Vitreous changes and retinal detachment in highly myopic eyes

Although the impressive increase in the number of filters placed since 1988 is not surprising, it is appropriate to continue to review the indications for placement to determine whether abuse of these devices is occurring. Initially, there were very stringent requirements that were appropriate because there were few data to evaluate the efficacy and safety of the device. Now, data have been accumulated indicating the Greenfield filter has a high degree of efficacy (95%) and comparable caval patency (96%)32 for 20 years.1 Knowing that the filter is safe and effective, physicians are electing to place it in patients with greater comorbidity factors or with longer life-expectancy. In addition, advances in the treatment of patients with multiple trauma and malignancy have resulted in improved survival, leaving more patients at risk of DVT and PE. Finally, the number of patients older than age 60 is increasing rapidly, and the number of elective and emergent orthopaedic procedures is growing. All of these factors have led to an increased number of filter placements that should be considered appropriate. Although there are certainly cases in which the filter was placed without sufficient justification, the explosion in use can more accurately be correlated with changes in medical care, the established efficacy and safety of the device, the growing numbers of patients diagnosed with thromboembolism, and the increased awareness of the risk of complications from anticoagulation. When filter placement is preceded by a careful assessment of the patient to determine the risks and benefits of alternative treatments, there is little danger of abuse. However, more clinical investigation will be necessary to determine the optimal, cost-effective approach in situations in which controversy currently exists.     

Rhegmatogenous retinal detachment

Among all the types of retinal detachments, the most common are rhegmatogenous detachments, as defined by the presence of a break in the retina. This is the predominant factor in their mechanism. For this reason, treatment is exclusively surgical and consists of sealing the retinal holes by adhesion. The main cause is modification of the vitreous fluid due to age. Presently, surgery obtains good functional results if undertaken rapidly: retinal detachment is an emergency. An essential factor in prophylaxy is information of patients and physicians.     

Bilateral phakic retinal detachment

Ninety-nine (11.6%) of 850 phakic retinal detachment patients had bilateral detachments. The incidence of bilaterality was greater in nontraumatic detachments (13.4%) than traumatic detachments (3.8%). Patients were divided into two refractive classes: (1) myopic, containing refractive errors of -2.50 diopters or more, and (2) nonmyopic, containing all other refractive errors. The rate of bilaterality in nontraumatic detachments varied with refractive class and lattice degeneration: nonmyopic without lattice (8.1%), nonmyopic with lattice (14.2%), myopic without lattice (16.3%), and myopic with lattice (24.6%). Mean age in years at onset of the initial detachment varied with refractive class and lattice degeneration: nonmyopic without lattice (59.1), nonmyopic with lattice (55.8), myopic without lattice (49.2), and myopic with lattice (28.2). Lattice degeneration reduced the interval between detachments. Annual risks of fellow eye detachments were calculated for four groups: nonmyopic without lattice (0.12%), nonmyopic with lattice (0.95%), myopic without lattice (1.3%), and myopic with lattice (0.98%).     

Bilateral retinal detachment in Marfan''s syndrome

A 31-year-old man with type A chronic aortic dissection associated with annuloaortic ectasia underwent the concomitant graft replacement of the total aortic root and the transverse aortic arch. The two coronary arteries were reconstructed using the Carrel patch method. The false lumen of right coronary artery was closed by injection of GRF glue into the dissected space and compressing the dissected layers. Postoperative course was uneventful, and the patient has returned to normal daily life 2 months after surgery. Remarkable progression of the right coronary artery ostial stenosis was observed by coronary angiography 6 months after surgery. The remarkable progression of stenosis may occur in association with injection of GRF glue into the dissected space, although the exact etiology of the progressive stenosis remains obscure.     

