[Vitreous surgery in paediatric population. Visual and anatomic outcomes]. / Cirugía vítreo-retiniana en pacientes pediátricos. Resultados anatómicos y visuales.

PURPOSE: To determine the anatomic and visual outcome of children that had undergone vitreoretinal surgery. METHOD: 229 clinical files where analyzed at our center, were included 73 patients, 77 eyes. We considered those who were 18 years old or younger and had undergone retinal surgery, retinopathy of prematurity (ROP) was excluded. RESULTS: The mean age was 10 years; the main indication for surgery was retinal detachment. Trauma and congenital and developmental abnormalities where found in 80% of the ocular pathology involved. 90.9% of the patients had an initial visual acuity of light perception to counting fingers. Final visual acuity ranged from counting fingers to 1.0 in 41.6%. There was no statistical significance between initial visual acuity and the final (p = 0.782) neither was the time of surgery and the final visual acuity (p = 0.454). 12.5% presented total retinal detachment and the macula was involved in 63.6% of all patients. Vitrectomy and retinopexy was the preferred surgery. Silicon oil was used in 58.4%. Retinal attachment was achieved in 63% of the patients after 6 months. CONCLUSION: In this kind of patients the ocular characteristics of the vitreous, made the surgery a very difficult procedure, and the final success include the visual rehabilitation.

Successful erbium: YAG laser-induced chorioretinal venous anastomosis for the management of ischemic central retinal vein occlusion. A report of two cases.

BACKGROUND: Central retinal vein occlusion (CRVO) is a disorder with potentially blinding complications, particularly when associated with retinal ischemia. There is no reliable treatment for ischemic CRVO. METHODS: We developed a new approach for ischemic cases of CRVO consisting of vitrectomy, posterior hyaloid detachment, and four erbium:YAG laser-induced chorioretinal anastomoses, one in each quadrant. RESULTS: We report two cases of ischemic CRVO treated with this approach, with initial visual acuity of count fingers at 30 cm and hand movements respectively. After the surgery, there was resolution of hemorrhages and macular edema and visual improvement to 20/400 in the first case and to 20/180 in the second case. In both cases, there was successful creation of chorioretinal anastomoses, and there was no anterior segment neovascularization or other complications related to the surgery. CONCLUSION: This treatment shows promise in the management of the ischemic cases of CRVO, and further evaluation is justified.

Induced posterior vitreous detachment by intravitreal sulfur hexafluoride (SF6) injection in patients with nonproliferative diabetic retinopathy.

PURPOSE: To induce posterior vitreous detachment (PVD) in patients with nonproliferative diabetic retinopathy (NPDR) by injecting an intravitreal gas bubble of SF6 and to compare the evolution of the diabetic retinopathy between eyes with gas induced PVD and non-injected eyes without PVD. METHODS: An intravitreal gas bubble of SF6 was injected via the pars plana in twelve eyes of twelve patients with NPDR and no previous PVD. Subsequent clinical, ultrasonographic and angiographic controls were performed to evaluate the development of PVD and progression of the disease. RESULTS: All gas-injected eyes developed PVD. All eyes with induced PVD (treatment group) remained stable without progression of the retinopathy after 2 years of follow up. In the control group (contralateral eyes without PVD), two eyes (16.6%) progressed to proliferative diabetic retinopathy (PDR) (p= 0.23); five (41.6%) showed progression to more severe stages of NPDR (p= 0.01) and another 41.6% of such eyes remained stable. CONCLUSIONS: Intravitreal SF6 injection induced PVD in all eyes of our study without undesirable side effects. Further studies are necessary to make conclusions regarding the correlation between the presence of induced PVD and the progression of diabetic retinopathy.