Ciliary body detachment associated with transient myopic shift after pars plana vitrectomy.
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Adult↗
Biomedical subjects
M Ohji
Publications and source records attributed to M Ohji.
Intraocular gas tamponades.
Intraocular gas tamponades are an important part of vitreoretinal surgery and have become a standard of care. The use of intraocular gas began in 1911. Modem use of intraocular gases as a surgical adjunct is continuously broadening. Today, sulfur hexafluoride and perfluoropropane are increasingly being used as intraocular gas tamponades for a wide range of complicated vitreoretinal diseases. This article reviews the types and function of commonly used gases, their indications and efficacy in certain types of vitreoretinal diseases, and their complications.
Air↗
Fixation patterns of idiopathic macular holes after vitreous surgery.
BACKGROUND: Evaluation of idiopathic macular holes with the scanning laser ophthalmoscope (SLO) has shown fixation to be located at or near the margin of the hole and above the horizontal meridian in most cases. However, changes between preoperative and postoperative fixation have not been well studied. METHOD: We used SLO microperimetry to determine scotomas and fixation points in 13 patients with idiopathic macular holes before and after vitreous surgery. The distance between preoperative and postoperative fixation points and the direction of movement were measured. RESULTS: Preoperatively, fixation was found to be at or near the margin of the macular hole in all eyes and was located above the horizontal meridian in most (84.6%) eyes. Postoperatively, there was a shift in the position of the fixation points. The distance between preoperative and postoperative fixation correlated with the degree of visual improvement (P = 0.032), but the direction of movement was variable. CONCLUSION: A shift in the position of fixation occurs after macular hole surgery, and the amount of shift correlates with visual improvement. From this observation, we define the term functional macular hole closure, characterized by centripetal movement of the neurosensory retina and improvement in vision, and the broader term anatomic macular hole closure, in which apparent hole closure may result from gliosis in the absence of movement of the neurosensory retina, not associated with visual improvement.
Adult↗
Bilateral giant macular hole.
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Diagnostic Techniques, Ophthalmological↗
Retinal changes after retinal translocation surgery with scleral imbrication in dog eyes.
PURPOSE: To examine retinal changes induced by scleral imbrication during retinal translocation surgery in dog eyes. METHODS: Fifteen dogs were anesthetized and underwent retinal translocation surgery. After lensectomy and vitrectomy, an intentional retinal detachment was created, and the upper temporal sclera around the equator was imbricated with five mattress sutures. Translocated distances were calculated by pre- and postoperative photographs. At 1, 2, and 4 weeks after the surgery, the retina was studied by TdT-dNTP terminal nick-end labeling (TUNEL) and immunohistochemistry of peanut agglutinin (PNA) lectin and glial fibrillary acidic protein (GFAP). RESULTS: The retina was translocated by a mean distance of 0.53 +/- 0.30 disc diameters or 959 +/- 543 micrometer. Retinal folds were created around the optic disc in all eyes. Histologic examination of the retinal folds 1 week after the surgery showed many TUNEL-positive cells in the outer nuclear layer, loss of photoreceptor cells, and shortening of the outer and inner segments. A strong immunoreactivity to GFAP was detected in the folds of the retina. CONCLUSIONS: . The results demonstrated that retinal translocation surgery by scleral imbrication inevitably caused retinal folds as a postoperative complication, and the retina within the folds showed extensive loss of photoreceptor cells. It is recommended that the foveal translocation surgery be planned to avoid involving the fovea in the retinal folds.
Animals↗
Foveal translocation surgery in age-related macular degeneration.
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Aged↗
Prevention of visual field defect after macular hole surgery by passing air used for fluid-air exchange through water.
PURPOSE: To evaluate the effect on peripheral visual field defects occurring after macular hole surgery of passing air that is used for fluid-air exchange through water before infusion to the eye. METHODS: We used Goldmann perimetry to measure the visual fields of patients who underwent vitrectomy to manage idiopathic full-thickness macular holes using either room air or humidified air for fluid-air exchange. We retrospectively studied visual fields measured in 39 patients (group 1) who underwent vitrectomy without humidification of air and prospectively studied visual fields measured in 33 patients (group 2) who consecutively underwent vitrectomy with humidified air for fluid-air exchange. RESULTS: In group 1, nine patients (23%) had peripheral visual field defects, most often located in the inferior or inferotemporal quadrant. No patients (0%) in group 2 had a visual field defect after vitrectomy. The difference between groups 1 and 2 in the proportion of patients with visual field defects after vitrectomy was statistically significant (P = .003). CONCLUSIONS: Passing air used for fluid-air exchange through water seems to prevent visual field defects after vitrectomy for macular hole surgery. Visual field defects that occur after room air is used may result from desiccation of the retina by room air.
