: Suspecting vascular connections between the placentae, the fetal reduction was declined. The patient was delivered at 31 weeks. The 4 female neonates survived with slight ventilatory assistance. CONCLUSION: Multifetal pregnancies in general, but those of higher order in particular, have to be scanned as early as 8-10 weeks to correctly and easily assign their chorionicity and amnionicity. The case of a monochorionic/quadramniotic pregnancy and its clinical course are presented.     

Retinal detachment following congenital cataract surgery. I. Preoperative findings in 114 eyes

One hundred fourteen eyes of patients with retinal detachment occurring after congenital cataract surgery were studied. Retinal detachment was typified by high incidences of men, myopia, preference for the second and fourth decades of life, and a fairly long interval after cataract surgery. Frequently found were the following: (1) undetected retinal breaks, (2) high incidences of small oval or round holes in the upper nasal quadrant near the ora serrata, (3) retinal detachment in more than one quadrant, and (4) extensive vitreous and preretinal traction. Preoperative examination was often hampered by a small, bound-down pupil, nystagmus, extreme photophobia, and an inability to move the eye in desired directions. The major factor in the pathogenesis of retinal detachment after congenital cataract surgery appears to be chronic vitreoretinal traction in the anterior vitreous caused by cataract removal.     

Retinal detachment following phacoemulsification in highly myopic cataract patients

OBJECTIVE: To compare trifluridine eyedrops, cidofovir eyedrops, and penciclovir ophthalmic ointment for the treatment of herpes simplex virus type 1 keratitis. METHODS: New Zealand white rabbits were infected with the McKrae strain of herpes simplex virus type 1. Three days after viral inoculation, the rabbits were randomly assigned to treatment with 1% trifluridine, 0.2% cidofovir, 3% penciclovir ointment, or phosphate-buffered saline (for control) on various schedules. The severity of keratitis was graded in a masked manner. RESULTS: Treatment with any of the antiviral drugs resulted in significantly less severe keratitis than treatment with phosphate-buffered saline. There was no statistically significant difference between eyes given trifluridine 2, 4, or 7 times a day and eyes given cidofovir 2 times a day (P=.06, P=.43, and P=.19, respectively, using the F test of the analysis of variance). Cidofovir given twice a day was significantly more effective than penciclovir given either 2 or 4 times a day (P<.001 and P=.002, respectively). Even with once-a-day dosage, all 3 drugs were significantly more effective than phosphate-buffered saline (P<.001 for all). There was no significant difference between once-a-day trifluridine and cidofovir treatments (P=.17). Trifluridine administered 5 times a day was as effective as 1% cidofovir. A similar degree of punctate keratitis was seen after 4 to 5 days in eyes treated with trifluridine at the highest frequency, 1% cidofovir, or penciclovir ointment. CONCLUSION: Trifluridine treatment was highly effective in this rabbit model, even when given only once a day. Treatment with cidofovir was as effective as that with trifluridine. CLINICAL RELEVANCE: Cidofovir and penciclovir treatments may prove to be effective against epithelial keratitis. Clinical trials of trifluridine, cidofovir, and penciclovir with lower treatment frequencies appear to be warranted.     

Retinal detachment

A retinal detachment is often traumatic and shocking to patients once they become aware of the condition. Nurses have the unique opportunity to assist these patients in accepting and in coping with this potential serious vision loss through understanding, education, rehabilitation, and ocular safety.     

Incidence of retinal detachment after cataract surgery and neodymium: YAG laser capsulotomy

The objective of this retrospective study was to determine the incidence of retinal detachment (RD) in patients following cataract extraction with intraocular lens placement and after neodymium:YAG (Nd:YAG) laser capsulotomy. This study comprised 1092 patients (1168 eyes) who had cataract extraction and related procedures between January 1986 and December 1992 identified from the coding and billing database. Of the 1092 patients, 215 (244 eyes) had had Nd:YAG laser capsulotomy. Their charts were reviewed for incidence of RD, and these data were correlated with age, sex, axial length, surgical complications, and other surgical procedures done at the time of cataract extraction. The incidence of RD following phacoemulsification alone was 0.75% (6/799), with a mean time between cataract extraction and RD of 11.6 months. The cases of RD after extracapsular cataract extraction, combined phacoemulsification and trabeculectomy, combined extracapsular cataract extraction and penetrating keratoplasty, and combined phacoemulsification and anterior vitrectomy were too few to draw any conclusions. The incidence of RD following Nd:YAG laser capsulotomy was 0.82% (2/244), with a mean time of 32 months between cataract surgery and capsulotomy and 13.5 months between capsulotomy and RD. There was a statistically significant higher incidence of RD after posterior capsule rupture and anterior vitrectomy than after uncomplicated phacoemulsification (2/12 versus 6/799). In conclusion, the rate of RD after uncomplicated phacoemulsification was less than or similar to the rate found in other recent studies. It was not statistically different from the rate following phacoemulsification and Nd:YAG laser capsulotomy (0.82%). This study confirms the increased risk of RD following posterior capsule rupture and anterior vitrectomy.     

