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Retinal Detachment (retinal + detachment)
Kinds of Retinal Detachment Terms modified by Retinal Detachment Selected AbstractsKinetic Echography in the Evaluation of Retinal DetachmentACADEMIC EMERGENCY MEDICINE, Issue 6 2010Elizabeth J. Rubano MD No abstract is available for this article. [source] Acute Glaucoma after Dilated Eye Exam in a Patient With Hyphema, Retinal Detachment, and Vitreous HemorrhageACADEMIC EMERGENCY MEDICINE, Issue 1 2009Gavin Budhram MD No abstract is available for this article. [source] 1235: How to prevent postoperative complications?ACTA OPHTHALMOLOGICA, Issue 2010C CREUZOT Purpose Retinal detachment can lead to early and delayed post-operative complications. The purpose of the course is to present the different complications following retinal detachment surgery with their appropriate treatments. Methods The postoperative complications will be divided according to the presentation of the patient (ie inflamed, painful eye or white painless eye) with or without visual loss.Then, IOP measurement and the results from slit lamp and fundus exam will provide us with the main signs useful for diagnosis. Results With a painful red eye, the main severe diagnoses will be the different causes of increased IOP and endophthalmitis. The main cause of increased ocular pressure is related to the internal tamponade used during surgery (gas or silicone). However, the diagnosis of massive passage of silicone in the anterior chamber should be difficult. Hyphema or cataract due to gas should prevent us from a good fundus examination. Conclusion This course will mainly focus on the different early and more delayed complications after retinal detachment surgery and will try to give some rules to decrease this risk. [source] 4414: Flow cytometry for the characterization of retinal neural populations and the quantification of retinal apoptosisACTA OPHTHALMOLOGICA, Issue 2010PA TSOKA Purpose The primary purpose of this study was to evaluate the potential to quantify the different retinal neuronal populations, as also the retinal detachment-induced apoptosis in Sprague,Dawley rats, in an accurate quantitative way by using flow cytometry. Methods Retinal detachment was performed on the right eye of deeply anesthetized animals. The detachment was induced by a sub-retinal injection of sodium hyaluronate. Rats were sacrifised and the eyes were enuclated to achieve retinal dissection. Tissue dissociation was accomplished with trypsin. The cells were mechanically dissociated into a single-cell suspension. At least 100.000 cells were analyzed with a FACScalibur and FlowJo software. The primary antibodies were anti-rhodopsin against rod photoreceptors, anti-PKC against rod bipolars, anti-calbindin against horizontals, anti-ChAT against cholinergic amacrine cells and anti-MAP1 against ganglion cells. Annexin-V-FITC/Propidium Iodide was used to identify apoptosis. Results Quantification of retinal neuronal cells was possible using flow cytometry. Photoreceptors had the 53.99%, the ganglion the 7%, the bipolars the 2%, the horizontal the 4% and the cholinergic amacrine cells the 1,5% in the hole mixed retinal population. Quantification of the apoptotic rate was also possible. The early apoptotic cells was 22.4% while in the control eye was 6.28% after retinal detachment. The experiments were repeated ten times and these measurements are the mean value. Conclusion Flow cytometry can be used to quantify the apoptotic neuronal cells as well as the healthy retinal neurons. It is quick and precise and it will be very useful in future in studies in neuroprotection and quantification of apoptosis during time. [source] Retinal detachment in phakic patientsACTA OPHTHALMOLOGICA, Issue 2009C CHIQUET Purpose this review aims to summarize risk factors, preoperative evaluation and principles of operative methods of retinal detachment of phakic eyes Methods Preoperative evaluation includes detailed examination of the retina, the identification of retinal breaks and classification of proliferative retinopathy. Main operative methods will be presented with ab externo or ab interno techniques. Results after a detailed characterization of the retinal detachment, the more appropriate surgical methods will be explained for the search, the treatment (laser or cryotherapy), closure (scleral buckling materials) of retinal breaks, management of subretinal fluid (drainage) and the choice of the intraocular tamponnade (gas or silicone). Conclusion this review will discuss the main advantages of each surgical technique and examples of management will be presented (simple phakic detachment, associated cataract, giant tears, high myopia). [source] Retinal detachment after ocular traumaACTA OPHTHALMOLOGICA, Issue 2009JB JONAS Purpose To discuss the clinical characteristics and treatmentoptions for retinal detachment after ocular trauma Methods The various types of ocular trauma and the different types of retinal detachments occurring as a complication of ocular trauma will be presented and comapred with each other Results The surgical treatment options for retinal detachment after ocular trauma will be presented. Conclusion Due to the high variability of ocular traumata and the reulting high high variability in the type and extent