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Begaj T, Marmalidou A, Papakostas TD, Diaz JD, Kim LA, Wu DM, Miller JB. Outcomes of primary rhegmatogenous retinal detachment repair with extensive scleral-depressed vitreous removal and dynamic examination. PLoS One 2020; 15:e0239138. [PMID: 32970724 PMCID: PMC7514044 DOI: 10.1371/journal.pone.0239138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 08/31/2020] [Indexed: 11/23/2022] Open
Abstract
There are multiple surgical approaches to the repair of rhegmatogenous retinal detachment (RRD). Here, we evaluated the outcomes of small-gauge pars plana vitrectomy (PPV), alone or in combination with scleral buckle (SB-PPV), for RRD repair using a standardized technique by 3 vitreoretinal surgeons: “extensive” removal of the vitreous with scleral depression and dynamic examination of the peripheral retina. One hundred eighty seven eyes of 180 consecutive patients treated for primary RRD by three vitreoretinal surgeons at a tertiary academic medical center from September 2015 to March 2018 were analyzed. Most RRDs occurred in males (134 [71.3%] eyes), affected the left eye (102 [54.3%]), and were phakic (119 [63.3%]). PPV alone was performed in 159 eyes (84.6%), with a combined SB-PPV used in the remaining 29 eyes (15.4%); focal endolaser was used in all (100%) cases. The single surgery anatomic success rate was 186 eyes (99.5%) at 3 months, and 187 (100%) at last follow up. Overall best-corrected visual acuity (BCVA) had significantly improved at 3 months ([Snellen 20/47] P<0.00005) and last follow up ([Snellen 20/31] P<0.00005), as compared to day of presentation ([Snellen 20/234]). Our findings suggest that “extensive” removal of the vitreous and dynamic peripheral examination with scleral depression may lead to high single surgery success in primary uncomplicated RRD repair.
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Affiliation(s)
- Tedi Begaj
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Anna Marmalidou
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Thanos D. Papakostas
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Ophthalmology, Retina Service, Cornell University Medical School, New York, New York, United States of America
| | - J. Daniel Diaz
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Leo A. Kim
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David M. Wu
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John B. Miller
- Department of Ophthalmology, Retina Service, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
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Papavasileiou E. New application of membrane blue-dual dye for retinal or iatrogenic break staining in retinal detachment surgery. Hell J Nucl Med 2019; 22 Suppl 2:63-70. [PMID: 31802047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION The principles of surgery for managing primary rhegmatogenous retinal detachment (RRD) are to precisely identify and correctly treat all causative retinal breaks. Estimates regarding unidentified breaks complicating RRDs vary from 2.2%-22.5%. PURPOSE To evaluate the efficacy of membrane blue-dual heavy dye solution for staining of undetected preoperatively retinal and iatrogenic breaks. SUBJECTS, MATERIAL AND METHODS 1. This is a prospective interventional study. 23 and 27-gauge vitrectomy surgeries were evaluated for primary repair of 5 patients with rhegmatogenous retinal detachment (RRD). No breaks where identified prior to surgery despite meticulous pre-operative examination using binocular indirect ophthalmoscopy with indentation. 0.1ml of MembraneBlue-Dual™ was applied onto the vitreous cavity, while it was completely filled with fluid, and all excess dye was immediately aspirated with a blunt backflush instrument. In all eyes with RRD, the surgery was completed by gas tamponade (C3F8 or SF6). Follow up was 6 months. RESULTS We compared the number of breaks identified when examined intraoperative with internal peripheral indentation before and after injection of the dye and found that in all cases (100%) at least one more break was found after injection of dye which was subsequently treated with cryotherapy or endolaser. At last follow up six months after surgery the success rate was 100% and none of our cases re-detached. CONCLUSIONS The greatest advantage of use of this "heavy" dye solution membrane blue-dual is improved intraoperative identification of ILM at the edges of retinal breaks and the discrimination of them from surrounding intraocular structures. Due to its increased molecular weight and viscosity properties it eliminates the need for fluid-air exchange, injection of PFCL or subretinal injection.
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Dedania VS, Ozgonul C, Besirli CG. Peripheral Persistent Fetal Vasculature: A Report of Three Cases. Ophthalmic Surg Lasers Imaging Retina 2019; 49:e83-e88. [PMID: 30222824 DOI: 10.3928/23258160-20180907-12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/27/2018] [Indexed: 11/20/2022]
Abstract
The authors report three cases of persistent fetal vasculature (PFV) presenting with an atypical peripheral fibrovascular stalk. A 5-month-old with congenital exotropia with a vitreous hemorrhage in the right eye underwent vitrectomy, and a mid-peripheral vitreal vascular stalk was visualized within the area of hemorrhage. The second case is of an 8-year-old with two fetal vascular remnants in the right eye: (1) a stalk superotemporally extending from the pars plana to the mid-peripheral retina that was associated with a retinal break and (2) a focal lens opacity. The third case is a 12-year-old with a history of familial exudative vitreoretinopathy and peripapillary choroidal neovascular membrane found to have a peripheral vitreal stalk in the right eye. These cases demonstrate a rare form of PFV with primarily peripheral remnants. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e83-e88.].
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Shin KS, Park HJ, Jo YJ, Kim JY. Efficacy and safety of primary posterior capsulotomy in combined phaco-vitrectomy in rhegmatogenous retinal detachment. PLoS One 2019; 14:e0213457. [PMID: 30849095 PMCID: PMC6407776 DOI: 10.1371/journal.pone.0213457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 02/21/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of posterior capsulotomy by analyzing the long-term visual outcomes in patients with rhegmatogenous retinal detachment (RD), who underwent combined phaco-vitrectomy with or without primary posterior capsulotomy. METHODS A retrospective longitudinal cohort analysis was performed by using data of rhegmatogenous RD patients undergoing combined phaco-vitrectomy. Patients were divided into two groups; Group A (68 eyes of 68 patients) with capsulotomy, and Group B (39 eyes of 39 patients) without capsulotomy. We reviewed the best-corrected visual acuity (BCVA), incidence of posterior capsule opacification (PCO), clinical features at the diagnosis of rhegmatogenous RD, and intraoperative or postoperative complications following posterior capsulotomy. RESULTS The modified BCVA measured by the logarithm of the minimum angle of resolution at initial diagnosis and 3, 6, and 12 months after surgery was 0.67 in Group A versus 0.85 in Group B (p = 0.258), 0.40 in Group A versus 0.50 in Group B (p = 0.309), 0.27 in Group A versus 0.45 in Group B (p = 0.055), and 0.21 in Group A versus 0.47 in Group B (p = 0.014), respectively. In subgroup with macula-on RRD, Group A exhibited better visual outcomes compared to Group B at 6(0.17 versus 0.40 [p = 0.037]) and at 12 months(0.14 versus 0.39 [p = 0.030]). The incidence of PCO in Group B was higher than Group A(28.2% versus 4.4% (p < 0.001)). There were no complications associated with posterior capsulotomy. CONCLUSIONS A primary posterior capsulotomy during combined phaco-vitrectomy using a 23-gauge vitreous cutter was a safe and effective surgical procedure in patients with RRD patients for preventing postoperative intraocular lens-related PCO.
