Primary vitrectomy alone for repair of retinal detachments following cataract surgery.

PURPOSE: To report the visual, anatomic, and refractive results of primary vitrectomy alone for the repair of retinal detachments (RD) following cataract surgery. METHODS: Retrospective review of office charts and operative reports of 83 eyes. RESULTS: A minimum of 4 months' follow-up was achieved for 78 pseudophakic or aphakic eyes that underwent primary vitrectomy, internal drainage of subretinal fluid, retinopexy, and intravitreal gas injection for RD repair. Anatomic reattachment was achieved in 93.6% of cases after one procedure and in 96.2% eventually. Median preoperative Snellen acuity was 20/200 and increased to 20/25 at final examination. For the 45 eyes with macula-off detachments, 80% achieved final acuities greater than or equal to 20/40. The average refractive change following surgery was -0.11 diopters. Transient postoperative ocular hypertension was seen in 17.9% and proliferative vitreoretinopathy with recurrent RD in 5.1%. CONCLUSION: Primary pars plana vitrectomy is a highly effective treatment modality for the repair of RD following cataract surgery, and appears to be refractively neutral.

Choroidal neovascularization after laser photocoagulation for diabetic macular edema.

Choroidal neovascular membranes (CNVMs) developed in eight patients after photocoagulation for clinically significant diabetic macular edema (DME). The CNVMs developed in areas where Bruch's membrane was ruptured and were diagnosed 2 weeks to 5 months after treatment. Only six patients had symptoms. The CNVMs were treated in four patients; final visual acuity was poor in all eight patients. This serious complication that follows laser treatment for DME may be related to the use of repeated small-size, short-duration laser or intense laser burns, or both.

A screening method using tissue culture for evaluation of potential retinal adhesives.

Several adhesives have been tested for their potentially toxic effects on embryonic retinal tissue. The authors have characterized the effects of the adhesives on neurofilament extension and also on surgical-wound "re-knitting." While none of the adhesives in the sample (including those in current surgical use) seem to be ideal, the model advanced has application for the continuing development of better 'bio-adhesives'. The most immediate application is within the field of vitreoretinal surgery in situations where conventional procedures currently seem inadequate.

Differentiation of adenoma of the iris pigment epithelium from iris cyst and melanoma.

A 32-year-old black man had a deeply pigmented anterior uveal lesion that was indenting and subluxing the lens. The mass was successfully removed by a sector iridectomy and diagnosed histologically as an adenoma of the iris pigment epithelium. Although this rare tumor is sometimes misdiagnosed clinically as a malignant melanoma or iris cyst, it has distinctive clinical features which should differentiate it from these other entities.

Retinal detachment in the Morning Glory syndrome. Pathogenesis and management.

A case of bilateral Morning Glory syndrome is presented, unusual because of a rhegmatogenous posterior pole retinal detachment in the left eye. Posterior pole retinal detachments have been described in association with this syndrome. This case report is the first presentation of a retinal tear located within the excavation surrounding the optic nerve. A surgical management approach is presented wherein vitrectomy and internal gas tamponade are utilized to reattach the retina.