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At least 37 records · Page 2Linked to original sources
PubMed1995

Prospective, randomised, controlled trial comparing suture needle drainage and argon laser drainage of subretinal fluid.

AIMS: This study was designed to compare suture needle drainage (SND) with argon laser drainage (ALD) of subretinal fluid. METHODS: A prospective, randomised, controlled, clinical trial was carried out on 93 patients undergoing external drainage of subretinal fluid during scleral buckling surgery for rhegmatogenous retinal detachment. The incidence of successful drainage, incidence of subretinal haemorrhage, incidence of retinal incarceration, and incidence of retinal perforation were determined. RESULTS: The success rate was 97.9% in the ALD group and 84.8% in the SND group (difference-13.1%, 95% CI-26.4% to 2.0%). The incidence of clinically significant subretinal haemorrhage was 4.3% in the ALD group compared with 28.3% in the SND group (difference 24.0%, 95% CI 7.6% to 40.4%). The incidence of incarceration was comparable in each group. There were no cases of retinal perforation. CONCLUSIONS: The use of ALD was associated with a higher rate of successful SRF drainage, and a lower incidence of clinically significant subretinal haemorrhage than SND. ALD is preferred when an endolaser is available.

Adolescent↗
PubMed1984

[Microsurgery of retinal detachment after perforating injury].

Twenty consecutive retinal detachments (R.D.) after penetrating ocular injury were operated on with vitreoretinal microsurgery. The follow-up after surgery varies from 6 months to 30 months. Retinal reattachment was achieved in 15 of the 20 eyes (75%). The final visual acuity was 0,4 or better in 10 of the 15 eyes operated on with success (66%). Surgical success was achieved in 7 of the 8 R.D. associated with proliferative vitreoretinopathy (P.V.R.) grade C1, C2 and C3; and 6 of the 7 R.D. associated with subretinal proliferation without clinical evidence of epiretinal proliferation. 2 R.D. associated with P.V.R. grade D2 were surgical failures. The patients should be kept under control for a long period of time since gradual shrinkage of the vitreous base may develop beyond 6 months after surgery.

Adolescent↗
PubMed1986

Natural history of penetrating ocular injury with retinal laceration in the monkey.

In one eye each of four cynomolgus monkeys, an 8-mm penetrating injury was made through the equator; there was retinal perforation with vitreous loss. None of the four eyes with this injury developed posterior vitreous detachment or retinal detachment during a follow-up period of 8 months to 1 year. Another group of 26 monkeys had the same injury but also had 0.5 ml autologous whole blood injected into the vitreous at the time of injury. The eyes were examined weekly and enucleated at scheduled intervals from 1 day to 52 weeks post-injury. Posterior vitreous detachment occurred at the earliest at 2 weeks post-injury, and was ultimately present in 91% of the eyes. Vitreous detachment can occur either as a separation at the level of the internal limiting membrane or as a cleavage within the cortical vitreous. Retinal detachment occurred at the earliest at 8 weeks post-injury, and eventually was present in 50% of the eyes. The retinal detachment was tractional; no retinal breaks were detected in any of the eyes.

Animals↗
PubMed1993

Drainage of subretinal fluid with the argon laser.

We performed 115 scleral-buckling procedures for primary rhegmatogenous retinal detachments in which the argon endolaser drained subretinal fluid. The laser was set at 0.80 to 1.25 W and 0.5 second; the endolaser probe was held adjacent to, but not touching, the choroid. The procedure was successful in 112 of 115 (97.0%) patients. When inadequate drainage occurred, the use of the penetrating diathermy tip was successful. The only major complications were subretinal hemorrhages that had migrated posterior to the buckle in two patients (1.70%), retinal perforation in one patient (0.87%), and retinal incarceration in one patient (0.87%). Laser drainage caused a slow, controlled drainage of subretinal fluid.

Body Fluids↗
PubMed1991

[Retinal detachment after perforating eye injuries. II. The interval between injury and retinal detachment and factors which may have contributed to the development of retinal detachment].

The authors operated in 1977-1987 by the cryosurgical method 69 patients after injuries on account of detachment of the retina. Detachment developed in 37 patients after simple perforation of the eye and in 32 patients after perforation of the eye with a foreign intraocular body. In all patients the perforation reached as far as the vitreous body. The interval injury--detachment was assessed retrospectively. The authors found that for the development of post-traumatic detachment of the retina a period of two years after the injury is decisive--within this period detachment of the retina occurred in 55% of the cases. Another 31.9% of the cases occurred during the late post-traumatic period, i.e. 6-40 years after injury. In 21.7% patients anamnestic data were found which were, no doubt, associated with the detachment of the retina: surgical trauma in 8.7%, direct contusion of the eye in 10.1% and lifting a heavy burden in 2.9%.

Adolescent↗
PubMed1989

Use of the carbon dioxide laser in the drainage of subretinal fluid.

