Jack O. Sipperley

Pars plana vitrectomy without scleral buckle for pseudophakic retinal detachments

OBJECTIVE To report the anatomic and visual results of primary pars plana vitrectomy (PPV) without scleral buckling to repair primary rhegmatogenous retinal detachments in pseudophakic eyes. DESIGN Nonrandomized, prospective, comparative clinical trial. PARTICIPANTS Two hundred eighty-three consecutive patients (294 eyes) with pseudophakia, peripheral retinal tears, and new rhegmatogenous retinal detachments were treated according to the surgery protocol. INTERVENTION Patients underwent PPV with fluid-gas exchange and endolaser to repair the retinal detachment. Two hundred sixty-four patients (275 eyes) were followed from 6 months to 6 years and 8 months with an average follow-up of 19 months. MAIN OUTCOME MEASURES Reattachment of the retina and visual outcome were compared to previously published studies. RESULTS Of 97 eyes with a macula-attached rhegmatogenous retinal detachment, 88 eyes (91%) were reattached with a single operation, and of the 178 eyes with a macula-detached retinal detachment, 153 (86%) eyes were reattached with a single operation. In 241 (88%) of 275 eyes, the retina was reattached with a single operation, and in 265 (96%) of 275 eyes, the retina was ultimately reattached with subsequent operations. The median initial visual acuity was 20/300, and the median final visual acuity was 20/40. The rate of reattachment with one operation was similar for eyes with an anterior chamber intraocular lens (91%) and for eyes with a posterior chamber intraocular lens (88%). Refractive error measurements obtained in 81 eyes were essentially unchanged. The mean change in refractive error was -0.15 diopter. Seventeen eyes (6%) developed macular puckers requiring surgery, 46 eyes (17%) developed cystoid macular edema, and 6 eyes (2%) developed full-thickness macular holes. CONCLUSION Primary PPV with fluid-gas exchange and laser is a safe, effective method to repair primary pseudophakic retinal detachments. The anatomic reattachment rate and the visual acuity obtained with this technique appear to be at least as good as those reported in the literature for scleral buckling, PPV with scleral buckling, and pneumatic retinopexy.

Macular pucker removal with and without internal limiting membrane peeling: pilot study

OBJECTIVE To investigate results of macular pucker surgery with and without internal limiting membrane (ILM) peeling. DESIGN Retrospective noncomparative interventional case series. PARTICIPANTS Forty-four consecutive patients underwent pars plana vitrectomy to remove an idiopathic macular pucker by two surgeons from June 1999 to July 2000. INTERVENTION During the vitrectomy, one surgeon removed only the macular epiretinal membrane (24 patients), whereas the other surgeon removed the macular epiretinal membrane and then performed an additional ILM peeling (20 patients). MAIN OUTCOME MEASURES Visual acuity and recurrence of macular pucker. RESULTS Twenty-four (55%) patients underwent pars plana vitrectomy without ILM peeling, and 20 patients (45%) underwent pars plana vitrectomy with ILM peeling. Visual acuity improved or was unchanged in 79% of operated eyes without ILM peeling and 100% of operated eyes with ILM peeling (P = 0.01). Visual acuity improved 5 or more lines in 25% of operated eyes without ILM peeling and 30% of operated eyes with ILM peeling. At the final visit, 21% of eyes without ILM peeling at the initial surgery showed postoperative recurrent macular pucker or persistent contraction to the ILM, whereas none of the eyes with ILM peeling had evidence of this. CONCLUSIONS This pilot study provides evidence that peeling of the ILM during macular pucker surgery may not have deleterious effects.

