DENSIRON 68 HEAVY SILICONE OIL AS A SHORT-TERM INTRAOCULAR TAMPONADE FOR MACULA-ON INFERIOR RETINAL DETACHMENTS-A CASE SERIES.

PURPOSE: To describe our experience using short-term heavy silicone oil (Densiron 68) for macula-on inferior rhegmatogenous retinal detachments with inferior retinal breaks. METHODS: Retrospective, consecutive, observational case series. Data were retrospectively collected from the medical records of patients who underwent pars plana vitrectomy and Densiron 68 endotamponade for macula-on rhegmatogenous retinal detachment repair. RESULTS: Eight patients were included in the study. The mean patient age was 57.1 ± 12.3 (±SD) years. The mean time to Densiron 68 removal was 57.8 ± 17.8 (±SD) days (ranging from 24 to 83 days). One patient (12.5%) detached three weeks after Densiron 68 removal and required further surgery. All patients were attached at last follow-up with a mean follow-up of 192 days. The mean final best-corrected visual acuity was 20 of 40 (0.29 logarithm of the minimum angle of resolution) similar to the 20 of 45 preoperative best-corrected visual acuity (0.35 logarithm of the minimum angle of resolution, P = 0.501). No significant emulsification was noted before or during the removal of the Densiron 68. Two patients developed an increase in intraocular pressure before Densiron 68 removal that resolved after removal. One patient developed cystoid macular edema that resolved with a short course of topical medications, and one patient had persistent CME that required an intravitreal triamcinolone acetate 1% injection. CONCLUSION: The high anatomic success rate, good visual outcomes, and minimal complications suggest that Densiron 68 can be considered as a short-term tamponade for macula-on retinal detachments with inferior pathology.

Pars Plana Vitrectomy With or Without Circumferential Scleral Buckling for Primary Repair of Retinal Detachments Secondary to Retinal Dialysis.

PURPOSE: The aim of this study was to evaluate the anatomical and functional outcomes after pars plana vitrectomy with or without circumferential scleral buckling, in patients with retinal detachment secondary to retinal dialysis. DESIGN: Case series. METHODS: A retrospective consecutive case series involving 30 eyes of 30 patients with retinal detachments secondary to retinal dialysis was completed. All 30 patients underwent primary pars plana vitrectomy, with the addition of a circumferential scleral buckle in 24 patients. The main outcome measure was the primary reattachment rate at 6 months after a single surgery. RESULTS: Primary anatomical success was achieved in 90% of patients. The final anatomical success rate was 93%, with 4 of 30 eyes still having silicone oil in situ. The main indication for vitrectomy surgery was an inadequate fundal view for scleral buckle surgery alone. The macula was detached in 50% of patients and proliferative vitreoretinopathy grade C was found in 23% of cases. The mean preoperative visual acuity was 20/814 (range 20/20-light perception) and the mean postoperative visual acuity was 20/258 (range 20/20-hand movements). CONCLUSIONS: Good final anatomical success rates can be achieved with pars plans vitrectomy, plus or minus circumferential buckling, in patients with retinal detachments secondary to retinal dialysis.

Symptomatic intracranial hypertension during recovery from the syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HANDL).

The syndrome of headache with neurologic deficits and cerebrospinal fluid lymphocytosis (HANDL) is rare; it comprises migrainous headaches (generally in headache-naïve people), fluctuating neurological symptoms and cerebrospinal fluid (CSF) lymphocytosis. The syndrome generally runs a benign, self-limiting course over weeks. A small proportion of patients develop intracranial hypertension as a consequence of the illness. Recurrence of headaches or development of visual symptoms following apparent recovery from HANDL should prompt urgent re-evaluation for elevated intracranial pressure. Short-to-medium term management with CSF drainage and acetazolamide may be necessary to prevent visual loss.

Differentiation of compressive from glaucomatous optic neuropathy with spectral-domain optical coherence tomography.

