Intravitreal gas injection for hypotony after cataract surgery.

PURPOSE: To evaluate the efficacy and safety of intravitreal perfluoropropane gas injection to treat hypotony after cataract surgery. SETTING: The ophthalmology department of a major tertiary medical center. METHODS: After uneventful cataract extraction, 5 patients with hypotony due to iridocyclitis, choroidal detachment, and serous retinal detachment were treated with an intravitreal injection of 1.0 cc of perfluoropropane gas. RESULTS: The hypotony, choroidal detachment, and exudative retinal detachment resolved in all 5 patients, and visual acuity improved. No complications were observed. CONCLUSION: Intravitreal gas injection can be used to treat hypotony after cataract surgery in selected patients.

Sulfur hexafluoride injection for Descemet's membrane detachment in cataract surgery.

Extensive Descemet's membrane detachment persisted after small incision cataract surgery in three patients. Unfolding and repositioning of Descemet's membrane by sodium hyaluronate (Healon) were followed by injection of sulfur hexafluoride 20% gas mixed with air to fill the anterior chamber. Initially, the gas bubble filled most of the anterior chamber; it disappeared over 7 to 9 days. Descemet's membrane remained attached, and the corneal edema cleared.

Three-dimensional measurements of central serous chorioretinopathy using a scanning laser tomograph.

PURPOSE: To evaluate the topographic three-dimensional mapping of retinal elevation in central serous chorioretinopathy using the Heidelberg Retina Tomograph and to correlate the measured parameters with the fluorescein angiographic findings. METHODS: Seventy-six consecutive patients with central serous chorioretinopathy (63 men, 13 women), between 26 and 54 years of age, were examined to identify areas of neurosensory retinal detachment and fluorescein leakage. In areas of retinal detachment, the parameters measured were the area, volume, maximal height, and diameters of the retinal elevation, which were statistically analyzed, and the correlations between these parameters were evaluated. RESULTS: Mean +/- SD area of elevation was 9.6 +/- 5.22 mm2 (range, 2.7 to 21.5 mm2); mean volume was 1.16 +/- 1.3 mm3 (range, 0.11 to 4.73 mm3); mean maximal height was 238 +/- 108 microns (range, 97 to 450 microns); mean x-axis was 3.4 +/- 1.1 mm (range, 1.6 to 5.6 mm); and mean y-axis was 3.03 +/- 0.98 mm (range, 1.6 to 4.7 mm). Most of the retinal elevations were oval (the x-axis longer than the y-axis); the maximal height was in the geometric center in the smaller blebs and below the geometric center in the larger blebs. There were statistically significant correlations between area, volume, and height of the sensory elevation. No correlation was found between the location and the shape of leakage on fluorescein angiography and the Heidelberg Retina Tomograph measurements. CONCLUSIONS: Confocal laser tomography is potentially useful as a noninvasive diagnostic technique for quantitative measurements of the neurosensory retinal detachment in central serous chorioretinopathy.

Changing indications for enucleations in Hadassah University Hospital, 1960-1989.

The frequencies of various indications for enucleations have changed during the past decades. Knowledge of these trends may aid us in assessing the efficacy of early diagnostic techniques and improved modes of treatment. This study was designed to evaluate the indications for enucleations and their changes during a period of thirty years in a major Israeli medical center. We present a retrospective review of 463 enucleations performed between 1960 and 1989 at the Hadassah University Hospital, Jerusalem, Israel, and analyze the changes in the indications for enucleations. In our study, fewer enucleations were performed in the last two decades: 105 in the 1970's and 111 in the 1980's, as opposed to 247 in the 1960's. The incidence of enucleations due to glaucoma and to traumatic complications decreased significantly, from 22.3% in the 1960's to 7.7% glaucoma-related enucleations in the 1970's and 1980's, and 7.2% trauma-associated enucleations in the 1980's as opposed to 11.3% in the 1960's, reflecting improved medical management of these conditions. No significant change was noted in the frequency of enucleations due to inflammation, congenital disease or retinal detachment, nor in the number of malignant melanoma-related enucleations. The number of enucleations due to retinoblastoma rose in our study between 1960 and 1989.

Analysis of microsatellite repeats in pediatric brain tumors.

Tumorigenesis has been shown to proceed through a series of genetic alterations involving protooncogenes and tumor suppressor genes. However, investigation of genomic instability of microsatellites has disclosed a new mechanism for human carcinogenesis, which is involved not only in hereditary nonpolyposis colon cancer (HNPCC) but also in a number of other malignancies. To determine whether microsatellite instability is involved in pediatric brain tumors, we screened 15 such tumors using seven microsatellite marker loci on six chromosomes 4, 5, 9p, 9q, 11, 14, and 17. Using the polymerase chain reaction method, DNA samples from the tumors and from normal peripheral blood leukocytes from each patient were compared for the allelic pattern produced at each locus. Our preliminary results indicate loss of heterozygosity at the fatty acid binding protein (FABP) locus, located on chromosomal arm 4q28-q31, the only trinucleotide repeat in the panel of markers used, for 3 of 15 cases, suggesting the presence of previously unidentified sequences relevant to brain tumorigenesis at or in the vicinity of this locus. We did not observe any microsatellite instability in these samples, indicating that the mechanisms operating in HNPCC are not active in this subset of pediatric brain tumors.

Three-dimensional measurements of idiopathic macular holes using a scanning laser tomograph.

PURPOSE: The diagnosis of macular holes is difficult. Confocal laser tomographic analysis of the retina permits the precise measurements of the macular surface. The authors used this technique to study the macular area of patients with full-thickness macular holes. The purposes of these studies is to perform three-dimensional measurements of the macular holes and their rims and to search for a correlation between these parameters. METHODS: Thirty-one eyes with idiopathic full-thickness macular holes underwent scanning of their affected macular area using the Heidelberg retinal tomograph (HRT). The authors evaluated the following parameters: area of the hole and its elevated rim, the maximal depth of the hole, and the maximal elevation of the rim at 12, 3, 6, and 9 o'clock. RESULTS: The average hole area was 0.33 mm2, and the rim area average was 2.99 mm2. The average area of the rim was found to be 9.06 times larger than that of the hole (P < 0.001). The depth of the hole averaged 144 microns. CONCLUSIONS: The area of the rim is usually bigger than that of the hole and in direct correlation to it. Also, the bigger the hole area, the greater its depth. The average height in each of the four quadrants (12, 3, 6, and 9 o'clock) correlates to the other quadrant heights (P < 0.001).

Effect of eye patching on ocular surface.

We studied the effect of pressure patching in 27 medical students. Fourteen students had pressure patching in one eye (group 1) and 13 (group 2) had light patching. The fellow eye of each volunteer remained unpatched (group 3). Clinical signs and symptoms were scored and evaluated at the first and the following (after overnight) examinations. Before patching no subject had any of the clinical signs or symptoms. After the patch was removed in groups 1 and 2, all except one volunteer in each group had clinical signs or symptoms, or both, whereas in group 3, none had clinical signs or symptoms. Group 1 had greater scores for clinical signs (P = .019) and for symptoms (P = .038) as compared to group 2. In group 1, two participants did not complete the study period (by removal of the patch) because of severe discomfort and three had temporary irregularities in corneal surface with temporary decrease of vision. We suggest that pressure patching may cause discomfort and changes in visual acuity that are usually attributed to other reasons.