Clinicopathologic findings in eyes with retained perfluoro-n-octane liquid.

OBJECTIVE: To describe the clinical and histopathologic findings in five eyes with retained perfluoro-n-octane (PFO) liquid after retinal reattachment surgery. DESIGN: Retrospective, noncomparative, clinicopathologic case series. PARTICIPANTS: Surgical specimens from five eyes were studied. METHODS: Surgical specimens from eyes with prior intraoperative PFO use submitted to the W. Richard Green Eye Pathology Laboratory at the Wilmer Ophthalmological Institute were identified and reviewed. MAIN OUTCOME MEASURES: Histopathologic analysis and energy dispersive spectroscopy identified intracellular vacuoles containing PFO. RESULTS: Five cases were identified. Three specimens were obtained at the time of further surgery for recurrent retinal detachment; one at repeat penetrating keratoplasty, and one at removal of retained PFO. Each eye had macroscopic white flake-like material on intraocular structures noted before or during surgery. Histopathologic analysis disclosed an inflammatory response featuring macrophages with intracellular vacuoles containing PFO. Removal of the PFO in all five eyes combined with repeat retinal reattachment surgery in three eyes resulted in resolution of the inflammatory response. CONCLUSIONS: Retention of PFO after surgery elicits an inflammatory response. We suspect that young patients, those with considerable residual vitreous gel, and eyes with larger amounts of retained PFO may be at higher risk for this complication.

Management of eyes with both idiopathic macular hole and choroidal neovascularization.

PURPOSE: To describe the characteristics, treatment, and outcome of five eyes with both choroidal neovascularization (CNV) and macular hole. METHODS: Medical records of five patients with both macular hole and CNV were reviewed. RESULTS: All eyes had full-thickness macular holes. Most eyes had atypical-appearing macular holes (subretinal hemorrhage, prominent subretinal fluid, or discoloration at the hole margin) at presentation or subsequently when CNV developed. Fluorescein angiography (FA) confirmed the presence of CNV in each eye. Three eyes underwent combined macular hole repair and CNV removal, and sustained closure of these macular holes was achieved. A fourth eye underwent successful argon laser photocoagulation of extrafoveal CNV, and macular hole surgery was declined. The final eye underwent two macular hole repairs before sustained closure was achieved. Final visual acuity, ranging from 20/100 to hand motions, was limited by macular pathology and/or cataract. CONCLUSIONS: Choroidal neovascularization can occur in association with a macular hole. In eyes with an atypical-appearing macular hole, FA should be obtained to detect CNV. Excision of the CNV can be done safely in conjunction with macular hole surgery. Final visual acuity may be limited by cumulative retinal and retinal pigment epithelium damage, especially in eyes with underlying macular disease.

Eye pain after vitreoretinal surgery: a prospective study of 185 patients.

PURPOSE: To assess subjective levels of eye pain, nausea, and sedation following vitreoretinal surgery performed with intravenous sedation and retrobulbar anesthesia. METHODS: One hundred eighty-five consecutive patients who underwent vitreoretinal surgery and had access to a standard postoperative analgesic regimen prospectively quantified levels of eye pain, nausea, and sedation 2 hours and 5 hours after surgery by using a standard visual analog scale. Analgesic requests were recorded. Responses were statistically analyzed. RESULTS: Fifty-six percent of patients had some eye pain after vitreoretinal surgery; 48% of patients requested an analgesic within 5 hours after surgery. Twenty-seven percent of patients required narcotic analgesia. There was a significant relationship between the presence of eye pain and surgery duration of >2 hours (P < 0.02). Sixteen percent of patients had postoperative nausea, which more likely occurred in those who received a narcotic analgesic (P < 0.02). Eighty percent of patients had postoperative sedation, which more likely occurred in those who received a narcotic analgesic (P < 0.02). CONCLUSION: One half of individuals undergoing vitreoretinal surgery, especially those who have lengthy procedures (>2 hours), will request pain medication within 5 hours after surgery; one half of these patients will need narcotic analgesia for pain control. Narcotics may result in nausea and sedation.

Conjunctival vasculature in the assessment of anemia.

OBJECTIVE: To assess the correlation of the bulbar conjunctival blood column (BCBC) with anemia. DESIGN: A prospective, randomized, masked, two observer case series. PARTICIPANTS: Inpatients on hospital wards; outpatients in both the Hematology-Oncology and Ophthalmology Clinics. METHODS: Observations of the palpebral conjunctival hue (PCH) and BCBC by two observers masked to the patient's diagnosis, laboratory test results, and other's observations. The PCH and BCBC were correlated by slit-lamp examination with serum hemoglobin values. Different threshold levels for anemia were defined as hemoglobin <10, <11, and <12 mg/dl. MAIN OUTCOME MEASURES: The parameters included determination of (1) the conjunctival hue, assessed as pink or pale and (2) the bulbar conjunctival blood column, assessed as full (normal), granular, or discontinuous. These data were compared against the patient's hemoglobin level. RESULTS: Mean hemoglobin was 11.0+/-2.2 mg/dl. Sensitivity of the BCBC and PCH for anemia was 83%-94% and 38%, respectively, regardless of the definition of anemia. Specificity of BCBC improved with increasing hemoglobin threshold levels for anemia: 56% (hemoglobin <10 mg/dl) to 73% (hemoglobin <12 mg/dl); specificity for PCH ranged from 82% to 94%. The BCBC was significantly (P<0.03) associated with anemia for hemoglobin <11 mg/dl for both observers (logistic regression, Spearman correlation). There was a significant (P<0.05) association of PCH with anemia only for hemoglobin <10 mg/dl with logistic regression (one observer only) and with Spearman correlation (both observers). CONCLUSIONS: The BCBC is significantly associated with anemia, with higher sensitivity and only slightly less specificity than PCH.

A prospective, randomized comparison of thermal cautery and argon laser for permanent punctal occlusion.

Permanent punctal occlusion was performed by two techniques on 27 patients (73 puncta). Patients were randomly assigned to be treated with either thermal cautery or argon laser for keratitis sicca. Follow-up assessment disclosed that the puncta to which thermal cautery was applied remained closed significantly longer than those to which laser treatment was applied (P < .05, log-rank test). Using time to recanalization of a punctum as the end point, we found a long-term advantage of thermal cautery over argon laser treatment.

Subconjunctival fibrosis after conjunctival autograft.

While largely successful, the use of a conjunctival autograft in the exposed scleral bed following a pterygium excision can result in postoperative complications. We report two cases of a previously undescribed complication: subconjunctival fibrosis at the harvest site of the graft. In one case, the fibrosis caused an asymptomatic, purely cosmetic defect; however, in the other case, the scar tissue constricted the extraocular movement with resultant diplopia. We call attention to this complication as it can affect visual function; we discuss its management and prevention.