Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 741
Filtrar
1.
Zhonghua Yan Ke Za Zhi ; 55(10): 747-756, 2019 Oct 11.
Artigo em Chinês | MEDLINE | ID: mdl-31607063

RESUMO

Objective: To investigate the characteristics of morphological changes of inner retinal layer after internal limiting membrane peeling in macular hole surgery. Methods: Retrospective case study. Patients with idiopathic macular hole from 2015 to 2018 underwent vitrectomy+internal limiting membrane peeling (inverting)+ gas tamponade in China-Japan Friendship Hospital were investigated. A total of 19 eyes (17 patients) were enrolled, including 4 males (4 eyes) and 13 females (15 eyes). The average age was 62.74±5.25 years. Optical coherence tomography (OCT) was used to obtain the topographic maps of retinal thickness, the thickness of retinal ganglion cell complex and probability maps, and the Angio/en-face maps of macular retina. The characteristics of the morphological changes of the inner retinal were comprehensively analyzed. Results: Among 19 eyes, 9 eyes had internal limiting membrane peeling, 8 eyes had lotus-like internal limiting membrane inverting, and 2 eyes had the uper180 degrees internal limiting membrane inverting. The minimum diameter of macular hole was (543.06+220.17) µm and the maximum diameter was (947.18+319.12) µm. The follow-up time was (21.05+9.66) months, and the visual acuity was 0.45+0.35 at the last follow-up. In the 19 eyes, all the macular holes were closed postoperatively and dissociated optic nerve fiber layer appearance (DONFL) and concentric macular dark spots (CMDS) all showed, as well as mGCC thinning. The changes of CMDS and mGCC in 2 eyes in the uper180 degrees internal limiting membrane inverting group were mainly seen in the upper retina and in the remaining 17 eyes were seen diffused around the macula, which roughly corresponded to the extent of internal limiting membrane peeling. Two eyes showed clear decrease of retinal capillary density on Angio/map. Conclusions: Long-term morphological changes of the inner retinal after internal limiting membrane peeling in macular hole surgery are obvious. In addition to the appearance changes like DONFL and CMDS, the macular ganglion cell complex (mGCC) is also involved. (Chin J Ophthalmol, 2019, 55:747-756).


Assuntos
Membrana Basal/cirurgia , Membrana Epirretiniana/cirurgia , Retina/patologia , Perfurações Retinianas/cirurgia , Vitrectomia , Idoso , China , Membrana Epirretiniana/diagnóstico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retina/diagnóstico por imagem , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/diagnóstico por imagem , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento
2.
Ophthalmologica ; 242(4): 222-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533121

RESUMO

PURPOSE: To report the surgical results and technique of perfluorocarbon-assisted neurosensory retinal flap transplantation into macular hole for concomitant macular hole and complicated retinal detachment. METHOD: This is a retrospective, consecutive case series of 7 cases with concomitant macular hole and complicated retinal detachment with proliferative vitreoretinopathy. All eyes had previous vitrectomy and internal limiting membrane peeling, or very large (>1,000 µm) macular holes. Perfluorocarbon liquid-assisted free neurosensory retinal flap transplantation into the macular hole, and subretinal fluid drainage through iatrogenic retinectomy/retinotomy were performed, followed by air-fluid exchange with gas or silicone oil tamponade. RESULTS: All eyes had retina reattached. Macular hole was closed in all eyes, with the graft visualized by optical coherence tomography. The best corrected visual acuity in logarithm of minimal angle of resolution improved from 2.80 ± 0.45 preoperatively to 1.40 ± 0.51 postoperatively (p < 0.01). CONCLUSIONS: Neurosensory retinal flap may be a good option in closing macular holes in eyes with concomitant macular hole and complicated retinal detachment. Because of its specific properties, the flap is easy to handle during the operation. Retinectomy or retinotomy serves to release traction, drain subretinal fluid, and provide retinal flap tissue.


