DOCSLIB.ORG

222 November 2002 Category 1

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
222 November 2002 Category 1 Rhegmatog PAMELA DALY, CST, SA-C genousRETINAL o DETACHMENTS he retina is comprised of in the area of detachment.16,22,2 1.2 million photorecep- The incidence of primary reti- tors that are responsible nal detachment is approximately for changing light rays 12 cases per 100,000.11 They occur T into electrical impulses more often in men, typically that are carried along the optic between ages 40 and 70.17 nerve to the brain.22 The retina This article will describe the must remain firmly adhered to pathogenesis and treatment of the retinal pigment epithelium primary rhegmatogenous retinal (RPE) on the inside wall of the eye detachment (RRD), an uncommon in order to function properly. In yet important cause of visual loss a retinal detachment, the retina that can be treated most effec- separates from the RPE, causing tively by early recognition of malfunction of the photorecep- symptoms and urgent surgical tors and diminished vision correction. NOVEMBER 2002 The Surgical Technologist 9 222 NOVEMBER 2002 CATEGORY 1 Anatomy for the posterior portion of the vitreous. The The posterior eye wall is formed by three juxta- posterior hyaloid collapses inward toward the posed layers: (1) the sclera, which is a tough, central vitreous cavity, peeling itself off of the fibrous outer shell that serves to protect the retina. The more liquefied vitreous fluid leaks internal ocular structures; (2) the choroid, a into the space created by the collapse of this pos- highly vascular layer that provides nutrients to terior gel. This process is called a posterior vitre- the outer portion of the retina, (along with the ous detachment (PVD).1,2,3,6,7,10,16 PVDs occur in RPE); and (3) the retina which contains the pho- virtually all adults and the incidence increases toreceptors, neurosensory fibers and support- with age.4 Myopia, aphakia, pseudophakia, ing cells that transmit visual information to the inflammation and trauma can also increase the brain.21,22 (Figure 1) likelihood of PVD.7 Roughly 75% of all 75-year- The posterior segment of the eye receives light old patients show evidence of PVD on a dilated that passes through the anterior segment struc- eye examination.17 tures (the cornea, iris and lens) and converges PVDs are usually asymptomatic, but patients that light on the retinal surface.21 (Figure 2) The may notice an abrupt increase in visual abnor- acentral part of the retina, the macula, is the part malities (usually in the form of new floaters or of the retina that is aligned with the central visu- peripheral flashes of light).6,8 Floaters occur for al axis; when it is diseased, central acuity is poor several reasons. The liquefied vitreous is now while peripheral vision is often spared. The vitre- much more mobile because it has detached itself ous cavity is the central portion of the globe, and from the retinal surface. The differences in the is filled with a clear, collagenous gel, called the viscosity of the more formed and less formed vitreous body. As the eye ages, the relationship portions of the gel can cause visual aberrations.23 between the vitreous gel and the peripheral reti- As the gel detaches from the retina it can also pull na forms the basis for understanding the patho- fibrous, glial tissue off the optic nerve head (a genesis of rhegmatogenous retinal detach- Weiss ring) that can be seen as a circular floater ments.1,2,5,7 in the central portion of vision.22 Hemorrhage can also cause new floaters. This Pathogenesis and classification typically occurs when the retina becomes torn Primary RRD are formed when a retinal tear or during a PVD.2 As the gel peels away from the break occurs, allowing the vitreous fluid to seep retina, any area of abnormally strong vitreoreti- through the retinal break and gain access to the nal adhesion (prior trauma, scars, lattice degen- subretinal space.4 This process occurs as a com- eration or other retinal disease) may place the plication of a natural maturing of the vitreous patient at risk for a retinal tear.3,13,22 The gel will gel.2 In a younger person, the vitreous gel has a either break free (with no retinal damage) or will high concentration of collagen and relatively low remain stuck. A flap of retina will be pulled water content. This makeup creates a vitreous toward the central part of the eye along with the body that is well formed, with the consistency of vitreous body, creating a tear. Patients with gelatin. evolving PVD often experience peripheral With age, the collagen content naturally flashes caused by the traction and tugging on diminishes and the water content increases, the retina by the vitreous.1,2,4,16 The resulting yielding vitreous that has the consistency of an horseshoe tear usually progresses to a primary egg white. As the vitreous breaks down and RRD—primary, since no other disease led to the becomes much more fluid, the collagenous