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[Retinal detachment following blunt trauma].

In the first part of this study a description of the different types of ocular trauma is given. This is followed by the pathogeny of retinal detachment after blunt trauma. Then the specific characteristics of the tears and other signs of non-perforation traumatic retinal detachment are discussed. Finally a description is given of the operative technique used in those cases.

Contusions↗

[Silicone oil injection in the treatment of complicated retinal detachments].

Silicone oil injection was used in the treatment of 300 selected cases of complicated retinal detachment (after PVR, trauma, giant tears, macular holes, proliferative diabetic retinopathy) and in 7 prephthisical eyes. The anatomical and visual results are analyzed in a retrospective study. Total or partial reattachment was seen in 52% and 27% of the cases reexamined one year postoperatively. At least a navigating visual acuity was achieved in 54%. The results in the different indication groups are discussed. The silicone oil injection was performed after mobilization of the retina by means of pars plana vitrectomy and periretinal surgery.

Cataract Extraction↗

Glial cell proliferation in human retinal detachment with massive periretinal proliferation.

By transmission electron microscopy we studied 38 epiretinal membranes obtained from human eyes by vitrectomy operation in rhegmatogenous retinal detachment. Two of the membranes were composed of closely packed glial cell processes. The cytoplasm of the glial cell processes in both membranes contained little besides loosely packed filaments and microtubules. Microvilli protruded from the cells at the vitreal surface of one of the membranes. Junctional complexes were present between the cells only at the vitreal surface. In the other glial membrane, microvilli extended into a duct-like structure with junctional complexes sealing the lumen. A discontinuous basal lamina was laid down by cell processes at the retinal side of the membranes. Similar glial membranes, formed by migration and proliferation of astrocytes from the retina, were seen in owl monkeys with experimental and naturally occurring retinal detachment. A new epiretinal membrane (reformed in one of the eyes from which a dense glial membrane had been removed three weeks previously), was composed primarily of single large cells with extensively developed rough endoplasmic reticulum. The new cells were surrounded by collagen, fine fibrillar material, and fibrin. The new membrane also contained free pigment granules and pigment-containing macrophages. Additionally, we observed spicule-like crystals between the cells in the glial membrane specimens, identified as calcium phosphates by energy-dispersive x-ray analysis.

Animals↗

Motility disturbances induced by operations for retinal detachment.

Study of the incidence and characteristics of motility alterations following various operations for retinal detachment. Diplopia and asthenopia following retinal surgery are rare, despite relatively frequent muscular imbalance, because of: (a) suppresion (which war frequently found even in orthophorics with good postoperative vision in both eyes); (b) compensation owing to fusional power, and (c) probable role of the sensory factor for the compensation of the subjective experience of cyclotropia. However, asthenopia and diplopia may occur and may be hard to deal with. It is felt that these disorders could be avoided in many cases since they are frequently the result of technical errors.

Diplopia↗

[The evaluation of macular thickness in patients with retinal detachment treated with conventional surgery--preliminary report].

The aim of the study was to evaluate retinal thickness in macular area (before and after surgery), and its correlation with visual acuity in patients with retinal detachment treated conventional surgery. Twenty eyes of 20 patients, treated in our clinic and eyes of 20 healthy subjects without any ocular pathology were evaluated. Retinal thickness in macular area (obtained with retinal thickness analyzer RTA - TALIA Technology) and visual acuity achieved after surgery compared with ocular pathology before and after surgery were analyzed. The correlation between visual acuity changes after successful surgery and macular thickness was evaluated. Retinal thickening in macula in patients with detached retina (even if macula was attached), and immediately after successful surgery in comparison to control group was observed. In selected cases, withdrawal of subclinical macular edema correlated with improvement of visual acuity. RTA allows for quantitative evaluation of retinal thickness in macula and its correlation with visual rehabilitation in patients with retinal detachment treated conventional surgery. Therefore RTA can be a useful tool in monitoring and determining visual acuity improvement.

Adolescent↗

OCT in successful surgery of retinal detachment associated with optic nerve head pit.

