Perfluorodecalin-induced intravitreal inflammation.

OBJECTIVE: To report an unusual case of intravitreal inflammation in a human eye caused by the presence of residual perfluorodecalin in a case of giant retinal tear and retinal detachment. METHODS: The posterior capsule of the lens, which was infiltrated with deposits, was collected during surgery. The specimen was stained with hematoxylin and eosin, with periodic acid-Schiff, and for melanin. Part of it was examined with electron microscopy. Immunohistochemical staining was performed to demonstrate CD68 antigens, cytokeratin, and glial fibrillary acid protein. RESULTS: Vacuolated macrophages and retinal pigment epithelial cells infiltrated the posterior capsule. Electron microscopy showed the presence of membrane-lined vacuoles within the macrophages. A monolayer of epithelial cells covered the cellular infiltration. CONCLUSION: Residual perfluorodecalin can induce an intraocular chronic macrophage response.

Use of the anterior chamber maintainer in anterior segment surgery.

Over a 12 month period, we used the anterior chamber maintainer (ACM) in cataract surgery in 258 patients; ages ranged from 15 to 95 years (mean 73 years). Surgery was performed using general or local anesthesia. The procedures were standard extracapsular cataract extraction (ECCE), mini-nuc ECCE, vectis extraction of the endonucleus, manual phacofragmentation, phacoemulsification, phacotrabeculectomy, repositioning the IOL, and anterior segment revision. We recorded our subjective assessment of the degree of anterior chamber (AC) maintenance and control of the position of the posterior capsule during surgery. We also kept clinical notes of the practical aspects of the procedures. The AC was well maintained in all patients throughout the surgery; posterior position of the posterior capsule was maintained during irrigation/aspiration. Five patients required the use of a viscoelastic agent at some stage. Our subjective assessment is that use of the ACM increased surgical control of the anterior chamber depth and position of the posterior capsule during surgery. Provided that it is used correctly, the ACM may offer increased safety during anterior segment surgery and require less use of viscoelastic agents.

Success rate and complications of intraoperative 0.2 mg/ml mitomycin C in trabeculectomy surgery.

Adjunctive chemotherapy with Mitomycin C (MMC) has been used in an attempt to modulate the wound healing response in glaucoma filtration surgery. A consecutive series of 20 eyes from 18 patients undergoing trabeculectomy with MMC intraoperatively was studied. Sixteen cases were considered high risk regarding surgical success and 4 patients with low tension glaucoma (LTG) required lower intraocular pressure (IOP) to prevent further visual field loss. Surgical technique involved the use of a limbal-based conjunctival flap and MMC 0.2 mg/ml applied via a sponge (under the scleral flap) to both scleral and conjunctival surfaces for 5 minutes. The mean follow-up period was 12.7 months (range 3-24). There were 17 successful eyes. Of these, 14 are high pressure glaucoma eyes with a mean pre-operative IOP of 30.9 +/- 10.9 mmHg and a mean postoperative IOP of 15.3 +/- 5.2 mmHg (p = 0.001). The remainder of the successful cases include 4 patients with LTG with a mean preoperative IOP of 17.8 +/- 0.5 mmHg and a mean postoperative IOP of 6.8 +/- 0.7 mmHg (p = 0.001). Serious complications included chronic repeated bleb leaks (n = 2) and scleral necrosis (n = 2). There was one case of hypotonous maculopathy. These results are comparable with those of other studies. Despite a relatively low dose of MMC serious side-effects were encountered. Management of these complications is described, and how these effects may be prevented by altering scleral exposure to MMC. In addition a possible explanation for the serious side-effects of MMC-treated trabeculectomies is presented.

A common sense approach to the retina.

Retinal surgery can be simple if the binocular indirect ophthalmoscope is mastered and certain surgical principles followed. Mastering the binocular indirect ophthalmoscope is described in step by step detail. Thereafter which eyes develop which sort of retinal detachment are discussed with special reference to the type and position of retinal breaks. Treatment emphasises that there is no such thing as a single retinal operation but rather a series of legitimate manoeuvres which may be used alone or in combination as the eye demands. To seek the simplest intervention that seals the retinal break(s) is the aim; to do so without closing off the central retinal artery is the art.

Nd:YAG laser augmented pneumatic retinopexy.

We present the first ten consecutive cases of rhegmatogenous retinal detachment treated by one surgeon using pneumatic retinopexy with Nd:YAG laser disruption of vitreoretinal adhesions. In nine cases the retina has remained reattached, after a follow-up period of 11 to 18 months. The use of the Nd:YAG laser to disrupt vitreoretinal adhesions at the sites of retinal tears is discussed.

Pregnancy after vitrectomy for proliferative diabetic retinopathy.

A 26-year-old female with insulin-dependent diabetes of 16 years duration had a vitrectomy for a dense non-resolving vitreous haemorrhage. Two months later she became pregnant. She delivered a healthy baby and despite the known adverse effects of pregnancy on retinopathy no deterioration occurred in visual acuity or in retinal appearance.

A review of techniques employed in 1100 cases of retinal detachment.

To produce a flat retina after an operation demands an unrestricted view of the retina during the operation, and to achieve such a view most retinal surgeons would unhesitatingly recommend the binocular indirect ophthalmoscope and scleral depression. Once the retina and all its breaks are clearly in view, the keynote of the ensuing surgery should be simplicity and safety. The former requires that the intended operation should be the least complicated available, and, should the surgical intention be frustrated, that each step should blend with the next in orderly progression, the surgeon exhausting the possibility of one step before moving on to the next and being able to recognise when the possibilities are exhausted. The latter requires experience in deciding which is in fact the least complicated operation. In general the cavity of the globe should not be entered unless the eye stands to lose more than it gains by remaining inviolate. Paracentesis, fluid release, and intravitreal air all have their place, and to avoid them gains us nothing if the retina remains detached.

Aspiration from the vitreous of a non-magnetic foreign body.

A non-magnetic vitreal foreign body was aspirated from over the macula through the pars plana. The surgeon guided a blunt needle towards the foreign body while watching both with the binicular indirect ophthalmoscope. His assistant's tentative suction movements with an attached syringe drew the foreign body up into the needle without risking a retinal perforation. Visual recovery was complete. It is suggested that aspiration might be the procedure of choice for such small visible intraocular fragments.

Retinal detachment treated with intravitreal air: an evaluation of 241 cases.

241 unselected cases of retinal detachment treated since 1971 with cryopexy and intravitreal air are discussed. The series is analysed according to the position of the retinal tears(s), and we describe briefly the surgical technique and evaluate the main complications.