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PubMedDate not supplied

[Formation of idiopathic macular holes].

Sixty-eight patients (136 eyes) with idiopathic macular hole (IMH) were examined, using optic coherent tomography. 91% of these patients were women, mean age 66.6 years. Preholes were detected in 14 eyes, lamellar ruptures in 11, and perforating ruptures in 78 eyes. Specific functional and morphological changes in the retina, vitreous, and vascular membrane were detected. Three main mechanisms of IMH formation were distinguished. Conceptual scheme of the pathogenesis of this condition was developed and a new more complete pathogenetically justified classification of IMH is offered, which helps more objectively diagnose, predict the functional outcome, determine the treatment strategy, and evaluate the efficiency of surgery.

Age Factors↗
PubMed1987

Management of intraocular foreign bodies.

Thirty-five consecutive cases of perforating ocular injuries with retained intraocular foreign body (IOFB) are examined in this retrospective study. Of the 35 cases with injuries, 30 (86%) were due to metallic foreign bodies. Of these, 25 (83%) involved foreign bodies of ferromagnetic origin. Magnetic extraction in combination with pars plana vitrectomy (or when possible, magnetic extraction alone) was successfully used to remove these foreign bodies. Even in cases where posterior vitrectomy is indicated, magnetic extraction allows good control of the foreign body during removal minimizing surgical trauma and the subsequent postoperative inflammatory response.

Eye Foreign Bodies↗
PubMed1991

The nature, causes, and visual outcome of ocular trauma requiring posterior segment surgery at a county hospital.

Fifty consecutive, severe ocular trauma cases with posterior segment involvement underwent vitreoretinal surgery over a 14-month period at a county hospital. Forty-five (90%) of the patients were boys and men, and the mean age was 27 years. The injuries were the result of assaults in 37 cases (74%), industrial accidents in six (12%), accidents involving children at play in six (12%), and child abuse in one (2%). Twenty-five (50%) of the injuries were inflicted by firearms, by knives or sharp objects in ten (20%), by baseball bats in two (4%), by broken glass in two (4%), and unknown in 11 (22%). Twenty-six (52%) were penetrating injuries, of which eight were double perforations. There were ten (20%) intraorbital foreign bodies and three (6%) intraocular foreign bodies. Forty-three (86%) of the cases had initial visual acuities of 20/400 or worse. After a minimum of six months' follow-up, 48.8% improved two or more lines visually, and 69.4% were anatomic successes. Unlike other ocular-trauma studies, where industrial accidents and sports-related injuries were the most common causes of the trauma, assaults with firearms were the most common cause of ocular trauma at this county hospital. The visual and anatomic surgical results, however, were similar to those of other ocular-trauma studies.

Adolescent↗
PubMedDate not supplied

The pathology of diverticulosis coli.

Left-sided diverticulosis coli is a common condition in western communities, with 30% to 50% of adults over the age of 60 being affected. It predominantly involves the sigmoid colon. The diverticula (pseudodiverticula) are pockets of mucosa bounded by muscularis mucosae and invested with a thin layer of submucosa, that are forced out through weak points in the muscularis propria, the tips ending in the colonic subserosa. The weak points in the muscle coat are the sites of entry of the nutrient vessels of the colonic mucosa. Diverticulosis is attributed to increased colonic intraluminal pressure while straining at stool in individuals who eat low-fiber diets. Muscular hypertrophy, shortening of the bowel, and thickened mucosal folds due to mucosal redundancy are characteristic of this condition. Complications of diverticulosis include bleeding, diverticulitis, peridiverticular abscess, perforation, stricture, and fistula formation. However, most individuals with diverticulosis are asymptomatic, without evidence of complications. Mucosal changes in the diverticula in uncomplicated diverticulosis include an increased lymphoid infiltrate, development of lymphoglandular complexes, mucin depletion, mild cryptitis, architectural distortion, Paneth cell metaplasia, and ulceration. The mucosa of the remainder of the sigmoid colon (ie, the nondiverticular mucosa) is usually normal, but in about 1% of cases it has features that are indistinguishable from ulcerative colitis or from Crohn's disease (segmental colitis associated with diverticular disease, SCAD). Such cases pose a difficult diagnostic challenge as patients with SCAD respond to medical or surgical therapy for diverticular disease, whereas those with ulcerative colitis or Crohn's disease will develop other manifestations of their disease in time and require different treatment. In SCAD, the mucosal changes are confined to the area of diverticulosis; therefore, histologic evaluation of the rectum (which is unaffected by diverticulosis) and more proximal bowel can be helpful in the differential diagnosis.

