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Biomedical subjects

M T Trese

Publications and source records attributed to M T Trese.

At least 37 records · Page 2Linked to original sources
PubMed2000

Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid.

PURPOSE: To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid. METHODS: Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut. RESULTS: The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months. CONCLUSION: In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.

Adult↗
PubMed2000

A new approach to stage 3 macular holes.

PURPOSE: The purpose of this article is to demonstrate the feasibility of a surgical approach that might be possible in an office setting for idiopathic stage 3 macular holes. The posterior hyaloid of the vitreous and perihole tissue is enzymatically manipulated to create an atraumatic posterior vitreous separation and may stimulate cell proliferation to close macular holes. DESIGN: Prospective noncomparative interventional case series. PARTICIPANTS: Nine eyes of eight patients with idiopathic stage 3 macular holes were treated. METHODS: The patients were treated with an injection of 0.4 IU of autologous plasmin enzyme into the midvitreous cavity and lavage of the vitreous cavity with an infusion light pipe and vitreous cutter followed by filling 70% to 80% of the vitreous cavity with 14% C3F8 and head-down positioning. MAIN OUTCOME MEASURES: Posterior vitreous detachment, macular hole closure, and vision improvement. RESULTS: Eight of nine eyes showed a spontaneous posterior vitreous detachment. One eye required minimal suction of less than 50 mmHg to elevate the posterior hyaloid off the retinal surface. Eyes were followed for a minimum of 6 months. All holes closed, and there was an average visual acuity improvement of four lines. The average surgical time for this procedure was 20 minutes. CONCLUSIONS: Autologous plasmin enzyme-assisted vitreous surgery techniques can reduce operative time, expense, and patient inconvenience while maintaining excellent surgical results, which may allow office-based vitreous surgery for idiopathic stage 3 macular holes.

Aged↗
PubMed2000

Telemedical evaluation and management of retinopathy of prematurity using a fiberoptic digital fundus camera.

OBJECTIVE: We sought to determine whether retinopathy of prematurity (ROP) can be evaluated and managed telemedically. DESIGN: Multicenter noncomparative case series. PARTICIPANTS: Ten patients (19 eyes) with ROP were evaluated and treated per standard of care and imaged with the RetCam 120 digital fundus camera (Massie Research Laboratories, Inc., Dublin, CA). INTERVENTION: Images were transmitted to a remote site for evaluation and management recommendations. MAIN OUTCOME MEASURES: Telemedical evaluations and management recommendations were compared with traditional on-site standard of care evaluations and treatments. RESULTS: The identification of Plus disease at the remote site was accurately identified in 95% of eyes. Prethreshold, threshold, and stage 4 or 5 ROP were correctly detected in 17 of 19 (89%) eyes. CONCLUSIONS: Results indicate ROP can be evaluated and treatment recommendations made at remote sites with telemedicine strategies.

Diagnostic Techniques, Ophthalmological↗
PubMed2000

A comparison of dense versus less dense diode laser photocoagulation patterns for threshold retinopathy of prematurity.

OBJECTIVE: To determine if the density of diode laser photocoagulation for the treatment of zone 1 or zone 2 threshold retinopathy of prematurity (ROP) affects the rate of progression of the disease. DESIGN: Retrospective, nonrandomized, comparative trial (n = 12) and prospective, randomized, clinical trial (n = 46). PARTICIPANTS: Two surgeons treated a total of 107 eyes from 58 patients with zone 1 or zone 2 threshold ROP within 72 hours of diagnosis. The two consecutive groups of patients were treated with two different diode laser photocoagulation patterns between May 1995 and October 1997 and were observed for at least 3 months. INTERVENTION: All patients underwent diode laser photocoagulation of the peripheral avascular retina extending from the ridge of extraretinal proliferation to the ora serrata. One cohort received a near confluent laser pattern, whereas the second cohort received a pattern of laser spots placed 1 to 1.5 burn widths apart. MAIN OUTCOME MEASURES: Anatomic outcome, rate of progression to stage 4 or 5 retinopathy of prematurity, postoperative complications, and timing and frequency of retreatment. RESULTS: For analysis, the retrospective and randomized outcome data were grouped. The rate of progression in the near confluent laser treatment group was 3.6% overall, 0% of zone 1 eyes, and 3.8% of zone 2 eyes. The rate of progression in the less dense treatment group was 29% overall, 44% of zone 1 eyes, and 21 % of zone 2 eyes. Mean time to retreatment was 16 days in cohort 1 and 24 days in cohort 2. CONCLUSIONS: A dense pattern of diode laser treatment for threshold ROP and prompt retreatment for residual plus disease significantly reduce the rate of progression in eyes with zone 2 disease (P = 0.02) and may be beneficial in eyes with zone 1 disease.

