1/133. vitrectomy for cystoid macular oedema with attached posterior hyaloid membrane in patients with diabetes.AIM: To report the success of vitrectomy in eliminating cystoid macular oedema and improving vision in three eyes of two patients with diabetic cystoid macular oedema. In all of the eyes there was no ophthalmoscopic evidence of traction from a posterior hyaloid membrane or from proliferative tissue. methods: Pars plana vitrectomy was performed on three eyes of two patients with diabetic cystoid macular oedema who did not show traction upon examination with a slit lamp biomicroscope and a scanning laser ophthalmoscope. RESULTS: Cystoid changes disappeared 1, 3, and 5 days, postoperatively, and diffuse macular oedema resolved within 2 weeks. The visual acuity was improved and maintained. CONCLUSION: vitrectomy can be effective in some patients with diabetic cystoid macular oedema even in patients who lack evidence of traction by ophthalmoscopy.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
2/133. Providing timely and ongoing vision rehabilitation services for the diabetic patient with irreversible vision loss from diabetic retinopathy.BACKGROUND: diabetic retinopathy (DR) remains the leading contributor to severe vision loss in the united states among persons 20 to 70 years of age. Despite advances in disease management and treatment, patients with vision loss from DR continue to constitute a significant portion of patients served in vision rehabilitation service (VRS) settings. These patients present special challenges to VRS providers because of early onset, fluctuations in and the complex nature of vision loss, unique visual demands of disease management, and associated multi-system losses. case reports: After introductory epidemiologic review, a case presentation format is used to illustrate solutions a multidisciplinary VRS can offer the special visual challenges of the person with diabetes with vision loss from DR. Four patients are presented--ages 30 to 70 years--with varying degrees and types of vision loss, with different lifestyle demands and disease management needs. The cases address vocational issues, vision fluctuation, coordinating adaptive solutions to complex visual losses, and meeting diabetic needs to measure medication, insulin, and blood glucose levels, to maintain skin care, diet, exercise, transportation, family roles, and support systems. CONCLUSIONS: The unique and complex needs of people with diabetes who experience vision loss can be well addressed through timely and ongoing VRS consultations, in conjunction with medical/ocular disease management.- - - - - - - - - - ranking = 3keywords = visual (Clic here for more details about this article) |
3/133. Preservation of vision through Weiss ring after dense vitreous hemorrhage.PURPOSE: To report an unusual case of retained vision through a Weiss ring in the setting of dense vitreous hemorrhage. METHOD: Case report of a 55-year-old woman with a 23-year history of type 1 diabetes mellitus who presented with new onset of blurred vision in the left eye as a result of a dense vitreous hemorrhage. RESULTS: The patient had received full scatter laser photocoagulation for proliferative diabetic retinopathy in the right eye several years earlier and reported previous resolving episodes of vitreous hemorrhage in the left eye. Best-corrected visual acuity in the left eye was hand motions at 3 feet. However, with careful head positioning visual acuity improved to 20/40 through a small clear central island. Examination of the left fundus showed a dense vitreous hemorrhage with a clear, mobile opening in the posterior hyaloid corresponding to the Weiss ring. The retina could be partially visualized only through the area of the Weiss ring. CONCLUSIONS: This unusual case demonstrates the anatomical relationship between the posterior hyaloid and Weiss ring.- - - - - - - - - - ranking = 3keywords = visual (Clic here for more details about this article) |
4/133. Subthreshold (invisible) modified grid diode laser photocoagulation in diffuse diabetic macular edema (DDME)BACKGROUND AND OBJECTIVE: To determine the effectiveness of subthreshold (invisible) diode laser (810 nm) modified grid photocoagulation for the treatment of diffuse diabetic macular edema (DDME). methods: Fifty eyes of 29 patients were treated with subthreshold (invisible) diode laser modified grid photocoagulation for DDME in a prospective pilot clinical trial. Follow-up was conducted for a minimum of 6 months (average: 14.11 /- 6.15 months). Re-treatment was performed for residual edema involving the foveal avascular zone. Ten patients were tested with Goldman visual field pre- and post-treatment. Visual improvement, visual loss, visual field, reduction/elimination of macular edema, and the number of treatments per eye were studied. RESULTS: Reduction/elimination of DDME was observed in 39% of the eyes after 1 to 3 treatments (2.22 /- 0.84 treatments) in 6 to 12 months; and in 74% of eyes after 1 to 5 treatments (2.90 /- 1.02 treatments) 15-24 months follow-up. The presence of cystoid macular edema, initial poor visual acuity, or a history of systemic hypertension did not affect the outcome. patients without a history of systemic vascular diseases had a better chance of visual stabilization or improvement. Eighty-eight percent of the patients had at least stable vision at the last follow-up. Two out of 10 visual field tests showed a decrease in paracentral scotomas; no post-treatment subjective complaints of increased paracentral scotomas were encountered. CONCLUSION: Subthreshold (invisible) diode laser modified grid photocoagulation is effective in reducing/eliminating DDME, although resolution of edema may be slightly prolonged. However, this method may be advantageous in that it appears to reduce the objective and subjective effect on the paracentral visual field. Subthreshold (invisible) diode laser modified grid photocoagulation substantially reduces the post-treatment atrophic scarring.- - - - - - - - - - ranking = 7keywords = visual (Clic here for more details about this article) |
