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Objective: To compare pars plana vitrectomy (PPV) with PPV and scleral buckle (PPV/SB) for repair of rhegmatogenous retinal detachment (RRD)., Design: A retrospective chart review., Participants: Patients who underwent PPV or PPV/SB for RRD repair at a single institution., Methods: A retrospective chart review of patients in two different treatment groups and analysis of the anatomic and functional results., Results: Single-surgery anatomic success was achieved in 31 of 37 (83.8%) phakic eyes that underwent PPV and in 66 of 68 (97.1%) phakic eyes that underwent PPV/SB (p = 0.0216). Among pseudophakic eyes, 42 of 48 (87.5%) in the PPV group and 62 of 66 (93.9%) in the PPV/SB group achieved single-surgery reattachment (p = 0.3175). Visual acuity improvement was marginally greater in the PPV group among phakic (p = 0.4898) and pseudophakic (p = 0.2465) eyes., Conclusions: PPV/SB may be associated with a decreased risk for retinal redetachment when compared to PPV for repair of phakic RRD. In pseudophakic eyes, the anatomic success rate between the two techniques appears to be similar., (Copyright © 2011 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the anatomic closure rate and visual outcome in patients undergoing pars plana vitrectomy (PPV) with internal limiting membrane (ILM) peeling with and without indocyanine green (ICG) enhancement., Design: Retrospective, noncomparative interventional case series., Participants: One hundred ninety-three consecutive patients (204 eyes) seen at the Barnes Retina Institute with the clinical diagnosis of macular hole who underwent PPV between January 1998 and December 2000., Intervention: A consecutive series of 97 patients undergoing PPV with or without unilateral epiretinal membrane removal without ILM peeling (group 1), 44 patients with PPV and ILM peeling without ICG (group 2), and 35 patients with ICG-assisted ILM peeling (group 3)., Results: Overall, 86.4% of the holes closed with one operation, with 75 of 97 (77.3%) eyes in group 1, 43 of 44 (97.7%) eyes in group 2, and 34 of 35 (97.1%) eyes in group 3 (chi(2)= 10.51, P = 0.007). Of the eyes that did not close, 18 patients in group 1 underwent repeat surgery, with 90 of 97 (92.8%) eyes ultimately achieving closure. Visual acuity after surgery was 20/50 or better in 55 of 97 (56.7%) patients, 31 of 44 (70.4%) patients, and 18 of 35 (51.4%) patients in groups 1, 2, and 3, respectively (chi(2) = 3.43, P = 0.18) and increased by 2 or more lines from their preoperative status in 63 of 97 (64.9%) patients, 34 of 44 (77.3%) patients, and 25 of 35 (71.4%) patients, respectively (chi(2)= 2.25, P = 0.32). Multivariate logistic regression demonstrated that use of ILM peeling during vitrectomy increases the chances of developing 20/50 vision or better (odds ratio [OR], 2.4; 95% confidence interval, 1.06-5.45; P = 0.04). No eyes received concurrent cataract extraction with macular hole surgery, but 75 of 166 (45.2%) required cataract extraction postoperatively. Complications included 20 retinal tears, 4 retinal detachments, and 34 patients with postoperative elevations in intraocular pressure (IOP; defined as IOP greater than 30 mmHg)., Conclusions: Although this study is limited by the shorter follow-up in patients undergoing ILM peeling with or without ICG relative to the control group, our experience indicates that the use of ILM peeling is associated with a statistically significant improvement in the rate of primary macular hole closure with a single operation.

Purpose: To review our experience with vitrectomy surgery techniques for the treatment of traumatic macular holes and the biomicroscopic and surgical findings., Design: Retrospective noncomparative, multicenter, case series., Participants and Intervention: Twenty-five patients with traumatic macular hole underwent surgical repair., Intervention: Vitrectomy with membrane peeling and gas injection followed by prone positioning for 7 to 14 days., Main Outcome Measures: Postoperative evaluation included visual acuity testing, closure of the macular hole, and ocular complications., Results: The macular hole was successfully closed in 24 of 25 cases (96%). The visual acuity improved two or more lines in 21 (84%) cases, and 16 (64%) achieved 20/50 or better vision., Conclusions: Vitrectomy surgery can successfully close macular holes associated with trauma and improve vision.

