فهرست مطالب

Ophthalmic & Vision Research - Volume:14 Issue:2, 2019
  • Volume:14 Issue:2, 2019
  • تاریخ انتشار: 1398/03/07
  • تعداد عناوین: 22
|
  • Per Kallestrup * Pages 123-124
  • Hossein Jamali, Ahmad Reza Gholampour * Pages 125-130
    Purpose
    The study aimed to review the indications and techniques for corneal transplantation at a tertiary referral center over a 5-year period.
    Methods
    Records of patients who underwent corneal transplantation at Khalili Medical Center, Shiraz, Iran from September, 2012 to September, 2017 were reviewed.
    Results
    A total of 1149 eyes of 956 patients underwent corneal transplantation. The most common indication was infectious corneal ulcers (n = 296, 25.8%), followed by keratoconus (n = 243, 21.1%), bullous keratopathy (n = 219, 19.1%), failed grafts (n = 117, 10.2%), non-herpetic corneal scars (n = 113, 9.8%), corneal stromal dystrophies (n = 33, 2.9%), pellucid marginal degeneration (n = 31, 2.7%), and trauma (n = 26, 2.3%); other indications included thin descemetocele, post-herpetic corneal scar, endothelial corneal dystrophies, anterior segment dysgenesis, corneal ectasia after laser in situ keratomileusis, and corneal fibrosis. Corneal transplantation techniques included penetrating keratoplasty (PKP, n = 789, 68.7%), deep anterior lamellar keratoplasty (DALK, n = 187, 16.3%), Descemet's stripping automated endothelial keratoplasty (n = 171, 14.9%), and keratolimbal allograft (n = 2, 0.1%) in descending order. In children (aged ≤18 years), the most common indication was keratoconus (n = 32, 41.6%), and the most common technique was PKP (n = 50, 64.9%). In patients aged 19-27 years, the most common indication was keratoconus (n = 89, 64.5%), and the most common technique was PKP (n = 75, 54.4%).
    Conclusion
    Infectious corneal ulcer was the most common indication, and PKP was the most prevalent technique in patients undergoing corneal transplantation. DALK was an emerging alternative surgical treatment in patients with corneal disorders in which corneal endothelium is spared.
    Keywords: Corneal Transplantation, Penetrating Keratoplasty, Deep Anterior Lamellar Keratoplasty, Descemet’s StrippingAutomated Endothelial Keratoplasty
  • Shaban Alizadeh, Sahar Balagholi, Alireza Baradaran, Rafii, Siamak Delfaza, Baher, Sare Safi, Hamid Safi, Rasul Dabbaghi, Mozhgan Rezaei Kanavi * Pages 131-135
    Purpose
    To investigate whether autologous platelet-rich plasma (PRP) eye drops accelerate re-epithelialization of post-keratoplasty persistent corneal epithelial defects (PEDs).
    Methods
    A total of 34 eyes with PEDs after keratoplasty (24 penetrating keratoplasty and 10 deep anterior lamellar keratoplasty) that were refractory to conventional medical treatments were treated with PRP eye drops every 3 hours. PRP eye drops were prepared with a low- and high-speed centrifugation method and final platelet counts were 700,000-800,000 plt/μl. The mean treatment duration for complete re-epithelialization was compared with the mean treatment duration of conventionally treated corneal defects before the PRP treatment by paired t-test. The mean treatment duration was also statistically analyzed between age groups, gender, indications for keratoplasty, and types of keratoplasty using analysis of variance (ANOVA).
    Results
    Treatment with autologous PRP eye drops led to rapid re-epithelialization in all eyes. The mean treatment duration for complete re-epithelialization was 2.47 ± 1.21 weeks, which was significantly shorter than the mean treatment duration of conventionally treated corneal defects before PRP treatment (6.82 ± 1.24 weeks) (P = 0.0001). There was no significant correlation between re-epithelialization time and patients' age, sex, indications for keratoplasty, and techniques of corneal transplantation.
