Biomedical subjects

G W Abrams

Publications and source records attributed to G W Abrams.

At least 19 recordsLinked to original sources

PubMed1999

Cystoid macular edema associated with latanoprost therapy in a case series of patients with glaucoma and ocular hypertension.

OBJECTIVE: To identify coexisting ocular diagnoses in a case series of eyes that developed cystoid macular edema (CME) associated with latanoprost therapy. DESIGN: Retrospective observational case series. PARTICIPANTS: Seven eyes of seven patients who developed CME possibly associated with latanoprost treatment were studied. INTERVENTION: When these patients, all of whom were treated with latanoprost in addition to other glaucoma medications, described blurred vision or eye irritation, ocular examination revealed CME, which was confirmed by fluorescein angiography. Latanoprost was discontinued, and in three cases topical corticosteroids and nonsteroidal anti-inflammatory agents were used to treat the CME. MAIN OUTCOME MEASURES: Visual acuity and intraocular pressure were determined before latanoprost use began, during therapy, and after latanoprost use ceased. In these cases, resolution of CME was documented clinically after discontinuing latanoprost. RESULTS: Clinically significant CME developed after 1 to 11 months of latanoprost treatment, with an average decrease of 3 lines in Snellen visual acuity. Intraocular pressure decreased an average of 27.9% during treatment. Cystoid macular edema was confirmed in all cases by fluorescein angiography. In these seven patients, the following coexisting ocular conditions may have placed these eyes at risk for prostaglandin-mediated blood-retinal barrier vascular insufficiency: history of dipivefrin-associated CME, epiretinal membrane, complicated cataract surgery, history of macular edema associated with branch retinal vein occlusion, history of anterior uveitis, and diabetes mellitus. In all cases, the macular edema resolved following discontinuation of latanoprost, in some instances with concomitant use of steroidal and nonsteroidal anti-inflammatory agents. CONCLUSIONS: In this case series of pseudophakic, aphakic, or phakic eyes, the temporal relationships between the use of latanoprost and developing CME, and the resolution of CME following cessation of the drug, suggest an association between latanoprost and CME. In all cases, coexisting ocular conditions associated with an altered blood-retinal barrier were present.

Aged↗

PubMed1999

Mechanisms of retinal arterial occlusive disease in African American and Caucasian patients.

BACKGROUND AND PURPOSE: The aim of our study was to evaluate the causes of retinal arterial occlusive disease in African American patients and to compare these etiologies with those observed in Caucasian patients with retinal ischemic symptoms. METHODS: We performed a retrospective analysis of a series of consecutive patients evaluated by both the ophthalmology department and the neurology/stroke clinic. Patients had a diagnosis of amaurosis fugax, branch retinal artery occlusion, central retinal artery occlusion, or intra-arterial retinal plaques. RESULTS: Twenty-nine African American patients and 17 Caucasian patients were evaluated. African American patients had a mean age of 61 years (range, 30 to 77 years) and Caucasian patients a mean age of 73 years (range, 56 to 94 years) (P=0.003). There was no statistically significant difference between the 2 groups with respect to visible emboli on funduscopy (P=0.462). After adjusting for age, there was also no difference between the 2 groups with regards to risk factors for arterial occlusive disease such as hypertension, coronary artery disease, hypercholesterolemia, tobacco use, and history of stroke or transient ischemic attacks. Caucasian patients had a 41% incidence (7/17) of high-grade ipsilateral internal carotid artery stenosis, measured by carotid duplex, compared with 3.4% incidence (1/29) in African American patients (P=0.002). CONCLUSIONS: There are racial differences in the causes of retinal arterial occlusion. African American patients have a low prevalence of moderate to severe extracranial carotid stenosis, and a high proportion of African American patients have cryptogenic retinal ischemia. In Caucasian patients there is a stronger association between extracranial carotid artery disease and retinal arterial occlusion.

Adult↗

PubMed1998

Comparison of recombinant transforming growth factor-beta-2 and placebo as an adjunctive agent for macular hole surgery.