5/133. Treatment of severe proliferative retinopathy and diabetic maculopathy.Strict blood glucose control, early detection and surveillance of diabetic retinopathy by means of validated screening programmes, and judicious use of laser photocoagulation can greatly reduce the risk of visual loss in diabetes. Some patients however, have aggressive neovascular disease resistant to laser treatment, or present at a late stage with advanced fibroproliferative disease, and may progress rapidly to blindness. In the elderly with Type 2 disease, diabetic maculopathy is more common and requires a different therapeutic approach. The present article describes two diabetic patients and discusses the management of patients with severe proliferative retinopathy or diabetic maculopathy.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
6/133. Optical cross-sectional observation of resolved diabetic macular edema associated with vitreomacular separation.PURPOSE: To describe the resolution of cystoid macular edema associated with vitreomacular separation in a diabetic patient. methods: Case report. A 58-year-old man who had cataract surgery 3 years earlier developed diabetic macular edema after panretinal laser photocoagulation. For a detailed fundus examination, we performed neodymium: YAG (Nd:YAG) laser capsulotomy in the left eye as the initial management. RESULTS: Two days after the laser capsulotomy, fundus biomicroscopy and B-mode ultrasonography disclosed a vitreomacular separation in the left eye that was not detectable preoperatively. Optical coherence tomography through the macula disclosed a dramatic decrease in the size of intraretinal cystoid spaces with an improvement of visual acuity. Scanning retinal thickness analysis also confirmed the decrease of retinal thickness at the macula with the resolution of cystoid macular edema. CONCLUSION: Resolution of diabetic macular edema with subsequent visual recovery is potentially associated with the vitreomacular separation in a patient after Nd:YAG laser capsulotomy.- - - - - - - - - - ranking = 2keywords = visual (Clic here for more details about this article) |
7/133. Improved retinal capillary perfusion following treatment of severe proliferative diabetic retinopathy.The authors report a photodocumented case of improved retinal capillary perfusion accompanied by visual acuity improvement after treatment of severe proliferative diabetic retinopathy.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
8/133. Surgical treatment for severe diabetic macular edema with massive hard exudates.PURPOSE: Massive diabetic macular exudates respond poorly to conventional laser treatment. The purpose of this study was to analyze the surgical results of eyes with massive hard exudates secondary to diabetic macular edema treated with combined pars plana vitrectomy, posterior hyaloid removal, focal endolaser treatment, and panretinal photocoagulation. methods: The author retrospectively analyzed the surgical outcome of 13 consecutive eyes (11 patients) with massive diabetic macular exudates. All patients had had at least one session of focal and/or grid laser treatment without any effect. Pars plana vitrectomy, posterior hyaloid removal, focal macular endolaser treatment, and intraoperative panretinal photocoagulation were performed. Postoperative visual acuity, evolution of macular edema, and hard exudates were recorded. RESULTS: All 13 eyes showed significant decreases in macular edema and hard exudates, a process that became clinically obvious 3 months after the operation. Eleven eyes had improved vision of at least two lines during an average follow-up period of 14.8 months. Intraoperative and postoperative complications included angle closure glaucoma (one eye), persistent vitreous hemorrhage (two eyes), choroidal detachment (one eye), intravitreal fibrin formation (one eye), epiretinal membrane formation (one eye), and neovascular glaucoma (one eye). CONCLUSION: Combined surgery may offer an opportunity for improvement of vision and reduction of massive macular exudates in patients with severe diabetic macular edema.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
9/133. Endoscopic vitreoretinal surgery for complicated proliferative diabetic retinopathy.PURPOSE: To evaluate the indication for endoscopic vitreoretinal surgery in proliferative diabetic retinopathy (PDR). methods: Chart review of consecutive cases of vitreoretinal surgery for PDR performed by one of the authors (Y.L.F.) over a 2-year period. RESULTS: Endoscopic vitreoretinal surgery was performed in 8 of 41 (19.5%) eyes. The surgical indications were small pupil (3), hyphema (3), pseudophakia with fibrotic posterior capsule (1), and pars plana neovascularization with anterior tractional retinal detachment (6). CONCLUSION: Endoscopic vitreoretinal surgery, by enhancing the visualization of the retroirideal space, is a useful technique in PDR with opaque ocular media and/or neovascularization of the pars plana and ciliary body.- - - - - - - - - - ranking = 1keywords = visual (Clic here for more details about this article) |
10/133. Surgical removal of choroidal neovascular membranes after laser photocoagulation for diabetic maculopathy.PURPOSE: Choroidal neovascularisation (CNV) occurs rarely following laser photocoagulation for macular oedema in diabetic retinopathy, and its management is not well established. We report the clinical course and visual outcomes in a series of patients who underwent surgical extraction of the CNV membrane. methods: A retrospective review of 4 cases was carried out. RESULTS: Two women and 2 men, mean age 59.5 (range 58-62) years, were reviewed. The CNV developed 2-24 (mean 11) months after laser coagulation and resulted in decreased visual acuity to between 6/60 and HM. All underwent pars plana vitrectomy, extraction of the CNV membrane and fluid-air exchange. Follow-up ranged between 9 and 48 months. In 2 patients, the vision improved by 4 and 1 Snellen lines respectively and remained stable, in 1 patient it improved by 1 line initially but then regressed to CF, and in 1 patient it remained unchanged. recurrence of CNV occurred in only 1 patient. Histological characteristics were those of CNV without evidence of photoreceptors. CONCLUSIONS: This study shows that surgical removal of post-laser CNV is technically feasible despite the previous laser scars and may have beneficial outcome. This surgical approach may provide a therapeutic option in such patients.- - - - - - - - - - ranking = 2keywords = visual (Clic here for more details about this article) |
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