Background: Giant cell arteritis is a common cause of severe visual loss in older individuals. Patients often present to the ophthalmologist having already lost vision in one eye. Detection of early ophthalmoscopic signs that precede irreversible visual loss in giant cell arteritis would allow preventative treatment in an otherwise frequently blinding disease., Methods: Case presentations., Results: Seven patients with mild visual symptoms and results of an ophthalmologic examination significant for cotton-wool spots were found to have giant cell arteritis. On specific questioning, six of seven patients described constitutional symptoms consistent with giant cell arteritis. Six patients had an abnormally elevated Westergren erythrocyte sedimentation rate. Temporal artery biopsy confirmed giant cell arteritis in six patients. The seventh patient received a diagnosis of polymyalgia rheumatica. Prompt treatment with corticosteroids led to preservation of vision and uneventful resolution of the cotton-wool spots in all seven patients., Conclusion: Cotton-wool spots are an early ophthalmoscopic finding in giant cell arteritis and can precede severe visual loss. Recognition of the significance of cotton-wool spots, use of laboratory studies, and prompt treatment may preserve vision in an otherwise frequently blinding disease.

Purpose: To assess the frequency of persistent infection after injection of intravitreal antimicrobials as therapy for endophthalmitis and to determine if persistent infection influences the final visual outcome after treatment., Methods: In a series of 42 eyes with culture-positive endophthalmitis of various types, the authors performed a second vitreous culture and injection of antimicrobial agents in 22 eyes. Repeat cultures were obtained 3 to 8 days after initial therapy in 20 of the 22 eyes., Results: Twelve of the 22 eyes were persistently culture-positive. Organisms identified in the persistently culture-positive eyes included staphylococcal species (n = 4), Streptococcus (n = 4), Serratia (n = 1), Propionibacterium acnes (n = 1), and fungi (n = 2). Eyes in which the initial antimicrobial therapy failed to eradicate a bacterial infection had a worse outcome than those that were culture-negative on repeat sampling. Final visual acuity of 20/200 or better after repeat injection was attained in 4 of the 12 culture-positive eyes., Conclusion: A single injection of intravitreal antimicrobial agents may be insufficient to cure some cases of endophthalmitis, and a second injection should be considered in some circumstances.

Background: Subfoveal choroidal neovascularization (CNV) usually is associated with a poor visual prognosis. Laser photocoagulation of certain subfoveal membranes secondary to age-related macular degeneration (ARMD) appears preferable to observation based on recent Macular Photocoagulation Study (MPS) findings but is associated with decreased vision. The authors explored the use of vitreoretinal surgical techniques as an alternative method of eradicating subfoveal CNV., Methods: After vitrectomy, a small retinotomy technique was used to extract or disconnect from the choroidal circulation subfoveal CNV in 58 eyes. There were 33 eyes with ARMD, 20 eyes with presumed ocular histoplasmosis, and 5 eyes with miscellaneous etiologies. Five eyes also received subfoveal RPE patches., Results: With limited follow-up, significant improvement in vision (defined as 2 Snellen lines) was achieved in 7 of 22 eyes with ARMD CNV removal (1 eye 20/20), 0 of 4 eyes with ARMD CNV removal and RPE patches, and 1 of 7 eyes with ARMD CNV disconnection. Significant improvement was achieved in 6 of 16 eyes with presumed ocular histoplasmosis removal and 0 of 4 eyes with presumed ocular histoplasmosis CNV disconnection. In 5 eyes with miscellaneous CNV, 2 improved (20/20 and 20/40). CNV recurred in 29%., Conclusions: Some patients with subfoveal CNV appear to benefit from surgical removal. Only rarely do eyes with ARMD improve. Longer-term follow-up and refined case selection are required before this approach can be widely recommended.

