Dislocated intraocular lens fixation using intraocular cowhitch knot.

PURPOSE: To describe a technique for suturing a dislocated intraocular lens (IOL) using an intraocular cowhitch knot without IOL extraction. METHODS: Through the sideports of paracentesis, a cowhitch knot is made outside of the anterior chamber by looping 10-0 Prolene around the haptics of the IOL. The knot is then tied in the anterior chamber by pulling up the suture. After repeating this for the opposite side, the cowhitch knots are fixated to the ciliary sulcus. RESULTS: In 4 cases treated this way, the IOL remained well positioned. CONCLUSION: This technique enables secure fixation of the IOL haptics.

Factors related to subretinal proliferation in patients with primary rhegmatogenous retinal detachment.

PURPOSE: To evaluate factors related to subretinal proliferation in patients with primary rhegmatogenous retinal detachment (RD). METHODS: A total of 262 consecutive patients (267 eyes) with rhegmatogenous RD were evaluated retrospectively to determine factors associated with subretinal proliferation. RESULTS: Logistic regression analysis was used to identify the following factors associated with subretinal proliferation that caused retinal traction: number of quadrants detached (adjusted odds ratio [AOR] = 2.21), longer duration of RD (AOR = 1.52), younger patient age (AOR = 0.51), and presence of atrophic retinal breaks (AOR = 0.41). CONCLUSION: Atrophic retinal breaks, younger patient age, and RD of long duration and greater extent were associated with the presence of subretinal proliferation.

Ultrasound biomicroscopy for detection of breaks and detachment of the ciliary epithelium.

PURPOSE: To elucidate details of the pathologic changes in the ciliary epithelium associated with atopic dermatitis and blunt ocular trauma. METHODS: We examined prospectively 52 eyes of 42 patients with detachment of the nonpigmented epithelium of the ciliary body associated with atopic dermatitis and blunt ocular trauma. All the eyes underwent ultrasound biomicroscopic examination as an adjunct to binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy. RESULTS: Of the 52 eyes examined, high-resolution ultrasound biomicroscopy and conventional diagnostic methods (that is, binocular indirect ophthalmoscopy with scleral depression and slit-lamp biomicroscopy) disclosed breaks at the anterior vitreous base border in 40 eyes, at the pars plicata of the ciliary body in 27 eyes, and at the white midline (that is, the line located in the mid pars plana anterior to the anterior vitreous base border) in four eyes. In 40 eyes the breaks at the anterior vitreous base border could be detected with conventional methods but in only 28 eyes could they be diagnosed with ultrasound biomicroscopy. Conversely, in 27 eyes the breaks of the pars plicata could be observed with ultrasound biomicroscopy but in 25 eyes they were detected with conventional methods. In 21 eyes with breaks only at the anterior vitreous base border, the detachment of the nonpigmented ciliary epithelium was limited posterior to the white midline. In all 27 eyes with the nonpigmented ciliary epithelial detachment anterior to the white midline, the breaks of the pars plicata were identified by ultrasound biomicroscopy. CONCLUSION: Because of the minimum deformation of the globe during examination, ultrasound biomicroscopy contributed to the diagnosis of detailed structural change in the ciliary body associated with atopic dermatitis and blunt ocular trauma in relation to the white midline. In our sample of patients, the white midline may act as a barrier against ciliary nonpigmented epithelial detachment, and detachment of the nonpigmented epithelium anterior to the white midline indicated the presence of the pars plicata break in most cases.

A novel compound heterozygote (FAP ATTR Arg104His/ATTR Val30Met) with high serum transthyretin (TTR) and retinol binding protein (RBP) levels.

A 64-year-old Japanese male suffering from very slowly progressive amyloidosis was studied by immunohistopathologic, mass spectrometric, and molecular genetic methods. After confirming the immunoreactivity of transthyretin (TTR) in the amyloid deposits using an anti-TTR polyclonal antibody, matrix-assisted laser desorption ionization/time-of-flight-mass spectrometry (MALDI/TOF-MS) was employed to look for the presence of variant TTR(s) in the serum. Two variant forms of TTR, one with a molecular weight 32 Da greater and another with a molecular weight 19 Da less than that of normal TTR encoded by the two respective alleles, were detected in this patient. Direct sequence analysis confirmed the presence of a double substitution: one at codon 30 from GTG (Val) to ATG (Met) and the other at codon 104 from CGC (Arg) to CAC (His) in the two alleles. MALDI/TOF-MS of the parents of the proband revealed that his father was a heterozygote of ATTR Arg104His and his mother was a heterozygote of ATTR Val30Met. The total TTR and retinol binding protein (RBP) concentrations in the serum samples of the proband were very high compared with those of FAP ATTR Val30Met patients and control subjects. We report here a new compound heterozygote in the TTR gene with familial amyloidotic polyneuropathy (FAP).

