Macular hole surgery without routine membrane excision or use of adjuvants.

PURPOSE: To present results of macular hole surgery without adjunctive treatment or routine membrane dissection, but with a long duration tamponade. METHODS: Fifty-one consecutive eyes underwent surgery with vitrectomy. Membrane peeling was performed only when traction was obvious. Pure perfluoropropane gas was injected as a tamponade followed by prone positioning for two weeks. All eyes were examined with scanning laser ophthalmoscopy (SLO) before and after surgery. RESULTS: The macular hole was closed successfully in 48 eyes (94%) after one procedure. Visual acuity improved to 0.50 or more in 18 eyes (35%). Improvement of two or more lines was achieved in 35 eyes (69%). Two eyes developed retinal detachments and two eyes showed post-operative visual field defects previously reported after macular hole surgery. CONCLUSION: In this series the results and complication rates compare favourably with other reports of macular hole surgery. However, in contrast to many previous studies, membrane peeling was not done. The extent and long duration of the gas tamponade was thought to be important for the surgical success.

Preoperative measurements of macular hole with scanning laser ophthalmoscopy. Correlation with functional outcome.

PURPOSE: To measure the dimensions of macular holes before surgery and compare them with the functional outcome. METHODS: A prospective study of ten consecutive patients scheduled for macular hole surgery. Macular holes were imaged with scanning laser ophthalmoscopy with different laser wavelengths. Computerized image analyses were used to measure the size of the hole and the surrounding rim. RESULTS: Eyes were referred to three different groups preoperatively according to visual function. Measurements of the longest diameter and the area of the macular hole were found to correlate well with visual function tested before and after surgery. All holes closed after one operation. Eighty per cent of eyes improved two or more lines on the distance visual chart and all patients but one could read a newspaper six months after surgery. CONCLUSION: Preoperative size of macular hole can be used as a predictor of the functional outcome of macular hole surgery.

Tackling the "dropped nucleus".

PURPOSE: To summarize and analyse the results of our experience in treating patients with a "dropped nucleus". METHODS: The case records of nineteen patients who underwent surgery for a "dropped nucleus" at the Ophthalmology Departments of Sahlgren's University Hospital, Gothenburg, and Orebro Medical Centre, Orebro, Sweden during 1994 were retrospectively reviewed to determine the mode of treatment used and the results of surgery. The frequency of this complication was also calculated for Sweden as a whole with the help of the National Cataract Register. RESULTS: The lens was successfully removed in all eyes. No retinal breaks or detachments were present at vitrectomy or follow-up. One eye was lost to panophthalmitis 11 days after the vitrectomy; the remaining 18 eyes showed a favourable outcome. CONCLUSION: The loss of a crystalline lens to the vitreous during cataract surgery is a severe complication. We recommend that an experienced vitreoretinal surgeon should be consulted at an early stage.

Perforating eye injuries in a western part of Sweden.

We performed a prospective study of all perforating eye injuries in a western part of Sweden during 1989-1991. We registered 140 cases (141 eyes) in a population of 1.4 million. Annual incidence was 3.3 per 100,000 inhabitants. Follow-up time was 6 months or more in 91 (64%) of the cases. Perforating eye injuries were 5.6 times more common in men than in women. Occupational injuries accounted for 37% of perforating eye injuries. Twenty-nine per cent of perforating eye injuries were injuries that occurred during domestic and leisure time. In addition to metal fragments, a whole nail was a common perforating object in these groups. Playing activity accounted for 11% of the perforating eye injuries, traffic accidents for 3% and assault for 9%. In a group of elderly patients (9%) perforating eye injuries were caused by falls. Visual acuity was 0.5 or better in 57 (63%) of the eyes with a follow-up period of at least 6 months. Only 2 of the 141 eyes were enucleated.