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Role of the Vitreous in Age-Related Macular Degeneration

PURPOSEnTo investigate the relationship between posterior vitreous detachment (PVD) and age-related macular degeneration (AMD).nnnMETHODSnThe condition of the vitreous was examined by slit-lamp funduscopy and ultrasonography in 93 eyes of 50 patients with AMD (exudative or dry) and 100 eyes of 50 controls.nnnRESULTSnThere was complete PVD in 31 of the 93 eyes (33.3%) of 50 patients with AMD and the posterior vitreous was attached in 62 of these eyes (66.6%). In the control group, in 50 eyes (50%) of 50 subjects there was posterior vitreous detachment. The prevalence of PVD in eyes with macular degeneration was significantly lower (P < .05). There was no statistically significant difference between the exudative and the nonexudative groups in respect to PVD.nnnCONCLUSIONSnPVD may have a protective role against the development of AMD. Chronic vitreomacular traction and/or continuous exposure to free radicals and cytokines may possibly be one of the causes of AMD in eyes with attached vitreous.

Outcome of Complex Retinal Detachment Surgery after Silicone Oil Removal

Background and objective: To evaluate anatomical prognosis after silicone oil removal.Patients and methods: Sixty-eight eyes which underwent silicone oil removal were enrolled into the study. The underlying ocular pathology for pars plana vitrectomy, surgical methods, and time of silicone oil removal were analysed.Results: Sixteen of 68 eyes (23.5%) redetached following the removal of silicone oil. According to etiology redetachment rates: PVR C 9.5% (2/21), PVR D 25% (4/16), trauma without intraocular foreign body 27.3% (3/11), with intraocular foreign body 33.3% (2/6), giant retinal tear 37.5% (3/8), and proliferative diabetic retinopathy with tractional retinal detachment 33.3% (2/6). The rate of redetachment was 22% in patients with encircling band and 27.8% without encircling band. Retina was redetached in the first 10 days in 81.3% of patients after silicone oil removal.Conclusion: The residual vitreoretinal traction especially at the vitreous base is the most likely reason for retinal redetachment after silicone oil removal, which is most commonly seen during the first 10 days.

Intraocular intrusion of a scleral sponge implant

A patient with intrusion of a scleral sponge implant after retinal reattachment surgery is described. Retinal incarceration occurred during primary retinal reattachment surgery and the patient underwent additional cryopexy and radial sponge implant. However, the retina remained detached and pars plana vitrectomy was performed with silicone oil endotamponade to reattach the retina. The interval between placement of the sderal buckle and development of intrusion was 3 months. The buckle was sutured to the sclera with mattress sutures. During the postoperative follow-up period, the intraocular pressure was elevated and controlled with topical antiglaucomatous medication. The encircling band was cut but left in place to avoid perforation, and the retina remained attached. Intrusion of a buckle after retinal reattachment surgery is a rare complication that usually does not require surgical intervention. Cutting the silicone band without removing it may be a treatment option.

Calculation of intraocular lens power with the SRK II formula for axial high myopia.

Aim. The SRK II formula has been widely used for intraocular lens (IOL) power calculations. The predictability of this formula is evaluated in axial myopic patients. Methods. Planned extracapsular cataract extraction and posterior chamber IOL implantation (PECCE+IOL) were performed on 98 eyes of 98 patients with axial length > 24.5 mm. Cases had no preoperative complications and postoperative visual acuity was at least 0.5 (Snellen). Corneal refractive power and axial length were measured preoperatively and emmetropic IOL power calculations were made using the SRK II formula. Long-term (mean 4.7 months) visual acuities and refractions were noted postoperatively. Results. The absolute refractive error was < 1.00 Diopters (D) in 57 eyes (58.2%) and < 2.00 D in 83 eyes (84.7%). The mean absolute error of the SRK II formula in axial myopia was 1.16 D ± 0.78 SD. Conclusions. The SRK II formula is not very accurate in axial myopic patients.

