William Tasman

Inadvertent Globe Perforation during Retrobulbar and Peribulbar Anesthesia: Patient Characteristics, Surgical Management, and Visual Outcome

The authors report a series of 20 eyes from 20 patients in whom inadvertent perforation of the globe occurred during local anesthesia for ocular surgery. Perforation resulted from retrobulbar anesthesia in 18 eyes and from peribulbar anesthesia in 2 eyes. Nine (45%) of 20 eyes had an axial length greater than or equal to 26.00 mm. Combining this figure with axial length data for the general population and estimates for the risk of globe perforation during local anesthesia yields an approximate incidence of perforation in eyes with axial length greater than or equal to 26.00 mm of 1 in 140 injections. Proliferative vitreoretinopathy (PVR) developed in 8 of the 20 eyes (40%) in this series. Overall, 15 (75%) of the 20 eyes were successfully repaired, and, in five eyes (25%), the final visual acuity was 20/70 or better.

Laser Photocoagulation for Stage 3 + Retinopathy of Prematurity

Twenty-two infants with threshold stage 3+ retinopathy of prematurity (ROP) were entered into a prospective, randomized clinical trial to compare the efficacy of transscleral cryotherapy versus laser photocoagulation delivered by the indirect ophthalmoscope. Eighteen infants have been followed for at least 3 months. Fifteen of 16 eyes randomized to laser and 9 of 12 eyes randomized to cryotherapy showed regression. The results suggest that laser therapy is as effective as cryotherapy in the treatment of ROP (P = 0.285).

Coats’ Disease: Evaluation of Management

Forty-one patients representing 43 eyes with retinal telangiectasia and subretinal exudates (Coats Disease) were managed between 1966 and 1980. Thirty-three eyes in 31 patients between 4 and 45 years of age had an average of two quadrants involved with telangiectasia. Of four untreated eyes, three deteriorated and one stabilized. In contrast, of 29 eyes treated with cryotherapy or photocoagulation, eight deteriorated, 15 stabilized, and six improved. Ten patients in the series were under 4 years of age and had more severe disease than older patients. On the average three quadrants were involved with telangiectasia and subretinal exudate. Three untreated eyes rapidly progressed to total retinal detachment with glaucoma. The seven treated children required frequent assessment and repeated treatment. Of these, one stabilized but had no light perception, and the remaining six improved. The authors stress that the disease can be controlled with aggressive treatment. Their treatment methods are described.

Early Treatment of Posterior Retinopathy of Prematurity: A Controlled Trial

OBJECTIVEnThe purpose of the study is to assess the possible benefits of early laser treatment for posterior retinopathy of prematurity (ROP) and to provide data concerning the natural history of posterior ROP.nnnDESIGNnThe study design was a prospective, multicenter, randomized trial.nnnPARTICIPANTSnA total of 19 infants with prethreshold posterior ROP were studied.nnnINTERVENTIONnRandomization to immediate indirect laser photocoagulation or observation, with application of laser photocoagulation for those control eyes reaching threshold disease, was performed.nnnMAIN OUTCOME MEASURESnPatients were assessed at 3 months and the anatomic outcome recorded along with any adverse treatment effects.nnnRESULTSnAn unfavorable structural outcome developed in 3 (16%) of 19 early treatment eyes compared with 3 (18%) of 17 for those treated only if threshold disease was reached. Of the 17 control eyes, 15 (88%) reached threshold disease. Progression to threshold occurred within 1 week in all but two eyes. All 12 control eyes with posterior ROP and any amount of extraretinal fibrovascular proliferation progressed to threshold disease.nnnCONCLUSIONSnAlthough the number of patients studied is too small to reach statistical significance, the likelihood of a favorable outcome for eyes with prethreshold posterior ROP treated immediately with laser photocoagulation is comparable to that obtained by withholding treatment until threshold disease is reached. There is a high probability of progression from prethreshold to threshold disease, usually within 1 week or less.

Effects of argon laser photocoagulation on rubeosis iridis and angle neovascularization.

Of 93 eyes with proliferative diabetic retinopathy treated by argon laser panretinal photocoagulation, two (2.2%) developed rubeosis. The incidence of rubeosis in five xenon-treated eyes was one (1.9%) and in an untreated group of 52 eyes, two (3.8%) developed rubeosis. The incidence of rubeosis in central retinal vein occlusion demonstrating retinal ischemia on fluorescein angiography was 60%, while in patients with central retinal vein occlusion and good capillary perfusion, the incidence of rubeosis only 1%. Panretinal photocoagulation was more effective in controlling rubeosis in diabetics than in patients with central retinal vein occlusion.

Management of Late-onset Angle-closure Glaucoma Associated with Retinopathy of Prematurity

Late-onset angle-closure glaucoma secondary to retinopathy of prematurity (ROP) occurred in ten eyes of ten patients. The age at presentation ranged from 12 to 45 years (mean, 32 years). Eight eyes had nonneovascular mechanisms for the angle closure while two had neovascular angle closure. Treatment of eyes with this form of secondary angle closure included medical management alone, peripheral iridectomy, trabeculectomy, lensectomy, alloplastic tube shunt implantation, and cilioablative procedures. Three eyes required more than one of these treatments. The choice of therapy was based on the initial intraocular pressure and vision, degree of lens opacity and intumescence, presence of anterior segment neovascularization, and the gonioscopic appearance of the anterior chamber angle. The clinical features of this condition are described and a proposed mechanism and therapeutic approach are presented.

