RESUMEN
OBJECTIVE: To evaluate the role of surgical intervention in cases with severe, vision-threatening complications of X-linked retinoschisis. DESIGN: A retrospective survey of consecutive patients with X-linked retinoschisis who underwent surgery at our institution during a 16-year period. SETTING: A tertiary-care eye hospital. PATIENTS: Six eyes of four patients were identified. The mean age of the patients at the time of the first surgical procedure was 4.9 years (range, 18 months to 9 years). INTERVENTION: Scleral buckling procedure or pars plana vitrectomy. MAIN OUTCOME MEASURE: Surgical indications and long-term anatomic and visual outcome. RESULTS: Patients were initially operated on for rhegmatogenous retinal detachment (three eyes), exudative retinal detachment (one eye), and vitreous hemorrhage (two eyes). The surgical approach was scleral buckling for retinal detachment and vitrectomy for vitreous hemorrhage or proliferative vitreoretinopathy. Anatomic success and ambulatory vision (20/400 or better) was achieved in five of the six eyes with a mean follow-up of 3.8 years (range, 1 to 6 1/2 years). An average of 1.8 procedures per eye were performed. Two of the four eyes approached by primary scleral buckling eventually required vitrectomy. Proliferative vitreoretinopathy with retinal detachment was the major reason for reoperation. CONCLUSIONS: Surgery for X-linked retinoschisis-associated retinal detachment and vitreous hemorrhage can yield favorable anatomic and functional results. Multiple operations and the use of advanced vitreoretinal techniques to manage proliferative vitreoretinopathy-related complications, however, were necessary for ultimate success in certain cases.
Asunto(s)
Desprendimiento de Retina/cirugía , Perforaciones de la Retina/genética , Perforaciones de la Retina/cirugía , Hemorragia Vítrea/cirugía , Niño , Preescolar , Fondo de Ojo , Ligamiento Genético , Humanos , Lactante , Masculino , Desprendimiento de Retina/etiología , Perforaciones de la Retina/complicaciones , Estudios Retrospectivos , Curvatura de la Esclerótica , Resultado del Tratamiento , Agudeza Visual , Vitrectomía , Hemorragia Vítrea/etiología , Cromosoma XRESUMEN
PURPOSE: The authors evaluated factors that might influence the outcome of extracapsular cataract extraction with placement of a posterior chamber lens in patients with diabetic retinopathy. The factors included patient age and sex, severity of the retinopathy, preoperative laser photocoagulation, vitrectomy, and posterior capsulotomy. METHODS: The records of 109 patients who had been examined by the authors before cataract surgery were retrospectively reviewed. RESULTS: The final visual acuity in only 48% of the eyes was 20/40 or better, and 28% had 20/200 or worse visual acuity. Only 65% had an improvement in visual acuity of two or more Snellen lines. Eyes with preoperative macular edema had a poorer visual outcome than eyes without. Macular edema and ischemia accounted for 70% of the eyes with a final visual acuity of 20/50 or worse. The authors found that age was a strong predictor of final visual acuity and chances of improvement. In patients 63 years of age and younger, 58% had 20/40 or better and 81% had improved visual acuity. In patients 64 years of age and older, only 38% had 20/40 or better and only 54% were improved. Supplementary panretinal photocoagulation was required in 37% of patients who had received it preoperatively. Neovascularization of the iris developed in 6% of patients. Posterior capsulotomy did not cause an increased incidence of neovascularization of the iris or in the development or progression of proliferative retinopathy or macular edema. CONCLUSION: The prognosis of patients with diabetic retinopathy about to undergo cataract surgery, even extracapsular cataract extraction with placement of a posterior chamber lens, is guarded.