por- detachment, and rhegmatogenous, since a reti- tion is still attached to the retinal surface as a nal break led to the accumulation of subretinal broad sheet. This is called the posterior hyaloid fluid (rhegma=break).23 or posterior vitreous face. The liquefaction of the Once fluid begins to enter the subretinal central vitreous cavity causes a loss of support space and elevate the retina off of the choroids, The Surgical Technologist NOVEMBER 2002 10 FIGURE 1 Extraocular muscle Anatomy Retina of the eye. Conjuctiva Sclera Ciliary body Choroid Schlemm’s canal Retinal blood vessels Anterior chamber Macula Pupil Cornea Iris Crystalline lens Anterior chamber angle Posterior chamber Zonules Central retinal Optic nerve blood vessels visual field anomalies can be seen in the area detachment usually can preserve sharp 20/20 of detachment due to lack of nutrition of the acuity (with correction).23 photoreceptors.1,22 At this stage, patients may Other forms of retinal detachment include still have crisp central vision but a slowly exudative and tractional. Exudative detachments enlarging field deficit. If repair is not per- occur as a result of extreme inflammation, formed at this stage, the visual darkening will abnormal blood vessel growth beneath the retina progress across the eye, through the central (choroidal neovascular membranes), or cancer- part of vision. When this occurs, the vision ous conditions (lymphoma, melanoma).22 The usually drops to the “finger-counting” to fluid that collects in the subretinal space does not “hand-motions” level. Prompt surgical inter- come from the vitreous cavity as in primary vention once the macula has detached will usu- rhegmatogenous detachments, but instead is ally restore a significant amount of central acu- proteinasceous serous fluid that leaks from ity, but, in most cases, the best-corrected vision abnormally permeable blood vessels.15,22 improves postoperatively only to the 20/50 Tractional detachments occur as a result of level.23 Prompt correction prior to macular scar tissue that grows across the concave retinal NOVEMBER 2002 The Surgical Technologist 11 FIGURE 2 Sclera Light rays converge Iris Film on to the retina like Lens the film of a camera. Ifthe film or retina is Lens Cornea not good,the image Retina won’t be clear. Vitreous Optic nerve surface and then contracts, shortening the reti- placed cautery 2-3 mm into the wound. Using na and elevating it off of the concave eye wall. this technique, he achieved a 40-50% reattach- Proliferative diabetic retinopathy and prolifera- ment rate.23 tive vitreoretinopathy are two examples of severe Others quickly improved upon Gonin’s orig- traction-producing diseases.12,15,22,23 inal operation. Gonin espoused two main prin- ciples that remain the basis for all successful reti- History of surgical correction nal detachment surgery: (1) all breaks must be Hermann Von Helmholtz is credited with found, and (2) all breaks must be accurately inventing the ophthalmoscope in 1851; this localized (so they can be closed).22 Gonin recog- advance created the means to accurately describe nized that a surgical failure meant that the retinal and subsequently repair retinal detachments.17,23 break was not properly closed or that another Jules Gonin is considered to be the father of reti- break existed.22,23 nal detachment surgery. He believed, along with Two significant advances in fundus examina- Theodor Leber, that liquid vitreous forced holes tion were made in the late 1940s. Charles Schep- in the retina. Leber found retinal breaks in 70% ens’ electrically illuminated binocular indirect of all retinal detachments and noted that there ophthalmoscope remains the most valuable was usually a break in the area where the retinal instrument currently available for evaluation of detachment began.17,23 Both Gonin and Leber a detached retina. The Goldman three-mirror stressed that contraction of the vitreous body lens permits stereoscopic slit lamp examination tore holes in the retina at sites of previous chori- of almost the entire retina if the pupil can be oretinitis (inflammation) or by chorioretinal widely dilated and if the ocular media (cornea, degeneration. lens, vitreous) is clear.22 In 1938, Bengt Rosen- Once Gonin realized that retinal breaks led to gren increased the rate of reattachment by detachment, he concluded that a permanent injecting air into the vitreous to tamponade the cure depended on sealing them. In 1919, he per- retinal break after diathermy treatment and formed the first operation designed to close reti- drainage of subretinal fluid.With this technique, nal breaks.17 After localization of the break, he Rosengren’s reattachment rate improved to made a radial incision through the sclera to the 76%.23 choroids with a Graefe knife, then used the knife In 1953, Ernst Custodis introduced scleral to incise the choroids and enter the subretinal indentation, or “buckling,”to help close retinal space, draining the subretinal fluid.
