The occurrence of a retinal detachment in a patient with a macular hole is quite rare unless the patient is a high myope or has experienced ocular trauma. The incidence of spontaneous reattachment of retinal detachment with a macular hole is not uncommon in the highly myopic patients. However, data on nonmyopic cases are lacking. I herein describe two nonmyopic cases of retinal detachment with a macular hole, of which retinas reattached spontaneously.
Adult ; Aged ; Female ; Humans ; Male ; Myopia/complications ; Remission, Spontaneous ; Retinal Detachment/*physiopathology ; Retinal Perforations/*complications/physiopathology ; Visual Acuity

Proliferative vitreoretinopathy is the principal cause of failure in rhegmatogenous retinal detachment surgery. The final cause of anatomic failure is anterior proliferative vitreoretinopathy. Surgical outcome of anterior proliferative vitreoretinopathy is poorer than that of posterior proliferative vitreoretinopathy. Of 147 cases which underwent vitreoretinal surgery from January through December 1993, 16 eyes(l6 patients) had anterior proliferative vitreoretinopathy. Seven eyes had anterior proliferative vitreoretinopathy at initial surgery(group 1). Remaining 9 eyes developed anterior proliferative vitreoretinopathy after primary vitrectomy(group 2). Of 16 eyes, 3 were aphakic, 2 were pseudophakic, and remaining 11 were phakic. Lens was removed in 11 phakic eyes. Meticulous vitreous base dissection and removal of anterior epiretinal membrane were performed. After minimal follow-up of 6 months, retina reattached in 11 eyes(69%) including all nine eyes of group 2. Nine eyes(56%) had postoperative visual acuity of 0.025 or better. These results suggest that both vitreous base dissection and meticulous removal of anterior and posterior epiretinal membrane should be crucial in improving surgical success rate of anterior proliferative vitreoretinopathy.
Epiretinal Membrane ; Follow-Up Studies ; Retina ; Retinal Detachment ; Visual Acuity ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative*

Ophthalmic artery occlusion results in a circulatory disturbance of both central retinal artery and posterior ciliary arteries, causing an ischemia of retina and choroid. On fundus examination, white retinal opacification and cherry-red spot can be noted if central retinal artery occlusion is not associated with lateral posterior ciliary artery obstruction. If, however, central retinal artery occlusion is asssociated with lateral posterior ciliary artery obstruction, the cherry-red spot is no longer visible. The author experienced five patients with a mottled loss of retinal transparency in the macular region. Combined central retinal artery occlusion with obstruction of both medial posterior ciliary artery and lateral posterior ciliary artery were observed in two patients, both central retinal artery occlusion and medial posterior ciliary obstruction in two patients, and central retinal artery occlusion alone in one patient. The fundus findings in all five cases are compatible with an incomplete central retinal artery occlusion which in at least four cases was associated with evidence of choroidal vascular obstruction.
Choroid ; Ciliary Arteries ; Humans ; Ischemia ; Ophthalmic Artery ; Retina ; Retinal Artery Occlusion* ; Retinal Artery* ; Retinaldehyde

Intravitreal fibrin clots were produced by intravitreal injection of 0.2 ml of autologous plasma in 62 rabbit eyes. The intravitreal injection of 0.25 micrograms or more of tissue plasminogen activator(tPA) resulted in a total clearing of intravitreal fibrin within one day in all treated eyes. This was significantly faster than in the control eyes, in which complete clearing was not seen until 8 days later. This represents the plateau on the dose-response curve in doses ranging from 0.25 to 200 micrograms. With light microscopy and transmission electron microscopy, retinal toxicity was demonstrated in eyes enucleated seven days after injection of 25 micrograms or more of tPA. This study demonstrates that tPA was effective and safe at 12.5 micrograms or less in clearing intravitreal fibrin in an experimental model. These results suggest that low dosages of tPA, probably of 3 micrograms or less, may be useful in the treatment of severe postvitrectomy fibrin formation seen clinically.
Animals ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Fibrinolysis/*drug effects ; Rabbits ; Retina/drug effects/pathology ; Tissue Plasminogen Activator/*toxicity ; *Vitreous Body

Many patients present simultaneously with visually significant (to the patient and surgeon) lens opacities and vitreoretional disease. Traditional management of this problem has included two operations: vitrectomy followed by cataract extraction or cataract extraction followed by vitrectomy. Visual rehabilitation of aphakic eyes after pars plana vitrectomy is often difficult when anatomic objectives are achieved. Intraocular lens provides more natural and convenient vision. Now, simultaneous cataract extraction and lens implantation during pars plana vitrectomy can be considered. We performed posterior chamber lens insertion in the ciliary sulcus after completion of pars plana lensectomy, vitrectomy, and removal of intraocular foreign body. During pars plana lensectomy, we left the anterior lens capsule and zonules intact. After posterior chamber lens insertion, we removed the central anterior lens capsules from behind the optical component leaving a peripheral rim to support the haptics. The procedure provided good pseudophakic vision.
Capsules ; Cataract ; Cataract Extraction ; Foreign Bodies ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Optical Devices ; Rehabilitation ; Vitrectomy*

