RESUMO
PURPOSE: The authors evaluated factors that might influence the outcome of extracapsular cataract extraction with placement of a posterior chamber lens in patients with diabetic retinopathy. The factors included patient age and sex, severity of the retinopathy, preoperative laser photocoagulation, vitrectomy, and posterior capsulotomy. METHODS: The records of 109 patients who had been examined by the authors before cataract surgery were retrospectively reviewed. RESULTS: The final visual acuity in only 48% of the eyes was 20/40 or better, and 28% had 20/200 or worse visual acuity. Only 65% had an improvement in visual acuity of two or more Snellen lines. Eyes with preoperative macular edema had a poorer visual outcome than eyes without. Macular edema and ischemia accounted for 70% of the eyes with a final visual acuity of 20/50 or worse. The authors found that age was a strong predictor of final visual acuity and chances of improvement. In patients 63 years of age and younger, 58% had 20/40 or better and 81% had improved visual acuity. In patients 64 years of age and older, only 38% had 20/40 or better and only 54% were improved. Supplementary panretinal photocoagulation was required in 37% of patients who had received it preoperatively. Neovascularization of the iris developed in 6% of patients. Posterior capsulotomy did not cause an increased incidence of neovascularization of the iris or in the development or progression of proliferative retinopathy or macular edema. CONCLUSION: The prognosis of patients with diabetic retinopathy about to undergo cataract surgery, even extracapsular cataract extraction with placement of a posterior chamber lens, is guarded.
Assuntos
Extração de Catarata/métodos , Retinopatia Diabética/cirurgia , Cápsula do Cristalino/cirurgia , Lentes Intraoculares , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Retinopatia Diabética/patologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Prognóstico , Estudos Retrospectivos , Fatores Sexuais , Acuidade VisualRESUMO
A review of 484 consecutive eyes that were undergoing an initial pars plana vitrectomy for the sequelae of proliferative diabetic retinopathy disclosed that 41 eyes (8.5%) required one or more additional vitrectomy operations. The primary causes for reoperation included rhegmatogenous retinal detachment in 18 (44%) of the 41 eyes, recurrent vitreous hemorrhage in 21 eyes (51%), and glaucoma in two eyes (5%). The visual prognosis was worse in the group with rhegmatogenous retinal detachment, with 10 (56%) of 18 eyes progressing to no light perception (P = .003). Severe preretinal and subretinal fibrous proliferation, as demonstrated histopathologically, accounted in large part for the poor result. The preretinal membrane formation appeared to occur secondary to a combination of diabetic extraretinal vascular growth and proliferative vitreoretinopathy. Among the total group of 41 eyes that required subsequent surgery, the retina eventually remained detached in 18 eyes (44%), and phthisis bulbi occurred in 13 eyes (32%). Rubeosis iridis developed in 17 (94%) of 18 eyes in which the retina remained detached.
Assuntos
Retinopatia Diabética/cirurgia , Vitrectomia , Adulto , Retinopatia Diabética/patologia , Retinopatia Diabética/fisiopatologia , Oftalmopatias/patologia , Enucleação Ocular , Feminino , Glaucoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reoperação , Descolamento Retiniano/patologia , Descolamento Retiniano/cirurgia , Doenças Retinianas/patologia , Acuidade Visual , Corpo Vítreo/patologia , Hemorragia Vítrea/cirurgiaRESUMO
A systemically healthy 22-year-old man presented with unilateral acute retinal necrosis (ARN) that featured diffuse retinal whitening throughout the posterior retina, exudative retinal detachment, and a visual acuity of no light perception. Diagnostic vitrectomy revealed necrotic retinal cells containing intranuclear inclusions visible with light microscopy. On electron microscopy, viral particles consistent with a herpes family virus were detected. Culture of the vitrectomy specimen showed herpes simplex, type 1 (HSV 1) and rising convalescent serum ELISA titers to HSV 1 confirmed a recent infection. This case of ARN is unusual for its severity, early macular involvement, and development of exudative retinal detachment. In addition, it represents one of the few reported cases in which HSV 1 has been confirmed by both vitreous culture and serum titers as the etiologic agent. A review of the literature suggests that posterior segment inflammatory conditions secondary to HSV 1 can be associated with exudative retinal detachment, a clinical finding that may help differentiate such conditions from other infectious causes of chorioretinitis.
