Do climatic variables influence the development of posterior vitreous detachment?
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Adult↗
Biomedical subjects
P H Rosen
Publications and source records attributed to P H Rosen.
Posterior subcapsular and nuclear cataract after vitrectomy.
PURPOSE: To examine the morphological changes in the postvitrectomy lens and to monitor the development of these changes over time. SETTING: Oxford Eye Hospital, Oxford, United Kingdom. METHODS: In this prospective study, 33 consecutive phakic patients having pars plana vitrectomy were recruited. Cataract development was quantified by clinical grading and digital Scheimpflug image analysis. Slitlamp biomicroscopy and photography were used to document the morphological appearance. The main outcome measures were the incidence, morphology, and development of posterior subcapsular and nuclear cataract. RESULTS: A characteristic, transient posterior subcapsular cataract (PSC) was present in 89% (17 of 19) of tamponade patients within 24 hours of surgery. Of the patients who had vitrectomy without tamponade, 9% (1 of 11) developed similar changes. Nuclear opacity developed in 61% (11 of 18) of tamponade patients and in 50% (3 of 6) of nontamponade patients. A longer term retrospective review of the same patients' case notes revealed nuclear cataract in 67% (12 of 18) of tamponade cases and 30% (3 of 10) of nontamponade cases. Eighteen percent (2 of 11) of nontamponade cases and 67% (14 of 21) of tamponade cases had cataract surgery after a 10.7 month and a 12.4 month follow-up, respectively. CONCLUSIONS: Vitrectomy and tamponade produced a characteristic transient PSC in the immediate postoperative period. Disruption of fluid balance in the region of the posterior lens was suggested by the morphological appearance. The acute changes resolved but were followed by accelerated nuclear opacification.
Aged↗
Postoperative intraocular lens rotation: a randomized comparison of plate and loop haptic implants.
OBJECTIVE: To compare the postoperative rotation of plate and loop haptic implants of spherical power to ascertain the optimal design appropriate for toric intraocular lenses (IOLs). DESIGN: Randomized, controlled trial. PARTICIPANTS: Forty-eight patients attending for routine cataract surgery by phacoemulsification. METHOD: Patients with cataract as the only ocular disease were randomly implanted with plate or loop haptic implants after uncomplicated phacoemulsification. The baseline position of the IOL was determined from a video frame acquired at the conclusion of surgery. Postoperative IOL position was documented using digital retroillumination images at 2 weeks and 6 months after surgery. Capsular fusion patterns were recorded using slit-lamp biomicroscopy. Correlation of IOL rotation with axial length, capsular contraction, and fusion was attempted. MAIN OUTCOME MEASURES: Early IOL rotation, occurring between surgery and 2 weeks after surgery, was graded as mild (<10 degrees), moderate (10 degrees < to <30 degrees), or severe (>30 degrees) by a semiobjective online comparison of the images. Late IOL rotation, occurring between 2 weeks and 6 months, was measured more precisely using software developed specifically for the study. RESULTS: Twenty-three patients were allocated the loop haptic and 25 the plate haptic IOL. The groups were comparable for demographic variables and numbers of patients excluded from analysis (P > 0.05). Five (24%) of 21 of plate haptic IOLs underwent severe early rotation compared to 2 (9%) of 22 loop haptics (P = 0.36). The median late rotation was 6.8 degrees for loop haptics compared to 0.6 degrees for plate haptics (P = 0.0073). Between 2 weeks and 6 months, anticlockwise rotation had occurred in 16 (89%) of 18 loop haptic IOLs compared to 11 (52%) of 21 plate haptic IOLs (P = 0.0081). CONCLUSIONS: Plate haptic IOLs show greater rotational stability than do loop haptics made from polypropylene once capsular fusion has taken place. Loop haptics invariably rotate anticlockwise after 2 weeks.
Capsulorhexis↗
Per-operative malposition of foldable implants (IOL flip).
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Humans↗
Retinal detachment complicating scleral-sutured posterior chamber intraocular lens surgery.