Surgical management of retinal detachment with choroidal coloboma

Purpose To verify the functional and anatomical results of retinal detachments related to choroidal coloboma. Methods Seven eyes with retinal detachment secondary to retinal breaks at the margin of or within a choroidal coloboma were analysed retrospectively. Results Scleral buckling was performed in five of the seven eyes; two needed additional pars plana vitrectomy (PPV) with internal tamponade using silicone oil to reattach the retina. In two eyes PPV with internal tamponade using silicone oil or gas was used as a primary procedure. All seven eyes were reattached. Five eyes (71.4%) showed improvement or had visual acuity of 20/400 or better after surgery, but two remained unchanged. Conclusions Retinal detachment secondary to choroidal coloboma can be treated successfully by scleral buckling or PPV with internal tamponade.

Takayasu’s Disease and Secondary Ocular Ischemic Syndrome

Takayasus, or pulseless, disease is a rare, idiopathic, chronic granulomatous vasculitis that affects large arterial blood vessels. Ocular manifestations occur as a consequence of obliteration of the carotid artery, and ocular ischemia may develop. A 14-year-old girl with progressive visual loss and ocular ischemic syndrome secondary to Takayasus disease is described.

Macular involvement in secondary systemic amyloidosis.

Purpose A patient with subretinal and pre-retinal hemorrhage after secondary systemic amyloidosis due to familial Mediterranean fever is presented. Methods Case presentation. Results A 30-year-old woman with secondary systemic amyloidosis secondary to familial Mediterranean fever presented with painless visual loss in the right eye. The examination demonstrated multiple subretinal and pre-retinal hemorrhages, massive deposits which may represent amyloid material at the left macular region. After 6 months, the hemorrhages disappeared, but deposits persisted. Conclusions The macular deposition and hemorrhage is an uncommon manifestation of secondary systemic amyloidosis secondary to familial Mediterranean fever. Further evidence is necessary to understand the nature of these deposits and their relevance to secondary systemic amyloidosis and/or familial Mediterranean fever.

Management of rhegmatogenous retinal detachment without detectable breaks

Purpose: To evaluate the causes of failure to find retinal breaks, the anatomical and functional outcomes of patients with rhegmatogenous retinal detachment (RD) without detectable breaks (Group I), to compare the results with detectable breaks (Group II).

Duration of renal failure as risk factor for conjunctival squamous metaplasia.

OBJECTIVEnTo assess ocular surface changes in patients with chronic renal failure (CRF), to compare the results with the duration of illness.nnnSTUDY DESIGNnImpression cytology from 48 patients with CRF on regular hemodialysis and 16 age- and sex-matched control subjects were studied. Specimens were taken from the temporal bulbar conjunctiva using cellulose acetate filter paper.nnnRESULTSnAmong the patients with CRF who were ill for 0-10 years, 25 patients (78.1%) disclosed grade 0-1, and 7 patients (21.9%) disclosed grade 2-3 cytologic changes, whereas in those with the duration of CRF > 10 years, 9 patients (56.2%) had grade 0-1 and 7 patients (43.8%) had grade 2-3 changes. Specimens from the control group revealed 93.8% grade 0-1 and 6.2% grade 2-3 changes (p < 0.05).nnnCONCLUSIONnThe ocular surfaces of patients with CRF differ significantly from those of normal individuals, and the severity of conjunctival changes is related to the duration of CRF.

A case of retinal detachment in retinitis pigmentosa.

PURPOSEnTo report case of retinitis pigmentosa in association with rhegmatogenous retinal detachment.nnnMETHODSnAn eight year old boy complained of a sudden visual loss. The patient had night blindness, bone spicule-like hyperpigmentation, pale optic disc in both eyes, and the retina was totally detached in the right eye.nnnRESULTSnHe was initially treated with conventional scleral buckling surgery, then pars plana vitrectomy with silicone tamponade was performed and retinal reattachment was established. After the phacoemulsification combined with silicone oil removal the final visual acuity of counting fingers was obtained.nnnCONCLUSIONSnThe association of retinitis pigmentosa and rhegmatogenous retinal detachment is uncommon in young patients.