Automated lamellar keratoplasty for the correction of hyperopia.

Hyperopic automated lamellar keratoplasty (H-ALK) is a refractive procedure that corrects low to moderate hyperopia of up to +5.00 diopters (D). In this retrospective series, we examined the efficacy, predictability, and safety of H-ALK in 85 eyes in 49 patients. Follow-up was from 4 to 34 weeks (mean 18 weeks). Eyes were divided into three subsets: those in which we attempted an emmetropic result (n = 45), those in which we attempted to reduce, but not eliminate, hyperopia greater than 5.00 D (n = 23), and those in which we attempted a monovision result of -1.50 D (n = 17). In the eyes in which we attempted emmetropia, 76% achieved uncorrected visual acuity of 20/40 or better and 78.6% were within a range of -1.00 to +0.87 D. In those in which we attempted monovision, 47% achieved a spherical equivalent result between -2.50 and -1.00 D because of a tendency toward undercorrection. In those in which we attempted to reduce hyperopia, there was a mean correction of 4.33 D (standard deviation 1.36 D), with a range of 2.12 to 6.75 D. The most significant complication was a reduction in best corrected visual acuity of one to three lines in 11 of 85 eyes; this was transient in six eyes. These preliminary results compare favorably with those of other procedures to correct hyperopia.

Collagen shields and intraocular drug delivery: concentration of gentamicin in the aqueous and vitreous of a rabbit eye after lensectomy and vitrectomy.

Five albino New Zealand rabbits underwent bilateral lensectomy and vitrectomy. All left eyes were fitted with a collagen shield that had been soaked for 5 min in 2.0 mL of gentamicin solution (40 mg/mL for IV use). Right eyes were treated with fortified gentamicin drops (13.6 mg/mL) every 30 min for 12 hrs. Aqueous and vitreous specimens were obtained at the following time intervals: 1, 2, 4, 8, 12 and 24 hrs. We found the gentamicin concentrations to be higher in the aqueous of all eyes treated with fortified gentamicin drops. Only those eyes treated with fortified gentamicin drops attained a therapeutic drug level (4 micrograms-9 micrograms/mL) in the aqueous. Therapeutic drug levels were not attained in the vitreous of either treatment group.

Submacular scar excision in age-related macular degeneration.

Disciform scars secondary to age-related macular degeneration were surgically removed in three patients. Postoperative visual acuity improved minimally in one case and decreased in the other two cases. The results suggest further investigation is needed with possible modifications of our technique for future studies.

Vitreon, a new perfluorocarbon.

We evaluated a new liquid perfluorocarbon, perfluorophenanthrene (Vitreon). This material has proven to be non-toxic in vitrectomised rabbit eyes for up to six weeks. Present investigation under FDA guidelines establishes both the safety and efficacy of Vitreon in human eyes. We used Vitreon for intraoperative hydrokinetic retinal manipulation in 15 patients. In cases of proliferative vitreoretinopathy (6), rhegmatogenous retinal detachment (5), giant retinal tear (2), retinal dialysis (1), and tractional retinal detachment (1) the retina was successfully reattached. Postoperatively two patients developed proliferative vitreoretinopathy necessitating further surgery, and one patient developed hypotony. Follow-up showed 100% reattachment rate with a mean duration of 6.3 months. Postoperative visual acuity ranges from light perception to 20/30.

Intravitreal recombinant tissue plasminogen activator in the treatment of experimentally induced bacterial endophthalmitis.

Intravitreal injection of antibiotics has been shown to be effective in the treatment of bacterial endophthalmitis, but does not prevent the formation of fibrin. Recombinant tissue plasminogen activator (rTPA), a fibrinolytic agent, was evaluated in experimentally induced Staphylococcus aureus endophthalmitis in an animal model. Significant fibrinous reaction in the vitreous was present in three of six eyes treated with intravitreal injection of clindamycin and rTPA (50%) and in one of five eyes treated with clindamycin only (20%). Fibrin clot formation in the anterior chamber was present in two of six eyes treated with clindamycin and rTPA (33%) and not observed in the clindamycin treated eyes (0%). These findings suggest that rTPA does not play a beneficial role in the treatment of bacterial endophthalmitis in the presence of the vitreous.

Fluorosilicone oil in the treatment of retinal detachment.

We evaluated the use of a heavier-than-water fluorinated silicone oil in the treatment of 30 selected cases of complicated retinal detachment from January 1988 to July 1989. Proliferative vitreoretinopathy grade C-2 or greater accounted for 19 cases, proliferative diabetic retinopathy with traction detachment for two cases, giant retinal tears five, ruptured globe with retinal detachment two, massive choroidal effusion with retinal detachment one, and acute retinal necrosis with retinal detachment one. Initial retinal reattachment was achieved in all cases. Complications included redetachment seven (23%), cataract six (75% of phakic patients), raised intraocular pressure four (13%), hypotony four (13%), keratopathy three (10%), uveitis-synechia formation three (10%), phthisis two (3%), choroidal haemorrhage one (3%), and vitreous haemorrhage one (3%). Postoperative visual acuities with at least six months' follow-up range from no light perception to 20/50, with seven patients (23%) 20/400 or better.

Surgical removal of a branch retinal artery embolus: a case report.

A patient with embolic retinal artery occlusion of sixty-hour duration underwent a surgical procedure resulting in the removal of one embolus and the fragmentation with distal flow of a second. Visual acuity improved from counting fingers to 20/200 and was stable 3 months postoperatively.

Posterior relaxing retinotomy.

Three patients with retinal detachments complicated by proliferative vitreoretinopathy underwent posteriorly located relaxing retinotomy to facilitate retinal reattachment. Six months postoperatively the retina remained attached in all cases, with an improvement in visual acuity in two cases (light perception to hand motion and 20/200 to 20/60) and a drop of one line in visual acuity in the third (20/20 to 20/25).

Eye wall resection in the management of uveal neoplasms.

Management of intraocular tumors, specifically uveal melanoma, is a matter of controversy. The treatment of these ocular neoplasms varies from observation to enucleation, irradiation (cobalt plaque and proton-helium particle) and eye wall resection. Over the last 18 years, we have developed two techniques for surgical resection of intraocular tumors. An encircling laser photocoagulation and limited scatter photocoagulation with laser precede both procedures. The operation is performed under hypotensive anesthesia in both techniques. The external approach is used for anteriorly located tumors (ciliary body and anterior choroidal lesions) and makes use of an eye basket to stabilize the operation area. A partial dissection of the sclera is performed, then the tumor is removed en bloc with the sclera, choroid and retina. The remaining sclera is resutured to cover the resected area. A modification of this technique is used for a limited excision of choroidal and retinal tissue for the purpose of biopsy and tissue analysis. The internal approach (developed four years ago) has been successfully used for removal of malignant and benign lesions located posterior to the equator and around the optic nerve. This technique uses vitrectomy instrumentation in addition to endolaser. Detailed surgical technique and results achieved in both procedures are described.