    Conclusion
    Treatment with autologous PRP eye drops is an effective and reliable approach that accelerates re-epithelialization of post-transplantation PEDs.
    Keywords: Corneal Epithelial Defects, Eye Drop, Healing, Keratoplasty, PED, Platelet
  • Shreya Thatte *, Ankita B Dube, Stuti Sharma Pages 136-143
    Purpose
    To evaluate the efficacy of autologous serum in fixing conjunctival autografts of various sizes in different grades and types of pterygium and to determine the largest successfully secured graft size.
    Methods
    This prospective interventional study comprised 151 eyes of 151 patients belonging to age group of 21 to 64 years with different grades and types of primary and recurrent pterygium that underwent excision with inferior conjunctivo - limbal autograft secured with autologous serum. The autografts were measured with calipers and were grouped by size into three categories: Group A, small (5 × 5 mm); Group B, medium (5–7 × 5 mm); and Group C, large (>7 × 5 mm). The adhesive fixation power of autologous serum for the various conjunctival autograft sizes was determined for each group using the following criteria: graft stability, cosmetic appearance and complications in the immediate ( first week) and two-months postoperative follow-up visits. Descriptive statistical analysis was used to calculate the percentage frequency of the variables.
    Results
    The groups A, B, and C included 48%, 22%, and 30% of the autografts, respectively. Overall, 93.34% of the grafts were stable with good cosmetic appearance. However, subconjunctival hemorrhage (36%), graft edema (36%) and graft retraction (13.5%) were the most common complications. The largest successfully fixed graft was 14 × 5 mm in size.
    Conclusion
    Autologous serum is efficient in securing conjunctival autografts of various sizes with minimal complications and satisfactory results, including good cosmesis.
    Keywords: Pterygium, Conjunctiva, Autograft, Fibrin Glue, Suture, Autologous, Serum
  • Farideh Sharifipour *, Shahin Yazdani, Mona Asadi, Azadeh Saki, Kouros Nouri, Mahdavi Pages 144-150
    Purpose
    To report the short-term outcomes of modified deep sclerectomy (MDS) in the management of open angle glaucoma.
    Methods
    This prospective, non-randomized, controlled study included 105 eyes (105 patients) with open angle glaucoma. Eyes were categorized as follows: trabeculectomy (30 eyes), MDS (27 eyes), phacotrabeculectomy (28 eyes), and phaco-MDS (20 eyes). The MDS technique involved removal of a third scleral flap to expose the suprachoroidal space and excision of a trabecular block. A two-site approach was used for combined surgeries. Main outcome measures included intraocular pressure (IOP), number of glaucoma medications, and complications. Treatment success was defined as an IOP of 6–15 mmHg and/or a 30% reduction in IOP.
    Results
    All groups showed significant decrease in IOP and number of medications (both P s < 0.001). The MDS group had a higher IOP (13.9 ± 3.8 vs. 12.4 ± 2.5 mmHg, P = 0.080) and required more medications (P = 0.001) than the trabeculectomy group at 1 year. The MDS group had a higher baseline IOP than the trabeculectomy group (P = 0.004) and both the groups showed similar IOP reductions (33.3% vs. 25.7%, P = 0.391). The phaco-MDS and phacotrabeculectomy groups had comparable IOP (13.3 ± 3.1 vs. 12.4 ± 3.1 mmHg, P = 0.354), number of medications (P = 0.594), and IOP reduction (P = 0.509) at 1-year follow-up visit. The trabeculectomy and phacotrabeculectomy groups developed more wound leaks (P = 0.043) and required more bleb needling during the early postoperative period (P < 0.001).
    Conclusion
    The MDS technique seems to be slightly inferior to trabeculectomy, but when combined with phacoemulsification, is safer and results in similar IOP outcomes.
