Search PubMed⌕ Search

Biomedical subjects

L Gopal

Publications and source records attributed to L Gopal.

At least 37 records · Page 2Linked to original sources
PubMed1999

Vitreoschisis in Eales' disease: pathogenic role and significance in surgery.

PURPOSE: To report the surgical anatomy of vitreoretinal adhesions as observed intraoperatively in patients undergoing vitreous surgery for complications of Eales' disease. METHODS: Eighteen consecutive male patients (18 eyes) undergoing vitrectomy for Eales' disease were studied prospectively. Intraoperative diagnosis was vitreous hemorrhage (VH) in nine cases, traction retinal detachment (TRD) in four, VH and TRD in three, and combined traction-rhegmatogenous retinal detachment in two. Epiretinal membranes (ERMs) obtained during surgery were studied using light microscopy and immunohistochemistry. RESULTS: An incomplete posterior vitreous detachment was observed in all eyes. Multifocal vitreoretinal adhesions were evident in 83.3% of eyes. The proliferation was fibrovascular in 10 eyes and fibrous in eight. A radial traction fold extending from optic disk to periphery was observed in three eyes. A double-layered membrane, probably the result of vitreoschisis, caused tangential traction. ERMs consisted principally of type II collagen and the cellular element was predominantly composed of lymphocytes, glial cells, and macrophage-like cells (probably hyalocytes). CONCLUSIONS: Fibrous and fibrovascular proliferations have multiple areas of adhesions to the posterior vitreous cortex. The presence of type II collagen in the ERM indicates a possible vitreous collagen component to the double-layered membranes (vitreoschisis). Recognition of the double-layered membranes aids in relief of traction during surgery by delamination.

Adult↗
PubMed1999

Subconjunctival cysts following silicone oil injection: a clinicopathological study of five cases.

PURPOSE: To study the occurrence, risk factors and management of subconjunctival cysts formed following the use of intraocular silicone oil as a tamponade. METHODS: We analyzed 5 cases of single and multioculated subconjunctival oil cysts between 1986 and 1996. RESULTS: Cysts were observed 15 days to 4 months following silicone oil injection. Clinically they showed minimal inflammatory signs but histopathology of removed cysts showed emulsified silicone oil globules with chronic inflammatory cellular infiltration. CONCLUSION: Though silicone oil is considered to be nontoxic, it can cause chronic inflammation when spilled into the subconjunctival space.

Adolescent↗
PubMed1999

pH-adjusted periocular anaesthesia for primary vitreoretinal surgery.

PURPOSE: To evaluate the efficacy of pH-adjusted bupivacaine in conjunction with medial orbital periconal block (periocular anaesthesia). METHODS: Sixty consecutive patients undergoing primary vitreoretinal surgery were enrolled prospectively. RESULTS: Adequate anaesthesia and akinesia with no intraoperative supplementation was achieved in 53 eyes (88.3%). Factors influencing intraoperative supplementation were combined vitrectomy with scleral buckling (p = 0.005) and duration of surgery of more than 2 hours (p = 0.001). No ocular or systemic complication resulted. CONCLUSION: pH-adjusted periocular anaesthesia is safe and effective in patients undergoing primary vitreoretinal surgery.

Adult↗
PubMed1998

Primary vitrectomy for rhegmatogenous retinal detachment associated with choroidal detachment.

OBJECTIVE: This study aimed to report the success rate of primary vitrectomy, scleral buckling, and oral steroids in eyes with combined rhegmatogenous retinal detachment (RRD) and choroidal detachment (CD) and to compare these results with those reported in the literature for similar cases managed by scleral buckling alone. DESIGN: Consecutive case series. PARTICIPANTS: Twenty-one eyes of 21 consecutive patients with primary RRD associated with CD were examined. INTERVENTION: All patients were treated with systemic corticosteroids before surgery. Pars plana vitrectomy with scleral buckling or encircling or both were performed. MAIN OUTCOME MEASURES: Retinal reattachment rate and resolution of choroidal detachment were measured. RESULTS: At mean follow-up of 11.4 months, retinal reattachment was attained in 19 eyes (90.5%) compared to less than 53% reported in the literature for scleral buckling alone. With preoperative oral steroids, choroidal detachment regressed completely in 13 eyes (61.9%). In the remaining eyes with persistent choroidal detachment, suprachoroidal fluid was drained during vitrectomy. CONCLUSION: Aggressive treatment with oral steroids followed by pars plana vitrectomy and scleral buckling or encircling is recommended instead of scleral buckling alone in the management of combined primary rhegmatogenous retinal detachment and choroidal detachment.