Assuntos
Tamponamento Interno/métodos , Fluorcarbonetos/farmacologia , Retalhos de Tecido Biológico , Retina/transplante , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Vitrectomia/métodos , Idoso , Feminino , Seguimentos , Humanos , Macula Lutea/patologia , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/complicações , Descolamento Retiniano/diagnóstico , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Tomografia de Coerência Óptica , Resultado do Tratamento , Vitreorretinopatia Proliferativa/complicações , Vitreorretinopatia Proliferativa/diagnóstico , Vitreorretinopatia Proliferativa/cirurgia
3.
Turk J Ophthalmol ; 49(4): 209-212, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31486608

RESUMO

Objectives: To investigate the frequency of retinal tear, retinal hole, and lattice degeneration in peripheral retinal examination of patients with macular hole. Materials and Methods: The files of patients who underwent pars plana vitrectomy surgery with a diagnosis of macular hole at Eskisehir Osmangazi University Department of Ophthalmology between 2008 and 2018 were retrospectively analyzed. A total of 106 patients with primary macular hole who underwent peripheral retinal examination were included in the study. The frequency of retinal tears, holes, and lattice degeneration associated with macular hole was investigated. Results: Peripheral retinal examination of 106 patients who underwent macular hole surgery revealed retinal tear in 3 patients (2.8%), retinal hole in 4 patients (3.8%), and lattice degeneration in 10 patients (9.4%). Retinal hole and lattice degeneration were observed concomitantly in 1 patient. Conclusion: This study showed that patients with macular hole have concomitant retinal tears and holes, which are also thought to arise due to vitreoretinal traction, at a frequency similar to that in the general population. This result suggests that both the anterior and posterior vitreous may have different pathologies at the same time related to these diseases.


Assuntos
Degeneração Retiniana/epidemiologia , Descolamento Retiniano/epidemiologia , Perfurações Retinianas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Perfurações Retinianas/epidemiologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual , Corpo Vítreo/patologia
4.
Medicine (Baltimore) ; 98(31): e16577, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374025

RESUMO

RATIONALE: Macular hole (MH) is a rare complication of Terson syndrome. Delayed closure of persistent MH after pars plana vitrectomy (PPV) is occasionally reported in literature, none of them is MH secondary to Terson syndrome. We describe a case of MH secondary to Terson syndrome and delayed closure occurred after PPV, and we also study the characteristics of delayed closure of persistent MH by reviewing related literatures. PATIENT CONCERNS: A 61-year-old man presented with vitreous hemorrhage in right eye following a subarachnoid hemorrhage due to spontaneous rupture of his right vertebral artery dissecting aneurysm. The visual acuity was hand motion in the right eye and 20/30 in the left eye. Fundus examination showed dense and diffuse vitreous hemorrhage in the right eye. DIAGNOSES: Terson syndrome was diagnosed according to his subarachnoid hemorrhage history and vitreous hemorrhages in right eye. INTERVENTIONS: PPV combined with phacoemulsification and intraocular lens implantation was performed in his right eye, and internal limiting membrane (ILM) peeling was also performed due to a MH noted during the surgery. OUTCOMES: One week after PPV, optical coherence tomography (OCT) showed a persistent MH. Without any intervention, the MH became smaller and flattened, with the best corrected visual acuity (BCVA) improved to 30/200 at 1 month after surgery. Six months later, the MH completely closed with BCVA improved to 20/40. According to our literature review, there are 8 cases of the delayed MH closure, which includes idiopathic MH (4 eyes), traumatic MH (2 eyes), and vitreomacular traction (2 eyes). There is no report about delayed closure of MH secondary to Terson syndrome. The times for these delayed closure occurred following PPV were ranged from 1 to 28 months. Holes even with obviously raised edges after PPV may spontaneously close, just like the case presented here. LESSONS: Delayed closure of persistent MH after PPV is rarely reported. The significance of this case is to suggest that similar patients should be monitored carefully by OCT, and additional surgery for the MH may be delayed, since delayed closure is possible. The exact mechanisms of delayed closure of persistent MH still need to be clarified.


Assuntos
Perfurações Retinianas/complicações , Hemorragia Subaracnóidea/complicações , Hemorragia Vítrea/complicações , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Facoemulsificação , Perfurações Retinianas/cirurgia , Vitrectomia , Hemorragia Vítrea/cirurgia
5.
Cir Cir ; 87(5): 496-500, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448802

RESUMO

Objective: To identify the efficacy and safety of the steam-roller maneuver, in patients treated with pneumatic retinopexy. Method: Experimental, prospective, comparative, longitudinal study in patients with retinal detachment, treated with pneumatic retinopexy. Patients were assigned to one of two groups: without steam roller maneuver (group 1) or with it (group 2). The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events were compared between groups (chi squared); preoperative and postoperative visual acuity in logMAR was compared within groups (Wilcoxon's t). Results: 40 eyes were evaluated (mean age 55.9 ± 13.3 years); 15 were assigned to group 1, 25 to group 2. The proportions of single-intervention anatomical success, visual improvement, anatomical success with reintervention, and adverse events did not differ between groups (p > 0.05). At the end of follow up, visual acuity improved in both groups; however, it only improved in group 2, in eyes with single intervention anatomical success (mean log MAR before surgery 1.72 ± 1.64; after surgery 0.61 ± 0.61; p = 0.008). Conclusions: The steam roller maneuver is efficient for improving visual acuity in patients with pneumatic retinopexy, who achieve single intervention anatomical success; furthermore, the maneuver does not impair prognosis in eyes that require reintervention.


