Prophylactic scleral buckle for prevention of retinal detachment following vitrectomy for macular hole.

AIM: To review the rate of retinal detachment after macular hole surgery in patients who received vitrectomy and scleral buckle versus those who had vitrectomy alone. METHODS: All patient charts and hospital records were examined for patients who underwent vitrectomy surgery for macular hole between September 1993 and June 1997. A total of 326 patients were identified and all were followed for a minimum of 6 months. Clinical records were examined for details of the surgical procedure, visual acuity, hole closure status, adjuvant therapies used, and postoperative retinal attachment status. Relative risks (the ratio of the incidence rate in the exposed to that in the unexposed) with 95% confidence intervals and chi(2) tests were calculated to determine which variables were associated with retinal detachment. The primary outcome measure in this review was retinal attachment status. RESULTS: Of 326 eyes which underwent surgery for macular hole during the study period, scleral buckles were utilised in 152 (46.6%) patients. Analysis revealed a detachment rate of 13.2% in patients who did not receive a scleral buckle compared with 5.9% detachment rate in those who did. Analysis of these results indicated a 2.42 times greater risk of developing a retinal detachment in patients without a scleral buckle. Complications related to the use of scleral buckles occurred in two of 152 cases (1.3%) CONCLUSIONS: A reduction in the rate of retinal detachment was noted in patients receiving prophylactic scleral buckles. Those finding suggest a possible beneficial effect of this adjunctive procedure in preventing postoperative retinal detachments. The authors are currently preparing a multicentred, prospective, clinical trial to further study this hypothesis

Topical versus intravenous administration of tranexamic acid: a comparison of intraocular and serum concentrations in the rabbit.

BACKGROUND: Tranexamic acid has been shown to greatly reduce the incidence of secondary hemorrhage when administered orally or intravenously. Topical administration of the drug should result in much lower serum concentrations, with fewer adverse effects. We performed a study to determine whether topical application of tranexamic acid would yield higher intraocular concentrations and lower serum concentrations of drug than intravenous administration. METHODS: Ten New Zealand white rabbits received 25 mg/kg of tranexamic acid intravenously every 8 hours for 3 days. Another group of 10 rabbits received one drop (0.05 mL) of commercially available tranexamic acid solution (100 mg/mL) every 8 hours for 3 days to one eye. Tranexamic acid levels in the aqueous humour, vitreous humour and serum 1 hour after administration of the last dose of drug were determined. RESULTS: Analysis of variance showed that aqueous concentrations of tranexamic acid were significantly higher with topical delivery than with intravenous administration (15 vs. 9 micrograms/mL)(p < 0.05). Serum concentrations were significantly lower following topical administration (9 vs. 19 micrograms/mL)(p < 0.01). The drug was not detected in the vitreous humour in either group. INTERPRETATION: Topical delivery of tranexamic acid may prove to be valuable in yielding therapeutic intraocular concentrations of drug in patients with hyphema while minimizing systemic toxicity.

Treatment of cytomegalovirus retinitis with intravitreal injection of liposome encapsulated ganciclovir in a patient with AIDS.

To study its safety and efficacy in treating cytomegalovirus (CMV) retinitis, an AIDS patient received an intravitreal injection of liposome encapsulated ganciclovir in the right eye. The left eye served as a control, receiving intravitreal free ganciclovir. The right eye showed no retinal haemorrhages or detachment; however, vision declined initially, stabilising later. Weekly examination showed neither progression of the CMV retinitis nor new lesions in the right eye. The left eye showed reactivation of old CMV retinitis. Liposome encapsulated ganciclovir reduced the number of intravitreal injections, stabilising CMV retinitis, and warrants further study.

Repair of retinal detachment associated with proliferative vitreoretinopathy using perfluoroperhydrophenanthrene (Vitreon). Vitreon Study Group.

A total of 140 consecutive patients underwent repair of retinal detachment associated with grade C2 to D3 proliferative vitreoretinopathy with perfluoroperhydrophenanthrene (Vitreon) as an intraoperative hydrokinetic tool. In seven patients the Vitreon was left in the eye for extended tamponade. Intraoperative reattachment was obtained in 98% of patients. At the final follow-up examination (mean 7 months) 84% of retinas remained attached, and 92% of patients had stable or improved visual acuity. Vitreon was found to be safe and effective in the repair of complicated retinal detachments. No complications were directly related to Vitreon when used intraoperatively or when left in the eye for extended tamponade.

The surgical management of retinopathy of prematurity using a perfluorocarbon liquid.

Retinopathy of prematurity with retinal detachment continues to present a challenge to the vitreoretinal surgeon despite many advances in technique. We report on two eyes with stage 4 and 5 ROP operated on using vitrectomy techniques and a perfluorocarbon liquid (Vitreon). The surgical technique is described in detail.

Perfluoroperhydrophenanthrene (Vitreon) in the management of giant retinal tears: results of a collaborative study.

Fifty cases of retinal detachment with a giant retinal tear were managed using perfluoroperhydrophenanthrene (Vitreon) as an intraoperative and postoperative tool. The giant tear was less than 180 degrees in 76% of the eyes, greater than 180 degrees in 22%, and greater than 270 degrees in 2%. Proliferative vitreoretinopathy was present in 40%. Vitreon was used only intraoperatively in 84% of the eyes, and was left in 16% for up to 4 weeks. Intraoperative retinal reattachment was achieved in 98%. Retinal attachment was maintained in 88%, with a mean follow up of 8.6 months. Postoperative visual acuity was better than 20/400 in 52%. Postoperative complications included cataract in 23%, choroidal effusion in 2%, hypotony in 4%, and recurrent retinal detachment with proliferative vitreoretinopathy in 26%.

Bimanual technique of subfoveal neovascular membrane removal in presumed ocular histoplasmosis.

We describe a bimanual technique of subfoveal neovascular membrane removal in a patient with presumed ocular histoplasmosis syndrome. His postoperative vision has improved from 20/400 to 20/100 at 3 months follow-up. No recurrence of the membrane was noted.