Peeling of internal limiting membrane during vitrectomy for complicated retinal detachment prevents epimacular membrane formation.

BACKGROUND: To investigate the clinical benefit of internal limiting membrane (ILM) peeling at the macula for the prevention of epimacular membrane formation following vitreous surgery using silicone oil for the treatment of complicated retinal detachment. METHODS: This was a non-randomized, retrospective, interventional study of a case series. Patient charts were reviewed retrospectively for 20 consecutively recruited patients who underwent successful primary vitrectomy with ILM peeling at the macula using silicone oil (group 1) and 22 consecutively recruited patients who underwent successful primary vitrectomy using silicone oil without ILM peeling at the macula for complicated rhegmatogenous retinal detachment (group 2). The main outcome measures were distant visual acuity and epimacular membrane formation. The data were analyzed and compared using Fisher's Exact test, Pearson Chi-square test, independent t-test, Mann-Whitney U-test, and a repeated ANOVA. RESULTS: The mean age of patients was 52.7 +/- 12.6 years in group 1 and 53.2 +/- 13.3 years in group 2 (p = 0.89). The mean follow-up time was 24.6 +/- 7.6 weeks in group 1 and 34.1 +/- 12.6 weeks in group 2 (p = 0.01). Preoperatively, ten eyes in group 1 and 10 eyes in group 2 were pseudophakic; the macula was detached in all cases. Silicone oil had been removed from all eyes of both groups at least 3 months before the final examination. There were no significant differences between the two groups with regard to sex (p = 0.44), mean duration of retinal detachment (p = 0.12), mean preoperative visual acuity (logMAR), mean number of retinal breaks (p = 0.43), and grade of proliferative vitreoretinopathy (p = 0.35). The final visual acuity (logMAR) was 0.60 +/- 0.30 in group 1 and 0.72 +/- 0.35 in group 2 (p = 0.49). Four eyes in group 1 and two eyes in group 2 underwent cataract surgery during silicone oil removal. Epimacular membrane formation was observed in two eyes before silicone oil removal and in four eyes within 8 weeks after silicone oil removal in group 2. No epimacular membrane formation was seen in group 1 (p = 0.02). CONCLUSION: ILM peeling at the macula during vitreous surgery with silicone oil for the treatment of complicated retinal detachment may prevent epimacular membrane formation without negatively affecting distant visual acuity.

Early surgery for dysthyroid orbitomyopathy based on magnetic resonance imaging findings.

PURPOSE: To investigate the value of magnetic resonance imaging (MRI) in the determination of the fibrotic phase in dysthyroid orbitopathy, which may be an indication for early surgery. PATIENTS AND METHODS: Thirteen patients with dysthyroid orbitopathy who had vertical deviation in excess of 20 PD and associated diplopia in the primary position that did not respond to medical treatment were included in the study. On MRI, the absence of high-intensity foci in the T2 sequence, especially in the coronal planes, indicated that the extraocular muscles were not edematous. These muscles were evaluated as being in the fibrotic phase, and surgery was performed without waiting the recommended 6 months for the stabilization of the angle of deviation. RESULTS: The complaint of diplopia disappeared after a single operation in 8 patients, and after a second operation in 4. Thus, success was obtained in 12 of the 13 patients. One patient with persistent vertical diplopia refused a second operation. CONCLUSION: Our results indicate that MRI is an effective and reliable method for the determination of the fibrotic phase in patients with dysthyroid orbitopathy who have diplopia in the primary position, and that MRI results have an important role in determining whether early surgery is appropriate.

Consecutive exotropia following strabismus surgery.

We investigated the clinical factors affecting the development of consecutive exotropia following esotropia surgery. The development period of consecutive exotropia, amblyopia and limitation of adduction were evaluated in 89 patients with primary esotropia that changed to consecutive exotropia after surgery. In the presence of deep amblyopia, consecutive exotropia developed earlier. When two horizontal muscles were operated, limitation of adduction was more frequent in symmetrical rather than asymmetrical surgical procedure. Since consecutive exotropia may develop many years after esotropia surgery, a long-term follow-up period in patients without consecutive exotropia in the early postoperative period is advised.

Extraocular muscle surgery in dysthyroid orbitomyopathy: influence of previous conditions on surgical results.

PURPOSE: To determine the influence of previous treatments other than the surgical treatment of restrictive myopathy resulting from dysthyroid orbitomyopathy. METHODS: The outcome of 23 cases with dysthyroid orbitomyopathy was evaluated after extraocular muscle surgery. RESULTS: It has been observed that the duration of the orbitomyopathy, severity of myopathy of the deviation angle, and the modality of treatment prior to surgery (radiotherapy and corticotherapy) did not influence surgical outcome. Binocular single vision was achieved in primary and reading positions in 14 of 23 cases (60.9%) after surgery while prisms were required to achieve the same result in 5 cases (21.7%). CONCLUSION: It is concluded that previous treatment does not influence the results of extraocular muscle surgery in patients with dysthyroid orbitomyopathy.