PURPOSE: To compare optic disc topography in eyes with compressive optic neuropathy (CON) and open-angle glaucoma (OAG) using spectral-domain (SD) optical coherence tomography (OCT) and Heidelberg retinal tomograph (HRT) (Heidelberg Engineering GmbH, Heidelberg, Germany). DESIGN: Cross-sectional, observational study. PARTICIPANTS: A total of 200 eyes from 123 patients with CON (69 eyes) or OAG (58 eyes) and controls (73 eyes). METHODS: Univariate and multivariate analyses of HRT parameters, SD-OCT circumpapillary retinal nerve fiber layer (RNFL) thickness, and optic nerve head (ONH) parameters. MAIN OUTCOME MEASURES: Circumpapillary RNFL, OCT ONH parameters, and HRT parameters. RESULTS: The univariate analysis of OCT parameters demonstrated significant differences between the temporal and nasal quadrants; clock hours 3 (55 vs. 73 µm), 4, 8 (93.9 vs. 70.7 µm), 9, and 10; vertical cup-to-disc ratio (C:D) (0.6 vs. 0.8) and cup volume (0.2 vs. 0.5) (P<0.001) between patients with CON and OAG, respectively. The CON discs were significantly different from normal discs for all OCT parameters except cup volume. The CON discs were not significantly different from normal discs for HRT parameters, except for mean RNFL thickness and cup shape measure. The OAG discs were significantly different from normal discs in all HRT and OCT parameters (P<0.001). Multivariate analysis demonstrated that the OCT 3 o'clock temporal sector, average C:D ratio, vertical C:D ratio, and cup volume measurements were able to differentiate OAG from CON. CONCLUSIONS: Compressive optic neuropathy is associated with significantly thinner nasal and temporal sectors compared with OAG, whereas OAG results in larger cups and cup volume with OCT measurements. The Heidelberg retinal tomograph is not able to differentiate CON from normal discs.

Cystoid macular edema associated with acitretin.

Cystoid macular edema represents a "final common pathway" response of the retina to a variety of insults. It has been reported in association with vascular problems, inflammatory conditions, inherited diseases, tractional problems, intraocular surgery and medications. We report a case of cystoid macular edema associated with acitretin in a 65-year-old woman and document its resolution with optical coherence tomography (OCT).

Timing of thrombotic events in patients receiving 2 weeks of clopidogrel therapy post bare metal coronary artery stenting: a New Zealand retrospective study.

OBJECTIVE: To investigate if increased thrombotic events occurred after cessation of a 2-week course of clopidogrel treatment in patients who had implantation of bare metal stent. SETTING: Dunedin Public Hospital, a tertiary referral centre in New Zealand. PATIENTS: 1000 consecutive patients undergoing percutaneous coronary intervention (PCI) with stent implantation from January 2000 to October 2003 were analysed. Those who had successful implantation of bare metal stent without clinical events in the first 24 hours and who received 2 weeks of clopidogrel treatment were included in the study (n=983). MAIN OUTCOME MEASURES: Stent thromboses between 24 hours and 6 weeks post PCI. RESULTS: There were 13 (1.3%) stent thromboses between 24 hours and 6 weeks post PCI, resulting in 3 deaths (23%), 2 ST-elevation acute coronary syndrome [ACS] (15%), and 8 non-ST elevation ACS (62%). The median time for stent thrombosis was 18 +/-s 14 days. Five of the 13 cases (38%) of stent thrombosis occurred after the first 2-weeks (1 in week 3, 1 in week 5, 3 in week 6), and all had predisposing factors for stent thrombosis (2 with stent length > or = to 30 mm, 3 with stent diameter < or = to 2.5mm and 2 with bifurcation stenting). CONCLUSION: Five of 13 (38%) stent thromboses occurred in week 3 to week 6 after cessation of a 2-week course of clopidogrel post bare metal stenting.