A Comparison of Retrobulbar versus Sub-Tenon's Corticosteroid Therapy for Cystoid Macular Edema Refractory to Topical Medications

OBJECTIVE The objective is to compare the effectiveness of retrobulbar and posterior sub-Tenons injection of corticosteroids for treatment of post-cataract cystoid macular edema that was refractory to topical medications. DESIGN A retrospective study was performed. PARTICIPANTS A total of 48 patients (49 eyes) with post-cataract cystoid macular edema refractory to topical medications was studied. INTERVENTION Patients received either a single retrobulbar injection (18 eyes) or 3 biweekly posterior sub-Tenons injections (31 eyes) of corticosteroids. MAIN OUTCOME MEASURES Patients were observed for clinical resolution of the cystoid macular edema, visual acuity, and intraocular pressure. RESULTS Both treatment methods resulted in significant improvement in visual acuity. The posterior sub-Tenons group had a visual improvement from 20/92 pretreatment to 20/50 post-treatment (P = 0.0001) with a median follow-up of 12 months. The retrobulbar group had a visual improvement from 20/97 pretreatment to 20/58 post-treatment (P = 0.035) with a median follow-up of 10 months. The visual improvement was not significantly different between the two groups. The average intraocular pressure increased from a pretreatment level of 14.1 mmHg to a high of 17.7 mmHg (P < 0.00005) in the sub-Tenons group. The average intraocular pressure increased from 15.1 mmHg to a high of 17.6 mmHg (P = 0.04) in the retrobulbar group. CONCLUSIONS Cystoid macular edema that persists after treatment with topical medications may improve after retrobulbar or posterior sub-Tenons corticosteroid injections. There was no significant difference in outcome between the two treatment groups.

Ocular injuries from paintball pellets.

OBJECTIVE To evaluate the ocular effects of blunt trauma due to injury from a paintball pellet. DESIGN Noncomparative case series. PARTICIPANTS Thirteen patients who suffered ocular injury from paintballs are described. The patients presented to six different civilian and military emergency departments in tertiary care medical centers. INTERVENTION Patients were treated for the ocular injury. MAIN OUTCOME MEASURES Patients were evaluated for initial and final visual acuity. The reason for persistent loss of vision was delineated. RESULTS There were 12 males and 1 female with an average age of 21 years (range, 12-33 years). Eleven of the 13 had no ocular protection at the time of the ocular injury. On initial examination, nine patients had a hyphema, nine had a vitreous hemorrhage, six had a retinal tear or detachment, three had corneal or corneal-scleral ruptures, and one had traumatic optic neuropathy. The final visual acuity was 20/40 or better in two patients, 20/50 to 20/150 in three patients, and 20/200 or worse in eight patients. CONCLUSION Injuries due to paintball pellets can result in severe ocular damage and significant loss of vision. Eyecare professionals should be aware of the risks of this sport and must strongly advise participants to wear adequate protection when involved in this activity.

Outcome of sulcus fixation of dislocated posterior chamber intraocular lenses using temporary externalization of the haptics33

OBJECTIVE This study evaluated the visual outcome and complications of repositioning and sulcus fixation of a dislocated posterior chamber intraocular lens (PC IOL) using a technique in which the haptics of the IOL are temporarily externalized for suture placement. DESIGN Retrospective, noncomparative case series. PARTICIPANTS Seventy-eight patients with a dislocated PC IOL. INTERVENTION All patients underwent surgery to fixate the PC IOL using this technique. MAIN OUTCOME MEASURES Patients were evaluated for visual acuity, refractive error, and surgical complications associated with the procedure. RESULTS The average visual acuity before surgery was 20/205 (range, 20/20 to light perception), with a median refractive error of -1.00 diopters (D; range, -7.25-+15.00 D). After surgery, the average visual acuity improved to 20/72 (range, 20/20 to no light perception), with a median refractive error of -0.75 D (range, -5.50-+3.50 D). Patients were observed for a median of 15.5 months (range, 6-57 months). Twenty patients had postoperative cystoid macular edema (26%), 7 patients had an epiretinal membrane (ERM) (9%), and 5 patients had a retinal detachment (6%). Eight patients (10%) experienced iris capture of the sutured IOL, and in three patients (4%) the PC IOL dislocated again after surgery. CONCLUSIONS This technique is an effective method for securing a dislocated PC IOL.