Asunto(s)
Extracción de Catarata/métodos , Retinopatía Diabética/cirugía , Cápsula del Cristalino/cirugía , Lentes Intraoculares , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Retinopatía Diabética/patología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Pronóstico , Estudios Retrospectivos , Factores Sexuales , Agudeza VisualRESUMEN
One hundred consecutive patients with macular choroidal neovascularization were studied in a cross-sectional fashion. Evidence of bilateral choroidal neovascularization was present in 31 patients. Among the 100 subjects, 59% related a history of seeing flickering or flashing lights (photopsias) in the affected eye or eyes. The colors varied, but in 59% of instances the lights were white. Twelve subjects experienced formed hallucinations (Charles Bonnet syndrome); in nine (75%) of these patients, the sequelae of choroidal neovascularization were bilateral. Symptoms that are commonly attributed to vitreoretinal tractional phenomena as well as neurologic and/or psychiatric disease are also frequently encountered in patients with macular degeneration associated with choroidal neovascularization.
Asunto(s)
Coroides/irrigación sanguínea , Alucinaciones/diagnóstico , Neovascularización Patológica/fisiopatología , Trastornos de la Visión/fisiopatología , Percepción Visual , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Fondo de Ojo , Humanos , Luz , Mácula Lútea , Degeneración Macular/diagnóstico , Masculino , Persona de Mediana Edad , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/fisiopatología , Síndrome , Agudeza VisualRESUMEN
PURPOSE: This study describes hemodynamic characteristics of the ophthalmic, central retinal, and posterior ciliary arteries in 16 eyes of 11 patients with the ocular ischemic syndrome. Understanding the hemodynamic characteristics of the retrobulbar circulation may elucidate the natural history and pathophysiology of the ocular ischemic syndrome and perhaps form the basis for rational treatment of this condition. METHODS: Color Doppler imaging, a procedure that permits rapid noninvasive imaging of the ophthalmic, central retinal, and posterior ciliary arteries, was used to quantitate peak systolic blood flow velocities and vascular resistance (pulsatility index) within these vessels in study group eyes and in an age-matched control population. RESULTS: We demonstrated markedly reduced ocular ischemic syndrome central retinal and posterior ciliary artery peak systolic velocities compared with control group eyes. Central retinal and posterior ciliary artery vascular resistance (pulsatility index) was greater in ocular ischemic eyes versus control group eyes. Reversal of ophthalmic artery blood flow was detected in 12 of 16 ocular ischemic syndrome eyes. Study group eyes with poor vision had no detectable posterior ciliary arterial blood flow. CONCLUSION: Color Doppler imaging quantitates hemodynamic characteristics of the retrobulbar circulation in the ocular ischemic syndrome. There is markedly reduced peak systolic velocity and increased vascular resistance in ocular end arteries such as the central retinal and posterior ciliary arteries. Ophthalmic artery reversal of flow seems to represent collateral blood flow to lower resistance vascular beds. Posterior ciliary artery hypoperfusion may correlate with poor vision in the ocular ischemic syndrome.
Asunto(s)
Ojo/irrigación sanguínea , Ojo/diagnóstico por imagen , Isquemia/diagnóstico por imagen , Isquemia/fisiopatología , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Cuerpo Ciliar/diagnóstico por imagen , Ojo/fisiopatología , Femenino , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Arteria Oftálmica/diagnóstico por imagen , Arteria Retiniana/diagnóstico por imagen , Síndrome , UltrasonografíaRESUMEN
A review of 484 consecutive eyes that were undergoing an initial pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy disclosed that 41 eyes (8.5%) required one or more additional vitrectomy operations. The primary causes for reoperation included rhegmatogenous retinal detachment in 18 (44%) of the 41 eyes, recurrent vitreous hemorrhage in 21 eyes (51%), and glaucoma in two eyes (5%). The visual prognosis was worse in the group with rhegmatogenous retinal detachment, with 10 (56%) of 18 eyes progressing to no light perception (P = .003). Severe preretinal and subretinal fibrous proliferation, as demonstrated histopathologically, accounted in large part for the poor result. The preretinal membrane formation appeared to occur secondary to a combination of diabetic extraretinal vascular growth and proliferative vitreoretinopathy. Among the total group of 41 eyes that required subsequent surgery, the retina eventually remained detached in 18 eyes (44%), and phthisis bulbi occurred in 13 eyes (32%). Rubeosis iridis developed in 17 (94%) of 18 eyes in which the retina remained detached.