    Keywords: Glaucoma, Glaucoma Surgery, Modified Deep Sclerectomy, Trabeculectomy
  • Nasser Shoeibi, Mohammad, Reza Ansari, Astaneh *, Mohammad Reza Sedaghat, Saeed Shokoohi Rad Pages 151-156
    Purpose
    To evaluate the effect of intravitreal bevacizumab (IVB) injection on corneal biomechanical parameters as measured by the ocular response analyzer (ORA) and Corneal Visualization Scheimpflug Technology (CorVis).
    Methods
    In this prospective pilot study, ORA and CorVis parameters were recorded before and after a three-month course of IVB injection therapy in 16 patients in the injected and the contralateral non-injected control eyes. The changes in the recorded parameters in each group and the differences between the two groups were evaluated and compared.
    Results
    None of the changes in ORA parameters were statistically significant in the injected and non-injected groups before and three months after injection, except for corneal resistance factor (CRF) in injected eyes (paired t-test, P = 0.039). The differences in corneal hysteresis (CH) and CRF were not statistically significant between the two groups (P = 0.441 and 0.236, respectively), but significant differences were noted between corneal compensated IOP (IOPcc) and Goldmann-correlated IOP (IOPg) (P = 0.045 and 0.047, respectively). None of the changes in CorVis parameters were statistically significant in the groups before and at the end of study, except for the time of first corneal applanation (TAp1 ms) in the injected group (P = 0.040, paired t-test). Differences in TAp1, length of the second corneal applanation (LAp2 mm), velocity of the second corneal applanation (VAp2 m/s), intraocular pressure (IOP), and central corneal thickness (CCT) also showed borderline significance between the two groups.
    Conclusion
    In this pilot study IVB injection could change CRF, IOPcc, IOPg, and TAP1 as measured by ORA and CorVis.
    Keywords: Bevacizumab, CorVis, Corneal Biometrics, Ocular Response Analyzer
  • Ramak Roohipour, Elahe Sharifian, Sasan Moghimi, Masoud Aghsaei Fard, Fariba Ghassemi, Mohammad Zarei, Samaneh Davoodi, Fatemeh Bazvand*, Bobeck S Modjtahedi Pages 157-163
    Purpose
    The current study aimed to evaluate changes in peripapillary retinal nerve fiber layer (RNFL) thickness in diabetic patients with bilateral proliferative diabetic retinopathy (PDR) after receiving panretinal photocoagulation (PRP) or intravitreal bevacizumab (IVB) with PRP.
    Methods
    Ocular examination and peripapillary optical coherent tomography (OCT) were performed for each patient at baseline, 1, 3, 6, and 10 months after treatment. Both eyes of each patient were randomized into either PRP or PRP + IVB group.
    Results
    Sixty-four eyes (32 patients) were enrolled in this randomized clinical trial. In the PRP group, global RNFL thickness initially increased and reached statistical significance in the third month (from 105.9 ± 21.4μm at baseline to 119 ± 41.6μm at 3 months, P = 0.03). Subsequent decline was observed with no significant difference from baseline at 10 months (106 ± 19.3μm, P = 0.914). There were no statistically significant changes in the PRP + IVB group (from 101.7 ± 22.2μm at baseline to 109.3 ± 26.9μm at 3 months, P = 0.996 and 101.9 ± 16.5μm at 10 months, P = 0.999). In the latter group, slight increase in RNFL thickness was observed in the first month (107.7 ± 21.1μm). RNFL thickness was similar to baseline in the two groups at month 10, with the exception of significant increase in superior-temporal sector in the PRP group (145.3 ± 13.4μm vs. 127.2 ± 17.3μm, P = 0.045).
    Conclusion
    Compared to eyes treated with PRP, eyes treated with adjunctive IVB showed less significant post-treatment changes in RNFL thickness.