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Affiliation(s)
- Kyung-Sup Shin
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Hye-Jin Park
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Young-Joon Jo
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
- * E-mail:
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Daruich A, Le Rouzic Q, Jonet L, Naud MC, Kowalczuk L, Pournaras JA, Boatright JH, Thomas A, Turck N, Moulin A, Behar-Cohen F, Picard E. Iron is neurotoxic in retinal detachment and transferrin confers neuroprotection. Sci Adv 2019; 5:eaau9940. [PMID: 30662950 PMCID: PMC6326753 DOI: 10.1126/sciadv.aau9940] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 11/28/2018] [Indexed: 05/12/2023]
Abstract
In retinal detachment (RD), photoreceptor death and permanent vision loss are caused by neurosensory retina separating from the retinal pigment epithelium because of subretinal fluid (SRF), and successful surgical reattachment is not predictive of total visual recovery. As retinal iron overload exacerbates cell death in retinal diseases, we assessed iron as a predictive marker and therapeutic target for RD. In the vitreous and SRF from patients with RD, we measured increased iron and transferrin (TF) saturation that is correlated with poor visual recovery. In ex vivo and in vivo RD models, iron induces immediate necrosis and delayed apoptosis. We demonstrate that TF decreases both apoptosis and necroptosis induced by RD, and using RNA sequencing, pathways mediating the neuroprotective effects of TF are identified. Since toxic iron accumulates in RD, we propose TF supplementation as an adjunctive therapy to surgery for improving the visual outcomes of patients with RD.
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Affiliation(s)
- Alejandra Daruich
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
- Ophthalmology Department, Necker-Enfants Malades University Hospital, AP-HP, Paris, France
| | - Quentin Le Rouzic
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
| | - Laurent Jonet
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
| | - Marie-Christine Naud
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
| | - Laura Kowalczuk
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Jean-Antoine Pournaras
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Jeffrey H. Boatright
- Department of Ophthalmology, School of Medicine, Emory University, Atlanta, GA, USA
- Center of Excellence, Atlanta Veterans Administration Medical Center, Decatur, GA, USA
| | - Aurélien Thomas
- Geneva University Hospitals, Unit of Toxicology, CURML, Geneva, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Natacha Turck
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
- Geneva University, Department of Human Protein Science, Geneva, Switzerland
| | - Alexandre Moulin
- Department of ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Francine Behar-Cohen
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
- Faculty of Biology and Medicine, University of Lausanne, Rue du Bugnon 21, 1011 Lausanne, Switzerland
- Ophtalmopole, Cochin Hospital, AP-HP, Assistance Publique Hôpitaux de Paris, 24 rue du Faubourg Saint-Jacques, 75014 Paris, France
- Corresponding author.
| | - Emilie Picard
- INSERM, UMRS1138, Team 17, From physiopathology of ocular diseases to clinical development, Université Sorbonne Paris Cité, Centre de Recherche des Cordeliers, 15 rue de l’Ecole de Médecine, 75006 Paris, France
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Marchese A, Rabiolo A, Bandello F, Querques G. Familial Exudative Vitreoretinopathy Imaged With Optical Coherence Tomography Angiography. Ophthalmic Surg Lasers Imaging Retina 2018; 49:e112-e113. [PMID: 30222830 DOI: 10.3928/23258160-20180907-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 01/30/2018] [Indexed: 11/20/2022]
Abstract
The authors present a case of a 29-year-old man who presented to the Department of Ophthalmology at their institution to complete a peripheral laser treatment in his left eye for familial exudative vitreoretinopathy complicated by tractional macular edema. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e112-e113.].
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Michalska-Małecka K, Sierocka-Stępień J, Michalik-Jakubek A, Witek K, Nowomiejska K, Jünemann A, Rejdak R. Evaluation of the treatment results in patients with rhegmatogenous retinal detachment treated by pars plana vitrectomy with air: Preliminary results. Medicine (Baltimore) 2018; 97:e10902. [PMID: 29851816 PMCID: PMC6392625 DOI: 10.1097/md.0000000000010902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the effectiveness of treatment and the restoration of the anatomic conditions (retinal reattachment) in rhegmatogenous retinal detachment treated by pars plana vitrectomy (PPV) using air as endotamponade. METHODS Twelve patients (12 eyes) with rhegmatogenous retinal detachment were included in the study. These were eyes with retinal detachment both with and without macular involvement. During the PPV surgery, the peripheral and central part of the vitreous body was excised to eliminate the formation of vitreoretinal traction after surgery, laser therapy was performed peripherally and in retinal openings, and the eyeball was filled with filtered air. Local conditions were evaluated at 1, 7, 14, 30, 90, and 180 days after the procedure. RESULTS The result of the patients' examination on the 30 day after surgery showed that 100% of cases achieved retinal reattachment and improved vision (best corrected visual acuity). In the long-term assessment, the final visual acuity was better in 11 patients (91.7%) compared to the initial results. On average, 7 days after the surgery, air in the eyeball occupied about one-fifth of the vitreous chamber and was completely absorbed about 10 to 14 days after surgery. CONCLUSIONS In the above-mentioned study, very good results of treatment of open-rooted retinal detachment were achieved. The air was quickly absorbed and visual acuity improved. Owing to the relatively fast absorption time, this method could be used successfully in high altitude patients and people often travelling by airplane.
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Affiliation(s)
- Katarzyna Michalska-Małecka
- Department of Ophthalmology, School of Medicine in Katowice
- Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice
| | | | - Aneta Michalik-Jakubek
- Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice
| | - Katarzyna Witek
- Professor K. Gibinski University Clinical Center, Medical University of Silesia, Katowice
| | | | - Anselm Jünemann
- Department of Ophthalmology, University Eye Hospital, Rostock, Germany
| | - Robert Rejdak
- Department of General Ophthalmology, Medical University in Lublin, Lublin, Poland
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Reinstein DZ, Carp GI, Archer TJ, Buick T, Gobbe M, Rowe EL, Jukic M, Brandon E, Moore J, Moore T. LASIK for the Correction of High Hyperopic Astigmatism With Epithelial Thickness Monitoring. J Refract Surg 2018; 33:314-321. [PMID: 28486722 DOI: 10.3928/1081597x-20170111-04] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
PURPOSE To evaluate outcomes of high hyperopic LASIK using the MEL 80 excimer laser (Carl Zeiss Meditec, Jena, Germany). METHODS Retrospective analysis of 830 consecutive high hyperopic LASIK procedures using the MEL 80 excimer laser and either the VisuMax femtosecond laser (Carl Zeiss Meditec) or zero compression Hansatome microkeratome (Bausch & Lomb, Rochester, NY). Inclusion criteria were attempted hyperopic correction of +4.00 diopters [D] or higher in one axis and corrected distance visual acuity (CDVA) of 20/20 or better. Patients were observed for a minimum of 1 year. Epithelial thickness monitoring by Artemis very high-frequency (VHF) digital ultrasound (ArcScan Inc., Morrison, CO) was used to evaluate potential for further steepening as a re-treatment. RESULTS One-year data were available for 785 eyes. Mean attempted spherical equivalent refraction (SEQ) was +4.52 ± 0.84 D (range: +2.00 to +6.96 D) for the primary treatment and mean cylinder was 1.05 ± 0.86 D (range: 0.00 to 5.25 D). Mean age was 50 ± 12 years (range: 18 to 70 years) and 61% were women. Postoperative SEQ was ±0.50 D in 50% and ±1.00 D in 77% of eyes after primary treatment. After re-treatment, 67% of eyes were within ±0.50 D and 89% were within ±1.00 D. Uncorrected distance visual acuity was 20/20 or better in 76% of eyes after final treatment. One line of CDVA was lost in 25% of eyes and two lines were lost in 0.4%. There was a clinically insignificant but statistically significant decrease (P < .05) in contrast sensitivity (CSV-1000) by less than 1 log unit at 3 and 6 cycles per degree (cpd) and by 1 log unit at 12 and 18 cpd. Diurnal fluctuation in refraction was identified in 2 eyes, proven by VHF digital ultrasound to be due to diurnal epithelial remodeling overnight and unrelated to maximum postoperative keratometry induced. CONCLUSIONS LASIK for hyperopia by cumulative treatment of up to +8.33 D with the MEL 80 excimer laser was found to satisfy accepted criteria for safety, efficacy, and stability when applying specialized protocols, including epithelial monitoring. [J Refract Surg. 2017;33(5):314-321.].