Asunto(s)
Retinopatía Diabética/cirugía , Vitrectomía , Adulto , Retinopatía Diabética/patología , Retinopatía Diabética/fisiopatología , Oftalmopatías/patología , Enucleación del Ojo , Femenino , Glaucoma/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Reoperación , Desprendimiento de Retina/patología , Desprendimiento de Retina/cirugía , Enfermedades de la Retina/patología , Agudeza Visual , Cuerpo Vítreo/patología , Hemorragia Vítrea/cirugíaRESUMEN
Patients with sickle cell disease can have a distinct retinopathy in which the posterior pole shows abnormalities, including perifoveolar vascular abnormalities. The foveal avascular zone (FAZ) was examined using fluorescein angiography in patients with sickle cell disease and in healthy normal controls. The longest FAZ diameters of 38 patients (51 eyes) with sickle cell disease were compared with those of the 48 patients (60 eyes) in the control group. The average of the longest FAZ diameter in the patients with sickle cell disease was 1.00 mm compared with 0.61 mm for the controls. This difference was statistically significant (P less than .00001). Within the sickle cell group, there were no significant differences in the FAZ diameters with respect to degree of retinopathy, type of sickle hemoglobinopathy, or visual acuity. Thus, an enlarged FAZ diameter in patients with sickle cell disease is confirmed.
Asunto(s)
Fóvea Central/patología , Enfermedad de la Hemoglobina SC/patología , Enfermedades de la Retina/patología , Adulto , Femenino , Angiografía con Fluoresceína , Hemoglobina Falciforme/metabolismo , Humanos , Masculino , Fotograbar , Agudeza VisualRESUMEN
Twenty-two infants with "threshold" stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).
Asunto(s)
Criocirugía , Fotocoagulación , Retinopatía de la Prematuridad/cirugía , Femenino , Estudios de Seguimiento , Fondo de Ojo , Edad Gestacional , Humanos , Lactante , Recién Nacido , Terapia por Láser , Masculino , Pronóstico , Estudios ProspectivosRESUMEN
We conducted a prospective study to determine the incidence of ocular neo-vascularization following acute central retinal artery obstruction. Only patients initially evaluated within 7 days of visual loss were eligible. Any patient with pre-existing ocular neovascularization or clinical evidence of the ocular ischemic syndrome noted at the initial evaluation was excluded. During the 18-month study, 33 consecutive patients were enrolled. Six patients subsequently developed neovascularization of the iris, an incidence of 18.2%. In these six patients, neovascularization of the iris appeared as early as 12 days to as late as 15 weeks following the artery obstructions. Five of the six patients (15.2% of the total) later developed neovascular glaucoma. Another patient in this series developed neovascularization of the optic disc without neovascularization of the iris, an incidence of 3.0%. Only two of the seven patients with ocular neovascularization had ipsilateral hemodynamically significant carotid artery disease as determined by noninvasive carotid artery testing. This study confirms results of previous retrospective studies that the incidence of ocular neovascularization after central retinal artery obstruction is higher than commonly thought. It also shows that, in the majority of cases, carotid artery disease is not responsible for the neovascularization seen after central retinal artery obstruction.
