Vitreo-retinal surgery in sickle cell disease [abstract]

Sickle cell disease is the commonest haemo-globinopathy. The gene is present in about 8 percent of Afro-American and 10 percent of Afro-Jamaican. Severe ocular complications of this condition include proliferative retinopathy, vitreous haemorrhages, and retinal detachment ultimately leading to blindness in a number of cases. There are not many reports of vitreo-retinal surgery in the literature dealing with cases. This is a report of 28 vitero-retinal surgeries in 20 eyes of 19 patients with sickle cell eye disease. Four eyes had surgery for viterous haemorrage, 16 for retinal detachment. All four eyes with vitreous haemorrage had successful pars plana vitrectomy (PPV) with full restoration of full potential vision. Eight of 16 eyes had successful retinal detachment surgery. Four eyes had pneumatic retinopexy with one unsuccessful result. Five eyes had scleral buckles with four having successful results, and six had bad results and one was unchanged. Six of ten eyes that had pars plana virectomy for retinal detachment had bad results. The unsuccessful cases were difficult ones with extensive proliferative vitero-retinopathy and long-standing retinal detachment. (AU)

Ultrasonography and ocular trauma [abstract]

Blunt or perforating trauma can cause considerable damage to both the anterior and posterior segment of the eye. Since the media are often opaque following trauma, the extent of the damage may be difficult to assess with routine examination. Ultrasonography can reveal hidden pathology and is often helpful in deciding upon the proper line of treatmemt. In post-contusional trauma without an open globe, full ultrasonographic investigation, including immersion techniques, can be performed. On the contrary, after perforation lesions, an exploratory B-scan can be used for locating an intraocular foreign body in addition to gross assessment of the damage. The ultrasonographic examination can only be continued in further detail after primary closure of the wound. When an x-ray of the orbit reveals the presence of an intraocular foreign body B-mode ultrasonography is superior to the Comberg-Pfeiffer method and computer tomography for precise localizations of the object and for detection of collateral damage. Transpalpebral echography or scans with the probe directly applied to the eye, at significantly reduced sensitivity levels (-20 or -30 dB) are the methods of choice for tracing a foreign body in the posterior segment or orbit. Lowering the sensitivity settings will also improve the accurate location of the foreign body. The immersion technique is used when the foreign body is located anteriorly in the eye, providing that the entry wound is closed. In particular after contusional injuries, ultrasound biomicroscopy (UBM) can be used for detailed observations of the cornea, anterior lens, chamber angle and ciliary body. Recession of the angle, subluxation of the lens and dialysis of the iris or ciliary body can be diagnosed with relative ease. When vitrectomy is indicated either as a primary or secondary procedure following ocular trauma, ultrasonography is essential in the preoperative evaluation. It will help in deciding upon the length of the preoperative period, the estimated duration of the operation and the appropriate surgical approach. A full anatomical analysis can be obtained by systemically assessing the biometric, topographic, kinetic and quantitative characteristics of the various parts of the eyes. The most commonly occuring ocular pathology following trauma, along with the most suitable diagnostic ultrasonic techniques will be discussed in detail and are depicted in the table. (AU)

Post-Vitrectomy survival

Diabetics with proliferative retinopathy are likely to have multi-system complications which contribute to their reduced life expectancy. The management of proliferative diabetic retinopathy may require costly vitreous surgery and, if life expectancy is low, the cost benefit is questioned by all concerned (patients, relatives, governments, health planners and doctors). The objective of this study is to determine the trends in life expectancy in diabetic patients undergoing vitreous surgery and any pre-morbid factors that may be of significance. A retrospective study of 145 diabetic patients who had vitreous surgery from 1992 to 1997 at the Port of Spain Adventist Hospital was done. Analysis of the data reveals that 20 percent of the patients died within two years and 68 percent of those within one year. Patients with insulin dependent diabetes were more likely to die than those on oral medication, and patients of East Indian origin were twice as likely to die in the first two years as those of African descent. The findings are important with respect to counselling candidates for surgery and also for health planners contemplating directing resources in vitreo-retinal services. The study continues and will attempt to identify other markers.(AU)