Giant pigment epithelial tear and exudative retinal detachment complicating choroidal effusions

PURPOSE: To report a case of a giant pigment epithelial tear and transient exudative retinal detachment occurring in a patient with hypotonic choroidal effusions after trabeculectomy. METHODS: Case report and brief literature review. RESULT: The retinal and choroidal detachments settled, disclosing an extremely large crescentic pigment epithelial defect in the temporal midperiphery. CONCLUSIONS: An exudative retinal detachment secondary to a peripheral pigment epithelial rip may complicate choroidal effusions. Recognition of this association may prevent unnecessary investigation or surgery.     

Primary vitrectomy without scleral buckling for rhegmatogenous retinal detachment

BACKGROUND: Pars planta vitrectomy has evolved as an alternative method in the treatment of more complicated rhegmatogenous retinal detachments. We report a series of patients who underwent primary vitrectomy with gas tamponade without the use of additional scleral buckling. METHODS: A retrospective study of 53 patients with a follow-up of 6-45 months (mean 17.8 months) was carried out. Preoperative findings included unusual, multiple or large breaks, vitreous haemorrhage, proliferative vitreoretinopathy and bullous retinal detachment. Preoperative visual acuity was between light perception and 1.0, with 30% (16/53) of patients with 0.4 or better. RESULTS: Retinal reattachment was achieved in 64% of cases (34/53) with one and in 92% (49/53) with one or more operations. Final visual acuity was between light perception and 1.0, with 41% (22/53) of patients with 0.4 or better. Cataract formation occurred in 86% (37/43) of all patients with a clear lens preoperatively. Macular pucker was noted in 11% (6/53) and postoperative proliferative vitreoretinopathy causing redetachment in 6% (3/53). CONCLUSION: With primary vitrectomy, a high final anatomical success rate with few intraoperative complications can be achieved in more complicated forms of rhegmatogenous retinal detachment. The major drawback of the procedure is the high incidence of post-operative cataract formation.     

Repair of a complex retinal detachment with proliferative vitreoretinopathy in an eye with extreme scleral thinning

Two new withanolides (steroidal lactones) named coagulin F [27-hydroxy-14,20-epoxy-1-oxo-(22R)-witha-3,5,24-trienolide] (1) and coagulin G [17beta,27-dihydroxy-14,20-epoxy-1-oxo-(22R)-witha-2,5, 24-trienolide] (2) were isolated from the whole plant of Withania coagulans, and their structures were deduced by spectral analysis.     

Pneumatic retinopexy as supplemental therapy for persistent retinal detachment after scleral buckling operation

BACKGROUND: Factors associated with the development of basal cell carcinomas (BCCs) are radiation exposure, sunlight, trauma, and burns. OBJECTIVE: We wish to further document the relationship between the development of BCCs and previous diathermic exposure for therapeutical purposes. Moreover, we compared the histological subtypes of BCCs developed in patients with or without previous therapy. METHODS: A retrospective study of 1053 patients with BCCs seen at our dermatologic clinic was performed. RESULTS: Twenty-three patients had histories of diathermic therapy for different osteoarticular problems. The interval of time between the treatments and the appearance of the tumor was 12-31 years. The histologic subtypes involved were the same of other BCCs on the same areas. CONCLUSIONS: Our study supports the association of BCCs and diathermic therapy in the development of the tumor of the previously treated areas. Histological subtypes do not seem to be affected by environmental factors but are a characteristic of the site location of the tumor.     

Long-term results after scleral buckling surgery in uncomplicated juvenile retinal detachment without proliferative vitreoretinopathy