Asunto(s)
Iris/irrigación sanguínea , Neovascularización Patológica , Disco Óptico/irrigación sanguínea , Oclusión de la Arteria Retiniana/complicaciones , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades de las Arterias Carótidas/complicaciones , Femenino , Glaucoma Neovascular/etiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
The records of fifty-two consecutive patients with the ocular ischemic syndrome seen between 1978 and 1985 were reviewed with the purpose of investigating the visual prognosis and effects of treatment. On initial presentation, 43% of affected eyes had a visual acuity of 20/20-20/50, whereas 37% were counting fingers or worse. By the end of one year, only 24% remained in the 20/20-20/50 group, while 58% were counting fingers or worse. The presence of rubeosis iridis was an indicator of poor visual prognosis. Ninety-seven percent of eyes with rubeosis had vision of counting fingers or worse at the end of one year. We were unable to demonstrate convincingly that carotid endarterectomy and superficial temporal artery to middle cerebral artery bypass were of benefit in stabilizing or improving vision in persons with the ocular ischemic syndrome.
Asunto(s)
Ojo/irrigación sanguínea , Isquemia/cirugía , Oclusión de la Arteria Retiniana/cirugía , Agudeza Visual , Anciano , Anciano de 80 o más Años , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/cirugía , Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/cirugía , Endarterectomía , Femenino , Humanos , Enfermedades del Iris/etiología , Isquemia/etiología , Fotocoagulación , Masculino , Persona de Mediana Edad , Pronóstico , Hemorragia Retiniana/cirugía , Estudios Retrospectivos , SíndromeRESUMEN
The short- and long-term effects of a 10-mg dose of intravitreal gentamicin were studied in the subhuman primate eye with regard to the changes in clinical appearance, fluorescein angiography, electroretinography, histopathologic finding, and electron microscopy. The gentamicin produced retinal whitening with a cherry-red spot, generalized vascular incompetence, diffuse retinal necrosis, thrombosis of the large retinal blood vessels, widespread loss of the retinal capillary pericytes and endothelial cells, and a rapid extinction of the electroretinogram.
Asunto(s)
Gentamicinas/envenenamiento , Retina/efectos de los fármacos , Animales , Electrorretinografía , Angiografía con Fluoresceína , Inyecciones , Macaca nemestrina , Microscopía Electrónica , Oftalmoscopía , Retina/patología , Retina/fisiopatología , Factores de Tiempo , Cuerpo VítreoRESUMEN
Forty-one patients with a unilateral, macular epiretinal membrane (ERM) underwent pars plana vitrectomy and membrane peeling to improve the visual acuity. The authors retrospectively reviewed the histopathology of the vitrectomy specimen in each instance to determine whether the presence of internal-limiting membrane (ILM) had an adverse effect on visual acuity. Eleven specimens contained long segment of ILM, as determined by light microscopy. With a minimum of 6 months of follow-up, none of these 11 eyes achieved a visual acuity of better than 20/60. Of 30 eyes that did not have ILM present, 41% achieved a visual acuity of 20/60 or better. Overall, 29% of the eyes in the entire series achieved 20/60 or better visual acuity. The difference between the group with ILM versus that without ILM was statistically significant (P = 0.01). The presence of long segments of ILM within the histopathologic specimen after vitreous surgery for removal of a macular ERM appears to indicate a less favorable visual outcome.
Asunto(s)
Enfermedades de la Retina/patología , Agudeza Visual , Vitrectomía , Estudios de Seguimiento , Humanos , Membranas/patología , Pronóstico , Enfermedades de la Retina/cirugíaRESUMEN
The axial lengths of 24 consecutive adult eyes with unilateral central retinal vein obstruction (CRVO) were compared with those of contralateral unaffected eyes and those of a control population. The lengths of the two eyes of persons with a unilateral CRVO were not significantly different. By contrast, eyes of persons with CRVO averaged 0.67 mm (approximately 2 diopters) shorter than their control counterparts (P = .03). This anatomic difference may be a factor in the development of CRVO.