Load more

Recommended publications
  • Pattern of Vitreo-Retinal Diseases at the National Referral Hospital in Bhutan: a Retrospective, Hospital-Based Study Bhim B
    Rai et al. BMC Ophthalmology (2020) 20:51 https://doi.org/10.1186/s12886-020-01335-x RESEARCH ARTICLE Open Access Pattern of vitreo-retinal diseases at the national referral hospital in Bhutan: a retrospective, hospital-based study Bhim B. Rai1,2* , Michael G. Morley3, Paul S. Bernstein4 and Ted Maddess1 Abstract Background: Knowing the pattern and presentation of the diseases is critical for management strategies. To inform eye-care policy we quantified the pattern of vitreo-retinal (VR) diseases presenting at the national referral hospital in Bhutan. Methods: We reviewed all new patients over three years from the retinal clinic of the Jigme Dorji Wangchuck National Referral Hospital. Demographic data, presenting complaints and duration, treatment history, associated systemic diseases, diagnostic procedures performed, and final diagnoses were quantified. Comparisons of the expected and observed frequency of gender used Chi-squared tests. We applied a sampling with replacement based bootstrap analysis (10,000 cycles) to estimate the population means and the standard errors of the means and standard error of the 10th, 25th, 50th, 75th and 90th percentiles of the ages of the males and females within 20-year cohorts. We then applied t-tests employing the estimated means and standard errors. The 2913 subjects insured that the bootstrap estimates were statistically conservative. Results: The 2913 new cases were aged 47.2 ± 21.8 years. 1544 (53.0%) were males. Housewives (953, 32.7%) and farmers (648, 22.2%) were the commonest occupations. Poor vision (41.9%), screening for diabetic and hypertensive retinopathy (13.1%), referral (9.7%), sudden vision loss (9.3%), and trauma (8.0%) were the commonest presenting symptoms.
    [Show full text]
  • Clinical Findings and Management of Posterior Vitreous Detachment
    American Academy of Optometry: Case Report 5 Clinical Findings and Management of Posterior Vitreous Detachment Candidate’s Name, O.D. Candidate’s Address Candidate’s Phone number Candidate’s email Abstract: A posterior vitreous detachment is a degenerative process associated with aging that affects the vitreous when the posterior vitreous cortex separates from the internal limiting membrane of the retina. The composition of the vitreous gel can degenerate two collective ways, including synchysis or liquefaction, and syneresis or shrinking. Commonly, this process of separation occurs with the posterior hyaloid resulting in a Weiss ring overlying the optic nerve. Complications of a posterior vitreous detachment may include retinal breaks or detachments, retinal or vitreous hemorrhages, or vitreomacular traction. This case presentation summarizes the etiology of this ocular condition as well as treatment and management approaches. Key Words: Posterior Vitreous Detachment, Weiss Ring, Vitreous Degeneration, Scleral Depression, Nd:YAG Laser 1 Introduction The vitreous humor encompasses the posterior segment of the eye and fills approximately three quarters of the ocular space.1 The vitreous is a transparent, hydrophilic, “gel-like” substance that is described as a dilute solution of collagen, and hyaluronic acid.2,3,4 It is composed of 98% to 99.7% water.4 As the eye matures, changes may occur regarding the structure and composition of the vitreous. The vitreous functions to provide support to the retina against the choroid, to store nutrients and metabolites for the retina and lens, to protect the retinal tissue by acting as a “shock absorber,” to transmit and refract light, and to help regulate eye growth during fetal development.3,4 Case Report Initial Visit (03/23/2018) A 59-year-old Asian female presented as a new patient for examination with a complaint of a new onset of floaters and flashes of light in her right eye.