OBJECTIVE: This study aimed to compare the visual and anatomic results of macular hole surgery in eyes treated with recombinant transforming growth factor-beta-2 (TGF-beta2) or placebo. DESIGN: The design was a prospective, multicenter, randomized, double-masked, placebo-controlled clinical study. PARTICIPANTS: One hundred thirty eyes with idiopathic macular holes of 1 year or less and a refracted Early Treatment Diabetic Retinopathy Study visual acuity of 20/80 or worse were treated with 1.1 microg recombinant TGF-beta2 or placebo to the macular hole after fluid-gas exchange. INTERVENTION: The effect of recombinant TGF-beta2 as an adjunctive agent for macular hole surgery was evaluated. MAIN OUTCOME MEASURES: Closure of the macular hole and change in visual acuity at 3 months were measured. RESULTS: The 3-month visits were completed for 120 eyes. The macular hole was closed at 3 months in 35 (61.4%) of 57 eyes treated with placebo and 49 (77.8%) of 63 eyes treated with recombinant TGF-beta2 (P = 0.08). The mean visual acuity gain was +6.4 letters in eyes receiving placebo and +8.9 letters in eyes treated with recombinant TGF-beta2 (P = 0.27). Visual acuity improved 2 or more lines in 23 (40.4%) of 57 eyes treated with placebo and 30 (47.6%) of 63 eyes treated with recombinant TGF-beta2 (P = 0.42). Intraocular pressure elevation greater than 30 mmHg was more common 2 weeks after surgery in eyes treated with recombinant TGF-beta2 (P < 0.001). CONCLUSIONS: Recombinant TGF-beta2 resulted in a similar proportion of successful closure of macular holes as placebo. There was no statistically significant visual acuity benefit with the use of recombinant TGF-beta2 for the treatment of macular holes.

Aged↗

PubMed1997

Vitrectomy with silicone oil or long-acting gas in eyes with severe proliferative vitreoretinopathy: results of additional and long-term follow-up. Silicone Study report 11.

BACKGROUND: The Silicone Study evaluated the outcomes of vitreoretinal surgery for retinal detachment with proliferative vitreoretinopathy (PVR). OBJECTIVE: To evaluate short-term (up to 36 months) outcomes in eyes randomized to silicone oil or perfluoropropane gas and long-term (up to 72 months) outcomes in eyes with attached maculas at 36 months. DESIGN: Prospective, randomized, multicentered surgical trial. SETTING: Community- and university-based vitreoretinal practices. PATIENTS: Two-hundred sixty-five eyes with PVR randomized to perfluoropropane gas and silicone oil with follow-up through 3 years (cohort 1) and 249 eyes with attached maculas at 36 months (121 eyes randomized to long-acting gas [either sulfur hexafluoride or perfluoropropane] and 128 eyes randomized to silicone oil) with follow-up up to 6 years (cohort 2). Both cohorts consisted of eyes that had and had not undergone vitrectomy for PVR (groups 1 and 2, respectively) before randomization. Of the 265 eyes in cohort 1, 24-month follow-up data were available for 218 eyes (82%) and 36-month follow-up data were available for 196 eyes (74%). Of 208 eyes in cohort 2, 48-month follow-up data were available for 146 eyes (70%), 60-month follow-up data for 119 eyes (57%), and 72-month follow-up data for 73 eyes (35%). INTERVENTIONS: Vitrectomy surgery for PVR with a long-acting gas or silicone oil as the intraocular tamponade. MAIN OUTCOME MEASURES: Changes in visual acuity, recurrent retinal detachment, and incidence of complications. RESULTS: In group 1 of cohort 1, compared with oil-treated eyes, gas-treated eyes had a higher rate of complete retinal reattachment from 18 to 36 months (P < .05). No other differences were found. In group 2 of cohort 1, no notable differences were found between treatment arms. In cohort 2, during 6 years of follow-up, attachment of the macula was maintained for all eyes. No notable differences in the rates of complete retinal attachment, visual acuity of 5/200 or better, or glaucoma were found between treatment groups. In contrast, gas-treated eyes had more hypotony (P < .001). Silicone oil-treated eyes that underwent subsequent surgery were more likely to have the oil retained (P = .02). Compared with oil-retained eyes, oil-removed eyes had higher rates of complete posterior attachment (P = .01) and of a visual acuity of 5/200 or better (P < .001) and less keratopathy (P < .05). Compared with oil-removed eyes, gas-treated eyes had a worse visual acuity outcome (P < .05) and more hypotony (P < .01). CONCLUSION: The Silicone Study showed that silicone oil and perfluoropropane gas were equal in most respects for the management of retinal detachments with PVR. Success in the first surgery for PVR is paramount for obtaining better visual results. Overall, surgery for PVR had a high likelihood of retinal reattachment, and if anatomically and visually successful at 3 years, there is an excellent chance that the results will be maintained over the long-term.