One patient with bilateral acute retinal necrosis underwent encircling scleral buckle, vitrectomy, and intravitreal acyclovir on both eyes. This procedure was performed on the right eye while the retina was attached. The retina of the right eye was reattached by performing fluid-gas exchange and modified panretinal photocoagulation when the retina subsequently detached. Soon after the development of retinal detachment in the left eye, the above surgical procedures were performed on the left eye, and the retina was successfully reattached.Bilateral acute retinal necrosis with significant vitreous opacification, which is a devastating ocular disease causing possible blindness in both eyes, requires more aggressive, early surgical management.
Acute Disease ; Acyclovir/therapeutic use ; Adult ; Fundus Oculi ; Humans ; Light Coagulation ; Male ; Necrosis/surgery ; Retinal Detachment/surgery ; Retinal Diseases/drug therapy/pathology/*surgery ; Scleral Buckling ; Syndrome ; Vitrectomy

We reviewed the records of 23 patients who underwent repeat operation after initial vitreoretinal surgery in Chungnam National University Hospital between January 1993 and December 1993. Of 193 eyes who underwent vitreoretinal surgery in that period, 23(12%) had undergone reoperation. The most common cause of initial anatomic failure and reoperation was either new or recurrent proliferative vitreoretinopathy(10 eyes). Other causes included iatrogenic retinal tears(5 eyes), hidden retinal breaks(4 eyes), vitreous traction(1 eye), inappropriate chorioretinal adhesion(1 eye), and new break(1 eye). We performed vitreous base dissection on all 9 eyes with anterior proliferative vitreoretinopathy. With additional surgery and after a mean follow-up period of 10.4 months, 21(91%) of 23 retinas were reattached. The final cause of anatomic failure was anterior proliferative vitreoretinopathy. Of the 23 reoperated eyes, 20(87%) had postoperative visual acuity of 0.05 or better.
Chungcheongnam-do ; Follow-Up Studies ; Humans ; Reoperation ; Retina ; Retinaldehyde ; Visual Acuity ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative

Four patients with intraocular foreign bodies and traumatic cataracts underwent combined pars plana lensectomy, vitrectomy, and intraocular foreign body removal. During pars plana lensectomy, anterior lens capsule and zonules were left intact. At the end of surgery, a posterior chamber intraocular lens was placed in the sulcus in front of the anterior capsule through a 7-mm limbal incision. This procedure was performed in selected cases of combined anterior and posterior segment trauma. Combining pars plana lensectomy and posterior chamber intraocular lens implantation with posteior segment procedures allows rapid visual rehabilitation and functional unaided vision. We therefore suggest that this technique is effective in treating selected patients with both cataract and vitreoretinal diseases.
Cataract ; Foreign Bodies* ; Humans ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Rehabilitation ; Vitrectomy

Posterior chamber intraocular lenses were implanted into 20 eyes without the posterior capsular capsular support by securing both haptics of the lens to the sclera with 10-0 prolene suture. The follow-up period ranged from 6 to 24 months(average 9.4 months). At the last follow-up visit, 17 eyes(85%) had a vision of 0.7 or better. The position of the implanted lens was proved satisfactory when compard with eyes with posterior chamber intraocular lens without scleral fixation suture by postoperative A-scan measurement of the anterior chamber depth, the results of refraction and slit-lamp examination. There were no eyes with remarkable decentration or tilt of the implanted lens. In two eyes, intraoperative bleeding occurred from the inferior chamber angle and ceased spontaneously. Postoperatively there were no remarkable inflammatory responses or complications. From the results, we suggest that the position of scleral puncture with a hypodermic needle is 1.2 - 1.4mm from the posterior surgical limbus in the upper quadrant and the advancement of the needle is directing parallel to the posterior surface of the iris.
Anterior Chamber ; Follow-Up Studies ; Hemorrhage ; Iris ; Lens Implantation, Intraocular* ; Lenses, Intraocular* ; Needles ; Polypropylenes ; Punctures ; Sclera ; Sutures*

Sensory Heterotropia is defined as a secondary deviation following loss or severe reduction in visual function in one eye. We have analyzed the records of 68 patients with sensory heterotropia in order to find the incidence, etiologic causes, the factors influencing the direction of the deviation, and the amount of deviation. The incidence of sensory heterotropia was 1.1% of total out patients, and 10.5% of strabismic patients. The major causative factors of sensory heterotropia was anisometropia(33.8%) followed in frequency by uncorrected aphakia(25.0%), cataract(16.2%), retina and vitreous diseases(16.2%), optic nerve atrophy(8.8%) and corneal opacity(2.9%). Esotropia and exotropia were encountered with almost equal frequency when the onset of visual impairment occured between birth and 5 years of age, but exotropia predominated in older children and adult. Those was statistically significant(p<0.01). The direction of a sensory heterotropia was determined by the refractive error of the sound eye, i.e., if the sound eye was emmetropic or myopic, thd blind eye was predominantly exotropic, and if it is hyperopic, it was predominantly esotropic. Also, duration of visual impairment was related to the amount of deviation in exotropic patients. If the duration was under 5 years, the amounts of deviation was 16.3 prism, and over 5 years, it was 25.5 prism, and difference was statistically significant.
Adult ; Child ; Esotropia ; Exotropia ; Humans ; Incidence ; Optic Nerve ; Outpatients ; Parturition ; Refractive Errors ; Retina ; Vision Disorders