Felipe I. Tolentino

Pseudophakic Retinal Detachment: Surgical Success Rate with Various Types of IOLs

The overall anatomic success rate of surgical treatment of 122 consecutive cases of pseudophakic retinal detachment was 82%. In 78 eyes with iris-supported intraocular lenses (IOLs), the success rate was 83%, and it did not differ between the 47 eyes with intracapsular and the 31 eyes with extracapsular extraction. Reattachment rate was highest in 14 eyes with posterior chamber IOLs (100%) and lowest (70%) in 30 eyes with anterior chamber IOLs. Low success rate was associated with the preoperative findings of vitreous gel in the anterior chamber in front of the IOL, vitreous reaction, and vitreous hemorrhage, all of which were found most frequently with retinal detachment in eyes with anterior chamber IOLs. Of the 30 eyes with anterior chamber IOLs, 43% required repeat operations, 43% had perioperative complications, and only 14% of the 21 successful cases achieved 20/40 or better postoperative vision.

Glaucoma Occurring after Closed Vitrectomy

Six of 20 eyes developed postoperative glaucoma within two to ten days after closed vitrectomy for vitreous hemorrhage. Intraocular pressure was greater than 40mm Hg in all six eyes, and three developed pressure greater than 60 mm Hg. Intraocular pressure in four eyes was controlled with medical antiglaucoma therapy and two eyes required anterior chamber irrigation. Six months postoperatively three of the eyes had normal pressures, one was hypotonous, and two developed increased intraocular pressure secondary to angle neovascularization. Three of the 14 eyes that did not develop glaucoma developed a cellular accumulation in the anterior chamber. The glaucoma was caused mainly by obstruction of the trabecular meshwork by degenerated red blood cells known as ghost cells. The cells may be identified by phase-contrast examination of anterior chamber aspirates. Glaucoma can be prevented through irrigation of the vitreous cavity at the time of vitrectomy ensuring that no cells and debris are left behind to migrate into the anterior chamber and obstruct the trabecular meshwork. This type of glaucoma is caused mainly by ghost cells, whereas hemolytic glaucoma is caused mainly by macrophages and red blood cell debris.

Vitreous amyloidosis in familial amyloidotic polyneuropathy. Report of a case with the Val30Met transthyretin mutation

We present a clinical pathological review of vitreous amyloidosis in a case of familial amyloidotic polyneuropathy, type I. Vitreous opacification was the first manifestation of disease in the proband, who was successfully treated with vitrectomy. The eyes were obtained at autopsy after the patient died from an unrelated cause, and the histopathology is presented here. Analysis of DNA from the pathology specimen revealed the most commonly reported transthyretin mutation, Val30Met. The classification of systemic and ocular amyloidosis as well as the genetics of familial amyloidotic polyneuropathy are briefly reviewed.

The role of vitreous in aphakic cystoid macular edema: A review

The etiology of aphakic cystoid macular edema (ACME) is still unclear. It is associated with many conditions and probably represents a nonspecific response of the macula to a host of stimuli under the circumstances of altered stability of the vitreous cavity secondary to aphakia. Recognizing the alteration in the vitreous body and its relationship to intraocular structures in aphakia is important in understanding the milieu in which ACME occurs. Aphakic vitreous changes in the posterior vitreous surface, including posterior vitreous detachment and vitreomacular traction; anterior vitreous changes, including rupture of the anterior hyaloid face and incarceration of vitreous in the corneal wound, and changes in the vitreous gel, including vitreous collapse and loss of hyaluronic acid, are reviewed in light of their relationship with ACME. The theoretical merits of surgical approach aimed at producing the least amount of structural and physiologic changes in the intraocular structures from phakia to aphakia are also discussed.

Experimental Cataract Fragmentation: Instrumentation and Laboratory Evaluation

A newly designed mechanical phacofragmentator powered by compressed air was tested on 200 human hard nuclear cataracts and ten traumatic owl monkey cataracts. The device, which consists of a turbine-driven diamond burr, successfully fragmented hard human cataracts, both in vitro and when implanted in the anterior chamber of rabbits and monkeys. Iatrogenic damage to the iris was noted in the early cases, but no collapse of the anterior chamber or gross damage of the cornea occurred. Iris damage can be avoided, once the operator gains sufficient skill in manipulating the instrument. The ten traumatic monkey cataracts were all removed without complication, except for one case in which the posterior lens capsule was ruptured with subsequent vitreous prolapse.