Assuntos
Ceratite Dendrítica/complicações , Doenças Retinianas/etiologia , Adulto , Antígenos Virais/sangue , Ensaio de Imunoadsorção Enzimática , Angiofluoresceinografia , Fundo de Olho , Humanos , Masculino , Necrose , Descolamento Retiniano/etiologia , Descolamento Retiniano/patologia , Doenças Retinianas/patologia , Simplexvirus/isolamento & purificação , Simplexvirus/ultraestrutura , Acuidade Visual , Vitrectomia , Corpo Vítreo/microbiologia , Corpo Vítreo/ultraestruturaRESUMO
Forty-one patients with a unilateral, macular epiretinal membrane (ERM) underwent pars plana vitrectomy and membrane peeling to improve the visual acuity. The authors retrospectively reviewed the histopathology of the vitrectomy specimen in each instance to determine whether the presence of internal-limiting membrane (ILM) had an adverse effect on visual acuity. Eleven specimens contained long segment of ILM, as determined by light microscopy. With a minimum of 6 months of follow-up, none of these 11 eyes achieved a visual acuity of better than 20/60. Of 30 eyes that did not have ILM present, 41% achieved a visual acuity of 20/60 or better. Overall, 29% of the eyes in the entire series achieved 20/60 or better visual acuity. The difference between the group with ILM versus that without ILM was statistically significant (P = 0.01). The presence of long segments of ILM within the histopathologic specimen after vitreous surgery for removal of a macular ERM appears to indicate a less favorable visual outcome.
Assuntos
Doenças Retinianas/patologia , Acuidade Visual , Vitrectomia , Seguimentos , Humanos , Membranas/patologia , Prognóstico , Doenças Retinianas/cirurgiaRESUMO
Extracapsular cataract extraction (ECCE), placement of a posterior chamber intraocular lens (PC IOL), and pars plana vitrectomy were combined in a single operation in 24 patients. Sixteen of these, 11 of whom are diabetic, have had 6 months or more of follow-up. In all cases, excellent visualization of the posterior segment was obtained, and the surgical objectives were achieved. No diabetic patient without preoperative neovascularization of the iris had this complication later. The advantages and disadvantages of alternative techniques are discussed.
Assuntos
Extração de Catarata , Lentes Intraoculares , Vitrectomia , Adulto , Idoso , Idoso de 80 Anos ou mais , Catarata/complicações , Complicações do Diabetes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Acuidade VisualRESUMO
A review of 306 eyes undergoing pars plana vitrectomy for the complications of proliferative diabetic retinopathy revealed that 26 (8.5%) required a second vitrectomy operation. Among the eyes that required repeat vitrectomy, the eventual visual acuity ranged from 20/20 to 20/400 in 35% and was no light perception in 31%. Reasons for subsequent surgery included recurrent vitreous hemorrhage in 54% of eyes, retinal detachment in 42% and neovascular glaucoma in 4%. Twelve eyes (46%) remained with a permanent retinal detachment despite attempts at surgical repair, and eleven of these twelve eyes subsequently developed rubeosis iridis.
Assuntos
Retinopatia Diabética/cirurgia , Vitrectomia , Adulto , Feminino , Glaucoma Neovascular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reoperação , Descolamento Retiniano/cirurgia , Acuidade Visual , Hemorragia Vítrea/cirurgiaRESUMO
Sodium hyaluronate (Healon) was used in conjunction with pars plana vitrectomy and scleral buckling to manage unilateral giant retinal tears of 180 degrees or more with severe folding in six consecutive cases. In each instance the retina was successfully flattened, and five of the six have remained so for at least one year. The technique enables the surgeon to unroll a retinal flap that is markedly inverted on itself and oppose it to the underlying retinal pigment epithelium.
Assuntos
Ácido Hialurônico/uso terapêutico , Perfurações Retinianas/cirurgia , Adolescente , Adulto , Ar , Criança , Criocirurgia , Humanos , Ácido Hialurônico/administração & dosagem , Masculino , Pessoa de Meia-Idade , Recurvamento da Esclera/métodos , Hexafluoreto de Enxofre/administração & dosagem , Vitrectomia/métodos , Corpo VítreoRESUMO
The authors studied the records of 30 patients who suffered a massive suprachoroidal hemorrhage during cataract surgery. Immediate development of a retinal detachment (RD) is a very bad prognostic sign. In none of 12 such cases could the retina be reattached. Retinal complications developed in five of six patients who had vitreous incarceration and who did not have vitrectomy as opposed to only one of seven who underwent vitrectomy along with drainage of the hemorrhage. If vitreous is incarcerated in the cataract incision, drainage of the hemorrhage without vitrectomy is a dangerous procedure.