Although retinal detachment has been reported in association with sutured posterior chamber intraocular lenses (PCIOL), detailed analysis of the pathogenesis, clinical features and risk factors is lacking. Thirty-nine patients who had undergone surgery for scleral-sutured PCIOL were therefore reviewed, revealing 8 patients with associated retinal tears or detachments. Retinal breaks resulted from vitreous incarceration by the intraocular suture (6), post-operative vitreous detachment (1), preretinal manipulation of the dislocated PCIOL (1), surgical entry-sites (1) and surgical induction of posterior vitreous detachment (1). An axial length > 25 mm was associated with the development of retinal tears (p < 0.05, Fisher's exact test). All patients had attached retina with median visual acuity of 6/12 (range 6/6 to CF) at last follow-up (median 15 months, range 1-41 months). In patients requiring a pars plana approach, careful attention to the posterior hyaloid face, basal gel, surgical entry-sites and suture tract is recommended to reduce the risk of retinal detachment associated with scleral-sutured PCIOL procedures.
Adult↗
Posterior capsule opacification following diabetic extracapsular cataract extraction.
Review was performed of extracapsular cataract extraction with posterior chamber lens implantation in 90 diabetic patients and 263 non-diabetic patients. There was a higher incidence of posterior capsular opacification as judged by the requirement for Nd:YAG posterior capsulotomy in patients with non-proliferative (12/35, 34%) or quiescent proliferative diabetic retinopathy (8/18, 44%) than in non-diabetic patients (48/263, 18%) (Mantel-Haenszel p = 0.04). Although subgroup analysis showed a higher incidence of posterior capsule opacification in diabetics with non-proliferative or quiescent proliferative retinopathy than in diabetics without retinopathy, this was not statistically significant (Mantel-Haenszel p = 0.19 and p = 0.07, respectively). Following cataract surgery in diabetics with retinopathy, frequent review and prompt management of posterior capsular opacification is recommended, to maintain adequate fundus visualisation at a time when deterioration of retinopathy is likely.
Aged↗
An illuminated flute needle for vitreoretinal surgery.
We have developed a simple self-illuminated flute needle for internal drainage of subretinal fluid during three-port vitrectomy. This instrument facilitates visualization and drainage through peripheral retinal breaks.
Body Fluids↗
Trans-scleral fixation of dislocated posterior chamber intraocular lenses using a 9/0 microsurgical polypropylene snare.
We describe a new technique for retrieval, sulcus relocation and trans-scleral fixation of posteriorly dislocated (posterior chamber intraocular lenses (PC-IOLs) in a closed eye using a 9/0 polypropylene snare instrument adapted specifically for this purpose. Our experience is described of the first 5 consecutive cases in which the snare was used. The posteriorly dislocated PC-IOL was successfully relocated in 4 of these cases but per-operative fracture of a lens haptic necessitated removal of the IOL in the fifth. A number of surgical techniques have already been described in the management of this problem but we consider the polypropylene snare to offer the advantages of a simpler technique that obviates the need for either manipulation of needles within the eye or complex suturing procedures.
Adult↗
Retinal detachment following anterior chamber lens implantation for the correction of ultra-high myopia in phakic eyes.
The development of retinal detachment is reported in three eyes, of two patients, following implantation of an anterior chamber intraocular lens (AC-IOL) in phakic eyes for the correction of ultra-high myopia. The presence of an AC-IOL may hamper the identification of retinal breaks and removal of the intraocular lens may prove necessary to improve visualisation. Shallowing of the anterior chamber may also occur during, or following, vitreoretinal surgery with risk of endothelial contact. The risks and relative contraindications of AC-IOL implantation into phakic eyes are discussed.
Adult↗
Perfluorocarbon heavy liquids in the management of posterior dislocation of the lens nucleus during phakoemulsification.
We report a case in which the lens nucleus dislocated into the vitreous cavity through a posterior capsular rupture during phakoemulsification. We performed a vitrectomy and removed the lens nucleus using the perfluorocarbon heavy liquid perfluoro-1,3-dimethylcyclohexane. The management of posterior dislocation of the lens nucleus during cataract surgery is discussed.