Risk of retinal detachment in patients with lattice degeneration.

To determine the risk of retinal detachment in patients with lattice degeneration of the retina, we statistically analyzed the incidence of retinal detachment in these patients. The data of hospital patients with retinal detachment associated with lattice degeneration in Kumamoto Prefecture, Japan, in 1990 were collected. The prevalence of lattice degeneration in Kumamoto was reported to be 9.5% in 1980. Based on population data from the 1990 census, the cumulative incidence of retinal detachment associated with lattice degeneration was calculated in this study. Among 1,840,000 residents in Kumamoto, there were 110 patients with retinal detachment associated with lattice degeneration; 72 with detachment resulting from tractional tears (tears), and 38 with detachment from atrophic holes. The cumulative incidence of retinal detachment from atrophic holes was 1.5% at the age of 40 years; from tears it was 3.6% at the age of 80 years. The cumulative incidence of detachment from both atrophic holes and tears was 5.3% at the age of 80 years. The results of this study are useful for clarifying the natural course of lattice degeneration.

Immunogenetic study of sympathetic ophthalmia.

Sympathetic ophthalmia (SO) is very rare but it remains one of the most intractable eye diseases. In clinical manifestations and histopathologic features SO is known to resemble closely Vogt-Koyanagi-Harada's disease (VKH disease). We had reported that VKH disease was significantly associated with HLA-DRB1*04 and -DQB1*04 in Japanese patients. In this study, to investigate an HLA association with SO we performed HLA serological and PCR-based DNA typing in 16 patients and 50 healthy controls. Our study revealed that HLA-DRB1*04 (0405; Pc < 5 x 10(-4)), DQA1*03 (Pc < 5 x 10(-3)), and DQB1*04 (0401; Pc < 5 x 10(-4)) were significantly associated with SO as compared to the healthy controls but there was no significant difference in the frequencies of any DPB1 alleles between the patients and healthy controls. It can be postulated that not only the clinical manifestations but also the genetic predisposition of SO are very similar to those of VKH disease.

Epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan.

BACKGROUND: The epidemiology of rhegmatogenous retinal detachment in Asians is not well known. We studied the epidemiologic characteristics of rhegmatogenous retinal detachment in Kumamoto, Japan. METHODS: The study was based on a retrospective chart review of hospital patients who were treated for primary rhegmatogenous retinal detachment in 1990. The data were collected from seven hospitals in the Kumamoto area. RESULTS: From a population of 1 840 000, 192 residents developed retinal detachment. The annual incidence was therefore 10.4 per 100 000 population (9.6 for males, 11.2 for females). The incidences of three types of detachment-nontraumatic phakic, aphakic, and blunt trauma--were 9.8, 0.5 and 0.2 per 100 000 population, respectively. In 109 of 180 patients (60.6%) with nontraumatic phakic detachment, retinal breaks were associated with lattice degeneration. In females, 14 of 106 nontraumatic phakic cases (13.2%) were secondary to macular holes. CONCLUSION: Compared with previously published studies from other countries, the incidence of detachments associated with lattice degeneration and macular hole was higher, while the incidences of aphakic detachment and detachment due to blunt trauma were lower in Japan. Racial factors and living habits may affect the development of retinal detachment.

Anterior chamber inflammation after transconjunctival cryosurgery.

BACKGROUND: Inflammation caused by transconjunctival cryotherapy for prophylactic retinal detachment surgery was measured in various conditions. METHODS: Thirty-four eyes of 28 patients with peripheral retinal lesions predisposing to retinal detachment were studied by laser flare cell meter before and after treatment. RESULTS: The mean flare value for 34 eyes was 4.06 +/- 1.45 photon counts/ms before surgery and 5.72 +/- 2.52 pc/ms after surgery (p < 0.05). Flare value was elevated at 1, 2, and 3 weeks after treatment, peaking at 2 weeks (p < 0.05), and normal again at 4 weeks. There were no significant differences in flare increase between eyes with and without retinal breaks, eyes with and without limited retinal detachment, eyes with myopia more and less than -8.0 D, and eyes with a treatment area limited to one quadrant and extending over more than one quadrant. CONCLUSION: Transconjunctival cryosurgery caused mild inflammation in the anterior chamber of the eye for 3 weeks. The inflammation was not affected by the presence of retinal break or limited retinal detachment, the degree of myopia, or the extent of the treatment area.

