Glial proliferation after vitrectomy for a macular hole: a spectral domain optical coherence tomography study.

PURPOSE: To characterize eyes with glial proliferation after macular hole (MH) surgery. METHODS: We retrospectively reviewed patients who underwent vitrectomy for an idiopathic MH using spectral domain optical coherence tomography (SD-OCT). The pattern of the closed MH after surgery was categorized according to the presence (group 1) or absence (group 2) of apparent glial proliferation, which was determined by glial tissue reflectivity involving the external limiting membrane (ELM) and photoreceptor layers. Photoreceptor layer defect areas were categorized as mild or severe. Best-corrected visual acuity (BCVA) and pre- and postoperative OCT parameters were compared between the two groups. RESULTS: Among 30 eyes followed-up for a median of 11 months, seven (23 %) were assigned to group 1 and 23 (77 %) to group 2. The median age was higher in group 1 (70 years) than in group 2 (63 years). The postoperative BCVA was poorer in group 1 than in group 2 at 3 months and at the final examination (P = 0.022 and P < 0.001 respectively). The median preoperative basal hole diameter in group 1 (1,219 µm) was larger than that of group 2 (590 µm) (P = 0.002). The MH index (hole height/basal hole diameter) was smaller in group 1 than in group 2 (P = 0.012). At the final examination, group 1 had larger mild and severe photoreceptor layer defect areas (medians 1,300 µm and 207 µm respectively) than group 2 (medians 110 µm and 70 µm respectively) (P < 0.001 and P < 0.001 respectively). CONCLUSIONS: Eyes with glial proliferation after surgery for MH had different preoperative characteristics than eyes with no evidence of glial proliferation. In addition to a large hole diameter, other factors such as a small MH index and advanced age could be involved in the development of glial proliferation.

Hyperreflective external limiting membranes after successful macular hole surgery.

PURPOSE: To evaluate changes in external limiting membranes (ELMs) in the foveae of patients with surgically closed macular holes. METHODS: In this retrospective observational case series, spectral-domain optical coherence tomography scan images were obtained from eyes of patients with macular holes closed after vitrectomy. The integrity of the ELMs was evaluated at the fovea. In eyes with a restored ELM, the reflectivity of the ELM was estimated. RESULTS: At a mean of 19 months (range, 3.0-59.7 months) after surgery, the integrity of the ELM was restored in 21 (77.8%) of 27 eyes with closed macular holes. The ELM was not restored in six eyes with glial sealing, in which glial tissues were present in the entire retinal layer. All 21 eyes with restored ELMs had an area of hyperreflectivity within the ELM observed at the thinnest part of the fovea; this was associated with an underlying photoreceptor defect. CONCLUSION: Abnormally hyperreflective ELMs were frequently observed at the thinnest point of the fovea after macular hole surgery. These hyperreflective ELMs may be newly formed after surgery.

Inadvertent ocular perforation during lid anesthesia for hordeolum removal.

PURPOSE: Ocular perforation during lid anesthesia is rarely reported. We describe here a case of inadvertent corneal perforation and traumatic cataract that occurred during lid anesthesia in a procedure for hordeolum removal. METHODS: A 33-year-old woman presented with a sudden visual loss of her left eye. She had undergone hordeolum removal the day before at a local clinic. On ophthalmologic examination, the cornea was perforated and the lens cortex was extruded into the anterior chamber. After cataract removal and IOL implantation, antibiotics were injected into the vitreous. RESULTS: Her final visual acuity of the left eye was 20/20. Postoperative specular microscopic examination revealed a normal-range endothelial cell count, coefficient of variation, and hexagonality despite the intracameral lidocaine injection. CONCLUSIONS: Anesthetic injection of an infected lid should be done with great caution. Although there are possibilities of corneal endothelial toxicity and endophthalmitis in case of intracameral lidocaine injection through the infected lid, yet proper management may save the patient's vision without complications.

Spontaneous rupture of the left external iliac vein.

Recently, we have experienced a case of spontaneous rupture of the left iliac vein in a 62-year-old woman, who had been suffering from hemiparesis and chronic constipation. An urgent laparotomy was performed for massive hemoperitoneum without knowing the bleeding point, and laceration on the left external iliac vein was repaired. Spontaneous rupture of the iliac vein is extremely rare. However, it should be included in differential diagnoses of the patient with massive hemoperitoneum who have no known pathology or any evidence of blunt trauma.

Pararenal leiomyosarcoma of the inferior vena cava.

A complete surgical resection is the only proven therapeutic modality that prolongs the survival in patients with leiomyosarcoma of the inferior vena cava (IVC). Reconstruction of the IVC is not always necessary but is often required to facilitate venous drainage of the kidney for the tumors at the pararenal area of the IVC. Controversy exists in postoperative adjuvant therapy. Recently, we experienced four cases of pararenal leiomyosarcoma of the IVC, of which treatment consisted of a complete resection of the tumor, ringed polytetrafluoroethylene (PTFE) graft interposition, and bilateral renal vein reconstructions in all patients. Postoperative radiation therapy was instituted in 3 of 4 patients. One patient who did not receive the postoperative radiation therapy was treated with adjuvant chemotherapy. The kidneys were preserved in all patients and no deep vein thrombosis (DVT) or venous insufficiency of the lower extremity veins developed. Distant metastasis to the lung was noted in one patient at 18 months after surgery, who was not received the postoperative radiation therapy but chemotherapy. In conclusion, a complete resection of the tumor, IVC reconstruction, and bilateral renal vein reconstruction followed by adjuvant radiation therapy is recommended for the treatment of pararenal leiomyosarcoma of the IVC.