of retinal detachments after ocular traumata, the decision on the type of surgical treatment will usually be rather indivudual according to the special clincal situation. [source] Retinal detachment after uveitisACTA OPHTHALMOLOGICA, Issue 2009M DE SMET [source] Retinal detachment in Falcinelli's modified osteoodontokeratoprosthesisACTA OPHTHALMOLOGICA, Issue 2009P COLLIARDO Purpose Aim is to evaluate the incidence, surgical treatment and outcomes of retinal detachment in eyes that had undergone Falcinelli's modified osteoodontokeratoprosthesis (MOOKP). Methods Technological and surgical advancements allow to treat successfully a severe pathology as retinal detachment, even in eyes with keratoprosthesis (KPro). The autors accurately describe the surgical technique which usually uses an Eckardt or Landers temporary KPro, a pars plana vitrectomy and a gas or silicone oil tamponade, even if in selected cases it is possible to perform just a scleral buckling. Results By the means of the described techniques good anatomical success and improvement in visual acuity have been obtained. Nine retinal detachments were successfully operated, one retinal detachment was unsuccessfully operated, four retinal detachments were judged to be inoperable for severe proliferative vitreoretinopathy because of late turning-up to clinical examination and lack of technology in the 70's. Conclusion The autors point out that an accurate MOOKP procedure it is necessary for preventing the retinal detachment. An early diagnosis by echography performed at every clinical examination during the follow-up in patients with MOOKP and an appropriate surgical planning for each case are fundamental for a better anatomo-functional outcome. [source] Metastatic disease in small uveal melanomas : retrospective review of 368 patientsACTA OPHTHALMOLOGICA, Issue 2009L DESJARDINS Purpose To determine the metastatic rate and survival curves of small uveal melanomas and find the smallest uveal melanoma associated with metastatic disease. Methods We studied uveal melanomas patients treated with radiotherapy in Curie Institute between 1992 and 2004. We selected the tumors with a diameter inferior or equal to 12 mm and a thickness inferior or equal to 3 mm. All the datas concerning initial tumor findings, radiotherapy treatment and follow up were routinely entered in the data base. Retrospective review and statistical analysis were performed. Results Among 2258 patients treated during this period, 368 had small tumors. Median tumor diameter was 9 mm and median tumor thickness was 2,5 mm. Retinal detachment was present in 32 patients. 282 patients were treated by proton beam therapy, 77 by iodine plaque and 9 by transpupillary thermotherapy. Median follow up is 109 months. 71 patients died and 20 patients developped metastatic disease. Local recurrence was observed in two cases. Overall survival at 5 years was 92%and at 10 years 78% survival without metastasis at 5 years was 96% and at 10 years 93%. According to our data the smallest tumor associated with metastatic death was 5mm in diameter and 1,5 mm in thickness and 14 of the tumors had a diameter of less than 10 mm develloped. Half of the metastatic patients developped metastasis 5 years or more after treatment. Conclusion Very small uveal melanoma can be responsible for metastatic death. [source] Outcome indicators for vitrectomy in Terson syndromeACTA OPHTHALMOLOGICA, Issue 2 2009Justus G. Garweg Abstract. Purpose:, There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. Methods:, In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. Results:, Thirty-seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best-corrected visual acuity (BCVA) at first and last presentation was 0.07 ± 0.12 and 0.72 ± 0.31, respectively. Thirty-five eyes (79.5%) achieved a postoperative BCVA of , 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of , 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 ± 0.27 compared to 0.66 ± 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 ± 0.24 compared to 0.60 ± 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. Conclusion:, Ninety-eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery. [source] Micro Incisional Vitrectomy (MIVS): a new device for trocar insertionACTA OPHTHALMOLOGICA, Issue 2008S RIZZO Purpose Despite its clinical advantages, MIVS poses significant challenges in performing airtight incisions especially dealing with 23-gauge system. Aim of this paper was to assess the feasibility of performing 23-g MIVS using an injector system for trocar insertion. Methods 60 consecutive eyes of 56 patients underwent 23-g pp vitrectomy and gas endotamponade for the treatment of Regmatogenous Retinal detachment and Diabetic Prolipherative Retinopathy by the same surgeon (SD). 