Air pump for retinal detachment with macular hole.

From 1984 to 1992, 128 eyes with substantial retinal detachment due to macular hole underwent vitrectomy at the Ideta Eye Hospital. In the first 76 eyes treated, air was injected by syringe after removal of the vitreous (group A); in the subsequent 52 eyes, air was injected by a pump while subretinal fluid was aspirated through the macular hole (group B). The rates of retinal reattachment after the first surgery were 63.2% in group A and 82.7% in group B (P < .05). Thus, using the air pump was more effective than air injection.

[Statistical study of aqueous flare in rhegmatogenous retinal detachment].

Inflammation of the anterior chamber in rhegmatogenous retinal detachment was studied in 338 eyes with a laser flare cell meter. The mean flare value, 32.84 +/- 81.39 pc/msec, was significantly higher (p < 0.0001) than the 5.01 +/- 2.05 pc/msec of the control group of 133 normal eyes. Clinical findings of retinal detachment were grouped into 11 factors and each factor was divided into 34 details. The following details were proven by t-test to cause significant elevation of the flare value: (1) duration of more than 3 months, (2) hypotony of less than 9 mmHg, (3) aphakia, (4) retinal breaks in the ora area or the posterior area, (5) extension of retinal detachment with more than 2 quadrants, and (6) choroidal detachment. The correlation coefficients of the 6 clinical factors showed significant elevation of flare value in the following order: (1) presence or absence of choroidal detachment (0.396), (2) extension of retinal detachment (0.375), (3) intraocular pressure (-0.28), (4) duration of retinal detachment (0.18), (5) location of the break (0.15), and (6) presence or absence of the lens (0.134).

Retinal detachment with atopic dermatitis similar to traumatic retinal detachment.

PURPOSE: The cause of retinal detachment (RD) with atopic dermatitis remains uncertain. The purpose of this study is to show that the probable cause of RD with atopic dermatitis is ocular contusion. METHODS: The authors retrospectively compared the fundus findings of 24 eyes (16 patients) that had RD and atopic dermatitis with 36 eyes (36 patients) that had traumatic RD. RESULTS: The authors found similar characteristics. Retinal breaks at vitreous base borders characterized by ocular contusion occurred in 79.2% of eyes with RD and atopic dermatitis and in 75.0% of eyes with traumatic RD. Irregular retinal traumatic breaks in the equatorial zone occurred in 20.8% of eyes with RD and atopic dermatitis and in 47.2% of eyes with traumatic RD. Objective signs of ocular contusion outside the retina appeared in 54.2% of eyes with RD and atopic dermatitis. CONCLUSIONS: The authors' data support the conclusion that self-inflected ocular contusion by tapping the eyes can cause RD with atopic dermatitis.

The age of onset of posterior vitreous detachment.

The age of onset of posterior vitreous detachment (PVD) was studied in 930 eyes with a clearly defined onset time and no vitreoretinal diseases except refractive error or equatorial degeneration. We found a positive correlation between onset age of PVD and refractive error, with the regression line y = 0.91 x + 60.93 (y onset age, x diopter of refractive error). The higher the degree of myopia, the younger the onset age of PVD. Comparing onset ages for 240 eyes from males and 690 eyes from females, there was a possible tendency toward a lower PVD onset age for females. There was no significant difference in onset age between 112 eyes with and 818 eyes without equatorial degeneration of the retina.

A case-control study of risk factors for proliferative vitreoretinopathy in aphakia.

A case-control study was performed to elucidate the risk factors of proliferative vitreoretinopathy (PVR) in aphakia. Twenty-five aphakic eyes with rhegmatogenous retinal detachment accompanied by PVR were compared with the control group of 156 aphakic eyes with rhegmatogenous retinal detachment without PVR. Unconditional logistic regression analysis identified the following risk factors for developing PVR in order of significance: choroidal detachment (odds ratio 15.41, 95% confidence interval 3.29-72.09), duration of retinal detachment longer than one month (odds ratio 12.07, 95% confidence interval 3.53-41.26), occurrence of retinal detachment within one year following cataract surgery (odds ratio 6.2, 95% confidence interval 1.64-23.47), and history of vitreous loss in cataract surgery (odds ratio 3.91, 95% confidence interval 1.28-11.92).

