Stage III macular hole surgery.

Twelve macular holes in 12 patients underwent a pars plana vitrectomy and epiretinal membrane resection with intravitreal gas tamponade for repair of their macular holes. The patients had stage III macular holes and had previously undergone a normal funduscopic examination within 2 years. The patients have been followed for a mean of 14 months (range 12-18 months) postoperatively. The results show that visual acuity improvements were not seen until at least 6 months after surgery if the hole was closed successfully. Seven holes were closed (58.3%) and all improved their best corrected visual acuity by more than two Snellen lines. In the five eyes that did not demonstrate hole closure (41.6%), one eye improved by two lines as well. The other four eyes remained at their preoperative acuity. One eye developed a dialysis which responded to a fluid air exchange and cryopexy (8.3%). Three eyes developed minimal lenticular opacities during the follow up period (25%). One eye demonstrated an altered perifoveal pigment epithelium perhaps related to intraoperative light toxicity. Macular hole surgery can restore some central acuity even in patients with longstanding holes.

Treatment of retinal detachments in patients with the acquired immune deficiency syndrome.

Thirty-nine eyes from 31 patients with retinal detachment due to cytomegalovirus (CMV) retinitis were treated by either laser photocoagulation (22 eyes), scleral buckle (9 eyes), pars plana vitrectomy (5 eyes), or no therapy (3 eyes). The success rates for photocoagulation (77.2%), scleral buckle (77.7%), and vitrectomy (with gas or oil, 80%) were similar. The median survival time was 95 days (range, of 7 to 280 days). The extent of detachment, the presence of active disease in either the periphery or the posterior pole, and overall health served to determine what type of therapy was best suited for each patient. Although silicone oil appears to be best for patients with a total retinal detachment and active disease, this small series suggests that conservative modes of therapy such as laser photocoagulation and scleral buckles can be used successfully to treat these patients if there is an absence of active retinitis.

Seizures associated with fluorescein angiography.

We describe a case of grand mal generalized tonic-clonic seizure after fluorescein angiography. The patient had a history of seizure disorders and had been controlled with proper medication before the test. We advocate the need to include diazepam and phenytoin in the list of emergency medications needed to control adverse reactions of fluorescein angiography.