30 eyes were operated on with standard one-step 23-g and 30 using a prototype of injector holding the same 23-g trocar cannula system. The trocar squeezed into the plunger of the injector. The device had a metallic terminal oriented with a fix angle, allowing the insertion in the settled direction, able to fix the globe and displace the conjunctiva at the same time.Main outcome measure were sclerotomies airtightness, surgical time and complications. Results In the 30 eyes operated with the 23-g ones step system 9 sclerotomies were sutured, in 5 refilling was required. Mean surgical time were 54 minutes. In the 30 eyes operated with the new device, the inserter was easy to apply in all cases and was useful especially in the nasal quadrant. Also dealing with sunken eyes the inclination of the system 5-10° tangential to the sclera was easily achieved. No suture was placed, refilling was needed in 3 cases. Mean surgical time was 45 minutes. No complications due to these device were highlighted. Conclusion The new injector was safe and effective. The device facilitates the insertion manoeuvre allowing easier and quicker trocar positioning helping the airtight wound construction. MIVS success lie in the surgeon's skill but also in the development of the technology and instrumentations. [source] Screening for retinal detachment using a wide field scanning laser ophthalmoscopeACTA OPHTHALMOLOGICA, Issue 2009G BONNAY Purpose The development of non-mydriatic retinal photography has changed the clinical practice, allowing detection of abnormalities in the posterior pole without clinical examination in mydriasis. However the field of view does not exceed 60° and peripheral retinal detachments are likely to be missed on these images. The purpose of this study was to evaluate a wide field (200°) imaging system (Optos, UK ) using a scanning laser ophthalmoscope (SLO) for screening purposes in retinal detachment. Methods All patients referred for retinal detachment from November 2007 to April 2008 were examined by one retinal surgeon who also performed the fundus drawing. An SLO image was taken by an orthoptist in training. A masked image lecture of the entire data base was performed by a resident. Both were unaware of the details of the retinal examination. The number of breaks and the extent of the detachment on the drawing were compared with the findings detected on the SLO image. Results 56 eyes with retinal detachment were documented. In 40 out of 56 eyes the retinal breaks could be detected on the SLO images obtained. The retinal breaks situated superiorly between 11 and 1o'clock or inferiorly between 5 and 7 o'clock and two retinal detachments, one superior and one inferior, were not detected on the SLO images. SLO image analysis enabled correct diagnosis of retinal breaks in more than 7/10 cases. Retinal detachments were detected in more than 9/10 cases. Conclusion Although the wide field SLO imaging system is not suitable as a diagnostic tool of retinal breaks and retinal detachment replacing the fundus examination by a retinal specialist, it represents a reliable screening method. Commercial interest [source] Protein kinase C beta inhibitor prevents diabetic peripheral neuropathy, but not histopathological abnormalities of retina in Spontaneously Diabetic Torii ratDIABETES OBESITY & METABOLISM, Issue 11 2009T. Sasase Spontaneously Diabetic Torii (SDT) rat shows severe ocular complications such as tractional retinal detachment. In the present study, effect of protein kinase C beta (PKC,) inhibitor JTT-010 was evaluated to clarify the involvement of PKC, in complications of SDT rat. SDT rats were administered JTT-010 (10 or 50 mg/kg/day) for 48 weeks. SDT rats showed delayed oscillatory potentials in electroretinogram. Delayed motor nerve conduction velocity, decreased coefficients of variation of R,R intervals in electrocardiogram and thermal hypoalgesia were also observed. These functional disorders were prevented by administration of JTT-010. Abnormal retinal vascular was formed and the optic disc was protruded in SDT rat; however, JTT-010 did not prevent these hyperglycaemia-induced retinal abnormalities. These findings indicate that PKC, is intimately involved in diabetic complications; however, it seems that other factor(s) are primary contributors to histopathological abnormalities in retina. Therefore, PKC, inhibitors require concurrent administration of antihyperglycaemic drugs to achieve maximum effect on diabetic complications. [source] Cytopathological diagnosis of adult retinoblastoma in a vitrectomy specimen,DIAGNOSTIC CYTOPATHOLOGY, Issue 1 2010Maria E. Orellana M.D. Abstract Retinoblastoma (RB) is extremely rare in adults. We describe a case of RB diagnosed by cytology in a vitrectomy specimen of a 23-year-old patient who presented with diminished visual acuity and retinal detachment in the absence of a clinically-visible mass. Cytological examination of the vitreous fluid showed clusters of loosely cohesive atypical cells with high nuclear to cytoplasmic ratio and "salt and pepper" chromatin pattern in a background of normal neuronal retinal cells. Nuclear molding was present as well as numerous apoptotic bodies. The cells were focally positive for epithelial markers and showed strong and diffuse positivity for neuroendocrine markers. Ki-67 stained 90% of the "atypical cells" nuclei, in contrast to nonneoplastic retinal neuronal cells, which were negative for the marker. A diagnosis of RB was rendered, and subsequently was confirmed in the enucleation specimen. The cytological differential diagnosis is discussed as well as the role that cytology and immunohistochemistry can play in differentiating neoplastic cells from normal retinal cellular elements in vitreous fluid specimens. Diagn. Cytopathol. 