Aged↗
Analysis of vitrectomy for idiopathic macular hole by optical coherence tomography.
PURPOSE: To evaluate foveal structure after vitrectomy for idiopathic macular hole in relation to postoperative visual outcome. METHODS: Optical coherence tomography was performed postoperatively to assess retinal thickness at the foveal center in patients who underwent vitrectomy, posterior hyaloid membrane removal, and perfluoropropane gas tamponade for idiopathic macular hole. Thirty-seven eyes of 36 patients documented to have achieved anatomic hole closure by optical coherence tomography were included in the study. RESULTS: Increased visual acuity significantly correlated with greater foveal thickness assessed at a median of 5 months postoperatively (Spearman analysis; R = .453, P = .005). CONCLUSION: Visual outcome after anatomic closure of macular holes by vitrectomy is closely related to the structure of the center of the fovea postoperatively.
Aged↗
Methicillin-resistant Staphylococcus aureus infections after scleral buckling procedures for retinal detachments associated with atopic dermatitis.
OBJECTIVE: To determine the incidence and the clinical course of methicillin-resistant Staphylococcus aureus as a cause of acute-onset infections in patients with atopic dermatitis after a scleral buckling procedures. DESIGN: A retrospective chart review. PARTICIPANTS: Two hundred eighty-seven patients (293 eyes) who underwent scleral buckling procedures to treat rhegmatogenous retinal detachments at either Osaka Rosai Hospital or Osaka University Medical School between July 1, 1995, and June 30, 1997, participated. Of these, 32 eyes (10.9%) were associated with atopic dermatitis. INTERVENTION: Demographic and clinical data were abstracted from patients' medical records. MAIN OUTCOME MEASURES: The incidence, clinical features, and management of postoperative infections associated with methicillin-resistant S. aureus were studied. RESULTS: Methicillin-resistant S. aureus infection after scleral buckling procedures was identified in 6 (18.8%) of 32 eyes of patients with atopic dermatitis but in only 1 (0.4%) of the other 261 cases without atopic dermatitis (P < 0.001). The average interval from the scleral buckling procedures to the initial onset of infection was 8.3 +/- 9.1 days (range, 2-28 days). Bacterial infection and inflammation were controlled in four eyes by prompt removal of the infected buckle in combination with vancomycin administration. In the other three eyes, however, repeat intravitreous injections of vancomycin or emergent vitrectomies were required because of the development of endophthalmitis. CONCLUSIONS: Methicillin-resistant S. aureus is an important causative pathogen of scleral buckling infections, particularly in patients with retinal detachment associated with atopic dermatitis. Preoperative evaluation and intraoperative attention to contamination are recommended to prevent methicillin-resistant S. aureus infections in these patients.
Acute Disease↗
Nonvitrectomizing vitreous surgery: a strategy to prevent postoperative nuclear sclerosis.
OBJECTIVE: The development or progression of postoperative nuclear sclerosis is the most common complication of successful vitrectomy in elderly patients. The authors treated idiopathic epimacular proliferation (EMP) with nonvitrectomizing vitreous surgery in an attempt to prevent postoperative nuclear sclerosis. DESIGN: Prospective, nonrandomized, comparative case series. PARTICIPANTS: The authors surgically removed membranes from the sensory retina in 21 eyes of 21 patients with EMP. INTERVENTION: Neither intravitreal infusion nor vitrectomy of any kind was performed during the procedure. The peeled membrane was left floating in the vitreous cavity in 11 (group 1) eyes and removed in 10 eyes (group 2). Nonoperated fellow eyes served as controls. MAIN OUTCOME MEASURES: Visual acuity, slit-lamp and/or Scheimpflug photography, and refractometry were performed pre- and postoperatively to evaluate changes in the degree of lenticular opacity. RESULTS: There was no difference in the rate of development or progression of nuclear sclerosis or the degree of myopic shift between operated and control eyes during the postoperative follow-up period (mean, 9.7 months). No serious complications were noted. There was no difference in postoperative course between patients in the two operative groups. CONCLUSIONS: Although interpretation of the results of this study is limited due to its small size and short follow-up, nonvitrectomizing vitreous surgery seems to decrease the postoperative development or progression of nuclear sclerosis in patients with idiopathic EMP.