Aged↗
Neovascular response in ischaemic central retinal vein occlusion after panretinal photocoagulation.
Twenty seven eyes treated for ischaemic central retinal vein occlusion with panretinal photocoagulation were reviewed. Prior to laser therapy anterior segment neovascularisation predominated (17 eyes) over posterior segment involvement (6 eyes). After photocoagulation anterior segment new vessels regressed or did not develop in the majority of cases. However, in five eyes previously absent posterior segment neovascularisation occurred. These results suggest that photocoagulation alters but does not eliminate retinal ischemia, thus modulating the neovascular response.
Aged↗
Intraocular tuberculosis.
Twelve patients with a diagnosis of intraocular tuberculosis are described. Nine patients presented with florid ischaemic retinal vasculitis and a marked tendency to neovascularisation. Two patients developed choroidal tubercles; iris nodules were observed in association with anterior uveitis in the remaining patient. The methods of diagnosis, management and possible mechanisms of pathogenesis of these different clinical presentations are discussed.
Adult↗
Incidence of inadvertent globe perforation during strabismus surgery.
Visual loss following strabismus is rare and usually follows inadvertent perforation of the globe at the time of surgery. Previous studies have reported that the incidence of this complication occurs in 8% to 12.1% of patients undergoing conventional strabismus surgery, and higher incidences have been reported for posterior fixation sutures. We conducted a prospective study to determine the incidence of this complication in our patients. We identified one case of globe perforation in 67 patients (100 eyes). Twenty-two patients (44 eyes) had undergone previous strabismus surgery, and there was no evidence of previous scleral perforation in this group. We discuss the recent advances in strabismus surgery which may account for this difference in the incidence of scleral perforation.
Adolescent↗
Endocapsular cataract extraction.
Endocapsular (intercapsular) cataract surgery has recently gained popularity, particularly in Europe. We describe our technique of endocapsular cataract extraction and insertion of an intraocular lens and prospectively compare 93 eyes which underwent endocapsular cataract extraction with 83 which underwent a standard extracapsular procedure. There was no apparent difference between the two groups in visual outcome. Preoperative and post-operative complications were more common in the endocapsular group: posterior synechiae formation in the latter occurred in 19%. In 90% of the endocapsular cataract extractions, the lens was placed 'in the bag' at the time of surgery but at three months only 53% remained 'in the bag'. Displacement of one haptic from the capsular bag was associated with symptomatic lens decentration requiring repositioning in four eyes in the endocapsular group and two eyes in the extracapsular group.
Adult↗
Indentation microsurgery: internal searching for retinal breaks.
Breaks responsible for rhegmatogenous retinal detachments in 78 eyes could not be seen preoperatively owing to opacities in the media, previous buckling or other causes. Deep kinetic indentation of the sclera combined with endoillumination enabled retinal breaks to be identified during closed microsurgery in 95% of these eyes, and retinal reattachment was eventually achieved in 85%.
Adolescent↗
Neodymium-YAG laser zonulotomy. Case report.
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Adult↗
Slit-lamp fundus photography.
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Fluorescein Angiography↗
Self-sealing sclerotomies for sutureless pars plana vitrectomy.
OBJECTIVE: To determine the efficacy of self-sealing pars plana sclerotomies for vitrectomy and to identify complications associated with this new technique. METHOD: There were 150 self-sealing sclerotomies performed in 50 patients undergoing pars plana vitrectomy between October 1996 and March 1998. RESULTS: Of the 150 sclerotomies, 115 (76.6%) did not require suturing while 35 (23.3%) were closed with one radial 7.0 vicryl suture. The scleral tunnel incisions ensured minimal loss of intraocular fluids during instrument exchange and scleral plugs were not required to avoid ocular hypotony during scleral indentation. Distortion of scleral flap incisions requiring a suture were commonly seen in procedures using multiple instrumentations and extensive explants. CONCLUSIONS: Sutureless sclerotomies are simple to perform, save operative time, and reduce the risk of peroperative hypotony following removal of instruments or the infusion cannula. The technique reduces postoperative inflammation, suture-related problems including astigmatism, and allows more rapid rehabilitation.
Adult↗