The authors describe the course of a patient with retinal detachment associated with optic nerve head pit for whom optical coherence tomography (OCT) was performed before and after vitrectomy and gas tamponade. An 18-year-old woman presented with macular elevation and a lamellar macular hole associated with optic nerve head pit. OCT showed that the retinal elevation consisted of both separation of the inner and outer retinal layers and detachment of the outer layers from the retinal pigment epithelium. After vitreous surgery and postoperative intraocular gas tamponade, the macular elevation gradually resolved, and OCT showed that improvement in central vision corresponded with flattening of the outer layer detachment in the fovea. OCT is a useful tool for monitoring the therapeutic effect of vitrectomy and gas tamponade for retinal detachment associated with optic nerve head pit.

Adolescent↗

Cutis marmorata telangiectatica congenita associated with bilateral congenital retinal detachment.

Cutis marmorata telangiectatica congenita is a rare congenital vascular disorder of the skin, characterized by persistent telangiectasia of the cutaneous blood vessels often associated with cutaneous ulcers. The only previously recognized ophthalmic association with this condition has been rare instances of unilateral congenital open angle glaucoma. The authors report their observations in a child in whom this cutaneous disorder was associated with congenital bilateral total retinal detachments and secondary neovascular glaucoma. The retinal detachments produced bilateral leukocoria simulating retinoblastoma. The cutaneous disorder and the ocular findings were confirmed histopathologically.

Corneal Diseases↗

Choroidal and retinal detachment following argon laser iridotomy.

This case report examines another of the many complications resulting from argon laser iridotomy. The authors believe that choroidal and retinal detachment subsequent to argon laser iridotomy are a product of the exceptionally high cumulative energy used in the procedure and might result from changes induced in the chamber angle. Although the authors could not prospectively find any choroidal or retinal detachment in the patient, they think that it might occur subclinically and must be suspected in a pale iris if the energy used is high and/or if vision is transiently lowered during the postoperative period.

Argon↗

[Macular pucker after retinal detachment surgery (author's transl)].

A report is given on 6 cases of macular pucker after retinal detachment surgery. Two of these 6 patients were found only by a check up of 145 detachment patients one year after surgery. In accordance with the literature presumbly causative factors were present in 5 of the cases: vitreous hemorrhage (4), reoperations (3) vitreous loss (1). A 6Th case with very unusual centrally located retinal breaks was operated on with a silicone explant and was seen with a macular pucker 6 months later.

Adult↗

Retinal detachment following Nd:YAG capsulotomy.

In a retrospective study of 862 patients undergoing Nd:YAG capsulotomy for secondary posterior capsule opacification after extracapsular cataract surgery, the prevalence of retinal detachment was found to be 1.4% with minimum follow-up of six months. Thirty-eight per cent of these detachments occurred within the first two months and 69% occurred within the first six months following capsulotomy. The increase in the prevalence of retinal detachment following Nd:YAG capsulotomy is most likely due to changes in the vitreous which occur when the posterior capsule is no longer intact.

Australia↗

Outcomes and complications associated with perfluoro-n-octane and perfluoroperhydrophenanthrene in complex retinal detachment repair.