2010. © 2009 Wiley-Liss, Inc. [source] Knobloch syndrome: Novel mutations in COL18A1, evidence for genetic heterogeneity, and a functionally impaired polymorphism in endostatin,HUMAN MUTATION, Issue 1 2004Olivier Menzel Abstract Knobloch syndrome (KNO) is an autosomal recessive disorder characterized by high myopia, vitreoretinal degeneration with retinal detachment, and congenital encephalocele. Pathogenic mutations in the COL18A1 gene on 21q22.3 were recently identified in KNO families. Analysis of two unrelated KNO families from Hungary and New Zealand allowed us to confirm the involvement of COL18A1 in the pathogenesis of KNO and to demonstrate the existence of genetic heterogeneity. Two COL18A1 mutations were identified in the Hungarian family: a 1-bp insertion causing a frameshift and a premature in-frame stop codon and an amino acid substitution. This missense variant is located in a conserved amino acid of endostatin, a cleavage product of the carboxy-terminal domain of collagen alpha 1 XVIII. D1437N (D104N in endostatin) likely represents a pathogenic mutation, as we show that the endostatin N104 mutant is impaired in its affinity towards laminin. Linkage to the COL18A1 locus was excluded in the New Zealand family, providing evidence for the existence of a second KNO locus. We named the second unmapped locus for Knobloch syndrome KNO2. Mutation analysis excluded COL15A1, a member of the multiplexin collagen subfamily similar to COL18A1, as being responsible for KNO2. Hum Mutat 23:77,84, 2004. © 2003 Wiley-Liss, Inc. [source] Cataract surgery in previously vitrectomized eyesINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 5 2008A. Akinci Summary Purpose:, To evaluate the results of extracapsular cataract extraction (ECCE) and phacoemulsification (PHACO) performed in previously vitrectomized eyes. Material and method:, In this retrospective study, 56 vitrectomized eyes that had ECCE and 60 vitrectomized eyes that had PHACO were included in the study group while 65 eyes that had PHACO in the control group. The evaluated parameters were the incidence of intra-operative and postoperative complications (IPC) and visual outcomes. Chi-squared, independent samples and paired samples tests were used for comparing the results. Results:, Deep anterior chamber (AC) was significantly more common in the PHACO group of vitrectomized eyes (PGVE) and observed in eyes that had undergone extensive vitreous removal (p < 0.05). Except for this there were no significant differences in the rate of IPC between the ECCE group and the PGVE (p > 0.05). Some of the intra-operative conditions such as posterior synechiae, primary posterior capsular opacification (PCO) and postoperative complications such as retinal detachment (RD), PCO were significantly more common in vitrectomized eyes than the controls (p < 0.05). There was no significant difference in the visual acuity gain between the ECCE group and the PGVE (p > 0.05). Conclusion:, Deep AC is more common in eyes with extensive vitreous removal during PHACO than ECCE. Decreasing the bottle height is advised in this case. Except for this, the results of ECCE and PHACO are similar in previously vitrectomized eyes. Posterior synechiaes, primary and postoperative PCO and RD are more common in vitrectomized eyes than the controls. [source] Discriminate characteristics of photopsia in posterior vitreous detachment, retinal tears and retinal detachmentOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 1 2010Jonathan F. B. Goodfellow Abstract Aims:, To characterize photopsia in posterior vitreous detachment (PVD), retinal tears (RT) and rhegmatogenous retinal detachment (RRD). Methods: Seventy seven patients presenting to an eye emergency department and vitreoretinal clinic with photopsia had documentation of their symptoms. Results:, A total of 27 patients had PVD alone, 7 had RTs and 25 RRD. In patients with isolated PVD, photopsia were temporal (94%), lasting seconds (81%) and vertically orientated (59%) flashes. Patients with photopsia located in quadrants other than temporal were more likely to have RRD (p = 0.0003). Patients with an oblique or horizontal orientation of their photopsia were likely to have RRD or RT (p = 0.001, specificity 96%, sensitivity 40%). Conclusions:, Most patients with PVD have a typical presentation of photopsia, with temporal, vertically orientated, momentary flashes. Patients with RTs or RRD may describe subtle differences in their photopsia which may raise the index of suspicion for the presence of a complication from PVD. [source] Technical Note: Method for estimating volume of subretinal fluid in cases of localized retinal detachment by OCT ophthalmoscopyOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 5 2007Hideto Nakajima Abstract The volume of the subretinal fluid can be used to assess the condition of different types of retinal and macular disorders. The purpose of this report is to introduce a method to measure the volume of the subretinal fluid with the images of the optical coherence tomography (OCT) Ophthalmoscope in three cases of central serous chorioretinopathy and one case of retinal pigment epithelial detachment. We used the topography-mode program of the OCT Ophthalmoscope and measured the average height of the retinal detachment. By multiplying the size of the area of the retinal detachment and