Retinal detachment in retrolental fibroplasia

Retrolental fibroplasia is a continuing problem in ophthalmology and may lead to retinal detachment. In this study, two groups of patients with retrolental fibroplasia and retinal detachment are described. The first group consists of youngsters who develop retinal detachment during their teenage years and frequently have not been diagnosed as having the disease until the retina detaches. Usually definite retinal breaks can be found near the equator and these are round or oval in appearance and without opercula. A second group of patients was noted to develop retinal detachment at an earlier age. The configuration of these detachments suggested a rhegmatogenous etiology, but retinal breaks were hard to detect because the peripheral retina was frequently obscured by a membrane or cataract. Additional evidence to support this opinion was provided when a small retinal hole was identified in one youngster whose ora could be easily seen. Because of the progressive nature of vitreoretinal adhesion in retrolental fibroplasia, it is advocated that youngsters with any evidence of retrolental fibroplasia at the time of discharge from the premature nursery be followed at one month, three months, and six months of age and at four-month intervals thereafter until the age of four years. If no difficulty develops by that time, yearly examinations suffice. Follow-up examinations are important because when prompt diagnosis of retinal detachment is made, the involved eye can often be salvaged with surgery. Die retrolentale Fibroplasie bleibt weiter ein Problem der Augenheilkunde. Sie kann zur Netzhautablösung führen. In diesem Bericht werden zwei Gruppen von Patienten mit retrolentaler Fibroplasie und Netzhautablösung beschrieben. Die erste Gruppe besteht aus jungen Patienten, die eine Netzhautablösung während des zweiten Lebensjahrzehntes entwickeln und deren korrekte Diagnose erst gestellt wurde, als sich die Netzhaut ablöste. Die üblichen Risse in der Retina werden in der Nähe des Äquators gefunden. Sie sind rund oder oval und ohne Opercolom. Die zweite Patientengruppe entwickelte eine Netzhautablösung früher. Die Konfiguration der Ablösung ließ ein Loch vermuten, aber Netzhautrisse waren schwer zu finden, da die Netzhautperipherie oft durch eine Membran oder einen Katarakt verschleiert wurde. Zusätzlichen Beweis lieferte ein kleines Netzhautloch, das bei einem jungen Patienten nahe der gut erkennbaren Ora serrata gefunden werden konnte. Jedes Kleinkind, das im Spital Zeichen der retrolentalen Fibroplasie zeigt, soll wegen der progressiven Adhäsionen zwischen Glaskörper und Netzhaut in regelmäßigen Abständen untersucht werden. Diese Untersuchung soll im Alter von einem Monat, drei Monaten und sechs Monaten erfolgen und dann in viermonatigen Intervallen bis zum Alter von vier Jahren. Wenn keine Komplikationen zu diesem Zeitpunkt beobachtet werden können, genügt danach eine jährliche Untersuchung. Diese Untersuchungen sind wichtig, da bei einer früheren Diagnose das Auge oft durch Operation gerettet werden kann.

Open Sky Vitrectomy for Total Retinal Detachment in Retinopathy of Prematurity

Open sky vitrectomy was performed on 23 eyes in 18 children between 4 and 35 months of age with stage V retinopathy of prematurity (ROP). Postoperatively, the retina was reattached in the posterior pole in eight eyes (34.7%). Follow-up ranged between 7 and 55 months (average, 16 months). Prognostic factors based on preoperative findings and surgical observations are analyzed.

Macular Degeneration in Angioid Streaks

This study examines different clinical parameters and the occurrence of macular degeneration in a series of 110 patients with angioid streaks of the fundus. Among the parameters considered were: age of the patient at the time of ocular diagnosis, associated systemic disease, optic nerve drusen, peau dorange appearance in the fundus, number of radiating angioid streaks as well as their length, width, and distance from the fovea. Statistically significant correlations were found between the occurrence of macular degeneration (of the exudative hemorrhagic type) and the following: angioid streak length, distance from the fovea, and the diffuse type or cracked egg-shell fundus appearance.

Psychological and cognitive determinants of vision function in age-related macular degeneration.

OBJECTIVEnTo investigate the effect of coping strategies, depression, physical health, and cognition on National Eye Institute Visual Function Questionnaire scores obtained at baseline in a sample of older patients with age-related macular degeneration (AMD) enrolled in the Improving Function in AMD Trial, a randomized controlled clinical trial that compares the efficacy of problem-solving therapy with that of supportive therapy to improve vision function in patients with AMD.nnnMETHODSnBaseline evaluation of 241 older outpatients with advanced AMD who were enrolled in a clinical trial testing the efficacy of a behavioral intervention to improve vision function. Vision function was characterized as an interval-scaled, latent variable of visual ability based on the near-vision subscale of the National Eye Institute Vision Function Questionnaire-25 plus Supplement.nnnRESULTSnVisual ability was highly correlated with visual acuity. However, a multivariate model revealed that patient coping strategies and cognitive function contributed to their ability to perform near-vision activities independent of visual acuity.nnnCONCLUSIONSnPatients with AMD vary in their coping strategies and cognitive function and in their visual acuity, and that variability determines patients self-report of vision function. Understanding patient coping mechanisms and cognition may help increase the precision of vision rating scales and suggest new interventions to improve vision function and quality of life in patients with AMD. Trial Registrationxa0 clinicaltrials.gov Identifier: NCT00572039.