Assuntos
Movimentos da Cabeça , Modalidades de Fisioterapia , Descolamento Retiniano/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Injeções Intraoculares , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Hexafluoreto de Enxofre/administração & dosagem , Resultado do Tratamento , Acuidade Visual
6.
Graefes Arch Clin Exp Ophthalmol ; 257(10): 2147-2154, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31342148

RESUMO

PURPOSE: To investigate the outcomes of embedding lamellar hole-associated epiretinal proliferation (LHEP) into retinal cleavage for the surgical treatment of degenerative lamellar macular hole (LMH). METHODS: We retrospectively reviewed the medical records of 34 consecutive eyes of degenerative LMH patients who underwent vitrectomy with LHEP embedding and who were followed up for at least 12 months. Best-corrected visual acuity (BCVA), central retinal thickness (CRT), and macular structure preoperatively and at the final follow-up were compared. RESULTS: The mean (±SD) follow-up period was 30.0 ± 17.7 months. Twelve patients (35.3%) were men, and the mean age was 69.6 ± 10.1 years. Twenty-three eyes (67.6%) underwent simultaneous cataract surgery. BCVA was significantly improved at the final visit, from 0.31 ± 0.25 logarithm of the minimum angle of resolution units to 0.10 ± 0.25 (P < 0.01). This improvement in mean BCVA at the final postoperative visit occurred regardless of whether the eyes underwent simultaneous cataract surgery, from 0.30 ± 0.26 preoperatively to 0.04 ± 0.16 (P < 0.01) in the "with cataract surgery" group and from 0.32 ± 0.26 preoperatively to 0.21 ± 0.35 (P < 0.05) in the "without cataract surgery" group. CRT was also significantly improved at the final visit, from 123.2 ± 42.6 µm preoperatively to 191.2 ± 42.6 µm (P < 0.01). External limiting membrane and ellipsoid zone defects were detected in 17 (50.0%) and 15 (44.1%) eyes, respectively, but these were resolved in 10 (58.8%) and 7 (46.7%) eyes, respectively, at the final visit. No intraoperative or postoperative complications were observed. CONCLUSIONS: Embedding LHEP may be an effective and safe procedure to treat degenerative LMH.


Assuntos
Membrana Epirretiniana/cirurgia , Angiofluoresceinografia/métodos , Retina/patologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos , Idoso , Membrana Epirretiniana/diagnóstico , Membrana Epirretiniana/etiologia , Feminino , Seguimentos , Fundo de Olho , Humanos , Masculino , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento
7.
Korean J Ophthalmol ; 33(2): 142-149, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30977324

RESUMO

PURPOSE: To determine the origin of epiretinal proliferation (EP), a condition that is occasionally observed in lamellar hole and macular hole cases, and EP outcomes after vitrectomy. METHODS: This is a retrospective observational case review of 17 eyes with EP that underwent vitrectomy, EP dissection, and internal limiting membrane peeling between January 2013 and December 2016. Surgical specimens of EP tissue were successfully obtained from 5 cases and they were analyzed after immunohistochemical staining. Postoperative outcomes, including best-corrected visual acuity (BCVA) and macular configuration in spectral domain-optical coherence tomography, were reviewed. RESULTS: Mean BCVA improved from 0.54 ± 0.36 logarithms of the minimum angle of resolution preoperatively to 0.32 ± 0.38 logarithms of the minimum angle of resolution postoperatively (p = 0.002). BCVA improved in 13 eyes and remained unchanged in four eyes. No cases experienced vision decline after surgery. All 17 patients' lamellar hole or macular hole were successfully closed. Despite hole closure, ellipsoid zone defects were not corrected in 11 of the 17 patients. In immunohistochemical analyses, anti-glial fibrillary acidic protein and pan-keratin (AE1/AE3) were positive, but synaptophysin, anti-α-smooth muscle actin, and anti-CD68 were negative. CONCLUSIONS: The epiretinal proliferative membrane seems to originate from Müller cells, not from the vitreous. It is unclear whether retinal pigment epithelia also contribute to EP formation. Gentle handling and preservation of the epiretinal proliferative tissue is crucial for successful surgical outcomes.