    Keywords: Bevacizumab, Diabetes, Panretinal Photocoagulation, Retinal Nerve Fiber Layer, Retinopathy
  • Daren Hanumunthadu, Elon H C van Dijk, Sunila Dumpala, Bindu Rajesh, Ayesha Jabeen, Asiya Jabeen, Momin Ansari, Pooja Mehta, Shilpi Shah, Chintan Sarvaiya, Catherine Meyerle, Lihteh Wu, Alay Banker, Camiel J Boon, Jay Chhablani* Pages 164-170
    Purpose
    To evaluate medium and large choroidal vessel layer thickness (MCVT and LCVT, respectively) in eyes with acute and chronic central serous chorioretinopathy (CSC) in comparison with age-matched controls.
    Methods
    The study included 96 eyes of 96 patients with CSC, including 53 eyes with acute CSC, 43 eyes with chronic CSC, and 30 eyes of 30 age-matched normal subjects. Manual measurements of subfoveal choroidal thickness (SFCT), MCVT, and LCVT at subfoveal and 750 μm nasal and temporal to the fovea locations were made on enhanced depth imaging optical coherence tomography (EDI-OCT) of the macula in all subjects using ImageJ software (National Institutes of Health, Bethesda, MD, USA).
    Results
    SFCT in acute CSC was significantly larger than that in healthy eyes (P = 0.0001). SFCT in acute CSC did not differ significantly from that in chronic CSC eyes. Subfoveal LCVT and MCVT in acute CSC eyes were greater than those in healthy eyes (P = 0.02 and P = 0.03, respectively). Mean SFCT and MCVT in chronic CSC eyes were significantly larger than those in control eyes (P = 0.01 and P = 0.04, respectively). No significant difference in LCVT was observed between chronic and control eyes.
    Conclusion
    Choroidal vasculature is altered in both acute and chronic CSC. SFCT, MCVT, and LCVT are higher in eyes with acute CSC. The thickening of medium choroidal vessels is still detectable in chronic CSC compared to control eyes.
    Keywords: Central Serous Chorioretinopathy, Choroid, Optical Coherence Tomography
  • Siti Zulaikha Nashwa Mohd Khair, Abdul Salim Ismail, Zunaina Embong, Abdul Aziz Mohamed Yusoff * Pages 171-178
    Purpose
    To determine the mutational analyses of familial exudative vitreoretinopathy (FEVR)-causing genes in Malay patients with retinopathy of prematurity (ROP) to obtain preliminary data for gene alterations in the Malay community.
    Methods
    A comparative cross-sectional study involving 86 Malay premature babies (ROP = 41 and non-ROP = 45) was performed from September 2012 to December 2014. Mutation analyses in (FEVR)-causing genes (NDP, FZD4, LRP5, and TSPAN12) were performed using DNA from premature babies using polymerase chain reaction (PCR) and direct sequencing. Sequencing results were confirmed with PCR-Restriction Fragment Length Polymorphism (RFLP).
    Results
    We found variants of FZD4, LRP5, and TSPAN12 in this study. One patient from each group showed a non-synonymous alteration in FZD4, c.502C>T (p.P168S). A synonymous variant of LRP5 [c.3357G>A (p.V1119V)] was found in 30 ROP and 28 non-ROP patients. Two variants of TSPAN12, c.765G>T (p.P255P) and c.*39C>T (3′UTR), were also recorded (29 and 21 in ROP, 33 and 26 in non-ROP, respectively). Gestational age and birth weight were found to be significantly associated with ROP (P value < 0.001 and 0.001, respectively).
    Conclusion
    Analysis of data obtained from the ROP Malay population will enhance our understanding of these FEVR-causing gene variants. The c.3357G>A (p.V1119V) variant of LRP5, and c.765G>T (p.P255P) and c.*39C>T variants of TSPAN12 could be common polymorphisms in the Malay ethnic group; however, this requires further elucidation. Future studies using larger groups and higher numbers of advanced cases are necessary to evaluate the relationship between FEVR-causing gene variants and the risk of ROP susceptibility in Malaysian infants.