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Abstract
RATIONALE Megalophthalmos anterior is a rare, bilateral, nonprogressive, hereditary, congenital disorder, characterized by the enlargement of all anterior segment structures of the eye, with megalocornea, iris atrophy, and zonular abnormalities commonly found. Usually almost asymptomatic in young patients, with most complaints concerning blurred vision due to the common corneal astigmatism, it might in time lead to several complications including premature cataract formation and pigmentary glaucoma. PATIENT CONCERNS This review presents the case of a 47-year old patient referred to our clinic for traumatic cataract surgery, with striking bilateral megalocornea, somehow overlooked during previous ophthalmic examinations in his local outpatient clinic. DIAGNOSIS We noticed markedly enlarged corneas and deepened anterior chambers of his both eyes, accompanied by intumescent, white cataract of the right eye, and incipient cortical cataract of the left eye. Best corrected visual acuity (BCVA) was counting fingers in the right eye and 20/25 in the left eye. Additional examination revealed multiple abnormalities of the anterior segment, leading to the diagnosis of anterior megalophthalmos. It is astounding the patient remained undiagnosed during previous examinations, with his megalocornea and remarkably deep anterior chamber so apparent. INTERVENTIONS AND OUTCOMES We performed standard phacoemulsification procedure, with 3 piece posterior chamber intraocular lens (PCIOL) implantation into the lens capsule. The surgery was uneventful, with postoperative BCVA of 20/20 in the right eye, and no dislocation of the lens in 9-month observation period. LESSONS Complicated cataract in patients with anterior megalophthalmos can be successfully treated with standard phacoemulsification procedure followed by the bag PCIOL implantation.Care needs to be taken during cataract surgery in these patients, as zonular abnormalities and lens enlargement are common, resulting in increased rate of intra- and postoperative complications. As patients with anterior megalophthalmos require a more careful follow-up.
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Kiang L, Johnson MW. Formation of an Intraretinal Fluid Barrier in Cavitary Optic Disc Maculopathy. Am J Ophthalmol 2017; 173:34-44. [PMID: 27697474 DOI: 10.1016/j.ajo.2016.09.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE Cavitary optic disc maculopathy develops when fluctuating pressure gradients along anomalous communications in the optic nerve head induce migration of fluid into the adjacent retinal tissue. We sought to determine whether carefully titrated laser photocoagulation combined with vitrectomy and gas tamponade can safely create an effective intraretinal barrier to fluid egress from the optic disc cavitation. DESIGN Retrospective interventional case series. METHODS We retrospectively evaluated medical records and imaging studies of 22 consecutive patients with cavitary disc maculopathy evaluated by a single surgeon between 1991 and 2014. Patients requiring surgery underwent carefully titrated juxtapapillary laser photocoagulation followed immediately by vitrectomy and gas tamponade. Main outcome measures were change in visual acuity, macular fluid resolution, and recurrence of maculopathy. RESULTS Eleven patients (11 eyes) had undergone vitreous surgery and were included in the study. No preoperative evidence for vitreous traction on the optic disc or macula was seen in any eye. Nine patients underwent a single surgery and 2 patients required additional procedures to resolve the macular fluid. Mean length of follow-up after the last surgery was 48.2 months (range, 4-143 months). All 11 patients (100%) had complete resolution of macular fluid, with an average time to resolution of 8.5 months (range, 1-18 months). Only 1 of 11 patients (9%) had recurrence of macular fluid (14 months postoperatively). The average preoperative visual acuity of 20/125 (logMAR 0.81, standard deviation [SD] = 0.36) improved by nearly 4 lines to an average final visual acuity of 20/57 (logMAR 0.45, SD = 0.37) (P = .0072). A possible laser-induced central scotoma was suspected in only 1 patient who had undergone extensive prior laser treatments. CONCLUSIONS An effective intraretinal barrier to fluid migration from cavitary optic disc anomalies can be safely achieved in most patients with carefully titrated juxtapapillary laser photocoagulation combined with vitrectomy and gas tamponade. Once achieved, the barrier facilitates resolution of macular fluid and long-term avoidance of recurrent maculopathy.
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Affiliation(s)
- Lee Kiang
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Mark W Johnson
- W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
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Abstract
BACKGROUND Histologic characteristics have proven to be very useful for classifying different types of tumors of the pancreas. As a result, the major tumor types in the pancreas have long been classified based on their microscopic appearance. MAIN BODY Recent advances in whole exome sequencing, gene expression profiling, and knowledge of tumorigenic pathways have deepened our understanding of the underlying biology of pancreatic neoplasia. These advances have not only confirmed the traditional histologic classification system, but also opened new doors to early diagnosis and targeted treatment. CONCLUSION This review discusses the histopathology, genetic and epigenetic alterations and potential treatment targets of the five major malignant pancreatic tumors - pancreatic ductal adenocarcinoma, pancreatic neuroendocrine tumor, solid-pseudopapillary neoplasm, acinar cell carcinoma and pancreatoblastoma.
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MESH Headings
- Biomarkers, Tumor/genetics
- Carcinoma, Acinar Cell/diagnosis
- Carcinoma, Acinar Cell/genetics
- Carcinoma, Acinar Cell/surgery
- Carcinoma, Pancreatic Ductal/diagnosis
- Carcinoma, Pancreatic Ductal/genetics
- Carcinoma, Pancreatic Ductal/surgery
- Eye Diseases, Hereditary/diagnosis
- Eye Diseases, Hereditary/genetics
- Eye Diseases, Hereditary/surgery
- Humans
- Neuroendocrine Tumors/diagnosis
- Neuroendocrine Tumors/genetics
- Neuroendocrine Tumors/surgery
- Optic Nerve Diseases/diagnosis
- Optic Nerve Diseases/genetics
- Optic Nerve Diseases/surgery
- Pancreas/pathology
- Pancreatic Neoplasms/diagnosis
- Pancreatic Neoplasms/genetics
- Pancreatic Neoplasms/surgery
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Affiliation(s)
- Wenzel M Hackeng
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ralph H Hruban
- Department of Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Lodewijk A A Brosens
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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Shen Z, Gao E, Weng W, Luo W. [Hereditary vitreous degeneration muddy: report of ten cases]. Zhejiang Da Xue Xue Bao Yi Xue Ban 2016; 45:636-640. [PMID: 28247609 PMCID: PMC10396828 DOI: 10.3785/j.issn.1008-9292.2016.11.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Hereditary vitreous degeneration muddy is rare in clinic. Here we report ten cases (thirteen eyes) of hereditary vitreous degeneration muddy from two families. All patients presented with vitreous opacity, and the textures appeared tough and tensile. Two cases had concurrent detachment of rhegmatogenous retina. HE staining showed red changeableness, and methyl violet staining appeared purple. All patients received vitrectomy with traditional Chinese medicine treatment, and got satisfactory efficacy.
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Affiliation(s)
- Zhixin Shen
- Department of Ophthalmology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, China
| | - Enfang Gao
- Department of Ophthalmology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, China
| | - Wenqing Weng
- Department of Ophthalmology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, China
| | - Weiling Luo
- Department of Ophthalmology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314000, China
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Abstract
Congenital fibrosis of the extraocular muscles is a rare hereditary strabismus disorder. A case of congenital fibrosis of the inferior rectus muscles with severe chin-up posture and bilateral limitation of up gaze is reported. Bilateral large recessions of the tight inferior rectus muscles provided only partial improvement. Residual head posture and hypotropia were successfully corrected with bilateral horizontal rectus muscle transpositions toward the superior rectus muscles, despite persistently tight inferior rectus muscles at the time of surgery.