the average height of the retinal detachment, the volume of subretinal fluid could be determined. Examples are given to show the results of volume measurement of subretinal fluid in cases of localized retinal detachments. [source] Optometrists' examination and referral practices for patients presenting with flashes and floatersOPHTHALMIC AND PHYSIOLOGICAL OPTICS, Issue 3 2002A. Alwitry Introduction:,Patients experiencing flashes and floaters commonly present to their optometrist. Some of these patients may have significant pathology, yet there is a great deal of variability with regard to examination technique and referral practice. Methods:,A questionnaire survey was undertaken to determine the current management of patients presenting to their optometrist with flashes and floaters. All practising community optometrists within Southern Derbyshire received a questionnaire and 74 (56.9%) completed replies were received. Results:,Optometrists estimated that an average of 14 patients per month per optometrist presented with symptoms of flashes and/or floaters. Mydriasis was utilised routinely for examination in approximately half of the patients. Mean relative confidence was 2.0 at identifying a vitreous haemorrhage and 6.5 for vitreous pigment (complete confidence = 0, complete lack of confidence = 10). Eight percent of responders were unfamiliar with the clinical sign of vitreous pigment, and 17% identifying this sign did not refer all such patients to the hospital services. Conclusions:,Patients presenting to their optometrists with flashes and/or floaters make up a sizeable part of the community optometrist's workload and the management of these patients is highly variable. A large proportion of these patients are examined without mydriasis, even in the presence of various risk factors for retinal detachment. There is a relative lack of confidence amongst optometrists with regards the detection of vitreous pigment and the prognostic implications of this finding. Educational measures such as study days may help the level of understanding and heighten the appreciation of the implications of flashes and floaters and the various clinical signs encountered. [source] Predictive factors of invasion in eyes with retinoblastoma enucleated after eye salvage treatmentsPEDIATRIC BLOOD & CANCER, Issue 3 2009Julia Balaguer MD Abstract Background The impact of chemotherapy, focal therapies, radiation and co-existing ocular morbidities on histology of eyes with retinoblastoma enucleated following chemoreduction is not well known. Procedure Twenty-five eyes (23 patients) with retinoblastoma enucleated after failing eye-salvage therapy were evaluated. Reasons for enucleation (tumor progression, subretinal or vitreous seeds) and co-morbid conditions (neovascular glaucoma, cataract, vitreous hemorrhage and retinal detachment) were documented. All specimens were reviewed for evidence of ciliary body, choroidal, optic nerve, and scleral invasion. Results The median age at diagnosis was 14 months (range, 1,37 months). Twenty eyes were classified as Reese-Ellsworth Group IV,V at diagnosis. Twenty-four eyes had recurrent disease at enucleation; one eye was enucleated for neovascular glaucoma and vitreous hemorrhage. Co-existing ocular morbidities at enucleation included vitreous hemorrhage (n,=,6), retinal detachment (n,=,9), neovascular glaucoma (n,=,9) and cataracts (n,=,3). Histologic findings included choroidal invasion (n,=,7), ciliary body invasion (n,=,4), optic nerve invasion (n,=,6) and scleral invasion (n,=,3). The median time from diagnosis to enucleation was 11 months. Co-existing retinal detachment and vitreous hemorrhage significantly increased the likelihood of optic nerve invasion (P,=,0.014 and P,=,0.011, respectively). Prolonged time to enucleation was significantly associated with the likelihood of choroidal (P,=,0.010) and ciliary body (P,=,0.021) invasion as well as invasion of multiple sites. Conclusion In eyes with retinoblastoma enucleated after chemoreduction, co-existing ocular morbidities and time to enucleation are predictive of extra-retinal extension. Pediatr Blood Cancer 2009;52:351,356. © 2008 Wiley-Liss, Inc. [source] Retinopathy of prematurity: Mutations in the Norrie disease gene and the risk of progression to advanced stagesPEDIATRICS INTERNATIONAL, Issue 2 2001Mohammad Z Haider AbstractBackground: Retinopathy of prematurity (ROP) is a retinal vascular disease that occurs in infants with short gestational age and low birth weight and may lead to retinal detachment and blindness. Missense mutations in the Norrie disease (ND) gene have been associated with the risk of progression to advanced stages in cases of ROP from the US and also in clinically similar ND and familial exudative vitreoretinopathy. Methods: We have screened two ND gene mutations, namely A105T and Val60Glu, by polymerase chain reaction,restriction fragment length polymorphism (PCR-RFLP) and allele-specific PCR methods, respectively, in 210 Kuwaiti premature newborns to replicate these findings in a different ethnic group. Results: In the Kuwaiti premature newborn cohort, 115 of 210 babies had no eye problems and served as controls, while 95 were cases of ROP. In 71 of 95 ROP cases, the disease regressed spontaneously on or before stage 3, while in 24 of 95 ROP