Adult↗

PubMed1997

Vascular endothelial growth factor is present in glial cells of the retina and optic nerve of human subjects with nonproliferative diabetic retinopathy.

PURPOSE: To determine whether vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF), which have been implicated in the development of retinal and choroidal neovascularization, are present in the retinas and optic nerves of patients with diabetes before proliferative retinopathy appears. METHODS: Light microscopic immunocytochemistry using antibodies to VEGF, bFGF, vimentin, glial fibrillary acidic protein (GFAP), and factor VIII on frozen sections from eyes of patients with diabetes without proliferative retinopathy, eyes of patients without diabetes and without known ocular disease, and eyes with disciform age-related macular degeneration (ARMD). Retinal vascular digest preparations to evaluate microvascular abnormalities. RESULTS: Based on morphology and on GFAP and vimentin immunopositivity, retinas from all subjects with diabetes immunostained strongly to VEGF in elongated processes that appeared to be Müller cells. Glial cells within septa surrounding axons in the anterior optic nerve also immunostained for VEGF, as did endothelial cells of some posterior retinal blood vessels and some retinal pigment epithelial cells. Retinas from eyes with disciform ARMD immunostained for VEGF, though less extensively than did those of subjects with diabetes. Retinas and optic nerves from subjects without ocular disease were VEGF negative. Basic fibroblast growth factor was expressed minimally in the inner retinal layers of subjects with and without diabetes, but it was substantial in the photoreceptor layer of all eyes. Vascular endothelial growth factor immunopositivity was present in eyes with no, or little, retinal vascular anatomic abnormality in digest preparations. CONCLUSIONS: Vascular endothelial growth factor expression precedes retinal neovascularization in the retinas and the optic nerves of humans with diabetes. Its localization to glial cells of the inner retina and the anterior optic nerve suggests a relationship to neovascularization in these sites. That VEGF immunopositivity may occur when there is no anatomic evidence of retinal nonperfusion and little likelihood of retinal neovascularization suggests the possibility that ischemia may not be the sole stimulus for VEGF expression.

Aged↗

PubMed1997

Phacoemulsification for cataract following pars plana vitrectomy.

BACKGROUND AND OBJECTIVE: To determine if the technical aspects of phacoemulsification for removal of cataract following pars plana vitrectomy differ from those of phacoemulsification for removal of cataract in nonvitrectomized eyes. PATIENTS AND METHODS: Twenty-two eyes that had undergone prior vitrectomy were identified through a retrospective review of chart notes and operative records of 1039 consecutive cataract extractions performed by one surgeon. RESULTS: Complications of proliferative diabetic retinopathy was the most common indication for prior vitrectomy. The predominant lens change was nuclear sclerosis. Deep anterior chambers with large anterior to posterior excursions of the iris lens diaphragm with simultaneous fluctuation in pupil size occurred during phacoemulsification. The posterior capsule was flaccid and mobile during lens cortex removal. No posterior capsules ruptured. Postoperative visual acuity improved in 91% of the patients. CONCLUSIONS: Prior vitrectomy was associated with diabetes and nuclear sclerotic cataract. Phacoemulsification in this patient population was associated with inadequate pupillary mydriasis, superior conjunctival scarring, intraoperative anterior chamber depth, pupil size, and iris lens excursions that hindered phacoemulsification tip placement. Posterior capsules were excessively flaccid, prone to rapid anterior and posterior excursions, and may have plaques that are resistant to intraoperative removal.