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Bergmanson JPG. Comment on 'Contact lens correction for an aphakic patient with megalocornea'. Cont Lens Anterior Eye 2014; 37:474. [PMID: 25447855 DOI: 10.1016/j.clae.2014.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/02/2014] [Accepted: 09/12/2014] [Indexed: 11/18/2022]
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van de Put MAJ, Croonen D, Nolte IM, Japing WJ, Hooymans JMM, Los LI. Postoperative recovery of visual function after macula-off rhegmatogenous retinal detachment. PLoS One 2014; 9:e99787. [PMID: 24927502 PMCID: PMC4057275 DOI: 10.1371/journal.pone.0099787] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 05/17/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine which factors affect the recovery of visual function in macula off rhegmatogenous retinal detachment (RRD). METHODS In a prospective study of forty-five patients with a primary macula-off RRD of 24 hours to 6 weeks duration, the height of the macular detachment was determined by ultrasonography. At 12 months postoperatively, best corrected visual acuity (BCVA), contrast acuity, and color confusion indexes (CCI) were obtained. RESULTS Macular detachment was present for 2-32 (median 7) days before repair. A shorter duration of macular detachment was correlated with a better CCI saturé (p = 0.0026) and lower LogMAR BCVA (better Snellen visual acuity) (p = 0.012). Also, a smaller height of macular detachment was correlated with a lower LogMAR BCVA (p = 0.0034). A younger age and lower pre-operative LogMAR BCVA at presentation were both correlated with better postoperative contrast acuity in the total group (age: p = 1.7×10(-4) and pre-operative LogMAR BCVA: p = 0.0034). CONCLUSION Functional recovery after macula-off RRD is affected by the duration and the height of the macular detachment. Recovery of contrast acuity is also affected by age and BCVA at presentation. MEETING PRESENTATION ARVO annual meeting 2013, May 7, Seattle, Washington, United States of America. TRIAL REGISTRATION trialregister.nl NTR839.
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Affiliation(s)
- Mathijs A. J. van de Put
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Danna Croonen
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ilja M. Nolte
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wouter J. Japing
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Johanna M. M. Hooymans
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
| | - Leonoor I. Los
- Department of Ophthalmology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- W.J. Kolff Institute, Graduate School of Medical Sciences, University of Groningen, Groningen, the Netherlands
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Feltgen N, Walter P. Rhegmatogenous retinal detachment--an ophthalmologic emergency. Dtsch Arztebl Int 2014; 111:12-21; quiz 22. [PMID: 24565273 PMCID: PMC3948016 DOI: 10.3238/arztebl.2014.0012] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 09/09/2013] [Accepted: 09/09/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Rhegmatogenous retinal detachment is the most common retinological emergency threatening vision, with an incidence of 1 in 10 000 persons per year, corresponding to about 8000 new cases in Germany annually. Without treatment, blindness in the affected eye may result. METHOD Selective review of the literature. RESULTS Rhegmatogenous retinal detachment typically presents with the perception of light flashes, floaters, or a "dark curtain." In most cases, the retinal tear is a consequence of degeneration of the vitreous body. Epidemiologic studies have identified myopia and prior cataract surgery as the main risk factors. Persons in the sixth and seventh decades of life are most commonly affected. Rhegmatogenous retinal detachment is an emergency, and all patients should be seen by an ophthalmologist on the same day that symptoms arise. The treatment consists of scleral buckle, removal of the vitreous body (vitrectomy), or a combination of the two. Anatomical success rates are in the range of 85% to 90%. Vitrectomy is followed by lens opacification in more than 70% of cases. The earlier the patient is seen by an ophthalmologist, the greater the chance that the macula is still attached, so that visual acuity can be preserved. CONCLUSION Rhegmatogenous retinal detachment is among the main emergency indications in ophthalmology. In all such cases, an ophthalmologist must be consulted at once.
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Park SJ, Choi NK, Park KH, Woo SJ. Five year nationwide incidence of rhegmatogenous retinal detachment requiring surgery in Korea. PLoS One 2013; 8:e80174. [PMID: 24236173 PMCID: PMC3827446 DOI: 10.1371/journal.pone.0080174] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 10/09/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To define the incidence and demographic characteristics of rhegmatogenous retinal detachment (RRD) requiring surgery in Korea. DESIGN Nationwide population-based retrospective study. METHODS Patients who underwent surgery for RRD from 2007 to 2011 were retrospectively identified using the diagnostic code for RRD and the surgical codes for retinal detachment surgeries in the national claim database. The average incidence rate of RRD during the 5-year period was estimated using the population data of the 2010 Census in Korea. RESULTS A total of 24,928 surgically treated RRD cases were identified. The average incidence of surgery requiring RRD was 10.39 cases per 100,000 person-years [95% confidence interval (CI), 10.26-10.52). The incidence in men (11.32 cases per 100,000 person-years; 95% CI: 11.13-11.51) was significantly higher than that in women (9.47 cases per 100,000 person-years; 95% CI: 9.29-9.64) (p<0.001). The incidence of surgery requiring RRD showed a bimodal distribution across age groups, with one peak (28.55 cases per 100,000 person-years; 95% CI: 27.46-29.67) representing patients between 65 and 69 years of age and the second peak (approximately 8.5 per 100,000 person-years) representing patients between 20 and 29 years of age. The male-to-female ratio was approximately 1.0 for the peak-incidence age groups, whereas the ratio was higher for the other age groups. CONCLUSIONS The incidence of RRD in the Korean population was similar to that reported previously, with the peak incidence being lower than that in the Caucasian population. The age-specific RRD incidence pattern in Korea followed a bimodal distribution.
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Affiliation(s)
- Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Nam-Kyoung Choi
- Medical Research Collaborating Center, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Republic of Korea
- Institute of Environmental Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Se Joon Woo
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Chaker N, Mghaieth F, Chebil A, Bouladi M, El Matri L. [Management of rhegmatogenous retinal detachment with unseen breaks: about 50 cases]. Bull Soc Belge Ophtalmol 2013:111-115. [PMID: 24923091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the clinical and therapeutic characteristics of rhegmatogenous retinal detachment (RRD) with unseen retinal breaks. PATIENTS AND METHODS Retrospective study 50 eyes (50 patients) with RRD with unseen retinal breaks in the pre and intraoperative examination. These patients were treated between 2005 and 2010 by vitrectomy or scleral buckling. Retinal breaks were meticulously sought by indentation of the vitreous base. The subretinal fluid was drained by a peripheral retinotomy when a vitrectomy was needed and puncture ab externo when a scleral buckling was performed. RESULTS A retinal detachment with unseen retinal breaks accounted for 15% of all RRD operated during this 5-year duration period (2005 - 2010). The average age of our patients was 57 years.Ten were myopic (20%) and 27 (54%) pseudophakic, with inferior RRD in 60% of the cases cases while advanced vitreoretinal proliferation (PVR) greater or equal to stage C in was present in 72%. Primary vitrectomy was performed in 46 cases. Retinal reattachment rate was achieved after a single procedure in 41 eyes (82%). Among them, 40 were operated by vitrectomy and one eye by scleral buckling. The recurrence rate was significantly higher in patients operated by scleral buckling (75%) than by vitrectomy (15%). CONCLUSION RRD with unseen retinal breaks are often seen inferiorly and have a chronic evolution (60%). They concern pseudophakic patients in the majority of the cases. Their poor prognosis and high recurrence rate also appear to be related to an advanced PVR (72%). The good results of primary vitrectomy should be confirmed by randomized studies, especially in phakic eyes.
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Orczykowska M, Omulecki W, Wilczyński M. [Cataract surgery in a patient with megalocornea - a case report]. Klin Oczna 2013; 115:53-56. [PMID: 23882742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE 10 describe a rare case ot a patient wiTh megalocorneas wno underwent cataract surgery. MATERIAL AND METHODS A 52 years old patient with extremely wide corneas 16 mm in diameter in both eyes, was admitted to our department with cataract diagnosis. Four other male members of his family are known to have megalocorneas. This suggests X-linked recessive inheritance. The visual acuities were; 0.9 with correction -3.00 Dsph in the right eye and 0.6 with correction -5.50 Dsph in the left eye. Mosaic corneal dystrophy and slight iridodonesis was found in both eyes. Posterior subcapsular cataracts were seen in both eyes with predominance in the left eye. Moreover, flat peripheral retinal detachment in the lower part of the eye fundus was found, which was presumably long-lasting. Phacoemulsification through the clear corneal temporal micro-incision of 1.8 mm and the foldable intraocular lens IOL) implantation in the left eye were performed. The IOL refractive power was calculated with 101 Master and with standard contact ultrasound biometry. Preventive laser photocoagulation of the retina was performed in the right eye. RESULTS No intraoperative and postoperative complications were observed. Two weeks after cataract surgery corrected visual acuity in the left eye was ii] with correction + 1.00 Dsph. The patient was very satisfied with the surgery result. CONCLUSIONS Phacoemulsification with an implantation of foldable 101 in patients with megalocornea may be a safe procedure with very good functional results. Precise IOL power calculation may be difficult to achieve.
