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Purpose: This is a retrospective consecutive study to assess the long-term results of combined scleral buckling and pars plana vitrectomy (PPV) with silicone oil for the management of perforating ocular injury caused by gunshots., Methods: Data were gathered from medical records of patients who underwent scleral buckling and PPV with silicone oil 2 weeks after primary repair elsewhere, in Magrabi eye center (Tanta, Egypt), from June 2005 to May 2010., Results: The evaluated group consisted of 49 cases, out of which 26 cases presented with gunshot injury. Twenty-two were male (84.62%) and four were female (15.38%), with a mean age of 27.19+12.7 years. The follow-up ranged from 12 to 72 months, with a mean period of 32.04+8.9 months. The t-test was used to determine the visual outcome and main prognostic factors. Visual acuity improved in 22 of 26 eyes (76.92%), was unchanged in 4 eyes (15.38%), and worsened in 2 eyes (6.69%). Ten eyes (38.46%) achieved visual acuity between (20/40) and (20/100), and eight eyes (30.76%) had visual acuity between (20/200) and (20/400). The 18 eyes (69.23%) with visual acuity better than counting fingers (CF) had an attached retina with no signs of active proliferation after removal of the silicone oil., Conclusion: POI due to gunshot is usually a terminal event for the eye. Eyes with perforating injury can be saved and may attain useful vision after performance of combined scleral buckling and PPV with silicone oil tamponade. The final visual outcome depends on the macular or the optic nerve involvement and the final retinal stability, and phthisis bulbi can also be prevented.

Purpose: To determine the types of macular holes encountered during vitrectomy for complicated cases of diabetic retinopathy., Methods: This is a retrospective study of consecutive cases of macular holes diagnosed either before or during pars plana vitrectomy for complications of proliferative diabetic retinopathy over a 6-year period. The morphology of these holes is described. Possible mechanisms of their development, surgical considerations, and results after a follow-up of at least 3 months are discussed., Results: Nineteen consecutive cases of macular holes associated with proliferative diabetic retinopathy were reviewed over a 6-year period. Five cases were lamellar and 14 were full thickness. The 14 cases of full thickness macular holes occurred in patients with the following conditions: tractional rhegmatogenous retinal detachment (5); tractional retinal detachment (3); premacular hemorrhage (3); and cystic macular edema (3). Closure of the full thickness holes was achieved in 8 of 11 patients who were followed up for at least 3 months. All the patients had visual improvement, but no patient had a visual acuity of better than 20/100., Conclusion: Macular holes may occur in proliferative diabetic retinopathy in different configurations. Full thickness macular holes can be closed in most cases. Functional improvement can be achieved.

Purpose: To evaluate the role and the results of primary vitrectomy in treating cases with coexisting rhegmatogenous retinal detachment and choroidal detachment., Methods: Eleven consecutive eyes with coexisting rhegmatogenous retinal detachment and choroidal detachment with proliferative vitreoretinopathy less than grade C were included. Release of traction on the breaks was achieved by vitrectomy and augmented by episcleral buckle if needed. Perfluorocarbon liquids were used to drain the subretinal fluid through the vitrectomy sclerotomies. The breaks were treated by endolaser under perfluorocarbon liquids. Postoperative tamponade was done by C3F8 gas or silicone oil. Cases were followed up for at least 3 months., Results: Retinal reattachment could be achieved and maintained in all cases by one or more surgeries. No recurrence of choroidal detachment has occurred. In each case, choroidal detachment was drained through the sclerotomies and retinal detachment was repaired., Conclusion: Primary vitrectomy represents an effective line in the management of rhegmatogenous retinal detachment with coexisting choroidal detachment in phakic or nonphakic eyes., Summary: Primary vitrectomy is recommended for the management of choroidal detachment associated with retinal detachment.

Objective: To study the risk factors, management, and end results of suprachoroidal hemorrhage that occur during or after vitrectomy., Materials and Methods: This retrospective study involves patients suffering from this complication either during the curing process or immediately after vitrectomy. Preoperative risk factors, operative management, postoperative picture, and end results are reported., Results: During the study period, surgery was performed on 3342 patients with primary vitrectomy. Complications were experienced by 4 patients: 2 occurred near the end of vitrectomy, and 2 in the first postoperative day. The 4 patients were myopic more than 7 diopters, 2 were pseudophakic and 2 were aphakic. Cryopexy was used to treat the retinal breaks in the operative cases. Perfluorophenanthrene was used as a postoperative tamponade in one operative case. Reoperation was done in the 4 patients 3 to 8 weeks after surgery. Silicone oil was used as a prolonged tamponade in all cases. Hypotony persisted in operative cases. All the patients had vision more than 20/400 at the end of follow-up (6 to 24 months)., Conclusion: The risk factors for suprachoroidal hemorrhage were old age, high myopia, aphakia or pseudophakia, retinal detachment, and scleral buckle. Postoperative suprachoroidal hemorrhage has a better prognosis than the operative type. Perfluorophenanthrene "vitreon" as an operative and postoperative tamponade has a beneficial effect in keeping the retina attached and in preventing pooling of blood under the macula.

Silicone oil is used in the treatment of complex retinal detachments, but late complications have been reported by many authors. Silicone oil removal (SOR) is therefore performed in order to reduce these complications. SOR was investigated in 63 consecutive cases. All these eyes had had a totally attached retina for at least 3 months before SOR was performed, there were no signs of traction or reproliferation, and the minimum vision was 4/200. The duration of silicone oil tamponade was less than 6 months in 13 eyes, 6-12 months in 18 and more than 1 year in 32 eyes. In post-traumatic and diabetic cases it was possible to remove silicone oil after 8 to 10 months and in PVR cases after 14 months. Redetachment of the retina was the most frequent complication of SOR, appearing in 18/63 eyes; 16 of them were refilled. In 9 eyes, the visual acuity present before silicone oil removal was reestablished. The redetachment rate was similar in PVR, diabetes and trauma cases and had no correlation with the duration of silicone oil tamponade. Increased intraocular pressure was observed in 13 eyes before SOR but it returned to normal levels afterwards in 8 cases without further surgery. The results of our study show that even if the indication is established very carefully, SOR results in a relatively high rate of complications, such as redetachment of the retina. Therefore every case undergoing this procedure must be evaluated in detail.

The authors discuss the pathogenesis and the method of treatment of a retinal detachment with a macular hole basing on personal material and a review of foreign literature. Personal material consists of 11 eyes in 10 patients operated upon in the University Ophthalmic Department in Munich in the period November 1988--April 1990. In all the cases the primary method of treatment based on vitrectomy performed through the pars plana with a gas tamponade. In 4 cases a reoperation with silicon oil tamponade was necessary. Anatomical reattachment of the retina was achieved in 9 among 11 treated eyes. In 10 cases the visual acuity was 1/50 or better. Five among them showed the visual acuity at last 0.1.