William B. Snyder

Current popularity of pneumatic retinopexy.

PURPOSEnTo compare the popularity of pneumatic retinopexy (PR) in 1997 with its popularity in 1990 among retinal specialists.nnnMETHODSnIn 1997, a survey was mailed to the 1994-1995 members of the Retina or Vitreous Societies who lived in the United States or Canada, asking how they would manage a hypothetical retinal detachment. The choices were limited to PR, segmental scleral buckling, scleral bucking with encircling, primary vitrectomy, and Lincoff balloon. The results of the survey were compared with those previously reported by a similar survey in 1990.nnnRESULTSnThe majority (55%) of respondents selected PR, which is a twofold increase over those who preferred it in 1990 (odds ratio 2.08; 95% confidence interval 1.53, 2.85). The popularity of PR was inversely proportional to the length of time the respondents had been in practice. If the eye with the hypothetical detachment had pseudophakia, only 30% of respondents selected PR. If the eye had additional tears, vitreous hemorrhage, or lattice degeneration, only about one-sixth preferred PR.nnnCONCLUSIONnPneumatic retinopexy was much more popular in 1997 than it was in 1990. Its popularity continues to be influenced by the age of the surgeon and by the complexity of the detachment.

Vitrectomy in the Treatment of Ocular Perforating Injuries

Using pars plana (closed) vitrectomy with related procedures we achieved improved vision in certain catagories of perforating ocular injuries. These procedures were particularly useful in removing retained nonmagnetic foreign bodies and correcting retinal detachments associated with traction bands and opaque vitreous. Limited success was obtained with longstanding injuries, double perforations from shotgun injuries, and large corneoscleral lacerations. Early vitreous surgery produced the best results.

Cataract Extraction after Brachytherapy for Malignant Melanoma of the Choroid

Thirteen eyes of 55 consecutive patients treated with brachytherapy for malignant melanoma of the choroid developed postirradiation cataracts. Cataract development was more common in older patients and in patients with larger and more anterior tumors. Eleven eyes had extracapsular cataract extraction and intraocular lens implantation. Initial visual improvement occurred in 91% of eyes, with an average improvement of 5.5 lines. Visual acuity was maintained at 20/60 or better in 55% of the eyes over an average period of follow-up of 24 months (range, 6 to 40 months). These data suggest that, visually, cataract extraction can be helpful in selected patients who develop a cataract after brachytherapy for malignant melanoma of the choroid.

Survey: Pneumatic Retinopexy Versus Scleral Buckle: Preferences of Vitreous Society Members, 1990

A survey was conducted among the 1990 members of the Vitreous Society in order to measure their acceptance of pneumatic retinopexy. They were asked which treatment they would prefer should they suffer a hypothetical detachment. The choices were limited to pneumatic retinopexy or scleral buckling (encircling or segmental). The majority of respondents selected a scleral buckling procedure for a phakic retinal detachment with two adjacent superior temporal quadrant tears. Surgeons who had been in practice for 10 years or less (median for entire group = 10 years) were significantly more likely to select a pneumatic retinopexy procedure. As the details of the hypothetical detachment became more complicated with myopia, additional tears, vitreous hemorrhage, or lattice degeneration with a positive family history, the respondents selected a scleral buckling procedure with greater frequency, and the differences between the choices of the surgeons became nonsignificant. This survey shows that many surgeons feel pneumatic retinopexy is an acceptable alternative to buckling surgery in select cases. There were no trends by geographic location.

Surgical Removal of Nonmagnetic Foreign Bodies

A microsurgical technique for the removal of nonmagnetic foreign bodies in eyes with opaque media incorporated the simultaneous use of the foreign body forcepts with a vitrectomy machine equipped with fiberoptics. The superb viewing system provided by the operating microscope combined with the excellent illumination from intraocular fiberoptics offered precise surgical control. Nonencapsulated nonmagnetic foreign bodies in eyes with clear vitreous cavities were removed by using the operating microscope, corneal contact lens, and foreign body forceps introduced through a pars plana location. Vitrectomy was not performed. The surgical techniques allowed early removal of the foreign body and, in a preliminary series of cases, improved visual results in what is usually a devastating ocular injury.

Retinal Hemorrhage Associated with Thrombasthenia

A healthy 20-year-old man presented with a spontaneous unilateral retinal hemorrhage. Because of a history of easy bruisability, we obtained hematologic studies and diagnosed thrombasthenia, a hereditary hemorrhagic disorder. The association of retinal hemorrhage and thrombasthenia is rare. Thrombasthenia and other platelet functional disorders are becoming better defined as tests for these abnormalities become more reliable and available. Patients with apparent spontaneous retinal hemorrhages of unknown origin should be questioned about hemorrhagic tendencies, and the various tests for hemorrhagic disorders should be obtained. The hematologic survey should include the more sophisticated tests of platelet function. Patients with thrombasthenia should avoid aspirin intake.

Vitrectomy in Eyes at Risk for Macular Hole Formation

Fifteen eyes believed to be at increased risk for macular hole formation underwent vitrectomy in an attempt to prevent macular hole formation. Full-thickness macular holes have not developed in 10 of 11 eyes with stage 1 macular holes. Four eyes were noted to have small full-thickness foveal defects (stage 2 macular holes) at the time of vitrectomy. Two of the four eyes have not progressed to macular hole formation and have 20/25 visual acuity. All patients have been followed for a minimum of 13 months (median, 18 months). The 12 eyes that have not experienced macular hole formation have had a significant (P less than 0.001) improvement in vision with seven (58%) attaining visual acuity of 20/25 or better. The postoperative foveal electroretinogram (ERG) amplitude was higher than the preoperative amplitude in five of the six eyes tested.