ABSTRACT
AIM: To examine the histological and immunocytochemical characteristics of epiretinal membranes (ERM) associated with stage 4 macular holes (MH) so as to establish a vitreoretinal rationale for surgery in stage 4 MH. METHOD: Consecutive patients with stage 4 MH undergoing vitrectomy and membrane peeling were recruited. Preoperatively, the eyes were examined for ERM formation over the macula and completeness of posterior hyaloid membrane (PHM) separation from the retina. ERM peel specimens obtained during surgery were sent for histological and immunocytochemical studies and were compared with the PHM specimens taken from a previous post-mortem study of eyes with physiological posterior vitreous detachment but without macular holes. RESULT: A total of 13 patients with stage 4 MH fulfilled the inclusion criteria and were recruited. Preoperatively, all eyes had an ERM over the macula and incomplete separation of the PHM seen as a defect in the PHM on specular biomicroscopy. Histologically, the ERM specimens had very similar morphological characteristics to PHM, consisting of an eosinophilic membrane of varying thickness with scattered spindle-shaped cells. The membranes stained positively for type IV collagen while the cells were glial fibrillary acidic protein positive. Postoperatively, successful closure of MH was achieved in all cases. CONCLUSION: Stage 4 MH is characterised by incomplete separation of the PHM from the retina with remnants overlying the macula manifesting as ERM. Removal of the ERM is required during vitrectomy in order to relieve the tangential forces involved in the development of MH.
Subject(s)
Epiretinal Membrane/surgery , Retinal Perforations/surgery , Aged , Aged, 80 and over , Collagen/metabolism , Epiretinal Membrane/metabolism , Epiretinal Membrane/pathology , Female , Follow-Up Studies , Glial Fibrillary Acidic Protein/metabolism , Humans , Immunoenzyme Techniques , Male , Middle Aged , Retinal Perforations/pathology , Retinal Perforations/physiopathology , Specimen Handling , Treatment Outcome , Visual Acuity , Vitrectomy/methodsSubject(s)
Calcinosis/etiology , Kidney Failure, Chronic/complications , Retinal Artery , Retinal Diseases/etiology , Adult , Female , HumansABSTRACT
OBJECTIVES: To assess the effect of irrigation of the distal vas deferens with sterile water at the time of vasectomy on sperm clearance. Is it possible to accelerate clearance and avoid the problem of lingering sperm? METHODS: Two hundred men undergoing vasectomy were randomized to receive either a standard vasectomy or vasectomy plus irrigation of each vas deferens with sterile water. The interval between vasectomy and the production of two azoospermic semen samples was recorded. RESULTS: Overall, 37 patients were excluded for failing to follow the postvasectomy protocol for semen analysis, leaving 87 in the control group and 76 who received vasal irrigation. No statistically significant differences existed between the two groups with regard to the mean time to clearance (26.4 weeks, control group versus 28.6 weeks, flush group), proportion clear at 16 weeks (29% versus 21%), or proportion with lingering sperm at 40 weeks (22% versus 26%). CONCLUSIONS: Irrigation of the vas deferens with sterile water does not accelerate the clearance of spermatozoa after vasectomy. Men wishing to undergo vasectomy must be counseled about the possibility of lingering sperm.