Pseudophakic retinal detachment in high axial myopia

PURPOSE: To investigate the effect of extracapsular cataract surgery with intraocular lens (IOL) implantation and neodymium:YAG (Nd:YAG) laser posterior capsulotomy on the rate of retinal detachment (RD) in myopic eyes with an axial length of 27 mm or more. SETTING: Department of Ophthalmology, University of Giessen, Germany. METHODS: This retrospective, nonrandomized study comprised the records of 386 consecutive surgical procedures in 275 patients performed between December 1985 and December 1993. In May 1994, all patients were asked by a mailed questionnaire whether they had had an RD in either eye or laser treatment for posterior capsule opacification. Responses from 190 patients concerning 253 surgical procedures were evaluated. RESULTS: The pseudophakic RD rate was 0.8% (two cases). One patient developed aphakic RD after IOL explanation. One expulsive choroidal hemorrhage occurred during secondary IOL implantation. Four eyes (1.6%) had vitreous loss, and 74 eyes (29.2%) had an Nd:YAG capsulotomy. Mean axial length was 29.2 mm +/- 1.71 (SD), mean follow-up was 3.8 +/- 2 years, and mean age at surgery was 69.8 +/- 12 years. CONCLUSION: Pseudophakia with no other risk factor posed little additional risk for RD in eyes with high axial myopia; however, Nd:YAG laser posterior capsulotomy was a risk factor for pseudophakic RD. Complicated surgery, such as a secondary procedure or vitreous loss, and young age were major causative factors.     

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.     

Toxoplasmic chorioretinitis complicated by retinal detachment

PURPOSE: To describe and analyse relationship between chorioretinal toxoplasmosis and retinal detachment. PATIENTS AND METHODS: Seven immunocompetent patients examined and treated between November 1992 and March 1996, with ocular toxoplasmic retinochoroiditis and retinal detachment. RESULTS: Of the 7 patients examined, 5 had active retinochoroiditis and 2 had typical inactive scars. Of the patients with active focus 3 had giant retinal tears, one had a posterior retinal tear and one had a retinal tear located at the edge of an atrophic scar. Of the patients with inactive lesions, one had tractional retinal detachment and the other presented with a complete retinal detachment, multiples tears and PVR. Five patients were treated by corticosteroid without antitoxoplasmic drug before they were referred. The seven patients underwent endo-ocular surgery with silicon oil or long actic gas tamponade. Three patients developed PVR and redetachment of the retina and two patients underwent further surgery. Good anatomical result was obtained in 6 patients. CONCLUSION: Retinal detachment associated with toxoplasmic retinochoroiditis is rare. However it represents a serious complication. Steroid administrated to salvage vision may then worsen the clinical course, these may be justified to reduce hypersensitivity to toxoplasma antigen, but they should be combined with an antimicrobial agent.     

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.     

Histopathological changes in aluminium phosphide poisoning

A total of thirty cases of aluminium phosphide poisoning were studied for gross and microscopic changes in various organs of the body ie, lungs, liver, kidneys, heart, brain, stomach and adrenals. The histopathological changes revealed varying degrees of congestion, oedema and leucocytic infiltration, changes suggestive of cellular hypoxia. The most dramatic effects were produced in lungs, kidneys and adrenals.     

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.     

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.     

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.     

The effect of total protein and albumin levels in serum on retinal detachment due to EPH-gestosis]

The ob gene product might influence the hypothalamo-pituitary axis and ovarian function directly via specific ovarian receptors. Premenopausal women have higher leptin concentrations compared to postmenopausal controls. In this study, we determined changes in leptin serum concentrations under the influence of supraphysiological estradiol levels during controlled ovarian hyperstimulation. In a prospective study of 20 patients undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), morning blood samples were collected to determine leptin and estradiol concentrations on day 3 and day 9 of the stimulation cycle and on alternate days until ovulation induction. There was a significant increase in serum leptin concentrations from day 3 to day 9 (9.87 +/- 1.5 ng/ml on day 3 and 13.8 +/- 2.1 ng/ml on day 9 respectively). No further increase in leptin was observed until the day of ovulation induction. These data further underline the role of leptin as a hormone of reproduction.     

Limits of constriction in the treatment of retinal detachment

A constricting silicone band was added to 13% of local sponge buckle operations in this series. The purpose was to relieve circumferential traction or to maintain a high buckle. The inclusion of a cerclage did not require drainage of subretinal fluid. The rate of reattachment without drainage (42 of 50 detachments) is comparable to what might be expected if the subretinal fluid had been drained. Constriction was controlled and limited to between 10% and 25% of the circumference of the eye. Anterior segment ischemia requiring relaxation of the band occurred in two patients; scleral erosion did not occur.