Sulfur hexafluoride injection for Descemet's membrane detachment in cataract surgery

Extensive Descemet's membrane detachment persisted after small incision cataract surgery in three patients. Unfolding and repositioning of Descemet's membrane by sodium hyaluronate (Healon) were followed by injection of sulfur hexafluoride 20% gas mixed with air to fill the anterior chamber. Initially, the gas bubble filled most of the anterior chamber; it disappeared over 7 to 9 days. Descemet's membrane remained attached, and the corneal edema cleared.     

Retinal detachment following intracapsular and extracapsular cataract extraction. A comparative, retrospective follow-up study

In a retrospective study we reviewed the post-operative incidence of retinal detachment in a consecutive series of 762 eyes operated on with intracapsular cataract extraction and a consecutive series of 1351 eyes operated on with extracapsular cataract extraction. Follow-up time was 2 1/2-4 1/2 years in both series. The incidence of retinal detachment was 0.79% after intracapsular cataract extraction and 0.44% after extracapsular cataract extraction. The difference was not statistically significant. Age below 70 years was not statistically significantly correlated to retinal detachment.     

Retinal detachment in the rat

Retinal detachment is uncommon in the rat. Retinal atrophy, rosette formation and folding of the retina are some of the sequelae following reattachment.     

Retinal detachment with vitreous hemorrhage

The aim of this study was to assess the influence of prehospital advanced life support (PALS) on the survival of victims of severe trauma in our hospital. During a period of 24 months, 46 patients with severe trauma were admitted to our Emergency Department after receiving PALS; this included endotracheal intubation and ventilatory support (IVS) in 35 cases, and cardiopulmonary resuscitation (CPR) in 11. The severity of the trauma in this group of patients was confirmed by assessing the clinical condition on admission and the Glasgow Coma Scale score (mean = 4.0, median = 3), the Revised Trauma score (mean = 4.1, median = 4) and the Injury Severity Score (mean = 44.5 and median = 41 in blunt trauma; mean = 58.3 and median = 75 in penetrating trauma). The overall survival was 41%. The survival rate was 48% in patients with prehospital IVS rate and 18% in those receiving CPR. We conclude that PALS in severe trauma was able to save the lives of many patients at high risk of dying before reaching hospital.     

Corneal sensation after cataract and refractive surgery

Most surgical procedures involving the anterior segment of the eye disrupt the normal organization of corneal innervation. Since denervation of the cornea results in impaired epithelial wound healing, increased epithelial permeability, decreased epithelial metabolic activity, and loss of cytoskeletal structures associated with cellular adhesion, it is important to identify the factors that determine the extent of neural regeneration. Mechanisms of corneal nerve damage and studies of corneal nerve fiber loss and reinnervation after cataract and refractive surgery--epikeratophakia, cryokeratomileusis, keratomileusis in situ, photorefractive keratectomy, laser in situ keratomileusis, and phacoemulsification--are reviewed and the decrease in corneal sensitivity, as a measure of corneal destruction and corneal metabolism, after these surgical procedures is compared.     

Retinal detachment in a battered infant

A 12-week-old battered infant boy had bilateral retinal detachments. The retina in the left eye was considered inoperable, but retinal detachment surgery was performed in the right eye. This retina was reattached and limited vision was restored. The history, the location of the retinal pathology, and the absence of a lens coloboma helped differentiate this result of physical abuse from a congenital retinal detachment.     

Repair of Descemet's membrane detachment after intraocular surgery

We repaired three unselected cases of Descemet's membrane detachment. A visually successful outcome was achieved in one case, an anatomically successful outcome in another, and no improvement in the last. We believe that large detachments should be repaired early rather than waiting for possible spontaneous reattachment, and we advocate sulfur hexafluoride fluid-gas exchange as the procedure of choice.