Aged↗
Pneumatic displacement of subretinal hemorrhage without tissue plasminogen activator.
OBJECTIVE: To assess the efficacy and complications of intravitreal injection of perfluoropropane gas for displacement of subretinal hemorrhage (SRH), without the use of tissue plasminogen activator. PATIENTS AND METHODS: Pure perfluoropropane gas (0.4-0.5 mL) was injected into the vitreous cavity in 5 patients with SRH involving the fovea because of age-related macular degeneration (4 eyes) or ruptured retinal arterial macroaneurysm (1 eye). The patients were instructed to maintain a prone position. RESULTS: Visual acuity ranged from 20/300 to 20/2000 before gas injection. On the day after gas injection, SRH was dramatically displaced in 3 eyes and slightly displaced with a reduction in the thickness of subfoveal hemorrhage in the remaining 2 eyes. Final visual acuity improved in all cases, ranging from 20/15 to 20/220. Three eyes had a final visual acuity of 20/50 or better. Vitreous hemorrhage caused by migration of SRH into the vitreous cavity and retinal detachment each occurred in 1 eye, and both complications were successfully treated by vitrectomy. CONCLUSIONS: Gas injected into the vitreous cavity can displace SRH without the use of tissue plasminogen activator in some cases. Visual acuity after gas injection may be improved, making this treatment an alternative to evacuation of SRH with vitrectomy.
Aged↗
Visual function after foveal translocation with scleral shortening in patients with myopic neovascular maculopathy.
PURPOSE: To document the visual outcome after successful foveal translocation with intentional retinal detachment and scleral shortening for the treatment of myopic neovascular maculopathy. METHODS: Two severely myopic patients with subfoveal neovascular membranes underwent surgical translocation of the fovea to an area of healthy retinal pigment epithelium by means of scleral shortening and intentional retinal detachment. In the postoperative period, monocular and binocular visual function were studied. RESULTS: In one patient, best-corrected visual acuity improved from 20/150 to 20/20 postoperatively. In the second patient, acuity initially improved from 20/70 to 20/30. In both patients, the fixation point shifted from the site of the neovascular membrane. Oblique astigmatism developed and was managed with hard contact lenses. Diplopia and subjective torsion occurred transiently. Micropsia occurred in one patient. Peripheral fusion assessed by Worth four-dot testing after resolution of diplopia disclosed suppression in the nondominant eye in both cases. CONCLUSIONS: Foveal translocation with intentional retinal detachment and scleral shortening was useful in improving visual acuity in two patients with myopic neovascular maculopathy. Diplopia and aniseikonia occurred but resolved over time as suppression developed. This technique is promising for patients with myopic neovascular maculopathy.
Adult↗
Chorioretinal damage caused by the excision of choroidal neovascularization.
PURPOSE: To determine whether choroidal neovascularization excision causes mechanical damage to the neurosensory retina, retinal pigment epithelium, or choriocapillaris. METHODS: Prospectively, 18 eyes of 18 consecutive patients who underwent choroidal neovascularization excision were observed. Preoperatively and postoperatively, the integrity of the choriocapillaris circulation in the pathway of choroidal neovascularization extraction was studied by fluorescein and indocyanine green angiography. Using static scanning laser ophthalmoscope microperimetry, the presence of iatrogenic scotomas that developed postoperatively in the pathway of choroidal neovascularization extraction was also investigated. RESULTS: Postoperatively, a choriocapillaris defect was detected in 17 (94.4%) of 18 cases. In 15 cases (83.3%), the choriocapillaris defect had a clear relationship to the pathway of choroidal neovascularization extraction. Postoperatively, a scotoma was present in 16 (88.9%) of 18 cases. In 14 cases (77.8%), the location of the scotoma had a clear relationship to the pathway of choroidal neovascularization extraction. CONCLUSION: Surgical excision of choroidal neovascularization leads to severe damage of the choroid and retina in the pathway of the extracted choroidal neovascularization. The injury involves the neurosensory retina, retinal pigment epithelium, and choriocapillaris.