Asunto(s)
Ojo/anatomía & histología , Oclusión de la Vena Retiniana/etiología , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Ojo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , UltrasonografíaRESUMEN
Eighty infants with proliferative retinopathy of prematurity (ROP) were treated with peripheral retinal cryoablation. Among the serious systemic complications encountered were three instances of respiratory arrest and one of cardiorespiratory arrest. Recommendations that may help prevent these adverse systemic effects in premature infants include: (1) avoidance of excess subconjunctival anesthetic doses, (2) preoperative administration of systemic atropine to minimize the oculocardiac reflex, (3) consideration of an analgesic agent to decrease the pain and exhaustion, and (4) cardiorespiratory monitoring in a hospital setting, with an intravenous line in place, at the time of treatment.
Asunto(s)
Criocirugía/efectos adversos , Paro Cardíaco/etiología , Insuficiencia Respiratoria/etiología , Retinopatía de la Prematuridad/cirugía , Anestésicos/administración & dosificación , Atropina/uso terapéutico , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Complicaciones Intraoperatorias/tratamiento farmacológico , Complicaciones Intraoperatorias/prevención & control , Masculino , PronósticoRESUMEN
The authors prospectively evaluated 387 consecutive patients with proliferative diabetic retinopathy (PDR) for asymmetry in posterior segment neovascularization and its relationship to carotid artery disease. For the purpose of this study, asymmetry is defined as the presence of PDR with high-risk characteristics (as per the Diabetic Retinopathy Study) in one eye, with neither proliferative nor preproliferative changes in the opposite eye. Over the 2-year time period of the study, 20 (5.2%) of 387 patients manifested asymmetric PDR by this definition. All 20 patients underwent carotid artery noninvasive testing and 4 (20%) were found to have hemodynamically significant carotid artery disease. Two of the four patients had their proliferative retinopathy ipsilateral to their severe carotid artery stenosis. This finding does not support the hypothesis that a hemodynamically significant carotid artery stenosis protects against the development of PDR.
Asunto(s)
Enfermedades de las Arterias Carótidas/complicaciones , Retinopatía Diabética/complicaciones , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Agudeza VisualRESUMEN
Extracapsular cataract extraction (ECCE), placement of a posterior chamber intraocular lens (PC IOL), and pars plana vitrectomy were combined in a single operation in 24 patients. Sixteen of these, 11 of whom are diabetic, have had 6 months or more of follow-up. In all cases, excellent visualization of the posterior segment was obtained, and the surgical objectives were achieved. No diabetic patient without preoperative neovascularization of the iris had this complication later. The advantages and disadvantages of alternative techniques are discussed.
Asunto(s)
Extracción de Catarata , Lentes Intraoculares , Vitrectomía , Adulto , Anciano , Anciano de 80 o más Años , Catarata/complicaciones , Complicaciones de la Diabetes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Agudeza VisualRESUMEN
We observed seven patients with the unusual combination of a central retinal vein obstruction in conjunction with a simultaneous branch retinal artery obstruction. The patients presented with sectoral retinal whitening, as well as diffuse peripapillary and superficial retinal hemorrhages. In five of the seven patients, the retinal hemorrhages appeared most florid in the territory of the obstructed arteriole, resulting initially in the consideration that these cases represented a combined branch retinal artery and branch retinal vein obstruction. In all cases, however, the presence of dilated, tortuous veins with diffuse retinal hemorrhages, in addition to generalized delay in arteriovenous transit on fluorescein angiography, localized the venous blockage to the central retinal vein. No intra-arterial retinal emboli were visualized. Initially, five of the seven patients suffered markedly diminished visual function; although visual acuity returned to near normal in all but two patients. In the two patients with non-resolving, markedly impaired visual acuity, neovascularization of the iris complicated the clinical course. Both of these patients were treated with panretinal photocoagulation, with resolution of the iris neovascularization. These seven patients highlight another variation of combined arterial and venous retinal vascular disease.
