Biomedical subjects
Publications and source records attributed to R G Devenyi.
We report two cases of parafoveal telangiectasis encountered in the same family. The patients are father and son. Both patients are healthy. Both presented with small parafoveal telangiectatic vessels, with minimal associated subretinal fluid. There were no other associated conditions. To the best of our knowledge these cases represent the first reported cases of father-to-son transmission of parafoveal telangiectasis.
Repair of retinal detachments in high myopia may be associated with numerous intraoperative complications. Included are complications involved with the drainage of subretinal fluid as well as those arising from thin sclera. Highly myopic eyes tend to be more prone to these complications than less myopic or nonmyopic eyes. A retrospective study of 51 consecutive highly myopic eyes (six diopters (D) or greater) undergoing primary scleral buckling procedures was performed. Intraoperative complications occurred in a total of six eyes (12%). The complications were related to drainage of subretinal fluid in four eyes (8%) and associated with thin sclera in two eyes (4%). Despite the above-noted complications, there was no adverse effect on the final level of visual acuity or on the anatomic status of the retina. In the comparison of the incidence of drainage-related complications with previously published studies not preselected according to refractive status, there appears to be no added risk of complications based on the degree of myopia.
We reviewed 27 consecutive eyes with peripheral uveitis and vitreous base neovascularization that had been treated with cryopexy and followed up for a median of 4.5 years. During the follow-up period, 21 eyes (78%) remained quiescent, whereas five eyes (18%) demonstrated intermittent inflammation, although only one of these eyes progressed to a traction retinal detachment. One eye (4%) eventually atrophied; however, this was believed to be a result of the ongoing uveitis rather than the cryopexy. The treated eyes had an average improvement of three lines in Snellen visual acuity. We found that corticosteroid therapy remains the primary treatment modality for active inflammation, and vitreous base cryopexy should be reserved for those cases which are resistant to corticosteroids, and which demonstrate active neovascularization.
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Twenty-five micrograms of human recombinant tissue plasminogen activator (tPA) was injected intracamerally into the eyes of three aphakic patients who developed severe intraocular fibrin formation within 24 hours after vitrectomy surgery. Fluid obtained from gas-fluid exchange specimens taken 24 hours after tPA injection was analyzed for tPA by an enzyme-linked immunosorbent assay and a spectrophotometric solid-phase fibrin assay. In each of the three patients, complete fibrin resolution occurred within four hours after the tPA injection. There were no complications associated with the intraocular tPA injections. There was measurable tPA activity 24 hours after the initial injection ranging from 0.23 to 1.4 micrograms. In contrast, tPA was undetectable in gas-fluid exchange specimens obtained from seven patients who did not receive intraocular tPA injections. Intraocular tPA is an effective means of treating postvitrectomy fibrin formation in selected aphakic patients.
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Transscleral neodymium: YAG (Nd:YAG) cyclocoagulation has been successfully used to lower intraocular pressure (IOP) in rabbits. The authors treated 24 patients with uncontrolled glaucoma using the thermal mode of the Nd:YAG laser. The patients were followed for a mean of 8.8 months. A total of 62.5% of treated eyes achieved an IOP on last follow-up of 25 mmHg or less. The mean pretreatment pressure was 47.2 mmHg and the mean posttreatment pressure was 25.7 mmHg (P = 0.009). The complications and potential clinical usefulness of this mode of therapy are discussed.
Transscleral ruby cyclocoagulation has been successfully used to lower intraocular pressure. The recent commercial availability of Nd-YAG lasers with a thermal mode provides a possible alternative by which to perform this procedure. We treated one eye of seven pigmented rabbits using the thermal mode of the Nd-YAG laser. The intraocular pressures were followed up for three months. The treated eyes had significantly lower mean intraocular pressures were followed up for three months. The treated eyes had significantly lower mean intraocular pressures than the untreated contralateral eyes (p less than 0.001). Moreover, the decrease was sustained over the three-month duration of the study. Pathological examination revealed very selective destruction of the ciliary processes, with sparing of the overlying ciliary muscle, sclera, and conjunctiva. The potential value of this mode of therapy for use in patients with glaucoma is discussed.
BACKGROUND AND OBJECTIVE: Pseudophakic and aphakic retinal detachments are associated with a lower percentage of successful primary repair with standard scleral buckling surgery, than phakic retinal detachments. The objective of this study was to determine whether a combined scleral buckle and vitrectomy, as a primary procedure, offers any advantage over conventional scleral buckling in primary pseudophakic and aphakic retinal detachments, without proliferative vitreoretinopathy. MATERIALS AND METHODS: This was a prospective, non-randomized clinical study. Ninety-four consecutive pseudophakic and aphakic retinal detachments were included in the study. All patients were operated upon by the same surgeon. Each patient underwent a combined scleral buckle and pars plana vitrectomy with perfluorocarbon injection and air-fluid exchange. Each patient was followed by the operating surgeon for a minimum of 6 months. Patients were followed with respect to anatomic reattachment, visual acuity improvement, and surgical complications. RESULTS: All eyes were anatomically reattached after a single operation. All demonstrated an increase in their visual acuity, and there were no complications attributable to the vitrectomy procedure. CONCLUSIONS: We conclude that such a combined approach to primary pseudophakic and aphakic retinal detachments offers significant benefits to scleral buckling alone. We believe that the improved success rate is a function of vitrectomy contributing to both an improved peripheral visibility, resulting in fewer missed peripheral breaks, and a lower likelihood of proliferative vitreoretinopathy. We recommend this combined surgical approach for all primary pseudophakic and aphakic retinal detachments.