Two hundred seventy eyes with premacular fibroplasia consecutively treated by pars plana vitrectomy and membrane peeling were reviewed. This study is among the largest series with long-term follow-up reported to date. Visual improvement of two or more lines was achieved in 43% of eyes at 6 to 12 months, in 54% at 1 to 2 years, in 60% at 2 to 3 years, and in 58% at 3 to 5 years. Overall, complications occurred in 34 eyes (13%). Cataract progression after vitrectomy was noted in 106 (57%) of phakic eyes at 3 to 5 years, and 43 of these eyes underwent subsequent cataract extraction. Mean time to best visual acuity after vitrectomy was slightly less than 1 year for all eyes unless they had cataract worsening with subsequent cataract extraction (1.9 years). Significant factors affecting visual outcome were: preoperative lens status, visual acuity before vitrectomy, duration of preoperative symptoms of distortion and/or blurred vision, and the occurrence of intraoperative complications.

A new hereditary syndrome characterized by a frontoparietal lobe pseudotumor and retinal capillary abnormalities is described. A pedigree is presented in which characteristic ophthalmic findings have been found in ten family members and are suspected in eight additional family members spanning a total of four generations. Typical retinal findings include perifoveal capillary obliteration, peripheral focal capillary occlusion, and microvascular abnormalities, particularly involving the posterior pole. Eight patients spanning three generations had a central nervous system pseudotumor with identical histopathology. Histopathologic analysis of brain tissue shows a characteristic pattern of an unusual vasculopathy without vasculitis characterized by fibrinoid necrosis and resulting in necrosis of white matter with sparing of cortical brain tissue. The pedigree shows an apparent autosomal dominant pattern of inheritance with delayed expression of abnormalities. Of note, two patients unrelated to the pedigree having similar neuropathologic and retinal findings also have been seen at the authors' institution.

In a retrospective study, 2688 eyes treated with xenon arc photocoagulation which would have qualified for inclusion in the Diabetic Retinopathy Study (DRS) were reviewed in the format of the DRS. When comparable risk groups were compared, the results of treatment were even more favorable than reported in the DRS without the severe complications attributed to xenon treatment in the DRS. A critical analysis of the DRS gives clues for the greater amount of visual loss found with xenon than argon in the DRS. Since these complications may be avoidable in some cases, and since xenon has been shown to be at least as effective as argon, it should continue to be used in the treatment of proliferative diabetic retinopathy.

A prospective randomized trial was carried out during the years 1974 to 1981 to determine whether preoperative antibiotic soaking of silicone sponges used in retinal detachment surgery would reduce the incidence of postoperative infection and extrusion. During this period 2972 consecutive primary scleral buckles were performed and in 921 (31%) of the cases an episcleral sponge was utilized either alone or in conjunction with a hard silicone encircling band. In alternate cases the sponge was soaked in an antibiotic solution for at least 30 minutes prior to insertion. In the remaining cases the sponge was not soaked. Overall, a statistically significant (P = 0.00018) seven-fold reduction in the rate of infection or extrusion was observed in cases where the silicone sponge was soaked preoperatively in antibiotics. An additional result of the study showed the rate of sponge removal was significantly increased by the use of multiple episcleral sponges (P = 0.00002).

Nylon line lawn trimmers represent a source of potentially devastating ocular trauma. Five cases of ocular trauma associated with the use of line trimmers are reported. These case reports document new mechanisms and circumstances of injury, including trauma from debris other than nylon line fragments and injury to bystanders. Furthermore, injuries are often serious, with two of these patients requiring an evisceration or enucleation after endophthalmitis developed. In one patient, six different organisms were cultured and another patient exhibited an Aspergillus organism and Propionibacterium acnes. As nylon trimmers gain in popularity, they will become an increasingly frequent source of ocular injury. A retrospective 40-month review of 85 cases (87 eyes) of penetrating and perforating ocular trauma shows line trimmers to be the fifth leading cause of such injury.