Anterior Chamber↗

PubMed1996

Basic fibroblast growth factor and vascular endothelial growth factor are present in epiretinal and choroidal neovascular membranes.

PURPOSE: To determine whether vascular endothelial growth factor and basic fibroblast growth factor, which may be critical mitogens for neovascularization, are present together in human retinal and choroidal neovascular membranes. METHODS: Light microscopic immunocytochemistry using antibodies against vascular endothelial growth factor, basic fibroblast growth factor, and several cellular "marker" proteins on frozen sections from three choroidal neovascular membranes from patients with age-related macular degeneration, seven surgically excised epiretinal membranes from patients with proliferative diabetic retinopathy, and six epiretinal membranes from patients with nonischemic proliferative retinopathies. RESULTS: All three choroidal neovascular membranes and all seven epiretinal membranes stained positive for vascular endothelial growth factor. Two choroidal neovascular membranes and six of the epiretinal membranes were positive for basic fibroblast growth factor. The same cells were often positive for both antigens. None of the epiretinal membranes from patients with nonischemic proliferative retinopathies were positive for either growth factor. Many of the cells that demonstrated growth factors were glial cells, vascular endothelial cells, and retinal pigment epithelial cells. CONCLUSIONS: Colocalization of two growth factors in the same cells of ocular neovascular membranes suggests that more than one growth factor may contribute to pathologic angiogenesis. Growth factors in neovascular tissues are not localized exclusively in the vascular endothelium. Because expression of some growth factors is stimulated by hypoxia, their localization within choroidal neovascular membranes suggests that hypoxia may be an etiologic factor for choroidal as well as for retinal neovascularization.

Adult↗

PubMed1996

Vitrectomy in eyes with peripheral retinal angioma associated with traction macular detachment.

PURPOSE: Peripheral angiomas have been associated with epiretinal membranes and traction retinal detachment. The authors investigated the timing, results, and complications of vitreous surgery to remove the retinal traction and treat the peripheral vascular tumor. METHODS: The authors reviewed the results of ten eyes that had undergone vitrectomy for macular pucker and/or traction retinal detachment. These eyes had either preoperative or intraoperative treatment of the peripheral tumor. RESULTS: Patients were followed 4 to 95 months. Six eyes had nonfamilial peripheral acquired retinal hemangioma, three had von Hippel angiomas, and one had multiple large peripheral retinal angiomas associated with extensive retinal telangiectasis. Four eyes received cryotherapy and/or laser photocoagulation 2 to 3 months before surgery. In the remaining six eyes, initial treatment to the peripheral angioma was performed at the time of vitreous surgery. At final follow-up, all eyes were attached without retinal traction. Vision improved in all eyes; six (60%) achieved 20/50 or better visual acuity. Complications included recurrent epiretinal membrane (n=3); nonregressed angiomas (n=3); increased nuclear sclerosis (n=2); and retinal detachment (n=1). CONCLUSION: Vitreous surgery, when applied to epiretinal membranes or traction retinal detachments associated with peripheral vascular tumors, has a good chance of improving vision. Treatment of the hemangioma, before or during vitrectomy, usually results in tumor regression.

Adult↗

PubMed1995

High-resolution magnetic resonance imaging evaluation of blood-retinal barrier integrity following transscleral diode laser treatment.

