ABSTRACT
PURPOSE: To evaluate the advantages and disadvantages of the retention and removal of silicone oil in the treatment of complicated retinal detachments. METHODS: The records of 344 patients (348 eyes) that underwent vitrectomy and silicone oil injection for complicated retinal detachments were abstracted and analysed. The anatomical and functional results, complications and influencing factors are discussed. The outcome in eyes after removal of the silicone oil was compared with the outcome in a comparable group of eyes in which the silicone oil was retained. RESULTS: The overall retinal reattachment rate was 63% (220/348). The final vision of 5/300 or better was 52% (115/220) in those eyes with totally attached retinas. The silicone oil-related complications included keratopathy (23%) and secondary glaucoma (11%). Comparing removal of silicone oil with retention of silicone oil, we found: (i) there was no statistical difference in the redetachment rate (19 vs 17%); (ii) oil-removed eyes had a better final vision (P < 0.05); and (ii) keratopathy (13 vs 23%), secondary glaucoma (11 vs 25%) and optic nerve atrophy (4 vs 18%) were significantly lower in oil-removed eyes. CONCLUSION: Silicone oil injection is useful in the treatment of complicated retinal detachments. For reducing the incidence of complications, early removal of silicone oil is recommended in those cases in which the retina is attached, all breaks adequately closed and traction relieved.
Subject(s)
Retinal Detachment/surgery , Silicone Oils/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Drainage , Female , Follow-Up Studies , Humans , Injections , Male , Middle Aged , Postoperative Complications , Recurrence , Retinal Detachment/complications , Retrospective Studies , Treatment Outcome , Visual Acuity , VitrectomyABSTRACT
Needle drainage of subretinal fluid with simultaneous observation using the indirect ophthalmoscope has been reported to have a very low complication rate. The technique was evaluated by a prospective clinical trial. The study group consisted of 100 patients undergoing scleral buckling for rhegmatogenous retinal detachment who were randomly assigned to groups treated with needle drainage or conventional two-stage drainage. At 1 month, the retina was anatomically flat in 88% of all cases. Subretinal hemorrhage occurred in 10 of 45 patients (22.2%) after needle drainage and in 7 of 55 patients (12.7%) after conventional drainage. The difference was not statistically significant. Retinal puncture occurred during conventional drainage in one case and in no cases during needle drainage. There were no cases of retinal incarceration. The results showed that subretinal hemorrhage was more common after needle drainage, but a larger study would be required to show whether this difference was statistically significant. The fear that the retina would be damaged by placement of a needle in the subretinal space throughout the drainage procedure was unfounded.
Subject(s)
Drainage/methods , Exudates and Transudates , Retinal Detachment/surgery , Aged , Aged, 80 and over , Humans , Middle Aged , Needles , Postoperative Complications , Prospective Studies , Scleral BucklingABSTRACT
A 19-year-old man, who was a soft contact lens wearer for correction of myopia, presented with right corneal ulceration. The diagnosis of Acanthamoeba polyphaga infection was made by culture and serology. In-vitro sensitivity tests suggested that the organism was sensitive to Neosporin (polymyxin, neomycin and gramicidin) and natamycin. Topical therapy with these agents resulted in complete healing of the corneal ulcer in two months. To our knowledge, our patient is the only case of successful medical treatment of this condition that has achieved a good visual result.
Subject(s)
Amebiasis/complications , Corneal Ulcer/etiology , Adult , Amebiasis/diagnosis , Amebiasis/parasitology , Bacitracin/therapeutic use , Corneal Ulcer/drug therapy , Corneal Ulcer/pathology , Drug Combinations/therapeutic use , Humans , Keratitis/drug therapy , Keratitis/etiology , Male , Natamycin/therapeutic use , Neomycin/therapeutic use , Polymyxin B/therapeutic use , Recurrence , Serologic TestsABSTRACT
Based on our close personal observation of several patients after blepharoplasty who developed retrobulbar hemorrhage progressing to blindness, the mechanism appears to operate through ischemia of the anterior optic nerve head. Relief of this blindness has followed prompt surgical intervention, with supportive medical therapy. The importance of close nursing observation for some hours after the operation is stressed, as it may be the only means of detecting this complication while the sight can still be saved.
Subject(s)
Blindness/etiology , Eyelids/surgery , Optic Nerve/blood supply , Surgery, Plastic/adverse effects , Acetazolamide/therapeutic use , Adult , Exophthalmos/etiology , Female , Hemorrhage/complications , Hemorrhage/surgery , Humans , Intraocular Pressure , Ischemia/etiology , Ischemia/therapy , Middle Aged , Postoperative Care/methodsABSTRACT
A second case of blindness following blepharoplasty is reported. The symptoms became relieved and the vision became restored after prompt decompression of the orbit by opening the wound and evacuating clots. The importance of vigilant nursing care and observation after these operations is emphasized.
