[Retinal detachment with retinal tears--clinical characteristics and surgical results]. / Odchlípení sítnice s orální trhlinou--klinická charakteristika a operacní výsledky.

The authors evaluate a group of 53 eyes of 52 patients operated on account of retinal detachment with an oral dialysis. The mean follow-up period was 35 months. There were 37 (70%) traumatic dialyses. They were in the temporal lower quadrant in 58%, in the nasal upper quadrant in 16%, temporal upper quadrant in 13% and in the nasal lower quadrant in 13%. There were 16 (30%) idiopathic dialyses, all with one exception in the temporal upper quadrant, they were in the lower temporal quadrant. 52 eyes were operated primarily cryosurgically, one eye by pars plana vitrectomy. After primary surgery the retina adhered completely in 94% eyes. On account of relapses of detachment 9.4% eyes were reoperated. At the end of the follow up the retina adhered completely in 94% eyes. Functional improvement or stabilization of vision was achieved in 78% eyes with traumatic tears and in 87% eyes with idiopathic tears. The authors confirmed the existence of two different clinical entities--traumatic and idiopathic oral dialysis which differ as to site and to a certain extent also the prognosis of the disease.

[Vitrectomy and autologous thrombocyte concentrate in the treatment of idiopathic macular holes]. / Vitrektomie a koncentrát autologních trombocytu v lécbe idiopatických makulárních der.

OBJECTIVE: To evaluate the results of surgery of idiopathic macular holes (IMH) using or not using autologous thrombocyte concentrates (ATC). METHOD: Fifty eyes with IMH, stage 2-4, were divided into two groups. Group 1 comprised 27 eyes with an average persistence of complaints of 12 months where pars plana vitrectomy (PPV) and tamponade with 16% C3F8 were combined with the use of ATC. Group 2 comprised 23 eyes with a mean duration of complaints of 14 months which were treated by PPV and 16% C3F8 without ATC. In all IMH stage 2 and 3 the posterior vitreous membrane was detached from the retina. The epimacular membrane was removed, if present. The mean follow-up period in group 1 was 17.2 months and in group 2 12.3 months. RESULTS: In group 1 anatomical success was achieved in 21 eyes (78%), visual acuity improved by two lines and more in 16 eyes (59%). In group 2 anatomical success was recorded in 15 eyes (69%) (p = 0.326) and visual acuity improved in 10 eyes (44%) (p = 0.265). Nine eyes were reoperated with ATC. Reoperations improved the anatomical success in the whole series to 90% and the functional success to 62%. The visual acuity improved in 70% operated eyes within 12 months from the onset of complaints and in 47% eyes with a longer case-history (p = 0.1182). Complications included retinal tears in 5 eyes (10%), detachment of the retina in one eye (2%), minor facete-like defects in the pigmented epithelium in 22 eyes (44%), disciform maculopathy in 5 eyes (10%) and atrophy of the optic disc in 3 eyes (6%). CONCLUSIONS: PPV is beneficial in IMH in the majority of patients. ATC can improve anatomical and functional results. Functional success is more likely after surgery in the early stage of the disease. The results of surgery are jeopardized by various complications. It is important to inform patients on the limitations and risk of surgery.

Poly (triethylenglycol monomethacrylate) and poly (glycerol monomethacrylate) cross-linked gel as potential viscoelastics for intraoperative use.

BACKGROUND: The highly swelling poly (glycerol monomethacrylate) gel (polyGLYMA) and hydrophilic polymer poly (triethylenglycol monomethacrylate (polyTEGMA) were tested as potential viscoelastics for intraoperative use in anterior segment surgery. METHODS: PolyGLYMA was implanted into the anterior chamber in 5 rabbits, and 40% polyTEGMA in 16 rabbits. The eyes were enucleated 1 week to 3 months after the operation. The corneal endothelium was examined with specular microscopy, and then the whole eye histopathologically. RESULTS: In all eyes of the polyGLYMA group, the clinical findings were characterized by a marked ciliary injection and severe secondary glaucoma, and the histologic ones by a marked inflammatory infiltration and thickening of Descemet's membrane in the anterior chamber angle. Specular microscopy revealed a decrease in the endothelial cell density and polymorphism of the endothelial cells. In the polyTEGMA group, the anterior segment and the fundus were physiologic all the time, and specular microscopy and histologic findings showed no degenerative and/or inflammatory changes. CONCLUSIONS: PolyGLYMA proved unsuitable for intracameral application in rabbits. The new polymer polyTEGMA is characterized by high biologic tolerance after its implantation into the anterior chamber of rabbits. PolyTEGMA 40% might be considered as a potential viscoelastic material in humans.

[Pars plana vitrectomy in retinal detachment with a macular hole]. / Pars plana vitrektomie u odchlípení sítnice s makulární dírou.

The long-term results of pars plana vitrectomy (PPV) for retinal detachment due to a macular hole were evaluated in 40 eyes of 40 patients. The patients were followed up for 6 to 72 months. In 9 eyes, subtotal PPV with expansive gases was used: in 5 of them, in addition, the macular hole was treated with laser endocoagulation. The operation was successful in 4 out of 5 eyes treated with laser barrage. In the remaining 5 eyes, the operation failed and reattachment was obtained after secondary silicone oil implantation (SOI). In 31 eyes, PPV was combined with a primary SOI. Twenty of them suffered from serious myopic degenerative changes of the posterior eye pole, and in 11 posterior stafyloma. Reattachment of the retina was achieved in 28 eyes (90.3%), visual acuity 1/24 (0.04) or better in 13 eyes (41.9%). Silicone oil was removed in 13 eyes (41.9%), in all these without complications. PPV with expansive gases and laser coagulation proved to be effective in macular holes with the well-preserved pigment epithelium. Silicone oil proved competent in macular holes associated with serious chorioretinal degeneration and posterior stafyloma.

[Relaxing retinectomy: anatomic and functional results]. / Relaxacní retinektomie: anatomické a funkcní výsledky.

The author analyzed the results of relaxing retinectomy (RR) combined with internal tamponade of the retina by silicone oil in 50 patients. The causes of tractional detachment and shortening of the retina were: proliferative vitretinopathy complicating idiopathic rhegmatogenic detachment of the retina in 25 eyes, proliferative diabetic retinopathy in 12 eyes, post-traumatic proliferation in seven eyes, intraocular inflammation in four eyes and the cicatricial stage of retinopathy of the premature in two eyes. During an observation period of 6-75 months, mean 17 months, the authors recorded complete adherence of the retina in 60%, partial anatomical success with defined retinal detachment and adherent macula in 24% and functional success with visual acuity of 0.02 or better in 66%. The poorest functional results were obtained in proliferative diabetic retinopathy (success in 30%). Functional success declined with the observation period from 66% 6 months after RR to 38% after 36 months following RR. The extent of RR did not have a substantial effect on the anatomical and functional results. Sufficiently extensive RR with internal tamponade of the retina with silicone oil is the operation of choice in complicated retinal detachment where radical membranectomy does not release the retinal traction. Reproliferation after RR were the frequent causes of relapses of retinal detachment and an impediment for removal of silicone oil from the eye.