1/218. Repair of scleral rupture and total retinal detachment in a self-injuring psychotic patient under local anesthesia: a case report.PURPOSE: Ocular self-injury by psychotic patients is an uncommon cause of ocular morbidity that poses peculiar problems. This report describes a schizophrenic self-injuring patient with scleral rupture and retinal detachment (RD), treated under loco-regional anesthesia. CASE REPORT: A 65-year-old man presented with scleral rupture, hyphema, traumatic lens luxation, vitreous prolapse, vitreous hemorrhage and total RD after deliberately hitting his head. The fellow eye had been successfully operated with scleral buckle surgery for the same reason two years earlier. The patient underwent a two-step surgical procedure under local anesthesia, with repositioning and resection of the uveal prolapse and scleral rupture repair and, separately, lens removal pars plana vitrectomy (PPV), membrane peeling, retinotomy, laser treatment and SiO tamponade. RESULTS: Twelve months after PPV, the cornea was clear, IOP was 16 mmHg, the retina was attached and VA was 20/200. The fellow eye maintained 20/30 VA. CONCLUSIONS: In psychotic patients the intrinsic difficulty of a traumatic RD is combined with systemic illness, no compliance and the risk of recurrence. Although ocular traumas usually require general anesthesia, this patient underwent both interventions under local anesthesia with sedation, because of his psychotic condition and chronic liver failure. Local anesthesia and sedation proved effective in controlling pain and intra-operative compliance even in such a difficult patient. Although it is reasonable to question operating on such patients, we nonetheless believe that every attempt should always be made at gaining useful vision in both eyes since these patients are at a high risk of recurrent ocular trauma.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/218. retinal detachment in postpartum preeclampsia and eclampsia: report of two cases.retinal detachment is an unusual complication of hypertensive disorder in pregnancy. It has been reported in 1% to 2% of patients with severe preeclampsia and in 10% of patients with eclampsia. Choroidal ischemia may be the cause of retinal detachment. We know that mild arteriolar spasm involving the bulbar conjunctival vessels has been observed in the normal pregnancy, but in pregnancy-induced hypertension the vasospasm may be severe and result in choroidal ischemia. Most patients with retinal detachment in pregnancy-induced hypertension have had full spontaneous resolution within a few weeks, and they did not have any sequelae. Medical treatment with antihypertensive drugs and steroids may be helpful. We report two rare cases of retinal detachment and persistent hypertension in association with postpartum eclampsia and post-cesarean section preeclampsia. These patients had normotension throughout pregnancy. Preeclampsia or eclampsia developed after delivery, and blurred vision, headache, and reduced vision accompanied serous retinal detachment. The serous retinal detachment disappeared within 3 weeks. Good outcomes were found in the follow-up examinations in both of these cases. For women who had been normotensive at the time of delivery and then complained in the postpartum period of blurred vision, headaches, nausea and vomiting, we should consider the possibility of retinal detachment and perform fundoscopy.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
3/218. Transscleral diathermy: an additional tool in the management of retinal detachment due to posterior breaks in highly myopic eyes.PURPOSE: To investigate the usefulness of transscleral diathermy for the treatment of retinal detachment due to breaks located at the posterior pole in areas of advanced chorioretinal atrophy or staphyloma in highly myopic eyes. methods: We reviewed the charts of seven consecutive patients who were operated on between 1984 and 1994 and for whom transscleral diathermy was used during intraocular retinal reattachment surgery to reduce posterior staphyloma. Mean refraction of the seven eyes was -24 diopters (range -16 to -35 diopters). RESULTS: After surgery, which included diathermy, the retina was reattached in six eyes (86%) that also had undergone vitrectomy and silicone oil tamponade, but remained detached in one eye (14%) that had undergone pneumopexy and diathermy; in this eye, the retina was subsequently reattached after vitrectomy and silicone oil injection. Silicone oil was removed from all seven eyes after a mean duration of 2.5 months. During a mean follow-up of 3 years, a recurrent retinal detachment developed in one eye 8 months after silicone oil removal. This retina was reattached after reinjection of silicone oil. CONCLUSIONS: In the treatment of retinal detachment in highly myopic eyes, closure of posterior holes in areas of advanced chorioretinal atrophy or staphyloma can be achieved by transscleral diathermy in conjunction with vitrectomy and temporary silicone oil tamponade. The main benefit of transscleral diathermy results from its posterior pole scleral buckling effect due to shrinkage of the sclera.- - - - - - - - - - ranking = 32.663959262688keywords = area (Clic here for more details about this article) |
4/218. Simultaneous bilateral painful ophthalmoplegia and exudative retinal detachment in rheumatoid arthritis.A 47-year-old woman who suffered from chronic rheumatoid arthritis presented with bilateral painful ophthalmoplegia with proptosis and exudativeretinal detachment. The painful ophthalmoplegia with proptosis might have been caused by pachymeningitis involving the cavernous sinus bilaterally, or bilateral posterior scleritis spreading to the extraocular muscles and tendons. The exudative retinal detachment might have been a result of bilateral posterior scleritis which had spread to the choroid. These two unusual complications of rheumatoid arthritis occurred simultaneously in this case. Both complications responded to corticosteroid treatment.- - - - - - - - - - ranking = 6keywords = pain (Clic here for more details about this article) |
5/218. Reattachment of retina and retinoschisis in pit-macular syndrome by surgically-induced vitreous detachment and gas tamponade.The origin of the subretinal fluid in pit-macular syndrome is unknown. Using optical coherence tomography, the authors observed that an optic disk pit is not a true pit but a cystic cavity covered with a superficial layer of the optic disk in a patient with retinal detachment and retinoschisis. The cyst was connected to the intraretinal space of the retina, which was split in several layers, or the retinoschisis in the papillomacular area. vitrectomy and gas tamponade were performed to treat the patient. During surgically-induced vitreous detachment, strong vitreoretinal attachment at the disk margin and the fovea was observed. After surgery, the cystic space at the optic disk disappeared and the retinal detachment and retinoschisis reattached. Vitreous traction may play a role to introduce the fluid from the optic cyst to the subretinal space through the superficially split retina.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
