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At least 235 records · Page 13Linked to original sources
PubMed2004

Immediate postoperative use of a topical agent to prevent intraocular pressure elevation after pars plana vitrectomy with gas tamponade.

OBJECTIVE: To determine whether a single topical aqueous suppressant applied immediately after pars plana vitrectomy with long-acting gas tamponade prevents intraocular pressure (IOP) elevation. METHODS: Fifty patients who met the inclusion criteria and underwent pars plana vitrectomy with long-acting gas tamponade were randomized to receive a combination of timolol maleate and dorzolamide hydrochloride, long-acting timolol alone, dorzolamide alone, or placebo at the conclusion of surgery. The IOP was checked by a portable, handheld tonometer (Tono-Pen) at the conclusion of surgery and at 5 hours, 1 day, and 1 week after surgery. RESULTS: There were no significant differences in IOP among the groups at the conclusion of surgery. The IOP at 5 hours after surgery (27.0 vs 17.4 mm Hg; P<.001) and 1 day after surgery (26.1 vs 19.9 mm Hg; P =.01) showed a statistically significant difference between the placebo and timolol-dorzolamide groups. The timolol-dorzolamide group showed greater IOP control than either the timolol alone or the dorzolamide alone groups at 5 hours (P =.04 for both). CONCLUSION: The use of a single topical aqueous suppressant (timolol-dorzolamide) given after pars plana vitrectomy with long-acting gas tamponade effectively prevents significant postoperative IOP elevation at 5 hours and 1 day after surgery.

Administration, Topical↗
PubMed2004

Effect on visual outcome after macular hole surgery when staining the internal limiting membrane with indocyanine green dye.

OBJECTIVES: To determine the effect on the visual outcome after macular hole surgery when staining the internal limiting membrane (ILM) with indocyanine green (ICG) dye and to study the mechanism of the adverse effects. PATIENTS AND METHODS: We studied 40 eyes of 38 patients with an idiopathic macular hole (size, <0.5 disc diameter; duration, <12 months). The concentration, exposure time, and amount of the ICG solution that was minimally required to make the ILM visible were determined. The patients were randomly divided into group 1 (20 eyes of 19 patients) who underwent ILM peeling without ICG staining, and group 2 (20 eyes of 19 patients) who underwent ILM peeling with ICG staining. Routine examinations were conducted during the 12-month follow-up period. Multifocal electroretinogram, optical coherence tomography, and fluorescein angiography were performed on 31 eyes of 30 patients. RESULTS: The macular hole was closed in all patients. Visual acuity was improved in both groups, but it was significantly better in group 1 (median, 0.85) than in group 2 (median, 0.60; P =.02) after 12 months. The improvement of visual acuity in group 1 (logarithm of the minimum angle of resolution [logMAR] units [SD], 0.82 [0.19]) was significantly better than that in group 2 (logMAR units, 0.67 [0.21]; P =.30). The multifocal electroretinogram and optical coherence tomographic findings were not significantly different in the 2 groups. Fluorescein angiogram showed only weak hyperfluorescence at the macula in some patients of both groups. CONCLUSIONS: The results suggest that ICG staining should not be used as long as the visibility of the retinal surface is good. However, ICG staining may be acceptable at a low concentration when a clear view of the retinal surface is unattainable. The results of the multifocal electroretinogram, optical coherence tomography, and fluorescein angiography suggest that the differences in visual recovery were caused not only by pigment epithelial cell damage or retinal toxic effect but also probably by the effect of ICG staining on ganglion cells and their axons.

Axons↗
PubMed2005

Retinal detachment with macular holes in infants with retinopathy of prematurity.

OBJECTIVE: To describe retinal detachment with macular holes in infants with retinopathy of prematurity and the methods of surgical repair with their outcomes. METHODS: A retrospective review of 4 cases of retinopathy of prematurity and 1 case of retinopathy in a full-term infant that resembled retinopathy of prematurity, in which a macular hole and associated retinal detachment developed and surgical repair was attempted. RESULTS: The average gestational age of the 4 infants with retinopathy of prematurity was 26 weeks. All 5 patients had a history of vitreoretinal surgery prior to discovery of the macular hole. All 4 who underwent further surgical correction have partially or completely attached retinas and ambulatory vision. CONCLUSIONS: Vitrectomy combined with fluid-air exchange failed to close a macular hole associated with retinal detachment in infants with retinopathy of prematurity. Athermal scleral buckling of the macula can close macular holes and reattach the retina. Scleral buckling appears to be the method of choice for repair.

Child, Preschool↗
PubMed2005

Effect of plasmin on laminin and fibronectin during plasmin-assisted vitrectomy.

