Subject(s)
Choroid Diseases/genetics , Adult , Aged , Choroid Diseases/diagnosis , Exudates and Transudates , Family , Female , Fluorescein Angiography , Fundus Oculi , Humans , Male , Middle Aged , Visual AcuityABSTRACT
BACKGROUND: Diabetic retinopathy is an important cause of severe vision loss. The risk of vision loss from diabetic retinopathy is substantially reduced by intensive control of diabetes and appropriate laser surgery for proliferative diabetic retinopathy and diabetic macular edema. METHODS: The Diabetic Retinopathy Vitrectomy Study (DRVS) helped identify the indications and most propitious time for performing diabetic vitrectomy for nonresolving vitreous hemorrhage. The DRVS also highlighted the risks and potential complications of vitrectomy surgery. RESULTS: Diabetic persons with severe vision loss from severe proliferative diabetic retinopathy are candidates for vitrectomy after vitreous hemorrhage and severe fibrous changes in the retina. CONCLUSION: In cases in which vision loss occurs, pars plana vitrectomy frequently can restore useful vision, and reduce the risk of vision loss from traction retinal detachment.
Subject(s)
Diabetic Retinopathy/surgery , Vitrectomy , Diabetic Retinopathy/complications , Diabetic Retinopathy/diagnosis , Humans , Retinal Detachment/etiology , Retinal Detachment/surgery , Retinal Hemorrhage/etiology , Retinal Hemorrhage/surgery , Vitreoretinopathy, Proliferative/etiology , Vitreoretinopathy, Proliferative/surgeryABSTRACT
BACKGROUND: Retinal ischemia induces intraocular neovascularization, which often leads to glaucoma, vitreous hemorrhage, and retinal detachment, presumably by stimulating the release of angiogenic molecules. Vascular endothelial growth factor (VEGF) is an endothelial-cell-specific angiogenic factor whose production is increased by hypoxia. METHODS: We measured the concentration of VEGF in 210 specimens of ocular fluid obtained from 164 patients undergoing intraocular surgery, using both radioimmuno-assays and radioreceptor assays. Vitreous proliferative potential was measured with in vitro assays of the growth of retinal endothelial cells and with VEGF-neutralizing antibody. RESULTS: VEGF was detected in 69 of 136 ocular-fluid samples from patients with diabetic retinopathy, 29 of 38 samples from patients with neovascularization of the iris, and 3 of 4 samples from patients with ischemic occlusion of the central retinal vein, as compared with 2 of 31 samples from patients with no neovascular disorders (P < 0.001, P < 0.001, and P = 0.006, respectively). The mean (+/- SD) VEGF concentration in 70 samples of ocular fluid from patients with active proliferative diabetic retinopathy (3.6 +/- 6.3 ng per milliliter) was higher than that in 25 samples from patients with nonproliferative diabetic retinopathy (0.1 +/- 0.1 ng per milliliter, P = 0.008), 41 samples from patients with quiescent proliferative diabetic retinopathy (0.2 +/- 0.6 ng per milliliter, P < 0.001), or 31 samples from nondiabetic patients (0.1 +/- 0.2 ng per milliliter, P = 0.003). Concentrations of VEGF in vitreous fluid (8.8 +/- 9.9 ng per milliliter) were higher than those in aqueous fluid (5.6 +/- 8.6 ng per milliliter, P = 0.033) in all 10 pairs of samples obtained simultaneously from the same patient; VEGF concentrations in vitreous fluid declined after successful laser photocoagulation. VEGF stimulated the growth of retinal endothelial cells in vitro, as did vitreous fluid containing measurable VEGF. Stimulation was inhibited by VEGF-neutralizing antibodies. CONCLUSIONS: Our data suggest that VEGF plays a major part in mediating active intraocular neovascularization in patients with ischemic retinal diseases, such as diabetic retinopathy and retinal-vein occlusion.
Subject(s)
Aqueous Humor/metabolism , Diabetic Retinopathy/metabolism , Endothelial Growth Factors/analysis , Lymphokines/analysis , Retinal Diseases/metabolism , Retinal Vessels/metabolism , Vitreous Body/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Child , Endothelial Growth Factors/physiology , Extracellular Space/metabolism , Female , Humans , Lymphokines/physiology , Male , Middle Aged , Neovascularization, Pathologic/etiology , Retinal Vessels/cytology , Vascular Endothelial Growth Factor A , Vascular Endothelial Growth FactorsABSTRACT
We evaluated visual outcome and risk of metastases in patients who underwent cataract extraction after protonbeam irradiation of a uveal melanoma. A total of 84 patients underwent cataract extraction between 2 months and 11 years after irradiation. One year after cataract extraction, approximately half of the patients had visual acuity of 20/100 or better, and approximately one third had an acuity of 20/40 or better. Larger tumor size was highly correlated with poor visual outcome 1 year after extraction. Six patients underwent enucleation after cataract removal, five due to blind, painful eyes and one due to continued growth of a previously undiagnosed ring melanoma. The rate of metastases was not higher among patients who underwent cataract extraction (adjusted rate ratio, 0.83). Results suggest that cataract extraction offers improvement of vision in selected eyes previously irradiated for a uveal melanoma, without adding to the risk of metastases among patients undergoing the procedure.
Subject(s)
Cataract Extraction , Melanoma/radiotherapy , Uveal Neoplasms/radiotherapy , Adult , Aged , Aged, 80 and over , Cataract/physiopathology , Eye Enucleation , Female , Follow-Up Studies , Humans , Liver Neoplasms/secondary , Male , Melanoma/secondary , Middle Aged , Postoperative Complications , Risk Factors , Treatment Outcome , Visual AcuityABSTRACT
We report a 22-year-old Hispanic man with familial congenital nystagmus, iris transillumination, and pigmentary retinal anomalies with subretinal fatty exudates similar to those seen in Coats' disease. Direct treatment of the telangiectatic vessels with cryotherapy caused a subretinal hemorrhage. We therefore recommend surrounding the area of abnormal vessels (posterior to vessels and between vessels and ora serrata) with cryotherapy to reverse the formation of the vascular anomalies.
Subject(s)
Retinal Diseases/complications , Retinitis Pigmentosa/complications , Adult , Arteriovenous Fistula/complications , Arteriovenous Fistula/pathology , Exudates and Transudates/metabolism , Humans , Male , Nystagmus, Pathologic/complications , Nystagmus, Pathologic/congenital , Nystagmus, Pathologic/genetics , Retina/metabolism , Retina/pathology , Retinal Vessels , Telangiectasis/complications , Telangiectasis/surgeryABSTRACT
The usefulness of computerized tomography (CT scanning) in managing orbital cellulitis is analyzed in six cases. What appears as orbital abscess on CT scan may not be confirmed at surgery. Careful clinical evaluation and responsiveness to antibiotic therapy are most important in determining the need for surgical intervention.
Subject(s)
Cellulitis/diagnostic imaging , Orbital Diseases/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , MaleABSTRACT
The role of orbital computed tomography (CT) in the management of retinoblastoma is reviewed. All 21 patients with retinoblastoma studied with high-resolution computed tomography had intraocular calcification demonstrable in at least one eye. 83% of tumours showed evidence of calcification on CT scan. The degree of calcification appeared to depend on tumour size; only small tumours were devoid of calcification. The amount and distribution of calcification was similar on both histological study and CT scan. In patients under 3 years old in whom a retinoblastoma is suspected the presence of calcification on CT is virtually diagnostic of it. Patients with leucocoria without calcification on CT probably have a simulating lesion.