Colon↗
PubMed2007

Vasoactive intestinal peptide balances pro- and anti-inflammatory cytokines in the Pseudomonas aeruginosa-infected cornea and protects against corneal perforation.

Corneal infection with Pseudomonas aeruginosa perforates the cornea in susceptible C57BL/6 (B6), but not resistant BALB/c, mice. To determine whether vasoactive intestinal peptide (VIP) played a role in development of the resistant response, protein expression levels were tested by immunocytochemistry and enzyme immunoassay in BALB/c and B6 corneas. Both mouse strains showed constitutive expression of corneal VIP protein and nerve fiber distribution. However, disparate expression patterns were detected in the cornea after infection. VIP protein was elevated significantly in BALB/c over B6 mice at 5 and 7 days postinfection. Therefore, B6 mice were injected with rVIP and subsequently demonstrated decreased corneal opacity and resistance to corneal perforation compared with PBS controls. rVIP- vs PBS-treated B6 mice also demonstrated down-regulation of corneal mRNA and/or protein levels for proinflammatory cytokines/chemokines: IFN-gamma, IL-1beta, MIP-2, and TNF-alpha, whereas anti-inflammatory mediators, IL-10 and TGF-beta1, were up-regulated. Treatment with rVIP decreased NO levels and polymorphonuclear neutrophil (PMN) number. To further define the role of VIP, peritoneal macrophages (Mphi) and PMN from BALB/c and B6 mice were stimulated with LPS and treated with rVIP. Treatment of LPS-stimulated Mphi from both mouse strains resulted in decreased IL-1beta and MIP-2 protein levels; PMN responded similarly. Both cell types also displayed a strain-dependent differential response to rVIP, whereby B6 Mphi/PMN responded only to a higher concentration of VIP compared with cells from BALB/c mice. These data provide evidence that neuroimmune regulation of the cytokine network and host inflammatory cells functions to promote resistance against P. aeruginosa corneal infection.

Animals↗
PubMed1998

Objective assessment of photoreceptor displacement and metamorphopsia: a study of macular holes.

BACKGROUND: We have developed a binocular perimetry technique for the quantitative assessment of retinal photoreceptor displacement and metamorphopsia. OBJECTIVE: To study the direction and amplitude of retinal photoreceptor displacement in eyes with idiopathic macular holes using our binocular perimetry technique. SUBJECTS: Five healthy control subjects and 10 patients with unilateral stage 3 to 4 macular holes in one eye and a healthy fellow eye. METHOD: Kinetic perimetry using red and green filter glasses, black binocular fixation targets, red and green selective monocular stimuli (Goldmann III-4-e), and fundus image superimposition of perimetry data. RESULTS: We found no discrepancy between the 2 visual fields in any healthy subjects. In patients with a unilateral macular hole, the central scotoma invariably extended beyond the rim of the hole. In 8 patients, each point on the rim of the scotoma had a perceptually corresponding location in the visual field of the fellow eye that was closer to the center of the visual field. In the 2 patients with the longest duration of symptoms (>2 years), no such discrepancy was found. CONCLUSIONS: Differential perimetry enables the objective study of retinal photoreceptor displacement and metamorphopsia. We found objective evidence for radial centrifugal photoreceptor displacement in most patients with idiopathic macular holes.

Aged↗
PubMed1998

Spontaneous resolution of retinal detachment occurring after macular hole surgery.

OBJECTIVE: To document the spontaneous resolution of retinal detachment developing after macular hole surgery. METHODS: We identified all patients who developed a postoperative retinal detachment after undergoing macular hole surgery at Washington University School of Medicine, St Louis, Mo; the surgery was performed by one of us (L.V.D.P. or H.J.K.) between 1991 and 1996. RESULTS: Six of 73 eyes developed a postoperative retinal detachment; the retinal detachment was inferior in all cases. Two eyes that had inferior retinal breaks underwent further surgery to repair the retinal detachment. Retinal breaks could not be identified in the other 4 eyes; the retinal detachment resolved without further surgery in all 4 of these eyes. CONCLUSION: The recognition that retinal detachment occurring after macular hole surgery can resolve without additional surgery may result in the avoidance of further surgical intervention in some eyes.

