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PURPOSE: To evaluate the endothelial cell density changes in eyes with silicone oil tamponade after vitrectomy for complex rhegmatogenous retinal detachment. METHODS: A prospective controlled study with 81 eyes with complex rhegmatogenous retinal detachment undergoing vitrectomy and silicone oil tamponade. Fellow eyes that fulfilled specific inclusion criteria served as controls. Endothelial cell density (in cells per square millimeter), coefficient of variance (standard deviation per mean cell area × 100), percentage of hexagonal cells, and corneal thickness were documented preoperatively and compared with values obtained at 3, 6, and 12 months postoperatively. For the purpose of the study analysis, all study eyes were divided into 5 groups, according to their lens status during the follow-up. RESULTS: High endothelial cell density loss was found in Group 3, (eyes that underwent an additional phacoemulsification procedure) and Group 4 (eyes that underwent lens and/or intraocular lens removal during the follow-up) at 12 months with a mean cell loss of 19% and 39%, respectively (P < 0.001). CONCLUSION: An intact natural or artificial lens-iris diaphragm may provide a protective barrier against corneal endothelial cell damage from long-term silicone oil tamponade.
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Pérdida de Celulas Endoteliales de la Córnea/diagnóstico , Endotaponamiento , Endotelio Corneal/patología , Desprendimiento de Retina/cirugía , Aceites de Silicona/administración & dosificación , Vitrectomía , Anciano , Recuento de Células , Femenino , Humanos , Masculino , Persona de Mediana Edad , Facoemulsificación , Periodo Posoperatorio , Estudios ProspectivosRESUMEN
PURPOSE: The possibility of postoperative binocular diplopia is seen as an important drawback of conventional scleral buckling surgery for rhegmatogenous retinal detachment. The goal of this study was to evaluate the occurrence and pattern of binocular diplopia after scleral buckle procedures in patients with rhegmatogenous retinal detachment. METHODS: In a retrospective study of 1,030 patients with primary rhegmatogenous retinal detachment who were treated by scleral buckle surgery between January 2001 and July 2008, the postoperative occurrence of binocular diplopia was retrieved from the medical charts. RESULTS: Secondary strabismus developed in 39 subjects (3.8%) after scleral buckle surgery during a mean follow-up of 6.4 ± 6.3 months. Twenty-eight patients (2.7%) developed strabismus because of a mechanical restriction of one of the muscles. No association was found between the position of the buckle, that is, the muscle affected, and the incidence of diplopia. A moderate significant association was found when two muscles were affected with a higher incidence of diplopia. This was, however, not found for three or more muscles. In 28 of 39 patients, binocular single vision was restored at the end of the follow-up period. In the majority, this was accomplished with conventional prism treatment. CONCLUSION: Strabismus caused by a restriction of the muscles in scleral buckle surgery was not predictable based upon the buckle position. Patients with a minimal restriction of the muscles after scleral buckle surgery can often be well treated with prisms.
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Diplopía/etiología , Músculos Oculomotores/patología , Complicaciones Posoperatorias , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica/métodos , Estrabismo/etiología , Diplopía/diagnóstico , Anteojos , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Estrabismo/diagnóstico , Estrabismo/terapia , Visión Binocular , Agudeza Visual/fisiologíaRESUMEN
OBJECTIVE: Myopic patients have an increased risk for the development of a rhegmatogenous retinal detachment (RRD). Currently, myopic patients have the choice to undergo correction of their refractive error by the implantation of a phakic intraocular lens (pIOL). After pIOL implantation, progressive endothelial cell loss may result if the anterior chamber is too shallow. Because scleral buckling (SB) surgery for treatment of an RRD may in itself result in a decreased anterior chamber depth (ACD), this may become an important issue not only for the retinal surgeon who is faced with a patient who has both an RRD and a pIOL, but also for the refractive surgeon who should consider the potential problems of the implantation of pIOL in an eye that has previously undergone SB surgery. The goal of this study was to evaluate how long changes in ACD persist after SB procedures in patients with RRD. DESIGN: Prospective case series. PARTICIPANTS: Thirty-eight eyes with a primary RRD treated by SB using an encircling element and a radial or segmental buckle; 31 fellow eyes served as controls. METHODS: Anterior chamber depth (in the horizontal meridian) and axial length were measured preoperatively and at 1 week and 1, 3, 6, 9, and 12 months postoperatively with an anterior optical coherence tomography method and an IOLMaster (Carl Zeiss Meditec, Jena, Germany), respectively. MAIN OUTCOME MEASURES: In all 38 eyes, ACD was significantly reduced compared with preoperative levels up to 9 months after SB surgery. RESULTS: Anterior chamber depth returned to normal at 1 year after surgery. Axial length was significantly enlarged during the whole follow-up period. No significant differences were found between the use of radial or segmental buckles. CONCLUSIONS: Anterior chamber depth may remain decreased after SB for a longer time period than previously reported. FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.
