Long-term results of laser treatment in the ocular histoplasmosis syndrome.

OBJECTIVE: To determine the long-term visual outcome, rate of persistent choroidal neovascularization, and rate of recurrent choroidal neovascularization in eyes undergoing laser photocoagulation for choroidal neovascularization secondary to ocular histoplasmosis syndrome. DESIGN AND PATIENTS: One hundred one eyes with 5 to 16 years of follow-up that presented with choroidal neovascularization secondary to ocular histoplasmosis were retrospectively evaluated. Patients were grouped according to location of choroidal neovascularization and assignment to observation or laser photocoagulation. MAIN OUTCOME MEASURES: Visual acuity outcome and loss for all groups were compared. The rates of persistent and recurrent choroidal neovascularization for the treated eyes were also evaluated. RESULTS: Visual acuity of 20/40 or better was obtained in 71% of eyes with treated extrafoveal choroidal neovascularization and 68% with treated juxtafoveal choroidal neovascularization. Recurrent choroidal neovascularization was observed in 23% of treated eyes during a mean follow-up of 9.6 years. CONCLUSION: Results support the long-term benefit of photocoagulation and need for careful follow-up.

Visual acuity after the repair of pseudophakic retinal detachments involving the macula.

Postoperative visual acuities were retrospectively evaluated in a series of 100 pseudophakic eyes in which rhegmatogenous retinal detachments involved the macula and in which reattachment surgery was anatomically successful. Preoperative visual acuity and duration of macular detachment were related to visual outcome. Eyes in which extracapsular surgery had been followed by posterior chamber lens implantation had significantly better postoperative visual acuities than cases in which older iris-fixation intraocular lenses (IOLS) were placed after intracapsular procedures. Retinal detachments associated with posterior chamber IOLs have a relatively favorable anatomical and visual prognosis.

Hospitalization requirements after vitreoretinal surgery.

Two hundred patients undergoing vitreoretinal surgery were prospectively studied to determine the postoperative hospitalization requirements and to analyze preoperative and intraoperative factors that influence the need for inpatient care. Fifty-two percent of the patients had postoperative events that were best treated in an inpatient setting. Forty-four patients (22%) had pain requiring intramuscular injections five or more hours following surgery, 35 patients (18%) had nausea requiring intramuscular medications five or more hours following surgery, 30 patients (15%) required physician consultation for medical illness five hours or more following surgery, and 41 patients (20%) required more than one postoperative day of hospitalization because of ocular abnormalities. We concluded that although vitreoretinal surgery can sometimes be performed on an ambulatory basis, most cases require hospitalization for optimum care.

Vitrectomy for nondiabetic vitreous hemorrhage. Not associated with vascular disease.

Forty-nine consecutive eyes with nonclearing vitreous hemorrhage not associated with retinal or choroidal vascular disease underwent vitrectomy. Etiologies included vitreous hemorrhage during anterior segment surgery (22 eyes), blunt trauma (8 eyes), retinal tears with and without retinal detachment (8 eyes), Terson's syndrome (2 eyes), avulsed retinal vessel (1 eye), and idiopathic cases (8 eyes). The final visual acuity improved in 48 eyes (98%). Follow-up was 6-91 months (mean, 20 months). Of the 49 eyes, 40 eyes (82%) had a best postoperative visual acuity of 20/100 or better, 31 eyes (63%) had visual acuity of 20/40 or better, and 12 eyes (24%) had visual acuity of 20/20. The major complications included intraoperative iatrogenic retinal breaks (5 eyes), postoperative progressive cataract (7 eyes), late retinal detachment (4 eyes) and recurrent vitreous hemorrhage (2 eyes). The major complication associated with later visual loss was progressive cataract.

Recovery of visual acuity following the repair of pseudophakic retinal detachment.

Postoperative visual acuities were evaluated in a series of 100 pseudophakic eyes in which rhegmatogenous retinal detachments involved the macula and in which reattachment surgery was successful. Preoperative visual acuity and duration of macular detachment were directly and indirectly related to visual outcome, respectively. Eyes in which extracapsular surgery had been followed by posterior chamber lens implantation had significantly better postoperative visual acuities than cases in which older iris-fixation IOLs were placed following intracapsular procedures.

Vitrectomy for nondiabetic vitreous hemorrhage. Retinal and choroidal vascular disorders.

The results and complications of pars plana vitrectomy for nondiabetic vitreous hemorrhage due to retinal and choroidal vascular disorders were studied in 68 eyes of 66 patients. Diagnoses included: retinal branch vein obstruction (34 eyes), choroidal neovascularization (15 eyes), central retinal vein occlusion (5 eyes), Eales' disease (10 eyes), pars planitis (3 eyes), and hemoglobin S-C retinopathy (1 eye). The duration of the vitreous hemorrhage was 6 months or more in 48 eyes (71%), and averaged 17.8 months. Preoperative visual acuity was less than 5/200 in 57 eyes (84%). Best postoperative visual acuity was 5/200 or better in 55 patients (81%), and vision improved two or more lines after vitrectomy in 54 eyes (80%). Patients with retinal branch vein obstruction, Eales' disease, or pars planitis had the best prognosis. Those with central retinal vein obstruction or choroidal neovascularization had the worst prognosis.