Asunto(s)
Oclusión de la Arteria Retiniana/complicaciones , Oclusión de la Vena Retiniana/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Angiografía con Fluoresceína , Fondo de Ojo , Humanos , Iris/irrigación sanguínea , Iris/cirugía , Fotocoagulación , Masculino , Persona de Mediana Edad , Neovascularización Patológica/patología , Oclusión de la Arteria Retiniana/patología , Hemorragia Retiniana/etiología , Oclusión de la Vena Retiniana/patología , Agudeza VisualRESUMEN
A review of 306 eyes undergoing pars plana vitrectomy for the complications of proliferative diabetic retinopathy revealed that 26 (8.5%) required a second vitrectomy operation. Among the eyes that required repeat vitrectomy, the eventual visual acuity ranged from 20/20 to 20/400 in 35% and was no light perception in 31%. Reasons for subsequent surgery included recurrent vitreous hemorrhage in 54% of eyes, retinal detachment in 42% and neovascular glaucoma in 4%. Twelve eyes (46%) remained with a permanent retinal detachment despite attempts at surgical repair, and eleven of these twelve eyes subsequently developed rubeosis iridis.
Asunto(s)
Retinopatía Diabética/cirugía , Vitrectomía , Adulto , Femenino , Glaucoma Neovascular/cirugía , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Reoperación , Desprendimiento de Retina/cirugía , Agudeza Visual , Hemorragia Vítrea/cirugíaRESUMEN
Sodium hyaluronate (Healon) was used in conjunction with pars plana vitrectomy and scleral buckling to manage unilateral giant retinal tears of 180 degrees or more with severe folding in six consecutive cases. In each instance the retina was successfully flattened, and five of the six have remained so for at least one year. The technique enables the surgeon to unroll a retinal flap that is markedly inverted on itself and oppose it to the underlying retinal pigment epithelium.
Asunto(s)
Ácido Hialurónico/uso terapéutico , Perforaciones de la Retina/cirugía , Adolescente , Adulto , Aire , Niño , Criocirugía , Humanos , Ácido Hialurónico/administración & dosificación , Masculino , Persona de Mediana Edad , Curvatura de la Esclerótica/métodos , Hexafluoruro de Azufre/administración & dosificación , Vitrectomía/métodos , Cuerpo VítreoRESUMEN
Four patients with a central retinal vein obstruction associated with excessive deposits of hard exudate are described. When compared with a control group of 15 consecutive patients with a central retinal vein obstruction, those with large amounts of hard exudate were noted to have significantly elevated triglyceride levels, poorer visual acuity, and increased degrees of retinal ischemia on fluorescein angiography.
Asunto(s)
Exudados y Transudados/metabolismo , Hipertrigliceridemia/complicaciones , Metabolismo de los Lípidos , Oclusión de la Vena Retiniana/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Colesterol/sangre , Femenino , Humanos , Hipertrigliceridemia/sangre , Isquemia/patología , Masculino , Persona de Mediana Edad , Hemorragia Retiniana/metabolismo , Oclusión de la Vena Retiniana/complicaciones , Oclusión de la Vena Retiniana/fisiopatología , Vasos Retinianos/patología , Triglicéridos/sangre , Agudeza VisualRESUMEN
We evaluated retrospectively the cases of 25 patients (26 eyes) with a recent, temporal, branch retinal vein obstruction to determine the relative anatomic position of the obstructed vein in relation to its crossing artery. In 26 (100%) of 26 eyes, the artery lay anterior to the vein, toward the vitreous cavity. A control group was obtained by evaluating the relative anatomic position between the branch retinal artery and vein at an equivalent crossing site along the opposite vascular arcade within the same eye. In the control crossing sites, the artery lay anterior to the vein 65% (15/23) of the time. We conclude that the likelihood that the artery will lie anterior to the obstructed vein at the site of blockage in a branch retinal vein obstruction is substantially greater than what would be expected by chance alone. This anatomic relationship between artery and vein probably plays a role in the cause of a branch retinal vein obstruction and may have therapeutic significance in light of a recent report concerning surgical treatment of such obstructions.