OBJECTIVE: To compare rates of perfluorocarbon liquid (PFCL) intraocular retention, anatomic and visual acuity outcomes, and complications associated with intraoperative perfluoro-n-octane (Perfluoron) versus perfluoroperhydrophenanthrene (Vitreon) in retinal detachment repair. DESIGN: Retrospective noncomparative consecutive case series. PARTICIPANTS AND METHODS: Records of consecutive patients who underwent retinal detachment repair with intraoperative Perfluoron (n = 78) or Vitreon (n = 84) at the Bascom Palmer Eye Institute between November 1, 1991, and October 31, 1994, were retrospectively reviewed. MAIN OUTCOME MEASURES: Comparison of PFCL intraocular retention rates, retinal reattachment rates, visual acuity outcomes, and postoperative complication rates between the Perfluoron and Vitreon groups at postoperative day 1, week 1, month 1, month 3, and month 6. To assess the study's generalizability, the Perfluoron data obtained in the current study were compared with results of the Perfluoron Multicenter Clinical Study. RESULTS: Retained Perfluoron was noted less frequently (P < 0.03) than retained Vitreon at each postoperative visit assessed. At 6 months postoperatively, the cumulative rate of retained PFCL (noted at any of the study postoperative visits) was 7.8% of patients in the Perfluoron group and 38.3% in the Vitreon group (P < 0.001). No significant difference was found between the groups in retinal reattachment rates; at 6 months postoperatively, the retina was attached in 45 of 61 (74%) patients in the Perfluoron group and 36 of 57 (63%) patients in the Vitreon group (P = 0.2). There was a trend (P = 0.055) toward better 6-month visual acuity in the Perfluoron group compared with the Vitreon group. The incidence of corneal abnormality at any study visit was 46.7% in the Perfluoron group and 77.4% in the Vitreon group (P < 0.001). At 6 months postoperatively, the cumulative rate of elevated intraocular pressure (>25 mmHg) was 13 +/- 4% and 37 +/- 5%, respectively (P = 0.004). No significant difference was found between the groups in rates of postoperative hypotony. Results of this study are comparable with those observed in the Perfluoron Multicenter Clinical Study. CONCLUSIONS: In this study, Perfluoron was retained intraocularly less frequently than Vitreon. Although no significant difference was found between groups in retinal reattachment rates, Perfluoron is associated with slightly better 6-month visual acuity and lower rates of corneal abnormality and elevated intraocular pressure compared with Vitreon.

Adolescent↗

Management of silicone-induced cataract in AIDS patients treated for viral retinitis-associated retinal detachment.

BACKGROUND AND OBJECTIVE: To evaluate the outcome of cataract surgery for patients with acquired immunodeficiency syndrome (AIDS) who underwent vitrectomy and silicone tamponade for viral retinitis-associated retinal detachment. PATIENTS AND METHODS: The authors retrospectively reviewed the data of five AIDS patients (five eyes) who had cataract within a mean period of 4 months following vitrectomy and silicone oil tamponade for viral retinitis-associated retinal detachment. Phacoemulsification and implantation of a poly-methylmethacrylate posterior chamber intraocular lens were performed. The mean postoperative follow-up was 3 months. RESULTS: Neither silicone oil loss nor retinal redetachment were reported postoperatively. Visual acuity improved in two eyes and remained unchanged in one eye. Total blindness occurred in two eyes. CONCLUSION: Although cataract surgery in these eyes is a relative easy procedure and does not interfere with the retinal status, visual outcome remains poor because of possible postoperative optic atrophy.

AIDS-Related Opportunistic Infections↗

Microglial cell activation following retinal detachment: a comparison between species.

PURPOSE: To compare the activation of microglia in response to retinal detachment in four species. METHODS: Experimental detachments were created in cats, rabbits, and ground squirrels and the retinas harvested 1, 3, 7, or 28 days later. Retinal reattachments of 28 days in duration were also performed in cats following a 3-day detachment. Human tissue was obtained during reattachment surgery. Microglia and macrophages were labeled with the lectins Griffonia simplicifolia and Ricinus communis and the antibody CD11b. Müller cell and photoreceptor responses were followed immunocytochemically on the same tissue sections labeled with microglial markers. Images were collected by laser scanning confocal microscopy. RESULTS: Lightly labeled microglia were observed primarily in the inner retina of control tissue. In the cat and rabbit, a progressive increase in the number of labeled cells occurred in the outer retina beginning at 1 day of detachment. In both long term human and cat detachments numbers of microglia were elevated throughout the retina. This is in contrast to the rabbit and ground squirrel retinas where microglial activation was dramatically diminished in longer term detachments. Presumptive macrophages (anti-CD11b labeled cells) occurred only in the subretinal space. Retinal reattachment in cats significantly attenuated the response except in areas of poor outer segment regeneration. CONCLUSIONS: The robust microglial response to retinal detachment is an indicator of the importance of this cell type in the overall response of the retina. Our data suggest that the feline retina is a particularly appropriate model system for understanding this response in humans. Inhibiting the microglial response in that species should help us understand more precisely its potential role in photoreceptor survival in human pathology.

Animals↗