Child, Preschool↗
PubMed2000

External versus internal approach to the removal of metallic intraocular foreign bodies.

OBJECTIVE: To review the management of metallic intraocular foreign bodies (IOFB) at a single institution and to compare the use of internal and external approaches for their removal. SUBJECTS AND METHODS: A retrospective review was conducted on 70 eyes from 70 patients who underwent surgical removal of a metallic IOFB with either an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet) by seven vitreoretinal surgeons at a single institution between 1973 and 1996. Visual acuity and complications occurring with the two approaches were the main outcome measures studied. RESULTS: Overall, patients showed significant improvement in visual acuity following surgical intervention (P < 0.001) despite widely varying surgical techniques. When the authors compared patients treated with an external versus an internal approach they found no statistically significant difference with regard to visual outcome and a trend toward a higher rate of postoperative endophthalmitis in the external approach group. CONCLUSION: Surgical removal of metallic IOFB results in significant visual improvement. The external approach to the removal of magnetic metallic IOFB remains a viable treatment option in select cases.

Adolescent↗
PubMed2000

Enzymatic vitreous surgery.

Enzymatic manipulation of the vitreous and vitreoretinal juncture is currently in the process of being evaluated in many centers around the world. The goals of such manipulation are either to disinsert the posterior hyaloid from the retina surface in an atraumatic, very clean, cleavage plane or, at this point, to try to disinsert the peripheral vitreous from the neurosensory retina. In addition, enzymatic manipulation of the central vitreous in terms of liquefaction has also been evaluated. Although this is certainly the beginning of this type of vitreal surgery, adjuvant or alternative, it does appear to be a new and exciting area of vitreoretinal surgery.

Animals↗
PubMed1999

Recurrent missense (R197C) and nonsense (Y89X) mutations in the XLRS1 gene in families with X-linked retinoschisis.

Congenital retinoschisis (RS) is a hereditary eye disorder characterized by intraretinal schisis and central and peripheral retinal lesion. The gene responsible for the X-linked retinoschisis (XLRS1) has recently been isolated and found to contain mutations in affected members of several families. In this communication, two families with X-linked RS were analyzed for possible disease-causing mutations by polymerase chain reaction amplification of exons followed by DNA sequencing. Our analyses reveal a missense mutation at codon 197 in exon 6 and a nonsense mutation in exon-4 of XLRS1 gene. These changes resulted in the replacement of a highly conserved arginine by a cysteine residue and introduced a premature termination signal at codon 89, respectively. These mutations, which are transmitted through three generations, cosegregated with the disease, and are not found in the unaffected family members and 150 normal X-chromosomes, are likely to be pathogenic in these families.

Amino Acid Substitution↗
PubMed1999

A technique for suturing peripapillary radioactive plaques.

PURPOSE: To describe a technique for suturing radioactive plaques positioned posteriorly and adjacent to the optic nerve. METHODS: Posterior and juxtapapillary notched radioactive iodine-125 plaques were sutured using four 5/0 nylon sutures. Two sutures were placed in the sclera at the anterior border of the plaque position and passed through the eyelets at the anterior edge of the plaque. Two sutures were attached to the posterior eyelets and brought to either side of the optic nerve, under the rectus muscles, to be sutured to sclera anterior to the insertion of the recti muscles. The position of the plaques was documented intraoperatively using sterile B-scan ultrasonography. RESULTS: Plaques positioned and sutured using this technique were found by ultrasonography to be tight up against the sclera and optic nerve.

Brachytherapy↗
PubMed1999

Silicone oil in the repair of pediatric complex retinal detachments: a prospective, observational, multicenter study.