OBJECTIVE: To compare the effects of contact transscleral diode laser treatment and retinal cryotherapy on blood-retinal barrier integrity with the use of high-resolution magnetic resonance imaging techniques with constant infusion of gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA). METHODS: Transscleral diode laser photocoagulation and retinal cryotherapy were used to treat equivalent areas of the inferior retinal periphery of pigmented rabbits. Magnetic resonance imaging time-course studies with measurement of signal enhancements due to Gd-DTPA leakage were conducted 2 and 15 days following treatment. RESULTS: Two days following treatment, cryotherapy-treated eyes exhibited a mean (+/- SD) effective Gd-DTPA permeability coefficient of 4.6 +/- 0.8 x 10(-6) cm/s; in comparison, diode laser-treated eyes exhibited 1.6 x 1.4 x 10(-6) cm/s effective permeability. Significant decreases in the effective permeability were also noted 15 days after treatment in both groups. CONCLUSIONS: Transscleral contact probe diode laser photocoagulation induces less disruption of the blood-retinal barrier than does conventional cryotherapy. In addition, the continuous infusion method of Gd-DTPA delivery is a reliable and easily interpretable alternative to the commonly used bolus injection approach.

Animals↗

PubMed1995

The incidence of corneal abnormalities in the Silicone Study. Silicone Study Report 7.

OBJECTIVE: To determine factors that were prognostic of corneal abnormalities in eyes following surgery for severe proliferative vitreoretinopathy. DESIGN: Subgroup analysis of the Silicone Study. SETTINGS: Community and university-based ophthalmology clinics. MATERIALS: Eyes with attached maculae at the 24-month follow-up examination that did not have a pre-existing corneal abnormality. INTERVENTIONS: Vitrectomy surgery with long-acting gas or silicone oil. OUTCOME MEASURES: Epithelial and/or stromal edema, corneal opacity and/or previous corneal transplant. RESULTS: The incidence of corneal abnormalities at 24 months was 27% and did not differ significantly between treatment groups. Prognostic factors were preoperative aphakia or pseudophakia (P = .003), preoperative iris neovascularization (P = .006), reoperation (P = .001), the absence of a fluid/gas exchange (P = .03), corneal touch by silicone oil (P = .02), and the presence of aqueous cells (P = .009) or aqueous flare (P = .08). In a multivariate analysis, independent prognostic factors were iris neovascularization (relative risk [RR] = 13.1), aphakia or pseudophakia (RR = 3.0), postoperative aqueous flare (RR = 5.4), and reoperations (RR = 3.4). Corneal abnormalities were correlated with poor visual acuity and hypotony (P < .001). CONCLUSIONS: To our knowledge, this is the first study to document that the incidence rates of corneal abnormalities are equivalent between oil and gas. The incidence of corneal abnormalities in gas-filled eyes was higher than expected, and remained high in oil-filled eyes, despite the use of an inferior iridectomy. Successful surgical repair of the retinal detachment with a single operation, and prevention and early management of corneal touch by silicone oil should help to prevent corneal abnormalities. If rubeosis iridis or severe aqueous flare is present, preoperative treatment with intense topical and possibly periocular steroids might reduce inflammation, which might mediate corneal damage.

Adult↗

PubMed1995

Reversible loss of light perception after vitreoretinal surgery.

PURPOSE: We studied reversible loss of light perception after vitreoretinal surgery to show that functional vision can return in some patients. METHODS: We reviewed the medical records of seven patients who had postoperative reversible loss of light perception in the eye that underwent vitreoretinal surgery. Differences in the postoperative courses and interventions were studied. RESULTS: Five of the seven patients had diabetes mellitus but none had hypertension. The indications for vitreoretinal surgery were severe proliferative diabetic retinopathy in five patients and retinal detachment with advanced proliferative vitreoretinopathy in two patients. Seven patients had reversible loss of light perception within the first three postoperative days. Six of the seven patients had an intraocular pressure greater than 26 mm Hg at the time the eye had no light perception. Decreasing the intraocular pressure was associated with return of light perception in five of seven patients. Return of useful vision was gradual. Four of seven patients had a visual acuity of 20/400 or better one month after surgery, and all seven had a visual acuity of 20/400 or better three months after surgery. Visual acuity in four eyes improved further to 20/70 or better at six months or more after surgery. CONCLUSION: Reversible loss of light perception after vitreoretinal surgery does occur in some patients. Monitoring vision and intraocular pressure is important because prompt treatment may assist in the recovery of functional vision.