Hyponatremia is a common complication after subarachnoid hemorrhage (SAH). Although the mechanism of hyponatremia is still controversial, cerebral salt-wasting syndrome (CSNS) is currently regarded as being more responsible than the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). The aim of our study was to assess the plasma volume status of a patient with hyponatremia following subarachnoid hemorrhage. In doing this it may be possible to indirectly differentiate its pathogenesis. Fifty patients with SAH were studied. Twenty patients demonstrated hyponatremia (serum sodium < 135 mEq/L) during day 7 to 13 after subarachnoid hemorrhage. Patients with hyponatremia were categorized on the basis of their daily body weight, and central venous pressure. Group A consisted of patients with hypovolemia (16 patients), with the onset time of hyponatremia being day 7 to 9. Group B included those with hypervolemia (4 patients); hyponatremia was observed during day 10 to 11 and was corrected in all patients within 72 hours after induction of fluid restriction. Our findings suggest that hyponatremia following subarachnoid hemorrhage usually occurs due to CSWS, although SIADH remains as a minor pathogenesis. We conclude that the combination of daily body weight and CVP measurements is a simple and practical method to distinguish promptly SIADH from CSWS.     

Variation of technique of episcleral sponge placement: effect on scleral indentation for retinal detachment repair

Seventy-eight 5 mm silicone sponges were sutured to autopsy eyes using various techniques, and resulting scleral indentation was compared to a control series. Indentation was decreased by suture separation narrower or wider than 8 mm, short suture passage, loose sutures, high intraocular pressure, and partial thickness sponges. Increased indentation resulted from excessively tight sutures and low intraocular pressure. No change was produced by variation of sponge stretch or lengthening scleral suture passage. Lateral adjustability of sponge position was gained when wide suture separation was used.     

Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment

OBJECTIVE: This study aimed to report the success rate of primary vitrectomy, scleral buckling, and oral steroids in eyes with combined rhegmatogenous retinal detachment (RRD) and choroidal detachment (CD) and to compare these results with those reported in the literature for similar cases managed by scleral buckling alone. DESIGN: Consecutive case series. PARTICIPANTS: Twenty-one eyes of 21 consecutive patients with primary RRD associated with CD were examined. INTERVENTION: All patients were treated with systemic corticosteroids before surgery. Pars plana vitrectomy with scleral buckling or encircling or both were performed. MAIN OUTCOME MEASURES: Retinal reattachment rate and resolution of choroidal detachment were measured. RESULTS: At mean follow-up of 11.4 months, retinal reattachment was attained in 19 eyes (90.5%) compared to less than 53% reported in the literature for scleral buckling alone. With preoperative oral steroids, choroidal detachment regressed completely in 13 eyes (61.9%). In the remaining eyes with persistent choroidal detachment, suprachoroidal fluid was drained during vitrectomy. CONCLUSION: Aggressive treatment with oral steroids followed by pars plana vitrectomy and scleral buckling or encircling is recommended instead of scleral buckling alone in the management of combined primary rhegmatogenous retinal detachment and choroidal detachment.     

Crystalline retinopathy associated with chronic retinal detachment

OBJECTIVE: To describe the presence of crystalline opacities located at the level of the inner retina in patients with chronic retinal detachment. METHODS: We reviewed the clinical records, fundus photographs, and fluorescein angiograms of patients with superficial retinal crystals in the presence of a chronic retinal detachment. RESULTS: Eleven eyes in 11 patients with chronic retinal detachment were found to have these peculiar crystalline opacities on the inner retinal surface. In 5 patients, the crystalline opacities were noted on initial assessment prior to surgery and persisted without change in appearance or number after surgical repair. In 6 eyes, the crystals were not appreciated until after surgical repair of the retinal detachment. The crystals appeared similar in all 11 eyes, were highly refractile, and were located in the posterior pole. Eight of the eyes had retinal detachment associated with retinal dialysis and 6 of these had a history of trauma. There was a definite history of vitreous hemorrhage in 2 eyes. The crystals did not seem to be associated with any visual deficit. CONCLUSIONS: Chronic retinal detachment can be associated with crystals on the inner retinal surface. The cause and composition of these crystals are unknown. They seem to be visually inconsequential and unchanging.     

Rushing the net and retinal detachment

With the growth in popularity of tennis has come an increase in ocular injuries due to tennis balls. This report describes ten patients who sustained ocular confusion from high-speed tennis balls. Seven of the patients required either retinal surgery, laser photocoagulation, or both. Early detection of regional damage is essential, but of greater importance is prevention. For that reason, we advise use of some sort of ocular protection device for high-risk individuals.     