    [Show full text]
  • Floaters-Survey-Ophthalmol-2016.Pdf
    survey of ophthalmology 61 (2016) 211e227 Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/survophthal Major review Vitreous floaters: Etiology, diagnostics, and management Rebecca Milston, MOptoma, Michele C. Madigan, PhDb,c, J. Sebag, MD, FACS, FRCOphth, FARVOd,* a Centre for Eye Health, University of New South Wales, Sydney, New South Wales, Australia b School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia c Save Sight Institute and Discipline of Clinical Ophthalmology, Sydney Medical School, University of Sydney, New South Wales, Australia d VMR Institute for Vitreous Macula Retina, Huntington Beach, California, USA article info abstract Article history: Vitreous is a hydrated extracellular matrix comprised primarily of water, collagens, and Received 3 July 2015 hyaluronan organized into a homogeneously transparent gel. Gel liquefaction results from Received in revised form 25 molecular alterations with dissociation of collagen from hyaluronan and aggregation of November 2015 collagen fibrils forming fibers that cause light scattering and hence symptomatic floaters, Accepted 25 November 2015 especially in myopia. With aging, gel liquefaction and weakened vitreoretinal adhesion Available online 8 December 2015 result in posterior vitreous detachment, the most common cause of primary symptomatic floaters arising from the dense collagen matrix of the posterior vitreous cortex. Recent Keywords: studies indicate that symptomatic floaters are not only more prevalent, but also have a vitreous negative impact on the quality of life that is greater than previously appreciated. We review collagen the literature concerning management of symptomatic vitreous floaters, currently either myopia with observation, vitrectomy, or Nd:YAG laser.
    [Show full text]
  • What Is Macular Degeneration?
    The Eyes Have It: Protecting Your Precious Gift of Sight Rajiv Rathod, MD, MBA Retina Specialist Orange County Retina Medical Group Orange County Retina Types of Eye Doctors Optometrist (OD) Attend 4 years of Optometry school after college Only focus on the eye General eye exams for glasses and basic eye disease Not licensed to perform procedures Types of Eye Doctors Ophthalmologist (MD) Medical doctors that further specialize in diseases and surgery of the eye Attend medical school (4 years) then specialty training (4 years), and possibly subspecialty training (1-2 years) Licensed to take care of all aspects of eye disease, including diseases that affect the entire body Perform surgery of the eye and areas around the eye Vitreoretinal Surgeon Any disease that affects the vitreous or retina Macular Degeneration Diabetes Vascular Eye Disease Retinal Detachment/Retinal Tear Macular Pucker/Macular Hole Cataract complications Infections inside the eye Tumors of the eye Main Points Many eye diseases are age related “An ounce of prevention is worth a pound of cure.” Prevention: Healthy diet Exercise Quit smoking Protect eyes from sun (UV) Get an eye exam early detection and treatment can prevent many eye diseases from causing vision loss Healthy Diet Exercise Quit smoking Protect eyes from UV light Should block 99% of UVA and UVB light Look for a label Get an eye exam Not just getting checked for glasses Full exam includes checking eye pressure and a dilated eye exam Many eye diseases, if caught early enough,
    [Show full text]
  • Total Eye Care Brochure 2019 CORRECT Without the Triangle
    LASIK As one of the leading LASIK and refractive surgeons in the area, Dr. Harmon Stein has successfully performed over 20,000 laser vision procedures to treat nearsightedness, farsightedness and astigmatism, allowing patients to live without the hassle of glasses and contact lenses! At Total Eye Care, we carefully examine each patient during a complimentary consultation to determine if you are a candidate for laser vision correction. Dr. Stein will review your best option for refractive surgery, including the benefits and differences between Custom WAVEfront LASIK and Bladeless LASIK technology. He also specializes in PRK and the Visian ICL procedures. We offer affordable 0% financing as well as free enhancements for life. How does it work? Step 1: The laser is applied Step 2: Flap of precise at predefined depth on thickness and shape is cornea forming a canal, a formed and now eye is ready cleavage plane and a side for the reshaping to be done cut to lift the flat. with the laser. OFFICE LOCATIONS 1568 Woodbourne Road Levittown, PA 19057 Dedicated to a Lifetime of Healthy Vision 451 South State Street Newtown, PA 18940 2495 Brunswick Pike Lawrenceville, NJ 08648 Step 3: The cornea is Step 4: After correcting the 3100 Princeton Pike, Building, 1 Suite G reshaped permanently to cornea the flap is gently Lawrenceville, NJ 08648 correct the patient’s placed back. refractive error. 215.943.7800 215.943.7993 Schedule a Complimentary Consultation Today! www.totaleyecarecenters.com MEET THE DOCTORS OUR SERVICES BOARD-CERTIFIED OPHTHALMOLOGIST Total Eye Care & Cosmetic Laser Centers provides comprehensive ocular care for patients of all ages - from infants to seniors.