    Keywords: Genetic Variants, Malay, Premature Infant, Retinopathy of Prematurity
  • Elham Ashrafi, Seyed, Farzad Mohammadi, Marzieh Katibeh, Ebrahim Ghaderi, Cyrus Alinia, Naser Nourmohammadi, Alireza Lashay, Ramin Beiranvand, Mahsa Yousefpour Marzbali *, Ali Sadeghi Tari Pages 179-184
    Purpose
    To determine the magnitude and causes of blindness and visual impairment (VI) in Kurdistan, using the Rapid Assessment of Avoidable Blindness methodology.
    Methods
    In this population-based cross sectional study, 99 clusters were selected through probability proportional to size sampling. Visual acuity (VA) was measured using a standard tumbling “E” chart. Ophthalmologists examined participants with VA < 6/18 in both eyes. The cause of VI in the better eye or the most treatable cause was considered as the primary cause of VI.
    Results
    A total of 3203 (response rate: 92.4%) individuals aged 50 years and older participated, of whom 1657 (51.7%) were female. The standardized prevalence of blindness, severe visual impairment (SVI), and moderate visual impairment (MVI) based on available correction (presenting VA) were 2.1% (1.5-2.6), 1.7% (1.2-2.2), and 9.6%(8.4-10.8), respectively. The proportion of avoidable causes of blindness, SVI, and MVI were 58.1%, 78.4%, and 83.4%, respectively. The most common cause of blindness and SVI was cataract (27.4% and 60.8% respectively), followed by age-related macular degeneration (25.8% and 13.7%, respectively). The leading causes of MVI were uncorrected refractive errors (RE) (37.2%) and cataract (33.6%).
    Conclusion
    The prevalence of blindness in the study population seems comparable to the region. According to our results, blindness, SVI, and MVI were mostly due to avoidable causes. Cataract and refractive errors are the principal causes of blindness and VI in Kurdistan.
    Keywords: Prevalence, Blindness, Visual Impairment, Iran, Kurdistan
  • Shima Tabatabai, Mohammad Ali Javadi * Pages 185-194
    Purpose
    To analyze the growth trends in ophthalmic education in Iran since 1979, and to discuss their implications on the profession.
    Methods
    This comprehensive national study was performed by the Academy of Medical Sciences of I.R. Iran. The data were gathered from the Specialty Training Council of the Ministry of Health and from the Medical Council of Iran.
    Results
    Our analysis revealed ten important current growth trends and seven future trends and implications. Between 1979-80 and 2015-16, the number of residents annually admitted to ophthalmology increased from 21 to 84 and related fellowships and from 0 to 34. The number of ophthalmologists graduating in the country increased from 21 (45%) in 1979 to 69 (98%) in 2015. The ratio of ophthalmologists per 100,000 people averaged 1.91 in 1979 and 3.00 in 2016. Considering migrant and retired ophthalmologists, there are approximately 2400 active ophthalmologists in Iran. In 1979, there was one active ophthalmologist per 52,112 people; in 2014, there was one per 33,333 people. This represents a per capita increase of 57%. Since 1979, the number of active ophthalmologists has increased by 234%. The number of active women ophthalmologists has increased by more than 600%, from 65 (9%) in 1979 to 470 (20%) in 2016.
    Conclusion
    Equitable geographic distribution and balanced combination of ophthalmologists (women/men and specialists/fellowships) are necessary to optimize community eye health. We propose further studies on the effects of fellowship training growth and work patterns of female and male ophthalmologists.