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Affiliation(s)
- Maria Orczykowska
- Zaktad Patofizjologii Widzenia Obuocznego i Leczenia Zeza I Katedry Chor6b Oczu Uniwersytetu Medycznego w Lodzi Kierownik.
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Abeysiri P, Bunce C, da Cruz L. Outcomes of surgery for retinal detachment in patients with Stickler syndrome: a comparison of two sequential 20-year cohorts. Graefes Arch Clin Exp Ophthalmol 2007; 245:1633-8. [PMID: 17579881 DOI: 10.1007/s00417-007-0609-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Revised: 03/15/2007] [Accepted: 05/08/2007] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Stickler syndrome is a hereditary oculo-systemic disorder where patients are predisposed to retinal detachments which are often complex and challenging to manage. Significant progress has been made regarding the molecular genetics of the condition; however, there is little recent literature on surgery for retinal detachment in Stickler syndrome. Our aim is to describe a population of Stickler patients presenting to Moorfields Eye Hospital with detachment from 1986 to 2003. We looked at patient characteristics, characteristics of detachment, management and anatomical and functional outcomes. We also aim to compare this group from 1986 to 2003 with a past group of Stickler patients treated at Moorfields between 1965 and 1985, reported by (Billington et al. in Trans Ophthalmol Soc UK 104:875-879, 1985). This comparison of 20-year matched cohorts examined patient characteristics, features of detachment, management and anatomical outcome in the two groups using the same definitions as the earlier authors. RESULTS In the Stickler group from 1986 to 2003, complete re-attachment rate was 67% for primary scleral-buckle surgery, 84.2% for primary vitrectomy and 78.57% for all surgery in 30 eyes of 23 patients. Overall in this group there was an average increase in Logmar visual acuity of 0.33 and 0.32 in patients undergoing primary cryo-buckle and primary vitrectomy surgery respectively. When comparing the two groups using Fisher's exact test, we found that the group from 1986 to 2003 had significant improvement in re-attachment for detachments with multiple tears and for vitrectomy surgery, compared with the group from 1965 to 1985. CONCLUSIONS This study shows that despite complicated surgery and often multiple procedures, good anatomical outcomes were achieved as well as useful functional visual results after retinal detachment surgery in Stickler patients. It would also appear that when comparing the group of Stickler patients from 1986 to 2003 with the group from 1965 to 1985 improvements were seen in outcome from vitrectomy surgery and surgery for multiple breaks probably due to advances in technique and technology in vitreoretinal surgery, over the past 4 decades.
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Affiliation(s)
- Poorna Abeysiri
- Western Eye Hospital, 153 Marylebone Road, London NW15QH, UK.
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22
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O'Hearn TM, Fawzi A, He S, Rao NA, Lim JI. Early onset vitreous amyloidosis in familial amyloidotic polyneuropathy with a transthyretin Glu54Gly mutation is associated with elevated vitreous VEGF. Br J Ophthalmol 2007; 91:1607-9. [PMID: 17522146 PMCID: PMC2095545 DOI: 10.1136/bjo.2007.119495] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To report the early vitreous involvement in a rare familial amyloidotic polyneuropathy (FAP) mutation and associated vitreous vascular endothelial growth factor (VEGF) levels. DESIGN Observational case series. METHODS Review of clinical, pathological, photographic, and angiographic records of two FAP siblings with severe vitreous involvement. Laboratory ELISA analysis of vitreous samples for VEGF, and DNA sequence analysis of peripheral blood for transthyretin (TTR) mutational analysis. RESULTS Two patients underwent 25-gauge vitrectomy in three eyes with marked improvement of visual acuity. Neovascularisation seen intraoperatively responded to endolaser. Analysis of vitrectomy samples for VEGF showed raised levels in all three specimens. Mutational analysis revealed an isolated Glu54Gly mutation in the transthyretin gene. CONCLUSIONS Early involvement of the vitreous occurs in a rare transthyretin mutation of FAP, with increased vitreous levels of VEGF.
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MESH Headings
- Adult
- Age of Onset
- Amyloid Neuropathies, Familial/diagnosis
- Amyloid Neuropathies, Familial/epidemiology
- Amyloid Neuropathies, Familial/genetics
- Amyloid Neuropathies, Familial/metabolism
- Amyloid Neuropathies, Familial/surgery
- Asian People/genetics
- Eye Diseases, Hereditary/diagnosis
- Eye Diseases, Hereditary/epidemiology
- Eye Diseases, Hereditary/genetics
- Eye Diseases, Hereditary/metabolism
- Eye Diseases, Hereditary/surgery
- Fluorescein Angiography
- Fundus Oculi
- Glutamic Acid
- Glycine
- Humans
- Male
- Mutation
- Prealbumin/genetics
- Vascular Endothelial Growth Factor A/metabolism
- Vitrectomy
- Vitreous Body/metabolism
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Affiliation(s)
- T M O'Hearn
- Retina Service, Eye and Ear Infirmary, University of Illinois, 1855W Taylor St, Suite 2.50, Chicago, IL 60612, USA
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Chaudhry IA, Shamsi FA, Elzaridi E, Arat YO, Riley FC. Congenital cystic eye with intracranial anomalies: a clinicopathologic study. Int Ophthalmol 2007; 27:223-33. [PMID: 17453153 DOI: 10.1007/s10792-007-9059-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Accepted: 02/13/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe clinical, imaging and histopathologic findings of congenital cystic eyes associated with intracranial malformations. METHODS Retrospective, noncomparative, interventional, clinicopathologic case reports of two female children (ages 15 days and six months) who were found to have non-discernable eye globes at birth. The patients underwent complete clinical examination, imaging studies, surgical exploration and histopathological evaluation of the excised orbital cystic structures. RESULTS The fellow socket in one patient was found to be anophthalmic and the fellow eye in the second patient was highly myopic. Clinical, imaging [ultrasonography, computerized tomography (CT) scan and magnetic resonance imaging (MRI)], and histopathologic evaluations were consistent with the diagnosis of congenital cystic eye in both cases. Intracranial abnormalities were found in both patients, requiring ventroperitoneal shunting. Orbital cysts in both patients were excised and no recognizable eye structures were identified at the time of surgery. Histopathologic study in each case revealed a cyst externally surrounded by dense fibrous connective tissue with the inner aspect of the cyst lined by primitive neuroglial tissue in one case and immature and dysplastic retinal elements in the other. No recognizable ocular structures or microphthalmos were identified in either case. Immunohistochemical staining for glial fibrillary acidic protein, neuron-specific enolase and neurofilament protein were positive without evidence of normal elements of cornea, lens, ciliary body, choroid or retina. CONCLUSION Congenital cystic eye should be suspected in patients with an unrecognizable eye globe and the possible association with intracranial malformation investigated. Early recognition of the association may help in the diagnosis and treatment of anophthalmic socket and intracranial anomalies.
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Affiliation(s)
- Imtiaz A Chaudhry
- Oculoplastic and Orbit Division, King Khaled Eye Specialist Hospital, PO Box 7191, Riyadh 11462, Saudi Arabia.