    [Show full text]
  • Home>>Common Retinal & Ophthalmic Disorders
    Common Retinal & Ophthalmic Disorders Cataract Central Serous Retinopathy Cystoid Macular Edema (Retinal Swelling) Diabetic Retinopathy Floaters Glaucoma Macular degeneration Macular Hole Macular Pucker - Epiretinal Membrane Neovascular Glaucoma Nevi and Pigmented Lesions of the Choroid Posterior Vitreous Detachment Proliferative Vitreoretinopathy (PVR) Retinal Tear and Detachment Retinal Artery and Vein Occlusion Retinitis Uveitis (Ocular Inflammation) White Dot Syndromes Anatomy and Function of the Eye (Short course in physiology of vision) Cataract Overview Any lack of clarity in the natural lens of the eye is called a cataract. In time, all of us develop cataracts. One experiences blurred vision in one or both eyes – and this cloudiness cannot be corrected with glasses or contact lens. Cataracts are frequent in seniors and can variably disturb reading and driving. Figure 1: Mature cataract: complete opacification of the lens. Cause Most cataracts are age-related. Diabetes is the most common predisposing condition. Excessive sun exposure also contributes to lens opacity. Less frequent causes include trauma, drugs (eg, systemic steroids), birth defects, neonatal infection and genetic/metabolic abnormalities. Natural History Age-related cataracts generally progress slowly. There is no known eye-drop, vitamin or drug to retard or reverse the condition. Treatment Surgery is the only option. Eye surgeons will perform cataract extraction when there is a functional deficit – some impairment of lifestyle of concern to the patient. Central Serous Retinopathy (CSR) Overview Central serous retinopathy is a condition in which a blister of clear fluid collects beneath the macula to cause acute visual blurring and distortion (Figure 2). Central serous retinochoroidopathy Left: Accumulation of clear fluid beneath the retina.
    [Show full text]
  • Corneal Diseases Contact Lens Trends
    December 2017 ADVANCING OPTOMETRY Corneal diseases CFEH’s Chairside reference Contact lens trends Efron, Morgan and Woods 18th annual survey results CPD POINTS WITH PHARMA ONLINE ® December 2017 Editor JEFF MEGAHAN 02 13 National Communications Contact lens prescribing Early keratoconus and Manager SANDRA shaw trends 2017 potential progression Dr Nathan Efron, Dr Philip B Lindsay Moore Clinical Editor Associate Professor MARK ROTH Morgan and Dr Craig A Woods BSc(Pharm) BAppSc(Optom) PGCertOcTher NEWENCO FAAO 14 OAM 05 CHAIR-SIDE REFERENCE Vision and life-threatening Corneal ectatic diseases Cover complications of Sjögren’s Corneal topography map. Image and thinning disorders syndrome courtesy of Medmont Centre for Eye Health Vanessa Tang and Dr Adrian Optometry Australia Bruce 20 ABN 17 004 622 431 Relief for blepharitis and Suite 101, 70 York Street 08 dry eye South Melbourne VIC 3205 Dr Allan Ared Ph 03 9668 8500 Ultra-widefield imaging in Fax 03 9663 7478 clinical practice [email protected] Michael Wicks 22 www.optometry.org.au Therapeutic News of note Mark Roth Copyright © 2017 10 All lenses great and small Comments made in Pharma are of a general nature and intended for Damon J Ezekiel 24 guidance only. Optometry Australia and the individual contributors expressly Assessing artificial tears disclaim all liability and responsibility Dr Nicholas Young to any person in respect of, and for the 12 17 consequences of, anything done or Axial versus tangential Melbourne Rapid Fields omitted to be done in reliance wholly or partly on anything in this publication. maps Selwyn M Prea, Dr Algis J 26 Vingrys and Dr George YX Pharma is distributed in Australia Richard Lindsay, Andrew PBS list of medicines and New Zealand.
