Motilal Raichand

Ten Years Experience with Eye Wall Resection for Uveal Malignant Melanomas

Thirty-four patients underwent eye wall resection for choroidal malignant melanoma over a period of more than ten years. Of these, 11 eyes were later enucleated for complications. Average mean follow-up has been more than 5.3 years. Postoperative visual acuity ranged from light perception to 20/30. Two patients developed liver metastasis 4 years following eye wall resection and later died. However, no local metastasis has been observed. Two patients died from unrelated causes.

Experimental Aspects and Their Clinical Application

After laboratory evaluation of nontoxic doses of intravitreal antibiotics, 26 cases of bacterial and fungal endophthalmitis were treated by intravitreal antibiotic or vitrectomy. In 46% of all cases, visual acuity was better than 20/100, whereas 27% had light perception to 20/300 visual acuity, 4% had no light perception, and 23% of the cases were enucleated or eviscerated. Best results have been achieved when the treatment began within 36 hours after symptomatic onset of infection and when the organism involved was not to virulent. We advocate intravitreal antibiotics immediately after intracameral and vitreous tap for culture, to be followed by vitrectomy 24 hours later if the culture is positive. In bacterial endophthalamitis when the vitreous is severely involved and in cases of fungal endophthalmitis, we advocate vitrectomy plus intravitreal antibiotics as the primary procedure.

Ocular Effects of Various Laser Wavelengths

Lasers have become an indispensable tool in management of many ocular disorders. This review describes the principles of lasers and the effects various laser modalities and wavelength modalities can produce on ocular structure. Guidelines are provided for appropriate selection of various wavelengths and prevention of complications of the laser treatment.

Effect of argon laser photocoagulation on fluorescein transport across the blood-retinal barrier

Abstract The effect of argon laser photocoagulation on the active transport of fluorescein across the blood-retinal barrier was examined in the rabbit, before and after healing of the photocoagulation scars. The outward fluorescein transport across the blood-retinal barrier, which was assessed by vitreous fluorophotometry after intravitreal administration of sodium fluorescein, was greatly reduced in the first days after panretinal photocoagulation with the argon laser. However, this alteration of the barrier recovered progressively with time, depending on the intensity of the photocoagulation burns. When moderate panretinal laser photocoagulation was used (500 μm, 0·1 sec, 0·1 W), the transport activity was markedly altered by 6 days, but there was almost complete recovery at the end of 30 days. When severe photocoagulation was performed (500 μ, 0·1 sec and 0·25–0 · 35 W), very little recovery was observed, even 90 days afterwards.

Full-thickness eye-wall biopsy: long-term results in 9 patients.

Nine patients who had an eye-wall biopsy were evaluated for long-term results. The follow-up time ranged from 2 1/2 months to 7 years. Six patients were followed up for more than 2 years. Few operative and postoperative complications were observed. Except for 1 patient with reticulum cell sarcoma, all eyes retained preoperative visual acuity. Tractional retinal detachment occurred only in 1 patient, who had vitreous bands around the biopsy site and did not undergo a simultaneous vitrectomy during the biopsy operation.

Metastatic Peptostreptococcus Intermedius Endophthalmitis After a Dental Procedure

A 46-year-old man developed symptoms of a chronic progressive uveitis in his right eye approximately one week after a dental procedure. The patients intraocular inflammation was not diminished by massive treatment with topical and systemic corticosteroid therapy or intravenously administered adrenocorticotropic hormone. The inflammatory process progressed to an overt endophthalmitis during a period of three weeks and the eye eventually required evisceration. A pure culture of Peptostreptococcus intermedius was isolated from the eye. The most likely source of this organism was hematologic transport following a dental procedure.

Pars Plicata Lensectomy and Vitrectomy in the Management of Congenital Cataracts

Abstract Thirty-two eyes with congenital cataracts were surgically managed by pars plicata lensectomy and vitrectomy. All eyes have maintained clear media without pupillary membranes; no detached retina or cases of pupillary block have occurred during a follow-up period of up to 72 months.

Vitrectomy for the anterior segment surgeon.

Summary The advent of vitrectomy instruments has improved the management of many complications of anterior segment surgery or trauma. 4,5 The anterior segment surgeon should become familiar with both anterior and pars plicata approaches in using a vitrectomy instrument. Although the topics discussed here are within the framework of anterior segment surgery and can be managed by an anterior segment surgeon, initial cases should be performed under the supervision of a more experienced vitreous surgeon.