Assuntos
Células Ependimogliais/patologia , Membrana Epirretiniana/diagnóstico , Retina/patologia , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica/métodos , Acuidade Visual , Vitrectomia/métodos , Proliferação de Células , Membrana Epirretiniana/etiologia , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos
8.
Ophthalmol Retina ; 3(1): 32-41, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30935657

RESUMO

PURPOSE: To evaluate clinical outcomes and safety up to 12 months after ocriplasmin injection for the treatment of patients with symptomatic vitreomacular adhesion (VMA)/vitreomacular traction (VMT) in a real-world setting. DESIGN: The Phase IV Ocriplasmin Research to Better Inform Treatment (ORBIT) trial (NCT02079883) was a Phase IV multicenter, prospective, observational study. PARTICIPANTS: Patients aged ≥18 years with symptomatic VMA/VMT treated with ocriplasmin. METHODS: Patients received a single 0.125 mg intravitreal injection of ocriplasmin. All assessments and treatment decisions were at the discretion of the treating physician. Spectral-domain OCT (SD-OCT) images were analyzed by an independent central reading center (CRC). All enrolled patients were included in demographic, baseline characteristics, and safety analyses. Patients with symptomatic VMA/VMT at baseline determined by CRC were included in baseline ocular characteristics and efficacy analyses. MAIN OUTCOME MEASURES: Clinical outcomes were measured up to 12 months and included resolution of symptomatic VMA, closure of full-thickness macular hole (FTMH), mean change from baseline in best-corrected visual acuity (BCVA), incidence of vitrectomy, and time to first vitrectomy. Safety outcomes included the incidence and timing of onset of adverse drug reactions (ADRs). RESULTS: Of the 539 patients enrolled, 480 were determined to have symptomatic VMA/VMT at baseline post-CRC assessment. After treatment with ocriplasmin, the rate of VMA/VMT resolution was 45.8% (95% confidence interval [CI], 41.3-50.4) at month 1 and 59% (95% CI, 54.4-63.4) at months 10 to 12. The rate of FTMH closure was 30.5% (95% CI, 22.4-39.7) at month 1 and 32.2% (95% CI, 23.9-41.4) at months 10 to 12. Mean (standard deviation) change from baseline in BCVA was 1.5 (11.19) letters at month 1 and 5.2 (13.60) letters at months 10 to 12. Vitrectomy was performed in 28.5% of patients, with a median time to vitrectomy of 63 days. Adverse drug reactions were reported by 30.6% of patients; 5.2% experienced a serious ADR. CONCLUSIONS: Results from the ORBIT study demonstrate that treatment with ocriplasmin is effective and well tolerated in patients with symptomatic VMA/VMT in a real-world setting. The percentage of patients with VMA/VMT resolution at month 1 was higher than previously reported in well-controlled clinical trials. No new safety signals were identified.


Assuntos
Fibrinolisina/administração & dosagem , Fragmentos de Peptídeos/administração & dosagem , Perfurações Retinianas/tratamento farmacológico , Acuidade Visual , Corpo Vítreo/patologia , Descolamento do Vítreo/tratamento farmacológico , Idoso , Feminino , Seguimentos , Humanos , Injeções Intravítreas , Masculino , Estudos Prospectivos , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Tomografia de Coerência Óptica/métodos , Resultado do Tratamento , Descolamento do Vítreo/complicações , Descolamento do Vítreo/diagnóstico
9.
Cochrane Database Syst Rev ; 3: CD009562, 2019 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-30848830

