Insights Into Epiretinal Membranes: Presence of Ectopic Inner Foveal Layers and a New Optical Coherence Tomography Staging Scheme

Comparison of fluorescein angiography with microvascular anatomy of macaque retinas

Purpose To evaluate the efficacy and safety of a silicone oil-RMN3 mixture ("heavy silicone oil") as heavier as water internal retinal tamponade after vitrectomy for complicated retinal detachment. The relative density of the heavier-than-water silicone oil was 1.03 g/cm3, and the viscosity was 3,800 cSt. Heavy silicone oil is designed to tamponade the inferior retina in complicated retinal detachment. Methods Patients with a complicated retinal detachment involving the inferior part of the retina requiring internal tamponade with silicone oil were recruited for this prospective study. Inclusion criteria were retinal detachment secondary to proliferative vitreoretinopathy (stage > or = C2), inferior or posterior tears, or penetrating trauma. The heavy silicone oil was injected at the end of surgery after peeling of retinal membranes or retinotomy. Follow-up examinations were scheduled at 1, 3, 6 months, and 1 year after the initial surgery. Results A total of 33 eyes of 33 patients aged from 20 to 84 years (mean, 56 +/- 18 years) were treated with heavy silicone oil. Follow-up ranged from 12 to 16 months. Rhegmatogenous retinal detachment with significant proliferative vitreoretinopathy accounted for 17 cases, inferior holes for three, and trauma with retinal detachment for three. Initial visual acuity ranged from 20/50 to hand motions. Initial retinal reattachment was achieved in all cases. Complications included increased intraocular pressure in six eyes (18%), intraocular inflammation and synechia formation in one eye (3%), a central retinal artery occlusion after heavy oil removal in one eye, and scattered retinal hemorrhages during follow-up in two eyes (6%). Significant emulsification was not observed during intraocular tamponade with heavy silicone oil. At the last follow-up, all eyes had macular attachment, and 24 eyes had a visual acuity better than or equal to 20/400. Conclusions The results of this prospective study show the good intraocular tolerance of heavy silicone oil as tamponade in complicated retinal detachment. Its specific gravity allows for sufficient tamponade of inferior retinal tears for at least 3 months without significant side effects.

Silicone oil-RMN3 mixture ("heavy silicone oil") as internal tamponade for complicated retinal detachment

Acanthamoeba Keratitis: A Growing Problem in Soft and Hard Contact Lens Wearers

Corneal pathophysiology with contact lens wear.

Needle drainage of subretinal fluid with simultaneous observation using the indirect ophthalmoscope has been reported to have a very low complication rate. The technique was evaluated by a prospective clinical trial. The study group consisted of 100 patients undergoing scleral buckling for rhegmatogenous retinal detachment who were randomly assigned to groups treated with needle drainage or conventional two-stage drainage. At 1 month, the retina was anatomically flat in 88% of all cases. Subretinal hemorrhage occurred in 10 of 45 patients (22.2%) after needle drainage and in 7 of 55 patients (12.7%) after conventional drainage. The difference was not statistically significant. Retinal puncture occurred during conventional drainage in one case and in no cases during needle drainage. There were no cases of retinal incarceration. The results showed that subretinal hemorrhage was more common after needle drainage, but a larger study would be required to show whether this difference was statistically significant. The fear that the retina would be damaged by placement of a needle in the subretinal space throughout the drainage procedure was unfounded.

Needle Drainage Of Subretinal Fluid A Randomized Clinical Trial

Purpose: To evaluate the advantages and disadvantages of the retention and removal of silicone oil in the treatment of complicated retinal detachments.



Methods: The records of 344 patients (348 eyes) that underwent vitrectomy and silicone oil injection for complicated retinal detachments were abstracted and analysed. The anatomical and functional results, complications and influencing factors are discussed. The outcome in eyes after removal of the silicone oil was compared with the outcome in a comparable group of eyes in which the silicone oil was retained.



Results: The overall retinal reattachment rate was 63% (220/348). The final vision of 5/300 or better was 52% (115/220) in those eyes with totally attached retinas. The silicone oil-related complications included keratopathy (23%) and secondary glaucoma (11%). Comparing removal of silicone oil with retention of silicone oil, we found: (i) there was no statistical difference in the redetachment rate (19 vs 17%); (ii) Oil-removed eyes had a better final vision (P < 0.05); and (iii) keratopathy (13 vs 23%), secondary glaucoma (11 vs 25%) and optic nerve atrophy (4 vs 18%) were significantly lower in oil-removed eyes.



Conclusion: Silicone oil injection is useful in the treatment of complicated retinal detachments. For reducing the incidence of complications, early removal of silicone oil is recommended in those cases in which the retina is attached, all breaks adequately closed and traction relieved.

Use of silicone oil in the treatment of complicated retinal detachment: Results from 1981 to 1994

Summary

The occurrence of atypical vascularization of the macular-foveal zone in 20 eyes of 17 patients is described. The significance of this fluorescein stereoangiographic finding is discussed.

Macular-foveal capillaries in human retina.

A 19-year-old man, who was a soft contact lens wearer for correction of myoia, presented with right corneal ulceration. The diagnosis of Acanthamoeba polyphaga infection was made by culture and serology. In-vitro sensitivity tests suggested that the organism was sensitive to Neosporin (polyrnyxin, neomycin and gramicidin) and natamycin. Topical therapy with these agents resulted in complete healing of the corneal ulcer in two months. To our knowledge, our patient is the only case of successful medical treatment of this condition that has achieved a good visual result.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-9071.1986.tb00025.x

Julian Heinze

Papers

Needle Drainage Of Subretinal Fluid A Randomized Clinical Trial

Use of silicone oil in the treatment of complicated retinal detachment: Results from 1981 to 1994

Macular-foveal capillaries in human retina.

Successful medical treatment of a corneal ulcer due to acanthamoeba polyphaga

The Surgical Management of Total Hyphæma