    Keywords: Ophthalmic Education, Physician Trends, Residency, Fellowship, Women, Future Challenges
  • Sepehr Feizi *, Danial Roshandel Pages 195-210
    Autoimmune bullous diseases with ocular involvement consist of a group of systemic entities that are characterized by formation of autoantibodies against the proteins of the epithelial basement membrane zone of the conjunctiva. Mostly, the elderly are affected by these diseases. The characteristic patterns of mucocutaneous involvement and the specific tissue components targeted by these autoantibodies are differentiating features of these diseases. Ocular pemphigus vulgaris exhibits intraepithelial activity, whereas the autoimmune activity in linear immunoglobulin A disease, mucous membrane pemphigoid, and epidermolysis bullosa acquisita occurs at a subepithelial location. Given the increased risk for blindness with delays in diagnosis and management, early detection of ocular manifestations in these diseases is vital. The precise diagnosis of these autoimmune blistering diseases, which is essential for proper treatment, is based on clinical, histological, and immunological evaluation. Management usually includes anti-inflammatory and immunosuppressive medications. Inappropriate treatment results in high morbidity and even potential mortality.
    Keywords: Eye, Autoimmune Bullous Diseases, Epidermolysis Bullosa Acquisita, Linear Immunoglobulin A Disease, Mucous Membrane Pemphigoid, Ocular Pemphigus Vulgaris, Paraneoplastic Pemphigus
  • Amir Faramarzi, Kiana Hassanpour *, Danial Roshandel, Ali Fatourechi Pages 211-214
    Purpose
    Corneal collagen cross-linking (CXL) has become the standard initial intervention in eyes with progressive keratoconus (KC) that have not undergone keratoplasty. The prolonged exposure of the de-epithelialized cornea predisposes it to adverse complications, such as microbial keratitis and melting. Herein, we report a case of bilateral recurrent peripheral stromal keratitis following CXL.
    Case Report
    We present a 29-year-old woman who complained of ocular redness and discomfort in both eyes for 4 months, and had undergone bilateral CXL 10 months before. The best spectacle corrected visual acuity (BSCVA) was 60/200 in the right and 80/200 in the left eye. Both eyes showed moderate conjunctival hyperemia, dilation, and engorgement of the perilimbal episcleral vessels. There was a peripheral corneal stromal infiltration with thinning, and an overlying epithelial defect in the right eye with a lucid interval from the limbus. She was treated with lubricating eye drops and ointments and topical corticosteroids every 4 hours for 2 weeks then slowly tapered off. Afterwards, she experienced multiple recurrences in both eyes, which were successfully managed with topical corticosteroids and lubricants. After 2 years, her BSCVA was 20/30 with −3.00-5.50 * 90 in the right eye and 20/40 with −4.00-4.50 * 90 in the left.
    Conclusion
    Although CXL is a safe method, studies with longer follow-ups are needed to investigate the risk of rare complications.
    Keywords: Corneal Collagen Cross?linking, Peripheral Stromal Keratitis, Keratoconus
  • Mohammad Reza Razeghinejad *, Shane J Havens Pages 215-218
    Purpose
    To report a case of uveitis-glaucoma-hyphema syndrome (UGHS) secondary to a large capsulorhexis with an intracaspular intraocular lens (IOL) managed with IOL exchange and gonioscopy assisted transluminal trabeculotomy (GATT).
    Case Report
     A 73-year-old male patient presented with UGHS of the right eye in the setting of an intracapsular single-piece acrylic IOL with circumferential optic and partial haptics exposure due to a large capsulorhexis. In lieu of the patient's uncomplicated surgical history, subtle symptoms, and clinical findings, the diagnosis and referral was delayed until intraocular pressure reached a peak of 50 mmHg with recurrent anterior chamber cells. The patient underwent combined IOL exchange with placement of a 3-piece sulcus IOL and GATT, which finally resolved the UGHS.
    Conclusion
    With respect to the increasing prevalence of intracapsular single-piece IOL implantation, it is important to recognize UGHS and thus fashion proper sized capsulorhexis to prevent this vision threatening complication. GATT may be considered to be one of the glaucoma surgeries combined with the IOL surgical procedures in UGHS.
    Keywords: IOL?exchange, Iris Chafing, Trabeculotomy, Uveitis?Glaucoma?Hyphema Syndrome
  • Pejvak Azadi *, Alireza Lashay, Mohammad Riazi Esfahani Pages 219-222
    Purpose
    To describe a case of bilateral multiple serous retinal detachments (SRD) following bone marrow transplantation (BMT), which showed bilateral response to a single unilateral intravitreal bevacizumab injection.