Macular pucker after retinal detachment surgery.

To better understand postsurgical macular pucker in rhegmatogenous retinal detachment, we reviewed a consecutive series of 277 eyes in 268 patients in whom retinal detachment had spared the macular area and in whom no preretinal membrane with distortion of the retinal vessels had been present preoperatively. Postoperatively, 17 eyes (6.1%) developed obvious macular pucker; 260 eyes (93.9%) did not. Using the Mantel-Haenszel chi-square test, we found that patient age, preoperative vitreous hemorrhage, large retinal breaks of more than three disc diameters, and cryoapplication were significant precipitating factors of postoperative macular pucker. These findings are consistent with the view that dispersion of retinal pigment epithelial cells through the retinal break into the vitreous cavity is the major cause of this disorder. Minimal use of cryotherapy is recommended in treating elderly patients who have a large retinal break or a preoperative vitreous hemorrhage.

Neovascularization of the iris in rhegmatogenous retinal detachment.

To identify conditions associated with neovascularization of the iris in rhegmatogenous retinal detachment, we examined 36 eyes with this disorder seen at our hospital between 1979 and 1990. Clinical courses of disease were divided into the following three groups: (1) neovascularization of the iris without a history of a vitreoretinal operation (four eyes), (2) neovascularization of the iris after an unsuccessful vitreoretinal operation (26 eyes), and (3) neovascularization of the iris after surgical complications (six eyes). In all eyes of Groups 1 and 2, retinal detachment persisted at the onset of iris neovascularization; however, in six eyes, iris neovascularization subsided after retinal reattachment. Characteristic features of Groups 2 and 3 were patient age of 50 years or more, severe myopia, a history of increased intraocular pressure, a history of choroidal detachment, and a large scleral buckle.

Comparative study of clinical factors that predispose patients to proliferative vitreoretinopathy in aphakia.

To clarify the risk factors of proliferative vitreoretinopathy (PVR) in aphakia, the clinical features of 25 aphakic eyes with PVR were statistically analyzed and compared with a control group of 157 aphakic eyes with non-PVR rhegmatogenous retinal detachment. The statistically significant (P less than 0.05) factors that predisposed patients to PVR in aphakia were as follows: a history of vitreous loss on cataract surgery, retinal detachment developing within 3 months after cataract extraction, duration of retinal detachment longer than 3 months, break larger than three disc diameters, and choroidal detachment. Vitreous loss is believed to play the most important role in the development of PVR in aphakia.

Causative factors of retinal detachment in macular holes.

Two hundred nine macular holes of both pathologic myopia and idiopathic senile type were statistically analyzed to find out which factors cause retinal detachment in eyes with macular holes. The incidences of retinal detachment were as follows: 97.6% in myopia over -8.25 D, 67.7% in myopia between -8.0 and -3.25 D, and 1.1% in eyes under -3.0 D; 100% in widespread chorioretinal atrophy, 90.6% in spotty or lineal chorioretinal atrophy, 64.3% in myopic tigroid fundus, and 0% in eyes without myopic tigroid or atrophy; 96.0% in eyes with posterior staphyloma and 8.2% in eyes without it; 56.4% in posterior vitreous detachment [PVD] (+) eyes, 53.3% in PVD(+/-) eyes, and 51.9% in PVD(-) eyes. The statistically significant (P less than 0.05) factors that caused retinal detachment were refractive error, myopic chorioretinal change, and posterior staphyloma. There was no statistically significant difference regarding PVD.

Comparative study of clinical factors predisposing patients to proliferative vitreoretinopathy.

Clinical features of 57 eyes with proliferative vitreoretinopathy (primary PVR) that developed preoperatively were statistically analyzed and compared with a control group of 1353 eyes with non-PVR rhegmatogenous retinal detachment. The statistically significant (P less than 0.05) factors predisposing to PVR were as follows: retinal detachment for more than 1 month; aphakia (47.4% in the PVR group versus 11.1% in the control group); vitreous hemorrhage (26.3% versus 11.0%); giant tear (15.8% versus 0.8%); breaks larger than 3 disc diameters (62.1% versus 27.3%); and horseshoe tear (65.5% versus 44.9%).