Hemorrhage and retinal perforation are two sight-threatening complications associated with techniques employed to drain subretinal fluid in rhegmatogenous retinal detachment. We hypothesized that the carbon dioxide (CO2) laser would reduce these complications because of its cauterizing action and high absorption in water. The CO2 laser was compared with a conventional technique of using a penetrating diathermy electrode to drain subretinal fluid in rabbits with experimentally detached retinas. No hemorrhage occurred in 223 drainage trials using the CO2 laser, whereas hemorrhage occurred in 21 (4.8%) of 434 trials using the penetrating diathermy electrode. Furthermore, a depth of saline of only 45 microns protected the retina from perforation at CO2 laser dose adequate for drainage. These results indicate that further evaluation of the CO2 laser in treating human retinal detachment is warranted.

Animals↗
PubMed1998

External argon laser choroidotomy for subretinal fluid drainage.

PURPOSE: To evaluate the efficacy and safety of external argon laser choroidotomy for drainage of subretinal fluid (SRF) during scleral buckling procedures for the repair of rhegmatogenous retinal detachments. METHODS: Fifty eyes of 50 consecutive patients presenting to a hospital-based retinal outpatient clinic with rhegmatogenous detachments underwent choroidotomy with argon endolaser for SRF drainage. The laser parameters used were 0.5s duration and 0.8W power. The primary outcome measures were successful drainage of SRF and incidence of complications. The drainage was considered successful if it was sufficient to complete the planned scleral buckling procedure. The extent of subretinal haemorrhage was graded. RESULTS: The mean age of patients was 55 years (range 16-80 years). Successful drainage of SRF was obtained in 47 eyes (94%). The complications observed at the drainage site included subretinal haemorrhage of less than 1 disc diameter in six eyes (12%) and retinal perforation in one eye (2%). CONCLUSION: External argon laser choroidotomy appears to be an effective method of draining SRF in rhegmatogenous retinal detachments.

Adolescent↗
PubMedDate not supplied

[Evaluation of the methods of surgical treatment of retinal detachment with perforation of the posterior pole based on 10 years' clinical data].

In the period 1978-1987 20 eyes were operated for retinal detachment with a hole in the posterior pole. Various surgical methods were applied with a preponderance of the extrascleral surgery in 1978-1985. In cases of existence of a hole at the posterior pole reattachment of the retina was achieved in 63.7%. Instead in cases of a hole at the posterior pole and at the periphery the reattachment of the retina was observed in 55.6%. In the years 1985-1987 after application of endotamponade with a gas and a laser photocoagulation the percentage of a cure increased (3 cases--3 reattachments).

Adult↗
PubMed1982

Pseudoretinitis pigmentosa secondary to preretinal malignant melanoma cells.

A 75-year-old white woman with a previously diagnosed malignant melanoma of the choroid presented with pseudoretinitis pigmentosa secondary to epiretinal pigmented cells. Histopathologic examination of the enucleated globe revealed that the retinal pigmentation was due to a preretinal membrane of spindle A malignant melanoma cells, which had been dispersed by the tumor. Scanning electron microscopy of the preretinal tumor cells revealed characteristics similar to those previously reported in tissue culture. The pigment dispersion was associated with retinal perforation by the melanoma, denoting an aggressive, growing tumor that should be treated rather than observed.

Aged↗
PubMed1996

Indirect argon laser drainage of subretinal fluid.

We report on a new method of subretinal fluid drainage which uses the indirect ophthalmoscopic delivery of argon laser energy to perforate the choroid. This carries all the theoretical advantages of drainage with the endolaser probe but is simpler and less expensive. We present a prospective series of 31 patients in whom this method was applied. Satisfactory drainage was obtained in 28. There were 4 cases of limited subretinal haemorrhage attributable to the laser, and 1 case of subfoveal haemorrhage. No cases of retinal perforation or incarceration were observed.

Adult↗
PubMed1999

A study of the ability of tissue plasminogen activator to diffuse into the subretinal space after intravitreal injection in rabbits.

PURPOSE: Intravitreal injections of tissue plasminogen activator have been used to lyse fibrin from blood in the subretinal space, despite the lack of proof that tissue plasminogen activator can diffuse across the retina. We tested whether tissue plasminogen activator injected into the vitreous could penetrate the neural retina and enter the subretinal space. METHODS: We injected a mixture of 50 microg of tissue plasminogen activator (70 kD) labeled with fluorescein isothiocyanate and rhodamine B isothiocyanate-labeled dextran, which has a lower molecular weight (20 kD), into the midvitreous cavity of one eye in each of 18 rabbits. The eyes were enucleated after 3, 6, and 24 hours, and cryosections were examined with epifluorescent microscopy to determine the distribution of the labeled molecules. We also evaluated tissue plasminogen activator pharmacokinetics in one eye each of 18 rabbits in which a subretinal clot was induced by injecting autologous blood (50 microL) into the subretinal space through the sclera. Fluorescein isothiocyanate-labeled tissue plasminogen activator was injected into the vitreous 2 days after induction of the subretinal clot. RESULTS: Fluorescein isothiocyanate-labeled tissue plasminogen activator was present at the vitreal surface of the retina in a linear array in all 36 eyes studied, whereas the rhodamine B isothiocyanate-labeled dextran had diffused throughout the neural retina in the same sections. No fluorescein isothiocyanate signal was observed in the neural retina or in the subretinal clot. Vitreous hemorrhage caused by retinal perforation was observed in all eyes with intraretinal hemorrhage in which fluorescein isothiocyanate fluorescence was seen in the neural retina and inside the clot. CONCLUSION: Intravitreal tissue plasminogen activator did not diffuse through the intact neural retina to reach a subretinal clot. This study demonstrates no scientific rationale for the intravitreal tissue plasminogen activator treatment of submacular hemorrhage without vitreous hemorrhage presumably caused by an overlying retinal break.

