Office repair of retinal detachment using a Lincoff Temporary balloon buckle.

PURPOSE: The purpose of the study is to report on a series of patients with retinal detachments that were repaired in an office setting using a temporary Lincoff balloon scleral buckle. METHODS: A retrospective review was performed on 162 consecutive casepatients with retinal detachment repaired in the authors' office between January 1989 and June 1995 using a temporary Lincoff balloon scleral buckle. All procedures were performed using local anesthesia and minimal equipment. RESULTS: The retina was attached completely with a single procedure in 88% of patients. Of the 19 retinas (12%) that failed primary surgery, all except 1 ultimately were reattached using traditional scleral buckling in 14, combined scleral buckling and vitrectomy in 3, and pneumatic retinopexy in 1, for a total success rate of 99.4%. Complications were minimal. CONCLUSION: A temporary Lincoff balloon scleral buckle can be used safely and effectively in an office setting for retinal detachment repair. The results are comparable to other available methods that take more time, involve greater risk, have higher complication rates, and are more costly. This technique represents a viable alternative, particularly in a managed care environment.

Eye care: diabetic retinopathy.

Diabetic retinopathy is the leading cause of blindness in the United States for adults, ages 20 to 74 years. Yet, the strict control of blood glucose may help ameliorate the potentially catastrophic effects of diabetes on vision. Physicians need a working knowledge of diabetic retinopathy.

Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling.

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.

Vitreous haemorrhage as a complication of HELLP syndrome.

In the last trimester of an uncomplicated pregnancy a woman developed a spontaneous vitreous haemorrhage. She was later diagnosed as having HELLP syndrome, a recently described disorder comprising haemolytic anaemia, elevated liver enzymes, and a low platelet count in women with severe pre-eclampsia or eclampsia. We believe this rare complication of pregnancy to be the cause of the intraocular bleeding.

The complication of pneumatic retinopexy.

There have been 26 published series with a total of 1274 detachments operated with pneumatic retinopexy. Eighty percent were reattached with a single procedure and 98% with reoperations. New breaks occurred in 13% and PVR in 4%. The complications published in 101 papers on pneumatic retinopexy in the last 5 years are analyzed as to frequency, prevention, management, and results.

Tumor-associated retinal pigment epithelial proliferation simulating retinal pigment epithelial tear.

A lesion with both the clinical and fluorescein angiographic appearance of the classical retinal pigment epithelial (RPE) tear was discovered over the dome of an actively growing metastatic choroidal tumor in a patient with a previous history of breast carcinoma. However, our patient exhibited no evidence of pigment epithelial detachment or age-related macular degeneration, the underlying cause of the RPE tear. Although we cannot be sure that a true RPE tear did not exist over our patient's tumor, more likely, we are observing a tumor induced zone of RPE dehiscence accompanied by RPE proliferation at its border, giving a very similar fundus appearance. Possible pathogenic mechanisms for the finding in our patient, and a comparison to those mechanisms responsible for the classical RPE tear, are discussed.

Rhegmatogenous retinal detachment after YAG laser posterior capsulotomy.

Twenty-five eyes in 24 patients with rhegmatogenous retinal detachment (RD) after YAG laser posterior capsulotomy were treated during 1984 and 1985. The average time from extracapsular cataract surgery to YAG capsulotomy was 15 months. The average interval from capsulotomy to RD was 6 months (median time, 3 1/2 months). In 8 of the 25 eyes, a risk factor for RD (i.e., high myopia, lattice degeneration, or a history of RD in the fellow eye) was present. All but one of the detachments was successfully repaired.

Congenital corneal staphyloma: clinical, radiological, and pathological correlation.

A 2-year-old child was referred because of a prominent blind left eye with an opaque cornea. Although extraocular extension of a retinoblastoma was an initial diagnostic possibility, computed tomography (CT) showed only a large globe with a corneal staphyloma. Because of the cosmetically unacceptable appearance the involved eye was enucleated. The clinical, CT, and histopathological features of congenital corneal staphyloma are discussed, as well as the possible pathogenic mechanisms.

Focal fluorescence of choroidal melanoma.

The surface of the tumours of four patients with apparently dormant small choroidal melanomas showed a distinct, localised, hyperfluorescent zone by fluorescein angiography. It was interpreted as being secondary to atrophy of the retinal pigment epithelium. In each patient later growth of the tumour was evidenced by its eruption through Bruch's membrane at this same site. This angiographic finding may predict a tumour that is prone to grow and break through Bruch's membrane at that location.

Unilateral eyelid, conjunctival, and choroidal tumours as initial presentation of diffuse large-cell lymphoma.

Simultaneous ipsilateral eyelid, conjunctival, and choroidal tumours developed in an otherwise healthy man. Biopsy of the eyelid mass led to the diagnosis of large-cell lymphoma. Further examination revealed systemic lymphoma. Although the ocular and adnexal lesions responded to systemic chemotherapy, additional skin tumours later developed. Large-cell lymphoma (also called reticulum cell sarcoma and histiocytic lymphoma) is becoming increasingly recognised for its ophthalmic manifestations. The clinical signs, diagnostic investigations, and treatment of this disease are discussed.

Retinochoroidal coloboma associated with subretinal neovascularization.

Reported herein are the cases of two patients who developed subretinal neovascularization at the margin of a retinochoroidal coloboma. Possible explanations for the occurrence of this previously unemphasized association are addressed.

Rhabdomyosarcoma and late malignant melanoma of the orbit.

Forty-five years following surgical excision and radiation for a childhood rhabdomyosarcoma of the left orbit, a patient with primary lymphedema developed an ipsilateral malignant melanoma of the anterior orbital tissue. This was excised, but a metastasis of the melanoma occurred in the contralateral upper lid. This is the first case report of treated rhabdomyosarcoma of the orbit followed by a second primary tumor occurring in the field of radiation.