Christopher L. Paris

A Technique for Retinal Pigment Epithelium Transplantation for Age-Related Macular Degeneration Secondary to Extensive Subfoveal Scarring

We describe the surgical excision of submacular scar in end-stage age-related macular degeneration and transplantation of autologous and homologous retinal pigment epithelial (RPE) cells. The technique involves the preparation of a large retinal flap encompassing the macula and the arcades, removal of the submacular scar, and replacement of the RPE cells, using either an autologous pedicle graft or homologous RPE cells and Bruchs membrane. Fourteen months following the procedure, visual acuity in a patient with a pedicle graft had improved from counts fingers to 20/400 and the patient fixated over the transplanted RPE cells. After 10 months, a homologous graft in a second patient had become encapsulated with a fine subretinal membrane without neovascular tissue; visual acuity had not improved. No intraoperative or postoperative complications resulting from the surgery occurred in either patient.

Management of retinal detachment associated with choroidal coloboma using perfluoroperhydrophenanthrene (Vitreon).

Vitreous surgery using an internal tamponading agent and chorioretinal adhesion is commonly used to repair retinal detachment associated with choroidal coloboma. The detachment may, however, recur if fluid continues to leak through a retinal defect in the area of the coloboma, despite internal tamponade. We present a case in which a recurrent retinal detachment associated with coloboma following vitreous surgery with SF6 was successfully repaired in outpatient surgery using perfluoroperhydrophenanthrene (Vitreon) and endolaser photocoagulation.

Posterior relaxing retinotomies: analysis of anatomic and visual results.

Fifteen eyes with complicated retinal detachments--11 with proliferative vitreoretinopathy (C3 D3), 2 with posterior segment trauma, and 2 with inflammatory retinopathy--were treated with vitrectomy, membrane peeling, and large posterior retinotomy. All posterior relaxing retinotomies were circumferential, including temporal quadrants in all cases. With a minimum follow up of 6 months, 12 eyes (80%) were attached posterior to the retinotomy. Reproliferation resulted in redetachment in 3 eyes (20%). Visual acuity improved in 53%, remained unchanged in 20%, and decreased in 27%. Of the 11 eyes that achieved stable or improved visual acuity, 5 (45%) achieved 20/400 to 20/25 vision, 5 achieved counts fingers perception, and 1 patient remained stable at hand motion perception. Of all the eyes undergoing surgery, hypotony (intraocular pressure < 5 mm Hg) occurred in 6 eyes (40%); 3 of these were among the 12 eyes with attached retinas.

Intravitreal dexamethasone following vitreous surgery

We used 1 mg of dexamethasone intravitreally after vitrectomy. No toxic reaction was noticed. Postoperative inflammation was reduced. Over the years corticosteroids have been used with increased frequency to reduce morbidity in vitreoretinal surgery. Important actions of these agents are the reduction of inflammatory exudation and the decrease in granulation tissue formation [2]. Although the precise concentration to achieve maximum anti-inflammatory efficacy has not been established, it has been demonstrated that up to 400/~g/ml dexamethasone phosphate can be placed in infusion fluids and up to 4.8mg/0.2ml injected intravitreally without toxicity to ocular structures [4, 5]. Herein we describe an exemplary case in which vitreoretinal surgery was combined with intraocular injections of 1 mg dexamethasone phosphate.

Neonatal macular hemorrhage

Retinal hemorrhages occur with increased frequency in neonates following prolonged or difficult labor, especially if associated with primipara, surgical or mechanical intervention, low Apgar scores, perinatal hypoxia, low birth weight or coagulopathy. When involvement occurs peripheral to the arcades resolution occurs generally without sequalae. Hemorrhages involving the macula are much more serious since resolution in these cases may result in degenerative changes or an exudative or glial scar, resulting in amblyopia and possible strabismus. Early examination is warranted in high-risk infants in order to facilitate intervention and the prevention of more serious visual sequalae.

Internal choroidectomy of posterior uveal melanomas under a retinal flap

Local excision of uveal melanoma is an intriguing therapeutic modality in selected cases. An internal choroidectomy under a retinal flap has been developed as an alternative to retinochoroidectomy in managing posterior pole melanomas. This technique offers more adequate preservation of retinal architecture, thus potentially enhancing central visual function in patients with tumors located close to the fovea.

SURGICAL TECHNIQUE FOR MANAGING RHEGMATOGENOUS RETINAL DETACHMENT FOLLOWING PROSTHOKERATOPLASTY

The authors report the successful repair of a retinal detachment following Cardona prosthokeratoplasty. The surgical technique included pars plana vitrectomy, endolaser photocoagulation, peripheral cryopexy, scleral buckling, and the use of a liquid perfluorocarbon derivative, perfluorophenanthrene, to achieve and maintain reattachment. Perfluorophenanthrene was removed 3 weeks postoperatively. Postoperative visual acuity stabilized at functional levels. No ocular complications, adverse reactions, or redetachment were observed.

Diffuse Posterior Punctate Pigment Epitheliopathy

Purpose To describe the funduscopic and fluorescein findings of an unusual variant of an inflammatory chorioretinopathy, which is descriptively labeled as diffuse posterior punctate pigment epitheliopathy (DPPPE). Methods The funduscopic and fluorescein angiogram findings in a case involving a 35-year-old man with sudden onset of decreased vision during a 2-year period are discussed. Results A 35-year-old man with sudden visual loss presented with bilateral macular lesions. These lesions were initially well-circumscribed hypopigmented areas, which, over the course of 2 years, developed significant atrophic changes with pigmentary migration. The patient also developed peripheral retinal findings of progressive linear punched-out lesions, and a peripheral serous retinal detachment. Conclusion This case, although somewhat similar to previously described cases of inflammatory chorioretinopathies, is unique in its presentation and course. The possible pathophysiologic characteristics are discussed, and the descriptive label of diffuse posterior punctate epitheliopathy is used to assist in the recognition of future cases.