Administration, Oral↗
PubMed1998

Surgical management of retinal detachments related to coloboma of the choroid.

OBJECTIVE: This study aimed to develop a rationale for the management of retinal detachments related to choroidal coloboma and to study the outcome of their management. DESIGN: The study design was a retrospective study. PARTICIPANTS: A total of 85 eyes of 81 patients with retinal detachments related to coloboma of the choroid participated. INTERVENTION: All eyes underwent pars plana vitrectomy with internal tamponade using silicone oil (80 eyes) or perfluropropane gas (5 eyes). Behavior of the retina on fluid-air exchange was used to guide the further steps of surgery. Endolaser was performed along the coloboma border. Silicone oil was removed in 80% of eyes. The main outcome measures were retinal reattachment and visual recovery. RESULTS: Recurrent retinal detachment occurred in 16.3% of silicone oil-filled eyes and 60% of gas-filled eyes. After silicone oil removal, 15.6% of eyes had recurrent retinal detachment. After a mean follow-up of 13.4 months, 81.2% of eyes had attached retina and 69.4% recovered equal to or better than 10/200 visual acuity. CONCLUSION: Retinal detachment secondary to coloboma of choroid is treated best by pars plana vitrectomy along with silicone oil tamponade. Gas tamponade has limited indications. Clinical evaluation of the extent of retinal detachment within the colobomatous area and the behavior of the retina on fluid-air exchange help the authors understand the pathogenesis of the retinal detachment and plan a rational therapy.

Adolescent↗
PubMed1998

Long term visual results of vitrectomy for Eales disease complications.

BACKGROUND AND OBJECTIVES: Complications of Eales disease can cause visual loss. Long term visual prognosis following vitrectomy for Eales disease complications has been studied. PATIENTS AND METHODS: Retrospective analysis of 64 eyes of 57 patients who underwent vitrectomy for Eales disease complications with a minimum follow-up of 60 months. RESULTS: 62.4% eyes at 2 months and 71.8% at 60 months had 6/60 or better visual acuity. Visual acuities for individual cases were quite stable at the 60 month follow up with 50 eyes (78.5%) either maintaining or improving upon their 2 month post operative visual acuity. CONCLUSION: Visual acuity improves after vitrectomy in majority of patients with Eales disease complications and remains stable on long term follow-up.

Adolescent↗
PubMed1998

Combined phacoemulsification, pars plana vitrectomy, removal of intraocular foreign body (IOFB), and primary intraocular lens implantation for patients with IOFB and traumatic cataract.

PURPOSE AND METHODS: Small-incision cataract extraction by phacoemulsification through an anterior continuous circular capsulorhexis, pars plana vitrectomy, forceps removal of intraocular foreign body (IOFB) and primary intraocular lens implantation were performed in 4 eyes (4 patients) with IOFB and traumatic cataract, as an emergency combined procedure. RESULTS: At a mean follow-up of 12.3 months (range 7-19 months) the best corrected visual acuity of the 4 eyes ranged from 6/6 to 6/12. The only complication encountered in our series was an opacified posterior capsule that developed 10 months post-operatively in one case. This was easily dealt with by neodymium:YAG laser capsulotomy, with good final visual outcome. CONCLUSIONS: The results of combined one-stage instead of sequential surgeries, and phacoemulsification instead of lensectomy or extracapsular cataract extraction for patients with IOFB and cataract are encouraging. It could be a good option in selected cases. However, the safety and efficacy of this combined procedure need to be evaluated further by a larger-scale, longer follow-up study.

Adult↗
PubMed1998

Subretinal fibrosis and nonrhegmatogenous retinal detachment associated with multifocal central serous chorioretinopathy.