OBJECTIVE: To report anatomic and visual acuity outcomes, as well as complications, after using 1000-centistoke silicone oil as a retinal tamponade for the treatment of complex retinal detachments in a pediatric population. DESIGN: A prospective, observational, multicenter study. PARTICIPANTS: The study cohort consisted of 205 patients 16 years of age or younger (211 eyes) treated at community and university-based ophthalmology clinics for complex retinal detachments associated with trauma, proliferative vitreoretinopathy (PVR), giant retinal tear (GRT), or retinopathy of prematurity (ROP). INTERVENTION: Vitrectomy surgery for complex retinal detachment with 1000-centistoke silicone oil as the retinal tamponade. MAIN OUTCOME MEASURES: Anatomic outcomes include complete retinal attachment and macular attachment. Visual acuity outcomes include ambulatory vision (> or = 4/200) and preservation of preoperative visual acuity. Complications include rates of secondary intraocular pressure (IOP) elevation (> or = 30 mmHg), hypotony (< or = 5 mmHg), corneal opacification (including band keratopathy, corneal edema, and corneal abrasions), oil emulsification, and cataract. All outcome measures were assessed 6, 12, and 24 months after surgery and at last examination. RESULTS: At the 6-month examination, the retina was completely attached in 43 (57%) of 76 eyes in the trauma group, 24 (63%) of 38 PVR eyes, 23 (68%) of 34 GRT eyes, and 6 (33%) of 18 ROP eyes. The macula was attached in 60 (79%), 33 (87%), 26 (76%), and 8 (44%) eyes, respectively. Ambulatory vision was achieved in 19 (25%) eyes in the trauma group, 18 (47%) PVR eyes, 19 (56%) GRT eyes, and 4 (22%) ROP eyes. Visual acuity was preserved in 53 (70%), 26 (68%), 28 (82%), and 9 (50%) eyes, respectively. The corresponding rates of complications for traumatic, PVR, GRT, and ROP eyes were: elevated IOP-3 (4%) of 76, 1 (3%) of 38, 1 (3%) of 34, and 0 (0%) of 18; hypotony--9 (12%), 3 (8%), 2 (6%), and 2 (11%); corneal opacity--25 (33%), 8 (21%), 15 (44%), and 5 (28%); emulsification--4 (5%), 1 (3%), 3 (9%), and 1 (6%); and cataract in phakic eyes--1 (33%) of 3, 2 (67%) of 3, 2 (50%) of 4, and 1 (33%) of 3. CONCLUSIONS: Retinal reattachment and preserved visual acuity were achieved in the majority of eyes using vitrectomy and silicone oil retinal tamponade. Complete retinal and macular attachment was achieved less frequently in ROP eyes than in eyes in the other diagnostic groups. Use of 1000-centistoke silicone oil can be considered in the management of pediatric complex retinal detachments associated with multiple etiologies.

Adolescent↗
PubMed1999

Surgical results of persistent hyperplastic primary vitreous.

PURPOSE: To evaluate the surgical success of patients with persistent hyperplastic primary vitreous (PHPV) and to identify preoperative indicators of visual outcome. DESIGN: Noncomparative case series. METHODS: The diagnosis of PHPV was made in 35 eyes of 27 patients from 1982 to 1994. In each case, anterior and/or posterior PHPV findings, preoperative testing, surgical procedures, and visual outcomes were documented. Twenty-nine of 35 eyes were managed surgically. Follow-up ranged from 2 months to 12 years. RESULTS: Of the 35 eyes, 2 (5.7%) had strictly anterior PHPV, 8 (22.9%) had strictly posterior PHPV, and 25 (71.4%) had components of both anterior and posterior disease. Initial lensectomy and vitrectomy was performed in 24 eyes (68.6%). Surgery was withheld in four eyes secondary to severity of disease with an unrecordable visual-evoked potential (VEP). Reoperation rate was 32.3% for membrane reproliferation, glaucoma, vitreous hemorrhage, retinal detachment, or strabismus. Best-corrected final visual acuity ranged from 20/60 to no light perception. Six eyes (17%) maintained Snellen visual acuity despite posterior PHPV with some degree of retinal dysplasia. CONCLUSIONS: Surgical treatment of PHPV can result in functional visual outcome despite posterior segment involvement. The degree of ocular malformation, however, will ultimately limit the amount of visual improvement. Preoperative testing, including VEP, may aid in determining surgical candidates.

Child↗
PubMed1999

Successful closure of traumatic macular holes.

PURPOSE: To establish the efficacy of vitreoretinal surgery without the use of transforming growth factor-beta or autologous platelet concentrate in the repair of traumatic macular holes. METHODS: This retrospective review consisted of 16 eyes from 16 consecutive patients treated by five vitreoretinal surgeons at a single institution between 1993 and 1997. Intervention included pars plana vitrectomy with creation of posterior vitreous detachment, placement of 14% to 16% C3F8 gas, and postoperative face-down positioning. Ten eyes received intraoperative autologous plasmin to facilitate formation of posterior vitreous detachment. Main outcome measures were anatomic closure rate and visual outcome. RESULTS: Anatomic closure of the macular holes was achieved in 15 (94%) of 16 eyes, with an average follow-up of 7 months. Six (38%) eyes achieved visual acuity of 20/40 or better. Visual acuity improved by 2 or more lines in 11 (69%) of 16 eyes. The average preoperative logMAR-converted visual acuity of 20/175 improved to 20/60 postoperatively. CONCLUSION: Traumatic macular holes can be closed successfully with substantial visual recovery without the use of transforming growth factor-beta or platelet concentrate.

Adolescent↗