PURPOSE: To evaluate clinical analyses & risk factors for retinal detachment after silicone oil removal in the eyes with completely stable retinal state. METHOD: The authors retrospectively analyzed the clinical diagnosis, timing of retinal detachment, operative record, and final anatomic success of 10 consecutive eyes with retinal detachment after silicone oil removal. RESULTS: The retinal detachment group after silicone oil removal consisted of 3 eyes with proliferative vitreoretinopathy, 3 eyes with proliferative diabetic retinopathy, 3 eyes with the retinal detachment with macular hole and 1 eye with traumatic rhegmatogenous retinal detachment. Retinal detachment occurred from 1 to 17 weeks after the silicon oil removal surgery. The retinal detachments were associated with reopening of old breaks (5 eyes), new retinal breaks (3 eyes), vitreoretinal tractions (2 eyes). The retina was completely or partially reaatached after additional vitreoretinal surgery in 9 eyes, but total retinal detachment occurred in 1 eye due to reattachment operation rejection. CONCLUSIONS: The retinal break with remained vitreous traction and the proliferative membrane appeared to be an important factor in retinal detachments after silicone oil removal. Therefore, potential retinal breaks and complete removal of vitreous and tractional force during intraocular surgery should be considered.
Diabetic Retinopathy ; Eye ; Membranes ; Rejection (Psychology) ; Retina ; Retinal Detachment ; Retinal Perforations ; Retinaldehyde ; Retrospective Studies ; Risk Factors ; Silicone Oils ; Traction ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

PURPOSE: To evaluate the effectiveness of tramadol for the reduction of pain in panretinal photocoagulation (PRP). METHODS: A double-masked randomized controlled study was performed. Fifty-eight eyes in 29 patients with proliferative diabetic retinopathy were enrolled. The eyes of the patients were randomized into two groups. Group A received an empty capsule. Group B received an oral intake of 100 mg tramadol. The capsule used in Group A had the same appearance as that used in Group B. Pain during PRP was assessed using a visual analog scale. Vital signs, including blood pressure and heart rate, were measured. RESULTS: The mean pain scores for groups A and B were 4.80+/-2.10 and 3.83+/-1.82 (p=0.09). There were no significant differences in the mean pain scores between the two groups. More patients in group A complained of greater pain than moderate intensity (visual analogue scale=4). Systemic blood pressure increased significantly in group A after laser treatment. However, there were no significant differences in the diastolic blood pressure changes between the two groups. We found no statistical correlation in the heart rate changes. CONCLUSIONS: We failed to prove that tramadol is effective for pain relief because of the small sample size. However, tramadol was effective for the relief of more severe pain. It was also found to stabilize vital sign changes, such as systolic blood pressure during PRP.
Administration, Oral ; Adult ; Aged ; Analgesia/*methods ; Analgesics, Opioid/*administration & dosage ; Case-Control Studies ; Diabetic Retinopathy/*surgery ; Dose-Response Relationship, Drug ; Double-Blind Method ; Follow-Up Studies ; Humans ; Laser Coagulation/*methods ; Middle Aged ; Pain/*drug therapy/physiopathology ; Pain Measurement ; Prospective Studies ; Tramadol/*administration & dosage ; Treatment Outcome ; Vitreoretinopathy, Proliferative/*surgery

Adolescent ; Adult ; Aged ; Humans ; Middle Aged ; Pupil Disorders ; diagnosis ; etiology ; Refraction, Ocular ; Retina ; physiopathology ; Retinal Detachment ; surgery ; Scleral Buckling ; Visual Acuity ; Vitreoretinopathy, Proliferative ; surgery

OBJECTIVE: To demonstrate the mechanism of positive effects of the sequential air-fluid exchange on the use of complicated vitroretinal microsurgery. METHODS: Seventy-one patients who underwent vitreoretinal microsurgery were performed 2 or 3 times sequential air-fluid exchange. The regenerated fliud in vitreous cavity at various periods was collected to act on cultured human retinal pigment epithelial (RPE) cells,and then the secretion of bFGF and the expressions of bcl-2 and ki-67 by RPE cells were observed. RESULTS: The expressions of bcl-2 and ki-67 were up-regulated and the secretion of bFGF significantly increased after RPE cells was acted with the regenerated fluid in the vitreous cavity. CONCLUSION The sequential air-fluid exchange can mechanically reduce intraocular growth factors after the vitreoretinal microsurgery, indirectly restrain the proliferation of RPE cell, and improve the successful rate of vitreoretinal microsurgery.
Cell Division ; Cells, Cultured ; Fibroblast Growth Factor 2 ; metabolism ; Humans ; Ki-67 Antigen ; biosynthesis ; genetics ; Microsurgery ; Pigment Epithelium of Eye ; pathology ; Proto-Oncogene Proteins c-bcl-2 ; biosynthesis ; genetics ; Regeneration ; Retina ; surgery ; Retinal Detachment ; prevention & control ; Secondary Prevention ; Vitrectomy ; Vitreoretinopathy, Proliferative ; surgery

