Pars plana vitrectomy in the management of dislocated posterior chamber lenses.

We used pars plana vitrectomy techniques in the management of pseudophakia and a dislocated posterior chamber lens in 17 patients. In six patients, the implant was decentered with the optic axis still located in the visual axis. In nine patients, the implant was rotated inferiorly and posteriorly but with the haptic still adherent to the vitreous base. In two patients, the implant was dislocated into the vitreous cavity. Surgical repositioning of the implant was indicated in 12 (71%) patients because of retained lens material, vitritis, vitreous adhesion to the cataract wound, vitreous hemorrhage, or retinal detachment. Preoperatively, visual acuity ranged from 20/30 to hand motions. Postoperatively, visual acuity ranged from 20/20 to 20/400. In eight patients, visual acuity was improved to 20/25 or better.

Ocular perforation from a retrobulbar injection.

Proliferative vitreoretinopathy occurred in three of seven cases of ocular perforation from retrobulbar injection, resulting in a visual acuity of 20/200 or worse. Direct macular injury and macular pucker occurred in two cases each. Needle injury exit sites were in the posterior pole in all cases. Predisposing factors were not experimentally verified, but associated conditions included axial myopia, multiple injections, traditional superonasal gaze position, previous retinal buckling procedure, and enophthalmos.

The use of an irrigating endo-illuminator for anterior vitrectomy.

Visualization of the vitreous during a closed anterior vitrectomy is difficult. We have recently begun to use an irrigating endo-illuminator in conjunction with the Ocutome to better visualize the clear vitreous during an anterior vitrectomy, and have used it in four different situations. We believe this technique is well suited to the general ophthalmologist and it is easy to learn.

Vitrectomy for nondiabetic vitreous hemorrhage.

In a group of 94 eyes with nondiabetic vitreous hemorrhage that underwent pars plana vitrectomy between March 1974 and September 1982, the causes of the hemorrhages were retinal branch vein obstruction (36 eyes), blunt trauma (11 eyes), cataract extraction (ten eyes), subretinal neovascularization (nine eyes), Eales' disease (eight eyes), Terson's syndrome (four eyes), and idiopathic (five eyes) and miscellaneous (11 eyes) conditions. Vision was improved postoperatively in 88 of the 94 eyes, including all of those that underwent blunt trauma or cataract extraction, those with Eales' disease and Terson's syndrome, and those in the idiopathic and miscellaneous groups. Final visual acuities, which depended primarily on the underlying condition and its effect on the macula, were 20/20 or better in ten eyes, 20/25 to 20/40 in 37 eyes, 20/50 to 20/200 in 26 eyes, 20/300 to 20/400 in 11 eyes, 9/200 to 5/200 in three eyes, and hand movements or light perception in seven eyes. Retinal tears, the most common surgical complication, occurred in 18 eyes. The incidence of anterior retinal tears was reduced from 11% (11 of 38 eyes) to 4% (two of 56 eyes) after we began using a vitrectomy probe with a smaller diameter. Some postoperative lens opacification occurred in 16 of 50 phakic eyes, and the incidence of later lens opacification increased as the follow-up lengthened.

Complications of vitreous surgery for diabetic retinopathy. II. Postoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of postoperative complications after vitrectomy for proliferative diabetic retinopathy. One hundred twenty-nine (72%) of the 179 eyes achieved improved vision, and 117 (65%) were considered visual successes with final vision in the functional range of 5/200 or better. Corneal epithelial defects occurred in 51 eyes (28%), but severe corneal complications were rare, and no eye developed corneal clouding as the sole cause of later visual loss. The lens was retained in 128 eyes (75%), and visually significant lens opacities occurred later in 17% of the phakic eyes. Postoperative iris neovascularization was reduced by not removing the lens, and rubeosis iridis occurred in 15 (13%) of 114 phakic eyes and in 21 (32%) of 65 aphakic eyes (P = 0.012). Vitreous hemorrhage was present in 75% of eyes immediately after surgery and cleared in an average of 6.2 weeks in phakic eyes and 5.4 weeks in aphakic eyes. Fifty-two eyes (29%) had recurrent vitreous hemorrhage after the initial postoperative period. New retinal detachment occurred after surgery in 16% of eyes and was treated successfully in 38%. Reoperations were done in 45 eyes (25%), and 32 (71%) of these were for repair of retinal detachment or removal of nonclearing vitreous hemorrhage. Six eyes (3%) developed phthisis bulbi, and one other eye was enucleated.