    [Show full text]
  • Clay Eye First to Offer Advanced Technology for Visual Floaters
    BUSINESS PROFILE PD. ADV. Clay Eye first to offer advanced technology for visual floaters Normal Cloud floater Cobweb floater Laser procedure laser vitreolysis, designed specifically to normal and caused by age-related changes very excited to offer this new laser option treat eye floaters, a common and generally that occur as the gel turns to liquid. to patients, as it will greatly reduce treats ‘floaters’ for harmless condition. While floaters are Microscopic fibers within the vitreous floaters and allow patients to regain their part of the normal aging process, under tend to clump and can cast tiny shadows clarity,” he said. increased clarity the right circumstances, they can now on your retina, called a “floater.” In addition to laser vitreolysis, Clay be effectively treated. Laser vitreolysis is He continued, “Seventy percent of Eye Physicians and Surgeons offers Have you ever wondered the latest tool available to help patients people will have floaters in their lifetime. comprehensive eye care in the following about the little specks with floaters live their lives with less While floaters are certainly an annoyance, specialties: Glaucoma Surgery, Diabetic or “cobwebs” that float Russell Pecoraro, visual disruption. The laser offers a high they can also negatively impact the Eye Disease and Macular Degeneration, in your line of vision? If M.D., Retina degree of patient satisfaction and a low quality of people’s lives and interfere Laser Cataract Surgery, Laser floater Specialist you have, did you assume rate of complications. with everyday tasks such as watching lysis, Cornea Surgery, Medical Retina, it would be something that you just had to Russell Pecoraro, M.D., Retina Specialist television, driving and/or reading.” LASIK Surgery, Cosmetic Eye Procedures, live with? With the latest in advanced with Clay Eye Physicians and Surgeons, “If you experience floaters and are Pediatric Ophthalmology, and Pediatric technology, that is no longer the case.
    [Show full text]
  • The Case of the Black Spot and Blurred Lines
    WHAT’S YOUR DIAGNOSIS? MORNING ROUNDS The Case of the Black Spot and Blurred Lines few weeks before the holidays, 1A 1B while working long hours, A Sean Rodriguez* began to notice a new black spot in his vision. The spot lingered in the center of the vision in his left eye and would not disappear. At first, he convinced himself that stress and weariness were causing him to imagine things. But the spot grew in size, and the letters on his computer screen began to blur. After 3 weeks, he WE GET A LOOK. His right eye (1A) has a small PED superotemporally at the edge grew frantic and rushed to see us. of the macula (arrows); his left eye (1B) has a large serous detachment (arrow). The Presentation pupils were round and reactive with Other potential diagnoses included Mr. Rodriguez sat in the exam room no relative afferent pupillary defect. an optic pit with associated serous chair, tapping his foot anxiously. Intraocular pressure was 16 mm Hg in retinal detachment (although no optic Medical history. The 34-year-old both eyes. Extraocular movements and pits were noted on exam), age-related Hispanic male was generally healthy. confrontation visual fields were full. macular degeneration (although the He sometimes suffered from bouts of The anterior segment exam was patient was younger than the usual de- asthma, for which he used an albuterol notable for patent superior peripheral mographic affected by this condition), or fluticasone-salmeterol inhaler. iridotomies in both eyes. On posterior or an inflammatory choroidal disorder. Ocular history. He had previously segment examination, a small pigment been diagnosed with anatomic narrow epithelial detachment (PED) was noted Tests and Final Diagnosis angles and had undergone bilateral superotemporally at the edge of the Optical coherence tomography (OCT) laser peripheral iridotomies in 2012.