cases the disease progressed to advanced stages 4 and 5. In case of missense mutation (A105T), the AA genotype was detected in 96% of controls compared with 87% of ROP cases (NS); similarly no significant difference was found between spontaneously regressed ROP cases and those who progressed to advanced stages. For the Val60Glu mutation, no significant association was detected between the genotype and progression of ROP to advanced stages. Conclusions: Unlike data from the US, our findings from a Kuwaiti cohort of ROP cases and controls suggest a lack of association between the two ND gene mutations (A105T and Val60Glu) and ROP and the risk of progression of the disease to advanced stages. [source] Reducing the incidence of early postoperative vitreous haemorrhage by preoperative intravitreal bevacizumab in vitrectomy for diabetic tractional retinal detachmentACTA OPHTHALMOLOGICA, Issue 6 2010Ling Yeung Acta Ophthalmol. 2010: 88: 635,640 Abstract. Purpose:, This study aimed to evaluate whether preoperative intravitreal injection of bevacizumab reduces early postoperative vitreous haemorrhage (VH) in vitrectomy for diabetic tractional retinal detachment. Methods:, We conducted a retrospective chart review of a consecutive, interventional case series. This included 29 eyes (27 patients) in the bevacizumab group and 40 eyes (37 patients) in the non-bevacizumab group. For statistical analysis, each patient was assigned to one of four groups according to the haemostatic modalities used (group 1, none; group 2, only long-acting gas; group 3, only preoperative intravitreal bevacizumab; group 4, both long-acting gas and preoperative intravitreal bevacizumab). The primary outcome measure was the incidence of early postoperative VH. The secondary outcome measure was visual acuity (VA) at 1 month. Results:, The incidence of early postoperative VH was highest in group 1 (63%), followed by group 2 (21%), group 3 (20%) and group 4 (5%). Group 3 showed the best visual recovery in the first month. All eyes in group 3 reached VA , 1/100 at 1 month after the operation, compared with 44%, 29% and 42% in groups 1, 2 and 4, respectively. Conclusions:, Preoperative intravitreal injection of bevacizumab may be useful for reducing early postoperative VH in vitrectomy for diabetic tractional retinal detachment. Eyes receiving preoperative intravitreal bevacizumab without the use of long-acting gas achieved the best visual recovery at 1 month after the operation. [source] 1263: Symptoms and signs of posterior uveitisACTA OPHTHALMOLOGICA, Issue 2010M KHAIRALLAH Purpose Posterior uveitis (PU) is an important anatomic form of uveitis in which the primary site of inflammation is the choroid or retina, with or without subsequent vitreous involvement. Methods Review of symptoms and signs of PU. Results The onset of PU can be sudden or less frequently insidious. Most common ocular symptoms include blurred vision, loss of vision, and floaters. Some patients with PU may have no symptoms, especially if inflammatory process is asymmetric. PU is usually associated with vitritis that can vary from mild to severe. Vitritis should be graded according to standardized grading systems. Other vitreous changes may include vitreous strands, vitreous hemorrhage, vitreous traction, and posterior vitreous detachment. Retinal and/or choroidal inflammation can be focal, multifocal, or more diffuse. It is important to distinguish between active and inactive chorioretinal disease. Retinal vasculitis can occur in the setting of several PU entities. It can involve retinal veins or arteries. It appears as focal, multifocal, or diffuse vascular cuffing or sheathing. Other retinal vasculitic changes include retinal hemorrhages, retinal vascular occlusion, retinal/optic disc neovascularization, and aneurysms. Maculopathy is common patients with PU. It may result from direct inflammatory infiltration, macular edema, serous retinal detachment, retinal ischemia, epiretinal membrane, or macular hole. Optic nerve involvement that can occur in association with PU include optic disc hyperemia/edema, optic neuritis, neuroretinitis, optic disc exudate, and optic disc granuloma. Conclusion Clinical examination is a key step in the diagnostic approach to PU. Clinician should be aware of the array of ocular symptoms of signs and their importance in orienting the differential diagnosis. [source] 1251: Diagnosis of adult ophthalmic tumours: role of clinical history, symptoms and signsACTA OPHTHALMOLOGICA, Issue 2010T KIVELÄ Purpose To summarise signs and symptoms useful in diagnosing adult ophthalmic tumours. Methods Personal experience of the author as a member of the European Ophthalmic Oncology Group. Results According to studies from the United Kingdom, Finland and United States, 28-42% of adult patients with intraocular tumours may experience delays because the lesion is either misdiagnosed (e.g. as macular degeneration, naevus, rhegmatogenous retinal detachment) or missed at the initial visit. Of these patients, 72-87% have symptoms attributable to the tumour such as blurred vision, photopsia, floaters, metamorphopsia, and visual field loss. These symptoms can also be caused by many benign conditions (e.g. vitreous detachment) but should not be interpreted as innocent without thorough clinical examination. Signs