Aged↗
PubMed1998

Foveal cysts: a premacular hole condition associated with vitreous traction.

OBJECTIVE: To define the clinical findings, cause, and outcome of patients with foveal cysts due to vitreous traction. METHODS: Follow-up of 18 patients with foveal cysts and no posterior vitreous detachment (PVD). Changes were documented in visual acuity, the appearance of the fovea, or the development of a macular hole or PVD. We studied 8 eyes using the retinal thickness analyzer. RESULTS: On follow-up, 9 of 23 eyes did not develop a PVD and still had a foveal cyst; 8 of 23 developed a full-thickness macular hole; 4 of 23 developed a PVD with resolution of the cyst; and 2 eyes underwent vitrectomy for the cyst before a full-thickness hole developed. Analysis with the retinal thickness analyzer showed splitting within the middle retinal layers and in some cases unroofing or absent inner retinal layers in the center of the cyst. CONCLUSIONS: Foveal cysts are caused by vitreous traction. These eyes may remain stable, develop full-thickness holes, or develop a PVD with resolution of the cystic changes. A foveal cyst seems to be a common finding in patients with foveal traction from a variety of mechanisms.

Aged↗
PubMed1999

A multicentered clinical study of serum as adjuvant therapy for surgical treatment of macular holes. Vitrectomy for Macular Hole Study Group.

OBJECTIVE: To evaluate and compare the risks and benefits of autologous serum as an adjuvant therapy in macular hole surgery for stage 3 or 4 macular holes. METHODS: Comparison of 2 consecutive (nonrandomized) cohorts using standardized methods for the determination of hole size and for surgical procedures, and using the same study surgeons. The serum cohort consisted of 106 eyes using autologous serum as an adjuvant, and the no serum cohort consisted of 58 eyes without adjuvants. The primary end point was the closure of the macular hole as determined by the 6-month fundus photographs. Secondary end points included the number and types of postoperative complications. Comparison in outcomes between the 2 cohorts used chi2 and logistic regression procedures, adjusting for preoperative differences between the study cohorts. RESULTS: At 6 months, the (unadjusted) rate of hole closure was significantly greater for the eyes treated with serum than for the eyes not treated with serum (90 [85%] of 106 vs. 40 [69%] of 58, P = .04). However, after adjusting for preoperative differences in hole diameter and the prevalence of epiretinal membranes, no overall difference in hole closure rates due to serum was found (P = .44). In contrast, benefit due to serum for large holes (diameter >573 microm) was seen (12 [75%] of 16 vs 13 [57%] of 23, P = .04). No differences in complication rates were found between the cohorts. CONCLUSIONS: Any beneficial effect of serum used as an adjuvant to macular hole surgery is small, and, if present, the beneficial effect may be limited to larger holes. A randomized, prospective, controlled study in larger macular holes is needed.

Adult↗
PubMed1999

Ulnar neuropathy as a complication of macular hole surgery.

OBJECTIVE: To report a series of patients manifesting ulnar neuropathy as an extraocular complication following macular hole surgery and facedown positioning. METHODS: Retrospective chart review of 7 patients identified by the operating surgeon as developing ulnar neuropathy during the immediate postoperative period after undergoing vitrectomy surgery with fluid-gas exchange for macular hole followed by at least 1 week of strict facedown positioning. RESULTS: All 7 patients developed symptoms of ulnar neuropathy, including paresthesias, dysesthesias, pain, weakness, and muscle atrophy. Signs included abnormal electromyogram, prolonged nerve conduction velocities, and impaired neurologic clinical test results in patients examined. Symptoms did not resolve with cessation of facedown positioning, and with follow-up ranging from 3 to 24 months all patients had persistent symptoms. All patients had positioned themselves with their arms continuously flexed. Three of 7 patients had placed pressure directly on their bent elbows. CONCLUSIONS: Ulnar neuropathy is an extraocular complication of macular hole surgery that can be attributed to arm position during postoperative facedown positioning. Surgeons performing macular hole surgery should caution their patients to minimize the amount of time spent with their elbows in a flexed position. Particular effort should be made to minimize pressure on the bent elbow.

Aged↗
PubMed1999

Clinical course of macular holes: the Eye Disease Case-Control Study.