Two hundred forty-one eyes with a "limited retinal detachment" were treated between 1967 and 1983 by transconjunctival retinocryopexy without scleral buckling. Follow-up ranged from 6 months to 10 years (mean, of 34 months). Anatomic reattachment was accomplished with retinocryopexy alone in 95% (228 eyes) of cases. Thirteen eyes (5%) were anatomic failures, but 12 of these were subsequently reattached with additional surgery. Risk factors for anatomic failure included multiple breaks, vitreous hemorrhage, and breaks with a rolled posterior edge. Visual results indicated that 229 eyes (95%) had stable or improved vision, while 12 eyes (5%) lost two or more Snellen lines. Causes for visual deterioration included premacular fibroplasia, proliferative vitreoretinopathy, and preexisting ocular pathology. Single breaks occurred in 172 eyes (71.4%), and multiple breaks in 69 eyes (28.6%). Associated clinical findings included high myopia (17%), surgical aphakia (12%), and retinal detachment in the fellow eye (27%).

Transconjunctival anterior retinal cryotherapy (ARC) for proliferative diabetic retinopathy (PDR) in 408 eyes was reviewed retrospectively. Of 266 eyes available for analysis for treatment effect on neovascularization, 138 (52%) had reduced neovascularization at 6 months. Eighty (30%) had no change in neovascularization, and 48 (18%) had increased neovascularization at 6 months. Factors having a significant effect on reduction of neovascularization were duration of diabetes and severity of retinopathy. Of 238 eyes available for analysis for treatment effect on vitreous hemorrhage at 6 months, 118 (50%) had reduced vitreous hemorrhage, 80 (33%) had no change, and 40 (17%) had increased vitreous hemorrhage. Severity of vitreous hemorrhage significantly affected the outcome in the subgroup of eyes with both neovascularization and vitreous hemorrhage. Of the total 408 eyes in this series, at 6 months, 172 (44%) had improved visual acuity, 89 (23%) had no change, and 126 (33%) had decreased visual acuity. Retinal detachments developed in 17 eyes (4%) post-treatment, 68 eyes (17%) had significant recurrent vitreous hemorrhage, and 61 eyes (15%) eventually underwent vitrectomy.

This report describes a 13-year-old girl who presented with angioid streaks associated with pseudoxanthoma elasticum (PXE). Extensive retinal pigment epithelial (RPE) mottling, known as peau d'orange, characteristic of PXE, was also noted. The potential complication of choroidal neovascularization is described. Physicians should be aware that angioid streaks and their potentially sight-threatening complications can occur in this age group.

CAT scanning was used in the localization of intraocular and periorbital foreign bodies in 36 consecutive patients. The method was found to be convenient, well-tolerated by the patient, and provided accurate and useful clinical information. Six cases are described to illustrate clinical situations where traditional localizing methods were unable to supply satisfactory information and where CAT scanning proved to be of significant assistance. This included uncooperative patients, multiple foreign bodies, anterior foreign bodies, and foreign bodies adjacent to the posterior scleral wall.

A series of 600 pseudophakic retinal detachments in 578 patients undergoing surgical repair between 1974 and 1984 was reviewed. Patients with previous retinal surgery of less than six months follow-up were excluded. The series included 395 iris-fixated (IF) lenses, 130 anterior chamber (AC) lenses, and 75 posterior chamber (PC) lenses. The overall success rate for retinal detachment was 88% but was significantly better in the PC lens group and significantly worse in the AC lens group. Forty-one percent of all cases achieved 20/40 visual acuity or better, although the AC lens group did worse (28%), while the PC lens group did significantly better (48%). Risk factors that were predictive of failure also were identified. Many of these factors occurred more frequently in the AC lens group and probably are related to the overall worse outcome in eyes with AC lens implants. The implications of these results for retinal and cataract surgeons are discussed.

Thirteen cases of rhegmatogenous retinal detachment repaired by pneumatic retinopexy were reviewed retrospectively. All patients were followed for a minimum of 6 months after surgery. At the end of follow-up, retinal detachment repair by pneumatic retinopexy succeeded in nine cases (70%) and failed in four (30%). Within 2 days of pneumatic retinopexy, vitreous condensation and traction with new retinal tears and associated detachments in previously uninvolved quadrants developed in two patients. The occurrence of new retinal detachments in the early postoperative period after pneumatic retinopexy has not been previously observed.