RESUMO

BACKGROUND: Rhegmatogenous retinal detachment (RRD) is a separation of neurosensory retina from the underlying retinal pigment epithelium. It is caused by retinal tears, which let fluid pass from the vitreous cavity to the subretinal space. Pars plana vitrectomy (PPV), scleral buckling surgery and pneumatic retinopexy are three accepted management strategies whose efficacy remains controversial. Pneumatic retinopexy is considered in a separate Cochrane Review. OBJECTIVES: The primary objective of this review was to assess the efficacy of PPV versus scleral buckling for the treatment of simple RRD (primary RRD of any extension with up to two clock hours large break(s) regardless of their anterior/posterior localisation) in people with (phakia) or without (aphakia) a natural lens in the eye, or with an artificial lens (pseudophakia). A secondary objective was to assess any data on economic and quality-of-life measures. SEARCH METHODS: We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the WHO ICTRP. The date of the search was 5 December 2018. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing PPV versus scleral buckling surgery with at least three months of follow-up. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology. Two review authors independently extracted the data and study characteristics from the studies identified as eligible after initial screening. We considered the following outcomes: primary retinal reattachment, postoperative visual acuity, final anatomical success, recurrence of retinal detachment, number of interventions needed to achieve final anatomical success, quality of life and adverse effects. We assessed the certainty of evidence using GRADE. MAIN RESULTS: This review included 10 RCTs (1307 eyes of 1307 participants) from Europe, India, Iran, Japan and Mexico, which compared PPV and scleral buckling for RRD repair. Two of these 10 studies compared PPV combined with scleral buckling with scleral buckling alone (54 participants). All studies were high or unclear risk of bias on at least one domain. Five studies were funded by non-commercial sources, while the other five studies did not report source of funding.There was little or no difference in the proportion of participants who achieved retinal reattachment at least 3 months after the operation in the PPV group compared to those in the scleral buckling group (risk ratio (RR) 1.07, 95% confidence intervals (CI) 0.98 to 1.16; 9 RCTs, 1261 participants, low-certainty evidence). Approximately 67 in every 100 people treated with scleral buckling had retinal reattachment by 3 to 12 months. Treatment with PPV may result in 4 more people with retinal reattachment in every 100 people treated (95% confidence interval (CI) 2 fewer to 11 more).There was no evidence of any important difference in postoperative visual acuity between participants in the PPV group compared to those in the scleral buckling group (mean difference (MD) 0.00 logMAR, 95% CI -0.09 to 0.10, 6 RCTs, 1138 participants, low-certainty evidence).There was little or no difference in final anatomical success between participants in the PPV group and scleral buckling group (RR 1.01, 95% CI 0.99 to 1.04, 9 RCTs, 1235 participants, low-certainty evidence). There were 94 out of 100 people treated with control (scleral buckling) that achieved final anatomical success compared to 96 out of 100 in the PPV group.Retinal redetachment was reported in fewer participants in the PPV group compared to the scleral buckling group (RR 0.75 (95% CI 0.59 to 0.96, 9 RCTs, 1320 participants, low-certainty evidence). Approximately 28 in every 100 people treated with scleral buckling had retinal detachment by 3 to 36 months. Treatment with PPV may result in seven fewer people with retinal detachment in every 100 people treated (95% CI 1 to 11 fewer).Participants treated with PPV on average needed fewer interventions to achieve final anatomical success but the difference was small and data were skewed (MD -0.20, 95% CI -0.34 to -0.06, 2 RCTs, 682 participants, very low-certainty evidence).Very low-certainty evidence on quality of life suggested that more people in the PPV group were "satisfied with vision" compared with the scleral buckling group (RR 6.22, 95% CI 0.88 to 44.09, 1 RCT, 32 participants).All included studies reported adverse effects, however, it was not always clear whether they were reported as number of participants or number of adverse effects. Cataract development or progression was more prevalent in the PPV group (RR 1.71, 95% CI 1.45 to 2.01), choroidal detachment was more prevalent in the scleral buckling group (RR 0.19, 95% CI 0.06 to 0.65) and new/iatrogenic breaks were observed only in the PPV group (RR 8.21, 95% CI 1.91 to 35.21). Estimates of the relative frequency of other adverse effects, including postoperative proliferative vitreoretinopathy, postoperative increase in intraocular pressure, development of cystoid macular oedema, macular pucker and strabismus were imprecise. Evidence for adverse effects was low-certainty evidence. AUTHORS' CONCLUSIONS: Low- or very low-certainty evidence indicates that there may be little or no difference between PPV and scleral buckling in terms of primary success rate, visual acuity gain and final anatomical success in treating primary RRD. Low-certainty evidence suggests that there may be less retinal redetachment in the PPV group. Some adverse events appeared to be more common in the PPV group, such as cataract progression and new iatrogenic breaks, whereas others were more commonly seen in the scleral buckling group such as choroidal detachment.


Assuntos
Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Recurvamento da Esclera , Vitrectomia , Humanos , Complicações Pós-Operatórias , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Descolamento Retiniano/etiologia , Recurvamento da Esclera/efeitos adversos , Recurvamento da Esclera/estatística & dados numéricos , Resultado do Tratamento , Acuidade Visual , Vitrectomia/efeitos adversos , Vitrectomia/estatística & dados numéricos
11.
Medicine (Baltimore) ; 98(4): e14271, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30681627