Surgical treatment of lung abscesses

The authors analysed a group of patients with lung abscesses that received surgical treatment, as well as the characteristics of their evolution. Seventeen patients with lung abscesses which underwent surgical therapy from 1984 to 1995 were analysed. The group was composed of 12 male and 5 female. The age varied from 25 to 78 years (mean-50.1 years). The etiologies were: post-pneumonic, tuberculosis, foreign-body, empyema. Two types of surgical procedures were performed: pulmonary resection and transthoracic drainage. The indication of surgery was based on the failure of clinical treatment, massive hemoptysis, pleural empyema and residual cavity wider than 2 cm after 6 weeks of clinical treatment. The patients with poor clinical conditions were selected to transthoracic drainage, the less invasive procedure. Most patients had a satisfactory post-operative evolution (58.9%). Five patients had complications (29.4%) as empyema and air leak for more than three weeks and two patients died (11.9%). Regarding the surgical technics, the pulmonary resection (lobectomy and segmentectomy) showed no morbidity and mortality. The usage of external chest tube drainage of the abscess had a morbidity of 40% and mortality of 20%. In conclusion, the complicated lung abscess is still a surgical pathology and the best approach seems to be the resection of the pulmonary segment affected. The drainage has specific indication, mainly in patients with deteriorating condition, but this procedure has high mortality and morbidity rates.     

Scleral buckling with Bioplast fibrin in retinal detachment

The study includes a series of 38 patients with retinal detachment of different aetiology. Scleral reduction combined with the intrascleral implantation of absorbable Bioplast fibrin scleral buckling rods was performed and reattachment achieved in 31 cases. The implant material is biocompatible and is eliminated from the eye in the course of a few weeks.     

Schisis-like rhegmatogenous retinal detachment associated with choroidal colobomas

BACKGROUND: The breaks that cause retinal detachments in colobomatous eyes are often hidden within the lesion and difficult to find. METHOD: To elucidate the pathoanatomy and possible pathomechanism of such detachments, histological sections of eight choroidal colobomas were reviewed. RESULTS: Sections of the margin showed central continuation of the inner neuroblastic layer (the intercalary membrane) and eversion and separation of the outer neuroblastic layer. The opposite direction of continuity of the neuroblastic layers created a schisis-like configuration between the intercalary membrane and the everted outer retina. The zone of duplication was a point of retinal adhesion, but also a locus minoris resistentiae due to vitreous attachments and variable glial support at the margin. CONCLUSION: The subset of coloboma-associated retinal detachments requires both a central break in the inner layer and a break in the outer layer at the margin of the coloboma. The inner layer break may be precipitated by retinovascular ischemia or scleral stretching; that in the outer layer may be caused by vitreous traction on the margin of the coloboma or extension of the formerly isolated detachment through the outer marginal zone of decreased glial support.     

Comparison of pneumatic retinopexy and scleral buckling in the management of primary rhegmatogenous retinal detachment. Southern Wisconsin Pneumatic Retinopexy Study Group

PURPOSE: To compare pneumatic retinopexy and scleral buckling for repair of primary rhegmatogenous retinal detachment with respect to visual outcome, single-procedure reattachment rate, and development of proliferative vitreoretinopathy. METHODS: A consecutive series of eyes initially treated with pneumatic retinopexy (n = 56) between March 1986 and February 1996 were compared with a selected group of eyes treated with scleral buckling (n = 86) with similar location and distribution of retinal breaks and absence of proliferative vitreoretinopathy. A regression model was developed to adjust for underlying differences between treatment groups, resulting in a cohort of 50 eyes in each group for final comparison. A minimum follow-up of 6 months was obtained. RESULTS: Single-procedure reattachment rate was significantly higher for scleral buckle eyes (42 of 50 eyes, 84%) than for pneumatic retinopexy eyes (31 of 50 eyes, 62%; P < or = .01). Correspondingly, reoperation rate was significantly higher for pneumatic retinopexy eyes (19 of 50 eyes, 38%) than for scleral buckle eyes (7 of 50 eyes, 14%; P < or = .01). Multiple regression analysis evaluating perioperative factors demonstrated that the use of pneumatic retinopexy was the sole factor predictive of retinal detachment after a single procedure (relative odds = 2.20, P = .02). Final reattachment rate, after reoperations, was 98% (49 of 50 eyes) in each group. Except for nonphakic eyes, final visual outcome and rate of postoperative proliferative vitreoretinopathy development did not differ significantly between the two procedures. CONCLUSIONS: In phakic eyes, pneumatic retinopexy was associated with a significantly higher reoperation rate than scleral buckling, but resulted in equivalent final visual outcome and reattachment rate after reoperations. If used, it must be incorporated into a strategy in which patient and physician are prepared for a greater chance of reoperation compared to initial management with scleral buckling.     