Complications of vitreous surgery for diabetic retinopathy. I. Intraoperative complications.

One hundred seventy-nine eyes were analyzed to determine the incidence of intraoperative complications during vitrectomy for proliferative diabetic retinopathy. Inadvertent corneal epithelial defects occurred in 51 eyes (28%). The lens was removed in 42 (25%) of 170 phakic eyes. This was done through a pars plana approach. Accidental mechanical lens damage occurred in one eye, and mild pharmacologic lens damage occurred in two eyes. Some bleeding from fibrovascular tissue occurred in nearly every case, but this was controlled with diathermy except in seven eyes (4%) in which severe bleeding required premature termination of the operation. Latrogenic retinal tears occurred in 36 (20%) of the 179 eyes. Fifteen (34%) of the total of 44 retinal tears were anterior to the equator, and 11 (73%) of the 15 anterior tears were located posterior to the sclerotomy through which the vitrectomy probe was introduced. Twenty-nine (66%) of the 44 retinal tears were posterior to the equator, and 19 of the 29 occurred within 15 degrees radius of the fovea.

Idiopathic juxtafoveolar retinal telangiectasis.

Twenty-seven healthy adult patients had visual loss in one or both eyes because of exudation from juxtafoveolar retinal capillary telangiectasis of uncertain cause. These patients were subdivided as follows: group 1, men with uniocular involvement, intraretinal lipid exudation, and telangiectasis largely confined to the temporal half of the juxtafoveolar area; group 2, mostly men with symmetric areas of telangiectasis affecting the temporal half of the juxtafoveolar areas and minimal intraretinal exudation; group 3, both sexes with symmetric involvement of all of the parafoveolar capillary bed an minimal exudation; and group 4, one case of telangiectasis with occlusive perifoveolar capillary changes and familial optic disc pallor. The visual acuity prognosis in groups 1 through 3 is relatively good. Photocoagulation may be of some value in the treatment of patients in group 1.

Clear-cornea cataract extraction in eyes with functioning filtering blebs.

In 22 glaucomatous eyes with functioning filtering blebs and adequately controlled intraocular pressures (less than or equal to 22 mm Hg) that underwent clear-cornea cataract extraction, the intraocular pressure remained controlled in 20 (91%). Seven of the 21 eyes, however, required an increased dosage of antiglaucoma drugs. Sixteen eyes had final visual acuities between 6/6 and 6/9 (20/20 and 20/30) and only four eyes had final visual acuities worse than 6/60 (20/200). The only intraoperative complication was a ruptured lens capsule. Postoperative bullous keratopathy developed in two eyes, both of which had had corneal edema postoperatively. A third eye, which had undergone filtering surgery 17 years earlier, had vitreous incarceration after the sutures were removed.

Corneal astigmatism from conjunctival cysts.

Two patients had decreasing visual acuity because of corneal astigmatism induced by a conjunctival cyst. In both cases, surgical removal of the cyst resulted in marked improvement because of a reduction in astigmatism. In one case, the cause of decreased visual acuity was unknown for two years; keratometry and a careful examination of the eyelids disclosed the cyst.

Extended-wear contact lenses and intraocular lenses for aphakic correction.

We evaluated extended-wear soft contact lens use in 128 aphakic eyes of 113 patients, 44 of whom had been unable to wear conventional contact lenses; 116 eyes (91%) have been successfully fitted and have worn the extended-wear lenses without significant complication. Eleven patients were unable to wear the lens or had to be discontinued for transient lens-related problems. In 103 eyes successfully fitted the lens is removed for cleaning less often than monthly. Ninety six of the 116 eyes fitted have visual acuity as good as, or better than, with aphakic correcting spectacles. The results obtained with the extended-wear soft contact lens are similar to those obtained with intraocular lenses, except for the recent high incidence of inflammation seen after intraocular lens insertion when using ethylene-oxide-sterilized lenses.