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Theelen T, Go SL, Tilanus MAD, Klevering BJ, Deutman AF, Cremers FPM, Hoyng CB. Autosomal dominant rhegmatogenous retinal detachment--clinical appearance and surgical outcome. Graefes Arch Clin Exp Ophthalmol 2004; 242:892-7. [PMID: 15064954 DOI: 10.1007/s00417-004-0903-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2003] [Revised: 01/19/2004] [Accepted: 02/20/2004] [Indexed: 10/26/2022] Open
Abstract
PURPOSE To study the clinical appearance and surgical results of autosomal dominantly inherited rhegmatogenous retinal detachments (RRDs). METHODS After prospective examination of all but two family members, the medical records of 16 affected patients (21 eyes) of two families from the Netherlands with autosomal dominantly inherited RRD were retrospectively evaluated. Special attention was paid to the age at onset, the ocular morphology and the clinical appearance of the RRD. The type and number of the various surgical procedures were analyzed with respect to preoperative appearance of the RRD, postoperative results and final visual acuity. RESULTS The mean age at onset of RRD of affected individuals in families A and B was 37 +/- 18 years and 19 +/- 10 years, respectively. The mean ocular axial length in the two families was 24.7 mm and 26.7 mm. The mean number of retinal defects preoperatively found was 2.2 in family A and 7.1 in family B. Round, atrophic retinal holes predominated. Two of 21 affected eyes showed significant preoperative proliferative vitreoretinopathy. Pars plana vitrectomy was the primary procedure in 4 cases; extra ocular buckling was the initial procedure in 15 cases. One eye received scleral folding with diathermy as primary surgery. Redetachment following surgery occurred in 5 of 10 cases in family A and 4 of 10 eyes in family B. Anatomical success could be achieved in 9 of 10 and 8 of 10 eyes in families A and B, respectively. CONCLUSIONS In these families the prevalence of RRD is high. Most patients were affected at a relatively young age compared with non-genetically linked forms of RRD. Because of the low success rate of surgical intervention and, subsequently, the high number of operations necessary to achieve reattachment of the retina, the use of diagnostic genetic techniques to identify individuals at risk would be advisable. In these subjects measures to prevent RRD are an option, even when anatomical substrates of precursors of RRD are absent.
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Affiliation(s)
- Thomas Theelen
- Department of Ophthalmology, University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Shukla D, Singh J, Sudheer G, Soman M, John RK, Ramasamy K, Perumalsamy N. Familial exudative vitreoretinopathy (FEVR). Clinical profile and management. Indian J Ophthalmol 2003; 51:323-8. [PMID: 14750620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
PURPOSE To report our experience with the diagnosis and management of Familial Exudative Vitreoretinopathy (FEVR) in a predominantly older Indian population.. METHODS This prospective interventional non-comparative case series included 38 patients of FEVR and their 23 family members. The diagnosis was established by clinical examination, fluorescein angiography and family screening. Prophylactic photocoagulation/cryotherapy or surgical treatment was done depending on the severity of the disease. RESULTS The mean age of the patients was 23.6 years. The fundus/fluorescein angiographic findings in 116 eyes of our 61 patients (6 eyes phthisical) were as follows: forty eight (41.4%) eyes had only peripheral avascular zone, 8 (6.9%) eyes had peripheral new vessels, and 35 (30.1%) eyes had retinal detachments (RD)--10 (8.6%) exudative, 5 (4.3%) tractional and 20 (17.2%) rhegmatogenous. Prophylactic photocoagulation or cryotherapy was done in 34 eyes for retinal holes, local exudative detachments and bleeding new vessels. All the eyes retained stable vision over a mean follow-up of 16 months. Only 14 RDs were suitable for surgery: scleral buckling, vitrectomy or both. The reattachment rate was 85.7% (12 of 14) and the best-corrected visual acuity (BCVA) improved to 5/60 or better in 50% of these eyes over a 2-year follow-up. CONCLUSIONS FEVR appears to be more common than reported. Timely diagnosis and intervention is essential in view of the lifelong progression of the disease, late exacerbations, frequent involvement of family members, and poor surgical results. A high index of suspicion, family screening and early prophylaxis are recommended to prevent avoidable blindness from this underdiagnosed disease.
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Affiliation(s)
- Dhananjay Shukla
- Retina Vitreous Service, Aravind Eye Hospital & Postgraduate Institute of Ophthalmology, Madurai, Tamil Nadu, India.
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Abstract
PURPOSE To evaluate the visual functions of children with hereditary dislocated lenses after within-the-bag lensectomy surgery and to report the results of 18 eyes with a follow-up interval of 11 to 19 years. DESIGN Prospective, noncomparative, interventional case series. PARTICIPANTS Ninety-seven children (age range, 6 months-16 years) were examined. Fifty-seven patients had poor functional vision. Surgery was performed in 97 eyes. METHODS Fifty-nine eyes (37 patients) were operated on from 1980 through 1994, and 38 eyes (20 patients) underwent surgery from 1994 through 2001. The indications for surgery included a best-corrected visual acuity of less than 20/60, progressive subluxation of the lens with bisection of the pupil, imminent total dislocation, or cataractous changes. Within-the-bag lensectomy combined with a limited anterior vitrectomy was carried out either through the pars plana or the limbus. The resulting aphakia was corrected with contact lenses, glasses, or both and the children were followed up regularly. MAIN OUTCOME MEASURES Best-corrected visual acuity, intraocular pressure, and complications after surgery. RESULTS Preoperative mean visual acuity for all operated eyes was 0.17 +/- 0.1 (standard deviation). The postoperative mean visual acuity of the 59 eyes operated from 1980 through 1994 was 0.60 +/- 0.25. For the group of 38 eyes operated on from 1994 through 2001, the postoperative visual acuity was 0.63 +/- 0.22. In most eyes, vision achieved shortly after the surgery remained stable or improved on a follow-up of up to 19 years after surgery. Repeated refraction of the operated eyes showed a trend toward a decrease of hypermetropia. No major complications occurred during or shortly after surgery. Ten children (18 eyes) followed up regularly for more than 11 years and up to 19 years after surgery demonstrated a stable visual acuity with minor fluctuations and an intraocular pressure within the normal range in all operated eyes. CONCLUSIONS Within-the-bag lensectomy is a safe and rewarding procedure for the handling of dislocated lenses in children.
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Affiliation(s)
- Irene Anteby
- Pediatric Ophthalmology Unit, Hadassah Hebrew University Hospital, Jerusalem 91120, Israel
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Abstract
Phacoemulsification with implantation of an acrylic foldable intraocular lens in a 14-year-old girl with microspherophakia is described. The associated lenticular myopia was disabling in terms of quality of life. With the help of nylon iris hooks, the procedure was uneventful and the outcome successful
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Affiliation(s)
- Sudarshan Khokhar
- Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi, India.
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28
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Abstract
An infant born with bilateral corneal clouding diagnosed clinically as congenital anterior staphyloma and Peters' anomaly was confirmed histopathologically. This case report demonstrates one clinical spectrum of Peters' anomaly. The clinical course and histopathologic findings are detailed as is a unique surgical approach of corneoscleral graft used to perserve the right globe.
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Affiliation(s)
- Marijean M Miller
- Department of Ophthalmology, The George Washington University School of Medicine and Health Sciences, Washington, DC 20010, USA
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Khairallah M, Ladjimi A, Ben Yahia S, Zaouali S, Messaoud R, Boulima K. Elevated macular retinoschisis associated with Goldmann-Favre syndrome successfully treated with grid laser photocoagulation. Retina 2002; 22:234-7. [PMID: 11927864 DOI: 10.1097/00006982-200204000-00021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Moncef Khairallah
- Department of Ophthalmology, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
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Abstract
PURPOSE To report four cases of primary pupillary pigment epithelial iris cysts, all members of one family, in which two of the patients had recurring transitory visual impairment. METHODS Observational case series. History was taken, the patients were examined with slit-lamp and ultrasound biomicroscopy, and surgically removed cyst tissue was examined with transmission electron microscopy. RESULTS Pupillary pigment epithelial cysts of the iris generally show an autosomal dominant heredity pattern, with occasional lack of penetrance. In two of our cases, the size and location of the cysts caused visual symptoms, necessitating surgical removal. The cyst wall consists entirely of pigment epithelial cells. CONCLUSION The origin of pupillary pigment epithelial cysts is unclear, and a hereditary background is very likely. Their clinical significance is in their similarity to pigmented tumors of the iris. They may also be indicative of coexisting systemic disease. In symptomatic cases, treatment is indicated.