specific for iris and ciliary body tumours include a tumour mass, sentinel vessels, acquired astigmatism, and cataracts. Choroidal tumours may induce serous retinal detachments, subretinal and vitreous bleedings and, sometimes, lipid exudation. Finally, orange subretinal pigment suggests the diagnosis of a uveal melanoma whereas many drusen point to a long-standing naevus. Conclusion Signs and symptoms of ophthalmic tumours are mostly nonspecific, necessitating an appropriately high level of suspicion and a systematic approach to clinical examination to avoid delayed or missed diagnoses. Earlier diagnosis could be achieved especially if dilated fundus examinations were performed without exception and if all suspicious naevi were referred for a second opinion. [source] 1252: Diagnostic tools for adult intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010L ZOGRAFOS Purpose Fundus examination completed with Fundus drawings and panoramic, fundus pictures, standard and panoramic fluorescein angiography, standard and panoramic ICG, 10, 20 and 50 MHz ultrasonography, and OCT are the main diagnostic tools for intraocular tumours in adult's patients. Methods These various diagnostic techniques provide complementary informations contributing to the final diagnosis. A document tumour growth during a periodic observation may be recorded with standard or panoramic fundus pictures. The modifications of the pigmant epithelium as well as an increase permeability of the tumour vessels may be recorded with standard or panoramic fluorescein angiography. Intra-tumoral and Peri-tumoral with hemodynamic modifications may be recorded with standard and panoramic ICG. Results Tumour shape, and tumour height is recorded with standard 10 or 20 MHz ultrasonography. The volume and the shape of anteriorly located intra ocular tumours are recorded with 50 MHz UBM. Conclusion The presence of the retinal detachment in contact with the tumours may be recorded with modern OCT. Additional examinations which can be used in ocular oncology are: Fundus auto- fluorescence, MRI, and computed tomography. An intraocular biopsy can be required in specific cases. [source] 1253: Technique and role of biopsies in intraocular tumoursACTA OPHTHALMOLOGICA, Issue 2010BE DAMATO Purpose To discuss the roles of various forms of biopsy of intraocular tumours, to describe the techniques and to highlight the main pitfalls and complications. Methods Intraocular tumours can be sampled by exo- or endo-biopsy. Exo-biopsy can consist of excisional biopsy (e.g., iridocyclectomy), trans-scleral incisional biopsy, or trans-scleral fine-needle aspiration biopsy. Endo-biopsy comprises vitreous biopsy and retinal or choroidal biopsy performed with a fine needle or vitreous cutter. In rare cases, enucleation is the most pragmatic method of establishing the diagnosis, especially if the eye is blind and painful. Results For many years, biopsy was performed mostly for diagnostic purposes the main reasons being to distinguish melanoma from metastasis and lymphoma from various forms of uveitis. Recently, prognostic biopsy has become more popular, the objective being to determine whether or not a uveal melanoma is likely to be life-threatening. Biopsy can profoundly influence the management of an individual patient but requires special expertise both in the operating theatre and in the laboratory. There are many possible complications, which include endophthalmitis, extraocular seeding of tumour, rhegmatogenous retinal detachment, cataract, haemorrhage, inconclusive result, and mis-diagnosis. Conclusion Biopsy of intraocular tumours is invaluable in the management of selected patients, but requires special expertise to ensure that good results are obtained without causing complications. [source] 1231: How to identify retinal tears?ACTA OPHTHALMOLOGICA, Issue 2010JP BERROD Purpose Locating the retinal tear(s) in rhegmatogenous retinal detachment witout PVR is the first step of a successful treatment. The purpose of the course is to present the different techniques and rules to examine the retina in order to detect and locate all the tears. Methods We emphasised the 3 Lincoff's rules that permit concentration of the efforts to a small area of the periphery to identify the breaks. More than one break is present in 50% of eyes. Hence, there is a need to inspect the rest of the fundus including areas of attached retina. Results In the evaluation, one needs to stress the importance of good binocular indirect ophthalmoscopy with scleral depression or direct ophthalmocopy with slitlamp and 3 mirror contact lens. Vitrectomy can be indicated in certain cases of failure to detect breaks. In the presence of severe PVR the surgery would involve thorough cleaning of the entire retina, hence it may not be so important to identify all breaks preoperatively. Conclusion A minimal rate of postoperative failure for rhegmatogenous retinal detachment can only be achieved if a maximal preoperative search for the retinal breaks has been performed. [source] 1233: How to choose the best surgical procedure?ACTA OPHTHALMOLOGICA, Issue 2010CJ POURNARAS Purpose Dealing to the localization and sealing retinal breaks, the surgical success rate for the cure of rhegmatogenous retinal detachment greatly changed with the introduction of