Animals↗
PubMed2003

A new instrument for drainage or injection of fluid within subretinal space.

PURPOSE: To describe a new instrument, the subretinal aspiration and injection device (SR-AID), designed to facilitate the controlled external drainage or injection of fluid in the subretinal space. METHODS: The SR-AID is formed by an assembly of a probe, handle body, and a driving unit. The curved conduit within the probe segment forms a curved tunnel and acts as a guide along which a needle moves back and forth. The feasibility of fluid injection beneath the attached retina was tested in animal eyes. The efficacy of subretinal fluid drainage with the SR-AID were assessed in six cases of clinical retinal detachment. RESULTS: External approach to the subretinal space under ophthalmoscopic monitoring can be achieved by oblique angle penetration of the scleral wall with a needle from the SR-AID. Fluid was injected successfully into the subretinal space in three of six rabbit eyes and in two of two pig eyes. The mean duration required for the drainage of subretinal fluid with the SR-AID was 127 seconds. There was no incidence of significant subretinal hemorrhage or retinal perforation in the animal experiments and in human cases. CONCLUSION: Our case series suggests that the SR-AID provides an efficient and safe means of access to the subretinal space.

Adult↗
PubMed2006

Safety in nonhuman primates of ocular AAV2-RPE65, a candidate treatment for blindness in Leber congenital amaurosis.

Leber congenital amaurosis (LCA) is a molecularly heterogeneous disease group that leads to blindness. LCA caused by RPE65 mutations has been studied in animal models and vision has been restored by subretinal delivery of AAV-RPE65 vector. Human ocular gene transfer trials are being considered. Our safety studies of subretinal AAV-2/2.RPE65 in RPE65-mutant dogs showed evidence of modest photoreceptor loss in the injection region in some animals at higher vector doses. We now test the hypothesis that there can be vectorrelated toxicity to the normal monkey, with its human-like retina. Good Laboratory Practice safety studies following single intraocular injections of AAV-2/2.RPE65 in normal cynomolgus monkeys were performed for 1-week and 3-month durations. Systemic toxicity was not identified. Ocular-specific studies included clinical examinations, electroretinography, and retinal histopathology. Signs of ocular inflammation postinjection had almost disappeared by 1 week. At 3 months, electroretinography in vector-injected eyes was no different than in vehicle-injected control eyes or compared with presurgical recordings. Healed sites of retinal perforation from subretinal injections were noted clinically and by histopathology. Foveal architecture in subretinally injected eyes, vector or vehicle, could be abnormal. Morphometry of central retina showed no photoreceptor layer thickness abnormalities occurring in a dose-dependent manner. Vector sequences were present in the injected retina, vitreous, and optic nerve at 1 week but not consistently in the brain. At 3 months, there were no vector sequences in optic nerve and brain. The results allow for consideration of an upper range for no observed adverse effect level in future human trials of subretinal AAV-2/2.RPE65. The potential value of foveal treatment for LCA and other retinal degenerations warrants further research into how to achieve gene transfer without retinal injury from surgical detachment of the retina.

Animals↗
PubMed2001

Locally invasive tumors arising from hyperplasia of the retinal pigment epithelium.

PURPOSE: Focal hyperplasia of the retinal pigment epithelium (RPE) is a common fundus condition that is generally stationary, with little or no tendency to enlarge or spawn neoplasms. The purpose of this report is to describe the unusual clinical features of two similar cases in which a nodular tumor of the RPE was documented to arise from a small focus of hyperplasia of the RPE. METHODS: Clinical and cytopathologic observations of two patients. RESULTS: Both patients were observed for approximately 25 years with an unusual progressive fundus tumor that originally arose from a small, flat, irregular focus of hyperplasia of the RPE. The originally observed pigmented lesion was attributed to toxoplasmosis in one patient and laser treatment for central serous chorioretinopathy in the other. In both patients, the tumor enlarged, invaded through the full-thickness sensory retina, and produced a characteristic retinal perforation with apposition of the mass to the vitreous. In both instances, fine-needle aspiration biopsy showed scant pigmented cells, but a definite diagnosis was not made. However, clinical observations in both patients suggested that these tumors were acquired neoplasms that arose from small foci of hyperplasia of the RPE. CONCLUSION: Focal hyperplasia of the RPE can give rise to unusual invasive tumors that invade and replace the overlying sensory retina. These tumors have unique clinical features that differentiate them from uveal melanoma and other pigmented fundus lesions.

Adult↗
PubMed1984

Rhegmatogenous retinal detachments caused by paravascular vitreoretinal traction.

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.

Adult↗