OBJECTIVE: To describe the clinical course of affected and unaffected eyes in patients with idiopathic macular holes. PATIENTS: Prospective study of patients with macular holes enrolled in the Eye Disease Case-Control Study. MAIN OUTCOME MEASURES: The best-corrected visual acuity at follow-up was compared with that at baseline. Changes in the macular holes, including increases in size or spontaneous regression, were assessed. The rates of development of new macular holes in fellow unaffected eyes were estimated. RESULTS: Of the 198 patients examined at baseline, 28 (14.1%) died before reevaluation. Of those who survived, 122 (71.8%) had a follow-up examination. Approximately 34% (34.4%) of all eyes with macular holes had an increase in the size of the macular hole. Forty-five percent of eyes had a decrease in visual acuity of 2 or more lines and 27.8%, of 3 or more lines; 40.9% remained stable, with a gain or loss of fewer than 2 lines. The rate of development of a new macular hole during follow-up in fellow eyes that were unaffected at baseline was 4.3% for 3 or fewer years of follow-up, 6.5% for 4 to 5 years of follow-up, and 7.1% for 6 or more years of follow-up. Spontaneous regression of the macular hole occurred in 3 (8.6%) of 35 patients with a follow-up interval of 6 or more years, whereas no regression occurred in patients with a shorter follow-up. CONCLUSIONS: The visual acuity of 45.0% of eyes with macular holes deteriorated by 2 or more lines during follow-up. The rate of development of macular holes in unaffected fellow eyes was low.

Adult↗
PubMed1999

The importance of qualitative vitreous examination in patients with acute posterior vitreous detachment.

OBJECTIVE: To determine whether patients with acute posterior vitreous detachment with pigmented vitreous granules or hemorrhage have a higher likelihood of retinal tear compared with those with qualitatively normal vitreous examination findings. METHODS: A multicenter cross-sectional study was performed in 3 peripheral ophthalmic clinics. Patients with acute posterior vitreous detachment were examined for the presence or absence of vitreous pigment granules, vitreous hemorrhage, and horseshoe retinal tear. RESULTS: Fifty-nine consecutive patients with acute posterior vitreous detachment met our eligibility criteria. Eight patients had a retinal tear, and thus its prevalence in our study was almost 14%. Thirteen patients (22%) had a high likelihood because they had evidence of either pigmented vitreous granules or hemorrhage. The prevalence of retinal tear in the setting of acute posterior detachment associated with vitreous hemorrhage alone, pigment alone, or vitreous hemorrhage and pigment was 54%. Patients with posterior vitreous detachment with pigmented vitreous granules or hemorrhage were significantly more likely to have a retinal tear (odds ratio, 52.0; 95% confidence interval, 5.4-497.0). Patients with a retinal tear were 7 times more likely to have pigmented vitreous granules or hemorrhage (LR + ve = 7.4, in which LR + ve indicates positive likelihood ratio; 95% confidence interval, 3.3-16.4). CONCLUSION: Patients with posterior vitreous detachment with vitreous pigment granules or hemorrhage are 52 times more likely to have a retinal tear compared with those who have normal findings on qualitative vitreous examination.

Acute Disease↗
PubMed1999

Histopathological features of vitreous removed at macular hole surgery.

OBJECTIVE: To describe the histopathological features of the vitreous removed at surgery for macular holes in 200 consecutive cases. METHODS: The complete vitrectomy specimen in each case was concentrated by means of cellulose membrane filters and stained for light microscopy. The cases were organized into 5 categories: (1) all cases (N = 200), (2) eyes without previous vitrectomy (n = 174), (3) eyes with previous vitrectomy (n = 26), (4) idiopathic cases (n = 143), and (5) traumatic (accidental or surgical) cases (n = 31). The type and frequency of tissue fragments present in the vitreous were determined for each case. RESULTS: Fibrocellular and cellular membrane fragments were found in a minority of cases in all categories. Retinal fragments were a rare finding, present in only 4 cases. Inflammation was present in 57 (28.5%) of all cases. CONCLUSIONS: The absence of fibrocellular and cellular membrane fragments in the majority of cases suggests that mechanisms other than cellular proliferation are important in the pathogenesis of macular holes. These fragments are, however, the likely histopathological correlate of the opercula that are often observed clinically in patients with macular hole. Opercula rarely if ever contain retinal fragments, and thus are better termed pseudo-opercula, as has been previously suggested. The cellular proliferation and inflammation that are observed in some of the cases are likely a secondary or reactive process.

Aged↗