Clinicopathologic correlation of localized retinal pigment epithelium debridement

PURPOSE: To characterize changes in the retina, retinal pigment epithelium (RPE), and choriocapillaris with fluorescein angiography (FA) and histology after hydraulic or abrasive RPE debridement in 26 domestic short-haired cats. METHODS: Hydraulic debridement was produced by injecting balanced salt solution forcefully into the subretinal space. For abrasive debridement, RPE were removed with a silicone-tipped cannula after creating a localized retinal detachment. The FAs were performed after surgery, and tissue was prepared for light microscopy (LM) and scanning electron microscopy (SEM). RESULTS: Sixty-seven blebs were examined by FA 1 hour after surgery, and RPE debridement was confirmed by SEM or LM in 15 blebs from 10 animals. Hyperfluorescence and variable central fluorescein leakage were seen 1 week after surgery in 52 of 53 blebs (which includes all 27 blebs from the 1-week timepoint and 26 of 29 blebs from the 4-week timepoint that were studied by FA 1 week after surgery). Choriocapillary filling delays were seen in no hydraulic debridements, but in 11 of 14 abrasive blebs, especially in areas showing leakage late in the angiogram. In 1 of 13 hydraulic and 12 of 14 abrasive debridements, areas of late dye leakage had no RPE with outer retinal degeneration. At the 4-week timepoint, 1 of 17 hydraulic and 10 of 12 abrasive debridements had foci of delayed or absent choriocapillary perfusion by FA, with degenerated outer retina, no RPE, and choriocapillary atrophy by histologic analysis. CONCLUSIONS: Abrasive debridement is more commonly associated with abnormal FAs and with incomplete RPE repopulation, choriocapillaris atrophy, and outer retinal degeneration than is hydraulic debridement. This clinicopathologic study may give insight into FA interpretation after choroidal neovascular membrane removal in human patients.     

Vitrectomy in the treatment of simple retinal detachment

PURPOSE: To report the indications and results of vitrectomy in the treatment of uncomplicated retinal detachment. METHODS: This retrospective study covered 103 vitrectomies that were carried out during an 8-year period for the treatment of rhegmatogenous retinal detachment without severe proliferative vitreoretinopathy, macular hole, or giant tear. Mean follow-up time was 20.3 months. RESULTS: The indications for vitrectomy were vitreal opacities in 32 cases, unseen or uncertain retinal breaks despite a good retinal view in 9 cases, a difficult arrangement of breaks in 34 cases, severe vitreal traction in 15 cases, and iatrogenic intraocular bleeding in 13 cases, 6 of them referred. In all, retinal breaks were uncertain or invisible in 49 cases. A buckle was used in 83 cases and an internal tamponade in 93. After vitrectomy, the retina was reattached in 76 cases, and after further surgery in 88 (85.4%). With vitrectomy, we were able to confirm or to detect all breaks in 36 cases. Of the 13 intraoperatively unseen breaks, 10 were responsible for vitrectomy failure. Late recurrence after more than 6 months was observed in 5 cases (4.9%). Secondary cataract was observed in 22 (66.6%) of the 33 phakic cases that had been operated on successfully and without complication. CONCLUSION: Our results indicate that vitrectomy is a useful procedure in the management of certain cases of uncomplicated rhegmatogenous retinal detachment. However, secondary cataract is a problem, and the risk of late recurrence needs further evaluation.