RESUMO
By comparing the incidence of cystoid macular edema (CME) in three groups of patients having different surgical procedures, we attempted to assess the role of vitreous loss as a risk factor for CME development. In the first group (n = 470), the surgical procedure was extracapsular cataract extraction followed by implantation of posterior chamber lens (EC-CE + PC-IOL). The second group (n = 42) had extracapsular cataract extraction which was complicated by posterior capsule rupture, and therefore anterior vitrectomy followed by implantation of anterior chamber lens had to be performed (ECCE + anterior vitrectomy + AC-IOL). In the third group (n = 22) the surgery was intracapsular cataract extraction followed by anterior chamber lens implantation (ICCE + AC-IOL). The third group was included in this follow up study to assess the role of AC-IOL as a possible causative factor for development of CME in uncomplicated cases of ICCE and AC-IOL. The difference of incidences of CME in the second and third group would therefore depend mostly on the vitreous loss. The incidence of CME diagnosed by fluorescein angiography in the first, second and third group was 1.5% (7/470), 35.7% (15/42) and 9.0% (2/22), respectively. All patients who developed CME were treated with combination of corticosteroid-antibiotic drops, dexamethasone retrobulbarly (40 mg/day) and peroral indomethacin (25 mg/day/6 weeks). This therapeutic regime resulted in only moderate improvement of visual acuity.
Assuntos
Câmara Anterior/cirurgia , Extração de Catarata/efeitos adversos , Cápsula do Cristalino/lesões , Lentes Intraoculares/efeitos adversos , Edema Macular/etiologia , Antibacterianos/uso terapêutico , Angiofluoresceinografia , Fundo de Olho , Glucocorticoides/uso terapêutico , Humanos , Incidência , Edema Macular/tratamento farmacológico , Fatores de Risco , Ruptura , VitrectomiaRESUMO
In spite of hundreds of harmless retrobulbar applications of anesthetics and drugs, a certain risk still exists. In the past ten years in our Department with 7200 retrobulbar procedures performed in local anesthesia and 12500 retrobulbar applications of the drugs (corticosteroids, antibiotics, vasodilatators) 14 incidents were registered. Palpebral chemosis and retrobulbar hematoma or eyeball protrusion were transient in 11 patients. Acute disturbance of the chorioretinal circulation occurred in three patients. In one of them vascular occlusion was total with permanent loss of vision, while in the other two recuperation of vision was the sign that vascular spasm was transient.