RESUMO

RATIONALE: We experienced 2 cases of retinal detachment (RD) with giant tears located in the intermediate periphery of the fundus. In this case report, we investigated the clinical characteristics in these 2 cases. PATIENT CONCERNS AND DIAGNOSES: Case 1 involved a 63-year-old male, who became aware of metamorphopsia and decreased visual acuity (VA) in his left eye. Upon examination, he was diagnosed with a giant tear at the margin of the intermediate peripheral lattice degeneration. Case 2 involved a 54-year-old male, who became aware of decreased VA in his right eye. Upon examination, he was diagnosed with vitreous hemorrhage and a giant tear located in the upper intermediate periphery. In these 2 cases, there was no obvious previous or familial history. INTERVENTIONS: In both cases, reattachment was achieved by performing vitrectomies. OUTCOMES: These 2 cases were characterized by the refraction being close to emmetropia due to the flat corneal curvature, even though there was a long axial length and the eyeballs were spherically large. In both cases, the postoperative clinical course outcome was favorable and no complication occurred LESSONS:: Our findings indicate that intermediate peripheral giant tears may occur in spherically large eyeballs, and that vitreous surgery is effective in such cases. Since the risk of the onset of RD in the fellow eye is thought to be high, strict postoperative follow-up is necessary.


Assuntos
Degeneração Retiniana/complicações , Descolamento Retiniano/complicações , Perfurações Retinianas/complicações , Descolamento do Vítreo/complicações , Fundo de Olho , Humanos , Masculino , Pessoa de Meia-Idade , Degeneração Retiniana/cirurgia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Acuidade Visual , Vitrectomia , Descolamento do Vítreo/cirurgia
12.
Acta Ophthalmol ; 97(2): e271-e276, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30284388

RESUMO

PURPOSE: To evaluate the outcomes of pars plana vitrectomy with silicone oil tamponade in the management of retinal detachment associated with giant retinal tears. METHODS: We reviewed 45 eyes of 42 patients with primary retinal detachment associated with giant retinal tears over 10 years at a tertiary referral centre. Patients underwent 23-gauge vitrectomy without adjuvant scleral buckling by a single surgeon and had follow-up at least 6 months after silicone oil removal. RESULTS: Mean follow-up was 37 ± 35 months. Seven eyes (16%) had grade C proliferative vitreoretinopathy, and 16 (36%) had a giant retinal tear ≥180° at baseline. The primary reattachment rate was 84%, and the overall final anatomical success rate was 98%. The mean Snellen visual acuity equivalent at the final visit was 20/58. Final visual acuity ≥20/40 was achieved in 64%. The mean duration of silicone oil tamponade was 10.5 ± 4 weeks. By the final visit, silicone oil had been removed from 44 eyes (98%). CONCLUSION: The high rates of anatomical and functional success support management of giant retinal tears-associated retinal detachment with vitrectomy without adjuvant scleral buckling. Removal of silicone oil at the earliest possible time helps to avoid complications such as keratopathy, glaucoma and visual loss without apparent reason.


Assuntos
Tamponamento Interno/métodos , Descolamento Retiniano/cirurgia , Perfurações Retinianas/cirurgia , Óleos de Silicone/administração & dosagem , Acuidade Visual , Vitrectomia/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Perfurações Retinianas/diagnóstico , Estudos Retrospectivos , Recurvamento da Esclera , Resultado do Tratamento , Adulto Jovem
13.
Ophthalmic Res ; 61(2): 88-93, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29788031

RESUMO

PURPOSE: The aim of this study was to demonstrate the surgical technique and clinical outcome of autologous neurosensory retinal patch transplantation for recurrent large macular hole (MH)-induced retinal detachment after failed surgery with internal limiting membrane (ILM) removal or transplantation. METHODS: We reviewed 5 patients with recurrent MH-induced retinal detachment after failed surgeries with ILM removal or transplantation who underwent vitrectomy combined with autologous neurosensory retinal patch transplantations and were followed up over 6 months. In the autologous neurosensory retinal patch transplantation procedure, a small piece of neurosensory retina was removed and transplanted inside the MH. The anatomic outcomes of MH-induced retinal detachment were evaluated by fundus examinations and optical coherence tomography. The pre-operative and postoperative best-corrected visual acuities (BCVAs) were compared and the MH closure rates were measured as the main outcomes. RESULTS: A total of 5 patients (3 men and 2 women; average age 35.4 ± 18.72 years) were included in our study. Complete MH sealing was achieved in 5 eyes after autologous neurosensory retinal patch transplantations, and no complications were observed. The mean BCVA was 2.38 ± 0.57 (range 1.6-3) before surgery, and 1.46 ± 0.51 (range 1-2) at 6 postoperative months. There was a significant difference in BCVA before versus after the surgery (p < 0.05, paired t test). CONCLUSIONS: Autologous neurosensory retinal patch transplantation is an effective addition to the surgical options for large MH-induced retinal detachment after failed surgery with ILM removal or transplantation.