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Affiliation(s)
- Ferenc B Sallo
- Faculty of Health Sciences, Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Gupta SK, Leonard BC, Damji KF, Bulman DE. A frame shift mutation in a tissue-specific alternatively spliced exon of collagen 2A1 in Wagner's vitreoretinal degeneration. Am J Ophthalmol 2002; 133:203-10. [PMID: 11812423 DOI: 10.1016/s0002-9394(01)01339-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the genetic basis of an autosomal dominant vitreoretinopathy in a large French-Canadian kindred. METHODS A clinical cohort study followed by laboratory-based genetic and molecular analysis. Thirty-two affected and 22 unaffected members of the kindred were examined. Candidate genes/regions for Wagner's disease and Stickler syndrome were tested for genetic linkage. Mutation analysis was carried out with direct PCR-based sequencing. RESULTS Funduscopic examinations of 32 affected patients revealed optically clear vitreous, vitreous veils, and radial perivascular pigmentation. Spondyloarthropathies or craniofacial abnormalities were notably absent. There was a 53% rate of retinal detachments that required surgical intervention. Genetic linkage was obtained to COL2A1, the candidate gene for Stickler's type I. A frame shift mutation in exon 2, leading to early truncation of the protein (Cys57Stop), was detected. CONCLUSIONS Wagner's disease in this large kindred has had devastating visual consequences. In affected individuals, we found a novel COL2A1 frame shift mutation in exon 2. The mutation arises in an exon that is selectively present in vitreous collagen mRNAs, but absent in cartilage mRNAs through tissue-specific alternative splicing. Tissue-specific alternative splicing of COL2A1 mRNAs thus provides an elegant biochemical mechanism for a clinical phenotype of Wagner's disease in this kindred.
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Abstract
A phacoemulsification procedure with implantation of a foldable acrylic intraocular lens in a 31-year-old man with spherophakia is described. The procedure was necessitated by anterior dislocation of the spherophakic lens, with corneal endothelial contact and development of central corneal edema. With a careful approach, the procedure was uneventful and the outcome successful. Modern small-incision cataract surgery techniques are of great benefit in this type of complicated case.
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Affiliation(s)
- Anders Behndig
- Department of Clinical Science/Ophthalmology, Umeå University Hospital, Umeå, SE-901 85 Sweden.
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Affiliation(s)
- L J Singerman
- Retina Associates of Cleveland, Inc., Enterprise Place, 3401 Enterprise Parkway, Suite 300, Cleveland, OH 44122, USA
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34
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Abstract
Penetrating keratoplasty in infants and young children is performed on an infrequent basis. The most common indication is visually significant congenital corneal opacity. Surgery must be performed early to avoid amblyopia. Surgical techniques differ from those used in adult penetrating keratoplasty because of the reduced ocular rigidity encountered in infants and young children. Use of a multispecialty team approach is important to improve visual outcome. Poor prognostic indicators include bilateral disease, concomitant infantile glaucoma, lensectomy and vitrectomy at the time of surgery, previous graft failure, extensive goniosynechiae, and extensive corneal vascularization. Prompt postoperative optical rehabilitation, combined with occlusion therapy when appropriate, is an important determinant of success.
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Affiliation(s)
- J J Reidy
- Department of Ophthalmology, State University of New York, School of Medicine & Biomedical Sciences, Buffalo, New York, USA.
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35
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Abstract
In order to investigate the refractive error, amblyopic frequency, and refractive change, if any, following recovery of cornea injury through surgery of epiblepharon and congenital entropion patients, we retrospectively reviewed the sex distribution, age at operation, chief complaints, preoperative and postoperative refractive errors, and best corrected visual acuity in 160 previously operated patients. The average age at operation was 7.9 years. The preoperative best corrected visual acuity of 133 eyes (41.6%) was below 5/9. Ninety-five eyes (29.7%) were preoperative myopes above -1.0D; 77 eyes (24%) were hyperopes above +1.0D; and 163 eyes were astigmatic above -1.0D. Of 228 eyes that were followed up for more than one year, 66 eyes demonstrated a best corrected visual acuity of below 5/9. There was no significant difference in the change in corneal astigmatism following surgery between the group under the age of 7 and the group over the age of 7. However, the mean best corrected visual acuity at postoperative one year was 6/9, which was significantly different from the preoperative value (P=0.006). Concurrent postoperative glasses correction and amblyopic therapy is indicated because the incidence of refractive errors and amblyopia is higher in epiblepharon and congenital entropion.
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Affiliation(s)
- S W Yang
- Department of Ophthalmology, College of Medicine, The Catholic University of Korea, Seoul
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Aldave AJ, Eagle RC, Streeten BW, Qi J, Raber IM. Congenital corneal opacification in De Barsy syndrome. Arch Ophthalmol 2001; 119:285-8. [PMID: 11176995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A newborn male was noted to have bilateral congenital corneal opacification. Findings from examination disclosed a variety of dysmorphic features, including cutis laxa, progeroid aspect, short stature, multiple hyperextensible subluxated joints, muscular hypotonia, and hyperreflexia. Bilateral penetrating keratoplasties were performed; histopathologic examination revealed diffuse epithelial thickening, loss of the Bowman layer, and stromal attenuation with anterior stromal scarring. Special stains showed no deposition of abnormal material in the corneas. Electron microscopy demonstrated absence of Bowman layer differentiation with a paucity of collagen fibers, as well as extensive small elastic fibers in the anterior stroma. The diagnosis of De Barsy syndrome was made, a rare progeroid syndrome associated with characteristic ocular, facial, skeletal, dermatologic, and neurologic abnormalities. De Barsy syndrome should be included in the differential diagnosis of congenital corneal opacification; its distinctive clinical features enable the clinician to easily differentiate it from other causes of congenitally cloudy corneas.
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Affiliation(s)
- A J Aldave
- Cornea Service, Wills Eye Hospital, 900 Walnut St, Philadelphia, PA 19107, USA.
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37
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Hedin A. [Oculoplastic surgery implies restoration to "normalcy". Cosmetic surgery is performed only for congenital malformations or disease]. Lakartidningen 2000; 97:5444-5, 5448-50. [PMID: 11192768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Ophthalmic plastic or oculoplastic surgery is the current term for the surgical treatment of disorders of the eyelid, the lacrimal apparatus and the orbit. The most frequent causes are congenital malformations, malpositions, abnormal motility, tumors and injuries. A good functional result with the best possible appearance is the goal; cosmetic surgery is performed only when the underlying cause is a malformation or disease. Several specialties have qualifications relevant to this field or parts of it; this article describes the tasks of an ophthalmologist working in this field and what he can accomplish.
