Office repair of retinal detachment using a Lincoff Temporary balloon buckle.

PURPOSE: The purpose of the study is to report on a series of patients with retinal detachments that were repaired in an office setting using a temporary Lincoff balloon scleral buckle. METHODS: A retrospective review was performed on 162 consecutive casepatients with retinal detachment repaired in the authors' office between January 1989 and June 1995 using a temporary Lincoff balloon scleral buckle. All procedures were performed using local anesthesia and minimal equipment. RESULTS: The retina was attached completely with a single procedure in 88% of patients. Of the 19 retinas (12%) that failed primary surgery, all except 1 ultimately were reattached using traditional scleral buckling in 14, combined scleral buckling and vitrectomy in 3, and pneumatic retinopexy in 1, for a total success rate of 99.4%. Complications were minimal. CONCLUSION: A temporary Lincoff balloon scleral buckle can be used safely and effectively in an office setting for retinal detachment repair. The results are comparable to other available methods that take more time, involve greater risk, have higher complication rates, and are more costly. This technique represents a viable alternative, particularly in a managed care environment.

Eye care: diabetic retinopathy.

Diabetic retinopathy is the leading cause of blindness in the United States for adults, ages 20 to 74 years. Yet, the strict control of blood glucose may help ameliorate the potentially catastrophic effects of diabetes on vision. Physicians need a working knowledge of diabetic retinopathy.

Nocardia choroidal abscess.

Nocardia is a Gram positive, aerobic, filamentous branching micro-organism that rarely causes human infection. When infection does occur it usually takes the form of a subcutaneous abscess or a pneumonia-like illness. We describe a case of a patient with chronic lymphocytic leukaemia who developed painless loss of vision in the right eye secondary to a choroidal abscess after a prolonged course of treatment on several immunosuppressive agents. The patient also complained of right shoulder pain that was unresponsive to conventional therapy, and had been admitted and treated for several episodes of 'pneumonia'. A diagnostic transvitreal fine-needle aspiration biopsy of the ocular lesion was performed which demonstrated Nocardia asteroides. This allowed for appropriate antibiotic therapy to be instituted early in the course of the infection and prompted the systemic work-up which also demonstrated central nervous system and arthropic nocardial infection.

Pneumatic retinopexy. A two-year follow-up study of the multicenter clinical trial comparing pneumatic retinopexy with scleral buckling.

The authors report 2-year follow-up information on 179 of 198 eyes (90%) enrolled in a previously published multicenter, randomized, controlled clinical trial comparing pneumatic retinopexy (PR) with scleral buckling (SB) for the management of selected retinal detachments. Scleral buckling was compared with PR with regard to redetachment after the initial 6-month follow-up period (1% versus 1%), overall attachment (98% versus 99%), subsequent cataract surgery (18% versus 4%; P less than 0.05), preoperative visual acuity (no significant difference), and final visual acuity of 20/50 or better in eyes with macular detachment for a period of 14 days or less (67% versus 89%; P less than or equal to 0.05). Reoperations after a failed PR attempt did not adversely affect visual outcome. After 2 years, PR continues to compare favorably with SB.

Vitreous haemorrhage as a complication of HELLP syndrome.

In the last trimester of an uncomplicated pregnancy a woman developed a spontaneous vitreous haemorrhage. She was later diagnosed as having HELLP syndrome, a recently described disorder comprising haemolytic anaemia, elevated liver enzymes, and a low platelet count in women with severe pre-eclampsia or eclampsia. We believe this rare complication of pregnancy to be the cause of the intraocular bleeding.

Tumor-associated retinal pigment epithelial proliferation simulating retinal pigment epithelial tear.

A lesion with both the clinical and fluorescein angiographic appearance of the classical retinal pigment epithelial (RPE) tear was discovered over the dome of an actively growing metastatic choroidal tumor in a patient with a previous history of breast carcinoma. However, our patient exhibited no evidence of pigment epithelial detachment or age-related macular degeneration, the underlying cause of the RPE tear. Although we cannot be sure that a true RPE tear did not exist over our patient's tumor, more likely, we are observing a tumor induced zone of RPE dehiscence accompanied by RPE proliferation at its border, giving a very similar fundus appearance. Possible pathogenic mechanisms for the finding in our patient, and a comparison to those mechanisms responsible for the classical RPE tear, are discussed.