scleral buckling (SB), intraocular gas injection, and pars plana vitrectomy (PPV). Methods In localized cases, pneumatic retinopexy and scleral buckling surgery (SB) remains the most popular surgical methods. Complicated cases with PVR grade B or C, giant tears, or macular holes are most commonly treated with primary pars plana vitrectomy. A large group of rhegmatogenous RDs with medium severity that comprise about 30% of all primary rhegmatogenous RDs in the Scleral Buckling versus Primary Vitrectomy in Rhegmatogenous Retinal Detachment recruitment study, were treated by SB and PPV. Advances in vitrectomy instrumentation and wideangle imaging systems have increased the popularity of PPV. Results The decision by the surgeon to use scleral buckling rather than PPV depends on a number of factors, including the lens status, size and location of breaks, patient compliance, and individual experience. Initial PPV may be successful for phakic patients. However, the SPR study shows a benefit of SB in phakic eyes with respect to BCVA improvement. Although no difference in BCVA was demonstrated in the pseudophakic trial, PPV was recommend for pseudophakic RD based on a better anatomical outcome. Conclusion There was a significant trend towards more frequently employing primary PPV (with or without SB) for the management of primary RRD. A significant improvement in the primary success rates for RD, were shown for all retinal surgical modalities applied for the treatment of rhegmatogenous retinal detachment. [source] 4414: Flow cytometry for the characterization of retinal neural populations and the quantification of retinal apoptosisACTA OPHTHALMOLOGICA, Issue 2010PA TSOKA Purpose The primary purpose of this study was to evaluate the potential to quantify the different retinal neuronal populations, as also the retinal detachment-induced apoptosis in Sprague,Dawley rats, in an accurate quantitative way by using flow cytometry. Methods Retinal detachment was performed on the right eye of deeply anesthetized animals. The detachment was induced by a sub-retinal injection of sodium hyaluronate. Rats were sacrifised and the eyes were enuclated to achieve retinal dissection. Tissue dissociation was accomplished with trypsin. The cells were mechanically dissociated into a single-cell suspension. At least 100.000 cells were analyzed with a FACScalibur and FlowJo software. The primary antibodies were anti-rhodopsin against rod photoreceptors, anti-PKC against rod bipolars, anti-calbindin against horizontals, anti-ChAT against cholinergic amacrine cells and anti-MAP1 against ganglion cells. Annexin-V-FITC/Propidium Iodide was used to identify apoptosis. Results Quantification of retinal neuronal cells was possible using flow cytometry. Photoreceptors had the 53.99%, the ganglion the 7%, the bipolars the 2%, the horizontal the 4% and the cholinergic amacrine cells the 1,5% in the hole mixed retinal population. Quantification of the apoptotic rate was also possible. The early apoptotic cells was 22.4% while in the control eye was 6.28% after retinal detachment. The experiments were repeated ten times and these measurements are the mean value. Conclusion Flow cytometry can be used to quantify the apoptotic neuronal cells as well as the healthy retinal neurons. It is quick and precise and it will be very useful in future in studies in neuroprotection and quantification of apoptosis during time. [source] 4233: Outcomes of the Boston Keratoprosthesis Type IIACTA OPHTHALMOLOGICA, Issue 2010J CHODOSH Purpose To report the long term outcomes of Boston keratoprosthesis type II implantation in the management of severe ocular surface disease and corneal blindness. Methods A retrospective review of medical records of patients after Boston keratoprosthesis type II implantation at the Massachusetts Eye and Ear Infirmary from January, 1, 2000 through December 31, 2009. Main outcome measures included visual acuity, device retention, and postoperative complications. Results A total of 29 eyes of 26 patients received a Boston keratoprosthesis type II during the study period. Operated patients had corneal blindness due to mucous membrane pemphigoid (51.7%), Stevens Johnson syndrome/toxic epidermal necrolysis (41.4%), or other ocular surface disease (6.9%). Visual acuity after surgery improved to at least 20/200 in 23 eyes (79.3%), and to 20/30 or better in 10 eyes (34.5%). In patients with at least 1 year of follow-up (n=21), visual acuity of 20/200 or better was maintained in 14 eyes (66.7%). Of these 14 eyes, 6 eyes (42.9%) retained visual acuity of 20/200 or better for more than 5 years. Overall, visual acuity of 20/200 or better was maintained for at least 5 years in 6 of 23 eyes (26.0%). Eyes that failed to improve to 20/200 or lost vision during follow-up were found to have end stage glaucoma, previous retinal detachment, or age related macular degeneration. Of the total of 29 eyes, 17 devices (58.6%) were retained without extrusion or replacement during a total follow-up time of 107.9 person-years. Conclusion The Boston keratoprosthesis type II is a viable option for corneal blindness from severe autoimmune ocular surface diseases. Complications require prompt recognition and management to promote retention of the device and preservation of vision. [source] | |||||||||||||