Adult↗

PubMed1994

Management of complex retinal detachment with combined relaxing retinotomy and intravitreal perfluoro-n-octane injection.

We evaluated intravitreal perfluoro-n-octane injection for the positioning of large retinal flaps after relaxing retinotomies. Nineteen eyes underwent vitrectomy for advanced retinal detachments from proliferative vitreoretinopathy (11 eyes), trauma (five eyes), and proliferative diabetic retinopathy (three eyes). After retinotomy and complete relief of traction, injection of perfluoro-n-octane to a level anterior to the retinotomy edge was used to remove subretinal fluid thoroughly from beneath the retinal flap. All irrigation fluid anterior to the perfluoro-n-octane meniscus was aspirated before perfluoro-n-octane removal. Final tamponade was obtained with gas (four eyes) or silicone oil (15 eyes). After six to 17 eyes) or silicone oil (15 eyes). After six to 17 months of follow-up, the retinas were attached in 13 eyes (68%), and visual acuity of 5/200 or better was obtained in eight eyes (42%). Subretinal migration of perfluoro-n-octane and posterior slippage of the retinal flap occurred during perfluoro-n-octane/silicone oil exchange in one eye. No other complications were detected. Perfluoro-n-octane injection is an effective technique for positioning large retinal flaps after relaxing retinotomy.

Adolescent↗

PubMed1994

Postoperative fibrin formation and visual outcome after pars plana vitrectomy.

PURPOSE: To determine whether postvitrectomy fibrin formation was associated with visual outcome, a prospective study of patients undergoing pars plana vitrectomy was performed. METHODS: In 121 patients undergoing vitrectomy at the Medical College of Wisconsin between July 1986 and April 1989, the association of fibrin formation and other perioperative factors with visual outcome was evaluated by univariate and multivariate regression analysis. Poor visual outcome was defined as visual acuity worse than 5/200. RESULTS: After a median follow-up period of 23 months (range 6 to 51 months), patients with severe fibrin formation experienced a higher rate of poor visual outcome (19 of 26 patients, 73%) than patients with little or no fibrin formation (23 of 95 patients, 24%; P < 0.0001, univariate analysis). After adjusting for a variety of factors with multivariate regression analysis, fibrin formation was not significantly predictive of final visual outcome. CONCLUSIONS: Factors associated with postvitrectomy fibrin formation may affect visual outcome more than fibrin formation itself.

Adolescent↗

PubMed1993

Perioperative choroidal hemorrhage at pars plana vitrectomy. A case-control study.

PURPOSE: Risk factors for choroidal hemorrhage during pars plana vitrectomy surgery are currently not well defined. The authors analyzed potential risk factors for perioperative choroidal hemorrhage at pars plana vitrectomy in a case-control study. METHODS: Of 683 consecutive vitrectomy procedures, 13 cases of choroidal hemorrhage were identified in the operative or immediate postoperative period. Fifty vitrectomy controls from the same period were randomly selected and were compared with the hemorrhage cases by univariate analysis with respect to various potential risk factors. RESULTS: The incidence of choroidal hemorrhage associated with vitrectomy was 1.9%. Statistically significant risks (P < or = 0.05) included: greater age (mean, 70.9 versus 52.1 years); elevated preoperative pressure (19.9 versus 13.0 mmHg); preoperative diagnosis of rhegmatogenous retinal detachment (relative risk, 8.1); aphakic or pseudophakic status (relative risk, 5.2); and scleral buckle procedure at vitrectomy (relative risk, 12.0). Eyes with previous ocular trauma and previous vitrectomy had a reduced risk of choroidal hemorrhage. The incidence of severe visual loss (final visual acuity < 5/200) did not differ significantly from controls. CONCLUSIONS: Significant risk factors for choroidal hemorrhage are identified in this study which may help to identify patients at increased risk for this complication. Good visual outcome is possible after choroidal hemorrhage at vitrectomy (69% with visual acuity > 5/200).