OBJECTIVE: To determine whether plasmin will cleave the laminin and fibronectin located at the vitreoretinal junction during plasmin-assisted vitrectomy. METHODS: Western blot analyses were performed with antilaminin or anti-fibronectin antibodies on the internal limiting membranes collected from patients with macular holes or cystoid macular edema who underwent vitrectomy with or without plasmin. The results were compared with the results of in vitro experiments in which commercially available laminin and fibronectin were exposed to commercially available plasmin. RESULTS: In all eyes treated with plasmin, a posterior vitreous detachment was not present before surgery but was created easily with a minimal suction of less than 100 mm Hg during vitrectomy. Western blot analyses showed that the laminin and fibronectin in the internal limiting membrane exposed to plasmin during vitrectomy were degraded to several fragments of lower molecular weights, including a fragment of approximately 13,000 Da for laminin and a fragment of approximately 30,000 Da for fibronectin. These lower-molecular-weight fragments also appeared in the in vitro experiments. CONCLUSION: The laminin and fibronectin at the vitreoretinal junction are degraded during plasmin-assisted vitrectomy. CLINICAL RELEVANCE: These findings provide evidence for the efficacy of using plasmin to create a posterior vitreous detachment during vitreoretinal surgery.

Basement Membrane↗
PubMed2005

Symptoms and findings predictive for the development of new retinal breaks.

OBJECTIVE: To validate the conclusion of our previous prospective study of 250 patients with isolated posterior vitreous detachment: follow-up visits are only necessary if patients mention symptoms of flashes in combination with multiple floaters or a curtain or cloud at the initial examination, or an increase in number of floaters after the initial examination. METHODS: Prospective study of 270 consecutive patients with symptomatic isolated posterior vitreous detachment. All patients completed a questionnaire detailing their symptoms and had a full eye examination at the initial examination and at follow-up visits. Logistic regression with backward elimination was used for statistical analysis. We also performed pooled analysis of our previous and present study data. RESULTS: New retinal breaks developed in 10 patients (3.7%). Multiple floaters, a curtain or cloud, hemorrhages (retinal or vitreous) at the initial examination, and an increase in the number of floaters after the initial examination were found to be predictive factors for the development of new retinal breaks. These factors were also the only significant predictors after pooled analysis of both studies (520 patients, 23 breaks). CONCLUSIONS: We assume we can formulate a safe policy for scheduling patients with isolated posterior vitreous detachment: only patients with multiple floaters, a curtain or cloud, or hemorrhages (retinal or vitreous) at the initial examination should be scheduled for reexamination. All other patients should return only if the number of floaters increases.

Aged↗
PubMed2005

Management of inferior breaks in pseudophakic rhegmatogenous retinal detachment with pars plana vitrectomy and air.

OBJECTIVE: To determine the role of pars plana vitrectomy without scleral buckling and air as a tamponade with 24 hours of prone positioning in the management of inferior breaks in primary pseudophakic rhegmatogenous retinal detachment. METHODS: Prospective, noncomparative, interventional case series. Fifteen consecutive eyes (15 patients) with primary pseudophakic rhegmatogenous retinal detachment with causative breaks located between the 4-o'clock and 8-o'clock positions underwent pars plana vitrectomy with air tamponade. The prone position was maintained for 24 hours. Anatomic and functional results are presented. RESULTS: The anatomic reattachment rate was 93.3% after 1 procedure and 100% at the 6-month visit. Mean preoperative best-corrected visual acuity was 20/60 (range, 20/400 to 20/25) and mean postoperative best-corrected visual acuity was 20/30 (range, 20/100 to 20/20). In 1 case the retina redetached at the second week because of an undetected break. Postoperative epiretinal membrane was observed in 1 case. CONCLUSION: Pars plana vitrectomy and air tamponade with only 24 hours of prone positioning postoperatively is effective in the management of primary pseudophakic rhegmatogenous retinal detachment with causative breaks between the 4-o'clock and 8-o'clock positions.

Adult↗
PubMed2006

Association of connective tissue growth factor with fibrosis in vitreoretinal disorders in the human eye.

OBJECTIVE: To investigate the expression of the profibrotic connective tissue growth factor (CTGF) in relation to severity of intraocular fibrosis and neovascularization in human vitreoretinal disorders for the identification of potential therapeutic targets to prevent fibrosis. METHODS: Concentrations of CTGF were measured by enzyme-linked immunosorbent assay in 119 vitreous samples from patients with proliferative diabetic retinopathy, proliferative vitreoretinopathy, epiretinal membrane, and macular hole. Clinical data, including degree of intraocular fibrosis and neovascularization, were collected using standardized forms. RESULTS: Multifactorial analysis revealed that only CTGF levels correlated highly significantly with degree of fibrosis in the various vitreoretinal disorders studied (P<.001; R2= 47.7%). Likewise, variation in degree of fibrosis was best predicted by CTGF levels (P<.001). CONCLUSION: The strong correlation between CTGF levels and degree of fibrosis in vitreoretinal disorders suggests that CTGF is an important factor in ocular fibrosis, similar to its role in pathologic fibrosis in other organs. CLINICAL RELEVANCE: Connective tissue growth factor may be a therapeutic target for prevention of sight-threatening vitreoretinal scarring in the eye.

Connective Tissue Growth Factor↗
PubMed2006

The macular hole: histopathologic studies.