    [Show full text]
  • 600 Sir, Retinal Cryotherapy Is Now the Most Commonly Used
    600 LETTERS TO THE JOURNAL Sir, whitening extending to the surface of the retina; adjacent Retinal Necrosis as a Complication of Cryotherapy lesions overlapped very slightly and no refreezing was Retinal cryotherapy is now the most commonly used applied in any area. A 3 mm radial plomb was used to method for creating a chorioretinal adhesion in conven­ buckle sclera over the tear. External drainage and fluid tional retinal reattachment surgery. It achieves its effect by exchange with Hartmann' s solution was performed and dissolution of cellular membranes. The strength of the the retina was observed to re-attach. adhesion between the retina and the retinal pigment epi­ The next day the tear was found to be flaton the buckle thelium is approximately proportional to the intensity of although there was a small amount of subretinal fluid the application. inferior to the plomb. Later that day the patient com­ A number of complications have been reported includ­ plained of a shadow over the vision worse than before sur­ ing intravitreal dispersion of viable retinal pigment gery. Examination at this stage revealed visual acuity of epithelial cells2 and retinal tear extension through the light perception and a bullous superotemporal detachment cryosurgical scar. 3 The formation of new retinal tears in involving the macula with several large ragged holes in the cryosurgical scar tissue has been reported as a late compli­ retina along and within the area of cryotherapy application cation of cryotherapy for retinopathy of prematurity4 and (Fig. I). In addition to the full-thickness holes there was recently in the Japanese literature as an early complication extensive thinning of adjacent retina.
    [Show full text]
  • Vitrectomy for Vitreous Floaters
    November // 2019 // njretina.com Physicians Vitrectomy for Vitreous Floaters Nneka O. Brooks, MD Vitreous floaters are ubiquitous in retina practice. Patients are often disproportionately Nicholas D. Chinskey, MD worried about floaters and can lose sight of other possible underlying visually threatening Leonard Feiner, MD, PhD diseases such as retinal detachments, macular degeneration or diabetic retinopathy. Howard F. Fine, MD, MHSc When treated and cleared with vitrectomy these patients are generally the most satisfied Eric S. Friedman, MD with their surgical outcome. This inevitably leads to attempts to balance between the Paul Hahn, MD, PhD desire to treat this frustrating but typically benign condition with the very real risks of Vincent Y. Ho, MD vitrectomy. Bruce J. Keyser, MD David Y. Kim, MD Jennifer M. Krawitz, MD What are vitreous floaters? Vitreous floaters form as an alteration in the vitreous structure and are typically secondary Marisa K. Lau, MD to age related changes. Generally, they are not clinically significant and have very minimal Steven A. Madreperla, MD, PhD impact on a patient’s quality of vision. Asteroid hyalosis is a common example of these Lekha K. Mukkamala, MD asymptomatic primary floaters(Figure 1). Stuart W. Noorily, MD Jonathan L. Prenner, MD Daniel B. Roth, MD Christopher M. Seery, MD Sumit P. Shah, MD Elizabeth Tegins, MD Vinod B. Voleti, MD H. Matthew Wheatley, MD Figure 1: Bilateral asteroid hyalosis in a 49-year-old woman Locations A posterior vitreous detachment, commonly seen as a Weiss ring, is the most common North Jersey Central Jersey Belleville Bridgewater primary floater. Myopic vitreopathy and vitreous syneresis are also common causes for 973-450-5100 908-218-4303 floaters in young patients.
    [Show full text]
  • Posterior Vitreous Detachment Contact Us We’Re Here to Answer Any Questions You Have About Your Eye Condition Or Treatment
    Understanding Posterior vitreous detachment Contact us We’re here to answer any questions you have about your eye condition or treatment. If you need further information about posterior vitreous detachment or on coping with changes in your vision, then our Helpline is there for you. Just give us a call on 0303 123 9999 or email us at [email protected] and we’ll be happy to speak with you. RNIB’s Understanding series The Understanding series is designed to help you, your friends and family understand a little bit more about your eye condition. The series covers a range of eye conditions, and is available in audio, print and braille formats. 2 Contents 4 What is posterior vitreous detachment? 6 What causes PVD? 8 What are the symptoms of PVD? 10 What medical investigations should I have? 12 Long-term PVD symptoms 14 How do I cope with my floaters? 15 Is there any treatment for PVD? 16 Are there any complications of a PVD? 19 What activities can I still do with PVD? 21 Degenerative vitreous syndrome 22 Further help and support 23 Information sources 24 RNIB Booklet Series 26 We value your feedback 3 What is posterior vitreous detachment? Posterior vitreous detachment (PVD) is a condition where your vitreous comes away from the retina at the back of your eye. This detachment is caused by changes in your vitreous gel. PVD isn’t painful and it doesn’t cause sight loss, but you may have symptoms such as seeing floaters (small dark spots or shapes) and flashing lights.
    [Show full text]