Evaluation of primary surgical procedures for retinal detachment with macular hole in highly myopic eyes: a comparison [corrected] of vitrectomy versus posterior episcleral buckling surgery.

PURPOSE: To evaluate postoperative outcomes between pars plana vitrectomy (PPV) and posterior episcleral buckle procedure (PEBP) in myopic eyes with retinal detachment (RD) and macular hole (MH). DESIGN: Retrospective nonrandomized comparative interventional trial. PARTICIPANTS AND INTERVENTION: The study included 30 phakic, highly myopic eyes (from 19-30 negative diopters) of 30 patients with an RD and MH. The patients were divided into two groups: They were assigned to PPV (15 eyes, group A) or to PEBP (15 eyes, group B). No significant (P > 0.01) differences in preoperative visual acuity (VA) between group A and group B eyes were found. Follow-up was 12 months. MAIN OUTCOME MEASURES: Anatomic attachment of the retina was determined, and VA was measured. RESULTS: Retinal reattachment was obtained on 11 of 15 (73.3%) eyes of group A and on 14 of 15 (93.3%) eyes of group B. In group A eyes the VA was substantially unmodified after surgical treatment, whereas in group B eyes the VA observed after surgical treatment increased significantly (P < 0.001) with respect to the preoperative values. CONCLUSIONS: PEBP resulted in better postoperative anatomic and functional results compared with PPV in eyes with extreme degrees of myopia, pronounced posterior staphyloma, and posterior vitreous schisis affected with RD caused by MH.

Morphological evaluation of full-thickness idiopathic macular holes by optical coherence tomography.

PURPOSE: To assess the efficacy of optical coherence tomography (OCT) for the morphological evaluation of idiopathic full-thickness macular holes and for detecting any morphological changes with time. METHODS: Serial sagittal tomographs through the macula were taken by OCT in a consecutive series of 34 eyes of 34 patients with diagnosis of idiopathic full-thickness macular hole. The patients were divided into two groups on the basis of "recent" (group 1, 25 patients) or "not-recent" (group 2, 9 patients) onset of symptoms related to the macular hole. Fourteen of the 25 patients in group 1 and all nine in group 2 underwent vitrectomy. The 11 in group 1 who refused surgery were observed by OCT examination with follow-up from 6 to 13 months. RESULTS: In most eyes OCT scans revealed two different anatomical features of macular holes depending on the time of onset of symptoms. Eleven of the 14 "recent-onset" holes that underwent surgery showed "sharp", undermining edges at preoperative OCT; the other three had "rounded" edges. Seven of the nine eyes operated for long-standing full-thickness macular holes had preoperative "rounded" edges, while the edges in the remaining two eyes were "sharp". OCT of eight of the 11 non-operated eyes in group 1 showed a morphological evolution of the macular hole edges from a "sharp" to a "rounded" contour and an increase in the diameter of the hole. CONCLUSIONS: OCT can help in the morphological evaluation of idiopathic full-thickness macular holes and in the detection of morphological changes with time.

Optical coherence tomography.

The optical coherence tomograph is a new, noninvasive technical device that can obtain cross-sectional, high-resolution images-optical coherence tomographs (OCT)-of the retina. This instrument permits an accurate evaluation of various macular and chorioretinal pathologies and the early detection of glaucomatous damage. Images of the retina are obtained similar to ultrasound B-scan, with 10-microm longitudinal resolution. Because the OCT operates with a near-infrared wavelength (about 840 nm), the examination is of minimal discomfort for the patient. OCT examination is indicated in cases of macular pathologies such as vitreoretinal interface syndrome, in the early detection and quantitative assessment of macular edema, and in the evaluation of a glaucomatous damage by measuring the retinal nerve fiber layer thickness. The future role of this instrument and its applications for clinical diagnosis depend on the future improvement and updating of the software.

Copper intraocular foreign body: diagnosis and treatment.

Copper intraocular foreign bodies (IOFB) are relatively common after penetrating eye injuries. Ocular signs and symptoms vary greatly in relation to the copper content, ranging from chronic uveitis and severe visual loss for IOFB containing more than 85% copper, to local copper deposits with no severe ocular damage for less toxic alloys. Reported here is the case of a ten-year-old boy who suffered from recurrent chronic uveitis five months after a perforating eye injury due to copper wire. Diagnostic ultrasound and computerized tomography revealed an IOFB within the lens and X-ray spectrometry (DXS) indicated the nature of the IOFB as copper, and accurately measured the dissolution of the metal. The patient underwent cataract extraction and standard three-port pars plana vitrectomy with gas-fluid exchange. Twelve months after surgery the retina was flat and visual acuity had risen to 20/60. Undiluted vitreous samples obtained in the course of the intervention, studied by immunohistochemical techniques, showed an inflammatory reaction with a prevalence of PMN-N and CD3 T-lymphocytes. DXS thus appears to be a new and reliable diagnostic tool for the early detection and management of copper and other toxic metal IOFB.

Analgesic effect of topical diclofenac versus betamethasone after posterior segment surgery.

BACKGROUND: In clinical use, topical diclofenac, a nonsteroidal antiinflammatory, was found to be remarkably effective as an analgesic. A trial was therefore conducted to quantify and compare this effect with that of other drugs commonly used after posterior segment surgery. METHODS: A single-blind, randomized study of 37 patients undergoing posterior segment surgery was conducted. On the day of surgery and for 30 days thereafter, one group received topical diclofenac 0.1% and one group received topical betamethasone 0.1%. Pain intensity was assessed by two standard psychologic tests, the McGill Pain Questionnaire (MPQ) and Scott's Visual Analogic Scale (VAS). RESULTS: The group receiving diclofenac had significantly lower pain scores on the MPQ at days 1 and 15 (P < 0.05 and P < 0.03, respectively). The VAS scores were also statistically lower for this group on day 15 (P < 0.03). CONCLUSION: Topical diclofenac 0.1% has greater analgesic action than topical betamethasone 0.1% without the side effects of steroids, and may be useful after posterior segment surgery.