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Cámara Anterior/patología , Complicaciones Posoperatorias , Desprendimiento de Retina/cirugía , Curvatura de la Esclerótica , Adulto , Anciano , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Tamaño de los Órganos , Estudios Prospectivos , Factores de Tiempo , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
AIM: To provide evidence for the effect of bevacizumab on visual acuity (VA) and central retinal thickness (CRT) in exudative age-related macular degeneration METHODS: A systematic review of all articles of bevacizumab for exudative AMD was conducted. Articles published up to March 2008 were identified in Medline, Embase, the Cochrane Controlled Trials Register and references from included articles. Search terms were "Bevacizumab or Avastin" and "Macula* or ARMD or AMD or intra(-)vitreal or intra(-)vitreous". Three observers participated in the data retrieval and assignment of the quality scores. RESULTS: A total of 561 articles were retrieved. Three randomised controlled trials (RCT) and 23 before-and-after studies of patients (n = 1,435) who had received bevacizumab were published. Inclusion criteria varied. Lack of masking was the main methodological shortcoming. These RCTs showed that bevacizumab is more effective than PDT. Bevacizumab was given intravenously or as intravitreal injection. The latter was given once, or repeatedly every 4 weeks, and with or without additional injection when a recurrence occurred, mostly based on visual acuity and/or findings from optical coherence tomography. After intravenous administration, the weighted mean change in VA was +12.8 ETDRS letters (range +11 to +14) and the weighted mean change for CRT was -129 microm (range -100 to -202). For the 23 studies with intravitreal injections, the change in VA was +8.6 letters (range +2 to +26) and the change in CRT was -90 microm (range -46 to -190). The incidence of adverse events was low. The change in VA was 2.7 letters higher for studies with a higher quality vs lower quality. CONCLUSION: Visual acuity improves and central retinal thickness decreases in patients with exudative AMD after bevacizumab. There is no reasonable doubt that this is caused by bevacizumab. It is likely that a randomised controlled trial will show that bevacizumab is equivalent in effect to ranibizumab, which showed a change in ETDRS of +5.9 letters for occult or minimally classic CNV and +9.8 letters for classic CNV after three monthly injections in two large RCTs.
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Inhibidores de la Angiogénesis/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Degeneración Macular/tratamiento farmacológico , Agudeza Visual/efectos de los fármacos , Envejecimiento , Anticuerpos Monoclonales Humanizados , Bevacizumab , HumanosRESUMEN
PURPOSE: To evaluate the six-month results of patients treated with intravitreal prednisolone sodium succinate injections for persistent diabetic macular edema. DESIGN: Retrospective, noncontrolled, clinical case series. METHODS: Nineteen eyes had intravitreal injections with prednisolone sodium succinate. Need for retreatment was based on fluorescein angiographic or optical coherence tomography evidence of persisting macular edema. RESULTS: Mean visual acuity at six weeks, three months, and six months after injection was significantly better than the mean preoperative visual acuity (P = .015, P = .004, and P = .031, respectively). In none of the studied eyes intraocular pressure exceeded 22 mm Hg. No other adverse events, such as endophthalmitis or retinal detachment, occurred. CONCLUSIONS: In this small pilot study, mean visual acuity improvement was statistically significant up to six months postoperatively. Current results suggest that intravitreal injection of the solution of prednisolone sodium succinate may be a safe and good alternative in eyes with macular edema.