PURPOSE: To report the rare occurrence of subretinal fibrosis in patients with multifocal central serous chorioretinopathy and evaluate the role of systemic corticosteroids and the effects of laser photocoagulation on multifocal leaks. METHODS: A total of 29 patients (mean age, 37.7 years; 89.7% male) treated for subretinal fibrosis and multifocal central serous chorioretinopathy from 1983-1995 were reviewed retrospectively. Mean follow up was 26 months (range, 6.8-81 months). RESULTS: Retinal detachment involved the macula in 72.4% cases. Fluorescein angiography showed a mean of 6.7 (range, 2-22) central serous chorioretinopathy leaks and a mean of 1.8 (range, 1-5) retinal pigment epithelial detachments. The fundus pictures of 23 patients who were taking systemic corticosteroids showed no improvement. Following laser treatment, however, retinal reattachment was obtained in all eyes, and improvement in visual acuity of > 2 Snellen lines was noted in 68.9% of patients. CONCLUSIONS: The presence of subretinal fibrosis with secondary retinal detachment in otherwise healthy young patients, particularly in men, should alert the physician to look for multifocal central serous retinopathy leaks. Systemic corticosteroids did not prove effective in treating these patients, although laser treatment is recommended for each leak identified on an angiogram.

Adult↗
PubMed1998

Management of glass intraocular foreign bodies.

PURPOSE: To describe the results of management of glass intraocular foreign bodies (IOFBs). METHODS: A total of 51 eyes of 43 patients that sustained penetrating injury with glass IOFB were studied retrospectively. A total of 23.5% had IOFB only in the anterior segment; the rest had IOFB in the posterior segment alone or in both the anterior and posterior segments. Six eyes were followed conservatively despite IOFB in a functional eye. Removal of IOFB was combined with repair of retinal detachment (where present) using internal tamponade with gas or silicone oil or buckle. RESULTS: After a mean follow-up of 16.8 months, 66.7% of eyes recovered better than 6/60 (20/200) vision and 75.6% had attached retina. On univariate analysis, scleral entry wound, posterior segment IOFB, larger size of IOFB, and retinal damage were found to be associated with poor anatomic outcome. Lower presenting visual acuity, hyphema, retinal damage, subretinal hemorrhage, detached retina, and larger IOFB were associated with a poor functional result. Multivariate analysis identified retinal damage caused by the foreign body as the only factor significantly associated with poor anatomic as well as functional outcome. CONCLUSIONS: Glass IOFBs are caused in a majority of cases by blast injury. Bilaterality is not uncommon. Presence of retinal damage is predictive of poor functional and anatomic results. Overall results are modest with modern vitreoretinal surgical techniques.

Adult↗
PubMed1998

Ultrasonic characterisation of malignant melanoma of choroid.

An in-vitro study of wave spectral analysis in 8 enucleated eyes was conducted in order to differentiate histological subtypes of malignant melanoma. To obtain the backscattering coefficient for the tissues, we used a broadband focussed transducer with a frequency range of 7-12 MHz and a centre frequency of 10 MHz. Experimental measurement of backscattering coefficient and attenuation coefficient at various frequencies was done by substitution techniques. The backscattering coefficient, scatterer size, and root mean square velocity fluctuation were derived by the numerical method, while the attenuation coefficient at 1 MHz was derived from attenuation coefficient at different frequencies. This study revealed that backscattering coefficient and attenuation coefficient, over a frequency range of 7-12 MHz, show an increase in the spindle cell type compared to the mixed cell type of malignant melanoma. Particularly, the scatterer size was significantly higher in the spindle cell group (p = 0.013) in contrast to the mixed cell type. Spindle cells have uniform and compact histological pattern which contributes to an increase in scatterer size and root mean square velocity fluctuation. The ultrasonically obtained parameters have been shown to have a good correlation with the histology of malignant melanoma.

Choroid Neoplasms↗
PubMed1998

Posterior scleritis: clinical profile and imaging characteristics.