PURPOSE: Using a temporary keratoprosthesis(TKP), earlier surgical treatment became amenable in eyes with coexisting vitreoretinal and corneal disease. We analysed our experience with this type of surgery. METHOD: Medical records of patients who had undergone pars plana vitrectomy(PPV) using Eckardt TKP from 1994 to 2000 were reviewed. Analysis was focused on preoperative conditions, surgical outcome and complications. RESULT: Of 34 eyes of consecutive 34 patients, 25(73.5%) showed trauma-related indications and 4 had IOFB. Retinal detachments were present in 24(70.6%) eyes, proliferative vitreoretinopathy in 8(23.5%) and vitreous hemorrhage in 10(29.4%) eyes. Penetrating keratoplasty(PKP) with donor corneas were performed in only 3 patients at the time of surgery and patient's excised corneas were sutured to 31 patients, 9 of whom underwent PKP later. After mean follow up period of 14 months, retinas remained attached in 27(79.4%) eyes and 3 eyes were phthisical. Visual acuity improved in 18(53%) eyes and worsened in 5 eyes. CONCLUSIONS: In cases with coexisting corneal and vitreoretinal pathology, PPV using TKP was effective for preserving vision and globe. Timing of grafting clear cornea might be delayed when donor cornea was not available.
Cornea ; Corneal Diseases ; Follow-Up Studies ; Humans ; Keratoplasty, Penetrating* ; Medical Records ; Pathology ; Retina ; Retinal Detachment ; Tissue Donors ; Transplants ; Visual Acuity ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative ; Vitreous Hemorrhage

PURPOSE: Vascular endothelial growth factor (VEGF) has been identified as an endothelial cell-specific angiogenic factor of intraocular neovascularization, a pathologic complication of many vitreoretinal disorders. We studied to evaluate clinical correlation of intravitreal VEGF concentration and various vitreoretinal disorders. METHODS: Forty eight vitreous fluid samples were obtained at the time of vitreoretinal surgery from 43 patients of various disorders. Concentrations of VEGF1 6 5 in vitreous fluid were determined by Human VEGF ELISA kit and its correlation with diabetes, intraocular hemorrhage, neovascularization, proliferative vitreoretinopathy, retinal detachment, pan retinal photocoagulation, and postoperative condition was statistically analyzed. RESULTS: Intravitreal concentrations of VEGF in case of intraocular hemorrhage (0.809+/-1.467 ng/ml), neovascularization (1.167+/-1.656 ng/ml), and anterior segment neovascularization (2.381+/-2.043 ng/ml) were significantly high (P<0.05). CONCLUSIONS: VEGF plays a major role in the development of neovascularization in the various retinal disorders.
Angiogenesis Inducing Agents ; Enzyme-Linked Immunosorbent Assay ; Hemorrhage ; Humans ; Light Coagulation ; Retinal Detachment ; Retinaldehyde ; Vascular Endothelial Growth Factor A* ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

PURPOSE: Epiretinal membrane in proliferative vitreoretinopathy (PVR) may cause tractional retinal detachment after vitreoretinal surgery. It has been thought that the proliferative membrane is mainly composed of choroidal fibroblasts and retinal pigment epithelial cells. Inspite of the technical advances, the treatment of PVR is still difficult. Therefore, the need for phamarcologic treatment of proliferative vitreoretinopathy is increasing. METHODS: In vitro models of proliferative vitreoretinopathy allow to identify the factors which may inhibit proliferation and contraction of collagen matrix by choroidal fibroblast and retinal pigment epithelial cells. Cultured choroidal fibroblasts and the RPE cells were plated to the collagen matrix and antiproliferative drugs was tested. RESULTS: Each antiproliferative drug showed the inhibition of collagen matrix contraction at following concentration: colchicine(0.1 microgram/ml), puromycin(1~10 microgram/ml), cytochalasin B(0.05 microgram/ml). Transmission electron micrograph of collagen matrices showed dense collagen fibers surrounding choroidal fibroblast and fine collagen fibers surrounding RPE cell. Scanning electron micrograph of collagen matrices contaning colchicine, puromycin, or cytochalasin B showed that collagen fibers were well preserved without distortion. All collagen matrices containing RPE cells showed more fine collagen fibers than those containing choroidal fibroblasts. CONCLUSION: Colchicine, puromycin, cytochalasin B showed inhibitory effect on cell mediated contraction in addition to potent antiproliferative effect. Retinal pigment epithelial cell played less significant role in causing PVR than choroidal fibroblast.
Choroid* ; Colchicine ; Collagen* ; Cytochalasin B ; Epiretinal Membrane ; Epithelial Cells* ; Fibroblasts* ; Membranes ; Puromycin ; Retinal Detachment ; Retinaldehyde* ; Traction ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

