Steven A. Madreperla

Office-based sutureless transconjunctival pars plana vitrectomy.

Purpose This is a preliminary report to describe our technique of office-based vitrectomy (OVIT) and to report the incidence of complications over a 6-year period. Methods In a retrospective, noncomparative case series, OVIT was performed on 225 patients in four participating offices. Each patient was operated on with a 23-gauge vitreous cutter that the authors have developed. They have also developed a 23-gauge transconjunctival infusion needle device. Diagnoses included endophthalmitis, uveitis, intravitreal lens fragments, ghost cell glaucoma, and rhegmatogenous retinal detachment. Results The surgical goal was accomplished in all cases, but supplemental office procedures were required for two eyes, and a scleral buckle was necessary in one eye. There were 15 complications in 14 eyes: “fish-egg” gas bubbles (one eye), intraocular hemorrhage (nine eyes), choroidal detachment (two eyes), new retinal breaks (one eye), retinal detachment (one eye), and temporary elevation of intraocular pressure (one eye). The hemorrhages, choroidal detachments, and fish-egg bubbles all resolved spontaneously. Conclusion Office-based sutureless transconjunctival pars plana vitrectomy, with infusion when needed, is an effective operation for selected diseases of the posterior segment. In a multicenter series of 225 eyes, there were 15 complications in 14 (6%) eyes. Two of the complications were successfully managed with additional office procedures; one was managed in the operating room; and 12 resolved spontaneously.

Clinicopathologic Correlation of Surgically Removed Macular Hole Opercula

Purpose To determine the ultrastructural characteristics of the operculum associated with macular holes. Methods We developed instrumentation and a technique to capture the operculum observed with macular holes. Two opercula were studied by transmission electron microscopy. Results The two specimens were attached to a layer of native collagen identified as cortical vitreous and were composed primarily of Mueller cells and fibrous astrocytes without adjacent inner limiting membrane. No distinct retinal neuronal tissue was present. Conclusions Our findings indicate that proliferation of fibrous astrocytes and Mueller cells occurs with the formation of a macular hole, that this reparative tissue may be dislodged, and it is the reparative tissue that previously has been interpreted as an operculum.

Macular hole : pathogenesis, diagnosis, and treatment

Vitreous Anatomy and the Vitreomacular Interface Clinical Characteristics and Epidemiology of Macular Holes Optical Coherence Tomography of Macular Holes Histopathology of Macular Holes Pathogenesis of Idiopathic Macular Holes Impending Macular Holes Vitreous Surgery for Full-Thickness Macular Holes Pharmacologic Adjuncts and Macular Hole Surgery Virectomy for Macular Hole: The Randomized Multicenter Clinical Trials Internal Limiting Membrane Removal in Surgery for Full-Thickness Macular Holes Silicone Oil in the Treatment of Idiopathic Macular Holes Complications of Macular Hole Surgery

Repair of late retinal detachment after successful treatment of retinoblastoma.

Purpose: To analyze the results of vitreous surgery for late retinal detachment (RD) after successful treatment of retinoblastoma. Methods: The records of all patients with retinoblastoma seen at a single ocular oncology service between 1982 and 1998 were reviewed to identify patients treated for late RD. Previous treatments, characteristics of the RD, surgical techniques used, and visual and anatomic results of the surgery were recorded. Results: Of more than 500 charts reviewed, four patients treated for late RD were identified. All four had received previous, whole‐eye, external beam radiotherapy and subsequently required cataract surgery. Other previous treatments included radioactive plaque, cryotherapy, xenon photocoagulation, and chemotherapy. At presentation, some patients had shifting subretinal fluid. None had a tear identifiable preoperatively, but two patients had a definite small slit tear at a tumor edge identified at surgery. One patient had a primary scleral buckle that failed. All patients had vitreous surgery with silicone oil. Average postsurgical follow‐up was 30 months. Preoperative visual acuity ranged from 20/80 to light perception and improved postoperatively in two patients. The retina re‐ mained completely attached in three patients. Conclusions: Despite shifting subretinal fluid and no identifiable tear, a rhegmatog‐ enous RD should be considered if it occurs late in patients with otherwise stable, treated retinoblastoma. Tumor reactivation must be excluded carefully. Vitreous surgery can be used to repair the RD successfully and improve vision.

Clinicopathologic Correlation of Surgically Removed Macular Hole Opercula: Author Reply

PURPOSE To determine the ultrastructural characteristic of the operculum associated with macular holes. METHODS We developed instrumentation and a technique to capture the operculum observed with macular holes. Two opercula were studied by transmission electron microscopy. RESULTS The two specimens were attached to a layer of native collagen identified as cortical vitreous and were composed primarily of Mueller cells and fibrous astrocytes without adjacent inner limiting membrane. No distinct retinal neuronal tissue was present. CONCLUSIONS Our findings indicate that proliferation of fibrous astrocytes and Mueller cells occurs with the formation of a macular hole, that this reparative tissue may be dislodged, and it is the reparative tissue that previously has been interpreted as an operculum.