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Affiliation(s)
- A Hedin
- Ogonkliniken, Akademiska sjukhuset, Uppsala
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Abstract
PURPOSE To evaluate the structure of the anterior segment after congenital cataract surgery with ultrasound biomicroscopy. METHODS Ultrasound biomicroscopy was performed on 28 eyes of 15 patients after congenital cataract surgery (age range, 8-27 years; mean, 13.1 +/- 1.1 years), of which 26 eyes had pars plana lensectomy and two eyes had phacoemulsification and aspiration, and on 21 eyes of 11 phakic control subjects who were healthy (age range, 6-17 years; mean, 11.5 +/- 1.1 years). The angle-opening distance at 500 microm was measured on a line perpendicular to the trabecular meshwork 500 microm from the scleral spur, and the trabecular-iris angle was measured. RESULTS Angle-opening distance at 500 microm in the congenital cataract group ranged from 174 to 920 microm (mean, 424 +/- 28 microm), and in the control group it ranged from 260 to 1,119 microm (mean, 643 +/- 57 microm), a difference that was significantly different (P =.0004, Student t test). The trabecular-iris angle in the congenital cataract group ranged from 30.4 to 66.9 degrees (mean, 41.9 +/- 1.6 degrees) and in the control group ranged from 32.1 to 69.8 degrees (mean, 44.9 +/- 2.5 degrees), a difference that was not significantly different (P =.28, Student t test). This means that there is a tendency for high insertion of the iris in the congenital cataract group, and intraocular pressure was elevated after surgery (including glaucoma and ocular hypertension) in 10 (47.6%) of 21 eyes with high insertion. The pars plicata after congenital cataract surgery was significantly flatter than that of control subjects (P =.0057, Student t test). CONCLUSIONS Ultrasound biomicroscopy is a useful method for evaluating the anterior segment of eyes with congenital cataract, and complications after cataract surgery can be caused by disorganization of the anterior segment. Patients with abnormalities of the anterior segment should be followed up closely for the development of glaucoma.
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Affiliation(s)
- K Nishijima
- Department of Ophthalmology, Tenri Yorozu Hospital, (all authors), Nara, Japan.
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Abstract
Ophthalmic manifestations are a common component of the ectrodactyly-ectodermal dysplasia-clefting (EEC) syndrome; however, few ophthalmic publications have specifically addressed these features. The authors describe a 38-year-old patient with EEC syndrome who demonstrated several associated ocular signs and symptoms. The ophthalmic findings in this patient included bilateral entropion with secondary trichiasis, and shallow inferior fornices with symblepharon. Interestingly, the patient also had vertically deficient tarsi and absence of the meibomian glands. Ophthalmologists should be aware of the ocular signs and symptoms associated with EEC because some manifestations can potentially be sight threatening.
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Affiliation(s)
- I A Ireland
- Division of Oculoplastic and Orbital Surgery, Lions Eye Institute, Albany, NY 12208, USA
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40
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Abstract
BACKGROUND Ectopia lentis et pupillae (ELeP) is a rare congenital inherited disorder characterized by lenticular and pupillary ectopia. Recent speculation on its pathogenesis is based on clinical observation and includes a neuroectodermal defect or persistence of fetal vasculature. None of these reports included histopathology or imaging studies. STUDY DESIGN Case report and literature review. INTERVENTION The authors examined a 55-year-old woman with ELeP using 10-MHz and 50-MHz ultrasonography to demonstrate the structural abnormalities present. Five patients (eight eyes) who had undergone cataract extraction without lens implantation were also examined. RESULTS In the patient with ELeP, the right pupil was displaced inferiorly and the left temporally. An ultrasound scan at 10 MHz showed both lenses lying inferiorly in the vitreous. An ultrasound scan at 50 MHz allowed detailed examination of the anterior segment, including the iris and ciliary body, and showed two main features in each eye, including a lack of definition of ciliary processes, except in that quadrant toward which the pupil was displaced, and a membrane-like structure extending forward and attaching to the proximal pupil margin. The membrane passed over the tips of the ciliary processes to a more posterior origin. CONCLUSIONS The only histologic reports of this condition are from the beginning of this century in the German literature. Ultrasonography at 50 MHz allows high-resolution in vivo imaging of anterior structures that are not clinically visible. The authors' findings in this case of ELeP are sufficiently different from those of non-ELeP-related aphakia to suggest that they are not solely due to aphakia. Furthermore, the authors' findings are very similar to the only histologic reports suggesting that the pupillary and lenticular ectopia results from mechanical tethering of the pupil with zonular disruption. This hypothesis has not been discussed in the recent literature.
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Abstract
PURPOSE To describe a new manifestation of Peters' anomaly. METHODS We managed four infants with an unusual form of Peters' anomaly. One eye of each patient had a thickened and scarred cornea, mimicking a corneal staphyloma, protruding anteriorly from the corneal plane. The other eye of each patient ranged from normal to having severe ocular anomalies. A corneal transplant was performed in each case. RESULTS Follow-up ranged from 1 to 3 years. Three eyes maintained graft clarity for at least 1 year. Each of these eyes developed vision. Two of these eyes developed glaucoma. The one eye with graft failure developed an inoperable retinal detachment. The histopathology of each corneal button showed changes consistent with Peters' anomaly. CONCLUSIONS These corneas demonstrated characteristics of both Peters' anomaly and congenital anterior staphyloma. Despite their severe anomalies, surgery successfully restored a more normal cosmetic appearance in all four eyes and vision in three eyes.
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Affiliation(s)
- G W Zaidman
- Westchester Medical Center, Our Lady of Mercy Hospital, New York Medical College, Department of Ophthalmology, Valhalla 10595, USA
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Gorin MB. The interplay of genetics and surgery in ophthalmic care. Semin Ophthalmol 1995; 10:303-17. [PMID: 10160217 DOI: 10.3109/08820539509063801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M B Gorin
- Department of Ophthalmology, University of Pittsburgh School of Medicine, PA, USA
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43
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Peng X, Wang G, Zhang F. [Familial exudative vitreoretinopathy]. Zhonghua Yan Ke Za Zhi 1995; 31:426-9. [PMID: 8762569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Familial exudative vitreoretinopathy (FEVR) is an autosomal dominant inherited disease. The developmental abnormality of retinal vessels is the basis of various lesions in FEVR. 11 affected members (21 eyes) from 5 families with FEVR were studied. The emphasis was placed on describing the changes of fundus and fundus fluorescein angiography of the disease. Argon laser photocoagulation was performed on 8 patients (14 eyes) and they were followed for 5 approximately 14 months. The diagnosis, differential diagnosis, complications and treatment of FEVR were discussed with some materials in this paper.
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Affiliation(s)
- X Peng
- Ophthalmology Department, Beijing Tongren Hospital
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44
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Affiliation(s)
- R C Ratnavel
- Department of Dermatology, Addenbrooke's Hospital, Cambridge
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45
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Benson WE. Familial exudative vitreoretinopathy. Trans Am Ophthalmol Soc 1995; 93:473-521. [PMID: 8719692 PMCID: PMC1312071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the natural history of Familial Exudative Vitreoretinopathy (FEVR) with emphasis on the effect of the age of onset on its severity and on the development of late complications such as cataract and retinal detachment. Also, to evaluate affected patients for DNA abnormalities. METHODS The records of thirty-nine patients with FEVR were studied. All were asked to come in for a final follow-up examination. The referring physician was asked to provide the latest findings for those who could not. On 10 patients, karyotypes were prepared. RESULTS Only 2 of 28 patients whose onset of symptoms was prior to their third birthday had a final visual acuity of 20/200 or better. Older patients had a better prognosis, because they were more likely to have asymmetrical retinal deterioration with only one eye deteriorating. Preservation of good visual acuity into the teens and later was no guarantee that deterioration would not occur. In 3 eyes of 4 patients who were asymptomatic until 15 years of age, the final visual acuity was counting fingers or worse. In 5 patients, retinal detachment developed 6 to 17 years after apparent stabilization. The karyotype of 10 patients showed no evidence for rearrangement, altered size, translocations or deletions of chromosome 11 or any other chromosome. Of the 31 eyes in patients older than 15 years, 10 (32%) had a significant cataract. Three eyes underwent cataract surgery. CONCLUSIONS The prognosis for infants with FEVR is extremely poor and the long-term prognosis for patients with a later onset of the condition is guarded. Retinal detachment, macular dragging, and cataract are common late complications which can develop even in patients whose eye findings appear to be stable. Karyotype studies ruled out involvement of chromosome 11 or others at a gross level, but did not exclude them at the location for some genetic defect related to FEVR because single base changes and small deletions or insertions may be undetectable by the methods utilized.
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