6/218. Confirmation of persistent closure of surgically repaired macular hole in subsequent retinal detachment by optical coherence tomography.Idiopathic macular holes have shown response to surgical intervention with vitrectomy, presumably because of glial cell proliferation in the reapproximated tissue. We describe a patient with postoperative closure of a macular hole who subsequently developed a retinal detachment involving the macular area. Despite the detachment, the macular hole remained closed as evidenced by biomicroscopy and optical coherence tomography (OCT). OCT provides accurate documentation and assessment of pre- and postoperative conditions in macular hole surgery.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
7/218. Idiopathic multiple serous detachments of the retinal pigment epithelium followed by bilateral central serous chorioretinopathy: a case report.An uncommon case of a 25-year-old woman affected by bilateral idiopathic multiple serous detachments of the macular retinal pigment epithelium is described. During the fluorescein angiography follow-up, in either macular area one of these detachments resulted in a typical central serous chorioretinopathy active leakage point. These findings detail that idiopathic serous detachments of the retinal pigment epithelium may represent predisposing changes for the development of macular neurosensory retinal detachment.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
8/218. Ocular-central nervous system lymphoma mimicking posterior scleritis with exudative retinal detachment.OBJECTIVE: We describe an unusual ocular presentation of ocular-central nervous system lymphoma in a young patient. DESIGN: Interventional case report and literature review. methods: A previously well 24-year-old white woman presented with left eye pain and reduced vision. Episcleral injection, globe tenderness, an afferent pupil defect, and exudative retinal detachment were present. Computed tomographic scan of the head and orbits demonstrated scleral thickening, retinal detachment, and no other abnormality. A provisional diagnosis of posterior scleritis with exudative retinal detachment was made. Investigation for underlying connective tissue diseases was negative. There was an initial prompt response to corticosteroid therapy. The patient's symptoms and signs then recurred, and a left third cranial nerve palsy developed. Systemic investigations including lumbar puncture ultimately led to the diagnosis of primary T-cell central nervous system (CNS) lymphoma. serologic tests for human immunodeficiency virus were negative. MAIN OUTCOME MEASURES AND RESULTS: The patient underwent orbital and cranial irradiation and intrathecal and systemic chemotherapy. Despite an initial response to treatment, she returned with a recurrence of the lymphoma in the anterior segment of the left eye. Her systemic disease progressed rapidly, and she died shortly thereafter. CONCLUSIONS: This patient's young age and initial presentation mimicking posterior scleritis with unilateral exudative retinal detachment, without evidence of vitreous involvement, are highly unusual for ocular involvement in primary CNS lymphoma. A review of the literature highlights the atypical nature of this presentation.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
9/218. Early rhegmatogenous retinal detachment following laser in situ keratomileusis for high myopia.PURPOSE: Four eyes had early rhegmatogenous retinal detachment within 3 months of laser in situ keratomileusis (LASIK) for correction of high myopia using the microkeratome, Clear Corneal Molder. methods: In two eyes, retinal detachment resulted from horseshoe tears, one occurring in an otherwise normal region of the retina and the other at the margin of an area of lattice degeneration detected during preoperative examination. The first eye was treated with retinopexy using a 287 encircling scleral exoplant, drainage of subretinal fluid, and laser photocoagulation by indirect ophthalmoscopy. The other eye was treated with pneumatic retinopexy and cryotherapy. In the other eyes, retinal detachment was the result of giant tears with no evidence of prior retinal degeneration. These eyes were treated with pars plana vitrectomy, fluid-gas exchange with 15% perfluoropropane (C3F8), endolaser photocoagulation, and a 42 encircling scleral exoplant. RESULTS: After treatment, the first two eyes achieved spectacle-corrected visual acuity of 20/40. In the last two eyes, final spectacle-corrected visual acuity was 20/400 in one eye and light perception in the other. CONCLUSIONS: Although no cause-effect relationship between LASIK and retinal detachment can be stated, these cases suggest that LASIK may be associated with retinal detachment, particularly in highly myopic eyes. Further studies are necessary to determine high-risk patient characteristics.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
10/218. Diode laser photocoagulation for retinopathy of prematurity: a histopathologic study.Laser photocoagulation has largely supplanted cryotherapy as an effective treatment for retinopathy of prematurity. This case describes the ocular histopathologic findings of a pair of eyes in a severely premature male infant treated with diode laser photocoagulation for bilateral stage 3 retinopathy of prematurity (ROP) for 360 degrees in zone 1 with severe plus disease. The right eye responded to treatment; the left eye developed persistent vitreous hemorrhage and total retinal detachment. The histopathologic examination of laser burns in the right eye disclosed segmental areas of chorioretinal scarring with retinal atrophy and gliosis, loss of RPE and extensive atrophy of the choroid and its vasculature, which involved both the choriocapillaris and larger vessels. The left eye had iris neovascularization, a chronic organized vitreous hemorrhage and a totally detached retina. The histopathologic findings in an eye of a premature infant with threshold ROP treated with diode laser photocoagulation resembled those reported after transsceral cryotherapy. Diode laser photocoagulation may produce less severe chorioretinal damage.- - - - - - - - - - ranking = 16.331979631344keywords = area (Clic here for more details about this article) |
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