ABSTRACT
PURPOSE: To establish whether total vitrectomy with posterior hyaloid removal and choroidal hemorrhage drainage posterior sclerotomies improved the outcome of eyes with massive postoperative suprachoroidal hemorrhage (kissing choroidals). METHODS: We reviewed the medical records of five patients with massive suprachoroidal hemorrhage (MSCH) who had received the same medical and surgical management. RESULTS: Three eyes had MSCH secondary to surgery of the anterior segment and two after ocular trauma. All had hemorrhagic choroidal detachment with retinal apposition, producing vitreous changes and adherence of the "kissing" retina. Surgery was delayed one to three weeks to allow liquefaction of the blood clot. All eyes had complete ocular evaluation including ultrasound, and were treated with steroids before surgical treatment. The procedure consisted of anterior chamber fluid infusion, posterior drainage sclerotomies, and primary total pars plana vitrectomy with posterior hyaloid removal. Mean follow-up was 9.4 months. Visual acuity after surgery improved in all eyes from light perception to 20/60. One patient without light perception improved to 20/200. CONCLUSIONS: Total vitrectomy may be indicated in selected cases with MSCH. The successful outcome of these patients comes from the combination of vitrectomy and external drainage.
Subject(s)
Choroid Hemorrhage/surgery , Sclerostomy/methods , Vitrectomy/methods , Vitreous Body , Adolescent , Adult , Aged , Cataract Extraction/adverse effects , Choroid Hemorrhage/diagnosis , Choroid Hemorrhage/etiology , Eye Injuries/complications , Eye Injuries/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Visual AcuityABSTRACT
BACKGROUND: Cysticercosis is one of the parasitic diseases that most frequently affects the eye. The most common and severe manifestations of ocular infection are secondary to posterior segment involvement, which often leads to blindness and atrophy of the eye. The pathogenesis of ocular injury in this disease is poorly understood. The authors have developed an experimental animal model for intravitreous cysticercosis using New Zealand rabbits and Taenia crassiceps cysticerci. METHODS: Twelve rabbits were divided into two groups. Rabbits in group I were inoculated with one living cysticercus in the vitreous cavity. Rabbits in group II received an intramuscular dose of steroids prior to inoculation of parasites. RESULTS: An intense inflammatory reaction, which lead to a severe ocular injury, was observed in rabbits of group I, while rabbits in group II had minimal inflammatory changes. Histopathological studies showed a severe histiocytic infiltrate with generalized retinal damage in group I, and a mild inflammatory infiltrate, limited to the area of direct contact with the parasite in group II. The ocular lesions found in rabbits which did not receive steroids (group I) resembled those found in human ocular cysticercosis. CONCLUSION: These observations indicate that ocular damage in this parasitic disease might be directly related to inflammatory changes produced by the presence of cysticerci. This model appears to be useful for future investigations.
Subject(s)
Cysticercosis/etiology , Eye Infections, Parasitic/etiology , Retinal Diseases/parasitology , Taenia/physiology , Vitreous Body/parasitology , Animals , Betamethasone/pharmacology , Cysticercosis/diagnostic imaging , Cysticercosis/pathology , Disease Models, Animal , Eye Diseases/diagnostic imaging , Eye Diseases/parasitology , Eye Diseases/pathology , Eye Infections, Parasitic/diagnostic imaging , Eye Infections, Parasitic/pathology , Fundus Oculi , Glucocorticoids/pharmacology , Histiocytes/pathology , Rabbits , Retinal Diseases/diagnostic imaging , Retinal Diseases/pathology , Ultrasonography , Vitreous Body/diagnostic imaging , Vitreous Body/pathologyABSTRACT
PURPOSE: Multiple, bilateral areas of congenital hypertrophy of the retinal pigment epithelium (CHRPE) have been described in association with familial adenomatous polyposis (FAP). Histopathologic findings have suggested a generalized effect of the FAP gene on the RPE, which could impair the functional integrity of the RPE. The clinical, psychophysical, electrophysiologic, and fluorescein angiographic findings in CHRPE in subjects with FAP were assessed. METHODS: RPE function was assessed in 7 subjects with CHRPE and a family history of FAP. Four had documented FAP (mean age = 22.25 years) and the other three were siblings of affected subjects, with a 50% risk of developing FAP (mean age = 6.33 years). All subjects underwent comprehensive ophthalmologic examination. RESULTS: All subjects showed mild hyperopia (mean, +1.13 D; best corrected visual acuity, 20/20 or better). On perimetry, there were scotomas corresponding to some lesions. ERG showed normal rod, maximal, single-flash cone, and flicker responses. Light-dark ratio was within the normal range on EOG. Fluorescein angiography demonstrated normal retinal vasculature overlying the CHRPE lesions, which blocked background choroidal fluorescence. A normal choriocapillaris was observed through some hypopigmented lacuna. CONCLUSION: CHRPE has been related to generalized expression of an abnormal gene in RPE, but its functional abnormalities tend to be localized.
