Faculty Bibliography

PURPOSE: This study sought to determine the influence of relaxing retinotomy (RR) incisions upon surgical outcomes in the repair of recurrent retinal detachment (RD) attributable to proliferative vitreoretinopathy (PVR). DESIGN: Retrospective, consecutive, nonrandomized, single-center series. METHODS: Eighty-one eyes with recurrent RD attributable to PVR were retrospectively reviewed. Exclusion criteria were giant retinal tear, uveitis, trauma, proliferative diabetic retinopathy, and age under 18 years. A total of 52 eyes underwent RR at the time of surgery (64.2%); 29 eyes were repaired without this technique. Perfluorocarbon gas (n = 34) or silicone oil (n = 47) was used as postoperative tamponade. Statistical analyses were performed using the Fisher exact test. RESULTS: Eyes that received RR had significantly higher rates of anterior PVR (P = .009). Eyes receiving silicone oil for postoperative tamponade had worse baseline characteristics compared with those receiving gas. The use of RR in eyes receiving gas tamponade had no marked influence on the initial anatomic outcomes, with recurrent retinal detachment occurring in five of 14 eyes that received an RR and seven of 20 eyes that did not receive an RR (P = .62). Eyes in which silicone oil was used as a postoperative tamponade had a significantly lower rate of recurrent RD requiring additional surgery when RR was employed (one of 38 eyes) when compared with eyes that did not receive an RR (three of nine eyes, P = .02). Ultimately, surgical reattachment was attained in all eyes except one. Eyes that received gas tamponade without RR had significantly better median vision (P = .008). CONCLUSIONS: Surgical management of PVR often results in ultimate retinal reattachment. An RR incision does not appear to influence initial anatomic repair when gas tamponade is used after vitrectomy surgery for PVR. However, RR may increase the initial surgical success rate in eyes receiving silicone oil tamponade for PVR. In eyes undergoing RR for the treatment of severe PVR, the use of silicone oil may increase the initial rate of reattachment compared with the use of gas tamponade.

PURPOSE: To evaluate the efficacy of intravitreal triamcinolone injection in eyes with macular edema due to branch retinal vein occlusion (BRVO) over a 2-year period. METHODS: The authors performed a retrospective chart review of 13 eyes of 13 patients (mean age 68 years) who underwent intravitreal injections with 4 mg triamcinolone acetonide for macular edema due to BRVO. Six eyes received a single injection. Repeated injections were performed in one eye twice, four eyes three times, and two eyes four times. Mean follow-up was 13 months (range, 4 to 24). The time between the onset of symptoms and the injection averaged 7.4 months (range, 2 to 24). RESULTS: Mean postinjection central foveal thickness decreased to 56% of preinjection values (529 mum versus 295 mum, P < 0 .001). Final visual acuity improved in seven eyes (range 2 to 6 Snellen lines), remained the same in four eyes (range 0 to 1 Snellen lines), and worsened in two eyes (range -1 to -4 Snellen lines) compared to baseline. The retinal thickness decreased in all cases; vision improved in most cases. As the number of injections increased cataractous changes increased. Visual acuity improvement was significantly correlated with patient age (P = 0.026). Eight patients developed steroid induced ocular hypertension controlled by topical medication. Cataract extraction was judged to aggravate macular edema in three of the five eyes undergoing surgery, based upon optical coherence tomography or fluorescein angiography. Median best postinjection visual acuity (20/50) was significantly better than that of baseline (20/100) (P = 0.028) as well as last follow-up (20/70) (P = 0.003). CONCLUSIONS: Intravitreal triamcinolone should be further evaluated as a treatment option for macular edema associated with BRVO.

PURPOSE: To assess cataract progression after intravitreal triamcinolone injection. DESIGN: Retrospective, interventional, case-control study. METHODS: Forty-two phakic eyes of 37 patients were injected one, two, or three times with intravitreal triamcinolone for various indications. Noninjected phakic fellow eyes served as the control. The mean follow-up time for single injection was 12 months, for multiple injections was 14 months, and for control group was 13 months. Lens status, best-corrected visual acuity, and refractive errors were recorded at baseline and at each follow-up examination. RESULTS: At the last follow-up, changes in posterior subcapsular cataract and refractive error from baseline were significantly different between single triamcinolone-injected eyes and the control group [0.7 +/- 0.2 (mean +/- SEM [arbitrary unit] vs 0.2 +/- 0.1, P = .02; and -0.5 +/- 0.1 diopter vs -0.2 +/- 0.1 diopter, P = .01, respectively). For multiple-injected eyes and control eyes, change from baseline in corticonuclear cataract (1.1 +/- 0.2 vs 0.2 +/- 0.1), posterior subcapsular cataract (1.1 +/- 0.2) and refractive error (-1.8 +/- 0.4 diopters) were significantly different (P < .001, P < .001, and P < .001, respectively). Visual acuity did not change after single injection (P = .83) and in control group (P = .19) but decreased after multiple injections (P = .006). Eleven study eyes and two control group eyes underwent cataract extraction during study period. Corticonuclear and posterior subcapsular cataract progression significantly correlated with follow-up time (P = .003 and P = .02, respectively) and number of injections (P = .01 and P = .04, respectively). CONCLUSIONS: Single intravitreal triamcinolone injection induces posterior subcapsular cataract development, whereas multiple injections result in all-layer cataract progression.

PURPOSE: Staphylomatous thinning of the sclera and retina are among the numerous changes associated with the elongated eye of high myopia. We report a case of scleral and retinal transparency in high myopia in which ocular coherence tomography was used to measure retinal and scleral thickness in vivo. DESIGN: Observational case report. METHODS: The clinical presentation and evaluation of a case of scleral transparency in high myopia are presented. RESULTS: This case demonstrates numerous anatomical changes to the sclera and retina known to occur in association with high myopia. Initial evaluation by optical coherence tomography demonstrated a retinal thickness of 74 microm and a scleral thickness of 80 microm. CONCLUSIONS: Optical coherence tomography can be used to measure scleral and retinal thickness in vivo in a patient with high myopia. It is not known at this time what precautions are necessary in such a patient should intraocular surgery be required.