Adult↗
Anatomic and functional recovery of the fovea after foveal translocation surgery without large retinotomy and simultaneous excision of a neovascular membrane.
PURPOSE: To document the anatomic and functional recovery of the fovea after foveal translocation surgery with scleral shortening and simultaneous excision of a neovascular membrane in a patient with age-related macular degeneration. METHOD: Case report. RESULTS: The visual acuity of a 54-year-old woman with age-related macular degeneration improved from 20/200 to 20/50 after excision of subretinal neovascular membrane and foveal translocation surgery in the right eye. Fixation shifted inferonasally 0.6 disk diameters, corresponding to the direction of foveal translocation, as shown by scanning laser ophthalmoscope microperimetry. Postoperative optical coherence tomography through fixation disclosed normal foveal concavity and intact retinal pigment epithelium. CONCLUSION: Anatomic and functional recovery of the fovea was confirmed in a patient with age-related macular degeneration after foveal translocation surgery with scleral shortening and simultaneous excision of a neovascular membrane.
Female↗
Photocoagulation and fluid-gas exchange to treat persistent macular holes after prior vitrectomy. A pilot study.
OBJECTIVE: This study aimed to determine the efficacy of photocoagulation to the retinal pigment epithelial (RPE) cells and fluid-gas exchange (FGX) in the treatment of persistent macular holes. DESIGN: A clinical trial. PARTICIPANTS: Thirteen eyes of 12 patients who had undergone photocoagulation to the RPE and FGX for persistent macular holes after initial vitrectomy and gas tamponade were examined. All eyes had persistent full-thickness macular holes (diameter range, 290-820 microns; 610 +/- 190, mean +/- standard deviation) and no vitreous cortex around the holes on biomicroscopic examination. INTERVENTION: Argon laser photocoagulation was applied to the RPE in the hole bed, and FGX with 20% sulfur hexafluoride was then performed, followed by 2 weeks with the patient in a prone position. The follow-up period of the patients ranged from 3 to 18 months (10.2 +/- 4.2; mean +/- standard deviation). MAIN OUTCOME MEASURES: Anatomic success and final visual outcome were measured. RESULTS: Macular holes were closed successfully after treatment in 12 (92%) of 13 eyes, and visual acuity improved 2 or more lines in 6 eyes (46%). Two eyes (15%) attained visual acuities of 20/40 or better, and seven eyes (54%) attained 20/67 or better visual acuity. There were no intraoperative complications. Cataract formation or progression was recognized during follow-up in five (83%) of six phakic eyes. CONCLUSIONS: Although this study includes only a small number of patients, it suggests that photocoagulation and FGX can be effective in the treatment of persistent macular holes.
Aged↗
Sulfur hexafluoride does not escape from plastic syringes capped with fine needles.
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Chromatography, Gas↗
Foveal translocation: a comparison of two techniques.
Subfoveal choroidal neovascular membrane is a leading cause of legal blindness. Photocoagulation has been effective, but photocoagulation of the fovea causes a decrease in vision immediately after treatment. Surgical removal of the choroidal neovascular membrane is effective for choroidal neovascular membrane in some cases, but it restores useful vision for reading (20/40 or better) in a small number of cases of choroidal neovascular membrane not due to presumed ocular histoplasmosis syndrome. A new treatment for subfoveal choroidal neovascular membrane, foveal translocation, is an innovative procedure in which the fovea is translocated onto healthier retinal pigment epithelium. Three techniques have been developed to relocate the retina, 2 of which (retinotomy and scleral shortening) we performed in 5 cases each. Preliminary results in these 10 cases indicate that foveal translocation provides improvement of visual acuity in 40% of eyes and final visual acuities useful for reading (better than 20/40) in 20% of eyes undergoing translocation with either technique. Further study is essential to refine the amount of translocation needed and to decrease complications of the 2 techniques, including retinal detachment, proliferative vitreoretinopathy, macular pucker, corneal astigmatism, and constricted visual field.
Adult↗