OBJECTIVE: To delineate the light and electron microscopic features of tissue removed at the time of macular hole surgery. METHODS: The ocular fluid specimens were concentrated using Millipore filters and stained with a modified Papanicolaou and the periodic acid-Schiff stains in 697 cases. In 92 cases, surgically isolated tissue was processed and examined by electron microscopy. RESULTS: The findings in the specimens studied by the Millipore filter technique included vitreous strands; cellular fragments in 108 cases (13.3%); fibrocellular fragments in 75 (9.2%); and fragments of internal limiting lamina (ILL) of the retina in 104 (12.8%). Findings in the 92 specimens with tissue studied by electron microscopy included native vitreous collagen in 48 cases (52.2%); new collagen in 6 (6.5%); native and new collagen in 1 (1.2%); ILL of the retina in 54 (58.7%); and a variety of cells in 22.5% of cases, including fibrocytes, myofibrocytes, fibrous astrocytes with and without myoblastic features, Mueller cells, retinal pigment epithelium with and without myoblastic features, and inflammatory cells. The organization of the tissue elements included a cellular layer along one surface of a layer of cortical vitreous in 18 cases, cortical vitreous along the inner surface of the ILL of the retina in 10, and cortical vitreous sandwiched between the ILL of the retina and a layer of cells in 9. CONCLUSIONS: Tangential traction induced by fluid movements affecting the cortical vitreous is a major factor in the pathogenesis of idiopathic macular holes. Cellular proliferation is a secondary change seen in 22.2% of cases.

Basement Membrane↗
PubMed2006

Ultrahigh-resolution optical coherence tomography of surgically closed macular holes.

OBJECTIVE: To evaluate retinal anatomy using ultrahigh-resolution optical coherence tomography (OCT) in eyes after successful surgical repair of full-thickness macular hole. METHODS: Twenty-two eyes of 22 patients were diagnosed as having macular hole, underwent pars plana vitrectomy, and had flat/closed macular anatomy after surgery, as confirmed with biomicroscopic and OCT examination findings. An ultrahigh-resolution-OCT system developed for retinal imaging, with the capability to achieve approximately 3-microm axial resolution, was used to evaluate retinal anatomy after hole repair. RESULTS: Despite successful closure of the macular hole, all 22 eyes had macular abnormalities on ultrahigh-resolution-OCT images after surgery. These abnormalities were separated into the following 5 categories: (1) outer foveal defects in 14 eyes (64%), (2) persistent foveal detachment in 4 (18%), (3) moderately reflective foveal lesions in 12 (55%), (4) epiretinal membranes in 14 (64%), and (5) nerve fiber layer defects in 3 (14%). CONCLUSIONS: With improved visualization of fine retinal architectural features, ultrahigh-resolution OCT can visualize persistent retinal abnormalities despite anatomically successful macular hole surgery. Outer foveal hyporeflective disruptions of the junction between the inner and outer segments of the photoreceptors likely represent areas of foveal photoreceptor degeneration. Moderately reflective lesions likely represent glial cell proliferation at the site of hole reapproximation. Thin epiretinal membranes do not seem to decrease visual acuity and may play a role in reestablishing foveal anatomy after surgery.

Aged↗
PubMed2006

Cellular migration associated with macular hole: a new method for comprehensive bird's-eye analysis of the internal limiting membrane.

OBJECTIVE: To elucidate the pathogenesis of macular hole formation, focusing in particular on the possible role of cellular migration on the cortical vitreous and internal limiting membrane (ILM) around the macular hole. METHODS: To gain a comprehensive overview of the ILM excised in macular hole surgery (n = 36), the ILMs were carefully unfolded and spread out onto glass slides as continuous flat sheets that each contained a macular hole. The specimens were observed by light microscopy and transmission electron microscopy (n = 9), and the cellular distribution was analyzed by scanning electron microscopy in a quantitative manner (n = 27). Immunohistochemistry for glial fibrillary acidic protein and cytokeratin 18 was carried out for cellular characterization. Cellular proliferation was assessed by immunohistochemistry for proliferating cell nuclear antigen and Ki-67. RESULTS: Cellular migration was not apparent around the macular hole in the early stage of development of the macular hole (stage 2, 0 microm). As the macular hole passed through the later stages of development, cellular migration developed around the macular hole (stage 3, 84 microm) and the area of cellular migration gradually enlarged (stage 4, 420 microm). The immunophenotypic analysis showed that these cells were mainly glial fibrillary acidic protein-positive glial cells and cytokeratin 18-positive retinal pigment epithelial cells. The proliferating cell nuclear antigen and Ki-67 immunohistochemistry showed that some of these cells were proliferating on the ILM. CONCLUSIONS: Cellular migration on the ILM is not necessary for the initial formation of a macular break. Cellular migration developed after the macular break occurred, and the migration and proliferation increased gradually from the macular hole. CLINICAL RELEVANCE: This study provides a new method for understanding the ultrastructural analysis of the pathogenesis of the macular hole.

Basement Membrane↗