Prognosis of penetrating eye injuries with posterior segment intraocular foreign body.

PURPOSE: To identify the prognostic factors concerning the anatomy and visual acuity of eyes subject to trauma related posterior intraocular foreign body. PATIENTS AND METHODS: The records of 28 eyes of 27 patients who underwent pars plana vitrectomy and intraocular foreign body removal during a 5 year period were retrospectively reviewed. Ocular trauma score was calculated for each eye. RESULTS: The most common initial findings were corneal wound (68%), lens injury (50%), retinal lesion (50%), vitreous hemorrhage (25%), and endophthalmitis (14%). Multiple foreign body causing perforating injury with retained posterior segment foreign body occurred in 7% of the cases. The foreign body was found on the surface of the retina in 39% of the cases. Postoperative complications were retinal detachment (46%), proliferative vitreoretinopathy (25%), and phthysis (4%). No eye was enucleated and 1 eye (4%) lost light perception. The final best corrected visual acuity became better or equal to 0.5 Snellen E in 34% of the eyes. The mean follow-up was 19 months (1.5-60 months). CONCLUSIONS: Prognosis was significantly worse in cases with lower trauma score, initial visual acuity less than 0.1 Snellen E, large foreign body, upset of bacterial endophthalmitis, and with proliferative vitreo-retinopathy. Visual outcomes in our cases were better than estimated follow-up visual acuity based on ocular trauma score parameters.

Primary bone marrow T-cell anaplastic large cell lymphoma with triple M gradient.

We present a case of a 60-year-old male patient with primary bone marrow anaplastic large cell lymphoma. He was admitted to the hospital with the symptoms of anemia and fever. There was no evidence of lymphadenopathy or splenomegaly. Immunoelectrophoresis showed the presence of a triple M gradient (double IgM and an IgG), with the IgG and one of the IgM paraproteins functioning as a cryoglobulin. The patient had no hepatitis C virus infection. Bone marrow biopsy showed massive CD30-positive, ALK-negative large lymphoid cell infiltration of T-cell origin with anaplastic morphology. PCR analysis of lymphoid cells separated from the bone marrow demonstrated the presence of a B/T hybrid genotype disorder with no evidence of the t(2;5), nor t(1;2) translocations. The patient entered a period of remission following CHOP chemotherapy. The patient subsequently died of sepsis as a consequence of serious humoral immunodeficiency.

Pseudophakic retinal detachment after phacoemulsification.

The authors estimated the onset, incidence and treatment of pseudophakic retinal detachment after phacoemulsification and intraocular lens implantation in 11,098 consecutive patients over a 10-year period. About 40 eyes in 37 patients were diagnosed with pseudophakic retinal detachment (risk = 0.36%). Significant risk factors included: axial length > 25.0 mm, age < 65 years and intraoperative complications. The final best corrected visual acuity improved by 2 or more Snellen E lines in 52.5% of cases.

Bilateral full-thickness macular hole: a case report.

Bilateral full-thickness macular hole is a rare retinal disease. A 63-year-old man complained of metamorphopsy on his left eye. Pars plana vitrectomy was performed for stage 2 macular hole with anatomical and functional success. Postoperatively, the right eye showed the same symptoms, and stage 2 macular hole, detected by ocular coherency tomography, developed within 4 months, but closed after pars plana vitrectomy.

Vitrectomy with internal limiting membrane removal for clinically significant macular oedema.

BACKGROUND: Little has been published on internal limiting membrane (ILM) removal for clinically significant macular oedema (CSME) in eyes not improving following maximal laser treatment. METHODS: Retrospective review of the charts and intraoperative video films of 30 consecutive eyes of 27 patients undergoing vitrectomy, ILM peeling, and gas tamponade by a single surgeon. RESULTS: The average patient was 52 years old; 56% were males. The oedema was caused by diabetes in 87% of the eyes, 42% of which had proliferative disease. The oedema was diffuse in 16 eyes (53%) and cystoid (CME) in 14 (47%). In 21% of eyes, spontaneous vitreous detachment was present or the eye had already undergone vitrectomy. All but one eye had at least 6 months of follow-up (mean 12 months). The oedema resolved completely in 26 eyes (90%) and partially in 3 eyes (10%). The visual acuity improved at least two Snellen lines in 19 eyes (66%) and one line in 4 eyes (14%); the average improvement was 4 lines. The acuity was unchanged in three eyes (10%) and worsened in three eyes (10%), all due to cataract. Among the 14 eyes with CME, 11 (79%) became completely dry and the visual acuity improved in 11 eyes (79%). No ILM-related complication was encountered in any eye. CONCLUSIONS: Vitrectomy with ILM peeling is a promising approach to eyes with CSME. It appears to offer visual improvement at a much higher rate than laser therapy and with a longer-lasting effect than that of intravitreal triamcinolone. A larger study is necessary to confirm these preliminary findings.