Perfluorocarbon liquids have been used to facilitate surgery in complicated retinal detachments or giant retinal tears which were difficult to manage. The results of perfluorophenanthrene usage in 26 eyes that had been taken vitreoretinal surgery were analyzed.The causes of retinal detachments were giant retinal tears in five eyes[19%], pseudophakia or aphakia in three[12%]and trauma in three.As tamponades, C3F8 gas was used in 11 eyes and silicone oil in 15 eyes. Overall, anatomical success rate was 73%and functional success rate was 58%.All of the giant retinal tears were successfully reattached and four eyes[80%]were functionally successful.The rates of anatomical success were 75%in eyes with grade C proliferative vitreoretinopathy, and 64%in grade D.Regarding postoperative tamponade materials, there was no significant difference between C3F8 gas and silicone oil.Releasing retinectomy was perfomed in four eyes and there was no functional success. In conclusion, perfluorocarbon liquid is a useful instrument that improves the result of operation of complicated retinal detachment if used selectively.
Aphakia ; Pseudophakia ; Retinal Detachment* ; Retinal Perforations ; Retinaldehyde* ; Silicone Oils ; Vitrectomy ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

We analyzed the surgical result of pars plana vitrectomy using silicone oil tamponade and evaluated the effect of different silicone oil viscosity on the result. Of all 66 patients, 48 were male and their mean age was 45.9 years. The most common underlying disease was proliferative vitreoretinopathy (29 patients) and 54 patients (81.9%) had visual acuity of 5/200 or less. Mean follow-up period was 8.94 months. Twenty eight patients had undertaken two or more vitreoretianl surgeries. Anatomical and functional success was achieved in 57 (86.4%) and 31 patients (47.0%), respectively. Complications included hypotony (7 patients), increased intraocular pressure (6 patients), keratopathy (4 patients) and closure of inferior iridectomy (3 patients) on the last follow-up. There was statistically significant correlation between preoperative and final visual acuity (p=0.0001), anatomical success and improvement of visual acuity (p=0.0057), and frequency of vitreoretinal surgery and final visual acuity (p=0.0143). There was no statistically significant difference in the surgical result between eyes using 1,000 cSt and 5,000 cSt silicone oil. This result suggests silicone oil injection may effectively support the surgical treatment of intractible retinal detachment. However, difference of its viscosity seems to make little effect on the surgical result.
Follow-Up Studies ; Humans ; Intraocular Pressure ; Iridectomy ; Male ; Retinal Detachment ; Silicone Oils* ; Viscosity* ; Visual Acuity ; Vitrectomy* ; Vitreoretinal Surgery ; Vitreoretinopathy, Proliferative

Perfluorocarbon liquids have been used as vitreous substitutes for the complicated vitreoretinal surgery. Some authors have reported that perfluorophenanthrene(C14, F24) liquid could be left in the eye for extended term without ocular toxicity. We reviewed 37 eyes that had undergone surgery using perfluorophe-nanthrene(C14, F24) liquid at our hospital since June, 1991 to March, 1996. It was used as intraoperative tool in 20 eyes(Group I), and as postoperative tamponade material in 17 eyes for variable period from 24 hours to 45 days(Group II). Group III includes 11 anatomically successful eyes among group II. Follow up periods were from 111 to 1763(mean 341) days. The rate of anatomical success was 100, 64.7% in group I and II, and the rate of functional success was 70, 70.6, 90.9% in group I, II, III, respectively. Postoperatively, proliferative vitreoretinopathy, recurrent retinal detachment, and elevation of intraocular pressure were observed in both group I and II. According to the above results, it would be better that perflourophenanthrene liquid be used as an intraoperative tool than as a postoprative extended period tamponade.
Follow-Up Studies ; Intraocular Pressure ; Retinal Detachment ; Vitreoretinal Surgery* ; Vitreoretinopathy, Proliferative