Assuntos
Retina/transplante , Perfurações Retinianas/cirurgia , Adolescente , Adulto , Criança , Tamponamento Interno , Feminino , Humanos , Fotocoagulação a Laser , Masculino , Pessoa de Meia-Idade , Retina/fisiopatologia , Descolamento Retiniano/etiologia , Perfurações Retinianas/complicações , Perfurações Retinianas/fisiopatologia , Estudos Retrospectivos , Óleos de Silicone/administração & dosagem , Tomografia de Coerência Óptica , Transplante Autólogo , Acuidade Visual/fisiologia , Vitrectomia/métodos , Adulto Jovem
14.
Retin Cases Brief Rep ; 13(1): 21-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30562236

RESUMO

PURPOSE: 1) To evaluate factors governing flow of subretinal fluid and validate Lincoff rules (LRs) in cases of rhegmatogenous retinal detachment. 2) To identify cases of rhegmatogenous retinal detachment where LRs are not followed. METHOD: This was a retrospective study where 253 patients of rhegmatogenous retinal detachment were identified through surgery records. Two hundred and twenty-nine case sheets with complete record of ocular examination and surgical findings were analyzed. Seventy-five of the 229 patients, having subtotal rhegmatogenous retinal detachment where LR could be applied were included for analysis. Validity of LR was analyzed about location of break, lattice degeneration, posterior vitreous detachment (PVD), proliferative vitreoretinopathy, lens status, myopia, and trauma. RESULT: The mean age of the patients was 40.12 years. Sixty-one were men. Lincoff rule was validated in 59 of the 75 patients. Anterior breaks (P < 0.008) and PVD (P < 0.001) were found to have a significant association with validity of LR. Other attributes did not have a statistically significant association with validity of LR. CONCLUSION: Presence of posterior retinal breaks and absent PVD is associated with unusual flow of subretinal fluid. Lincoff rules are valid in most of the clinical scenarios.


Assuntos
Descolamento Retiniano/diagnóstico , Perfurações Retinianas/diagnóstico , Acuidade Visual , Descolamento do Vítreo/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Microscopia Acústica , Pessoa de Meia-Idade , Oftalmoscopia , Descolamento Retiniano/etiologia , Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Recurvamento da Esclera , Vitrectomia , Descolamento do Vítreo/complicações , Descolamento do Vítreo/cirurgia , Adulto Jovem
15.
Klin Monbl Augenheilkd ; 236(8): 990-998, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30005441

RESUMO

The traumatic macular hole (TMH) is a rare complication of a blunt or an open injury of the globe and can lead to permanent loss of vision. The pathomechanism of TMH differs from that of the idiopathic macular hole (IMH). A sudden compression and expansion of the globe leads to vitreous traction, which can result in a TMH. The final visual acuity depends on the severity of the disruption of the photoreceptors and the retinal pigment epithelial cells. The posttraumatic approach is discussed controversially. A spontaneous closure and, therefore, a conservative approach should be considered in young patients with minor defects and good visual acuity without detachment of the posterior vitreous body. In these cases, it is advisable to wait for months. In the absence of adhesion at the edges of the hole and concomitant pathologies of the pigment epithelium, the spontaneous closure is improbable. In this case, a pars plana vitrectomy with removal of the vitreous and epiretinal membranes can lead to anatomical reconstruction and improvement of the visual acuity. The success of an operative intervention is complex and is associated with the experience of the surgeon as well as the characteristics of the trauma.


Assuntos
Membrana Epirretiniana , Perfurações Retinianas , Humanos , Perfurações Retinianas/complicações , Perfurações Retinianas/etiologia , Acuidade Visual , Vitrectomia , Corpo Vítreo
16.
Ophthalmic Surg Lasers Imaging Retina ; 49(11): 901-903, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30457651

RESUMO

The authors report a case of a retinal detachment secondary to multiple eccentric macular holes (MEMHs) following an uneventful pars plana vitrectomy and epiretinal membrane peel, successfully treated by autologous lens capsule graft. Anatomical and functional changes were also evaluated. Autologous lens capsule graft is a safe and effective treatment for MEMHs that may improve anatomical and functional results. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:901-903.].