    Case Report
     A 37-year-old man with acute myelogenous leukemia who had received bone marrow transplantation four months prior was referred to our clinic with the chief complaint of gradually decreasing vision in both eyes for three months. During the funduscopic examination, multiple serous retinal detachments (SRD) were observed bilaterally, and he was diagnosed with multiple foci of central serous chorioretinopathy (CSCR). He was advised to discontinue the steroid dosage, which did not make significant improvement, and he was treated with intravitreal bevacizumab injection in the more severely affected eye. One month later, significant improvement was noticed in both eyes.
    Conclusion
    Serous retinal detachment is a rare complication following BMT. Significant bilateral improvement after single unilateral intravitreal bevacizumab injection shows not only the possible role of increased level of vascular endothelial growth factor (VEGF) in this case, but also the systemic diffusion of the drug and effect on the contralateral eye following unilateral injection.
    Keywords: Allogenic Bone Marrow Transplantation, Bevacizumab, Central Serous Chorioretinopathy, Serous RetinalDetachment, Vascular Endothelial Growth Factor
  • Saeed Karimi, Homayoun Nikkhah, Sahba Fekri * Pages 223-225
    Purpose
    To report a case of unilateral retinal detachment with a large subretinal macrocyst, representing an atypical presentation of ocular toxoplasmosis.
    Case Report
    A healthy 30-year-old woman presented with a two month history of progressive visual loss in her right eye. Funduscopy revealed vitreous condensations, total retinal detachment with a large subretinal orange-red cystic mass and multiple retinal breaks sealed with surrounding retinal scars. B-scan echography showed a large subretinal cyst with non-homogenous tissue echogenicity. Pars plana deep vitrectomy and complete cyst removal were performed. Histopathologic examination of the excised cyst revealed intraretinal toxoplasma cysts containing bradyzoites. Analysis of intraocular fluids by polymerase chain reaction (PCR) and serologic tests also supported the diagnosis. After six months, the retina was completely attached with no signs of inflammation.
    Conclusion
    Toxoplasma retinochoroiditis should be considered in the differential diagnoses of retinal detachment with subretinal cyst.
  • Leo Santamarina *, John Godfrey Pages 226-228
  • Kaveh Abri Aghdam, Amin Zand *, Mostafa Soltan Sanjari Pages 229-231
  • VG Madanagopalan * Pages 232-235
    During retinal surgeries, the presence of large retinal defects or breaks (giant retinal tears or retinotomies ≥3 clock hours) requires the use of perfluorocarbon liquid (PFCL) to stabilize the posterior retina. Thereafter, direct PFCL-oil exchange is preferred to avoid posterior slippage of the retina. However, in an eye filled with PFCL, fluid currents at the surface of the PFCL pose a few problems when laser is attempted. Multiple bubbles are formed due to fluid currents, and the fluid jet from the infusion port may continually dislodge the free end of the retina despite the presence of PFCL. This effect is accentuated when instruments are exchanged or if the active port is unoccluded. On the other hand, if laser is postponed until the eye is filled with oil, fluid accumulation may occur under the macula, as posterior tamponade is absent. We present a modified technique that entails the use of a “sandwich” of anterior SO and posterior PFCL to comfortably perform laser in a well-formed closed vitreous chamber with continuous maintenance of retinal attachment.
    Keywords: Giant Retinal Tear, Perfluorocarbon Liquids, Retinal Detachment Surgery, Retinectomy, Silicone Oil
  • Carl P Herbort *, Ala'a El Ameen, Ilknur Tugal, Tutkun, Moncef Khairallah Page 237
  • Seyyed Alireza Golshani, Javad Abbasi *, Mohamad Taghi Imanpour, Seyyed Abulghasem Foroozani Page 238