Aged↗

PubMed1993

Treatment of anterior chamber fibrin following cataract surgery with tissue plasminogen activator.

Three patients who developed anterior chamber fibrinous exudates after cataract surgery were treated with tissue plasminogen activator injected into the anterior chamber. There was prompt dissolution of the fibrinous exudates and no observed complications. When fibrinous exudates occur in high-risk patients after cataract surgery, tissue plasminogen activator provides an excellent means of clearing the fibrin.

Adult↗

PubMed1993

Perfluoropropane 12% versus 20%. Effect on intraocular pressure and gas tamponade after pars plana vitrectomy.

A randomized prospective study was performed on 30 nonglaucomatous eyes undergoing pars plana vitrectomy and intraoperative fluid-gas exchange, comparing the effect of two perfluoropropane gas concentrations (12% and 20%) on postoperative intraocular pressure, early postoperative bubble size, and intravitreal longevity. No significant differences in mean intraocular bubble size at 36 to 48 hours and mean peak and final follow-up intraocular pressure were found between the 12% group (n = 15) and the 20% group (n = 15, unpaired T-test). Intravitreal longevity was significantly greater for the 20% concentration (mean +/- standard deviation = 8.4 +/- 1.8 weeks) compared with the 12% concentration (mean +/- standard deviation = 6.7 +/- 1.6 weeks). In nonglaucomatous eyes under careful observation and appropriate antiglaucoma therapy, the choice between a 12% or 20% concentration of perfluoropropane gas determined primarily longevity of gas tamponade rather than postoperative pressure or early bubble size.

Double-Blind Method↗

PubMed1992

Macular phototoxicity caused by fiberoptic endoillumination during pars plana vitrectomy.

Three cases of retinal phototoxicity were caused by light from the endoilluminator used in vitrectomy. Preoperative clinical examination, color photography, and fluorescein angiography in all three cases failed to disclose retinal pigment epithelial changes. Postoperative clinical findings, photographs, and fluorescein angiograms are highly suggestive of the presence of retinal phototoxicity. The characteristics of these lesions and surgical conditions implicate the endoilluminator as the source of photic injury. The macular lesions were noted within one week of the surgical procedure, measured between 2 and 5 disk diameters in size, involved the fovea in two eyes, and resulted in marked decrease in visual acuity in two of three eyes, with persistence in one eye. Initially, whitening of the outer retina was present, but was replaced by pigmentary mottling at the level of the retinal pigment epithelium within a few weeks. Preventive measures to avoid macular phototoxicity associated with vitrectomy are discussed.

Adult↗

PubMed1992

Combined phacoemulsification, pars plana vitrectomy, and posterior chamber intraocular lens insertion.

Eighteen eyes with coexisting cataract and vitreoretinal disease underwent combined phacoemulsification, pars plana vitrectomy, and posterior chamber lens implantation. Preoperative vitreoretinal disease included nonclearing vitreous hemorrhage (eight eyes), vitreous hemorrhage and tractional retinal detachment (three eyes), tractional retinal detachment (one eye), epiretinal membranes (three eyes), peripheral uveitis (two eyes), and a retained intraocular metallic foreign body (one eye). Postoperative visual acuity improved in each case; 14 eyes achieved visual acuity between 20/20 and 20/80 during an average postoperative period of 11 months (range, 3 to 39 months). Perioperative complications included an iatrogenic retinal break (one eye) and pupillary block glaucoma (one eye). Four eyes required YAG laser capsulotomy postoperatively. Phacoemulsification did not interfere with corneal clarity, allowed water-tight wound closure during vitrectomy, and preserved the capsular bag, allowing endocapsular fixation of the posterior chamber lens. Combining phacoemulsification, posterior chamber lens implantation, and pars plana vitrectomy allows rapid visual rehabilitation and functional unaided vision in these eyes.

Adult↗