Results of vitrectomy for non-clearing vitreous hemorrhage.
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Biomedical subjects
Publications and source records attributed to W E Benson.
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From March 1983 to October 1985, the members of the Retina Service of the Wills Eye Hospital treated nine boxers with traumatic retinal injuries. Eight of these had retinal detachments requiring scleral buckling procedures. The ninth had a large tear without subretinal fluid that was treated with cryotherapy alone. In this article the authors describe the type and location of retinal injury, initial and follow-up treatment, and associated ocular findings and the mechanism of injury.
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Twenty-eight patients with bilateral symmetrical Stage 3 retinopathy of prematurity (ROP) and plus disease had one eye assigned to cryotherapy and the other to control. The majority of patients weighed under 1000 grams at birth and females outnumbered males by nearly a two-to-one ratio.+ Cryotherapy was generally performed at a gestational age of less than 40 weeks and a mean chronologic age of 10 weeks. Eleven patients showed improvement in both the treated and untreated eyes possibly due to variables among prematures not identified in the study. Eleven other patients experienced improvement in the treated eye and progression in the untreated eye. Using the binomial distribution on the latter group the P value was 0.0005 with a one-tailed hypothesis test and 0.001 with a two-tailed test, suggesting that in the sampled population cryotherapy appears to be preferred over no treatment.
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Three patients with diabetic traction retinal detachment not involving the central macula were treated with the pulsed neodymium-YAG laser. In each case, with energy levels of 9 to 11 mJ, vitreous traction bands were sectioned and the traction retinal detachment diminished or disappeared. Other than a small choroidal hemorrhage in one instance, no adverse side effects occurred. The pulsed neodymium-YAG laser may provide a new therapeutic modality in a few selected cases of diabetic traction retinal detachment.
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Thirteen patients with BB-gun injuries to the eye are reported. Included are nine instances of double perforation, one case of vitreous hemorrhage, a case of late rhegmatogenous retinal detachment, one of retinitis sclopetaria, and a case of an intraocular shell casing introduced indirectly via an inadvertant BB-gun discharge into a drawer of bullets. Among the nine globes with double perforation, seven eyes were irreparably damaged and eventually enucleated, while two remained with hand motions vision. Despite modern vitrectomy techniques, double perforating BB-gun injuries to the globe imply a grim prognosis.
We describe three cases of shallow posterior rhegmatogenous retinal detachment caused by tiny retinal tears. The clinical appearance of the detachments was very similar to that of idiopathic central serous chorioretinopathy or traction retinal detachment. However, the correct diagnosis was made by finding a tiny paravascular break. Vitrectomy without a thermal adhesion was successful in repairing the detachments.
Ten moderately myopic women had blurred vision, light flashes, or paracentral scotomas associated with small yellow-white lesions of the inner choroid and pigment epithelium. Most lesions had an overlying serous detachment, were hyperfluorescent, and leaked fluorescein during the acute phase. The lesions healed into atrophic scars and became progressively more pigmented with time. Subretinal neovascular membranes later developed from scars in six patients. Vision was usually only minimally affected unless the lesions were subfoveal or unless choroidal neovascular membranes subsequently occurred. Extensive laboratory studies were noncontributory.
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Four patients with evulsion of the optic nerve caused by blunt trauma were clinically evaluated. The evulsion was complete in two of the patients and incomplete in the other two. The patients' visual acuity ranged from counting fingers to no light perception. In addition, two eyes were histopathologically studied. Several explanations of the exact cause and the extent of the evulsion are advanced within this report.
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A series of 24 consecutive pars plana posterior vitrectomies in children is reported. The postoperative visual acuities improved in 59%, were unchanged in 23%, and worsened in 28%. Trauma was the most common predisposing etiologic factor to vitrectomy and accounted for 59% of cases. Boys in the series outnumbered girls by a ratio of nearly 3:1, a factor most likely attributable to the high incidence of trauma. In no case did visual loss occur as a direct result of vitrectomy.
A series of 12 patients (13 eyes) with neovascular glaucoma in association with arterial obstructive disease is presented. Appropriately characterized as having an ocular ischemic syndrome, the anterior segment findings in each included aqueous flare and rubeosis iridis. Posterior segment manifestations included midperipheral intraretinal hemorrhages (venous stasis retinopathy), narrowed retinal arteries, often a cherry red spot, and neovascularization of the disc and/or retina. Most eyes with the ocular ischemic syndrome have either ipsilateral common carotid artery obstruction or severe bilateral obstruction of the internal carotid arteries.