Posterior scleritis is relatively uncommon and is often misdiagnosed due to its protean manifestations. We report eight cases of posterior scleritis to analyse the clinical profile, ultrasonographic and computed tomography (CT) scan features of this rare disorder. Fundus findings included serous retinal detachment, choroidal folds, retinal folds, subretinal mass, choroidal detachment, disc edema, and macular edema. There was associated anterior scleritis and anterior uveitis in the majority of the cases. In all cases ultrasound with or without CT scan confirmed the clinical diagnosis. All patients responded to systemic steroids except one who required immunosuppressive therapy. This paper describes the clinical profile of a series of posterior scleritis cases highlighting varied clinical presentation, and the role of ultrasound and CT scan findings in the diagnosis.

Adolescent↗
PubMed1998

Treatment of threshold retinopathy of prematurity.

This report deals with our experience in the management of threshold retinopathy of prematurity (ROP). A total of 45 eyes of 23 infants were subjected to treatment of threshold ROP. 26.1% of these infants had a birth weight of > 1,500 gm. The preferred modality of treatment was laser indirect photocoagulation, which was facilitated by scleral depression. Cryopexy was done in cases with nondilating pupils or medial haze and was always under general anaesthesia. Retreatment with either modality was needed in 42.2% eyes; in this the skip areas were covered. Total regression of diseases was achieved in 91.1% eyes with no sequelae. All the 4 eyes that progressed to stage 5 despite treatment had zone 1 disease. Major treatment-induced complications did not occur in this series. This study underscores the importance of routine screening of infants upto 2,000 gm birth weight for ROP and the excellent response that is achieved with laser photocoagulation in inducing regression of threshold ROP. Laser is the preferred method of treatment in view of the absence of treatment-related morbidity to the premature infants.

Child, Preschool↗
PubMed1998

Endophthalmitis in eyes following vitrectomy.

The authors describe two patients who underwent pars plana vitrectomy for nonclearing vitreous hemorrhage. Both patients had severe pain, increased intraocular pressure, and orbital swelling. The anterior chamber became flat in a phakic eye. The infection progressed rapidly, and ultimately evisceration was required in both cases. The presence of a flat anterior chamber in gas-filled, phakic eyes and a severe orbital inflammatory reaction in the early postoperative period should alert the physician to the possibility of endophthalmitis.

Cataract Extraction↗
PubMed1997

A multivariate analysis of anatomic success of recurrent retinal detachment treated with pneumatic retinopexy.

PURPOSE: The purpose of the study is to determine the success rate of pneumatic retinopexy (PR) after failed scleral buckling and to elucidate the predictors for anatomic failure by multiple logistic regression analysis. METHODS: Thirty-six eyes with recurrent retinal detachment after failed scleral buckling underwent PR. Intraocular tamponade was attained with SF6 (20 eyes), C3F8 (13 eyes), and air (3 eyes). Median follow-up was 14 months. RESULTS: Retinal reattachment was obtained in 69.4%. Multivariate analysis identified two risk factors for failure: location of retinal break either on the posterior slope or posterior to buckle (P = 0.01) and extent of retinal detachment greater than two quadrants (P = 0.02). CONCLUSIONS: Pneumatic retinopexy is an effective alternative to revision surgical operations if the leaking retinal break is located on the buckle.

Adolescent↗
PubMed1997

Parabulbar anesthesia for primary vitreoretinal surgery.

PURPOSE: The efficacy and safety of parabulbar anesthesia was investigated prospectively in 100 patients undergoing primary vitreoretinal surgery. METHODS: The technique involved three steps: (1) orbicularis oculi injection, (2) subconjunctival injection, and (3) sub-Tenon irrigation. The effect of anesthesia was graded 0 to 5 depending on inadequate anesthesia-akinesia with or without local supplementation. Ninety-three patients underwent vitrectomy without buckling and 4 with an encircling band; 3 had scleral buckling. Mean duration of surgery was 89.38 minutes. RESULTS: In 69% of patients (grades 4 and 5), no supplementation was required and in 31% (grades 1-3), local supplementation was needed for inadequate anesthesia or akinesia or both. No ocular or systemic complication occurred. Early onset of anesthesia correlated with adequate anesthesia throughout the procedure (P < 0.04). CONCLUSIONS: Parabulbar anesthesia is a safe and effective technique of local anesthesia in patients undergoing primary vitreoretinal surgery.

Adult↗