1/2. Management of traumatic rupture of the globe in aphakic patients.We report the successful treatment of three cases of traumatic ruptures of the globe complicated by massive choroidal hemorrhage, uveal prolapse and retinal detachment. All three of the eyes were aphakic prior to injury and all patients were age 64 or older. The presenting visual acuity in all patients was light perception. The blunt injury in each case caused a wound dehiscence at the site of previous cataract extraction. All injuries were associated with uveal prolapse. Secondary surgical intervention was performed when the hemorrhagic choroidal detachments had decreased as demonstrated by echography in the suprachoroidal space, occurring at an average of 14 days after injury. The management consisted of surgical drainage of the choroidal hemorrhage combined with vitrectomy and silicone oil injection. Successful reattachment of the retina was achieved in all cases. Postoperative epiretinal membranes formed in two cases but all were anatomically successful at six months. Final visual acuities varied from 20/70 to 1/200, visual acuity being a function of secondary contusive damage to the retina and choroid. We believe that in eyes sustaining severe blunt injuries resulting in rupture of the globe complicated by massive choroidal hemorrhage and retinal detachment, properly timed external drainage of the choroidal hemorrhage combined with pars plana vitrectomy and silicone oil injection is a useful approach.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |
2/2. Cystoid macular edema after aphakic penetrating keratoplasty.Aphakic penetrating keratoplasty (APKP) and combined penetrating keratoplasty with lens extraction (CPKP) are highly successful surgical procedures, with clear corneas occurring in over 90% of cases. However, macular problems tend to develop or appear postoperatively, and visual acuity is disappointing, principally because of either cystoid macular edema (CME) or pre-existing macular degeneration. To determine whether vitreous manipulation at the time of surgery alters the macular outcome, 132 eyes were studied prospectively. Eighty-four of these had pre-existing aphakia and all underwent anterior vitrectomy at the time of APKP. Forty-eight eyes were planned for CPKP and were randomly assigned to one group that had anterior vitrectomy or to a second group that had no vitrectomy at the time of CPKP. The incidence of clinically significant and angiographically documented CME at six months postoperative was 35/84 (42%) in APKP eyes, 9/48 (19%) in CPKP eyes, 8/24 (33%) in CPKP eyes with vitrectomy, and 1/24 (4%) in CPKP eyes without vitrectomy. The data strongly suggest that transpupillary anterior vitrectomy at the time of penetrating keratoplasty, as compared with no vitreous manipulation at all, may contribute to a high incidence of postoperative persistent CME.- - - - - - - - - - ranking = 1keywords = extraction (Clic here for more details about this article) |