Assuntos
Cápsula do Cristalino/transplante , Descolamento Retiniano/cirurgia , Perfurações Retinianas/complicações , Retalhos Cirúrgicos , Acuidade Visual , Vitrectomia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/etiologia , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Tomografia de Coerência Óptica , Transplante Autólogo
18.
Indian J Ophthalmol ; 66(5): 706-708, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29676325

RESUMO

Spontaneous vitreous hemorrhage is a rare entity, present in 7 out of 100,000 inhabitants. It is associated with different pathologies; however, it is rarely reported to be caused by retinal vessel avulsion syndrome. In the present manuscript, we report a case of avulsion of retinal vessels associated with recurrent vitreous hemorrhage managed, at first, by photocoagulation, but due to the several recurrence of bleeding, the patient went into surgical management.


Assuntos
Fotocoagulação/métodos , Perfurações Retinianas/complicações , Vasos Retinianos/diagnóstico por imagem , Hemorragia Vítrea/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva , Perfurações Retinianas/diagnóstico , Perfurações Retinianas/cirurgia , Vasos Retinianos/cirurgia , Tomografia de Coerência Óptica , Hemorragia Vítrea/diagnóstico , Hemorragia Vítrea/cirurgia
19.
Graefes Arch Clin Exp Ophthalmol ; 256(5): 863-877, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29589106

RESUMO

PURPOSE: The aim of this study is to review anatomical and functional outcomes following macular buckling (MB) in high myopia and to compare such results with those obtained by pars plana vitrectomy (PPV). METHODS: PubMed articles on MB in high myopia (2000-2016) were reviewed. Main outcomes included retinal reattachment and macular hole (MH) closure rates, resolution of myopic foveoschisis (MFS), and postoperative visual acuity. RESULTS: Thirty-one articles included 16 in patients with retinal detachment due to MH (MHRD group), 11 in MFS with or without foveal detachment (MFS group), and 4 in MH patients with MFS (MH-MFS group). Surgical techniques mainly differed in the type of buckle, rectus muscles involvement, and concurrent PPV. In eyes with persistent MH, prognosis in the MHRD and MH-MFS groups differed between eyes receiving MB compared to PPV: functional outcome was markedly poorer and there was a higher risk of retinal redetachment associated with PPV. In the MSF group, secondary MHs were more likely to develop in eyes treated with PPV and internal limiting membrane peeling than those undergoing MB alone or combined with PPV. Retinal pigment epithelium changes, malpositioning, perforation, and choroidal detachment were the main complications. CONCLUSIONS: Although different approaches are used, complete resolution of foveoschisis, retinal reattachment, and MH closure seem to be achieved more frequently with MB than PPV.


Assuntos
Miopia Degenerativa/complicações , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/métodos , Vitrectomia , Humanos , Miopia Degenerativa/fisiopatologia , Retina/fisiopatologia , Descolamento Retiniano/etiologia , Descolamento Retiniano/fisiopatologia , Perfurações Retinianas/complicações , Perfurações Retinianas/fisiopatologia , Retinosquise/complicações , Retinosquise/fisiopatologia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia
20.
Ophthalmologica ; 240(1): 8-13, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29590656

RESUMO

OBJECTIVES: To describe the prevalence of lamellar hole-associated epiretinal proliferation (LHEP) and to correlate this finding with lamellar macular hole (LMH) morphology and prognosis after a surgical or conservative approach. METHODS: This is a retrospective multicenter case series comprising consecutive LMH patients followed for ≥6 months. Serial spectral-domain optical coherence tomographies were evaluated for the presence of epiretinal membrane (ERM) and LHEP, diameter of the LMH aperture, base, and floor thickness. Pars plana vitrectomy with ERM and internal limiting membrane peeling was performed in the surgical cases. RESULTS: A total of 62 eyes from 57 consecutive patients were included. Mean follow-up time was 27.1 ± 19.8 months. LHEP was observed in 33 (53.2%) eyes. Patients with LMH and LHEP presented a larger external diameter (p = 0.001) and thinner floors (p = 0.018). Twenty-seven (81.8%) of the patients with LMH and LHEP presented a degenerative intraretinal cavitation, compared to 23.3% in the non-LHEP group (p = 0.001). No differences were observed in visual performance or closure rate between the 2 groups after surgery or in the subset of patients followed conservatively. CONCLUSIONS: LHEP was correlated with the anatomical conformation of the LMH, yielding thinner floors and larger external diameters. However, it did not correlate with the anatomical or functional results, both in the patients who underwent surgery and in those managed conservatively.


Assuntos
Membrana Epirretiniana/etiologia , Perfurações Retinianas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Membrana Epirretiniana/diagnóstico por imagem , Membrana Epirretiniana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Perfurações Retinianas/diagnóstico por imagem , Perfurações Retinianas/cirurgia , Estudos Retrospectivos , Tomografia de Coerência Óptica , Acuidade Visual/fisiologia , Vitrectomia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA