ABSTRACT
OBJECTIVE: To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes. DESIGN: Nonrandomized, prospective, comparative clinical trial. PARTICIPANTS: Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol. INTERVENTION: Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months. MAIN OUTCOME MEASURES: Reattachment of the retina and visual outcome were compared to previously published studies. RESULTS: Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was -0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes. CONCLUSION: Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.
Subject(s)
Pseudophakia/complications , Retinal Detachment/surgery , Scleral Buckling , Vitrectomy , Fluorocarbons/administration & dosage , Follow-Up Studies , Humans , Lenses, Intraocular , Postoperative Complications , Prospective Studies , Retinal Detachment/etiology , Retinal Perforations/etiology , Retinal Perforations/surgery , Sulfur Hexafluoride/administration & dosage , Treatment Outcome , Visual AcuityABSTRACT
OBJECTIVE: The objective is to compare the effectiveness of retrobulbar and posterior sub-Tenon's injection of corticosteroids for treatment of post-cataract cystoid macular edema that was refractory to topical medications. DESIGN: A retrospective study was performed. PARTICIPANTS: A total of 48 patients (49 eyes) with post-cataract cystoid macular edema refractory to topical medications was studied. INTERVENTION: Patients received either a single retrobulbar injection (18 eyes) or 3 biweekly posterior sub-Tenon's injections (31 eyes) of corticosteroids. MAIN OUTCOME MEASURES: Patients were observed for clinical resolution of the cystoid macular edema, visual acuity, and intraocular pressure. RESULTS: Both treatment methods resulted in significant improvement in visual acuity. The posterior sub-Tenon's group had a visual improvement from 20/92 pretreatment to 20/50 post-treatment (P = 0.0001) with a median follow-up of 12 months. The retrobulbar group had a visual improvement from 20/97 pretreatment to 20/58 post-treatment (P = 0.035) with a median follow-up of 10 months. The visual improvement was not significantly different between the two groups. The average intraocular pressure increased from a pretreatment level of 14.1 mmHg to a high of 17.7 mmHg (P < 0.00005) in the sub-Tenon's group. The average intraocular pressure increased from 15.1 mmHg to a high of 17.6 mmHg (P = 0.04) in the retrobulbar group. CONCLUSIONS: Cystoid macular edema that persists after treatment with topical medications may improve after retrobulbar or posterior sub-Tenon's corticosteroid injections. There was no significant difference in outcome between the two treatment groups.
Subject(s)
Glucocorticoids/therapeutic use , Macular Edema/drug therapy , Triamcinolone Acetonide/therapeutic use , Administration, Topical , Aged , Connective Tissue , Female , Glucocorticoids/administration & dosage , Humans , Injections , Intraocular Pressure , Male , Orbit , Retrospective Studies , Triamcinolone Acetonide/administration & dosage , Visual AcuityABSTRACT
Retinal detachment is the primary complication of bullous retinoschisis, a benign abnormality of the peripheral retina. We examined three patients (all women, 43, 55, and 56 years old) with typical bullous retinoschisis who had vitreous hemorrhage. In each case, there were sclerotic retinal vessels over the surface of the schisis cavity along with neovascularization above the central portion of the cyst. In one case there was also neovascularization of the peripheral retina in an area distant from the schisis. These findings were confirmed by fluorescein angiography in one case; the other two cases demonstrated similar changes by fluorescein angioscopy. Fluorescein angiography, also demonstrated intraretinal dye leakage from vessels along the posterior extent of the schisis, as well as from an adjacent area of white without pressure.
