Potential complication associated with removal of ganciclovir implants.

PURPOSE: To describe the complication of separation of the medication pellet from the tab during the removal of a ganciclovir implant. METHOD: Case reports. RESULTS: Separation of the pellet from the tab upon removal of ganciclovir implants occurred at the time of reimplantation in two human immunodeficiency virus (HIV)-positive patients with cytomegalovirus (CMV) retinitis. CONCLUSIONS: Our cases show the possibility of pellet separation from the tab during the removal of a ganciclovir implant. Although pellet separation from its tab is rare, surgeons should be aware of this potential complication. Modifying recommended techniques to remove the ganciclovir implant may reduce the incidence of pellet-tab separation.

Surfing-related ocular injuries.

PURPOSE: This report evaluates the clinical characteristics of surfing-related ocular trauma to learn the nature of such injuries and propose possible preventive measures. METHODS: The authors reviewed 11 cases of surfing-related eye injuries caused by direct trauma from the surfboard, studying their mechanism of injury, the associated ocular complications, and the anatomic and visual outcomes of surgical repair. RESULTS: Surfing-related ocular injuries occurred exclusively in young males (mean age, 24.8 years; range, 14-37 years). The mechanism of injury most frequently responsible was impact with the sharp nose of the surfboard following a fall. Serious posterior segment complications were observed in all 11 patients, with nine patients suffering ruptured globes. Despite immediate medical attention, five patients did not recover ambulatory levels of visual acuity (>5/200). CONCLUSIONS: Surfing-related ocular trauma presenting to the retinal specialist typically leaves the patient with a permanent visual disability. Important factors contributing to these high-velocity injuries include the sharply pointed nose of the surfboard and the leash keeping the surfer in close proximity to the board following a fall. A simple modification in surfboard design such as blunting the sharp nose of the surfboard, or appropriate protective guards fitted over the surfboard nose, should lessen the severity of such injuries.

Autogenous fascial grafts for exposed retinal buckles.

Three patients with exposed scleral buckling elements received autogenous fascial grafts as an alternative to buckle removal. All three patients had successful coverage of their scleral buckles. There were no redetachments or infections. One patient had a postoperative ptosis that required repair. Autogenous fascial grafts are useful procedures in patients with exposed retinal buckles who have a significant risk of retinal redetachment with buckle removal.

Ocular toxoplasmosis in patients with the acquired immunodeficiency syndrome.

In seven of eight cases of presumed ocular toxoplasmosis in patients with AIDS, the diagnosis was supported by a reduction or resolution of intraocular inflammation and healing of necrotic retinal lesions after initiation of antiparasitic drug therapy including one or more of the following medications: pyrimethamine, sulfadiazine, clindamycin, tetracycline, or spiramycin. In two cases the diagnosis was confirmed histologically. The cases differed clinically and histopathologically from those in immunocompetent patients. There was no evidence that disease originated in preexisting retinochoroidal scars. Lesions frequently were bilateral and multifocal. Vitreous inflammatory reaction was a common clinical finding, but histopathologic examination demonstrated scant retinal inflammation in areas of necrosis. Ocular toxoplasmosis in these patients with AIDS probably resulted from newly acquired infection or dissemination of organisms from nonocular sites of disease. Infections became clinically inactive with drug therapy in all treated patients, but reactivation and progression of disease occurred when therapy was stopped in two of three patients. Severe retinal necrosis led to retinal tears or detachment in three cases. Ocular lesions were the first manifestation of Toxoplasma gondii infection in four of five patients with evidence of multisystem infection.

Pneumatic retinopexy. Surgical results.

We reviewed 55 consecutive cases of rhegmatogenous retinal detachment treated with pneumatic retinopexy. Eyes with inferior retinal breaks from the 4- to 8-o'clock positions or macular holes with retinal detachment were excluded. Forty-five eyes (82%) were reattached with one operation. Although ten operations failed, nine retinas were subsequently reattached surgically, a 98% overall reattachment rate. Thirty-three (92%) of 36 phakic eyes, eight (66%) of 12 pseudophakic eyes, and four (57%) of seven aphakic retinas were reattached with one operation. In macula-off cases, phakic patients tended to have greater improvement in visual acuity. New breaks occurred in six eyes (11%), five (83%) of which were pseudophakic or aphakic. The safety, efficacy, and indications for pneumatic retinopexy remain to be established by a randomized, controlled, prospective study.

Intraocular carbon dioxide laser photocautery.

The indications and contraindications for the use of carbon dioxide laser photocautery at the time of vitrectomy have been reviewed. Indications include posterior retinal tears either in flat or elevated sensory retina; elevated fibrovascular fronds on the optic nerve or elsewhere; flat neovascularization elsewhere, bleeding rubeotic iris vessels. It is also used as a means of panretinal endophotocoagulation. Contraindications include flat disc neovascularization and areas within one disc diameter of the macula and nerve. The advantages and disadvantages of the 10.6 micrometer infrared wavelength of carbon dioxide laser photocautery are discussed.

Intraocular carbon dioxide laser photosurgery.

Intraocular carbon dioxide laser has been used for photocautery and photo-incision as an adjunct to vitrectomy. This utilizes a new fluid-tissue interface application for the 10.6 micrometer wavelength infrared radiation. The use of an intraocular probe with an infrared transmitting window through a pars plana incision allows the placement of infrared energy in a fluid medium. The results of animal experimentation and of preliminary clinical trials in human patients are reported. The carbon dioxide laser appears to be a safe and reliable means of intraocular photocautery and photoincision.

Pars plana transvitreal carbon dioxide laser photocautery: a new surgical technique.

Intraocular carbon dioxide laser photocautery has been used experimentally as well as clinically to surround and seal retinal tears and to treat fibrovascular fronds and blood vessels at the time of vitrectomy. All biologic tissue will absorb the 10.6-microm infrared wavelength; thus the tissue does not have to be pigmented in order to absorb infrared energy. This technique involves no electrical hazard to the patient or surgeon. We have followed patients treated with the carbon dioxide laser, and they have retained improved vision for over 18 months. Intraocular carbon dioxide laser photocautery appears to be a safe, reliable, and effective means of performing intraocular photocautery at the time of vitrectomy.

Intraocular carbon dioxide laser photocautery. II. Preliminary report of clinical trials.

Carbon dioxide laser photocautery was used successfully intraocularly in human patients to seal fibrovascular fronds and retinal tears at the time of vitrectomy. Closure of rubeotic vessels in the iris was demonstrated histologically. The 10.6-microgram infrared radiation was delivered to the intraocular treatment site by means of 1.5-mm-diameter photocautery probe containing a 1.0-mm-diameter lumen closed at the end with an infrared transmitting window. Treatment was localized to the tissue adjacent to the window. Typical energy dosage was 0.4 W for 2 to 4 s duration. These early clinical trials were carried out under the guidelines established by the Food and Drug Administration; informed consent clearly outlined the experimental nature of these studies.